Multicultural Understanding of Child and Adolescent Psychopathology: Implications for Mental Health Assessment

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Richard Skaff, social scientist on 12/01/2007

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A timely global volume: Universal psychopathology according to the global experts!

Psychopathology is an ominous term that has been tabooed by generations
but not fully understood.

Great effort by the pharmaceutical companies and the American Psychiatric Association has been fostered and imbued in the mental health field to transform the mental/psychiatric disorder into a medical one that can be cured by $4.00 silver pill.
The American Psychiatric Association even developed in 1952 a Diagnostic and Statistical Manual of Mental Disorders in order to promote this notion of medical psychopathology.
Ironically, The DSM initially labeled homosexuality as a mental disorder that was conveniently removed from the DSM III for political reasons. According to a recent study that has confirmed old suspicions by Cosgrove, Krimsky, Vijayaraghavan, and Shneider (2006) demonstrated that 95(56 percent) of 170 psychiatrists who contributed to the DSM, which defines disorders from personality problems to drug addiction, had one or more financial associations with companies in the pharmaceutical industry. One hundred percent of the members of the panels on mood disorders, schizophrenia, and other psychotic disorders had financial ties to drug companies.

The medicalizing of behavior is going to backfire on the architects that promoted the project. The reason is obvious. If a disorder is proven to be of physiological/medical etiology, it will cease to be a mental disorder; therefore, the patients would be referred to specialists like endocrinologists, neurologists, internists but definitely not psychiatrists. In addition, the notion that psychopathology is based on this mythological medical model
has not been proven yet, and instead a myth has been created and perpetuated by the same parties mentioned above that promote the alleged and infamous but unproven chemical imbalance theory. The diagnosis and the chosen criteria in the DSM tend to propagate this myth and fit the armament of medications available on the market.
Unfortunately, up to this day, no credible evidence to validate the
chemical imbalance theory has been presented, and no single medical test is available yet to prove this alleged chemical dysfunction. Even the FDA and the pharmaceutical companies use vague terms to explain the mechanism of their drugs that allegedly restore the chemical imbalance (i.e. serotonergics) like, presumed, believed, unknown, suggests, thought, may. They use words that would promote hedging and confusion instead of certainty.
According to Glenmullen (2000) a clinical instructor in psychiatry at Harvard medical school, the pharmaceutical companies turned to animal models to circumvent the major
problems with human subjects, since the studies on human blood cells couldn provide much of a picture of what is happening in the brain. He adds that a rat can be killed and its brain thrown into a blender and mashed to bits. In test tubes, fragments of the smashed brain reconstitute into little spheres, which researchers call synaptosomes, a name evoking synapses in patients, although the ground-up bits of rat brain may have little in common with them. The effect of drugs on serotonin levels in the synaptosomes is measured in test tubes, although the results may bear little relation to the complexity of what drugs do in the living human brain. These test tube studies show Prozac, Zoloft,
Paxil and Luvox (SSRI antidepressants) raise serotonin levels. This is where the hypothesis of a serotonin imbalance comes from: extrapolating to humans from test tube studies of blenderized rat brains. Glenmullen, adds that this is almost like saying that someone whose headache is relieved by aspirin has an aspirin deficiency. The truth is that
no one has anything but the vaguest idea of the chemical effects of these drugs on the human brain.

In the last few of years, a new campaign has been launched by the pharmaceutical companies and the APA supported by the inept FDA to market and revive old buzzwords that could promote a scientific approach to psychiatry. One main example is the term of "empirical based evidence."
This buzzword has spread like wild fire in the last two years all over the literature and in practice, suggesting a rebirth of psychiatry from a pseudo-science to an actual scientific field. Ironically, the empirical based evidence strategy happens to rely on

the expectancy factor, illusory correlation, raters bias, preexisting diagnostic schemas, subjective reporting and observations, as well as subjective behavioral check lists, interviews and questionnaires that people who are invested in being patients would love to take, and those that are invested in being practitioners and pseudo-scientists would love to give.

The use of standardization and statistical manipulation does not resolve the validity problem of these subjective tools, but instead provides a little more credence to symptoms and criteria in lieu of the current arbitrary and consensual system of psychiatry. That is somewhat a progress! However, we have to keep in mind that the standardization process is predominantly based on white population, and the automatic transfer of these standardization to other cultures by virtue of their computerization and the assumption that transferable technology could lead to transfer of standardized test is
erratic and faulty and would lead to innumerable false positives, due to the inherent bias in these tests that will continue to exist, and the results will continue to be slanted in disfavor of the culture that is being tested.

In this epoch of global warming, global corporations and global government comes a global book by Achenbach and Rescorla that globalizes psychopathology and endeavors to find common ground for insanity around children in the world. The volume presents an ethnocultural aspect of psychopathology from two perspectives: The empirically based and the diagnostically based approaches, their similarities and
their differences.

This text attempts to synthesize a display of international findings that increase awareness on cultural variations in childrens emotional and behavioral problems.
The book consists of eleven chapters that flow cohesively and cover multi-aspects of the multicultural forms of alleged psychopathology. Every chapter has a helpful summary that edifies the basic theme in each of the chapters. Chapter one discusses the need for multicultural research on childrens problems. In chapters two and three the authors present details of the empirically and diagnostically based approaches to psychopathology. While in chapter four, five, and six they present multicultural research on empirically based scale scores, correlates of scale scores and patterns of problems. In chapters seven and eight the authors discuss multicultural research on prevalence rates, correlates, and patterns of disorders defined in terms of diagnostic categories. In Chapter nine, they compare findings from the empirically based and diagnostically based approaches, and in Chapter ten they depict the demands posed by the findings and strategies for meeting these challenges. In the final eleventh chapter, the authors consider the various strategies in which multicultural research could contribute to understanding, assessing, preventing, and treating child psychopathology.

The text is basically a psychometric exhibition. The use of statistical and technical terms in this volume like etic, emic, bottom-up strategy, top-down strategy, taxonomy, nosology, kappa coefficient, Pearson rs, criterion related-validity, factor analysis, internalizing, externalizing, norming, etc, give the book a stout scientific and scholarly flavor.
Achenbach and Rescorla provide us with a guidebook for approaching the
alleged child and adolescent psychopathology from a multicultural perspective. They attempt to provide the reader with a solid cross-cultural research. They treat perplexing issues in a succinct and somewhat clear way. They also attempt to integrate their multicultural findings from both empirically and diagnostically based assessment
approaches.
The authors examine similarities and differences in the prevalence, patterns, and reciprocal relations of particular disorders that are based on pre-existing diagnostic models that set the standards for psychopathology. They attempt to distinguish between culture-specific and general problems of adaptation, identify instruments and procedures that could be suited to multicultural assessment, and explore strategies to
improve services for the underserved.
However, the book is filled with contradictions. Per example, the authors acknowledge that a fundamental conceptual challenge is posed by issues of construct validity and their implications for the validity of taxonomic constructs for child psychopathology, while at the same time, they discuss their research, results, and assessment instruments as valid
and transferable. They also admit that the lack of gold standard and the low agreement between clinical diagnoses and diagnoses made from standardized interviews raises questions about how to test the validity of both kind of diagnoses, while at the same time they advocate for these standardized interviews and laud them as credible.

Achenbach and Rescorla make the argument of transferability for standardized test in the first chapter of their book as a banality in relation to the age of computerization and promulgate it as a fact, which casts immediately on their work a shadow of false beginning with a false premise. They seem to forget that the standardization was based on
white population and the results will continue to be skewed in disfavor of the different culture that is being tested. They ignore the fact that multicultural data is already influenced by western data which contaminates samplings, and that normality and abnormality are linked to personal values and are culturally dependent. The authors contradict themselves again when they briefly discuss these notions in a later chapter.

The core problem of this book, is the authors attempt to integrate the existing diagnostic based system with their alleged empirical evidence system. By doing so, they have polluted their premise, contradicted themselves, and vitiated their entire work. The
top-down contaminated the bottom-up, because the bottom-up was based on a pre-existing top-down criteria that has set the stage for the pseudo-understanding of psychopathology. The criteria in their empirically evidenced system is based on the subjective and consensual diagnostic system that they criticized, and at the same time they attempted to correlate it with their alleged empirical results.
We can presume that the externalizing process of their work (relying on the diagnostic process-DSM) has corrupted the internalizing dynamics (empirical based evidence) that the authors have laboriously tried to objectify and incorporate in their research. In addition, Achenbach and Rescorla should have thoroughly discussed the common phenomenons of illusory correlation and expectancy and their impact on their
research and the raters ability to remain accurate and objective. An illusory correlation occurs when a relationship between two events is reported, when in fact no relationship exists, or a magnified reporting of a true relationship takes place. The expectancy factor happens when a rater is expected to find pathology, therefore, expectancy may diminish judgmental precision or at least present a systematic bias that
would lead to overestimating psychopathology and underestimating positive
characteristics.
Achenbach and Rescorla also state that a major challenge for the future is to formulate constructs for psychopathology that can be validly assessed and effectively used to link clinical services with research in multiple cultures. This statement could be confusing to the reader, because their whole book is a futile attempt to validate the existing instruments, in order increase their credibility by correlating it to results from other cultures. It also constitutes another problem, because the authors continued to treat psychopathology in children as an existing fact without attempting to provide the readers with convincing evidence of its existence, besides the biased testing instruments that were utilized, and the DSM diagnostic process that could literally diagnose anyone, anywhere and any time. They also failed to distinguish whether this alleged psychopathology is actually a proven medical condition or a mental disorder.
Intentional or not, the authors persisted in their attempts to medicalize and pathologize behavior, and to promote the erratic premise that is advocated for by the pharmaceutical companies and the APA. The authors should be reminded again that once a condition is proven to be of medical etiology, it ceases to be a mental/psychiatric one. It is extremely difficult to objectify a subjective field that is based on speculation, which the authors have attempted to do. Achenbach and Rescorla must have discussed the flaws and the subjectivity in the diagnostic process and the so-called empirical based evidence
more honestly and efficiently. Instead, they obfuscated the issues
further through psychometric jargon, and turned the cloudy ocean of child
and adolescent psychopathology into a murkier and more equivocal territory. Moreover, the behavior check lists and the clinical interviews they used in their universal quest for common childhood insanity confounded the results, and fecundated the empirical based evidence process with the contaminants that they tried very hard to avoid.
Finally, we can no longer walk around pretending to be scientists when we are in actuality practicing a pseudo-science that is shaped and dictated by marketing and political criteria. Intentional or not, Achenbach and Rescorla have written a global book
that promotes global psychopathology for the global corporation in the New World order.

References
Cosgrove, L., Krimsky, S., Vijayaraghavan, M., & Shneider, L. (2006). Financial ties between DSM-IV panel members and the pharmaceutical industry. Journal of Psychotherapy and Psychosomatics, 75(3), 154-160.

Joseph, G. (2000). Prozac backlash, Overcoming the dangers of Prozac, Zoloft, Paxil, and other antidepressants with safe, effective alternatives.
New York: Simon and Shuster Paperbacks. (pp. 201-202).