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Running Head: FINAL PAPER
Kimberley Panaligan
3070570
EDUC-4000-151
Final Research Paper
November 12, 2018
Dr. Jan DeFehr
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I am currently placed in a grade 7 and 8 classroom for my practicum. A student that has
specifically caught my attention at my practicum school is Francine who is a grade 8 student in
the class I am in. Based off of what I have observed of her, Francine is quite reserved, withdrawn
and often avoids communicating with others as much as she can. She will not initiate a
conversation with anyone and will only speak when she is spoken to directly. Francine rarely
asks for help with assignments done in class even if she does not exactly understand how to do
her worksheets. There are times when I would approach her and ask if she needed help with
anything. When these times occurred, Francine would often say that she does not need help or
instead covers her work up to keep me from seeing it. There are also times when I would walk
towards her and before I could get to her, she would already have her back turned towards me.
One thing that I for sure know about Francine is that she has a hearing impairment. During our
triad conferences with my cooperating teacher (CT) and her parents, I also discovered that her
parents were encouraging her to ‘use her words’ more, especially when she needed something.
In this paper, I intend to show how Francine’s situation can be understood through the
dominant mental health paradigm. I will be referring to the Diagnostic and Statistical Manual of
Mental Disorders – 5th edition (DSM-5) and will be using a specific diagnosis from DSM-5 as I
explain the diagnostic criteria that relates to Francine’s circumstance. I will then provide critique
of the pathologizing approach by discussing its controversial issues and its potential for harm.
Furthermore, I will analyze Francine’s situation by exploring non-pathologizing ways to
understand it. Lastly, I will conclude this paper by making specific recommendations regarding
how teachers can make a positive and meaningful difference that matters in their school and/or
classroom.
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According to DSM-5, there are five parts to the diagnostic criteria that make up the
diagnosis of Selective Mutism. Francine’s situation meets most of the five diagnostic criteria that
would qualify her to be diagnosed with the “mental disorder” of Selective Mutism. The first part
of the criteria is often failing to speak in specific social situations in which they are expected to
speak in, despite being able to speak in other situations (American Psychological Association,
2013). In the classroom, when the students are required to have a chat time with their table
groups or the partner they are sitting beside, Francine does not say much at all—especially if she
has to talk to guys. However, Francine would respond to me or to my CT when we would
directly ask her questions during chat time. The second diagnostic criteria for Selective Mutism
is that “the disturbance interferes with educational… achievement or with social
communication” (American Psychological Association, 2013, p. 195). When partners are
required to complete an assignment together in class, Francine’s partner most often takes the
lead, otherwise, my CT or I help Francine and her partner start if none of them takes the initiative
to begin the assignment. Third of all, the American Psychological Association (2013) states that
another criterion for Francine’s possible diagnosis is that the disturbance has been going on for at
least one month. It has been a little over two months since I’ve met Francine and from what I
have observed, she has made only little progress in talking more in class. Second to the last of
the criteria mentioned for Selective Mutism in the DSM-5 is that the failure to speak is not
related to the lack of knowledge or comfort with the required language in a social situation
(American Psychological Association, 2013). Francine meets this criterion because she
understands English well, and there has been no mention of her struggling with the English
language. The last criterion stated by the American Psychological Association (2013) is that the
situation is not better explained by a communication disorder and does not happen through the
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duration of another specific disorder. This criterion is true to Francine’s situation because she has
not been diagnosed with any disorder according to what my CT has told me. Since Francine
meets majority of the criteria for Selective Mutism, she is therefore qualified to be diagnosed
with this diagnosis. Moreover, the DSM-5 also indicates that some of the associated features
supporting the diagnosis of Selective Mutism include “excessive shyness, fear of social
embarrassment, [and] social isolation and withdrawal” (American Psychological Association,
2013, p. 195) just to name a few. Francine displays some of these associated features as well.
The process of diagnosing one’s situation, such as Francine’s, is a pathologizing
approach that has been critiqued with controversial issues and potentials for harm. First of all,
giving a diagnosis to a person does not consider the context of the person’s situation. Kinderman
(2014) mentions that a list of a person’s problems and what they actually experience is more
informative and communicative rather than assigning a diagnostic label to them. Kinderman
(2014) also states that the outcome of a person receiving a diagnosis seems to be more dependent
on their social situations rather than their actual diagnosis. Therefore, the context of a person’s
life plays a significant role in relation to their situation, which is unfortunately disregarded by a
given diagnosis. Secondly, the process of giving a diagnosis to a person considers them to no
longer be “normal,” but Kinderman (2014) indicates that research suggests that “there is no
dividing line between ‘normal’ and ‘abnormal’ emotions, experiences or behaviours…” (p. 71).
The act of differentiating between normal and abnormal is an assertion of normalizing power
which excludes those who may seem abnormal in regard to their mental health (Rimke & Brock,
2012). On the contrary, the “signs” or “symptoms” of what could be diagnosed as a mental
disorder actually “lie on a continuum with normality” (Kinderman, 2014, p. 71). Moreover,
Kinderman (2014) discusses that there is no ‘abnormal psychology’ that relates to mental
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illnesses and ‘normal psychology’ that relates to whatever is not involved with mental illnesses,
but that “there is just psychology” (p. 57). He also believes that everyone shares the same “one
psychology” (Kinderman, 2014, p. 58). Third of all, giving a diagnosis to a person is
stigmatizing (Kinderman, 2014). According to Kinderman (2014), a diagnosis can relay an
improper message about mental health problems and how they come to be. When a person
receives a diagnosis, their situation could be likely misinterpreted due to the stigma attached to
mental health illnesses. Fourthly, diagnosing a person could result in the use of psychiatric drugs,
which is quite a controversial issue since it can be harmful for its users. Kinderman (2014)
mentions that those who have been diagnosed are most likely to receive a prescribed medication
towards their diagnosis. Moncrieff, Cohen & Porter (2013) state that the “use of psychiatric
drugs is only worthwhile if the benefits outweigh the harms (p. 411). Using medications for
diagnosed mental disorders can also be either helpful or harmful to a person depending on
factors such as the reason for taking the drugs and how long it will be used for. (Moncrieff et al.,
2013). Furthermore, Moncrieff et al. (2013) claim that there is no evidence that psychiatric drugs
target disease-specific actions.
Francine’s situation could also be explored in several ways that involve different nonpathologizing approaches. One approach includes the socioecological approach. This approach
includes looking at the context and environment of a person in order to explain their situation. As
mentioned earlier in this paper, Rimke and Brock (2012) mention that the “psy effect” (p. 184)
should be identified with how it affects everyday life and participates in the way one lives.
Importance should be placed upon the environment of a person because it is through being
surrounded by the right social ecology that recovery and growth could be facilitated (Unger,
2013). Creating an environment that will encourage Francine to learn to be more outspoken
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could help her improve in how she interacts with her fellow classmates. Another approach that
allows for the exploration of understanding Francine’s situation is the collaborative approach. To
be more specific, this approach involves having a positive outlook on people. Anderson (2012)
asserts that thinking positively about people, despite their past and current circumstances, is a
part of believing that they are able to live a life that is satisfying. In addition, she says that a
positive outlook on people also includes viewing them as “naturally resourceful, resilient and
desiring of healthy relationships and qualities of life” (Anderson, 2012, p. 140). Having the right
perspective towards Francine’s situation and a positive outlook on her being will stir a faith in us
that she is able to live satisfactorily. Moreover, Francine and her situation could be better
understood with the idea of relational expertise. According to Anderson (2012), relational
expertise is where a client and practitioner offer expertise in their areas. The client, which would
be Francine in this case, would offer expertise on herself and how she lives (Anderson, 2012).
The practitioner, which would be my CT or myself in this situation, would be an expert in
creating a place and opportunity in which Francine and the teacher could both work together and
collaborate regarding her situation (Anderson, 2012). Another idea from the collaborative
approach is to change one’s understanding by limiting their pre-understandings, or in other
words, by limiting what one thinks they already know (Anderson, 2012). For instance,
understanding Francine’s situation in a non-pathologizing way could be done by avoiding the
application of any prior knowledge to why Francine acts the way she does. Instead, there should
be a willingness and openness to see and hear her situation in a way that is unfamiliar (Anderson,
2012). Anderson (2012) mentions that a combination of our pre-understanding and our current
understanding of a person’s situation produces a new understanding, which in turn can change
our pre-understanding in the process as well. To learn about the distinctiveness of a person from
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their own self is another part of the collaborative approach, which is similar to the previous point
of limiting our pre-understandings (Anderson, 2012). This idea requires avoiding any
generalizations (Anderson, 2012). Anderson (2012) states that “familiarity can risk
depersonalizing the person” (p. 133). If I were to understand Francine based on my own
assumptions, then I would only be learning about Francine in my own perspective rather than
learning about her in the way she would like to be viewed. Francine’s situation should not be
understood according to one’s generalizations but should instead be learned about directly from
herself in the things she says and the way she desires to present herself (Anderson, 2012).
In conclusion, Francine’s situation could be understood by both the pathologizing and
non-pathologizing paradigms. As a teacher that will encounter students who stand out or may
have more learning needs than others, I believe that the mindset of having the student diagnosed
must be avoided and that a focus should be placed on understanding the student and how they
could be helped. One way that a teacher could make a positive and significant difference in the
school and in the classroom is by emphasizing and encouraging the students to take advantage of
the resources around them. Before students could even use any resources, they must first know
there are resources that exist and are available to help them in their situations. As Unger (2013)
sates, “a social ecological interpretation of resilience emphasizes cultural sensitivity: a resource
is only useful if it is valued” (p. 256). Another way a teacher could make a positive impact in the
classroom is to create facilitative environments. Not all environments are beneficial for students,
so teachers must make a “second-order change (a change in [an] individual’s social ecology)”
(Unger, 2013, p. 257) when the environment for the students is no longer helping them. It is
important for teachers to create facilitative environments that will be helpful to students because
these types of environments attribute to students’ resilience (Unger, 2013). “There is little about
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individuals that is so fixed that a facilitative environment cannot be a positive influence for
change” (Unger, 2013, p. 257). Lastly, providing turning points for students is one more way that
a teacher can positively impact their students. According to Unger (2013), turning points are
opportunities provided for students despite the poor environments they are currently in. I believe
that these turning points that teachers can provide will give rise to a hope in the students that they
and their situations can get better. When teachers open up moments for students to learn, grow
and improve in the least expected settings, I strongly think that students will be drawn to take the
opportunity. The three recommendations I have just shared in relation to making a positive and
impactful difference in the lives of students are just some of many ways that teachers can apply
to their school and classrooms. Students, such as Francine, who display personalities and
behaviours that are distinct do not need a diagnosis in order to be helped and understood. In a
school setting, it just takes the initiative and first step of a teacher to start making a positive
impact that matters in the lives of students.
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References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author.
Anderson, H. (2012). Collaborative practice: A way of being “with.” In Psychotherapy and
Politics International 10(2), 130-145. Retrieved from https://onlinelibrary-wileycom.uwinnipeg.idm.oclc.org/doi/full/10.1002/ppi.1261.
Kinderman, P. (2014). Understand, don’t diagnose. In A prescription for psychiatry: Why we
need a whole new approach to mental health and wellbeing (pp. 48-82). New York, NY:
Palgrave McMillan.
Moncrieff, J., Cohen, D., & Porter, S. (2013). The psychoactive effects of psychiatric
medications: The elephant in the room. Journal of Psychoactive Drugs, 45(5), 409-415.
doi:10.1080/02791072.2013.845328.
Rimke, H. & Brock, D. (2012). The culture of therapy: Psychocentrism in everyday life. In D.
Brock, R. Baby, & Mark P. Thomas (Eds.), Power and everyday practices (pp. 182-202).
Toronto, ON: Nelson Education Ltd.
Unger, M. (2013). Resilience, trauma, context, and culture. Trauma, Violence, & Abuse, 14(3),
255-266. Retrieved from https://doi.org/10.1177/1524838013487805.