Discuss Issues surrounding the classification and diagnosis of schizophrenia including reliability and validity

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Ellen Howard
Discuss Issues surrounding the classification and diagnosis of schizophrenia including reliability and
Many issues are encountered when diagnosing a mental illness and it is often a harder task than
diagnosing a physical disease for example. A diagnostic tool used by psychiatrists is the Diagnostic
and Statistical Manual of Mental Disorders IV revised (DSM IVr) which has the aim of standardising
the symptoms of an illness and also to reduce subjectivity by psychiatrists. Unfortunately this is not
always the case, as Rosenham found through research. Not only were professionals not able to
distinguish whether someone did have a mental illness or not, but even though each confederate
presented the same symptom, the psychiatrists were not consistent amongst themselves in the
diagnosis they gave. Whaley also found that inter-rater reliability between psychiatrists had a
correlation coefficient of 0.11, so this shows how psychiatrists might not make the same diagnosis as
each other. However, the DSM IVr does aim to reduce this lack of reliability by reducing the
subjectivity of the diagnosis.
Furthermore an issue with the DSM IVr is that previous versions have been incorrect, for example in
the DSM III homosexuality was listed as a mental illness. This certainly calls into question the validity of
the new DSM if there have been mistakes in the past. However, perhaps development of revised
and new versions is inevitable as more is discovered about mental illnesses and we gain a better
understanding. Validity is called into question again due to the socio-economic group that is usually
diagnosing the patient, what might seem clearly irrational to the psychiatrist might be a normal part
of the patient's cultural background. For example a white middle-aged man might diagnose an
individual based on the symptom of hearing voices, when in fact it is a normal experience in some
This also leads to the point of whether the diagnosis itself is appropriate. If the individual is of no
harm to themselves or others, does appear to have mental illness symptoms but does not want
treatment, is it necessary to possibly jeopardise the individuals `normal life' by almost certainly
guaranteeing a future of hospitals and treatments. In many cases the treatments appear to subdue
the patient, so although they may appear to have improved, and no longer show symptoms,
psychologically they are more harmed than to begin with. When deciding on treatments for a
patient, appropriacy and effectiveness are often called in to question, perhaps the same analysis
should be applied for whether an individual should be diagnosed, with the positives and negatives of
the effect of the diagnosis debated. The DSM IVr does not allow this to happen and has a strong
emphasis on categorization and with this comes a label. This label can often be life altering, with the
perception of yourself and the perception of how others view you being changed forever. As well as
this label often causing emotional distress, there is also the risk that it may actually increase the
severity of the disorder if the individual subconsciously develops symptoms that they are expected
to develop. Much like an individual might develop side effects when taking a placebo due to them
being told that they might experience or feel. So the diagnosis might actually change the prognosis
of the individual, not just inform them of it.
Another issue with the DSM IVr is that individuals are often misdiagnosed due to overlapping
symptom criteria, for example split personality disorder has more symptoms of schizophrenia than
the average schizophrenic. Each person experiences a unique set of symptoms, but they are often
made to `fit' a category of a disorder to make the diagnostic process easier. The validity of the
category of schizophrenia could be questioned due to there being two sets of symptoms, positive

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Ellen Howard
and negative that are completely different and with the possibility that they could be symptoms of
two different disorders. For example Asperger disorder shares the same symptoms as the negative
schizophrenic symptoms, so it is clear to see how using the DSM IVr could lead to misdiagnosis.
In contrast to the issues, one positive of the DSM IVr is that it does relieve pressure from patients
compared to what was experienced in the past.…read more



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