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Discuss issues associated with the classification
and/or diagnosis of schizophrenia (8marks + 16
marks)
AO1
1.Outline DSM-IV &
ICD-102.Inter-reliability3.Subjectivity4.Labelling
5.Comorbidity6.Stigmatisation
AO2
Rosenhans study MUST link to each of above Becks study
Implications
Evaluation of research (MUST LINK!)
Could mention DSM V vs NIMH (NationalInstitute of Mental Health
refusing to fund DSM
V and are proposing a fairer alternative that
addresses issues raised above. This has major
implications for Psychology as practitioners will
need retraining etc however, a fairer system
will be of more benefit to patients and prevent
misdiagnosis etc).
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The main tools used for the diagnosis of schizophrenia are the
DSM-IVcriteria, which are in its fourth edition, and the ICD-10,
which is produced bythe world health organisation and is in its
10th edition. The two methods areoften used alongside each
other.
However there are several issues associated with the
classification anddiagnosis of schizophrenia. Firstly the
reliability of the ICD and the DSM canbe questioned because even
though they provide a fast and easy way tobreak down the symptoms,
treatments and prognoses of disorders, their inter-rater
reliability is low. This concerns the extent to which two or
morediagnosticians would at the same conclusions when faced with
exactly thesame individual and in many studies inter-rater
reliability has been shown tobe quite low.
This issue is backed up by research for example, Beck et al
found that outof 154 patients, only 2 psychiatrists only agreed on
the diagnosis of 54% ofthe individuals. These findings are
staggering and show that a lack of
reliability is a huge issue in diagnosis which means that there
is danger thatpatients will be misdiagnosed and may consequently be
prescribed drugs thatare not suited to their condition and result
in irreversible side effects.
Furthermore the behaviour of the individual is open to
interpretation, theprocess is subjective. This could lead to the
miss-diagnosis of millions ofpeople, causing them to be labelled
for the rest of their life even if they do notsuffer form the
disorder they have been diagnosed with. This therefore meansthat
the process raises some ethical concerns. In addition, misdiagnosis
may
result in a self-fulfilling prophecy may then also take place
which is where thesufferer who has been diagnosed believes that
they do have the disorder.
Secondly many disorders described in the diagnostic manuals
overlap,leading to a lot of patients being diagnosed with a
co-morbid disorder, thismay be because many individuals dont fit
neatly into one single category sothey are diagnosed with two
different disorders.
All of these issues were highlighted in Rosenhans study on sane
in insaneplaces,. Procedures, findings, conclusions
implications.
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Thirdly cultural relativism is another problem associated with
the diagnosis ofschizophrenia; every culture will see the symptoms
of a mental disorder in adifferent way. For example in Asian
cultures, a person experiencing someemotional turmoil is praised
and rewarded if they show no expression of theiremotions, whereas,
in Western cultures this would be seen as abnormal
behaviour. As a result the newer versions of the DSM and ICD
attempt tohighlight and deal with the issue of cultural differences
between both sub-cultures within our society and cultures around
the world.
Co-morbidity is another problem associated with the diagnosis
ofschizophrenia; this is where two mental health disorders seem to
occurtogether, for example schizophrenia and depression. This can
lead to thewrong diagnosis being made as the boundary between
schizophrenia anddepression is blurred with many of the symptoms
being the same. Again there
is the problem of subjectivity as it is down the mental health
professional todiagnose the individual, and this diagnosis may be
wrong. Furthermore theDSM and ICD have very similar approaches to
the classification anddiagnosis of schizophrenia, agreeing on the
symptoms and characteristics.
However Schneider proposed a different approach to the diagnosis
ofschizophrenia. He argued that it was the nature of the symptom
that woulddetermine whether a person was schizophrenic, not just
the fact that they hadthe symptom. For example he studied the types
of hallucinations thatschizophrenia sufferers would be afflicted
with and made a group of first ranksymptoms that were used to
distinguish schizophrenia from other psychoticdisorders. Finally to
diagnose a mental disorder, interaction between a healthcare
professional and the potential patient must take place. This
raisesanother issue in terms of culture; the clinician may not
speak the samelanguage as the patient therefore making it
impossible for the patient todescribe the symptoms and for the
clinician to diagnose the patient. This maylead to a
miss-diagnosis, and therefore a translator would be needed.
Conclusion reductionism, beta bias, (objective attempted
standardisation trained professionals)
Also must include detailed account of Rosenhans study and
explainwhich issues are highlighted within this.
