Classification and Diagnosis

What is the issue with the DSM?

A weakness of the DCM is that it is *culturally biased* as it was created by Americans for Americans. This may be an issue as behaviour in one culture may not be regarded as a symptom of schizophrenia but according to the DSM it is. For instance hearing voices in some cultures is considered to be a message from the spirit world, therefore regarded as an honour not a symptom of a mental disorder, whereas in America this would be a first rank symptom of schizophrenia.

Give one negative evaluation point of Rosenhan's study.

However the research is 40 years old so it is outdated; classification systems have been updated and improved along with research and knowledge into the disorder and so it could be said that the research is no longer valid because with the updates to the classification systems, the diagnosis would not be made now.

What are the two main diagnostic systems?

ICD DSM

Give two problems caused by comorbidity.

Issues of reliability are raised as we are unable to tell whether the low motivation reflects the existence of depression or schizophrenia, or both and is a problem because comorbidity appears in such a large percentage of sufferers. It also raises the question as to why these are thought to be two distinct disorders when they have common symptoms.

What was Rosenhan's study?

Rosenhan carried out a study to see if abnormal individuals could be classified as normal. They told staff at a psychiatric hospital that normal individuals, pretending to have symptoms would try to gain access to hospitals. Rosenhan did not send any individuals and yet 41 genuine patients were judged to by staff to be pseudo patients. Rosenhan concluded that 'it is clear that we cannot distinguish the sane from the insane in psychiatric hospitals'.

Give one positive evaluation point of Rosenhan's study

Rosenhan used a range of different hospitals in his experiment using hospitals from all different states, both private and federal, old and new, and so results can be generalised.

What is labelling?

Once patients are diagnosed they are then labelled as schizophrenic. Those who have suffered a mental disorder must disclose this information when applying for particular jobs so the label stays with a person throughout their life and they therefore risk carrying the stigma of their condition with the associated problems.

Give two advantages to being labelled.

One advantage to being diagnosed is the feeling of relief that patients have if they have been particularly scared or anxious about their symptoms as they finally have an explanation as to what has been going on in their lives. This also allows them to receive effective treatment that may enable them to live a normal, functioning life.

How would you conclude this essay?

One of the main problems with diagnosing schizophrenia is that we *do not have objective tests* such as blood tests or imaging to determine whether an individual is schizophrenic or not so we have to rely on an assessment carried out by a psychiatrist which is *inevitably biased*. However the classification systems have led to an *improvement* in the reliability of diagnosis which has benefitted the sufferers and society, as it allows appropriate treatment and support which allows a great majority of schizophrenic patients to resume a fairly normal and productive life.

What is the ICD?

This diagnostic system classifies all illnesses with one section for mental illness, it is used in Europe and a number of other countries.

What evidence is there for comorbidity?

12. Supporting evidence comes from *Sim et al*, who studied 142 hospitalised schizophrenics, 32% of whom had an additional mental disorder. Those with comorbidity had less awareness of their condition and poorer outcomes than those without.

What is comorbidity?

Comorbidity is when a patient is suffering from two or more mental disorders at one time, this is an issue when diagnosing schizophrenia. Many schizophrenic patients also suffer from other disorders such as depression and bipolar disorder. Comorbidity occurs in part because the symptoms of different mental disorders often overlap with each other. For example, low motivation can be present in both schizophrenia and depression.

Give two disadvantages to being labelled.

Despite this, it can be damaging as sufferers have to live with the attached label for the rest of their lives. This may go against them and lead to unemployment and consequently, poverty, furthermore labels may also lead to a self-fulfilling prophecy where people who are treated in a certain way produce the expected behaviour. In addition, their behaviour is interpreted in the light of the label and what might be considered eccentric will now be seen as evidence which confirms the label.

What is the DSM?

This diagnostic system is used throughout America and some parts of Europe. It takes account of the individual's situation rather than merely looking at the symptoms as it assesses the sufferer's social functioning such as social status and physiological state of health.