Discuss the advantages and disadvantages of using classificatory systems in mental illness.
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Discuss the advantages and disadvantages of using classificatory systems in mental illness. Although mental illness ("a level of functioning which is not socially acceptable or not personally satisfying" - Boehm, 1972) has as old a history as physical illness, it is only relatively recently that it has been classified: Kraeplin devised the first classification scheme in the 19th Century, with the concept that some syndromes have features in common. Classification has recently been defined rather well as 'the process of reducing the complexity of phenomena by arranging them into categories according to some established criteria for one or more purposes' (Spitzer and Wilson, 1975). However, despite their practical usefulness, or even necessity, classificatory systems have come in for much criticism, most particularly due to their apparent unreliability. Although the evidence seems to be massed against classification, it will become apparent that it is not the concept of classification that is at fault, but its mode of practice. There are seven basic categories for classification, on which most systems are based: mental retardation personality disorder mental disorder adjustment disorder other disorders developmental disorders specific childhood disorders The two main system presently in use in the UK and USA are the Diagnostic And Statistical Manual (DSM IIIR)
Simply naming a disorder does not help to cure it. Labelling also detracts from an understanding of each patient's unique abilities, and indeed many patients do not fit neatly into the available categories. Szasz (1960) suggests that we classify in order to gain control: by labelling, the psychiatrist legitimises the social aspirations and roles of others. Some labels, such as psychosis, are actually only used as convenient terms for disorders that cannot be given a more precise definition (Gelder et al, 1989), and would seem to serve only to dehumanise patients further. It is more important to consider each case individually, taking into account the history and experience of the patient, his interaction with society and his needs. Kleinmutz (1989) criticises the artificiality and reification of classification, saying that categories often correspond poorly with the actual experience of individual patients, and that clinicians are apt to make assumptions that alter their perception of, and behaviour towards, patients - that this leads the patient to act out the part in which they have been cast, i.e. a self-fulfilling prophecy. A patient when told, for example, that he is schizophrenic, may 'suddenly' begin to experience auditory hallucinations, as he is aware (consciously or subconsciously)
These papers help to illustrate the practical difficulties faced by psychiatrists in diagnosing cases for which the present systems provide little help. The case in favour of classificatory systems would seem to be rather weak in the light of the above evidence: the labelling problem, artificiality, unreliability and their practical repercussions would appear to be insurmountable difficulties of the use of classificatory systems. However, these problems are usually the result of misuse of such systems, rather than the systems themselves: there is no contradiction between labelling a patient and also attempting to understand him as an individual, and the inability of some psychiatrists to spot certain abnormalities is not strong evidence against the existence of a condition (Meehl, 1959). The answer to the problems of classification systems lies in improving procedures for reaching a diagnosis, perhaps by the use of functional (factor) analysis - to view the conjunction of symptoms with respect to their relation to one another (See Eysenck 1960, and Owens and Ashcroft, 1982). However it is achieved, it is essential to have one or another classificatory system in use, if only for communication value; psychiatrists would otherwise not be able to decide on diagnosis, prognosis and treatment with any degree of confidence. Approx 1,500 words.
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