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) and the International Classification of Diseases (ICD 10). The first edition of DSM in 1952 was influenced by Meyer and Menninger, and reflected the prevailing acceptance of psychoanalytic ideas in the USA. The most recent edition, DSM III (1980), contains many innovations (including a revised nonclemanture) and its revision, DSM IIIR, has remedied some of its faults (for example, by removing some diagnostic hierarchies). The fourth edition is awaited. ICD first included mental disorders in Edition 6, and in 1959 Stengel recommended a new approach based on operational definition. ICD 10 uses many of the advances of DSM III, and is similar to it except that its clinical descriptions and diagnostic guidelines are less detailed and less restrictive. They differ in nonclemanture, in grouping of disorders, and in some conceptual ways, for example, in the definition of schizophrenia. These systems are useful in themselves, but problems do arise because of their contradictions and disagreements.

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One of the main advantages of classificatory systems is that they enable doctors and psychiatrists to communicate easily about problems, prognosis and treatment (Gelder et al, 1989); taxonomic systems also have predictive value, i.e. they set up categories the mere membership of which makes the possession of certain attributes highly probable (Kleinmutz, 1980). If a psychiatrist tells a colleague that a patient is, for example, a manic depressive according to DSM III, the colleague will know what symptoms and behaviour to expect from the patient, how to treat him and how the illness is likely to develop. Such communication skills ...

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