Eight psychiatrically normal people presented themselves at the admissions offices of twelve different psychiatric institutions in the United States complaining of hearing voices or auditory hallucinations, all eight were admitted, eleven with a diagnosis of schizophrenia and one with manic depression; after which they stopped claiming to hear voices and assumed their normal selves. They were eventually discharged with schizophrenia and depression in remission; however it took an average of nineteen days to convince staff that they were well enough to be discharged. (Coordination Group Publications 2009; Richard Gross 2010).
Rosenhal has claimed that psychiatrists cannot reliably tell the difference from those that are sane and insane, Rosenhal argues that psychiatric labels stick in a way that medical labels do not therefore everything a patient does is interpreted in accordance with the diagnostic label once it has been applied; he suggested that instead of labelling a person as insane we should instead focus on the individuals specific problems and behaviours. (Rosenhal D. L. 1973).
The study demonstrated the limits of classification and also the appalling conditions in many psychiatric institutions; this has stimulated considerably greater research and has led to many institutions improving their philosophy of care. Rosenhal, like other anti-psychiatrists is arguing that mental illness is a social phenomenon and merely a consequence of labelling although those who suffer from severe mental illness might disagree. (Rosenhal D. L. 1973)
Validity is much more difficult to assess than reliability as for most mental disorders there is no absolute standard against which diagnosis can be compared, the primary purpose of making a diagnosis is to enable a suitable programme of treatment to be chosen thus aiding in an individual’s potential recovery. Bannister et al (1964) found that there was simply no clear-cut connection between diagnosis and treatment in one thousand cases, one reason for this seems to be that factors other than diagnosis may be equally important in deciding on a particular treatment. (Coordination Group Publications 2009; Richard Gross 2010).
Construct validity is the most relevant form of validity in relation to diagnosis, according to Davison et al (2004), the categories are constructs because they’re inferred, not proven entities; a diagnosis of schizophrenia doesn’t possess the potential status of a physical disease, but even in the more extreme psychotic states it’s not possible to separate or divorce such a debilitating illness from the individual. (Coordination Group Publications 2009; Richard Gross 2010).
Davison et al believe that the DSM diagnostic categories possess some construct validity, some more than others; however, according to Mackay (1975):
‘The notion of illness implies a relatively discrete disease entity with associated signs and symptoms, which has a specific cause, a certain probability of recovery and its own treatments. The various states of unhappiness, anxiety and confusion which we term ‘mental illness’ fell far short of these criteria in most cases.’ (Richard Gross 2010).
Pilgrim (2000) argued that that calling madness ‘schizophrenia,’ or misery, ‘depression,’ merely technicalises ordinary social judgements. What is gained by calling someone who communicates unintelligibly ‘schizophrenic?’ Similarly Winter (1999), argues that:
‘Diagnostic systems are only aids to understanding, not necessarily descriptions of real disease entities.’ (Winter, 1999).
Classifications are needed in psychiatry, as in medicine, primarily to aid communication regarding the nature of patients’ problems, prognosis and treatment. It is invaluable when exchanging and/or communicating information about individual cases if there is some agreed universal terminology available and if a label can be assigned that distinguishes one patients disorder from another’s. (Claridge and Davies, 2003; Gelder et al., 1989; Richard Gross, 2010).
The fact that there are different classification schemes demonstrates that there’s’ a certain degree of arbitrariness about how people are diagnosed, DSM-IV and ICD-10 merely represent the current beliefs of experts in the field regarding how such psychological disorders should be classified. (Richard Gross, 2010).
‘The fact that they, (DSM and ICD) are not identical indicates that the diagnostic categories they suggest are somewhat arbitrary and often represent compromise. This is bound to be the case, since the contents of both merely result from decisions made in committee by groups of professionals, experienced in their own fields, but often of differing theoretical persuasion or clinical expertise.’ (Claridge and Davis 2003; Richard Gross, 2010).
Reference List:
Coordination Group Publications 2009 AS & A2 Psychology Exam Board AQA A
Richard Gross 2010 Sixth Edition Psychology: The Science of Mind and Behaviour
Rosenhal D. L. 1973 On being sane in insane places accessed on the 16th March 2011
Bibliography:
Richard Gross 1996 Third Edition Psychology: The Science of Mind and Behaviour
Case Studies – How useful are diagnosis and classification when applied to people in real life situations?
Introduction
In this assignment the author will look at three independent and isolated case studies, attempt to ascertain how useful diagnosis and classification is when applied in real life situations; the author will diagnose their present psychological mental condition, justify that diagnosis and design appropriate treatment.
Diagnosis of Case Study One
Leane is a 29 year old woman, married with four children, she appears to be suffering from a major depressive disorder as there is long term stress and anxiety in her daily life which has become extremely complex; her symptoms appear to have degenerated to the extent that her thoughts and behaviour are now becoming delusional and neurotic. Her behaviour appears to be leaning towards a compulsive, obsessive disorder or OCD. (DSM-IV 1999 – 2003; Richard Gross 2010).
During the past three months Leanne has become increasingly unhappy with frequently recurring suicidal thoughts and behaviour that can only be described as being both delusional and neurotic, her daily routine has become marred by her increasingly intrusive and repetitive thought processes of potentially imminent danger to loved ones coupled with obsessive compulsion disorders. Leanne has a religious background with profound moral beliefs but after witnessing a profoundly traumatic event at an early age may have suppressed feelings of guilt and/or some form of post traumatic stress disorder which was suppressed but has since been ignited due to her husband’s recent heart attack and problems within the marriage. (DSM-IV 1999 – 2003).
The problem with making a diagnosis for this case is that Leanne appear to be suffering several symptoms of mental health disorders, Leanne is experiencing both anxiety and depression; Anxiety is a disorder in which the patient experiences extreme fear and worry and potentially repetitive inappropriate thoughts, whereas depression is characterised by depressed mood, loss of interest or pleasure, feelings of guilt and low esteem. (DSM-IV 1999 – 2003).
Any potential treatment for Leanne would have to take into account her present fragile condition and fragile state of mind, some form of prescription medication is vital providing any potential side effects are minimal; ultimately some form of long-term psychotherapy would be necessary providing the present difficulties at home and the responsibilities entailed are in some way alleviated. Should Leanne’s condition worsen and/or her suicidal tendencies appear to gain greater intent then a temporary mental health order might be required in order to safeguard her well-being. (DSM-IV 1999 – 2003; Richard Gross 2010).
Diagnosis of case study Two
Mike is a 33 year old man who is divorced with two children he rarely sees, Mike is clearly an intelligent and capable individual however, it is clear that he is suffering from some form of psychotic disorder, possibly a paranoid type of schizophrenia with underlying depression as his thoughts have become confused and delusional to the point that he believes he is being controlled. (DSM-IV 1999 – 2003).
Mike is under the impression that his brain has been removed and replaced with another’s, he is adamant that the alien brain is controlling him and that he is no longer responsible for his actions; he believes to have many friends but is under the opinion that one of them might be responsible. The symptoms appear to justify some form of paranoid schizophrenia with underlying depression, however, the symptoms of psychosis in bipolar disorder can emulate those found in schizophrenia therefore bipolar cannot be ruled out at this stage. These symptoms may have increased as a result of recent stresses such as his divorce and the scarcity in which he sees his children; there appears to be no underlying pathology to account for the symptoms being described, his MRI scan came back negative and the EEG normal; these results rule out any underlying neurological problems which might account for symptoms given. (DSM-IV 1999 – 2003; Coordination Group Publications 2009; Richard Gross 2010).
The problems with making a diagnosis of schizophrenia in Mikes case, is that he is refusing to go and see a psychiatrist; he will have to see a specialist mental health doctor (Psychiatrist) before a diagnosis can be obtained. (DSM-IV 1999 – 2003).
There are a number of difficulties in diagnosing an effective treatment for Mike; primarily it would have to be ascertained by a psychiatrist as to whether Mike indeed does have paranoid schizophrenia or perhaps the psychosis like states associated with bipolar disorder. Obviously it would be important to rule out psychosis induced drugs prior to any form of treatment; once a firm diagnosis is achieved Mike would have to agree to close supervision, both to monitor any prescription medication such as the anti-psychotic drug chlorpromazine and to evaluate any potential risk both toward himself and/or others. (DSM-IV 1999 – 2003; Coordination Group Publications 2009; Richard Gross 2010).
Diagnosis of case study three
Bill is a 52year old man who is presently married for the second time, he has three stepchildren who he is very close to; he appears to be suffering from clinical depression with anxiety and a probable drinking problem, he has a distinct lack of self confidence and low self esteem having been in an abusive relationship during his first marriage. (DSM-IV 1999 – 2003).
Bill appears to be suffering both from clinical depression and anxiety; he has periods of both sadness and anxiety as he believes that his children will soon be leaving him therefore displaying fears of abandonment. A possible drinking problem and/or alcohol dependency has led to some aggressive behaviour; such a coping strategy appears to be deep seated from the breakdown of his first marriage. Bill suffers from a low self-esteem derived from an abusive marriage, his low self confidence, alcohol dependency and subsequent depression has left him feeling isolated although he does appear to have a genuinely supportive family network. (DSM-IV 1999 – 2003; Coordination Group Publications 2009; Richard Gross 2010).
Bill appears to be suffering from both clinical depression and anxiety; any potential problems associated with a clear diagnosis would have to involve both his level of anger and alcohol consumption. (DSM-IV 1999 – 2003).
There are potentially a number of problems associated with designing an effective course of treatment for Bill, namely the level and frequency of alcohol consumed, as no psychological treatment can theoretically begin until such an issue has been addressed. However with the correct medication, psychotherapy and the support of his family he is likely to make steady progress and given time a full recovery. (DSM-IV 1999 – 2003; Richard Gross 2010).
Diagnosis and classification is a potentially controversial subject as once a diagnosis has been ascertained, the individual or patient is essentially labelled which has been proven to have permanent and profound effects upon such individuals; obviously any given treatment is impossible without the diagnosis and classification of a given psychological disorder therefore any disorders imposed have to be true and certain or demonstrate both reliability and validity. Psychologists argue that the implications of labelling for real patients can have the effect of creating a process known as the self-fulfilling prophecy, the patient begins to see him/herself in terms of the label applied and behave in ways associated with it, thus, the behaviour is perpetuated. The process of diagnosis has a significant effect on the patient which is difficult to remove or more significantly, it encourages others to view the patient as mentally ill which affects how he/she is subsequently treated, both medically and socially. Behaviour is seen in light of the label, which could arguably lead to prolonged illness and social problems because of the stigma attached to a mental disorder. (DSM-IV 1999 – 2003; Coordination Group Publications 2009; Richard Gross 2010).
If labelling is to be credited as an accurate theory then it highlights the importance of the label in diagnosis, and the problems attached to having a stigma. It is therefore of the most utmost importance that a diagnosis should be accurate, in both identification and treatment, thus highlighting the importance of the accuracy of the classification system; therefore the diagnosis and classification system is an essential diagnostic tool when being applied to people in real life situations. It is important to provide a starting point, a common language and standard criteria for the classification of mental disorders. (DSM-IV 1999 – 2003; Coordination Group Publications 2009; Richard Gross 2010).
Reference List:
DSM-IV 1999 – 2003 accessed at 01:01 hrs on the 12th March 2011
Coordination Group Publications 2009 AS & A2 Psychology Exam Board AQA A
Richard Gross 2010 Psychology: The Science of Mind and Behaviour Sixth Edition
Gary Wheadon. Access to Higher Education Page
