Classification/Diagnosis systems

• Classification systems are suppose to be objective.
• Traditional medical model in psychiatry is now assumed to be reductionist.
• Most psychiatrists use a biopsychosocial approach in diagnosis and treatment.
• Diagnose based on symptoms.
• Affective (mood) symptoms
• Behavioural symptoms
• Cognitive (thought process) symptoms
• Somatic (physical) symptoms
• Based heavily upon abnormal experiences and belief reported by patients.
• Agreed by a team of professionals.
• Explains why Classification/Diagnosis systems are often updated and revised.

Strengths of classification systems

• Statistical diagnosis
• Quantifiable
• Ability to identify disorders based on symptoms
• Therefore suitable treatment can be applied

Weakness of classification systems

• Ethical consideration is the main weakness of Classification systems
• The effects of labeling
• Leads to stigmatisation
• Prejudice and discrimination
• Self labeling can lead to Self-fulfilling prophecy
• Person diagnosed with disorder act according to the label

Cultural considerations

• An individual’s behaviour is governed to an extent by the culture they are brought up in.
• There are likely to be different perceptions of behaviour in different cultures, different cultural norms.
• A tendency to favor one’s own cultural view of the world.
• Studies on psychological disorders originated from the west, hence the tendency that the diagnosis system favor the western culture.

Overall conclusion

• Seems that Schizophrenia is a western model, Tribal Nigerians did not see hallucination as something negative.
• Cultural relativism suggests that abnormality is subjective cross culturally.
• Hallucinations and cultural perspectives was also investigated in the Kasamatsu & Hirai – Monk Serotonin Study. Hallucination is seen to be a spiritual experience by Japanese monks.

DCM vs CCMD

• Diagnostic and Statistical Manual of Mental Disorders (DCM) – Internationally recognised diagnosis system, westernised model.
• Chinese Classification of Mental Disorders (CCMD) – China specific diagnosis system based upon the chinese cultural background.
• The need for more than one classification systems suggests that culture has its effect on the criteria for abnormality and syndromes.
• Uses different criteria in the different classification systems.
• Takes care of certain Culture-Bound Syndromes.

Ethical considerations

• Ethical concerns regarding diagnosis mainly surround the issue of Labeling and its consequences.
• After diagnosis, the patient will inevitably be labeled with the diagnosed illness.
• Labeling will cause Stigmatisation.
• Where the patient will have a negative persona attached to them because they are labeled as mentally ill.

Depersonalisation and powerlessness

• Removal of human rights, frequent verbal or physical abuse.
• Usually seen in mental institutes.
• Demonstrated in Rosenhan’s study.
• Participants reported that cases of depersonalisation were observed in the institute.
• This thereby worsens the mental illness.

Self-fulfilling prophecy

• Patients may start to act according to the label they were given because they think they should act that way.
• Demonstrated in Scheff’s Labeling theory.
• “Scheff (1966) argued that receiving a psychiatric diagnosis creates a stigma or mark of social disgrace.” (Turner, 77)
• Showed criticism toward the classification systems, in particular the diagnosis of schizophrenia.
• Schizophrenic does not mean that they will break formal and obvious rules;
• But residual rule breaking (basically breaking the norm i.e. talking to themselves).
• He argued that many people breaks residual rules, but only those referred to a psychiatrist acquire a label, which influences their behaviour.

Prejudice and discrimination

• Demonstrated in Rosenhan’s study
• Stickiness of diagnostic labels
• When an individual returns to society, their record of mental illness goes with them.
• The pseudo-patients left with a diagnosis of ‘schizophrenia in remission’.
• This can lead to stigmatisation, stereotyping and discrimination against those who have been mentally disordered.
• Making reintegration back into the community difficult.