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On being Sane in insane places Rosenhan, (1973). Rosenhan orchestrated one of the most famous studies criticising basic psychiatric concepts and practices; his intention was to test the hypothesis that psychiatrists cannot reliably tell the difference between people who are genuinely mentally ill and those who are not. (Coordination Group Publications 2009; Richard Gross 2010). 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).