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Psychiatric diagnoses have been riddled with controversies for a long time with proponents and critics giving different views on the issue. The proponents hold that psychiatric diagnoses are normally near accurate, and thus the practice should not be dismissed based on misdiagnosis claims.
On the other side, critics argue that psychiatric diagnosis is a sham and its professionals are in it for money. Most psychiatric patients will side with the critics by arguing that every time they visit a different psychiatrist they get disparate diagnoses. For instance, a patient might be diagnosed with schizophrenia at one point and be diagnosed with major depression in another setup. These inconsistencies in psychiatric diagnoses have prompted worldwide debate on the soundness of psychiatry as a professional practice.
The critics’ side seems to be drawing significant support from different quarters as people question the accuracy of psychiatric evaluation. Psychiatry became a medical field in the mid 18th century even though the Greeks had been practicing it from as early as the 3rd century. However, despite the practice being in existence for many centuries, it has been dogged with controversies especially on the way diagnoses are carried out.
As opposed to other medical diagnoses, which rely on set laboratory procedures, psychiatry depends on subjective information without proper procedures to determine a case using data derived from scientific experiments. Nevertheless, critics should not overlook the view that some psychiatric patients have been treated successfully using the allegedly abstract diagnosis methods. However, the successful cases might be isolated cases of chance as opposed to accuracy.
This paper will explore the critics’ stand that psychiatric diagnoses are inaccurate, and thus they cannot be relied in the treatment of mental disorders. This stand is befitting due to the many inherent flaws in psychiatric diagnosis. Diagnosis in psychiatry does not have the same level of rigor and consistency as diagnosis in any other form of medicine.
When patients visit doctors regardless of the underlying sickness, they expect to get professional help based on facts derived from established scientific procedures. Unfortunately, when psychiatric patients visit their doctors, they are not sure of what to expect as the practice relies on subjective information given by the patient.
Ironically, people rely on their brains to make decisions or describe situations, but mentally unsound people are expected give information about their sickness from the very dysfunctional faculties. This aspect discredits the entire practice and it inevitably leads to misdiagnosis. Bhatia rues that there “is no doubt that among the medical professions, psychiatry is the most scientifically primitive” (3).
This primitivism hinges on the apparent lack of structures and scientific experiments to assist in psychiatric evaluation. Cases of psychiatric misdiagnosis are very common in the contemporary society, which further casts doubt over the credibility of the practice. In one interesting case, a woman killed herself only for investigations to reveal that she had been (mis)diagnosed with all known psychiatric disorders within a record period of twelve months.
The medical history does not have records of an individual suffering from all known mental disorders, and thus this case underscores the primitivism in the field of psychiatry. One might argue that the case was an isolated incidence and it should not be used as a reference point for all psychiatric cases. However, this case was not isolated as in 2010, “a study found that about 20 percent – or 900,000 – of the 4.5 million children identified as having ADHD had been probably misdiagnosed” (Henion and Elder par. 1).
This realization means that psychiatric diagnoses are more of guesswork than a professional procedure. Therefore, critics have a valid point when dismissing psychiatric evaluation as a sham procedure that adds little value in the field of medicine.
The psychiatry’s incapability to come up with a standard procedure of determining cases with high degrees of confidence forms the basis of its dismissal as a pseudoscience field. Therefore, the majority of patients cannot define their disorder with surety because at best they can only say ‘my doctor said this and that’.
Therefore, mental disorder patients cannot understand the technicalities that are used when giving a diagnosis, and thus they have to rely on the trust that their doctor is at least qualified to make sound judgments. Unfortunately, patients are given different diagnoses, and given that they are mentally unstable, they take these labels to define their personalities. For instance, a patient suffering from severe depression might be misdiagnosed with schizophrenia.
Given that this person cannot make sound judgments, s/he ends up with the schizophrenic label yet s/he simply suffered from a different case of severe depression. The concern of labeling individuals wrongly boils down to the primary purpose of diagnosis. Conventionally, diagnosis seeks to improve patient care outcomes by determining the course of action that should be taken towards recovery.
Essentially, if people have same diagnosis results they should logically be suffering from the same condition, and thus they should undergo set intervention procedures. In addition, diagnosis helps in determining whether a patient will deteriorate or recover, which determines the appropriate course of action.
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Unfortunately, psychiatric diagnoses do not lead to any of the above outcomes. In the worst-case scenario, a patient may die in the hands of psychiatrists due to misdiagnosis, which deteriorates an otherwise manageable condition. Hence, the credibility of psychiatric diagnosis falls short, and thus it becomes difficult for its proponents to prove critics wrong by giving tangible evidence on the practice’s usefulness in the field of medicine.
In a bid to narrow down the allegations leveled against psychiatric diagnosis, this section will focus on the numerous issues surrounding the bipolar disorder misdiagnosis. Currently, psychiatrists cannot agree on what symptoms one should possess in a bid to be classified under those suffering from bipolar disorder. Regrettably, anyone with some mood disorders is highly likely to be categorized as a bipolar disorder victim.
As noted earlier, information from mentally unstable people cannot be relied solely in a diagnosis, and thus in a bid to cover the inconsistencies that patients might give, psychiatrists make assumptions of what might have happened. For instance, an individual might be having mood disorders, but without the necessary collaborating evidence to show the presence of maniac episodes.
Therefore, a psychiatrist will easily conclude that the maniac episode lacks because the patient cannot remember it or they will somehow occur with time. The DSM “can be overly restrictive, requiring a full symptomatic picture of mania with a duration of four days, while many experts believe that the average duration of the hypomanic state is 1 to 3days… in bipolar II, it can be difficult to elicit a past history of hypomanic episodes from the patients” (Tanvir and Rajput 58).
Therefore, psychiatrists end up giving treatment based on assumptions, which might be wrong. Some patients develop maniac episodes after taking bipolar disorder prescriptions as directed by their doctors. Human health and well-being cannot be subjected to such guesswork especially in the 21st century where technology can be employed to improve patient care outcomes.
The proponents of psychiatric diagnosis will claim that the misdiagnoses are not as important for ultimately almost all mentally unstable individuals get almost a similar concoction of medication after all. This line of thinking may sound appealing, but its repercussions are far reaching. As mentioned earlier, labeling mentally unstable individuals wrongly elicits lifelong outcomes.
Individuals may start to think about themselves based on the verdict given from the guesswork that defines the psychiatric evaluation process. This aspect affects people’s future lives, and thus they might live miserable lives due to a misdiagnosis that could have been prevented if psychiatrists admitted that the practice has numerous loopholes.
Instead of wasting time and resources defending the conspicuous untrustworthiness that underlines the practice, psychiatrists should face the issue and stipulate guidelines on how to approach the issue professionally. Other individuals might not even be suffering from mental disorders, but they may fake symptoms in a bid to get some entitlements. Therefore, they will create perfect history to reflect the presence of the disorder in their families, and thus psychiatrists will easily believe the fabrications.
Unknowingly to the fake patients, after such information is entered in their medical charts, it becomes part of their lives whether true or false and the reverberations are serious. For instance, if someone faked bipolar disorder symptoms and s/he suffers from schizophrenia later in life, doctors will simply look at the past records, note a history of bipolar disorder, and offer prescription right away.
Therefore, the individual will end up being treated for the wrong disorder, due to some inherent errors bedeviling the psychiatry practice. Such loopholes should not exist in the medical field, which might determine life or death of an individual.
The highly publicized modern diagnostic processes like DSM-V are also dogged with numerous shortcomings. For instance, DSM-V largely relies on a series of mutually exclusive questions requiring ‘yes’ or ‘no’ answers. In addition, the allegedly new diagnostic methods still rely on the mentally unstable patients to offer reliable information concerning their past for effective treatment.
As aforementioned, this aspect was the bane of the earlier diagnostic methods, but regrettably, the new methods are falling in the same trap. Even if the patients had the capacity of understanding their past in details, the jargon used in psychiatry evaluation might be very technical for a non-professional to understand. On the other side, individuals might understand the course of action of the different psychiatric disorders.
Therefore, they may end up giving the wrong information so that they do not get certain prescriptions or lose some entitlements. In addition, some will falsify information in a bid to avoid the stigmatizations that accompany some cases like schizophrenia. The anosognosia issue is a threat to the current dysfunctional psychiatric diagnosis procedures.
According to Martyr et al., anosognosia is the “deficit of self-awareness, a condition in which a person who suffers certain disability seems unaware of the existence of his or her disability” (94). Therefore, it becomes insurmountable for a patient to describe his/her condition, yet s/he is not aware its existence.
Notwithstanding the smear campaign against psychiatric diagnosis, the process has been critical in dealing with mental disorder patients. Therefore, critics cannot dismiss the entire practice as a sham fuelled by philistinism, without appreciating the achievements realized in psychiatry courtesy of the involved procedures. Al-Huthail (53) maintains that without psychiatric diagnosis, victims of mental disorders would be living pathetically.
Patient care has improved with time, and with the current DSM-V diagnostic tool, the levels of accuracy are improving. Al-Huthail (35) holds that psychiatry, just like any other medical field, is evolving and despite the inherent challenges in the practice, it cannot be dismissed as a sham.
According to a study conducted by Al-Huthail in 2008, “the accuracy of diagnosing these disorders was the highest in this study, confirming that the detection of these disorders is poor, but once detected by the treating teams, the likelihood of accurate diagnosis is high” (37). Therefore, if the field could surmount the challenge of detecting the disorders, then psychiatric diagnosis will compare with other medical diagnoses.
In addition, Al-Huthail (36) holds that research is underway on how neurobiologists can use technology to improve diagnosis outcomes for psychiatric patients. This advancement will allow specialists to pinpoint the nature of mental disorder that an individual suffers just as laboratory tests can determine the presence of the malaria-causing pathogen in a patient’s blood.
However, Al-Huthail and his fellow proponents of psychiatric diagnosis fail to address the loophole of using subjective information to make reliable diagnosis (Martyr et al. 98). The claim that psychiatric diagnosis has helped many people with mental disorder is a platitude that adds no value to such position because this medical field is supposed to aid the sick.
In addition, Al-Huthail claims that the field of psychiatric diagnosis is undergoing an evolution, but he forgets that the practice has been around from the 3rd century, and thus human beings cannot be used continually as guinea pigs for a practice that has failed to advance. In addition, Al-Huthail admits that accuracy in psychiatric diagnosis can only be achieved after recognizing the presence of a condition first.
Therefore, this form of accuracy is dependent on other factors, which cannot be established using psychiatric diagnosis. Therefore, the proponents of psychiatric diagnosis like Al-Huthail do not have a valid point, and thus the practice should be scrapped from the field of medicine.
Psychiatric diagnosis is the most archaic system of all known medical procedures in the 21st century. Psychiatrists depend on information given by psychiatric patients to make a diagnosis, and thus the results cannot be reliable. Cases of misdiagnosis in this medical field are common in the contemporary society, and this situation has prompted critics to propose the scrapping of the profession as it adds little or no value to the field of medicine.
Sadly, a mentally unstable patient can be diagnosed with a myriad of disorders in a span of one year, which casts doubt over the reliability of psychiatric diagnosis. In addition, most disorders are classified as bipolar due to the lack of enough evidence to put them under any other category.
However, this trend is dangerous as it may have far-reaching repercussions as individuals might live with stigmatization that comes with some disorders like schizophrenia. From the discussion given in this paper, diagnosis in psychiatry does not have the same level of rigor and consistency as diagnosis in any other form of medicine, and thus Rosenhan and Slater are right as their studies support this assertion.
Al-Huthail, Ayer. “Accuracy of Referring Psychiatric Diagnosis.” International Journal of Health Sciences 2.1 (2008): 35-38. Print.
Bhatia, Manjeet. “Over Diagnosis, Overshadowing, and Overtreatment in Psychiatry.” Delhi Psychiatry Journal 15.1 (2012): 3-4. Print.
Henion, Andy, and Todd Elder. Nearly 1 million children potentially misdiagnosed with ADHD 2010.
Martyr, Anthony, Linda Clare, Sharon Nelis, Judith Roberts, Julia Robinson, Ilona Roth, Ivana
Markova, Robert Woods, Christopher Whitaker, and Robin Morris. “Dissociation between implicit and explicit manifestations of awareness in early stage dementia: Evidence from the emotional Stroop effect for dementia-related words.” International Journal of Geriatric Psychiatry 26.1 (2011): 92–99. Print.
Tanvir, Singh, and Muhammad Rajput. “Misdiagnosis of bipolar disorder.” Psychiatry 1.1 (2006): 57-63. Print.