Discuss Issues/Outline and Evaluate the Classification and Diagnosis of Schizophrenia (16 marks)

Schizophrenia is diagnosed using the DCM or the ICD. The DCM describes many mental disorders, and is used in the US.
The ICD is more commonly used in Europe. When diagnosing the illness, psychiatrists look for positive and negative
symptoms. Positive symptoms are additional to ‘normal’ functioning. These include hallucinations and delusions. On the
other hand, negative symptoms are taken away from ‘normal’ functioning. They are things that ‘normal’ people can do but
a schizophrenic cannot. An example of this is speech poverty.

Classification is more specific. This looks at the types of schizophrenia e.g. paranoid. They are classified using the DCM and
the ICD. These manuals must be reliable in order to be useful, in terms of classification and diagnosis. Thus, they must be
consistently. In addition, their validity must also be high. This means they must measure what they intend to, and the
diagnosis must represent something that is real and unique from other disorders.

Despite this, many symptoms of schizophrenia are also found in other disorders. Ellason and Ross say that people with DID
have more schizophrenic symptoms than people who are diagnosed as schizophrenic. Similarly, people with schizophrenia
also have symptoms of other disorders, and could receive another diagnosis. These conditions may in fact co-occur. This is
called co-morbidity. Buckeley et al estimate that co-morbid depression occurs in 50% of patients (with schizophrenia). And
47% of patients also have a lifetime diagnosis of substance abuse. Rare conditions may co-occur more often than expected,
suggesting a link between symptoms. Thus, the diagnosis and classification of schizophrenia lacks validity, and the manuals
have questionable accuracy.

There are further problems with validity when looking cross culturally. Research suggests large differences between
countries, when diagnosing schizophrenia. Copeland gave US and British psychiatrists a description of a patient, and were
asked for their professional opinions. 69% of US psychiatrists diagnosed the individual as schizophrenic, but only 2% of the
British psychiatrists gave the same opinion. This suggests the symptoms are judged differently by psychiatrists with
different backgrounds. In fact, one of the main symptoms of schizophrenia (hearing voices) is affected by cultural
environment. Luhrmann interviewed schizophrenic adults from Ghana, India and the US. Many of the African and Indian
participant reported the voices to be positive – offering advice and being playful. However, the Americans had a more
negative experience, saying the voices were violent and hateful. Luhrmann said this may be due to harsh voices not being
an inevitable feature of schizophrenia. Thus, the diagnostic manuals are culturally biased, leading to higher diagnosis rates
in some cultures, lowering the external validity of the classification and diagnosis methods.

Diagnosis is also gender biased, and may be based on gender stereotypes. Boverman found that clinicians in the US
perceived mentally healthy adult behaviour as mentally healthy male behaviour. Thus, women have a tendency to be
perceived as less mentally healthy. Loring and Powell conducted a study in which they randomly selected psychiatrists to
read cases of patient behaviour. 56% of psychiatrists diagnosed schizophrenia when the patient’s gender was male or
unspecified. 20% of psychiatrists diagnosed schizophrenia when the patient was female. This bias was less common in
female psychiatrists. Despite contradicting Boverman’s study, it does show that diagnosis is not only affected by the
patient’s gender but also by the gender of the psychiatrist. This results in false diagnoses or patients being undiagnosed,
and thus lowers the reliability of the methods.

As well as lacking validity, the diagnosis and classification of schizophrenia also lacks reliability. Specifically, it lacks inter-
rater reliability. There is little evidence that the DSM is routinely used with high reliability. Whaley found inter-rater
reliability correlations as low as 0.11.b further problems are shown in Rosenhan’s study – ‘normal’ people presented
themselves to psychiatric hospitals, claiming they heard a voice in their head saying negative words. They were all
diagnosed with schizophrenia and were admitted. During their stay, none of the staff recognized that they were ‘normal’.
Both manuals used in diagnosis claim that symptoms must occur for a specified amount of time, which psychiatrists clearly
ignored in this study. This suggests the manuals are not always used correctly by psychiatrists, resulting in misdiagnosis.