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Description of Issue Evidence/Evaluation Further commentary Ethnic bias Different criteria This could reduce reliability and validity in diagnosis. It is the idea that certain ethnic groups may be more likely to be diagnosed with a mental illness such as schizophrenia than other ethnic groups, with essentially the same symptoms. i.e. a bias in diagnosis. Evidence supports the existence of this bias. Keith et al. (1991) found that 2.1 % of African Americans are diagnosed with sz, compared with 1.4 % of White Americans. McGovern & Cope (1987) reviewed the ethnicity of patients in Birmingham mental hospitals: 2/3 of psychotic patients were African-Caribbean, compared with only 1/3 who were white or Asian. This suggests....... However, it could be argued that the evidence by Keith is due to the fact that African-Americans are more likely to live in poverty and to suffer marital separation, suffer discrimination etc. Therefore, it could be that these stressful life events trigger the sz (the social causation hypothesis). Consequently, there really is more sz in this ethnic group and suggests that the diagnosis is valid. Due to disagreement in the diagnosis of schizophrenia between US and UK clinicians, the diagnostic systems of DSM and ICD have been made similar to avoid these diagnostic differences. Whilst this has reduced reliability problems, there are still differences between the most recent versions E.g. DSM requires symptoms to be evident for 6 months, ICD requires only 1 month DSM V now has NO subtypes, ICD has 7 Another consequence of having different criteria to diagnose schizophrenia is that it makes it difficult to research studies. For example it is then very difficult to compare data on treatment outcomes since it is based on individuals diagnosed with schizophrenia using different criteria. This different starting point would act as an extraneous variable and therefore result in any research having reduced internal validity. Since clinicians cannot agree on precisely what the diagnosis of schizophrenia entails this suggests that any definitions are arbitrary and likely to be only temporary and therefore inconsistent. Up until recently, the diagnosis of schizophrenia could have been considered invalid and unreliable. Due to the variety of symptoms, course of the disorder and response to treatments, 5 subtypes of schizophrenia were developed to help categorise patients. The issue here is that patients considered ‘paranoid’ or ‘catatonic’ may have no symptoms in common and therefore how could they be measuring the same illness? This suggests it is not a valid measuring tool. To support this assumption, British psychiatrists prefer to use the overarching name and diagnosis of schizophrenia which suggests these subtypes are incorrect and impractical. Furthermore, this argument is backed up by the fact that the new edition (DSM V) has removed these subtypes due to their “low reliability, and poor validity” (APA, 2013). Consequently, this suggests this modern diagnostic tool should now have increased validity and reliability and avoid these issues. However, ICD 10 continues to use 7 subtypes of sz and therefore this issue is still relevant. This is the idea that a diagnostic and classification system can predict the course of the disorder and the outcome of any treatment. If someone is given a diagnosis of sz, it is expected that they should respond to a particular drug. If they do not respond this casts doubt on the validity of the original diagnosis. The fact that there are such differences in the course of schizophrenia suggests that the classification of this illness is perhaps incorrect. For example, in terms of sz there is the rule of 1/3s where approximately 1/3 may have an episode and not have any more, 1/3 may have increasingly worse episodes intermittently and a 1/3 may not recover at all. This variety suggests that the diagnosis of sz may not have been correct. In fact, research suggests that the predictive validity of sz diagnoses is reasonably high. However, Mason et al (1997) wanted to see what would happen if they changed the duration criterion to 1 month for the DSM and 6 months for the ICD system. Whilst predictive validity was reasonably high, it was higher for both when 6 months was used. This suggests that when using the 1 month criterion, people with a one-off disturbance are then incorrectly categorised as having schizophrenia. Diagnosis of a psychological disorder such as sz can lead to the individual being labelled. This can be stigmatising and have drastic effects on their lives as other people are often suspicious of such labels. Furthermore, Szasz (1974) suggested that mental illness is a myth and society uses this stigmatising label in order to exclude nonconformists from society. Consequently, being diagnosed with the label schizophrenia can lead to negative effects for the sufferer. However, the argument back would be that it is not the label schizophrenia that leads to stigma. People with mental disorders like sz were stigmatised long before modern diagnostic categories were used. Nevertheless, stigma can only be reduced when there is better public understanding of the true nature of the illness, eg by events like sz awareness week by the charity rethink. However, the self-fulfilling prophecy idea could be considered inadequate for such a serious disorder as schizophrenia. Can we really suggest that someone could conform to a label and then result in intense symptoms such as hallucinations and delusions? This seems illogical and therefore lacks face validity. This suggests that there will still be inconsistency in diagnoses by clinicians using different manuals. Sub-types Additionally, this problem still exists due to the categorical approach of the diagnostic systems: both ICD and DSM refer to schizophrenia-like disorders for people who show symptoms of schizophrenia but not enough to meet the exact criteria. This demonstrates the difficulty with diagnosing someone presenting with schizophrenialike symptoms and it has been suggested that that sz is not an “all or nothing” condition as suggested by the categorical diagnostic systems. Predictive validity Labelling Moreover, an additional implication of being given a label is that people could conform to the label they are given. This is known as the selffulfilling prophecy (1966). On the other hand, being labelled with an illness such as schizophrenia is also advantageous as it can then identify the appropriate treatment and therefore help the individual. Description of Issue Ethnic bias This could reduce reliability and validity in diagnosis. It is the idea that certain ethnic groups may be more likely to be diagnosed with a mental illness such as schizophrenia than other ethnic groups, with essentially the same symptoms. i.e. a bias in diagnosis. Evidence/Evaluation Evidence supports the existence of this bias. Keith et al. (1991) found that 2.1 % of African Americans are diagnosed with sz, compared with 1.4 % of White Americans. McGovern & Cope (1987) reviewed the ethnicity of patients in Birmingham mental hospitals: 2/3 of psychotic patients were African-Caribbean, compared with only 1/3 who were white or Asian. This suggests....... Further commentary However, it could be argued that the evidence by Keith is due to the fact that African-Americans are more likely to live in poverty and to suffer marital separation, suffer discrimination etc. Therefore, it could be that these stressful life events trigger the sz (the social causation hypothesis). Consequently, there really is more sz in this ethnic group and suggests that the diagnosis is valid. Different criteria Sub-types Predictive validity Labelling Extension: Why is it important to ensure there are no issues in the classification/diagnosis of schizophrenia? (Additional AO2)