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Description of Issue Evidence/Evaluation Further commentary Ethnic bias Different criteria Sub-types Predictive validity Labelling 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 and therefore there really is more sz in this ethnic group and that the diagnosis is valid. (this is known as the social causation hypothesis). This issue has also been suggested in terms of social class bias. 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. The consequence of having different criteria to diagnose schizophrenia 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. Therefore, it is confusing to have alternative diagnostic criteria. 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. In support of this issue, the diversity of symptoms associated with the different types poses problems for the notion of “schizophrenia”. E.g. catatonic and paranoid schizophrenia patients often have absolutely no symptoms in common – why should they be regarded as two forms of the same disorder? Are they actually reflecting sz and therefore valid? Moreover, the subtype of undifferentiated schizophrenia is basically a ‘rag bag’ category for those patients that are hard to classify into the other types. These patients therefore have a wide range of symptoms, and no two such patients might be the same. This therefore also shows issues of reliability in diagnosis. 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. However, the categorization of sz is from a biological approach. Consequently, if patients do not correctly respond to drug treatment (e.g. evidence shows between 15-30 %of patients) this may not mean the diagnosis was invalid, but that the assumption of it having a biological basis may be flawed. Diagnosis of a psychological disorder such as sz can lead to the individual being labelled. This can be helpful in terms of providing appropriate treatment, however it can be stigmatising and can lead to selffulfilling prophecy. Scheff (1966) believed that people labelled with a diagnosis will conform to the label and therefore be a self-fulfilling prophecy. However, the self-fulfilling prophecy idea could be considered inadequate for such a serious disorder as schizophrenia. Similarly, there are still several other diagnostic tools being used to diagnose schizophrenia such as the Schneider first rank criteria, or the standard interview technique PSE (present state exam). The marked variability among people with schizophrenia in terms of symptoms, course, treatment response and causal factors has led to a development of subtypes in the categorization of schizophrenia. However, the validity of these subtypes can be questioned. In fact, most British psychiatrists prefer to use the overarching diagnosis of sz and only use the subcategories in a minority of cases. This lack of practical use also suggests....... Nevertheless, it is true that mental illness labels stick and can have drastic effects on their lives, as other people are often suspicious of such labels. In fact, Szasz (1974) suggested that mental illness is a myth and society uses this stigmatising label in order to exclude non-conformists from society. Extension: Why is it important to ensure there are no issues in the classification/diagnosis of schizophrenia? (Additional AO2) It is important that the individual receives a correct diagnosis so that they receive the correct treatment for their illness. Evidence shows early diagnosis and treatment are linked to a better long-term outcome for people with schizophrenia (Jackson & Birchwood, 1996). 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 and therefore there really is more sz in this ethnic group and that the diagnosis is valid. (this is known as the social causation hypothesis). This issue has also been suggested in terms of social class bias. 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)