Issues Related the Classification of Schizophrenia Essay

At the other end of schizophrenia is negative symptoms which reflect a loss of normal functions, this includes catatonic trance, flattened affect and avolition. b) Explain and discuss issues related to the classification of Schizophrenia (20 marks) An issue with classifying schizophrenia with the medical model is that it requires a diagnosis, with physical illness; diagnosis is relatively straight forward as it can be based on clear physical tests which can help explain the cause of the disorder.However for mental disorders such as schizophrenia there are no yes or no tests that can be carried out making diagnosis and classification difficult. This may because there is no single aetiology, so if the cause is unknown it creates issues for diagnosis and the validity.

It has been suggested that genetics are a cause as in Gottesman’s twin studies, found there was 48% concordance in MZ twins compared to only 17% in DZ twins. Although this does suggest a genetic element, the fact that it is not 100% in MZ tins suggests that there must be other factors such as environmental.This interplay of a range of causes also creates issues for the prognosis of the disorder as different causes a likely to have different effects on how the schizophrenia develops. This is shown in the rule of thirds where one third will recover and lead normal lives, one third will experience occasional relapses, and for the last third, the schizophrenia will progressively and stay with them for life. Therefore diagnosis has low predictive validity, as you cannot guess which third the patient belongs to. Concerns have alos been raised about the reliability of symptoms used in classification.

Research by Klostercater found that out of 489 admissions to a German unit, positive symptoms were deemed to be more reliable. However there is a marked variability amongst schizophrenic patients in symptoms, and combined with the fact that the effectiveness of treatment differs for each patient seem to suggest that there is not just one illness with a single cause. So instead of all different variations be classed under one ‘umbrella’ term, syndromes comprised of a clusters of symptoms could classed as a separate illness and be considered separately and discreetly in order to find suitable treatments.There are also issues with the criteria used to classify schizophrenia and their inter-rater reliability, as the diagnosis of the patient relies on the perception of the psychiatrist and the reliability of the guidelines they are using. One reason for poor inter-rater reliability may be because a patient may provide different information to different doctors.

However Copeland’s study (1970) shows that this is not the case as he gave 194 British and 134 American psychiatrists the same description of a patient and asked to provide a diagnosis.He found that 69% of Americans diagnosed schizophrenia- an extremely significant difference compared to only 2% of British psychiatrists. This demonstrates a worrying inconsistency, but Carson claimed that any inter-rater issues were solve with the success of the DSM-III in 1980 so this should have led to greater agreement over who did, or did not have schizophrenia. However recent studies such as those carried out by Whaley 2001 have found that inter-rater reliability correlations in the diagnosis of schizophrenia as low as +0.

1. The DSM is not the only classification system used across the world. Another popular system is the International Classification of Diseases (ICD) there are vital differences between the two which could result in different diagnosis. For example in the DSM symptoms have to last for 6 months, but ICD is just 1 month; the course of the illness is important in the DSM, whereas the ICD looks only at first rank symptoms; also the DSM in multi-axial in that it considers all aspects of functioning, but the ICD deals with symptoms only.These variations in criteria can make each diagnosis unreliable when compared with other data; furthermore the fact that the systems are updated every few years means that studies on genetics become unreliable as older family members who have been labelled schizophrenic have been diagnosed under a different criteria, and may have received a different diagnosis under the newest edition, particularly as boundaries between different mental disorders are hard to define, for example it is often difficult to differentiate between a schizophrenic pisode and a manic phase of bipolar depression.

The DSM also states that if the Patient experiences ‘bizarre hallucinations’ no other symptom is needed to be diagnosed with schizophrenia. It is thought that this is a clear and reliable sign for classification. However research by Mojtabi and Nicholson found that when 50 senior psychiatrists in the US were asked to differentiate between ‘bizarre’ and ‘non-bizarre’ hallucinations, they produced inter-reliability correlations of +0. 4.This demonstrates that even a central diagnostic requirement is an insufficiently reliable method for differentiating between schizophrenic and non-schizophrenic. There is also a fine line between normality and abnormality.

This is demonstrated in Rosenhan’s study on ‘Being sane in insane places’ where 8 ‘normal’ and mentally healthy pseudopatients were sent to 12 hospitals. 7 were admitted and it took an average of 19 days to be discharged, even when they explained that the symptoms of hearing voices saying ‘empty’ and ‘thud’ had gone.This highlights the lack of scientific evidence on which a diagnosis is made and so wether someone is mentally ill is based on the opinion of the psychiatrist. However there are ethical issues in this study as the hospital staff were deliberately deceived, furthermore it is not necessary relatable to real life as people often only go to be assessed if they or family and friends genuinely believe that there is something wrong, not if they felt healthy.

However Rosenhan suggested that if there had been a more open study, results would have been less reliable and less striking.Rosenhan is supported by the fact that there have been cases where sane patients have been committed to hospitals, just because of an odd personality. This is seen in Janet Frame, a New Zealand writer, who was misdiagnosed and spent 8 years in a psychiatric hospital, only just escaping from an irreversible damage from a lobotomy. Cultural variations may also lead to misdiagnosis as customs which may be considered normal in one, may be seen as ‘irrational’ and ‘odd’ and viewed as a sign of a mental disorder.This could explain why in the UK and USA there are far more African American and Afro Caribbean diagnosis of schizophrenia. However this could also be due to genetic causes or social-deprivation.

There are also issues of once a patient has been diagnosed, they are labelled as schizophrenic. This has led to people viewing them as ‘different’ and created a stigma around the disorder. This could exacerbate problems for the patient as it could lead to a breakdown in support and relationships. Furthermore labelling someone can be self-fulfilling causing people to ‘act up’ to their diagnosis.

However despite all the negatives of the medical model, the diagnostic criteria is helpful in making sense out of mental disorders so they can be understood and treatments developed that attempt to tackle the disorder. Furthermore viewing schizophrenia from a medical perspective means that if a person is ill they have the right to treatment, and communications between health professionals is easier once a diagnosis is made. Also this diagnosis takes away the blame and guilt of families of patients as it looks to medical causes rather than pointing the finger at inadequate parenting.