Psychiatric Diagnosis as a Precursor to Research Difficulties in Mental Health

By Russell, Denise | Ethical Human Psychology and Psychiatry, April 1, 2007 | Go to article overview

Psychiatric Diagnosis as a Precursor to Research Difficulties in Mental Health


Russell, Denise, Ethical Human Psychology and Psychiatry


The starting point for most mental health research is psychiatric diagnosis. If diagnoses are controversial or unreliable, then the results of the research will be difficult to interpret and its value will be undercut. The most widely used system of psychiatric diagnosis is found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders . This article looks at the conceptual core of diagnosis in the latest manual, examines the definition of mental disorder, and exposes some key underlying conceptual issues especially with regard to the notions of "distress," "impairment," and "dysfunction." The role of subjectivity and values in the application of these concepts is also stressed and discussed in relation to specific mental disorders.

Keywords: psychiatric diagnosis; psychiatric research; DSM; mental disorder definition; psychiatric impairment

Research in mental health is focused on the causation or markers of a disorder and treatment. In both these endeavors the starting point is the assumed diagnosed condition, comparing, for instance, one group deemed to be suffering from schizophrenia with a control group whose members are not given this diagnosis. The hope is that if the two groups emerge as different then we might be able to say something about the causation or treatment of the assumed condition.

If diagnosis is controversial, then the division between the so-called abnormal and normal groups is muddied and research questions about causation and treatment will not be answered. Imagine if Group A were diagnosed with the assumed disorder of schizophrenia and Group B were assessed as normal. Suppose Group A were found to have a family history of violence and Group B not. Then a hypothesis might be posited that family violence causes so-called schizophrenia. However if the diagnosis of schizophrenia comes under question for some people falling within Group A, then all we can say is that some people diagnosed with so-called schizophrenia and some without that diagnosis have a history of family violence. Any causal hypothesis about this violence causing schizophrenia is then on shaky ground.

Similar problems arise with treatment research. Say Groups A and B both consist of people who have received the diagnosis of schizophrenia. Suppose A are given counseling and B not. Suppose there is no difference in outcome. A conclusion might be that counseling does not work to help so-called schizophrenia. However if the diagnosis of schizophrenia is open to question then it might be the case that few people, if any, in either group actually suffered from it and so the question about whether or not counseling helps this assumed condition of schizophrenia cannot be answered by this research.

A great deal of research in psychiatry proceeds on the assumption that diagnoses are objective and uncontroversial. This article supports a contrary view.

MENTAL DISORDER: THE CORE CONCEPT IN PSYCHIATRIC DIAGNOSIS

Psychiatric diagnosis in the Western world is based on the Diagnostic and Statistical Manual of Mental Disorders ( DSM ), published by the American Psychiatric Association, and to a lesser extent on the International Statistical Classification of Diseases and Related Health Problems, published by the World Health Organization (WHO, 1994). I will focus on the latest DSM , published in 2000 ( DSM-IV-TR) . The stated aim of this manual is to provide "a medical nomenclature for clinicians and researchers" ( DSM-IV-TR, 2000, p. xxvi). Others attest to its wide use by researchers (Hyman, 2003, p. xix; pp. 4-5). Harold Pincus, one of the key authors of the DSM, notes: "The most important research goal of the DSM-IV was to define homogenous groups for study" (Pincus & McQueen, 2002, p. 10).

The core concept in the manual is that of "mental disorder." The notion of "mental illness" that is common in everyday discourse about mental health does not feature at all in this scheme of psychiatric diagnosis. …

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