Mental Illness and Stats

So I decided not to write about qualitiative and quantitative data this week.  Mainly because I’ve written about it in a previous blog so I decided to write about mental illness because it really interests me.  As this is a stats blog I will somehow try and link the two together…

Being diagnosed with a mental health disorder can really have an impact on your life.  Illnesses like Schizophrenia cannot be cured and will impact your everyday life forever so when diagnosing mental illnesses we have to be sure that our diagnostic method is valid.  Especially if the patient is being prescribed strong tablets like lithium for example.  In 1952 the Diagnostic and Statistical Manual of Mental Disorders (DSM) was published.  It is used by many psychiatrists and clinical psychologists to  diagnose patients It is basically the standard criteria of mental disorders.  This ensures that over the world in diagnostics, research, health insurance and psychiatric drug regulation there is a general consensus over the symptoms and treatments of mental illness.  So If I was Schizophrenic I would expect to receive the same treatment in america as I would in the UK.  To ensure Validity the DSM is now in its 5th edition. It is keeping up to date so mental disorders are added and some are removed.  A good example is homosexuality was originally in the DSM but has now been removed as more research has demonstrated that it is not a mental disorder.

I have also found out that in different cultures there are different mental illnesses.  Anorexia and Bulimia are seen as western illnesses.  In India there is a mental illness called Dhat which is categorised by anxiety and hypochondria about the discharge or semen. Also in west africa there is a condition called “brain fag” which is associated with male high school or university students who have difficulty concentrating, remembering and thinking there are also physical symptoms around the head and the neck like blurriness of vision and pain.  The most interesting case I found though is mainly found in Japan and is called “Paris syndrome”.  Basically Japanese tourists go to Paris expecting a beautiful romantic city then find out that it is actually grotty and busy and not like the pictures in the magazine.  Other reasons for developing the syndrome have said to be the language barrier, jet lag and culture shock.  Symptoms include hallucinations, feelings of persecution, depression, anxiety and dizziness.  It has got to the point where Japanese tourists are given psychological tests and offered counselling when they return from paris.  Anyway, back to Validity.  If different cultures have different mental illness then surely we need to question the reliability and validity of the DSM because in todays society people experience very different upbringings and if social factors affect mental illness then surely scientific statistical diagnoses isn’t the best method.

There have been many critiques of the DSM some say that it is invalid and is based on the subjective opinions of a few powerful psychiatrists.  WIlliam Glasser says that is has “phony diagnostic categories”.  The Rosenhan “being sane in insane places” study shows how easy it is to get wrongly diagnosed and when somebody sees you are “crazy” they view you in a different way.  For example on participant was writing notes for the study and a nurse described it as “obsessive writing”.   I haven’t been able to find a citation but at A level I learnt about a study where mental health professionals were given a list of symptoms for a mental disorder more common in females, all symptoms were identical but there were both male and female names used.  They found that females were more likely to be diagnosed so there is the issue of gender bias aswell. There is also the controversial of influence from psychopharmaceutical companies influencing what treatment to recommend apparently over half of the authors of the DSM-IV had financial relationships with the psychopharmaceutical industry at some time.  

So basically what i’m trying to say is that although there are a lot of examples and ideas about why the DSM may not be effective I’m just happy that it exists because otherwise wrong diagnostics would be made all the time and at least there is a consensus on mental disorders.


Posted on November 25, 2011, in Uncategorized. Bookmark the permalink. 8 Comments.

  1. I also believe that the DSM is a good classification system for clinicians to use as guidelines whilst diagnosing mental disorders. However, this system is still not perfect. Many recent studies, for example Whaley (2001)¹ found reliability correlations of inter-rater reliability as low as 0.11 for the diagnosis of schizophrenia.
    As you mentioned cultural differences in the diagnosis of schizophrenia, I found a relevant study by Copeland et al. (1971)². In this study a description of a patient was given to 134 US psychiatrists and 194 British psychiatrists, 69% of the US psychiatrists diagnosed schizophrenia but only 2% of the British psychiatrists did. This study outlines the absolute need for classification systems for mental disorders, since this illustrates that many individuals may be suffering without medication since they have not been appropriately diagnosed.

    ¹. Whaley, A. L. (2001). Cultural mistrust and clinical diagnosis of paranoid schizophrenia in African-American patients. Journal of Psychopathology and Behavioural Assessment, 23, 93-100.
    ².Copeland, J. R., Cooper, J. E., Kendell, R. E. and Gourlay, A. J. (1971). Differences in usage of diagnostic labels amongst psychiatrists in the British Isles. British Journal of Psychiatry, 118, 629-40.

  2. I loved this blog! its so nicee not hearing about quantitative vs qualitative again!
    I agree that it is beneficial to have a diagnostic manual, for all of the same reasons you describe, however i think that it is important to remember that it is only a guide, as we are constantly reminded there are individual differences mucking up nice clean rules all over the place :P, so i do undertand why some people think that there is not a need for a manual. One other thing though, and that is that yes, DSM-IV-TR is the main manual that is in use today, but there are other manuals acros the world that are in fact slightly different, so i think as well, not only does individual differences have an affect on the effectiveness of manuals, but also the culture, as what some believe to be abnormal behaviour, others dont.

  3. Love this post 🙂 I remember hearing last year about Paris syndrome and thinking it was completely ridiculous! It’s interesting to know that there are so many different illnesses across the world that we have not yet come across, it just goes to show how ethnocentric western countries are and how we ignore so much of what happens in other countries. I do agree that the reliability and validity of the DSM-IV-TR should be questioned. Upon hearing of the many disorders that are apparent in other countries I think (although new editions do come out every now and then) a new edition should be revised and should be once that can be used worldwide. I believe this would benefit people in many different ways. Not just us as psychologists but the patients involved. It could come to our attention that somebody who we thought had a certain disorder in fact has another disorder that we had never even thought of. I also think you raise some valid points about the gender bias involved in diagnosing mental disorders. Grove and Tudor (1973) said that females are more likely to suffer from emotional issues, this however is an incorrect assumption to make, it may just be that males are more afraid of asking for help with an emotional problem. It shouldn’t be the case where women are being diagnosed with mental issues because they are forever seen as the more emotional sex.
    I agree with many of the points that you have made and really enjoy reading your blog! Keep more good comments coming 🙂

    Walter, R., Gove and Jeannette, F. Tudor. (1973). American Journal of Sociology , Vol. 78, No. 4, Changing Women in a Changing Society (Jan., 1973), pp. 812-835

  4. What comes to mind when I read this blog is the discussion Richard P Bentall brings up in his book, ‘Madness Explained: Psychosis and Human Nature’. Bentall suggests that, “We should abandon psychiatric diagnosis altogether and instead try to explain and understand the actual experiences and behaviours of psychotic people.” What he means by this, is that our focus should be on the symptoms of patients rather than having psychiatrists dole out pills assumed to “cure” these disorders. As you have rightly pointed out when referring to cultural factors, there are many inconsistencies with psychiatric diagnosis and therefore, it is unreliable. If we are to adopt Bentall’s new approach to diagnosing mental disorders, then this would mean a complete re-write or even an abandonment of the DSM-IV-TR. I agree with Bentall’s position on this matter as it is a more eclectic approach to helping the individual, rather than curing the masses. However, I agree with Harriet Stewarts review on his book when she says that, “surely we should improve our system of diagnosis and classification by enhancing the quality of research rather than abandon diagnoses altogether.”

    Bentall, R. P. (2003). Madness Explained: Psychosis and Human Nature. London: Penguin Books.

  5. I am extremely impressed together with your writing skills as smartly as with the format to your blog.
    Is that this a paid theme or did you modify it yourself?

    Anyway keep up the nice quality writing, it is rare to see a great blog like this
    one nowadays..

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