We all assume mental illness is accurately diagnosed before we begin our discussions of what to do. Is it?
Bentall in Madness Explained says no. He strongly criticises the science of psychiatry in terms of validity and reliability. Is diagnosis accurate and does it relate to a prognisis are what those two things ask. He only looks at the science though.
Science in mental health is easy to pick at. It doesn't matter though. Scientific methods aren't used in clinical diagnosis. This might sound odd but it is true.
Every psychiatrist has their ways to detect and differentiate mental illnesses. They're tasked with categorising people and the science alone isn't enough. They're also dealing with the demands of real world clinical practice rather than academia. It means they have pressures on time such that they can't do a full interview.
Psychiatrists in clinical practice don't make diagnoses which are the quality of those used in research. This results in a high degree of misdiagnosis.
The reason is simple. Psychiatrists don't use a standardised method in clinical practice. The reason is obvious to anyone who reads too much psychiatry. One of the diagnostic tests for schizophrenia is based on fashion sense. If a person dresses out of fashion - in the psychiatrists view - then they might have schizophrenia but if they dress subdued or normal then the psychiatric textbook is careful to point out that they might have schizophrenia too.
Clinical judgements are subjective and so much of psychiatry science is also subjective.
What is unrecorded is the techniques psychiatrists - in practice - use to make a diagnosis. They all have their own ways to work out who is mentally ill and why. They're different and that's why inter rater reliability can be poor in academia and non existent in clinical practice.
What would be fascinating to know is how, outside the presumed standardised diagnostic procedures, the psychiatrist labels the individual.
It has been joked that psychiatrists can tell a persons diagnosis by the way they park their car. This is silly of course but the urban legend has a seed of truth. Psychiatrists already label people using a test which asks how they dress and is subjective enough to allow the technique to practically offer one question answered: what's your fashion sense?
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