There is significant debate about what it is and what is the factor which makes it an illness. In fact the only factor is a biological componenet. In fact in an article on best practice for schizophrenia written by a Hong Kong psychiatrist they specify using brain scans. I didn't think this was possible yet because brain imaging in mental illness was not able to accurately identfy everyone. I'm not sure if it is a problem of over or underdiagnosis or both. I'm aware the problem is not there in neurological illnesses diagnosed using tests such as MRI scans.
Regardless of this the modern system is based on report of behaviour and understanding of patient communication by ther psychiatrist. Other factors are involved if a psychiatrist is doing their job properly, for example taking a patient and family history. Cultural and religious information are important too if making a high quality diagnosis which would have high inter-rated reliability was important in UK clinical practice.
It's not. Not in psychiatry anyway. The methods used by psychiatrists are borderline lunacy. One of them borders on using fashion sense as a diagnostic measure. I kid you not.
Every psychiatrist has a different understanding of what a diagnosis looks like. Many don't use the reference criteria. These are adhered to dogmatically in research studies but not in clinical practice.
What happens in clinical practice is rife under and overdiagnosis. It's all misdiagnosis the likes of which would not be tolerated in physical medicine.
Just one tiny example is how studies screen out patients with schizophrenia who have family members with schizophrenia when looking at clinical data. Though the evidence exists to show there is a hereditary/genetic component the pervasive knowledge of the effect in the psychiatric community has meant siblings of people with schizophrenia are more often diagnosed with schizophrenia when they shouldn't be. The results of the science have powerful effects on diagnosis trends, trends which shouldn't exist in real illnesses.
There are many other factors in this variance. A surprising result is a strong factor is where the psychiatrists studied psychiatry. After their learning period each alumini group continued the dogma of the individual teaching institution because at these institutions where psychiatrists actually spend time learning the stuff they learn isn't totally standardised. They don't stick to the research criteria's rigour in clinical practice and they're not taught standardised definitions of the concept.
And so onto the frequent overuse of the diagnosis of schizophrenia in black people and black men. They're also sectioned, drugged and forced into treatment than their white counterparts. This doesn't happen in their cultures native countries.
The model if schizophrenia has shifted significantly from the original biomedical one. NICE in the UK favour a stress vulnerability idea. They stick rigourosly to the standard model of pathologisation, one which I've ranted about in other posts. This model is meant to be robust to ethnic variation. At least PANSS is meant to be.
Psychiatry has accessed of being racist because of the disproportionate use of extreme treatments on black people. But many white psychiatrists reliably diagnose schizophrenia and concur with black psychiatrists.
These diagnoses wouldn't be concurrent with what a black or white psychiatrist from the Caribbean would diagnose and there is a reason.
Individual social learning is important in mental health. It's important to the mentally ill but an unrecognised importance is that of the person giving the label, the person who makes the judgement upon someone else's sanity and individuality's abberance.
By social learning I mean what we come to know from the environments of our growth. The cultures where we went to school and hung out. The people we met in life. What we learned about people from the people we've met in our lives.
Ask yourself? How do you come to experience people? How do you label them? What factors do you apply based on your own norms?
These social judgements are nothing which doctors should have anything to do with. Their meant to be bound by an oath of do no harm first. Medicine is not here to empower the whims of temporary fashions of behaviour as judged by some dominant clique.
That litte segue was me taking a little breather from what's an important point. A small rant to provide a little background to inform the relevance of what I'm trying to say.
Psychiatrists are doctors. This means they need to get into medical school. They need to get good grades and excel. They often to go private schools. They often come from rich, sheltered backgrounds. Those rare ones from poor backgrounds who make it as doctors are usually insanely driven and have no life.
As a group they live protected existences for their lives up until getting to medical school. It gets worse there. They are unlikely to see any black people. Especially at Oxford or Cambridge.
What's worse is those few black people and the lots of brown people they do meet are coconuts. This is a dereogatory term I am comfortable with. It is a person who is Westernised and far from their cultural roots in behaviour, norms and beliefs.
They never meet black, brown or people of any other skin colour from the ghetto. Not unless they do drugs, but that's a whole nuther story.
I've lived an unusual life in diverse communities. What I mean is my social learning is surprisingly high given my lack of social graces. I have experienced a privilege of wide experiences of people and cultures in the UK.
This social learning means I see a problem or the reason for a problem.
I'll be blunt. Much of the overdiagnosis is based on risk. This translates synonymously with fear of the angry black man or person. This isn't about racism though.
I have no fear of psychiatric patients just as I have no fear of black men and their hostility. I have had the privilege to live in poor areas where Afro-Caribbean (ugh. I hate that term. Propaganda bullshit.) Eastern European and Irish people live. I've seen aggressive people regularly. I've got no fear because they're of no harm to me. No more than any other person. They may be intimidating or look hostile but they pose no risk unless you give them a good reason.
I've met some very ...criminal people mostly in my youth. I never got involved in it but I learned about what poor people are like. They're more basic in many ways and it can be a quality. They still have the part of humanity which survives from the Savannah plains to the urban jungle, a mentality devoid in many affluent people who end up having kids who become doctors and psychiatrists.
The overdiagnosis problem in part is because psychiatrists lack the wisdom of having lived a full life with expansive social learning from the university of life and the school of hard knocks.
Me? I 'as got me PhD from there. Innit.
