How useful is a labelling system?

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21st Apr 2017 Psychology Reference this

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The British National Health Service (NHS), define the term mental health and claim it is about an individual’s feelings, behaviour and thought. People who have and still experience mental health problems, personally or relatively, can make positive changes and improvements if tHow useful is a labelling system hey are provided with the right support and information. The NHS claims that one in four people in the UK has a mental health problem which can therefore affect their daily life. Mental health, in some cases is viewed as a continuum of experience, ranging from a person’s general mental well-being through to a diagnosed acute mental illness. According to most health specialists, people experience changes in their mental health state, influenced by multiple factors. Most commonly, life events such as bereavement of a close family member, or perhaps migrating to a foreign country irrespective of choice, which could be insignificant to someone else, can impact on how people feel about themselves, for example, leading to depression and anxiety. This essay will explain the concept behind the labelling system in the classification of mental health disorders. Points for, in terms of treatment and research, and against, in terms of stigma and misunderstanding from the general public will be discussed. Finally, facts from various points of view proving the usefulness or the uselessness of the labelling system will be justified.

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Considering that most mental illnesses are cannot be or are not quantitatively measured, a number of clinicians believe it is a good idea to formulate paradigms in order to expect or perhaps predict some evident behaviours while for possible conditions. Classification has recently been defined rather well as ‘the process of reducing the complexity of phenomena by arranging them into categories according to some established criteria for one or more purposes’ (Spitzer and Wilson, 1975).

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), is a categorical classification system of disorders set under prototypes, the mere membership of which makes the possession of certain attributes highly probable (Kleinmutz, 1980). The DSM-IV-TR states, “the criteria…are offered as guidelines…” and therefore “there is no assumption each category of mental disorder is a completely discrete entity with absolute boundaries…”

Common conditions that are recognized as mental disorders, according to mental health faculties include; anxiety disorders (e.g.post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD) and phobias); Mood disorders (e.g. depression, bipolar disorder); Psychotic disorders (e.g. schizophrenia); Eating disorders ( e.g. anorexia nervosa, bulimia nervosa and binge eating disorder); Personality disorders (e.g. antisocial). (DSM-IV-TR). The DSM-IV-TR states its use by people without clinical training and knowledge would mean that its contents would be administered inappropriately.. Although, it advises that the ordinary person should not use the manual to make diagnoses of themselves or other people, there are other apparatuses that can be found in, for example, magazines that use the same labelling system to classify mental disorders. This therefore is the danger to possible misdiagnoses (Kring et al,2010).

The DSM-IV is often criticized for its validity and reliability. This refers to whether the disorders that the manual defines are, in actual fact, conditions in people that really do exist. (Rosenhan experiment, 1970, Kring et al,2010). Some researchers argue that the inter-rater reliability of the DSM-IV diagnoses is reasonable and the DSM-IV disorders correspond well with the evidence of distinct patterns of mental or behavioural irregularity. (Kring et al 2010)

McLaren (2010), argued that the DSM-IV lacked validity in that, it is not related to a scientific model of mental disorders which has been agreed upon, which means that the decisions made regarding the categories were not scientific ones. He also, argued that the manual lacked reliability mostly because the diagnoses share most of the criteria. Allegedly, the decision made to allocate one diagnosis to a consumer is perhaps a slight issue of personal prejudice.

It is immensely argued upon that the current approach does not the context in regard the person’s environmental context. Also, it doesn’t take into account the extent to which an internal disorder of an individual is evident, contrasted against the possible psychological response to undesirable situations the person might have. The DSM does include, however, “Axis IV”, which circles environmental factors contributing to the disorder, but this is considered once the person is diagnosed with a certain disorder. So, the environmental factors are seen as effectors rather causal factors. (“Axis IV”, DSM-IV-TR)

The diagnostic guidelines have been criticized and have been said to have a fundamentally ‘Western’ outlook .Critics argue that even when a diagnostic label is taken into account in different cultures, it does not mean that the constructs proposed are valid within the cultures. They state that legitimacy is not proven by the reliable application demonstrating consistency, (Kring et al,2010). According to Kleinman et al (2006), the fact that disorders from non-Western cultures are referred to as “culture-bound”, whereas the psychiatric diagnoses are given no cultural qualification at all. This indeed illustrates the assumption that Western cultural factors are completely universal.

However, Spitzer (2006) contested that the addition of cultural formulations was an attempt to please cultural critics and claimed the new culture-bound diagnoses, in practice, are hardly in use. He maintained that all the diagnoses apply regardless of the different cultures involved.

Zimmerman and Spitzer (1989) argue that the increase of identified diagnoses, possibly due to the labelling system (from 106 in DSM-I to 365 in DSM-IV-TR), perhaps is a sign showing the forms of pathology greatly specified, which would allow better arrangement in grouping similar consumers, effectively improving the whole system of mental disorder classification.

Furthermore, some people feel at ease when they find out that their condition in recognized and has a name. On the other hand, some feel disheartened in that they’ve been given a “label”, which could possibly be inaccurate, that will in turn invite social stigma and somewhat discrimination. From a counselling perspective, diagnoses can become internalized and affect what the individuals thinks about themselves this is seen as a hindrance to the client’s healing process (Kring et al, 2010).

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The labelling system in the classification of mental disorders also enables doctors and psychiatrists to communicate easily about the problems, prognosis and treatment (Gelder et al, 1989). For instance, if a clinician tells a colleague that a patient is a manic depressive according to DSM-IV, the colleague will know what symptoms and behaviour to expect from the patient, how to treat him and how the illness is likely to develop. It is believed that such communication skills are essential in treating patients, and without a classificatory system this would be very difficult. As stated by Kring (2010), Eysenck (1960) says that before one can look for the cause of dysfunction, one must isolate, however crudely, the dysfunction in question, and be able to differentiate it from other syndromes: this is greatly facilitated by the use of a classification system.

However, there are several disadvantages to having a labelling system. In summary, not everything and anything can fit under one umbrella. With regards to mental health disorders, it is well known that many disorders often mimic other disorders. For instance, bipolar disorder cannot be categorized as a disorder that is created by hormonal imbalance, however, Pre-Menstrual Dysphoric Disorder (PMDD), can be. Yet, one disorder often mimics the other and if a clinician is not willing to perform two seperate observations, the client could unfortunately be misdiagnosed. Also, the Labelling theory, states that to allocate a person to a diagnostic category is simply to apply a label to a deviant behaviour (Scheff, 1963), and that such labelling only increases a difficulties, because some psychiatric terms attract stigma. Labelling also detracts from an understanding of each patient’s unique abilities, and many patients do not fit into the available categories. Szasz (2001) suggested that we classify in order to gain control. Some labels, such as psychosis, are actually only used as convenient terms for disorders that cannot be given a more precise definition (Gelder et al, 1989), and would seem to serve only to dehumanise patients further. According to Thoits (2005), contrary to labeling theory, members of lower status groups are not consistently overrepresented among those who have seen a professional against their will. On the other hand, consistent with self-labeling theory, those that are not in poverty are disproportionately present among individuals who sought treatment by choice. Thoits (2005), states that the negative consequences of labeling and stigma continue to be well-supported in the literature. To illustrate the previously mentioned factor, Angermeyer & Matschinger’s (2003) study, showed that labelling is positively linked with encouraging the belief that the person portrayed in the image is dangerous. As a result, there is an increased negative social attitude towards the schizophrenia. This may also be the cause of the ‘Self-fulfilling prophecy’, which suggests that a person would often act as in accordance to the label he or she was given. Kroska and Harkness (2008) state that according to the modified labeling theory of mental illness, when an individual is diagnosed with a mental illness, cultural ideas associated with the mentally ill become personally relevant and foster negative self-feelings.

In conclusion, the primary benefit of having a Labelling system, is be to able to assess the possible treatment given options, whether they can be treated by medication, therapy or if need be, both forms of treatment. Classification allows clinicians to apply a framework to mental illness which makes treatment more possible and more appropriate for each patient.

However, following the label, social stigma can be life-long and as the result of discrimination against the mentally challenged and ill in society, finding or even the maintenance of employment could be quite difficult. When someone is diagnosed, there is an assumption that everything about that person is known. People-first language is an example of this and means that people should refer to a person with schizophrenia, rather than “a schizophrenic”. Placing the label as the qualifier makes it the important thing about the person, ignoring their other attributes.

Kroska and Harkness (2006) conclude their study by stating, that the cultural conceptions of the mentally ill do affect the self-meanings of individuals diagnosed with a mental disorder, although the connection is sometimes more complex than a one-to-one relationship between a stigma sentiment and its corresponding dimension of self-meaning. However, the main psychiatric opinion is that, if a diagnostic label or category is valid, cross-cultural factors are neither relevant nor significant to symptom presentations.

Bruce et al (2004) found out that children were exposed to stereotypes through the cartoons they watch and suggested that developmental issues are likely central by indicating that third graders have learned that mental illnesses are “bad” but have yet to develop specific stereotypes.

The NHS claim that in the UK, more than 250,000 people are admitted to psychiatric hospitals and over 4,000 people commit suicide, everyday. Figures such as these would be impossible without the labelling system in the classification of mental health disorders.

Evidence has shown that the major disadvantage of having a labelling system is that of misleading stigma. This alone is a strong argument because, the mere fear of being rejected by society is enough to hinder a person’s will to seek professional help and this can affect fellow friends and stop them from seeking help themselves. However, without the labelling system, it would be difficult to make important decisions about patients, and this consideration alone outweighs the disadvantages of the application of the system.

This is still an ongoing debate and this essay has merely touched on a few of the issues and key points from both sides of the argument. Some researchers propose alternative means such as; a fully dimensional, spectrum or complaint-oriented approach to the classification of mental disorders. They claim an approach of such caliber would better reflect the evidence needed.

The British National Health Service (NHS), define the term mental health and claim it is about an individual’s feelings, behaviour and thought. People who have and still experience mental health problems, personally or relatively, can make positive changes and improvements if tHow useful is a labelling system hey are provided with the right support and information. The NHS claims that one in four people in the UK has a mental health problem which can therefore affect their daily life. Mental health, in some cases is viewed as a continuum of experience, ranging from a person’s general mental well-being through to a diagnosed acute mental illness. According to most health specialists, people experience changes in their mental health state, influenced by multiple factors. Most commonly, life events such as bereavement of a close family member, or perhaps migrating to a foreign country irrespective of choice, which could be insignificant to someone else, can impact on how people feel about themselves, for example, leading to depression and anxiety. This essay will explain the concept behind the labelling system in the classification of mental health disorders. Points for, in terms of treatment and research, and against, in terms of stigma and misunderstanding from the general public will be discussed. Finally, facts from various points of view proving the usefulness or the uselessness of the labelling system will be justified.

Considering that most mental illnesses are cannot be or are not quantitatively measured, a number of clinicians believe it is a good idea to formulate paradigms in order to expect or perhaps predict some evident behaviours while for possible conditions. Classification has recently been defined rather well as ‘the process of reducing the complexity of phenomena by arranging them into categories according to some established criteria for one or more purposes’ (Spitzer and Wilson, 1975).

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), is a categorical classification system of disorders set under prototypes, the mere membership of which makes the possession of certain attributes highly probable (Kleinmutz, 1980). The DSM-IV-TR states, “the criteria…are offered as guidelines…” and therefore “there is no assumption each category of mental disorder is a completely discrete entity with absolute boundaries…”

Common conditions that are recognized as mental disorders, according to mental health faculties include; anxiety disorders (e.g.post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD) and phobias); Mood disorders (e.g. depression, bipolar disorder); Psychotic disorders (e.g. schizophrenia); Eating disorders ( e.g. anorexia nervosa, bulimia nervosa and binge eating disorder); Personality disorders (e.g. antisocial). (DSM-IV-TR). The DSM-IV-TR states its use by people without clinical training and knowledge would mean that its contents would be administered inappropriately.. Although, it advises that the ordinary person should not use the manual to make diagnoses of themselves or other people, there are other apparatuses that can be found in, for example, magazines that use the same labelling system to classify mental disorders. This therefore is the danger to possible misdiagnoses (Kring et al,2010).

The DSM-IV is often criticized for its validity and reliability. This refers to whether the disorders that the manual defines are, in actual fact, conditions in people that really do exist. (Rosenhan experiment, 1970, Kring et al,2010). Some researchers argue that the inter-rater reliability of the DSM-IV diagnoses is reasonable and the DSM-IV disorders correspond well with the evidence of distinct patterns of mental or behavioural irregularity. (Kring et al 2010)

McLaren (2010), argued that the DSM-IV lacked validity in that, it is not related to a scientific model of mental disorders which has been agreed upon, which means that the decisions made regarding the categories were not scientific ones. He also, argued that the manual lacked reliability mostly because the diagnoses share most of the criteria. Allegedly, the decision made to allocate one diagnosis to a consumer is perhaps a slight issue of personal prejudice.

It is immensely argued upon that the current approach does not the context in regard the person’s environmental context. Also, it doesn’t take into account the extent to which an internal disorder of an individual is evident, contrasted against the possible psychological response to undesirable situations the person might have. The DSM does include, however, “Axis IV”, which circles environmental factors contributing to the disorder, but this is considered once the person is diagnosed with a certain disorder. So, the environmental factors are seen as effectors rather causal factors. (“Axis IV”, DSM-IV-TR)

The diagnostic guidelines have been criticized and have been said to have a fundamentally ‘Western’ outlook .Critics argue that even when a diagnostic label is taken into account in different cultures, it does not mean that the constructs proposed are valid within the cultures. They state that legitimacy is not proven by the reliable application demonstrating consistency, (Kring et al,2010). According to Kleinman et al (2006), the fact that disorders from non-Western cultures are referred to as “culture-bound”, whereas the psychiatric diagnoses are given no cultural qualification at all. This indeed illustrates the assumption that Western cultural factors are completely universal.

However, Spitzer (2006) contested that the addition of cultural formulations was an attempt to please cultural critics and claimed the new culture-bound diagnoses, in practice, are hardly in use. He maintained that all the diagnoses apply regardless of the different cultures involved.

Zimmerman and Spitzer (1989) argue that the increase of identified diagnoses, possibly due to the labelling system (from 106 in DSM-I to 365 in DSM-IV-TR), perhaps is a sign showing the forms of pathology greatly specified, which would allow better arrangement in grouping similar consumers, effectively improving the whole system of mental disorder classification.

Furthermore, some people feel at ease when they find out that their condition in recognized and has a name. On the other hand, some feel disheartened in that they’ve been given a “label”, which could possibly be inaccurate, that will in turn invite social stigma and somewhat discrimination. From a counselling perspective, diagnoses can become internalized and affect what the individuals thinks about themselves this is seen as a hindrance to the client’s healing process (Kring et al, 2010).

The labelling system in the classification of mental disorders also enables doctors and psychiatrists to communicate easily about the problems, prognosis and treatment (Gelder et al, 1989). For instance, if a clinician tells a colleague that a patient is a manic depressive according to DSM-IV, the colleague will know what symptoms and behaviour to expect from the patient, how to treat him and how the illness is likely to develop. It is believed that such communication skills are essential in treating patients, and without a classificatory system this would be very difficult. As stated by Kring (2010), Eysenck (1960) says that before one can look for the cause of dysfunction, one must isolate, however crudely, the dysfunction in question, and be able to differentiate it from other syndromes: this is greatly facilitated by the use of a classification system.

However, there are several disadvantages to having a labelling system. In summary, not everything and anything can fit under one umbrella. With regards to mental health disorders, it is well known that many disorders often mimic other disorders. For instance, bipolar disorder cannot be categorized as a disorder that is created by hormonal imbalance, however, Pre-Menstrual Dysphoric Disorder (PMDD), can be. Yet, one disorder often mimics the other and if a clinician is not willing to perform two seperate observations, the client could unfortunately be misdiagnosed. Also, the Labelling theory, states that to allocate a person to a diagnostic category is simply to apply a label to a deviant behaviour (Scheff, 1963), and that such labelling only increases a difficulties, because some psychiatric terms attract stigma. Labelling also detracts from an understanding of each patient’s unique abilities, and many patients do not fit into the available categories. Szasz (2001) suggested that we classify in order to gain control. Some labels, such as psychosis, are actually only used as convenient terms for disorders that cannot be given a more precise definition (Gelder et al, 1989), and would seem to serve only to dehumanise patients further. According to Thoits (2005), contrary to labeling theory, members of lower status groups are not consistently overrepresented among those who have seen a professional against their will. On the other hand, consistent with self-labeling theory, those that are not in poverty are disproportionately present among individuals who sought treatment by choice. Thoits (2005), states that the negative consequences of labeling and stigma continue to be well-supported in the literature. To illustrate the previously mentioned factor, Angermeyer & Matschinger’s (2003) study, showed that labelling is positively linked with encouraging the belief that the person portrayed in the image is dangerous. As a result, there is an increased negative social attitude towards the schizophrenia. This may also be the cause of the ‘Self-fulfilling prophecy’, which suggests that a person would often act as in accordance to the label he or she was given. Kroska and Harkness (2008) state that according to the modified labeling theory of mental illness, when an individual is diagnosed with a mental illness, cultural ideas associated with the mentally ill become personally relevant and foster negative self-feelings.

In conclusion, the primary benefit of having a Labelling system, is be to able to assess the possible treatment given options, whether they can be treated by medication, therapy or if need be, both forms of treatment. Classification allows clinicians to apply a framework to mental illness which makes treatment more possible and more appropriate for each patient.

However, following the label, social stigma can be life-long and as the result of discrimination against the mentally challenged and ill in society, finding or even the maintenance of employment could be quite difficult. When someone is diagnosed, there is an assumption that everything about that person is known. People-first language is an example of this and means that people should refer to a person with schizophrenia, rather than “a schizophrenic”. Placing the label as the qualifier makes it the important thing about the person, ignoring their other attributes.

Kroska and Harkness (2006) conclude their study by stating, that the cultural conceptions of the mentally ill do affect the self-meanings of individuals diagnosed with a mental disorder, although the connection is sometimes more complex than a one-to-one relationship between a stigma sentiment and its corresponding dimension of self-meaning. However, the main psychiatric opinion is that, if a diagnostic label or category is valid, cross-cultural factors are neither relevant nor significant to symptom presentations.

Bruce et al (2004) found out that children were exposed to stereotypes through the cartoons they watch and suggested that developmental issues are likely central by indicating that third graders have learned that mental illnesses are “bad” but have yet to develop specific stereotypes.

The NHS claim that in the UK, more than 250,000 people are admitted to psychiatric hospitals and over 4,000 people commit suicide, everyday. Figures such as these would be impossible without the labelling system in the classification of mental health disorders.

Evidence has shown that the major disadvantage of having a labelling system is that of misleading stigma. This alone is a strong argument because, the mere fear of being rejected by society is enough to hinder a person’s will to seek professional help and this can affect fellow friends and stop them from seeking help themselves. However, without the labelling system, it would be difficult to make important decisions about patients, and this consideration alone outweighs the disadvantages of the application of the system.

This is still an ongoing debate and this essay has merely touched on a few of the issues and key points from both sides of the argument. Some researchers propose alternative means such as; a fully dimensional, spectrum or complaint-oriented approach to the classification of mental disorders. They claim an approach of such caliber would better reflect the evidence needed.

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