Mental Health Stigmas

      Mental Health Stigma can be defined in 2 different ways: as the Social Stigma and the perceived stigma or self-stigma. The Social Stigma is an extreme disapproval or discontent with a person or a group of people on a social level and distinguish them from others in a society because of the “psychiatric label” that they have received. The Self Stigma is the way that the sufferers feel about themselves because of the mental label. This usually leads to a feeling of shame in the person.

                   Studies about Social Stigma have come up with surprising results (Wang & Lai 2008, Realey & Jorm 2011). Through means of a survey with over 1700 adults in the UK, the researchers found that most commonly, people believed that other people with mental health problems (Like schizophrenia, alcoholism and drug dependence) were dangerous and not to be trusted. The next most common belief was that mental health problems like eating disorders were harming themselves, and the third most common was that people with mental health disorders were hard to talk to. Despite the responder’s age, knowledge they had of mental health, and whether they knew someone with a mental health problem, they all can back with relatively negative beliefs.

Many people hold stigmatizing beliefs about mental health problems. Everyone from people who know someone with a mental health problem, have a family member or even have relatively good knowledge about them, have stigmatizing beliefs. This was found by Moses (2010) who discovered that adolescents with mental health problems were mostly stigmatized by peers, teachers, and even family members.

Through history the stigmatization of mental health problems have been prevalent. They are almost always treated differently, excluded and sometimes brutalized. There are many misguided views that people have shared about people with mental health problems contributing to these beliefs. Early people believed that mental health problems were caused by demonic and spiritual possessions. These believes automatically made people cautious discriminate and fearful of people with mental health problems. Even in medical models could be a cause of the discrimination. They put mental health problems on the same level as physical problems and therefore people see them as different. Also, because there is a diagnosis involved, they could be considered as having undesirable attributions.

Another factor in the discrimination of mental health problems is the media and popular press. Cinematic depictions of diseases like schizophrenia are often very stereotypical and include misinformation about the intensity of symptoms, causes and treatments. Owen (2012) discovered that most cinematic depictions of schizophrenics were violent, one-third were involved in homicidal behavior and one-quarter committed suicide. These are all very negative depictions of people with mental health problems, reinforcing these beliefs that people with mental health problems are always dangerous.

Stigma matters because of its judgmental and discriminating attitudes to people with mental health problems. They end up with negative social effects like exclusion, poor to no social support, worse quality of life, and a low self-esteem brought on by comments and general beliefs about them.

Validity and Reliability of Diagnosis

Validity and Reliability of a Diagnosis is vital to understanding a patient and making sure that they are properly cared for. Being able to realize the importance of each aspect it and what affects an invalid or unreliable diagnosis can produce.

            Firstly, how and what is a Diagnosis? In the range of abnormal psychology, it is categorizing and detecting abnormal behavior by means of observing the patient, having clinical tests run, self reports from the patient, and gaining information from others such as relatives. When diagnosing a patient, Clinicians use diagnostic manuals, such as the DSM-IV. These list 300 different “mental disorders” and describe the symptoms but doesn’t explain the cause of it.

            Because of these manuals and means of observations, different clinicians should be able to diagnosis patients similarly, or in other words, with Inter-judge reliability. Also using inter rater reliability, assesses the degree to which several different observers (or “raters”) can give similar estimates to the same idea, can help increase the reliability. In the case of time, using Test- retest reliably assesses the ability of a consistent measure over a period of time.

            In 1973, Rosenhahn created a study that that challenged the psychiatric diagnosis problems by having 8 fake patients and each of them where claimed to have severe psychological disorders even though they were all imposters. A similar study was done by Cooper et al. (1972) just one year earlier named The US-UK Diagnostic Project to examine the reliability of diagnoses made by Clinicians for depression and Schizophrenia. Their method was to have western psychiatrists watch a videotaped interview and provide a diagnosis for the patient. The British psychiatrist diagnosed the patients twice as often and the American Psychiatrists diagnoses the same people with schizophrenia twice as often. Because the diagnoses were not the same, it’s apparent there are problems with reliability.

            The “Validity of Diagnosis” is also extremely important to understanding diagnoses and the patients. The term refers to the correct diagnosis of a patient. The DSM-IV manual doesn’t include causes of disease so it can be hard to make a valid diagnosis.

            In Mitchel et al. (2009), a meta-analysis of validity of diagnosis of depression, used 41 clinical trials with semi-structured interviews to assess depression. The General Practitioners were able to mange 80% reliability to identify healthy patients and 50% reliability in diagnosing depression. They were more likely to make false positive signs of depression during the first meeting with the patient. The study said that GP’s should see patients twice before diagnosing because the accuracy was improved over that time. 

Another study relating to the Validity of diagnosis is Rosenhahn (1973) on being sane in insane places.  5 men and 3 women were to present themselves to 12 different psychiatric hospitals in the US. They all acted normally but all but one was diagnosed with schizophrenia. The other one was diagnosed with manic depression. All though they acted normally through out their stay, the doctors interpreted them taking notes as symptoms of their diagnosis. It took between 7 to 52 days for the 8 pseudo-patients to be released. A follow up was done after this and the study told the doctors that there would be imposters that would present themselves at a hospital. Of the 193 patients who presented themselves, 41 were identified as imposters, 23 were suspected imposters, and one doctor or a staff member suspected 19. None of the identified or suspected patients were imposters. There were none.

Validity and Reliability of a Diagnosis is extremely important because, as in the case of the last study, people who were in fact sick, were thought to be faking. Being able to get a better and more reliable diagnosis will allow psychiatrists to help more people with proper treatments.