MENT3000 Aspect of Diagnostic Classification and Medicalisation of Mental Disorder Assessment Answer
The diagnosis and treatment of mental disorder might appear straightforward; diagnosing conditions based on signs and symptoms and prescribing medication, psychotherapy or both. However, expansion of knowledge about the mental disorder has challenged the understanding of components and process of mental disorder which remains rudimentary. Two major manuals providing classification system of mental illness are the International Classification of Disease and Diagnostic and Statistical Manual of Mental Disorder. The approach of these diagnosing understanding and classifying of mental disorder is hugely debated and questioned. The essay discusses the various potential aspect of diagnostic classification and medicalisation of mental disorder under ICD10/11 AND DRM-V. The essay put forward the evidence-based information supported through literature to argue in favour of the statement” Psychiatric diagnostic classification approaches is not fit for purpose.”
CRITICAL EVALUATION OF PSYCHIATRIC DIAGNOSTIC CLASSIFICATION SYSTEMS- ICD10/11, DSM-5
DSM-V and ICD 10/11 are the main diagnostic classification tool used for diagnosing mental disorder. Study Timini et al, 2014 suggested psychiatric diagnosis as not valid or useful in clinical application. The article reviewed the evidence-based empirical findings concerning topics like aetiology, validity, reliability, treatment and outcome. Along with other factors, the diagnostic model lacks cultural and public policy impact also. In these diagnostic manuals, a complete failure of biological or psychological marker relation with the psychiatric diagnosis can be observed. For example, post-traumatic stress syndrome, where trauma and abuse are associated with a psychiatric diagnosis of psychosis (Timini et al., 2014).
This is also supported by study Dias et al., 2017 which states that PTSD is associated with child maltreatment, neglect, potential harm physical and sexual abuse. Multiple co-morbid and overlapping diagnosis is also concerning as it indicates a deficient basic understanding of the mental condition. Article question the reliability, because of the low level of agreement between psychiatrist about the key symptoms (Timini et al, 2014). Lack of treatment specificity also hinders the establishment of the diagnostic labels for treatment decision outcome. The study argues diagnostic modal derived from general medicine is not suitable for psychiatric considerations where multidisciplinary disclosure including philosophy, biology, psychology, politics, anthropology is required. However, a study by Reed et al, 2019 suggests ICD 11 classification being evolved in terms of validity and reliability. The paper supports the evolution of mental disorder from ICD to ICD 11 for enhancing the clinical utility based on current evidence-based practice. The development of ICD 11 id based on mental, behavioural and neurodevelopment Disorder. The development is based on clinical utility and global applicability.
Perkins et al., 2018 systemic review found that psychiatrical diagnostic labels significantly influence people well-being. The study determined how diagnosis decided and communicated by the health care professionals is crucial in users experience. The reliability of the current model is also questioned by Deacon, 2013. The study describes that the biological model views mental disorder rather as a brain disease and is shaping the approaches of diagnosis and treatment of mental illnesses. Deacon, 2013 discussed the failure of DSM V for characterising mental disorder as phenomenological characteristic of brain function, further continuing study argues that DSM V classification of mental disorder is based on the biological validity, for example, amygdala activity as measured in MRI, this only assigns characteristic biological illness rather than addressing syndromic classifier.
However, several studies have supported the biomedical origin of mental illness on the basis including, genetical link and second the structure, composition and chemical changes in the brain (Wyatt, 2013).
This approach of the biomedical model is highly questionable due to the sceptical example which proves otherwise. For example, patient with attention hyperactivity disorder and psychosis both may show abnormality of frontal lobe functions (Deacon, 2013). Also, criticism of DSM V includes lowering of the threshold of certain conditions and expansion of the symptom criteria which may cause overdiagnosis and identification of condition not requiring treatment (Nemeroff et al., 2013). This is established in the Australian documentary How Mad Are You? Hickey et al., 2018 which demonstrates the challenges and difficulty in assessing people behaviour. It elaborates two types of errors; that is being negatively diagnosed or over-diagnosed. A counter study by Wyatt, 2013 indicate that knowledge of biomedical phenomenon contains verified interactions between genes disease and drugs hence brings out better clinical outcomes.
Another paper questions the reliability of the diagnostic system of DSM- V along with the failed validity of continuous separation of disorders. For example, a child previously diagnosed as autism will be diagnosed as ASD in DSM- V without intellectual impairment and structural language impairment (Regier et al., 2013). Asperger’s disorder was removed and replaced by broader autism spectrum disorder. However, some of the studies depict them as a different disorder arguing against the biomedical model while other support combining these diagnostic labels (Tsai & Ghaziuddin, 2013).
Medicalization is the process by which non-medical problem get defined and treated as the medical problem. This is also known as pathogenisation, that is turning something abnormal based on pathological evidence which was initially considered as normal. The potential impact of medicalization can be explored in three aspects including the interventional harm, stigma or dehumanisation and narrowing of our understanding of mental disorders. Psychotropic interventions like electroconvulsive therapy can cause significant long-term memory loss with little efficacy in mental disorder (read et al., 2019). People with forced intervention due to being diagnosed with mental illness based on the biomedical model are not benefited from the treatment due to a breach of the healthcare professional and personal relationship (Birkhauer et al., 2017)
As an impact on medicalization, the biomedical model causes stigmatization and dehumanising of people. The diagnosis and intervention of mental disorder should provide de stigmatisation however evidence from various literature has shown just opposite. Kvaale et al, 2012 suggested an increase the stigmatization due to biomedical model causing medicalisation, supported by another study which states that medicalisation of mental disorder enhances the stigma associated with it ("The Paradox of Mental Health: Over-Treatment and Under-Recognition", 2013). However, Stein et al., 2020 states the tools /models as one of the most broadly multilingual, global participative and multidisciplinary classifications of mental disorders. Study purposed the diagnostic tool as an individualised, collaborative, and holistic approach to mental health diagnosis. ICD 11 includes the provision of consistent and systemic characterized information, cultural related guidelines and lifestyle approach adoption. The dimensional approach in the classification is incorporated especially in personality and psychotic disorder. ICD 11 is compatible with the recovery-based approaches eliminating the artificial comorbidities. ICD 11 recognizes the emotional components of mental disorder including neurocognitive disorder as well as the underlying cause (Stein et al., 2020).
Dehumanisation is a problem when healthcare professional sticking to the diagnostic model fail to see the person beyond the illness or behaviour pattern. The study by Gambrill, 2013 also argues that concepts of mental suffering today has been pathologized and medicalized with diagnostic manuals. With broadening the classification for several depressive disorder DSM -V has included day to day stress as depression. The study argues that mental distress has been categorized as a medical problem obscuring the problem in the environment like social, poverty political and ethical. The study purposed that abnormal behaviour in response to stress or abnormality in the environment. Hence the labelling of mental conditions ignores the learning opportunities. Rather than the biomedical approach, there is a need for conceptualization which might be difficult due to constant economic expansion pressure from pharmaceutical and insurance sector (Gambrill, 2013). Despite this many studies have argued that getting a diagnosis framework based on research is reassuring for many individuals and often is considered as the first step of getting chemical care. The quantitative understanding of the neurobiological model increases the likelihood of identifying new and effective therapeutic approaches (Nicholson & Sommer, 2018).
The study by Lebowitz & Ahn, 2014 has shown that the biological model of diagnosis has led to more aggressive medication protocols by physicians with decreasing empathy toward the individual. Medicalisation of the mental condition may also affect the health outcome of the general public, as the healthcare professional will assume mental condition as a brain disorder. This also holds for the suffering individual themselves, for example, if individuals assume mental disorder is caused by the brain structural changes they never opt for non-pharmaceutical therapies. However, studies like Eduard & David, 2017, Carter, 2015 advocate applying neuroimaging, genetic, and blood-based approaches for understanding pathogenesis and treatment of mental disorder related to biomarkers.
Medicalisation is one of the biggest drawbacks of the biomedical model of mental disorder diagnosis. Not only surgeries and drugs but cognitive behaviour therapy also falls into the category of medicalization. The biomedical model of mental illness has enforced medicalization with minimal resistance in psychiatry causing the heavy marketing of psychotropic medications as effective treatments even in the absence of robust evidence. Although certain studies indicate toward the potential positive and progressive scientific aspect of the biological model of diagnosis adapted by DSM-5 and ICD 1-0/11, although these seem unsatisfactory in comparison to damage it causes in terms of overdiagnosis and overmedication.