Reliability is the extent to which psychiatrist can agree on the same diagnosis when independently assessing patients. Some parts of the world use the DSM and others may use the ICD to diagnosis schizophrenia. Issues of reliability occur as the DSM and ICD have different diagnostic criteria. Also the classification criteria changes over time for example the DSM-5 has dropped some sub-categorises of schizophrenia suggesting previous error. Diagnosis may also suffer cultural bias as in one country may diagnosis someone as normal and in another as schizophrenic. Therefore diagnosis is dependent on which identification tool is used and where in the world the individual is highlighting how inconsistent diagnosis actually is.
This raises issues of validity demonstrating that schizophrenia is not understood well enough to make diagnosis accurately. Validity, in this case, is the extent a diagnosis claims to accurately diagnose schizophrenia. Invalid diagnosis raises ethical issues for example being labelled as schizophrenic could affect other areas of life such as employment or how others perceive the individual. Diagnosis relies on patients reporting symptoms therefore makes an objective diagnosis difficult.
Copeland et al highlighted cultural differences in diagnosis and how it can vary between countries. They gave a description of a patient to US and British psychiatrists; 69% of US diagnosed with schizophrenia, while only 2% of British made this diagnosis. Therefore, differences exist in what people expect symptoms to look like and highlights further issues is diagnosis. As, behaviour in one country could be seen as relatively normal but in another could be symptoms of schizophrenia. This study highlights that some clinician may be inclined to offer a certain diagnosis possibly due to them 'liking' a certain disorder.
Rosanhan found when healthy individuals presented themselves to psychiatric hospitals in the US, claiming to hear voices they were all admitted, being diagnosed as schizophrenic. This highlights an issue of the lack of expertise in make a valid diagnosis. Additionally, in a follow up study Rosanhan warned hospitals he would be sending 'fake patients' this resulted in a 21% detection rate despite no fake patients ever being sent. This further highlights how diagnosis methods can be unreliable meaning current understanding of schizophrenia is insufficient and lacks validity.
Ellason and Ross stated people with Dissociative Identity Disorder (DID) had more schizophrenic symptoms than schizophrenics themselves. This raises issues of comordability as symptoms may appear schizophrenia but it may be due to a combination of other illness resembling it, making reliable diagnosis and treatment difficult. If we do not accurately know what schizophrenia is, we cannot treat it sufficiently. People diagnosed with schizophrenia rarely share the same symptoms, and there is little evidence they share the same outcomes. Therefore even with an accurate diagnosis it is still difficult to recommend a suitable treatment for the individual.
Diagnosis can lead to positive outcomes for example it presents the patient with the opportunity to receive treatment which would not have been available if undiagnosed. It may also help raise the patients self-efficacy through dispelling any feeling of guilt regarding their behaviour as schizophrenia can be offered as an explanation. However, negative implications can arise from diagnosis such as the risk of misdiagnosis which raises serious ethical issues as it could prevent sufferers from gaining the most beneficial treatment. A diagnosis may also lead individuals to believe that they have little or no control in directing their lived which could affect feeling of self-esteem or self-worth. This may then lead to stigmatising form others further worsening the individuals symptoms.
Tools such as the DSM are often used for diagnosis however these can be seen as reductionist as they reduce down a complex disorder to a few symptoms which cannot be operationalised effectively. This highlights the importance of the physician to understand the patient and their own interpretations of their symptoms to make the most beneficial and appropriate diagnosis.
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