In the world of psychology, diagnoses are an ever mutating and evolving thing. We diagnose, we try to see if changes happen. We look for medical interventions…this doesn’t always mean drugs, but what if there was an undiagnosed physical issue that is causing the mental one. Get general medical advice…does that change anything. Get specific psychiatric advice. Does that change anything.
Diagnoses in the psych world are often a game of differential diagnostics and hoping there aren’t mutilple things compounding what is masquerading as a single issue. Hell, there are DSM diagnoses that we KNOW are compound issues that we are trying to pull apart into their disseparate factors but politics still get in the way today (we have several clustered disorders that we don’t cluster because folks don’t want their issue associated with others…and things like this).
As for a single auditory hallucination? Obviously someone isn’t asking to be checked in because they heard a single voice, so we assume the patient is lying or minimizing it. WE ALL HEAR VOICES…it is separating them out and and understanding these voices are part of the choir that guides our lives. So if someone comes in saying they heard it once and need to be in institutionalized care…obviously there is more to it than that.
In the 1970s the Diagnostic and Statistical Manual II was the way disorders were diagnosed. There were generally classified as neurotic or psychotic in nature. The entire manual was 134 pages long. The current DSM V is 947 pages long. While I’m having trouble finding an online DSM II to read the diagnostic criteria for schizophrenia, I remember from my clinical training on the Rosenhan study that the criteria were few and unreliable. I did find this quote from Wikipedia:
“An influential 1974 paper by Robert Spitzer and Joseph L. Fleiss demonstrated the second edition of the DSM (DSM-II) was an unreliable diagnostic tool.[26] They found different practitioners using the DSM-II rarely agreed when diagnosing patients with similar problems. In reviewing previous studies of eighteen major diagnostic categories, Fleiss and Spitzer concluded “there are no diagnostic categories for which reliability is uniformly high. Reliability appears to be only satisfactory for three categories: mental deficiency, organic brain syndrome (but not its subtypes), and alcoholism. The level of reliability is no better than fair for psychosis and schizophrenia and is poor for the remaining categories”.[27]”
One would like to think things are different today. I’m a clinical psychologist which includes working with people diagnosed with schizophrenia and other psychotic disorders, and we take a great deal of care in diagnosing and in general are probably too conservative in given diagnostic labels (I live in New Zealand so we don’t need to diagnose in order to get insurance funding for treatment).
People forget how young psychiatry is. The first DSM is from 1952, the DSM-II was basically humanity’s second try at widely applicable diagnostic criteria. I wouldn’t want 1970’s psychiatric care but I also wouldn’t want 1970’s cancer treatment. I’m a quite sure that it is better today.
Ten Days in a Mad-House. 1887. Journalist Nellie Bly was easily able to get herself committed to a mental institution by feigning confusion and anxiety. “It is easy to get in, but once there it is impossible to get out”, she reported.
