Some considerations in the formulation of psychiatric diagnoses

This paper attempts to show that psychiatric diagnosis depends to a significant degree on not only the patient's presenting symptoms but also on the psychiatrist's psychosocial biases. The importance of a psychiatric diagnosis is seen in terms of the potential social restrictions and prejudices that can be a consequence of a person labeled with a mental illness. Also, current treatment techniques and valid statistics for research are based on reliable and consistent psychiatric diagnoses. A study of 267 cases from a major psychiatric hospital revealed over 12 per cent discrepancy between the official discharge diagnosis and a resident's training report diagnosis that is used only for teaching purposes. This discrepancy is statistically significant and the paper attempts to elucidate some of the characteristics of the special population that had its diagnosis made less severe on discharge. Of the 267 charts surveyed, 33 patients had their diagnosis changed from a psychotic diagnosis on the resident's training report to a neurotic or characterological diagnosis on the official discharge summary. In addition, interviews were arranged with the 18 psychiatric residents who had been involved in changing the diagnosis of target group patients. The results obtained from these interviews definitely confirm that psychiatric diagnoses are changed due to social conditions unrelated to the psychopathological state. From the demographic data of the patient groups, a pattern evolved showing that men were generally more protected than women, that black males were more protected than black females, that unskilled laborers and those on the lower end of the socioeconomic scale were more protected than professionals, and that housewives were less protected than other categories. A number of conclusions were made by the authors concerning the data. The authors hope that these findings will enable other mental health workers to be more aware of their psychosocial biases that may be influencing their diagnostic skills.