Ethics of Diagnosis and Classification in Psychiatry

Abstract

Present medical action is increasingly ruled by evidence-based and consequently formalised and standardised procedures. This is counterbalanced by an increasing emphasis on value-based, qualitative, individual aspects of the patient-physician relationship. The topic will be elaborated from this latter perspective. Ethically relevant consequences of psychiatric classification and diagnosing result from the fact that neither the process of diagnosing and classifying nor the individual classification systems are free from valuation. The diagnosis involves separating an observed psychopathological phenomenon from its context, describing it in words, and evaluating it in relationship to an ordering system. To be sure, there are, according to criteria, operationalised and thus objectivising standards for the scientific form of this evaluation, but at the same time moral valuations, usually unreflected, are included in the observation of a psychopathological phenomenon separated from its context, regardless of whether observed by the patient or the examiner, as well as its description, e.g. those with stigmatising effects, which are transported, among other paths, by language. These include subjective appraisal of the individual as well as socially accepted values of society (Wakefield 2005, Wakefield et al. 2002) in their individual regional and cultural specificity, which is also dependent on social class (Sartorius 2005). These appraising subjective and normative influences are not only effective on the level of the identification of the phenomenon (1), but also on the level of the diagnosis (2), and also on the level of nosological classification (3), especially in the choice of the ordering criteria. This socially and culturally related and thus implicitly evaluating context dependency of shaping, processing, describing, and ordering the illness characteristics is for the relationship to the individual patient and thus the individualisation of the treatment, e.g. for the treatment adherence, of considerable, if not decisive significance (First 2005). This will be discussed by first illustrating ethically relevant evaluating influences on the above-mentioned three levels with several examples and then by clarifying, through their relationship to the illness concept, what this means for the individual patient who comes to the psychiatrist because of disturbing psychopathological phenomena and who is diagnosed within a psychiatric classification system by the psychiatrist. (PsycINFO Database Record (c) 2012 APA, all rights reserved)