Psychiatrists themselves have highlighted the unreliability of diagnostic verdicts

To be fair to psychiatrists, even doctors practising in other branches of medicine where illnesses are clearly biologically-based may make frequent diagnostic errors:

"Many patients in intensive care units are being wrongly diagnosed, according to a study in a UK hospital. Some are dying because doctors fail to spot major conditions such as heart attacks, cancer and pulmonary embolism...a consultant checked the accuracy of diagnoses by comparing post-mortem results with patients' medical records. In 39 per cent of cases, they found major problems had been missed." (Day, 2004).

Although most British psychiatrists are undoubtedly well-meaning and skilful  practitioners who do their best for their patients, the vagaries of  the diagnostic criteria in psychiatry are such that despite their best efforts, errors are inevitable.

One of Britain's most distinguished psychiatrists, Dr Anthony Storr (1989) observed: "The psychiatrist may often be wrong or premature in his interpretation of his patient's behaviour or character...[and consequently] It is very easy indeed for individuals to be judged insane upon dubious criteria...to be deprived of liberty...in spite of the fact that they may  be causing no harm to themselves or to anyone else".

The difficulties involved in identifying psychiatric conditions  is compounded by the approaches which doctors have developed towards diagnosing illness.

Doctors Skrabanek and McCormick (1989) have revealed that doctors' training tends to encourage them to diagnose a non-disease rather than fail to spot a true disease. That is, they are more likely to convict the innocent than acquit the guilty.  This approach is one of: "If in doubt, diagnose". 

As Skrabanek and McCormick comment: "The apparent diagnostic acumen of the senior clinician may be nothing more than deja vu;  having seen it before, he can now recognise it"  However, they also point out that: "Although knowledge and experience are the mainstay of diagnostic skill over reliance on their virtues frequently leads to nothing more than making the same mistakes with increasing confidence" (Skrabanek and McCormick, 1989).

As the eminent Harley Street psychiatrist Dr Leopold Henry Field (1998) commented: "It is possible for a subject to be seen by a neurologist, cardiologist, endocrinologist or chest physician and leave the consulting room having been told there is nothing wrong with him or her.  It is virtually impossible for someone to be interviewed by a psychiatrist and leave the consulting room without having some psychiatric label attached to them.  Psychiatrists are adept at interpreting all human behaviour and emotional reactions in terms of psychopathology."

In view of Dr Fields observation, it is unsurprising if, as Dr A M Colman (1993) comments: "There is hardly an important historical figure who has not, at one time or another, been diagnosed as suffering from a mental 'illness' of some description" .

Dr Sydney Walker (1998) Director of the prestigious Southern California Neuro-Psychiatric Institute has also complained that, too often, psychiatrists[in America] have been found to practise what he terms "cook book psychiatry" -they just match symptoms with the ever-growing lists of diseases  found in  standard texts such as the Diagnostic and Statistical Manual and the International Classification of Diseases book.  The consequence, he argues, is that many psychiatrists just mix and match diseases and symptoms instead of diagnosing what's really wrong. 

Dr Walker concluded: "The precise science of diagnosis has given way to the imprecise and inaccurate pseudo-science of labelling..." As the former Guardian health correspondent Dr Donald Gould (1985), referring to psychiatrists, concluded: "The good can be very, very good, even though the poor are horrid."

SOURCES

Coleman A M (1993) 'Facts, Fallacies and Frauds in Psychology' Routledge.

Day, Michael, (2004) 'Wrong Diagnoses are Killing Patients' New Scientist 18 February

Field, L. H. (1998) letter to the Independent newspaper, March 20. 

Gould, D (1985) 'The Medical Mafia' Sphere Books.

Storr A (1989 ) 'Churchill's Black Dog and Other Phenomena of the Human Mind' Collins.

Srabanek, P and McCormick J (1989) 'Follies and Fallacies in Medicine' Tarragon Press.

Walker, S (1998) 'A Dose of Sanity' John Wiley.