The diagnosis of a mental illness naturally has the most impact at the level of an individual. In each progressively larger tier of social organization (e.g., families, networks of friends, subcultures, communities, societies), the impacts of mental health concerns become more pronounced and palpable. Common mental health concerns have names which have permeated modern medical and therapeutic cultures – regardless of any given culture’s recognition or observance of the existence of a given diagnosis. Symptoms of mental illness can be easily translated for both medical and common usages across languages and cultures, yet the underlying meaning of any given groupings of symptoms can also differ substantially among professionals who share common languages or cultures. As a result, even in the scope of ethical and science-based medical and therapeutic practices, error due to subjective forces are an ever-present concern.
The pathologizing of everyday life (an example of overdiagnosis), the minimization of mental health complaints (an example of underdiagnosis), and the continued proliferation of traditional forms of misdiagnosis that grow out of subjective factors are commonplace. Occupational burnout, for example, has the potential to prove to be a massively underdiagnosed mental health condition when the true total number of laborers in the agricultural, manufacturing, and industrial sectors are globally considered. The misdiagnosis of this single recognized condition can serve to satisfy the supposition that misdiagnosis may constitute a silent global epidemic of humanitarian concern.
Agreed-upon psychological or psychiatric diagnoses, nonetheless, reach far beyond occupational burnout, differing substantially between cultures and individual mental health professionals. The reported circumstances of clients or patients and the agreed-upon diagnostic criteria that mental health professionals use to form diagnoses are also rooted in subjectivity.
Different cultures and languages might share recognition and diagnostic criteria for any given agreed-upon diagnosis, yet within the enclaves of what could be termed a ‘diagnostic creed,’ diagnoses can be affected by the biases found in a therapeutic subculture’s collective outlook and training. Some professionals do not follow evidence-based treatments, others follow the bleeding-edge of evidence-based scientific medicine, while still others might not recognize the existence or etiology of something so widely accepted as depression or anxiety. Among agreed-upon diagnostic criteria and the nuances of how the symptoms are accepted or interpreted, variances will permeate the means of triage and diagnostics until the element of subjectivity is remedied. In a perfect world, diagnostic scans and laboratory tests would link arrays of symptoms associated with various disorders, acting as the sources of clean data that are necessary for accurate medical assessments.
At present, subjectivity plays a pervasive roll in the identification and treatment of mental health concerns. The process of defining whether a client or patient qualifies as suffering from something like severe depression, for example, can sometimes seem like a matter of opinion. The subjectivity of a client or patient’s communication and behavioral presentation, if hypothetically self-reporting symptoms that align with severe depression, still rely upon the judgements of diagnosing professionals. The frequency, veracity and overall severity of any mental health complaints must permeate the subjective human filters of client or patient, any triage professionals, and any diagnosing medical or mental health professionals. Even small nuances and mistakes in the diagnostic process can grow to create larger problems, negatively affecting clients or patients in the process.
The social networks of client or patient can impact diagnostic processes in this manner as well. When clinicians speak to family or friends about the symptoms and concerns of an individual, a single misrepresented symptom might seem arbitrary at first, but could skew the accuracy of a diagnosis.
Similarly, the rise of telehealth’s prominence can act as a filter that obscures the diagnostic process. In cases of telehealth therapy, key aspects of non-verbal communication or rapport can be diminished. Telehealth may impede the kinds of therapeutic relationships necessary for successful talk therapy, counseling, and psychoanalysis. The complications imposed on traditionally in-person diagnostic processes, created by web connected digital devices, may serve to further obscure objectivity despite expanding access to evaluation and treatment.
Diagnostic criteria, the diagnostic process, and a formulated diagnosis each rely upon data. In addition to ‘diagnostic creeds,’ elements like the interpretation, record keeping, and analysis of a client or patient’s complaints can be further skewed by the experiences, biases, and cultural biases of a diagnosing mental health professional, among other possible influential factors. Biases of uncountable kinds (e.g., implicit biases, stigmas, stereotypes, personal opinions, theologies, social schemas, worldviews, et alia) are in some form present in all clinicians by default being human. The more objective the medical opinion, the more likely a mental health professional is to be able to save, heal, and otherwise improve a life. Increasing accuracy is a necessity to achieve favorable outcomes more frequently. Currently, modern medicine’s ability to recognize, diagnose, and treat mental illness, in comparison to other medical and therapeutic disciplines, is relatively low.
Cultural biases are perhaps the most complex and impactful kinds of biases that any human being possesses, affecting outlooks and schemas of all individuals – not just medical professionals. Japan acts as a fine example, as modern Japanese society largely does not acknowledge mental illness. Most collectivist cultures stigmatize the behaviors, thoughts, and feelings associated with mental health disorders, and often judging them as false, fated, or as personal failings. Some add a supernatural etiology, others observe these as causes for secrecy and shame. The still-suffering individual, the mental health professionals qualified to diagnose or treat an illness, and social groups or every order of magnitude feel the effects of such cultural schemas in some capacity. Generally, with notable exceptions like Argentina, there are a dearth of mental health professionals in collectivist cultures due to such long-standing cultural biases. Few individuals are brave enough to reach out for help to the few professionals progressive enough to provide treatments. Culturally-bound syndromes, interestingly, appear to erupt most frequently in these kinds of societies.
An awareness of implicit biases and cultural biases are essential ethical considerations for any mental health or medical professional, no matter their culture of origin or ‘diagnostic creed.’ Mitigating those biases is necessary to fulfil ethical duties and moral imperatives alike.
Stigma is a particularly common source of bias that can affect the triage and diagnostic processes. Though any ethical, objective mental health professional is most likely already aware of stigmas, they can unknowingly be perpetuated. Even in affluent and connected cultures, populated with mental health professionals who are more likely to advocate against stigma, bias remains alive and well. A Swiss study, conducted globally, showed that psychiatrists expressed less willingness to have social contact with individuals who suffered from any recognized or diagnosed mental health concern (Lauber et al., 2006). This was not a dance or a dinner party, merely ‘social contact.’ A study that canvased mental health professionals regarding people who have psychiatric diagnoses, using average citizens as a control group, determined that both surveyed groups expressed less desire to spend time in the company of people who were diagnosed with schizophrenia. Individuals across both groups expressed a greater willingness to spend time with people who were diagnosed with less severe mental illnesses, like depression, and with people who had no mental health diagnoses (Nordt et al., 2005). Similarly, a Brazilian study showed psychiatrists have greater prejudices against individuals who may suffer from schizophrenia in comparison to the quotidian prejudices held toward other groupings of people (Loch et al., 2013).
An article by Wulf Rössler examines the stigma of mental illnesses across cultures, concluding the most pragmatic route to achieve reductions or ameliorations of such pervasive stigmas is simply to encourage community interactions between those who suffer from mental health concerns and the rest of a community (Rössler, 2016). Rössler’s work is a modern illustration of the kinds of philosophic and anthropologic conclusions that can create progress against these longstanding qualms that exist within humanity. Firmly established by Michel Foucault in “Madness and Civilization,” the ostracization or alienation of marginalized groups, including those deemed mentally ill, is a historical problem that has found no easy cure (Foucault, 1988). Foucault relays the historical shifts in how mental illness was defined, touching on the presence of homelessness, ‘vagrancy,’ non-generativity, and the false etiologies of mental illnesses as some of the individual and systemic ‘sicknesses’ that clearly exist within a lens of causal histories. Rössler’s article focuses on modern manifestations of stigma and mental illness, yet stigma can occur independently of a correct diagnosis. Rössler’s practical solution can only be effective when powered by empathy and applied continuously, regardless of cause or source.
Diagnostic opinions of the severities of mental illnesses can vary as widely. Psychosis is often considered to be one of the more severe symptoms or diagnoses, affecting cognition, mood, sense of agency, and overall quality of life. Among medical experts, the recognition of the various forms of psychosis or schizophrenias may eventually prove to be several different disorders that have erroneously been grouped together under an umbrella term. Stigma surrounding individuals affected by such states seems to be deeply entrenched across many societies, impacting treatment and recovery. The misdiagnosis of these states is unfortunately quite common – even in the modern and connected world. Various arrays of the symptoms of psychosis can manifest through so many varying symptomologies, each requiring longitudinal observation and data gathering, for a conclusive diagnosis to be made. All such symptomologies can have different etiologies across individuals and within individual cases, complicating diagnostic efforts.
A misdiagnosis has dire consequences for any individual labeled or diagnosed as experiencing a psychosis or any variety of schizophrenia. A small 2019 study acts as a glimpse to what is speculated to be a much larger problem. Of 78 patients who were referred to an early intervention clinic for disorders approximated as psychosis, 43 were diagnosed within the schizophrenia spectrum. Of those 43 patients, comprising 55% of the sample, 22 received a primary diagnosis that was different from the original diagnosis. Further, 18 of those patients did not receive a primary diagnosis involving a psychotic disorder (Coulter et al., 2019). Individuals in similar in-patient circumstances, per standard practices of western medicine, can be prescribed or involuntarily administered powerful medications of anti-psychotic, mood stabilizing, and GABAergic classes of drugs during a hospitalization. This kind of pharmaceutical intervention would affect substantial numbers of patients who do not suffer from psychosis or schizophrenia.
The problem of misdiagnosis was widely sensationalized by the Rosenhan experiment which profoundly impacted many related professional fields (Rosenhan, 1973). The accuracy of the Rosenhan experiment was drawn into question via some clever investigative reporting in “The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness” (Cahalan, 2019). Regardless of the validity and veracity of the claims raised by the Rosenhan experiment, the problem of misdiagnosis seems to continuously reappear; bias and subjectivity remain so many decades later. This kind of study replicates easily; the major systemic concern of the diagnostic accuracy of mental illnesses has itself not found a cure. Numerous longitudinal studies parallel and highlight the misdiagnosis of disorders like psychosis, as observed by Coulter et al. Another example is found with bipolar disorder. Various bipolar disorder diagnoses are common for individuals who suffer mental illnesses ranging from OCD, ADHD, severe irritability, psychosis, or substance use, among other mental illnesses (PsychCentral, 2022). Most of these disorders are not even formally grouped within the same spectrum of ‘mood disorders.’
In western medicine, severe diagnostic disparities exist with groups of individuals that are clearly based on their ethnic heritage. Individuals of African-American heritage, in the USA, are inordinately misdiagnosed with bipolar disorder (Akinhanmi et al., 2018). Similar studies exist regarding minority groups and the diagnosis of psychoses, OCD, ADHD, dissociative disorders, trauma, etc.
Permutations of various psychoses, considering that a stimulant-induced psychosis is different from a psychedelic-induced psychosis, are often misdiagnosed and then mismanaged. Individuals can be diagnosed with a psychotic disorder, medicated unnecessarily or improperly, and experience psychiatric treatment plans that do not align with best practices due the fundamental misdiagnosis of what might otherwise be transient symptoms. When drug-induced psychosis is present, a comprehensive evidence-based rehabilitation is the correct treatment plan and protocol. Here, a common diagnostic mistake can intervene with the application of common sense – a reliance on pharmaceutical interventions can prevent recovery from substance use disorders or even act to prolong active addictions. After any physical withdrawals are managed, if present, focus should immediately shift to rehabilitative efforts with a primary goal of long-term recovery.
Despite the concerns and confusions which can surround the concept of medication assisted therapies as treatments for addictions, rehabilitation and long-term recoveries (of many concurrent years) can be free of long-term prescriptions. Drug replacement therapies and harm reduction pharmaceuticals, harnessed to provide a fix, blunt cravings, or nullify the potential of a high, can prevent relapse in the short term. Aftercare and follow up supports, especially social, socioeconomic, psychotherapeutic, and harm-reduction measures, seem to be far more valuable for long term recoveries for psychoses, drug-induced psychoses, and addictions.
In the USA, overall long term outcomes are less favorable for those who are medicated without comprehensive treatments over longer periods of time. Individuals can retain an ongoing diagnosis as a result. In the most favorable of long-term scenarios, patients are treated in a more complete manner and are then not prescribed drugs over many years or decades. Better lifetime outcomes are statistically observable in the the USA whenever patients are comprehensively treated instead of longitudinally drugged. Overmedicating a nebulously-diagnosed psychosis – treating some of the biology while neglecting the rest of the biopsychosocial model – can produce a long-term outcomes for patients in which they never grow well and are treated for a permanent disability despite not actually having a permanent disorder with an active psychosis. Some patients who might otherwise achieve recoveries can become trapped in a state of a perpetuated illness.
The more complete forms of treatment are costly for healthcare systems in terms of both time and money. Patients might find these to be inconvenient, unaffordable, or deny such commitments altogether, serving to perpetuate the commonplace proliferation of prescriptions. While prescribed drugs can and do manage symptoms, they are not usually not targeted treatments, generally affect all organ systems in some way, cause disabling side effects, and are almost never a cure. Ostensibly extending a patient’s active diagnosis, a failure to achieve a more complete implementation of best practices while favoring the convenience of pharmaceuticals can quickly create ethical an debate.
States of psychosis that result from substance abuse can become prolonged with habitual use over time. The neural networks of an individuals can become imprinted over those spans of time, the structures and functions of their neural networks experiencing those prolonged altered states at the cellular level. Anything learned while an individual is intoxicated, for example, is reinforced and colored by a pharmacologically altered nervous system that was responding to otherwise ‘normal’ allostatic loads. The same can be said of prescription drugs to similar and varying degrees. If someone abuses stimulants or spends years in poly-drug abuse, their thoughts, behaviors, and speech can be affected by additional factors (e.g., unhealthy/unsatisfying social relationships, malnutrition, a lack of cognitive stimulation, chronic sleep deprivation). The lifestyle will have altered their individual neurology just as much as the presence of psychoactive substances, altering their ability to experience reality normally – and to cope with it.
New diagnoses, like stimulant use disorder, hope to provide specialized treatments for individuals who were prone to psychosis-adjacent states that can result from stimulant abuse. Similarly, some synthetic opiods (e.g. the various fentanyl analogs and some of the novel mu-opiate receptor agonist test chemicals) produce a lasting psychosis and states that mimic traditional notions of delirium. Naturally-derived opiates, like morphine or semi-synthetics like hydrocodone, can produce such lasting aftereffects, yet this appears to be less common. A differential diagnosis should include these kinds of considerations, carefully refraining from defaulting to diagnosing a psychosis as schizophrenia when a synthetic opiod is to blame. The etiologies of each of these presentations of psychoses are blatantly different; an individual adapting to a life of sobriety has entered a time-consuming process that must be considered. The diagnostic criteria for currently-recognized psychotic disorders do suggest limitations of time, yet the discretion of diagnosing professionals and the biases created by the presence of such a diagnosis, on charts, can serve to allow a faulty diagnosis to be perpetuated to remain.
Early recovery from substance abuse disorders are an allostatic load of immense proportions; to interfere with this process (when not medically necessary) is to impede or prevent the recovery process from occurring. Relying on pharmaceutical interventions and easy diagnoses, once again, can be likened to placing an adhesive bandage on a gushing wound. This course of action would of course draw claims of malpractice in any scenario related to a physical injury, and similarly, transient states of psychosis must be acknowledged and treated appropriately. The approach of achieving an objective differential diagnosis should be the norm – as should be the presence of longitudinal data. Ethically, clinicians must approach these scenarios with an open mind to minimize subjectivity and increase diagnostic accuracies.
Dissociated states or catatonia are other examples of disorders that are often mistaken and misdiagnosed as psychoses and schizophrenias (Hall, 2022). These states can be characterized by severe social or sensory withdraw, disassociation, fugue states, psychogenic mutism, unresponsiveness, can mirror symptoms of trauma, et alia. The trouble with such a diagnosis is how severe autism, delirium, dementia, physical injury, infectious diseases, intoxicated states, or severe cases of cPTSD can each present in very similar ways. Differential diagnostic practices remind the professional community of the antiquated classification systems that hinge on subjective observation. Disassociations, tunnel vision, thousand-yard stare, fugue states, and somatic symptoms linked to the severe anxiety of dissociative states are examples of instinctual self-protection that can manifest across many recognized disorders. Triaging or diagnosing an unresponsive patient unfortunately allows for heuristics to contribute to misdiagnosis when an effective differential diagnosis is too stubborn to be gleaned and thus initially achieved.
A newer and more objective test for paranoid schizophrenia uses algorithms to analyze the speech patterns of individuals to help determine if this recognized variety of schizophrenia is present, showing the kinds of progress necessary in the quest against misdiagnosis (Nour et al., 2023). While not conclusive, and potentially prone to programmer error, subjective biases can be minimized by such tests. Currently, such tests are used only to provide supportive evidence for a diagnosis, yet these technologies will surely mature. Similarly objective, Cambridge University has created and verified a biomarker test that utilizes very small amounts of blood to better differentiate a diagnosis of bipolar disorder. Their biomarker test is most useful when used in combination with a relatively brief self-report inventory, filled out by a client or patient. The combination, despite the presence of the subjectivity in a well-designed and well-controlled self-report inventory, can be much faster and more accurate than traditional diagnostic methods (Tomasik et al., 2023). These cutting-edge technologies exist at the forefront of mental health diagnostics with more to come. Until then, diagnostic manuals and the professional experience of diagnosing clinicians remain vital to the field.
The Cluster A personality disorders found in the DSM-5 (Schizoid Personality Disorder, Schizotypal Personality Disorder, Paranoid Personality Disorder) are classified as ‘disorders’ of personality (American Psychiatric Association & American Psychiatric Association, 2013). Labeling these medical complaints as ‘disorders’ serves to categorize individual cases, secondarily or tertiarily increase stigma, and serves very little purpose aside from the therapies that might be suggested to those who have received such diagnoses. Though the semantics and weight of words is a tangential subject that considers how words impart meaning and impact, words very much matter. The origins of how these categories were originally conceived, like many others, is as interesting as it is problematic.
Featuring little sense of scale to gauge or rate how symptoms affect the daily lives of individuals, the categories and labels found in the DSM-5 can appear vague or overly conclusive. The DSM-5 is not a purely binary diagnostic system, though being diagnosed with a mental illness can seem like a binary gate. A DSM-5 diagnosis can appear as an ostensible tabulation. The system is inadvertently skewed by the suggestion of the inclusion of the discretion of trained clinicians: subjectivity. While the presence of a clinician’s discretion is meant to avoid misdiagnoses, it can ironically create them.
The prototypical personality types found in the DSM-5 and ICD-10 are examples of conditions that were formulated within a clinical setting (Swales, 2022). The origin of the ten archetypes of personality disorders grew from historical clinical spaces. Decades of observations and reinforcing science produced shifts in these definitions and theories, yet ultimately these archetypes originated from subjective clinical observations and conjecture. Many mental health conditions can be viewed as a modern clinical and medical manifestations of obscurantism. Despite having evolved into the modernized forms found in the DSM-5 and ICD-10, contemporary professional communities point out that hard science must be the point of origin for medical diagnoses. Reinventing the definitions and diagnostic systems for mental health complaints has the potential to align the relevant professions with the science-based evidence of modern medicine, minimize subjectivity and bias, and could contribute to an increase in access to mental health treatments, globally.
The adoption of a new diagnostic method can be viewed as a massive experiment. Created to assess personality disorders, a relatively new measure of personality traits is a suitable example of how complex an inventory-creation process can be. The “Personality Inventory for the DSM-5 – Brief Form” (PID5BF + M) has confirmed some validity of competing personality disorder inventories through concurrent results (Riegel et al., 2021). While the primary use of the PID5BF + M is with the assessment of personality disorders, a secondary application of an accurate inventory can be found in validating other inventories which seek to measure similar traits. The intricate statistical analysis that validated the PID5BF + M can also act as bridge between aspects of the DSM-5, the ICD-10, and personality assessments that have yet to be conceived. The brief form of the PID5BF + M features the use of 36 items that were extracted from the 220 total items used in the “Personality Inventory for the DSM-5,” (PID-5). Some salient points of this study are some variabilities within the traits it recognizes. ‘Borderline traits,’ ‘negative affectivity,’ ‘disinhibition’ and ‘psychoticism’ are each mentioned as qualifiers for further pursuits in the borderline psychopathologies portion of the ICD-11’s personality disorder section. The brevity and accuracy of inventories like the PID5BF + M serve to evolve the understanding of mental health concerns while significantly reducing the confounding factors of subjectivity and cultural biases. The contributions to validating newer models also increases confidence regarding the validity of newer systems, like those of the ICD-11.
An even more recent study cross-references the ICD-11 with the DSM-5 Alternative Model of Personality Disorders (AMPD), affirming the validity of both older and current personality disorder criteria, strengthening the new approaches found in the ICD-11 (Pires et al., 2023). The AMPD diverged from the DSM-5 by utilizing the five-factor model of personality traits as the framework used for gauging psychopathologies of personality. Regarding the ICD-11’s new approach to classifying disorders of personality, efficacy, validity, and usefulness must be gauged due to the number of lives that will be affected by the increasing adoption of this paradigm shift. Fortunately, the study’s limitations fall exactly where they should. Notably, the AMPD retains the dimension termed psychoticism, while the ICD-11 model replaces psychoticism with anankastia. The ICD-11 controversially includes a very different perspective regarding theories of borderline personality disorder as a result.
The DSM-5 and ICD-10 (as well as their many precursors) contain diagnostic criteria for personality disorders which problematically overlap. Differentiating histrionic personality disorder from borderline personality disorder via the DSM-5’s cluster B criteria could seem like an exercise of opinion. Aspects like the intensities of interpersonal conflicts, the degrees of attention seeking behaviors, the frequency and severity of impulsive behaviors, or merely the addition of risk-taking behaviors like sexual promiscuity, gambling, or substance use, can complicate the diagnostic process for these separate conditions. The biases of mental health professionals could inadvertently blur the lines between one category and the next. Diagnostic methods with fewer overlapping criteria, higher degrees of objectivity, and the use of many spectra through which to gauge distinct concerns would increase diagnostic accuracy. New schemas and criteria seem necessary.
All personality disorders in the ICD-11 receive the overarching diagnosis of ‘Personality Disorder.’ Additional traits are then noted individually. The “Personality Inventory for the ICD-11” (PiCD) draws from the newer five-factor model, being more closely aligned with recognized psychopathologies (Whitbourne, 2022). The five domain traits utilized in the new framework are thought to be more useful in describing facets of personality which can exhibit disturbances. Those disturbances of personality are ‘negative affectivity,’ ‘detachment,’ ‘dissociality,’ ‘disinhibition,’ and ‘anankastia’ (Swales, 2022). The traits overlap well with the five-factor model, yet when tested, an exception to this alignment exists with anankastia. This is the same outlier the AMPD had encountered with its psychoticism domain.
Anankastia is suggested to include behaviors and thoughts which create feelings of security and self-perseveration (e.g., emotional/behavioral constraints, perfectionism, stubbornness, rigorous adherence to routines/rules, or focuses on various kinds of control). Anankatsia is thought to be connected to an individual’s need to adhere to their own ideals and are often described as compulsive in nature. It is important to reinforce how these kinds of cognitions and behaviors are thought to be manifestations of creating or feeling a sense control. For the purposes of diagnosis, the interrelationships of the other four domains of personality are used to distinguish between various recognized disturbances of personality. A recent study that sought to measure anankastia’s utility found that it was more applicable for practical purposes than psychoticism for the diagnosis of disturbances of personality (Strus et al., 2021). A diagnosis for the same hypothetical patient made with any of these diagnostic models will produce unique results. Despite progress in the field, a unified model of personality disturbances does not yet exist.
Per the ICD-11, the presence traits that can qualify as creating disturbances in a client or patient’s life must be enduring – fully present for at least two years. The traits must create a significant impact in their life, causing a self-dysfunction. Examples of self-dysfunction could include an inability to maintain a stable self-sense of identity, the presence of an exaggerated sense of self-worth (either inflated or impoverished), trouble with making decisions, having difficulties sustaining healthy relationships, or having problems understanding the perspectives and feelings of other people. Disturbances of intrapersonal and interpersonal function are the twin features that must be evidenced through reported experiences of emotions, behaviors, and cognitions. Through listing the types of disturbances, either internal or in dealing with the external world, clinicians hope be able to treat individuals who might not have found treatment through older frameworks of diagnosis. This line of thinking may create pathways to treatments for individual cases viewed as difficult to treat in therapeutic settings. The presence of a clinician denotes that misdiagnoses will still occur, despite this re-envisioning of a diagnostic framework via science.
The use of the word ‘disturbance’ as opposed to ‘disorder’ reflects a trend in communication in which the connotation of words is more carefully considered. Encouraging the diminishment of stigma and bias results from more than just exchanging one synonym for another, however. Biases, present in all human beings, do not have to be barriers to diagnosis, treatment, or recovery. The misdiagnoses common to mental health concerns are by no means a lost cause. Wellness for clients and patients, the individuals seeking betterment of life, is tenable through paradigm shifts that appear to be accelerating. The progress evidenced in science-derived diagnoses and the newer working models of mental health concerns are testaments to the impacts of psychology’s cognitive revolution, and, more broadly, of modern medicine and the current state of scientific progress.
While the need for cross-cultural awareness, ethics, and differential diagnosis remains important, novel scans and laboratory tests will facilitate fewer misdiagnoses through the elimination of the subjective elements that seem to underpin diagnostic errors. Curing the problem of misdiagnosis will propel economies, saving individuals and governments vast sums of resources, money, and time. Scientific inquest will improve and heal countless lives in the process. As originally intended when Hippocrates pondered the Hippocratic Oath or when Francis Bacon cried out for empiricism, the cascading effects of science-based medicine will eventually achieve fully objective medical diagnostics. This will be a historical improvement of a magnitude that parallels the formulation of germ theory, when reached, creating a world in which nearly all medical conditions are correctly diagnosed and treated.
References
Akinhanmi, M. O., Biernacka, J. M., Strakowski, S. M., McElroy, S. L., Balls Berry, J. E., Merikangas, K. R., Assari, S., McInnis, M. G., Schulze, T. G., LeBoyer, M., Tamminga, C., Patten, C., & Frye, M. A. (2018). Racial disparities in bipolar disorder treatment and research: a call to action. Bipolar Disorders, 20(6), 506–514. https://doi.org/10.1111/bdi.12638
American Psychiatric Association. (2023). DSM-5-TR Update: Supplement to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, September 2023 Text Revision.
American Psychiatric Association, & American Psychiatric Association (Eds.). (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed). American Psychiatric Association.
Cahalan, S. (2019). The great pretender: the undercover mission that changed our understanding of madness (First edition). Grand Central Publishing.
Coulter, C., Baker, K. K., & Margolis, R. L. (2019). Specialized Consultation for Suspected Recent-onset Schizophrenia: Diagnostic Clarity and the Distorting Impact of Anxiety and Reported Auditory Hallucinations. Journal of Psychiatric Practice®, 25(2), 76. https://doi.org/10.1097/PRA.0000000000000363
Foucault, M. (1988). Madness and civilization: a history of insanity in the age of reason (Vintage Books Ed., Nov. 1988). Random House.
Hall, H. (2022). Dissociation and misdiagnosis of schizophrenia in populations experiencing chronic discrimination and social defeat. Journal of Trauma & Dissociation, 1–15. https://doi.org/10.1080/15299732.2022.2120154
Lauber, C., Nordt, C., Braunschweig, C., & Rössler, W. (2006). Do mental health professionals stigmatize their patients? Acta Psychiatrica Scandinavica, 113(s429), 51–59. https://doi.org/10.1111/j.1600-0447.2005.00718.x
Loch, A. A., Hengartner, M. P., Guarniero, F. B., Lawson, F. L., Wang, Y.-P., Gattaz, W. F., & Rössler, W. (2013). The more information, the more negative stigma towards schizophrenia: Brazilian general population and psychiatrists compared. Psychiatry Research, 205(3), 185–191. https://doi.org/10.1016/j.psychres.2012.11.023
Nordt, C., Rossler, W., & Lauber, C. (2005). Attitudes of Mental Health Professionals Toward People With Schizophrenia and Major Depression. Schizophrenia Bulletin, 32(4), 709–714. https://doi.org/10.1093/schbul/sbj065
Nour, M. M., McNamee, D. C., Liu, Y., & Dolan, R. J. (2023). Trajectories through semantic spaces in schizophrenia and the relationship to ripple bursts. Proceedings of the National Academy of Sciences, 120(42), e2305290120. https://doi.org/10.1073/pnas.2305290120
Pires, R., Henriques-Calado, J., Sousa Ferreira, A., Gama Marques, J., Ribeiro Moreira, A., Barata, B. C., Paulino, M., & Gonçalves, B. (2023). Bridging the ICD11 and the DSM-5 personality disorders classification systems: The role of the PID5BF + M. Frontiers in Psychiatry, 14. https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1004895
PsychCentral. (2022, August 5). Misdiagnosis of Bipolar Disorder: Conditions and Reasoning. Psych Central. https://psychcentral.com/bipolar/misdiagnosed-bipolar
Riegel, K. D., Ksinan, A. J., & Schlosserova, L. (2021). Psychometric Properties of the Independent 36-Item PID5BF+M for ICD-11 in the Czech-Speaking Community Sample. Frontiers in Psychiatry, 12. https://www.frontiersin.org/articles/10.3389/fpsyt.2021.643270
Rosenhan, D. L. (1973). On Being Sane in Insane Places. Science, 179(4070), 250–258. https://doi.org/10.1126/science.179.4070.250
Rössler, W. (2016). The stigma of mental disorders. EMBO Reports, 17(9), 1250–1253. https://doi.org/10.15252/embr.201643041
Strus, W., Łakuta, P., & Cieciuch, J. (2021). Anankastia or Psychoticism? Which One Is Better Suited for the Fifth Trait in the Pathological Big Five: Insight From the Circumplex of Personality Metatraits Perspective. Frontiers in Psychiatry, 12. https://www.frontiersin.org/articles/10.3389/fpsyt.2021.648386
Swales, M. A. (2022). Personality Disorder Diagnoses in ICD-11: Transforming Conceptualisations and Practice. Clinical Psychology in Europe, 4(Spec Issue), e9635. https://doi.org/10.32872/cpe.9635
Tomasik, J., Harrison, S. J., Rustogi, N., Olmert, T., Barton-Owen, G., Han, S. Y. S., Cooper, J. D., Eljasz, P., Farrag, L. P., Friend, L. V., Bell, E., Cowell, D., & Bahn, S. (2023). Metabolomic Biomarker Signatures for Bipolar and Unipolar Depression. JAMA Psychiatry, e234096. https://doi.org/10.1001/jamapsychiatry.2023.4096
Whitbourne, S. K. (2022, June 21). What You Need to Know About the Trait of Anankastia | Psychology Today. https://www.psychologytoday.com/us/blog/fulfillment-any-age/202206/what-you-need-know-about-the-trait-anankastia
World Health Organization (Ed.). (1992). The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization.
Neogeneses 