This blog has stemmed from an article I came across online from ‘The psychologist’ which critically analyses the film ‘The Woman In Black’. For anyone who hasn’t seen this film the basic plot can be found here. Green (2012) has analysed the behaviour of Arthur Kipps and tried relating this to the context of the film and Kipp’s situation, and has come to the conclusion that he has a case of psychosis. However, is this really a correct diagnosis? It could be suggested that the figure Kipps sees is just a delusion, one of the criteria set by the DSM to diagnose psychosis (p. 332), however as Kipps sees the woman before he hears the horror stories from the villagers is it more likely to actually be reality? When this is combined with the deaths of the children in the village, and previous encounters by others with the figure then how can it all be in his head? To me there appears to be too many linked variables for it just to be coincidence and for him to be diagnosed with psychosis. Also, does this superstition regarding the woman in black mean that all of the villagers should be diagnosed aswell, and that any form of belief about an unexplained event or being can be described as a case of psychosis?
So is too much psychological research regarding mental health disorders resulting in over diagnosis, and how does publicly available information impact on diagnosis?
According to the World Health Organisation (2003) mental health disorders make up for 12-15% of disabilities in the world, which is twice as many as cancer. But is it really possible to distinguish between over diagnosis and the potential reality of prevalence of disorders within society? Zimmerman et al. (2008) used 700 patients with psychological disorders and compared their previous diagnoses of BiPolar disorder with diagnosis using the current criteria. He found that less than half of the patients who had been diagnosed in the past would be diagnosed using the latest version of the DSM, suggesting that diagnoses are very inconsistent.
It has also been suggested that there are too many conditions that people could be diagnosed with, therefore the amount of ‘normal’ people is rapidly decreasing (Mayo Clinic, 2011). For example, there has recently been a disorder identified as the premenstrual dysmorphic disorder, where the symptoms are pretty much the same as what most woman have when approaching menstruation, such as tension and mood swings, so is this really a disorder or is it just a natural state?
Over diagnosis also results in overtreatment, which can have damaging side effects on people. Enhanced technology increases the likelihood that an abnormality will be identified when someone is examined (Hall, 2011), however the majority of these abnormalities will have no impact on the individual’s health so is it worth the diagnosis? It has been found that many forms of cancer and similar disorders actually reduce in size without treatment, therefore a diagnosis does not help the situation. It has also been suggested that the anxiety and increased amount of tests needed on an individual can impact on their health and may result in more damaging consequences than not knowing. On many occasions a certain diagnosis can be found in so many people that it could be considered normal, so where is the distinction between over diagnosis and reality?
So do the public benefit from information that is made available to them? The NHS have created self-help guides for certain disorders that an individual can use to modify their own behaviour, see here. These leaflets include information regarding the effects of the behaviour, criteria for diagnosis, ways to measure your own behaviour and identify a problem and ways to then modify this behaviour. Reports suggest that these help people understand their feelings more and realise that often something that may appear abnormal is actually normal. These guides have also been recommended by GPs to their patients. Publicly available information can also help reduce the stigma associated with certain mental health issues so that people who really do require help are not scared to get some, as only 9% of individuals who require counselling or therapy for common mental health issues actually receive any (Royal College of Psychiatrists).
As you can see from the information presented above over diagnosis is a big issue within the field of psychology and can have negative impacts on individuals. Making research about mental health issues available to the public may help reduce the amount of misdiagnoses and may encourage people to tackle their own problems without needing an official diagnosis.