Editing Anti-psychiatry (section)

=== Psychiatric labeling ===
[[File:Cartoon by Emil Kraepelin.jpg|thumb|300px|right|"{{lang|de|Psychiater Europas! Wahret Eure heiligsten Diagnosen!}}" ("Psychiatrists of Europe! Protect your sanctified diagnoses!"), says the inscription on the cartoon by [[Emil Kraepelin]], who introduced the schizophrenia concept, "{{lang|de|Bierzeitung|italics=no}}", Heidelberg, 1896]]
Mental disorders were first included in the sixth revision of the [[International Classification of Diseases]] (ICD-6) in 1949.<ref name=Katsching>{{cite journal|last=Katsching |first=Heinz |title=Are psychiatrists an endangered species? Observations on internal and external challenges to the profession |journal=[[World Psychiatry (journal)|World Psychiatry]] |date=February 2010 |volume=9 |issue=1 |pages=21–28 |pmc=2816922 |pmid=20148149 |doi=10.1002/j.2051-5545.2010.tb00257.x }}</ref> Three years later, the American Psychiatric Association created its own classification system, DSM-I.<ref name=Katsching /> The definitions of most [[psychiatric assessment|psychiatric diagnoses]] consist of combinations of phenomenological criteria, such as symptoms and signs and their course over time.<ref name=Katsching /> Expert committees combined them in variable ways into categories of mental disorders, defined and redefined them again and again over the last half century.<ref name=Katsching />

The majority of these diagnostic categories are called ''disorders'' and are not validated by biological criteria, as most medical diseases are; although they purport to represent medical diseases and take the form of medical diagnoses.<ref name=Katsching /> These diagnostic categories are actually embedded in top-down classifications, similar to the early botanic classifications of plants in the 17th and 18th centuries, when experts decided a priori about which classification criterion to use, for instance, whether the shape of leaves or fruiting bodies were the main criterion for classifying plants.<ref name=Katsching /> Since the era of Kraepelin, psychiatrists have been trying to differentiate mental disorders by using clinical interviews.<ref name="Kato"/>

====Experiments admitting "healthy" individuals into psychiatric care====
In 1972, psychologist [[David Rosenhan]] published the [[Rosenhan experiment]], a study questioning the validity of psychiatric diagnoses.<ref name=Rosenhan>{{cite journal|author=Rosenhan D |year=1973 |title=On being sane in insane places |journal=Science |volume=179 |issue=4070 |pages=250–258 |doi=10.1126/science.179.4070.250 |pmid=4683124 |bibcode=1973Sci...179..250R |s2cid=146772269 }} {{link note|note=URL given leads to abstract of study}}</ref> The study arranged for eight individuals with no history of psychopathology to attempt admission into psychiatric hospitals. The individuals included a graduate student, psychologists, an artist, a housewife, and two physicians, including one psychiatrist. All eight individuals were admitted with a diagnosis of schizophrenia or bipolar disorder. Psychiatrists then attempted to treat the individuals using psychiatric medication. All eight were discharged within 7 to 52 days. In a [[Rosenhan experiment#Non-existent impostor experiment|later part of the study]], psychiatric staff were warned that pseudo-patients might be sent to their institutions, but none were actually sent. Nevertheless, a total of 83 patients out of 193 were believed by at least one staff member to be actors. The study concluded that individuals without mental disorders were indistinguishable from those with mental disorders.<ref name=Rosenhan />

Critics such as [[Robert Spitzer (psychiatrist)|Robert Spitzer]] cast doubt on the validity and credibility of the study, but did concede that the consistency of psychiatric diagnoses needed improvement.<ref name=Spitzer2005>{{cite journal|author=Spitzer R.L. |author2=Lilienfeld S.O. |author3=Miller M.B. |year=2005 |title=Rosenhan revisited: The scientific credibility of Lauren Slater's pseudopatient diagnosis study |journal=Journal of Nervous and Mental Disease |volume=193 |issue=11 |pages=734–739 |pmid=16260927 |doi=10.1097/01.nmd.0000185992.16053.5c |s2cid=3152822 }}</ref> The challenge of the validity versus the reliability of diagnostic categories continues to plague diagnostic systems. Neuroscientist Tadafumi Kato advocates for a new classification of diseases based on the neurobiological features of each mental disorder.<ref name=Kato /> while Austrian psychiatrist Heinz Katsching advises psychiatrists to replace the term "mental illness" by "brain illness."<ref name=Katsching />

There are recognized problems regarding the diagnostic reliability and validity of mainstream psychiatric diagnoses, both in ideal and controlled circumstances<ref>{{cite journal|last1=Williams |first1=J.B. |title=The structured clinical interview for DSM-III-R (SCID) II: Multi-site test-retest reliability |journal=Archives of General Psychiatry |volume=49 |pages=630–36 |year=1992 |pmid=1637253 |issue=8 |doi=10.1001/archpsyc.1992.01820080038006|first2=M|last3=First |first3=MB|last4=Spitzer |first4=RL|last5=Davies |first5=M|last6=Borus |first6=J|last7=Howes |first7=MJ|last8=Kane |first8=J|last9=Pope Jr |first9=HG|last10=Rounsaville |first10=B|last2=Gibbon }}</ref> and even more so in routine clinical practice (McGorry ''et al.''. 1995).<ref>{{cite journal|title=Spurious precision: procedural validity of diagnostic assessment in psychotic disorders |first1=PD |last1=McGorry |first2=C |last2=Mihalopoulos |first3=L |last3=Henry |first4=J |last4=Dakis |first5=HJ |last5=Jackson |first6=M |last6=Flaum |first7=S |last7=Harrigan |first8=D |last8=McKenzie |first9=J |last9=Kulkarni |first10=R |last10=Karoly |display-authors=9 |year=1995 |journal=Am J Psychiatry |volume=152 |pages=220–223 |issue=2 |pmid=7840355 |doi=10.1176/ajp.152.2.220|citeseerx=10.1.1.469.3360 }}</ref> Criteria in the principal diagnostic manuals, the DSM and [[International Classification of Diseases|ICD]], are not consistent between the two manuals.<ref>{{cite journal|last1=van Os |first1=J. |title=A comparison of the utility of dimensional and categorical representations of psychosis |journal=Psychological Medicine |volume=29 |pages=595–606 |year=1999 |pmid=10405080 |issue=3 |doi=10.1017/S0033291798008162|first2=C.|last3=Bale |first3=R.|last4=Van Horn |first4=E.|last5=Tattan |first5=T.|last6=White |first6=I.|last7=Murray |first7=R.|last2=Gilvarry |s2cid=38854519 }}</ref> Some psychiatrists in critiquing diagnostic criteria point out that [[comorbidity]], when an individual meets criteria for two or more disorders, is the rule rather than the exception, casting doubt on the distinctness of the categories, with overlap and vaguely defined or changeable boundaries between what are asserted to be distinct disorders.<ref>{{cite web|url=http://www.rossinst.com/trauma.htm |title=The Ross Institute – Trauma |publisher=The Colin A. Ross Institute for Psychological Trauma |url-status=dead |archive-url=https://web.archive.org/web/20080706115955/http://www.rossinst.com/trauma.htm |archive-date=July 6, 2008 }}</ref>

Other concerns raised include using standard diagnostic criteria in different countries, cultures, genders or ethnic groups. Critics contend that Westernized, white, male-dominated psychiatric practices and diagnoses disadvantage and misunderstand those from other groups. For example, several studies have shown that [[African Americans]] are more often diagnosed with schizophrenia than white people,<ref>{{cite journal|title=The influence of racial factors on psychiatric diagnosis: a review and suggestions for research|journal=Community Mental Health Journal|year=1989|volume=25|issue=4|pages=301–311|doi=10.1007/BF00755677|pmid=2697490|last1=Neighbors |first1=HW |last2=Jackson |first2=JS |last3=Campbell |first3=L |last4=Williams |first4=D|citeseerx=10.1.1.547.8240|hdl = 2027.42/44303|s2cid=11079394}}</ref> and men more than women. Some within the anti-psychiatry movement are critical of the use of diagnosis at all as it conforms with the [[biomedical model]], seen as illegitimate.