Ethics of Diagnosis and Classification in Psychiatry

  • Juan José López-Ibor
  • Maria-Inès López-Ibor
  • Hanfried Helmchen
Chapter
Part of the International Library of Ethics, Law, and the New Medicine book series (LIME, volume 45)

Abstract

The ethical obligation of the psychiatrist includes acting in the best interest of the patient, doing no harm, and observing justice, i.e. acting with regard to the limited resources of the community. The psychiatrist can perform this best if he is sensitive on the one hand to the consequences of his determination that an illness value is a disorder, i.e. if he considers not only the medical but also the psychic and social consequences of his diagnosis, and, on the other hand, if he has the diagnostic competence not only to apply the standardised diagnostic algorithms for assessing the illness of the patient but also for the patient’s personal experience of ill being. Furthermore, the moral valuation of our language (and of our scientific instruments expressed in language) should be recognized and its influence should be reflected in the diagnostic assessment of a disorder; it should be considered particularly in assessing the individuality of the patient as a sick person and should be used in dealing with him and optimizing his treatment.

Keywords

Chronic Fatigue Syndrome Psychiatric Diagnosis Moral Evaluation Moral Valuation Psychiatric Classification 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

DRG

Diasgnosis Related Groups

DSM-IV

Diagnostic and Statistic Manual (of Mental Disorders), 4th Revision (American Psychiatric Association)

ICD

International Classification of Diseases (World Health Organisation)

References

  1. Baker R (1997) Transkulturelle Medizinethik und Menschenrechte. In: Tröhler U, Reiter-Theil S (eds) Ethik und Medizin 1947–1997. Wallstein, Göttingen, pp 433–459Google Scholar
  2. Finzen A (2000) Psychose und Stigma. Psychiatrie Verlag, Bonn, zit. n. Fritze J et al (2005) Entwurf des Antidiskriminierungsgesetzes. Nervenarzt 76(5):653Google Scholar
  3. First MB (2005) Keeping an eye on clinical utility. World Psychiatry 4:87–88Google Scholar
  4. Fulford KWM, Broome M, Stanghellini G, Thornton T (2005) Looking with both eyes open: fact and value in psychiatric diagnosis. World Psychiatry 4:78–86Google Scholar
  5. Gethmann CF, Gerok W, Helmchen H, Henke KD, Mittelstraß J, Schmidt-Assmann E, Stock G, Taupitz J, Thiele F (2004) Gesundheit nach Maß? Eine transdisziplinäre Studie zu den Grundlagen eines dauerhaften Gesundheitssystems. Akademie, Berlin, S 345Google Scholar
  6. Häfner H (1997) Was tun mit Krankheiten, die keine sind? Munch Med Wochenschr 139:158–160Google Scholar
  7. Helmchen H (1978/1981) Functions and consequences of psychiatric diagnoses. In: Agassi, J(ed) Psychiatric diagnoses. Proceedings of an International Interdisciplinary Interschool Symposium, Bielefeld University 1978. Balaban International Science Services, Philadelphia, PA 1981, pp 99–105Google Scholar
  8. Helmchen H (1983) Multiaxial classification in psychiatry. Compr Psychiatry 24:20–24CrossRefGoogle Scholar
  9. Helmchen H (1994) Relevanz der Diagnostik in der psychiatrischen Therapie. In: Dilling H, Schulte-Markwort E, Freyberger H (eds) Von der ICD-9 zur ICD-10. Neue Ansätze der Diagnostik psychischer Störungen in der Psychiatrie, Psychosomatik und Kinder- und Jugendpsychiatrie. Huber, Bern, pp 89–100Google Scholar
  10. Helmchen H (2001) Unterschwellige psychische Störungen. Nervenarzt 72:181–189CrossRefGoogle Scholar
  11. Helmchen H (2003) Krankheitsbegriff und Anspruch auf medizinische Leistungen. Nervenarzt 74:395–397CrossRefGoogle Scholar
  12. Helmchen H (2006) Ökonomische Determinanten ärztlichen Handelns. In: Schneider F (Hrsg) Entwicklungen der Psychiatrie. Springer, Berlin, Heidelberg, New York, NY, pp S93–S105CrossRefGoogle Scholar
  13. Helmchen H, Lauter H (2001) Diagnostic problems in geriatric psychiatry. In: Henn FA, Sartorius N, Helmchen H, Lauter H (eds) Contemporary psychiatry, vol 2. Psychiatry in special situations. Springer, Berlin, Heidelberg, New York, NY, pp 117–127Google Scholar
  14. Kendell RE (1975) The role of diagnosis in psychiatry. Blackwell, OxfordGoogle Scholar
  15. King C (2005) Coloring our eyes. World Psychiatry 4:95Google Scholar
  16. Kisker KP (1979) Antipsychiatrie. In: Kisker KP, Meyer JE, Müller C, Strömgren E (Hrsg) Psychiatrie der Gegenwart, 2. Aufl., Bd. I/1 Grundlagen und Methoden der Psychiatrie. Springer, Heidelberg, pp 811–825CrossRefGoogle Scholar
  17. Laing RD (1960) The divided self. Tavistock, LondonGoogle Scholar
  18. Lee S (1998) Estranged bodies, simulated harmony, and misplaced cultures: neurasthenia in contemporary chinese society. Psychosom Med 60:448–457Google Scholar
  19. Lin K, Cheung F, Zheng Y, Weiss M, Nakasaki G, Ren Y (1996) A cross cultural study of neurasthenia and CFS in LA. Tenth World Congress of Psychiatry, Madrid, 23–28 August, p 184Google Scholar
  20. Lopez-Ibor JJ Jr (2003) Cultural adaptations of current psychiatric classifications: are they the solution? Psychopathology 36(3):114–119CrossRefGoogle Scholar
  21. Sadler JZ (2005) Bug-eyed and breathless: emerging crises involving values. World Psychiatry 4:87Google Scholar
  22. Sartorius N (2005) Recognizing that values matter. World Psychiatry 4:90Google Scholar
  23. Scheff TJ (1966) Being mentally ill: a sociological theory. Aldine, Chicago, ILGoogle Scholar
  24. Szasz TS (1960) The myth of mental illness. Am Psychol 15:113–118CrossRefGoogle Scholar
  25. Wakefield JC (2005) On winking at the facts, and losing one’s Hare: value pluralism and the harmful dysfunction analysis. World Psychiatry 4:88–89Google Scholar
  26. Wakefield JC, Pottick KJ, Kirk SA (2002) Should the DSM-IV diagnostic criteria for conduct disorder consider social context? Am J Psychiatry 159:380–386CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Juan José López-Ibor
    • 1
    • 2
  • Maria-Inès López-Ibor
    • 2
    • 3
  • Hanfried Helmchen
    • 4
  1. 1.Institute of Psychiatry and Mental Health, San Carlos Hospital, Complutense UniversityMadridSpain
  2. 2.CIBERSAM (Spanish Network for Research on Mental Health)Complutense UniversityMadridSpain
  3. 3.Department of Psychiatry and Medical PsychologyComplutense UniversityMadridSpain
  4. 4.Department of Psychiatry and Psychotherapy, CBFCharitè – University Medicine BerlinBerlinGermany

Personalised recommendations