This essay deals with the diagnosis of schizophrenia. It explains the challenges faced by patients who are diagnosed with schizophrenia against their own will. It will base its argument on the views of Thomas S Szasz on mental illness diagnosis and treatment. The essay starts by explaining the symptoms and patterns that the physicians observe in diagnosis. The main disorders in the essay are schizophrenia, schizophrenic form disorder, schizoaffective disorder and delusional disorder. It tackles the problems that these patients face by considering cases of patients who have undergone diagnosis against their will. It also explains the management and treatment processes that these patients usually have to undergo. It also outlines different observations from those around the patients and the psychiatrists who diagnosed them.
According to official psychiatry, Schizophrenia is a psychiatric disorder that changes an individual’s thoughts, perceptions and behaviour. The experiences and symptoms of those who develop schizophrenia differ and each one exhibits unique symptom combinations. Their circumstances influence the pattern of the experiences. Some textbooks say that the initial symptoms include some breakdown in the functioning of the person. As the disorder develops, the patients experience difficulties in their daily life. These difficulties according to official psychiatry include amnesia, social withdrawal, concentration problems, unusual behaviour, poor personal hygiene, bizarre ideas, disturbed communication, perceptual experiences and low motivation and interest in daily activities. The person feels a change in the world but those around them have different views. The relatives and friends state the person has changed. This also affects the person’s ability to work, relate with others or study.
Prognosis and Symptoms
The disorder is fully evident in the second and third stages. In the second stage, the symptoms vary from delusions, hallucinations and disturbances in behaviour such as distress and agitation. In this stage, the patient may seek some treatment since the disorder has effects on daily life. In some of the patients, these symptoms disappear or diminish after some time. However, there follows a third stage which always lasts for many years. During this period, the patient experiences relapses which require professional interventions (Wykes 2001). A small percentage (14-20%) of individuals recovers fully after the second stage. Others improve but have recurrences which include social adversity, stress and isolation. The difficulties in the long term occur in episodes rather than continuously. Some patients recover spontaneously due to their individual traits like resilience.
Many professionals in the healthcare field and psychiatrists have considered schizophrenia as a disorder that is intractable and severe. They observe that it is a state of mental disorder that occurs throughout the life of the patient. However, this is not necessarily true. Although the patients have relapses which occur after a long period such as twenty years, interventions in the early stages can help the individual retain normalcy in life. This according to the medical model is by the use of psychological and social interventions together with antipsychotic medication. The people involved manage to live in the society if they have the relevant help and support from those around them. The causes of schizophrenia vary from social and economic factors. The deprivation of social and economic satisfaction not only affects recovery but also is a major cause of schizophrenia (Yagcioglu 2005).
The diagnosis of schizophrenia affects the individual both socially and personally in terms of economic life the individual leads. Due to numerous variations in symptoms and outcomes, it is always a difficult task to diagnose an individual as suffering from schizophrenia. This variation is as a result of cultural, social, biological, psychological and economic factors. After establishment of proper systems to guide in diagnosis of mental illnesses such as Diagnostic and Statistical Manual of Mental Disorders (DSM) by the American Psychiatric Association, the process of diagnosis is easier. Less and less variations in diagnosis happen. The differences now occur in the determination of whether the diagnosis represents a single disorder.
For complete diagnosis, the psychiatrists observe certain symptoms that should be prevalent for at least one month. These are reduced social functioning, effective blunting, alogia, reduction in ability to experience pleasure, reduced motivation and poor self-care, thought disorder evident by speech that is incomprehensible, delusions such as telepathy and paranoia and auditory hallucinations (Yang 1998). The psychiatrist must also observe a number of symptoms that have been present but unclear for at least six months. There have always been uncertainties in the diagnosis since the only way to observe all these symptoms is through voluntary declaration and explanation. Many health experts in matters of mental disorders show reluctance in giving diagnosis of schizophrenia which makes it hard for the patients and their relatives to get help in time.
According to official psychiatry, mental illnesses and disorders are not diseases in general terms. They are observations only seen in the behaviour of an individual. At times some people have difficulty in obtaining a diagnosis form a psychiatrist. This includes the patients being told that there is no access to service without having a formal diagnosis. Several psychiatrists support this observation that they do not feel that schizophrenia is an illness that require treatment. When an individual exhibits these symptoms, it is the duty of the psychiatrist to explain to the individual. The psychiatrist must also explain the problems that the individual will face after the diagnosis. These will include stigma and compulsory treatment for the individual. The individual will appear to the society as a full psychotic who should be in mental hospitals. This is mostly facilitated by the individual having some unwarranted images in the media . This is also a major hindrance to personal development since it becomes difficult to secure good jobs after the diagnosis. Recent patients who suffer from schizophrenia show no signs of violence in spite of the famous misconceptions. However, patients who recover have reported that they feel stigmatized especially by the legislation on mental health which makes them have a sense of exclusion. The medication has severe side effects which further contribute to the singling out of patients with schizophrenia (Davy and Ince 1999). The individual’s friends and relatives take the initiative to seek psychiatric help after they admit that it is difficult for the patients to get better. This is also another reason for diagnosis without the consent of the patients (Thomas 2000, Yang et al 1998, Young et al 1998, Wykes 2001).
Due to the above reasons, the individuals fear that the diagnosis will ruin their lives. Therefore, they do not disclose mental distress fully to the physicians. Therefore, the physicians need to test to the limit the state of mind of the patient. This is because they might diagnose the individuals wrongly with schizophrenia, if they just make assumptions about the patient’s state of mind thus ruining their lives. They fear that the individuals might pay a heavy price with the social stigma involved especially if their friends and relatives are not supportive. The individuals who receive diagnosis also object to a compulsory treatment and simply state that they can handle their behavioural difficulties. For this reason, the patients do not receive treatment in time and leading to further development of the distress. They live with frequent frightening and painful experiences without the diagnosis.
Most patients do not accept diagnosis with schizophrenia. Most people argue that they are subjected to poor physical health without the interventions of health experts. This is regardless of them not causing any harm to the community. The people in the community often come forward and present their cases to the relevant experts. The prevalence of the distress in this case is so serious that it poses a danger to the individual and those around. This is the main reason why the patients receive diagnosis and compulsory treatment against their will.
The mental health act in the UK says that when one is detained in a hospital, there should be appropriate treatment that is available in the hospital and also to the patients. The people who are responsible to make any enactment o the mental health legislation includes the doctor, a mental health profession that is approved, the nearest relative and the responsible clinician. According to the mental status of the patient, some people are allowed t o discharge the patients. These include the hospital managers, the mental health tribunal, a responsible clinician and the nearest relative. However, according to the mental health act in the UK, the responsible Clinician can stop the nearest relative from discharging the patient.
Thomas Szasz explains clearly that the determination whether a mental illness patient will receive treatment does not rely on the patient but rather on the diagnosis of the psychiatrist. After diagnosis, the patient is at times free to live in the society and work, vote and marry just like any other citizen unless he or she commits a crime (Yang 1998). However, the condition of the patient should be clear to those around him or her so that the patient will receive the necessary support from them and not being stigmatized. The problem arises when the perception of the society to those diagnosed with schizophrenia is such that they are psychotic and should be in mental hospitals. Therefore, the individuals face rejections from the society which feels that the patients endanger peaceful social coexistence.
The denial by the individuals who receive diagnosis against their will further aggravates the situation. They feel that the society is against them and have a negative attitude towards those who try to help them. The physical status of the individuals deteriorates due to social alienation (Young et al, 1999). The individuals end up smoking and use of other drugs. Smoking is common to those who suffer from schizophrenia. The poor health leads to higher mortality rates of the individuals. These individuals are also not ready to move on with their lives since they feel that those who regard them as suffering from the disorders are themselves sick. (Young et al, 1999)
Research shows that the individuals who receive diagnosis without their consent end up succumbing to conditions in their endocrine and circulatory systems. The process and criteria for any detention that is not voluntary is being reviewed by some researchers who see it as a risk to the patients. The patient may be at risk of harming themselves. This is because it is slight difficult to make any prediction when the patient is likely to harm themselves. They are also at high risks of cardiovascular diseases since they end up developing other complications such as hypertension. At time the drugs that are used on them might end up having side effects to the patient. Most of the times, people with mental disorders faces discrimination and social isolation that leads to depression. This shows that there is need for any patient to have consent on the type of treatment that he or she is receiving. This is however according to the mental health act of 1983 that stated that if one is of 18 plus years and have a mental capacity, one can refuse the kind of treatment that they are given. The patients that are never given any consent when receiving a treatment may have a lower self esteem thinking that their mental orders are in extremely bad form. Other individuals with good state of mind may feel the same about the individuals making their lives miserable. These patients also face the general problems that other schizophrenia patients face with or without consent of diagnosis. They face lifestyle factors since they are incapable of effective physical health management (Young 1999). They also face socioeconomic problems in their day to day lives. These include social exclusion and stigma. They are not favoured in job applications and other economic activities. This is a great hindrance to their personal development. The fact psychiatrists generally handles their treatment also explains the deterioration in their physical conditions. This is because the psychiatrists generally concentrate on their treatment on the psychological perspective of the patient. Therefore, they are slow to notice and treat physical conditions such as endocrine and cardiovascular ailments.
The issue of consent in diagnosis of schizophrenia is also very important in the diagnosis. This is because the individuals who suffer from schizophrenia often experience distress. This brings about agitation, fear, anger or suspicion.
Schizophrenia is a common mental disorder probably the most common in all the cases of mental disorders in mental health institutions. Many professionals in the healthcare field and psychiatrists have considered schizophrenia as a disorder that is intractable and severe .The consent of the individual suffering from schizophrenia is the first step to ensuring effective management and treatment. People should be educated about the disease and the available forms of treatment so as to help the mental disorder patients. In these cases, the essay has explained in detail the problems that the patients and the doctors face.