The goal of diagnosis is to decide on a treatment that should help people to improve a patient's quality of life. However, because the validity and reliability of diagnosis are questionable, this leads to some ethical concerns. If the diagnosis is not valid, then the treatment will not be successful.  This could either expose individuals to unnecessary drugs or expensive therapy sessions, without any hope of improvement.  This also means that the actual problem is not addressed, potentially prolonging the suffering of the patient. 

Another ethical concern is the question of labelling and stigmatization. Langer & Abelson (1974) carried out an experiment to see how a diagnosis would influence a person’s perception. Psychiatrists watched a video of a younger man talking to an older man with the sound removed. Half the therapists were told that the younger man was a patient; the other half, that he was a job applicant.

After viewing the video, participants responded to a series of questions about the interviewee. If the viewers were told that he was a job applicant, he was described as attractive and confident; if they were told that he was a patient, he was described as defensive, aggressive and/or frightened. The results clearly indicate that stereotypes may interfere in the diagnosis and lead to a wrong diagnosis. However, this was not a real situation where the participants interacted with a real person. It is difficult to know if this is how the psychiatrists would diagnosis an actual patient. But the study does demonstrate that the label of being a “patient” lead to a more negative assessment by the psychiatrist. 

However, there is research that indicates that diagnosis does not necessarily lead to a feeling of social isolation or stigmatization. Gove & Fain (1973) carried out extensive interviews with 429 former mental health patients. The vast majority stated that diagnosis had led to an improvement in their social relationships. They had positive evaluations of their hospital experiences and they felt that they were better able to deal with their problems. It appears that diagnosis had a positive effect on the patients. A small minority of the former patients (19) reported exclusively negative outcomes. However, there is no way to tell whether these negative outcomes were the result of diagnostic labels.

A limitation of Gove & Fain’s study is that all of the participants were “former” mental health patients. The participants were asked to recall feelings and experiences that occurred many years ago.  It is impossible to validate the accuracy of their memories.  However, the fact that they felt that the diagnosis was a positive step is an important finding which challenges labelling theory.

Doherty (1975) studied 43 psychiatric in-patients to see the effect of labelling on their recovery. Patients who accepted that they were mentally ill were rated as showing the least improvement. Those who consistently denied that they were mentally ill did slightly better, and the patients who began by accepting that they were mentally ill but then rejected the label showed the greatest gains. However, in a study by Warner et al (1989), they found that it was not the label that made the difference – it was the amount of mastery that the patient had over his or her own life. There may be a link between accepting one’s label and a feeling of self-control, but they were unable to exactly replicate the findings of Doherty’s study.

Although there are concerns about labelling and stereotyping which may result from diagnosis, research shows that in many cases the patient actually finds a sense of satisfaction in the diagnosis – believing that this is the first step toward feeling better. 

Another ethical consideration is the question about who is supposed to receive information about a patient’s diagnosis.  Diagnoses should be confidential unless there is a concern that the individual may be a danger to himself or to others.

Another ethical consideration is informed consent. In several of the studies described in this chapter, patients how have been diagnosed with a disorder are used as participants to test the reliability of diagnosis.  It is important that researchers not objectify patients in order to study them – whether it be in an experiment or in a longer case study.

One of the key ethical considerations that an approving board would need to make is whether the research is justified.  Many of the studies in this chapter have led to a greater understanding of diagnosis and have led to the improvement of diagnosis and patient care.  For example, Rosenhan’s study led to better admissions procedures and follow up care in mental hospitals – and studies on culture and gender have led to greater awareness by psychiatrists that should decrease the misdiagnosis of individuals because of their culture, gender or class.  

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