A valid diagnosis leads to successful treatment of someone with mental illness. This can be life changing and lower a person’s distress.  However, when an invalid diagnosis is made, a patient may be exposed to treatment that is not helpful and may even harmful.  There are several ethical considerations that must be kept in mind when carrying out diagnosis – these include undue stress or harm and confidentiality. Psychiatrists must think about the ethical implications of their work in order to make sure that they protect their clients.

The introduction introduces the question of ethics in diagnosis and explains why the question is important.  There is also some indication of how the question will be addressed.

Psychiatrists have to be careful not to allow their own biases and stereotypes to affect diagnosis – potentially leading to a misdiagnosis.  Langer & Abelson carried out a study in which psychiatrists watched a video of a younger man talking to an older man. There was no sound. Half of the participants were told that the younger man was a psychiatric patient; half were told he was a job applicant. When participants were told he was a patient, they said he was aggressive and frightened.  When they were told he was a job applicant, they said he was confident. The psychiatrists allowed their own stereotypes to influence the diagnosis.  This could lead to drug treatments for a patient that could actually cause harm, as they are unnecessary. However, the study is problematic as this is not the way that a psychiatrist would carry out a diagnosis – so the study lacks ecological validity.  Also, the study may lack temporal validity.  The study was carried out in the 1970's. 

The first study addresses the importance of objectivity - and the ethical problems that result from a failure to diagnose appropriately.  The study is linked to the question and evaluated.

Some psychologists argue that diagnosis may lead to a self-fulfilling prophecy. This has been seen in some treatments where suggestions of repression leading to anxiety or depression have led to false memories of abuse, a breakdown in relationships with family members and a higher level of anxiety or depression.  Doherty also found that those patients that rejected their diagnosis and believed that they were healthy, improved from symptoms more quickly. However, in studies on how diagnosis may lead to a self-fulfilling prophecy, it not possible to isolate variables and know whether the person would have improved or developed symptoms as a result of not having the label.  The research is only correlational in nature and cannot establish cause and effect. In other words, we cannot know whether it was the diagnosis that led to the further development of a disorder. 

Labels may not only affect diagnosis, they may negatively influence a patient.  Knowing that one has a disorder is often thought to lower one’s quality of life, but Gove and Fain carried out a series of interviews with over 400 former mental health patients.  The majority of the participants said that their diagnosis had been helpful.  Although some reported negative effects such as poor relationships or discrimination, 90% said that their diagnosis had allowed them to better deal with their problems.

The study is appropriate counter-evidence for the argument that diagnosis with mental illness may lead to problems for the client.

This study has a few problems.  First, for those who said that diagnosis led to negative effects, it is not possible to know that the diagnosis was the direct cause of these negative effects. It is possible that their behaviours alone led to negative effects, regardless of the diagnosis.  But it is also difficult to draw conclusions about the positive effects of diagnosis.  As the sample was made up of former patients, it is clear that the diagnosis must have led to successful treatment.  Being asked how diagnosis affected them required them to remember back to how their life changed after diagnosis.  Such memories are open to distortion – and the positive results of diagnosis may have influenced those memories.  However, research has shown that many patients see the diagnosis as the first step in recovery.

The response has effectively evaluated the research by Gove and Fain.

Another ethical consideration is confidentiality.  When a person receives a diagnosis, it is important that this information only be shared with those that have a right to know.  In the case where a person may be a danger to himself or others, it may require that people besides the patient may need to be informed about the diagnosis.  In addition, in the case of minors who are diagnosed, parents would be informed about mental health concerns. Confidentiality is important for a few reasons.  First, it may have a negative effect on a person's employment or lead to stigma in a community.  Linked to this, if a person fears stigma because diagnosis will be somehow shared with others, it will make people less likely to seek out help for mental health problems. 

There are several ethical considerations in carrying out diagnosis.  It is important for psychiatrists to avoid bias; this can be done through good practice, using data triangulation or researcher triangulation – that is, having more than one person involved in the diagnostic process.  In addition, the diagnosis must be confidential – given only to the individual and, as necessary, family.  The question of the ethics of diagnosis continues to be debated. But the question may not be about whether to diagnose, but how psychiatrists provide support after a diagnosis in order to help people best cope with their disorder.

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The conclusion proposes some solutions and also areas of further inquiry.