The Real Purpose of Formal Classification Systems of Mental Disorders is to preserve the Status Quo
Introduction
A classification system provides a common language with which mental health professionals can discuss similar patients, regardless of their own geographical location. Furthermore, it also allows the natural history of a given disorder in order to be studied. Classification can also be considered as crucial and vital for the process of administrative as well as legal documentation for the purpose of research and development (Lundbeck Institute n.d., p. 2).
The current classification system is the result of the different observation regarding the mental depression during the past. Thus the evolution of the formal classification system is considered as a phenomenon during the 20th century. The main goal of the classification system is to ensure improved communication between the clinicians. In addition to that, it also helps to enhance the understanding regarding the different disorders in question as well as to promote more effective treatment (Licinio & Wong 2005, p. 2).
Classification is considered as a significant and controversial matter in the field of behavioral science. A thorough and systematic application of the taxometric analysis to the hundreds of mental disorders are now being recognized in the formal classification system like the Diagnostic and Statistical Manual of Mental Disorders or DSM or the International Classification of Disease might suggest altering the said systems in considerable and unforeseen ways (Ruscio &Haslam 2006, p. 22).
Classification aims to catalogue the different kinds of entities that are presumed to exist in a given particular domain, that reflect the ways where in the said entities are understood in order to vary and interrelate (Ruscio & Haslam 2006, p. 22).
This paper will focus on two disorders in connection to two theories and different research evidence against each other.
Differences between Schizophrenia and Depression
Schizophrenia is considered as a psychotic disorder to group of different psychotic disorders that causes the patient to lose his or her touch with the reality. It can be observed with severely impaired reasoning, together with the instability that will cause violent behavior. People with the said disorder are often unable to make sense of the different signals that they are receiving the world around them. Thus it causes them to imagine different objects and events that are entire different from the reality (Gale Group 2001). On the other hand, depression is an illness that involves the feeling of sadness that lasts for two weeks or even longer. It is often accompanied with the loss of the interests in life, hopelessness and even decreased energy. Thus it can affect the entire performance of the patient in everyday life (The Arab American News 2005). The said definition shows that schizophrenia has a high level connection with the psychological aspect while depression focuses on the emotion and daily living activities.
Furthermore, it can be considered that both of the mental disorder can affect people despite of their age, race, sex and even social class together with the education as well as ethnic background. Most of the patients are being diagnosed during their late teens or even early twenties, but the said two mental disorders can appear at any time in the life of a person (Gale Group 2001).
On the other hand, it is important to consider that while schizophrenia is more visible to men, women are more prone to depression.
Both of the mental healths are considered as serious health problem in the world due to the growing number of cases. Schizophrenia affects millions of people in the world. There is about 1% of the entire population of the world that is suffering from the said mental health. Furthermore, people who are diagnosed with the said mental disorder make up abut half of al the patients in the psychiatric hospitals and may occupy as many as one quarter of the hospital beds in the world (Gale Group 2001). On the other hand, unlike schizophrenia, depression is often undiagnosed and untreated. It occurs in as much as 15% of older adults and often called as the common cold of mental illness that affects more or less 18.8 million Americans, or 9.5% of the total population. It is considered as even larger concern for older adults. According to the National Institute of Mental Health, depression is a widespread and serious public health concern. It is considered as the most common mental illness among persons over the age of 60 (Beverly 2001).
DSM-IV and Psychodynamic Approach to Schizophrenia
The fourth edition of DSM or DSM-IV is a reference work that is used and consulted by psychiatrists, psychologies, physicians in clinical practice, social workers, medical and nursing students, pastoral counsellors and other professional in the field of the health care and social service fields (Frey 2003). It offers different classifications of mental disorders as well as different criterias that are set in oder to guide the entire process of differential diagnosis and numerical codes for each disorder to facilitate the medical record (Frey 2003). It had listed the different characteristics and symptoms of schizophrenia such as: delusions; hallucinations; disorganized speech such as frequent derailment or incoherence; grossly disorganized or catatonic behavior; and negative symptoms such as affective flattening, alogia or avolition. It requires generally that two of more of the said symptoms must be present for an essential portion of time during a month (Csernansky 2002, p. 12). However, the DSM-IV-TR acknowledges that its present classification of subtypes is not fully satisfactory for either clinical or research purposes, thus alternative subtyping schemes are being actively investigated (Frey 2008). Furthermore, DSM-IV also defined five important subtype of schizophrenia, namely: Paranoid type, that shows the presence of auditory hallucinations or delusion; disorganized type that shows disorganized speech, disorganized behavior and flat or inappropriate effect; catatonic type, which focuses on the disturbances of movement that can vary from remaining motionless for a long period of time or even excessive or purposeless movement; undifferentiated type, that do not meet the full criteria for paranoid, disorganized or catatonic subtypes; and residual type that shows at least one psychotic episode, continue to have some of the negative symptoms, but do not have current psychotic symptoms (Morrison & Anders 1999, p. 294). This is the answer regarding the earlier beliefs that schizophrenia is a group of diseases, rather than a single disease, and that the brain characteristics are associated with some of the subtype (cited in Farmer & Pandurangi 1997, p. 109).
However, often treatment programs are designed with the assumption that all the people who are suffering from the said mental disorder experience the same illness. The current literature does not fully evaluate the differences among people with schizophrenia. It is very important to consider that research helps to identify different factors that determine differential responses and how they are related to the medication response, relapse proneness and course of illness (Farmer & Pandurangi 1997, p. 110).
Furthermore, DSM-IV also explains that causes of schizophrenia are unknown and it cannot be cured, but it can be treated. Predictors for good treatment outcomes are normal adjustment before the onset of the disease and little or no family history of schizophrenia, confusion, paranoia, depression, or catatonic behavior. There are also different predictors of poor outcome like earlier age of onset, a family history of illness, withdrawal, apathy as well as prior history of a thought disorder. There are different theories that explain the development of the said mental disorder such as genetic factors, psychological as well as social factors (PsychNet-UK 2003). With connection to that, Alanen & Leinonen (1997), strongly believe that schizophrenia is not just an organic disorder with no relation to psychosocial environment factors. This is due to the fact that interactional relationships with other people are considered as part of the human biology and it plays an important role in the development of the psychosocial development of human as well as the underlying cerebral functions (p. 45).
DSM-IV and Behavioral Approach to Depression
Depression is considered as common mental health problem in later life, there are at least one in ten people aged 65 or more have significant symptoms of depression like sadness, loss of energy and difficulties in sleeping (Manthorpe & Iliffe 2005, p. 7). However, it is important to take note that although the said mental disorder is common in older people, it is not consider as normal part of aging (Birrer & Sathya 2004). This is due to the fact that despite the perception that old age can bring unhappiness, research suggests that the majority of seniors feel satisfied with their lives. In the study of the University of California in San Diego, which asked 500 respondents ages 60 – 98 to rate on a scale of 1 to 10 to show how successfully they though they had aged, the result shows that the average rating was 8.4. The presumption during the past that depression is inevitable at the said stage of life is due to the losses and different social disruptions that are being faced by many older people such as death of loved once and physical disabilities (Mind, Mood & Memory 2007).
The DSM-IV gives 9 different criteria for depression such as: depressed mood, sleep disturbance, lack of interest or pleasure in activities, guild and feelings of worthlessness, lack of energy, loss of concentration and difficulty making decision, anorexia or weight loss, psychomotor agitation or retardation, and suicidal ideation. The presence of at least five of the said criteria, that occurs every day during the same two-week period, or even a score of more than 10 on the Beck Depression Inventory or 10 more on the Geriatric Depression Scale supports the diagnosis of depression in elderly patients (Birrer & Sathya 2004). However, there are other studies that show that the development period for depression in older adults may be much longer, even years. The study of Berger & Small (1998) shows that people over the age of 75 who demonstrate depressive symptoms such as appetite disturbance, psychomotor disturbances, and dysphoria at baseline, are more apt or prone to be diagnosed with depression after 3 years. In addition, these patients also showed more severe baseline symptoms than their non-depressed counterparts. The study shows that major depression has more persistent nature in very old age (Beverly 2001).
Schizophrenia and Depression
Schizophrenia and depression are somewhat and somehow connected with each other. Depression is frequently occurring symptom in Schizophrenia, and both are important category of mental disorder that must be considered in order to further study the remaining mystery regarding the human mentality, that can affect the overall productivity of each and every individual.
One of the main differences between the two disorders focuses on the causes. While different studies regarding schizophrenia focus on the biological implications, studies about depression focuses on the impact of the environment or the social factors.
Causes
Schizophrenia can be associated with certain brain characteristics. Brain areas implicated in this illness are the frontal lobe, temporal lobes, limbic system, and the basal ganglia. However, there is probably not one single area of the brain that is connected with the illness. This is due to the fact that interconnections among brain parts play the greatest role in the development of symptoms. Different psychodynamic researches shows that in some of people that are suffering from the said mental disorder, the lateral and third ventricles are enlarged and the temporal lobes are reduced in size (Farmer & Pandurangi 1997, p. 109). In addition to that, the study of Robin Sherrington of the University of London, England and his colleagues shows that schizophrenia in seven Icelandic and English families is associated with inheriting a specific region of chromosome 5, that indicates the presence of a gene that influence the occurrence of the disorder (Bower 1988). That is the reason why characteristics features of schizophrenia focuses on different mental aspects such as hallucinations and delusions, disorder of thought and speech, disorder of behavior, disturbance of emotions and effect, cognitive deficits and avolition. Hallucinations and delusions are frequently observed at some time during the course of schizophrenia. Visual hallucinations occur in 15%, auditory in 50% and tactile in 5% of subjects, and delusions in more than 90% (Maj & Sartorius 2002, p. 3).
On the other hand, depression is different from Schizophrenia due to the fact that depression is primarily connected with the different environmental and social aspect such as self-esteem, body image, peer relations, parental rearing behavior, socioeconomic status, conduct problems, attention regulation problems and pubertal status (Macphee 2006, p. 435).
Violence
According to the U.S. Department of Health & Human Services’ National Institutes of Health, some people with schizophrenia who become violent may do so for reasons that are unrelated to their current illness. The study of Clinical Antipsychotic Trials for Intervention Effectiveness or CATIE in 2007 shows that most of the people with schizophrenia are not violent, but the likelihood of violence is higher among people with the said mental disorder but also with the history of other disorders such as childhood conduct problems. The study shows that the overall percentage of participants who committed acts of violence was 19%. Those respondents with the history of childhood conduct problems reported violence twice as frequently or 28%, as those without the said problems or 14%. In addition to that the result shows that violence is also affected by other environmental and social issues such as unemployment o underemployment, living with family or restrictive setting or have been recently arrested or involved with the police. In addition to that, violence was associated with alcohol and substance abuse in both group, but unlike the group without childhood conduct problems, violence in the group with the childhood conduct problems was associated even with the levels of alcohol and substance use (US Fed News Service 2007).
On the other hand, different studies regarding the relationship of violence and depression shows that those people who are exposed to violence, more specifically at home are more likely to be depressed or hopeless than those who are not. According to the research that is based on a questionnaire filled out almost 200 adolescents that was randomly selected by computer from patients at a primary health care clinic at the John Hopkins Children’s Center, 70% of those teenagers reported having watched a beating, 50% a stabbing and 44% a shooting, and almost 1 out of 5 or 18% had seen someone get killed. The study shows that adolescents who reported being threatened by violent crime in their neighborhoods had above average rates of depression and hopelessness, but the prevalence of depression and hopelessness was even higher among those who had witnessed violence in their own home (Colburn 1994).
Medication
The process of medication is also different for the two diseases, this is due to the fact that there are studies that shows that Schizophrenia is related to other mental and physical disorders that are commonly related with brain, primarily inherited, while depression is just acquired due to the different impact of the environment as well as different issues that are related to the social life.
On the other hand, both of the disorders are in great needs for medical as well as other emotional support in order to improve the mental conditions of the patients.
In terms of depression, there are different therapies that are being recommended to the patients. One of this is the psychologic therapies that will cater to the vulnerability to adverse effects and high rates of medical problems as well as medication use. Stressful life events, family conflicts, and the reduction or absence of social support likely will not be affected by medication and other somatic treatment approaches, but patients with the said problems are responsive to psychologic intervention. It includes different cognitive-behavior therapy, supportive psychotherapy, problem-solving therapy and other interpersonal therapy (Birrer & Sathya 2004). By doing the said treatment, the patient will be able to come up with the different aspects or factors that had made them feel or cause their depression.
On the other hand, the medication process of schizophrenia focuses on the different antipsychotic drugs. This is due to the fact that schizophrenic patients are showing symptoms like hallucinations and delusions. The AP drugs can help to reduce and even eliminate the two important symptoms in about 70%. The entire phase of the medication process of schizophrenia focuses on the different medications that could help to maintain the normal mental behavior and condition of the patient, rather than taking up different therapies that will help the patient to know his or her condition. This is due to the fact that the medication process of schizophrenia focuses on the brain structure of the patient that is greatly affecting the entire system of the patient.
Conclusion
Schizophrenia and depression are two of the most important issues in the field of mental health, this is due to the fact that it is affecting different people from different part of the globe, and continuous studies are being held in order to know the roots and the reasons behind the mental disorders.
The two mental disorders are different in terms of causes and medication, this is due to the fact that the two mental disorders have different path of studies. Different studies regarding schizophrenia focuses on the impact of genes and other hereditary factors that are connected with the family and other related aspects, while depression focuses on the different environmental and social aspects that can affect the feelings and emotions of the people.
It is also important to consider that both of the mental disorders are hard to distinguish from other mental disorders due to the different symptoms and causes. And because of that, both of them are associated or connected with other emotional, physical and mental disorders. The two mental disorders are also being interconnected, due to the fact that there are different symptoms of depression that can be experienced by the patients who are suffering from s Schizophrenia.
On the other hand, different formal classification systems of mental disorder such as DSM-IV are important because it is the one that set the standard, in order to maintain the consistency of findings of different mental organizations and professionals. Its main role is to maintain the current state of the studies regarding the mental health, particularly in terms of Schizophrenia and depression. This is due to the fact that there are different studies that are pertaining on the different aspects of the mental disorder, and it can affect the relationship and communication of the global mental health. And it can only be changed when one knowledge or facts regarding the different mental disorders had been strongly defined or proven something that could help to improve the current knowledge and understanding regarding the field of mental health.
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