Clinical Diagnosis and Assessment 77
pathological, and thus be more likely to diagnose a psychological disorder. So,
for instance, the clinician might view a Caribbean immigrant family’s closeness as
“overinvolvment” rather than as normal for that culture.
Other groups, such as low-income Mexican Americans, may have their mentalillnesses under–diagnosed (only a percentage of cases are diagnosed) (Schmaling &
Hernandez, 2005). Part of the explanation for the under-diagnosis may be that
the constellation of symptoms experienced by some Mexican Americans does not
fi t within the classifi cation system currently used in North America; another part
of the explanation may be language differences between patient and clinician that
make accurate assessment diffi cult (Kaplan, 2007; Villaseñor & Waitzkin, 1999).
Diagnosis as a Stigmatizing Label
When someone has a psychological disorder, the diagnosis may be seen as a stig-
matizing label that influences how other people—including the mental health
clinician—view and treat the person. It may even change how a diagnosed person
behaves and feels about himself or herself (Eriksen & Kress, 2005). Such labels can
lead some people with a psychological disorder to blame themselves and try to hide
their problems (Corrigan & Watson, 2001; Wahl, 1999). Feelings of shame may
even lead them to refrain from obtaining treatment (U.S. Department of Health and
Human Services, 1999).
Great strides have been made toward destigmatizing mental illness,although there is still a way to go. In 2006, actor Tom Cruise said about
actor Brooke Shield’s postpartum depression, “When you talk about post-
partum, you can take people today, women, and what you do is you use
vitamins. There is a hormonal thing that is going on, scientifi cally, you
can prove that. But when you talk about emotional, chemical imbalances
in people, there is no science behind that” (Grove, 2005). However, to
the contrary, clinicians and researchers do in fact have scientifi c evidence
that chemical imbalances can be involved in a psychological disorder.
And, fortunately, many people challenged Cruise’s statements by provid-
ing facts, leading to greater awareness of postpartum depression. One
organization devoted to confronting the stigma of mental illness is the
National Alliance for the Mentally Ill (nami.org), which has a network of
advocates—called StigmaBusters—who combat incorrect and insensitive
portrayals of mental illness in the media.
Reliability and Validity in
Classifi cation Systems
Classifi cation systems are most useful when they are reliable and valid. If a classifi ca-
tion system yields consistent results over time, it is reliable. To understand what con-
stitutes a reliable classifi cation system, imagine the following scenario about Rose
Mary Walls: Suppose she decided to see a mental health clinician because she was
sleeping a lot, crying every day, and losing weight. Further, she consented to have her
interview with the clinician fi lmed for other clinicians to watch. Would every clini-
cian who watched the videoclip hear Rose Mary’s words and see her behavior in the
same way? Would every clinician diagnose her as having the same disorder? If so,
then the classifi cation system they used would be deemed reliable. But suppose that
various clinicians came up with different diagnoses or were divided about whether
Rose Mary even had a disorder. They might make different judgments about how
her behaviors or symptoms fi t into the classifi cation system. That is, they might in-
terpret the same behaviors and characteristics differently. For instance, some clini-
cians might interpret Rose Mary’s experiences and behaviors as appropriate to the
situation—as understandable given the regular disruptions to her social and family
life. If there were signifi cant differences of opinion about her diagnosis among the
clinicians, the classifi cation system they used probably is not reliable.
The National Alliance for the Mentally Ill
protested the airing of a television show, Crumbs,
and its portrayal of the lead character, Mother
Crumb, who was hospitalized with a “nervous
breakdown.” When her mental illness led to
violent behavior, audience laughter followed.
The show both trivialized mental illness and
reinforced stereotypes of the mentally ill.Gale Adler/© ABC/Courtesy: Everett CollectionReliable
Classifi cation systems (or measures) that
consistently produce the same results.