The diagnostic process

It used to be argued that a diagnosis of schizophrenia in itself caused disability and morbidity due to social 'labelling' and stigmatization. Evidence that this accounts for schizophrenic disability is lacking but the reality of the stigma of mental illness and negative attitudes towards 'schizophrenics' cannot be denied. Hence, making a diagnosis of schizophrenia should not be taken lightly. In the author's experience, very few psychiatrists spontaneously convey the diagnosis to the patient. If a patient asks whether he or she has schizophrenia, the clinician should first try to understand the motivation behind the question and the patient's knowledge and understanding of the term. Ultimately there is seldom justification in withholding the diagnosis if it is established. A schizophrenic diagnosis can be framed in a relatively positive light—this is a condition which we are now beginning to understand and for which there are effective treatments—and may lessen the burden of responsibility and blame that the patient and his or her family may carry for the disorder.

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