Depression
No TL;DR found
Abstract
ences in the frequency with which the major diag nostic categories figure among U.K. and U.S. mental hospital admissions. A good initial hypothesis was that the discrepancies were due to differences in diagnostic habits on the two sides of the Atlantic, and the results show that this is indeed practically the whole story. Such differences as still remain, after the axe of diag nostic reliability has been truly swung, are likely to reflect differences in the availability of psychiatric facilities, admission policies, the existence of a National Health Service here, and the like. The reliability of psychiatric diagnosis has become a fashionable topic over the past decade, perhaps because its importance has at last become widely appreciated, and possibly because the hunting down of sources of variation between psychiatrists is intrinsically a fascinating exercise for other psychi atrists. The earlier studies in the field—curiously described in the introduction as †̃¿ pessimistic'—showed that under minimally structured conditions diagnostic agreement was generally rather low. Later investiga tions indicate that with a highly organized team reliability could be made much higher. It is likely that with enough training psychiatrists can be brought to agree completely on anything, and at a time when demonological theories were in vogue they would doubtless have succeeded in agreeing on just which devils were responsible for their patient's plight. The point is of course that reliability is an issue of limited importance. It is a crucial consideration at the present stage of psychiatry, since it is essential for us to achieve a common language. But the task for the future is that ofdiagnostic validity. It is relatively more important to know whether one's diagnosis is right or wrong than what company one keeps. This point, among so many others, is lucidly brought out by the authors. The presentation is commendably straightforward and almost chatty at times. (There is a universal tendency for the learned monograph to approximate to the popular paper back.) The details will appeal to those who enjoy the statistical equivalent of playing with trains, though some may regret that it was not possible to use a