The Illusion of Objectivity

Diagnosis is defined as “the process of determining which disease or condition explains a person's symptoms and signs,” but this process differs significantly between physical and mental health. In physical medicine, a patient may present with a fever, cough, and runny nose, and a physician is able to order tests to quickly reach a diagnosis. By comparison, mental health diagnosis is guided by the Diagnostic and Statistical Manual of Mental Disorders (DSM). Although the DSM provides a structured framework for diagnosis, mental health diagnosis relies less on objective testing and more on patient self-report, symptom interpretation, and clinical judgment. These factors demonstrate that psychiatric diagnosis is not fully objective and is shaped by how mental health conditions are identified and classified.

Research Questions

To what extent is mental health diagnosis based on objective criteria versus clinical interpretation?
How does the DSM influence consistency and variability in psychiatric diagnosis?
How do cultural and historical changes shape definitions of mental illness?
What role do clinician judgement and prior diagnostic labels play in misdiagnosis?

Methods

This is a literary research project that used textual analysis of scholarly sources, including:

DSM editions (DSM-III, DSM-IV, and DSM-V)
Clinical Case Study: Is There No Place on Earth for Me
Memoir The Collected Schizophrenias
Scholarly critiques of psychiatric classification systems
- "The DSM-5: Classification and criteria changes"
- "DSM-5: An Overview of Changes and Controversies"
- Framing Disease: Studies in Cultural History

These sourses were compared to identify patterns in diagnostic variability, interpretive judgement, and cultural influence on psychiatric classification.

Findings and Discussion

DSM Standardization vs. Clinical Variability

Although the DSM provides structured diagnostic criteria, clinicians still interpret symptoms subjectively. This leads to variation in diagnosis even when patients present similar symptoms.

Case Study Evidence of Diagnostic Inconsistency

Sylvia Frumkin's multiple shifting diagnoses (schizophrenia subtypes, manic depressive disorder) demonstrate how identical symptoms can be categorized differently depending on clinican judgement and DSM edition.

Misdiagnosis and Evolving Labels

Esmé Wang's experience shows how long-term diagnoses can persist even when inaccurate. Her case highlights how prior labels influence future clinical judgement sometimes delaying correct diagnosis.

DSM Revision and Cultural Influence

Changes between DSM editions demonstrate that psychiatric categories are not fixed. Cultural context also influences what is considered a disorder, such as historical changes in classification of homosexuality and culturall specific symptoms like taijin kyofusho.

Mental Illness as a Social Construct

Scholars such as Rosenberg argue that definitions of mental illnesses are shaped by cultural norms and historical context, reinforcing the idea that diagnosis is not purely biological but socially constructed.

Conclusions and Future Study

In conclusion, while mental health diagnosis may seem objective in its presentation, it is not. The DSM creates a framework that psychiatrists use to develop consistency. However, psychiatrists’ interpretation of the DSM criteria differs. This variability depends on the subjectivity of the symptoms presented, cultural influences on both patient and clinician, and clinical judgment. Additionally, the DSM is an evolving document, meaning that diagnostic categories and labels are not fixed across time. These diagnostic labels extend beyond classification, as they change the diagnostic process for a patient. These labels shape how patients are perceived and how future clinicians interpret their behavior, especially when a patient has an existing diagnostic label. As a result, psychiatric diagnosis cannot be considered fully objective in the same way as many physical health diagnoses. Instead, it reflects a structured but interpretive process shaped by how mental health conditions are identified, classified, and understood. Recognizing the interpretive nature of the DSM does not mean it should not be used; rather, it emphasizes a more humble, patient-centered approach to psychiatric care.

Acknowledgements

I would like to thank my faculty mentor, Cynthia Klestinec, who allowed me to conduct this research as part of her class. She helped me along the way with this research and was a crucial part in its development.

I would also like to thank the authors of the works that I cited.

References

Regier, Darrel A et al. “The DSM-5: Classification and criteria changes.” World Psychiatry : Official Journal of the World Psychiatric Association (WPA), vol. 12, no. 2, 2013, pp. 92-98. doi:10.1002/wps.20050.

Rosenberg, Charles E. Framing Disease: Studies in Cultural History. Rutgers University Press, 1992.

Sheehan, Susan. Is There No Place on Earth for Me?. Random House, 1982.

Wakefield, Jerome C. “DSM-5: An Overview of Changes and Controversies.” Clinical Social Work Journal, vol. 41, 2013, pp. 139-154. https://doi.org/10.1007/s10615-013-0445-2.

Wang, Esmé Weijun. The Collected Schizophrenias. Graywolf Press, 2019.

NACE Career Readiness Competencies

This project demonstrates the following competencies:

Critical Thinking & Problem Solving - Analyzing conflicting diagnostic frameworks and evaluating DSM reliability
Communication - Synthesizing complex psychiatric and sociological research into a structured argument
Professionalism - Engaging with scholarly sources and maintaining academic tone
Equity & Inclusion - Examining cultural influences on diagnosis and mental health interpretation

The following is the presentation presented at the 2026 Undergraduate Research Forum

URF Project

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