Social/Personal Consequences
Once a diagnostic label is attached to a person, It becomes all too easy to accept that label to be an accurate description of that individual rather than his or her behaviour. It makes it difficult to look objectively at the said person's behaviour without preconceptions of how such an individual would act. There is a likelihood of it affecting the way we would interact with such a person. For example, how would you react to the news that your new next-door neighbour had been diagnosed as a paedophile? It would be surprising if this label has no influence on your perception and interaction with that individual, whether or not the label was accurate.
According to one famous study in 1973, eight normal individuals, including psychologist David Rosenhan, got themselves admitted to psychiatric hospitals of five different states by informing mental health workers of hearing strange voices. Not surprisingly, they are diagnosed with schizophrenia upon admission. However, after admission, they acted completely normal for the duration of their stay. Upon discharge, after intervals ranging from 7 to 52 days, they typically received the diagnosis of 'schizophernia, in remission'. This label means that even with the absence of deviant behaviour, the disorder was still presumed to be present, though not currently active. Once a label is attached (understandably, in this case, given the reports of hearing strange voices), diagnosis labels are not easily shed, even with the disordered behaviour no longer present.
Psychiatrist Thomas Szasz has long been an outspoken critic of psychiatric diagnosis. He argues that the concept of mental health is itself a myth; a poor analogy to physical illness. In contrast to physical illness diagnoses, there are no physical criteria for mental illness. According to Szasz, the deviance called mental illness by psychiatry are better viewed as "problems in living" rather than "inner disorders". According to his suggestion, society invented the concept of mental illness in order to make it easier to control or change people whose behaviour upsets or threatens the existing social order. Although many mental health experts disagree with Szasz's extreme argument, they readily acknowledge the arbitrary elements in judgments of deviance.
Diagnostic labels can also play a role in the creation and worsening of psychological disorders. When individuals are aware of a psychiatric label being applied to them, they may accept the new identity implied by the label and develop the expected role and outlook. Due to the psychiatric labels often carrying degrading and stigmatised implications, the effects on morale and self-esteem can have devastating effects. Moreover, a person may despair of ever-changing and therefore, give up trying to deal with life's circumstances that may be responsible for their problems. In this way, the expectations that accompany a label may result in a self-fulfilling prophecy in which expectations become reality. Many individuals with psychological problems do not seek treatment due to the stigma attached to mental illness.
Legal Consequences
Psychiatric diagnoses also have legal consequences. Individuals judged to be dangerous to themselves or others may be involuntarily committed to mental institutions under certain circumstances. When so committed, they lose some of their civil rights and could be detained indefinitely if there is no improvement in their behaviour.
The law tries to take into account the mental statuses of individuals who are accused of crimes. Two peculiar legal concepts are competency and insanity. Competency refers to a defendant's state of mind at the time of a judicial hearing (not at the time of which the crime was committed). A defendant judged to be too disturbed to understand the nature of the legal proceedings may be labelled as "not competent to stand trial" and will be institutionalised until judged competent.
Insanity relates to the presumed state of mind of the defendant at the time which the crime was committed. Defendants may be cleared "not guilty by reason of insanity" if he/she is judged to have been severely impaired during the commotion of a crime, in which they lacked the capacity to either identify the wrongfulness of their acts or the control of their conduct. It is important to understand that insanity is a legal term, not a psychological one.
Despite the fact of the Insanity Plea being entered in only 1 in 500 cases and that in 85 percent of cases, the prosecution agrees that person is insane, the plea has long been hotly debated. For example, following the uproar due to the acquittal of John Hinckley Jr. over the attempted assassination of late US President Ronald Reagan in 1981; instead of prison, Hinckley Jr. was committed to a mental hospital.
Guilt and Insanity
Twelve years later, Jeffrey Dahmer, who was accused of grisly murders and mutations of 17 men, also entered a plea of not guilty by reason of insanity. The defence contended that no sane person could have committed the shocking acts that Dahmer freely admitted to committing, which included cutting up his victims and eating their body parts. Diagnostic interviews, as well as psychological test results, also were indicative of psychological disturbance. Yet, the insanity plea was rejected and Dahmer was found guilty.
Both these defendants had severe mental disorders. So, why different verdicts? In Hinckley Jr.'s case, the law required the prosecution to prove that he was sane. They could not prove sanity beyond reasonable doubt, which was the reason for Hinckley's acquittal. Partly as a response to his acquittal, the law was changed, shifting the burden of proof to the defence instead of prosecution. This caused the defence to have to convince the jury that their client was insane during the committing of the crimes.
Dahmer's attorneys were unable to prove his insanity, causing his murder conviction. In order to balance the punishments for crimes with concerns of a defendant's mental status and the possible need for treatment; Canada, as well as an increasing number of US jurisdictions; have adopted a verdict of "guilty but mentally ill." This verdict imposes a normal sentence for a crime, but instead of jail, sends the defendant to a mental hospital for treatment. Defendants that recover before serving out their time are sent to prison for the remainder of their sentence.
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