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3 Crim. Behav. & Mental Health iii (1993)

handle is hein.journals/cbmh3 and id is 1 raw text is: Criminal Behaviour and Mental Health, 3, iii-viii, 1993 © Whurr Publishers Ltd Editorial: When does a prisoner become a patient? The division of subjects into cases and non-cases is a classification, and like all classifications it is man-made and not in nature. It is a concept created for a purpose and is useful only in so far as it serves that purpose. (Copeland, 1981) The attraction of standardised interviews for detecting psychiatric cases is easily understood. They appear to offer simple and reliable answers to the difficult question of what constitutes a psychiatric case. For this reason, they may be used by referees, editors and readers as a means of judging the quality of a study; if it uses the Diagnostic Interview Schedule or DIS (Robins, Helzer, Croughan, Williams & Spitzer, 1981), PSE (Wing, Cooper & Sartorius, 1974) or another recognised system, then the diagnoses must be reliable and valid. When the authors speak of schizophrenia, it is 'real' schizophrenia; when they speak of personality disorder, that is also 'real'. In other words, such systems may invite the reification of diagnoses; we could be fooled into thinking that psychiatric diseases exist as discrete entities in the outside world. The standardised interview becomes the net in which they can be captured. In this way, it is easy to forget about the purpose of classification. The strength of standardised diagnostic interviews lies in their reliability; different interviewers will obtain similar results from the same patient. This does not necessarily mean that they have a high validity. Like all psychiatric diagnoses, they are limited by our lack of criteria against which they can be validated. Until pathologists have the skills to confirm a diagno- sis of personality disorder or neurosis, diagnoses made using one system can only be validated by comparing them to those obtained using other systems - or by the extent to which they reflect clinical practice. The latter possibility suggests the use of clinical criteria in research studies; such criteria may achieve a high face validity, by allowing clinicians to repli- cate their clinical practice in a research setting. Depending on the purpose of a study, it may be better to use clinical criteria (and, by implication, trained psychiatrists as interviewers) than to rely on standardised instruments. These points become very important in relation to studies of psychiatric disorder in prisoners. When the purpose of such studies is recognised, the use iii

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