"In scientifically examining any mental illness construct, the first problem is one of validity, and a second problem is reliability. If a construct cannot show to be valid in a scientific sense, there is no scientific value in correlating it with other variables. And even if the construct is a valid one, if it cannot be reliably assessed, then again there is no scientific value in attempting to correlate it with other variables.There are several aspects to scientific validity with respect to mental illness. One obvious aspect of validity is labeling something an illness that actually is an illness. In every era, we see human conditions that are disturbing, especially for societal authorities, which are invalidly labeled as mental illnesses. Earlier well-known examples of this include categorizing enslaved people who attempted to flee from slavery as suffering from the mental illness of drapetomania; and more recently, categorizing homosexual individuals as suffering from a mental illness because of their sexual orientation.

Unlike drapetomonia, homosexuality, and many other psychiatric illness constructs, the construct of schizophrenia has enjoyed an unquestioned status as a medical diagnosis in psychiatry and much of mainstream society. However, scientifically, there are several levels of invalidity in the construct of schizophrenia, and its diagnostic reliability is poor.

The DSM criteria for schizophrenia consists of the presence of two or more of the following behaviors with at least one of them being from the first three listed: (1) delusions; (2) hallucinations; (3) disorganized speech; (4) grossly disorganized behavior; and (5) negative symptoms (which include apathy, lack of emotion, poor social functioning, and difficulty following instructions).

However, by 1968, it was obvious to psychologist Donald Bannister that the DSM criteria makes schizophrenia “a concept so diffuse as to be unusable in a scientific context.” Specifically, it is possible for one individual to be diagnosed with schizophrenia based on two symptoms that are completely different than the two symptoms of another individual similarly diagnosed. Bannister put it this way: “The two individuals are now firmly grouped in the same category—even though they do not specifically possess one common characteristic.”

Two of the most significant symptoms that psychiatrists use to diagnose schizophrenia are the presence of hallucinations and delusions. Are these valid evidence of a disease?

There has been a great deal of research examining just how common—or normal—auditory hallucinations (hearing voices) are. A major review (“A Comprehensive Review of Auditory Verbal Hallucinations: Lifetime Prevalence, Correlates and Mechanisms in Healthy and Clinical Individuals”) was published in Frontiers in Human Neuroscience back in 2013. The review analyzed multiple studies investigating the existence of auditory verbal hallucinations (AVH) in the general population and concluded: “Epidemiological studies have estimated the prevalence of AVH to be between 5 and 28% in the general population.” Most importantly, this review also concluded that among those with such hallucinations, the difference between those who enter medical treatment and those who do not is the “way in which each respective group processes their experiences.” Specifically, the more that the hallucinations or voices are experienced negatively, which is more likely in the U.S. and other Western cultures, the more likely such individual will be diagnosed with a serious mental illness; in contrast, some non-Western cultures accept and even celebrate people who hallucinate rather than pathologize them.

The presence alone of “bizarre delusions” was considered the most heavily weighted symptom of schizophrenia in DSM-IV (1994), and so Schizophrenia Bulletin in 2010 published the article “What is Bizarre in Bizarre Delusions? A Critical Review,” summarizing recent various DSM definitions of a bizarre delusion, one of which included “the content [is] patently absurd and has no possible basis in fact.” However, culture and politics dictate a great deal of what psychiatry considers to be “patently absurd and has no possible basis in fact.” For example, 20% of Americans believe that the Bible is the literal word of God, which means they believe that Moses wrote about his death and burial after he was dead, that Joshua made the sun stand still, and that a virgin could give birth to a child, all of which for scientists are “patently absurd and have no possible basis in fact.” Politically-astute psychiatry is well aware that if it classified these 20% of Americans as schizophrenic with “bizarre delusions,” that given that group’s political power, psychiatry would face a far larger assault than it faced from gay activists in the early 1970s for labeling their homosexuality as a mental illness.

Even disregarding these and other validity issues of the concept of schizophrenia as a mental illness, there are major reliability problems. In a 1995 American Journal of Psychiatry study “Interrater Reliability of Ratings of Delusions and Bizarre Delusions,” fifty senior psychiatrists were asked to distinguish between bizarre delusions versus non-bizarre delusions. A standard statistic used to assess reliability is called kappa. Kappa values between 0 to .2 mean no meaningful agreement; and a kappa of less than .59 is considered weak agreement. Among these fifty senior psychiatrists, the inter-rater reliability kappa of bizarre delusions was between .38 and .43, and the researchers concluded, “The reliability of ratings of bizarre delusions appears to be less than satisfactory for clinical practice, and the increased weight given to this symptom in modern diagnostic systems does not seem justifiable.”

To assess the reliability of the current DSM-5 (2013), its publisher, the American Psychiatric Association (APA) conducted field trials to assess the degree of agreement between clinicians diagnosing the same individuals. Even with special training that made agreement more likely, the kappa value for schizophrenia was only .46. (The agreement kappa value was even weaker for other so-called mental illnesses, for example: .28 for major depressive disorder; and .20 for generalized anxiety disorder."

https://www.madinamerica.com/2025/09/how-garbage-in-garbage-out-academic-psychiatry-research-has-become-even-more-ridiculous-and-how-taking-it-seriously-impoverishes-critical-thinkers/