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As discussed in Chapters 1 and 2, the 1960s and 1970s saw psychiatry face a number of challenges to its legitimacy, both within its own ranks (e.g. psychiatrists such as Thomas Szasz and R.D. Laing) and from scholars and activists in civil rights movements. Questions were being raised about links between mental health and social conditions, the notion of mental illness itself and its relationship with restrictive social norms. Some researchers took up the challenge to examine the scientific basis of psychiatry, chiefly the validity and reliability of psychiatric diagnosis.

Validity The utility of a diagnostic system (does it do what it intends to do?); the degree to which the classification system provides a way of conceptualising problems that corresponds to service-users’ experiences and provides a means of accurately classifying them.

Reliability The degree to which clinicians agree on a diagnosis for a service user.