An anthropological critique of psychiatric rating scales

Armstrong, Neil; Byrom, Nicola

Abstract

This article discusses sceptical arguments about measurement scales. Measurement scales are part of a promising agenda of openness, transparency and patient and public involvement (PPI) in medical research, but have received critical, sometimes hostile attention from anthropologists. This is because scales repackage localised cultural assumptions about distress as something universal and pan-human and have the capacity to reshape people's interior lives in unhelpful, possibly harmful ways. We take as an example the Patient Health Questionnaire-9 (PHQ-9). Use of the PHQ-9 is currently mandated by major funders. But its history suggests flawed PPI and a lack of openness. The article suggests a constructive role for anthropology in mental health research, using ethnographic evidence and theory to show how, although they have their uses, mental health scales should not be regarded as inert or harmless.

Citation

Armstrong, N., & Byrom, N. (2025). An anthropological critique of psychiatric rating scales. BJPsych Advances, 31(2), 73-81. https://doi.org/10.1192/bja.2024.60

• Journal Article Type: Article
• Acceptance Date: Sep 10, 2024
• Online Publication Date: Oct 25, 2024
• Publication Date: Mar 1, 2025
• Deposit Date: Nov 13, 2024
• Publicly Available Date: Nov 13, 2024
• Print ISSN: 2056-4678
• Electronic ISSN: 2056-4686
• Publisher: Royal College of Psychiatrists
• Peer Reviewed: Peer Reviewed
• Volume: 31
• Issue: 2
• Pages: 73-81
• DOI: https://doi.org/10.1192/bja.2024.60
• Keywords: Anthropology; rating scales; depressive disorders; history of psychiatry; patients and service users
• Publisher URL: https://www.cambridge.org/core/journals/bjpsych-advances/article/an-anthropological-critique-of-psychiatric-rating-scales/7AAC3BF7561A84862568E80B0677141F