Psychiatric Diagnosis Revisited : From DSM to Clinical Case Formulation

This book explores the purpose of clinical psychological and psychiatric diagnosis, and provides a persuasive case for moving away from the traditional practice of psychiatric classification. It discusses the validity and reliability of classification-based approaches to clinical diagnosis, and frames them in their broader historical and societal context. __The Diagnostic and Statistical Manual of Mental Disorders (DSM)__ is used across the world in research and a range of mental health settings; here, Stijn Vanheule argues that the diagnostic reliability of the DSM is overrated, built on a limited biomedical approach to mental disorders that neglects context, and ultimately breeds stigma. The book subsequently makes a passionate plea for a more detailed approach to the study of mental suffering by means of case formulation. Starting from literature on qualitative research the author makes clear how to guarantee the quality of clinical case formulations. Acknowledgments 6 Contents 7 List of Figures 10 List of Tables 11 1: Introduction 13 Other References 18 2: Dynamics of Decision-Making: The Issue of Reliability in Diagnosis 19 Diagnosis and the DSM 19 From Prototype to Checklist: A Brief History 20 Commotion in Psychiatry, Part I: Diagnosis Under Fire in the 1970s 28 Commotion in Psychiatry, Part II: Critical Researchers Dethrone the Psychiatric Ethos 40 Commotion in Psychiatry, Part III: Deinstitutionalization, Rationalization, Medicalization, and Fuzzy Decision-Making 52 Neo-Kraepelinian Restoration 56 Diagnostic Reliability Since the DSM-III 64 Conclusion 79 Other References 82 3: Symptom and Context: The Issue of Validity in Diagnosis 90 Toward a Functional Account of Psychopathology 90 How the DSM Takes into Account Context 91 The Paradox of Polythetic Descriptive Diagnosis 95 Sign-Based Diagnosis 98 Beyond Sign-Based Diagnosis: Symptoms as Personal Constructions 101 Intermezzo: Lacan’s Position 112 The Search for Biomedical Referents 116 Toward an Era of Biopsychopathology? 121 The Mental Disorder: What Kind of Kind? 130 Conclusion 136 Other References 137 4: From Mental Suffering to Mental Disorder and Back Again 144 What Do We Diagnose? 144 Psychopathology 147 Psychopathology Versus Abnormality 149 What Is Pathos? 155 A Plea for Studying the Quality and Circumstances of Mental Suffering 161 DSM-5: A Matter of Disorders 164 What About Suffering: Verstehen or Gardez-vous de comprendre? 169 Conclusion 172 Other References 174 5: Working with Clinical Case Formulations: Methodological Considerations 178 Mapping Mental Health Problems 178 Function-Oriented Diagnosis 180 Case Construction 183 Qualitative Research as a Methodological Framework 185 Quality Assurance in Diagnostic Case Formulation 190 Reflexivity 191 Reflexivity in the Context of Function-­Oriented Case Formulation 195 Aiming at Validity and Reliability: A Matter of Careful Verification 204 Reliability Considered Closely 208 A Closer Look at Validity 211 Conclusion 216 Other References 218 Bibliography 223 Other References 224 Index 242 Front Matter....Pages i-xvi Introduction....Pages 1-6 Dynamics of Decision-Making: The Issue of Reliability in Diagnosis....Pages 7-77 Symptom and Context: The Issue of Validity in Diagnosis....Pages 79-132 From Mental Suffering to Mental Disorder and Back Again....Pages 133-166 Working with Clinical Case Formulations: Methodological Considerations....Pages 167-211 Back Matter....Pages 213-243