Psychiatric Diagnosis Revisited: From DSM to Clinical Case Formulation PDF
Preview Psychiatric Diagnosis Revisited: From DSM to Clinical Case Formulation
PSYCHIATRIC DIAGNOSIS REVISITED From DSM to Clinical Case Formulation Stijn Vanheule Psychiatric Diagnosis Revisited Stijn Vanheule Psychiatric Diagnosis Revisited From DSM to Clinical Case Formulation Stijn Vanheule Ghent University Ghent, Belgium ISBN 978-3-319-44668-4 ISBN 978-3-319-44669-1 (eBook) DOI 10.1007/978-3-319-44669-1 Library of Congress Control Number: 2017930174 © The Editor(s) (if applicable) and The Author(s) 2017 This book was advertised with a copyright holder in the name of the publisher in error, whereas the author holds the copyright. This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and trans- mission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Cover illustration: Michaël Borremans, “The Egg IV”, 2012, 42,0 x 36,0 cm, oil on canvas, photographer: Peter Cox, courtesy Zeno X Gallery, Antwerp Printed on acid-free paper This Palgrave Macmillan imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Other books by Stijn Vanheule: The Subject of Psychosis—A Lacanian Perspective (Palgrave Macmillan, 2011). Diagnosis and the DSM—A Critical Review (Palgrave Macmillan, 2014) v Acknowledgments Many people supported me while researching and writing this book. My collaborators at the Department of Psychoanalysis and Clinical Consulting at Ghent University provided me with support and inspira- tion, for which I am grateful. The same is true for the many colleagues that I regularly meet and have met in the clinical setting, and for the experts by experience including Brenda Froyen, Ingrid Lammerant, and Hind Fraïhi, who, with their personal stories, inspired me to refine my ideas. Special thanks to Ignaas Devisch, with whom I discussed several key ideas that are discussed in Chap. 4. Above all I want to thank the psychology students following my classes on Clinical Psychological Assessment at Ghent University between 2006 and 2016. Their presence, curiosity, and concerns invited me to articulate my ideas as clearly as possible. Finally I am most grateful to Clare Murphy. She not only copy-edited the manu- script but also joined me in my lines of reasoning, thus pointing to ideas that needed further clarification. vii Contents 1 I ntroduction 1 Other References 6 2 Dynamics of Decision-Making: The Issue of Reliability in Diagnosis 7 Diagnosis and the DSM 7 From Prototype to Checklist: A Brief History 8 Commotion in Psychiatry, Part I: Diagnosis Under Fire in the 1970s 16 Commotion in Psychiatry, Part II: Critical Researchers Dethrone the Psychiatric Ethos 28 Commotion in Psychiatry, Part III: Deinstitutionalization, Rationalization, Medicalization, and Fuzzy Decision-Making 40 Neo-Kraepelinian Restoration 44 Diagnostic Reliability Since the DSM-III 52 Conclusion 67 Other References 70 3 Symptom and Context: The Issue of Validity in Diagnosis 79 Toward a Functional Account of Psychopathology 79 ix x Contents How the DSM Takes into Account Context 80 The Paradox of Polythetic Descriptive Diagnosis 84 Sign-Based Diagnosis 87 Beyond Sign-Based Diagnosis: Symptoms as Personal Constructions 90 Intermezzo: Lacan’s Position 101 The Search for Biomedical Referents 105 Toward an Era of Biopsychopathology? 110 The Mental Disorder: What Kind of Kind? 119 Conclusion 125 Other References 126 4 From Mental Suffering to Mental Disorder and Back Again 133 What Do We Diagnose? 133 Psychopathology 136 Psychopathology Versus Abnormality 138 What Is Pathos? 144 A Plea for Studying the Quality and Circumstances of Mental Suffering 150 DSM-5: A Matter of Disorders 153 What About Suffering: Verstehen or Gardez- vous de comprendre? 158 Conclusion 161 Other References 163 5 Working with Clinical Case Formulations: Methodological Considerations 167 Mapping Mental Health Problems 167 Function-Oriented Diagnosis 169 Case Construction 172 Qualitative Research as a Methodological Framework 174 Quality Assurance in Diagnostic Case Formulation 179 Reflexivity 180 Conten ts xi Reflexivity in the Context of Function- Oriented Case Formulation 184 Aiming at Validity and Reliability: A Matter of Careful Verification 193 Reliability Considered Closely 197 A Closer Look at Validity 200 Conclusion 205 Other References 207 Bibliography 213 Other References 214 Index 233 List of Figures Fig. 3.1 Triangular model of symptom formation 101 Fig. 4.1 Two orthogonal axes on which Ricoeur situates mental suffering 146 xiii
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