Psychiatric Diagnosis Revisited: From DSM to Clinical Case Formulation

252 Pages·2017·2.237 MB·English

by  Stijn Vanheule (auth.)

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
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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
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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