Who is sick? Who is not? – Die entscheidenene Rolle psychiatrischer Diagnosen – und ihre gravierenden Mängel

I have reviewed all of the definitions of mental disorder and have written one myself, but can assure you that none of them is very meaningful. The definitions can’t do either of the two tasks they are meant to do: 1) determine which syndromes belong in a diagnostic manual; and, 2) which individuals qualify for a diagnosis of mental disorder. ‚Mental disorder‘ and ‚Normal‘ are opposing terms which (like ‚Disease‘ and ‚Health‘) are familiar enough in casual speech, but impossible to define with operational precision. We must admit that here is no clear or permanent boundary between them and even the fuzzy boundary is elastic and easily shifted by local custom and changing social context. There is also no epistemological consensus about the nature of mental disorder. There are three contending models: Schizophrenia as disease, equivalent to diabetes? Schizophrenia as fallible and subjective (but nonetheless very useful) construct? Or Schizophrenia as myth, invented by psychiatrists? We will discuss how these different conceptual understandings and misunderstandings of mental disorder have affected practical decisions related to classification, diagnosis, and treatment. The overall theme will be the great value of embracing doubt both in creating the diagnostic manual and in diagnosing the individual patient.

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Eine Keynote von Allen Frances