previous post) new book A prescription for psychiatry. Peter is very clear that "there is no place for medical diagnosis in mental health care". He suggests this is "a challenging assumption" and "may sound revolutionary". He even recognises it "may go against decades of accepted wisdom in psychiatric circles".
I'm not sure how many decades Peter wants to go back! The publication of DSM-III in 1980 marked a return to medical diagnosis in Peter's sense. However, he might have been happier with Karl Menninger's The vital balance published in 1963, which represented a pragmatic consensus, at least in American psychiatry. And going back even further, Adolf Meyer, regarded as the dean of American psychiatry in the first half the 20th century, developed psychobiology which has parallels with Peter's psychobiosocial approach. As Menninger put it, "As a result of his efforts ..., American psychiatrists began to ask, not "What is the name of this affiction?" but rather, "How is this man reacting and to what?"". DSM-III replaced the Meyerian approach to diagnosis, which it saw as too woolly.
Meyer said of the American Medico-Psychological Association's (1918) Statistical manual for the use of institutions for the insane, "I have no use for the essentially 'one person, one disease' view". He went further and suggested that "... statistics published ... are a dead loss ... and an annual ceremony misdirecting the interests of staff". Susan Lamb has described Meyer's psychiatric development from neuropathologist to psychobiologist (see previous post).
For my position on diagnosis, you might want to look at the slides from my presentation 'Some aspects of the moral basis of diagnosis: The challenge of Meyer's psychobiology'. My views are:-
(1) Psychiatry should not abandon diagnosis but recognise it for what it is
(2) Psychiatry should not be panicked by the unreliability of psychiatric diagnosis
(3) Psychiatry should avoid the reification of diagnostic concepts
I think this is a similar but more subtle, maybe, manifesto than Peter's.
Tuesday, September 16, 2014
What place for diagnosis in mental health care?
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