We had a good meeting this week. We discussed the Johnstone chapter and people seemed to be in agreement about the difficulties we face when we feel that we have no other option but to use psychiatric diagnoses, even if just as an administrative tool. We questioned it's role in legitimising psychiatry, as a metric for funding, as a scientific tool to base treatment and prognosis on, and it's impact on the individual and the system around them when a diagnosis is given by an 'expert'.

We seemed to all be in agreement that psychiatric diagnoses are flawed at their best and abusive at their worst. However, we came up against the same quandary, so what do we do now? Although we can think critically, how to we act critically? 

The Johnstone chapter suggested psychological formulation as an alternative. However, the group spoke more about the need for a political voice and how clinical psychology was not well represented in that way. We felt that our representative bodies were more concerned with cosying up with psychiatry than questioning it. As with always, we are left with more questions than answers. But, I think, it's better to know what you don't know than to think you know it all.....

Finally, if people would like to suggest topics for future discussions then please email me, aidanjakelly[at]gmail.com.

What is diagnosis and why do we use it?

Diagnosis and the scientific ideology of reductionism go hand-in-hand. Reductionism is the belief that everything can be explained by the sum of its parts, i.e. that it can be reduced to one type of knowledge. So for psychiatry this means “that aspects of meaningful human behaviour can be fully explained in terms of ‘non-meaningful’ entities such as genes, neurotransmitters and ultimately atoms and molecules” (Bracken & Thomas, 2009, p 14). Diagnosis is a reductionist practice, where a label or diagnosis is said to represent an illness with a biological aetiology.  

Johnstone (2008), in explaining the purpose of diagnosis, writes first about how it functions in general medicine. She states that it is used as an essential first step to determine the appropriate treatment and then goes on to detail a list of other preferred, but not essential, criterion that are often also fulfilled. These include; that it gives information to patients and families who want to know what condition they are suffering from, gives details of prognosis, allows professionals to communicate in shorthand, provides a basis for research, informs aetiology, and signposts patients and their families towards appropriate services and resources. 

How suited then, is diagnosis to the field of psychiatry where medical causes, such as ‘biochemical abnormalities’ and ‘genetic vulnerabilities’, are still only working theories, rather than established facts (Bentall, 2009; Johnstone, 2008)? Psychiatry, as with natural sciences such as chemistry, biology and physics, relies upon the ability to use valid and reliable categories or units as a way of testing hypotheses and developing theories. In medicine the ability to define and classify different illnesses allows for hypotheses about prognosis, aetiology, and treatments that can then be tested (Johnstone, 2008). In summation, the medical model and psychiatry needs classification of its units of study, to act as objective truths, so that it can then engage in scientific thinking, but does our understanding of distress need, or benefit from, it’s classification?