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Citation
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Vanheule S, Adriaens P, Bazan A, Bracke P, Devisch I, Feys JL, Froyen B, Gerard S, Nieman DH, van Os J, Calmeyn M. Lancet Psychiatry 2019; 6(9): 726. |
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Abstract
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Worldwide, the DSM is, much like the ICD, a frequently used classificatory diagnostic instrument. However, questions have been raised about its pragmatic and scientific status.1, 2, 3 Therefore, in 2016, the Belgian Governmental Superior Health Council set up an expert group comprised of academics and practitioners in psychiatry, clinical psychology, sociology, and philosophy as well as a service user to evaluate relevant literature and evidence.
Epistemologically, the expert group concluded that mental disorder categories should not be treated as natural kind categories but as constructs that have a causal impact on those who are classified. Sociologically, the group observed that diagnostic classifications tend to legitimise organisational structures and protect psychiatry from pressures to change. Moreover, the literature suggests that a biomedical approach does not, as hoped, reduce stigma and discrimination. Clinically, the group concluded that common diagnostic categories lack validity, reliability, and predictive power. Additionally, these do not tally with new conceptions of health, defined by the ability to adapt despite biopsychosocial obstacles.
The Council observed that multilayered clinical case formulation provides a useful alternative. Thus, symptoms, complaints, and suffering can best be contextualised in terms of biographical information, existential challenges, contextual-interactional functioning, mental processes, and biological considerations. Classification can still occur but on the basis of a small number of general syndromes (eg, psychotic syndrome or depression syndrome), which stimulates personal diagnostic formulation. These should be discussed in terms of a continuum from crisis to recovery to assess the need for care and support...
Language: en |