Deployment of descriptive diagnoses based on symptom report and identification in the clinic does not necessarily require any interpretation. One can diagnose “major depressive disorder” (or “generalized anxiety disorder” or “bipolar disorder,” etc.) without having any clear idea of, or saying a word about, what it means. Similarly, we can proceed with treatment following the standard of care set by various guidelines for any particular diagnosis or condition without any clarity about how treatment should be conceptualized. We can stay at a very superficial level along the lines of, “This medication has been shown to help patients with X, reduces symptoms of X, has been approved for X, or is recommended for in the treatment of X” without any details of how the relationship between the medication, the diagnosis, and the psychopathology is supposed to be understood (View Highlight)
psiquiatría tratamiento etiología
Every psychiatrist is familiar with some colleagues who start asking these questions and end up in a place of unpalatable skepticism and nihilism. (View Highlight)
There are, for better or worse, no theory-free observations. We always approach human behavior, and the world generally, with preconceived notions and theoretical constructs, whether these are recognized or unrecognized. The question, therefore, is not whether philosophical assumptions are inherent in our frameworks but whether we wish to examine them. The failure to give due importance to philosophical foundations of the field has resulted in widespread confusion and has negatively impacted the historical trajectory of the profession. The reification of diagnostic constructs, the tendency towards explanatory reductionism, and the debates surrounding medicalization are all linked to inadequate conceptual appreciation of the nature of psychiatric diagnoses, the role of causal explanations, and the pragmatic functions served by diagnoses (View Highlight)
As Rachel Aviv put it memorably in Strangers to Ourselves (2022):
**“**There are stories that save us, and stories that trap us, and in the midst of an illness it can be very hard to know which is which. Psychiatrists know remarkably little about why some people with mental illnesses recover and others with the same diagnosis go on to have an illness “career.” Answering the question, I think, requires paying more attention to the distance between the psychiatric models that explain illness and the stories through which people find meaning themselves. Even if questions of interpretation are secondary to finding effective medical treatment, these stories alter people’s lives, sometimes in unpredictable ways, and bear heavily on a person’s sense of self—and the desire to be treated at all.” (p 24) (View Highlight)
cura cita psicoterapia narrativa
the biomedical model is now the dominant folk model of disease in the Western world. (View Highlight)
When there is little exploration of the meaning of diagnosis and treatment in the clinical encounter, when we leave patients to their own devices to come up with a narrative of what they are going through, we leave them at the mercy of folk biomedical narratives and folk resistance to such narratives. We should diagnose, and we should treat, and we should do it well, but to do justice to the clinical process, we cannot “shut up” about its meaning. Even though answers may seem obscure and we are all muddling our way through an interpretative bog, speaking up is better than silence. (View Highlight)