Psychiatric Diagnosis in This Chapter

¶ … Psychiatric Diagnosis

In this chapter of the DSM-IV Guidebook, an accessory to the DSM-IV manual (Diagnostic and Statistical Manual of Mental Disorders), published by the American Psychiatric Press in 1995, the subject of conceptual issues in psychiatric diagnosis is explored in great depth and with much authority and should be read by all scholars and researchers in the field of mental illness prior to consulting the DSM-IV manual itself. In general terms, this chapter examines a number of conceptual issues related to psychiatry and how a practicing psychiatrist should approach a diagnosis of a particular mental disease.

The first sub-heading "Epistemology of the Diagnostic Endeavor" offers a simple analogy to the psychiatrist in the form of umpires who see balls and strikes in a game of baseball as very different in terms of epistemology or the "study of the nature of knowledge and how it is experienced and organized in the human mind" (Denison, 2003, p. 245). Thus, the nature of reality and knowledge, at least for the psychiatrist, "has profound implications for understanding the nature of psychiatric classification" (DSM-IV Guidebook, 1995, p. 14) regarding how to approach a diagnosis of a mental illness in a patient. Overall, one might ask the question, "Do psychiatric disorders exist as entities in nature (i.e., occurring naturally) or do they arise as mental constructs created in the minds of the classifiers?" (DSM-IV Guidebook, 1995, p. 14).

The second sub-heading explores the definition of a mental disorder which Walter D. Glanze sees as "any disturbance of emotional equilibrium as manifested in maladaptive behavior and impaired functioning," caused by genetics, physical, chemical, biological, psychologic and/or cultural/social factors (2000, p. 741). According to the DSM-IV guidebook, a mental disorder is merely a human concept which "lacks a consistent operational definition that covers all situations" which might arise in the office of a psychiatrist. In other words, a mental illness, such as schizophrenia, bi-polar/depression, ADHD or some type of disorder associated with substance abuse, cannot be fully diagnosed by simply relying upon poorly-defined psychological entities or constructs which oftentimes only discuss traditional ideas of Western culture related to biology, treatment and testing.

This chapter then proceeds to discuss the term "mental disorder" itself via Rene Descartes' dualism which supports the idea that the mind and the body are separate entities, such as found in mental disorders vs. physical disorders (Harrison, 2004, p. 145). However, modern-day psychiatry is now focusing on a synthesis of the mind/body entities as a whole that works in tandem, an approach that is supported by much research which has consistently shown that "there is much that is physical in the so-called mental disorders and much that is mental in the physical disorders" (DSM-IV Guidebook, 1995, p. 16), an indication that the brain and the body are sorts of partners when it comes to thought, emotion and psychopathology.

The next section discusses descriptive syndromal diagnosis, "a complex of signs and symptoms resulting from a common cause or in combination" (Lambert, 2005, p. 332) versus a well-established and knowable disease. For example, an illness like Alzheimer's has a "sufficiently well-established pathogenesis," while the symptoms of an illness/disorder like a specific phobia is often circumscribed, i.e., a mixture of various traits and characteristics (DSM-

IV Guidebook, 1995, p. 16). Following this section, the guidebook goes into exploring seven specific modes of diagnosis -- "Nosology: Categorical vs. Dimensional Diagnosis," "Polythetic vs. Monothetic Criteria," "Multiple Diagnoses and Comorbidity," being "a combination of abnormal condition and quality" (Glanze, 2000, p. 770), "Clinical vs. Research Criteria," "Core vs. Discriminating Features," "Level of Clinical Inference in Criteria Sets," and lastly, "Diagnostic Tests as Criteria."