Psychiatric Diagnosis and Classification - ResearchGate
Psychiatric Diagnosis and Classification - ResearchGate
Psychiatric Diagnosis and Classification - ResearchGate
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<strong>Psychiatric</strong> <strong>Diagnosis</strong> <strong>and</strong> <strong>Classification</strong>. Edited by Mario Maj, Wolfgang Gaebel, Juan Jose LoÂpez-Ibor <strong>and</strong> Norman Sartorius<br />
Copyright # 2002, John Wiley & Sons, Ltd. ISBNs: 0±471±49681±2 Hardback); 0±470±84647±X Electronic)<br />
CHAPTER<br />
6<br />
The Role of Phenomenology in<br />
<strong>Psychiatric</strong> <strong>Diagnosis</strong> <strong>and</strong><br />
<strong>Classification</strong><br />
Josef Parnas 1 <strong>and</strong> Dan Zahavi 2<br />
1 Department of Psychiatry, Hvidovre Hospital, Hvidovre, Denmark<br />
2 Danish Institute for Advanced Studies in the Humanities, Copenhagen, Denmark<br />
INTRODUCTION<br />
As with most classifications, psychiatric classification has essentially a pragmatic<br />
purpose, that is to delimit entities useful for the choice of treatment,<br />
prevention <strong>and</strong> prediction of outcome. Moreover, classifications create important<br />
constraints for aetiological <strong>and</strong> pathogenetic research, because they<br />
dictate, more or less explicitly <strong>and</strong> authoritatively, the boundaries of what is<br />
declared as relevant fields of research. According to the medical model,<br />
psychiatric classification should be ultimately based on aetiological knowledge,<br />
<strong>and</strong> any other approach, be it symptomatic, syndromatic or even more<br />
complexly descriptive like the multiaxial) is considered as provisional.<br />
Validity of psychiatric diagnosis is considered as a problem of matching<br />
clinical entities with ``real'' processes of nature [1]. In the case of most<br />
psychiatric disorders, however, hoping for a segmentation of ``real'' processes<br />
of nature into neat ``real kind'' categories is perhaps overoptimistic or<br />
even expressive of a certain epistemological naõÈveteÂ. In any case, the majority<br />
of current diagnostic categories are based on typologies of human experience <strong>and</strong><br />
behavior, <strong>and</strong> in all likelihood this state of affairs will continue to prevail in a<br />
foreseeable future. Therefore, a search for a faithful description of experience<br />
must be considered as a necessary first step in any taxonomic effort, including<br />
attempts of reducing abnormal experience to its potential biological<br />
substrate. This prerequisite, articulated in psychopathology by Karl Jaspers<br />
in 1923 [2], has been more recently expressed by Thomas Nagel [3] in the<br />
context of consciousness research: ``a necessary requirement for any coherent<br />
reductionism is that the entity to be reduced is properly understood''. But the<br />
<strong>Psychiatric</strong> <strong>Diagnosis</strong> <strong>and</strong> <strong>Classification</strong>. Edited by Mario Maj, Wolfgang Gaebel, Juan Jose LoÂpez-Ibor <strong>and</strong><br />
Norman Sartorius. # 2002 John Wiley & Sons, Ltd.