Meaning and melancholia: Why the DSM-IV cannot (entirely) ignore the patient's intentional system.

Research output: Chapter in Book/Report/Conference proceedingChapter (peer-reviewed)peer-review

Abstract

After carefully describing his "harmful dysfunction" criteria for diagnosis, he asserts that the atheoretical Diagnostic and Statistical Manual of Mental Disorders (DSM) approach has been unfairly criticized by those who either do not understand or do not accept its limited objectives.
Using the diagnosis of depression as an example, the author takes psychoanalytic critics to task for failing to differentiate the etiology of the disorder itself from the etiology of the disorder's symptoms and for conflating diagnosis, assessment, and formulation of a treatment plan. The author emphasizes the failure of the DSM to make room for the patient's subjective meanings, thereby weakening or undermining the validity of the diagnosis of major depressive disorder in particular and, by extension, other disorders as well. The author suggests a possible rapprochement of the syndromal and psychoanalytic approaches if the DSM-IV were to include theory-neutral meanings, necessary to enhance validity, and if psychoanalysts were to evaluate the DSM-IV in terms of its limited purpose. He concludes that it is the relations among the situational context, the patient's meanings, and the patient's responses that are the most valid indicators of whether the patient is suffering from a disorder.
Original languageEnglish (US)
Title of host publicationMaking Diagnosis Meaningful: Enhancing evaluation and treatment of psychological disorders
Place of PublicationWashington, DC
PublisherAmerican Psychological Association Press
Pages29-72
DOIs
StatePublished - 1998

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