University Hospital of Psychiatry Zurich, Department of Psychiatry, Psychotherapy and Psychosomatics, Lenggstrasse 31, P.O. Box 363, 8032 Zurich, Switzerland.
Dialogues Clin Neurosci. 2020 Mar;22(1):27-35. doi: 10.31887/DCNS.2020.22.1/phoff.
Ever since psychiatry emerged as a clinical discipline and field of scientific inquiry in the late 18th century, debates about diagnosis have been at its very heart. Considered by many a requirement for clinical communication as well as for systematic study, others have critiqued psychiatric diagnosis for being modeled on a medical conception of disease that is ill-suited to the specific nature of mental disorders. Based on a review of seminal positions in the conceptual history of psychiatry and an examination of their epistemological underpinnings, we propose to consider diagnosis as dialogue. Such understanding, we argue, can serve as a meta-framework that provides a conceptual and practical umbrella to encourage open-minded conversation across the diverse conceptual and experiential frameworks that are characteristic of psychiatry. In this perspective psychopathology will also reinforce the interpersonal realm as a necessary element of any clinical encounter, be it diagnostic in purpose or otherwise. Current challenges to traditional diagnostic systems like Research Domain Criteria (RDoC) and Hierarchical Taxonomy of Psychopathology (HiTOP) are discussed in light of these considerations. .
自 18 世纪末精神病学作为一门临床学科和科学探究领域出现以来，关于诊断的争论一直是其核心问题。许多人认为诊断是临床交流以及系统研究的必要条件，而另一些人则批评精神病学诊断是基于一种不适用于精神障碍特定性质的医学疾病概念。基于对精神病学概念史中开创性立场的回顾和对其认识论基础的考察，我们建议将诊断视为对话。我们认为，这种理解可以作为一个元框架，为跨精神病学特有的各种概念和经验框架提供一个开放思维的对话的概念和实践保护伞。从这个角度来看，精神病理学也将强化人际领域作为任何临床接触的必要元素，无论是出于诊断目的还是其他目的。根据这些考虑，讨论了当前对传统诊断系统（如研究领域标准 (RDoC) 和精神病理学分层分类 (HiTOP)）的挑战。
