Clinical diagnoses as social constructs

Abstract

Diagnostic manuals of recent decades intended or effected an ongoing de-contextualization of mental disorders, which went hand in hand with the advancing biologizing of psychiatry, that ultimately served the pharmaceutical industry rather than the patients. Moreover, the findings of biological psychiatry are far from encouraging, notably because the diagnostic categories lack validity. The Research Domain Criteria (RDoC) constitutes a new research framework that is based on functional neural subsystems of the healthy brain and may advance neurobiology. It is not foreseeable whether this approach will succeed. The first and foremost objective of clinical diagnoses, on the other hand, should be understanding and communication. Since they are fundamentally the result of a social construction process, the primary focus should be on co-constructing through dialogue with the significant others in the social environment of the person concerned. Accordingly, an inner and outer polyphony of these constructions of reality is necessary and inevitable. Psychotherapeutic expertise also forms a part of this polyphony.