Psychiatric Diagnosis and the Medical Model: A Critique of a Suggested Revision

Reviews the book, Psychiatric Diagnosis Revisited: From DSM to Clinical Case Formulation by Stijn Vanheule (see record 2017-13342-000). Vanheule presents a strongly worded, stringently critical analysis of the standard medical model of psychiatric diagnosis. He cites extensive evidence to show that interrater agreement statistics for psychiatric diagnostic classification generally have remained poor. The application of the medical model to psychiatric diagnosis continues to lead to the expectation that descriptive behavioral criteria that are used to define most psychiatric syndromes eventually can be linked to specific biological substrates. This model of psychiatric diagnosis has gained little empirical support over the years. Vanheule recommends that “a function-oriented approach allows us to aggregate information about symptoms at a group level, and enables a bottom-up mapping of how symptoms are related” (p. 171). Underlying his theoretical model is the concept that behaviors that cause emotional distress or cognitive coping difficulty are symptomatic of some unitary underlying disorder. Vanheule advocates for a qualitative approach to syndrome analysis that does not have a fixed, specific syndrome at its core. (PsycINFO Database Record (c) 2017 APA, all rights reserved)