Thursday, 10 July 2008

Diagnosis in psychiatry

Last week I parachuted into a single session of the Royal College of Psychiatry annual meeting to take part in a debate on diagnosis. I was slightly worried that a philosophically based session would not fill enough of the main lecture hall in which we’d been scheduled but I was wrong. That said, whilst Phil Thomas’ talk on moral aspects of diagnosis and mine on the relation of idiographic and narrative approaches generated enough questions to fill the time it was Jo Moncrief’s talk that generated all the heat.

Jo is a member of the critical psychiatry movement and the main aim of her argument was to criticise the application of the idea of diagnosis to mental health care. One of her many points was to stress the social or historical interdependence of the availability of kinds of psychotropic drugs and the ‘availability’ of a corresponding diagnosis. Thus one reaction by members of the audience was to stress that such diagnostic categories had really existed prior to the marketing of treatments.

I was struck by the parallel with forms of sociological analysis of scientific knowledge in general. It is easy to see a contrast between a simple-minded realism in which scientists can simply ‘mainline’ on the facts and a contrasting view in which social factors, rather than natural scientific facts, play an explanatory role. On the simple minded contrast, the presence of social factors can only play a debunking role. But there is a range of other views which recognise that scientific projects are social projects and require great social and managerial skills but nevertheless think that these factors are deployed in order to persuade nature to reveal itself.

What was not clear to me at the Royal College meeting was that Jo’s argument had actually established a debunking reading of the role of social factors in the history of psychiatric diagnosis rather than simply pointing out the complex background of any recent (correct or incorrect) scientific claims. It was clearly her intent but I had the feeling that the audience reaction was premature.

For more on the idea of debunking versus realist use of sociology see this.