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Related Topics
Psychiatric DiagnosisReview - Psychiatric Diagnosis
Challenges and Prospects
by Ihsan M. Salloum and Juan E. Mezzich (Editors)
Wiley, 2009
Review by Helge Malmgren, Ph.D., M.D.
Mar 22nd 2011 (Volume 15, Issue 12)

This volume, edited and written by an impressive array of authors, is one of the most recent additions to The World Psychiatric Association Evidence and Experience in Psychiatry Series. Its four sections, Concepts of mental illness and health across the world, Psychopathology, Comorbidity in mental and general health and Diagnostic models cover many aspects of diagnosis and classification, ranging from basic philosophical issues such as the definition of mental illness and the reasons vs. cause distinction, via surveys of  current classifications within specific psychopathological fields to today's urgent issues about what the upcoming great systems for classification -- DSM-5 and ICD-11 -- should look like and will look like. So it has something to offer everybody, and everybody will surely like something and have objections to something.

I will not attempt to go through all the contributions (there are 30 chapters in all) but will only mention a few. On the positive side, the brief but compact Chapter 3: Culture and Mental Illness: Social Contexts and Explanatory Models, by L.J. Kirmayer and D. Bughra, impressed me by the depth of the analysis of "how reasons become causes", an analysis firmly rooted in psychiatric praxis rather than in overused philosophical examples of reasons and causes. Chapter 22, The Validity of Psychiatric Diagnosis: Etiopathogenetic and Clinical Approaches, by K.F. Schaffner, should serve well both as an introduction to different concepts of validity and as a suggestion to be taken very seriously about what kind of classificatory approach -- a "prototypical-dimensional" one -- to go for in the future. My reaction to other chapters was more ambivalent. The most distinctly philosophical contribution, Philosophical Perspectives on Health, Illness and Clinical Judgement in Psychiatry and Medicine by T. Thornton, K.W.M. Fulford and G. Christodoulou (Chapter 2), did not quite live up to the promise that I read into its almost all-embracing title. Their discussion of subtleties in Kant's theory of mind is simply too "philosophical" for most of the expected readers of the volume, and if you have a less than perfect knowledge of Greek you may react with some irritation to the many but only schematically translated quotes from Aristotle and Hippocrates. (I did.) And Chapter 29, C.R. Cloninger's The Science of Well-Being and Comprehensive Diagnosis surely makes fascinating reading, but left me with a serious doubt whether there is really only one "Science of Well-being" and whether Cloninger is really its true prophet. Personally, I prefer more cautious ways of presenting one's message.

These objections should surely not be taken as implying that I do not recommend the book. On the contrary: this unusually rich volume adds considerably to the already large literature on classification and diagnosis in psychiatry. Although prompted by the present need for a secure ground for the new diagnostic systems that will soon emerge, most of its chapters have a bearing far outside that context. And, to repeat, it has something to offer everybody.


© 2011 Helge Malmgren

Helge Malmgren, Ph.D., M.D., Department of Philosophy, Göteborg University, Sweden



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