Psychological Formulation as an Alternative to Psychiatric Diagnosis

“… we might be in the very strange position of admitting, as one psychiatrist has pointed out, that psychiatry is ‘something very hard to justify or defend—a medical specialty that does not treat medical illnesses’ …”

Dr. Peter Breggin, 1993, p. 505, Toxic psychiatry. London, England: Fontana.

This article by Dr. Lucy Johnstone has been published in the Journal of Humanistic Psychology. The abstract says that it:

“… gives an overview of psychological formulation, a rapidly expanding practice in the United Kingdom that is supported by the British Psychological Society. It is argued that formulation can provide a credible alternative to psychiatric diagnosis in the context of public admissions about lack of reliability and validity of current diagnostic systems. However, vigilance and best-practice principles are essential to ensure that this approach is not assimilated back into the status quo.”

The article begins:

“Psychiatric diagnosis has been criticized on many grounds over many years—lack of reliability and validity, excluding social contexts, causing stigma, and so on (see, e.g., Bentall, 2009; Boyle, 2002; Kirk & Kutchins, 1997). Rather than repeat these arguments here, I will note that the fundamental reason they are so long-standing, heated, and inconclusive is because ‘diagnosis is the Holy Grail of psychiatry and the key to its legitimation’ (Kovel, 1981, p. 86). In the psychiatric system, diagnosis supports the idea that psychiatry is a branch of medicine—just like neurology, oncology, pediatrics, and so on—in which the main cause of a person’s difficulties is thought to be something that has gone wrong with the functioning of the body or brain. Medicine, like every branch of science, has to be based on a reliable way of describing and grouping its basic elements so that general laws and theories can be developed. Therefore, the lack of a reliable and valid way of drawing up diagnoses, in other words, the lack of a proper classification system, raises very fundamental questions about whether psychiatry really is a legitimate branch of medicine, and specifically, whether these particular forms of human suffering are best understood as disease processes (Boyle & Johnstone, 2014). In other words, we might be in the very strange position of admitting, as one psychiatrist has pointed out, that psychiatry is ‘something very hard to justify or defend—a medical specialty that does not treat medical illnesses’ (Breggin, 1993, p. 505) …”

You can read more from here.

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