Making diagnoses in psychiatric clinical practice: The point of view of the psychotherapeutic attitude

Abstract

Using a “psychotherapeutic attitude”, as a criterion and measure of the psychiatrist’s involvement in clinical relationship (with the “trial identification” according to Fliess), some phenomenological and epistemological considerations are offered about diagnostic assessments, as a synchronic and diachronic recognising process. Inspired by Gehlen’s notion of “exoneration” (i.e., the reducing and focusing of the perceptive experience as applied to the wealth of the perceptible), this paper examines how the mind of a skilled diagnostician might work. Three levels are explored: firstly, “the symbolic perception”, where perceptive/emotional data derived by “trial identification” and worked through during one’s professional experience, automatically selects wide fields of allusions (e.g., in the psychopathological prefigurations, suggested by the ‘‘contact’’); then, we consider the “exoneration” of scientific hypothesis, which allows the psychiatrist to give a scientifically recognisable form to the first diagnostic outlines gathered in the interpersonal communication; and thirdly, the holistic reflection is examined, which returns the doctor’s focus to the patient’s individual problems, after going through different and, at times, very high inference levels. It is not a question of phases, but of varyingly interwoven moments in the mind of the skilful clinician, which are based on the dialectics of identification/separation.