Abstract
In this chapter Stijn Vanheule argues that all diagnostic assessment implies value-laden judgment, and as a result great care must be taken with respect to whose opinions predominate in diagnostic judgment about what is acceptable and what is normal. Psychopathology, abnormality, and mental disorder are the core concepts reviewed. Starting from the work of Canguilhem it is demonstrated that decision-making about normality and abnormality typically builds on external norms, such as opinions of others, or statistical norms. In the diagnosis of psychopathology, the subjective experience of pathos or suffering is central. Through its focus on mental disorders, the DSM-5 mainly builds on an assessment of abnormality. Vanheule makes a plea for focusing on psychopathology, and for studying the quality of mental suffering in case formulations or case constructions.
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Notes
- 1.
Studies using these instruments indicate that qua symptom mental suffering is indeed distinguishable from other psychiatric symptoms. Psychic pain, or psychache, is an indicator for the severity of a psychopathological condition, and of suicidality, and patients often experience it as much harder to tolerate than somatic pain, to which it is often linked. Yager (2015, p. 941) hypothetically suggests: “psychic pain might be experienced as gut-wrenching, teeth-gnashing anguish that often seems embedded in noxious somatic sensations, which, one might speculate, result from the fact that the neural networks serving these pain functions highly overlap.”
- 2.
Bruce Fink translated “Gardez-vous de comprendre” as “Don’t try to understand.” I believe “Beware of understanding” is better.
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Vanheule, S. (2017). From Mental Suffering to Mental Disorder and Back Again. In: Psychiatric Diagnosis Revisited. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-44669-1_4
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