The Lancet Psychiatry “Diagnosis Debate” Continues


The Lancet Psychiatry‘s December issue includes two letters commenting on Mary Boyle and Lucy Johnstone’s article, “Alternatives to psychiatric diagnosis,” along with a new letter on the topic from Boyle and Johnstone.

“Boyle has postulated that many patients diagnosed with schizophrenia in the past had encephalitis lethargica,” writes Robert McCutcheon. “If we accept this statement, would biologically based research targeting the clinical diagnosis have been indicated even though no tests existed to suggest a biological cause?”

“In view of all this weakness in the argument for diagnostic systems, we remain intrigued by the desire to retain them,” write Johnstone and Boyle. “Part of the answer might be, as we have said, that psychiatric diagnosis includes much more than a series of classifications. Psychiatric diagnosis reflects a whole way of thinking, embedded in social, psychological, political, and economic processes well beyond questions of its scientific status.”

“While these battles for the soul of psychiatry rage on, we offer a practical suggestion that all mental health practitioners can get along with in the meantime,” writes Sam Thompson. “In clinical practice, try as far as possible, to let the service users themselves identify the conceptual frame (ie, biological, psychological, social, or any combination thereof) within which their difficulties are understood.”

(Full text) The Lancet Psychiatry, Correspondence Section, Volume 1, Issue 7, December 2014.

See also previously:

Alternatives to Psychiatric Diagnosis? (Mad In America, October 23, 2014)


  1. “we offer a practical suggestion (…) try as far as possible, to let the service users themselves identify the conceptual frame”
    The suggestion that will be happily ignored as all the other good practice guidelines including not using benzos beyond 2-4 weeks and differential diagnosis for schizophrenia and so on…

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