The survival of psychiatric diagnosis
Abstract
Past and current debates about applying medical diagnoses to psychological difference in society are examined. Beginning with a brief historical overview from antiquity to 'anti-psychiatry' and a summary of recent debates, the article then offers two case studies of common diagnoses ('depression' and 'schizophrenia'). The main challenge for social science is no longer about what is wrong with psychiatric diagnosis (that is now well rehearsed) but how to account for how and why it has survived. In answering this question about survival, inter-disciplinary work could attend to the pre-empirical positions of mental health researchers; the ways in which mental disorders are similar and different to physical disorders; and the interest work of different social groups defending or attacking psychiatric diagnoses in varying contexts.
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Syndromal diagnoses are clinical judgments that lack independent validation, and so what is or is not a disease is, to a large extent, socially negotiated through scientific discussion and clinical practice.
“Conveniently, syndromal diagnoses are clinical judgments that lack independent validation, and so what is or is not a disease is, to a large extent, socially negotiated through scientific discussion and clinical practice [115]”
From Psychological Treatment of Exhaustion Due to Persistent Non-Traumatic Stress: A Scoping Review. (2024) · cites this paper as [115]
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BackgroundReading ‘Happiness’: CBT and the Layard thesis
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“Consequently, we need to understand the variety of interests that maintain categories that are scientifically dubious and are experienced often as stigmatising and unhelpful by their recipients (Pilgrim, 2007).”
BackgroundInfluentialSelf-citationLynch, J. M., Askew, D. A., Mitchell, G. K., & Hegarty, K. L. (2012) · Social Science & Medicine · doi:10.1016/j.socscimed.2011.08.043 · Cited by 23 · see citing works
“Despite all this debate, use of the psychiatric diagnosis as gold standard has persisted (Pilgrim, 2007), and the practice of those primary care practitioners who do not adhere to this standard is declared not conventionally evidence based (Small, 2003).”
BackgroundCampos‐Castillo, C., Thomas, B. J., Reyes, F. E. M., & Laestadius, L. I. (2021) · JMIR Mental Health · doi:10.2196/26176 · Cited by 16 · see citing works
Lavie‐Ajayi, M., & Nakash, O. (2015) · Qualitative Social Work · doi:10.1177/1473325015604043 · Cited by 17 · see citing works
“Moreover, more critical views of the use of psychiatric diagnosis suggests that medicalizing psychiatric nosology and discounting the political context in which psychopathology emerges—is used to justify predetermined social structures, and at the same time, it serves to control and contain disturbed behavior and prov…”
BackgroundPsychological Treatment of Exhaustion Due to Persistent Non-Traumatic Stress: A Scoping Review.
van de Leur, J. C., Jovicic, F., Åhslund, A., McCracken, L. M., & Buhrman, M. (2024) · International Journal of Behavioral Medicine · doi:10.1007/s12529-023-10185-y · Cited by 16 · see citing works
“Conveniently, syndromal diagnoses are clinical judgments that lack independent validation, and so what is or is not a disease is, to a large extent, socially negotiated through scientific discussion and clinical practice [115], which currently centers around the ICD and DSM.”
BackgroundThe clinical phenomenology and classification of child and adolescent anxiety
Fonseca, A. C., & Perrin, S. G. (2011) · Cambridge University Press eBooks · doi:10.1017/cbo9780511994920.003 · Cited by 16 · see citing works
Henckes, N. (2019) · Culture Medicine and Psychiatry · doi:10.1007/s11013-019-09636-7 · Cited by 16 · see citing works
L’organisation sociale des « hasards heureux ». Qu’est-ce qu’un soin en psychiatrie ?
Brossard, B. (2013) · Sociologie du Travail · doi:10.1016/j.soctra.2012.12.003 · Cited by 15 · see citing works
The ABCs of Autism: Aspects of Maternal Pedagogy in Australia
Lilley, R. (2011) · Social Analysis · doi:10.3167/sa.2011.550107 · Cited by 15 · see citing works
The rhetoric/reality gap in social determinants of mental health
Larsson, P. (2013) · Mental Health Review Journal · doi:10.1108/mhrj-04-2013-0013 · Cited by 13 · see citing works
“With the medical model firmly established as a grand narrative, fundamental assumptions about the nature of mental health problems are maintained, including: that they are naturally occurring categories; that they are inherited categories with a predictable deteriorating course; and, that the symptoms of mental illnes…”
BackgroundCritical Psychiatry, Critical Psychology, and the Behaviorism of B. F. Skinner
Goddard, M. J. (2014) · Review of General Psychology · doi:10.1037/gpr0000012 · Cited by 13 · see citing works
“Indeed, the objections to psychiatric diagnosis are now so widespread (and well rehearsed) that the main challenge for social science is to explain how and why psychiatric diagnosis has managed to survive (Pilgrim, 2007).”
BackgroundWhither DSM and ICD, Chapter V?
Middleton, H. C. (2008) · Mental Health Review Journal · doi:10.1108/13619322200800023 · Cited by 9 · see citing works
Douglas, B. (2009) · Cited by 10 · see citing works
Pilgrim, D. M., & Carey, T. A. (2010) · Social Theory & Health · doi:10.1057/sth.2010.11 · Cited by 9 · see citing works
Self-citationCampo‐Arias, A., & Herazo, E. (2016) · Revista Colombiana de Psiquiatría · doi:10.1016/j.rcp.2016.08.008 · Cited by 11 · see citing works
Making sense of the evolving nature of depression narratives and their inherent conflicts
Ridge, D. (2018) · Subjectivity · doi:10.1057/s41286-018-0048-z · Cited by 9 · see citing works
“1 Making sense of the evolving nature of depression narratives and their Originally a psychiatric diagnosis fashioned by Western psychiatry in the 20th Century, depression evolved to encompass varying lineages of discourse and care.”
InfluentialClinical psychology in psychiatric services: The magician’s assistant?
Coles, S., Diamond, B., & Keenan, S. (2009) · Clinical Psychology Forum · doi:10.53841/bpscpf.2009.1.198.5 · Cited by 9 · see citing works
An exploratory statistical approach to depression pattern identification
Feng, Q., Griffiths, F. E., Parsons, N., & Gunn, J. M. (2012) · Physica A Statistical Mechanics and its Applications · doi:10.1016/j.physa.2012.10.025 · Cited by 8 · see citing works
“Depression remains a problem for primary care practice and research [4].”
BackgroundA crisis of meaning: can ‘schizophrenia’ survive in the 21st century?
Tew, J. (2017) · Medical Humanities · doi:10.1136/medhum-2016-011077 · Cited by 8 · see citing works
Theoretical Paper Counselling psychology and diagnostic categories: A critical literature review
Larsson, P., Brooks, O., & Loewenthal, D. (2012) · Counselling Psychology Review · doi:10.53841/bpscpr.2012.27.3.55 · Cited by 8 · see citing works
Personality disorders: illegitimate subject positions
Crowe, M. (2008) · Nursing Inquiry · doi:10.1111/j.1440-1800.2008.00417.x · Cited by 8 · see citing works
Women’s Mental Health: A Critique of Hetero-Patriarchal Power and Pathologization
Ussher, J. M. (2023) · Springer eBooks · doi:10.1007/978-3-031-41531-9_24 · Cited by 7 · see citing works
Santiago-Delefosse, M. J. (2011) · Bulletin de psychologie · doi:10.3917/bupsy.511.0005 · Cited by 7 · see citing works
From Talk to Action: Mapping the Diagnostic Process in Psychiatry
Godderis, R. (2011) · Advances in medical sociology · doi:10.1108/s1057-6290(2011)0000012011 · Cited by 6 · see citing works
Tosh, J., & Golightley, S. (2016) · Springer eBooks · doi:10.1007/978-3-319-41174-3_8 · Cited by 6 · see citing works
Making sense of melancholy: Sub-categorisation and the perceived risk of future depression
Browne, T. K., & Iqbal, F. (2012) · Health Risk & Society · doi:10.1080/13698575.2012.661039 · Cited by 5 · see citing works
“…emergence of pharmaceuticals for the treatment of unipolar and bipolar depression has played an important role in shifting psychiatry towards this categorisation of depression and away from the exogenous–endogenous distinction (Pilgrim and Bentall 1999, McPherson and Armstrong 2006, Pilgrim 2007).”
BackgroundWhat is theBritish Journal of Clinical Psychologyfor?
Pilgrim, D. M. (2008) · Clinical Psychology Forum · doi:10.53841/bpscpf.2008.1.189.15 · Cited by 5 · see citing works
Self-citationInfluencing Mental Health Policy and Planning: DSM–5 as a Disciplinary Challenge for Psychology
Pilgrim, D. M. (2014) · Review of General Psychology · doi:10.1037/gpr0000021 · Cited by 5 · see citing works
“A range of communities of interest sustain diagnostic psychiatry, and it is clear that to date it has not collapsed from its own internal contradictions and scientific inadequacies, nor has it been sustained simply by asserted medical preeminence (Pilgrim, 2007).”
BackgroundSelf-citationInterdependent Concepts and their Independent Uses: Mental Imagery and Hallucinations
Smith, E. T. (2018) · Perspectives on Science · doi:10.1162/posc_a_00278 · Cited by 5 · see citing works
“For more on these other concepts, see: Rabkin 1970; Scull 1983; Pilgrim 2007; Berrios 2013; 2014.”
BackgroundButler, C. (2019) · Social Science & Medicine · doi:10.1016/j.socscimed.2019.03.038 · Cited by 5 · see citing works
Liersch-Sumskis, S. (2013) · Research Online (University of Wollongong) · Cited by 5 · see citing works
Exploring the Connection Between Underdiagnosed Mental Health Issues and Societal Stigma in the UAE
Behi, A. K., Guzelel, D. M., & Mari, L. W. (2024) · International Journal of Innovative Science and Research Technology (IJISRT) · doi:10.38124/ijisrt/ijisrt24may1628 · Cited by 4 · see citing works
A Critical Discursive Perspective on Psychiatric Hospitals
Bone, C., & Marchant, N. (2016) · Palgrave Macmillan UK eBooks · doi:10.1057/9781137496850_24 · Cited by 4 · see citing works
Coles, S., & Mannion, A. (2017) · Palgrave Macmillan UK eBooks · doi:10.1057/978-1-137-51018-1_27 · Cited by 4 · see citing works
Psychiatry’s little other: DSM-5 and debates over psychiatric science
Decoteau, C. L., & Sweet, P. L. (2016) · Social Theory & Health · doi:10.1057/s41285-016-0013-2 · Cited by 4 · see citing works
Assessment of Psychiatric Outcomes in Japan Based on Diagnostic Procedure Combination Information
Abe, T., Ikeda, K., Kuroda, K., & Hagihara, A. (2010) · Psychiatric Quarterly · doi:10.1007/s11126-010-9158-7 · Cited by 4 · see citing works
“Although several countries (Australia [10], Germany [11], and the UK [ 12 ]) have introduced DRG or casemix approaches, these programs could not precisely reflect the content and outcomes of psychiatric care in particular because the framework employed in the programs was too simplistic to appropriately evaluate this…”
BackgroundThe therapeutic value of communicating a diagnosis
Kelly, K. V. (2018) · Journal of Communications In Healthcare · doi:10.1080/17538068.2018.1444726 · Cited by 3 · see citing works
The Power of Madness: A Marxist Critique of Social Constructionism
Cohen, B. M. Z. (2013) · BRILL eBooks · doi:10.1163/9781848882034_008 · Cited by 3 · see citing works
Legitimising depression: community perspectives and the help-seeking continuum
Gilbert, A. S., Antoniades, J., Bowen, Z., & Brijnath, B. (2019) · Health Sociology Review · doi:10.1080/14461242.2019.1670090 · Cited by 3 · see citing works
“Brijnath & Antoniades, 2016; Deacon & Baird, 2009; Dowrick, 2013; Pilgrim, 2007).”
BackgroundMethodInfluentialCampo‐Arias, A., & Herazo, E. (2018) · Revista Colombiana de Psiquiatría (English ed ) · doi:10.1016/j.rcpeng.2017.12.008 · Cited by 3 · see citing works
A Genetic Neuro-Fuzzy System for Diagnosing Clinical Depression
Adegboyega, A., & Agboizebeta, I. A. (2021) · Machine Learning Research · doi:10.11648/j.mlr.20210602.12 · Cited by 3 · see citing works
“It is also known to be a major contributor to the global burden of diseases [4], and affects humans irrespective of sex, race, and age [2, 5, 6].”
Supporting Students' Mental Health and Emotional Well-Being in Inclusive Classrooms
Graham, D., Killoran, I., & Parekh, G. (2015) · Advances in early childhood and K-12 education · doi:10.4018/978-1-4666-9452-1.ch005 · Cited by 3 · see citing works
Somali male refugees: Perceptions of depression and help-seeking
Rae, S. (2014) · UEL Research Repository (University of East London) · doi:10.15123/pub.4181 · Cited by 3 · see citing works
Struggling for clarity : cultural context, gender and a concept of depression in general practice
Lehti, A. (2009) · KTH Publication Database DiVA (KTH Royal Institute of Technology) · Cited by 3 · see citing works
The Use and Misuse of Psychometrics in Clinical Settings
Scoyoc, S. V. (2017) · doi:10.1002/9781119183020.ch13 · Cited by 3 · see citing works
The Problem With Decontextualized Approaches
Cosgrove, L., Peters, S. M., Karter, J. M., & Vaswani, A. (2018) · Women s Reproductive Health · doi:10.1080/23293691.2018.1429524 · Cited by 3 · see citing works
Desmarais, S. L. (2016) · University of the Arts London Research Online (University of the Arts London) · Cited by 3 · see citing works
Naissance d'une psychiatrie critique anglo-saxonne, perspectives et limites
Santiago-Delefosse, M. J., Nicole, A., & Sautter, C. S. (2011) · Encyclopédie médico-chirurgicale. Psychiatrie · doi:10.1016/s0246-1072(11)52766-x · Cited by 2 · see citing works
Social dystonia and psychosis: An alternative perspective
Pilgrim, D. M. (2013) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867413491160 · Cited by 2 · see citing works
“Indeed all forms of functional diagnosis are caught in this tautology, not just those alluding to the presentation of psychotic symptoms (Pilgrim, 2007).”
BackgroundSelf-citationDeux représentations sociales des troubles bipolaires
Fromentin, C. (2014) · Perspectives Psy · doi:10.1051/ppsy/2014534320 · Cited by 2 · see citing works
Classification in psychiatry: Inevitable but not insurmountable
Green, H. (2014) · Social Theory & Health · doi:10.1057/sth.2014.11 · Cited by 2 · see citing works
“Such is the pedigree of the ‘anti-nosological’ position (I draw here on a term coined by Meehl, 1973 to describe clinicians who reject labelling) that Pilgrim (2007) is emboldened to state:”
BackgroundSupporting Students' Mental Health and Emotional Well-Being in Inclusive Classrooms
Graham, D., Killoran, I., & Parekh, G. (2016) · IGI Global eBooks · doi:10.4018/978-1-5225-0778-9.ch029 · Cited by 2 · see citing works
Mental health, subjectivities and forms of neuroscience: a critical realist examination
Pilgrim, D. M. (2019) · Social Theory & Health · doi:10.1057/s41285-019-00088-y · Cited by 2 · see citing works
Self-citationShould we be doing more to reduce stigma?
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The art of debate: Attempts to open up a questioning space
Keenan, S., & Coles, S. (2012) · Clinical Psychology Forum · doi:10.53841/bpscpf.2012.1.233.19 · Cited by 2 · see citing works
Technology Tools Supportive of DSM-5: An Overview
Clark, N., Herman, T., Halverson, J. L., & Trivedi, H. K. (2015) · Health informatics · doi:10.1007/978-3-319-14109-1_10 · Cited by 2 · see citing works
A grounded theory analysis of the forms of support on two online anorexia forums
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Behavioural Activation Interventions for Depression and Well-being
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Negotiating Diagnostic Talk in Psychotherapy
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Aspects of Diagnosed Mental Illness and Offending
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Self-citationPsychiatric Gaslighting: The Surveillance of Mental Illness during Pregnancy
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“[L]abels of Themselves Condition Our Perceptions”: The DSM and the Diagnostic Sign of Schizophrenia
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- Authors
- Pilgrim, D.
- Affiliations
- University of Lancashire (GB)
- Corresponding author
- Pilgrim, David
- ORCID
- Pilgrim, David
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2007-08
- Volume
- 65
- Issue
- 3
- Pages
- 536-547
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W2041142984
- Cited by
- 156
- References
- 86
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 16 · 2023: 3 · 2021: 5 · 2020: 3 · 2019: 10 · 2018: 8 · 2017: 10 · 2016: 8 · 2015: 9 · 2014: 11 · 2013: 13 · 2012: 16
- FWCI
- 75.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- CLOK (University of Central Lancashire) (submittedVersion)
- Topics
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Clinical Psychology › Historical Psychiatry and Medical Practices
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Keywords
- psychiatric diagnosis, medicalization of mental disorders, antipsychiatry, history of psychiatry, depression, schizophrenia, social construction of mental illness, interdisciplinary research
- MeSH terms
- Depressive Disorder, Humans, Public Opinion, Schizophrenia, Schizophrenic Psychology, Social Environment
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