C.W. Van Staden

Examining fallacies in diagnostic reasoning

The paper by Gurova takes issue with the claim of Meehl that ‘understanding makes it normal’ is a fallacy in diagnostic reasoning [1,2]. Her paper prompts the more general question of appropriate methods for testing whether a specific way of reasoning in making a clinical diagnosis is fallacious. So prompted, I will compare the methods that the Gurova paper deploys with some of requirements for testing whether a particular way of reasoning is fallacious. It should become clear in this comparison that the dictum ‘understanding it makes it normal’ per se is insufficient to proclaim whether reasoning by it is fallacious.

Ethics in Person-Centered Psychiatry

The Ethics of Person-centered Psychiatry (PCP) considers the person as central in psychiatric practice but recognizes it not only in the singular but also in the plural (i.e., people in society). Thus, PCP resonates not only with approaches that insist on the well-being of the individual vis a vis benefit to society (like the Helsinki Declaration on Medical research) but also with approaches like the Utilitarian theory of Jeremy Bentham in which an act is considered ethical if it gives pleasure to most people (societal perspective). Ancient Greek perspectives, modern perspectives, phenomenological contributions, the phenomenological perceptions of Max Scheler, the perspectives of H.-G. Gadamer, and Karl Jaspers are briefly reviewed. The person-centered perspective in Psychiatry as exemplified in the Madrid Declaration is further discussed, as well as the values-based ethical perspectives. It is concluded that person-centered perspectives are closely associated with Ethics and that this relationship provides fertile ground for discussion under clinical and philosophical vistas. The issue of priority of certain ethical principles vis a vis other ethical considerations in clinical psychiatric practice is one of the important issues to be discussed within this framework.

Health Experience and Values in Person-Centered Assessment and Diagnosis

Subjective experience is central to person-centered psychiatry for ethical, conceptual, and pragmatic reasons. Experience is central to what is of greatest concern to patients and drives help-seeking, coping, and treatment response. In the case of psychiatric disorders, alterations of experience may be crucial signs and symptoms of illness, indicating the nature of the problem and providing targets for intervention. In this chapter, we consider some of what is known about the nature of the processes of embodiment, interpretation, and enactment that contribute to subjectivity. We discuss phenomenological, cognitive-interpretive, and sociocultural approaches to illness experience. Both the experience and expression of health and illness depend on bodily, psychological, and interpersonal processes of perception, attention, interpretation, coping, and communication. We outline an approach to clinical assessment that gives explicit attention to patients’ experience and values through understanding the meanings of symptoms and suffering in social and cultural context.