Diagnostic Reduction in Psychiatry: Ethical Issues and Implications for the Clinic

Abstract

This article addresses the theme of diagnostic reduction in psychiatry, a process by which necessarily complex and multifactorial situations are reduced to medical conditions. This process presents obvious pitfalls, but also certain functions, in particular that of circumscribing what the psychiatric judgment can legitimately or not focus upon. In parallel, I will discuss the distinctions between narrative and pathological suffering, as well as the moral and medical judgments that may be associated with them. This will lead me to argue in favour of a pragmatic attitude with regard to psychiatric diagnostic classification, i.e., with regard to the standardized term used to categorize and identify so-called mental health disorders. I will then highlight the implications for clinical practice, notably that a transparent discussion of these aspects with certain patients can benefit the therapeutic relationship and allow people with mental disorders to envisage a narrative that does not have to be limited to a psychiatric condition or be constituted by the rejection of the latter, but which can leave it a legitimate place. Ultimately, I hope that raising clinicians’ awareness of the ethical issues inherent in psychiatric diagnosis will limit the potentially pejorative and dehumanizing nature of diagnostic reduction, by allowing them to adopt reflexive and transparent attitudes on these issues.