The nosological entity in psychiatry: a historical illusion or a moving target?

Assen Jablensky

in Philosophical Issues in Psychiatry II

Published on behalf of Oxford University Press

Published in print April 2012 | ISBN: 9780199642205
Published online February 2013 | e-ISBN: 9780191754777 | DOI:

Series: International Perspectives in Philosophy & Psychiatry

The nosological entity in psychiatry: a historical illusion or a moving target?

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By nosology we do not only mean the set of classification categories, but also—and above all—we have in mind the underlying theory about the nature of the conditions that are being classified and the principles and rules of the classifying process. Are we dealing with discrete, discontinuous entities, or with graded continuous phenomena to which we can apply a sliding rule of thresholds in order to separate “pathology” from “normal variation” and determine the need for treatment? What is the relationship between the clinical manifestations of a presumed “disorder” and the pathological processes or genetic aberrations, partial aspects and fragments of which are being progressively uncovered by research?

Questions like these have been asked and answered—variously—since the earliest stages of clinical research in psychiatry in the second half of the 19th century. Yet, notwithstanding the impressive recent achievements in the neuroscience and genetics of psychiatric disorders, many of the present day's answers to these basic questions are, in fact, variations on themes that have been played and replayed in the earlier periods of scientific psychiatry. This suggests that there may be inherent shortcomings in the mainstream nosological paradigm adopted in clinical psychiatry since the beginning of the 20th century that need to be critically examined and, possibly, transcended with the help of concepts and methodological tools that are available today. In my discussion of these issues I will focus primarily on the taxonomy of the major psychoses since their history epitomizes many of the controversies, conjectures and refutations that continue to cast a long shadow on the present juncture of classification revision involving both DSM and ICD.

Chapter.  8899 words. 

Subjects: Psychiatry

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