Abstract
For health and social care practitioners, the accurate understanding of mental health problems is an important aspect of their effective amelioration. The practices of diagnosis and formulation have both been used for this task. The first has been associated with individual cases being allocated to pre-existing professionally agreed categories. The second is typically expressed by some form of tailored description of the patient's presenting problems in his or her life context. Both diagnoses and formulations are thus traceable to professional assumptions, expressed in codified forms of knowledge. This article provides a description of the tensions between diagnostic- and formulation-based mental health assessments. The picture emerging of theoretical contestation and practical compromise is then considered in relation to the potential sense-making value of social theories.
Similar content being viewed by others
References
Abbott, P. and Wallace, C. (eds.) (1990) The Sociology of the Caring Professions. London: Farmer Press.
American Psychiatric Association. (1947) Recommended graduate training program in clinical psychology. American Psychologist 2 (12): 539–558.
American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington DC: APA.
Baruch, G. and Treacher, A. (1978) Psychiatry Observed. London: RKP.
Bentall, R.P., Jackson, H. and Pilgrim, D. (1988) Abandoning the concept of schizophrenia: Some implications of validity arguments for psychological research into psychotic phenomena. British Journal of Clinical Psychology 27: 303–324.
Bieling, P.J. and Kuyken, W. (2003) Is cognitive case formulation science or science fiction? Clinical Psychology: Science and Practice 10 (1): 52–69.
Blashfield, R.K. and Burgess, D.R. (2007) Classification provides an essential basis for organizing mental disorders. In: S.O. Lilienfield and W.T. O’Donohue (eds.) The Great Ideas of Clinical Science: 17 Principles that Every Mental Health Professional Should Understand. New York: Routledge, pp. 93–117.
Brown, P. (1995) Naming and framing: The social construction of diagnosis and illness. Journal of Health and Social Behavior, Extra issue: 34–52.
Butler, G. (1999) Clinical formulation. Comprehensive Clinical Psychology 6: 1–24.
Carr, A. and McNulty, M. (2006) Classification and epidemiology. In: A. Carr and M. McNulty (eds.) The Handbook of Clinical Psychology: An Evidence-based Practice Approach. London: Routledge, pp. 42–60.
Cooper, R. (2004) What is wrong with DSM? History of Psychiatry 15 (1): 1–25.
Coulter, J. (1973) Approaches to Insanity. New York: Wiley.
Crellin, C. (1998) Origins and social contexts of the term ‘formulation’ in psychological case-reports. Clinical Psychology Forum 112: 18–28.
Crossley, N. (2005) Contesting Psychiatry. London: Routledge.
DeSwaan, A. (1990) The Management of Normality. London: Routledge.
Doerner, K. (1981) Madmen and the Bourgeoisie: A Social History of Psychiatry and Insanity. Oxford: Basil Blackwell.
Dohrenwend, B.P. (1998) A psychosocial perspective on the past and future of psychiatric epidemiology. American Journal of Epidemiology 147 (3): 222–229.
Double, D. (1990) What would Adolf Meyer have thought about the neo-Kraepelinian approach? Psychiatric Bulletin 1: 471–474.
Dryden, W. (ed.) (2002) Handbook of Individual Therapy. London: Sage.
Eells, T.D. (2002) Formulation. Encyclopedia of Psychotherapy 1: 815–822.
Engel, G. (1980) The clinical application of the biopsychosocial model. American Journal of Psychiatry 137: 535–544.
Eysenck, H.J. (1975) The Future of Psychiatry. London: Methuen.
Foucault, M. (1973) The Order of Things: An Archaeology of the Human Sciences. New York: Vintage Books.
Foucault, M. (1988) Technologies of the self. In: L. Martin (ed.) Technologies of the Self. London: Tavistock.
Frank, G. (1984) The Boulder model: History, rationale, and critique. Professional Psychology: Research and Practice 15 (3): 417–435.
Friedson, E. (1970) The Profession of Medicine. New York: Harper and Row.
Goffman, E. (1963) Stigma: Some Notes on Spoiled Identity. Harmondsworth, UK: Penguin.
Goffman, E. (1971) Relations in Public. Harmondsworth, UK: Penguin.
Healy, D. (1997) The Anti-depressant Era. London: Harvard University Press.
Hinsie, L.E. (1931) Criticism of treatment and recovery in schizophrenia. Proceedings of the Association for Research in Nervous and Mental Disease for 1928. Schizophrenia (dementia praecox). Baltimore: Williams and Wilkins.
Ingleby, D. (ed.) (1980) Critical Psychiatry. Harmondsworth, UK: Penguin.
Ingleby, D. (1985) Mental health and social order. In: S. Cohen and A. Scull (eds.) Social Control and the State. Oxford: Basil Blackwell.
Johnstone, L. (2006) Controversies and debates about formulation. In: L. Johnstone and R. Dallos (eds.) Formulation in Psychology and Psychotherapy: Making Sense of People's Problems. London: Routledge, pp. 208–235.
Johnstone, L. and Dallos, R. (2006) Introduction to formulation. In: L. Johnstone and R. Dallos (eds.) Formulation in Psychology and Psychotherapy: Making Sense of People's Problems. London: Routledge, pp. 1–16.
Kirk, S.A. and Kutchins, H. (1988) The business of diagnosis: DSM III and clinical social work. Social Work 33: 215–220.
Kirk, S.A. and Kutchins, H. (1994) The myth of the reliability of DSM. The Journal of Mind and Behavior 15 (1 and 2): 71–86.
Kraepelin, E. (1883) Compendium der Psychiatrie. Leipzig, Germany.
Laing, R.D. (1959) The Divided Self. London: Tavistock.
Lane, D.A. and Corrie, S. (2006) The Modern Scientist-practitioner. London: Routledge.
Lemert, E. (1974) Beyond reach: The social reaction to deviance. Social Problems 21: 457–467.
McPherson, S. and Armstrong, D. (2006) Social determinants of diagnostic labels in depression. Social Science and Medicine 62 (1): 50–58.
McWilliams, N. (1994) Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process. New York: Guildford Press.
Mellsop, G.W. (2006) A concise conceptualisation of formulation. Academic Psychiatry 30 (5): 424–425.
Moncrieff, J. (2008) The Myth of the Chemical Cure. Basingstoke, UK: Palgrave.
Moynihan, R. and Cassels, A. (2005) Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All into Patients. New York: Nation Books.
Pentony, P. (1981) Models of Influence in Psychotherapy. New York: Free Press.
Persons, J.B. and Mikami, A.Y. (2002) Strategies for handling treatment failure successfully. Psychotherapy: Theory/Research/Practice/Training 39 (2): 139–151.
Pilgrim, D. (2007) The survival of psychiatric diagnosis. Social Science and Medicine 65: 536–547.
Pilgrim, D. (2008) The eugenic legacy in psychology and psychiatry. International Journal of Social Psychiatry 54: 272–284.
Pilgrim, D. and Bentall, R.P. (1998) The medicalisation of misery: A critical realist analysis of the concept of depression. Journal of Mental Health 8 (3): 261–274.
Pilgrim, D. and Treacher, A. (1992) Clinical Psychology Observed. London: Routledge.
Raimy, V.C. (1950) Training in Clinical Psychology. New York: Prentice-Hall.
Rogers, A. and Pilgrim, D. (2003) Mental Health and Inequality. Basingstoke, UK: Palgrave.
Rose, N. (1990) Governing the Soul. London: Routledge.
Saks, M. (1983) Removing the blinkers? A critique of recent contributions to the sociology of the professions. Sociological Review 33: 1–21.
Sarason, S.B. (1981) An asocial psychology and a misdirected clinical psychology. American Psychologist 36 (8): 827–836.
Scheff, T. (1966) Being Mentally Ill: A Sociological Theory. Chicago, IL: Aldine.
Scott, M.J. and Sembi, S. (2006) Cognitive behaviour therapy treatment failures in practice: The neglected role of diagnostic inaccuracy. Behavioural and Cognitive Psychotherapy 34: 491–495.
Scull, A. (1979) Museums of Madness. Harmondsworth, UK: Penguin.
Scull, A. (1985) Humanitarianism or control? Some observations on the historiography of Anglo-American psychiatry. In: S. Cohen and A. Scull (eds.) Social Control and the State. Oxford: Basil Blackwell.
Smart, B. (1990) On the disorder of things: Sociology and the end of the social. Sociology 24 (3): 397–416.
Stone, M. (1985) Shellshock and the psychologists. In: W.F. Bynum, R. Porter and M. Shepherd (eds.) The Anatomy of Madness. London: Tavistock.
Szasz, T.S. (1961) The use of naming and the origin of the myth of mental illness. American Psychologist 16: 59–65.
Szasz, T.S. (1963) Law, Liberty and Psychiatry. New York: Macmillan.
Tarrier, N. et al (1998) A randomised control trial of intense cognitive behaviour therapy for chronic schizophrenia. British Medical Journal 317: 303–307.
Wakefield, J.C. (1992) The concept of mental disorder: On the boundary between biological facts and social values. American Psychologist 4 (3): 373–388.
Wilson, M. (1993) DSM-III and the transformation of American psychiatry: A history. American Journal of Psychiatry 150 (3): 399–410.
Witmer, L. (1925) Psychological diagnosis and the psychonomic orientation of analytic science. The Psychological Clinic 16 (1 & 2): 1–18.
World Health Organization. (1992) The ICD-10 Classification of Mental and Behavioural Disorders. Geneva: WHO.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pilgrim, D., Carey, T. Contested professional rationales for the assessment of mental health problems: Can social theories help?. Soc Theory Health 8, 309–325 (2010). https://doi.org/10.1057/sth.2010.11
Published:
Issue Date:
DOI: https://doi.org/10.1057/sth.2010.11