The concept of context in psychiatric diagnosis

Abstract

First, the author analyses the use of the concept of contextualisation in discussions of the possibility of a comprehensive diagnosis and, specifically, an ideographic diagnostic formulation. Certain blind spots and ambiguities are demonstrated in the concept as it is used in the WPA’s Institutional Program on Psychiatry for the Person and in the supplements of the workgroup for the International Guidelines for Diagnostic Assessment. It is shown how these ambiguities in some cases lead to validity problems, in other cases to reliability problems. The author then explains why the concept of context is introduced into the theory of psychiatry at all and identifies its advantages and pitfalls. To avoid the pitfalls and sustain the advantages, the author presents a critically founded model of context motivated by contextual epistemology and epistemic logic. The model’s use is demonstrated in the outline of a practical instrument of contextualisation. The model neither reduces contextual information to a detached supplement to diagnosis, which would undermine its validity value, nor does it give contextualisation the power to relativise the standardised typologies and scales, and thus opening up reliability problems. Instead, it shows how contextual information is used in justifying what evidence counts as relevant in applying the standardised typologies and scales.