Health · Mental Health · 15 hrs ago
Washington University’s approach shaped psychiatric diagnosis
Psychiatrists at Washington University in St. Louis developed a new approach to diagnosis during the 1950s, 1960s and 1970s.
They wanted psychiatry to rely more on research evidence than on theory or professional agreement.
The approach looked beyond symptoms to how illnesses unfold over time and what outcomes they lead to.
That matters because different conditions can cause similar symptoms, while one condition can affect people in different ways.
A useful diagnosis should help indicate what an illness is and how it may progress, not just describe current symptoms.
The approach had wide influence, though some of its principles were later neglected; it is still taught to psychiatry residents at Washington University.
Its ideas inform a proposed validity-based hierarchy for DSM-6, the next edition of the American Psychiatric Association’s diagnostic manual, in a proposal due to appear in Psychiatric Services.
Psychiatrists at Washington University in St. Louis developed an approach that grounded psychiatric diagnosis in empirical research.
The approach took shape during the 1950s, 1960s and 1970s, led notably by Eli Robins, Samuel Guze and George Winokur.
It aimed to make psychiatric diagnoses more reliable and based them on evidence beyond symptoms, including the course and outcome of illness.
The approach had substantial influence, though the article says many of its central principles were later neglected.
The article links the tradition to a proposal for a validity-based diagnostic hierarchy in the forthcoming DSM-6.
- Who
- Psychiatrists at Washington University in St. Louis, notably Eli Robins, Samuel Guze and George Winokur.
- What
- They developed an empirical approach to psychiatric diagnosis that considered illness course and outcome as well as symptoms.
- When
- It was developed during the 1950s, 1960s and 1970s.
- Where
- Washington University in St. Louis.
- Why
- To ground psychiatric diagnosis in empirical research and establish psychiatry firmly as a branch of medicine.
Psychoanalytic approach
Washington University approach
Basis for diagnosis
Psychoanalytic approach
Psychoanalysts generally placed little emphasis on formal diagnosis and often classified patients broadly as neurotic or psychotic.
Washington University approach
Diagnosis should be grounded in empirical research, including symptoms and the course and outcome of illness.
Psychiatrists at Washington University in St. Louis developed their approach to psychiatric diagnosis.
The U.S.–U.K. Diagnostic Project found that American psychiatrists diagnosed schizophrenia at roughly twice the rate of British psychiatrists, largely because of differences in diagnostic practice.
David Rosenhan's study fueled public skepticism about psychiatric diagnosis; the article says the study was later discredited.
Goodwin and Guze emphasized that diagnosis is prognosis.
- Institution
- Washington University in St. Louis
- Key figures
- Eli Robins, Samuel Guze and George Winokur
- Development period
- 1950s, 1960s and 1970s
- U.S.–U.K. Diagnostic Project
- American psychiatrists diagnosed schizophrenia at roughly twice the British rate
- Proposed diagnostic hierarchy
- Validity-based hierarchy for DSM-6, proposed by the article's author and psychiatrist Ronald W. Pies
What people are saying
Diagnosis is prognosis.
Sources
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