For van Praag (2008, 31), the reason why half a century of intensive research has failed to elucidate the biology of depression is that “insufficiently specified diagnostic constructs” will not turn out “to be caused by specific, well-definable pathological processes.”
Herman van Praag, Dutch psychiatrist.
For many years, psychiatry has been devoted to nosology. This disease model conceives psychiatric conditions as discrete entities, with a particular pathophysiology and predictable relations between phenomenology, course and outcome.
This model witnessed a true revival with the introduction of the DSM III. Its foundations, however, are weak. Many of the disorders, so delineated, are of doubtful validity. This is demonstrated, taking major depression as a paradigm. The nosological way of thought, moreover, carries with it harmful side effects, such as proliferation of new diagnoses, magnification of comorbidity, border problems and neglect of the factor psychogenesis.
The question is raised of a possible alternative disease model and the reaction form model is considered to be just that. This model is defined and discussed and the conclusion is reached that it fits clinical practice and biological research better than the nosological disease model.
A reconstruction of the diagnostic process in psychiatry is proposed, in such a way that it gains in sophistication and at the same time creates opportunities for comparative studies of the merits of the nosological and the reaction form model for psychiatric practice and research.
Find this article by Herman van Praag, along with all the others mentioned by Vidal and Ortega, on the links below:
Herman van Praag survived the Holocaust. Watch this great documentary about his story, directed by his grandson:
Inspired by the homonymous book by Fernando Vidal and Francisco Ortega, this timespace presents the authors' genealogy of the cerebral subject and the influence of the neurological discourse in human sciences, mental health and culture.