Nosologomania: A Disorder of Psychiatry, by Herman van Praag
A denosologized psychiatry would focus on symptoms that, instead of being linked to particular conditions envisaged as discrete entities, would be shared by several conditions (as currently defined) and correlate with dimensions, such as aggression, anxiety, or mood. An instance, provided by Herman van Praag, a Maastricht University psychiatrist who has long criticized his field’s “nosologomania,” is the stress-inducible, “anxiety/aggression-driven depression” (van Praag 2005; on denosologizing, van Praag et al. 1987; van Praag 2000, 2010).
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.”
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:van Praag, Herman. 2010. “Biological Psychiatry: Still Marching Forward in a Dead End.” World Psychi...
Herman van Praag survived the Holocaust. Watch this great documentary about his story, directed by his grandson: