Discourse and Diagnosis: A Comparison between the Medical Model and Lacanian Approach to Diagnosis using a Clinical Example of Anorexia Nervosa (original) (raw)

Diagnosis as dialogue: historical and current perspectives

Dialogues in Clinical Neuroscience

Ever since psychiatry emerged as a clinical discipline and field of scientific inquiry in the late 18th century, debates about diagnosis have been at its very heart. Considered by many a requirement for clinical communication as well as for systematic study, others have critiqued psychiatric diagnosis for being modeled on a medical conception of disease that is ill-suited to the specific nature of mental disorders. Based on a review of seminal positions in the conceptual history of psychiatry and an examination of their epistemological underpinnings, we propose to consider diagnosis as dialogue. Such understanding, we argue, can serve as a meta-framework that provides a conceptual and practical umbrella to encourage open-minded conversation across the diverse conceptual and experiential frameworks that are characteristic of psychiatry. In this perspective psychopathology will also reinforce the interpersonal realm as a necessary element of any clinical encounter, be it diagnostic in...

Beyond the clinic? Eluding a medical diagnosis of anorexia through narrative

Transcultural Psychiatry, 2018

The persistence and recurrence of anorexia nervosa poses a clinical challenge, and provides support for critiques of oppressive and injurious facets of society inscribed on women’s bodies. This essay illustrates how a phenomenological, linguistic anthropological approach fruitfully traverses clinical and cultural perspectives by directing attention beyond the embodied experience of patients diagnosed with anorexia nervosa to those who are not clinically diagnosed. Extending a model of illness and recovery as entailing sufferers’ emplotting of past, present, and imagined future selves, I argue that women’s accounts of their experiences do not simply reflect lived reality, but actually propel health-relevant states of being by enlivening and creating these realities in the process of their telling. In indexical interaction with public and clinical discourses, narratives’ grammar, lexicon, and plot structures modify subjects’ experiences and interpretations of the events and feelings recounted. This article builds on the insight that linear narratives of “full recovery” that adopt a clinical and feminist voice can help tellers stay recovered, whereas for those “struggling to recover,” a genre of contingent, uncertain, sideshadowing narratives alternatively renders recovery an elusive and ambivalently desired object. This essay then identifies a third narrative genre, eluding a diagnosis, which combines elements of the first two genres to paradoxically keep its teller simultaneously sheltered from, and invisible to the well-meaning clutches of medical care, leaving her suffering, yet free, to starve. This focus on narrative genres illustrates the utility of linguistic analyses for discerning and interpreting distress in sub-clinical populations.