We have so far focused (at a fairly high level of abstraction!) on what is involved in shedding light on the impact of social factors on mental illness by looking at the idea of causation implicit in aetiology and the connection between it and laws; at the prospects of understanding the connections by relating people to a rational structure of norms; and at the way in which societal values may determine what counts as illness. But all these approaches have involved levels of generality (though of different forms). What though of the prospect for understanding individuals as individuals?
As part of its attempt to improve person centred mental health care, the World Psychiatric Association, for example, has established an Institutional Program on Psychiatry for the Person which calls for an idiographic component alongside conventional criteriological diagnosis. This call for idiographic judgement reflects a concern that criteriological diagnosis is too crude a tool to capture the nature of human individuality. Idiographic judgement would be aimed at the particular details of an individual’s experiences, life history and values
But if so, what is idiographic understanding, does it threaten diagnostic validity and how does it relate to narrative understanding? In this session we examine the very brief guidance offered on an idiographic formulation by the WPA’s workgroup and a little more detail suggested b the psychiatrist Jim Phillips. But to shed further light on what idiographic understanding is supposed to be, we return to the original account of it by the the post-Kantian philosopher of science Wilhelm Windelband who first coined it.
The other word used by both IGDA and James Phillips to describe the addition to narrow criteriological diagnosis is ‘narrative’. This prompts two questions:
What is special or distinct about narrative understanding?
How does it differ from criteriological diagnosis?
As the forthcoming DSM V is aiming to place validity at the heart of psychiatric diagnosisif diagnosis is augmented by a form of narrative understanding aimed at capturing aspects of the subjectivity of individuals, can it be said to be valid? What sense attaches to this? That is, can narrative judgement about particular individuals aspire to validity?
Essential reading
IDGA Workgroup, WPA (2003) ‘IGDA 8: Idiographic (personalised) diagnostic formulation’ British Journal of Psychiatry, 18 (suppl 45): 55-7
Phillips, J. (2005) ‘Idiographic Formulations, Symbols, Narratives, Context and Meaning’ Psychopathology 38: 180-184
Windelband, W. (1980) ‘History and natural science’ History and Theory & Psychology 19: 169-85. Read this paper with the following question in mind: Does he substantiate what 'idiographic' judgement or understanding actually is?
Further reading
Thornton, T. (2008) ‘Does understanding individuals require idiographic judgement?’ European Archives of Psychiatry and Clinical Neuroscience 258 Suppl 5:104–109
Thornton, T. (2010) ‘Narrative rather than idiographic approaches as counterpart to the nomothetic approach to assessment’ Psychopathology 16: 284-291
The slides for this session are here.
Further reflection on this session is here.
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