The British Journal of Psychiatry: Volume 195 -

From the Editor's desk
Peter Tyrer
Published online by Cambridge University Press:

02 January 2018, p. 470
- Article
- - You have access
- PDF
- HTML
- Export citation
Classification in the dock
‘Dr Nosology, you are charged with bringing the science of classification into disrepute in your handling of psychiatric disorders. Specifically, you have developed a set of spurious categories that have no independent standing and which have led to confusion, doubt and error. How do you plead?’ It would take a tough-minded psychiatrist with a capacity for psychopathic dissociation to plead anything but ‘guilty as charged’ to this accusation, and we have admitted as much in our pages many times recently. This is sad, as diagnosis is intended to be one of the strongest assets of the psychiatrist. I have worked in many multidisciplinary psychiatric settings over the years and in some the hierarchy of management had become almost as flat as a pancake, but even in these the exercise of diagnosis was regarded as a skill that was the special province of the psychiatrist. So now is it really a false prospectus, exercised by an interpreter who pretends to be fluent in languages but in practice picks up only the odd word? Not yet, but in this issue Frances (pp. 391–392) reminds us that psychiatry is still only on the margins of diagnostic credibility. In the UK the initial part of medical training is called the first MB and so it is entirely appropriate that our bottom-line starter is by an author of the same title (First, pp. 382–390). This includes the worrying statistic that 21% of current diagnoses in the ICD and DSM classifications have conceptual differences, but as Jablensky (pp. 379–381) points out it would be quite bizarre if there was good agreement – it would almost represent scientific fraud. The search for validity as a long-term goal may seem to be a mirage, but at least we should try for clinical utility.