The Nosology of Mental Disorders

Abstract

A physician who was not a psychiatrist and who was participating in a symposium on diagnosis, whether at the national or international level, would be astounded at the ease with which the various participants in the symposium, all highly trained specialists, gave completely different diagnoses to one and the same patient. The range of diagnoses is so broad that it sometimes covers every nosological classification of mental illness; and it even often happens that some psychiatrists will diagnose a chronic, progressive psychosis in a patient others will pronounce mentally normal. This state of affairs cannot be explained merely by the burst of polemics among different schools that usually takes place at such diagnostic symposia. In one of his articles Conrad (1) describes a typical case in which a patient received four different psychiatric diagnoses within a short span of time at four different mental hospitals in West Germany.