Diagnosis and Its Discontents: Reflections on Our Current Dilemma

ABSTRACT

The author reflects on contemporary diagnostic conventions in mental health and their impact on clinical practice, framing the “neo-Kraepelinian” (descriptive and categorical) diagnostic shift that began with DSM-III as unintentionally destructive to effective psychotherapy. She describes the international project of creating and improving the Psychodynamic Diagnostic Manual, an effort to restore a clinically useful diagnostic sensibility that values inference, dimensionality, context, and meaning.

KEYWORDS:

• Diagnosis
• nosology
• personality
• symptoms
• PDM

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Notes on contributors

Nancy McWilliams

Nancy McWilliams, Ph.D., ABPP, teaches at Rutgers University’s Graduate School of Applied & Professional Psychology and has a private practice in Lambertville, New Jersey. She is author of Psychoanalytic Diagnosis (1994; rev. ed. 2011), Psychoanalytic Case Formulation (1999), Psychoanalytic Psychotherapy (2004), and Psychoanalytic Supervision (2021), all with Guilford Press. She has edited, coauthored, or contributed to several other books, and is Associate Editor of both editions of the Psychodynamic Diagnostic Manual (2006; 2nd ed. 2017). A former president of the Division of Psychoanalysis (39) of the American Psychological Association, she is on the editorial board of Psychoanalytic Psychology and on the Board of Directors of the Austen Riggs Center.

Dr. McWilliams graduated from the National Psychological Association for Psychoanalysis and is also affiliated with the Center for Psychotherapy and Psychoanalysis of New Jersey. She was featured in three master-therapist videos for the American Psychological Association and was plenary speaker for their 2015 convention. Dr. McWilliams is an honorary member of the American Psychoanalytic Association, the Moscow Psychoanalytic Society, the Institute for Psychoanalytic Psychotherapy of Turin, Italy, and the Warsaw Scientific Association for Psychodynamic Psychotherapy. Her writings have been translated into twenty languages.