Classifying Mental Disorders Nontraditional Approaches

Theodore R. Sarbin Ernest Keen

University of California, Santa Cruz Bucknell University

I. Introduction

II. The Purposes of Classification

III. The Traditional Approach to Classification

IV. The Contextualist Construction of Deviant Conduct

V. Assumptions and Alternatives

VI. Diagnosing within a Contextualist Framework

VII. Coda

Contextualism A worldview that requires taking into account the entire context in which actors' behavior takes place. For human beings, the context is largely symbolic and languaged so that one must consider the meanings that persons assign to aspects of their worlds.

Discourse Analysis Analysis of the verbal and nonverbal communication contexts within which meanings of the world and its events and objects are constructed.

Historical Act The root metaphor of contextual-ism, the basic concept for interpreting conduct as addressing the world in its narrative flow, thus assuming a past and anticipating a future. Internality A characteristic of traditional diagnostic language that locates the crucial context for understanding the causes of conduct as internal to the actor, tending to neglect other contexts. Mechanistic A worldview for understanding conduct in terms of the properties of machines, such as the transmission of energy.

Narrative The story, implicit or explicit, that con-textualizes and gives meaning to human conduct; the story may be idiosyncratic but most often is borrowed from the stock of stories that comprise a culture. Nosology A classification system of diseases assumed to be discrete entities, such as tuberculosis or measles.

Root Metaphor The basic concept, often implicit, of a particular worldview that facilitates some interpretations of the world and forecloses others. The machine and the historical act are root metaphors for, respectively, the mechanistic worldview and the con-textualist worldview.

Strategic Actions Intentional acts performed by a person directed toward solving identity and existential problems.

Classifying for purposes of research or intervention is a feature of the scientific method. Traditional methods for CLASSIFYING MENTAL DISORDERS emerged from 19th century advances in the biological sciences basic to the science and practice of medicine. Underlying such advances was the explicit adoption of the world view of mechanism, the root metaphor of which was the transmittal of forces. In this context, physicians constructed systems for classifying organic disease. These systems provided the model for traditional psychiatric diagnostic and classification systems.

Nontraditional classification systems flow from an alternate worldview—contextualism, the root meta

Classifying Mental Disorders: Nontraditional Approaches phor of which is the historical act in all its complexities. Instead of relying on the medically inspired concept of psychopathology, nontraditional practitioners speak of "unwanted conduct.'' This practice explicitly recognizes that a moral judgment is being made on the strategic actions that people employ to solve their problems in living. In the nontraditional method described in this article, classification is not of disease processes but of interactional strategies and the conditions that influence the success or failure of such strategies.

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