Diagnostic understanding and diagnostic explanation in psychiatry

Purpose of review To examine ways in which the validity of psychiatric diagnoses could be improved. Recent findings Genetic and neuroscientific explanations about the aetiology of psychiatric disorders could improve psychiatric diagnostic classification systems. However, the diagnostic classification systems would remain wanting without sufficient diagnostic understanding of patients' experiences, of cultural, group and personal values, and of contextual factors. Understanding is, for example, crucial for the clinical validity of diagnoses and in ethical decisions about capacity to give informed consent. Sophisticated ways to uncover diagnostic understanding of patients' experiences include empirical symptomatological investigations, interpretive studies, and analytical examinations in which the use of language features critically. Summary For a clinically valid diagnosis, scientific explanations should be balanced with an understanding of patients' experiences, the context, and the values of all the people involved.