Realismo e pragmatismo em psiquiatria: um debate / Realism and pragmatism in Psychiatry: a debate / Réalisme et pragmatisme em Psychiatrie: un débat / Realismo y pragmatismo en Psiquiatría: un debate / Realismus und Pragmatismus in der Psychiatrie: eine Debatte

O artigo apresenta um debate sobre a natureza do objeto da psiquiatria. Apresentam-se duas perspectivas de abordagem da questão — o realismo e o pragmatismo. Segundo o realismo, as condições denominadas transtornos mentais existiriam de forma autônoma, a despeito da conceitualização humana. Já as perspectivas pragmáticas pressuporiam que transtornos mentais não são suficientemente explicados como tipos naturais, porque normas e interesses humanos sempre estariam presentes em classificações psiquiátricas. São descritas as características, diferenças e pontos de limitação dessas abordagens.

This paper presents a debate on the nature of the object of Psychiatry. Two approaches to the issue are discussed: realism and pragmatism. According to realism, would exist autonomously the conditions known as mental disorders regardless of human conceptualization. Pragmatist perspectives assume that mental disorders are not sufficiently explained as natural types, since human norms and interests are always at stake in the making of psychiatric classifications. The specific features, differences, and limitations of both approaches are described.

Les auteurs présentent une réflexion critique à propos de la nature de l’objet de la psychiatrie. D’emblée, ils postulent deux voies [approches] majeures permettant d’explorer cette question fondamentale: le réalisme et le pragmatisme. Selon le réalisme, les troubles mentaux existent comme des entites autonomes, de facon independant d’une structuration conceptuelle. D’autre part, l’approche pragmatique met en avant les enjeux sociaux ce qui permet d’en déduire et d’affirmer que les troubles mentaux ne sont pas réductible à de types naturels. Enfin, les auteurs examinent brièvement et mettent en évidence les caractéristiques et limites de ces différentes approches dans la clinique psychiatrique.

El artículo presenta un debate sobre la naturaleza del objeto de la psiquiatría. Son discutidas dos perspectivas del problema: realismo y pragmatismo. Para el realismo, los trastornos mentales existen autónomamente, a pesar de la conceptua-lización humana. Las perspectivas pragmáticas suponen que los trastornos mentales no pueden ser explicados suficientemente como tipos naturales, pues las clasificaciones psiquiátricas son siempre atravesadas por normas e intereses humanos. Son descritas las características, diferencias y límites de ambos enfoques.

In diesem Artikel präsentieren wir eine Debatte über die Natur des Objektes in der Psychiatrie. Wir bieten somit zwei perspektiven bezüglich dieser Problematik- den Realismus einerseits, und den Pragmatismus als gegen Stellung. Für den Realismus würden die sogenannten Bedingungen der Psychiatrischen Störungen auf autonomer Weise vorhanden sein, und dies trotz menschlicher Konstruktionen. Pragmatische Perspektiven setzten voraus das Psychische Störungen nicht genügend durch ‘natural kinds’ erklärt werden können, weil menschliche Normen und sonstige Interessen sonst immer in Psychiatrischen Klassifikationen zu finden sind. Die Charakteristiken, Unterschiede und Einschränkungen werden dieser Perspektiven werden hier beschrieben.

Classificando diferenças: as categorias demência precoce e esquizofrenia por psiquiatras brasileiros na década de 1920 / Classifying differences: the dementia praecox and schizophrenia categories used by Brazilian psychiatrists in the 1920s

Analisa o modo como os psiquiatras brasileiros Henrique Roxo e Murillo de Campos conceituaram e distinguiram as categorias diagnósticas de demência precoce e esquizofrenia, no final da década de 1920, em artigos publicados no principal periódico psiquiátrico à época. Observa-se como ambos se apropriaram do conhecimento europeu que forjou tais categorias e como as representaram no contexto da institucionalização da psiquiatria no Brasil. Busca compreender como esse processo de nomeação e definição cientifica de diagnóstico se articulava à produção da diferença entre o que deveria ser considerado fenômeno, no que se refere à patologia mental.

The Viewpoints of Psychiatrists on Psychiatric Classification in East Asian Countries / 신경정신의학

OBJECTIVES : Though both International Classfication of Disease (ICD) and Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV) are currently in use for psychiatric diagnosis in practice, education, research and reimbursement of medical fees in Asian countries, there seem to be few studies about similarities and differences among them in terms of viewpoints on psychiatric classification. METHODS : A questionnaire which has been developed to investigate the views of psychiatrists on their requirements of a classification system, and their opinions on those currently in use was translated into each language and adopted as survey tool in four East Asian countries. The total number of responses obtained was 703 (Korea, n=154;Japan, n=124;China, n=192, and Taiwan, n=233) although the method of data collection varied across all 4 countries. Since the response rate varied in these countries depending upon the convenience of sampling procedures, we compared percentages of responses to each of the questions instead of conducting a statistical analysis across them. RESULTS : The comparison of surveyed data revealed diversity in the utilization, preferences and opinions for further revision of the DSM and the ICD classification systems in East Asia. Psychiatrists in China and Japan routinely used the ICD, while those in Korea and Taiwan favored the DSM. The majority of Asian psychiatrists expressed the view that reliable inter-clinician communication is considered the main purpose of a classification system. Psychiatrists seemed to prefer classifications with 30-100 diagnostic options. CONCLUSION : Though there was limitation in terms of representation due to sampling methods, East Asian psychiatrists showed different pattern on the use of DSM and ICD across countries and had negative viewpoints on current diagnostic classification systems in terms of transcultural use.

The Viewpoints of Psychiatrists on Psychiatric Classification in East Asian Countries / 신경정신의학

OBJECTIVES : Though both International Classfication of Disease (ICD) and Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV) are currently in use for psychiatric diagnosis in practice, education, research and reimbursement of medical fees in Asian countries, there seem to be few studies about similarities and differences among them in terms of viewpoints on psychiatric classification. METHODS : A questionnaire which has been developed to investigate the views of psychiatrists on their requirements of a classification system, and their opinions on those currently in use was translated into each language and adopted as survey tool in four East Asian countries. The total number of responses obtained was 703 (Korea, n=154;Japan, n=124;China, n=192, and Taiwan, n=233) although the method of data collection varied across all 4 countries. Since the response rate varied in these countries depending upon the convenience of sampling procedures, we compared percentages of responses to each of the questions instead of conducting a statistical analysis across them. RESULTS : The comparison of surveyed data revealed diversity in the utilization, preferences and opinions for further revision of the DSM and the ICD classification systems in East Asia. Psychiatrists in China and Japan routinely used the ICD, while those in Korea and Taiwan favored the DSM. The majority of Asian psychiatrists expressed the view that reliable inter-clinician communication is considered the main purpose of a classification system. Psychiatrists seemed to prefer classifications with 30-100 diagnostic options. CONCLUSION : Though there was limitation in terms of representation due to sampling methods, East Asian psychiatrists showed different pattern on the use of DSM and ICD across countries and had negative viewpoints on current diagnostic classification systems in terms of transcultural use.

Diagnóstico psiquiátrico: evolução histórica, conceitos e vicissitudes / Psychiatric diagnosis: historical evolution, concepts and vicissitudes

Objetivo: Revisitar a temática do diagnóstico psiquiátrico, suas controvérsias e pressupostos teóricos nas classificações atuais a partir da evolução histórica do conceito. Método: pesquisa da literatura sobre o tema,destacando os principais marcos históricos e conceitos na construção do diagnóstico psiquiátrico que permitam seu entendimento na atualidade. Considerações Finais: o diagnóstico psiquiátrico intimamente ligado ao conceito de doença mental, se encontra em processo evolutivo em busca de uma linguagem comum, que permita melhor comunicação entre os profissionais e pesquisadores no campo da saúde mental.

Objectives: to review the topic of psychiatric diagnosis, its controversies and theoretical assumptions in current classifications from the historical evolution of the concept.. Method: a literature review was conducted on this topic to identify the most relevant historical milestones and concepts in the formulation of psychiatric diagnosis to enable their understanding in the present. Final Considerations: psychiatric diagnosis is intimately connected to the concept of mental illness; it is in an evolutionary process in search of a standard terminology that can provide better communication between researchers and professionals in the of mental health.