University of Western Brittany and Brest University Hospital, Brest, France
May be more than other medical disciplines, Psychiatry and Mental Health are exposed to the negative effects of disorder centered approach. Because of the many competing theories about the very nature of the psychiatric disorders, mental health classifications had to neglect key aspects of the person’s mental health status, such as subjectivity and psychodynamic dimensions, in order to mimic the paradigm on which are based the biomedical classifications in other medical disciplines. The first stake of a person-centered perspective is to fight against this abusive reductionism that leaves us “with half a science” (Strauss) and a nosography not well adapted to clinical practice.
The Person-centered Integrative Diagnosis (PID) model has been constructed to respond to this stake. It is based on the previous International Guidelines for Diagnostic Assessment (IGDA) constructed on the results of a series of focus groups (involving psychiatrists, health professionals and other health stakeholders as patients, families and advocates) and of a survey realized by a global network of national classification . One of the main findings of this systematic work is that the patients’ perception, values and experiences of illness and health are key components of their health status and can be provided only if dimensions and narratives (idiosyncratic formulations) are added to traditional descriptive procedures. For this reason, a PID matrix included in the diagnostic process affords a new and specific level corresponding to the patient’s Experience of Health with the aim of taking into account the patient’s health-related individual and cultural values and experiences approached through guided narrative procedure, built upon the worldwide experience of Cultural Formulation . Through narratives, the physician has to access the patient’s conscious and unconscious feelings and representations. He does not rely only on what he observes of the patient’s behavior or physical condition. This paper will develop this idea showing how empathy (narrative empathy rather than mirror empathy) is the only tool to access the patient’s subjectivity in many clinical situations.
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