TY - JOUR
T1 - Clinician and patient perspectives on the ontology of mental disorder
T2 - a qualitative study
AU - Kohne, Annemarie Catharina Johanna
AU - de Graauw, Lukas Peter
AU - Leenhouts-van der Maas, Reina
AU - Van Os, Jim
N1 - Funding Information:
We wish to thank the Dutch Healthcare institution GGZ Momentum, De Hoop GGZ, The Academic Medical Centre of Amsterdam in their support of our research. Furthermore, we would like to thank Merel Claus, Marjolijn Heerings, Femke Truijens, Arjen Noordhof, Lisa Wijsen, and Nienke van Sambeek for their valuable contribution to this study.
Funding Information:
AK was supported by a fellowship grant from the Netherlands Organization for Health Research and Development (ZonMw), grant number 636320001. JO was supported by the Ophelia research project, ZonMw grant number: 636340001 and Horizon 2020 project YOUTH-GEMs, grant number 101057182.
Publisher Copyright:
Copyright © 2023 Kohne, de Graauw, Leenhouts-van der Maas and Van Os.
PY - 2023
Y1 - 2023
N2 - BACKGROUND: Psychiatry may face an "identity crisis" regarding its very foundations. The lack of consensus regarding the theoretical grounds of psychiatry as a discipline has its epicenter in the discussion about the Diagnostic and Statistical Manual (DSM). A growing number of academics considers the manual broken and a growing number of patients voice concern. Despite the huge body of critique, 90% of Randomized Trials are based on DSM definitions of mental disorder. Therefore, the question regarding the ontology of mental disorder remains: what is a mental disorder, exactly?AIMS: We aim to identify ontologies that live among patients and clinicians, evaluate the degree of consistency and coherence between clinician and patient views and contribute to the establishment of a novel ontological paradigm of mental disorder that is aligned with patients' and clinicians' perspectives.METHOD: Eighty participants (clinicians/patients/clinicians with lived experience) were interviewed using a semi-structured interview, exploring their ideas on the ontology of mental disorder. This question was approached from different angles which led to comprising the interview schedule into different topics: "concept of disorder," "representation by DSM," "what is treated," "what is recovered," and "the right outcome measure." Interviews were transcribed and analyzed using inductive Thematic Analysis.RESULTS: From all subthemes and main themes, a typology was constructed in which six, not necessarily mutually exclusive, ontological domains were identified: mental disorder as (1) disease, (2) functional impairment, (3) loss of adaptation, (4) existential problem, (5) highly subjective phenomenon, and (6) deviation from social norms. Common ground for the sample groups was that mental disorder is about functional impairment. Although about a fourth of sample clinicians holds an ontological concept of disease, only a small percentage of patients and none of the clinicians with lived experience adhered to an ontological concept of disease. The sample clinicians most often understand mental disorder to be a highly subjective phenomenon, and individuals with lived experience (patients and clinicians) most often understand mental (dis)order to be adaptational in nature: an (im)balance of burden in relation to strengths, skills, and recourses.CONCLUSION: The ontological palette is more diverse than what is taught about mental disorder in dominant scientific and educational discourse. There is a need to diversify the current, dominant ontology and make room for other ontologies. Investment is required in the development, elaboration and coming of age of these alternative ontologies, allowing them to reach their full potential and act as drivers of a landscape of promising novel scientific and clinical approaches.
AB - BACKGROUND: Psychiatry may face an "identity crisis" regarding its very foundations. The lack of consensus regarding the theoretical grounds of psychiatry as a discipline has its epicenter in the discussion about the Diagnostic and Statistical Manual (DSM). A growing number of academics considers the manual broken and a growing number of patients voice concern. Despite the huge body of critique, 90% of Randomized Trials are based on DSM definitions of mental disorder. Therefore, the question regarding the ontology of mental disorder remains: what is a mental disorder, exactly?AIMS: We aim to identify ontologies that live among patients and clinicians, evaluate the degree of consistency and coherence between clinician and patient views and contribute to the establishment of a novel ontological paradigm of mental disorder that is aligned with patients' and clinicians' perspectives.METHOD: Eighty participants (clinicians/patients/clinicians with lived experience) were interviewed using a semi-structured interview, exploring their ideas on the ontology of mental disorder. This question was approached from different angles which led to comprising the interview schedule into different topics: "concept of disorder," "representation by DSM," "what is treated," "what is recovered," and "the right outcome measure." Interviews were transcribed and analyzed using inductive Thematic Analysis.RESULTS: From all subthemes and main themes, a typology was constructed in which six, not necessarily mutually exclusive, ontological domains were identified: mental disorder as (1) disease, (2) functional impairment, (3) loss of adaptation, (4) existential problem, (5) highly subjective phenomenon, and (6) deviation from social norms. Common ground for the sample groups was that mental disorder is about functional impairment. Although about a fourth of sample clinicians holds an ontological concept of disease, only a small percentage of patients and none of the clinicians with lived experience adhered to an ontological concept of disease. The sample clinicians most often understand mental disorder to be a highly subjective phenomenon, and individuals with lived experience (patients and clinicians) most often understand mental (dis)order to be adaptational in nature: an (im)balance of burden in relation to strengths, skills, and recourses.CONCLUSION: The ontological palette is more diverse than what is taught about mental disorder in dominant scientific and educational discourse. There is a need to diversify the current, dominant ontology and make room for other ontologies. Investment is required in the development, elaboration and coming of age of these alternative ontologies, allowing them to reach their full potential and act as drivers of a landscape of promising novel scientific and clinical approaches.
KW - diagnostic and statistical manual
KW - lived experience
KW - outcome
KW - psychiatric object
KW - qualitative interviews
KW - recovery
KW - thematic analysis
KW - typology
UR - http://www.scopus.com/inward/record.url?scp=85160073065&partnerID=8YFLogxK
U2 - 10.3389/fpsyt.2023.1081925
DO - 10.3389/fpsyt.2023.1081925
M3 - Article
C2 - 37252148
SN - 1664-0640
VL - 14
JO - Frontiers in Psychiatry
JF - Frontiers in Psychiatry
M1 - 1081925
ER -