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The six most essential questions in psychiatric diagnosis: a pluralogue. Part 4: general conclusion

James Phillips1*, Allen Frances2, Michael A Cerullo3, John Chardavoyne1, Hannah S Decker4, Michael B First5, Nassir Ghaemi6, Gary Greenberg7, Andrew C Hinderliter8, Warren A Kinghorn29, Steven G LoBello10, Elliott B Martin1, Aaron L Mishara11, Joel Paris12, Joseph M Pierre1314, Ronald W Pies156, Harold A Pincus1617185, Douglas Porter19, Claire Pouncey20, Michael A Schwartz21, Thomas Szasz15, Jerome C Wakefield2223, G Scott Waterman24, Owen Whooley25 and Peter Zachar10

Author Affiliations

1 Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA

2 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St, Durham, NC, 27710, USA

3 Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH, 45219, USA

4 Department of History, University of Houston, 524 Agnes Arnold, Houston, 77204, USA

5 Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA

6 Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA

7 Human Relations Counseling Service, 400 Bayonet Street Suite #202, New London, CT, 06320, USA

8 Department of Linguistics, University of Illinois, Urbana-Champaign, 4080 Foreign Languages Building, 707 S Mathews Ave, Urbana, IL, 61801, USA

9 Duke Divinity School, Box 90968, Durham, NC, 27708, USA

10 Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL, 36117, USA

11 Department of Clinical Psychology, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL, 60654, USA

12 Department of Psychiatry, Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, McGill University, 4333 cote Ste. Catherine, Montreal, QC, H3T1E4, Canada

13 Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90095, USA

14 VA West Los Angeles Healthcare Center, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA

15 Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St., #343CWB, Syracuse, NY, 13210, USA

16 Irving Institute for Clinical and Translational Research, Columbia University Medical Center, 630 West 168th Street, New York, NY, 10032, USA

17 New York Presbyterian Hospital, 1051 Riverside Drive, Unit 09, New York, NY, 10032, USA

18 Rand Corporation, 1776 Main St Santa Monica, California, 90401, USA

19 Central City Behavioral Health Center, 2221 Philip Street, New Orleans, LA, 70113, USA

20 Center for Bioethics, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA, 19104, USA

21 Department of Psychiatry, Texas A & M College of Medicine, 4110 Guadalupe Street, Austin, TX, 78751, USA

22 Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA

23 Department of Psychiatry, NYU Langone Medical Center, 550 First Ave, New York, NY, 10016, USA

24 Department of Psychiatry, University of Vermont College of Medicine, 89 Beaumont Avenue, Given Courtyard N104, Burlington, VT, 05405, USA

25 Institute for Health, Health Care Policy, and Aging Research, Rutgers, the State University of New Jersey, 112 Paterson St, New Brunswick, NJ, 08901, USA

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Philosophy, Ethics, and Humanities in Medicine 2012, 7:14  doi:10.1186/1747-5341-7-14

Published: 18 December 2012


In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined.