The psychiatric interview: validity, structure, and subjectivity

Abstract

There is a glaring gap in the psychiatric literature concerning the nature of psychiatric symptoms and signs, and a corresponding lack of epistemological discussion of psycho-diagnostic interviewing. Contemporary clinical neuroscience heavily relies on the use of fully structured interviews that are historically rooted in logical positivism and behaviorism. These theoretical approaches marked decisively the so-called “operational revolution in psychiatry” leading to the creation of DSM-III. This paper attempts to examine the theoretical assumptions that underlie the use of a fully structured psychiatric interview. We address the ontological status of pathological experience, the notions of symptom, sign, prototype and Gestalt, and the necessary second-person processes which are involved in converting the patient’s experience (originally lived in the first-person perspective) into an “objective” (third person), actionable format, used for classification, treatment, and research. Our central thesis is that psychiatry targets the phenomena of consciousness, which, unlike somatic symptoms and signs, cannot be grasped on the analogy with material thing-like objects. We claim that in order to perform faithful distinctions in this particular domain, we need a more adequate approach, that is, an approach that is guided by phenomenologically informed considerations. Our theoretical discussion draws upon clinical examples derived from structured and semi-structured interviews. We conclude that fully structured interview is neither theoretically adequate nor practically valid in obtaining psycho-diagnostic information. Failure to address these basic issues may have contributed to the current state of malaise in the study of psychopathology.

Association between Clinician's Subjective Experience during Patient Evaluation and Psychiatric Diagnosis

“…The phenomenological approach can enrich the diagnostic process in several ways [17,32,33]. Some scholars have pointed out that subjectivity and intersubjectivity, basic categories of the structure of human being-in-the-world, remain intrinsic aspects of thorough psychiatric assessment [34,35].…”

Preparation, translation and evaluation of face and content validity of the Preschool Age Psychiatric Assessment (PAPA) in Farsi

“…Till recent years, studies of psychopathology in children were focused mainly on reported symptoms on behalf of parents/ caregivers and scoring were always based on scores in checklists rather than using structured interview based on clinical criteria. 10 The information obtained from checklists [like child behavior checklist (CBCL) 1.5-5] does not give details on intensity, frequency or duration of symptoms. 11 This information is critical for diagnosis and management and a clinical interview will be the best method for this aim.…”

EAFI: Examination of Anomalous Fantasy and Imagination

“…Questions are suggested to each item, but if an interviewer decides to use some of them, they should be modified according to the content, the context, and the flow of the interview. We point this out, since the interview targets experiences that are impossible to explore in a structured interview, as addressed in details elsewhere [5, 6]. Accordingly, a valid exploration presupposes that the interviewer has become familiar with the definition of the items and the use of the instrument.…”