From Talk to Action: Mapping the Diagnostic Process in Psychiatry

Purpose – There is a paucity of research that examines how diagnostic decisions are made by psychiatrists. Moreover, previous work in the area tends to be grounded in labeling theory, which highlights the conflict-based nature of diagnosis. The goal of this research is to examine the utility and benefits of diagnosis to psychiatrists' everyday work.

Methodology – Using institutional ethnography (IE), I undertook a small-scale interview-based study that documented the diagnostic processes of three psychiatrists in Calgary, Alberta, Canada. The IE-based goals of the study were to: (1) identify what texts were employed during the diagnostic process, (2) map sequences of action and text that coordinated psychiatric decision-making, and (3) theorize the utility of diagnosis for the everyday work of psychiatrists.

Findings – The analysis demonstrates how diagnosis can be understood as a valuable work process that produces a standardized diagnostic story in order to bring an individual's experiences of distress into relation with psychiatrists' daily practices, and institutional discourses more generally.

Limitations – Although IE-based research does not depend on large sample sizes for analytic accuracy, results from the current study need to be replicated because of the limited number of interview participants and to examine whether the diagnostic process is generalizable to other settings.

Social implications – This research challenges the idea that standardization through diagnosis is a negative process and highlights the value of diagnostic decision-making in the daily work of psychiatrists.