Chris Van Es

Konzeptionelle Verletzung der Sorgfaltspflicht in der Psychiatrie

NEW YORK – Die kürzlich vom amerikanischen psychiatrischen Fachverband American Psychiatric Association vorgeschlagenen Änderungen seines offiziellen Diagnosehandbuchs – das Diagnostic and Statistical Manual of Mental Disorders (DSM, Handbuch für Diagnose und Statistik bei mentalen Störungen), oft als „Bibel der Psychiatrie“ bezeichnet – könnten die psychiatrische Diagnose eher in Verruf bringen, statt sie zu verbessern. Im DSM werden die Symptome spezifiziert, anhand derer jede mentale Störung diagnostiziert wird und es definiert so praktisch, was in den Vereinigten Staaten – und zunehmend auch im Großteil der restlichen Welt – als psychologisch normal gilt und was als nicht normal.

Die Überarbeitung der diagnostischen Kriterien für die kommende fünfte Ausgabe (DSM-5) geht mit hoher Verantwortung einher. Wird die Grenze zwischen Normalität und Störung zu weit gefasst, könnten Personen durch Fehldiagnosen zu Schaden kommen und unnötigen und potenziell abträglichen Behandlungen unterzogen werden. Tatsächlich tauchen in der Geschichte des DSM viele solche durch übermäßige Einbeziehung verursachte Fehler auf.

Wird die Grenze jedoch zu eng gefasst, könnte Individuen die benötigte Hilfe verwehrt bleiben. Psychiater kümmern sich eher darum, potenzielle Patienten zu erkennen, die Hilfe benötigen, und weniger darum, normale Exzentrizität und Kummer von der Diagnose zu trennen. Trotzdem ist es für jede Gesellschaft, die die menschliche Vielfalt respektiert und die die moralische Verantwortung des Einzelnen fördert, von enormer Bedeutung normalen Kummer und Exzentrizität von einer mentalen Störung zu unterscheiden.

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