On Diagnosis and Formulation

"Diagnosis is a descriptive and phenomenological act. It is grounded in the form of symptoms, their patterning, and longitudinal course. It answers the question: What kind of illness is present? This mode of thinking belongs to the domain of explanation and to the natural-scientific tradition in psychiatry."

"The problem is not that formulation is emphasized too much. It is that diagnosis is increasingly treated as optional or even dispensable. This represents a fundamental misunderstanding of what diagnosis actually is."

"Diagnosis, in this sense, is necessarily resistant to speculative narratives. It does not ask why a patient is ill in a biographical or historical sense; it asks what the illness is, based on observable phenomena and their evolution over time."

Diagnosis and formulation are complementary but distinct clinical activities that answer different questions and cannot substitute for one another. Diagnosis is a descriptive, phenomenological act grounded in symptom patterns and longitudinal course, identifying what illness is present based on observable phenomena. It belongs to the natural-scientific tradition in psychiatry, exemplified by Kraepelin and Jaspers. Formulation, conversely, operates in the domain of understanding subjective experience and biographical context. The contemporary problem is not overemphasis on formulation, but rather the treatment of diagnosis as optional or dispensable. Sound clinical thinking requires both: diagnosis anchors understanding in psychopathological realities, while formulation explains individual manifestation.

Read at Psychology Today