Psychopathological knowledge and methodically sound diagnostics are core elements of forensic psychiatry

Abstract

Methodically sound psychiatric diagnoses are necessary quality-assuring elements in forensic psychiatry, but on their own they are not sufficient to answer the questions posed for an expert assessment. This position will be developed here in the context of a historical outline of key ideas in forensic psychiatry, a reflection on nosology and diagnosis in psychiatry, and the argument that psychopathology needs to be accorded greater influence. Regarding psychiatric assessments, the reference back to the experiential history of clinical psychiatry in dealing with all forms and degrees of mental disorder (the “psychopathological reference system”) does not represent a backward-looking traditionalism, nor is it adversarial to current neuroscientific or socioscientific research. On the contrary, such an historical anchoring, which specifically and methodically incorporates the internationally established diagnostic manuals ICD-10, DSM-5 and (from 2022) ICD-11, will enhance the quality of diagnosis, therapy and research. Especially, but not only in forensic psychiatric work, the following applies: The hasty replacement of operationally defined diagnoses by possibly plausible but “isolated” individual findings that are not sufficiently embedded in an overall scientific context can lead to an overvaluation of these findings and to the loss of substantial psychopathological knowledge. These risks must be avoided, because psychiatry will continue to depend on psychopathology in each of its fields of activity.