Headnote
ABSTRACT
Introduction: This article addresses the problem of diagnostic inaccuracy in medicine, focusing on neurodevelopment. The central thesis is that the pursuit of objectivity and standardization through the DSM can lead to misunderstandings, ignoring the uniqueness of the individual. The objective is to critically analyze these manuals, advocating for a more holistic approach.
Theoretical Framework: The text delves into the history of the DSM, criticizing its categorical nature and overlapping diagnoses. On the other hand, it incorporates the theory of subjectivity, which values understanding the meaning of behaviors, and Deleuze's thinking, which views subjectivity as a multiplicity, not a fixed entity. This approach allows us to reinterpret neurodiversity as a legitimate expression, not a symptom to be corrected.
Methodology: The methodology is qualitative and theoretical-conceptual, based on a critical analysis of specialized literature. The study is based on authors such as Foucault and Deleuze and considers the political context of psychiatric knowledge production, including the influence of the pharmaceutical industry on the definition of diagnostic criteria. Documentary analysis and review of works and articles that comprise the theoretical corpus are used, without empirical data collection.
Discussion: The discussion emphasizes the profound consequences of incorrect diagnoses, such as stigma and ineffective interventions. The text advocates for a multidimensional and interdisciplinary approach that prioritizes attentive listening and the individual's uniqueness, overcoming the protocol-based application of manuals.
Research Implications: This study suggests that mental health diagnoses should go beyond lists of symptoms, considering the patient's life history and sociocultural context. The research highlights the need for a more humane and less mechanistic perspective, encouraging collaboration between different specialties for a complete understanding of the individual.
Originality and Value: The originality of this work lies in the articulation of unconventional theoretical frameworks, such as Deleuze's philosophy, with a critique of psychiatric manuals, offering a new analytical framework for the debate on diagnosis. The value of the research lies in questioning the instrumental rationality that dominates the field and in proposing an alternative based on complexity and subjectivity, contributing to more ethical and effective clinical practice.
Conclusion: It is concluded that progress in mental health depends on a balance between technical rigor and clinical sensitivity, ensuring that diagnosis is a tool for promoting comprehensive health, not a mere classificatory exercise.
Keywords: Diagnosis, Neurodevelopment, Subjectivity, Neurodiversity, Mental Health.
RESUMO
Introdução: Este artigo aborda a problemática da imprecisão diagnóstica na medicina, com foco no neurodesenvolvimento. A tese central é que a busca por objetividade e padronização através do DSM pode levar a equívocos, ignorando a singularidade do indivíduo. O objetivo é analisar criticamente esses manuais, defendendo uma abordagem mais holística.
Referencial Teórico: O texto aprofunda-se na história do DSM, criticando seu caráter categórico e a sobreposição de diagnósticos. Em contrapartida, incorpora a teoria da subjetividade, que valoriza a compreensão do significado dos comportamentos, e o pensamento de Deleuze, que vê a subjetividade como uma multiplicidade, não uma entidade fixa. Essa abordagem permite reinterpretar a neurodiversidade como uma expressão legítima, não um sintoma a ser corrigido.
Metodologia: A metodologia é qualitativa e teórico-conceitual, baseada na análise crítica de literatura especializada. O estudo se fundamenta em autores como Foucault e Deleuze, e considera o contexto político da produção do conhecimento psiquiátrico, incluindo a influência da indústria farmacêutica na definição dos critérios diagnósticos. A análise documental e a revisão de obras e artigos compõem o corpus teórico, sem coleta empírica.
Discussão: A discussão enfatiza as profundas consequências de diagnósticos incorretos, como estigma e intervenções ineficazes. O texto defende uma abordagem multidimensional e interdisciplinar, que priorize a escuta atenta e a singularidade do sujeito, superando a aplicação protocolar dos manuais.
Implicações da Pesquisa: Este estudo sugere que diagnósticos em saúde mental devem ir além de listas de sintomas, considerando a história de vida e o contexto sociocultural do paciente. A pesquisa aponta para a necessidade de um olhar mais humano e menos mecanicista, incentivando a colaboração entre diferentes especialidades para uma compreensão completa do sujeito.
Originalidade e Valor: A originalidade deste trabalho reside na articulação de referenciais teóricos não convencionais, como a filosofia de Deleuze, com a crítica aos manuais psiquiátricos, oferecendo um novo quadro analítico para o debate sobre o diagnóstico. O valor da pesquisa está em questionar a racionalidade instrumental que domina o campo e em propor uma alternativa baseada na complexidade e na subjetividade, contribuindo para uma prática clínica mais ética e eficaz.
Conclusão: Conclui-se que o avanço na saúde mental depende do equilíbrio entre rigor técnico e sensibilidade clínica, assegurando que o diagnóstico seja um instrumento de promoção da saúde integral, e não um mero exercício classificatório.
Palavras-chave: Diagnóstico, Neurodesenvolvimento, Subjetividade, Neurodiversidade, Saúde Mental.
RESUMEN
Introduccion: Este artículo aborda el problema de la inexactitud diagnóstica en medicina, centrándose en el neurodesarrollo. La tesis central es que la búsqueda de objetividad y estandarización a través del DSM puede dar lugar a malentendidos, ignorando la singularidad de cada individuo. El objetivo es analizar críticamente estos manuales, abogando por un enfoque más holístico.
Marco Teórico: El texto profundiza en la historia del DSM, criticando su naturaleza categórica y la superposición de diagnósticos. Por otro lado, incorpora la teoría de la subjetividad, que valora la comprensión del significado de las conductas, y el pensamiento de Deleuze, que considera la subjetividad como una multiplicidad, no como una entidad fija. Este enfoque permite reinterpretar la neurodiversidad como una expresión legítima, no como un síntoma a corregir.
Metodología: La metodología es cualitativa y teórico-conceptual, basada en un análisis crítico de la literatura especializada. El estudio se basa en autores como Foucault y Deleuze y considera el contexto político de la producción de conocimiento psiquiátrico, incluyendo la influencia de la industria farmacéutica en la definición de criterios diagnósticos. El análisis documental y la revisión de trabajos y artículos conforman el corpus teórico, sin recopilación de datos empíricos.
Discusión: La discusión enfatiza las profundas consecuencias de los diagnósticos incorrectos, como el estigma y las intervenciones ineficaces. El texto aboga por un enfoque multidimensional e interdisciplinario que prioriza la escucha atenta y la singularidad del individuo, superando la aplicación protocolaria de los manuales. Implicaciones de la Investigación: Este estudio sugiere que los diagnósticos de salud mental deben ir más allá de las listas de síntomas, considerando la historia de vida y el contexto sociocultural del paciente. La investigación destaca la necesidad de una perspectiva más humana y menos mecanicista, fomentando la colaboración entre diferentes especialidades para una comprensión completa del individuo.
Originalidad y Valor: La originalidad de este trabajo reside en la articulación de marcos teóricos no convencionales, como la filosofía de Deleuze, con una crítica a los manuales psiquiátricos, ofreciendo un nuevo marco analítico para el debate sobre el diagnóstico. El valor de la investigación reside en cuestionar la racionalidad instrumental que domina el campo y proponer una alternativa basada en la complejidad y la subjetividad, contribuyendo a una práctica clínica más ética y eficaz.
Conclusión: Se concluye que el avance en salud mental depende de un equilibrio entre el rigor técnico y la sensibilidad clínica, asegurando que el diagnóstico sea una herramienta para promover la salud integral, no un mero ejercicio clasificatorio.
Palabras clave: Diagnóstico, Neurodesarrollo, Subjetividad, Neurodiversidad, Salud Mental.
1 INTRODUCTION
Contemporary medicine, in its incessant search for diagnostic accuracy, has increasingly invested in the elaboration of increasingly detailed parameters, based on statistical indicators, numerical metrics and categorical classifications. However, when applied to highly complex domains, such as neurodevelopment and human behaviour, such instruments can paradoxically produce uncertainty, shifting clinical practice from its alleged objectivity to a zone of technical and epistemological imprecision. The obsession with diagnostic anticipation and accurate measurement, instead of reducing margins of error, can inadvertently expand them, creating a fertile field for misinterpretations and inadequate therapeutic decisions, especially when reading the data ignores the multiplicity and uniqueness of individual trajectories (Regier, Kuhl and Kupfer, 2013; Reed and Ayuso-Mateos, 2018).
This problem can be elucidated by analogy with maritime navigation: a deviation of only one degree in latitude or longitude, although apparently insignificant at the beginning, leads inevitably to an arrival point located kilometres away from the originally desired destination. Similarly, the rigid and dogmatic application of the Diagnostic and Statistical Manual of Mental Disorders (DSM), especially since the DSM-III reformulations, implies the possibility of substantially altering the outcome of a diagnosis, as if small "decimal places" of a subject's life were arbitrarily rounded. This excessive simplification, although motivated by intentions of standardisation and clarity, tends to erase essential clinical nuances, setting the propitious ground for iatrogenesis (American Psychiatric Association, 2013).
The parallelism with the loss of decimal places in high-precision calculations is particularly illuminating. In certain operations, such as the launch of a rocket or the dosage of drugs, the suppression of one or two decimal units, although tiny in absolute terms, can have disastrous consequences. Similarly, in the field of psychiatry and clinical psychology, reducing the complexity of human phenomena to watertight, measurable, and supposedly universal categories means operating arbitrary cuts in an equation that integrates multiple historical, social, and cultural variables. By adopting inflexible criteria, the health professional runs the risk of obscuring fundamental aspects of the presented picture, compromising the diagnostic accuracy and, consequently, the effectiveness of the intervention (Bezerra Jr., 2006).
The delicacy of this process becomes even more evident when one considers that a misdiagnosis can be precipitated by apparently minimal factors: an interpretative bias, the incomplete observation of a behaviour in different contexts, or the lack of consideration for the variability of development in different cultures and environments. Such critical sensitivity is exacerbated in conditions whose symptoms overlap, such as Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and Learning Disorders. In these circumstances, the literal and decontextualised application of the DSM criteria, dissociated from the analysis of life history, family and school environment, as well as social interactions, can result in both false positives and false negatives. The direct effect of this imprecision is not restricted to the clinical sphere, but reverberates in the social and subjective trajectory of the individual, displacing him from potentially adequate interventions and reinforcing dynamics of stigmatisation (Vygotsky, 1978; González Rey, 2015; Mesquita and Pinto, 2019).
2 THEORETICAL FRAMEWORK
2.1 DSM AND DIAGNOSTIC COMPLEXITY
The publication of the Diagnostic and Statistical Manual of Mental Disorders in its third edition, in 1980, configured a paradigmatic inflexion in the history of psychiatry. Until then, previous versions of the manual were strongly influenced by psychodynamic and psychopathological references, favouring the subjective interpretation of the clinician and the elaboration of hypotheses based on theoretical formulations widely variable among professionals. This model, although more flexible, resulted in low inter-rater reliability, given the heterogeneity of implicit criteria. With the DSM-III, a methodological turn towards objectivity was consolidated, based on the description of observable symptoms and the operationalisation of diagnostic criteria, in order to standardise procedures and ensure that different evaluators arrived at the same diagnosis for the same individual. This transformation deliberately reduced the interpretive space of the professional, replacing it with a structured and standardised symptom listing system (Mesquita and Pinto, 2019; Regier, Kuhl and Kupfer, 2013).
Although this change has raised the technical consistency of the classifications, its eminently descriptive and theoretical character has raised substantial criticism, especially for tending to ignore the clinical heterogeneity and dimensional nature of numerous mental disorders. The adoption of fixed cutoff points, even if operational, ends up excluding manifestations that do not strictly fit the criteria or, conversely, by including cases whose symptomatology does not represent significant dysfunction. This binary logic, instead of capturing the complexity of human experience, often reduces it to an arbitrary diagnostic category (Regier, Kuhl and Kupfer, 2013).
Subsequent editions, particularly the DSM-V, sought to mitigate this problem by easing diagnostic boundaries and recognising the coexistence of symptoms between different conditions. This approach, if on the one hand it broadened the recognition of psychopathological complexity, on the other hand it originated areas of diagnostic overlap that, in the absence of an in-depth analysis of the individual's life history and subjectivity, become difficult to clinical resolution. In these "vouchers of inaccuracy", symptoms common to different disorders, such as Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD) and certain learning disorders, can lead to misinterpretations, favouring both multiple diagnoses and precipitated interventions, often justified by the premise that acting early would prevent a future worsening (Caponi, 2018).
This scenario, characterised by diffuse boundaries between normality and pathology, fostered the diagnostic expansion and the dissemination of preventive strategies aimed at detecting early signs of mental illness, even before any consolidated manifestation. Under this logic, the conception emerged that it would be possible to identify subtle signs of serious pathologies and, thus, to intervene preventively, seeking to prevent their chronicity. However, this approach, by extending the notion of risk beyond objective parameters, enhances the phenomenon of medicalisation and early labelling of individuals without established clinical impairment (Caponi, 2014; Caponi, 2018).
The process of pathologisation, fuelled by the classificatory logic of psychiatric manuals, converts variations of the norm into universal categories, disregarding the social and cultural determinants that modulate psychological distress. This trend, reinforced since the DSM-III, not only increases the number of diagnoses, but also consolidates a growing social intolerance to behavioural and cognitive diversity (Caponi, 2014). Although DSM-V updates have increased the visibility of ASD diagnosis in adults and introduced classifications by support levels, there are still relevant inconsistencies in the delimitation between autism and conditions such as intellectual disability or schizophrenia, leading to significant diagnostic variations among professionals.
A similar problem occurs in the diagnosis of ADHD, whose determination is strongly influenced by contextual variables and the perception of parents and teachers. These interlocutors, often without specialised training, may misinterpret typical developmental behaviours as indicative of a disorder, which, together with the rigid application of the criteria without longitudinal and multifaceted evaluation, increases the risk of misunderstandings. Additionally, there are recurrent diagnostic confusions between ADHD, Defiant Oppositional Disorder (DOD), and certain personality disorders.
From a critical perspective, the instrumental rationality that permeates such practices tends to transform the person into a mere object of classification, neglecting the subjective dimension of the health-disease process. Approaches based exclusively on universal and standardised criteria minimise the uniqueness of the experiences, removing the diagnosis from its comprehensive and contextualised function. Thus, the promise of objectivity contained in the DSM proves to be paradoxical, because, while it seeks to reduce biases, it can generate a departure from the concrete reality of the subject, compromising the integrality of care (González Rey, 2015).
2.2 THE HORIZON OF UNDERSTANDING IN DIAGNOSIS
The diagnosis of autism remains, according to Silva and Andrade (2020), as one of the most debated themes in the health and education sciences, involving not only clinical issues, but also social, legal and educational implications. The discussions, which expand from academia to legal and digital spaces, range from the validation of evidence-based intervention models to the definition of the ideal therapeutic workload, but all converge on a central axis: diagnostic determination.
As Kupfer (2016) points out, diagnostic practice has historically undergone significant changes, with a progressive replacement of the thorough clinical analysis, which integrates the subjective singularity, by approaches focused exclusively on the description of observable behaviours. Such movement, strongly influenced by the rigid use of the Diagnostic and Statistical Manual of Mental Disorders (DSM), may restrict the development of a broader understanding horizon, not only for autism, but for other neurodevelopmental disorders (APA, 2014).
It is crucial, as Zavaschi et al. (2021) warns, to differentiate early diagnosis from diagnostic precipitation. The first seeks to identify signs and characteristics of autism at early ages, taking advantage of periods of greater brain plasticity to enhance development and quality of life. The second, in turn, often driven by bureaucratic demands or institutional pressures, runs the risk of producing hurried and reductionist labels.
Specific deficits, such as language delays, motor difficulties or impairments in social interaction, have their own classifications in the International Statistical Classification of Diseases and Related Health Problems (CID) and the DSM (WHO, 2019; APA, 2014). This allows, as Oliveira (2018) points out, the adoption of targeted interventions even in the absence of a definitive diagnosis, especially when the child's subjectivity is still in formation and the clinical manifestations are more fluid and unstable.
Such diagnostic prudence, however, is often misinterpreted. As Kupfer (2016) notes, critics of this approach mistakenly associate it with the notion that one should "wait and see," disregarding the proven benefit of early, evidence-based interventions.
The theory of subjectivity, in its psychoanalytic, phenomenological and constructionist aspects, maintains that reality is constructed and interpreted in a singular way, influenced by historical, social, cultural and affective determinants (Vygotsky, 2001; González Rey, 2003). By applying this lens to autism, the diagnosis ceases to be a merely classificatory act and begins to demand an understanding of the meaning that each behaviour assumes for the individual.
For example, the difficulty in social interaction, the central criterion of autism according to the DSM-V (APA, 2014), may be due to limitations in reading social signals, a preference for predictable interactions or even sensory overload that leads to withdrawal. As González Rey (2003) emphasises, understanding such nuances implies investigating the "why" and "how" of behaviours from the subjective perspective of the subject, ensuring a more human, complex and contextualised diagnosis.
2.3 DELEUZE'S PERSPECTIVE: BODIES WITHOUT ORGANS AND MULTIPLE SUBJECTIVITIES
The thought of Gilles Deleuze (1925-1995), often co-authored with Félix Guattari, presents a theoretical instrument capable of destabilising rigid conceptions about subjectivity and "normality". In A Thousand Plateaus: Capitalism and Schizophrenia, published in 1987, Deleuze and Guattari propose to understand subjectivity as a field of forces, flows and becomings, marked by multiple connections and intensities, and not as a fixed, stable and unitary entity.
One of the central concepts, the Body Without Organs (BoS), is defined by the authors as "the body of immanence, the body where intensities occur" (Deleuze and Guattari, 1987). This notion departs from the understanding of the body subordinated to a predetermined biological, psychological or social organisation. In the context of Autism Spectrum Disorder (ASD), OCs do not refer to a "defective" body, but to a singular somatic and sensorial configuration, which operates according to its own logics, establishing connections and sensitivities often incomprehensible to the neurotypical organisation. Thus, characteristics such as hypersensitivities, restricted interests or repetitive movements can be reinterpreted as legitimate expressions of a distinct embodied experience, whose transversal connections and "short circuits" escape the expected patterns of organisation.
Another fundamental element is the notion of deterritorialisation, associated with the concept of refrain. For Deleuze and Guattari, the chorus constitutes a device of stabilisation and creation of meaning in the midst of chaos (Deleuze and Guattari, 1987). In the case of autism, deterritorialisation can manifest itself in the subversion or reformulation of dominant models of communication and social interaction. The refrains, understood as repetitive actions, phrases or interests, function as existential anchors that structure their own territory of signification. This reading shifts such behavioural patterns from the category of "symptoms" to that of creative strategies for ordering the world, especially in contexts perceived as unpredictable or overwhelming.
The Deleuzian approach of subjectivity as multiplicity reinforces the need for recognition of different forms of existence. By stating that "the self is a collective, an agency" (Deleuze and Guattari, 1987), the authors break with the idea of a universal and linear subjectivity. For the field of autism, this conception implies considering autistic subjectivity as a legitimate form, endowed with its own logics and powers, which must be understood and valued in their uniqueness, and not pathologized according to external normative standards.
2.4 DIAGNOSTIC, INTERVENTIONAL IMPLICATIONS AND CONSEQUENCES OF OVERLAPPING CLINICAL CATEGORIES
Broadening the horizon of understanding in diagnosis, from the theoretical lenses of Gilles Deleuze, implies recognising neurodiversity as a legitimate way of being in the world. Such perspective requires going beyond the mere observation of behaviours, seeking to understand the experience lived according to the perceptual and existential particularities of the autistic person. It is recognised, therefore, that each subject in the spectrum has unique ways of thinking, feeling and interacting, which are an integral part of their subjectivity, and not mere deviations from a normative standard. The diagnostic and interventional strategies, therefore, must respect the own logics and modes of subjectivation of the autistic person, promoting their development from their powers and interests, to the detriment of externally imposed models. This approach demands to value the time dedicated to listening to the patient, retaking, in a way, Michel Foucault's thinking about the "subject knowledge" that had been historically disqualified. According to the author, this knowledge encompasses non-conceptual forms, insufficiently elaborated, hierarchically inferior or located below the recognised level of scientificity, but which carry epistemic value and relevance in the understanding of human experience (Foucault, 2005).
However, there is still a need to critically reflect on the consequences of diagnostic errors and on the overlapping of clinical categories. The simplifying reduction of variables, often driven by interests unrelated to the patient's well-being, can lead to misinterpretations of clinical reality. The influence of the pharmaceutical industry is significant in this context, attributing ontological value to market demands and transforming deviations from the norm into commercial opportunities. A 2006 study revealed that one third of the DSM-IV commission experts maintained financial ties with pharmaceutical companies through the funding of congresses, publications and research associated with the APA, evidencing significant conflicts of interest (Cosgrove, Krimsky, Vijayaraghavan and Schneider, 2006 apud Mesquita and Pinto, 2019). The implications for the individual in the face of a misdiagnosis are profound and multifaceted. Interventions based on incorrect assessments tend to be ineffective or potentially harmful, diverting time and resources that could be directed to more appropriate approaches considering "their impacts on autonomy, diversity of psychic expressions and quality of life" (Roseira et al, 2024). In addition, an imprecise label can generate social stigma, negatively affect self-image and compromise academic, professional and social trajectory. The absence of a precise diagnosis and, therefore, of relevant interventions, leads to delays in the development of essential skills and in the overall well-being of the subject.
The categorical structure present in diagnostic manuals, such as the DSM, although aiming at clarity, agility and reduction of the interval between diagnosis and treatment, often gives rise to overlaps. The same individual can receive multiple diagnoses for conditions whose symptoms intersect, configuring zones of imprecision that make a precise clinical framework impossible. This phenomenon produces uncertainty and makes it difficult to formulate cohesive therapeutic plans, in addition to raising questions about the academic training of professionals, in order to prepare them to deal with such complexities. The risk is not limited to clinical confusion, because the patient's own uniqueness can be obscured by the multiplicity of labels, preventing a holistic understanding of suffering and promoting fragmented or contradictory interventions.
2.5 THE NEED FOR A MULTIDIMENSIONAL APPROACH
To mitigate the risks inherent in the so-called "imprecise precision" resulting from the diagnosis based exclusively on the criteria of the DSM manuals, it is essential to adopt a multidimensional approach that encompasses different knowledge and dimensions of the human experience. This perspective requires the articulation of multiprofessional evaluations, involving psychologists, psychiatrists, neurologists, occupational therapists, speech therapists and other specialists, according to the specific needs of each individual. As Foucault (2005) observes, "a series of knowledge that was disqualified, such as non-conceptual knowledge, such as insufficiently elaborated knowledge", is relegated to a secondary level, but this knowledge has crucial epistemological relevance for the integral understanding of the subject. In the clinical context, "decisions about closing the diagnosis to the therapeutic prescription" often disregard this knowledge, favouring a hegemonic, technocratic and limited knowledge.
This need for critical review also permeates the training and performance of health professionals. Bezerra-Junior (2006) emphasises that "the discussion about what constitutes the boundary between normal and pathological should therefore be at the centre of clinical reflection and the basis of the training of health professionals." The diagnosis cannot be understood in isolation, but must be situated in the individual's life context, which includes family, school, cultural and socioeconomic environments, as well as personal experiences and resilience.
In addition, the rhizomatic perspective proposed by Deleuze and Guattari (1987) in Thousand Plateaus suggests a horizontal observation of the phenomena, as opposed to traditional causal linear analyses. This approach comprises development and behaviour as complex networks of interconnected influences, where there is no single origin or definitive cause, nor a fixed point of responsibility.
Ramos (2025), from the perspective of the theory of subjectivity, warns that "excessive dependence on diagnostic classifications, often unaccompanied by a deep understanding of subjective processes and social dynamics, can result in interventions focused only on symptom control and normalisation of behaviours, and not on the promotion or concern for integral health". The author points out that "when we ignore this subjective dimension in favour of rigid diagnostic criteria, we run the risk of losing the essence of the individual, compromising the accuracy and effectiveness of care".
Thus, it is evident the urgency of a clinical practice that values attentive listening, shared construction of meaning and interdisciplinary integration, surpassing the merely technical and protocol application of diagnostic manuals. This practice should focus on the uniqueness of the subject, recognising their subjective, social and cultural particularities so that care is truly effective and humanised.
3 METHODOLOGY
The present investigation adopted a qualitative theoretical-conceptual and documentary approach, based exclusively on the critical and systematic analysis of specialised literature and reliable secondary sources. The theoretical corpus was composed of academic productions, scientific articles, official documents and classic and contemporary works, with emphasis on the epistemological contributions of Michel Foucault (2005), Gilles Deleuze and Félix Guattari (2012), and Fernando González Rey (2015), as well as studies on psychiatric diagnoses and neurodevelopment, including the critical analysis of the DSM-III and its subsequent updates (AMERICAN PSYCHIATRIC ASSOCIATION, 2013; REGIER et al., 2013; REED; AYUSO- MATEOS, 2011, 2018). The choice of this methodology met the guideline of avoiding direct empirical collection, as recommended for theoretical-conceptual investigations, privileging the integrative review and the documentary analysis of the theoretical and political constructions on psychiatric diagnosis, pathologisation and medicalisation (CAPONI, 2014; MESQUITA; PINTO, 2019). This methodological option allowed the critical articulation between the philosophical references of subjectivity, the operational diagnostic devices and their practical implications in the clinical and social scope, seeking to overcome simplifications and reductionisms arising from the inflexible use of diagnostic manuals.
The analysis also considered the historical and political context that involves the production of psychiatric knowledge, highlighting conflicts of interest in the construction of diagnostic criteria, as evidenced in studies that point to the influence of the pharmaceutical industry in the definition of DSM parameters (COSGROVE et al., 2006; MESQUITA; PINTO, 2019). In addition, the reflection on the cultural, social and subjective dimensions of the diagnosis, inspired by the historical-cultural theory and the poststructuralist critique, was central to the understanding of the complexity of the phenomenon under analysis (GONZÁLEZ REY, 2015; FOUCAULT, 2005).
4 CONCLUSIONS
The analysis undertaken throughout this study shows that the diagnostic practice in mental health and neurodevelopment cannot be restricted to rigid protocols or exclusively symptomatic models. Although standardisation has value in the standardisation of criteria and technical communication between professionals, its mechanical and decontextualised application leads to substantial risks of clinical imprecision and distortion.
The field demands a conceptual reformulation that contemplates the complexity of human experience, recognising that psychological suffering is influenced by multiple interdependent dimensions, biological, psychological, social, cultural and historical. This view implies overcoming the logic of dichotomous classification and incorporating assessment methodologies that prioritise qualified listening, contextual analysis and the uniqueness of the subject. In addition to the diagnosis, clinical practice should assume a dialogical and interdisciplinary character, integrating different knowledge and perspectives. This integration not only enriches the understanding of the clinical phenomenon, but also increases the therapeutic efficacy, since it allows interventions more adjusted to the real needs of the individual. Future research should deepen the understanding of the interfaces between subjective and objective factors in diagnosis, as well as investigate hybrid models that reconcile standardised criteria with interpretative flexibility. Longitudinal studies examining the impact of multidimensional approaches on prognosis and treatment adherence represent a promising path. In addition, it is essential to explore the influence of sociocultural and economic variables on symptomatic expression and therapeutic response, in order to develop guidelines adapted to different contexts.
It is concluded that scientific progress in the field of mental health will depend on the ability to integrate technical rigour, clinical sensitivity and openness to complexity, ensuring that diagnosis and intervention are not mere classification exercises, but effective instruments for promoting comprehensive health.
ACKNOWLEDGMENTS
With sincere gratitude, I acknowledge Juliana Uggioni and her family, whose generosity made it possible not only to carry out this work, but also to cross the world. May the gesture of sponsoring this project reverberate as an act of affection, courage and commitment to the dignity of lives that deserve to be seen, heard and celebrated.
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