Handbook of Diagnostic and Structured Interviewing

From our regular book review column.

With the advent of DSM-III-R, psychiatry committed itself to a quantitative and operational system. Although a dramatic increase in reliability was achieved, clinical diagnosis was, and is, still completely dependent on how the history of illness was obtained. Slight changes in inflection, in choice of language, and in sequence of questioning, coupled with clinicians’ idiosyncratic choices as to what questions should be asked and determination of what answers are clinically relevant, result in unnecessary diagnostic variability. Structured interviews were designed to remedy this problem by organizing clinician inquiry and by limiting, as much as possible, sources of needless variance. As the author of this work notes, however, mindless adherence to structured interviews, at the cost of rapport and abandonment of clinical intuition, can result in a cure that is worse than the problem itself.