Commentary on Gracia et al.: diagnostic entity or dynamic processes?

The case of Mr. G is a fascinating and beautifully presented, although sad, history of a patient. The clarity of the presentation and the discussion are particularly impressive in this example of the use of longitudinal data for descriptive diagnosis and conceptualization. The report exemplifies current trends in descriptive psychiatry, which focus on diagnosing an illness as a whole. The illness itself is considered a relatively static entity, even if it includes changes within its course. From this perspective, longitudinal data provide information for deciding what type of illness is being described. In my commentary, I would like to focus on a different way of using longitudinal data from that employed by the authors--a different type of longitudinal perspective, one that does not have the primary goal of defining a type of disorder diagnostically. I would like instead to focus on understanding this patient in terms of longitudinal processes rather than as someone afflicted with a persisting diagnostic entity. Attention to longitudinal processes can raise different questions and suggest what further information would be needed to understand these processes and plan optimal treatment. This more dynamic approach to understanding processes is not mutually exclusive with the static approach to diagnosis, but the two orientations provide very different perspectives on assessment, conceptualization and treatment.