The aim of diagnosis is to establish that this is, or is not, the particular case by eliciting symptoms during the professionals assessment of the patient.If no symptoms are elicited, then the diagnosis of a particular mental disorder is left uncertain or the person is not deemed to be a patient at all.The least professionally inflected formulations would come from the phenomenological and narrative traditions of psychological therapy and the most from the psychoanalytical tradition.The latter has been a strong lobby in the American Psychiatric Association to retain a developmental approach to aetiology, while also retaining a form of diagnosis.Moreover, psychoanalysis utilises diagnostic language to signal that developmental and dynamic approach to formulation.Notwithstanding this linguistic blurring between diagnostic psychiatry and psychoanalysis, generally formulations are more sophisticated because they are sensitive to, and flexibly open about, the particular biographical context and personal meanings ascribed to their experience by the patient.Moreover, a space for the legitimacy of formulations has been created by the proven shortcomings of functional psychiatric diagnoses.For psychological formulations to establish a mandate from society in general, or the people they are applied to in particular, they must offer clear advantages to the summary labelling of diagnostic psychiatry.And this is where arguments about logic, evidence and values begin to interweave from different communities of interest in different ways.For example, the logic of diagnosis is different from formulation, as has just been indicated.However, the logic of different models of psychological formulations also varies.Both would take the clients experience and meaning attributions seriously, but they would describe their preferred formulation using differing concepts and terminology.They also will have different explanatory paradigms when articulating their formulation verbally to the client or say in writing to a third party, such as a referrer.When we compare diagnosis to formulation then two eventualities emerge.The second is that formulations are articulated as a clear and preferred alternative to diagnosis in all cases.In the second group are those who reject diagnosis in principle and who consider that psychological formulations are more respectful of the clients view.Intuitively, we would expect the latter advantage of formulation to always trump that of diagnosis for patients.The term myth of mental illness indicates that minds, like economies, can be sick only in a metaphorical sense.People may be frightened, sad, incorrigible or incomprehensible, but unless a bodily disease can be proved to underpin these forms of conduct, then they are not an indication of true illness.The logic of the myth of mental illness is explained.Critical responses to the notion are outlined.He argued that mental illness is a myth because it does not fulfil the criteria, required by scientific medicine, to describe true pathology.Originally, he used the terms illness and disease interchangeably.More recently, in both medicine and medical sociology, the term disease tends to refer to formal professional descriptions of pathology.Illness, more typically, refers now to an individual patients experience of being unwell.Mental illness is a metaphor, rather than a valid description of reality, which is conveniently used by a number of parties.The profession of psychiatry accrues the status of a proper medical specialty by claiming jurisdiction over illness.The state gains from the notion of mental illness because it can delegate lawful powers to medicine for the social control of disruptive psychological deviance.Those who do not attract the label of mental illness also gain from the concept because their troublesome fellow citizens can be dealt with by medical paternalism and removed from sight and mind.He concludes that the modern mental patient occupies the same devalued, oppressed and stigmatised role as witches did in the Middle Ages.He begins with a traditional medical assumption that diseases require that both signs and symptoms must be present in an individual to warrant any confident diagnosis.These, he says, should be called proper neurological diseases.By contrast, where a diagnosis starts and finishes only with examples of thoughts and action, which others do not understand or do not approve of, then unless a biological cause can be unequivocally demonstrated in the person, they are not really ill.To call a person mentally ill is to deploy a metaphor dressed up as a fact.Szasz argues that a mind can only be sick in a metaphorical sense – like an economy or a society.By describing mental illness as a myth, he does not imply that people are not sad, mad or frightened.His point is that these are ways of being, or problems in living, not symptoms of illness.By keeping an open mind about their nature, we may find different ways of making sense of them.Alternatively, sometimes they may simply remain mysterious.Szasz expresses a preference to interpret problems in living as games or communications, with particular situated meanings for a person in their interpersonal context and life as a whole.Until then, according to Szasz, all functional psychiatric diagnoses, like schizophrenia, bipolar disorder, depression and so on should be deemed unscientific and invalid.Psychiatry makes sporadic claims that brain abnormalities can indeed be demonstrated in those with functional diagnoses.However, these claims have been varied, inconsistent, and even contradictory.Moreover, cause and effect have never been proven.A detected change in brain biochemistry in a patient could be a cause of psychotic symptoms or it could be a consequence of stress or the patients drug treatment.This provocative position taken by Szasz has attracted both enthusiastic supporters and indignant critics.Despite being a professor of psychiatry, he has repeatedly attacked modern psychiatric theory and practice, and reactions from his colleagues have varied from fury to exasperation.Many simply ignore him and place him beyond the pale.This may seek to move the problem of psychiatric knowledge to an envious or hostile enemy without.Some psychiatrists listen to the attack but still come to the conclusion that the symptom presentation of patients indicates that they are obviously mentally ill.