Immediately before the release of DSM-5, a group of psychiatric thought leaders published the results of field tests of DSM-5 diagnostic criteria. They characterized the interrater reliability for diagnosing major depressive disorder by two trained mental health practitioners as of "questionable agreement." These field tests confirmed an open secret among psychiatrists that our current diagnostic criteria for diagnosing major depressive disorder are unreliable and neglect essential experiences of persons in depressive episodes. Alternative diagnostic criteria exist, but psychiatrists rarely encounter them, forestalling the discipline's epistemological crisis. In Alsadair MacIntyre's classic essay, such crises occur in science when a person encounters a rival schemata that is incompatible with their current schemata and subsequently constructs a narrative that allows them to reconstruct their own tradition. In search of rival schemata that are in conversation with their own tradition, psychiatric practitioners can utilize alternative diagnostic criteria like the Cultural Formulation Interview, embrace an epistemologically humble psychiatry, and attend to the narrative experience of a person experiencing a depressive episode.

中文翻译：

---

有问题的协议：抑郁症的经历和 DSM-5 重度抑郁症标准

就在 DSM-5 发布之前，一群精神病学思想领袖公布了 DSM-5 诊断标准的现场测试结果。他们将两名训练有素的心理健康从业者诊断重度抑郁症的评价者间可靠性描述为“有问题的一致意见”。这些实地测试证实了精神科医生之间的一个公开秘密，即我们目前诊断重度抑郁症的诊断标准不可靠，并且忽视了抑郁症患者的基本经历。存在替代诊断标准，但精神病学家很少遇到它们，从而避免了该学科的认识论危机。在 Alsadair MacIntyre 的经典论文中，当一个人遇到与他们当前的图式不相容的竞争图式并随后构建一个允许他们重建自己的传统的叙述时，这种危机就会发生在科学中。为了寻找与他们自己的传统对话的竞争对手图式，精神病学从业者可以利用替代诊断标准，如文化公式访谈，接受认识论上谦逊的精神病学，并关注经历抑郁发作的人的叙事体验。