Identifying delusional discourse: issues of rationality, reality and power

This paper addresses a foundational issue at the interface of psychiatry an d medical sociology; namely, how the judgement of pathology is made. In par ticular, it examines a debate over how the symptom of delusion is identifie d. The psychiatric approach is realist in orientation with delusions being commonly defined in the American Psychiatric Association's Diagnostic and S tatistical Manual as 'incorrect inferences about external reality'. However , from a social constructionist perspective, delusions are reconceptualised as the product of a power relationship in which the views of a less powerf ul patient are pathologised. Reviewing this argument reveals a number of wa ys in which constructionist sociology is critical of the psychiatric approa ch. However, the 'debate' has a paradoxical quality in that, although the c onstructionist critique addresses psychiatry's foundations, it has been lar gely ignored. An ethnomethodological analysis of delusion is offered which attempts to account for, and move beyond, this paradox. This involves devel oping criticisms which are responsive to the sorts of phenomena that clinic ians deal with. In other words, the argument points towards the development of a sub-discipline that deals with clinical phenomena and hence might be called 'clinical sociology'.