Philosophy of science and the progressiveness of the DSM's theory-neutral nosology: response to Follette and Houts, Part 1.

Follette and Houts [Follette, W. C., Houts, A. C. (1996). Models of scientific progress and the role of theory in taxonomy development: a case study of the DSM. Journal of Consulting and Clinical Psychology, 64, 1120-1132] argue on philosophy-of-science grounds that the DSM's theory-neutral nosology is scientifically unprogressive because of its growing number of categories and lack of a unifying explanatory theory. They suggested replacing the DSM by competing theory-laden diagnostic manuals. I argue: (1) the ways things can go wrong with the mind are inherently diverse, so a unified theory of mental disorders is unlikely; (2) the claim that an increase in categories is inconsistent with scientific progress is empirically false; (3) the claim that the DSM's new categories expand the domain of disorder is largely false; (4) progress in a theoretically fragmented field requires a shared theory-neutrally defined domain; (5) theory-neutral diagnosis and integration of etiological theories is preferable for now to competition among theory-based diagnostic manuals; (6) philosophy of science supports use of a theory-neutral nosology for now.     

Introduction to the special section on the concept of disorder.

Despite the absence of a consensual definition of disorder, considerable research and clinical work is based on the categorization and diagnosis of mental disorder. This article introduces a special section of the Journal of Abnormal Psychology that expands the debate between J. C. Wakefield (1999), who has proposed a "harmful dysfunction" analysis of disorder and S. O. Lilienfeld and L. Marino (1995, 1999), who offer an alternative "Roschian" or prototype analysis. This introduction summarizes the main arguments of Wakefield's target article and 8 critiques and discusses the conceptual value of the debate, especially an integration of diverse viewpoints and stimulation to further consideration of this important topic.     

Essentialism revisited: evolutionary theory and the concept of mental disorder.

J. C. Wakefield's (1999) elaboration of his harmful dysfunction analysis (HDA) of mental disorder does little to address previous criticisms (S. O. Lilienfeld & L. Marino, 1995) and instead reveals further conceptual weaknesses in his position. The authors demonstrate that (a) a Roschian analysis can account for the results of all of Wakefield's conceptual experiments and predicts a number of judgments of disorder not predicted by the HDA, (b) the HDA is incapable in many cases of providing a scientifically nonarbitrary distinction between disorder and nondisorder, and (c) the HDA cannot account for failures of cultural ex adaptations, mismatches between evolutionary design and novel environments, or defenses against threat. The authors argue that the HDA has been convincingly falsified and discuss the failure of essentialistic concepts to resolve controversies in other domains of biological science.     

Harmful dysfunction and the search for value neutrality in the definition of mental disorder: response to Wakefield, part 2

Wakefield's claims to have identified and objective scientific component of mental disorders in the concept of dysfunction are examined in light of previous attempts to state a value free concept of mental disorders. The harmful dysfunction concept of dysfunction is not value free because it confounds cause and purpose in a specious use of evolutionary theory and because evolutionary theory cannot reliably supply standards for when a function is broken. Harmful dysfunction analysis collapses into a value-laden concept of mental disorders and serves the untoward goal of promoting the status quo in the modern DSMs. If the concept of dysfunction were taken seriously and rigorously defined, then it might be possible to separate what is medical from what is not in the domain of mental disorders.     

The concept of mental disorder. On the boundary between biological facts and social values.

Although the concept of mental disorder is fundamental to theory and practice in the mental health field, no agreed on and adequate analysis of this concept currently exists. I argue that a disorder is a harmful dysfunction, wherein harmful is a value term based on social norms, and dysfunction is a scientific term referring to the failure of a mental mechanism to perform a natural function for which it was designed by evolution. Thus, the concept of disorder combines value and scientific components. Six other accounts of disorder are evaluated, including the skeptical antipsychiatric view, the value approach, disorder as whatever professionals treat, two scientific approaches (statistical deviance and biological disadvantage), and the operational definition of disorder as "unexpectable distress or disability" in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987). The harmful dysfunction analysis is shown to avoid the problems while preserving the insights of these other approaches.     

The ecological approach to perceiving as a foundation for understanding the development of knowing in infancy

The ecological thesis of direct realism is used as a framework for examining the development of knowing in human infancy. When information for perceiving is defined ecologically (i.e., relative to the situational context and to the physical dimensions, capabilities, and needs of the perceiver), knowing need not be construed as the act of using representations to give meaning to acts or percepts. Knowing, alternatively, is the act of noticing affordances, situation and perceiverspecific meanings of objects, according to their value to the perceiver for achieving specific goals. Changes with development in infant sensorimotor functioning may, in this view, be explained by a process of increasing economy in noticing potentially available affordances, rather than a process of constructing a representational system for making present something not present. Studies of three infant skills widely attributed to the onset of representation are examined with regard to this ecological thesis. Results indicate that the noticing of affordances is critically involved in each of these skills.     

Culture and context in the evolutionary concept of mental disorder.

The evolutionary theory of the concept of mental disorder as harmful dysfunction that J. C. Wakefield (1999) proposed (a) does not correspond to how the term disorder is used in psychiatric nosology or in clinicians' everyday practice; (b) does not cover the territory to which the term reasonably could be applied; and (c) is not especially useful for research, clinical, or social purposes. The broad concept of disorder is a polythetic, not a monothetic, concept. As such, there need be no essential characteristic, criterion, or single prototype of disorder. Instead, multiple prototypes with varying features are used to group together a wide range of disparate phenomena by analogy. Useful refinements of our concepts of disorder have come from analyses of the nature of action and intentionality. What are most needed now are careful analyses of the social embedding of our concepts in cultural knowledge and practice.     

The role of hyperventilation in panic disorder: a response to Ley (1991)

Ley (Behaviour Research and Therapy, 29, 301–304, 1991) provided a reinterpretation of experimental findings on the efficacy of breathing retraining plus cognitive restructuring in reducing the symptomatology of patients with panic disorder with agoraphobia which were presented in a 1989 article in this journal. On the basis of his reinterpretation, they concluded that our findings supported the central role of hyperventilation in panic attacks. Ley's arguments are discussed and we conclude that his reinterpretation provides new arguments against a hyperventilation theory of panic. Furthermore, recent evidence from empirical studies does not support a central role for hyperventilation in panic attacks.     

Interventive Interviewing: Part I. Strategizing as a Fourth Guideline for the Therapist

A clinical interview affords far more opportunities to act therapeutically than most therapists realize. Because so many of these opportunities remain outside the therapist's conscious awareness, it is useful to elaborate guidelines that orient his or her general activity in directions that are liable to be therapeutic. The Milan associates defined three such basic guidelines: hypothesizing, circularity, and neutrality. Hypothesizing is clear and easy to accept. The notions of circularity and neutrality have aroused considerable interest but are not as readily understood. These guidelines may be clarified and operationalized when reformulated as conceptual postures. This process is enhanced by differentiating a fourth guideline, strategizing, which entails the therapist's decision making, including decisions about how to employ these postures. This paper, the first in a series of three, explores these four interviewing guidelines. The other papers will appear in a subsequent issue. Part II will focus on reflexive questioning, a mode of inquiry oriented toward mobilizing the family's own healing capacity. Part III will provide a scheme for analyzing and choosing among four major types of questions: linear questions, circular questions, reflexive questions, and strategic questions.     

The functional independence of response latency and accuracy: Implications for the concept of conceptual tempo

Kagan (1965a) developed the concepts of impulsive and reflective cognitive styles (conceptual tempo) to add a new dimension to the understanding and assessment of human intelligence. Although latency (the principal component of conceptual tempo) is negatively correlated with academic performance, it may not be necessary to modify latency in order to modify accuracy. With 40 disadvantaged preschool children, it was found that reinforcing long latencies in choice tasks did not increase accuracy and vice versa, and that reinforcing both long latencies and accuracy was no more effective than reinforcing accuracy alone. These data were used to question the usefulness of the construct of conceptual tempo.This article is based on a master's thesis prepared by the first author under the supervision of the second author.     

The act of death and the gift of suffering: a response to Breck, Amundsen, and Bresnahan.

This response to the articles by Breck, Amundsen, and Bresnahan is argued from a traditional Orthodox point of view, which accepts the historical Tradition of the Church and recognizes the relevance of this Tradition in the modern world. Traditional Orthodox ethics is grounded in a radical perception of the Resurrection of Christ. Many Western and Eastern commentators on Orthodox religion and spirituality have noted the centrality of the Resurrection to all facets of our Tradition. Thus the discussion of euthanasia should be seen in the light of the Resurrection of Christ.     

The MMPI-2 as a predictor of symptom change following treatment for posttraumatic stress disorder

This study sought to examine the impact of personality factors on symptom change following treatment for 141 Vietnam veterans with chronic combat-related posttraumatic stress disorder (PTSD) using the Minnesota Multiphasic Personality Inventory-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). A series of partial correlation and linear multivariate regression analyses identified social alienation, associated with anger and substance use, as the most potent negative predictor of symptom change. Of the scales assessing personality disorder, Borderline Personality was identified as the strongest negative predictor of outcome. Regression analyses examining the most salient scales identified 5 items that contributed 14% of the variance in the prediction of change scores independently of the 21% accounted for by pretreatment PTSD severity.     

From Neurotic Guilt to Existential Guilt as Grief: The Road to Interiority, Agency, and Compassion Through Mourning. Part II

This study is a continuation of an article that was published in the previous issue of The American Journal of Psychoanalysis (Volume 66, Number 3, September 2006). The case of Helen is illustrated in terms of the analysand’s developmental mourning, countertransference, interiority, antilibidinal ego, and transformation of aggression into self-agency.Susan Kavaler-Adler, Ph.D., ABPP, is Founder and Executive Director, Training Analyst, Faculty Member, and Supervisor at the Object Relations Institute for Psychotherapy and Psychoanalysis, New York.     

Psychoanalysis as a science: a response to the new challenges

Few theoretical issues in psychoanalysis have been more constantly argued than the status of our discipline as a science. For long the attack has been from the logical positivists and the extensions of their argument by Karl Popper. Over recent decades the debate about the place of our metapsychology has intensified the concerns about our scientific status. In this paper I respond briefly to the logical positivist, the Popperian, and the information-processing systems theory arguments and then develop at greater length a response to the two current, most widespread philosophy-of-science assaults upon our credibility as science, that of the hermeneuticists (Ricoeur, Habermas, Gadamer, and others), and the newest, that of the philosopher, Adolf Grünbaum.