The concept of disorder as a foundation for the DSM's theory-neutral nosology: response to Follette and Houts, Part 2.

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 that 'mental disorder' and 'function' are value concepts that offer no scientific basis for the DSM's theory-neutral nosology or for distinguishing disorders from other behavioral problems. They also claim that the DSM presupposes a biological theory of etiology, thus is not really theory-neutral. They recommend replacing the DSM by theory-laden diagnostic manuals. I argue: (1) DSM criteria do not imply a biological model of disorder, (2) 'mental disorder' and 'function' have scientific content that allows one to distinguish disorder from nondisorder, (3) the evolutionary 'harmful dysfunction' analysis of disorder [Wakefield, J. C. (1992a). The concept of mental disorder: on the boundary between biological facts and social values. American Psychologist, 47, 373-388] coherently demarcates disorder from nondisorder, (4) the proposed behaviorist alternative to the DSM illustrated by the articles in Follette's special section [Follette, W. C. (Ed.) (1996a). Special section on the development of theoretically coherent alternatives to the DSM system. Journal of Consulting and Clinical Psychology, 64, 1117-1201] is incoherent because it does not distinguish disorder from nondisorder.     

The myth of DSM's invention of new categories of disorder: Houts's diagnostic discontinuity thesis disconfirmed

Houts (2001) argues that increases in DSM diagnostic categories are due to the invention of new disorders that are discontinuous with old conceptions of disorder and would not have been previously diagnosed. He maintains that DSM category increases are not comparable in nature to ICD category increases, which are mainly refinements of recognized disorders. I survey categories of disorder introduced after DSM-II and assess whether they are discontinuous with old concepts and categories of disorder. Candidate categories are identified from: Houts and Follette (1998), Mentalism, mechanisms, and medical analogues: Reply to Wakefield. Journal of Consulting and Clinical Psychology; Kutchins and Kirk (1997) Making us crazy: DSM: The psychiatric bible and the creation of mental disorders. New York: Free Press; and my own list. The result is that virtually none of the candidate categories are invented, discontinuous categories. In almost every case, the newly labeled conditions were considered disorders at the time of DSM-II and would have been diagnosed under DSM-II categories. I also reexamine DSM-IV sleep disorder categories, which Houts claims are discontinuous with past diagnostic conceptions. The result is that all DSM-IV sleep disorders were recognized as disorders at the time of DSM-II, and most were recognized as mental disorders. I conclude that DSM category increases are comparable in nature to ICD category increases, and that the invention-of-disorder account cannot explain the vast majority of such increases.     

The diagnostic and statistical manual's new white coat and circularity of plausible dysfunctions: response to Wakefield, part 1

Wakefield has claimed: (1) logical empiricist models of scientific progress support the view that expansions of the modern DSMs are consistent with such standards of progress; (2) diagnostic label proliferation of the modern DSMs is the same phenomenon as change in physical disease labels of the ICDs; (3) the concepts of disorder and dysfunction should not be separated. I show: (1) Wakefield has misrepresented traditional philosophy of science models of progress to serve his rhetorical aims: (2) Wakefield's claim that DSM label proliferation and ICD change are the same is empirically false; (3) failure to separate the concept of disorder from the concept of dysfunction leads to erroneous reasoning and label proliferation observed in the modem DSMs.     

Problems in the Definition of 'Mental Disorder'

Current diagnostic manuals in psychiatry such as DSM and ICD offer definitions of mental disorder, though it is recognized that they are unsatisfactory. It is likely that philosophy can help in this problem of definition. I argue that philosophical theories of mind have always implied definitions of mental disorder. Contemporary theories of mind commonly take intentionality to be fundamental, and I consider to what extent mental disorder can be defined in terms of radical failures of intentionality. Dennett has suggested that breakdown of intentional systems is to be explained from the physical stance, but explanations of breakdown from the design stance and even from the intentional stance are possible. Evolutionary theory emphasizes the intentionality of mind and behaviour, and is increasingly applied in models of psychopathology. It is unlikely that these models support the concept of mental disorder at work in current psychiatry.     

Reflections on the future of DSM axis II

Several proposals are enumerated in this article: (a) the need to employ a coherent classification-guiding theory; (b) the wisdom of conceptualizing personality patterns as prototypes; (c) a proposed shift away from the Axis I-Axis II distinction to a three-part continuum; (d) the utility of specifying relationships among the various classification categories of the nosology; (e) a proposal for refining and differentiating personality disorder subtypes; and (f) the utility of expanding the range and comparability of the diagnostic criteria.     

Presentism and Actualism

Presentism, some say, is either the analytic triviality that the only things that exist now are ones that exist now or the obviously false claim that the only things that have ever existed or will are ones that exist now. I argue that the correct understanding of presentism is the latter and so understood the claim is not obviously false. To appreciate this one has to see presentism as strictly analogous to anti-Lewisean actualism. What this modal analogue makes evident is that singular tensed statements can have scope ambiguities and so can be thought of as true with the temporal operator represented by the tense read as having wide scope. Secondly, I argue that the analogy with the modal case also makes it clear that presentism must be understood as a thesis of the form: ‘the only things that have ever existed or ever will exist stand in relation R to this (present) utterance’, and is not a substantive topic for debate until relation R is characterized in non-temporal terms. However, despite the strict analogy, I argue that presentism may be a harder position to defend than actualism, since the truth-maker objection, properly interpreted, with Lewis, as based on a supervenience thesis, has more force as an objection to presentism since supervenience is itself a modal notion.

     

The motor theory of speech perception reviewed

More than 50 years after the appearance of the motor theory of speech perception, it is timely to evaluate its three main claims that (1) speech processing is special, (2) perceiving speech is perceiving gestures, and (3) the motor system is recruited for perceiving speech. We argue that to the extent that it can be evaluated, the first claim is likely false. As for the second claim, we review findings that support it and argue that although each of these findings may be explained by alternative accounts, the claim provides a single coherent account. As for the third claim, we review findings in the literature that support it at different levels of generality and argue that the claim anticipated a theme that has become widespread in cognitive science.     

From personality disorders to the fact-value distinction

Louis Charland’s claim that DSM Cluster B personality disorders are moral rather than clinical kinds has recently triggered a lively debate. In order to deliver a reliable report of the latter, both (1) Charland’s arguments concerning the impossibility of identifying and treating personality disorders without applying a morally laden conceptual framework and (2) some critical responses they provoked are discussed. Then, in turn, the conceptual history of the notion of personality disorder is traced, including not only well-recognized contributions from (3) medical psychiatry, psychoanalysis, and DSM nosology, but also (4) an important, but often neglected, tradition of virtue and moral character. Finally, (5) the idea of a normatively neutral concept of personality disorder is scrutinized in the context of its logical dependence on the fact-value distinction. The latter dichotomy’s recent criticism, in particular, is employed to support Charland’s argument and to suggest that the normative character of personality disorders may go much deeper than this or that DSM formulation.     

Clinical psychologists' theory-based representations of mental disorders predict their diagnostic reasoning and memory

The theory-based model of categorization posits that concepts are represented as theories, not feature lists. Thus, it is interesting that the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) established atheoretical guidelines for mental disorder diagnosis. Five experiments investigated how clinicians handled an atheoretical nosology. Clinicians' causal theories of disorders and their responses on diagnostic and memory tasks were measured. Participants were more likely to diagnose a hypothetical patient with a disorder if that patient had causally central rather than causally peripheral symptoms according to their theory of the disorder. Their memory for causally central symptoms was also biased. Clinicians are cognitively driven to use theories despite decades of practice with the atheoretical DSM.     

An alternative hierarchical organization of the mental disorders of the DSM-IV

With the approaching publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), alternative organizations of the DSM (4th ed.; DSM-IV; American Psychiatric Association, 1994) categories have been proposed. This article compares several published alternative organizations to clinicians' organization of the DSM-IV categories. As demonstrations of their organization of DSM-IV categories, psychologists and psychiatrists sorted 66 DSM-IV diagnostic categories into groups of similar diagnoses and then made progressively larger and smaller groups of diagnoses or placed similar groups next to each other on a table. Hierarchical agglomerative data analysis of clinicians' individual sortings showed that clinicians retained many lower level DSM-IV categories (e.g., anxiety disorders, mood disorders), but not the higher level DSM-IV categories (e.g., Axis I vs. Axis II). Instead, at the highest hierarchical level, clinicians' categories resembled the structure of the first edition of the DSM (American Psychiatric Association, 1952), which followed clinicians' diagnostic decision-making scheme, dividing mental disorders into organic versus nonorganic and then psychotic versus neurotic disorders. At minimum, these data suggest a DSM organization that makes sense to clinicians.     

Darwin and moral realism: survival of the iffiest

This paper defends moral realism against Sharon Street’s “Darwinian Dilemma for Realist Theories of Value” (this journal, 2006). I argue by separation of cases: From the assumption that a certain normative claim is true, I argue that the first horn of the dilemma is tenable for realists. Then, from the assumption that the same normative claim is false, I argue that the second horn is tenable. Either way, then, the Darwinian dilemma does not add anything to realists’ epistemic worries.     

Ceteris Paribus Post

Many have claimed that ceteris paribus (CP) laws are a quite legitimate feature of scientific theories, some even going so far as to claim that laws of all scientific theories currently on offer are merely CP. We argue here that one of the common props of such a thesis, that there are numerous examples of CP laws in physics, is false. Moreover, besides the absence of genuine examples from physics, we suggest that otherwise unproblematic claims are rendered untestable by the mere addition of the CP operator. Thus, “CP all Fs are Gs” when read as a straightforward statement of fact, cannot be the stuff of scientific theory. Rather, we suggest that when ``ceteris paribus' appears in scientific works it plays a pragmatic role of pointing to more respectable claims. This revised version was published online in July 2006 with corrections to the Cover Date.     

The Brain Is Not a Tool

Some psychologists claim that the brain is a tool. This claim can be construed either literally or figuratively. We argue that, in the former case, it is false, whereas in the latter case it has no place in scientific psychology. We also try to show why this discussion is relevant and suggest how a metaphor should behave to be of use in science.     

Success and truth in the realism/anti-realism debate

I aim to clarify the relationship between the success of a theory and the truth of that theory. This has been a central issue in the debates between realists and anti-realists. Realists assume that success is a reliable indicator of truth, but the details about the respects in which success is a reliable indicator or test of truth have been largely left to our intuitions. Lewis (Synthese 129:371–380, 2001) provides a clear proposal of how success and truth might be connected, comparing a test of success of our theories to medical tests with low rates of false positives and false negatives. But, contrary to what Lewis claims, I argue that it is not enough for the realist to undercut the claim that success is not a reliable indicator of truth. Rather, the realist must show that our current best theories are likely true. Further, I argue that tests in science are unlike medical tests in a number of important ways.     

Explaining the Success of Science: Kuhn and Scientific Realists

In this essay, I critically evaluate the approaches to explaining the success of science in Kuhn and the works of inference-to-the-best-explanation scientific realists. Kuhn’s challenge to realists, who invoke the truth of theories to explain their success, is two-fold. His paradigm-account of success confronts realists with the problem of theory change, and the historical fact of successful theories later rejected as false. Secondly, Kuhn’s account of the success of science has no need to bring truth into the explanation. In turn, I argue that weakness in Kuhn and the prevailing forms of scientific realism motivate a better account of realism which I characterize as ‘best current theory realism’ and defend against the pessimistic meta-induction and the problem of theory-change. This realism argues that the best explanation of the success of current and past scientific theories only requires the simple claim that our best current theories are true. Kuhn’s account can explain how normal science succeeds but cannot account for why its problem solutions work where they do and why they fail for other puzzles.     

Psychologists' and counsellors' perspectives on prolonged grief disorder and its inclusion in diagnostic manuals

Introduction: In this research, proposed criteria for what has been termed ‘Prolonged Grief Disorder’ (PGD) (more recently termed, ‘Persistent Complex Bereavement‐Related Disorder’ (PCB‐RD) in the proposed DSM‐V), were presented to psychologists and counsellors. Method: Participants were asked about their views on the ‘disorder’ and whether they considered its inclusion in diagnostic manuals was justified. A total of 185 participants, (147 psychologists, specialist and general, and 38 counsellors) responded to an online survey (part of a larger research project), concerning their attitudes, choices and activities regarding bereavement therapy. In this part of the research, therapists’ perspectives about pathological grief, the recognition of PGD and its inclusion in diagnostic manuals were explored. Fifty‐nine participants took the option of adding written remarks to the survey to expand on their opinions regarding PGD. Results/Conclusions: Tentative support for the inclusion of PGD in diagnostic manuals was given; however many therapists indicated considerable reservations about potential negative repercussions of using such a diagnosis. One‐way between‐groups analysis of variance was undertaken to determine whether participants' opinions varied according to main occupation or specialism; however, no significant difference was found. This research was conducted prior to the latest update to the proposed revision and diagnostic category concerning bereavement in the DSM‐5 of April 2012, but many observations and recommendations concerning PGD made by the therapists participating in this research can be seen to be applicable to PCB‐RD. Implications: The implications of this research for assessing and diagnosing grief, and ways of working with bereaved clients, are discussed.     

Are shapes intrinsic?

It is widely believed that shapes are intrinsic properties. But this claim is hard to defend. I survey all known theories of shape properties, and argue that each theory is either incompatible with the claim that shapes are intrinsic, or can be shown to be false.     

Criminal insanity

In a recent article, ‘Marxism and Radical Democracy’,¹ Femia argues that Marxism is incompatible with radical democracy. In so doing he specifically reiterates² a now common claim that the notion of scientific socialism defended by Marx and Engels and prevalent in the Second International is anti‐democratic. This claim has not only been made by critics of Marxism.³ It has been a major criticism of classical Marxism within the Western Marxist tradition, in particular” in the work of the Frankfurt School.⁴ It is one of the main reasons why the classical Marxism of Engels and the Second International has been rejected as positivist and vulgar: no modern sophisticated Marxist admits to either positivism or vulgarity. In this paper I examine and reject Femia's arguments for the claim that the notion of scientific socialism is undemocratic. I argue that the orthodox view of Marxism as a scientific theory is compatible with democracy, and indeed encourages a democratic understanding of socialism. A thoroughly vulgar Marxism is thoroughly democratic.     

Toward a Spinozistic modification of skinner's theory of man

B. F. Skinner argues in Beyond Freedom and Dignity (New York 1971) that only his theory of man is compatible with a ‘scientific’ approach to human behavior. I argue that Skinner's entirely open‐ended view of man is inadequate for his own purposes in that it leaves no room for the claim that certain value judgments are universally valid, something I argue Skinner is committed to despite an explicit avowal in one place of cultural relativism. I then go on to show that a modification of Skinner's theory of man which builds on Spinoza's notion of conatus would provide one with a theory‐based rationale for universally valid judgments without involving one in a ‘non‐scientific’ approach to human behavior. Specifically, I argue that such a Spinozistic modification would provide one with a theory‐based guarantee that man will not evolve in such a way that a truly scientific observer would deem a totalitarian state good.