A pressing need for interrater reliability in the diagnosis of mental disorders emerged during the mid-twentieth century, prompted in part by the development of diverse new treatments. The Diagnostic and Statistical Manual of Mental Disorders (DSM), third edition answered this need by introducing operationalized diagnostic criteria that were field-tested for interrater reliability. Unfortunately, the focus on reliability came at a time when the scientific understanding of mental disorders was embryonic and could not yield valid disease definitions. Based on accreting problems (...) with the current DSM-fourth edition (DSM-IV) classification, it is apparent that validity will not be achieved simply by refining criteria for existing disorders or by the addition of new disorders. Yet DSM-IV diagnostic criteria dominate thinking about mental disorders in clinical practice, research, treatment development, and law. As a result, the modernDSMsystem, intended to create a shared language, also creates epistemic blinders that impede progress toward valid diagnoses. Insights that are beginning to emerge from psychology, neuroscience, and genetics suggest possible strategies for moving forward. (shrink)

An astonishing volume and diversity of evidence is available for many hypotheses in the biomedical and social sciences. Some of this evidence—usually from randomized controlled trials (RCTs)—is amalgamated by meta-analysis. Despite the ongoing debate regarding whether or not RCTs are the ‘gold-standard’ of evidence, it is usually meta-analysis which is considered the best source of evidence: meta-analysis is thought by many to be the platinum standard of evidence. However, I argue that meta-analysis falls far short of that standard. Different meta-analyses (...) of the same evidence can reach contradictory conclusions. Meta-analysis fails to provide objective grounds for intersubjective assessments of hypotheses because numerous decisions must be made when performing a meta-analysis which allow wide latitude for subjective idiosyncrasies to influence its outcome. I end by suggesting that an older tradition of evidence in medicine—the plurality of reasoning strategies appealed to by the epidemiologist Sir Bradford Hill—is a superior strategy for assessing a large volume and diversity of evidence. (shrink)

This book on the philosophy of science argues for an empiricism, opposed to the tradition of David Hume, in which singular rather than general causal claims are primary; causal laws express facts about singular causes whereas the general causal claims of science are ascriptions of capacities or causal powers, capacities to make things happen. Taking science as measurement, Cartwright argues that capacities are necessary for science and that these can be measured, provided suitable conditions are met. There are case studies (...) from both econometrics and quantum mechanics. (shrink)

The creation of the latest version of psychiatry's 'bible' has been surrounded by a great deal of controversy. The latest revision, the DSM-5, contains several controversial diagnoses that have been the subject of much debate. One of the central criticisms of DSM-5 is that it pathologizes some behaviors that were previously considered simply problematic, or variations of normal behavior—for example, fidgetiness, noisiness, abundance of energy, shyness, anxiety, and bereavement. Diagnoses such as Binge Eating Disorder, Disruptive Mood Dysregulation Disorder...