A large part of the controversy surrounding the publication of DSM-5 stems from the possibility of replacing the purely descriptive approach to classification favored by the DSM since 1980. This paper examines the question of how mental disorders should be classified, focusing on the issue of whether the DSM should adopt a purely descriptive or theoretical approach. I argue that the DSM should replace its purely descriptive approach with a theoretical approach that integrates causal information into the DSM’s descriptive diagnostic (...) categories. The paper proceeds in three sections. In the first section, I examine the goals (viz., guiding treatment, facilitating research, and improving communication) associated with the DSM’s purely descriptive approach. In the second section, I suggest that the DSM’s purely descriptive approach is best suited for improving communication among mental health professionals; however, theoretical approaches would be superior for purposes of treatment and research. In the third section, I outline steps required to move the DSM towards a hybrid system of classification that can accommodate the benefits of descriptive and theoretical approaches, and I discuss how the DSM’s descriptive categories could be revised to incorporate theoretical information regarding the causes of disorders. I argue that the DSM should reconceive of its goals more narrowly such that it functions primarily as an epistemic hub that mediates among various contexts of use in which definitions of mental disorders appear. My analysis emphasizes the importance of pluralism as a methodological means for avoiding theoretical dogmatism and ensuring that the DSM is a reflexive and self-correcting manual. (shrink)

In somatic medicine, diagnostic terms often refer to the disease processes that are the causes of patients' symptoms. The language used in some clinical textbooks and health information resources suggests that this is also sometimes assumed to be the case with diagnoses in psychiatry. However, this seems to be in tension with the ways in which psychiatric diagnoses are defined in diagnostic manuals, according to which they refer solely to clusters of symptoms. This paper explores how theories (...) of reference in the philosophy of language can help to resolve this tension. After the evaluation of descriptive and causal theories of reference, I put forward a conceptual framework based on two-dimensional semantics that allows the causal analysis of diagnostic terms in psychiatry, while taking seriously their descriptive definitions in diagnostic manuals. While the framework is presented as a solution to a problem regarding the semantics of psychiatric diagnoses, it can also accommodate the analysis of diagnostic terms in other medical disciplines. (shrink)

This thesis is a philosophical examination of the explanatory roles of diagnoses in psychiatry. In medicine, diagnoses normally serve as causal explanations of patients’ symptoms. Given that psychiatry is a discipline whose practice is shaped by medical traditions, it is often implied that its diagnoses also serve such explanatory functions. This is evident in clinical texts that portray psychiatric diagnoses as referring to diseases that cause symptoms. However, there are problems which cast doubt on whether (...) such portrayals are justified. I address these problems and examine whether psychiatric diagnoses provide explanations of symptoms. The first problem is conceptual. In diagnostic manuals, psychiatric diagnoses are defined by their symptoms. This suggests that invoking them as explanations of the symptoms amounts to circularity. I argue that this can be resolved with an appropriate conceptual framework that captures the complex semantic values of diagnostic terms and their different uses in clinical discourse. I put forward such a framework based on two-dimensional semantics. The second problem is ontological. Empirical research suggests that diagnostic categories in psychiatry do not correspond to invariant causal types, but are associated with variable combinations of diverse causes that interact across biological, psychological, and social levels. Given this heterogeneity, I argue that psychiatric diagnoses fall short of paradigmatic cases of causal explanation, but that some can still provide other sorts of useful causal explanatory information. The original contribution of this thesis is the illumination of the conceptual relations between diagnoses and symptoms. This philosophical work is important, because it can be brought to valuable application in modifying psychiatric practice. (shrink)

Psychiatric research is in crisis because of repeated failures to discover new drugs for mental disorders. Lack of measurement validity could partly account for these failures. If researchers do not actually measure the effects of drugs on the disorders they aim to investigate, one should expect suboptimal treatment outcomes. I argue that this is the case, focusing on depression, and fear & anxiety disorders. In doing so, I show how psychiatric research illustrates a more general phenomenon that (...) I call “validity drift.” A validity drift occurs when, in the course of developing new measurement procedures, researchers end up studying something different from what they originally aimed to study. I analyze the different ways in which scientists attempt to validate procedures for measuring mental disorders for the purpose of testing drugs in animal models. I show how those validation efforts might fail, thereby leading to validity drifts. Overall, this analysis highlights the complex interplay between the development of new measurement procedures, their calibration, and scientific theories of the target phenomena. (shrink)

This paper provides a historical analysis of a shift in the way animal models of mental disorders were conceptualized: the shift from the mid-twentieth-century view, adopted by some, that animal models model syndromes classified in manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), to the later widespread view that animal models model component parts of psychiatric syndromes. I argue that in the middle of the twentieth century the attempt to maximize the face validity of (...) animal models sometimes led to the pursuit of the ideal of an animal model that represented a behaviorally defined psychiatric syndrome as described in manuals such as the DSM. I show how developments within psychiatric genetics and related criticism of the DSM in the 1990s and 2000s led to the rejection of this ideal and how researchers in the first decade of the twenty-first century came to believe that animal models of mental disorders should model component parts of mental disorders, adopting a so-called endophenotype approach. (shrink)

The failure of psychiatry to validate its diagnostic constructs is often attributed to the prioritizing of reliability over validity in the structure and content of the Diagnostic and Statistical Manual of Mental Disorders. Here I argue that in fact what has retarded biomedical approaches to psychopathology is unwarranted optimism about diagnostic discrimination: the assumption that our diagnostic tests group patients together in ways that allow for relevant facts about mental disorder to be discovered. I consider the Research Domain Criteria (...) framework as a new paradigm for classifying objects of psychiatric research that solves some of the challenges brought on by this assumption. (shrink)

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)

Let’s begin by imagining a hypothetical psychotic illness called “Schneider’s Disease”, recognized for over 100 years. Let’s assume there has been great controversy as regards the “most valid” set of diagnostic criteria for SD.

Diagnoses are central to the practice of medicine, where they serve a variety of functions for clinicians, patients, and society. They aid communication, explain symptoms, inform predictions, guide therapeutic interventions, legitimize sickness, and authorize access to resources. Insofar as psychiatry is a discipline whose practice is shaped by medical conventions, its diagnoses are sometimes presented as if they serve the same sorts of function as diagnoses in bodily medicine. However, there are philosophical problems that cast doubt on (...) whether the functions of psychiatric diagnoses can legitimately be considered to be equivalent to those of medical diagnoses. The aim of this chapter is to explicate some of these problems, particularly conceptual and epistemological problems pertaining to the roles of diagnoses as explanations. I begin with an overview of the various functions that medical diagnoses normally serve and suggest that many of these functions receive justificatory support from the explanatory roles of the diagnoses. I then present issues regarding the epistemic functions of psychiatric diagnoses and how these issues have featured in the arguments of prominent critics of psychiatry. (shrink)

This chapter examines philosophical issues surrounding the classification of mental disorders by the Diagnostic and Statistical Manual of Mental Disorders (DSM). In particular, the chapter focuses on issues concerning the relative merits of descriptive versus theoretical approaches to psychiatric classification and whether the DSM should classify natural kinds. These issues are presented with reference to the history of the DSM, which has been published regularly by the American Psychiatric Association since 1952 and is currently in its fifth edition. (...) While the first two editions of the DSM adopted a theoretical (psychoanalytic) and etiological approach to classification, subsequent editions of the DSM have adopted an atheoretical and purely descriptive (“neo-Kraepelinian”) approach. It is argued that largest problem with the DSM at present—viz., its failure to provide valid diagnostic categories—is directly related to the purely descriptive methodology championed by the DSM since the third edition of the DSM. In light of this problem, the chapter discusses the prospects of a theoretical and causal approach to psychiatric classification and critically examines the assumption that the DSM should classify natural kinds. (shrink)

In the Netherlands and Belgium, it is lawful for voluntary euthanasia to be offered on the grounds of psychiatric suffering. A recent case that has sparked much debate is that of Aurelia Brouwers, who was helped to die in the Netherlands on account of her suffering from borderline personality disorder. It is sometimes claimed that whether or not a mentally ill person’s wish to die is valid hinges on whether or not that wish is a symptom of the person’s (...) mental disorder. This article addresses the philosophical problems raised by this claim, with a specific focus on the diagnosis of borderline personality disorder. After considering descriptivist and causal conceptualizations of mental disorder, I argue that the current approach to borderline personality disorder in psychiatry precludes the possibility of dissociating the wish to die from the disorder. I then examine the implications of this analysis for the question of whether or not the request for voluntary euthanasia in the case of borderline personality disorder can be considered valid. Ultimately, I conclude that the inability to dissociate the wish to die from the disorder does not invalidate the wish in the case of borderline personality disorder. (shrink)

This paper addresses philosophical issues concerning whether mental disorders are natural kinds and how the DSM should classify mental disorders. I argue that some mental disorders (e.g., schizophrenia, depression) are natural kinds in the sense that they are natural classes constituted by a set of stable biological mechanisms. I subsequently argue that a theoretical and causal approach to classification would provide a superior method for classifying natural kinds than the purely descriptive approach adopted by the DSM since DSM-III. My argument (...) suggests that the DSM should classify natural kinds in order to provide predictively useful (i.e., projectable) diagnostic categories and that a causal approach to classification would provide a more promising method for formulating valid diagnostic categories. (shrink)

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was published in 2013. This manual classifies all known mental disorders and provides operationalized criteria for their diagnosis. The goal of this manual is to facilitate communication, treatment and research with reliable and valid diagnoses. This article will provide a study of what this diagnostic validity actually entails. Firstly, it will include a discussion of the different conceptions of validity that have appeared in the literature (...) so far. To decide between these different conceptions, diagnostic validity will be defined as ”picking out a natural kind’. Secondly, two different accounts of natural and psychiatric kinds are examined, namely, essentialism and pragmatism. Both of these will be rejected in favor of conceiving natural kinds as causal-epistemic kinds. Thirdly, it is argued that the multidimensional complexity of psychiatric disorders does not exclude the possibility of psychiatric kinds being natural kinds. However, pragmatic considerations in classifying disorders have meant that the DSM most likely does not distinguish causal-epistemic kinds very well. I argue that the need to have a single classification both for clinicians and researchers and the priority given to reliability rather than validity has ultimately compromised the diagnostic validity of the DSM. (shrink)

Any theory of truth must find a way around Curry’s paradox, and there are well-known ways to do so. This paper concerns an apparently analogous paradox, about validity rather than truth, which JC Beall and Julien Murzi call the v-Curry. They argue that there are reasons to want a common solution to it and the standard Curry paradox, and that this rules out the solutions to the latter offered by most “naive truth theorists.” To this end they recommend a (...) radical solution to both paradoxes, involving a substructural logic, in particular, one without structural contraction. In this paper I argue that substructuralism is unnecessary. Diagnosing the “v-Curry” is complicated because of a multiplicity of readings of the principles it relies on. But these principles are not analogous to the principles of naive truth, and taken together, there is no reading of them that should have much appeal to anyone who has absorbed the morals of both the ordinary Curry paradox and the second incompleteness theorem. (shrink)

Discussions of psychiatric nosology focus on a few popular examples of disorders, and on the validity of diagnostic criteria. Looking at Anorexia Nervosa, an example rarely mentioned in this literature, reveals a new problem: the DSM has a strict taxonomic structure, which assumes that disorders can only be located on one branch. This taxonomic assumption fails to fit the domain of psychopathology, resulting in obfuscation of cross-category connections. Poor outcomes for treatment of Anorexia may be due to it (...) being pigeonholed as an Eating Disorder, when a disturbance of body perception may be a more central symptom than food restriction. This paper explores the possibility of restructuring the DSM taxonomy to allow for a pluralist classification of disorders. This change could improve treatment and research without requiring any changes to diagnostic criteria. (shrink)

Jonathan Y. Tsou examines and defends positions on central issues in philosophy of psychiatry. The positions defended assume a naturalistic and realist perspective and are framed against skeptical perspectives on biological psychiatry. Issues addressed include the reality of mental disorders; mechanistic and disease explanations of abnormal behavior; definitions of mental disorder; natural and artificial kinds in psychiatry; biological essentialism and the projectability of psychiatric categories; looping effects and the stability of mental disorders; psychiatric classification; and the validity (...) of the DSM's diagnostic categories. The main argument defended by Tsou is that genuine mental disorders are biological kinds with harmful effects. This argument opposes the dogma that mental disorders are necessarily diseases that result from biological dysfunction. Tsou contends that the broader ideal of biological kinds offers a more promising and empirically ascertainable naturalistic standard for assessing the reality of mental disorders and the validity of psychiatric categories. (shrink)

The observation that a crisis of confidence regarding Psychiatry exists is a notion shared even among psychiatrists themselves. Psychiatry has a checkered history and its alliance with the pharmaceutical industry, aka Big-Pharma, continues to reinforce a need for healthy skepticism. Why? Mainly, an over-reliance on the questionable expertise and authority afforded psychiatry as the specialists of mental health. I contend that the authority of psychiatry is misplaced and too often harmful. Since the criteria required to justify and satisfy psychiatric (...) expertise is not fully established as can be substantiated by compelling reasons to rethink its authority as a reliable profession in its current form. Psychiatric expertise is not particularly scientific and this is especially dangerous in a sector that prescribes mind-altering drugs. There are a number of identified criteria that would otherwise substantiate psychiatric expertise and whilst partially existent, are nonetheless deficient. These major yet deficient aspects of psychiatric practice concern diagnostic problems – reliability and verification of diagnoses and accurate testable validity of diagnoses - mainly due to an absence of identifiable underlying biomarkers ordinarily related to disease or biological conditions. Psychiatrists often fail to distinguish between reactive-depression (reaction to external event or circumstance) and endogenous-depression (biological) resulting, in part, from incorrectly distinguishing between conditions constitutive of ‘trait’ (endogenous) and of those of ‘state’ (e.g. reactive depression; adverse effects from medication, etc.). (shrink)

The psychiatric diagnostic system, as exemplified by the DSM, is a pseudo-scientific framework for diagnosing sick Cartesian isolated minds. As such, it completely overlooks the exquisite context sensitivity and radical context dependence of human emotional life and of all forms of emotional disturbance. In Descartes’s vision, the mind is a “thinking thing,” ontologically decontextualized, fundamentally separated from its world. Heidegger’s existential phenomenology mended this Cartesian subject-object split, unveiling our Being as always already contextualized, a Being-in-the-world. Here I offer a (...) critique of studies in “phenomenological psychopathology” that presuppose the validity of the psychiatric diagnostic system and leave it unchallenged. In this vein, I contend that all emotional disturbances are constituted in an indissoluble context of human interrelatedness. Specifically, I claim that all emotional disturbances, including those objectified by the DSM, take form in relational contexts of severe emotional trauma. There are no psychiatric entities, only devastating contexts. Additionally, I show that Heidegger’s analyses of Angst, world-collapse, uncanniness, and thrownness into Being-toward-death provide extraordinary philosophical tools for grasping the existential significance of such contexts of emotional trauma. Applying Heidegger’s concept of authenticity, I suggest that emotional health entails an ease of passage—i.e., an absence of dissociation—between the world of trauma and the world of everydayness. (shrink)

In this chapter, I provide an overview of phenomenological approaches to psychiatric classification. My aim is to encourage and facilitate philosophical debate over the best ways to classify psychiatric disorders. First, I articulate phenomenological critiques of the dominant approach to classification and diagnosis—i.e., the operational approach employed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-10). Second, I describe the type or typification approach to psychiatric classification, which I distinguish (...) into three different versions: ideal types, essential types, and prototypes. I argue that despite their occasional conflation in the contemporary literature, there are important distinctions among these approaches. Third, I outline a new phenomenological-dimensional approach. I show how this approach, which starts from basic dimensions of human existence, allows us to investigate the full range of psychopathological conditions without accepting the validity of current diagnostic categories. (shrink)

Dear Editor, in a previous paper we have tried to delve into what validity means in the context of psychiatric nosology, arguing for a pragmatic view of it. Here we want to briefly reassert the basic points of our analysis, make a few clarifications and address some issues raised by commentators.

In psychiatry some disorders of cognition are distinguished from instances of normal cognitive functioning and from other disorders in virtue of their surface features rather than in virtue of the underlying mechanisms responsible for their occurrence. Aetiological considerations often cannot play a significant classificatory and diagnostic role, because there is no sufficient knowledge or consensus about the causal history of many psychiatric disorders. Moreover, it is not always possible to uniquely identify a pathological behaviour as the symptom of a (...) certain disorder, as disorders that are likely to differ both in their causal histories and in their overall manifestations may give rise to very similar patterns of behaviour. -/- Consider delusions as an example. It wouldn’t be correct to define delusions as those beliefs people form as a result of a neurobiological deficit and a hypothesis-evaluation deficit (as some versions of the two-factor theory of delusions suggest), because for some delusions no neurobiological deficit may be found, and reasoning biases and motivational factors may be contributors to the formation of the delusion (e.g. McKay et al., 2005). Moreover, it would be a mistake to define delusions as symptoms of schizophrenia alone, because they occur also in other disorders, including dementia, amnesia, and delusional disorders. Thus, aetiological considerations may appear in the description and analysis of delusions, but do not feature prominently in their definition. -/- In this paper I argue that the surface features used as criteria for the classification and diagnosis of disorders of cognition are often epistemic in character. I shall offer two examples: confabulations and delusions are defined as beliefs or narratives that fail to meet standards of accuracy and justification. Although classifications and diagnoses based on features of people’s observable behaviour are necessary at these early stages of neuropsychiatric research, given the variety of conditions in which certain phenomena appear, I shall attempt to show that current epistemic accounts of confabulations and delusions have limitations. Epistemic criteria can guide both research and clinical practice, but fail to provide sufficient conditions for the identification of delusions and confabulations, and fail to demarcate pathological from non-pathological narratives or beliefs. -/- Another limitation of current epistemic accounts – which I shall not address here – is the excessive focus on epistemic faults of confabulations and delusions at the expense of their epistemically neutral or advantageous features (see Bortolotti and Cox, 2009). This may lead to a misconception of delusions and confabulations, and to an oversimplification in the assessment of the needs of people who require clinical treatment for their psychotic symptoms. (shrink)

Mouth ulcers, also known as canker sores, are a common oral health issue affecting a significant portion of the population. Early and accurate diagnosis of mouth ulcers is crucial for effective treatment and prevention of complications. This paper presents an expert system developed using CLIPS (C Language Integrated Production System) to diagnose mouth ulcer disease. The expert system utilizes a rule-based approach, incorporating a comprehensive knowledge base consisting of symptoms, risk factors, and medical literature related to mouth ulcers. By employing (...) an inference engine, the system evaluates patient input against the rules and generates a diagnosis based on the matching symptoms and relevant factors. The system also provides detailed explanations and recommendations for each diagnosis, aiding healthcare professionals and patients in understanding the condition and selecting appropriate treatment options. The development and validation of the expert system involved a multi-step process, including knowledge acquisition, rule formulation, and testing against a diverse dataset of mouth ulcer cases. The system's performance was evaluated by comparing its diagnoses with those made by medical professionals, demonstrating a high level of accuracy and consistency. The implementation of an expert system for diagnosing mouth ulcer disease offers several advantages, including the ability to provide timely and accessible healthcare services, reduce misdiagnosis rates, and assist healthcare professionals in decision-making processes. Moreover, it empowers individuals to make informed decisions about their health and seek appropriate medical intervention. This paper contributes to the field of medical expert systems by showcasing the practical application of CLIPS in the diagnosis of mouth ulcer disease. The results demonstrate the potential of expert systems as valuable tools for healthcare professionals and patients alike, enhancing the efficiency and accuracy of diagnosis in oral health care. (shrink)

Editor’s Note: If all goes as planned, the American Psychiatric Association will release a new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May 2013. Since 1980, the DSM has provided a shared diagnostic language to clinicians, patients, scientists, school systems, courts, and pharmaceutical and insurance companies; any changes to the influential manual will have serious ramifications. But, argues Dr. Steven Hyman, the DSM is a poor mirror of clinical and biological realities; a fundamentally new approach to diagnostic (...) classification is needed as researchers uncover novel ways to study and understand mental illness. (shrink)

To date, diagnosing Attention Defi cit Hyperactivity Disorder remains indeed one of the most controversial issues in contemporary psychiatry and behavioural sciences. Most of the conceptual problems regarding the validity of this diagnostic category arise from the heterogeneity of syndromal pictures and the high rate of comorbidity observed in subjects diagnosed with ADHD at all stages of the longitudinal course of the disorder. In this regard, DSM 5 increased complexity by allowing a diagnosis of comorbidity between ADHD and autism (...) spectrum disorders while these two diagnoses were mutually exclusive in DSM-IV-TR. (shrink)

Background: Despite being often taken as the benchmark of quality for diagnostic and classificatory tools, 'validity' is admitted as a poorly worked out notion in psychiatric nosology. Objective: Here we aim at presenting a view that we believe to do better justice to the significance of the notion of validity, as well as at explaining away some misconceptions and inappropriate expectations regarding this attribute in the aforementioned context. Method: The notion of validity is addressed taking into (...) account its role, the framework according to which it should be assessed and the specific contents to which it refers within psychiatric nosology. Results and Conclusions: The notion of validity has an epistemological thrust and its foremost role is distinguishing correct reasoning and truth from what is irrational or false. From it follows not only that 'validity' always refers to elements of knowledge and rationality such as arguments, inferences and propositions, but also that the appropriate frameworks to assess 'validity' are logics and scientific methodology. When the validity of a psychiatric diagnostic category is at stake, the contents to which it refers are those relevantly related to the notion of 'diagnostic concept'. The consequences of our reading on the notion of 'validity' are discussed vis-à-vis the challenges faced by psychiatric nosology in order to have its diagnostic categories validated. (shrink)

Contemporary psychiatry finds itself in the midst of a crisis of classification. The developments begun in the 1980s—with the third edition of the Diagnostic and Statistical Manual of Mental Disorders —successfully increased inter-rater reliability. However, these developments have done little to increase the predictive validity of our categories of disorder. A diagnosis based on DSM categories and criteria often fails to accurately anticipate course of illness or treatment response. In addition, there is little evidence that the DSM categories link (...) up with genetic findings, and even less evidence that they... (shrink)

Understood in their historical context, current debates about psychiatric classification, prompted by the publication of the DSM-5, open up new opportunities for improved translational research in psychiatry. In this paper, we draw lessons for translational research from three time slices of 20th century psychiatry. From the first time slice, 1913 and the publication of Jaspers’ General Psychopathology, the lesson is that translational research in psychiatry requires a pluralistic approach encompassing equally the sciences of mind (including the social sciences) and (...) of brain. From the second time slice, 1953 and a conference in New York from which our present symptom-based classifications are derived, the lesson is that, while reliability remains the basis of psychiatry as an observational science, validity too is essential to effective translation. From the third time slice, 1997 and a conference on psychiatric classification in Dallas that brought together patients and carers with researchers and clinicians, the lesson is that we need to build further on collaborative models of research combining expertise-by-training with expertise-by-experience. This is important if we are to meet the specific challenges to translation presented by the complexity of the concept of mental disorder, particularly as reflected in the diversity of desired treatment outcomes. Taken together, these three lessons – a pluralistic approach, reliability and validity, and closer collaboration – provide an emerging framework for more effective translation of research into practice in 21st century psychiatry. (shrink)

This dissertation seeks to examine the validity of the justification commonly offered for a coercive(1) psychiatric intervention, namely that the intervention was in the ‘best interests’ of the subject and/or that the subject posed a danger to others. As a first step,it was decided to analyse justifications based on ‘best interests’ [the ‘Stage 1’ argument] separately from those based on dangerousness [the ‘Stage 2’ argument]. Justifications based on both were the focus of the ‘Stage 3’ argument. Legal and (...) philosophical analyses of coercive psychiatric interventions generally regard such interventions as embodying a benign paternalism occasioning slight, if any, ethical concern. Whilst there are some dissenting voices even at the very heart of academic and professional psychiatry, the majority of psychiatrists also appear to share such views. The aim of this dissertation is to show that such a perspective is mistaken and that such interventions raise philosophical and ethical questions of the profoundest importance.(2) The philosophical well-spring of the Stage 1 dissertation argument lay in an observation made by Philippa Foot (3) that the “… right to be let free from unwanted interference” is one of the most fundamental and distinctive rights of persons, a right which takes precedence over any “… action we would dearly like to take for his sake.” This – in conjunction with the recognition that some coercive psychiatric interventions are of a gravity as to result in the personhood of the subject being severely damaged if not destroyed – suggested that the concept of personhood play a central role in the formulation of the dissertation argument. For ease of analysis it was presumed that the term ‘person’ could be defined by a set of necessary and sufficient conditions of which ‘minimum levels of rationality’ and ‘ability to communicate’ were the only conditions relevant to the formulation of justifications for coercive psychiatric interventions. This presumption was explicated into a number of postulates which enabled the construction of a rigorous foundation on which to develop the dissertation argument. This argument then sought to determine whether psychiatric assessments of irrationality were accurate and reliable. In furtherance of this analysis it was necessary to examine the reliability of psychiatric determinations in other areas of claimed expertise namely diagnosis, treatment and assessment of dangerousness. This ‘crossing of the disciplinary threshold’ brought to light the dearth of studies on psychiatric misdiagnosis and iatrogenic harm. A variant of the Precautionary Principle was developed to enable the extent of such harms to be estimated. The not insignificant levels of psychiatric misdiagnosis and iatrogenic harm and erroneous assessments of dangerousness which were thus found are of considerable relevance to any ethical analysis of the justification for coercive psychiatric intervention and serve to undermine simple paternalistic justifications. ---- (1)The term ‘coercive’ (rather than ‘non-consensual’) is used to indicate an intervention carried out against the explicit and contemporaneous objections of the subject (2)Not least because the number of individuals detained in Irish psychiatric hospitals is of a comparable order of magnitude to the number detained in Irish prisons subsequent to a criminal conviction. (3) See Foot (1977), p.102. (shrink)

This dissertation seeks to examine the validity of the justification commonly offered for a coercive (1) psychiatric intervention, namely that the intervention was in the ‘best interests’ of the subject and/or that the subject posed a danger to others. As a first step,it was decided to analyse justifications based on ‘best interests’ [the ‘Stage 1’ argument] separately from those based on dangerousness [the ‘Stage 2’ argument]. Justifications based on both were the focus of the ‘Stage 3’ argument. Legal (...) and philosophical analyses of coercive psychiatric interventions generally regard such interventions as embodying a benign paternalism occasioning slight, if any, ethical concern. Whilst there are some dissenting voices even at the very heart of academic and professional psychiatry, the majority of psychiatrists also appear to share such views. The aim of this dissertation is to show that such a perspective is mistaken and that such interventions raise philosophical and ethical questions of the profoundest importance.(2) The philosophical well-spring of the Stage 1 dissertation argument lay in an observation made by Philippa Foot (3) that the “… right to be let free from unwanted interference” is one of the most fundamental and distinctive rights of persons, a right which takes precedence over any “… action we would dearly like to take for his sake.” This – in conjunction with the recognition that some coercive psychiatric interventions are of a gravity as to result in the personhood of the subject being severely damaged if not destroyed – suggested that the concept of personhood play a central role in the formulation of the dissertation argument. For ease of analysis it was presumed that the term ‘person’ could be defined by a set of necessary and sufficient conditions of which ‘minimum levels of rationality’ and ‘ability to communicate’ were the only conditions relevant to the formulation of justifications for coercive psychiatric interventions. This presumption was explicated into a number of postulates which enabled the construction of a rigorous foundation on which to develop the dissertation argument. This argument then sought to determine whether psychiatric assessments of irrationality were accurate and reliable. In furtherance of this analysis it was necessary to examine the reliability of psychiatric determinations in other areas of claimed expertise namely diagnosis, treatment and assessment of dangerousness. This ‘crossing of the disciplinary threshold’ brought to light the dearth of studies on psychiatric misdiagnosis and iatrogenic harm. A variant of the Precautionary Principle was developed to enable the extent of such harms to be estimated. The not insignificant levels of psychiatric misdiagnosis and iatrogenic harm and erroneous assessments of dangerousness which were thus found are of considerable relevance to any ethical analysis of the justification for coercive psychiatric intervention and serve to undermine simple paternalistic justifications. --- (1)The term ‘coercive’ (rather than ‘non-consensual’) is used to indicate an intervention carried out against the explicit and contemporaneous objections of the subject (2)Not least because the number of individuals detained in Irish psychiatric hospitals is of a comparable order of magnitude to the number detained in Irish prisons subsequent to a criminal conviction (3)See Foot (1977), p.102. (shrink)

The logical-pragmatic perspective on the psychiatric diagnosis, presented by Rodriguez and Banzato contributes to and develops the existing conventional taxonomic framework. The latter is regarded as grounded on the epistemological prerequisites proponed by Carl Gustav Hempel in the late 1960s, adopted by the DSM task force of R. Spitzer in 1973.

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders included the Social Communication Disorder as a new mental disorder characterized by deficits in pragmatic abilities. Although the introduction of SPCD in the psychiatry nosography depended on a variety of reasons—including bridging a nosological gap in the macro-category of Communication Disorders—in the last few years researchers have identified major issues in such revision. For instance, the symptomatology of SPCD is notably close to that of Autism Spectrum Disorder. This (...) opens up the possibility that individuals with very similar symptoms can be diagnosed differently and receive different clinical treatments and social support. The aim of this paper is to review recent debates on SPCD, particularly as regards its independence from ASD. In the first part, we outline the major aspects of the DSM-5 nosological revision involving ASD and SPCD. In the second part, we focus on the validity and reliability of SPCD. First, we analyze literature on three potential validators of SPCD, i.e., etiology, response to treatment, and measurability. Then, we turn to reliability issues connected with the introduction of the grandfather clause and the use of the concepts of spectrum and threshold in the definition of ASD. In the conclusion, we evaluate whether SPCD could play any role in contemporary psychiatry other than that of an independent mental disorder and discuss the role that non-epistemic factors could play in the delineation of the future psychiatry nosography. (shrink)

This paper tests the predictions of an epistemological model that considered the DSM psychiatric classification (in the neopositivist and neo-Kraepelinian shape introduced by the DSM-III) as a scientific paradigm in crisis. As predicted, the DSM-5 did not include revolutionary proposals in its basic structure. In particular, the possibility of a dimensional revolution has not occurred and early proposals of etiopathogenic diagnoses were not implemented due to lack of specific knowledge in that field. However, conceiving the DSM-5 as a (...) bridge between the present phenomenally based operational diagnostic criteria and the neuro-cognitively based RDoC criteria introduces an internal tension into the system. It is expected that a liberalization of the research criteria will occur, the DSM operational criteria being only one possible way to select research subjects. (shrink)

Ayahuasca is a plant-based brew of indigenous Amazonian origin. It has psychedelic, anti-inflammatory, neuroprotective, cytotoxic, and anti-parasitic effects, which are primarily due to monoamine oxidase inhibitors (MAOIs) and N,N-dimethyltryptamine (DMT). This article describes the case of a woman in her late thirties with complex trauma due to severe, years-long sexual abuse in early childhood, resulting in a decades-long chronic condition involving suicidality. She was diagnosed with bipolar disorder and borderline personality disorder, but refused to accept either of them. She presented (...) with delusional parasitosis and deep dissociation. Despite being severely psychotic in private, she appeared high-functioning in public, hiding most of her symptoms. -/- In her mid-thirties, she participated in an ayahuasca ceremony in a legal setting. It resolved her suicidality, eliminated her social isolation, and reduced her shame related to her early trauma. Nine more ceremonies alleviated her distress further. Her abuser also participated in an ayahuasca ceremony and confirmed her memories of childhood abuse. -/- The first interview was conducted 1.5 years after her first ceremony, and a follow-up interview 2.5 years later. She had experienced sixteen additional ceremonies, recognized the validity of her bipolar disorder diagnosis, and believed her early trauma to be its sole cause. Her core trauma remained partially unresolved, but her dissociative symptoms continued to decrease. She had observed several other instances of psychosis and bipolar disorder in which ayahuasca had resulted in positive effects. This case study contributes to a better understanding of the use of ayahuasca in bipolar disorder and severe traumatization. It also reviews the current state-of-the-art in the treatment of bipolar disorder using low-dose ayahuasca, and a case in which bipolar disorder was resolved with LSD. -/- doi: 10.13140/RG.2.2.21294.18243. (shrink)

While Thomas Kuhn's theory of scientific revolutions does not specifically deal with validation, the validation of simulations can be related in various ways to Kuhn's theory: 1) Computer simulations are sometimes depicted as located between experiments and theoretical reasoning, thus potentially blurring the line between theory and empirical research. Does this require a new kind of research logic that is different from the classical paradigm which clearly distinguishes between theory and empirical observation? I argue that this is not the case. (...) 2) Another typical feature of computer simulations is their being ``motley'' (Winsberg 2003) with respect to the various premises that enter into simulations. A possible consequence is that in case of failure it can become difficult to tell which of the premises is to blame. Could this issue be understood as fostering Kuhn's mild relativism with respect to theory choice? I argue that there is no need to worry about relativism with respect to computer simulations, in particular. 3) The field of social simulations, in particular, still lacks a common understanding concerning the requirements of empirical validation of simulations. Does this mean that social simulations are still in a pre-scientific state in the sense of Kuhn? My conclusion is that despite ongoing efforts to promote quality standards in this field, lack of proper validation is still a problem of many published simulation studies and that, at least large parts of social simulations must be considered as pre-scientific. (shrink)

A diagnosis based exclusively on the so-called scientifi c evidence does not take into account the problem of the theoryladenness, widely debated in Twentieth Century epistemology. The theory of knowledge developed by Ludwik Fleck, physician and philosopher active in the 30s, can still be useful for shedding light on how psychiatric diagnoses are infl uenced by a specifi c thought style that directs the observations and affects the development of knowledge and the formation of connections between concepts.

Interdisciplinary research collaboration is crucial for addressing complex global challenges, and measuring researchers' perceptions of it is vital. The Perception of Interdisciplinary Research Collaboration (PIRC) Scale was meticulously developed and validated in this study to enable researchers to assess these perceptions comprehensively. The scale was developed in line with the team science theory. This cross-sectional study involved concept analysis, face and content validity, item pretesting, and pilot testing. A panel of eight specialists from relevant fields meticulously reviewed the items (...) in the instrument, and their inputs and suggestions were followed to refine the instrument, resulting in a 64-item questionnaire. A sample of 1,932 academic staff members with interdisciplinary research experience were selected from six universities in South-South Nigeria for a pilot study. A simple random sampling technique was employed in selecting these participants. Exploratory factor analysis yielded six underlying dimensions within the PIRC Scale, such as: "challenges of Interdisciplinary Disciplinary Research (IDR) collaboration," "IDR collaborative experiences," "motivations for IDR collaboration," "benefits of IDR collaboration," "career impact of IDR collaboration," and "IDR team dynamics." Confirmatory factor analysis confirmed this structure and revealed the bifactor model as the best-fitting model over the unidimensional, oblique and higher-order models. Utilising the Fornell-Larcker approach, strong convergent and discriminant validity was established across all dimensions, with Average Variance Extracted (AVE) above .50 and the square root of the AVE for all factors being greater than the correlation coefficients of each factor with other factors. Cronbach's alpha and McDonald's omega values exceeded the acceptable threshold of 0.70, with item-total correlation analyses further supporting the reliability of each sub-scale and the overall instrument. In conclusion, the PIRC scale can be valuable for researchers, institutions, and policymakers to assess and enhance interdisciplinary research collaboration. It can empower stakeholders to obtain useful information about researchers' perceptions of interdisciplinary research, promote effective collaboration, allocate resources efficiently, and foster innovation. (shrink)

Advocates of physician-assisted suicide often argue that, although the provision of PAS is morally permissible for persons with terminal, somatic illnesses, it is impermissible for patients suffering from psychiatric conditions. This claim is justified on the basis that psychiatric illnesses have certain morally relevant characteristics and/or implications that distinguish them from their somatic counterparts. In this paper, I address three arguments of this sort. First, that psychiatric conditions compromise a person’s decision-making capacity. Second, that we cannot have (...) sufficient certainty that a person’s psychiatric condition is untreatable. Third, that the institutionalisation of PAS for mental illnesses presents morally unacceptable risks. I argue that, if we accept that PAS is permissible for patients with somatic conditions, then none of these three arguments are strong enough to demonstrate that the exclusion of psychiatric patients from access to PAS is justifiable. (shrink)

Havstad (2022) argues that the argument from inductive risk for the claim that non-epistemic values have a legitimate role to play in the internal stages of science is deductively valid. She also defends its premises and thus soundness. This is, as far as we are aware, the best reconstruction of the argument from inductive risk in the existing literature. However, there is a small flaw in this reconstruction of the argument from inductive risk which appears to render the argument invalid. (...) This flaw is superficial, and a small amendment to it rescues the claim of validity. (shrink)

In this paper we describe a few interrelated issues for validating theories that posit levels of consciousness. First, validating levels of consciousness requires consensus about the ordering of conscious states, which cannot be easily achieved. This problem is particularly severe if we believe conscious states can be irreducibly smeared over time. Second, the relationship between conscious states is probably sometimes intransitive, which means levels of consciousness will not be amenable to a single continuous measure. Finally, even if a multidimensional approach (...) to levels of consciousness is adopted, we argue that there are further problems for its validation. (shrink)

In Eichmann in Jerusalem , Hannah Arendt struggled to defend the possibility of judgment against the obvious problems encountered in attempts to offer legally valid and morally meaningful judgments of those who had committed crimes in morally bankrupt communities. Following Norrie, this article argues that Arendt’s conclusions in Eichmann are equivocal and incoherent. Exploring her perspectival theory of judgment, the article suggests that Arendt remains trapped within certain Kantian assumptions in her philosophy of history, and as such sees the question (...) of freedom in a binary way. The article argues that Adorno’s philosophy of freedom provides the resources to diagnose and overcome Arendt’s shortcomings. Adorno’s position provides a way of embracing the antinomical character of judgment, by emphasising the need for elements of reason and nature in the phenomenon of freedom. In Adorno’s lights, judgment becomes an attempt to express a ‘spirit of solidarity’ with the tragic status of the potentially free but actually unfree subject of modernity. (shrink)

This study used a structural equation modelling approach to assess the association between employee work- life policies, psychological empowerment, and academic staff job commitment in universities in Cross River State, Nigeria. Three null hypotheses were formulated to guide the study following a descriptive survey research design. Multistage sampling procedure was adopted in the selection of 315 academic staff from two universities in the study area. “Work-Life Policies, Psychological Empowerment and Job Commitment Questionnaire (WPPEJCQ)” was used as the instrument for data (...) collection. The construct validity of the instrument was ascertained through an Exploratory Factor Analysis (EFA) using the Principal Component Analysis (PCA). The Kaiser-Meyer-Ohlin of .894 and the Bartlett coefficient of 7795.820 were obtained. Several fit indices of Confirmatory Factor Analysis were used to accept the model such as RMSEA=.031, TLI=.969, CFI=.971 and many others. The null hypotheses were all tested using Path analysis. Findings revealed, among others, that there is a significant effect of work-life policies on the affective (β=.774,t=21.636,p<.05), continuance (β=.450,t=8.932,p<.05), and normative (β=490,t=9.967,p<.05) dimensions of academic staff commitment; furthermore, psychological empowerment has a significant effect on the affective (β=.795,t=23.199,p<.05), continuance (β=.501,t=10.261,p<.05) and normative (β = .520, t = 10.795, p< .05) dimensions of staff commitment; and there is a significant composite effect of work-life policies and psychological empowerment on the affective, continuance, and normative commitment levels of academic staff in universities. Based on these findings, conclusions and recommendations were made. (shrink)

The psychiatric diagnosis of psychopathic personality—or psychopathy—signifies a patient stereotype with a callous lack of empathy and strong antisocial tendencies. Throughout the research record and psychiatric practices, diagnosed psychopaths have been predominantly seen as immune to psychiatric intervention and treatment, making the diagnosis a potentially strong discriminator for treatment amenability. In this contribution, the evidence in support of this proposition is critically analyzed. It is demonstrated that the untreatability perspective rests largely on erroneous, unscientific conclusions. Instead, recent (...) research suggests that practitioners should be more optimistic about the possibility of treating and rehabilitating diagnosed psychopaths. In light of this finding, concrete ethical challenges in the forensic practice surrounding the psychopathy diagnosis are discussed, adding to a growing body of research that expresses skepticism about the forensic utility of the diagnosis. (shrink)

Instructional material is an integral part of teaching and learning process. Validating instructional materials is imperative to ensure quality before widespread utilization. This study validated the developed Gamified Instructional Material (GIM) in genetics for grade 12 STEM students. It employed the descriptive-developmental research design involving 41 STEM students and 11 Biology education experts chosen through purposive sampling. Findings revealed that students and experts strongly agreed that the GIM satisfied the criteria for a sound and valid instructional material. Further, the significant (...) change in the pretest and posttest scores of students indicated an improvement of their knowledge in genetics. It is recommended that the GIM be used as supplementary instructional material in teaching genetics. (shrink)

This article argues for the formal validity of and the truth of the premises and conclusion of a version of Aquinas' "Third Way" that says: If each of the parts of nature is contingent, the whole of nature is contingent. Each of the parts of nature is contingent. Therefore, the whole of nature is contingent--where "contingent" means having a cause and not existing self-sufficiently.

We report on an exploratory study of the way eight mid-level undergraduate mathematics majors read and reflected on four student-generated arguments purported to be proofs of a single theorem. The results suggest that mid-level undergraduates tend to focus on surface features of such arguments and that their ability to determine whether arguments are proofs is very limited -- perhaps more so than either they or their instructors recognize. We begin by discussing arguments (purported proofs) regarded as texts and validations of (...) those arguments, i.e., reflections of individuals checking whether such arguments really are proofs of theorems. We relate the way the mathematics research community views proofs and their validations to ideas from reading comprehension and literary theory. We then give a detailed analysis of the four student-generated arguments and finally analyze the eight students' validations of them. (shrink)

This paper presents five studies on the development and validation of a scale of intellectual humility. This scale captures cognitive, affective, behavioral, and motivational components of the construct that have been identified by various philosophers in their conceptual analyses of intellectual humility. We find that intellectual humility has four core dimensions: Open-mindedness (versus Arrogance), Intellectual Modesty (versus Vanity), Corrigibility (versus Fragility), and Engagement (versus Boredom). These dimensions display adequate self-informant agreement, and adequate convergent, divergent, and discriminant validity. In particular, (...) Open-mindedness adds predictive power beyond the Big Six for an objective behavioral measure of intellectual humility, and Intellectual Modesty is uniquely related to Narcissism. We find that a similar factor structure emerges in Germanophone participants, giving initial evidence for the model’s cross-cultural generalizability. (shrink)

This chapter begins by sketching an account of morally responsible agency and the general conditions under which it may fail. We discuss how far individuals with psychiatric diagnoses may be exempt from morally responsible agency in the way that infants are, with examples drawn from a sample of diagnoses intended to make dierent issues salient. We further discuss a recent proposal that clinicians may hold patients responsible without blaming them for their acts. We also consider cognitively impaired (...) subjects in the light of related issues in moral and political theory, asking whether they have been unjustly excluded from liberal conceptions of political community due to their presumed lack of agency. (shrink)

Background: Moral Growth Mindset (MGM) is a belief about whether one can become a morally better person through efforts. Prior research showed that MGM is positively associated with promotion of moral motivation among adolescents and young adults. We developed and tested the English version of the MGM measure in this study with data collected from college student participants. Methods: In Study 1, we tested the reliability and validity of the MGM measure with two-wave data (N = 212, Age mean (...) = 24.18 years, SD = 7.82 years). In Study 2, we retested the construct validity of the MGM measure once again and its association with other moral and positive psychological indicators to test its convergent and discriminant validity (N = 275, Age mean = 22.02 years, SD = 6.34 years). Results: We found that the MGM measure was reliable and valid from Study 1. In Study 2, the results indicated that the MGM was well correlated with other moral and positive psychological indicators as expected. Conclusions: We developed and validated the English version of the MGM measure in the present study. The results from studies 1 and 2 supported the reliability and validity of the MGM measure. Given this, we found that the English version of the MGM measure can measure one’s MGM as we intended. (shrink)

The psychiatric diagnosis of psychopathic personality—or psychopathy—signifies a patient stereotype with a callous lack of empathy and strong antisocial tendencies. Throughout the research record and psychiatric practices, diagnosed psychopaths have been predominantly seen as immune to psychiatric intervention and treatment, making the diagnosis a potentially strong discriminator for treatment amenability. In this contribution, the evidence in support of this proposition is critically analyzed. It is demonstrated that the untreatability perspective rests largely on erroneous, unscientific conclusions. Instead, recent (...) research suggests that practitioners should be more optimistic about the possibility of treating and rehabilitating diagnosed psychopaths. In light of this finding, concrete ethical challenges in the forensic practice surrounding the psychopathy diagnosis are discussed, adding to a growing body of research that expresses skepticism about the forensic utility of the diagnosis. (shrink)

An inference is valid if it guarantees the transferability of knowledge from the premisses to the conclusion. If knowledge is here understood as demonstrative knowledge, and demonstration is explained as a chain of valid inferences, we are caught in an explanatory circle. In recent lectures, Per Martin-Löf has sought to avoid the circle by specifying the notion of knowledge appealed to in the explanation of the validity of inference as knowledge of a kind weaker than demonstrative knowledge. The resulting (...) explanation is the main topic of this article. (shrink)