Are psychiatric disorders natural kinds? This question has received a lot of attention within present-day philosophy of psychiatry, where many authors debate the ontology and nature of mental disorders. Similarly, historians of psychiatry, dating back to Foucault, have debated whether psychiatric researchers conceived of mental disorders as natural kinds or not. However, historians of psychiatry have paid little to no attention to the influence of (a) theories within logic, and (b) theories within metaphysics on psychiatric accounts of proper method, and (...) on accounts of the nature and classification of mental disorders. Historically, however, logic and metaphysics have extensively shaped methods and interpretations of classifications in the natural sciences. This paper corrects this lacuna in the history of psychiatry, and demonstrates that theories within logic and metaphysics, articulated by Christian Wolff (1679-1754), have significantly shaped the conception of medical method and (psychiatric) nosology of the influential nosologist Boissier De Sauvages (1706-1767). After treating Sauvages, I discuss the method of the influential nosologist William Cullen (1710-1790), and demonstrate the continuity between the classificatory methods of Sauvages and Cullen. I show that both Sauvages and Cullen were essentialists concerning medical diseases in general and psychiatric disorders in particular, contributing to the history of conceptions of the ontology and nature of mental disorders. (shrink)

Born 80 years ago, Continental Philosophy is on its last legs. Its extraordinary career has been helped along by an almost total absence of interest on the part of analytic or other exact philosophers in what the Australian philosopher David Stove calls "the nosology of philosophy" 1, the exploration of the manifold forms taken by bad philosophy. Stove points out that such an enterprise involves doing history. A nosology of Continental Philosophy is, at least in the first instance, (...) inseparable from the history of this strand in twentieth century philosophy, a history which would make clear the relations, philosophical and historical, between it and exact philosophy. Rorty is quite right to point to the absence of such a historical perspective. (shrink)

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)

At present, psychiatric disorders are characterized descriptively, as the standard within the scientific community for communication and, to a certain extent, for diagnosis, is the DSM, now at its fifth edition. The main reasons for descriptivism are the aim of achieving reliability of diagnosis and improving communication in a situation of theoretical disagreement, and the Ignorance argument, which starts with acknowledgment of the relative failure of the project of finding biomarkers for most mental disorders. Descriptivism has also the advantage of (...) capturing the phenomenology of mental disorders, which appears to be essential for diagnosis, though not exhaustive of the nature of the disease. I argue that if we rely on the distinction between conceptions (procedures of identification) and concepts (reference-fixing representations), which was introduced in the philosophical debate on the nature of concepts, we may understand a limited but valid role for descriptive characterizations, and reply to common objections addressed by those who advocate a theoretically informed approach to nosology. (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)

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)

The diagnostic category of borderline personality disorder (BPD) has come under increasing criticism in recent years. In this paper, we analyze the role and impact of epistemic injustice, specifically testimonial injustice, in relation to the diagnosis of BPD. We first offer a critical sociological and historical account, detailing and expanding a range of arguments that BPD is problematic nosologically. We then turn to explore the epistemic injustices that can result from a BPD diagnosis, showing how they can lead to experiences (...) of testimonial injustice which impede patient engagement in meaning-making activities, thereby undermining standard therapeutic goals. We conclude by showing how our arguments bolster ongoing efforts to replace the diagnostic category of BPD with alternatives such as complex post-traumatic stress disorder. (shrink)

This contribution consists of two parts. The first aims to clarify the structure of the nosology of psychopathologies that Kant proposes in the "Versuch über die Krankheiten des Kopfes". Such nosology consists of two series, arranged in ascending order, one relating to the social manifestations of madness, the other to its individual manifestations, which specifically concern the faculties of the soul. We will try to demonstrate the existence of a connection between these two series, and to illustrate how (...) this occurs. The second part of the contribution, on the other hand, intends to question the thesis according to which Kant in his "Versuch" provided a social aetiology of psychopathologies. We will show, in spite of this thesis, how society creates conditions only for the manifestation of these pathologies, and not for their production, which must instead be sought in the body. (shrink)

The Research Domani Criteria framework (RdoC) encourages research on specific impairments present across traditional nosological categories and suggests a list of biological and behavioral measures for assessing them. After a description of RdoC, in this article we focus on impairments of the ability of understanding others, specifically in Theory of Mind and empathy. We illustrate recent evidence on brain anomalies correlating with these deficits in Schizophrenia, Addiction Disorders and Mood Disorders populations. In the last section, we zoom out and consider (...) this kind of research vis-à-vis the objection of being reductionistic that is, in favoring mechanistic accounts of mental disorders. We argue that metaphysical reductionism and explanatory reductionism are not conceptually entailed by the RdoC framework. (shrink)

In the monograph Philosophy and Psychedelics: Frameworks for Exceptional Experience, Hauskeller raises the important subject of individualization and alienation in psychedelic psychotherapy. Under the prevailing conditions of neoliberalism, Hauskeller contends that psychedelic-assisted psychotherapy appropriates Indigenous knowledges in an oppressive fashion, may be instrumentalised to the ends of productivity gain and symptom suppression, and may be utilised to mask societal systems of alienation. Whilst offering a valuable socio-political critique of psychedelics' clinical uptake, we suggest that Hauskeller's view does not adequately acknowledge (...) the ways in which psychedelics offer a challenge to the Western reductive bio-medical understanding of healing and wellbeing. It is contended herein that Indigenous knowledges, in alliance with a range of emerging sciences, offer both an engagement with ethnomedicines in a less harmfully appropriative fashion, and a renewed understanding of the means by which psychedelics achieve therapeutic change. With this understanding, what becomes apparent are the potential ways in which psychedelic medical usage may produce positive feedback upon the oppressive systems in which we are embedded. That is, transpersonal experience through encounters with the ineffable may offer a revisioning of Western psychology and cognitive science. Indeed, if psychedelics are approached with an understanding of the actual means by which they produce therapeutic outcomes—changing mental representations of the self, or self-insight derived through non-ordinary states of consciousness—then psychedelic psychotherapy offers a reimagining of psychiatric nosology, challenging conventional understandings of both pathology and wellbeing through an overturning of specified and discrete deficit models of psychopathology. This may provide both a critique of the prevailing categories used to describe madness and an expansion of our understanding of the mind-body relation, as well as an increased recognition of positive psychology grounded in cross-cultural contemplative traditions. This provides an implicit challenge to the pharmaceutical industrial-complex and its profit motives; and the corresponding neoliberalist, globalising tendencies which Hauskeller seeks to address. -/- . (shrink)

"Der Aufsatz zielt darauf, der Prozess der historischen Überlagerung, Substitution und Verbreitung des theoretischen Paradigmas der Depression gegenüber jenem der Melancholie darzustellen. Im ersten Teil wird versucht, einige der einschneidenden Eigenschaften der Thematisierungen der Melancholie in der Frühen Neuzeit anzugeben, auch im Verhältnis zum Geist des Kapitalismus. Nachdem eine Skizze der Entstehung der moderne Kategorie der Depression, geht es darum, den Verlauf nachzuzeichnen, der im 20. Jahrhundert zu ihrer Transformation in ein weitläufiges theoretisches Paradigma geführt hat, das schließlich jenes der (...) Melancholie ersetzt hat. Der zweite Teil stellt den Versuch dar, eine Zeitdiagnose umzureißen: An dieser Stelle ist die psychosoziale Bedeutung bestimmter sozioökonomischer und kultureller Mechanismen zu untersuchen, unter besonderem Hinweis auf das, was als »der neue Geist des Kapitalismus« bezeichnet worden ist, sowie auf neue Formen des Individualismus und ihre paradoxen Dynamiken. Abschließend wird eine Brücke geschlagen, zwischen der Geschichte der beiden bezeichneten Paradigmen und der zeitgenössischen psychosozialen Dynamiken, die mit dem als »depressive Epidemie« interpretierten Phänomen verbunden sind. -/- The essay aims to analyse the gradual historical process of the partial overlap, replacement and expansion of the theoretical paradigm of depression with respect to that of melancholy. The first part is devoted to analysing some of the central features of the multivalent thematizations of melancholy drawn up during modernity, also with relation to the spirit of capitalism (in its Weberian acceptation). This is followed by an overview of the birth of the modern category of depression, and the process that during the twentieth century led to its transformation into a theoretical and nosological paradigm which in the end replaced that of melancholy. The second part is the attempt to draw up a Zeitdiagnose: the aim is to assess the ‘depressive’ psychosocial impact exercised by particular socio-economic mechanisms and cultural trends, with particular reference to what has been defined as the ‘new spirit of capitalism’, as well as the new forms of individualism and their paradoxical dynamics. In conclusion, I will form a bridge between the history of the two aforesaid paradigms and the contemporary psychosocial dynamics correlated to the phenomenon today interpreted as a ‘depression epidemic’.". (shrink)

Abstract: At present, psychiatric disorders are characterized descriptively, as the standard within the scientific community for communication and, to a cer- tain extent, for diagnosis, is the DSM, now at its fifth edition. The main rea- sons for descriptivism are the aim of achieving reliability of diagnosis and improving communication in a situation of theoretical disagreement, and the Ignorance argument, which starts with acknowledgment of the relative fail- ure of the project of finding biomarkers for most mental disorders. Descrip- tivism (...) has also the advantage of capturing the phenomenology of mental dis- orders, which appears to be essential for diagnosis, though not exhaustive of the nature of the disease. I argue that if we rely on the distinction between conceptions (procedures of identification) and concepts (reference-fixing representations), which was introduced in the philosophical debate on the nature of concepts, we may understand a limited but valid role for descrip- tive characterizations, and reply to common objections addressed by those who advocate a theoretically informed approach to nosology. (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)

The essay aims to analyse the gradual historical process of the partial overlap, replacement and expansion of the theoretical paradigm of depression with respect to that of melancholy. The first part is devoted to analysing some of the central features of the multivalent thematizations of melancholy drawn up during modernity, also with relation to the spirit of capitalism (in its Weberian acceptation). This is followed by an overview of the birth of the modern category of depression, and the process that (...) during the twentieth century led to its transformation into a theoretical and nosological paradigm which in the end replaced that of melancholy. The second part is the attempt to draw up a Zeitdiagnose: the aim is to assess the ‘depressive’ psychosocial impact exercised by particular socio-economic mechanisms and cultural trends, with particular reference to what has been defined as the ‘new spirit of capitalism’, as well as the new forms of individualism and their paradoxical dynamics. In conclusion, I will form a bridge between the history of the two aforesaid paradigms and the contemporary psychosocial dynamics correlated to the phenomenon today interpreted as a ‘depression epidemic’. Il saggio mira ad analizzare il graduale processo storico di parziale sovrapposizione, sostituzione ed ampliamento del paradigma teoretico della depressione rispetto a quello della melanconia. La prima parte è dedicata ad analizzare alcuni dei tratti nevralgici delle polivalenti tematizzazioni della malinconia avvenuti nel corso della modernità, anche in relazione allo spirito del capitalismo (nella sua accezione weberiana). Segue una panoramica sulla nascita della categoria moderna di depressione, e del processo che nel corso del XX secolo l’ha condotta alla sua trasformazione in un paradigma teoretico e nosologico che ha infine sostituito quello della melanconia. La seconda parte rappresenta il tentativo di elaborare una Zeitdiagnose: l’obiettivo è valutare l’impatto psicosociale di natura ‘depressiva’ esercitato da particolari meccanismi socioeconomici e tendenze culturali, con particolare riferimento a ciò che è stato definito il «nuovo spirito del capitalismo», nonché alle nuove forme dell’individualismo e alle loro dinamiche paradossali. In conclusione viene gettato un ponte tra la storia dei due suddetti paradigmi e le dinamiche psicosociali contemporanee correlate al fenomeno oggi interpretato quale «epidemia depressiva». (shrink)

The essay aims to analyse the gradual historical process of the partial overlap, replacement and expansion of the theoretical paradigm of depression with respect to that of melancholy. The first part is devoted to analysing some of the central features of the multivalent thematizations of melancholy drawn up during modernity, also with relation to the spirit of capitalism (in its Weberian acceptation). This is followed by an overview of the birth of the modern category of depression, and the process that (...) during the twentieth century led to its transformation into a theoretical and nosological paradigm which in the end replaced that of melancholy. The second part is the attempt to draw up a Zeitdiagnose: the aim is to assess the ‘depressive’ psychosocial impact exercised by particular socio-economic mechanisms and cultural trends, with particular reference to what has been defined as the ‘new spirit of capitalism’, as well as the new forms of individualism and their paradoxical dynamics. In conclusion, I will form a bridge between the history of the two aforesaid paradigms and the contemporary psychosocial dynamics correlated to the phenomenon today interpreted as a ‘depression epidemic’. Der Aufsatz zielt darauf, der Prozess der historischen Überlagerung, Substitution und Verbreitung des theoretischen Paradigmas der Depression gegenüber jenem der Melancholie darzustellen. Im ersten Teil wird versucht, einige der einschneidenden Eigenschaften der Thematisierungen der Melancholie in der Frühen Neuzeit anzugeben, auch im Verhältnis zum Geist des Kapitalismus. Nachdem eine Skizze der Entstehung der moderne Kategorie der Depression, geht es darum, den Verlauf nachzuzeichnen, der im 20. Jahrhundert zu ihrer Transformation in ein weitläufiges theoretisches Paradigma geführt hat, das schließlich jenes der Melancholie ersetzt hat. Der zweite Teil stellt den Versuch dar, eine Zeitdiagnose umzureißen: An dieser Stelle ist die psychosoziale Bedeutung bestimmter sozioökonomischer und kultureller Mechanismen zu untersuchen, unter besonderem Hinweis auf das, was als »der neue Geist des Kapitalismus« bezeichnet worden ist, sowie auf neue Formen des Individualismus und ihre paradoxen Dynamiken. Abschließend wird eine Brücke geschlagen, zwischen der Geschichte der beiden bezeichneten Paradigmen und der zeitgenössischen psychosozialen Dynamiken, die mit dem als »depressive Epidemie« interpretierten Phänomen verbunden sind. (shrink)

Although delusion is one of the central concepts of psychopathology, it stills eludes precise conceptualization. In this paper, I present certain basic issues concerning the classification and definition of delusion, as well as its ontological status. By examining these issues, I aim to shed light on the ambiguity of the clinical term ‘delusion’ and its extension, as well as provide clues as to why philosophers are increasingly joining the ranks of psychiatrists, psychologists, and neuroscientists in the effort to come to (...) a comprehensive understanding of delusion. (shrink)

The question of how psychiatric classifications are made up and to what they refer has attracted the attention of philosophers in recent years. In this paper, I review the claims of authors who discuss psychiatric classification in terms referring both to the philosophical tradition of natural kinds and to the sociological tradition of social constructionism — especially those of Ian Hacking and his critics. I examine both the ontological and the social aspects of what it means for something to be (...) a mental disorder, and how the ontological status of these disorders hinges on social causation. Finally, I conclude by suggesting a way in which the biological and the social may be reconciled in an integrative model of variation in psychiatric disorder. (shrink)

In view of the publication of the DSM-V researchers were asked to discuss the theoretical implications of the definition of mental disorders. The reasons for the use, in the DSM-III, of the term disorder instead of disease are considered. The analysis of these reasons clarifies the distinction between the general definition of disorder and its implicit, technical meaning which arises from concrete use in DSM disorders. The characteristics and limits of this technical meaning are discussed and contrasted to alternative definitions, (...) like Wakefield’s harmful/dysfunction analysis. It is shown that Wakefield’s analysis faces internal theoretical problems in addition to practical limits for its acceptance in the DSM-V. In particular, it is shown that: a) the term dysfunction is not purely factual but intrinsically normative/evaluative; b) it is difficult to clarify what dysfunctions are in the psychiatric context (the dysfunctional mechanism involved being unknown in most cases and the use of evolutionary theory being even more problematic); c) the use of conceptual analysis and commonsense intuition to define dysfunctions leaves unsatisfied empiricists; d) it is unlikely that the authors of the DSM-V will accept Wakefield’s suggestion to revise the diagnostic criteria of any single DSM disorder in accordance with his analysis, because this is an excessively extensive change and also because this would probably reduce DSM reliability. In conclusion, it is pointed up in which sense DSM mental disorders have to be conceived as constructs, and that this undermines the realistic search for a clear-cut demarcation criterion between what is disorder and what is not. (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.

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)

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)

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)

The process of medicalization has been analyzed in the medical humanities with disapprobation, with much emphasis placed on its ability to reinforce existing social power structures to ill effect. While true, this is an incomplete picture of medicalization. I argue that medicalization can both reinforce and disrupt existing social hierarchies within the clinic and outside of it, to ill or good effect. We must attend to how this takes place locally and globally lest we misunderstand how medicalization mediates power and (...) justice. I provide concrete examples of how this occurs by considering dysesthesia ethiopsis, autism, chronic fatigue syndrome, depression, and HIV/AIDS. (shrink)

In this paper I examine the ways in which our language and terminology predetermine how we approach, investigate and conceptualise mental illness. I address this issue from the standpoint of hermeneutic phenomenology, and my primary object of investigation is the phenomenon referred to as “mania”. Drawing on resources from classical phenomenology, I show how phenomenologists attempt to overcome their latent presuppositions and prejudices in order to approach “the matters themselves”. In other words, phenomenologists are committed to the idea that in (...) our everyday, natural attitude, we take for granted a number of prejudices and presuppositions that predetermine how we conceive of and understand what we experience. In order to properly approach the phenomena themselves, we need to find ways of neutralising our presuppositions and prejudices in order to develop new (and hopefully more accurate) accounts of the phenomena under investigation. One of the most popular examples of such an attempt at neutralisation is what Edmund Husserl calls the epoché, which is the practice of bracketing out or suspending presuppositions. However, later phenomenologists developed alternative approaches. Martin Heidegger, for instance, engaged in etymological analyses to discover latent meanings in our language and terminology. Hans-Georg Gadamer also engaged in historical analyses of how our traditions sediment into latent prejudices. After discussing the various ways in which phenomenologists have attempted to neutralise presuppositions and prejudices prior to engaging in their investigations, I apply some of these principles and methods to the domain of psychopathology, and discuss some of the prejudices inherent in contemporary discussions of the phenomenon of mania. I examine recent attempts to link the phenomenon that we today refer to as “mania” with the ancient Greek concept of “μανία” (mania), and argue that the practice of linking contemporary and historical concepts can be detrimental to attempts at reclassifying disorders. In addition, I consider the implications of the shift in terminology from “manic depressive illness” to “bipolar disorder” – especially how conceiving of mania as one of two “poles” predetermines its description by both clinicians and patients. Finally, I address the implications of the headings under which mania and bipolar disorder are discussed within diagnostic manuals. For example, I discuss the removal of the headings of affective and mood disorders in the DSM-5, and the explicit decision by the authors to place bipolar disorder between depressive disorders and schizophrenia. What I aim to accomplish in this paper is not so much a phenomenological investigation of mania as it is a pre-phenomenological investigation. In other words, I offer a preparatory investigation of the phenomenon (or phenomena) referred to as “mania” in contemporary discourse, with the intention of laying the groundwork for further phenomenological and psychological research. (shrink)