Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-12-03T20:46:07.489Z Has data issue: false hasContentIssue false

Psychiatric Progress and the Assumption of Diagnostic Discrimination

Published online by Cambridge University Press:  01 January 2022

Abstract

Psychiatry’s failure to validate its diagnostic constructs is often attributed to the prioritizing of reliability over validity in the Diagnostic and Statistical Manual of Mental Disorders (DSM). I argue that a more powerful way in which the DSM has retarded biomedical progress is by encouraging 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 argue that the Research Domain Criteria (RDoC) framework, a new paradigm for classifying objects of psychiatric research, solves some of the challenges brought on by this assumption.

Type
Psychology
Copyright
Copyright © The Philosophy of Science Association

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andreasen, Nancy. 1995. “The Validity of Psychiatric Diagnosis: New Models and Approaches.” American Journal of Psychiatry 152:161–62.Google Scholar
Andreasen, Nancy 2007. “DSM and the Death of Phenomenology in America: An Example of Unintended Consequences.” Schizophrenia Bulletin 33 (1): 108–12.Google ScholarPubMed
APA (American Psychiatric Association). 2000. Handbook of Psychiatric Measures. Washington, DC: American Psychiatric Association.Google Scholar
Berrios, German. 2014. “The Role of Cultural Configurators in the Formation of Mental Symptoms.” In Philosophical Issues in Psychiatry III: The Nature and Sources of Historical Change, ed. Kendler, Kenneth S. and Parnas, Josef, 107–18. Oxford: Oxford University Press.Google Scholar
Blashfield, Roger A., and Livesley, John W.. 1991. “Metaphorical Analysis of Psychiatric Classification as a Psychological Test.” Journal of Abnormal Psychology 100 (3): 262–70.CrossRefGoogle ScholarPubMed
Bolton, Derek. 2013. “Should Mental Disorders Be Regarded as Brain Disorders? 21st Century Mental Health Sciences and Implications for Research and Training.” World Psychiatry 12 (1): 2425.CrossRefGoogle ScholarPubMed
Bowker, Geoffrey C., and Star, Susan Leigh. 1999. Sorting Things Out: Classification and Its Consequences. Cambridge, MA: MIT Press.Google Scholar
Feighner, John, Robins, Eli, Guze, Samuel, Woodruff, Robert A., Winokur, George, and Muñoz, Rodrigo. 1972. “Diagnostic Criteria for Use in Psychiatric Research.” Archives of General Psychiatry 26:5763.CrossRefGoogle ScholarPubMed
First, Michael B., and Westen, Drew. 2007. “Classification for Clinical Practice: How to Make ICD and DSM Better Able to Serve Clinicians.” International Review of Psychiatry 19 (5): 473–81.CrossRefGoogle ScholarPubMed
Frances, Allen J. 2009. “A Warning Sign on the Road to DSM-V: Beware of Its Unintended Consequences.” Psychiatric Times 26 (8): 14.Google Scholar
Frances, Allen J. 2013. “The Role of Biological Tests in Psychiatric Diagnosis.” Huffington Post: Science, July 25.Google Scholar
Greenberg, Gary. 2013. The Book of Woe: The DSM and the Unmaking of Psychiatry. New York: Blue Rider.Google Scholar
Hacking, Ian. 2014. “Truth, Dissent, and Decision Vectors.” In Philosophical Issues in Psychiatry III: The Nature and Sources of Historical Change, ed. Kendler, Kenneth S. and Parnas, Josef, 7379. Oxford: Oxford University Press.Google Scholar
Hyman, Steven E., and Fenton, Wayne S.. 2003. “What Are the Right Targets for Psychopharmacology?Science 17:350–51.Google Scholar
Insel, Thomas R. 2013. “Transforming Diagnosis.” Director’s Blog, NIMH.Google Scholar
Kapur, Shitij, Phillips, Anthony G., and Insel, Thomas R.. 2012. “Why Has It Taken So Long for Biological Psychiatry to Develop Clinical Tests and What to Do about It?Molecular Psychiatry 17 (12): 16.CrossRefGoogle Scholar
Kendell, Robert, and Jablensky, Assen. 2003. “Distinguishing between the Validity and Utility of Psychiatric Diagnoses.” American Journal of Psychiatry 160:212.CrossRefGoogle ScholarPubMed
Kendler, Kenneth S., and Muñoz, R. A.. 2010. “The Development of the Feighner Criteria: A Historical Perspective.” American Journal of Psychiatry 167:134–42.CrossRefGoogle ScholarPubMed
Kendler, Kenneth S., Zachar, Peter, and Craver, Carl. 2009. “What Kinds of Things Are Psychiatric Disorders?Psychological Medicine 41:1143–50.Google Scholar
Kincaid, Harold. 2008. “Do We Need Theory to Study Disease?Perspectives in Biology and Medicine 51:367–78.Google ScholarPubMed
Kincaid, Harold, and Sullivan, Jacqueline A., eds. 2014. Classifying Psychopathology. Cambridge, MA: MIT Press.CrossRefGoogle Scholar
Klerman, Gerald L. 1978. “The Evolution of a Scientific Nosology.” In Schizophrenia: Science and Practice, ed. Shershow, John C., 99121. Cambridge, MA: Harvard University Press.Google Scholar
Knottnerus, J. A., and Buntinx, Frank. 2009. The Evidence Base of Clinical Diagnosis: Theory and Methods of Diagnostic Research. West Sussex: Blackwell.Google Scholar
Kupfer, David J., First, Michael B., and Regier, Darrel A.. 2008. A Research Agenda for DSM-V. Arlington, VA: American Psychiatric Association.Google Scholar
Kutschenko, Lara K. 2011. “How to Make Sense of Broadly Applied Medical Classification Systems: Introducing Epistemic Hubs.” History and Philosophy of the Life Sciences 33 (4): 583601.Google ScholarPubMed
McLaren, Niall. 2011. “Cells, Circuits, and Syndromes: A Critical Commentary on the NIMH Research Domain Criteria Project.” Ethical Human Psychology and Psychiatry 13 (3): 229–36.Google Scholar
Meehl, Paul E. 1986. “Diagnostic Taxa as Open Concepts.” In Contemporary Directions in Psychopathology, ed. Millon, Theodore and Klerman, Gerald L., 215–31. New York: Guilford.Google Scholar
Mishara, Aaron, and Schwartz, Michael. 2010. “Who’s on First? Mental Disorders by Any Other Name.” AAPP Bulletin 17 (2): 6063.Google Scholar
Morris, Sarah E., and Cuthbert, Bruce N.. 2012. “Research Domain Criteria: Cognitive Systems, Neural Circuits, and Dimensions of Behavior.” Dialogues in Clinical Neuroscience 14 (1): 2937.Google ScholarPubMed
Murphy, Dominic. 2006. Psychiatry in the Scientific Image. Cambridge, MA: MIT Press.Google Scholar
Nandi, Arijit, Beard, John R., and Galea, Sandro. 2009. “Epidemiologic Heterogeneity of Common Mood and Anxiety Disorders over the Lifecourse in the General Population: A Systematic Review.” BMC Psychiatry 9:31.CrossRefGoogle ScholarPubMed
Olbert, Charles. 2014. “On the Mathematical Coherence of Psychiatric Diagnostic Categories: A Framework for Quantifying Heterogeneity Attributable to Polythetic Diagnostic Criteria.” Master’s thesis, Fordham University.CrossRefGoogle Scholar
Olbert, Charles, Gala, Gary J., and Tupler, Larry A.. 2014. “Quantifying Heterogeneity Attributable to Polythetic Diagnostic Criteria: Theoretical Framework and Empirical Application.” Journal of Abnormal Psychology 123 (2): 452–62.CrossRefGoogle ScholarPubMed
Robins, Eli, and Guze, Samuel. 1970. “Establishment of DiagnosticValidity in Psychiatric Illness: Its Application to Schizophrenia.” American Journal of Psychiatry 126 (7): 983–87.CrossRefGoogle Scholar
Sadler, John Z. 2013. “Considering the Economy of DSM Alternatives.” In Making the DSM-5: Concepts and Controversies, ed. Paris, Joel and Phillips, James, 2138. New York: Springer.CrossRefGoogle Scholar
Sanislow, Charles A., Pine, Daniel S., Quinn, Kevin J., Kozak, Michael J., Garvey, Marjorie A., Heinssen, Robert K., Wang, Philip Sung-En, and Cuthbert, Bruce N.. 2010. “Developing Constructs for Psychopathology Research: Research Domain Criteria.” Journal of Abnormal Psychology 119 (4): 631–39.CrossRefGoogle ScholarPubMed
Sass, Louis A., Parnas, Josef, and Zahavi, Dan. 2011. “Phenomenological Psychopathology and Schizophrenia: Contemporary Approaches and Misunderstandings.” Philosophy Psychiatry and Psychology 18 (1): 123.CrossRefGoogle Scholar
Schaffner, Kenneth F. 2012. “A Philosophical Overview of the Problems of Validity for Psychiatric Disorders.” In Philosophical Issues in Psychiatry II: Nosology, ed. Kendler, Kenneth S. and Parnas, Josef, 169–89. Oxford: Oxford University Press.Google Scholar
Solomon, Miriam. 2014. “Expert Disagreement and Medical Authority.” In Philosophical Issues in Psychiatry III: The Nature and Sources of Historical Change, ed. Kendler, Kenneth S. and Parnas, Josef, 6072. Oxford: Oxford University Press.Google Scholar
Sullivan, Jacqueline. 2014. “Stabilizing Mental Disorders: Prospects and Problems.” In Classifying Psychopathology, ed. Kincaid, Harold and Sullivan, Jacqueline A., 195208. Cambridge, MA: MIT Press.Google Scholar
Van Loo, Hanna M., and Romeijn, Jan-Willem. 2015. “Psychiatric Comorbidity: Fact or Artifact?Theoretical Medicine and Bioethics 36 (1): 4160.CrossRefGoogle ScholarPubMed
Whooley, Owen. 2010. “Diagnostic Ambivalence: Psychiatric Workarounds and the Diagnostic and Statistical Manual of Mental Disorders.” Sociology of Health and Illness 32 (3): 452–69.CrossRefGoogle ScholarPubMed