Psychiatric diagnoses are not mental process: Wittgenstein on conceptual confusion

Background: Empirical explanation and treatment repeatedly fail for psychiatric diagnoses. Diagnosis is mired in conceptual confusion that is illuminated by Ludwig Wittgensteins later critique of philosophy (Philosophical Investigations). This paper examines conceptual confusions in the foundation of psychiatric diagnosis from some of Wittgensteins important critical viewpoints. Argument: Diagnostic terms are words whose meanings are given by usages not definitions. Diagnoses, by Wittgensteins analogy with games, have various and evolving usages that are connected by family relationships, and no essence or core phenomenon connects them. Their usages will change according to the demands and contexts in which they are employed. Diagnoses, like many psychological terms, such as reading or understanding, are concepts that refer not to fixed behavioural or mental states but to complex apprehensions of the relationship of a variety of behavioural phenomena with the world. A diagnosis is a sort of concept that cannot be located in or explained by a mental process. Conclusion: A diagnosis is an exercise in language and its usage changes according to the context and the needs it addresses. Diagnoses have important uses but they are irreducibly heterogeneous and cannot be identified with or connected to particular mental processes or even with a unity of phenomena that can be addressed empirically. This makes understandable not only the repeated failure of empirical science to replicate or illuminate genetic, neurophysiologic, psychic or social processes underlying diagnoses but also the emptiness of a succession of explanatory theories and treatment effects that cannot be repeated or stubbornly regress to the mean. Attempts to fix the meanings of diagnoses to allow empirical explanation will and should fail as there is no foundation on which a fixed meaning can be built and it can only be done at the cost of the relevance and usefulness of diagnosis

Chronic baclofen abuse and withdrawal delirium

Baclofen is a GABA-B agonist used for muscle spasticity in disorders such as multiple sclerosis. It has growing applications in the treatment of alcohol dependence [1] and its role in the treatment in other addiction disorders has recently been explored [2,3]. Because of its structural similarity to GABA, baclofen also has GABA-A effects [4] such as sedation and anxiolysis. These GABA-A effects presumably underpin baclofen’s abuse potential: both baclofen overdose with self-injurious intent [5] and baclofen overdose in a recreational setting have been described [6]. Baclofen withdrawal delirium has been described in other case reports [7]. Often these patients are on intrathecal baclofen pumps for management of severe muscle spasticity or using oral baclofen for the same indication. To our knowledge there have been no reports of withdrawal delirium in a patient chronically abusing baclofen