The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues in psychiatric diagnosis

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances

The six most essential questions in psychiatric diagnosis: A pluralogue part 2: Issues of conservatism and pragmatism in psychiatric diagnosis

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances

The six most essential questions in psychiatric diagnosis: a pluralogue. Part 4: general conclusion

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined

Filtering microplastics from water

My project is focused on removing microplastics from freshwater. I will test the efficiency of a microplastic filter in separating the particles from their environment

The *validity of psychiatric nosology

This dissertation has three tasks: to analyze the philosophy behind our current psychiatric nosology, to analyze and refute the myriad criticisms of that nosology, and to provide a more sophisticated understanding of what it is to have nosologic validity in general. Whereas most disease classifications do not generate much controversy, the current psychiatric nosology, the Diagnostic and Statistical Manual of Mental Disorders (DSM) constitutes a nearly universal focus for criticism, usually on philosophical grounds. However, neither critics not proponents of the DSM provide clear and defensible arguments for their positions. In order to remedy this situation, and to clear the way for more productive discussions about the validity of psychiatric nosology, I analyze both the DSM and the criticisms most commonly made of it. I compare psychiatric nosology to other classifications in biology and medicine; and I draw on insights from those sciences to determine which philosophical concerns about the DSM need to be taken seriously. I dispel several sources of misunderstanding about nosologic validity; and I recast questions about the nosologic validity of the DSM in terms of process rather than product. I conclude that in light of the tripartite view of nosologic validity used in psychology, the DSM is valid. However, I challenge the authors of the next edition of the DSM to clarify its methodological and philosophical assumptions so that further confusion about the validity of the DSM might be avoided

The Validity of Psychiatric Nosology

This dissertation has three tasks: to analyze the philosophy behind our current psychiatric nosology, to analyze and refute the myriad criticisms of that nosology, and to provide a more sophisticated understanding of what it is to have nosologic validity in general. Whereas most disease classifications do not generate much controversy, the current psychiatric nosology, the Diagnostic and Statistical Manual of Mental Disorders (DSM) constitutes a nearly universal focus for criticism, usually on philosophical grounds. However, neither critics not proponents of the DSM provide clear and defensible arguments for their positions. In order to remedy this situation, and to clear the way for more productive discussions about the validity of psychiatric nosology, I analyze both the DSM and the criticisms most commonly made of it. I compare psychiatric nosology to other classifications in biology and medicine; and I draw on insights from those sciences to determine which philosophical concerns about the DSM need to be taken seriously. I dispel several sources of misunderstanding about nosologic validity; and I recast questions about the nosologic validity of the DSM in terms of process rather than product. I conclude that in light of the tripartite view of nosologic validity used in psychology, the DSM is valid. However, I challenge the authors of the next edition of the DSM to clarify its methodological and philosophical assumptions so that further confusion about the validity of the DSM might be avoided