Philosophical Issues in Psychiatry II Nosology

Psychiatric and psychological practice and research is critically dependent on diagnosis. Yet the nature of psychiatric diagnosis and the rules by which disorders should be created and organized have been highly controversial for over 100 years. Unlike simple medical disorders (like infectious diseases), psychiatric disorders cannot be traced to one simple etiologic agent. The last two generations have seen major conceptual shifts in the approach to diagnosis with the rise of operationalized criteria and an emphasis on a descriptive rather than etiological approach to diagnosis. The interest in psychiatric diagnoses is particularly heightened now because both of the major psychiatric classifications in the world - DSM and ICD - are now undergoing major revisions. What makes psychiatric nosology so interesting is that it sits at the intersection of philosophy, empirical psychiatric/psychological research, measurement theory, historical tradition and policy. This makes the field fertile for a conceptual analysis. This book brings together established experts in the wide range of disciplines that have an interest in psychiatric nosology. The contributors include philosophers, psychologists, psychiatrists, historians and representatives of the efforts of DSM-III, DSM-IV and DSM-V. Some of the questions addressed include i) what is the nature of psychiatric illness? Can it be clearly defined and if so how? ii) What is the impact of facts versus values in psychiatric classification? iii) How have concepts of psychiatric diagnosis changed over time? iv) How can we best conceptualize the central idea of diagnostic validity? And v) Can psychiatric classification be a cumulative enterprise seeking improvements at each iteration of the diagnostic manual? Each individual chapter is introduced by the editors and is followed by a commentary, resulting in a dynamic discussion about the nature of psychiatric disorders. This book will be valuable for psychiatrists, psychologists and other mental health trainees and professionals with an interest in the questions and problems of psychiatric diagnosis, as well as philosophers and philosophy students interested in the problems posed by psychiatry, particularly those working in the philosophy of science.

1 - Classification and causal mechanisms - a deflationary approach to the classification problem
2 - Progress and the Calibration of Scientific Constructs: The Role of Comparative Validity
3 - Taking disease seriously: Beyond "pragmatic" nosology
4 - Is psychiatric classification a good thing?
5 - The nosological entity in psychiatry: an historical illusion or a moving target?
6 - The 19th Century Nosology of Alienism: History and Epistemology
7 - The Development of DSM-III From An Historical/Conceptual Perspective
8 - Title: DSM IV: Context, Concepts and Controversies
9 - A philosophical overview of the problems of validity for psychiatric disorders
10 - Structural Validity and the Classification of Mental Disorders
11 - When Does Depression become a Mental Disorder?
12 - The DSM-IV and the founding prototype of schizophrenia: are we regressing to a pre-Kraepelinian nosology?
13 - Rendering Mental Disorders Intelligible: Addressing Psychiatry's Urgent Challenge
14 - Diagnostic Threshold Considerations for DSM-5
15 - Epistemic Iteration as an Historical Model for Psychiatric Nosology: Promises and Limitations

The major focus of Kenneth Kendler's research is in the genetics of psychiatric and substance abuse disorders. Two major methodologies are used in this research. The first involves large population based twin samples. In these twins the aggregate role of genetic and environmental factors is addressed. The aim is to understand how these factors interact and correlate, and how, through development, the vulnerability to psychiatric illness and drug abuse is expressed. Samples have been taken from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders as well as Norway, Sweden and Holland. Kendler's work has focused on a wide range of disorders including major depression, anxiety disorders, eating disorders, externalizing behaviors, alcoholism, and drug abuse. He has also worked towards understanding the genetic and environmental sources of comorbidity of psychiatric and substance use disorders. Josef Parnas' main research interests comprise epidemiology and pathogenesis of schizophrenia, including longitudinal prospective studies of children at risk, genetic studies, and psychopathology of schizophrenia, addressed both on a theoretical level and through empirical research. Parnas, also trained as a medical doctor, has always been working at the interface between philosophy and psychiatry with a special emphasis on the psychiatric phenomenology. Over the last two decades he has been pioneering research on anomalies of self-experience in schizophrenia. He is a co-founder of the Center for Subjectivity Research at the University of Copenhagen, an interdisciplinary research institute, integrating philosophy of mind, phenomenology, psychopathology and cognitive science.