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Hence, it is understandable that its practitioners apply to it the methods and conventions of other medical disciplines. Sethi , italics added As an example, think of the differential diagnosis of a patient with episodes of anxiety and breathlessness. These symptoms are often caused by panic disorder.

Stevens and Rodin 74, italics added Depression and anxiety cause tiredness as do some somatization disorders.

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These passages suggest that psychiatrists are encouraged to think about diagnoses in psychiatry as being analogous to diagnoses in bodily medicine. Such causal claims can also be found in health information resources about psychiatric disorders that are targeted at the general public. Consider the following passages about schizophrenia and major depressive disorder from Patient. They range from lasting feelings of sadness and hopelessness, to losing interest in the things you used to enjoy and feeling very tearful.

NHS Choices , italics added Such portrayals of psychiatric diagnoses are significant, because they can influence how patients perceive and respond to their conditions. In a qualitative study of adults diagnosed with attention- deficit hyperactivity disorder, Svend Brinkmann notes that the participants commonly mediate understanding of their problematic behaviours by invoking their diagnoses as explanations of these behaviours. Hence, there is some evidence that patients think of psychiatric diagnoses as if they refer to underlying conditions that cause symptoms.

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However, there are worries about psychiatric diagnoses that raise doubts whether they actually do explain symptoms. One such worry concerns the way that psychiatric diagnoses are defined. I call this the conceptual problem. According to the most recent editions of DSM, psychiatric diagnoses are formally defined in terms of their symptoms. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes … American Psychiatric Association , italics added The essential feature of generalized anxiety disorder is excessive anxiety and worry apprehensive expectation about a number of events or activities.

American Psychiatric Association , italics added These descriptive definitions in DSM-5 suggest that psychiatric diagnoses are constituted by their symptoms. It is fairly uncontroversial that causes are distinct from their effects. That is to say, something cannot be its own cause. Therefore, if psychiatric diagnoses are mere labels for clusters of symptoms, then they cannot refer to the causes of these symptoms.

While the DSM formalized the descriptive approach to defining psychiatric diagnoses, the worry that psychiatric diagnoses merely have definitional connections with their respective symptoms had been present even before the introduction of the fully descriptive nosology in DSM-III.

I turn to the second argument in my discussion of the ontological problem in subsection 3. According to Hume, causal connections are contingent. We perceive causes and effects as distinct events, but do not perceive any necessary connection between them. Even if the causal chain is broken down further, we only perceive a finer succession of distinct causes and effects, but not any glue between them. Hence, one can conceive one event occurring without the other. However, if a psychiatric diagnosis is defined by its symptoms, then the connection between the diagnosis and the symptoms is not contingent, but necessary.

One cannot have panic disorder without having panic attacks, or generalized anxiety disorder without having excessive anxiety. Since contingency is an essential feature of causal connections, it follows that the connection between a psychiatric diagnosis and its symptoms is not causal. According to Immanuel Kant [] , an analytic proposition is true in virtue of its meaning, as its predicate concept is contained in its subject concept. By contrast, a synthetic proposition can only be true in virtue of its relation to the state of affairs in the world, because its predicate concept is not contained in its subject concept.

Again, this suggests that the relations between psychiatric diagnoses and their symptoms are not empirical, but definitional. The above considerations raise serious doubts about whether psychiatric diagnoses ca n serve the same causal explanatory functions as medical diagnoses. Jennifer Radden notes that while the purely descriptive approach to defining and classifying psychiatric diagnoses in the most recent editions of the DSM does permit probabilistic predictions, it renders its diagnostic categories devoid of explanatory value.

Because the connection between a psychiatric diagnosis and its symptoms is definitional rather than causal, such a diagnosis does not explain its symptoms, but merely describes them. Empirical research has revealed an array of causes associated with many of the major psychiatric syndromes, but the story has not been one of definite lesions. Rather, it has been one of complexity and heterogeneity at multiple levels of analysis, including the biological, psychological, and social Murphy ; Kendler ; Bolton Hence, it may be that a given diagnostic category in psychiatry does not correspond to a distinctive causal structure, but is associated with a range of possible causal pathways, each involving complex interactions of diverse factors across different levels.

This causal heterogeneity suggests that a psychiatric diagnosis does not pick out a distinctive structure or process that is citable as a cause in a causal explanation. Rather, it subsumes a range of possible causal structures, each made up of varying combinations of biological, psychological and social factors. In other words, in different patients with the same diagnosis, the symptoms may be caused by different sorts of process. In both psychiatry and philosophy, theorists have considered the symptom-based definitions of psychiatric diagnoses and the issue of causal heterogeneity to raise doubts about the validity of psychiatric classification.

Kendell and Jablensky write: [T]he surface phenomena of psychiatric illness i. Kendell and Jablensky 7 Similarly, the philosopher Jeffrey Poland criticizes the epistemic shortcomings of the current psychiatric diagnoses in the DSM: The DSM categories and associated epistemic practices related to information processing, inferential practice, explanatory practice, and clinical understanding, are ineffective and harmfully biased because, given their atheoretical focus on clinical phenomenology, they do not effectively identify and represent important features, problems, contexts, and processes … i.

In light of these problems, some theorists have suggested that diagnostic classification in psychiatry ought to be revised, so that its diagnostic categories correspond to more stable kinds of causal structure Murphy ; Tsou According to Dominic Murphy —4 , this would bring psychiatry in line with the rest of medicine, where diagnoses correspond to the causal antecedents of symptoms. However, it has also been argued that the high degrees of causal complexity associated with mental disorders pose significant problems for the prospects of such an aetiological classification that would be acceptable for practitioners and researchers Bolton There are also concerns regarding the semiotic roles of psychiatric diagnoses.

Again, these concerns relate to doubts regarding their explanatory functions. Moreover, Tekin suggests that the assumption of a biomedical disease model, whereby a given psychiatric category is assumed to reflect a particular kind of biological causal structure, further compounds this impoverished self-insight, because it fails to acknowledge the causal complexity of the disorder and ignores important causal contributory factors, such as psychological features, social context, and interpersonal dynamics. In addition to the above criticisms offered by philosophers, the epistemic roles of psychiatric diagnoses have also recently been contested by mental health practitioners.

Joanna Moncrieff , a psychiatrist and a leading figure of the currently active critical psychiatry movement, criticizes the uses of psychiatric diagnoses in social discourse. In light of these concerns, some clinical psychologists have advocated moving away from using categorical diagnoses in psychiatry and have recommended alternative approaches. For example, Richard Bentall suggests that assessments of patients should focus on individual complaints, such as paranoia and auditory hallucinations, rather than syndromes, such as schizophrenia and bipolar disorder.

While Johnstone presents the formulation as an alternative to the diagnosis, the view put forward by the World Psychiatric Association is that the diagnosis and the formulation have complementary roles. And so, the issues considered throughout this section highlight some differences between diagnoses in medicine and those in psychiatry. First, diagnoses in medicine are often, though by no means always, defined in terms of the pathologies that produce symptoms, while diagnoses in psychiatry tend to be defined in terms of the clusters of symptoms themselves.

Second, the diagnostic categories in medicine tend to correspond to reasonably stable and distinctive causal structures, while there is evidence to suggest that many of those in psychiatry are associated with high degrees of complexity and heterogeneity with respect to their underlying causal processes. This subsection has looked at some of the concerns raised about the roles of psychiatric diagnoses in explanation, prediction, intervention, classification, and the sanctioning of social responses.

In addition to these, I suggest that there are potential ethical implications for psychiatric discourse.

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As noted in subsection 3. However, if they do not serve such explanatory functions, then it is likely that patients and the wider public are being misinformed about psychiatric diagnoses. This raises the possibility that patients are misled into believing that their symptoms are being explained, when they are merely being labelled. Summary This chapter has explored some of the philosophical problems inherent in the comparisons between the functions of diagnoses in psychiatry and those of diagnoses in the rest of medicine.

In the course of the discussion, I have provided an overview of the various functions that medical diagnoses normally serve, shown how many of these functions receive justificatory support from the roles of the diagnoses as causal explanations of symptoms, presented conceptual and ontological problems concerning the explanatory statuses of psychiatric diagnoses, and looked at how these problems have featured in recent critiques of psychiatry.

References Aliseda, A. Balint, M. Bentall, R. Benzi, M. Bolton, D. Kendler and J. Brinkmann, S. Chiong, W. Caplan, J.

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McCartney, and D. Cooper, R. Cournoyea, M. Elliott, C. Hume, D. Ingleby, D. Wright and A. Lecture Notes: Psychiatry. Companion to Psychiatric Studies E-Book. Eve C Johnstone. Deja Review Psychiatry, 2nd Edition. Abilash A. Robert J. Deborah J. Fundamentals of Psychiatry. Allan Tasman. Textbook of Psychiatry. Basant K. Michael B.

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