Logical empiricism and psychiatric classification

Comprehensive Psychiatry (Impact Factor: 2.25). 01/1986; 27:101-14.
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Nosology has become a widely discussed topic in psychiatry with the appearance of DSM-III. Most current treatments of diagnostic categorization, however, presuppose a particular philosophy of science: logical empiricism. Ideas of Carl G. Hempel, a leading proponent of logical empiricism. can be shown to illuminate the contemporary classification of mental disorders. Moreover, the importance attached by many prominent psychiatrists to operational definitions in nosology can be seen to grow from logical empiricist roots. Even the etiology of mental disorders can be placed within a logical empiricist framework. We describe this logical empiricist position in order to prepare for alternative approaches to classification.

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    • "Les auteurs ne connaissent pas les patients ; une procédure explicite doit garantir que le projet puisse se dérouler, dans des conditions relativement similaires, dans sept établissements différents ; le jugement final n'est prononcé ni par les cliniciens ni par les patients, mais par l'opération d'un calcul statistique. Les années qui suivent seront marquées par l'intégration de nombreuses méthodes d'évaluation psychométriques, puis de procédures diagnostiques qui se standardiseront elles aussi, fondées sur l'approche opérationnelle développée par le groupe de l'Université de Washington à Saint-Louis et reprise par le DSM-III (Schwartz et Wiggins, 1986). Il faut toutefois relever que la plupart des essais randomisés contrôlés sont nettement plus simples que l'étude de Prien et Cole. "
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    ABSTRACT: RÉSUMÉ1 Cet article est une contribution à l’étude des transformations contemporaines du champ de la psychiatrie à partir d’une lecture de la recherche en psychopharmacologie reposant sur l’analyse de la structure et des styles des publications dans le domaine. Il met en évidence trois moments principaux : (1) l’âge d’or des découvertes majeures (lithium, chlorpromazine, imipramine), documentée par une description clinique au cas par cas ; (2) la montée en puissance de l’essai randomisé contrôlé et l’accent mis sur une méthodologie devant permettre d’éviter l’incertitude et les biais de la clinique ; (3) les années récentes, marquées par une concurrence entre molécules, le développement des approches méta-analytiques et une opacité croissante des articles pour le lecteur clinicien. Cette contribution s’inscrit dans le cadre d’une épistémologie historique des pratiques cliniques. Mots clés : psychotropes, evidence based medicine, essais cliniques, épistémologie Abstract: Transformations of proof in contemporary psychiatry. The case of clinical trials in psychopharmacology This paper contributes to the study of psychiatry’s contemporary transformations by analyzing the structure and form of the scientific literature in the field psychopharmacology. It highlights three main periods: (1) the “golden age” of the major discoveries (lithium, chlorpromazine, imipramine), which are reported through case-by-case clinical descriptions; (2) the emergence of the randomized controlled trial and the growing importance of a strict methodology attempting to avoid the uncertainty and biases of the clinical work; (3) the recent years, characterized by a competition between similar molecules, the development of meta-analytical methods and a growing opacity of the published literature for the clinician-reader. This contribution is part of a wider historical epistemology of clinical practice. Keywords: psychotropic drugs, evidence-based medicine, clinical trials, epistemology
    Revue d'Anthropologie des Connaissances 01/2013; 7(3-3):617-638. DOI:10.3917/rac.020.0617
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    • "Logical positivism was strongly preoccupied with the issue of how theories and concepts, stated in language, might correspond to extralinguistic reality.12 This preoccupation came to mark decisively the DSM-III descriptive psychiatric approach. "
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    ABSTRACT: Questions concerning both the ontology and epistemology of the “psychiatric object” (symptoms and signs) should be at the forefront of current concerns of psychiatry as a clinical neuroscience. We argue that neglect of these issues is a crucial source of the stagnation of psychiatric research. In honor of the centenary of Karl Jaspers’ book, General Psychopathology, we offer a critique of the contemporary “operationalist” epistemology, a critique that is consistent with Jaspers’ views. Symptoms and signs cannot be properly understood or identified apart from an appreciation of the nature of consciousness or subjectivity, which in turn cannot be treated as a collection of thing-like, mutually independent objects, accessible to context-free, “atheoretical” definitions or unproblematic forms of measurement (as is often assumed in structured interviewing). Adequate and faithful distinctions in the phenomenal or experiential realm are therefore a fundamental prerequisite for classification, treatment, and research. This requires a multidisciplinary approach, incorporating (among other things) insights provided by psychology, phenomenological philosophy, and the philosophy of mind.
    Schizophrenia Bulletin 12/2012; 39(2). DOI:10.1093/schbul/sbs153 · 8.45 Impact Factor
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    • "DSM-III’s [46] revolutionary neo-Kraeplinians were dedicated to setting up a research program rather than accurately reflecting clinical realities. Embracing Carl Hempel’s [47] logical empiricist agenda, they approached mental disorders in terms of operational definitions for the purpose of enhancing reliability in diagnosis [48]. Mayes and Horwitz [49] write: "Spitzer selected a group of psychiatrists and consultant psychologists who were committed primarily to medically oriented, diagnostic research and not to clinical practice" (p. "
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    ABSTRACT: 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 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 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.
    Philosophy Ethics and Humanities in Medicine 05/2012; 7:9. DOI:10.1186/1747-5341-7-9
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