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August 1995 - present
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Publications (134)
Conversations in Critical Psychiatry’ was an interview series led by Awais Aftab for Psychiatric Times from 2019 to 2022, exploring critical and philosophical perspectives in psychiatry and engaging with prominent commentators within and outside the profession who had made meaningful criticisms of the status quo. The series was well received and ge...
Work at the intersection of philosophy and psychiatry has an extensive and influential history, and has received increased attention recently, with the emergence of professional associations and a growing literature. In this paper, we review key advances in work on philosophy and psychiatry, and their related clinical implications. First, in unders...
In the eighteenth century, masturbation was extended from the moral to the medical sphere and conceptualized as being the cause of various deteriorative physical illnesses. In the nineteenth century, psychiatrists accepted that difficult to control masturbation was a feature of many mental disorders. They also believed that masturbation could play...
Now in its fourth edition, the acclaimed Oxford Textbook of Psychopathology aims for both depth and breadth, with a focus on adult disorders and special attention given to personality disorders. It provides an unparalleled guide for professionals and students alike. Esteemed editors Robert F. Krueger and Paul H. Blaney selected the most eminent res...
In the early 1990s, a research group that included Holly Prigerson
and Charles Reynolds established that disordered grief overlaps with depression
and anxiety but is not the same. They also developed a research inventory for
studying disordered grief. Subsequently, Prigerson focused on measuring disordered grief using advanced psychometric techniqu...
This article extends the ideas expressed in a special section on theories of psychopathology by expounding on heterotypic patterns in which different arrangements of symptoms appear over time. With heterotypic continuity, the different arrangements are somewhat predictable; with discontinuity, they are not. Among the reasons the articles in the spe...
This contribution argues that operational definitions are by nature partial representations of phenomena. With respect to classification systems such as the DSM-5, by convention, symptoms that are non-specific are not usually included in an operational definition. It is therefore not the purpose of a DSM operational definition to articulate a conte...
Objective:
This article narrates a history of several important changes to the substance-related disorders chapter in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), based on interviews with people involved in the pre-planning and the development of the revisions. These changes include collapsing substance abuse a...
Classification is basic to science and practice. Historical trajectories in psychiatric classification are identified while noting professional, scientific, and social forces affecting its evolution. Given that classification systems serve multiple purposes and stakeholders, major contemporary classification schemes are briefly reviewed. The nature...
Advocates for the psychological construction of emotion view themselves as articulating a non-essentialist alternative to basic emotion theory’s essentialist notion of affect programs. Psychological constructionists have also argued that holding essentialist assumptions about emotions engenders misconceptions about the psychological constructionist...
Philosophers discuss Jerome Wakefield's influential view of mental disorder as “harmful dysfunction,” with detailed responses from Wakefield himself.
One of the most pressing theoretical problems of psychiatry is the definition of mental disorder. Jerome Wakefield's proposal that mental disorder is “harmful dysfunction” has been both influential an...
This is part of a series titled Conversations in Critical Psychiatry by Awais Aftab, MD
https://www.psychiatrictimes.com/qas/psychiatric-disorders-imperfect-community-peter-zachar-phd
This article narrates a consensus history of the proposal to include diagnostic criteria for a psychosis risk syndrome in the DSM-5, in part, to document what happened, but also to potentially help focus future efforts at clinically useful early detection. The purpose of diagnosing a risk state would be to slow and ideally prevent the development o...
Levels of Analysis in Psychopathology - edited by Kenneth S. Kendler April 2020
Levels of Analysis in Psychopathology - edited by Kenneth S. Kendler April 2020
Levels of Analysis in Psychopathology - edited by Kenneth S. Kendler April 2020
Levels of Analysis in Psychopathology - edited by Kenneth S. Kendler April 2020
Toward a Philosophical Approach to Psychiatry presents a collection of philosophical and historical papers authored by the psychiatrist Kenneth S. Kendler. Written primarily for psychiatrists, psychologists, and other scholars in the mental health professions, as a body of work, the papers offer an accessible distillation of many of the best curren...
Intellectual biography of the psychiatric geneticist Kenneth S. Kendler
The initial plans for the DSM-5 revision envisioned a paradigm shift away from traditional diagnostic categories. However, plans for a major move from descriptive to etiologic diagnoses were quickly abandoned as infeasible. Support was much broader for adding dimensional/spectrum constructs to the categorical diagnoses, although this was interprete...
This book explores the central questions and themes lying at the heart of a vibrant area of philosophical inquiry. Aligning core issues in psychiatry with traditional philosophical areas, it presents a focused overview of the historical and contemporary problems dominating the philosophy of psychiatry.
Beginning with an introduction to philosophy o...
Commentary on Standards and Guidelines for the Development of Diagnostic Nomenclatures and Alternatives in Mental Health Research and Practice.
Beginning with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III), depressive episodes following the loss of a loved one were considered to represent normal grief if they did not include certain severe symptoms or if they lasted less than 2 months. This was called the bereavement exclusion rule. A debate about whether to e...
Many scholars believe that psychiatric nosology is undergoing a crisis of confidence. Some of the issues up for debate harken back to the introduction of the natural history approach to classification in the 17th century. Natural histories map out sameness and difference rather than speculate about causes. In contrast, the natural classification ap...
Critics contend that the categories within the DSM are fueling the current crisis in psychiatry because they are not valid. As a remedy, NIMH has established RDoC, a framework of psychological and behavioral constructs that will — they believe — better guide the search for the biological mechanisms of psychopathology. Here, we assess the ability of...
The concept of personality disorder was introduced in the twentieth century, emerging from a small collection of prior concepts such as constitution, temperament, self, character, and personality. Among the key events in the development of the concept are the introduction and subsequent rejection of degeneration theory, the work of Kurt Schneider,...
The concept of personality disorder was introduced in the twentieth century, emerging from a small collection of prior concepts such as constitution, temperament, self, character, and personality. Among the key events in the development of the concept are the introduction and subsequent rejection of degeneration theory, the work of Kurt Schneider,...
As the revision process leading to DSM-5 began, the domain of personality disorder embodied the highest aspirations for major change. After an initial prototype-based proposal failed to gain acceptance, the Personality and Personality Disorders Work Group (P&PDWG) developed a hybrid model containing categorical and dimensional components. A clash o...
The concept of natural kind, a term of art in philosophy, is being increasingly appropriated by mental health professionals (1–4). First introduced in the 19th century, the notion of a natural kind has benefited from sustained philosophical attention over the past forty years (5–7). Newly developed ways of thinking about the concept are worth takin...
Every side in the debate about eliminating or retaining the
bereavement exclusion for diagnosing major depressive disorder agreed
that the DSM-IV was inconsistent. It exempted symptoms of depression
from a depressive disorder diagnosis if they were a response to the
loss of a loved one, but diagnosed depression symptoms in response to
any other kin...
Having just spent 3 years completing a book that articulates a tough-minded Jamesian approach to the domain of psychiatry (Zachar, 2014), I am favorably disposed toward Jorid Moen’s analysis of the controversies surrounding evidence-based medicine (EBM). She does a good job of emphasizing the pragmatist inclination to get beyond fruitless philosoph...
To propose options for gradually transitioning to a thoroughgoing dimensional model of personality disorder.
The American Psychiatric Association was less willing to implement a dimensional approach to the diagnosis of personality disorder than the leadership of the DSM-5 anticipated. The next opportunity to implement such an approach will be in th...
Many current debates about validity in psychiatry and psychology are predicted on the unexpected failure to validate commonly used diagnostic categories. The recognition of this failure has resulted in what Thomas Kuhn calls a period of extraordinary science in which validation problems are being given increased weight, alternatives are proposed, m...
Many of the current debates about validity in psychiatry and psychology are predicated on the unexpected failure to validate commonly used diagnostic categories. The recognition of this failure has resulted in what Thomas Kuhn calls a period of extraordinary science in which validation problems are given increased weight, alternatives are proposed,...
Commentary on four articles in a special issue on "theories of emotion," comparing the theories with respect to five conceptual contrasts. The first four contrasts are essentialism versus nonessentialism, discriminative versus integrative theories, individual versus social focus, and instrumentalism versus scientific realism. Although scientific ps...
The pragmatist's tendency to construe concepts as tools that we use for certain purposes is applied to the contrast between natural kind and social construct. Both of these concepts offer informative ways of thinking about psychiatric disorders, but they are more useful when made less obscure by being decomposed into components. The decomposition o...
Scholars question the extent to which current psychiatric classification systems are inadequate for diagnosis, treatment, and research of mental disorders and offer suggestions for improvement.
In this volume, leading philosophers of psychiatry examine psychiatric classification systems, including the Diagnostic and Statistical Manual of Mental Dis...
In psychiatry, few question the legitimacy of asking whether a given psychiatric disorder is real; similarly, in psychology, scholars debate the reality of such theoretical entities as general intelligence, superegos, and personality traits. And yet in both disciplines, little thought is given to what is meant by the rather abstract philosophical c...
The proposals to include a menstruation-related mood disorder in the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R), and DSM-IV led to intense public and behind-the-scenes controversy. Although the controversies surrounding the DSM-5 revision were greater in number than the controversies of the earlier revi...
Significance
As complex systems such as the climate or ecosystems approach a tipping point, their dynamics tend to become dominated by a phenomenon known as critical slowing down. Using time series of autorecorded mood, we show that indicators of slowing down are also predictive of future transitions in depression. Specifically, in persons who are...
The Disordered Mind: An Introduction to Philosophy of Mind and Mental Illness, 2nd edn. By G.Graham. (Pp. 288; £23.99; ISBN 978-0-415-50124-8 pb). Routledge, 2013. - Volume 43 Issue 12 - PETER ZACHAR
The Contrast Between the nomothetic versus the idiographic was popularized in psychology by Gordon Allport (1937). In the early 1930s, Allport made his name by advocating for a quantitative, trait-based approach to the study of personality in contrast with the prevailing case study approach. In doing so, he was following the trend toward greater re...
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 th...
Thomas, Bracken, and Timimi (2012) make an important contribution in critiquing the extent to which the profession of psychiatry can be so bureaucratic that patients are treated as problems to be solved in an ‘efficient’ assembly line fashion rather than as individual persons. The trouble with bureaucracies is that they promote a cold and impersona...
It is only in the past 20 years that the concept of 'recovery' from mental health has been more widely considered and researched. This resource is unique in addressing philosophical issues - including conceptual challenges and opportunities - raised by the notion of recovery of people with mental illness.
It is argued that Mason and Capitanio (2012) are not clear on what would count as a “basic emotion,” and their reconstruction appears more geared toward emotionality in general. Their notion that species-typical outcome is the criterion of basicness requires making speculative assumptions about what is expected and average. Suggestions about an epi...
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 wheth...
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 wheth...
Psychiatry has long struggled with the nature of its diagnoses. This resource brings together established experts in the wide range of disciplines that have an interest in psychiatric nosology.
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 wheth...
Abstract We compare astronomers' removal of Pluto from the listing of planets and psychiatrists' removal of homosexuality from the listing of mental disorders. Although the political maneuverings that emerged in both controversies are less than scientifically ideal, we argue that competition for "scientific authority" among competing groups is a no...
This article describes five models that could be used to demonstrate that personality disorders are valid clinical kinds: the vulnerability model, the pathoplasticity model, the spectrum model, the decline in functioning model, and the defect model (of which there are three versions). It is argued that the empirically based vulnerability and pathop...
Izard's claim that the term emotion works well as an adjective is closer to B. F. Skinner's position than is acknowledged. Based on Izard's survey of scientists, I argue that the lack of consensus on emotion as a unitary construct could be considered to represent the dissolution of emotions. Given that something similar has happened in biology with...
This essay explores four answers to the question 'What kinds of things are psychiatric disorders?' Essentialist kinds are classes whose members share an essence from which their defining features arise. Although elegant and appropriate for some physical (e.g. atomic elements) and medical (e.g. Mendelian disorders) phenomena, this model is inappropr...
This article critically examines Louis Charland’s claim that personality disorders are moral rather than medical kinds by exploring the relationship between personality disorders and virtue ethics. We propose that the conceptual resources of virtue theory can inform psychiatry’s thinking about personality disorders, but also that virtue theory as u...
We are thankful for the opportunity to reflect more on the difficult problem of the relationship between moral evaluations and the construct of personality disorders in response to the commentaries by Mike Martin and Louis Charland. We begin by emphasizing to readers that this important problem is complicated by the different perspectives of the va...
Cramer et al.'s critique of latent variables implicitly advocates a type of scientific anti-realism which can be extended to many dispositional constructs in scientific psychology. However, generalizing Cramer et al.'s network model in this way raises concerns about its applicability to psychopathology. The model could be improved by articulating w...
I critically analyze Kagan’s claim that in order to advance the science of emotion we should abandon the practice of referring to emotions with common folk psychological names, such as fear and anger. Kagan recommends discovering more homogenous constructs that are segregated by the type of evidence used to infer those constructs. He also argues th...
Dr. Aragona's article in this issue of Philosophy, Psychiatry, & Psychology makes some important points regarding the relationship between comorbidity rates and the classification system currently used in psychiatry. Particularly persuasive is his claim that observed patterns of comorbidity are, in important respects, consequences of the structure...
The issues discussed by John Sadler are among the most complicated in the philosophy of psychiatry, if for no other reason than that they highlight an area where disciplinary fault lines between clinical psychiatry/ psychology and philosophy seem most evident. We spent a year writing an article on the relationship between the assessment of personal...
In this response to Panksepp’s, Russell’s and Sundararajan’s commentaries on Zachar (2006), I consider the utility of the concept of natural kind, and explore difficulties in applying it reliably. I examine categorical and dimensional approaches to affect with respect to both scientific realism and nominalist approaches to classification. I agree t...
Studies of graduate students learning to administer the Wechsler scales have generally shown that training is not associated with the development of scoring proficiency. Many studies report on the reduction of aggregated administration and scoring errors, a strategy that does not highlight the reduction of errors on subtests identified as most pron...
The authors investigated cognitive processing styles associated with interests in scientist and practitioner activities among a sample of undergraduate psychology majors who planned to attend graduate school. Results indicated that interests in scientist activities were associated with a greater motivation to engage in effortful processing (i.e., n...
Studies have found that Wechsler scale administration and scoring proficiency is not easily attained during graduate training. These findings may be related to methodological issues. Using a single-group repeated measures design, this study documents statistically significant, though modest, error reduction on the WAIS-III and WISC-III during a gra...
This article summarizes six conceptual dimensions that underlie common assumptions about what counts as an adequate category of psychiatric disorder. These dimensions are 1) causalism-descriptivism, 2) essentialism-nominalism, 3) objectivism-evaluativism, 4) internalism-externalism, 5) entities-agents, and 6) categories-continua. Four different ver...
Psychological test publishers have longstanding policies prohibiting the sale of psychological tests to unqualified persons. Psychologists are also ethically bound to maintain test security. The emergence of Internet auction sites, however, poses a heretofore unrecognized threat to test security. This 3-month survey of auction listings on eBay foun...
Healing Psychiatry: Bridging the Science/Humanism Divide. By D. H. Brendel. (Pp. 208; $26.00; ISBN 0262025949.) MIT Press: Cambridge, MA. 2006. - - Volume 37 Issue 1 - PETER ZACHAR
