Week 3: Lecture

Question 1

1. Diagnostic Literalism

Answer 1

→ mental problem ≠ diagnosis

Question 2

What happened in the 1940s?

Answer 2

psychoanalytic theory & practice start to dominate American psychiatry (Freud)

Question 3

What happened in the 1950s?

Answer 3

nearly every US department chair of psychiatry psychoanalysis proponent
–Negative view of diagnoses in general: inter-rater reliability for diagnoses hardly above chance →
response: rid of (psychoanalytic) theories, concerted efforts to introduce medical model, objectivity

Question 4

Explain the History & Path Dependence mbt Cassidy.

Answer 4

MDD criteria in DSM-5 go largely back to Cassidy 1957, with minor
changes that were often not supported by evidence
The only symptom Cassidy proposed in 1957 that is not in the DSM-5 is constipation
Interview with Cassidy in 1980: why 6 out of 10 symptoms? → “it sounded about right”

Question 5

By what two historical forces are diagnostic categories & thresolds shaped?

Answer 5

● Competing criteria to Cassidy 1957
● Wernicke vs Kraepelin

Question 6

“One can argue that the DSM-5 would be meaningfully different from what it is today” (Kendler 2016). What does this mean?

Answer 6

If it wasn/t kraeplin who basically ‘designed’ the dsm as it is now, it could’ve been anybody to be honest. Maybe the DSM would have looked totally different.

Question 7

Nosology

Answer 7

is science policy, not science → branch dealing with classification of diseases

Question 8

Diagnoses

Answer 8

idealisations designed as clinically useful tools to facilitate treatment selection,
planning, prognosis, & communication → mental disorders can be described as diagnoses, which may
have immense utility: categories ‘superimposed’ (Hyman, 2021)

Question 9

natural kinds

Answer 9

categories discovered, not constructed: unchanging entities that carve nature at her joints (describe how the world is), sharp boundaries, set of properties necessary and su cient for classification → works kind of like elements: atomic number necessary and su cient
Example → everything with Z = 83 is gold: the number of protons uniquely defines elements.

( To say that a kind is natural is to say that it corresponds to a grouping that reflects the structure of the natural world rather than the interests and actions of human beings)

Question 10

What is the main task of psychiatry ?

Answer 10

to find the natural disease units, which are distinct, in principle and without overlap, from each other and which have the same symptoms, course, cause, and physical abnormalities” (Jaspers, 1913)

Question 11

Diagnostic Literalism is basically inflating mental health problems with rough diagnostic proxies. Why is it impossible to reach diagnostic literalism in psychology?

Answer 11

→ unlikely that such designs are optimally positioned to inform research on psychopathology → dangerous reification of rough clinical proxies (the act of changing something abstract (= existing as a thought or idea) into something real: the reification of fantasies.)

Question 12

Reductionism

Answer 12

more than the sum of parts
Reductionism: simple mechanical system can be decomposed into elements and their relations (A→B→C) → reductionism = figuring out properties of the whole given properties of parts

Question 13

Explanatory Reductionism

Answer 13

lower levels (i.e. biology) o er inherently superior explanatory power than higher levels (e.g. psychology, development, environment) → biological reductionism dominated research landscape since 1980s: constrained funds, health-care policy & service delivery

Question 14

What are 4 problems with reductionism?

Answer 14

• implausible (quarks don’t explain hypertension)
• psychological content may drive causal relations
• multiple realisability (de stelling dat dezelfde mentale eigenschap, toestand of gebeurtenis kan worden geïmplementeerd door verschillende fysieke eigenschappen, toestanden of gebeurtenissen)
• higher-order phenomena require higher-order correlations

Question 15

Biological psychiatry

Answer 15

insights into how genes & brains work, but told us little about biology of specific mental disorders: for mental disorders, biomarkers explain little variance, and results are transdiagnostic (een visie op psychopathologie waarbij ervan wordt uitgegaan dat dezelfde onderliggende mechanis- men kunnen leiden tot verschillende stoornissen of deze stoornissen in stand houden) → not as biology not relevant but as diagnoses not sensible targets for e.g. discovery

Question 16

Why do we embrace the complexity?

Answer 16

Because mental disrders are complex systems. They are not bycicles.

Question 17

Common Cause Framework

Answer 17

alle veranderingen in zintuiglijke vermogens en intellectueel functioneren (cognitieve veroudering) op oudere leeftijd zijn te wijten aan een gemeenschappelijke factor, de verslechtering van de hersenfunctie
→ symptomen zijn passieve, uitwisselbare indicatoren
→ definitie van symptoom: indicator van een onderliggende ziekte
→ interventie moet gericht zijn op de latente variabele

Question 18

Network Theory Framework

Answer 18

(system of problems!)
set of psychological problems referred to as “mental illnesses” do not exist independently of their signs and symptoms → relationship is mereological: whole to part
→ symptoms are important, autonomous causal agents & symptoms should be studied
→ intervention should focus on symptoms
→ mental disorder as emergent property & has resonated well with clinical practitioners