Abstract
This chapter fleshes out the ‘bones of 3e Psychopathology’ as presented in the previous chapter, pulling them together into a full conceptual framework or model. This model is then considered using some different styles of language and metaphor in order to present a more thorough depiction of the conceptual object. 3e Psychopathology is rated on Zachar and Kendler’s (2007) conceptual taxonomy, and anxiety is analyzed as a summary example. Some questions relating to the classification of mental disorder are then considered. These questions include whether mental disorders are universal or culturally relative, and whether conditions of neurodiversity are better considered disorders or as alternative modes of functioning. A general stance of classificatory humility and pluralism is prescribed.
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Notes
- 1.
Note here I am lumping together a variety of classically differentiated scales of enquiry, from the physiological to the neurological and the genetic. The same is true for the variety of timescales I have lumped under factors relating to embedment. I have done this simply for ease of communication and to keep this example brief.
- 2.
For further example and comparison to extant conceptual models see table two in Chap. 7.
- 3.
Some disorders may even have dense hubs of connection in the environment and thus in a sense be ‘top-down’ disorders. This seems to be the case with dissociative identity disorder (i.e., ‘multiple personality disorder’), or other ‘culturally bound’ syndromes. I put quotes around ‘top-down’ as I do not wish to imply a hierarchy here, nor to fail to recognize the relational quality of such disorders.
- 4.
Note that something being broken and needing to be fixed also arguably entails a value judgement and prescription.
- 5.
Internalism could be further separated into those that think everything important is happening a holistic physiological level, the level of ‘neuro-circuitry’ (such as RDoC), at the level of brain-chemistry, at the genetic level, etc. 3e Psychopathology rejects all such views by its commitment to embedment (the recognition of the contextually dependent nature of behavior), and the taking of the whole brain-body-environment system as its focus of analysis.
- 6.
- 7.
As argued by Zachar (2014), this genuine fuzziness invites pragmatic decision making in the development of diagnostic systems. The problem is of course the divergent purposes that these diagnostic systems are meant to serve. In the service of different purposes (e.g., explanatory efforts, the treatment of individuals, the development of talk therapies, the development of pharmacological treatments, diagnosis as relevant for legal decisions) different degrees of abstraction may be pertinent. How those performing the task of classification should respond to these different needs however is well beyond the scope of the current project.
- 8.
Note the similarity to a Szaszian position here in making a distinction between a medical disease and mental disorder. Contra Szasz, this distinction is seen as fuzzy, and the current position also carves out a distinct conceptual space for mental disorder in a way that Szasz did not.
- 9.
Realism and essentialism—along with internalism—are often conflated. See Hartner and Theurer (2018) for discussion (although note that I disagree with their ultimate conclusion as it seems to rest on a the assumption that normativity cannot be part of the natural world—hence ruling out mental disorder as a fruitful target for mechanistic explanation).
- 10.
Co-morbidity refers to when an individual has more than one mental health diagnosis at one time. Under the DSM, this occurs at much higher rates than would be expected if mental disorders were independent phenomena, suggesting that this may be an artefact of how we conceive of and measure our diagnostic concepts. Note that there is continuing debate on this issue.
- 11.
Heterogeneity refers to diagnostic constructs being too ‘large’, capturing meaningfully different individuals under the same label. This can include individuals with very different symptom profiles (symptomatic), and/or disorders with very different causes/constitutions (etiological). Under the DSM this occurs frequently (Contractor et al., 2017; Dickinson et al., 2017; Galatzer-Levy & Bryant, 2013; Hawkins-Elder & Ward, 2019; Monroe & Anderson, 2015; Olbert et al., 2014).
- 12.
False positive refers to when people are diagnosed as having a disorder but probably do not have the disorder/a genuine problem.
- 13.
Concept creep refers to the observed tendency for our concepts of harm to grow over the last hundred years or so. I include this here as the cited paper by Haslam includes many examples from the DSM. If DSM concepts can expand (or contract) with social mores, this brings into question their objective nature.
- 14.
The problem of reification concerns the fact that DSM diagnoses are only intended to be draft descriptive concepts yet through their use have come to be seen as real things, often with causal power, to an unwarranted degree.
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Nielsen, K. (2023). Fleshing Out the Concept, and Questions of Classification. In: Embodied, Embedded, and Enactive Psychopathology. Palgrave Studies in the Theory and History of Psychology. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-031-29164-7_5
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