Peter Zachar

In this brief commentary, I would like to discuss two reservations I have about the article by Bergner and Bunford. Before doing so let me make some preliminary remarks.Their hypothesis that the concept of disability unites the various mental disorder constructs that have been proposed over the centuries and across cultures is reasonable and accords well with common sense. The concept of disability does a lot of good work in helping us to understand mental disorders.With respect to the authors’ contrast between the disability conception versus the behavioral conception of mental disorder, the notion that counting behaviors alone justifies diagnosing a psychiatric disorder is worth critiquing. Claiming that everyone...

This interdisciplinary work addresses the question, "What role should psychological conceptualization play for thinkers who believe that the brain is the organ of the mind?" It offers readers something unique both by systematically comparing the writings of eliminativist philosophers of mind with the writings of the most committed proponents of biological psychiatry, and by critically scrutinizing their shared anti-anthropomorphism from the standpoint of a diagnostician and therapist. Contradicting the contemporary assumption that common sense psychology has already been proven futile, and we are just waiting for an adequate scientifically-based replacement, this book provides explicit philosophical and psychological arguments showing why, if they did not already have both cognitive and psychodynamic psychologies, philosophers and scientists would have to invent them to better understand brains. (Series A)

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 that variable origins, biological implementations, and psychological and sociocultural contexts may combine to create distinct kinds of emotional states that require distinct names. I acknowledge that such a splitting strategy will provide increased validity, but also claim that atomizing alone may not give us everything we want from a scientific classification

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 impersonal accounting approach in which critical reflection on purposes is circumvented by decision-making algorithms (Zachar and Bartlett 2009). Psychotherapy treatment manuals definitely satisfy the bureaucratic instinct, and the fifteen-minute medication management session even more so (Harris 2011). Ideally, evidence-based medicine (EBM) should be used to promote the goals of ..

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 this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined

In lieu of an abstract, here is a brief excerpt of the content:Psychiatric Comorbidity:More Than a Kuhnian AnomalyPeter Zachar (bio)Keywordscomorbidity, classification, epidemiology, differential diagnosis, personality disorderDr. 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 of the classification system. I am not convinced, however, that comorbidity is best conceptualized as an artifact of the taxonic structure of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). Instead, I suggest that the use of dichotomies such as true versus artifactual should be used with caution when psychiatric classification is being discussed.In contrast with the artifact hypothesis, I argue that the phenomena covered by the term "comorbidity" are real, expectable features of the psychiatric domain. They are not the phlogiston and luminiferous ether of psychiatry. I am skeptical of the notion that high comorbidity rates as a whole can be understood as Kuhnian anomalies, or that there is a crisis, or that after a period of revolutionary science a new paradigm would eliminate these 'anomalies.' In short, high rates of comorbidity in psychiatry will not simply disappear once scientists develop a better nosological paradigm. High levels of comorbidity can, however, be both lowered and provided a better, evidence-based conceptual framework.Many Conditions, One OrganIn general medicine, comorbidity conventionally refers to the simultaneous occurrence of two independent disease processes or distinct clinical entities, such as heart disease and liver cancer (Feinstein, 1970; Jablensky 2004). The presence of one disease is supposed to affect the other in such a way that the co-occurrence of the two has implications for prognosis and treatment.Comorbidity in psychiatry is a broader concept, referring to a variety of conditions that overlap in multiple ways. The different kinds of overlap are amenable to detailed empirical analysis (e. g., Klein and Riso 1993; Neale and Kendler 1995). Depressive reactions to primary disorders, attention deficit symptoms associated with mania, panic attacks in the context of severe borderline personality disorder, substance abuse disorders among psychopaths, histrionic dynamics combined [End Page 13] with narcissistic personality traits, and emergent conditions such as schizoaffective disorder are all distinct types of comorbidity. The kinds of overlapping conditions just listed are sometimes termed psychiatric comorbidity. Also important is comorbidity between psychiatric disorders and general medical conditions as is studied in behavioral medicine and health psychology. The crisis, if there is one, is a crisis of comorbidities.The heart disease and liver cancer type of comorbidity as independent organ systems being affected is ruled out a priori in psychiatric comorbidity proper. In psychiatry, "psychopathological disease processes" can all be expected to affect a single organ, namely the brain or, more likely, affect the different systems that are tightly integrated in the brain. The tight integration can make putative comorbid psychiatric disorders difficult to disentangle.It is a widely held consensus that causes, not organ systems, are what matter in comorbidity. In this tradition, Dr. Aragona claims that in general medicine shared symptoms between two diseases (such as fever and fatigue) are not a problem because the diseases are differentiated with respect to etiology; in psychiatry, however, where syndromes are differentiated by a description of symptoms only, symptomatic overlap is a problem.Is descriptive psychopathology, therefore, a root cause of the "crisis of comorbidity" and should it be abandoned in favor of etiological classification? Unfortunately, forcing psychiatric nosology to conform to an etiological paradigm is unlikely to resolve the problem of psychiatric comorbidity. As noted, the problem is one of distinguishing between the different etiological disease processes that are affecting tightly integrated systems in the brain. The brain as a whole is a multilevel, dynamic, and open system, which has an ecology (Zachar 2000). As argued by Kendler (2005) and Schaffner (2002, 2008), it has not thus far, and may never be fully possible to segregate causes and their associated psychiatric disorders into parsimonious etiological packages. In the ecology of neuroscience, causes and effects tend to merge in a continuous series of common pathways.It would be foolish...

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 psychologists appear to have reached consensus in favor of nonessentialism and they freely use both realist and instrumentalist interpretations, there is no consensus on the other two contrasts. The final contrast explored addresses attitudes toward the use of philosophy in scientific theorizing, and whether philosophy is best kept in the background or brought into the foreground.

Reply by the current authors to the comments made by Jaak Panksepps , James.A. Russell and Louise Sundararajan on the original article by Peter Zachar . 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 that eliminativist analogies are beneficial but argue that they cannot fully account for the relationship between folk and scientific psychology. I also claim that neither Panksepp's nor Russell's models are incommensurable with Sundararajn's deeper approach to affective science. I suggest that Panksepp's conclusions about the structure of primary affect may be incompatible with the dimensional model, which illustrates the limits of translational work. 2012 APA, all rights reserved)

The scientific study of emotion has been characterized by classification schemes that propose to 'carve nature at the joints.' This article examines several of these classifications, drawn from both the categorical and dimensional perspectives. Each classification is given credit for what it contributes to our understanding, but the dream of a single, all purpose taxonomy of emotional phenomena is called into question. Such hopes are often associated with the carving at the joints metaphor, which is here argued to be harmful to scientific realism, and better rejected in favor of a pragmatic approach. Questioning the mere discovery theory of scientific progress, I argue that psychologists discover facts about their domain of study, but have to decide how to classify them. 2012 APA, all rights reserved).

In lieu of an abstract, here is a brief excerpt of the content:Vice, Mental Disorder, and the Role of Underlying Pathological ProcessesNancy Nyquist Potter (bio) and Peter Zachar (bio)Keywordsresponsibility, virtue theory, cultural norms, psychopathologyThe 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 personality disorders and moral evaluations, and these fault lines became manifest not only between ourselves, but also when discussing our ideas with members of the various disciplines.Many practicing psychiatrists acknowledge that moral attributions (such as manipulativity) might be made about people with certain disorders (such as borderline personality disorder), but also find the argument that psychiatric diagnoses are moral rather than medical conditions to be a ludicrous bit of antipsychiatry in the Szaszian tradition. Philosophers, on the other hand, are less involved with these diagnostic categories in their day-to-day work and are more willing to be skeptical. Whether they are doing philosophy of psychiatry, moral theory, or sociopolitical philosophy, they are interested in digging a little bit deeper and are not impressed by arguments to the effect that—it’s obvious that these are really disorders. Being “obvious” is not a persuasive philosophical argument.The metaphysical task of determining what belongs in the category of criminality compared with other ways of sorting behavior has parallels in moral philosophy: Why is fraud, or theft, criminalized whereas (most) lying is not? Why is one set of moral norms enforceable, whereas a second set is aspirational? Does the difference involve property, where infractions of property are thought to be more serious wrongs than lying, which is “only” psychological rather than material? Are the “most serious” wrongs the ones we mark as crimes? Why is sodomy still criminalized in some areas but betraying one’s lifelong love is viewed as morally reprehensible but not criminal? Both actions are private, and only one seems to do harm—unfaithfulness—yet that is the one that is not criminalized. The point here is that, regardless of domain, our classification systems need to be justifiable, yet justification is most often mystifying. [End Page 27]The same is true for classifying mental disorders. The class of mental disorders appears to be a somewhat inconsistent collection of heterogeneous conditions and does not form a natural kind (Zachar 2000). At the most, the class of mental disorders names a family of loosely related conditions and the reasons for inclusion can shift from disorder to disorder.If the class of mental disorders does not specify an internally coherent kind akin to gold, deciding on the scope of psychiatric practice becomes an important problem. As Sadler asks, for what reasons do we classify pedophilia with schizophrenia—both as disorders—but omit sadism? This is an important question of disciplinary scope.This question of scope is itself ethically charged because, on the one hand, bringing a condition under the purview of psychiatry offers the possibility for treatment, and at least establishes the goal of improving the lives of people with specific kinds of problems. Making lives better is one of the humanistic justifications for science itself; clearly it is a raison d’être of psychiatry. On the other hand, medicalization sets up the conditions for a certain kind of social control. Hospitalization, educational services, day treatment, and disability payments are all contingent upon psychiatric diagnostic practices. These programs and the institutions that manage them are both socially available and socially prescribed. The diagnosed behaviors can now be considered to be entities, and explanations of them can be developed. New technologies for altering them will also be introduced. Such practices have been associated with dehumanization (Phillips 2009).Two important questions also need to be distinguished. The first is a question for moral philosophy—What degree of responsibility do people with putative mental disorders have for their behaviors? For example, should people with psychotic disorders or personality disorders be held responsible for crimes they commit? If so, under what conditions? Should responsibility for certain behavior be mitigated? If so, under what conditions? Moral philosophy...

The thesis of this article is that an attitude akin to pragmatism is internal to the scientific enterprise itself, and as a result many scientists will make the same types of non-essentialistic interpretations of their subject matter that are made by pragmatists. This is demonstrably true with respect to those scientists who study the biological basis of emotion such as Panksepp, LeDoux, and Damasio. Even though these scientists are also influenced by what cognitive psychologists call the essentialist bias, their research programs are coherent with Peter Zachar?s rejection of natural kinds in favor of practical kinds. When the confrontation with complexity leads a scientist to offer non-essentialist interpretations, two popular options are to go eliminativist or go nominalist. Pragmatists prefer the nominalistic option, and we provide reasons for suggesting that scientists should as well

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.3 (2002) 219-227 [Access article in PDF] The Practical Kinds Model as a Pragmatist Theory of Classification Peter Zachar Pragmatist theories of scientific classification are intended to be pluralistic models that recognize different ways of cutting up the world as valuable, but do not require us to adopt whatever-goes relativism or metaphysical antirealism. How ironic that my application of pragmatism to psychopathology has been charged with not being sufficiently pluralistic because it tries to fit all psychiatric disorders into the Procrustean bed of practical kinds. The Practical Kinds Model in General As a point of clarification, the practical kinds model is not a description of a type of category combined with an argument that all psychiatric disorders should be seen as belonging to that type. If it were that kind of model, I would fully agree with Haslam that practical kinds, fuzzy kinds, and discrete kinds are all potential types of psychiatric disorders. Like Nick Haslam, I believe that there are many different things in the DSM-IV and the ICD-10, and they cannot neatly be classified as the same type of thing.Rather than identifying a type of category, the practical kinds model is a general theory of scientific classification. It is a nonessentialistic theory. Essentialism is the view that things have real essences. In the Aristotelian version of essentialism, an essence is an internal structure, and it is the internal structure that makes anything be the kind of thing it really is. In this classical category model, category members either have the essence or they do not, and everything that has the appropriate essence is a member of that category. The world is supposed to therefore have a well-defined structure, and the job of the scientist is to discover that structure. Ian Hacking (1999) has termed this view of categorization inherent structurism.The practical kinds model does not deny that things have internal structures; it only denies that internal structure by itself determines category membership. Internal structure is an important consideration in identifying categories, but external criteria can always play a role. External or relational criteria play more important roles in some cases than they do in others, but they cannot be eliminated once and for all. Essentialistic theories, which favor an almost exclusive focus on inherent structures, have the advantage of being more parsimonious, but they do so by ignoring real complexity.The best way to illustrate this point is to examine a category whose identification is heavily weighted in terms of internal criteria, or an inherent structure, such as a chemical element. [End Page 219] For example, hydrogen is defined as the element that has an atomic number of 1. This means that it has one proton in its nucleus and normally one electron orbiting its nucleus. The atomic number reflects an internal property, and anything that has an atomic number of 1 is hydrogen. The same is true for the other elements. Anything that has an atomic number of 79 is gold; anything that has an atomic number of 19 is potassium, and so on. Also part of the essentialistic view is the notion that all the important properties of an element are systematically (or lawfully) related to its internal structure.It would be foolish to deny the practical utility of the atomic theory of chemistry. But even in this strongest of cases, external criteria can potentially play a role in how we decide to carve up the world and what we identify as the relevant categories. The point can be clearly illustrated with a Gedanken experiment based on the ideas of Donnellan (1983). Assume that we were to make contact with extraterrestrial life, and the result of that contact was our initiation into a larger galactic community like those portrayed on Star Trek or Babylon 5. Fortunately for us, it turns out that all planets in the community use a gold-based currency, just like we do on Earth. What we call gold, however, is too common to be the galactic basis of a currency, but a particular isotope...