Georg Repnikov

This paper develops and defends a deflationary analysis of existence claims involving psychiatric disorders. According to this analysis, a given psychiatric disorder exists if, and only if, there are people who have the disorder. The implications of this analysis are spelled out for our views of nosological decision making, and for the relationship between claims about the existence of psychiatric disorders and claims about their reality. A pragmatic view of psychiatric nosology is defended and it is argued that worries about the “reality” of any given disorder have to be distinguished clearly from questions about its existence.

Classificatory realism is the view that nature divides herself up into classes, or “natural kinds”, and claims that it is the goal of scientific classification systems to correctly identify, name, and describe these classes. On this view, the legitimacy of a classification is independent of us and our needs, and instead depends entirely on how well the structure of the classification “matches” the natural kind structure of reality. Progress with respect to classification consists in finding classifications that better match reality. Ultimately, classifications are seen as representations of reality, and it is the world itself that dictates what is to count as a good or correct classification of a given domain. In this thesis I argue against classificatory realism. In the course of this argument, I develop and defend an alternative view of our diagnostic and classificatory practices in psychiatry. This alternative view takes seriously the fact that psychiatric classifications and diagnostic concepts are technical extensions of natural language — tools that are introduced by particular humans, at a particular point in time, for particular human purposes. Viewed from this alternative perspective, some of the most vexing problems in the philosophy of psychopathology suddenly become tractable.

Do our diagnostic terms refer? If they do not, what implications does this have for our understanding of the practice of validation in psychiatry? These are the questions raised and addressed in the main part of John Campbell’s contribution to this volume, and the ones we will focus on in our reply. While we are sympathetic to Campbell’s contentions that the Diagnostic and Statistical Manual of Mental Disorders (DSM) style of validation needs reassessment, and that causality should play a more prominent role in nosological revisions, we think his picture of reference and validation is misconceived. In this short comment, we first address Campbell’s question about the reference of our diagnostic terms, before briefly sketching an alternative view of validation.