Classification

comments on: Pearsons, 1986

I largely agree with the arguments Pearsons makes in her 1986 paper. I agree that we (as a field) often overlook important “phenomena,” symptoms, and manifestations of psychopathology by focusing on (somewhat arbitrary) categories outlined in the DSM.

However, some of Persons’ arguments seemed weak. Perhaps it is my own naive idealism regarding psychological research, but I just cannot believe that someone in their “right mind” (or a group of someones, as the case may be) would use the diagnostic category “Schizophrenia” as an operationalization for thought disorder when clearly the goal is to study (the symptom(s) of) thought disorder and not the cluster of symptoms referred to as schizophrenia! It would seem a more obvious choice to study the overt symptom(s) of thought disorder, which can be easily operationalized into observable and reportable behavior. To me, this seems to be less of an issue of “misclassification of subjects” and more an issue of bad science! …or perhaps Persons is being euphemistic. Perhaps what Persons really meant to say was that an advantage to studying psychological phenomena over psychiatric diagnoses is avoidance of stupidity.

On Widiger and Clark, 2000:

I was also interested in Widiger & Clark's piece about the DSM-V and the tasks at hand for the authors of this upcoming edition. Particularly, the section on differentiating between normal and abnormal struck me as a particularly important issue; for this is, in essence, what the DSM is about. First there is the argument of whether or not or what aberrant behavior is driven by underlying psychopathology and what is not. This seemed a particularly interesting question in light of the example used. As a(n American) society, it is hard to understand how "deviant sexual behavior" such as pedophilia could be driven by anything else than a mental disorder. This behavior is so distasteful to us that we do not want to think of it any other way. It also begs the question: what is voluntary? When we think about this in terms of the next example about affective and anxiety disorders, the term voluntary doesn't seem to fit. While "uncomplicated" bereavement may not be driven by underlying pathology, surely it is not voluntary or willful. Widiger and Clark quote Regier, Kaelber, et al. (1998) in saying that the high rate of affective disorders we see today may not be due to any underlying psychopathology but rather are "transient homeostatic responses to internal or external stimuli" and in the case where these "syndromes" have not been brought to clinical attention suggest that they are appropriate responses that are "neither pathologic nor in need of treatment." This seems to suggest that the additional criteria added to DSM-IV regarding functioning would largely be able to differentiate the two. But what of the case of bereavement that does lead someone to seek treatment, yet is not classifiable (according to the DSM-IV) as psychopathology. It is very likely that some degree of distress would lead one person to seek treatment and not another, yet they may be functioning on similar levels.

Widiger and Clark go on to say that it may not (at least at any time in the near future) be possible to differentiate between what constitutes normalacy and what constitutes psychopathology; the task at hand for the developers of the DSM-V may be to decide if, in fact, a distinction can even be made. If not, this is surely to change the face of psychology and treatment as we know it.