Neopositivism and Psychiatric Classification - Part 2

The second part of the study on Neopositivism and Psychiatric Classification has been published on History of Psychiatry. In this second part the concrete historical pathways are considered, showing that probably neopositivism shaped the DSM implicitly. In the same paper the present status of the epistemological debate is presented and it is showed that when the DSM-III appeared, Hempel himself had already abandoned the “reliability first” principle. The following is the abstract. The entire paper can be found at: http://hpy.sagepub.com/content/24/4/415.abstract

Abstract

Little is known about the concrete historical sources for the use of neopositivist operational criteria by the DSM-III. This paper suggests that distinct sources operated implicitly. The current usefulness of the operational approach is questioned. It is shown that: (a) in epistemology, neopositivism has been replaced by more adequate accounts; (b) psychologists rejected operational definitions because these were unable to define the majority of mental phenomena; (c) mental symptoms cannot be directly described as such, because they already make part of the psychiatric diagnosis to which they belong. In conclusion, diagnosing is based on the hermeneutical co-construction of mental symptoms. The failure of the neopositivist programme suggests that it is time to reconcile scientific formalization and semiotic activity.

Migrants' death in the Mediterranean Sea: OUR GUILT

1945: the Second World War is ended. Throughout Germany is ruin, not only material but also moral. The Germans are awakening from a nightmare: How had it been possible? Why had they not understood the aberration of their Nazi regime? The Allies say they are guilty. Are they? Some try to justify themselves, to advance excuses; others reject this accusation and project their guilt on the enemies. The philosopher Karl Jaspers decides that he must deal with this problem and dedicates to the question of German guilt a series of lectures. In Jaspers’ view, this is fundamental, because Germans “are indeed obliged without exception to understand clearly the question of [their] guilt, and to draw the conclusions. What obliges us is our human dignity. […] The way we answer it will be decisive for our present approach to the world and ourselves. It is a vital question” (Jaspers, 1947/2001, p.22).

October 2013: At least 130 African migrants have died and many more are missing after a boat carrying them to Europe sank off the southern Italian island of Lampedusa (BBC: http://www.bbc.co.uk/news/world-europe-24380247). The world wakes up: how was this tragedy possible? Who is responsible for it? As Italians, as Europeans, as Western citizens, are we guilty? Some declare Europe has to assume its responsibility: why are you leaving alone the willing but impotent Italians? Some reply that Italians had a lot of money from Europe in order to do this job. Some claim that we must empower Northern-African counties to control fluxes, i.e. to impede migrants to leave (do you remember how they are treated in that countries? Anything to say about abuses, torture and violence?). Some shift the attention and project guilt outside: the criminals organizing the journeys are guilt; the politicians and the warriors of the African nations from which migrants escape are guilt. In this moment in Italy there is only one recognized moral authority: the pope Francis. He clearly spoke against “the globalization of indifference” (Jul 8, 2013). Yesterday, after the shipwreck, he declared: “The word that comes to mind is ‘shame’. [...] Let us unite our strengths so that such tragedies never happened again”. In other words, the world should feel shame over the Lampedusa disaster (http://news.softpedia.com/news/Boat-Sinks-in-Italy-Pope-Francis-Says-the-World-Should-feel-Shame-over-Lampedusa-Tragedy-388269.shtml).
So the same question arises today as in post-war Germany: are we guilty?
Let us return to Jaspers. We see that present-day commentaries are similar to the reactions of the Germans: I am not guilty, someone else is. The criminals are guilty, not ourselves, we are good citizens and we have no responsibility of what happened. Jaspers clearly showed that no steps ahead could be made without dealing with the question of guilt, i.e. without assuming responsibilities in first person. Similarly, we cannot avoid new tragedies and propose solutions without understanding what is our role and our responsibility. We all knew that people were dying in the Mediterranean Sea, it had happened many times before (even the day before this new tragedy). We all know that migrants are obliged to travel in such risky conditions because European laws on immigration do not give them any alternative. We all know that many of these migrants are likely to be recognized as refugees, which obliges us to give them assistance. So, are we guilt for this?
Jaspers’ reply to his question was that Germans were guilty, but that there were differences, that not all kinds of guilt were the same. To understand, to self-understand what kind of guilt concerned them was the only way to assume responsibility and to start a process of self-transformation necessary to re-open a possibility of future. Germans largely did it.
We need it too. We must understand our responsibility in order to change things. We must clearly make a diagnosis in order to find the appropriate treatment.
Jaspers distinguished four kinds of guilt. Criminal guilt is not our guilt; it is the guilt of those making money by organizing these travels. However, in Jaspers’ terms we are politically and metaphysically guilt.
Political guilt refers to “my having to bear the consequences of the deeds of the state whose power governs me and under whose order I live. Everybody is co-responsible for the way he is governed (Jaspers, 1947/2001, p.25). As European citizens, we are all guilty because our laws on migration are a direct reason obliging migrants to try to enter in Europe with such risky means.
Metaphysical guilt is defined as follows: “There exists a solidarity among men as human beings that makes each co-responsible for every wrong and every injustice in the world, especially for crimes committed in his presence or with his knowledge. If I fail to do whatever I can to prevent them, I too am guilty (Jaspers, 1947/2001, p.26).

We all knew that people like us were dying in the Mediterranean Sea. We should be aware that migration is a process that cannot be stopped but just (partly) governed. We must know that paying Maghreb’s governments to stop migration is hypocritical; it is just to delegate to them the prosecution of violence and injustice but outside our view. We must clearly recognize our responsibility, our political and metaphysical responsibility. We have to do everything we can to have a clear view of the matter, and to change European laws and organization of migrants and refugees’ assistance. We must do it, if we really think that we must prevent such tragedies. Otherwise in a few weeks we will talk about something else, waiting for the next announced tragedy.

References

Jaspers K. (1947/2001) The question of German guilt. Fordham University Press, New York.

 

 

The Neopositivist Structure of the DSM Psychiatric Classification

The Association Crossing Dialogues has recently published a research on the epistemology of psychiatry. Its title is: “Neopositivism and the DSM psychiatric classification. An epistemological history. Part 1: Theoretical comparison”. The paper has been published in the prestigious international journal “History of Psychiatry”, 2013, Vol. 24(2), pp.166-179.

The following is the abstract:

Recent research suggests that the DSM psychiatric classification is in a paradigmatic crisis and that the DSM-5 will be unable to overcome it. One possible reason is that the DSM is based on a neopositivist epistemology which is inadequate for the present-day needs of psychopathology. However, in which sense is the DSM a neopositivist system? This paper will explore the theoretical similarities between the DSM structure and the neopositivist basic assumptions. It is shown that the DSM has the following neopositivist features: (a) a sharp distinction between scientific and non-scientific diagnoses; (b) the exclusion of the latter as nonsensical; (c) the faith on the existence of a purely observable basis (the description of reliable symptoms); (d) the introduction of the operative diagnostic criteria as rules of correspondence linking the observational level to the diagnostic concept.http://hpy.sagepub.com/content/24/2/166.abstract

Philosophy of clinical psychopharmacology

This is the abstract of a new paper on the Philosophy of Psychopharmacology. It is an example of the aid of epistemological reflections for the psychiatric practice and research.

Free download clicking here


Abstract
The renewal of the philosophical debate in psychiatry is one exciting news of recent years. However, its use in psychopharmacology may be problematic, ranging from self-confinement into the realm of values (which leaves the evidence-based domain unchallenged) to complete rejection of scientific evidence. In this paper philosophy is conceived as a conceptual audit of clinical psychopharmacology. Its function is to criticise the epistemological and methodological problems of current neopositivist, ingenuously realist and evidence-servant psychiatry from within the scientific stance and with the aim of aiding psychopharmacologists in practicing a more self-aware, critical and possibly useful clinical practice. Three examples are discussed to suggest that psychopharmacological practice needs conceptual clarification. At the diagnostic level it is shown that the crisis of the current diagnostic system and the problem of comorbidity strongly influence psychopharmacological results, new conceptualizations more respondent to the psychopharmacological requirements being needed. Heterogeneity of research samples, lack of specificity of psychotropic drugs, difficult generalizability of results, need of a phenomenological study of drug-induced psychopathological changes are discussed herein. At the methodological level the merits and limits of evidence-based practice are considered, arguing that clinicians should know the best available evidence but that guidelines should not be constrictive (due to several methodological biases and rhetorical tricks of which the clinician should be aware, sometimes respondent to extra-scientific, economical requests). At the epistemological level it is shown that the clinical stance is shaped by implicit philosophical beliefs about the mind/body problem (reductionism, dualism, interactionism, pragmatism), and that philosophy can aid physicians to be more aware of their beliefs in order to choose the most useful view and to practice coherently. In conclusion, psychopharmacologists already use methodological audit (e.g. statistical audit); similarly, conceptual clarification is needed in both research planning/evaluation and everyday psychopharmacological practice.

Basic course of Transcultural Psychopathology

The first edition will take place in Rome on march 23, 2013. It is open to those operating in this field. The course is organized by Massimiliano Aragona and Francesco Colosimo on behalf of the Crossing Dialogues Association

1913-2013 One undred years of General Psychopathology

On February 27, 2013 (8,00 pm) the Roman Circle of Psychopathology will celebrate the centenary of the first edition of Karl Jaspers' General Psychopathology. The event is co-organized with Crossing Dialogues

Dialogues in Philosophy, Mental and Neuro Sciences 2012 Number 5, Issue 2

The second issue of the fifth volume of the open access journal Dialogues in Philosophy, Mental and Neuro Sciences has been published. In the first article of this issue (Psychosis and Intersubjective Epistemology), HH. Maung claims that delusions and hallucinations present a challenge to traditional epistemology. Against the traditional objective realism that assumes that there is a mind-independent objective world of which people gain knowledge through experience, the author proposes an intersubjective account of psychosis, which avoids this sceptical attack on objective certainty by considering reality not at the level of an objective mind-independent world, but at the level of peoples' shared experiences. This intersubjective hypothesis is developed further, with reference to Husserl's concept of multiple lifeworlds, into a relativistic account.

To read it: http://www.crossingdialogues.com/Ms-A12-08.htm

In the second article, entitled “Pseudohallucinations: a critical review”, A. Sanati discusses a contentious phenomenon in clinical psychopathology: the pseudohallucinations. In a well developed historical account of the development of the concept, Sanati contributes to the discussion in clinical psychopathology by showing that while the pseudohallucinations’ location and the patient's insight into them are not able to distinguish pseudohallucinations from hallucinations, the quality of the perception is a better guide in this distinction.

To download this paper:

http://www.crossingdialogues.com/Ms-A12-09.htm

The third article is a new idea by A. Zoumpouli. She discusses the major contribution of the father of psychopathology, Karl Jaspers: i.e., the concept of “static understanding”. In this paper entitled “A contemporary approach to Jaspers' static understanding” Zoumpouli suggests that Japers' static understanding prefigures two main types of empathy emerging from contemporary scientific research in neuroscience and social psychology, namely "automatic emotional empathy" and "cognitive empathy".

To read it: http://www.crossingdialogues.com/Ms-C12-02.htm

The other “new idea” is by E. Gluskin, an expert of physics and complex systems. In a paper entitled “An argument regarding the nature of hooligan behaviour” the author transposes some ideas of the physicist Erwin Schrödinger to the debate about the hooligan behaviour, which is explained as a natural human response to the improper (in its content or form) "informational feeding" that does not allow one to normally treat ("digest") the received information.

This paper is at: http://www.crossingdialogues.com/Ms-C12-01.htm

Finally, two dialogues by A. Rudnick and D. Trafimow respectively discuss the problem of psychiatric comorbidity and that of the epistemological distinction between science and mysticism. The links to download these contributions are, respectively, http://www.crossingdialogues.com/Ms-D12-03.htm and http://www.crossingdialogues.com/Ms-D12-02.htm