My first post is a follow-up to a previous discussion. The beginning of this debate is in the thread “Depression” created by Cledwyn Bulbs. My comments below are a reply to Infinite_Jester's remarks.
Hey, IJ. I think we should start from the beginning since my position on reductionism builds on previous arguments. My first remark was a reply to this comment of yours:
Infinite_Jester wrote:As much as I want to agree with what you've written about depression much of it is really irksome. For example, saying that the relationship between symptoms of a psychological event (i.e. depression) and the event-itself is somehow circular misses the fact that the relationship is empirical: depression has behavioral manifestations like crying, sleeping too much, feeling lethargic, withdrawing from others, and so on. The relationship between the psychological event and those behavioral manifestations is not tautological, like the relationship between being a bachelor and being married, it is causal, being depressed causes the behaviors, in much the same way as fires produce smoke.
I think this paints a false picture of what is going on within the framework of DSM (from III onwards).
I specifically assert that diagnostic reasoning in psychiatry within the framework of DSM is tautological. Namely, the symptomatic criteria of DSM express necessary and jointly sufficient conditions for making a psychiatric diagnosis.
For example, in the case of depression the symptomatic criteria (along with the exclusion criteria) express jointly sufficient conditions for category inclusion (i.e. for a diagnosis). When these criteria are met the diagnostic conclusion “Patient P has depression” is necessarily true. Let “C” stand for “Patient P meets the symptomatic criteria” and “D” stand for “Patient P has depression (MDE)”. Now the diagnostic reasoning takes this tautological form: If C implies D, and if C is true, then D must be true.
In symbols: ((C ->D) & C) -> D
And C really is a sufficient condition for D. (i.e. C implies D.) Accordingly, this means that “Patient P meets the symptomatic criteria of depression and patient P does not have depression” is a contradictory statement.
By contrast, this is usually not the case for a somatic illness. Even if the patient P has all the (behavioral) symptoms of anemia, it does not follow that “Patient P has anemia” is necessarily true. In other words, we can have all the affirmative symptom-statements true and the conclusion false (without contradiction).
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One might be willing to bite a bullet and propose: But isn’t all diagnostic reasoning, on some level, deductive? It is, but what makes psychiatric reasoning distinctive is the fact that the diagnostic conclusion is logically dependent on symptom-statements. This is the reason why many have argued that our so called mental illnesses are nothing but labels for the aggregations of symptoms.
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Let me illustrate diagnostic reasoning in DSM framework with an example. Depression has too many criteria and I’m lazy so something more compact will do. These are the diagnostic criteria for body dysmorphic disorder (DSM IV – TR : 300.7). I’ll present them in statement form.
- (P v E) = The patient is preoccupied with an imagined defect in appearance or excessively concerned with a slight physical anomaly in appearance.
C = The patient's preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
-B = The patient's preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).
Let D be: The patient is a member of the diagnostic category of body dysmorphic disorder.
Our diagnostic statement D is a truth function of the criterial statements above. Namely, D is true if and only if ((P v E) & C & -B) is true.
In plain English: The patient is diagnosed with bdd if and only if all the criterial statements are true.
Patient’s spoken and written symptom-statements (questionnaires etc.), along with the behavioral signs, are the basis of a certain truth-value-assignment for the criterial statements. The truth-value interpretation and the reasoning process is naturally done by the doctor and hence human errors – both interpretational and inferential – are possible. However, this does not affect the form of reasoning I’m depicting here.
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Thus, I’m arguing that such is the general form of reasoning in the framework of DSM. Since this position has some far-reaching implications for the whole debate on the legitimacy of the current institutional psychiatry I suggest you either refute it or accept it and we’ll go on from there.
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