A Focus On: Psychiatric Validity
Trans-disciplinary validation between neuroscience and psychopathology: evidence from brain functional imaging of a subject in At-Risk-Mental-State (AMRS). Image courtesy of Professor Stefan J. Borgwardt.
Continuous debates around the types and phases of validity of psychiatric diagnosis have been a significant vector for the development of psychiatric classifications over the last half of the 20th century, and into the new millennium. Emerging pro- and anti-psychiatry movements, as well as the new philosophy of mental health conceived by values-based practice, have triggered a process of conceptual revision of the existing models of validation in mental health.
Psychiatry as a hybrid discipline that embraces facets from both the natural sciences and humanities has adopted relevant heterogeneous approaches to validity and classification. On the one hand, psychiatry adopted from medicine the categorical stance which resembled typical medical nosological units with narrow borders constituted from exclusion and inclusion criteria. This model turned out to be misleading, due to the lack of etiologically sound explanations and biomarkers robust enough to underpin such categories. Furthermore, categorical classifications have been undermined by the issues of co-morbidity and extensive theoretical controversies between various paradigms in mental health.
On the other hand, psychiatry adopted from psychology the more liberal and flexible approach of dimensional diagnosis, which is to some extent incorporated in the latest revisions of Diagnostic and Statistical Manual of Mental Disorders . Unfortunately, this model in itself turned out to be inconsistent as well.
In effect, validity was erroneously displaced with statistical reliability and utility of diagnostic criteria, which are both subject to critical considerations.
Eventually modern psychiatry entered into a major methodological crisis, which is rooted in different conceptual debates, one of them being on development of an effective, useful, and above all, scientifically valid taxonomy of mental disorders.
This crisis called for the development and implementation of alternative perspectives on psychiatric validity and validation, such as Research Domain Criteria (RDoc), prototype, cluster, narrative-based and person-centered diagnosis, four domains of mental illness (FDMI); translational validity, etc. It is important that clinicians are aware of, and use, as many validity criteria as possible when making a diagnosis. Ultimately, the application of accurate validity criteria is the core of what makes psychiatric validation successful.
Drozdstoj Stoyanov is Full Professor at Medical University on Plovdiv, Honorary Lecturer at Sofia University, Bulgaria; Visiting Fellow at the University of Pittsburgh, USA; Vice Chair of the Philosophy SIG, Royal College of Psychiatrists, London, UK.
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