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Classification and causal mechanisms: a deflationary approach to the classification problem 

Classification and causal mechanisms: a deflationary approach to the classification problem
Chapter:
Classification and causal mechanisms: a deflationary approach to the classification problem
Author(s):

Derek Bolton

DOI:
10.1093/med/9780199642205.003.0002
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date: 18 September 2018

“Mental disorder” may be conceptualized in various ways, all controversial, none a clear winner, such as: conditions characterized by distress and disability, in or out of combination with deviation from population norms, from evolutionary design, or absence of understandability; and so forth (Bolton 2008). These conceptualizations of mental disorder are relevant to one prior classification question—is this condition before us in the class of mental disorders or not?—arising, for example, when considering whether to include or exclude a condition from the diagnostic manuals. A different classification problem concerns how to classify conditions within that class, once they are considered to be mental disorders. There are interactions between these two kinds of classification problem—but they usually not much discussed. I will consider briefly one aspect of this interaction at the end of the paper, but most of the paper is about the second kind of classification problem, the one usually called by that name: how to classify within the class of psychiatric conditions. I will consider the following issues and make the following points:

1. As is well-known, in 1959 Hempel recommended to the American Psychiatric Association that psychiatric conditions be classified by surface characteristics to begin with, to ensure reliability, and later, as the science matures, by etiology (Hempel 1965). Hempel's advice for the beginning stage was followed in the DSM-III on, and the question now arises after half a century of research, do we now know enough about etiology to classify according to it. In this context I will take the view that there is not much prospect that the science of the etiology of psychiatric conditions will deliver a single, optimal classification scheme—the reason being that the last few decades of research has uncovered systemic complexity, rather than reductionist simplicity.

2. Not to worry, however, because classification is not the main point of science, and psychiatry may be, for historical reasons, overoccupied with it. The main aims of science are rather prediction, refined by causal explanatory models, and, on that basis, if cause–effect relationships are sufficiently strong, making technological applications including interventions. In brief, I will propose a deflationary approach to the classification problem: classification in itself is less important than often supposed to be, and less important than other tasks.

3. Regarding the prior procedure of classification, the one that picks out the mental disorders from normal, non-disordered conditions, I will suggest that this raises questions that are not primarily to do with the sciences of causes, but which are rather to do with subjective and social phenomenology.

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