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What kinds of things are psychiatric disorders?

Published online by Cambridge University Press:  22 September 2010

K. S. Kendler ,
P. Zachar  and
C. Craver
K. S. Kendler*
Affiliation:
Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry and Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
P. Zachar
Affiliation:
Department of Psychology, Auburn University, Montgomery, AL, USA
C. Craver
Affiliation:
Philosophy-Neuroscience-Psychology Program, Washington University in St Louis, St Louis, MO, USA
*
*Address for correspondence: K. S. Kendler, M.D., Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University Medical School, PO Box 980126, Richmond, VA 23298-0126, USA. (Email: [email protected])
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Abstract

This essay explores four answers to the question ‘What kinds of things are psychiatric disorders?’ Essentialist kinds are classes whose members share an essence from which their defining features arise. Although elegant and appropriate for some physical (e.g. atomic elements) and medical (e.g. Mendelian disorders) phenomena, this model is inappropriate for psychiatric disorders, which are multi-factorial and ‘fuzzy’. Socially constructed kinds are classes whose members are defined by the cultural context in which they arise. This model excludes the importance of shared physiological mechanisms by which the same disorder could be identified across different cultures. Advocates of practical kinds put off metaphysical questions about ‘reality’ and focus on defining classes that are useful. Practical kinds models for psychiatric disorders, implicit in the DSM nosologies, do not require that diagnoses be grounded in shared causal processes. If psychiatry seeks to tie disorders to etiology and underlying mechanisms, a model first proposed for biological species, mechanistic property cluster (MPC) kinds, can provide a useful framework. MPC kinds are defined not in terms of essences but in terms of complex, mutually reinforcing networks of causal mechanisms. We argue that psychiatric disorders are objectively grounded features of the causal structure of the mind/brain. MPC kinds are fuzzy sets defined by mechanisms at multiple levels that act and interact to produce the key features of the kind. Like species, psychiatric disorders are populations with central paradigmatic and more marginal members. The MPC view is the best current answer to ‘What kinds of things are psychiatric disorders?’

Keywords

Essentialismkindsphilosophypsychiatric disorders
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 6 , June 2011 , pp. 1143 - 1150
Copyright
Copyright © Cambridge University Press 2010

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