A metaphysics of psychopathology

292 Pages·2014·7.564 MB·English

by  Peter Zachar

A METAPHYSICS OF
PSYCHOPATHOLOGY
A METAPHYSICS OF PSYCHOPATHOLOGY
PETER ZACHAR
In psychiatry, few question the legitimacy of asking whether
a given psychiatric disorder is real; similarly, in psychology,
scholars debate the reality of such theoretical entities as
general intelligence, superegos, and personality traits. And
yet in both disciplines, little thought is given to what is meant
by the rather abstract philosophical concept of “real.” In­
deed, certain psychiatric disorders have passed from real to
imaginary (as in the case of multiple personality disorder)
and from imaginary to real (as in the case of post-traumatic
stress disorder). In this book, Peter Zachar considers such
terms as “real” and “reality”—invoked in psychiatry but often
obscure and remote from their instances—as abstract phil­
osophical concepts. He then examines the implications
of his approach for psychiatric classification and psycho­
pathology.
Proposing what he calls a scientifically inspired prag­
matism, Zachar considers such topics as the essentialist
bias, diagnostic literalism, and the concepts of natural kind
and social construct. Turning explicitly to psychiatric top­
ics, he proposes a new model for the domain of psychiatric
disorders, the imperfect community model, which avoids
both relativism and essentialism. He uses this model to
understand such recent controversies as the attempt to
eliminate narcissistic personality disorder from the DSM-5.
Returning to such concepts as real, true, and objective,
Zachar argues that not only should we use these meta­
physical concepts to think philosophically about other con­
cepts, we should think philosophically about them.
Philosophical Psychopathology
Jennifer Radden and Jeff Poland, editors
A Metaphysics of Psychopathology, Peter Zachar (2014)
Classifying Psychopathology: Mental Kinds and Natural Kinds, Harold Kincaid and Jac­
queline Sullivan, editors (2014)
The Ethical Treatment ofD epression, Paul Biegler (2011)
Addiction and Responsibility, Jeffrey S. Poland and George Graham, editors (2010)
Brain Fiction, William Hirstein (2004)
Divided Minds and Successive Selves, Jennifer Radden (1996)
Imagination and Its Pathologies, James Phillips and James Morley, editors (2003)
Imagination and the Meaningful Brain, Arnold H. Modell (2003)
Psychiatry in the Scientific Image, Dominic Murphy (2005)
The Myth ofP ain, Valerie Gray Hardcastle (1999)
When Self-Consciousness Breaks, G. Lynn Stephens and George Graham (2000)
A Metaphysics of Psychopathology
Peter Zachar
The MIT Press
Cambridge, Massachusetts
London, England
© 2014 Massachusetts Institute of Technology
All rights reserved. No part of this book may be reproduced in any form by any
electronic or mechanical means (including photocopying, recording, or information
storage and retrieval) without permission in writing from the publisher.
MIT Press books may be purchased at special quantity discounts for business or sales
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This book was set in Stone Sans and Stone Serif by the MIT Press. Printed and bound
in the United States of America.
Library of Congress Cataloging-in-Publication Data
Zachar, Peter.
A metaphysics of psychopathology / Peter Zachar.
pages cm — (Philosophical psychopathology)
Includes bibliographical references and index.
ISBN 978-0-262-02704-5 (hardcover : alk. paper)
1. Psychology, Pathological. 2. Metaphysics. I. Title.
RC435.Z33 2014
616.89—dc23
2013031917
10 9 8 7 6 5 4 3 2 1
Dedicated to
Kenneth Kendler
and Ralph Ellis
Thank you for noticing
I
Contents
Preface and Acknowledgments ix
1 Introduction: Science Wars, Psychiatry, and the Problem of Realism 1
2 A Scientifically Inspired Pragmatism 23
3 Instrumental Nominalism 41
4 Psychological and Scientific Essentialism 55
5 Misplaced Literalism 73
6 Literalism and the Distrust of Authority 85
7 The Objective Within, Not Beyond, Experience 99
8 Classification and the Concept of Psychiatric Disorder 115
9 Four Conceptual Abstractions: Natural Kind, Historical Concept,
Normative Concept, and Practical Kind 137
10 Can Grief Really Be a Disorder? 157
11 Is Narcissistic Personality Disorder Real? 181
12 Psychiatry, Progress, and Metaphysics 203
Notes 231
Glossary 237
References 241
Index 271
f
Preface and Acknowledgments
What now seems long ago, I wrote a book titled Psychological Concepts and
Biological Psychiatry. In that book I described the arguments of those phi­
losophers and psychiatrists who believe that psychological concepts will
eventually be eliminated in favor of concepts that refer directly to events at
the level of the brain. I thought that these arguments were persuasive and
could not be dismissed—but I also thought that they should be critically
examined from the perspective of a trained psychotherapist. In my early
thirties at the time, I had that book in me, needing to be written.
After the book was published, the question was what to do next. The
problem was . that there was not another book in there waiting to get out.
I had various and sundry ideas and made some preliminary notes, but at a
certain point I decided I did not want to write another book just to write
another book. I doubt it would have been a good book. Instead, I devoted
myself to the work of writing articles, book chapters, and book reviews
largely in the area of psychiatric classification as well as a few things in the
area of emotion.
My clinical skills turned out to be good department-chair skills, so I did
that for a few years and continued to write. Somewhere along the way I
developed the notion that my prime years as a philosophical thinker would
begin in my late forties. It is a developmental trajectory I have noticed that
others have followed. I had been working in classification theory for over
a decade, and as I entered my late forties it was time to put together what I
had learned—hence this book. Writing it was a completely different expe­
rience than I had with writing the first one. It was the difference between
wanting to express my ideas (first book) and surmising that I had some­
thing to say (current book). I knew that my work in producing it would be