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Imagine a society, which strongly disapproves of divorce. It is not illegal, but it is considered as a very bad, transgressive and immoral thing. Due to the activist pressure from certain well-organized groups, a National Psychiatric Association introduces to its diagnostic manual of mental disorders a new category Divorce Tendency Disorder (DTD). You suffer from the DTD if you have divorced more than once. DTD is further divided into subtypes: (1) divorce on your own initiative, (2) divorce on your spouse’s initiative, (3) mixed type and (4) not otherwise specified. The creation of this diagnostic category stimulates a lot of scientific research. National Institute of Health and Prevention invests large sums of money into epidemiological and biological research. It turns out that DTD may be comorbid with a Personality Disorder, a Suicidal Behavior Disorder or Drug and Alcohol Dependence. Genetic-epidemiological studies show that DTD runs in families and twin data indicate genetic and earlyenvironmental effect. A genetic consortium using large sample studies shows that DTD is massively polygenic.
Psychiatric diagnostic systems contain approximately 400 mainly descriptively defined categories with incomprehensible overlaps and comorbidity. Empirical research has demonstrated a multitude of biological, psychological, and social risk factors, which are, however, not integrated in any conceptually coherent pathogenetic model. We argue that over and above a purely superficial symptomatic description we should address the level of mental structures underlying the symptoms. We emphasize the basic ontological structures, which are conditions for human experience and existence: intentionality, selfhood, intersubjectivity, temporality, and embodiment. A structural level may serve the purposes of classification and provide an integrative bridge between biological and psychological phenomena. We concentrate upon the level of selfhood where we distinguish the structural features (the so-called core self) and the more personal language and history involving level (the ‘narrative self’). Through a review of literature and presentation of two clinical cases, we demonstrate the value of the concept in studying schizophrenia.
This commentary on Peter Zachar’s chapter on the issue of description is concerned with the nature and role of description in contemporary psychiatry: It is argued that the so-called operational revolution entailed severe epistemological problems leading to a crisis of description, and hence a more general problem of classification and research. Language in psychiatry, unlike in somatic medicine, does not operate with fixed referential terms but is more concerned with meanings. In other words language in psychiatry plays an important constitutive role. Thus, a description derived from the medical model and transposed into psychiatry exerts devastating consequences, briefly illustrated by a few psychopathological examples.
Levels of Analysis in Psychopathology draws research from psychiatry, philosophy, and psychology to explore the variety of explanatory approaches for understanding the nature of psychiatric disorders both in practice and research. The fields of psychiatry and clinical psychology incorporates many useful explanatory approaches and this book integrates this range of perspectives and makes suggestions about how to advance etiologic theories, classification, and treatment. The editors have brought together leading thinkers who have been widely published and are well-respected in their area of expertise, including several developers of the Diagnostic and Statistical Manual of Mental Disorders and authors of the US National Institute of Mental Health's Research Domain Criteria Project (RDoC). Each main chapter has a commentary provided by one of the other authors and an introduction written by one of the editors to create an accessible, interdisciplinary dialog.