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A Theory of Feelings Anger and Forgiveness"My Madness Saved Me"10 Good Questions about Life and Death12 Modern Philosophers50 Reasons People Give for Believing in a GodA Cabinet of Philosophical CuriositiesA Case for IronyA Companion to BioethicsA Companion to Buddhist PhilosophyA Companion to FoucaultA Companion to GenethicsA Companion to GenethicsA Companion to HumeA Companion to KantA Companion to Phenomenology and ExistentialismA Companion to PragmatismA Companion to the Philosophy of ActionA Companion to the Philosophy of BiologyA Companion to the Philosophy of LiteratureA Conceptual History of PsychologyA Critical Overview of Biological FunctionsA Critique of Naturalistic Philosophies of MindA Cursing Brain?A Delicate BalanceA Farewell to AlmsA Frightening LoveA Future for PresentismA Guide to the Good LifeA History of PsychiatryA History of the MindA Life Worth LivingA Manual of Experimental PhilosophyA Map of the MindA Metaphysics of PsychopathologyA Mind So RareA Natural History of Human MoralityA Natural History of Human ThinkingA Natural History of VisionA Parliament of MindsA Philosopher Looks at The Sense of HumorA Philosophical DiseaseA Philosophy of BoredomA Philosophy of Cinematic ArtA Philosophy of CultureA Philosophy of EmptinessA Philosophy of FearA Philosophy of PainA Physicalist ManifestoA Place for ConsciousnessA Question of TrustA Research Agenda for DSM-VA Revolution of the MindA Sentimentalist Theory of the MindA Stroll With William JamesA Tear is an Intellectual ThingA Theory of FreedomA Thousand MachinesA Universe of ConsciousnessA Very Bad WizardA Virtue EpistemologyA World Full of GodsA World Without ValuesAbout FaceAbout the Beginning of the Hermeneutics of the SelfAction and ResponsibilityAction in ContextAction Theory, Rationality and CompulsionAction, Contemplation, and HappinessAction, Emotion and WillAdam SmithAdaptive DynamicsAddictionAddictionAddiction and ResponsibilityAddiction Is a ChoiceAdvances in Identity Theory and ResearchAftermathAfterwarAgainst AdaptationAgainst AutonomyAgainst BioethicsAgainst HappinessAgainst HealthAgency and ActionAgency and AnswerabilityAgency and EmbodimentAgency and ResponsibilityAgency, Freedom, and Moral ResponsibilityAl-JununAlain BadiouAlain BadiouAlasdair MacIntyreAlien Landscapes?Altered EgosAn Anthology of Psychiatric EthicsAn Ethics for TodayAn Intellectual History of CannibalismAn Interpretation of DesireAn Introduction to EthicsAn Introduction to Kant's Moral Philosophy An Introduction to Philosophy of EducationAn Introduction to the Philosophy of MindAn Introduction to the Philosophy of MindAn Introduction to the Philosophy of PsychologyAn Introductory Philosophy of MedicineAn Odd Kind of FameAnalytic FreudAnalytic Philosophy in AmericaAncient AngerAncient Models of MindAncient Philosophy of the SelfAngerAnimal LessonsAnimal MindsAnimals Like UsAnnihilationAnother PlanetAnswers for AristotleAnti-ExternalismAnti-Individualism and KnowledgeAntigone’s ClaimAntipsychiatryAre We Hardwired?Are Women Human?Arguing about DisabilityArguing About Human NatureAristotle and the Philosophy of FriendshipAristotle on Practical WisdomAristotle's ChildrenAristotle's Ethics and Moral ResponsibilityAristotle, Emotions, and EducationArt & MoralityArt After Conceptual ArtArt in Three DimensionsArt, Self and KnowledgeArtificial ConsciousnessArtificial HappinessAspects of PsychologismAsylum to ActionAtonement and ForgivenessAttention is Cognitive UnisonAutobiography as PhilosophyAutonomyAutonomy and Mental DisorderAutonomy and the Challenges to LiberalismBabies by DesignBackslidingBadiouBadiou's DeleuzeBadiou, Balibar, Ranciere: Rethinking EmancipationBare Facts And Naked TruthsBasic Desert, Reactive Attitudes and Free WillBattlestar Galactica and PhilosophyBeautyBecoming a SubjectBecoming HumanBehavingBehavioral Genetics in the Postgenomic EraBeing AmoralBeing HumanBeing Mentally Ill: A Sociological Theory Being No OneBeing Realistic about ReasonsBeing ReducedBeing YourselfBelief's Own EthicsBending Over BackwardsBerlin Childhood around 1900Bernard WilliamsBertrand RussellBetter than BothBetter Than WellBetween Two WorldsBeyond HealthBeyond Hegel and NietzscheBeyond KuhnBeyond LossBeyond Moral JudgmentBeyond PostmodernismBeyond ReductionBeyond the DSM StoryBioethicsBioethics and the BrainBioethics in the ClinicBiological Complexity and Integrative PluralismBiology Is TechnologyBiosBipolar ExpeditionsBlackwell Companion to the Philosophy of EducationBlindsight & The Nature of ConsciousnessBlues - Philosophy for EveryoneBlushBob Dylan and PhilosophyBody ConsciousnessBody Image And Body SchemaBody ImagesBody LanguageBody MattersBody WorkBody-Subjects and Disordered MindsBoundBoundaries of the MindBoyleBrain Evolution and CognitionBrain FictionBrain, Mind, and Human Behavior in Contemporary Cognitive ScienceBrain-WiseBrainchildrenBrains, Buddhas, and BelievingBrainstormingBrave New WorldsBreakdown of WillBrief Child Therapy Homework PlannerBrief Inquiry into the Meaning of Sin and FaithBrief Therapy Homework PlannerBritain on the CouchBrute RationalityBuffy the Vampire Slayer and PhilosophyBut Is It Art?Camus and SartreCartesian LinguisticsCartographies of the MindCarving Nature at Its JointsCase Studies in Biomedical Research EthicsCassandra's DaughterCato's TearsCausation and CounterfactualsCauses, Laws, and Free WillChanging Conceptions of the Child from the Renaissance to Post-ModernityChanging the SubjectChaosophyCharacter and Moral Psychology Character as Moral FictionCharles DarwinCherishmentChildhood and the Philosophy of EducationChildrenChildren, Families, and Health Care Decision MakingChoices and ConflictChoosing Not to ChooseChristmas - Philosophy for EveryoneCinema, Philosophy, BergmanCinematic MythmakingCity and Soul in Plato's RepublicClassifying MadnessClear and Queer ThinkingClinical EthicsClinical Psychiatry in Imperial GermanyCodependent ForevermoreCoffee - Philosophy for EveryoneCognition and the BrainCognition of Value in Aristotle's EthicsCognition Through Understanding: Self-Knowledge, Interlocution, Reasoning, ReflectionCognitive BiologyCognitive FictionsCognitive Neuroscience of EmotionCognitive Systems and the Extended MindCognitive Systems and the Extended Mind Cognitive Theories of Mental IllnessCoherence in Thought and ActionCollected Papers, Volume 1Collected Papers, Volume 2College SexComedy IncarnateCommitmentCommunicative Action and Rational ChoiceCompetence, Condemnation, and CommitmentConcealment And ExposureConceptual Analysis and Philosophical NaturalismConceptual Art and PaintingConceptual Issues in Evolutionary BiologyConfessionsConfucianismConnected, or What It Means to Live in the Network SocietyConquest of AbundanceConscience and ConvenienceConsciousnessConsciousnessConsciousnessConsciousness ConsciousnessConsciousness and Its Place in NatureConsciousness and LanguageConsciousness and Mental LifeConsciousness and MindConsciousness and the NovelConsciousness and the SelfConsciousness EmergingConsciousness EvolvingConsciousness ExplainedConsciousness in ActionConsciousness RecoveredConsciousness RevisitedConsciousness, Color, and ContentConsole and ClassifyConstructing the WorldConstructive AnalysisContemporary Debates In Applied EthicsContemporary Debates in Moral TheoryContemporary Debates in Philosophy of BiologyContemporary Debates in Philosophy of MindContemporary Debates in Political PhilosophyContemporary Debates in Social PhilosophyContemporary Perspectives on Natural LawContested Knowledge: Social Theory TodayContesting PsychiatryContext and the AttitudesContinental Philosophy of ScienceControlControlling Our DestiniesConversations About Psychology and Sexual OrientationCopernicus, Darwin and FreudCrazy for YouCreating a Life of Meaning and CompassionCreating ConsilienceCreating HysteriaCreating Mental IllnessCreating Scientific ConceptsCreating the American JunkieCreation, Rationality and AutonomyCreatures Like Us?Crime and CulpabilityCrime, Punishment, and Mental IllnessCrimes of ReasonCritical New Perspectives on Attention Deficit/Hyperactivity DisorderCritical PsychiatryCritical PsychologyCritical ResistanceCritical Thinking About PsychologyCritical VisionsCross and KhoraCruel CompassionCTRL [SPACE]Cultural Psychology of the SelfCultural Theory: An IntroductionCulture and Psychiatric DiagnosisCulture and Subjective Well-BeingCulture of DeathCultures of NeurastheniaCurious EmotionsCurrent Controversies in Experimental PhilosophyCustom and Reason in HumeCustomers and Patrons of the Mad-TradeCutting God in Half - And Putting the Pieces Together AgainCylons in AmericaDamaged IdentitiesDamasio's Error and Descartes' TruthDangerous EmotionsDaniel DennettDaniel DennettDark AgesDarwin and DesignDarwin's Dangerous IdeaDarwin's LegacyDarwin, God and the Meaning of LifeDarwinian PsychiatryDarwinian ReductionismDarwinizing CultureDating: Philosophy for EveryoneDeathDeathDeath and CharacterDeath and CompassionDeath and the AfterlifeDebating DesignDebating HumanismDecision Making, Personhood and DementiaDecomposing the WillDeconstructing PsychotherapyDeconstruction and DemocracyDeeper Than DarwinDeeper than ReasonDefending Science - within ReasonDefining Psychopathology in the 21st CenturyDegrees of BeliefDelusion and Self-DeceptionDelusions and Other Irrational BeliefsDelusions and the Madness of the MassesDementiaDemons, Dreamers, and MadmenDennett and Ricoeur on the Narrative SelfDennett’s PhilosophyDepression Is a ChoiceDepression, Emotion and the SelfDepthDerrida, Deleuze, PsychoanalysisDescartesDescartes and the Passionate MindDescartes' CogitoDescartes's Changing MindDescartes's Concept of MindDescribing Inner Experience?Descriptions and PrescriptionsDesembodied Spirits and Deanimated Bodies Desert Islands and Other Texts (1953-1974)Desire and AffectDesire, Practical Reason, and the GoodDiagnosing the Diagnostic and Statistical Manual of Mental DisordersDialectics of the SelfDid My Neurons Make Me Do It?Difference and IdentityDigital SoulDimensional Models of Personality DisordersDisability, Difference, DiscriminationDisjunctivismDisorders of VolitionDisorientation and Moral LifeDispatches from the Freud WarsDisrupted LivesDistractionDisturbed ConsciousnessDivided Minds and Successive SelvesDo Apes Read Minds?Do Fish Feel Pain?Do We Still Need Doctors?Does Consciousness Cause Behavior?Does the Woman Exist?Doing without ConceptsDon't Believe Everything You ThinkDonald DavidsonDonald Davidson on Truth, Meaning, and the MentalDoubting Darwin?Dreaming and Other Involuntary MentationDSM-IV SourcebookDSM-IV SourcebookDSM-IV-TR CasebookDworkin and His CriticsDying to KnowDynamics in ActionDysthymia and the Spectrum of Chronic DepressionsEccentricsEducational MetamorphosesEffective IntentionsElbow Room: The Varieties of Free Will Worth WantingEmbodied Minds in ActionEmbodied RhetoricsEmbodied Selves and Divided MindsEmbryos under the MicroscopeEmergencies in Mental Health PracticeEmerging Conceptual, Ethical and Policy Issues in BionanotechnologyEmotionEmotion and ConsciousnessEmotion and PsycheEmotion ExperienceEmotion RegulationEmotion, Evolution, And RationalityEmotional IntelligenceEmotional ReasonEmotional ReasonEmotional TruthEmotions in Humans and ArtifactsEmotions in the Moral LifeEmotions in the Moral LifeEmotions, Value, and AgencyEmpathyEmpathy and AgencyEmpathy and Moral DevelopmentEmpathy and MoralityEmpathy in the Context of PhilosophyEmpirical Ethics in PsychiatryEnchanted LoomsEngaging BuddhismEngineering the Human GermlineEnjoymentEnvyEpicureanismEpistemic LuckEpistemologyEpistemology and EmotionsEpistemology and the Psychology of Human JudgmentEros and the GoodErotic MoralityEssays in Social NeuroscienceEssays in the Metaphysics of Mind Essays on Derek Parfit's On What MattersEssays on Free Will and Moral ResponsibilityEssays on Nonconceptual ContentEssays on Philosophical CounselingEssays on Reference, Language, and MindEssays on the Concept of Mind in Early-Modern PhilosophyEssential Sources in the Scientific Study of ConsciousnessEsssential Philosophy of PsychiatryEternal Sunshine of the Spotless MindEthical Conflicts in PsychologyEthical Issues in Forensic Mental Health ResearchEthical Issues in Human CloningEthical TheoryEthicsEthicsEthics and the A PrioriEthics and the Metaphysics of MedicineEthics and Values in PsychotherapyEthics Done RightEthics ExpertiseEthics in Plain EnglishEthics in PracticeEthics in Psychiatric ResearchEthics of PsychiatryEthics without OntologyEuropean Review of Philosophy. Vol. 5Everyday IrrationalityEvil in Modern ThoughtEvolutionEvolution and the Human MindEvolution's RainbowEvolutionary Origins of MoralityEvolutionary PsychologyExamined LifeExamined LivesExistential AmericaExistentialismExistentialism and Romantic LoveExperimental PhilosophyExperimental PhilosophyExperimental PhilosophyExperimental Philosophy, Rationalism, and NaturalismExperiments in EthicsExplaining ConsciousnessExplaining the BrainExplaining the Computational MindExplanatory PluralismExploding the Gene MythExploring HappinessExploring the SelfExpression and the InnerExpressions of JudgmentFaces of IntentionFact and ValueFact and Value in EmotionFacts, Values, and NormsFads and Fallacies in the Social SciencesFaith and Wisdom in ScienceFatherhoodFear of KnowledgeFearless SpeechFeeling Pain and Being in PainFeelings and EmotionsFeelings of BeingFellow-Feeling and the Moral LifeFeminism and Its DiscontentsFeminism and Philosophy of ScienceFeminist Ethics and Social and Political PhilosophyFeminist Interpretations of Rene DescartesFeminist TheoryField Notes from ElsewhereFinding Consciousness in the BrainFingerprints of GodFlesh in the Age of ReasonFolk Psychological NarrativesFolk Psychology Re-AssessedForces of HabitForgivenessForgiveness and LoveForgiveness and RetributionFoucault 2.0Foucault and PhilosophyFoucault NowFoucault, Psychology and the Analytics of PowerFoundational Issues in Human Brain MappingFoundations of Ethical Practice, Research, and Teaching in PsychologyFour Views on Free WillFree WillFree WillFree WillFree WillFree Will and Action ExplanationFree Will and LuckFree Will And Moral ResponsibilityFree Will as an Open Scientific ProblemFree Will, Agency, and Meaning in LifeFree: Why Science Hasn't Disproved Free WillFreedomFreedom and DeterminismFreedom And NeurobiologyFreedom and ResponsibiltyFreedom and ValueFreedom EvolvesFreedom RegainedFreedom vs. InterventionFreedom, Fame, Lying, and BetrayalFreudFreud and the Question of PseudoscienceFreud As PhilosopherFreud's AnswerFreud, the Reluctant PhilosopherFriedrich NietzscheFrom Chance to ChoiceFrom Clinic to ClassroomFrom Complexity to LifeFrom Enlightenment to ReceptivityFrom Knowledge to Wisdom: A Revolution for Science and the HumanitiesFrom Morality to Mental HealthFrom Passions to EmotionsFrom Philosophy to PsychotherapyFrontiers of ConsciousnessFrontiers of JusticeFurnishing the MindGalileo in PittsburghGenderGender and Mental HealthGender in the MirrorGender TroubleGenesGenes, Women, EqualityGenetic Nature/CultureGenetic ProspectsGenetic ProspectsGenetic SecretsGenocide's AftermathGenomes and What to Make of ThemGerman Idealism and the JewGerman PhilosophyGetting HookedGilles DeleuzeGlobal PhilosophyGluttonyGod and Phenomenal ConsciousnessGoffman's LegacyGoing Amiss in Experimental ResearchGoodness & AdviceGrassroots SpiritualityGrave MattersGrave MattersGreedGreek Models of Mind and SelfGut ReactionsHabilitation, Health, and AgencyHabits of MindHallucinationHandbook of BioethicsHandbook of EmotionsHappinessHappinessHappinessHappinessHappiness and EducationHappiness and the Good LifeHappiness Is OverratedHappiness, Death, and the Remainder of LifeHard LuckHarmful ThoughtsHaving the World in ViewHealing PsychiatryHealing the Soul in the Age of the BrainHealth, Illness and DiseaseHealth, Science, and Ordinary LanguageHegelHeidegger and a Metaphysics of FeelingHeidegger, Metaphysics and the Univocity of BeingHermann von Helmholtz's MechanismHermeneutics As PoliticsHeterophobiaHeterosyncraciesHeuristics and BiasesHeuristics and the LawHidden ResourcesHidden SelvesHiding from HumanityHigh Art LiteHistorical OntologyHistory of Psychiatry and Medical PsychologyHistory, Historicity And ScienceHobbesHomosexualitiesHope and Dread in PsychoanalysisHot ThoughtHow Can I Be Trusted?How Can the Human Mind Occur in the Physical Universe?How Children Learn the Meanings of WordsHow Could Conscious Experiences Affect Brains?How Do We Know Who We Are?How Emotions WorkHow Emotions WorkHow History Made the MindHow Images ThinkHow is Nature Possible?How Propaganda WorksHow Science WorksHow Scientific Practices MatterHow Scientists Explain DiseaseHow The Body Shapes The MindHow the Body Shapes the Way We ThinkHow the Mind Explains BehaviorHow the Mind Uses the BrainHow to Make Opportunity EqualHow to Solve the Mind-Body Problemhow to stop timeHow to Think More About SexHow We HopeHow We ReasonHuman CloningHuman Development, Language and the Future of MankindHuman EnhancementHuman Evolution, Reproduction, and MoralityHuman GoodnessHuman Identity and BioethicsHuman NatureHuman NatureHuman Nature and the Limits of ScienceHuman-Built WorldHumanismHumanism, What's That?HumanityHumans, Animals, MachinesHumeHumeHume on Motivation and VirtueHusserlHystoriesI of the VortexI Was WrongIdeas that MatterIdentifying the MindIdentity and Agency in Cultural WorldsIgnorance and ImaginationIllnessImagination and Its PathologiesImagination and the Meaningful BrainImagining NumbersImmortal RemainsImproving Nature?In Defense of an Evolutionary Concept of HealthIn Defense of SentimentalityIn Love With LifeIn Praise of Athletic BeautyIn Praise of the WhipIn Pursuit of HappinessIn Search of HappinessIn the Name of GodIn the Name of IdentityIn the Space of ReasonsIn Two MindsIncompatibilism's AllureIndividual Differences in Conscious ExperienceInfinity and PerspectiveInformation ArtsInformed Consent in Medical ResearchIngmar Bergman, Cinematic PhilosopherInhuman ThoughtsInner PresenceInsanityIntegrating Psychotherapy and PharmacotherapyIntegrity and the Fragile SelfIntelligent VirtueIntentionIntentionality, Deliberation and AutonomyIntentions and IntentionalityIntentions and IntentionalityInterpreting MindsInterpreting NietzscheIntroducing Greek PhilosophyIntrospection and ConsciousnessIntrospection VindicatedIntuition, Imagination, and Philosophical MethodologyIntuitionismInvestigating the Psychological WorldIrrationalityIrrationalityIs Academic Feminism Dead?Is It Me or My Meds?Is Long-Term Therapy Unethical?Is Oedipus Online?Is Science Neurotic?Is Science Value Free?Is the Visual World a Grand Illusion?Is There a Duty to Die?Issues in Philosophical CounselingJacques LacanJacques RancièreJacques RanciereJean-Paul SartreJohn McDowellJohn SearleJohn Searle's Ideas About Social RealityJohn Stuart MillJohn Stuart Mill and the Writing of CharacterJoint AttentionJokesJonathan EdwardsJudging and UnderstandingJustice for ChildrenJustice in RobesJustice, Luck, and KnowledgeKantKant and MiltonKant and the Fate of AutonomyKant and the Limits of AutonomyKant and the Role of Pleasure in Moral ActionKant on Freedom, Law, and HappinessKant on Moral AutonomyKant's Anatomy of EvilKant's Anatomy of the Intelligent MindKant's Theory of VirtueKarl JaspersKarl PopperKey Concepts in PhilosophyKierkegaardKierkegaard as PhenomenologistKierkegaard's Concept of DespairKinds of MindsKinds, Things, and StuffKnowing, Knowledge and BeliefsKnowledge MonopoliesKnowledge, Belief, and CharacterKnowledge, Possibility, and ConsciousnessLacanLack of CharacterLack of CharacterLanguageLanguage in ContextLanguage, Consciousness, CultureLanguage, Culture, and MindLanguage, Vision, and MusicLaw and the BrainLaw, Liberty, and PsychiatryLaws, Mind, and Free WillLeaving YouLectures on the History of Political PhilosophyLevelling the Playing FieldLiberal Education in a Knowledge SocietyLiberatory PsychiatryLife and ActionLife at the Texas State Lunatic Asylum, 1857-1997Life Is Not a Game of PerfectLife of the MindLife's FormLife, Death, & MeaningLife, Death, and Meaning: Key Philosophical Readings on the Big Questions Life, Liberty, and the Pursuit of UtilityLife, Sex, and IdeasLight in the Dark RoomLike a Splinter in Your MindLiving and Dying WellLiving NarrativeLiving Outside Mental IllnessLiving with DarwinLiving With One’s PastLockeLocke LockeLogic and the Art of Memory Loneliness in Philosophy, Psychology, and LiteratureLooking for SpinozaLooking for The StrangerLost SoulsLOT 2LoveLoveLove's ConfusionsLove's VisionLove, Friendship, and the SelfLove, Sex & TragedyLuckyLudwig WittgensteinLustLyingMachine ConsciousnessMad for FoucaultMad TravelersMade with WordsMadness And Death In PhilosophyMadness and DemocracyMadness at HomeMadness Is CivilizationMaking Natural KnowledgeMaking Sense of EvolutionMaking Sense of Freedom and ResponsibilityMaking the DSM-5Making the Social WorldMaking TruthMale Female EmailMan, Beast, and ZombieMandated Reporting of Suspected Child AbuseManiaManic Depression and CreativityMapping the Edges and the In-betweenMapping the Future of BiologyMarcus AureliusMaster PassionsMatters of the MindMe++Meaning and Moral OrderMeaning and Value in a Secular AgeMeaning in LifeMeaning in Life and Why It MattersMeaning, Basic Self-Knowledge, and MindMeasuring HappinessMeasuring PsychopathologyMedia MadnessMedical Enhancement and PosthumanityMedicine and Philosophy in Classical AntiquityMedicine of the PersonMedicine, Mental Health, Religion, Science and Well-BeingMelancholy And the Care of the SoulMelancholy and the Otherness of GodMementoMemory and NarrativeMental ActionsMental CausationMental Causation and OntologyMental HealthMental Health At The CrossroadsMental Health Policy in BritainMerit, Meaning, and Human BondageMerleau-PontyMerleau-Ponty and the Possibilities of PhilosophyMetacognition and Theory of MindMetacreationMetaethical SubjectivismMetaethicsMetal and FleshMetaphors of MemoryMetapoliticsMethods in MindMichel FoucaultMill's UtilitarianismMindMindMind and ConsciousnessMind and CosmosMind and MechanismMind GamesMind in a Physical WorldMind in Everyday Life and Cognitive ScienceMind in LifeMind TimeMind's LandscapeMind, Brain and the Elusive SoulMind, Brain, and Free WillMind, Reason and ImaginationMinding MindsMindreadersMindreading AnimalsMinds and PersonsMinds, Brains, and LawMinds, Ethics, and ConditionalsMindshapingMindsightMindworldsMirror, MirrorMixed FeelingsMockingbird YearsModels of the SelfModern Social ImaginariesModern Theories of JusticeModernity and SubjectivityModernity and TechnologyMoody Minds DistemperedMoral DimensionsMoral FailureMoral ImaginationMoral LiteracyMoral MachinesMoral ParticularismMoral PsychologyMoral Psychology and Human AgencyMoral Psychology, Volume 1Moral Psychology, Volume 2Moral Psychology, Volume 3Moral Psychology: Volume IVMoral RepairMoral Responsibility and Alternative PossibilitiesMoral TribesMoral Value and Human DiversityMorality and Self-InterestMorality in a Natural WorldMorality, Moral Luck and ResponsibilityMotherhoodMotive and RightnessMoving Beyond Prozac, DSM, and the New PsychiatryMultiple Analogies in Science and PhilosophyMultiple Identities & False MemoriesMusic, Madness, and the Unworking of LanguageMy Brain Made Me Do ItMy Double UnveiledMy WayNarrativeNarrative and IdentityNarrative MedicineNarrative PsychiatryNarrative Theory and the Cognitive SciencesNatural Ethical FactsNatural Kinds and Conceptual ChangeNatural MindsNatural-Born CybogsNaturalism and the First-Person PerspectiveNaturalism and the Human ConditionNaturalism in the Philosophy of HealthNaturalism in the Philosophy of HealthNaturalized BioethicsNaturalizing the MindNatureNature and NarrativeNear Death ExperienceNeither Bad nor MadNeither Victim nor SurvivorNeuro-Philosophy and the Healthy MindNeuroethicsNeuroethicsNeurological Foundations of Cognitive Neuroscience Neurophilosophy at WorkNeurophilosophy of Free WillNeuropoliticsNeuropsychoanalysis in PracticeNeuroscience and PhilosophyNew Essays on the Explanation of ActionNew Philosophy for a New MediaNew Versions of VictimsNew Waves in Philosophy of ActionNietzscheNietzsche and Buddhist PhilosophyNietzsche on Ethics and PoliticsNietzsche's TherapyNietzsche, Culture and EducationNietzsche: The Man and His PhilosophyNihil UnboundNoir AnxietyNormative EthicsNormativityNorms of NatureNotebooks 1951-1959Notes Toward a Performative Theory of AssemblyNothing So AbsurdOblivionOn AnxietyOn ApologyOn Being AuthenticOn Being AuthenticOn BeliefOn BetrayalOn BullshitOn DelusionOn DesireOn EmotionsOn HashishOn Human RightsOn Loving Our EnemiesOn Nature and LanguageOn PersonalityOn ReflectionOn Romantic LoveOn the EmotionsOn the Freud WatchOn the Government of the LivingOn the Human ConditionOn the InternetOn the Meaning of LifeOn the Philosophy of LawOn the Pragmatics of CommunicationOn the Punitive SocietyOn TruthOn Virtue EthicsOn What MattersOn What We Owe to Each OtherOne Hundred DaysOnflowOnly a Promise of HappinessOntology of ConsciousnessOpen MindedOpen Your EyesOrgans without BodiesOther MindsOur Last Great IllusionOur Own MindsOur Posthuman FutureOur StoriesOut of Its MindOut of Our HeadsOxford Guide to the MindOxford Handbook of Psychiatric EthicsOxford Textbook of Philosophy of PsychiatryPanic DisorderPanpsychism in the WestPartialityPassionate EnginesPassionate EnginesPathologies of BeliefPathologies of ReasonPatient Autonomy and the Ethics of ResponsibilityPC, M.D.Perceiving the WorldPerception & CognitionPerception and Basic BeliefsPerception, Hallucination, and IllusionPerceptual ExperiencePerfecting VirtuePerplexities of ConsciousnessPersistencePersonal AutonomyPersonal Autonomy in SocietyPersonal IdentityPersonal Identity and EthicsPersonal Identity and Fractured SelvesPersonhood and Health CarePersonsPersons and BodiesPersons, Humanity, and the Definition of DeathPersons, Souls and DeathPerspectives on ImitationPerspectives on PragmatismPessimismPhenomenal Concepts and Phenomenal KnowledgePhenomenal ConsciousnessPhenomenal IntentionalityPhenomenology and ExistentialismPhenomenology and Philosophy of MindPhilosophersPhilosophers on MusicPhilosophers without GodsPhilosophical CounselingPhilosophical Counselling and the UnconsciousPhilosophical DevicesPhilosophical Foundations of NeurosciencePhilosophical History and the Problem of ConsciousnessPhilosophical Issues in PsychiatryPhilosophical Issues in PsychiatryPhilosophical Issues in Psychiatry IIPhilosophical MethodologyPhilosophical MidwiferyPhilosophical Myths of the FallPhilosophical Perspectives on DepictionPhilosophical Perspectives on Technology and PsychiatryPhilosophical PracticePhilosophical Reflections on DisabilityPhilosophizing About Sex Philosophizing the EverydayPhilosophy and HappinessPhilosophy and LivingPhilosophy and PsychiatryPhilosophy and PsychotherapyPhilosophy and Science FictionPhilosophy and the EmotionsPhilosophy and the EmotionsPhilosophy and the Interpretation of Pop CulturePhilosophy and the Moving ImagePhilosophy and the NeurosciencesPhilosophy and This Actual WorldPhilosophy As FictionPhilosophy BitesPhilosophy Bites BackPhilosophy for Counselling and PsychotherapyPhilosophy for LifePhilosophy in a New CenturyPhilosophy in an Age of SciencePhilosophy in Children's LiteraturePhilosophy of ActionPhilosophy of ActionPhilosophy of BiologyPhilosophy of BiologyPhilosophy of BiologyPhilosophy of BiologyPhilosophy of BodyPhilosophy of Film and Motion PicturesPhilosophy of LovePhilosophy of Love, Sex, and MarriagePhilosophy of MindPhilosophy of Mind and CognitionPhilosophy of Personal Identity and Multiple PersonalityPhilosophy of PsychologyPhilosophy of Public HealthPhilosophy of SciencePhilosophy of SciencePhilosophy of Technology: The Technological ConditionPhilosophy of the Social SciencesPhilosophy on TapPhilosophy PracticePhilosophy the Day after TomorrowPhilosophy's Role in Counseling and PsychotherapyPhilosophy, Neuroscience and ConsciousnessPhilosophy, Politics, DemocracyPhotography and PhilosophyPhysical RealizationPhysicalism and Its DiscontentsPhysicalism and Mental CausationPhysicalism, or Something Near EnoughPhysician-Assisted DyingPillar of SaltPin-up GrrrlsPlatoPlatoPlato, Not Prozac!Platonic Ethics, Old and NewPluralistic CasuistryPolarities of ExperiencesPolitical EmotionsPopper, Objectivity and the Growth of KnowledgePornPorn StudiesPornography, Sex, and FeminismPortrait of the Psychiatrist as a Young ManPostcolonial DisordersPostpsychiatryPosttraumatic Stress DisorderPower and the SelfPower SplitPractical Autonomy and BioethicsPractical ConflictsPractical Identity and Narrative AgencyPractical PhilosophyPractical RulesPractical Tortoise RaisingPractically ProfoundPracticing Feminist Ethics in PsychologyPragmatic BioethicsPragmatismPragmatism, Old And NewPraise and BlamePredicative MindsPreferences and Well-BeingPrescriptions for the MindPresocraticsPrimary and Secondary QualitiesPrimates and PhilosophersPrivacyPrivileged AccessProblems in MindProblems of RationalityProzac As a Way of LifeProzac BacklashProzac on the CouchPsyche and SomaPsychiatric Aspects of Justification, Excuse and Mitigation in Anglo-American Criminal Law Psychiatric Cultures ComparedPsychiatric Diagnosis and ClassificationPsychiatric EthicsPsychiatric PowerPsychiatric SlaveryPsychiatry and Philosophy of SciencePsychiatry and ReligionPsychiatry as a Human SciencePsychiatry as Cognitive NeurosciencePsychiatry in SocietyPsychiatry in the New MilleniumPsychiatry in the Scientific ImagePsychiatry, Psychoanalysis, And The New Biology Of MindPsycho-Physical Dualism TodayPsychoanalysis and Narrative MedicinePsychoanalysis and the Philosophy of SciencePsychological Concepts and Biological PsychiatryPsychology and PhilosophyPsychology and the Question of AgencyPsychology's Interpretive TurnPsychology, Psychotherapy, Psychoanalysis, and the Politics of Human RelationshipsPsychotherapy and ConfidentialityPsychotherapy As PraxisPublic PhilosophyPunishmentPure ImmanencePurple HazePursuing MeaningQuality of Life and Human DifferenceQueer PhilosophyQuestions for FreudQuestions for FreudQuine and Davidson on Language, Thought and RealityRaceRace in Contemporary MedicineRadiant CoolRadical AlterityRadical ExternalismRadical HopeRational and Social AgencyRational CausationRational Choice in an Uncertain WorldRationality + Consciousness = Free WillRationality and FreedomRationality and the Reflective MindRationality in ActionRawls, Dewey, and ConstructivismRe-creating MedicineRe-EmergenceRe-Engineering Philosophy for Limited BeingsReading AutobiographyReading Bernard WilliamsReading SartreReadings in the Philosophy of TechnologyReal MaterialismReal Natures and Familiar ObjectsReal ScienceRealism in ActionReason & EmancipationReason in ActionReason in PhilosophyReason's GriefReasonably ViciousReasoning About Rational AgentsReasoning in Biological DiscoveriesReasons from WithinReasons without RationalismReclaiming CognitionReclaiming the SoulReconceiving SchizophreniaReconstructing Reason and RepresentationReconstructing the Cognitive WorldRecreative MindsRediscovering EmotionRediscovering EmpathyReference and ExistenceReference and the Rational MindReflections On How We LiveReframing Disease ContextuallyRefusing CareRegulating SexReinventing the SoulRelativism and Human RightsRelativism and the Foundations of PhilosophyRelativism and the Foundations of PhilosophyReliable ReasoningReligion without GodRelying on OthersRemembering HomeResponsibility and PunishmentResponsibility and PunishmentResponsibility from the MarginsRestraining RageRethinking ExpertiseRethinking IntrospectionRethinking Mental Health and DisorderRethinking RapeRethinking the DSMRethinking the Sociology of Mental HealthRethinking the Western Understanding of the SelfReturn to ReasonRevolt, She SaidRichard RortyRichard RortyRichard RortyRichard RortyRichard RortyRichard Rorty's New PragmatismRightsRights, Democracy, and Fulfillment in the Era of Identity PoliticsRise And Fall of Soul And SelfRitalin NationRobert NozickRousseauRousseau and the Dilemmas of Modernity Routledge Philosophy Guidebook to Derrida on DeconstructionRules, Reason, and Self-KnowledgeSaints, Scholars, and Schizophrenics: Mental Illness in Rural IrelandSartreSartreSartreSartre in Search of an EthicsSatisficing and MaximizingSaving GodScandalous KnowledgeSchizophreniaSchizophrenia and the Fate of the SelfSchizophrenia: A Scientific Delusion?SchopenhauerSchopenhauer's TelescopeScienceScience and EthicsScience and Pseudoscience in Clinical PsychologyScience and SpiritualityScience and the Pursuit of WisdomScience Fiction and PhilosophyScience Fiction and PhilosophyScience in Civil SocietyScience in DemocracyScience RulesScience WarsScience, Consciousness and Ultimate RealityScience, Policy, and the Value-Free IdealSciences from BelowScientific EvidenceScientific IrrationalismScientific PerspectivismScientific PluralismScientific Realism and the Rationality of ScienceScratching the Surface of BioethicsSecond NatureSecond OpinionsSecond PhilosophySecrets of the MindSecular Philosophy and the Religious TemperamentSecurity, Territory, PopulationSeeing and VisualizingSeeing DoubleSeeing Fictions in FilmSeeing RedSeeing Wittgenstein AnewSeeing, Doing, And KnowingSelfSelf and OtherSelf and SubjectivitySelf, No Self?Self-ConsciousnessSelf-ConstitutionSelf-ExpressionSelf-FulfillmentSelf-Knowledge and ResentmentSelf-Knowledge and Self-DeceptionSelf-Made MadnessSelf-Reference and Self-AwarenessSelf-Representational Approaches to ConsciousnessSelvesSentimental RulesSexing the BodySexualized BrainsShades of LonelinessShame and GuiltShame and NecessityShame and PhilosophyShop Class as SoulcraftShynessSigns, Mind, And RealitySimone de BeauvoirSimple MindednessSimulating MindsSimulation and SimilaritySinging in the FireSisyphus's BoulderSituating SemanticsSix Questions of SocratesSkeptical FeminismSkepticismSketch for a Theory of the EmotionsSleeping With Extra-TerrestrialsSlothSocial EpistemologySocial PhenomenologySocializing MetaphysicsSociological Perspectives on the New GeneticsSocratesSocrates CafeSocrates in LoveSocratic Moral PsychologySoft SubversionsSoren KierkegaardSorting Things OutSoul 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DSM-IV SourcebookReview - DSM-IV Sourcebook
Volume 2
by Thomas A. Widiger, Allen J. Francis, Harold Alan Pincus, Ruth Ross, Michael B. First, Wendy Wakefield Davis (editors)
American Psychiatric Association, 1996
Review by Jeffrey Poland, Ph.D.
Feb 25th 2002 (Volume 6, Issue 9)

The DSM-IV Sourcebook, Volume 2 is the second of a projected four volume series aimed at presenting the empirical bases and rationales underlying the recommendations and decisions that informed the development of DSM-IV (The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, developed and published by the American Psychiatric Association 1994.)  (Note that the fourth volume is out of print.)  Given the central role of the DSM in clinical practice and scientific research bearing on mental illness and given the considerable controversy that has traditionally accompanied psychiatric classification and has surrounded DSM based classification in particular, it was deemed important by the DSM developers to lay bare the empirical basis for the decisions leading to the production of the most recent DSM. In so doing, the scientific credibility of the classification system and of the practices based upon it would be affirmed. The DSM Sourcebook is a massive record of the results of literature reviews, data re-analyses, and field trials and of the deliberations based upon them.

In a prior review of the DSM-IV Sourcebook, Volume 1 (Metapsychology April 2001), I provided a general outline of the process by which the DSM-IV was developed and the various guidelines and standards that were supposed to inform that process. In addition, I outlined a number of lines of criticism of the DSM approach to classification. The main thrust of that review was to examine Volume 1 of the Sourcebook with an eye to determining how well the work recorded in that volume lived up to the standards of the developers and how well it responded to the concerns of the critics. In the present review, I will continue pursuing those objectives with respect to Volume 2.

As with Volume 1, this volume consists of a series of papers authored by members of the various work groups charged with identifying critical issues to be addressed in the development process, conducting literature reviews designed to collect relevant evidence, conducting data re-analyses and field trials to gather further evidence, framing development options for consideration, and eventually making recommendations for development of DSM-IV. The volume is divided into sections concerning five broad categories of mental disorder (Mood Disorders, Anxiety Disorders, Personality Disorders, Psychiatric System Interface Disorders, Sexual Disorders), and each of these sections is broken down into an introductory chapter (providing an “executive summary”) followed by a series of chapters summarizing the results of literature reviews relevant to issues related to specific disorders and presenting options and recommendations concerning those issues. A sixth section of the volume is devoted to Late Luteal Phase Dysphoric Disorder (LLPDD), and this section consists of a single long chapter with the same purposes as the other five sections. The existence of a separate section devoted to LLPDD is perhaps best explained in terms of the considerable controversy surrounding that category since its initial proposal in the mid 1980's.

The papers collected in this volume exhibit a number of shortcomings that lead one to conclude that the development process did not live up to its own standards and has not achieved some of its most important stated objectives. To begin, it does not seem likely that the DSM development process, as reflected in Volume 2 of the Sourcebook, has succeeded in effectively breaking with the long tradition (re-affirmed in both DSM-III and DSM-III-R) of basing decisions regarding the existence and nature of diagnostic categories on consensus among practitioners rather than on sound science, either in the form of carefully collected empirical data or well tested theories. There are at least three reasons for thinking this. First, throughout the volume there are repeated affirmations of the lack of relevant empirical research findings bearing on issues concerning the construct and predictive validity of the categories (i.e., their scientific meaningfulness.) Most of these issues could not be so much as seriously raised, let alone resolved during the DSM-IV development process. Second, as a consequence of the conservative approach to change (viz., to make changes only when there is a “solid basis” for doing so) and the lack of relevant empirical research, the inertia supplied by past editions of the DSM dominated this most recent effort. Since it is generally agreed that DSM-III and DSM-III-R were developed on the basis of a politically derived consensus (sometimes not even among “experts”; cf., p. 647) and without being informed by any serious research bearing on the validity of the categories, it can only be concluded that DSM-IV consists largely of categories which have been introduced and retained, not on the basis of science, but on the basis of political consensus unconstrained by empirical research. Third, the explicitly articulated guideline of making decisions that increased the consistency of DSM-IV with the ICD-10 (The International Classification of Diseases, 10th Edition), means that recommendations for change were made, not on the basis of empirical data addressing validity, but with an eye to enhancing agreement with a different system which, at least with respect to mental disorders, is also based on consensus largely uninformed by science.

A further shortfall with respect to the stated standards and objectives of the development process concerns the ideal of making significant changes only when there was a “solid basis” for doing so. Throughout this volume, the widespread lack of relevant and good quality research made the process quite vulnerable to loose, sometimes rambling and barely coherent, speculation. A frequent refrain throughout the volume involved vague appeals to “ease of use” and “clinical utility” without any clarification or justification. More serious problems perhaps are the imposition of dubious ideas onto the reasoning process (e.g., the idea that it is important to minimize differences between children, adolescents, and adults, p. 4-5) and pursuit of lines of reasoning which are barely relevant to an issue under discussion or barely coherent (e.g., discussions of whether pain is a mental disorder, p. 923-4). It is one thing to call for changes for which a solid basis exists, it is quite another to have and adhere to a serious standard of what counts as a solid basis.

Two specific sorts of change recommended for introduction into DSM-IV are especially noteworthy in both their significance and their lack of a solid basis. The first concerns the widespread introduction of a criterion of “clinical significance” (e.g., clinically significant distress or impairment in social, occupational or other important area of functioning) for most if not all categories. None of the work groups identified any relevant data to support such an introduction as improving the construct or predictive validity of the categories they considered. Apparently, the introduction of this criterion was mandated by the Task Force overseeing the work groups (e.g., p. 1082) perhaps because of some belief that raising the bar on distress and impairment (“clinical significance”) might have the effect of reducing false positives, creating more homogeneous categories, or reducing inflated prevalence rates. However, there is no reason to believe that a criterion of clinical significance will achieve either greater categorical homogeneity or fewer false positive diagnoses; and the proposal, as it bears on prevalence, seems quite arbitrary in the absence of an independent measure of the presence or absence of a disorder. Such a change clearly is significant insofar as it bears on who is diagnosed with a mental disorder for either clinical or research purposes; but it is far from solidly based.

The second sort of change, which is significant but lacking in a solid basis, concerns the indirect introduction into the official nomenclature for mental disorders of categories which were not deemed to have a sufficient basis for direct inclusion. This is typically accomplished by citing a category as an example of a residual category of mental disorder (e.g., Depressive Disorder Not Otherwise Specified.) Such categories exist so that someone who does not satisfy the criteria for any listed category can still be diagnosed as suffering from a mental disorder. At east two categories discussed in Volume 2 of the Sourcebook were determined not to have a sufficient basis to be included as an official diagnostic category, but were nonetheless included as examples of mental disorders which can fall under a residual label (i.e., they are real mental disorders that just don’t happen to satisfy one of the listed categories.) One example of this, “Telephone Scatalogia” (i.e., the making of obscene phone calls) demonstrates how something which certain clinicians believe “in their bones” is a sign of mental pathology can make it into the official classification system of mental disorders (under the heading, “Paraphilias Not Otherwise Specified”) despite there being no empirical or theoretical basis for believing this represents a legitimate mental disorder. A second example, “Premenstrual Dysphoric Disorder” (the new label for what was previously called “Late Luteal Phase Dysphoric Disorder”), is a clear case of the introduction into the diagnostic system through the backdoor of a category that was heatedly debated and found to lack a sufficient basis for direct inclusion. PMDD is now listed as an example of a mental disorder that qualifies one for a diagnosis of Depressive Disorder NOS.

Yet a third reason for questioning whether the DSM-IV development process, as reflected in Volume 2 of the Sourcebook, lived up to the stated ideals and objectives of the developers concerns its conformity to ideals of scientific objectivity frequently rehearsed throughout the volume. One such ideal concerns the openness of the development process: it is pointed out by the developers that the DSM development process involves many stages with ample opportunity for critical review and discussion of evidence, options, deliberations, and recommendations by the substantial number of consultants and the psychiatric community at large (e.g., by circulation of interim drafts, presentations at conferences, publications). In this way, the ideals of peer review and open critical discussion in the relevant scientific community are supposed to be realized. But, there is reason to be skeptical about just how open the process was. In particular, with respect to Late Luteal Phase Dysphoric Disorder (or, PMDD), there are grounds for concern that the process involved significant marginalization of critical perspectives and the stifling of dissent. Although the chapter concerning LLPDD mentions the controversy and provides a limited discussion of some of the concerns of critics, there is no very sophisticated discussion of the issues involved. Rather, the chapter is for the most part devoted to a long hashing over of a largely inconclusive research record and a clarification of just how little empirical support there is for direct inclusion of the category in the DSM. But, then, PMDD was included in the DSM nonetheless and despite the controversy surrounding the legitimacy of the category, a controversy which, if properly engaged, might have produced a solid basis for exclusion of the category entirely from the DSM. See Caplan 1995 for an alternative perspective on the process from that reflected in the Sourcebook. There it is suggested that, far from being open, the process ignored criticisms, stifled dissent, and marginalized dissenters. The importance of this episode is that it suggests that those controlling the DSM development process may not be very willing or able to grapple with issues that challenge implicit or explicit interests or presuppositions. Controversy may be permitted, but only within rigid assumptions to which many participants may well be blind and only subject to politically influenced procedural practices. At the least, this is something requiring closer scrutiny given the broad impact of the DSM system of classification.

Let us turn now to the question of how well the papers in Volume 2 of the Sourcebook, either individually or collectively, provide effective rejoinders to the critics of the DSM approach to classification of mental disorder. There are at least three areas of concern: foundational issues, validity of the categories, impact of the inertia of the system.

First, as with Volume 1, there was in Volume 2 a notable lack of serious attention to foundational issues and a serious mishandling of those that were discussed. There was frequent confusion about the nature of the entities being included in or excluded from the taxonomy (e.g., Are they empirically defined syndromes?, Are they disorders involving a core dysfunction?), and hence there was lack of clarity regarding the sorts of considerations relevant to making key decisions (e.g., p 5.) Further, discussions regarding the distinction between disorder and no disorder (normality and abnormality) were marred by a lack of understanding of and attention to conceptual issues raised by such questions. Hence, there was again an evident lack of clear understanding of what needs to be shown in order to effectively address important questions (e.g., p. 955-6.) And, as noted above, the broad incorporation of a clinical significance criterion was made without any serious attention to the issues raised by the problems of categorical heterogeneity, inflated prevalence rates, and false positives. Finally, an extended discussion regarding whether a categorical approach to classification should be replaced by a dimensional approach is found in the section concerning the personality disorders. The somewhat dismaying conclusion of the discussion was that, even though there is a broad consensus that the categorical approach needs to be replaced because it is riddled with problems and is not promoting either clinical or research purposes very effectively, the categorical approach will be retained in DSM-IV because it is the standard for research and clinical purposes and because changes would be too confusing and disruptive (cf., p. 647-650.) The deep problems with changing the DSM come into full view here: even when a solid basis for change exists, change proves impossible because of the powerful inertia of the interests and the tradition that supports the current form of the classification system. Never was there a more patent need for clarity about the foundations of a discipline than is evident here; and yet, the DSM development process, to date, has given no serious attention to such issues.

Second, the evident lack of empirical research bearing on the most critical issues concerning the development of a categorical system of classification, viz., the validity of the categories, meant that these issues could not so much as be meaningfully framed, let alone addressed by the Work Groups represented in Volume 2. As a consequence of both this lack of evidence and the conservative approach of the development process, the discussions represented in Volume 2 (as in Volume 1) displayed a very powerful bias to retention of categories (the vast majority of categories) which had been introduced in DSM-III and retained in DSM-III-R on the basis of no sound scientific evidence of validity. As a consequence, beginning in 1994 (the publication date of DSM-IV), we have had eight more years (and counting) of powerful influence on clinical and research practice of a system of classification containing categories with no demonstrated validity. Critics of the DSM approach to classification have contended for two decades that this approach (as initiated in DSM-III) is not a sound way to develop a system of classification that exhibits appropriate levels of validity, and the deliberations in Volume 2 of the Sourcebook provide nothing to encourage a more optimistic view.

Finally, since the deliberations and recommendations made in Volume 2 were rarely based on sound scientific considerations, they were inevitably made on the basis of considerations that tend to corrupt future scientific research. Thus, deliberations and recommendations based on consistency with ICD-10, clinical utility (“ease of use”), empirically unconstrained speculation, and the imposition of ideas and criteria with no empirical basis introduce arbitrary and unjustified factors that directly influence diagnostic practices in research settings and hence that influence the nature of the samples that are collected and studied. The failure of the DSM developers to appreciate this sort of impact has led to a continued endorsement of a flawed model of the relation between science and the clinic, a model that undermines research. The seemingly bankrupt research programs associated with the various categories discussed in Volume 2 are not likely to be revived given the way that diagnostic criteria are developed.

What is the significance of these shortcomings in the DSM development process as reflected in Volume 2 of the Sourcebook? The result of laying bare the nature of the scientific evidence and the deliberations supporting the decisions leading to the publication of DSM-IV is to bring into sharper relief just how deep the problems with the DSM system of classification go. The developers of DSM-IV appear to have been massively uninformed by sound scientific research and to have been deeply confused about a number of important foundational issues. Both of these shortcomings impact upon the coherence and credibility of the process, as well as upon its capacity to clarify and effectively cope with important problems as they arise. The result is that powerful inertial forces direct the development process and lead to retention of categories that have never had a scientific justification. These problems are compounded by concerns about the objectivity and scientific integrity of the DSM development process and about the potential for future research based upon DSM categories to be productive. Volume 2 of the Sourcebook has done nothing to allay such concerns, and has provided additional grounds for thinking it is time for some profound changes in how we conceptualize, investigate, and respond to mental illness, and in how a highly influential system of classification gets developed.

 

© 2002 Jeffrey Poland

 

Jeffrey Poland, Ph.D., University of Nebraska-Lincoln

 

 

References

Caplan, Paula (1995). They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal (New York: Addison-Wesley).


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