Time: 2 – 4pm
Place: Sheffield Hallam University, City Campus. Charles Street Building, Room 12.2.19 (This is on the second floor), Howard Street, S1 1WB.
Speaker 1: Sam Fellows
Title: “Why symptom-based approaches are not enough: the value of psychiatric diagnoses”
Critics are concerned that psychiatric diagnoses fail to accurately describe patients and therefore should be abandoned. Most patients do not have all symptoms associated with their diagnosis and most patients have symptoms which are not associated with their diagnosis. Knowing someone has a diagnosis seems to convey much less useful information compared to knowing what symptoms someone has. This situation has lead critics of psychiatric diagnosis to claim diagnoses make no contributions to understanding individuals, they are harmful distractions and should be abandoned (e.g. Timini, Gardner & McCabe 2011). Psychiatrists should instead establish what symptoms an individual has rather than give them a diagnosis. In this paper I will employ Ronald Giere’s account of scientific theories to show that those critics are mistaken to see psychiatric diagnosis as making no useful contribution.
Giere describes how scientific theories are abstract generalisations which lack specific detail. For example, Newton’s laws, by themselves, make no claims about the world. Rather, they guide the building of more specific models and these specific models can be used to make claims about the world. He describe scientific theories as “recipes for constructing models” (Giere 1994, p.293). This notion of scientific theories as recipes which guide the building of less abstract models has not yet been applied to psychiatric diagnoses.
Psychiatric diagnoses should be seen as recipes for constructing models of people. I argue they guide the construction of models of people, making contributions to understanding individuals which are absent when simply focusing upon what symptoms are being presented by specific individuals. Firstly, many symptoms can be subtle and difficult to spot. A patient may be unaware of the symptom and psychiatrists cannot practically investigate for every possible symptom. Psychiatric diagnoses can help guide investigation of symptoms. If an individual exhibits a few symptoms of a psychiatric diagnosis then there is reason to investigate for other symptoms of that psychiatric diagnosis. For instance, if an individual exhibits low social skills and low eye contact, both of which are symptoms of autism, then there is reason to investigate for other symptoms of autism. This may help spot subtle symptoms such as rigid thinking or difficulty accommodating to changes. Thus the diagnosis guides investigating for the presence of symptoms. Secondly, patients fluctuate in the symptoms they present over time. The symptoms which are presented to a psychiatrist at time of interview may not cover symptoms previously exhibited or those exhibited in the future. However, knowing the individual has a diagnosis which is associated with a range of symptoms, more than any one diagnosed person actually exhibits, guides awareness towards a range of possible symptoms not present in a diagnosed person at one specific time. The diagnosis guides awareness towards alternative symptoms that may present at other times within diagnosed individuals. Thirdly, symptoms themselves have a level of generality and may manifest in quite different ways. For example, the low social skills of autistic individuals are typically quite different to the low social skills of schizophrenic individuals. Thus knowing the diagnosis of an individual can lead to greater understanding of how specific symptoms manifest. The diagnosis guides building more realistic models of ways individuals manifest symptoms.
By framing psychiatric diagnosis in terms of Giere’s account of scientific theories I have shown how psychiatric diagnosis make a contribution to understanding individuals. Thus critics of psychiatric diagnosis are mistaken to believe psychiatric diagnosis make no contribution and are mistaken to believe they should be abandoned.
Giere, Ronald, N. (1994). The Cognitive Structure of Scientific Theories. Philosophy of Science, 61/2, 276-296.
Timini, Sami., Gardner, Niel. & McCabe, Bain. (2011). The Myth of Autism (Palgrave-McMillian).
Speaker 2: Richard Woods
Title: Is the concept of Demand Avoidance Phenomena (Pathological Demand Avoidance) real or mythical?
This talk presents results of a content analysis of the diagnostic and screening tools for the proposed autism subtype Demand Avoidance Phenomena (DAP, commonly called Pathological Demand Avoidance), investigating if the construct has specificity. There is much growing interest in DAP and despite the lack of supporting evidence, some expect it to be included in England’s coming Autism Strategy. Specificity is when a trait is unique to a particular subject. I replicated a similar content analysis conducted by Nick Chown on tools for Broader Autism Phenotype and Autistic Traits. His results suggest that those constructs lacked specificity and are reified constructs. It is frequently argued in the DAP literature that it lacks specificity, by replicating Nick Chown’s study; I am attempting to falsify this viewpoint. I will present my full results at the talk. My preliminary analysis of the main 2 tools for DAP, the Extreme Demand Avoidance-Questionnaire and 11 items on the Diagnostic Interview for Social and Communication Disorders, support the common notion that DAP lacks specificity. These results would indicate how seriously DAP should be taken and if it should additionally be diagnosed in non-autistic persons.