He diagnostic system- which necessarily has to focus on symptom similarities, rather than the particularities

He diagnostic system- which necessarily has to focus on symptom similarities, rather than the particularities and idiosyncrasies that make each PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/27766426 of us who we are. Holding fast to the person is the crucial task of every clinician, but it is not something the DSM can help with.Reply to Dr DeckerHannah Decker does us a great service by recalling and recording attempts to define mental disorder. I am afraid, however, that this is a situation in which knowing a problematic past is insufficient to avoid repeating it. There will always be a strong desire to define `mental disorder’ because it is so important in setting the boundary with normality. But all efforts at universal definition will fail because the concept is so inherently fuzzy and situation bound. The only consolation is that `medical illness’ is equally vague and hard to define.Conclusion The two questions covered in this article form a natural pair. How you define mental disorder (Question 2) will certainly depend on what you think mental disorders are and how we are able to know about them (Question 1). I will briefly summarize the discussion developed in these questions and save a larger review for the general conclusion. As indicated above in the General Introduction, the startling failure of research to validate the DSMcategories of DSM-III and DSM-IV has led to a conceptual crisis in our nosology: what exactly is the status of DSM diagnoses? Do they identify real diseases, or are they merely convenient (and at time arbitrary) ways of grouping psychiatric symptoms? These are the issues dealt with in Question 1, framed in the umpire metaphor introduced by Allen Frances in his “DSM in Philosophyland” piece published in Bulletin 1 and commented on at length in Bulletin 2. The commentaries in this article roughly follow the positions of the five imagined umpires, although, as PD150606 clinical trials explained above, most of us will not restrict ourselves to a purist version of one of the umpires. Indeed, Frances himself, while stating a clear point of view, acknowledges that each umpire position captures a bit of the truth. The first two commentaries address Question 1 in a broad way, commenting on the process of deciding about the merits of the various positions. Peter Zachar and Stephen Lobello are scholars who take their baseball seriously and weave the metaphor into a complex analysis in which their pragmatic (practical kinds) perspective subsumes all the umpires, including the pragmatic fourth umpire. In her commentary Claire Pouncey doesn’t quite assume a position but provides a clear presentation of the differences among the first three umpires. She begins with the clarification that the umpire question involves both ontology and epistemology: what is there, and can I know it. Umpire 1 is a Strong Realist – both an ontological realist and an epistemological realist. Umpire 2 is a Strong Realist/Weak Constructivist – an ontological realist and an epistemological less-than-realist. Umpire 3 is a Strong Constructivist – an ontological anti-realist and an epistemological anti-realist. In his commentary Nassir Ghaemi offers a spirited defense of a realist, first-umpire position, challenging those who don’t accept the reality of mental illnesses as to what they’re doing treating patients. I am calling him a first umpire, but he rejects the umpire metaphor, offering in its stead Kenneth Kendler’s notion of “epistemic iteration.” The next three commentators assume some variation on the “nominalist” second.