Philosophical issues in psychiatry III: The Nature and Sources of Historical Change by Kendler Kenneth S.; Parnas Josef

Author:Kendler, Kenneth S.; Parnas, Josef
Language: eng
Format: epub
Publisher: Oxford University Press
Published: 2014-04-02T04:00:00+00:00

Chapter 23

Psychiatry made easy: operation(al)ism and some of its consequences

Josef Parnas and Pierre Bovet

23.1 Introduction

The introduction of polythetic diagnostic criteria and the so-called operational definitions of such criteria in the DSM-III (American Psychiatric Association 1980) and in its subsequent editions (DSM-IIIR, -IV, -IV-TR, and -5, henceforth DSM-III+), and replicated in the ICD-10 in 1992, reflects perhaps the most profound transformation of clinical and scientific psychiatry in the twentieth century.

Psychiatric diagnosis, prior to this based on textbook narrative prototype-descriptions and a process of matching the individual patient’s clinical picture to such prototypes, was replaced by an explicit process of identifying a sufficient number of relevant symptoms and signs, representing allegedly “operational criteria” of the category in question. The “operational revolution” in psychiatry is an example par excellence of a profound scientific change that happened at the intersection of certain specific sociohistorical circumstances, novel theoretical ideas, conceptual and empirical crises and developments, cultural, linguistic, and political transformations, and a strong activism of a few, influential professionals. In other words, we witness here a multitude of “decision vectors” at play (see Solomon, Chapter 8, this volume).

The notions of “operational diagnoses” and “operational criteria” have acquired an exalted status among psychiatrists (Sato and Berrios 2001). Beginning at the undergraduate level, a student of psychiatry is trained to believe that whatever is called “operational” guarantees a high degree of objectivity needed by a scientific and evidence-based psychiatry. Given this mesmerizing effect of the adjective “operational,” it is striking to realize that most psychiatrists are simply unaware of what the term “operational” actually signifies. The contemporary diagnostic manuals (DSM-III+, ICD-10) do not provide any precise definition of this term and are mute on its origins and introduction in psychiatry. As Sato and Berrios (2001) conclude: “One of the central innovative features of DSM [i.e., operational criteria] has not received much academic concern, as though the adjective ‘operational’ hints at some basso continuo that regulates whole music yet remains inconspicuous.”

In this chapter, we will try to explicate the issue “operational.” We will trace its origins and permutation before and after its introduction in psychiatry. We cannot dissociate the issue of operationalism from the closely related, epistemological problems confronting psychiatry today. Therefore, we will also summarize some of the consequences of operationalism.

This chapter is written from a perspective of psychiatric clinicians-researchers, with a bent for epistemology, philosophy of mind, and phenomenology (Parnas and Bovet 1991, 1995). We have both experienced firsthand the operational transformations in psychiatry during our professional careers, which also include international teaching of psychopathology and research collaborations.

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