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  • A Fallacious Forced Choice:Cloninger and Stoyanov, Machamer, and Schaffner Are Compatible
  • Drozdstoj Stoyanov (bio), Peter Machamer (bio), and Kenneth F. Schaffner (bio)
Keywords

Cloninger, SMS paradigm, convergent validity

In his commentary entitled Degeneracy of Categorical Disease Paradigms, Robert Cloninger (2013) presents several arguments to challenge our program of convergent transdisciplinary validation across psychopathology, clinical psychology, and psychiatry.

The aim of this response is to demonstrate how Cloninger’s most insightful reflection is actually consistent with our paradigm. Let us summarize his major objections herewith: A paradigm is scientifically degenerate (perhaps in a Lakatosian sense) if it does not provide a way to test and modify its basic assumptions or if it cannot make predictions that go beyond observed data; Cloninger attempts to persuade us that the Stoyanov, Machamer, and Schaffner (SMS) paradigm is degenerate in this sense.

Cloninger insists that we wrongly attribute specificity to MMPI scores for depression when in actual fact the Minnesota Multiphasic Personality Inventory (MMPI) can only be meaningfully interpreted in any given person as a multidimensional profile of scores. This error illustrates the way that contemporary diagnostic systems tend to reify categories as discrete entities despite the fact that there is no justification for doing so.

Further, Cloninger raises the fundamental queries: Where is the basis for values and virtues in the SMS paradigm of health? How can we have an adequate model of health and disease without a role for values and virtue?

We shall not focus extensively on arguments, because there is a large literature that defends the thesis that the MMPI can perform heterogeneous (hybrid) measures, both of traits and states. More precisely, a depression score of over 70 in MMPI depression rating scale has been considered valuable clinical measure for depression along with the Hamilton rating scale and others.

First, it should be noted that we have not advocated the categorical approach only. On the contrary, in a number of previous publications we have argued that neurobiological signatures may underpin broader diagnostic entities (dimensions, [End Page 281] clusters, prototypes). However, we should keep in mind that there are many arguments of reservation in the current literature at the utility of the broader and complex diagnostic constructs (Phillips 2011).

The provisional disagreement arises with the field of the particular study design introduced in our paper as a possible route to improvement of the neuroscience–clinical psychiatry correlations via simultaneous investigation of the clinical features of mental disorders and the underlying brain mechanisms, which is taken to be categorical per se by Cloninger.

On a meta-theoretical level, it is not correct to say that our paradigm does not provide way to test and modify its basic assumptions since it has never been actually tested. Our predictions, however, can go far beyond the observed data, and toward bridging the explanatory gap and conformable dialogue of neuroscience and psychiatry. So, at least from these two perspectives, it is constructive and should not be defined as degenerate.

The alternative Cloninger brings forward is his psychobiological model of personality, referring to his very motivating research into neurobiological correlates of personality. For example, the brain circuit regulating persistence has been determined to involve the anterior cingulate cortex (Brodmann area 24), orbitofrontal cortex (Brodmann area 47), and the ventral striatum, which regulates conditioning of reward-seeking behavior. Real-time testing of circuit activity was carried out by varying the proportion of neutral stimuli when people were asked to rate pictures as pleasant, neutral, or unpleasant during functional magnetic resonance imaging. Circuit activity increased, along with increasing proportions of neutral pictures in highly persistent people, whereas it decreased under the same conditions in impersistent people; this nonlinear effect was direct evidence of a complex adaptive system. In addition, ratings of affective valence (i.e., pleasant or unpleasant) depended on nonlinear interactions of persistence with harm avoidance and self-directedness, which themselves modulate connectivity of the anterior cingulum with the amygdala and the medial prefrontal cortex respectively.

Regardless to all those inspirational research facts, there is growing awareness that finding of any genetic–neuroscience to clinical interrelations in Cloninger’s paradigm will be very complicated and so far out of reach (Service 2012).

In any case, it is exciting...

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