Mental Disorder, Methodology, and Meaning
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Essentialist bias, psychological essentialism, classical view of categories, disability, gene
In this brief commentary, I would like to discuss two reservations I have about the article by Bergner and Bunford. Before doing so let me make some preliminary remarks.
Their hypothesis that the concept of disability unites the various mental disorder constructs that have been proposed over the centuries and across cultures is reasonable and accords well with common sense. The concept of disability does a lot of good work in helping us to understand mental disorders.
With respect to the authors’ contrast between the disability conception versus the behavioral conception of mental disorder, the notion that counting behaviors alone justifies diagnosing a psychiatric disorder is worth critiquing. Claiming that everyone who has more than five drinks at least three times a week is an alcoholic is an example of a ‘behavioral model’ and a shallow one at that. Much more conceptual machinery is needed to justify a disorder attribution.
This contrast, however, has not been of much concern in the philosophy of psychiatry. Other than some textbook writers with a background in behaviorism, few actual advocates for the behavioral conception were named in the article.
On the international scene, some thinkers associated with the World Health Organization have argued that mental disorder and disability/ impairment should be distinguished (Sartorius, 2009; Üstün & Kennedy, 2009). They suggest this because they realize that two people may have equally severe cases of a disorder such as depression, but one of them can have compensatory assets and continue to function while the other experiences a debilitating decline in functioning. These thinkers, however, do not advocate anything like a behavioral conception of mental disorder.
Methodology
Turning now to my aforementioned reservations, the first is directed to potential readers of the journal rather than to the authors. It pertains to the study’s research methodology.
For many years, Jerry Wakefield and colleagues have argued that psychiatric diagnostic practices can benefit from a careful conceptual analysis of the meaning of the term mental disorder (Horwitz & Wakefield, 2007; Wakefield, 1992; Wakefield & First, 2003). Surely, an analysis of meaning should be informed by scientific research regarding how the concept is actually used, as Bergner [End Page 45] and Bunford set out to do. As they note, however, the methodology used in the current study has some important flaws. Although the authors acknowledge some of these, it may be useful to explicate them in more detail for readers without a background in scientific psychology or research methods.
In 8 of their 12 conditions, the dependent variable is evaluation of problematic behavior and the independent variable is disability, operationalized as loss of control. To test the hypothesis that disability is the distinguishing factor in differentiating mental disorder from ‘non-disordered’ behavior, the only difference between the conditions should be the presence or absence of disability. Unfortunately, all of these vignettes are confounded by multiple differences. For example, the two vignettes included in the main text of the article differ in the following ways: In case 1, the problematic behavior is deciding to not install a $17 part that would save lives but reduce profits, in case two it is impulsively mugging people in Central Park; the subject in case one is a 50-year-old corporate executive, in case 3 he is an age-unspecified purse snatcher; the man in case 1 feels very comfortable with his decision, in case 2 he feels absolutely no guilt or remorse; the man in case 1 consults his accountants and asks them to do a cost analysis before deciding what to do, the man in case 2 experiences very little sense of control over his impulsive attacks on women.
No matter how statistically significant the t tests are, the methodology used in this study does not warrant the inference that experiencing very little sense of control is the ‘critical discriminator.’
So, one point on which I disagree with the authors is their concluding claim that this study “provides strong empirical support for conceiving of mental disorder as a disability (dysfunction, functional impairment) concept…” (Bergner & Bunford, 2016, p. 26). The study results...
