Tuesday, 15 April 2008
Problems of Validity of Psychiatric Disorders
Kenneth Schaffner, University of Pittsburgh
12:05 pm, 817R Cathedral of Learning
Abstract: I review several different concepts of validity, but then focus in on diagnostic validity as introduced in Robins and Guze’s 1970 article. I also relate the diagnostic validity concept to two newer notions: reductive etiopathogenic validity and clinical validity. Problems with etiopathogenic validity are summarized, including uncertain progress in psychiatric genetics and in psychiatrically relevant neuroscience. Kendell and Jablensky’s 2003 article on validity and utility is then used as a framework to develop a prototype-dimensional approach to basic science and extend this to psychopathology. In addition, it is noted that biology (and psychopathology) involve multi-level non-reductive models. “Reality” is thus characterized as multi-level, and includes subjective and intersubjective mental life, and what might be summarized as “clinical reality,” among its levels. In the light of these theses concerning prototypes, dimensionality, and multilevel models, as well as the lack of progress in pursuing etiopathogenic validity, I argue that for the near future (~next ten years), clinical validity -- viewed in terms of “clinical utility” -- will be the most important form of validity for psychopathology. Implications of these views for a developing Pitt workshop on “Validity in Psychiatry: Toward the DSM-V and ICD-11” are considered.