Establishing Normative Validity for Scientific Psychiatric Nosology: The Significance of Integrating Patient Perspectives

  • Douglas PorterEmail author


Psychiatric nosology entails a complex combination of descriptive and prescriptive elements. While there has been a great emphasis upon developing empirical evidence to guide the further development of nosology, scant attention has been given to normative questions of what nosology ought to accomplish. A largely neo-Kraepelinian view of nosology has guided the DSM-5 revision process. The normative suppositions of the neo-Kraepelinian view remain largely implicit but, when made explicit, it becomes clear that they are contestable and lack proper justification. This chapter invokes the neo-Kantian philosophical work of Jurgen Habermas in order to address the normative issues at stake in nosology. Habermas establishes a procedural notion of normative validity that would safeguard normative issues in nosology from being resolved in an arbitrary or coercive manner. This procedural notion of normative validity clarifies the significance of integrating the perspectives of patients in order to determine what nosology should accomplish. The fact that normative issues form an essential part of nosology means that we should remain skeptical toward any claims for the validity of the science that ignore the normative dimension of the science while attending solely to empirical issues.


Normative Issue Illness Experience Normative Question Institutional Norm Normative Validity 
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  1. 1.
    Regier DA, Kuhl EA, Kupfer DJ, McNulty JP. Patient involvement in the development of DSM-5. Psychiatry. 2010;73(4):308–10.PubMedGoogle Scholar
  2. 2.
    Regier DA. Dimensional approaches to psychiatric classification: refining the research agenda for DSM-5: an introduction. Int J Methods Psychiatr Res. 2007;16 Suppl 1:S1–5. doi: 10.1002/mpr.209.PubMedCrossRefGoogle Scholar
  3. 3.
    Regier DA, Narrow WE, Kuhl EA, Kupfer DJ. The conceptual development of DSM-5. Am J Psychiatry. 2009;166(6):645–50.PubMedCrossRefGoogle Scholar
  4. 4.
    Decker HS. How Kraepelinian was Kraepelin? How Kraepelinian are the neo-­Kraepelinians?—from Emil Kraepelin to DSM-III. Hist Psychiatry. 2007;18(3):337–60. doi: 10.1177/0957154X07078976.PubMedCrossRefGoogle Scholar
  5. 5.
    Spitzer RL. Values and assumptions in the development of DSM-III and DSM-III-R: an ­insider’s perspective and a belated response to Sadler, Hulgus, and Agich’s “On values in recent American psychiatric classification”. J Nerv Ment Dis. 2001;189(6):351–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Robins E, Guze SB. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am J Psychiatry. 1970;126(7):983–7.PubMedGoogle Scholar
  7. 7.
    Murphy D. Philosophy of psychiatry. In: Zalta EN, editor. The stanford encyclopedia of ­philosophy fall 2010 edition. Available from:
  8. 8.
    Compton WM, Guze SB. The neo-Kraepelinian revolution in psychiatric diagnosis. Eur Arch Psychiatry Clin Neurosci. 1995;245:196–201.PubMedCrossRefGoogle Scholar
  9. 9.
    Kendell R, Jablensky A. Distinguishing between the validity and utility of psychiatric diagnoses. Am J Psychiatry. 2003;160(1):4–12.PubMedCrossRefGoogle Scholar
  10. 10.
    Jaspers K. General psychopathology [J. Hoenig and M.W. Hamilton, trans.]. Chicago: University of Chicago Press; 1963.Google Scholar
  11. 11.
    Ghaemi SN. Nosologomania: DSM & Karl Jaspers’ critique of Kraepelin. Philoso Ethics Humanit Med. 2009;4(10). doi: 10.1186/1747-5341-4-10.
  12. 12.
    Schwartz MA, Wiggins OP. Diagnosis and ideal types: a contribution to psychiatric classification. Compr Psychiatry. 1987;28(4):277–91.PubMedCrossRefGoogle Scholar
  13. 13.
    Zachar P. The practical kinds model as a pragmatist theory of classification. Philos Psychiatr Psychol. 2002;9(3):219–27.CrossRefGoogle Scholar
  14. 14.
    Lewis B. The biopsychosocial model and philosophic pragmatism: is George Engel a pragmatist? Philos Psychiatr Psychol. 2007;14(4):299–310.Google Scholar
  15. 15.
    Kendler KS. Explanatory models for psychiatric illness. Am J Psychiatry. 2008;165:695–702.PubMedCrossRefGoogle Scholar
  16. 16.
    Kendler KS. Toward a philosophical structure for psychiatry. Am J Psychiatry. 2005;162:433–40.PubMedCrossRefGoogle Scholar
  17. 17.
    Schaffner KF. Clinical and etiological psychiatric diagnoses: do causes count? In: Kendler JZ, editor. Descriptions & prescriptions: values, mental disorders, and the DSMs. Baltimore: The Johns Hopkins University Press; 2002. p. 271–90.Google Scholar
  18. 18.
    Kendler KS. Toward a scientific psychiatric nosology: strengths and limitations. Arch Gen Psychiatry. 1990;47:969–73.PubMedCrossRefGoogle Scholar
  19. 19.
    Insel T, Cuthbert B, Garvey M, Heinssen R, Pine DS, Quinn K, et al. Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry. 2010;167(7):748–51.PubMedCrossRefGoogle Scholar
  20. 20.
    Schwartz MA, Wiggins OP. The hegemony of the DSMs. In: Kendler JZ, editor. Descriptions & prescriptions: values, mental disorders, and the DSMs. Baltimore: The Johns Hopkins University Press; 2002. p. 199–209.Google Scholar
  21. 21.
    Rubin J. Political liberalism and values-based practice: processes above outcomes or rediscovering the priority of the right over the good. Philos Psychiatr Psychol. 2009;15:117–23.CrossRefGoogle Scholar
  22. 22.
    Baynes K. The normative grounds of social criticism: Kant, Rawls, and Habermas. Albany: State University of New York Press; 2002.Google Scholar
  23. 23.
    Kant I. Groundwork of the metaphysics of morals [M. Gregor trans. and ed.]. Cambridge: Cambridge University Press; 1998.Google Scholar
  24. 24.
    Habermas J. Moral consciousness and communicative action [C. Lenhardt and S.W. Nicholsen trans.]. Cambridge, Massachusetts: The MIT Press; 1990.Google Scholar
  25. 25.
    Rawls J. A theory of justice. Cambridge, MA: Harvard University Press; 1971.Google Scholar
  26. 26.
    Longino H. Science as social knowledge: values and objectivity in social inquiry. Princeton, NJ: Princeton University Press; 1990.Google Scholar
  27. 27.
    Faden RR, Beauchamp TL. A history and theory of informed consent. New York: Oxford University Press; 1986.Google Scholar
  28. 28.
    Beauchamp TL, McCullough LB. Medical ethics: the moral responsibilities of physicians. Englewood Cliffs, NJ: Prentice-Hall, Inc.; 1984.Google Scholar
  29. 29.
    Pellegrino ED, Thomasma DC. A philosophical basis of medical practice: toward a philosophy and ethic of the healing professions. New York: Oxford University Press; 1981.Google Scholar
  30. 30.
    Habermas J. Between facts and norms: contributions to a discourse theory of law and ­democracy [W. Rehg trans.]. Cambridge, Massachusetts: The MIT Press; 1996.Google Scholar
  31. 31.
    Kitcher P. Science, truth, and democracy. New York: Oxford University Press; 2001.CrossRefGoogle Scholar
  32. 32.
    Sadler JZ, Fulford B. Should patients and their families contribute to the DSM-5 process? Psychiatr Serv. 2004;55(2):133–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Habermas J. The inclusion of the other: studies in political theory. Cambridge, MA: The MIT Press; 1998.Google Scholar
  34. 34.
    Faulkner A, Thomas P. User-led research and evidence-based medicine. Br J Psychiatry. 2002;180:1–3.PubMedCrossRefGoogle Scholar
  35. 35.
    Hanley B, Truesdale A, King A, et al. Involving consumers in designing, conducting, and interpreting randomized controlled trials: questionnaire survey. BMJ. 2001;322:519–23.PubMedCrossRefGoogle Scholar
  36. 36.
    Perkins R. What constitutes success? The relative priority of service users’ and clinicians’ views of mental health services. Br J Psychiatry. 2001;179:9–10.PubMedCrossRefGoogle Scholar
  37. 37.
    Rose D. Collaborative research between users and professionals: peaks and pitfalls. Psychiatr Bull. 2003;27:404–6.CrossRefGoogle Scholar
  38. 38.
    Rose D. Having a diagnosis is a qualification for the job. BMJ. 2003;326:1331.PubMedCrossRefGoogle Scholar
  39. 39.
    Flanagan EH, Davidson L, Strauss JS. Issues for DSM-5: incorporating patients’ subjective experiences. Am J Psychiatry. 2007;164(3):391–2.PubMedCrossRefGoogle Scholar
  40. 40.
    Flanagan EH, Davidson L, Strauss JS. The need for patient-subjective data in the DSM and the ICD. Psychiatry. 2010;73(4):297–307.PubMedGoogle Scholar
  41. 41.
    Cuthbert B, Insel T. The data of diagnosis: new approaches to psychiatric classification. Psychiatry. 2010;73(4):311–4.PubMedGoogle Scholar

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© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Central City Behavioral Health CenterNew OrleansUSA

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