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Epistemic and Nonepistemic Values in Psychiatric Explanation and Classification

Kostko, Aaron

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2014, PhD, University of Cincinnati, Arts and Sciences: Philosophy.
My dissertation addresses two longstanding debates in the philosophy of psychiatry: the debate between objectivists and evaluativists regarding the relative significance of factual descriptions and evaluative judgments in attributions of psychiatric disorder and the debate between reductionists and pluralists over whether explanations of psychiatric disorders should proceed at a single level or multiple levels of explanation. The standard way to distinguish philosophical accounts of psychiatric disorder is in terms of the relative significance they grant to factual descriptions of abnormal functioning and evaluative judgments of this abnormal functioning. I argue that this way of categorizing philosophical accounts is overly simplistic and that a more fruitful approach is to focus on the role of epistemic and nonepistemic evaluative judgments in the contexts of psychiatric diagnosis, classification, and research. Using debates regarding the diagnostic criteria for diagnoses of Bipolar Disorder, I highlight the interaction between epistemic and nonepistemic value judgments and argue that the latter play a legitimate role in decisions regarding the relative risks of false positive and false negative diagnoses and whether to draw an inference quickly or wait for further evidence to reduce uncertainties. I show how this approach provides for a more straightforward comparison of the various accounts of psychiatric disorder by making explicit the role and type of evaluative judgments that are either ignored or often tacitly assumed by each account. The second half of my dissertation focuses on the debate between reductionists and pluralists. I outline and evaluate five specific reductionist theses within the philosophy of psychiatry literature: 1) ontological reductionism, 2) eliminative reductionism, 3) methodological reductionism, 4) epistemological reductionism, and 5) causal reductionism. I argue that eliminative, epistemological, and causal reductionism will likely not be borne out by the empirical evidence and that only ontological reductionism, characterized as a general commitment to physicalism, and methodological reductionism are consistent with the current evidence and explanatory aims of psychiatry. I then consider why reductionism has received so much attention and criticism despite the fact that there is no author who explicitly defends the view. I attribute this focus on reductionism to recent proposals to synthesize psychiatry with neuroscience. However, I argue that these proposals advocate nothing more than a general commitment to physicalism and a localized version of methodological reductionism and, therefore, that concerns about reductionist trends in psychiatry and the alleged harms associated with such trends are unwarranted. Pragmatism and pluralism are often defended as alternatives to reductionism in psychiatry. I examine three proposals for incorporating pragmatism into psychiatry and argue that they all fail to provide specific guidance as to how pragmatic considerations should influence decisions regarding psychiatric diagnosis and classification. I then examine proposals for incorporating empirically based pluralism and explanatory pluralism into psychiatry and argue that each view fails to fully address the problem of how to determine the relative explanatory significance of various levels of explanation. I argue that one can only address these shortcomings if one acknowledges a role of nonepistemic value judgments and that the inclusion of such judgments is the inevitable consequence of recognizing the complexity of psychiatric disorders and the provisional nature of psychiatric classification and explanation.
Valerie Hardcastle, Ph.D. (Committee Chair)
John Bickle, Ph.D. (Committee Member)
Thomas Polger, Ph.D. (Committee Member)
Robert Richardson, Ph.D. (Committee Member)
198 p.

Recommended Citations

Citations

  • Kostko, A. (2014). Epistemic and Nonepistemic Values in Psychiatric Explanation and Classification [Doctoral dissertation, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396522414

    APA Style (7th edition)

  • Kostko, Aaron. Epistemic and Nonepistemic Values in Psychiatric Explanation and Classification. 2014. University of Cincinnati, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396522414.

    MLA Style (8th edition)

  • Kostko, Aaron. "Epistemic and Nonepistemic Values in Psychiatric Explanation and Classification." Doctoral dissertation, University of Cincinnati, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396522414

    Chicago Manual of Style (17th edition)