A Myth in Creation

James Barnes is a psychotherapist, mental health advocate, and writer. He lives in Exeter in the UK. He is on twitter: @psychgeist52 Discussion Background This discussion started on Twitter in the context of the last blogpost in which Mark Ruffalo and Ron Pies discuss their views on psychiatric diagnoses and on the definition of “disorder”. James Barnes objected that a non-essentialist, pragmatic definition of disorder misses the entire point of the term “disorder” or “disease”, which for him is to discriminate an empirical object of/in the organism, as it does in the vast majority of cases of unquestioned physical disorders. I responded by saying it is possible to define disease/disorder is many different ways, that each definition has its internal logic, and each has pros and cons, and different implications. A common goal of most definitions is to try to capture the everyday use of this term in general medicine, but other definitions may not care for this goal.

The following are comments from Mark L. Ruffalo, D.Psa., L.C.S.W and Ronald W. Pies, M.D. in response to my previous blogpost: " Can Symptoms Be Caused by Descriptive Syndromes? An Analysis ". As a reminder, my blogpost was written in the context of an article by Ruffalo and Pies (" What Is Meant by a Psychiatric Diagnosis? ") that had been written in response to an article by Jonathan Shedler, Ph.D (" A Psychiatric Diagnosis Is Not a Disease "). Both these article were in  Psychology Today . I will post the comments from Ruffalo and Pies, followed by brief comments from me. COMMENTS FROM MARK RUFFALO AND RONALD PIES Dear Awais, Thank you for the opportunity to respond to your thoughtful comments on our article in  Psychology Today,  and on the broader—and very complex—issues we are all raising. Our position, roughly speaking, could be summed up in three basic principles: 1) Avoid definitional essentialism 2) Embrace clinical

In this post I want to examine the question of whether it makes sense to say that a patient’s anxiety is caused by ‘Generalized Anxiety Disorder’. Jonathan Shedler argues that it doesn’t. Mark Ruffalo and Ron Pies argue that it does . This is not a specific response to either, but simply a clarification of my own views. 1) The first thing I want to do is point to Hane Maung’s brilliant philosophical paper “ To what do psychiatric diagnoses refer? A two-dimensional semantic analysis of diagnostic terms ” (2016). Maung argues with great philosophical sophistication that reference of diagnostic terms in psychiatry can have two meanings or two intentions “ a diagnosis has a pre-theoretical mode of presentation that characterises the 1-intension, and an underlying structure that is discovered a posteriori and determines the 2-intension…. In the case of a diagnosis, the mode of presentation is the clinical manifestation and the underlying structure is the disease proce