Wakefield J C
Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ 08903, USA.
Behav Res Ther. 1997 Jul;35(7):651-65. doi: 10.1016/s0005-7967(97)00019-3.
In Part I (Wakefield, 1997, Behaviour Research and Therapy, 35, 633-649) of this two-article series, I used the harmful dysfunction analysis of the concept of disorder (Wakefield, 1992a, American Psychologist, 47, 373-388) to 'diagnose' a problem with DSM-IV. I argued that DSM-IV diagnostic criteria often violate the 'dysfunction' requirement by invalidity classifying harms not caused by dysfunctions as disorders. In Part II, I examine Eysenck's (Eysenck, 1986, Contemporary directions in psychopathology: Toward the DSM-IV) argument that DSM commits a 'categorical fallacy' and should be replaced by dimensional diagnoses based on Eysenckian personality traits. I argue that Eysenck's proposed diagnostic criteria violate the 'harm' requirement by invalidly classifying symptomless conditions as disorders. Eysenck commits an 'essentialist fallacy'; he misconstrues 'disorder' as an essentialist theoretical concept when in fact it is a hybrid theoretical-practical or 'cause-effect' concept. He thus ignores the harmful effects essential to disorder that are captured in DSM's symptom-based categories.
在这个两篇文章系列的第一部分(韦克菲尔德,1997年,《行为研究与治疗》,第35卷,第633 - 649页)中,我运用了对障碍概念的有害功能障碍分析(韦克菲尔德,1992a,《美国心理学家》,第47卷,第373 - 388页)来“诊断”《精神疾病诊断与统计手册》第四版(DSM-IV)存在的一个问题。我认为,DSM-IV的诊断标准常常违反“功能障碍”要求,将并非由功能障碍导致的伤害错误地归类为障碍。在第二部分中,我审视了艾森克(艾森克,1986年,《精神病理学的当代方向:迈向DSM-IV》)的观点,即DSM犯了“范畴错误”,应该被基于艾森克人格特质的维度诊断所取代。我认为,艾森克提出的诊断标准违反了“伤害”要求,将无症状状况错误地归类为障碍。艾森克犯了“本质主义错误”;他将“障碍”误解为一个本质主义的理论概念,而实际上它是一个理论与实践相结合的或“因果”的混合概念。因此,他忽略了DSM基于症状的类别中所体现的对障碍至关重要的有害影响。