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Biomedical subjects

J C Wakefield

Publications and source records attributed to J C Wakefield.

At least 19 recordsLinked to original sources
PubMed2001

Evolutionary history versus current causal role in the definition of disorder: reply to McNally.

The harmful dysfunction (HD) analysis (Wakefield, American Psychologist 47 (1992a) 373) asserts that "disorder" means "harmful dysfunction", where "harm" is a value concept anchored in social values and "dysfunction" is a factual concept referring to failure of a mechanism to perform a natural function. Additionally, the HD analysis claims that a mechanism's natural functions are its naturally selected effects. McNally (Behaviour Research and Therapy (2000) pp. 309-314) argues to the contrary that "dysfunction" is a value concept referring to negative failures of function, that "function" refers to current causal roles and not evolutionarily designed causal roles, and that "disorder" consequently means "harmful failure of a mechanism to perform a valued current causal role." I reply by showing that McNally's proposals lack the HD analysis's power to explain common judgments about function, dysfunction, and disorder. "Dysfunction" cannot be a negative value concept because many dysfunctions are positive or neutral; "function" cannot refer to current causal roles because many current causal roles are not functions and some functions are not current causal roles; and "disorder" cannot refer to harmful failures of current causal roles because that definition allows almost any negative condition whatever to be a disorder and thus fails to explain the distinctions we make between disorder and non-disorder.

Adaptation, Psychological↗
PubMed2001

The myth of DSM's invention of new categories of disorder: Houts's diagnostic discontinuity thesis disconfirmed.

Houts (2001) argues that increases in DSM diagnostic categories are due to the invention of new disorders that are discontinuous with old conceptions of disorder and would not have been previously diagnosed. He maintains that DSM category increases are not comparable in nature to ICD category increases, which are mainly refinements of recognized disorders. I survey categories of disorder introduced after DSM-II and assess whether they are discontinuous with old concepts and categories of disorder. Candidate categories are identified from: Houts and Follette (1998), Mentalism, mechanisms, and medical analogues: Reply to Wakefield. Journal of Consulting and Clinical Psychology; Kutchins and Kirk (1997) Making us crazy: DSM: The psychiatric bible and the creation of mental disorders. New York: Free Press; and my own list. The result is that virtually none of the candidate categories are invented, discontinuous categories. In almost every case, the newly labeled conditions were considered disorders at the time of DSM-II and would have been diagnosed under DSM-II categories. I also reexamine DSM-IV sleep disorder categories, which Houts claims are discontinuous with past diagnostic conceptions. The result is that all DSM-IV sleep disorders were recognized as disorders at the time of DSM-II, and most were recognized as mental disorders. I conclude that DSM category increases are comparable in nature to ICD category increases, and that the invention-of-disorder account cannot explain the vast majority of such increases.

Diagnosis-Related Groups↗
PubMed2001

The analyst's knowledge and authority: a critique of the "new view" in psychoanalysis.

A critical assessment is presented of positions recently taken by Mitchell and Renik, who are taken as representatives of a "new view" in psychoanalysis. One article by Mitchell and two by Renik are examined as paradigmatic of certain ways of construing the nature of mind, the analyst's knowledge and authority, and the analytic process that are unduly influenced by the postmodern turn in psychoanalysis. Although "new view" theorists have made valid criticisms of traditional psychoanalytic theory and practice, they wind up taking untenable positions. Specifically called into question are their views on the relation between language and interpretation, on the one hand, and the mental contents of the patient on the other. A disjunction is noted between their discussion of clinical material and their conceptual stance, and their idiosyncratic redefinitions of truth and objectivity are criticized. Finally, a "humble realism" is suggested as the most appropriate philosophical position for psychoanalysts to adopt.

Humans↗
PubMed2000

Point-source modelling using matched case-control data.

We describe an extension to matched case-control studies of the parametric modelling framework developed by Diggle (1990) and Diggle and Rowlingson (1994) to investigate raised risk around putative sources of environmental pollution. We use a conditional likelihood approach for the family of risk functions considered in Diggle and Rowlingson (1994). We show that the likelihood surface that results from these models may be highly irregular, and provide a Bayesian analysis in which we investigate the posterior distribution using Markov chain Monte Carlo. An analysis of one-one matched data that were collected to investigate the relationship between respiratory disease and distance to roads in East London is presented.

Journal Article↗
PubMed1999

Philosophy of science and the progressiveness of the DSM's theory-neutral nosology: response to Follette and Houts, Part 1.

Follette and Houts [Follette, W. C., Houts, A. C. (1996). Models of scientific progress and the role of theory in taxonomy development: a case study of the DSM. Journal of Consulting and Clinical Psychology, 64, 1120-1132] argue on philosophy-of-science grounds that the DSM's theory-neutral nosology is scientifically unprogressive because of its growing number of categories and lack of a unifying explanatory theory. They suggested replacing the DSM by competing theory-laden diagnostic manuals. I argue: (1) the ways things can go wrong with the mind are inherently diverse, so a unified theory of mental disorders is unlikely; (2) the claim that an increase in categories is inconsistent with scientific progress is empirically false; (3) the claim that the DSM's new categories expand the domain of disorder is largely false; (4) progress in a theoretically fragmented field requires a shared theory-neutrally defined domain; (5) theory-neutral diagnosis and integration of etiological theories is preferable for now to competition among theory-based diagnostic manuals; (6) philosophy of science supports use of a theory-neutral nosology for now.

Humans↗
PubMed1999

The concept of disorder as a foundation for the DSM's theory-neutral nosology: response to Follette and Houts, Part 2.

Follette and Houts [Follette, W. C., Houts, A. C. (1996). Models of scientific progress and the role of theory in taxonomy development: a case study of the DSM. Journal of Consulting and Clinical Psychology, 64, 1120-1132] argue that 'mental disorder' and 'function' are value concepts that offer no scientific basis for the DSM's theory-neutral nosology or for distinguishing disorders from other behavioral problems. They also claim that the DSM presupposes a biological theory of etiology, thus is not really theory-neutral. They recommend replacing the DSM by theory-laden diagnostic manuals. I argue: (1) DSM criteria do not imply a biological model of disorder, (2) 'mental disorder' and 'function' have scientific content that allows one to distinguish disorder from nondisorder, (3) the evolutionary 'harmful dysfunction' analysis of disorder [Wakefield, J. C. (1992a). The concept of mental disorder: on the boundary between biological facts and social values. American Psychologist, 47, 373-388] coherently demarcates disorder from nondisorder, (4) the proposed behaviorist alternative to the DSM illustrated by the articles in Follette's special section [Follette, W. C. (Ed.) (1996a). Special section on the development of theoretically coherent alternatives to the DSM system. Journal of Consulting and Clinical Psychology, 64, 1117-1201] is incoherent because it does not distinguish disorder from nondisorder.

Humans↗
PubMed1999

Evolutionary versus prototype analyses of the concept of disorder.

The harmful dysfunction (HD) analysis of the concept of disorder (J. C. Wakefield, 1992a) holds that disorders are harmful failures of internal mechanisms to perform their naturally selected functions. S. O. Lilienfeld and L. Marino (1995) proposed instead that disorder is a Roschian prototype concept without defining properties. Against the HD analysis, they argued that many disorders are not failures of naturally selected functions because they are either designed reactions (e.g., fever) or failures of functions that are not naturally selected (e.g., reading disorder). The HD analysis is defended here against these and other objections and compared with the Roschian account. It is argued that the objections are based on conceptual confusions and can be turned around to provide strong new support for the HD analysis. A series of conceptual experiments demonstrates the superior explanatory power of the HD analysis and disconfirms the Roschian account.

Biological Evolution↗
PubMed1999

Mental disorder as a black box essentialist concept.

This is a reply to commentaries on the target article (J. C. Wakefield, 1999) on the evolutionary foundations of the concept of mental disorder in defense of the harmful dysfunction analysis (HDA) of disorder. The author argues that the HDA is adequate to explain disorder and nondisorder judgments and is not disconfirmed by any of the claimed counterexamples put forward by the commentators; the commentators' proposed alternatives to the HDA are inadequate to explain disorder and nondisorder judgments; and the concept of natural function is a factual, scientific concept, contrary to K. W. M. Fulford's (1999) claim that it is inherently evaluative. The foundations of the HDA are clarified by providing a black box essentialist analysis (H. Putnam, 1975; J. C. Wakefield, 1997, in press) of the concept of natural function that underlies the concept of disorder.

Biological Evolution↗
PubMed1999

DSM-IV diagnostic criterion for clinical significance: does it help solve the false positives problem?

OBJECTIVE: A major change in DSM-IV is the inclusion in almost one-half of the diagnostic criteria sets of a clinical significance criterion, which requires that symptoms cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning." In response to concerns that the DSM criteria are overly inclusive, the clinical significance criterion attempts to minimize false positive diagnoses in situations in which the symptom criteria do not necessarily indicate pathology. This article examines whether the clinical significance criterion achieves its purpose and considers its broader impact on diagnostic validity. METHOD: The effect of the clinical significance criterion on the diagnostic validity of DSM-IV criteria for a wide range of disorders was examined. RESULTS: For many diagnoses to which the clinical significance criterion was added, the symptom criteria are inherently associated with significant impairment, so the clinical significance criterion is redundant and therefore does not affect caseness. For some diagnoses, the clinical significance criterion is potentially helpful in eliminating false positives by elevating the level of required distress. However, there may be advantages to obtaining the same results by modifying some of the symptom criteria. Often the clinical significance criterion has led to the possibility of false negative diagnoses. CONCLUSIONS: In the process of revising DSM-IV, the generic use of the clinical significance criterion should be reconsidered. For each DSM diagnosis, it should be determined whether there is a need to raise the threshold of any of the existing symptom criteria or to add a criterion that excludes normal reactions to psychosocial stress.

False Negative Reactions↗
PubMed1999

The Bayesian analysis of a pivotal pharmacokinetic study.

The aim of this paper is to carry out a detailed Bayesian population pharmacokinetic analysis of a three-period cross-over study of the drug fluticasone propionate carried out in 12 healthy male volunteers. The study was carried out to characterize the pharmacokinetics of the drug, in particular to investigate dose proportionality. We examine the appropriateness of modelling assumptions via a variety of diagnostic techniques. We also examine the effect of deleting time points at which the concentration was recorded as below the limit of quantification, as opposed to including these points as censored observations. We assess dose proportionality before carrying out a final combined analysis of data from all three doses.

Adult↗
PubMed1998

Adaptations, exaptations, and spandrels.

Adaptation and natural selection are central concepts in the emerging science of evolutionary psychology. Natural selection is the only known causal process capable of producing complex functional organic mechanisms. These adaptations, along with their incidental by-products and a residue of noise, comprise all forms of life. Recently, S. J. Gould (1991) proposed that exaptations and spandrels may be more important than adaptations for evolutionary psychology. These refer to features that did not originally arise for their current use but rather were co-opted for new purposes. He suggested that many important phenomena--such as art, language, commerce, and war--although evolutionary in origin, are incidental spandrels of the large human brain. The authors outline the conceptual and evidentiary standards that apply to adaptations, exaptations, and spandrels and discuss the relative utility of these concepts for psychological science.

Adaptation, Physiological↗
PubMed1998

The DSM's theory-neutral nosology is scientifically progressive: response to Follette and Houts (1996).

W. C. Follette and A. C. Houts (1996) argued on philosophy-of-science grounds that the Diagnostic and Statistical Manual of Mental Disorders (DSM) is scientifically unprogressive and should be replaced by competing theory-laden manuals. The author responds to their various arguments as follows: (a) The ways things can go wrong with the mind are inherently diverse, so failure to reduce the DSM's categories to 1 parsimonious theory is not necessarily scientifically unprogressive; (b) it is empirically untrue that growth in the number of a taxonomy's categories is inconsistent with scientific progress; (c) progress in theoretically fragmented fields requires shared theory-neutral categories, not theory-laden definitions of basic concepts; (d) at present in the mental health field, theoretical integration is scientifically more progressive than competition, and integration is promoted by the DSM's theory-neutral nosology; and (e) Follette and Houts's proposed behaviorist alternative to the DSM is incoherent.

Humans↗
PubMed1997

Diagnosing DSM-IV--Part I: DSM-IV and the concept of disorder.

In this first article in a two-article series, I diagnose' a problem with DSM-IV, specifically, the overinclusiveness of its diagnostic criteria. Using the harmful dysfunction analysis of the concept of disorder (Wakefield, 1992a, American Psychologist, 47, 373-388) as a framework, I argue that DSM-IV criteria for many diagnostic categories fail to satisfy the analysis' dysfunction' requirement, that is, the criteria do not distinguish harmful conditions due to internal dysfunctions from harmful conditions that are nondisordered 'problems in living'. The overinclusiveness problem, I suggest, can be partly dealt with by giving up purely symptomatic criteria and contextualizing diagnosis to take into account the relationship between triggering causes and resulting symptoms. In Part II (Wakefield, 1997, Behaviour Research and Therapy, 35, 651-665, I examine Eysenck's (1986, Contemporary directions in psychopathology: Toward the DSM-IV) proposal for a dimensional diagnostic system to supplant DSM-IV.

Humans↗
PubMed1997

Diagnosing DSM-IV--Part II: Eysenck (1986) and the essentialist fallacy.

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.

Humans↗
PubMed1997

When is development disordered? Developmental psychopathology and the harmful dysfunction analysis of mental disorder.

One goal of developmental psychopathology is to understand the origins and course of mental disorders. I argue that pursuit of this goal requires a valid conceptual understanding of disorder and that this understanding can be provided by the "harmful dysfunction" analysis of the concept of disorder. The harmful dysfunction analysis holds that a disorder is a condition that is both harmful according to social values and caused by an internal dysfunction, that is, by a failure of an internal mechanism to perform a function for which it was naturally selected. This analysis explains why many of the distinctive features of developmental psychopathology are appropriate to the study of disorder. It is argued that the harmful dysfunction analysis is a necessary supplement to other proposed criteria for disorder, such as developmental deviation or predictive validity.

Adolescent↗
PubMed1997

Modeling of trough plasma bismuth concentrations.

Disposition pharmacokinetics of bismuth following oral dosing of ranitidine bismuth citrate are complicated and variable. An analysis of data from healthy volunteers suggests a model with three disposition compartments and first-order absorption. Patient data are pooled from 10 separate studies and consist of 1140 trough concentrations measured in 802 patients following dosing of 2 to 12 weeks duration. There are therefore insufficient data to obtain reliable parameter estimates for the full model and we use instead a much reduced model and an informative prior based on the volunteer data. Individual parameter estimates from this model can then be used to establish covariate relationships. Trough concentrations were influenced by the coadministration of clarithromycin and by creatinine clearance. A simulation study was carried out to check the validity of the estimates obtained from the reduced model. We carry out analysis via Bayesian sampling-based techniques. Throughout, we use predictive distributions for both diagnostic and inference purposes. In particular, we determine predicted distributions for the Cmax, Cmin and AUC characteristics of new individuals.

Bayes Theorem↗
PubMed1996

A comparison of a Bayesian population method with two methods as implemented in commercially available software.

In this paper we describe and discuss three specific estimation procedures that are available within commercially available population software packages. The first version of NONMEM (l) was released in 1979 and later versions are the standard analysis tools in both industry and academia. Recently, two commercially available pieces of software have become available. PPHARM was released during 1994 and POPKAN was released in 1995. We provide descriptions and critique the FOCE method within NONMEM, the two-step algorithm within PPHARM and the Markov chain Monte Carlo method that is utilized by POPKAN. We use simulated data generated from a monoexponential model to evaluate the parameter estimation capabilities of these methods within the three software tools. In particular we investigate the effect on parameter estimation of increasing both interindividual and intraindividual variability.

Bayes Theorem↗