"The Prospects of General Psychiatry" Kathryn Tabb (Bard College)

Abstract--Since its inception, the Diagnostic and Statistical Manual of Mental Disorders (DSM) has regularly swung between two methodological commitments: validity and reliability. When seeking validity, its editors prioritize changes that improve the accuracy of the manual’s constructs. This is often accompanied by an enthusiasm for mechanistic models of disorder over a reliance on signs and symptoms. When reliability is prioritized, the focus is on making sure that the manual’s constructs allow clinicians to give the same diagnosis to similar patients (test-retest reliability), and different clinicians to make the same diagnoses (inter-rater reliability). Reliability and validity are both prized as ways to increase the predictive power of psychiatric categories. But in recent years, a consensus has formed in favor of validity as the commitment that should be prioritized. The turn toward “precision psychiatry” emerged in large part because of a breakdown of confidence in the predictive power of the DSM’s categories, and the virtue of precision is often equated with the pursuit of validity. In this talk I argue that insofar as psychiatric research is a zero-sum game, with clinical and translational studies typically competing for the same funding, validity can come at the cost of reliability. I suggest that insofar as the methods of precision psychiatry are in the service of validity, "generalism" should be introduced as an epistemic virtue embodying an alternative approach to psychiatry that maximizes reliability. I conclude by making the case on ethical grounds that psychiatry should move away from celebrating precision as an epistemic virtue, and instead embrace generalism. 

Speaker Biography

 Kathryn Tabb has degrees in the History and Philosophy of Science from the Universities of Chicago, Cambridge, and Pittsburgh, as well as a masters in Bioethics and Health Law. Her work focuses on the history and philosophy psychopathology, with interests spanning irrationality and madness in the early modern period, contemporary debates about psychiatric nosology and precision psychology, and debates in moral psychology regarding essentialism and moral responsibility. She is currently completing a monograph on John Locke's accounts of madness and sanity.