Measuring Mental Disorders

Psychiatry, Science and Society

Philippe Le Moigne

• Publisher: ISTE Press - Elsevier
• Year: 2018
• Print ISBN: 9781785483059
• eBook ISBN: 9780128172520
• Topic: Medicine
• Subtopic: Pharmaceutical, Biotechnology & Healthcare Industry

This book is a collective work draws on the perspective of social sciences, mobilizing perspectives from the sociology of science, the history of psychiatry, medical ethnography and public policy analysis. This initiative, which has no precedent in social sciences, is surrounded by an original, if not apparently paradoxical statement: considering that the deployment of these processes, strictly formal and depersonalized, is justified in becoming the rule in a society known as "individuals".- Presents the measurement of mental disorders (tests / scales) across the various sectors- Determines the underpinning of this measure and its performance- Explains the rise of these tests and its success- Understands its impact on users

Part 1

Basic Principles: Strengths and Limitations of Psychiatric Assessment Tools

Introduction to Part 1

This first part seeks, first and foremost, to question the principle underlying psychiatric assessments. This questioning is carried out using the specific case of the evaluation of depression, given that this constituted the first laboratory of contemporary psychiatric assessment. The two chapters in this section travel down two different paths but arrive at the same observation: namely, that it is important to distinguish between the organizing properties of the assessment and what it can yield, both epistemologically and clinically. In the first case, we must emphasize the strength of the assessment through its ability to structure entire fields of research. In the second case, we must highlight the weaknesses of its construction, especially with respect to its validation and the picture of the mental disorder, succinct to say the least, given by the scales.

The first of these two texts attempts to retrace the genesis and the diffusion of depression as an entity in research from the 1950s onwards using historical analysis. This historical perspective makes it possible to provide the background for an evaluation in the contradictory setting with, on the one hand, a clinical practice that was assailed by the question of subjectivity (of its data, its knowledge and its practices) and, on the other hand, the research on the hypothesis of a completely biological determinant for the diagnosis. This background helped promote the development of a categorization of depressive problems that could be laid out in a formal and numerical objectivity, based on psychometry and taxonomy, and which would give rise to the development of particularly regulatory measurement equipment using a series of arbitrations and a new codification of proofs. This production would make it possible to reconcile the tools of psychology and psychiatry, establishing the scope and function of scales and tests that were born out of these two rival traditions. These scales were then used and submitted to the verdict of the clinicians themselves: the search for a sufficiently convergent diagnosis, duly ratified by a new statistical test (Cohen’s kappa), thus allowed the affirmation of a unitary psychiatric judgement based on a criterion known as “consensual”. This perspective would allow the set of instruments created to establish a consistent definition of depression, which could be shared across disciplines, starting with biology and pharmacology. The circulation of the object that was thus created through standardized evaluation would then contribute, through a reinforcing effect, to bolstering the reputation of the scales, with the results of biological and psychopharmacological research being integrated as supports for the construction and validation of these tools.

As a result of these developments, the articles discussing these instruments would necessarily become references so that they featured among the most often cited publications across all scientific disciplines between 1960 and 1980. However, was the evidence used to create this new nomenclature of mental pathology truly convincing? As the first text seeks to demonstrate, the ratification methods used for the scales are built on a reciprocal delegation of evidence between the different disciplines mobilized by its knowledge, and the risk here is that it is always possible to postpone, in this delegation system, the production of a fact that could validate the psychiatric categorization.

Xavier Briffault takes this investigation further by applying his analysis to the internal organization of the scales using an exemplary case: the Hamilton Rating Scale for Depression. This second text returns to a simple fact (which was also indicated by the initial producers of these instruments but which has since often been omitted): to measure is to define. Starting from this principle, Xavier Briffault returns to the implicit definition of depression, which the Hamilton scale helped to some extent to diffuse not only in research but also among health authorities, from 1960 onwards. He shows, in particular, how the tool is centered on the idea of the uniformity of the depression disorder: uniformity, first of all, in the sense that this measurement, designed using an overall score, reduces the characterization of the depression to the indistinct sum of the different symptoms, without ever investigating the possible interactions they may have with each other; further, uniformity in the sense that the depression here is assumed to arise from a universal manifestation that is insensible to any local variation, hypothesizing that this homogeneity in form responded to a cause that was itself unique and most probably biological; and, finally, uniformity in the sense that this scale, based on an overall rating, does not enable us to go beyond a generic diagnosis of the syndrome, proscribing, right there, any readings of interindividual variations of the disorder that might shed light on the clinical aspects of the particularities of depression that each patient experiences.

Models that are capable of presenting the interaction of symptoms, or the particular manner in which these symptoms affect each patient, do exist today. These models are founded on the principle that symptoms are organized into a network and they are based on a sufficiently rich inventory of risk factors, such that it becomes possible, in all probability, to understand why and through what processes the depressive syndrome came about in the unique form with which it presents in each individual. Nonetheless, as Xavier Briffault emphasizes, the finesse and pertinence of these models, both in logical as well as clinical terms, is undone by the fact that evidence-based medicine prevails in the organization of all research today. From this point of view, the Hamilton scale, like most psychiatric assessment tools, is indeed a product left over from a world that today seems outdated but, for all that, it continues to dominate research because of its structuring force.

1

The Spread of Psychiatric Nosography into Science: Origins and Issues of the Research on Depression (1950–1985)

Philippe Le Moigne

Abstract

The problem of the social differentiation of the scientific field implied the resolution of two questions: first, that of its autonomy with respect to its environment; second, its internal unity. In the sociology of science, one of the avenues opened up by Terry Shinn focused on instrumentation and the role played by this in different production and diffusion regimes in science. In one of these regimes, which Shinn calls “transversal”, researchers dedicate themselves specifically to developing instrumental concepts or technical matrices, which can then be used by universities, industry, large-scale assessment centers or the military sector. These technologies may be called “generic” inasmuch as they constitute “basic” concepts, using which it is possible to create different instruments, depending on the purpose of each specific research project. Automatic control systems, ultracentrifuges, Fourier-transform infrared spectroscopy and LASER or microprocessors are all included in this particular category of instruments.

Keywords

Arbitration; Clinical evaluation; Constructivism; Cosography; Depression; Hypothesis; Iproniazid; Noradrenaline; Pathology; Psychometry

The problem of the social differentiation of the scientific field implied the resolution of two questions: first, that of its autonomy with respect to its environment; second, its internal unity. In the sociology of science, one of the avenues opened up by Terry Shinn focused on instrumentation and the role played by this in different production and diffusion regimes in science (Shinn 2000; Shinn and Ragouet 2005). In one of these regimes, which Shinn calls “transversal”, researchers dedicate themselves specifically to developing instrumental concepts or technical matrices, which can then be used by universities, industry, large-scale assessment centers or the military sector. These technologies may be called “generic” inasmuch as they constitute “basic” concepts, using which it is possible to create different instruments, depending on the purpose of each specific research project. Automatic control systems, ultracentrifuges, Fourier-transform infrared spectroscopy and LASER or microprocessors are all included in this particular category of instruments (Shinn 2000).

The generic nature of these basic instruments is an inbuilt feature. This is because they were specifically built by individuals who wanted to ensure that their creations would be modulable and adaptable. In effect, “technical-instrumental” researchers do not belong to any one discipline or employer: they constantly shift between institutions and, as a result, are endowed with a highly diversified relational capital including research practitioners, administrators and engineers from very different specializations. These researchers evolve within what Shinn calls “interstitiality” and are forced to be mobile for two reasons: (1) The development of generic instruments requires the mobilization of knowledge and information that are not restricted to any one disciplinary space; (2) the diffusion of a generic instrument requires that these researchers advise practitioners so that they are able to appropriate the fundamental principles of these generic technologies and adapt them to their own needs (Shinn 2000).

Shinn believes that generic instruments thus play an essential role in the unification of the field of science and the movements of intellectual convergence. Through the mobilization and application of the generic component of a given instrument across a large number of spaces whose needs are quite varied, the modes of action and the manner of perceiving and judging are shared. A sort of pan-community lingua franca emerges, which allows all the groups brought together to speak a common language. Thus, the robustness of an instrument becomes patently clear when several practitioners from different fields obtain stable and durable results using this instrument. The universal nature of this “instrumental knowledge” would, thus, be in accordance with the relevance that is attributed to it in an independent manner within several fields and, therefore, according to Shinn (2000), it can be compared to a form of “practical universality”.

The double role of the unific...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Introduction: Instruments and Subjects: Individuality and Its Rules
• Part 1: Basic Principles: Strengths and Limitationsof Psychiatric Assessment Tools
• Part 2: Developments: Chronicles of Successful Tests
• Part 3: Uses: the Tests in Context
• Conclusion
• List of Authors
• Index