A Metaphysics of Psychopathology

Peter Zachar’s A Metaphysics of Psychopathology is an extremely important book, dealing with the interlocking problems of classification in mental illness and the “reality” or “social construct” of mental illnesses. The book is a metaphysics because it addresses the underlying causes of why these two areas are indeed so problematic, and it includes a coherent philosophical critique. The “of Psychopathology” part of the title signals the author’s commitment to psychopathology as a real domain. Controversies attending successive editions of DSM, especially DSM-5, constitute a large part of the book. Beyond issues of classification, Zachar critically dissects the debates on the reality of multiple personality disorder, bereavement as a mental disorder, narcissistic personality disorder, and hysteria.

The book is difficult, despite clear and engaging writing. The reader must be prepared either with a good background in aspects of contemporary philosophy or with at least a willingness to wrestle with what will seem to be new and intricate arguments. Similarly, the reader would benefit from having a background in the history of “the myth of mental illness” controversies, and at least a willingness to follow the detailed arguments. But the result is rewarding—not so much for everyday clinical and programmatic work with seriously mentally ill patients—but for mental health practitioners who want to arrive at some pragmatic and sane view of the mental health professions. I say “pragmatic” because the author’s conception of psychiatric classifications as “imperfect communities”—that is, inherently imperfect categories—is quite helpful. I say “sane” because the ferocity of arguments professionally and in the larger culture about the reality of mental illness often reaches insane levels.

Zachar insists on a deep and ongoing dialogue about what we mean by “real”; there has been tremendous confusion and fuzziness of what we mean by “not real.” An excellent, accessible sample of Zachar’s work is a short 2012 article, coauthored with Kenneth Kendler, titled “The Removal of Pluto From the Class of Planets and Homosexuality From the Class of Psychiatric Disorders: A Comparison” (www.peh-med.com/content/7/1/4). The article delineates the cognitive and visceral or affective elements of classification wars in two very different professions. The objections to the removals in both instances involved arguments about exactly what is known and not known, the quality of evidence needed to adjudicate the disputes, and whether the so-called experts in both professions were qualified to serve as experts and involved accusations that people at the top were making the decision and not allowing the matter to be voted on by the membership.

Get to know Peter Zachar via this book.