The Dot-Matrix Star Galaxy of the Mind

Upon reading Persons (1986) and Widiger & Clark (2000), I was thoroughly disgruntled and disappointed with the misdirection and falsehoods that seem to be created as a result of using “clinical expertise” and intuition to diagnose clinical disorders in the DSM-IV-TR. Persons (1986) is right: we need to focus on individual features and phenomena, and not let language, and thus laziness, define how we approach research. Yes, it is convenient to save money by using schizophrenia to shed light on aspects of thought disorder, but it’s also just plain misguided. Widiger & Clark (2000) also seemed to hit it right-on when they proposed that the future DSM-V “consist of an ordered matrix of symptom-cluster dimensions, a diagnostic table of the elements that are used in combinations to describe the rich variety of human psychopathology.” Upon reading this, I pictured myself floating through a three-dimensional dot-matrix star galaxy of human psychological traits, a diagnostic utopia where I can hover in a certain dimension, put my hand out, and touch the cloud-like area where people lean toward borderline traits or generalized anxiety.

Regardless of how we come to conclusions about diagnoses, it seems clear that the entire concept of mental disorder is rather fudgey at best. Even the craziest of psychopaths might be considered questionably sane, if one really takes the DSM-IV’s classification seriously, as they are not distressed or impaired. The diagnosis of psychopathy, judging from the Psychopathy Checklist-Revised, sets half of its diagnostic criteria on a “conflict between that individual and society,” despite the DSM-IV’s goal to “prevent the misuse of diagnostic labels for the purpose of social control” (Allen, 1998). Though truthfully, there is evidence that psychopaths have it good, as unemotional traits found in psychopaths low in fear correlate negatively with internalizing psychopathology (Blonigen, Hicks, Krueger, Patrick, & Iacono, 2005), and some say that these unemotional personality traits may point to more positive outcomes in cognitive and psychosocial functioning (Hall et al., 2006), and resilience against depression and anxiety (Benning, Patrick, Hicks, Blonigen, & Krueger, 2003). This would be an argument for a more symptom-oriented approach, as such interesting correlations with low-fear personalities are probably not unique to people like Jeffery Dahmer – they might reside in “normal” individuals as protective factors, and would be overlooked in a diagnostic system that only looks at conditions arbitrarily labeled “disorders.”