Rejoinder--Assessing the Type and Severity of Psychological Problems: An Alternative to Diagnosis

Abstract

All three comments claim that we deny the reality of mental and emotional problems, even though Line 1, Paragraph 1 reads, Psychological problems are real, but are not entities. All three also equate assessment of a person's specific type of problem (depression, schizophrenia, phobia, paranoia) with categorical assessment. We think that both of these errors are encouraged by the traditional categorical concepts of medicine, in which symptoms are the manifestations of specific, unseen organisms or lesions. If psychiatric diagnoses are mythical entities, how can psychological problems be real? The answer is that depression, schizophrenia, paranoia, and the like are human attributes. As such they are just as real as height, weight, age, and a host of other attributes by which we characterize people. The myth, suggested strongly by medical language and concepts, is that the essential problem is the presence of an unseen thing which disturbs the normal functioning of the organism and thus produces the observable feelings, thoughts, and behaviors. Thus a word such as is not just a name for bizarre thoughts and behaviors. It is implicitly the name of the unseen thing believed to cause those bizarre thoughts and behaviors. Our view is that the thoughts and behaviors called schizophrenia (e.g., thought broadcasting, thought insertion, hearing voices) are real. They are also distinct in that they are