Values, Disagreement, and Psychiatric Classification

DOI 10.36446/af.e1126 VALUES, DISAGREEMENT, AND PSYCHIATRIC CLASSIFICATION Valores, desacuerdo y clasificación psiquiátrica Yafeng Wang a https://orcid.org/0000-0003-2126-4278 Department of Philosophy and Religion, Northeastern University, Boston, United States of America. a Abstract It has been argued that non-epistemic values have legitimate roles to play in the classification of psychiatric disorders. Such a value-laden view on psychiatric classification raises questions about the extent to which expert disagreements over psychiatric classification are fueled by disagreements over value judgments and the extent to which these disagreements could be resolved. This paper addresses these questions by arguing for two theses. First, a major source of disagreements about psychiatric classification is factual and concerns what social consequences a classification decision will have. This type of disagreement can be addressed by empirical research, although obtaining and evaluating relevant empirical evidence often requires interdisciplinary collaboration. Second, there is also a type of disagreement over value judgments; namely, disagreements over which aims of psychiatric classification should be prioritized. To address this type of value disagreement, it is helpful to develop a plurality of different psychiatric classification systems, each targeted toward satisfying a different subset of stakeholder aims. Key words: Values; Value-Laden; Expert Disagreement; Value Conflict; Psychiatric Classification. Resumen Se ha argumentado que los valores no epistémicos tienen roles legítimos en la clasificación de los trastornos psiquiátricos. Esta visión acerca de los valores en la clasificación psiquiátrica plantea preguntas sobre hasta qué punto los desacuerdos entre expertos sobre la clasificación psiquiátrica están alimentados por desacuerdos en torno a valores y hasta qué punto estos desacuerdos podrían resolverse. Este artículo aborda estas preguntas argumentando dos tesis. Primero, una fuente importante de desacuerdos sobre la clasificación psiquiátrica es fáctica y concierne a las consecuencias sociales que tendrá dicha clasificación. Este tipo de desacuerdo puede afrontarse mediante investigación empírica, aunque obtener y evaluar evidencia empírica relevante a menudo requiere colaboración interdisciplinar. Segundo, también existe un tipo de desacuerdo sobre juicios de valor; a saber, desacuerdos sobre cuáles deberían ser los objetivos prioritarios de la clasificación psiquiátrica. Para abordar este tipo de desacuerdo en torno a valores ANÁLISIS FILOSÓFICO 45(1) - pISSN 0326-1301 - eISSN 1851-9636 - CC: BY-NC - (mayo 2025) 173-202 174 YAFENG WANG es útil desarrollar diferentes sistemas de clasificación psiquiátrica, cada uno dirigido a satisfacer un subconjunto diferente de objetivos de las partes involucradas. Palabras clave: Valores; Carga valorativa; Desacuerdo entre expertos; Conflicto de valores; Clasificación psiquiátrica. 1. Introduction Psychiatric classification, or the systematic classification of mental disorders, plays a major role in psychiatry. Classifying mental disorders helps clinicians identify, diagnose, and treat mental health disorders using appropriate therapies and medications. It also helps researchers by providing a shared language for studying the prevalence, nature, and causes of mental disorders. The most prominent systems of psychiatric classification, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association (APA) and the International Classification of Diseases (ICD) published by the World Health Organization (WHO), are used worldwide in epidemiological research, clinical practice, and policy decisions about public health. The development and revision of these major psychiatric classification systems have a profound impact on psychiatric research and practice. In recent decades, psychiatrists and philosophers have debated whether non-epistemic values1 have legitimate roles to play in psychiatric classification, i.e., whether psychiatric classification should be value-laden or value-free. One type of argument in support of the value-laden view could be called the “definition-based argument”. The basic idea is that the definitions and the diagnostic criteria of mental disorders should appeal to value concepts, hence the applications of these definitions and diagnostic criteria should involve value judgments. Another type of argument supporting the value-laden view could be called the “consequence-based argument”. The basic idea is that many decisions about psychiatric classification systems (e.g., proposing new disease categories, changing disease names, changing diagnostic criteria, lumping or splitting categories, and removing categories) have social consequences. Insofar 1 The distinction between epistemic and non-epistemic values has been important in discussions about the role of values in science. One way of drawing the distinction is to define epistemic values as those that promote the pursuit of truth, whereas nonepistemic values do not (Steel, 2009; Lusk & Elliott, 2022). Empirical adequacy, predictive accuracy, and logical consistency are examples of epistemic values. In contrast, ethical, social, political, economic, cultural, and aesthetic values fall under the umbrella of nonepistemic values. ANÁLISIS FILOSÓFICO 45(1) - (mayo 2025) VALUES, DISAGREEMENT, AND PSYCHIATRIC CLASSIFICATION 175 as these decisions are uncertain and cannot be determined by epistemic considerations2 alone, non-epistemic values should play a role in shaping these decisions. The value-laden view on psychiatric classification, however, raises questions about the nature of expert disagreements over psychiatric classification and the extent to which these disagreements can be resolved. The classification of psychiatric disorders is often controversial. For instance, regarding the DSM-5, the tightening of the definition of autism, the decision to classify severe bereavement as a type of major depression, and the introduction of internet gaming disorder are just a few examples of decisions that generated considerable controversy (Nemeroff et al., 2013; Horwitz, 2021). Moreover, it is far from clear that these controversies have been resolved to everyone’s satisfaction. Why does the classification of psychiatric disorders remain so controversial? Are the controversies over psychiatric classification fueled not only by disagreements over facts and evidence but also by disagreements over (non-epistemic) values? What should experts do about persistent disagreements over psychiatric classification, given how difficult it is to resolve certain non-epistemic value disagreements? This paper aims to make progress on these questions by arguing for two theses. First, a source of disagreements about psychiatric classification is factual and concerns what social consequences a classification decision (...truncated)