Dissertations, Theses, and Capstone Projects

Date of Degree


Document Type


Degree Name





John Greenwood

Committee Members

Eric Mandelbaum

Justin Garson

Gary Ostertag

Subject Categories

Bioethics and Medical Ethics | Diagnosis | Disease Modeling | Medical Humanities | Mental Disorders | Other Mental and Social Health | Pathological Conditions, Signs and Symptoms | Philosophy of Science | Psychiatry


Psychiatric Nosology, Diagnostic Validity, Psychiatric Classification, Psychiatric Taxonomy, Medical Ethics, Bioethics


In this dissertation, I argue that the discussion surrounding the role of values in the conceptualization of mental disorders is reproduced in critical debates surrounding the issue of reliability and validity in a psychiatric nosology. In so doing, I oppose the conventional separation of the demarcation problem and the crisis of validity in psychiatric classification, arguing instead that they are inextricably linked. After drawing out the intersection between these literatures in the conceptual history of the DSM and its much-maligned transition to an etiologically neutral taxonomy of mental disorders, I consider Carl Hempel’s proposed conciliation between descriptive and theoretical systematization in psychiatric science through operational definitions. Foregrounding the conflation of reliability with construct validity, I then show what the received view has fundamentally mischaracterized about Hempel’s recommendations for psychiatric taxonomy and what Hempel himself overlooked about the dependency of operational definitions on antecedently understood terms. I characterize the normative force of these stipulated, ostensive terms as an inescapable barrier to the empiricist paradigm that has dominated psychiatric classification and argue that the tacit flavor of disvalue these terms express derives at least in part from the porousness of the boundary condition between descriptive and evaluative statements and their enjoinment in the conceptual architecture of psychiatric nosology. Against the backdrop of the biological turn in medical psychiatry (encapsulated by the reign of psychopharmacology and superseded by the precision turn), I gesture towards some ongoing logical and methodological issues which the confusions surrounding diagnostic validity has led to. Finally, I conclude by pointing towards the implications that follow from accepting the role of normative deliberation in diagnostic boundary drawing in which we attempt to negotiate the imperative of treatment, the preponderance of harm, and the etiological basis of psychiatric disorders.

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