The Limits Of Classification

As classification aspires to 'carve nature at the joints', the empirical relationships between psychiatric symptoms create special difficulties of their own. In particular, symptoms are related non-reflexively: thus, some symptoms are common and others are rare, and, in general, they are hierarchically related, rather than being associated in a random manner. Rare symptoms often predict the presence of common symptoms, but common symptoms do not predict rare symptoms. Deeply (that is, 'pathologically') depressed mood is commonly associated with more prevalent symptoms, such as tension or worry, while, in most instances, tension and worry are not associated with depressed mood (Sturt, 1981). Likewise, depressive delusions are almost invariably associated with depressed mood, whereas most people with depressed mood do not have delusions of any kind. The consequence is that the presence of the rarer, more 'powerful' symptoms indicates a case with many other symptoms as well, and therefore a case that is more symptomatically severe. It is because of this set of empirical relationships between symptoms that psychiatric syndromes are themselves largely arranged hierarchically. Thus, schizophrenia is very often accompanied by affective symptoms, although these are not officially part of the syndrome. Likewise, psychotic depression is not distinguished from non-psychotic depression by having a completely different set of symptoms, but by having extra, discriminating, symptoms, such as depressive delusions and hallucinations.

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