Conceptual Errors Committed in the Name of Science
Science gives us powerful ways for understanding and changing the world. This power sadly makes it ripe for fraud and abuse. Fraudulent claims of progress are often obvious. Abuse of the conceptual models of science can be less self-evident. Most debates revolve around data and whether conclusions fit the evidence. Yet error and confusion can also emanate from the theoretical constructs of science.
Those of us in clinical practice stay abreast of treatment options and have dozens of journals to assess their empirical support. Yet concepts or theories are building blocks that get less attention than other aspects of our science. We need balance. Our concepts are a key aspect of our work. There are no scientific advances without theories along the way. A spotlight is needed on specific ways we might err.
Two examples worth study involve the biomedical model and how it works. This model rests on identifying diagnoses or syndromes with specific signs and symptoms. A disease is then formally identified when a biological source is found. This hopefully leads to biological solutions that ameliorate or cure the disease. This ideal is often not reached. Biological sources and solutions can be elusive.
The biomedical model is a way of understanding physical, generally biological or chemical, realities. Yet we can overextend or reify this way of thinking. For example, we can overextend it by taking the diagnostic classification process too far. We can reify it, or mistakenly treat abstract ideas as real things, by accepting scientific constructs as real entities rather than as concepts or approximations of reality.
Overextended: When metaphor becomes diagnosis
Psychologists have been leaders in promoting a common conceptual error. It is marked by an unwarranted extension of diagnostic classification that turns metaphor into diagnosis. Consider burnout and its metaphor of declining passion or energy for work. This real experience has been elevated to a clinical disorder. It overinflates the metaphor and overextends diagnostic thought.
Historian Jill Lepore has traced the history of this development to understand how burnout became a scientific issue. She notes that a 2020 study found ¾ of U.S. workers to be burned out. The WHO recognized burnout syndrome as an occupational phenomena but not a medical condition in 2019. It is vague, hard to distinguish from depression, and confusing in a few ways.
Burnout is a metaphor disguised as a diagnosis. It suffers from two confusions: the particular with the general, and the clinical with the vernacular. If burnout is universal and eternal, it’s meaningless. If everyone is burned out, and always has been, burnout is just…the hell of life. But if burnout is a problem of fairly recent vintage—if it began when it was named, in the early nineteen-seventies—then it raises a historical question. What started it? (page 27)
Burnout may be an historical artifact that has been nurtured by certain social conditions since the 1970s, but it is also an example of exuberant categorizing (which has gained popularity during that same time). The medical model cries out for new syndromes or diagnoses. This one seems to describe a remarkably large swath of society. Care to see how you score on the Maslach Burnout Inventory?
Reified: When syndromes are mistaken for real things
Classification systems created by psychiatry can suffer from abuse as well. Reification can occur when we mistake psychiatric syndromes or diagnoses for that which they were created to describe in some tentative way. Our conceptual categories are estimates of the thing itself. They are ways of clarifying a type of psychological distress. They are useful until we have clear biological origins or better categories.
This point is made clearly by Paul Summergrad, MD, the 2014 chair of the American Psychiatric Association. He notes that our classification systems are constructs imposed on real conditions. We revise our syndromes and diagnoses as we gather more knowledge about these real clinical phenomena. Problems begin when “operational constructs become reified as real, as valid.”
Our bind starts from needing reliable classification systems to know how treatment works with different patients. We are lost in the chaos of psychic distress without such systems. However, we lose clarity by viewing our systems as bits of reality rather than as intellectual schemas. Explain the complex, variable reality of depression to someone. Should they be told depression is merely what the DSM describes?
Waiting for biology
The biomedical model leads to profound discoveries and treatments. It can also lead to fiction when the model and its tentative, temporary ideas are taken as articles of faith. We must value the extraordinary results of the biomedical model but not overvalue what is produced each step along the way. For example, hypotheses are ideas to be proven, and good ideas are sometimes wrong.
Our field has many valuable biological treatments but no cures. Does eagerness for cures predispose us to such thinking errors? We need skepticism in approaching the latest syndrome, product idea or speculation on biological causality. While we need theoretical constructs, we must patiently await empirical discoveries and not overburden our concepts. Let us avoid errors in the name of science.
Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management
