So Many Researchers Are SincerelyScientific about Factitious Fictions:Some Comments on the DSMClassification of Personality Disorders

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Alvin R. MahrerUniversity of Ottawa

Two comments/questions are flagged and discussed in response to anarticle by E. David Klonsky on the DSM classification of personality disor-ders: (a) What is a good way to arrive at the categories of the thing youwant to categorize? (b) Categorizing some thing has nothing to do withwhether the thing is real, but it is an exceedingly clever ploy. © 2000John Wiley & Sons, Inc. J Clin Psychol 56: 1623–1627, 2000.

Keywords: personality disorder; DSM; category systems

Comments Can Be Helpful and Useful, or Not Much at All

When Dr. Larry Beutler invited me to comment on Dr. David Klonsky’s article, which inturn was partly springboarded from my article on some embarrassing problems in thefield of psychotherapy (Mahrer, 1999), I was hesitant because I did not want to fall intosome easy traps. I did not want to quibble over irrelevant side issues, get into an uncon-structive argument, defend the virtue of my article, or try to diminish the value of Dr.Klonsky’s good work. Comments can so easily be unconstructively unhelpful.

The lofty reason I like to think I accepted the invitation was to clarify our respectivepositions and answers to a few basic issues and questions. However, I suspect that the realreasons I welcomed the invitation were (a) I was pleasantly surprised that at least twogood colleagues read my article, (b) I appreciate Dr. Beutler’s implied belief that con-structive commentaries on one another’s work can help advance our field, (c) how couldanyone resist an invitation capped by this well-crafted, irresistible line: “As always, Iappreciate your wisdom, and look forward to your paper.”!

Correspondence concerning this article should be sent to: Alvin R. Mahrer, School of Psychology, University ofOttawa, Ottawa, Canada K1N 6N5. E-mail: amahrer@uottawa.ca.

JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 56(12), 1623–1627 (2000)© 2000 John Wiley & Sons, Inc.

What Is a Good Way to Arrive at the Categoriesof the Thing You Want to Categorize?

Usually you start with the thing you want to categorize. Suppose that you start with athing called mental illness or disease or mental or personality disorder. Having startedwith that thing, you can then shift the attentional focus over to a different matter, animportant but secondary question: What is a good way to arrive at the categories, kinds,types of mental illnesses and diseases or, in Dr. Klonsky’s article, personality disorders?

First, he describes how the categories of personality disorders were arrived at in theDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; Amer-ican Psychiatric Association, 1994). Second, he shows how the current categories aregenerally judged as worthy or not, hold up or not, are to be subjected to critical analysis,are to be studied and researched, are to meet or fail to meet relevant criteria.

He then moves on to what is probably the main point. There is an alternative way ofarriving at the categories of personality disorders. The alternative way is defended andheralded as better, more sensible, more based on and generated from trustworthy empir-ical research, some of which has already been done, more of which could and should bedone. Tellingly, this alternative way seems to be yielding different categories of person-ality disorders compared to those in DSM-IV.

I have four comments about Dr. Klonsky’s carefully thought-out alternative proposalfor arriving at categories of personality disorders:

1. I believe it is exciting to have an alternative way of arriving at categories ofpersonality disorders. It is exciting that our field has good people who are search-ing for worthy alternatives to the established, generally accepted, standard way ofcategorizing things. It is exciting that our field has sufficient maturity to providesome welcomed room for serious alternatives to what the field generally takes forgranted.

2. I am impressed that Dr. Klonsky’s proposed alternative seems sufficiently worthyto warrant serious further work, development, and research as well as to warrantserious debate, discussion, and comparison with the current standard way of arriv-ing at categories of personality disorders.

3. Do you believe that there exists a set of categories of personality disorders thatare real, true, and veridical? Dr. Klonsky apparently does. So do most practition-ers, theoreticians, and researchers. If you do, then it makes solid sense to keepsearching and researching for the set of categories that comes closest to approx-imating the real, true, veridical categories of personality disorders that exist in thenatural true order of things.

4. I do not share a belief in the existence of a real, true, veridical set of categories ofpersonality disorders. In my own belief system (Mahrer, 1989, 1996), I prefer tojudge categories of some thing mainly on the basis of usefulness. Accordingly, Ido not judge alternative category systems on the basis of which is wrong, whichis right, or which provides the closest approximation to the categories that arepresumed to be real, true, and veridical. In my philosophy of science, alternativecategory systems can compete with one another or they can nicely coexist asfriendly alternatives depending on whether the alternative category systems arefor the same or for different uses, aims, and purposes. If they are for the same use,they compete. If they are for different uses, they can nicely coexist as friends.

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Categorizing Some Thing Has Nothing to Do with Whether the Thing Is Real,but It Is an Exceedingly Clever Ploy

Do you believe that there really are mental illnesses, mental diseases, personality disor-ders, that these things really and truly exist? You probably do if you believe, as Dr.Klonsky says, and so many others seem to accept, that there really and truly are “validconstructs that exist in nature” and that these include mental illnesses, mental diseases,and personality disorders.

If you do, then there are at least two exceedingly clever ways of preserving, entrench-ing, immunizing, and enhancing the belief that there really and truly are things likemental illnesses, mental diseases, and personality disorders.

One way is to steadfastly avoid direct and serious questioning of the thing itself. Donot subject the thing to scrutiny, to careful examination, to careful analysis. Do not allowothers to seek to see if the thing can be shown to be wrong, false, refuted (cf. Fuller, 1996;Popper, 1972a, 1972b, 1980). Do not attempt to scrutinize its logic, its scientific base, itsphilosophical base, its foundation. Instead, elevate the thing, for example, mental illness,mental disease, personality disorder, to the lofty status of an established truth, part of thecumulative body of knowledge, a foundational dictum, as a thing that is taken for granted,as one of the hallowed basic pillars on which the field rests. Protect the cherished thing byattacking those who dare to attack, to question, and especially those who have the effron-tery to let go of the cherished thing, who look for, find, and propose whole differentoutlooks, conceptual systems, and paradigm shifts that replace the cherished thing.

A second way of preserving, entrenching, immunizing, and enhancing some thing isto use the exceedingly clever ploy of categorizing it, concentrating on finding its kindsand types. You can effectively preserve, entrench, immunize, and enhance a thing calledmental illness, mental disease, personality disorder, by cleverly concentrating on estab-lishing its categories, its kinds, and types. Set researchers to work on the categories. Havetheoreticians theorize about the categories and propose alternative categories. Haveresearchers do research on the comparison of alternative category systems. Establishstandard nomenclatures of mental illnesses and diseases, and personality disorders. Haveprofessional committees endlessly debate, weigh, discuss, modify, and revise the stan-dard category systems of mental illnesses and diseases, and personality disorders. Havestudents learn the current category system. Make sure that practitioners and researchersuse the standard category system. Have virtually everyone actively wallowing in catego-ries of personality disorders. Without even knowing, virtually everyone is inadvertentlyswallowing the notion of personality disorder, inadvertently preserving, entrenching, immu-nizing, and enhancing the notion of personality disorder, and inadvertently apotheosizingpersonality disorder as a real thing.

The main point is that categorizing personality disorders has essentially nothing todo with showing that personality disorders are real, but the tactic is an exceedingly cleverploy. Done well, categorizing some thing goes a long way toward preserving, entrench-ing, immunizing, and enhancing whatever you are categorizing, whether the thing ispersonality disorders, mental illnesses and diseases, gods, devils, elves, or goblins. Fac-titious fictions are transformed into existing realities by the magic wand of categorizingthem. It seems sad that so many researchers are so sincerely scientific about categorizingfactitious fictions into existing realities.

What are some concluding beliefs about categorizing things such as personalitydisorders?

1. I believe it is better to avoid and to decline efforts, even sincerely scientificefforts, to categorize things like personality disorders and mental illnesses and

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diseases when categorization is a clever and effective ploy (a) to keep away fromand to prevent direct study of the factitious fiction that is categorized; and (b) topreserve, entrench, immunize, and enhance the factitious fiction as an existingreality.

2. In my experiential conceptual system, experiential practice, and discovery-oriented research, it is not at all useful to include things like personality disorderand mental illness and disease, either as real things or as fictitious constructs.Therefore, there is essentially no reason for me to get drawn into attempts atcategorizing things I find useless to begin with.

3. I do believe it can be useful to categorize things that are thought of as real, true,existing, and also things that are useful to invent, make up, or fictionalize. I do notthink of personality disorders as real, true, or existing; even if they were, I wouldnot categorize them because they are not useful in my experiential system. I dothink of personality disorders as invented fictions, fabricated constructs, but notat all useful in an experiential system, and therefore I do not categorize them.

4. In order to help advance the field of psychotherapy, I believe it is important toexamine, to scrutinize, and to be willing to modify, advance, or even let go of andreplace our foundational beliefs, taken-for-granted propositions, and fundamentalcore starting points (Mahrer, 1995a, 1995b, 1997, 1998) such as: (a) There aresuch things as mental illness, mental disease, personality disorder; (b) there aresuch things as categories, kinds, types of mental illness and disease, and person-ality disorder; (c) coming up with the categories of personality disorder and men-tal illness and disease shows that personality disorder, mental illness and diseaseare real, true, and veridical. I believe that the third is simply untrue, but that it isa clever, effective ploy to believe in the second, and that the second is a clever,effective ploy to believe in the first. Examine, but beware of, clever, effectiveploys.

5. The basic issues are still here: What is a good way to arrive at the categories ofthe thing you want to categorize? Does categorizing some thing really mean thatthe thing is real? Is categorizing some thing a clever, effective ploy in making thething seem real? In order for our field to advance, issues such as these deserveserious thinking and discussion. Please let me know what you think.

References

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders(4th ed.).Washington, DC: Author.

Fuller, S. (1996). Social epistemology and psychology. In W. O’Donohue & R.F. Kitchener (Eds.),The philosophy of psychology (pp. 33–49). London: Sage.

Mahrer, A.R. (1989). Experiencing: A humanistic theory of psychology and psychiatry. Ottawa:University of Ottawa Press.

Mahrer, A.R. (1995a). An introduction to some disposable myths, how to detect them, and a shortlist. Psychotherapy, 32, 484–488.

Mahrer, A.R. (1995b). A solution to an illusory problem: Clients construct their worlds versus therereally is a reality. Journal of Constructivist Psychology, 8, 327–338.

Mahrer, A.R. (1996). The complete guide to experiential psychotherapy. New York: Wiley.

Mahrer, A.R. (1997). What are the “breakthrough problems” in the field of psychotherapy? Psy-chotherapy, 34, 81–85.

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Mahrer, A.R. (1998). How can philosophy of science contribute to the advancement of psychother-apy? An introduction. Clinical Psychology: Science and Practice, 5, 229–232.

Mahrer, A.R. (1999). Embarrassing problems for the field of psychotherapy. Journal of ClinicalPsychology, 55, 1147–1156.

Popper, K.R. (1972a). Conjectures and refutations: The growth of scientific knowledge. New York:Harper & Row.

Popper, K.R. (1972b). Objective knowledge. Oxford: Oxford University Press.

Popper, K.R. (1980). The logic of scientific discovery. New York: Harper & Row.

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