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Science as instrumentation. The case for psychiatric rating scales

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Abstract

The aim of this article is to test the model analysis conceived by Terry Shinn on the autonomy and unity of science. For him, the differentiation of sciences can be explained in a large part by the diffusion of generic instruments created by research-technologists moving in interstitial arenas between higher education, industry, statistics institutes or the military. We have applied this analysis to research on depression by making the hypothesis that psychiatric rating scales could have played a similar role in the development of this scientific field. To that purpose, we proceeded to a lexicographic study of keywords mentioned in articles listed by the PsycINFO© data base on this subject between 1950 and 2000. In order to realize an associated words analysis, we constructed a co-occurrence matrix and used clustering analysis based on a grouping index; that is, the equivalency index. We obtained significant aggregates of keywords associated with significant periods, or major moments, of the development of research on depression. This periodization confirmed the structural role played by psychiatric rating scales in the development of this scientific field, and led us to discuss and to extend some elements of the model initiated by Shinn.

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Notes

  1. We used Sphinx Lexica© software because of its qualitative analysis module and its efficient recoding procedures.

  2. The DSM-III and the RDC made use of the Feighner Criteria, the diagnostic inventory developed in 1972 by the Saint Louis School. The publication presenting how this inventory was organized, Feighner et al. (1972) is one of the 100 most frequently cited articles in scientific literature from 1961 to 1982, all disciplines combined (Garfield 1984). Hamilton and Overall’s presentations of their scale are among the 100 most frequently cited publications for 1969–1977 (Garfield 1978). This literature, then, though not the result of a scientific discovery, explanation model, or formal object identification, made a substantial contribution to scientific communication.

  3. In a spirit similar to our own, Helen Street and her team have analyzed the semantic network of 27 psychological theories of depression, identifying four general interpretive areas: “One area is concerned with the cognitive processing bias towards negative information; the opposing area describes self-reinforcement in relation to the social environment. A third area emphasizes the individual’s lack of positive social support and is opposed by a fourth area that focuses on the pursuit of and prolonged commitment to unrealistic goals” (Street et al. 1999, p 175).

  4. Morgens Schou, the great lithium specialist, put it this way: “As we do not know the pathophysiological basis of manic depressive illness, we do not know how treatments work, and as we do not know how treatments work, we cannot understand the pathophysiology of manic depressive illness. The locked box with the key inside appears to present an insoluble problem” (Schou 1997, p 12).

  5. This constraint was underscored very early on. The need for careful samplings among patients participating in clinical trials was pointed out at the 1956 Congress of the Psychopharmacology Service Center, which had pioneered the specialty. In 1962 the Kefauver-Harris amendments required pharmaceutical laboratories to show that the products they wanted to market were effective and not dangerous, an obligation that once again required determining a standard symptomology (Healy 1997). The 1969 Williamsburg Conference on Depression, held at the behest of the National Institute of Mental Health (NIMH), underlined biology’s need for identical diagnostic criteria. This conference was at the origin of the NIHM’s Collaborative Studies Programs, which sought to facilitate the interpenetration of new pharmacological, biological, and clinical knowledge in an interdisciplinary perspective. In the early 1970s, this policy led to the development of the Collaborative Program on Psychobiology of Depression, which had a strong influence on how the standardized classification of mental disorders was organized (Marsella et al. 1987).

  6. In particular, we think to the talk “Fundamentals of Taxonomy” that Carl Hempel has given in February 1959 at the World Conference on Field Studies in Mental Disorders of the American Psychiatric Association in New York (Hempel 1965). For an analysis of the influence of Hempel’s model on contemporary psychiatric taxonomy, see Sadler et al. (1994).

  7. The DSM-III provided the following diagnostic criteria for major depression: the subject had to have manifested a disturbed mood in the preceding two weeks and displayed at least four of the following symptoms: (1) significant change in appetite and weight; (2) insomnia or hypersomnia; (3) psychomotor agitation or retardation; (4) loss of interest and pleasure in activities or diminished sexual appetite; (5) loss of energy, fatigue; (6) feelings of worthlessness or guilt; (7) diminished or slowed thinking ability; (8) thoughts of death or suicide; attempted suicide (American Psychiatric Association 1980).

  8. The DSM-I, published in 1952, and the DSM-II, in 1968, did not elicit much response since psychoanalytic theory, preeminent at the time, did not emphasize diagnosis, of if so only as the general identification of a disorder whose unconscious mechanisms then had to be discovered during the therapy.

  9. As in estimations of theoretical Khi2 distributions, the degree of chance in judgment is calculated from the sum of contingency table rows and columns. The kappa formula next involves the following operations: (1) value is calculated as observed agreement percentage (%Ao) minus degree of judgment attributed to chance (%Ac); (2) the degree thus obtained goes into the numerator, to be divided by absolute agreement (=1) minus degree of judgment attributed to chance.

    $$ K = \frac{\% Ao - \% Ac}{1 - \% Ac} $$

    K values thus fall between 0 and 1. When value is close to 1, convergence is said to be significant; when close to 0, it is attributed to chance and termed random.

  10. Max Hamilton, inventor of the most widely used depression scale in the world (Hamilton 1960), sums up the reversal thus: “At first the scales were validated in relation to an overall judgment; that is, when a scale was constructed we used to compare the results obtained by using it with clinician’s judgment. This was the priority, and it determined whether the scale could be considered satisfactory. Now that the scales have demonstrated their validity, we can reverse the procedure, as I’ve been suggesting for years. We can use the scales to examine overall judgments, to study what psychiatrists do and how they do it” (Hamilton 1981, p 11).

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Acknowledgment

We would like to thank Terry Shinn for his useful help and comment. This study is supported by the Centre National de la Recherche Scientifique (CNRS) “Appel à Projets Nouveaux (APN)” program, and by the French Research Ministry “Action Concertée Incitative (ACI)” program.

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Correspondence to Philippe Le Moigne.

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Le Moigne, P., Ragouet, P. Science as instrumentation. The case for psychiatric rating scales. Scientometrics 93, 329–349 (2012). https://doi.org/10.1007/s11192-012-0673-1

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