Do disorders come in natural kinds?

There has been a debate in philosophy for since forever about whether there are natural kinds. Philosophers who think that there are not natural kinds often call themselves "nominalists." "Nomos" is Greek for "name" and monimalists argue that our perception that the world comes in categories is entirely dependent upon our words.

It makes a lot of sense if you think about bodies of water. The name of my home town is an American Indian word which I am told means, "large flat body of water." It can refer to a lake or a bay. We have words like creek, river, stream, not to mention pond and lake. The world just has water. We divide it up according to our interests and then we think it comes that way.

Of course a true nominalist thinks that nothing comes pre-categorized, but in order to explain to you what I have been wondering, we need to assume that some things do come in natural kinds (like elephants and giraffes) and some things don't (like musical instruments).

We no longer regard consumption as a natural kind. Years ago if you had a chronic lung condition, you could get diagnosed with consumption. If we could go back in time we would diagnose most of the people with tuberculosis, but a good chunk of them would be people with bronchitis, pneumonia, asthma, emphysema or lung cancer.

Everyone with me? Consumption, as a kind (natural or nominalist), is not something we recognize anymore. If someone were to go back in time and tell doctors that there was no such thing as consumption they would be stunned and show us all the sick people. It might take a while to explain we weren't denying the existence of the sick people, just the category. By the way, if I'm wrong about consumption, I don't really care. This is set up.

And I wonder how many of the things in the DSM (pick your number) will be regarded as "real" in one hundred years.

There is just so much cross-over in symptomology. Disorders/conditions are described and there is no definitive test to figure it out. Consider all the forms of autism and FASD, not to mention OCD, ODD, RAD, ADHD, ADD, borderline personality disorder, narcissistic personality disorder, social anxiety disorder, and.. you get the idea.

It seems likely to me that someday we will regard ADD and ADHD as symptoms not diagnoses. I could really be wrong, but I think so. And I wonder if we will think that FASD is "real" or if we will decide that fetal alcohol exposure can cause damage to different parts of the body. We know that mothers who have Rubella (German Measles) when pregnant can have babies who have hearing, vision, heart, and cognitive impairments. We don't however think that there is such a thing as "Rubella Spectrum Disorder."

I have all this going through my head as I am getting ready to schedule Frankie for his neuropsych evaluation. The hope of many of us is that he will go with his file which includes at least four different disorders (two of which are generally considered to exclude each other) and come out with one. It is not clear that he has ever had a complete evaluation like the one he is going to get. He has had IQ tests, aptitude tests, and been diagnosed with various sorts of things based upon behaviors that he exhibited at the time, behaviors that might have been entirely reasonable responses to very unreasonable living conditions. (Did you know not so very long ago at least one physician diagnosed slaves who kept running away with Drapetomania? Of course the word just means "manic runaway slave" but the point was that some people regarded the reasonable behavior of running away from salvery as a psychiatric disorder.)

So, after this evaluation will Frankie be determined to have Asperger's, FASD-ARND, or will be told just that he is a sweet, clumsy kid with ADD?

And will whatever they tell us be really helpful? It will certainly have a great affect on the sorts of services I can get for him, but will it be real? Is it based on truth?

Or is it just the category to which he will be assigned. "Nope, too short for a mountain -- you are really a hill."