Behavioral Analysis: an Alternative to Diagnostic Classification.

Duri ngURING the past decade attacks on conventional psychiatric diagnosis have been so widespread that many clinicians now use diagnostic labels sparingly and apologetically. The continued adherence to the nosological terms of the traditional classificatory scheme suggests some utility of the present categorization of behavior disorders, despite its apparently low reliability 1,21; its limited prognostic value 7,26; and its multiple feebly related assumptive supports. In a recent study of this problem, the symptom patterns of carefully diagnosed paranoid schizo-phrenics were compared. Katz et al12 found considerable divergence among patients with the same diagnosis and concluded that "diag-nostic systems which are more circumscribed in their intent, for example, based on manifest behavior alone, rather than systems which attempt to comprehend etiology, symptom patterns and prognosis, may be more directly applicable to current problems in psychiatric research" (p202). We propose here to examine some sources of dissatisfaction with the present approach to diagnosis, to describe a framework for a be-havioral analysis of individual patients which implies both suggestions for treatment and outcome criteria for the single case, and to indicate the conditions for collecting the data for such an analysis. Numerous criticisms deal with the internal consistency, the explicitness, the precision, and the reliability of psychiatric classifications. It seems to us that the more important fault lies in our lack of sufficient knowledge to categorize behavior along those pertinent dimensions which permit prediction of responses to social stresses, life crises, or psychiatric treatment. This limita¬ tion obviates anything but a crude and tentative approximation to a taxonomy of effective indi¬ vidual behaviors. Zigler and Phillips,28 in discussing the re¬ quirement for an adequate system of classifica¬ tion, suggest that an etiologically-oriented closed system of diagnosis is premature. Instead, they believe that an empirical attack is needed, using "symptoms broadly defined as meaningful and discernible behaviors, as the basis of the classifi-catory system" (p 616). But symptoms as a class of responses are defined after all only by their nuisance value to the patient's social en¬ vironment or to himself as a social being. They are also notoriously unreliable in predicting the the patient's particular etiological history or his response to treatment. An alternate approach lies in an attempt to identify classes of dependent variables in human behavior which would allow inferences about the particular con¬ trolling factors, the social stimuli, the physio¬ logical stimuli, and the reinforcing stimuli, of which they are …