Falsifiability is the capacity for some proposition, statement, theory or hypothesis to be proven wrong. The concept of falsifiability was introduced in 1935 by Austrian philosopher and scientist Karl Popper (1902-1994). Since then, the scientific community has come to consider falsifiability to be one of the fundamental tenets of the scientific method , along with attributes such as replicability and testability.
A scientific hypothesis, according to the doctrine of falsifiability, is credible only if it is inherently falsifiable. This means that the hypothesis must be capable of being tested and proven wrong. It does not automatically mean that the hypothesis is invalid or incorrect, only that the potential exists for the hypothesis to be refuted at some possible time or place.
For example, one could hypothesize that a divine being with green scales, mauve hair, ochre-colored teeth and a propensity for humming show tunes rules over the physical universe from a different dimension. Even if millions of people were to swear their allegiance to such a being, there is no practical way to disprove this hypothesis, which means that it is not falsifiable. As a result, it cannot be considered a scientific assertion, according to the rules of falsifiability.
On the other hand, Einstein's theory of relativity is considered credible science according to these rules because it could be proven incorrect at some point in time through scientific experimentation and advanced testing techniques, especially as the methods continue to expand our body of knowledge. In fact, it's already widely accepted that Einstein's theory is at odds with the fundamentals of quantum mechanics, not unlike the way Newton's theory of gravity could not fully account for Mercury's orbit.
Another implication of falsifiability is that conclusions should not be drawn from simple observations of a particular phenomenon . The white swan hypothesis illustrates this problem. For many centuries, Europeans saw only white swans in their surroundings, so they assumed that all swans were white. However, this theory is clearly falsifiable because it takes the discovery of only one non-white swan to disprove its hypothesis, which is exactly what occurred when Dutch explorers found black swans in Australia in the late 17th century.
Falsifiability is often closely linked with the idea of the null hypothesis in hypothesis testing. The null hypothesis states the contrary of an alternative hypothesis. It provides the basis of falsifiability, describing what the outcome would demonstrate if the prediction of the alternative hypothesis is not supported. The alternative hypothesis might predict, for example, that fewer work hours correlates to lower employee productivity. A null hypothesis might propose that fewer work hours correlates with higher productivity or that there is no change in productivity when employees spend less time at work.
Karl Popper introduced the concept of falsifiability in his book The Logic of Scientific Discovery (first published in German in 1935 under the title Logik der Forschung ). The book centered on the demarcation problem, which explored the difficulty of separating science from pseudoscience . Popper claimed that only if a theory is falsifiable can it be considered scientific. In contrast, areas of study such as astrology, Marxism or even psychoanalysis were merely pseudosciences.
Popper's theories on falsifiability and pseudoscience have had a significant impact on what is now considered to be true science. Even so, there is no universal agreement about the role of falsifiability in science because of the limitations inherent in testing any hypothesis. Part of this comes from the fact that testing a hypothesis often brings its own set of assumptions, as well as an inability to account for all the factors that could potentially impact the outcome of a test, putting the test in question as much as the original hypothesis.
In addition, the tests we have at hand might be approaching their practical limitations when up against hypotheses such as string theory or multiple universes. It might not be possible to ever fully test such hypotheses to the degree envisioned by Popper. The question also arises whether falsifiability has anything to do with actual scientific discovery or whether the theory of falsification is itself falsifiable.
No doubt many researchers would argue that their brand of social or psychological science meets a set of criteria that is equally viable as those laid out by Popper. Even so, the important role that falsifiability has played in the scientific model cannot be denied, but Popper's black-and-white demarcation between science and pseudoscience might need to give way to a more comprehensive perspective of what we understand as being scientific.
See also: empirical analysis , validated learning , OODA loop , black swan event, deep learning .
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What to Know A hypothesis is an assumption made before any research has been done. It is formed so that it can be tested to see if it might be true. A theory is a principle formed to explain the things already shown in data. Because of the rigors of experiment and control, it is much more likely that a theory will be true than a hypothesis.
As anyone who has worked in a laboratory or out in the field can tell you, science is about process: that of observing, making inferences about those observations, and then performing tests to see if the truth value of those inferences holds up. The scientific method is designed to be a rigorous procedure for acquiring knowledge about the world around us.
In scientific reasoning, a hypothesis is constructed before any applicable research has been done. A theory, on the other hand, is supported by evidence: it's a principle formed as an attempt to explain things that have already been substantiated by data.
Toward that end, science employs a particular vocabulary for describing how ideas are proposed, tested, and supported or disproven. And that's where we see the difference between a hypothesis and a theory .
A hypothesis is an assumption, something proposed for the sake of argument so that it can be tested to see if it might be true.
In the scientific method, the hypothesis is constructed before any applicable research has been done, apart from a basic background review. You ask a question, read up on what has been studied before, and then form a hypothesis.
A hypothesis is usually tentative, an assumption or suggestion made strictly for the objective of being tested.
When a character which has been lost in a breed, reappears after a great number of generations, the most probable hypothesis is, not that the offspring suddenly takes after an ancestor some hundred generations distant, but that in each successive generation there has been a tendency to reproduce the character in question, which at last, under unknown favourable conditions, gains an ascendancy. Charles Darwin, On the Origin of Species , 1859 According to one widely reported hypothesis , cell-phone transmissions were disrupting the bees' navigational abilities. (Few experts took the cell-phone conjecture seriously; as one scientist said to me, "If that were the case, Dave Hackenberg's hives would have been dead a long time ago.") Elizabeth Kolbert, The New Yorker , 6 Aug. 2007
A theory , in contrast, is a principle that has been formed as an attempt to explain things that have already been substantiated by data. It is used in the names of a number of principles accepted in the scientific community, such as the Big Bang Theory . Because of the rigors of experimentation and control, its likelihood as truth is much higher than that of a hypothesis.
It is evident, on our theory , that coasts merely fringed by reefs cannot have subsided to any perceptible amount; and therefore they must, since the growth of their corals, either have remained stationary or have been upheaved. Now, it is remarkable how generally it can be shown, by the presence of upraised organic remains, that the fringed islands have been elevated: and so far, this is indirect evidence in favour of our theory . Charles Darwin, The Voyage of the Beagle , 1839 An example of a fundamental principle in physics, first proposed by Galileo in 1632 and extended by Einstein in 1905, is the following: All observers traveling at constant velocity relative to one another, should witness identical laws of nature. From this principle, Einstein derived his theory of special relativity. Alan Lightman, Harper's , December 2011
In non-scientific use, however, hypothesis and theory are often used interchangeably to mean simply an idea, speculation, or hunch (though theory is more common in this regard):
The theory of the teacher with all these immigrant kids was that if you spoke English loudly enough they would eventually understand. E. L. Doctorow, Loon Lake , 1979 Chicago is famous for asking questions for which there can be no boilerplate answers. Example: given the probability that the federal tax code, nondairy creamer, Dennis Rodman and the art of mime all came from outer space, name something else that has extraterrestrial origins and defend your hypothesis . John McCormick, Newsweek , 5 Apr. 1999 In his mind's eye, Miller saw his case suddenly taking form: Richard Bailey had Helen Brach killed because she was threatening to sue him over the horses she had purchased. It was, he realized, only a theory , but it was one he felt certain he could, in time, prove. Full of urgency, a man with a mission now that he had a hypothesis to guide him, he issued new orders to his troops: Find out everything you can about Richard Bailey and his crowd. Howard Blum, Vanity Fair , January 1995
And sometimes one term is used as a genus, or a means for defining the other:
Laplace's popular version of his astronomy, the Système du monde , was famous for introducing what came to be known as the nebular hypothesis , the theory that the solar system was formed by the condensation, through gradual cooling, of the gaseous atmosphere (the nebulae) surrounding the sun. Louis Menand, The Metaphysical Club , 2001 Researchers use this information to support the gateway drug theory — the hypothesis that using one intoxicating substance leads to future use of another. Jordy Byrd, The Pacific Northwest Inlander , 6 May 2015 Fox, the business and economics columnist for Time magazine, tells the story of the professors who enabled those abuses under the banner of the financial theory known as the efficient market hypothesis . Paul Krugman, The New York Times Book Review , 9 Aug. 2009
Since this casual use does away with the distinctions upheld by the scientific community, hypothesis and theory are prone to being wrongly interpreted even when they are encountered in scientific contexts—or at least, contexts that allude to scientific study without making the critical distinction that scientists employ when weighing hypotheses and theories.
The most common occurrence is when theory is interpreted—and sometimes even gleefully seized upon—to mean something having less truth value than other scientific principles. (The word law applies to principles so firmly established that they are almost never questioned, such as the law of gravity.)
This mistake is one of projection: since we use theory in general use to mean something lightly speculated, then it's implied that scientists must be talking about the same level of uncertainty when they use theory to refer to their well-tested and reasoned principles.
The distinction has come to the forefront particularly on occasions when the content of science curricula in schools has been challenged—notably, when a school board in Georgia put stickers on textbooks stating that evolution was "a theory, not a fact, regarding the origin of living things." As Kenneth R. Miller, a cell biologist at Brown University, has said , a theory "doesn’t mean a hunch or a guess. A theory is a system of explanations that ties together a whole bunch of facts. It not only explains those facts, but predicts what you ought to find from other observations and experiments.”
While theories are never completely infallible, they form the basis of scientific reasoning because, as Miller said "to the best of our ability, we’ve tested them, and they’ve held up."
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We have heard of many hypotheses which have led to great inventions in science. Assumptions that are made on the basis of some evidence are known as hypotheses. In this article, let us learn in detail about the hypothesis and the type of hypothesis with examples.
A hypothesis is an assumption that is made based on some evidence. This is the initial point of any investigation that translates the research questions into predictions. It includes components like variables, population and the relation between the variables. A research hypothesis is a hypothesis that is used to test the relationship between two or more variables.
Following are the characteristics of the hypothesis:
Following are the sources of hypothesis:
There are six forms of hypothesis and they are:
It shows a relationship between one dependent variable and a single independent variable. For example – If you eat more vegetables, you will lose weight faster. Here, eating more vegetables is an independent variable, while losing weight is the dependent variable.
It shows the relationship between two or more dependent variables and two or more independent variables. Eating more vegetables and fruits leads to weight loss, glowing skin, and reduces the risk of many diseases such as heart disease.
It shows how a researcher is intellectual and committed to a particular outcome. The relationship between the variables can also predict its nature. For example- children aged four years eating proper food over a five-year period are having higher IQ levels than children not having a proper meal. This shows the effect and direction of the effect.
It is used when there is no theory involved. It is a statement that a relationship exists between two variables, without predicting the exact nature (direction) of the relationship.
It provides a statement which is contrary to the hypothesis. It’s a negative statement, and there is no relationship between independent and dependent variables. The symbol is denoted by “H O ”.
Associative hypothesis occurs when there is a change in one variable resulting in a change in the other variable. Whereas, the causal hypothesis proposes a cause and effect interaction between two or more variables.
Following are the examples of hypotheses based on their types:
Following are the functions performed by the hypothesis:
Researchers use hypotheses to put down their thoughts directing how the experiment would take place. Following are the steps that are involved in the scientific method:
What is hypothesis.
A hypothesis is an assumption made based on some evidence.
What are the types of hypothesis.
Types of hypothesis are:
Define complex hypothesis..
A complex hypothesis shows the relationship between two or more dependent variables and two or more independent variables.
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Hypothesis is a testable statement that explains what is happening or observed. It proposes the relation between the various participating variables. Hypothesis is also called Theory, Thesis, Guess, Assumption, or Suggestion. Hypothesis creates a structure that guides the search for knowledge.
In this article, we will learn what is hypothesis, its characteristics, types, and examples. We will also learn how hypothesis helps in scientific research.
Table of Content
Hypothesis meaning, characteristics of hypothesis, sources of hypothesis, types of hypothesis, simple hypothesis, complex hypothesis, directional hypothesis, non-directional hypothesis, null hypothesis (h0), alternative hypothesis (h1 or ha), statistical hypothesis, research hypothesis, associative hypothesis, causal hypothesis, hypothesis examples, simple hypothesis example, complex hypothesis example, directional hypothesis example, non-directional hypothesis example, alternative hypothesis (ha), functions of hypothesis, how hypothesis help in scientific research.
A hypothesis is a suggested idea or plan that has little proof, meant to lead to more study. It’s mainly a smart guess or suggested answer to a problem that can be checked through study and trial. In science work, we make guesses called hypotheses to try and figure out what will happen in tests or watching. These are not sure things but rather ideas that can be proved or disproved based on real-life proofs. A good theory is clear and can be tested and found wrong if the proof doesn’t support it.
A hypothesis is a proposed statement that is testable and is given for something that happens or observed.
Here are some key characteristics of a hypothesis:
Hypotheses can come from different places based on what you’re studying and the kind of research. Here are some common sources from which hypotheses may originate:
Here are some common types of hypotheses:
Simple Hypothesis guesses a connection between two things. It says that there is a connection or difference between variables, but it doesn’t tell us which way the relationship goes.
Complex Hypothesis tells us what will happen when more than two things are connected. It looks at how different things interact and may be linked together.
Directional Hypothesis says how one thing is related to another. For example, it guesses that one thing will help or hurt another thing.
Non-Directional Hypothesis are the one that don’t say how the relationship between things will be. They just say that there is a connection, without telling which way it goes.
Null hypothesis is a statement that says there’s no connection or difference between different things. It implies that any seen impacts are because of luck or random changes in the information.
Alternative Hypothesis is different from the null hypothesis and shows that there’s a big connection or gap between variables. Scientists want to say no to the null hypothesis and choose the alternative one.
Statistical Hypotheis are used in math testing and include making ideas about what groups or bits of them look like. You aim to get information or test certain things using these top-level, common words only.
Research Hypothesis comes from the research question and tells what link is expected between things or factors. It leads the study and chooses where to look more closely.
Associative Hypotheis guesses that there is a link or connection between things without really saying it caused them. It means that when one thing changes, it is connected to another thing changing.
Causal Hypothesis are different from other ideas because they say that one thing causes another. This means there’s a cause and effect relationship between variables involved in the situation. They say that when one thing changes, it directly makes another thing change.
Following are the examples of hypotheses based on their types:
Hypotheses have many important jobs in the process of scientific research. Here are the key functions of hypotheses:
Researchers use hypotheses to put down their thoughts directing how the experiment would take place. Following are the steps that are involved in the scientific method:
Mathematics Maths Formulas Branches of Mathematics
A hypothesis is a testable statement serving as an initial explanation for phenomena, based on observations, theories, or existing knowledge. It acts as a guiding light for scientific research, proposing potential relationships between variables that can be empirically tested through experiments and observations.
The hypothesis must be specific, testable, falsifiable, and grounded in prior research or observation, laying out a predictive, if-then scenario that details a cause-and-effect relationship. It originates from various sources including existing theories, observations, previous research, and even personal curiosity, leading to different types, such as simple, complex, directional, non-directional, null, and alternative hypotheses, each serving distinct roles in research methodology .
The hypothesis not only guides the research process by shaping objectives and designing experiments but also facilitates objective analysis and interpretation of data , ultimately driving scientific progress through a cycle of testing, validation, and refinement.
What is a hypothesis.
A guess is a possible explanation or forecast that can be checked by doing research and experiments.
The components of a Hypothesis are Independent Variable, Dependent Variable, Relationship between Variables, Directionality etc.
Testability, Falsifiability, Clarity and Precision, Relevance are some parameters that makes a Good Hypothesis
You cannot prove conclusively that most hypotheses are true because it’s generally impossible to examine all possible cases for exceptions that would disprove them.
Hypothesis testing is used to assess the plausibility of a hypothesis by using sample data
Yes, you can change or improve your ideas based on new information discovered during the research process.
Hypotheses are used to support scientific research and bring about advancements in knowledge.
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Do you live with your partner?
Even if you're not married, engaged or haven't been living together for all that long, in the eyes of the Australian Tax Office, that person is your spouse.
And even if you still haven't introduced your partner to all your friends and family, the ATO wants you to declare them — and their income — on your tax return.
Here's what you need to know.
Because having a spouse might affect how much tax you pay .
"Having a spouse may impact the thresholds used for calculating the private health insurance rebate or liability for the Medicare Levy Surcharge, " the spokesperson says.
It can also include things like Medicare levy family reduction calculations and the ability to transfer senior and pensioner tax offset (SAPTO) to a spouse.
It can mean someone you were in a relationship with and that relationship was registered under a prescribed state or territory law .
But while many of us may use the word spouse as another term for husband or wife, the ATO's definition of spouse isn't just limited to legally married couples.
It can also mean someone you were in a relationship with who you lived with as a couple for any period of time during the past financial year.
And that's the definition we'll be focusing on for the rest of this article.
"Your spouse can be the same sex or a different sex, but they can't be a person who has another family relationship with you," an ATO spokesperson says.
"The duration of the relationship is one of the factors taken into account in determining if a relationship is a genuine relationship," the spokesperson said.
But, the main thing the ATO cares about is how long you lived together last financial yea r — or how much of the financial year you were in a registered relationship with that person.
Whether you've lived together for the past 12 months or your partner only moved in a few days before the end of June, it still counts.
If you haven't been living together for the whole year, there's an option to fill out how long you have lived together.
If you lived together but that relationship was not registered, you only have to declare the amount of time you were living together.
And an ATO spokesperson says there's help available for you.
"If you are experiencing difficulty with tax obligations due to the circumstances of your relationship we do provide support," they said.
They pointed to the ATO's support in difficult times portal and its personal crisis support website .
You can make an educated guess .
"We understand that there may be situations where you are unable to find out your spouse's income for the purposes of including that information when lodging your tax return," an ATO spokesperson said.
"In these situations, you can make a reasonable estimate.
"You won't be penalised for an incorrect estimate if you acted reasonably and in good faith."
If you need to change a tax return within two years of getting your return back, you can make a request to do so by:
"We don't charge a fee if you request an amendment and you don't have to send in another tax return unless we ask you to," the ATO's website says .
Defining yourself starts with getting to know your own thoughts, values, and ideals..
Posted July 29, 2024 | Reviewed by Michelle Quirk
It's a common belief that one must be alone or single to truly understand oneself. While there's some truth to this, the process of defining oneself is deeply intertwined with family dynamics. Personal growth often involves taking actionable steps in relationships with emotionally significant others, such as family members.
Defining yourself refers to developing a clear sense of self while maintaining healthy emotional connections with others. It's about finding a balance between being your own person and being close to others. It involves expressing your thoughts and feelings without losing your sense of identity in relationships. For example, a person may learn to voice their opinions during family discussions, asserting their perspective even when it differs from the majority. This ability to communicate honestly fosters personal growth and strengthens relationships by promoting understanding and respect for differing viewpoints.
When we are emotionally triggered, our feelings become intertwined with those of others, and it influences us to act in ways we don't like or say things we don't mean, especially when we are stressed or anxious. When we react while triggered, we behave in ways that are counterproductive to our values and best interests. When we are emotionally reactive, our judgment is clouded, and it influences how we see the world and ourselves.
Defining yourself involves aligning your behaviors with your values, ideas, and goals . This cannot happen when you rely on automatic "go-to" moves to relieve anxiety in your relationships. Relying on automatic "go-to" moves to alleviate anxiety in relationships refers to habitual reactions or coping mechanisms that individuals fall back on when faced with stress or emotional discomfort. These responses, often unconscious , can manifest in various forms, such as avoidance, defensiveness, or over-apologizing. While these behaviors might provide temporary relief from anxiety, they can hinder genuine communication and deepen relational issues.
For instance, someone might instinctively withdraw when conflict arises, avoiding difficult conversations that could lead to resolution and understanding. This pattern prevents individuals from truly addressing their feelings or needs and may result in miscommunication, resentment, or emotional disconnection. In essence, relying on such automatic responses limits personal growth and the opportunity to create more fulfilling relationships.
Defining yourself starts with internal learning—getting to know your own thoughts, values, and ideas—then integrating what you've learned by acting in ways that align with it. An example of defining yourself through self-discovery could be the journey of an individual who values honesty and authenticity . Initially, they might notice a tendency to agree with others to avoid conflict, a behavior rooted in fear of rejection. Through introspection, they begin to recognize that suppressing their true opinions causes internal discomfort and impacts their relationships.
They realize they deeply value open and honest communication by exploring their thoughts. Armed with this understanding, they practice expressing their viewpoints genuinely, even in challenging situations. For instance, during a team meeting, they voice their concerns respectfully instead of remaining silent about a disagreement on a project approach. This shift aligns their actions with their values and fosters a more authentic connection with their colleagues, ultimately leading to improved collaboration and mutual respect. This process of self-awareness and alignment allows them to define themselves more clearly.
Additionally, defining yourself within your family is essential to defining yourself in other relationships. Understanding your family patterns can help you better differentiate yourself and work toward improving your part within your family and other relationship networks. This can involve setting boundaries , expressing your needs and feelings, and learning to communicate openly and honestly.
Family relationships have a significant impact on how people develop and how they think about themselves. Perhaps that is why we all want the picture-perfect family—a family we connect with and feel on the same page with. A family in which all members agree on religion, politics , and lifestyle choices. A family that doesn't trigger us or make us question ourselves. A family that always has our back gives us the benefit of the doubt and allows us to be who we are without judgment.
That type of family does sound nice. However, have you ever seen that kind of family in real life? Every family is a lot messier and more complex than it looks from the outside. Seldom do we get the parents we dream of, the children we planned for, or the sibling relationships we see in movies. Sometimes, even a loving family can bring us more pain than joy.
Defining yourself within your family is a liberating process. It empowers you to break free from the habitual emotional processes of your family while maintaining a strong connection. When you can bond with others without losing connection to yourself, you gain the ability to reflect on a fight or argument, understand your part in it, and choose a new, more constructive way to respond.
If you grew up in a family where everyone maintains tight closeness despite having different thoughts and feelings—and even brief arguments—you likely find it easier to define yourself. Alternately, if your family's mantra was "Being close means agreeing on everything" or "It's my way or the highway," defining yourself is likely very difficult.
Every person possesses a division within themselves. We have our solid selves, with our own ideas and values, and we have other points of view that we've internalized from our family, society, and so on. When we feel anxious or upset, we instinctively alter our thinking to better fit our family patterns.
Recognizing what triggers you to revert to old thoughts and behavior patterns is a crucial step in the journey of self-definition. It equips you with the awareness and understanding needed to either continue those patterns or make choices that allow for a more solid, emotionally mature self.
Ilene S. Cohen, Ph.D. , is a psychotherapist and blogger, who teaches in the Department of Counseling at Barry University.
Sticking up for yourself is no easy task. But there are concrete skills you can use to hone your assertiveness and advocate for yourself.
From diagnosis to dialogue – reconsidering the dsm as a conversation piece in mental health care: a hypothesis and theory.
The Diagnostic and Statistical Manual of Mental Disorders, abbreviated as the DSM, is one of mental health care’s most commonly used classification systems. While the DSM has been successful in establishing a shared language for researching and communicating about mental distress, it has its limitations as an empirical compass. In the transformation of mental health care towards a system that is centered around shared decision-making, person-centered care, and personal recovery, the DSM is problematic as it promotes the disengagement of people with mental distress and is primarily a tool developed for professionals to communicate about patients instead of with patients. However, the mental health care system is set up in such a way that we cannot do without the DSM for the time being. In this paper, we aimed to describe the position and role the DSM may have in a mental health care system that is evolving from a medical paradigm to a more self-contained profession in which there is increased accommodation of other perspectives. First, our analysis highlights the DSM’s potential as a boundary object in clinical practice, that could support a shared language between patients and professionals. Using the DSM as a conversation piece, a language accommodating diverse perspectives can be co-created. Second, we delve into why people with lived experience should be involved in co-designing spectra of distress. We propose an iterative design and test approach for designing DSM spectra of distress in co-creation with people with lived experience to prevent the development of ‘average solutions’ for ‘ordinary people’. We conclude that transforming mental health care by reconsidering the DSM as a boundary object and conversation piece between activity systems could be a step in the right direction, shifting the power balance towards shared ownership in a participation era that fosters dialogue instead of diagnosis.
The Diagnostic Statistical Manual of Mental Disorders (DSM) has great authority in practice. The manual, released by the American Psychiatric Association (APA), provides a common language and a classification system for clinicians to communicate about people’s experiences of mental distress and for researchers to study social phenomena that include mental distress and its subsequent treatments. Before the DSM was developed, a plethora of mental health-related documents circulated in the United States ( 1 ). In response to the confusion that arose from this diversity of documents, the APA Committee on Nomenclature and Statistics standardized these into one manual, the DSM-I ( 2 ). In this first edition of the manual, released in 1952, mental distress was understood as a reaction to stress caused by psychological and interpersonal factors in the person’s life ( 3 ). Although the DSM-I had limited impact on practice ( 4 ), it did set the stage for increasingly standardized categorization of mental disorders ( 5 ).
The DSM-II was released in 1968. In this second iteration, mental disorders were understood as the patient’s attempts to control overwhelming anxiety with unconscious, intrapsychic conflicts ( 3 ). In this edition, the developers attempted to describe the symptoms of disorders and define their etiologies. They had chosen to base them predominantly on psychodynamic psychiatry but also included the biological focus of Kraepelin’s system of classification ( 5 , 6 ). During the development of the DSM-III, the task force added the goal to improve the reliability — the likelihood that different professionals arrive at the same diagnosis — of psychiatric diagnosis, which now became an important feature of the design process. The developers abandoned the psychodynamic view and shifted the focus to atheoretical descriptions, aiming to specify objective criteria for diagnosing mental disorders ( 3 ). Although it was explicitly stated in DSM-III that there was no underlying assumption that the categories were validated entities ( 7 ), the categorical approach still assumed each pattern of symptoms in a category reflected an underlying pathology. The definition of ‘mental illness’ was thereby altered from what one did or was (“you react anxious/you are anxious”) to something one had (“you have anxiety”). This resulted in descriptive, criteria-based classifications that reflected a perceived need for standardization of psychiatric diagnoses ( 5 , 6 ). The DSM-III was released in 1980 and had a big impact on practice ( 6 ) as it inaugurated an attempt to “re-medicalize” American psychiatry ( 5 ).
In hindsight, it is not surprising that after the release of the DSM-III, the funding for psychopharmacological research skyrocketed ( 8 ). At the same time, the debate on the relationship between etiology and description in psychiatric diagnosis continued ( 9 ). As sociologist Andrew Scull ( 10 ) showed, the election of President Reagan prompted a shift towards a focus on biology. His successor, President Bush, claimed that the 1990s were ‘the decade of the brain,’ which fueled a sharp increase in funding for research on genetics and neuroscience ( 10 ). Despite the public push for biological research, the DSM-IV aimed to arrive at a purely atheoretical description of psychiatric diagnostic criteria and was released in 1994 ( 11 ). The task force conducted multi-center field trials to relate diagnoses to clinical practice to improve reliability, which remained a goal of the design process ( 12 ). While the DSM-IV aimed to be atheoretical, researchers argued that the underlying ontologies were easily deducible from their content: psychological and social causality were eliminated and replaced implicitly with biological causality ( 13 ). In the DSM-5, validity — whether a coherent syndrome is being measured and whether it is what it is assumed to be — took center stage ( 10 ). The definition of mental disorder in the DSM-5 was thereby conceptualized as:
“… a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.” ( 14 ).
With the release of the DSM-5, the debate surrounding the conceptualization of mental distress started all over again, but this can be best seen as re-energizing longstanding debates around the utility and validity of APA nosology ( 15 ). Three important design goals from the DSM-III until current editions can be observed: providing an international language on mental distress, developing a reliable classification system, and creating a valid classification system.
The extent to which these three design goals were attained is only partial. The development of an international language has been accomplished, as the DSM (as well as the International Classification of Diseases) is now widely employed across most Western countries. Although merely based on consensus, the DSM enables — to an extent — professionals and researchers to quantify the prevalence of certain behaviors and find one or more classifications that best suit these observed behaviors. To this date, the expectation that diagnostic criteria would be empirically validated through research has not yet been fulfilled ( 10 , 16 , 17 ). As stated by the authors of the fourth edition ( 11 ), the disorders listed in the DSM are “valuable heuristic constructs” that serve a purpose in research and practice. However, it was already emphasized in the DSM-IV guidebook that they do not precisely depict nature as it is, being characterized as not “well-defined entities” ( 18 ). Furthermore, while the fifth edition refers to “syndromes,” it is again described that “there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder” ( 14 ). Consequently, there are no laboratory tests or biological markers to set the boundary between ‘normal’ and ‘pathological,’ thus, it cannot confirm or reject the presumed pathologies underlying the DSM classifications, thereby rendering the validity goal of the design unattained. Therefore, the reliability of the current major DSM (i.e., DSM-5) still raises concerns ( 19 ).
By focusing conceptually on mental distress as an individual experience, the DSM task forces have neglected the role of social context, potentially restricting a comprehensive clinical understanding of mental distress ( 20 ). There is mounting evidence and increased attention, however, that the social environment, including its determinants and factors, is crucial for the onset, course, and outcome of mental distress ( 21 – 27 ). Moreover, exposure to factors such as early life adversity, poverty, unemployment, trauma, and minority group position is strongly associated with the onset of mental distress ( 28 , 29 ). It is also established that the range of ontological perspectives — what mental distress is and how it exists — is far broader than what is typically covered in prevailing scientific and educational discussions ( 30 ). These diverse perspectives are also evident in the epistemic pluralism among theoretical models on mental health problems ( 31 ).
In the context of contemporary transformations in mental health care, the role of the DSM as an empirical instrument becomes even more problematic. In recent years, significant shifts have been witnessed in mental health care services, with a growing focus on promoting mental well-being, preventive measures, and person-centered and rights-based approaches ( 32 ). In contrast to the 1950s definition of health in which health was seen as the absence of disease, health today is defined as “the ability to adapt and to self-manage” ( 33 ), also known as ‘positive health.’ Furthermore, the recovery movement ( 34 ), person-centered care ( 35 ), and the integration of professionals’ lived experiences ( 36 ) all contributed to a more person-centered mental health care that promotes shared-decision making as a fundamental principle in practice in which no one perspective holds the wisdom. Shared decision-making is “an approach where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve informed preferences” ( 37 ). To realize and enable a more balanced relationship between professional and patient in shared decision-making, the interplay of healthcare professionals’ and patients’ skills, the support for a patient, and a good relationship between professional and patient are important to facilitate patients’ autonomy ( 38 ). Thus, mental health care professionals in the 21st century should collaborate, embrace ideography, and maximize effects mediated by therapeutic relationships and the healing effects of ritualized care interactions ( 39 ).
The DSM and its designed classifications, as well as their use in the community, can hinder a person-centered approach in which meaning is collaboratively derived for mental health issues, where a balanced relationship is needed, and where decisions are made together. We can demonstrate this with a brief example involving the ADHD classification and its criteria, highlighting how its design tends to marginalize individuals with mental distress, reducing their behavior to objectification from the clinician’s viewpoint. The ADHD classification delineates an ideal self that highly esteems disengagement from one’s feelings and needs, irrespective of contextual factors ( 40 ). This inclination is apparent in the criteria, including criterion 1a concerning inattention: “often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort”. This indicates that disliking something is viewed as a symptom rather than a personal preference ( 40 ). Due to a lack of attention to the person’s meaning, a behavior that may be a preference of the individual can become a symptom of a disease. Another instance can be observed in criterion 2c: “often runs about or climbs in situations where it is inappropriate.” Although such behavior might be deemed inappropriate in certain contexts, many individuals derive enjoyment from running and climbing. In this way, ‘normal’ human behavior can be pathologized because there is no room for the meaning of the individual.
A parallel disengagement is evident in the DSM’s viewpoint on individuals with mental distress ( 40 ), as the diagnostic process appears to necessitate no interaction with an individual; instead, it fosters disengagement rather than engagement. For example, according to the DSM-5, when a child is “engaged in especially interesting activities,” the clinician is warned that the ‘symptoms’ may not manifest. Although it appears most fitting to assist the child by exploring their interests, clinicians are instead encouraged to seek situations the child finds uninteresting and assess whether the child can concentrate ( 40 ). If the child cannot concentrate, a ‘diagnosis’ might be made, and intervention can be initiated. This highlights that the design of the DSM promotes professionals to locate individual disorders in a person at face value without considering contextual factors, personal preferences, or other idiosyncrasies in a person’s present or history ( 41 ). It is also apparent that the term ‘symptom’ in the DSM implies an underlying entity as its cause, obscuring that it is a subjective criterion based on human assessment and interpretation ( 42 ). These factors make it difficult for the DSM in its current form to have a place in person-centered mental health care that promotes shared decision-making.
Diagnostic manuals like the DSM function similarly to standard operating procedures: they streamline decision-making and assist professionals in making approximate diagnoses when valid and specific measures are lacking or not readily accessible ( 43 ). However, the DSM is often (mis)used as a manual providing explanations for mental distress. This hinders a personalized approach that prioritizes the patient’s needs. Furthermore, this approach does not align with the principles of shared decision-making, as the best available evidence indicates that classifications are not explanations for mental distress. Also, disengagement is promoted in the design of the DSM, which is problematic in the person-centered transformation of mental health care in which a range of perspectives and human-centered interventions are needed. This paper aims to describe the position and role the DSM may have in a mental health care system that is evolving from a medical paradigm to a more self-contained profession in which there is increased accommodation of other perspectives. For this hypothesis and theory paper, we have formulated the following hypotheses:
(1) Reconsidering the DSM as a boundary object that can be used as a conversation piece allows for other perspectives on what is known about mental distress and aligns with the requirements of person-centered mental health care needed for shared decision-making;.
(2) Embracing design approaches in redesigning the DSM to a conversation piece that uses spectra of mental distress instead of classifications will stimulate the integration of diverse perspectives and voices in reshaping mental health care.
The DSM originally aimed to develop a common language, and it has achieved that to some extent, but it now primarily serves as a common language among professionals. This does not align with the person-centered transformation in mental health care, where multiple perspectives come into play ( 32 , 44 ). In this section, we will address our first hypothesis: reconsidering the DSM as a boundary object that can be used as a conversation piece allows for other perspectives on what is known about mental distress and aligns with the requirements of person-centered mental health care needed for shared decision-making. First, we will examine several unintended consequences of classifications. After that, we propose considering the DSM as boundary objects to arrive at a real common language in which the perspective of people with lived experience is promoted. This perspective views the DSM as a conversation piece that can be used as a subject, the meaning of which can be attributed from various perspectives where the premise is that there is not an omniscient perspective.
Classifications influence what we see or do not see, what is valorized, and what is silenced ( 45 ). DSM classifications and the process of getting them can provide validation and relief for some service users, while for others, it can be stigmatizing and distressing ( 46 , 47 ). The stigma people encounter can be worse than the mental problems themselves ( 48 ). The classification of people’s behaviors is not simply a passive reflection of pre-existing characteristics but is influenced by social and cultural factors. The evolution of neurasthenia serves as a fascinating illustration of the notable ontological changes in the design of the DSM, constantly reflecting and constructing reality. Initially, neurasthenia was considered a widespread mental disorder with presumed somatic roots. Still, it was subsequently discarded from use, only to resurface several decades later as a culture-bound manifestation of individual mental distress ( 49 ). Consequently, certain mental disorders, as depicted in the DSM, may not have existed in the same way as before the classifications were designed. This has been called ‘making up people’, which entails the argument that different kinds of human beings and human acts come into being hand in hand with our invention of the categories labeling them ( 50 ). Furthermore, it is important to consider that whether behavior is deemed dysfunctional or functional is always influenced by the prevailing norms and traditions within a specific society at a given time. Therefore, the individual meaning of the patient in its context is always more important than general descriptions and criteria of functional and dysfunctional behavior (i.e., ADHD climbing example).
Individuals might perceive themselves differently and develop emotions and behaviors partly due to the classifications imposed upon them. Over time, this can result in alterations to the classification itself, a phenomenon referred to as the classificatory looping effect ( 51 ). Moreover, when alterations are made to the world that align with the system’s depiction of reality, ‘blindness’ can occur ( 45 ). To illustrate, let’s consider an altered scenario of Bowker and Star ( 45 ) in which all mental distress is categorized solely based on physiological factors. In this context, medical frameworks for observation and treatment are designed to recognize physical manifestations of distress, such as symptoms, and the available treatments are limited to physical interventions, such as psychotropic medications. Consequently, in such a design, mental distress may solely be a consequence of a chemical imbalance in the brain, making it nearly inconceivable to consider alternative conceptualizations or solutions. Thus, task forces responsible for designing mental disorder classifications should be acutely aware that they actively contribute to the co-creation of reality with the classifications they construct upon reality ( 49 ).
Another unintended consequence is the reification of classifications. Reification involves turning a broad and potentially diverse range of human experiences into a fixed and well-defined category. Take, for example, the case of the classification of ADHD and its reification mechanisms (i.e., language choice, logical fallacies, genetic reductionism, and textual silence) ( 42 ). Teachers sometimes promote the classification of ADHD as they believe it acknowledges a prior feeling that something is the matter with a pupil. The classification is then seen as a plausible explanation for the emergence of specific behaviors, academic underperformance, or deviations from the expected norm within a peer group ( 52 , 53 ). At first glance, this may seem harmless. However, it reinforces the notion that a complex and multifaceted set of contextual behaviors, experiences, and psychological phenomena are instead a discrete, objective entity residing in the individual. This is associated with presuppositions in the DSM that are not explicitly articulated, such as attributing a mental disorder to the individual rather than the system, resulting in healthcare that is organized around the individual instead of organized around the system ( 54 ).
In this way, DSM classifications can decontextualize mental distress, leading to ‘disorderism’. Disorderism is defined as the systemic decontextualization of mental distress by framing it in terms of individual disorders ( 55 ). The processes by which people are increasingly diagnosed and treated as having distinct treatable individual disorders, exemplified by the overdiagnosis of ADHD in children and adolescents ( 56 ), while at the same time, the services of psychiatry shape more areas of life, has been called the ‘psychiatrization of society’ ( 57 ). The psychiatrization of society encompasses a pervasive influence whereby the reification and disorderism extend beyond clinical settings and infiltrate various facets of daily life. It is a double-edged sword that fosters increased awareness of mental health issues and seeks to reduce stigma, but at the same time, raises concerns about the overemphasis on medical models, potentially neglecting the broader social, cultural, and environmental factors that contribute to individual well-being as well as population salutogenesis ( 58 ).
Instead of using the DSM as a scientific and professional tool in order to classify, the DSM can be reconsidered as a boundary object. When stakeholders with different objectives and needs have to work together constructively without making concessions, like patients and professionals in person-centered mental health care, objects can play a bridging role. Star and Griesemer ( 59 ) introduced the term boundary objects for this purpose.
“Boundary objects are objects that are plastic enough to adapt to the local needs and constraints of the different parties using them, yet robust enough to maintain a common identity in different locations. They are weakly structured in common use and become strongly structured in use in individual locations. They can be abstract or concrete. They have different meanings in different social worlds, but their structure is common enough to more than one world to make them recognizable, a means of translation.” ( 59 ).
Before exploring the benefits of a boundary object perspective for the DSM, it is important to note that it remains questionable whether the DSM in its current form can help establish a shared understanding or provide diagnostic, prognostic, or therapeutic value ( 60 – 63 ). To make the DSM more suitable for accommodating different perspectives and types of knowledge, the DSM task force can focus its redesign on leaving the discrete disease entities — which classifications imply — behind by creating spectra. This way of thinking has already found its way to the DSM-5, in which mental distress as a spectrum was introduced in the areas of autism, substance use, and nearly personality disorders, and following these reconceptualization, also a psychosis spectrum was proposed ( 43 ), but this proposition was eventually not adopted in the manual. As mental distress can be caused by an extensive range of factors and mechanisms that result from interactions in networks of behaviors and patterns that have complex dynamics that unfold over time ( 64 ), spectra of mental distress may be more suitable for conversations about an individual’s narrative and needs in clinical practice, as each experience of mental distress is unique and contextual.
If the DSM is reconsidered as a boundary object that is intended to provide a shared language for interpreting mental distress while addressing the unintended consequences of classifications, it is also essential to consider where this language now primarily manifests itself, how it relates to shared decision-making, and the significant role it plays for patients in the treatment process. In recent decades, the DSM has positioned itself primarily as a professional tool for clinical judgment (see Figure 1 ). In this way, professionals have more or less acquired a monopoly on the language of classifications and the associated behaviors and complaints described in the DSM. It provides professionals with a tool to pursue their professional objectives and legitimacy for their professional steps with patients, resulting in a lack of equality from which different perspectives can be examined side by side. However, with shared decision-making, patients are expected to be engaged and to help determine the course of treatment; the language surrounding classifications and symptoms does not currently allow that to happen sufficiently.
Figure 1 DSM as a professional tool, adapted from Figure 1, ‘Design of a Digital Comic Creator (It’s Me) to Facilitate Social Skills Training for Children With Autism Spectrum Disorder: Design Research Approach’, by Terlouw et al., CC-BY ( 65 ).
This is where boundary objects come into play. The focused shaping of boundary objects can ensure a more equal role for different stakeholders ( 65 – 67 ). Boundary objects can also trigger perspective-making and -taking from a reflective dialogical learning mechanism ( 68 – 70 ), which ensures a better shared understanding of all perspectives. Boundary objects and their dialogical learning mechanisms also align well with co-design ( 71 ). If we consider the DSM a boundary object, it positions itself between the activity system of the professionals, patients, and other people close to the patient ( Figure 2 ). The boundary between activity systems represents not only the cultural differences and potential challenges in actions and interactions but also the significant value in establishing communication and collaboration ( 71 ). All sides can give meaning to the DSM language from their perspective. By effectively considering the DSM as a boundary object, the DSM serves as a conversation piece—a product that elicits and provides room for questions and comments from other people, literally one that encourages conversation ( 72 ). As a conversation piece rather than a determinative classification system, it can contribute to mapping the meaning of complaints, behaviors, signs, and patterns for different invested parties. It also provides space for the patient’s contextual factors, subjective experience, needs, and life events, which are essential to giving constructive meaning to mental distress. This allows for interpretative flexibility; professionals can structure their work, while patients can give meaning to their subjective experience of mental distress.
Figure 2 DSM as a boundary object, adapted from Figure 1, ‘Design of a Digital Comic Creator (It’s Me) to Facilitate Social Skills Training for Children With Autism Spectrum Disorder: Design Research Approach’, by Terlouw et al., CC-BY ( 65 ).
As the DSM as a boundary object enables interpretative flexibility, it could then be used to enact conversations and develop a shared understanding in partnership between the patient and the professional; patients are no longer ‘diagnosed’ with a disorder from a professional point of view. It is important to note that the conceptual history of understanding the diagnostic process as essentially dialogical and not as a merely technical-quantitative procedure was already started in the early 1900s. For example, in the 1913 released ‘General Psychopathology,’ Karl Jaspers presented a phenomenological and comprehensive perspective for psychiatry with suggestions about how to understand the psychopathological phenomena as experienced by the patient through empathic understanding, allowing to understand the patient’s worldview and existential meanings ( 73 ). A century after its first publication, academics continue to leverage Jaspers’ ideas to critique modern operationalist epistemology ( 74 ). Following the notion of the diagnostic process as a dialogical one, the reconsideration of the DSM as a boundary object could accommodate the patient’s idiographic experience and the professional’s knowledge about mental distress by using these potential spectra as conversation pieces, shifting the power balance in clinical practice towards co-creation and dialogue. The spectra can then be explained as umbrella terms that indicate a collection of frequently occurring patterns and signs that can function as a starting point for a co-creative inquiry that promotes dialogue, aligning more with current empirical evidence of lived experience than using classifications as diagnoses.
Considering the advantages and strengths boundary objects bring to a mental health care system centered around shared decision-making and co-creation, the DSM could be a boundary object that is interpreted from various perspectives. Take, for example, altered perceptions, which is a characteristic commonly seen in people who receive a psychosis-related classification in clinical care. For some, these perceptions have person-specific meaning ( 75 , 76 ). By using the DSM as a boundary object and as a conversation piece, the patient and professional can give meaning by using the spectra in the manual as a starting point for a common language instead of using a classification to explain the distress. This requires a phenomenological and idiographic approach considering person-specific meaning and idiosyncrasies. Consequently, diagnostic practices should be iterative to align with the dynamic circumstances, with the individual’s narrative taking center stage in co-creation between professional and patient ( 41 , 49 ), as this reconsidered role fosters the engagement instead of the disengagement of patients. Additionally, the potential role of the DSM as a boundary object and conversation piece may also have a positive effect on societal and scientific levels, specifically on how mental distress is perceived and conceptualized. It can ‘systemically contextualize’ mental distress, which could eliminate the disorderism and the psychiatrization of society, and in the end, hopefully, contribute to population salutogenesis.
If the DSM is reconsidered as a conversation piece in which spectra of mental distress replace classifications, it is important to address that these must be co-designed to accommodate diverse stakeholder perspectives and various types of knowledge side by side in clinical practice. Therefore, developers and designers need to embrace lived experience in the co-development of these spectra of mental distress to ensure patients’ engagement in clinical practice, as the patient effectively becomes a stakeholder of the DSM. This requires a different approach and procedure than DSM task forces used in past iterations. In this section, we will address our second hypothesis: embracing design approaches in redesigning the DSM to a conversation piece that uses spectra of mental distress instead of classifications will stimulate the integration of diverse perspectives and voices in reshaping mental health care. While we focus a little on the what (spectra of mental distress), we mainly focus on the how (the procedure that could be followed to arrive at the what). First, we will discuss the importance of lived experience leadership in design and research. Second, we argue that in the conceptual co-design of DSM spectra, lived experience leadership can be a way forward. Third, we take the stance that a designerly way of thinking and doing can shift the premature overcommitment task forces had to iterative exploration. In the concluding paragraph, we propose a design procedure that embraces engagement and iteration as core values for developing robust and flexible spectra of mental distress that are meaningful for service users and professionals.
First, let us briefly examine the evolution of lived experience in design and science over time to provide context for why engaging people with lived experience in the design of spectra of mental distress is important for innovation. Since 1960, people with lived experiences have tried to let their voices be heard, but initially to no avail, and their civil rights movement of reformist psychiatry was labeled as ‘anti-psychiatry’ ( 77 ). During the turn of the millennium, lived experience received increased recognition and eventually became an important pillar of knowledge that informed practice and continues to do so on various levels of mental health care ( 34 , 36 , 78 – 81 ). While there is currently growing attention to the perspective of lived experience in, for example, mental health research ( 79 , 80 , 82 , 83 ) and mental health care design and innovation ( 84 – 90 ), overall, their involvement remains too low in the majority of research and design projects ( 88 , 91 , 92 ). While there has been a significant increase in the annual publication of articles claiming to employ collaborative methods with people with lived experience, these studies often use vague terms to suggest a higher engagement level than is the case ( 93 ). This has led to initiatives such as that of The Lancet Psychiatry to facilitate transparent reporting of lived experience work ( 93 , 94 ).
Although the involvement of people with lived experience and its reporting needs attention in order to prevent tokenism and co-optation ( 89 ), some great user-driven initiatives resulted in innovative design and research that improved mental health care and exemplifies why their engagement should be mandatory. The Co-Design Living Labs is such an initiative. Its program exemplifies an adaptive and embedded approach for people with lived experiences of mental distress to drive mental health research design to translation ( 95 ). In this community-based approach, people with lived experience, their caregivers, family members, and support networks collaboratively drive research with university researchers, which is very innovative considering the relatively low engagement of people with lived experience in general mental health research. Another example is the development of person-specific tapering medication initiated by people with lived experience of withdrawal symptoms. People with lived experience began to devise practical methods to discontinue medications on their own safely because of the lack of a systematic and professional response to severe and persistent withdrawal. This resulted in the accumulation of experience-based knowledge about withdrawal, ultimately leading to co-creating what is now known as tapering strips ( 81 ). The development of these tapering strips shows that people with lived experience have novel experience-based ideas for design and research that can result in human-centered innovation. Both examples underline the importance of human-centered design in which people with lived experience and knowledge are taken seriously and why the participation era requires that individuals with lived experience are decision-makers from the project’s start to produce novel perspectives for innovative design and research ( 88 , 93 ).
Engaging people with lived experience of mental distress in redesigning the DSM towards a spectrum-based guideline is of special importance, albeit a more conceptual design task in comparison to the earlier examples. What mental distress is remains a fundamental philosophical and ontological question that should be addressed in partnership as it sits at the core of how mental health care is organized. To allow novel ontologies to reach their full potential and act as drivers of a landscape of promising innovative scientific and clinical approaches, investment is required in development and elaboration ( 30 ). This, as well as the epistemic pluralism among theoretical models on mental health problems ( 31 ), makes it evident there is currently not one coherent accepted explanation or consensus on what mental distress is and how it exists. Without clear etiological understanding, the most logical first step should be to involve people with lived experience of mental distress in the redevelopment of the DSM. Accounts from people with lived experience of mental distress are directly relevant to the design of the DSM, as they provide a more comprehensive and accurate understanding of mental distress and its treatment ( 96 ). Moreover, the DSM’s conceptualization as a major determinative classification system could be standing at the core of psychiatry’s “identity crisis”, where checklists of symptoms replaced thoughtful diagnoses despite after decades of brain research, no biomarker has been established for any disorders defined in the DSM ( 10 , 97 ).
Design approaches can help DSM task forces prioritize integrating lived experiences to co-create a framework that can accommodate a range of perspectives to make it viable as a conversation piece. As DSM classifications do not reflect reality ( 98 ), listening to people with firsthand experiences is necessary. The CHIME framework – a conceptual framework of people’s experiences of recovery – shows, for example, a clear need to diagnose not solely based on symptoms but also considering people’s stages in their journey of personal recovery ( 80 ). Further, bottom-up research shows that the lived experience perspective of psychosis can seem very different compared to conventional psychiatric conceptualizations ( 82 ). This is also the case for the lived experience of depression ( 99 ). Design approaches can ensure that such much-needed perspectives and voices are adhered to in developing meaningful innovations ( 88 ), which brings us back to the design of the DSM. Although the DSM aims to conceptualize the reality of mental distress, engaging people with experiences of living with mental distress has never been prioritized by the DSM task force as an important epistemic resource. This is evidenced by the historically low engagement of people with lived experiences and their contexts. For example, although “individuals with mental disorders and families of individuals with mental disorders” participated in providing feedback in the DSM-5 revisions process ( 14 ), when and how they were involved, what feedback they gave, and how this was incorporated are not described. According to the Involvement Matrix ( 100 ) — a matrix that can be used to assess the contribution of patients in research and design —, giving feedback can be classified as ‘listeners’ or ‘co-thinkers,’ which are both low-involvement roles. Moreover, a review of the members of the DSM task forces and working groups listed in the introductions of the DSMs shows patients have never been part of the DSM task force and thus never been part of the decision-making process ( 96 ). Human-centered design is difficult to achieve when people with lived experience are not involved from preparation to implementation but are only asked to give feedback on expert consensus ( 88 ).
In the participation era, using a design approach in mental health care without engaging important stakeholders can be problematic. For example, it is evident that the involvement of people with lived experience changes the nature of an intervention dramatically, as people’s unique first-hand experiences, insights about mental states, and individual meaning and needs are often different in design activities as opposed to what general scientific and web-related resources suggest ( 101 , 102 ). Further, clear differences are reported around designers, researchers, and clinicians on one side and service user ideas of meaningful interventions on the other ( 102 , 103 ). Thus, the meaningful engagement of people with lived experience in design processes always exposes gaps between general research and the interests and lives of service users ( 104 ). This makes the participation of people with lived experience in developing innovative concepts — and, as such, in the conceptual design of DSM spectra of mental distress — essential because their absence in design processes may lead to ineffective outcomes ( 102 ). This design perspective may explain some of the negative effects of the DSM. The classifications aimed to be empirical constructs reflecting reality, yet phenomena such as reification and the classificatory looping effect emerged ( 42 , 51 ). From a design perspective, the emergence of these effects may have a simpler explanation than previously presumed: the premature over-commitment in the DSM’s design processes without input from individuals with firsthand experiences.
The centrist development approach used to design the DSM implicitly frames people with mental distress as ‘ordinary people,’ resulting in ‘average solutions’ because their experiences are decontextualized and lumped together on a group level — eventually leading to general descriptions for a universal appliance. Instead, a more human-centered iterative design process in which people with lived experience play an important role, preferably as decision-makers, can promote the design of spectra of mental distress that leave room for idiosyncrasies that correspond with people’s living environments on an individual level. This can potentially ensure that they are actually helpful for shared decision-making between patients and professionals and resonate in person-centered mental health care. A design approach is feasible for this aim because design processes are not searching for a singular ‘truth’ but rather exploring the multiple ‘truths’ that may be relevant in different contexts ( 105 ). This can be of added value to conceptualizing spectra of mental distress, which is known to have characteristics that overlap between people but also to have a unique phenomenology and contextual foundation for each individual — in the case of mental distress, there literally are multiple truths dependable on who and what you ask in what time and place. Furthermore, design approaches enable exploration and discovery ( 106 ). Designers consistently draw cues from the environment and introduce new variables into the same environment to eventually discover what does and does not work ( 107 ). This explorative attitude also ensures the discovery of unique insights, such as people’s experiential knowledge and contexts. Therefore, from a design perspective, predetermining solutions might be ineffective for arriving at DSM innovation. This is, for example, aptly described by Owens et al. ( 101 ):
“… the iterative nature of the participatory process meant that, although a preliminary programme for the whole workshop series was drawn up at the outset, plans had to be revised in response to the findings from each session. The whole process required flexibility, a constantly open mind and a willingness to embrace the unexpected”.
These insights illustrate the core of design that can guide the development of future DSM iterations: design enables the task force to learn about mental health problems without an omniscient perspective by iteratively developing and testing conceptualizations in the environment in partnership with the target group. As participatory design studies consistently demonstrate, solutions cannot be predetermined solely based on research and resources. The involvement of individuals with lived experience and their contexts invariably uncovers crucial serendipitous insights that challenge the perspectives on the problem. This can expose important misconceptions, such as the tendency to underestimate the complexity of human experience and decontextualize it from its environment.
People with lived experience need to be highly involved in developing meaningful spectra of mental distress to guide conversations in clinical practice. As we now have a comprehensive understanding of what design approaches can offer to the development procedure of a lived experience-informed DSM, we will highlight these insights in this paragraph.
In the design procedure of a future DSM, academic research can be used to learn about people’s experiences of mental distress but never as the source alone for the development of spectra of mental distress. In this way, designers and researchers in mental health care need to involve people with lived experience at the heart of design processes as partners and come to unique insights together without an omniscient perspective. The aim should not be to design general descriptions but to design spectra that are flexible enough to adapt to local needs and constraints for the various parties using them yet robust enough to maintain a common identity across different locations. This allows the DSM to have different meanings in different social worlds, while at the same time, their structure is common enough for more than one world to recognize them.
Conceptualizations of spectra of mental distress must not be predetermined, and there should be no overcommitment to concepts in the early phases of the project. Thus, the task force should avoid viewing mental distress too narrowly, too early on in the process. This enables the evolution of lived experience-based spectra in an iterative design- and test process. The starting point should be an open representation of mental distress and discover together with people with lived experience how this could be best conceptualized and what language should be used. This allows room for exploring and discovering what works and aligns with patients’ needs and experiences in their living environments and professionals’ needs in their work environments.
Researchers and designers should realize that designing and testing conceptualizations in partnership with people with lived experience also results in unique knowledge that can guide the development — designing and testing the developed concepts is a form of research. For example, exploring if a certain designed spectrum resonates as a conversation piece between patients and professionals in clinical practice provides qualitative insights that cannot be predicted beforehand. In this way, science and design can complement the innovation of the DSM: science benefits from a design approach, while design benefits from scientific methods ( 108 ). Flexible navigation between design and science would indicate that the developed DSM can be meaningful as a conversation piece in clinical practice.
Good design comes before effective science, as innovations are useless if not used, even if they are validated by science ( 85 ). Although the development of the DSM is often described as a scientific process, our analysis indicates that it is more accurately described as a design process. As a design process, it requires a methodologically sound design approach that is suitable for involving patients and people with lived experience. Co-design is a great contender for this purpose, as a systematic review showed this approach had the highest level of participant involvement in mental health care innovation ( 89 ). Although people with lived experience have never been involved as decision-makers, this should be the aim of the design process of a novel DSM in the participation era. This promotes lived experience leadership in design and, ultimately, contributes to more effective science.
Involving people with lived experience as decision-makers in redesigning the DSM must avoid tokenism and co-optation and address power imbalances. The first step that the task force can take is to use the Involvement Matrix ( 100 ) together with people with lived experiences to systematically and transparently plan, reflect, and report on everyone’s contribution to the design process. This has not been prioritized in the past DSM revisions. In the end, transparency and honesty about collaboration can support the empowerment of people with firsthand perspectives and shift the power imbalance towards co-creation for more human-centered mental health care. This is needed, as the involvement of people with lived experience in design and research processes is currently too low and obscured by vague terms and bad reporting.
In this hypothesis and theory paper, we have argued that the current role of the DSM, as an operating manual for professionals, can be reconsidered as a boundary object and conversation piece for patients and professionals in clinical practice that stimulates dialogue about mental distress. In this discussion, we will address five themes. First, while we argued that research acknowledges the absence of empirical support for biological causation, we believe characterizing the DSM as entirely non-empirical may be incorrect. Second, we discuss our perspective on balancing between a too-narrow medical perspective and a too-broadly individualized perspective. Third, we discuss why mental health care also needs novel methods for inquiry if the DSM is reconsidered as a conversation piece. Fourth, we discuss that while we are certain that design approaches can be fruitful for redesigning the DSM, some challenges regarding tokenism, co-optation must be addressed. We conclude by examining various methodological challenges and offering recommendations for the co-design process of the DSM.
The DSM is too deeply entrenched in mental health care to discard it simply. The DSM is embedded in not only mental health care but also society. For instance, a DSM classification is necessary in the Netherlands to get mental health care reimbursement, qualify for additional education test time, or receive subsidized assisted living. Moreover, it is ingrained in research and healthcare funding, making it unproductive and somewhat dangerous to discard without an alternative, as it may jeopardize access to care and impact insurance coverage for treatment and services that people with mental distress need. Therefore, we posited that instead of discarding the DSM, its role should be reconsidered in a mental health care system centered around shared decision-making and co-creation to eliminate pervasive effects such as the disengagement of patients, reification, disorderism, and the psychiatrization of society. However, the DSM categories are not entirely a priori constructed as is sometimes claimed, as the psychiatric symptom space and diagnostic categories took shape in the late nineteenth century through decades of observation ( 109 ).
While this adds important nuance to the idea that the design of the DSM is entirely non-empirical, it does not invalidate the argument that the DSM design is grounded in a potentially false ontology ( 64 ). Though the lack of evidence does not necessarily indicate evidence of absence, and the biological context in some way plays a role, research shows various other dimensions of life — including the social, historical, relational, environmental, and more — also influence mental distress, yet are significantly underemphasized in its current design. We believe that we showed this manifests itself most prominently in the various highly arbitrary classification designs that can confuse the professional and the patient and appear limited in providing meaningful guidance for clinical practice, design, and research. That is why we have proposed redesigning the next iteration of the DSM to primarily focus on formulating a set of spectra of distress. Reconsidering the DSM leverages one of its biggest strengths: the DSM is not bound by an analytic procedure but rather is guided by scientific debate ( 17 ). Further, developments and amendments to psychiatric classification systems have always reflected wider social and cultural developments ( 110 ). The recognition, implementation, and impact of the DSM in Western countries can even be seen as a reason not to focus on developing alternative models but rather to redesign the DSM so that it conceptually aligns with the social developments, scientific findings, and needs of people in the 21st century, as it is already deeply embedded in systems. Given that DSM classifications are now recognized as inaccurate depictions of the reality of mental distress ( 98 ) and that, at the same time, mental health care is shifting towards person-centeredness and shared decision-making, we believe the proposals in this article are not radical but rather the most meaningful way forward to accommodate diverse perspectives.
From a classical psychopathological perspective, integrating the lived experiences of those with mental distress into the redevelopment of the DSM as a boundary object presents certain conceptual challenges. For example, uncritically overemphasizing individual experiences might lead to an underappreciation of psychopathological manifestations like, for example, altered perceptions. Conversely, excluding people with lived experience from the DSM’s design processes has resulted in its own conceptual and epistemic issues, such as undervaluing the idiographic, contextual, and phenomenological aspects of individual mental distress. Therefore, we argue that achieving a balance between these differing but crucial perspectives should result from a co-design procedure for a revised DSM. Determining this balance before obtaining results from such a process is too premature and arbitrary and would contradict our recommendation to prevent over-commitment in the early stages of the design process. As people with lived experience were never previously involved, it is impossible to predict the outcomes of a co-design procedure or hypothesize about a clear distinction between these perspectives in the DSM’s conceptual development beforehand. As seen in past iterations, prematurely drawing rigid lines could hinder the design process and result in design fixation. From the perspective of boundary objects, the DSM cannot have one dominant perspective if it is to function effectively. All stakeholders must be able to give meaning to the spectra of mental distress from their own activity systems, and these perspectives should be equal in order to create a shared awareness of the different perspectives involved. A DSM designed as a boundary object triggers dialogical learning mechanisms, ensuring the multiple perspectives are harmonized rather than adjusted to fit one another, ensuring no single perspective prevails over the others or consensus is pursued ( 71 , 111 ).
If the DSM is reconsidered and designed as a conversation piece and classifications are replaced by spectra, in clinical practice, a unique language needs to be co-developed between the patient and the professional, and an equal relationship is important to ally. For example, if we consider the person-specific meanings of altered perceptions, they need to be explored, as they have clinical relevance. However, for such purposes, current diagnostic methods in clinical practice are limiting because they are highly linguistic and tailored to classification systems and the needs and praxis of the professionals. This can impede the DSM’s effectiveness as a tool for dialogue. Expressing the uniqueness of an experience of mental distress is difficult — especially during a mental crisis — let alone effectively communicating it to a professional. While people with mental distress can effectively communicate their behaviors and complaints, which fits the current use of the DSM, people have far more embodied and experiential knowledge of their distress. How people cope with their mental distress in the contexts they are living in is very difficult to put into words without first making these personal and contextual insights tangible ( 41 ), yet this is essential information for when the DSM is used as a boundary object and conversation piece. To accommodate the patient in making this knowledge tangible, the professional becomes more of a facilitator than an expert, emphasizing therapeutic relationships and the healing effects of ritualized care interactions ( 39 ). This transformation requires novel co-creative methods for inquiry ( 41 ) and professional training ( 39 ). Therefore, expanding the diagnostic toolkit with innovative and creative tools and embracing professionals such as art therapists, social workers, and advanced nurse practitioners to enable and support patients to convey their narratives and needs in their own way is essential if the DSM is to be used as a boundary object and conversation piece.
Despite longstanding calls for the APA to include people with lived experience in the decision-making processes for diagnostic criteria, the DSM-5 task force did not accept this inclusion. The task force believed incorporating these perspectives could compromise objectivity in the scientific process ( 96 ). This mindset ensures that research, design, and practice remain predominantly shaped by academics and professionals, causing conventional mental health care to perpetuate itself. It continues to repeat the same approaches and consequently achieves the same results. Therefore, people with lived experience should have more influence in the participation era to accelerate change in mental health care. This proposition comes with some challenges regarding power imbalances that need addressing. While it is acknowledged that the involvement of individuals with lived experience yields unique insights and can serve as strong collaborators and knowledgeable contributors, they are never given decision-making authority in design processes in mental health care ( 88 , 89 , 92 ) or in the DSM’s development processes ( 96 ). This lack of authority impedes lived experience leadership ( 91 , 112 ) and subsequently stands in the way of effectively reconsidering and redesigning the DSM. To avoid tokenism, the DSM revision process should not settle for low engagement and involvement but set the bar higher by redressing power imbalances ( 113 ). Furthermore, in the co-design process of the DSM, the task force should not view objectivity as the opposite of subjectivity or strive for consensus. Instead, they should value group discussions and disagreements, encouraging stakeholders to debate and explore the sources of their differing perspectives and knowledge ( 96 ). Shifting towards lived experience leadership starts with perceiving and engaging people with lived experiences of mental distress as experts of their experiences in iterative design and research processes and giving them this role in revising the DSM.
Merely positioning people with lived experience as partners and decision-makers is insufficient; there are also significant methodological concerns regarding the execution of design research in mental health care. Although iteration and participation are essential for design in mental health care, as designers focus on the unmet needs of service users and ways to improve care ( 114 ), research shows design is not always executed iteratively, and end users are not always involved. For example, about one-third of projects that designed mental health interventions did not adopt an iterative process ( 85 ). The engagement of end users in design processes in mental health is also not yet a common practice. For instance, a systematic review of serious games in mental health for anxiety and depression found that only half of these games, even while reporting using a participatory approach, were designed with input from the intended end-users ( 115 ). A systematic review of design processes that aimed to design innovations for people with psychotic symptoms overlaps these findings, as less than half of the studies demonstrated a high level of participant involvement in their design processes ( 89 ).
The low level of involvement and lack of iterative approaches in mental health care design offer valuable insights for future processes. If the DSM task force aims to adopt a co-design approach, it should incorporate these lessons to enhance design effectiveness. First, the task force must understand that design has a different aim, culture, and methods than the sciences ( 116 ). The scientific approach typically implies investigating the natural world through controlled experiments, classifications, and analysis, emphasizing objectivity, rationality, neutrality, and a commitment to truth. In contrast, a design approach focuses on studying the artificial world, employing methods such as modeling, pattern formation, and synthesis, guided by core values of practicality, ingenuity, empathy, and concern for appropriateness. Second, the task force should consider the known challenges they will encounter and need to navigate to let the paradigms be complementary in practice ( 117 ). Further, the task force should consider that the nature of design is exploratory, iterative, uncertain, and a social form of inquiry and synthesis that is never perfect and never quite finished ( 84 ). This requires tolerating ambiguity and having trust ( 101 ). Lastly, more transparency in the participatory work of the task force is called for, beginning with being honest, being detailed, addressing power imbalances, being participatory in reporting the participatory approach, and being excited and enthusiastic about going beyond tokenistic engagement ( 118 ).
Despite these challenges, transforming psychiatric diagnoses by reconsidering and redesigning the DSM as a boundary object and conversation piece could be a step in the right direction. This would shift the power balance towards shared ownership in a participation era that fosters dialogue instead of diagnosis. We hope this hypothesis and theory paper can give decisive impulses to the much-needed debate on and development of psychiatric diagnoses and, in the end, contribute to lived experience-informed psychiatric epistemology. Furthermore, as a product of an equal co-production process between various disciplines and types of knowledge, this paper shows it is possible to harmonize perspectives on a controversial topic such as the DSM.
The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding author/s.
LV: Conceptualization, Methodology, Project administration, Writing – original draft, Writing – review & editing. GT: Conceptualization, Methodology, Visualization, Writing – original draft, Writing – review & editing. JVO: Conceptualization, Writing – original draft, Writing – review & editing. SM: Conceptualization, Writing – original draft, Writing – review & editing. JV: Writing – original draft, Writing – review & editing. NB: Writing – original draft, Writing – review & editing.
The author(s) declare financial support was received for the research, authorship, and/or publication of this article. We appreciate the financial support of the FAITH Research Consortium, GGZ-VS University of Applied Science, as well as from the NHL Stenden University of Applied Sciences PhD program. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
We thank the reviewers for their thorough reading of our manuscript and valuable comments, which improved the quality of our hypothesis and theory paper.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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Keywords: psychiatry, diagnosis, design, innovation, mental health care
Citation: Veldmeijer L, Terlouw G, van Os J, te Meerman S, van ‘t Veer J and Boonstra N (2024) From diagnosis to dialogue – reconsidering the DSM as a conversation piece in mental health care: a hypothesis and theory. Front. Psychiatry 15:1426475. doi: 10.3389/fpsyt.2024.1426475
Received: 01 May 2024; Accepted: 22 July 2024; Published: 06 August 2024.
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Copyright © 2024 Veldmeijer, Terlouw, van Os, te Meerman, van ‘t Veer and Boonstra. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Lars Veldmeijer, [email protected]
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Scientific Reports volume 14 , Article number: 18610 ( 2024 ) Cite this article
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The pollution haven hypothesis (PHH) is defined as follows: a reduction in trade costs results in production of pollution-intensive goods shifting towards countries with easier environmental laws. The previous studies examined this hypothesis in the form of Kuznets' environmental hypothesis. In this way, they test the effect of foreign direct investment (FDI) on carbon emissions. However, this study investigates PHH from a new perspective. I will use Newton's gravity model to test this hypothesis. The basis of PHH is the difference in the environmental standards of the two business partners. One of the indicators used to measure the severity of a country's environmental laws is carbon emission intensity. The stricter the country's laws are, the lower the index value will be. In order to test the hypothesis, experimental data from China and OECD countries are used. China was as the pollution haven for the countries of the Organization for Economic Cooperation and Development. I found that environmental laws of host and guest countries have different effects on FDI. In addition, transportation costs have a negative effect on the FDI flow. Finally, the research results confirm the hypothesis on gravity model.
Introduction.
The discussion on link between environment and trade started in 1970’s. This debate become serious in 1990’s when trade openness was expanded by different organizations like North American Free Trade Agreement (NAFTA). Copeland and Taylor 1 first introduced the PHH in the context of North–South trade under NAFTA. It was the first article that links the environmental rules severity and trade models with the level of pollution in a country 2 . They proved in the first and second propositions that the higher income country chooses harder environmental safekeeping, and specializes in relatively clean commodities 1 . These two propositions are actually the pollution haven hypothesis. As stated by the PHH, the movement of the unclean industries from advanced to developing countries happen by way of the trade of commodities and foreign direct investment (FDI) 2 . Two important factors are the basis of the pollution haven hypothesis. The first is foreign investment, and the second is environmental laws. The first factor, foreign direct investment (FDI) is an impartible item of an open and effective international economic process and an important catalyst to development 3 . FDI flow is an increase in the book value of the net worth of investments in one country held by investors of another country, where the investments are under the managerial control of the investors 4 . Developing and emerging economies have come passing through increasingly to see FDI as a factor of economic development and advance, income growth and employment 3 . The mutual connection between trade and FDI is an important feature of globalization. Empirical study shows that, until the mid-1980s, international trade generated direct investment. After this era, the cause-and-effect relationship has converted and direct investment has a huge impact on international trade 3 . In the today's economies, trade has an increasingly important effect in shaping economic and social performance and prospects of countries around the world, especially those of developing countries 5 .
The second factor was environmental laws (EL). Generally, international trade has two consequences on the environment. First, trade can improve environmental quality by exporting clean technologies from developed countries to developing countries. In fact, trade can improve environmental quality 6 , 7 . Second, international relations can increase pollution. More developed countries pay more attention to environmental standards. In these countries, with the increase in economic growth, people demand a higher quality of the environment. It is the opposite in less developed countries. They substitute higher economic growth for environmental quality. According to the Kuznets environmental curve, developed countries are located after the turning point, while less developed countries are located before this point. In other words, more developed countries have stricter environmental laws than less developed countries. If we want to have a definition of environmental laws: environmental rules is a series of policies or standards adopted by the government to maintain the environment 8 . Environmental regulations have effectively restricted the damages of enterprises by the environment and had an important role in protecting the environment 8 , 9 .
Paying more or less attention to environmental standards reminds us of the pollution haven hypothesis. The pollution haven hypothesis, which emerged in the 1990s, pivots on the relocation of polluting manufacturing from developed countries with hard environmental laws to developing countries with soft rules 10 . The pollution haven hypothesis tells that easy environmental rules in developing countries encourage investment in emission-intensive industries from developed countries, especially in the context of increasing numbers of countries committing to carbon neutrality before 2050 11 .
From the PHH standpoint, the stringent environmental rules in developed countries lead to relocate of the polluting industries from developed to developing countries and cause pollution to rise in developing countries 2 . According to the definition of PHP, what causes the movement of FDI between two countries is the severity of environmental laws. In other words, their environmental regulations determine the amount of FDI of two countries. As we mentioned earlier, PHP is Copeland and Talor 1 first and second presentation in their article. Therefore, the purpose of this article is to model the pollution haven hypothesis accurately. By carefully investigating this hypothesis and previous studies (Table 1 ), we found that there are two important gaps: first, none of them has included the two main factors of the hypothesis (FDI and EL) in their modeling simultaneously. Second, they assumed that FDI has an effect on EL. That is, they considered the FDI variable as independent. While FDI should be considered as dependent variable. Therefore, this research will make future researchers have a more accurate view of PHP. They can examine the effects of various social, economic, environmental and political variables in this new model. The framework presented by this paper allows researchers to better understand the distinction between the two environmental Kuznets and the pollution haven hypotheses.
So far, many researchers have investigated the pollution haven hypothesis. In these studies, different indicators have been used for the first factor of PHH. Some of them directly applied FDI, for example Usama and Tang 12 ; Solarin et al. 13 ; Benzerrouk et al. 7 ; Shijie et al. 14 ; Temurlenk and Lögün 15 ; Yilanci et al. 16 ; Ali Nagvi et al. 17 ; Chirilus and Costea 18 ; Campos‑Romero et al. 19 ; Liu et al. 20 ; Soto and Edeh 21 ; Ozcelik et al. 22 . Some researchers also used polluting goods and activities as proxies, here are some of them: Shen et al. 23 ; Sadik-Zada and Ferrari 24 ; Zhang and Wang 25 ; Bhat and Tantr 10 ; Moise 26 ; Hamaguchi 27 . In all studies, the first PHP factor is considered as an independent variable. These studies are briefly mentioned in Table 1 .
By reviewing previous research, the innovation of this study is the methodology section. The research methodology is based on Newton's gravity model. I will present the pollution haven hypothesis in terms of Newton's gravity model. This model is widely used in trade research. There are always two partners in business discussions. One country will be the importer and the other the exporter. The pollution haven hypothesis is also one of the business categories. The importer will become a pollution haven for the exporting country. In fact, the host country will become a trading partner's haven for the investment of polluting industries.
I selected the host country based on the pollution emission and foreign direct investment data in 2020 (Figs. 1 , 2 ).
( a ) Ten countries with the most CO 2 (kt) emissions in 2020, ( b ) ten countries with the most share of CO 2 emissions (percentage) in 2020.
( a ) Ten countries with the highest foreign direct investment (FDI) net inflows in 2020, ( b ) ten countries with the highest share of foreign direct investment (FDI) inflows in 2020.
Countries have different levels of CO 2 emissions based on their activities. As Fig. 1 a shows, China had the highest CO 2 emissions in 2020 (about 13 million kilotons). On the other hand, China's share of the world's total emission is more than 29% (Fig. 1 b). United States is next with a share of 12%. According to Fig. 1 b, China's share is two and a half times that of United States.
Foreign direct investment is an important indicator to determine the pollution haven. We reviewed the FDI countries of the world in 2020. The results of the investigation are shown in Fig. 2 a,b. Figure 2 a indicates that China has the highest FDI inflows in 2020. China had 2.5 thousand billion FDI net inflows in 2020 (Billions of United States dollars). According to Fig. 2 b, China's FDI share in 2020 was 21%.
After introduction, the results section is discussed in detail. The research findings were divided into three categories: 1. the validity of the pollution haven hypothesis. 2. The effect of control variables on foreign direct investment. 3. The effect of main or independent variables on foreign direct investment. Generally, results showed that the severity of environmental laws has different effects on FDI flow. Since the direction of FDI flow from OECD countries is to China, increasing the severity of the environmental regulations of the guest countries will increase FDI. On the other hand, more environmental laws of China (the host) reduce the flow of FDI.
This section presents and discusses the main findings of the empirical analysis. In this research, I investigated pollution haven hypothesis based on gravity model approach. The variables that were collected included CO 2 emission (World Bank), GDP (World Bank), trade costs (World Trade Organization), FDI inflows from OECD to China (Organization for Economic Co-operation and Development data), urbanization is represented by the number of individuals living in cities (World Bank), trade openness, whose calculation formula is as: X + M/GDP, where X = Exports; M = Imports) (World Bank) and share of manufacturing (World Bank). Table 2 indicates the measurement unit of the variables and their sources.
Because data has two dimensions (cross-section and period), I used the F-Limer test to determine whether the data is a panel. The null hypothesis was rejected based on the pool model and the model with panel data was accepted, Therefore, I used panel regression. Then, Hausman test was used to test the type effects (random or fixed). The result showed that there was a random effect for both cross-section and period. In the following, I investigated stationary of the variables to prevent spurious regression. Levin, Lin and Chu test, examined four variables. The result showed that variables are stationary at level (intercept and trend).
Finally, I estimated the model based on panel data. The regression results has been shown in Table 3 . FDI ijt is the dependent variable. ER it , ER jt , TC 2 ijt , \({\text{lnUR}}_{\text{jt}}\) , \({\text{lnTO}}_{\text{jt}}\) and \({\text{lnShM}}_{\text{jt}}\) are independent variables. Table 3 indicates that all the coefficients are significant at the level of 5% and R 2 was 0.79. R 2 shows that the independent variables were able to explain 79% of the changes in the dependent variable.
The coefficient for \({lnER}_{it}\) is − 0.54. The negative coefficient sign shows that with increasing \({ER}_{it}\) , FDI ijt will decrease. In other words, when host countries' environmental regulations become easier, FDI flows from host countries (OECD) to host countries (China) will decrease. The coefficient for \({lnER}_{jt}\) is 0.90. The positive sign indicates that if \({ER}_{jt}\) increases, FDI ijt also increase. The results related to the effect of environmental laws on trade were similar to the previous studies. For example, in Shen et al. 23 study, the coefficient sign for environmental regulation was positive. Sadik-Zada and Ferrari 24 indicated that environmental policy stringency has a positive effect on carbon trade. Bhat and Tantr 10 concluded that environmental policy has a positive effect on pollution-intensive exports. The coefficient for transportation costs was obtained − 0.11. In fact, with the increase in transportation costs, the FDI flow from i (guest country) to j (host country) decreases. The \({\text{lnTC}}_{\text{ijt}}^{2}\) coefficient sign in present study is consistent with the following studies: Nuroğlu and Kunst 28 ; Wang et al. 29 ; Golovko and Sahin 30 ; Wani and Yasmin 31 . Among the control variables, the urbanization coefficient was not significant. The coefficient for the TO and ShM was positive and significant. The coefficient for the TO was positive. It means that as TO increases, FDI also increases. Benzerrouk et al. 7 indicated that an increase in trade and FDI increases the developed countries’ polluting projects which are destined for the developing countries. Moise 26 showed that trade openness statistically and significantly increase CO2 emission. In addition, the coefficient value for the ShM was estimated positive. This coefficient states that if the share of manufacturing in GNP increases, foreign direct investment will increase. Shijie et al. 14 concluded the positive effect of FDI on the environment of dominant industrial agglomeration is increasing first and then decreasing. Sawhney and Rastogi 32 indicated that that the increase in trade liberalization, the growth of American industries and FDI has increased the emission of pollution in India.
Our model is in terms of logarithms, so the coefficients express elasticities. \({LnER}_{it}\) and \({ln ER}_{jt}\) coefficient were − 0.54 and 0.9, respectively. That is, if the environmental laws of guest country are tightened by 1%, FDI flow from the guest country to the host country will decrease by 54%. In addition, if environmental laws of the host country are relaxed by 1%, FDI flow from the guest country to the host country will increase by 90%. The \({lnTC}_{ijt}^{2}\) coefficient was − 0.11 that indicates with 1% increase in transportation costs, the FDI flow from the guest country to the host country decreases by 11%. The coefficient for the control variables \({lnTO}_{jt}\) and \({lnShM}_{jt}\) were 0.77 and 0.51, respectively. These coefficients state that if trade openness and share of manufacturing increase by 1%, foreign direct investment will increase by 71 and 55%. Thus, increasing trade openness reveals that lax environmental enforcement in developing countries attracts investment in emission-intensive industries from developed countries.
This paper fills a research gap by assessing pollution haven hypothesis based on its initial assumptions. In previous studies, this hypothesis was tested in the form of Kuznets curve. While the concept of pollution haven is due to differences in environmental laws. While the concept of pollution haven is foreign investment flow between the haven seeker and the haven giver. The main driver of which is the difference in environmental laws. When we talk about flow, the gravity model is the best option, for example: power flow, trade flow, labor flow, FDI flow (see Fig. 4 in the method section). Trade has permitted countries with more emission intensities to export goods or investment to countries with less emission intensities, which may result an increase in worldwide carbon emissions 11 . In this research, we examined foreign direct investment between OECD countries and China. In fact, we investigated the effect of environmental laws on FDI in the form of the pollution haven hypothesis. The indicator chosen for the environmental regulations was emission intensity. Figure 3 shows carbon emission intensity of guest (OECD) and host (China) countries in 2016–2020 (kt/10 billion $). Figure 3 (1–9) is for OECD countries and Fig. 3 (10) is for China. As Fig. 3 indicates, emission intensity has been decreasing in all selected countries in 2016–2020.
Carbon emission intensity of guest (OECD) and host (China) countries in 2016–2020. (1–9) is for OECD countries. (10) is also for China. Carbon emission intensity in kilotons per 10 billion dollars.
The emission intensity is in range (782–5439) for OECD countries, while it is in (5510–6308) kilotons per 10 billion dollars for China. The maximum emission intensity of OECD countries is lower than the minimum emission intensity of China. It means that the environmental rules of guest countries are stricter than China. Therefore, the pollution haven hypothesis discloses that weak environmental implement in developing countries absorbs investment in emission-intensive industries from developed countries 11 . The purpose of this paper is to model the pollution haven hypothesis in the form of gravity model. For this purpose, the effect of environmental laws of host and guest countries on FDI is investigated. The results showed that the severity of environmental laws has different effects on FDI flow. Since the direction of FDI flow from OECD countries is to China, increasing the severity of the environmental regulations of the guest countries will increase FDI. On the other hand, more environmental laws of China (the host) reduce the flow of FDI. After presenting the results and comparing them with previous studies, the results should be tested for robustness. The main empirical findings are robust to two different methods of multicollinearity tests (i) Cross-correlation across variables (ii) Variance inflation factor (VIF) of each variable 33 . VIF is a measure of the amount of multicollinearity in regression model. Multicollinearity exists when there is a correlation between multiple independent variables.
The variance inflation factor is calculated as follows:
where \({R}_{i}^{2}\) is the variance explained by the regression model (i is counter of explanatory variable). On the other hand, \({R}_{i}^{2}\) represents the regression of the predictor of interest on the remaining predictors. The VIF values cannot be less than 1.0, since 1.0 represents the ideal situation of no correlation with other predictors. Also implied is that VIF cannot be negative. The minimum VIF can be is 1.0. A VIF of 1.0 can only occur when \({R}_{i}^{2}\) is equal to 0, which implies that the given predictor has zero linear relationship with other predictors in the model. Tolerance is simply the reciprocal of VIF and is thus computed as
whereas large values of VIF are undesirable, large tolerances are preferable to smaller ones. It stands as well that the maximum value of tolerance must be 1.0 34 . As shown in Table 4 , the mean variance inflation factor (VIF) values in our model is equal to 2.34. The maximum VIF amount of explanatory variables is 4.62, which lie within the acceptable standard.
In this study, the pollution haven hypothesis was investigated from a new perspective. In fact, this hypothesis was formulated based on theoretical foundations. Copeland and Taylor 1 first introduced the PHH. It was the first article that links the environmental rules severity and trade models with the level of pollution in a country. According to Copeland and Taylor 1 's article, two factors of foreign direct investment and environmental laws constitute this hypothesis. In their study, it is stated that the environmental laws of countries determine the attraction of foreign direct investment. Therefore, we considered FDI between two countries as a function of their environmental laws. To achieve the research objectives, the commercial gravity model was used. The research innovation is first, none of authors has included the two main factors of the hypothesis (FDI and EL) in their modeling simultaneously. Second, they assumed that FDI has an effect on EL. That is, they considered the FDI variable as independent. While FDI should be considered as dependent variable. Therefore, this research will make future researchers have a more accurate view of PHP. The results showed that if environmental laws of guest country are tightened by 1%, FDI flow from the guest country to the host country will decrease by 54%. In addition, if environmental laws of the host country are relaxed by 1%, FDI flow from the guest country to the host country will increase by 90%. The \({lnTC}_{ijt}^{2}\) coefficient was − 0.11 that indicates with 1% increase in transportation costs, the FDI flow from the guest country to the host country decreases by 11%. The coefficient for the control variables \({lnTO}_{jt}\) and \({lnShM}_{jt}\) were 0.77 and 0.51, respectively. These coefficients state that if trade openness and share of manufacturing increase by 1%, foreign direct investment will increase by 71 and 55%. After presenting the results and comparing them with previous studies, the results should be tested for robustness. The mean VIF values in our model is equal to 2.34. The maximum VIF amount of explanatory variables is 4.62, which lie within the acceptable standard.
Based on the results of the research, suggestions are provided. But rigidity in environmental law could lead to reduce in FDI. On the other hand, FDI is a key factor for economic growth and development; hence, FDI can be transferred from polluting sectors to clean sectors, such as service sectors, labor-intensive industries or renewable energy sectors, and green technology investment, should be encouraged. The manufacturing sector is the largest contributor to global emissions when direct and indirect emissions are included. The key transformations needed to bring the industry sector towards environmentally friendly goals. These aims can include electrifying industry, transform production processes, using new fuels, accelerating material efficiency and scaling up energy efficiency everywhere, and promote circular material flow. Openness trade, like industry growth, increases FDI. Furthermore, to decrease the impact of trade openness and economic growth on environmental sustainability, it is very important to increase environmental friendly production system industries that could motivate green technology knowledge for all economic sectors. The receiving countries should improve their mechanism of absorption ability. The paper author has suggestions for future researchers. The regression model that was chosen is a linear model. Therefore, future authors can use other regression methods such as spatial regression and get results that are more accurate. Because one of the variables of the attraction model is the distance between countries. The dependent variable is FDI, which is also affected by key qualitative factors. In future studies, the effect of these qualitative variables can be investigated, such as government structure and investment management factors.
This section contains information about the empirical model. The empirical model is borrowed from common literature on the gravity model. In economic sciences, the gravity model forecasts bilateral trade flows based on measure of the economies (usually using GDP) and distance between the two locations 33 as in Eq. ( 3 ):
In above equation, the gravitational power (G or amount of trade between regions) is positively proportional to the size of the regions ( si and sj ) and negatively proportional to the distance between region (i) and region (j) ( di , j ). In this research, the components of the gravity model are different. In fact, the innovation of this study compared to previous researches is the different components of the gravity model. Figure 4 shows the innovation of this model with previous gravity models.
Newton's gravity model, Trade’s gravity model, FDI’s gravity model.
Two important factors in the pollution haven hypothesis are foreign direct investment between two countries and the severity of the countries' environmental laws. Differences in attention to the environmental quality coupled with trade liberalization may cause to the creation of pollution havens, with polluting activity relocating to areas with weak regulation 35 , 36 . If we consider gravity as FDI. What causes the attraction of foreign direct investment between two countries is the strictness of the countries in implementing environmental regulations. So Eq. ( 3 ) is modified as follows:
where i is country (OECD) i , j is country j (China) and t is time (2016–2020). FDI represents foreign direct investment flow among countries. ER is the severity of environmental laws. Co 2 is pollution emissions. The UR, TO and ShM are urbanization, trade openness and share of manufacturing. The TC denotes the trade costs between countries and GDP is gross domestic product. From Eq. ( 2 ), data is converted into log terms according to traditional methods in econometrics. The equation is established as follows (Eq. 6 ):
Many studies used FDI in their model, such as Usama and Tang 12 ; Solarin et al. 13 ; Benzerrouk et al. 7 ; Temurlenk and Lögün 15 ; Yilanci et al. 16 ; Ali Nagvi et al. 17 . Of course, they considered FDI as an independent variable. But in this study, it is considered as a dependent variable. In Eq. ( 6 ), \(ER\) is the pollution emission intensity, which is calculated in Eq. ( 5 ). In previous studies, several indicators have been used to measure environmental regulations. For example, Guo et al. 37 takes pollutant discharge fee and total investment in pollution controlling to represent environmental rules. Sun et al. 38 applied number of pollution enterprises for environmental rules. Nie et al. 39 make ISO14001 environmental management system certification. Xie et al. 40 used to fail to form fixed assets or form fixed assets for environmental regulation. Sadik-Zada and Ferrari 24 make used environmental policy stringency index as a proxy for PHH.
I measure these rules with the pollution intensity index like Cole and Elliott 41 's study, the proportion of pollution emissions in industrial output value can be used as a proxy for measuring environmental regulations 8 , 41 . In some studies for example Shen et al. 23 ; Bhat and Tantr 10 , emission intensity has been used as the degree of severity environmental regulations. TC also shows transportation costs, which is a proxy for the distance between countries. If we use the distance variable in the model, it would cause collinearity. This study includes annual data of 35 countries from OECD (Fig. 5 ) and China for 2016–2020. The reason for choosing these countries and period is as follows: first, China is the largest emitter of greenhouse gases in recent years. Second, China is the largest importer of foreign investment in recent years. Third, OECD countries were selected because exact information about their FDI inflow to China was available.
Selected countries from among the OECD countries that make foreign direct investment in China.
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Somayeh Avazdahandeh
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A hypothesis is a tentative statement about the relationship between two or more variables. Explore examples and learn how to format your research hypothesis.
A hypothesis is a statement that can be tested by scientific research. If you want to test a relationship between two or more variables, you need to write hypotheses before you start your experiment or data collection.
Definition: Hypothesis is an educated guess or proposed explanation for a phenomenon, based on some initial observations or data. It is a tentative statement that can be tested and potentially proven or disproven through further investigation and experimentation. Hypothesis is often used in scientific research to guide the design of experiments ...
A research hypothesis, in its plural form "hypotheses," is a specific, testable prediction about the anticipated results of a study, established at its outset. The research hypothesis is often referred to as the alternative hypothesis.
Research begins with a research question and a research hypothesis. But what are the characteristics of a good hypothesis? In this article, we dive into the types of research hypothesis, explain how to write a research hypothesis, offer research hypothesis examples and answer top FAQs on research hypothesis. Read more!
Explore how a hypothesis is a prediction about the relationship between variables that can take two forms: null hypothesis or alternative hypothesis.
A research hypothesis is an assumption or a tentative explanation for a specific process observed during research. Unlike a guess, research hypothesis is a calculated, educated guess proven or disproven through research methods.
Hypothesis is an idea or prediction that scientists make before they do experiments. Click to learn about its types, and importance of hypotheses in research and science. Take the quiz!
A hypothesis ( pl.: hypotheses) is a proposed explanation for a phenomenon. For a hypothesis to be a scientific hypothesis, the scientific method requires that one can test it. Scientists generally base scientific hypotheses on previous observations that cannot satisfactorily be explained with the available scientific theories.
Scientific hypothesis, idea that proposes an explanation for an observed phenomenon or narrow set of phenomena. Two key features of a scientific hypothesis are falsifiability and testability, which are reflected in an 'If...then' statement, and the ability to be supported or refuted in observation or experimentation.
hypothesis: [noun] an assumption or concession made for the sake of argument. an interpretation of a practical situation or condition taken as the ground for action.
A hypothesis (plural hypotheses) is a proposed explanation for an observation. The definition depends on the subject. In science, a hypothesis is part of the scientific method. It is a prediction or explanation that is tested by an experiment. Observations and experiments may disprove a scientific hypothesis, but can never entirely prove one.
Hypothesis testing is a formal procedure for investigating our ideas about the world using statistics. It is most often used by scientists to test specific predictions, called hypotheses, that arise from theories.
A hypothesis is usually written in the form of an if-then statement, which gives a possibility (if) and explains what may happen because of the possibility (then).
Learn exactly what a research hypothesis (or scientific hypothesis) is with Grad Coach's clear, plain-language definition, including loads of examples.
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A hypothesis states your predictions about what your research will find. It is a tentative answer to your research question that has not yet been tested. For some research projects, you might have to write several hypotheses that address different aspects of your research question. A hypothesis is not just a guess — it should be based on ...
What does hypothesis mean? Learn the hypothesis definition in this easy-to-follow lesson. Take an in-depth look at hypothesis examples and the...
What is Hypothesis? Hypothesis is a prediction of the outcome of a study. Hypotheses are drawn from theories and research questions or from direct observations. In fact, a research problem can be formulated as a hypothesis. To test the hypothesis we need to formulate it in terms that can actually be analysed with statistical tools.
hypothesis: A hypothesis ( plural: hypotheses ), in a scientific context, is a testable statement about the relationship between two or more variables or a proposed explanation for some observed phenomenon. In a scientific experiment or study, the hypothesis is a brief summation of the researcher's prediction of the study's findings, which may ...
A hypothesis is an assumption made before any research has been done. It is formed so that it can be tested to see if it might be true. A theory is a principle formed to explain the things already shown in data. Because of the rigors of experiment and control, it is much more likely that a theory will be true than a hypothesis.
What is Hypothesis? A hypothesis is an assumption that is made based on some evidence. This is the initial point of any investigation that translates the research questions into predictions. It includes components like variables, population and the relation between the variables. A research hypothesis is a hypothesis that is used to test the relationship between two or more variables.
Hypothesis is a testable statement that explains what is happening or observed. It proposes the relation between the various participating variables. Learn more about Hypothesis, its types and examples in detail in this article
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The definition of 'mental illness' was thereby altered from what one did or was ("you react anxious/you are anxious") to something one had ("you have anxiety"). ... the debate on the relationship between etiology and description in psychiatric diagnosis continued . ... We hope this hypothesis and theory paper can give decisive ...
The pollution haven hypothesis (PHH) is defined as follows: a reduction in trade costs results in production of pollution-intensive goods shifting towards countries with easier environmental laws.