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Abstract: Some would say that philosophy can contribute more to the occurrence of mental disorder than to the study of it. Thinking too much does have its risks, but so do willful ignorance and selective inattention. Well, what can philosophy contribute? It is not equipped to enumerate the symptoms and varieties of disorder or to identify their diverse causes, much less offer cures (maybe it can do that-personal philosophical therapy is now available in the Netherlands). On the other hand, the scientific study of mental disorder has a long way to go. There is much disagreement and uncertainty about the nature, causes, and treatment of many specific disorders, as is evident from DSM's classification of them in predominantly symptomatic terms. And even if what is reflected in DSM were a consensus rather than a compromise, still this shifts periodically with each new edition. Moreover, it is a notorious fact that many patients who clearly have psychiatric abnormalities do not fit any of the recognized diagnostic categories.1
Abstract: This paper argues for psychological realism in the conception of psychiatric disorders. We review the following contemporary ways of understanding the future of psychiatry: (1) psychiatric classification cannot be successfully reduced to neurobiology, and thus psychiatric disorders should not be conceived of as biological kinds; (2) psychiatric classification can be successfully reduced to neurobiology, and thus psychiatric disorders should be conceived of as biological kinds. Position (1) can lead either to instrumentalism or to eliminativism about psychiatry, depending on whether psychiatric classification is regarded as useful. Position (2), which is inspired by the growing interest in neuroscience within scientific psychiatry, leads to biological realism or essentialism. In this paper we endorse a different realist position, which we label psychological realism. Psychiatric disorders are identified and addressed on the basis of their psychological manifestations which are often described as violations of epistemic, moral or social norms. A couple of examples are proposed by reference to the pathological aspects of delusions, and the factors contributing to their formation.
Abstract: The DSM is the main classification of mental disorders used by psychiatrists in the United States and, increasingly, around the world. Although widely used, the DSM has come in for fierce criticism, with many commentators believing it to be conceptually flawed in a variety of ways. This paper assesses some of these philosophical worries. The first half of the paper asks whether the project of constructing a classification of mental disorders that âcuts nature at the jointsâ makes sense. What is mental disorder? Are types of mental disorder natural kinds (that is, are the distinctions between them objective and of fundamental theoretical importance, as are, say, the distinctions between the chemical elements)? The second half of the paper addresses epistemic worries. Even if types of mental disorder are natural kinds there may be reason to doubt that the DSM will come to reflect their natural structure. In particular, I examine the extent to which the DSM is theory-laden, and look at how it has been shaped by social and financial factors. Ultimately, I conclude that although the DSM is of immense practical importance it is not likely to become the best possible classification of mental disorders.
Abstract: who are unrecognizable because they are in disguise. ¼ The person I see in the mirror is not really me. ¼ A person I knew who died is nevertheless in the hospital ward today. ¼ This arm [the speaker’s left arm] is not mine it is yours; you have..
Abstract: 1923; Young, this volume); the Cotard delusion (Cotard, 1882; Berrios and Luque, 1995; Young, this volume); the Fregoli delusion (Courbon and Fail, 1927; de Pauw, Szulecka and Poltock, 1987; Ellis, Whitley and Luaute´, 1994); the delusion of mirrored-self misidentiﬁ- cation (Foley and Breslau, 1982; Breen et al., this volume); a delusion of reduplicative param- nesia (Benson, Gardner and Meadows, 1976; Breen et al., this volume); a delusion sometimes found in patients suffering from unilateral neglect (Bisiach, 1988); and the delusions of alien control and of thought insertion, which are characteristic of schizophrenia (Frith, 1992)
Abstract: A pluralistic view of psychiatric classification is defended, according to which psychiatric categories take a variety of structural forms. An ordered taxonomy of these forms—non-kinds, practical kinds, fuzzy kinds, discrete kinds, and natural kinds—is presented and exemplified. It is argued that psychiatric categories cannot all be understood as pragmatically grounded, and at least some reflect naturally occurring discontinuities without thereby representing natural kinds. Even if essentialist accounts of mental disorders are generally mistaken, they are not implied whenever a psychiatric category that is not pragmatically grounded is posited.
Abstract: Recently I wrote a review for the Louisville Courier-Journal newspaper of Professor Elyn Saks' memoir of life while secretly suffering from schizophrenia. I did not mention the parallels between my life and Professor Saks'. I also have a successful career as a law professor. I accomplished it while harboring the secret I have the severe mental illness bipolar disorder (formerly known as "manic-depressive illness"). Why did I hide my condition for so long? Mainly I kept quiet due to the fear of stigma. Sadly, people today stigmatize more than they did fifty years ago. They need to realize that a history of mental illness is not a moral failing, and that it is a chronic condition like any "physical" disease. Although most with severe mental illness pose no threat to anyone, stereotypes unduly link violence with mental illness. The vast majority of those with mental illness like Professor Saks and me are not violent; a very small portion of the level of violence in society is attributable to people with mental disorders. Why have I now chosen to tell my story? I write, as did Professor Saks, to show people can be effective members of society in high-level and often stressful jobs despite their psychiatric conditions. I wish to be accepted for who I am, a person with a full and satisfying professional and personal life, and not have to endure stigma or doubt as to my ability to perform. While not all with mental disorders flourish as Professor Saks and I have done, we show what is possible. How many other successful individuals with mental illness who for now remain silent, probably due to stigma concerns, are out there? Perhaps each of us should look at those in the offices next to us, or our friends and neighbors, and wonder which of these people secretly live with a severe mental condition
Abstract: Psychopaths are renowned for their immoral behavior. They are ideal candidates for testing the empirical plausibility of moral theories. Many think the source of their immorality is their emotional deficits. Psychopaths experience no guilt or remorse, feel no empathy, and appear to be perfectly rational. If this is true, sentimentalism is supported over rationalism. Here, I examine the nature of psychopathic practical reason and argue that it is impaired. The relevance to morality is discussed. I conclude that rationalists can explain the moral deficits of psychopaths as well as sentimentalists. In the process, I identify psychological structures that underpin practical rationality
Abstract: Recent years have witnessed a ground swell of interest in the application of evolutionary theory to issues in psychopathology (Nesse & Williams 1995, Stevens & Price 1996, McGuire & Troisi 1998). Much of this work has been aimed at finding adaptationist explanations for a variety of mental disorders ranging from phobias to depression to schizophrenia. There has, however, been relatively little discussion of the implications that the theories proposed by evolutionary psychologists might have for the classification of mental disorders. This is the theme we propose to explore. We'll begin, in Section 2, by providing a brief overview of the account of the mind advanced by evolutionary psychologists. In Section 3 we'll explain why issues of taxonomy are important and why the dominant approach to the classification of mental disorders is radically and alarmingly unsatisfactory. We will also indicate why we think an alternative approach, based on theories in evolutionary psychology, is particularly promising. In Section 4 we'll try to illustrate some of the virtues of the evolutionary psychological approach to classification. The discussion in Section 4 will highlight a quite fundamental distinction between those disorders that arise from the malfunction of a component of the mind and those that can be traced to the fact that our minds must now function in environments that are very different from the environments in which they evolved. This mis-match between the current and ancestral environments can, we maintain, give rise to serious mental disorders despite the fact that, in one important sense, there is nothing at all wrong with the people suffering the disorder. Their minds are functioning exactly as Mother Nature intended them to. In Section 5, we'll give a brief overview of some of the ways in which the sorts of malfunctions catalogued in Section 4 might arise, and sketch two rather different strategies for incorporating this etiologically
Abstract: In a series of recent works, Ian Hacking has produced a model of social causation in mental illness and begun to sketch in outline how this might be integrated with the medical model of psychiatry. This article elaborates and revises Hacking's model of social forces, criticizes him for attempting a merely semantic resolution of the tension between the social and the biological, and sketches an alternative approach that builds upon his substantial insights
Abstract: Introduction. Whatever its underlying causes, even the description of the phenomenon of thought insertion, of the content of the delusion, presents difficulty. It may seem that the best hope of a description comes from a broadly cognitivist approach to the mind which construes content-laden mental states as internal mental representations within what is literally an inner space: the space of the brain or nervous system. Such an approach objectifies thoughts in a way which might seem to hold out the prospect of describing the ''alienated'' relation to one's own thoughts that seems to be present in thought insertion.1 Method. Firstly, I examine the general structure of cognitivist accounts of intentional or content-laden mental states. I raise the general difficulty of explaining how free-standing, and thus world-independent, inner states can still have bearing on the outer world. Secondly, I briefly examine Frith's model for explaining thought insertion and other passivity phenomena by postulating a failure of an internal monitoring mechanism of inner states. I question what account can be given of non-pathological cases and raise two specific objects. Results. Cognitivist accounts of the mind face a general, and possibly insuperable, challenge: explaining the intentionality of mental states in non-intentional, non- question-begging terms. There have so far been no satisfactory solutions. Cognitivist accounts of passivity phenomena in terms of a failure of internal monitoring face two objections. Firstly, accounting for non-pathological cases generates an infinite regress. Secondly, no account can be given of the paradoxical nature of utterances of the form of Moore's paradox: ''it is raining but I do not believe it''. Conclusions. A cognitivist approach presents an alienated account of thought in normal, non-pathological cases and is no help in accounting for thought insertion
Abstract: This dissertation examines psychiatry from a philosophy of science perspective, focusing on issues of realism and classification. Questions addressed in the dissertation include: What evidence is there for the reality of mental disorders? Are any mental disorders natural kinds? When are disease explanations of abnormality warranted? How should mental disorders be classified?
In addressing issues concerning the reality of mental disorders, I draw on the accounts of realism defended by Ian Hacking and William Wimsatt, arguing that biological research on mental disorders supports the inference that some mental disorders (e.g., schizophrenia, mood disorders, and anxiety disorders) are real theoretical entities, and that the evidence supporting this inference is causal and abductive. In explicating the nature of such entities, I argue that real mental disorders are natural kinds insofar as they are natural classes of abnormal behavior whose members share the same causal structure. I present this position in terms of Richard Boyd’s homeostatic cluster property theory of natural kinds, and argue that this perspective reveals limitations of Hacking’s account on the looping effects of human kinds, which suggests that the objects classified by psychiatrists are unstable entities. I subsequently argue that a subset of mental disorders (e.g., schizophrenia and Down syndrome) are mental illnesses insofar as they are disorders caused by a dysfunctional biological process that leads to harmful consequences for individuals. I present this analysis against Thomas Szasz’s argument
that mental illness is a myth.
In addressing issues of psychiatric classification, my analysis focuses on the Diagnostic and Statistical Manual of Mental Disorders (DSM), which has been published regularly by the American Psychiatric Association since 1952, and is currently in its fourth edition. After examining the history of DSM in the twentieth century, and in particular, DSM’s shift to an atheoretical and purely descriptive system in the 1980s, I consider the relative merits of descriptive versus causal systems of classification.
Drawing on Carl Hempel’s analysis of taxonomic systems in psychiatry, I argue that a causal classification system would provide a superior approach to psychiatric classification than the descriptive system currently favored by DSM.