In this article, I side with those who argue that the debate about the definition of “disease” should be reoriented from the question “what is disease” to the question of what it should be. However, I ground my argument on the rejection of the naturalist approach to define disease and the adoption of a normativist approach, according to which the concept of disease is normative and value-laden. Based on this normativist approach, I defend two main theses: (1) that conceptual analysis (...) is not the right method to define disease and that conceptual engineering should be the preferred method and (2) that the method of conceptual engineering should be implemented following the principles of Alexandrova’s account of social objectivity in the context of the definition of disease. (shrink)

In this paper, my goal is to use an epistemic injustice framework to extend an existing normative analysis of over-medicalization to psychiatry and thus draw attention to overlooked injustices. Kaczmarek has developed a promising bioethical and pragmatic approach to over-medicalization, which consists of four guiding questions covering issues related to the harms and benefits of medicalization. In a nutshell, if we answer “yes” to all proposed questions, then it is a case of over-medicalization. Building on an epistemic injustice framework, I (...) will argue that Kaczmarek’s proposal lacks guidance concerning the procedures through which we are to answer the four questions, and I will import the conceptual resources of epistemic injustice to guide our thinking on these issues. This will lead me to defend more inclusive decision-making procedures regarding medicalization in the DSM. Kaczmarek’s account complemented with an epistemic injustice framework can help us achieve better forms of medicalization. I will then use a contested case of medicalization, the creation of Premenstrual Dysphoric Disorder in the DSM-5 to illustrate how the epistemic injustice framework can help to shed light on these issues and to show its relevance to distinguish good and bad forms of medicalization. (shrink)

In this paper, I argue for a new way to understand the integration of facts and values in the concept of mental disorder that has the potential to avoid the flaws of previous hybrid approaches. I import conceptual tools from the account of procedural objectivity defended by Helen Longino to resolve the controversy over the definition of mental disorder. My argument is threefold: I first sketch the history of the debate opposing objectivists and constructivists and focus on the criticisms that (...) led to the emergence of the debate. Second, I offer a reconstruction of the “Natural Function Approach” argument to make explicit an unsound assumption underlying this approach. The reconstruction will allow me to show that the NFO’s argument depends on the ideal of value-free science that I will criticize. Then I propose an alternative ideal for psychiatry: social objectivity. I argue that the concept of mental health should be seen as “socially objective” rather than value-free, moving the debate towards the social procedures by which the definition is produced rather than the normative and factual content of its definition. (shrink)

The anti-psychiatry movement of the 20th century has notably denounced the role of values and social norms in the shaping of psychiatric categories. Recent activist movements also recognize that psychiatry is value-laden, however, they do not fight for a value-free psychiatry. On the contrary, some activist movements of the 21st century advocate for self-advocacy in sciences of mental health in order to reach a more accurate understanding of psychiatric categories/mental distress. By aiming at such epistemic gain, they depart from the (...) anti-psychiatry movement. Through the analysis of the epistemic and political influence of two of these movements – Neurodiversity and the Mad Studies, we show how this new activism has taken a scientific turn compatible with current philosophical scientific frameworks, while still developing a critical approach on psychiatry. (shrink)

In this paper, we want to take a critical stance towards Tsou’s recent proposal that a neuro-oriented version of the homeostatic property cluster kind model (MPCK) should be an ideal for the DSM. Our strategy will be to discuss the creation of the Social Pragmatic Communication Disorder (SPCD) in DSM-5 to show the limits of MPCK as an ideal for the next DSM deliberations over a set of diagnoses revisions. We argue that an ideal model for the DSM should address (...) the issues of deep uncertainties and pragmatic considerations to be useful in this context. (shrink)

Anne-Marie Gagné-Julien et Pierre-Olivier Méthot Durant les deux dernières décennies, plusieurs questions classiques de la philosophie de la médecine et de la psychiatrie ont connu un renouvellement. Des angles de recherche jusqu’alors peu explorés font désormais l’objet de vifs débats, et les questions traditionnelles ont été réinterprétées à la lumière de ces nouveaux développements. En examinant ces récents thèmes grâce aux contributions de chercheur.e.s francophones, ce dossier vise à nourrir la progression de cette « nouvelle » (...) philosophie de la médecine et de la psychiatrie, à apporter un éclairage inédit sur certains de ses domaines et de ses objets encore méconnus de même que sur ses courants et ses problématiques émergents, et ainsi à faire avancer des débats classiques sous des angles nouveaux. (shrink)

ABSTRACT:One recent body of work has concerned medicalization and how it can create epistemic injustice. It focuses on medicalization as a hermeneutical process that shapes the conceptual framework(s) we use to refer to some conditions/experiences. In parallel, some scholars with lived experience of madness have started to explore the epistemic harms suffered by the Mad community. Building on this, I argue that the process of medicalization in psychiatry affects the Mad community in a specific way that has been overlooked in (...) the literature on medicalization and epistemic injustice. That is, medicalization can create what is called "contributory injustice." This form of injustice occurs when marginalized communities have been able to create alternative hermeneutical resources, but these resources are dismissed or discredited by the dominant group. I argue that the emerging field of Mad Studies is a victim of this type of injustice when Mad experiences are unilaterally medicalized. (shrink)

La création récente du diagnostic de trouble dysphorique prémenstruel (TDPM) dans le DSM-5 a été contestée sous de multiples angles. Les principales critiques mettent en avant les lacunes en faveur de la validité du TDPM, ainsi que le risque de pathologisation et de stigmatisation des changements physiques et comportementaux vécus par les femmes pendant leur phase prémenstruelle. Pour éclairer cette controverse, j’emprunte certains outils du cadre conceptuel des injustices épistémiques (IE) développé par Miranda Fricker. Plus précisément, je vais me baser (...) sur de récents travaux qui ont tenté d’appliquer ce cadre aux processus de catégorisation en médecine et en psychiatrie. Cela me permettra de mettre au jour un angle mort du débat actuel sur le TDPM, soit les perspectives des personnes touchées par ces symptômes. Ces points de vue ont été généralement négligés, mais le cadre des IE nous permet de recentrer le débat sur les intérêts et les besoins des personnes affectées par les processus de catégorisation psychiatrique. (shrink)

In the debate over the definition of ‘mental health,’ three different approaches are generally distinguished: the normativist approach, the hybrid approach and the naturalistic approach. This paper qualifies this classification by clarifying the sense in which Christopher Boorse defends a naturalistic approachvis-à-visthe central concepts of psychiatry. This paper also clarifies in what way Boorse is opposed to the normativist approach advocated by some authors of the anti-psychiatric movement, such as Szasz.

First, I want to thank PPP for the privilege of having my work read and commented on by esteemed colleagues. In this response, I briefly review some of the key issues that they have raised. These issues include 1) the usefulness of a definition of mental disorder for North American psychiatry, 2) the absence of a concrete criterion to address the demarcation problem, 3) the place and role of values in such a demarcation, and 4) the worries of over-inclusiveness, problematic (...) values and imposition of values.The first question that needs to be clarified is raised by Waterman's commentary : Is it really necessary to define mental disorder and mental health? Here I feel I should clarify a background assumption of... (shrink)

Christopher Boorse’s Biostatistical Theory of Health has been the main contender among naturalistic accounts of health for the last 40 years. Yet, a recent criticism of this theory, presented by Elselijn Kingma, identifies a dilemma resulting from the BST’s conceptual linking of health and statistical typicality. Kingma argues that the BST either cannot accommodate the situation- specificity of many normal functions or cannot account for many situation-specific diseases. In this article, we expand upon with Daniel Hausman’s response to Kingma’s dilemma. (...) We propose that recalling Boorse’s specification that health is an intrinsic property of its bearers and explicating this intrinsic property in relation to the concept of homeostasis can illuminate how proponents of naturalistic accounts of health should deal with the situation- specificity of normal functions. We argue that beyond what Boorse and Hausman have delineated, the situation- specificity of normal function cannot be fully captured in a simple dichotomy between normal and abnormal environment or between relevant and irrelevant situations. By bringing homeostasis to the fore of the analysis of health, we set out a richer picture of what the various situations that affect living organisms’ functional performance can be. Accordingly, we provide a broader classification of these various situations which, we contend, better accounts for the main intuitions that philosophers of medicine have sought to accommodate than previous naturalistic theories of health. (shrink)

The provision of informed consent is a prerequisite for inclusion of a patient in a clinical research project. In some countries, the legislation on clinical research authorizes a third person to provide informed consent if the patient is unable to do so directly . This is the case during acute stroke, when the symptoms may prevent the patient from providing informed consent and thus require a third party to be approached. Identification of factors associated with the medical team’s decision to (...) resort to surrogate consent may help the care team during the inclusion process and enable the patient’s family circle to be better informed about providing surrogate consent. (shrink)

Florence Tamagne présente dans ce livre dense, mais qui aurait parfois gagné à être plus ramassé, l'essentiel d'une thèse soutenue en 1998. Il faut se réjouir de cette publication, les travaux sur l'histoire de la sexualité étant fort rares. L'histoire de l'homosexualité présente de surcroît des difficultés propres. Elle souffre plus encore que l'histoire de l'hétérosexualité du silence des acteurs. L'auteur a donc fait feu de tout bois, combiné iconographie et littérature, discours sc...

Les études féministes s’intéressent depuis les années 1970 à la culture de l’enfance et de la jeunesse, et particulièrement aux représentations du féminin dans les albums (voir notamment les textes pionniers d’Elena Gianini Belotti et les albums d’Adela Turin), mais c’est depuis les années 2000 que les études sur ce domaine se sont multipliées. Études de sociologues pour la plupart, elles reposaient sur des enquêtes systématiques chiffrées et faisaient le constat que, si l’on assistait à un r...

Cherche à mettre en évidence les principes théoriques qui peuvent être au fondement de toute recherche ou réflexion en sociologie de la musique.

Ce livre présente une lecture globale du corpus kantien sous un angle particulier : comment "penser" le mal? Comme simple absence du bien? Comme erreur? Ou, ainsi que Kant l'a mis en évidence, comme une "grandeur négative", qui appartient à...

A reléguer les valeurs dans la sphère exclusive du privé, le risque est grand de les enfermer dans leur particularité, de leur permettre d’occuper ou prétendre occuper la place de l’universel sans aucune forme de confrontation et de gommer leur pluralité. A les relativiser purement et simplement, le risque n’est pas moins grand de voir la place de l’universel envahie, non par une quelconque valeur particulière, mais par ce qui se veut la mesure publique de toute qualité et appréciation aujourd’hui (...) : les items de compétence. (shrink)

Depuis près d'un demi-siècle, Madame Hélène ACKERMANS a coopéré très activement à l'organisation de l'École des sciences philosophiques et religieuses des F.U.S.L. Avec Monseigneur Henri van Camp, elle a donné à la tribune des leçons publiques sa renommée internationale ; auprès de l'actuel comité de direction, elle n'a cessé de prodiguer ses multiples compétences et ses conseils avisés. En hommage à son travail, il a été demandé à quelques-uns des penseurs avec lesquels Madame Hélène ACKERMANS a noué des liens d'amitié, (...) de réfléchir au rôle de la philosophie dans la Cité. (shrink)

In Ludwig Wittgenstein's writings, ethics takes a central place in his thinking. This element investigates his engagement with ethics in both early and later thinking. Starting from the remarks on ethics in the Tractatus Logico-Philosophicus and the framing of these remarks, it presents two influential approaches to Tractarian ethics, before it develops a coherent reading of ethics in the early thinking, focusing on ethical silence and the relationship notions of world and the philosophical 'I'. The reading of 'A Lecture on (...) Ethics' focuses on the critique of ethical theory and the personal dimension of ethics, two themes also running through Wittgenstein's later thinking. It considers Wittgenstein's later ethical investigations, of ethical examples, ethically relevant language uses of language and the connections between reflections on ethics and living. It also considers the role of the other in Wittgenstein's later thinking. (shrink)

Summary: This book studies the life of Étienne de La Boétie and his role in the parliament of Bordeaux in the years 1556-1563, those of his friendship with Montaigne. He has already written the Discourse on Voluntary Servitude, the contents, distribution and successive editions of which until now constitute the investigation of this book.--Classiques Garnier.

A virtue centred approach to ethics has been criticized for being vague owing to the nature of its central concept, the paradigm person. From the perspective of the practitioner the most damaging charge is that virtue ethics fails to be action guiding and, in addition to this, it does not offer any means of act appraisal. These criticisms leave virtue ethics in a weak position vis-à-vis traditional approaches to ethics. The criticism is, however, challenged by Hursthouse in her analysis of (...) the accounts of right action offered by deontology, utilitarianism and virtue ethics. It is possible to defend the action guiding nature of virtue ethics: there are virtue rules and exemplars to guide action. Insights from Aristotle’s practical approach to ethics are considered alongside Hursthouse’s analysis and it is suggested that virtue ethics is also capable of facilitating action appraisal. It is at the same time acknowledged that approaches to virtue ethics vary widely and that the challenges offered here would be rejected by those who embrace a radical replacement virtue approach. (shrink)

Background In 2001 a report on the provision of clinical ethics support in UK healthcare institutions identified 20 clinical ethics committees. Since then there has been no systematic evaluation or documentation of their work at a national level. Recent national surveys of clinical ethics services in other countries have identified wide variation in practice and scope of activities. Objective To describe the current provision of ethics support in the UK and its development since 2001. Method A postal/electronic questionnaire survey administered (...) to the chairs of all 82 clinical ethics services registered with the UK Clinical Ethics Network in July 2010. Results Response rate was 62% with the majority of responding services situated in acute trusts. All services included a clinical ethics committee with one service also having a clinical ethicist. Lay members were present in 72% of responding committees. Individual case consultation has increased since 2001 with 29% of chairs spending more than 50% of their time on this. Access to and involvement in the process of case consultation is less for patients and families than for clinical staff. There is wide variation in committee processes and levels of institutional support. Over half of the responding committees undertook some form of evaluation. Conclusion Clinical ethics services in the UK are increasing as is their involvement in case consultation. However, the significant variation in committee processes suggests that further qualitative research is needed to understand how these committees function and the role they play in their institution. (shrink)

This book explores five Platonic dialogues: Lysis, Charmides, Protagoras, Euthydemus, and the Republic. This book uses Socrates’ narrative commentary as its primary interpretive framework. No one has engaged in a sustained attempt to explore the Platonic dialogues from this angle. As a result, it offers a unique contribution to Plato scholarship. The portrait of Socrates that emerges challenges the traditional view of Socrates as an intellectualist and offers a holistic vision of philosophical practice.

This article is presented as a defence of voluntary active euthanasia from a virtue perspective and it is written with the objective of generating debate and challenging the assumption that killing is necessarily vicious in all circumstances. Practitioners are often torn between acting from virtue and acting from duty. In the case presented the physician was governed by compassion and this illustrates how good people may have the courage to sacrifice their own security in the interests of virtue. The doctor's (...) action created huge tensions for the nurse, who was governed by the code of conduct and relevant laws. Appraising active euthanasia from a virtue perspective can offer a more compassionate approach to the predicament of practitioners and clients. The tensions arising from the virtue versus rules debate generates irreconcilable difficulties for nurses. A shift towards virtue would help to resolve this problem and support the call for a change in the law. The controversial nature of this position is acknowledged. The argument is put forward on the understanding that many practitioners will not agree with the conclusions reached. (shrink)

Euthanasia has once again become headline news in the UK, with the announcement by Dr Michael Irwin, a former medical director of the United Nations, that he has helped at least 50 people to die, including two between February and July 1997. He has been quoted as saying that his ‘conscience is clear’ and that the time has come to confront the issue of euthanasia. For the purposes of this article, the term ‘beneficent voluntary active euthanasia’ (BVAE) will be used: (...) beneficent from the prima facie principle of beneficence, to do good, and voluntary to indicate that this must be carried out at the request of a competent client. This implies adherence to another prima facie principle, that of respect for autonomy. Active implies that something is done or given with the intention of hastening death. The word euthanasia itself simply means ‘good death’. This article examines the moral positions of two nurses and one junior doctor towards the subject of BVAE and an attempt is made to represent the main conflicting moral positions. The central arguments against BVAE and counterarguments are presented. The conclusion reached is that consenting adults should not be prevented from availing themselves of BVAE if another consenting adult (a medical doctor) is available and capable of carrying out their wishes. This being the case, it is suggested that BVAE should be available as an option in hospices and in the community. The aims of this article are: to generate debate among professionals; to present a three-way discussion that might be useful as a focus for educational purposes, particularly at undergraduate level; to challenge professionals to confront the issue of euthanasia; and to plead the case of those who request assistance in exercising autonomy by gaining control over their own deaths. (shrink)

The article claims that Ziauddin Sardar's contribution to the religion-science conversation is primarily a performance situated in a social location that gives him access to a highly significant perspective. Sardar places Western science within the context of the Western culture from which it emerged and which it continues to serve. The contemporary hegemonous science of today is one form of science. Its acceptance as a universal and objective form enables its users and promoters to exercise imperialistic control over much of (...) the world. Sardar's critique receives its effective bite from his social location as an immigrant Muslim, raised and educated in Western culture. The article examines the relevance of his social location to the issues with which he is most concerned, such as promotion of the rights and responsibilities of cultures, in particular Islamic cultures, traditionally cast as "Other" by the West. They too have their sciences and these sciences function often within worldviews that are "religious." Sardar's critique of science and his call for the recognition of the so-called Other cultures is significant for its performativity. His work is not merely a descriptive or explanatory account, but bears also the performative characteristics that seek to effect the change for which he calls. (shrink)

There is no concept, no matter how strange, in which human beings are not willing to believe fervently, so long as it offers some comfort from the knowledge that one day they will no longer exist, so long as it gives him them hope of some form of eternal life. Norbert Elias1.