Thesis: Those affected by mental disorders whose actions are episodically influenced by their disorder are often overlooked by philosophers of moral and ethical responsibility. Allen gives us reasons for thinking it is inappropriate to either: a) “summarily exclude people with mental problems out of the universe of moral agents, reducing them to the status of rocks, trees, animals, and infants” b) “include the group on the false assumption that their moral lives are precisely like the paradigmatic moral lives (...) of the epistemically-sound and well-regulated people never personally touched by a mental condition” We must explore a revised approach to moral and ethical responsibility and obligation for this group. (shrink)

This book offers a comprehensive study of the views of ancient philosophers on mental disorders. Relying on the original Greek and Latin textual sources, the author describes and analyses how the ancient philosophers explained mental illness and its symptoms, including hallucinations, delusions, strange fears and inappropriate moods and how they accounted for the respective roles of body and mind in such disorders. Also considered are ethical questions relating to mental illness, approaches to treatment and the position of (...) mentally ill people in societies of the times. The volume opens with a historical overview that examines ancient medical accounts of mental illness, from Hippocrates' famous Sacred Disease to late antiquity medical authors. Separate chapters interpret in detail the writings of Plato, Aristotle, Galen and the Stoics and a final chapter summarises the views of various strains of Scepticism, the Epicurean school and the Middle and Neo-Platonists. Offering an important and useful contribution to the study of ancient philosophy, psychology and medicine. This volume sheds new light on the history of mental illness and presents a new angle on ancient philosophical psychology. (shrink)

The question of whether mental disorders are disorders of the brain has led to a long- running and controversial dispute within psychiatry, psychology and philosophy of mind and psychology. While recent work in neuroscience frequently tries to identify underlying brain dysfunction in mental disorders, detractors argue that labelling mental disorders as brain disorders is reductive and can result in harmful social effects. This book brings a much- needed philosophical perspective to bear on this important question.

In lieu of an abstract, here is a brief excerpt of the content:What Makes a Mental Disorder Mental?Jerome C. Wakefield (bio)Keywordsharmful dysfunction, mental disorder, intentionality, mental dysfunction, mental functioning, phenomenality, somatic disorderWhat makes a medical disorder mental rather than (exclusively) somatic or physical? Psychiatry to some extent depends for its existence as a medical specialty on the distinction between mental and somatic disorders, yet the history of this distinction presents a bewildering array of (...) puzzling judgments, radical shifts, and seemingly arbitrary distinctions. The historical observation that putative mental disorders are often reclassified as physical disorders as soon as their physiologic basis is understood further confuses matters. Moreover, recent debates about such classifications often seem to reflect desires to protect professional turf or obtain optimal reimbursement for treatment more than they do the application of a coherent conceptual distinction. No wonder that Brülde and Radovic (2006) disarmingly admit at the outset of their exploration of this question that there is a case to be made that their topic is relatively unimportant or even meaningless intellectually, a rare way to start an inquiry!Could there nonetheless be a cogent conceptual distinction lurking here? Brülde and Radovic usefully invite us to reframe the question, in effect as follows: Suppose we pay attention to professional and lay judgments as evidence but at the same time try to avoid being ensnared by the distortions resulting from turf issues and other pragmatic motives and constraints. Can we then identify some principled distinction in this domain that is worth making and that interestingly corresponds to the distinction generally made between mental disorders and strictly somatic disorders? Brülde and Radovic do not come to any confident or compelling conclusion about this.My answer, based on my harmful dysfunction analysis of disorder (Wakefield, 1992a, 1992b, 1999a, 1999b), is that a mental disorder is a harmful mental dysfunction, where a mental dysfunction is a failure of the capacity of some mental mechanism to perform a function for which it was biologically designed. I argue that, owing to a series of logical missteps, Brülde and Radovic needlessly reject this view. After some preliminary comments and clarifications, I defend the internal dysfunction approach from the objections posed by Brülde and Radovic, and then conclude by elaborating this view in some new ways. Note that Brülde and Radovic critique something they call the "internal cause view" of what makes a disorder mental, and they name others who hold that view. However, my work figures prominently in their discussion, and for expository simplicity, I will presume to simply construe their arguments as aimed at the harmful dysfunction analysis. [End Page 123]Clarifying the QuestionIt is easy to misconstrue the question "What makes a mental disorder mental" as demanding a precise account of the mental, an error to which Brülde and Radovic succumb in their repeated complaints that various writers do not present principled accounts of the mental but rely on lists of prototypical mental states or tentative guidelines to fix the reference of mental. We would need a precise definition of mental if the problem were how to classify cases in which it is ambiguous whether some phenomenon is mental or physical. We might imagine, for example, someone being genuinely puzzled as to whether inability to sleep is failure of a mental function or process. But this sort of puzzle about the boundaries of the mental is not the problem with which Brülde and Radovic are concerned; anyway, ambiguous cases may just be inherently ambiguous. The problem, which a crisp definition of mental will not resolve, is what relation mental states or mechanisms must have to a disorder to make it a mental disorder; must there be mental symptoms, or mental dysfunctions, or either one, and so on? But, even if a precise resolution of the nature of the mental is not needed, some notion of the mental domain is essential in pursuing this discussion. We can pick out the mental ostensively, by pointing to lots of examples (e.g., perception, motivation, emotion, thought, and sensation) much more confidently than we can define it in a principled way. But because Brülde and Radovic find fault in such ostensive reference fixing, let me... (shrink)

According to the Argument for Autonomous Mental Disorder, mental disorder can occur in the absence of brain disorder, just as software problems can occur in the absence of hardware problems in a computer. This article argues that the AAMD is unsound. I begin by introducing the “natural dysfunction analysis” of disorder, before outlining the AAMD. I then analyze the necessary conditions for realizer autonomous dysfunction. Building on this, I show that software functions disassociate from hardware functions in a (...) way that mental functions do not disassociate from brain functions. It follows that mental disorders are brain disorders necessarily. (shrink)

This paper offers a philosophical analysis of the connection between mental disorder and suicide risk. In contemporary psychiatry, it is commonly suggested that this connection is a causal connection that has been established through empirical discovery. Herein, I examine the extent to which this claim can be sustained. I argue that the connection between mental disorder and increased suicide risk is not wholly causal but is partly conceptual. This in part relates to the way suicidality is built into (...) the definitions of some psychiatric diagnoses. It also relates to the broader normative assumption that suicidal behavior is by definition mentally disordered behavior. The above has significant epistemological implications, which I explore. I propose that the claim that suicide is connected with mental disorder cannot be justified solely by appealing to empirical evidence but also warrants a justification on conceptual and normative grounds. (shrink)

In this chapter I investigate the kinds of changes that psychiatric kinds undergo when they become explanatory targets of areas of sciences that are not “mature” and are in the early stages of discovering mechanisms. The two areas of science that are the targets of my analysis are cognitive neuroscience and cognitive neurobiology.

Meaning-making plays a central role in how we deal with experiences of suffering, including those due to mental disorder. And for many, religious beliefs, experiences, and practices (hereafter, religious engagement) play a central role in informing this meaning-making. However, a crucial facet of the relationship between experiences of mental disorder and religious engagement remains underexplored—namely the potentially positive effects of mental disorder on religious engagement (e.g. experiences of bipolar disorder increasing sense of God’s presence). In what follows, (...) I will present empirical findings from two recent studies of mine which shed light on the extent to which participants experienced these positive effects, specific components of these effects, and how they fit into their understanding of their mental disorder and its relationship to their religious identity. In doing so, I will draw on and expand Tasia Scrutton’s Potentially Transformative view (2015a, 2015b, 2020) according to which mental disorders may provide opportunities for spiritual growth. My empirical results align with and help deepen an account according to which mental disorders are potentially spiritually transformative by providing further insight into such instances: specifically, which symptoms and internal and external factors are often involved, as well as which religious beliefs, experiences, and/or practices are often affected. After presenting these results and articulating their relevance for a potentially transformative view of mental disorder, I will then address some potential objections to the theoretical account as well as some limitations of the empirical work, before sketching possible promising directions for future research. (shrink)

Authenticity has recently emerged as an important issue in discussions of mental disorder. We show, on the basis of personal accounts and empirical studies, that many people with psychological disorders are preoccupied with questions of authenticity. Most of the data considered in this paper are from studies of people with bipolar disorder and anorexia nervosa. We distinguish the various ways in which these people view the relationship between the disorder and their sense of their authentic self. We discuss the (...) principal modern ac-counts of authenticity within the analytic philosophical tradition. We argue that accounts based on autonomous, or wholehearted, endorsement of personal characteris-tics fail to provide an adequate analysis of authenticity in the context of mental disorder. Significant elements of true self accounts of authenticity are required. The concept of authenticity is a basic one that can be of particular value, in the context of self-development, to people with mental disorder and to others experiencing substantial inner conflict. (shrink)

Three reservations about Keller & Miller's (K&M's) argument are explored: Serious validity problems afflict epidemiological criteria discriminating disorders from non-disorders, so high rates may be misleading. Normal variation need not be mild disorder, contrary to a possible interpretation of K&M's article. And, rather than mutation-selection balance, true disorders may result from unselected combinations of normal variants over many loci. (Published Online November 9 2006).

This contribution focuses on what type of question “Are mental disorders brain disorders?” is and what task Anneli Jefferson performs in her book with the same title. I distinguish between conceptual engineering and conceptual choice, the former involving the individuation of an adequate concept for a specific goal, and the latter involving the normative problem of whether we should employ the concept at hand. I contend that Anneli Jefferson’s book is a work of conceptual engineering, which is valuable in (...) and of itself, but that this is insufficient to answer an equally essential version of the question, “Are mental disorders brain disorders?”, namely, whether we should adopt the newly engineered concept or not, considering a broader range of goals for mental health research and practice. (shrink)

Due to several socio-political factors, to many psychiatrists only a strictly objective definition of mental disorder, free of value components, seems really acceptable. In this paper, I will explore a variant of such an objectivist approach to defining metal disorder, natural function objectivism. Proponents of this approach make recourse to the notion of natural function in order to reach a value-free definition of mental disorder. The exploration of Christopher Boorse's 'biostatistical' account of natural function (1) will be followed (...) an investigation of the 'hybrid naturalism' approach to natural functions by Jerome Wakefield (2). In the third part, I will explore two proposals that call into question the whole attempt to define mental disorder (3). I will conclude that while 'natural function objectivism' accounts fail to provide the backdrop for a reliable definition of mental disorder, there is no compelling reason to conclude that a definition cannot be achieved. (shrink)

In this commentary on Anneli Jefferson’s book “Are Mental Disorders Brain Disorders?,” I offer an overview of her central thesis, and then propose my own modified account of when we are justified in calling mental disorders as “brain disorders.” In doing so, I draw on recent work in neuroscience that understands the relationship between brain and behavior in complex, dynamic, and computational terms. In particular, I disagree with Jefferson’s criterion of sufficiency, that a particular brain process should always (...) realize a psychological dysfunction. I propose that a psychiatric disorder can be said to be a brain disorder if there are empirically identifiable systematic brain differences associated with it and if these associations are contextualized within a scientifically robust theoretical understanding of the relationship between brain and behavior. I conclude by preliminary reflections on whether the issue of “mental disorder” versus “brain disorder” comes down to “the language of psychology” versus “the language of neuroscience,” and the degree to which the former can be expressed in the latter. (shrink)

People hold wildly opposing and very strong views on the question whether mental disorders are brain disorders, and the disagreement is primarily a conceptual one, not one about whether there are,...

What mental disorder means is controversial. I attempt to solve that controversy by applying the method of defining a phenomenon in terms of the goals we have for demarcating that phenomenon from other phenomena to the case of mental disorder. I thus address the question about the nature of mental disorder by paying attention to the goals we have for demarcating mental disorder. I maintain that these goals, which embody the reasons why we consider mental (...) disorder a significant phenomenon for us, have a common denominator: they refer to psychological capacity for autonomy. I present a conceptual foundation for defining mental disorder on the basis of that psychological capacity and argue that this way of understanding the nature of mental disorder avoids the main problems of the central contemporary theories of mental disorder. Then I explain why this conception of the nature of mental disorder is not undermined by anti-psychiatric criticisms to the effect that mental illness does not exist, that the mentally ill should not be treated differently from others, and that seeing problems of the mentally disordered as psychiatric problems is unjustified medicalization. I conclude by suggesting that the presented conceptual foundation for defining mental disorder would benefit from being complemented by results of empirical psychology. (shrink)

Mental disorders are often thought to be harmful dysfunctions. Jerome Wakefield has argued that such dysfunctions should be understood as failures of naturally selected functions. This suggests, implicitly, that evolutionary biology and other Darwinian disciplines hold important information for anyone working on answering the philosophical question, ‘what is a mental disorder?’. In this article, the author argues that Darwinian theory is not only relevant to the understanding of the disrupted functions, but it also sheds light on the disruption (...) itself, as well as on the harm that attends the disruption. The arguments advanced here are partially based on the view that a core feature of Darwinism is that it stresses the environmental relativity of functions and dysfunctions. These arguments show a very close empirical connection between social judgments and dysfunctions , which is of interest for psychiatric theory. Philosophically, they lead to the conclusion that the concept of mental disorder is identical to the concept of mental dysfunction. Consequently, it is both misleading and redundant to conceptualize mental disorders as ‘harmful dysfunctions’, and not simply as ‘mental dysfunctions’. (shrink)

The effects of mental disorder are apparent and pervasive, in suffering, loss of freedom and life opportunities, negative impacts on education, work satisfaction and productivity, complications in law, institutions of healthcare, and more. With a new edition of the 'bible' of psychiatric diagnosis - the DSM - under developmental, it is timely to take a step back and re-evalutate exactly how we diagnose and define mental disorder. This new book by Derek Bolton tackles the problems involved in the (...) definition and boundaries of mental disorder. It addresses two main questions regarding mental illness. Firstly, what is the basis of the standards or norms by which we judge that a person has a mental disorder - that the person's mind is not working as it should, that their mental functioning is abnormal? Controversies about these questions have been dominated by the contrast between norms that are medical, scientific or natural, on the one hand, and social norms on the other. The norms that define mental disorder seem to belong to psychiatry, to be medical and scientific, but are they really social norms, hijacked and disguised by the medical profession? Secondly, what is the validity of the distinction between mental disorder and order, between abnormal and normal mental functioning? To what extent, notwithstanding appearances, does mental disorder involve meaningful reactions and problem-solving? These responses may be to normal problems of living, or to not so normal problems - to severe psycho-social challenges. Is there after all order in mental disorder? With the closing of asylums and the appearance of care in the community, mental disorder is now in our midst. While attempts have been made to define clearly a concept of mental disorder that is truly medical as opposed to social, there is increasing evidence that such a distinction is unviable - there is no clear line between what is normal in the population and what is abnormal. 'What is Mental Disorder?' reviews these various crucial developments and their profound impact for the concept and its boundaries in a provocative and timely book. (shrink)

Mental disorders are often thought to be harmful dysfunctions. Jerome Wakefield has argued that such dysfunctions should be understood as failures of naturally selected functions. This suggests that evolutionary biology and other Darwinian disciplines hold important information for anyone working on answering the philosophical question, "What is a mental disorder?". In this article, the author argues that Darwinian theory is not only relevant to the understanding of the disrupted functions, but it also sheds light on the disruption itself, (...) as well as on the harm that attends the disruption. The arguments advanced here are partially based on the view that a core feature of Darwinism is that it stresses the environmental relativity of functions and dysfunctions. These arguments show a very close empirical connection between social judgments and dysfunctions, which is of interest for psychiatric theory. Philosophically, they lead to the conclusion that the concept of mental disorder is identical to the concept of mental dysfunction. Consequently, it is both misleading and redundant to conceptualize mental disorders as 'harmful dysfunctions', and not simply as 'mental dysfunctions'. (shrink)

According to a standard picture of agency, a person’s actions always reflect what they most desire, and many theorists extend this model to mental illness. In this chapter, I pin down exactly where this “volitional” view goes wrong. The key is to recognize that human motivational architecture involves a regulatory control structure: we have both spontaneous states (e.g., automatically-elicited thoughts and action tendencies, etc.) as well as regulatory mechanisms that allow us to suppress or modulate these spontaneous states. Our (...) regulatory abilities, however, are bounded. Mental illnesses, I argue, arise precisely where these bounds are reached, thus allowing inappropriate spontaneous states to regularly manifest in thought and action. I conclude that the volitional view of mental illness is wrong: when a person with mental illness reaches the limits of control, what they do often does not reflect what they most prefer. (shrink)

I shall begin with the "anti-psychiatry" view that the lack of a physical basis excludes many familiar mental disorders from the category of "illness". My response to this argument will be that anti-psychiatrists are probably right to hold that most mental disorders do not involve any physical disorder, but that they are wrong to conclude from this that these mental disorders are not illnesses.

Mental disorder is an urgent and growing public health problem.1 Scientific investigation of this problem has the pragmatic goals of identifying the causes of mental disorders and developing strategies to effectively treat them. Philosophers of psychiatry have participated in the inquiry into the empirical examination of mental disorders, predominantly by debating whether psychopathology is a legitimate target of scientific inquiry and, if so, how mental disorders should be explained, predicted, and intervened on. However, as I show (...) in this paper, these philosophical discussions have mostly neglected the actual state of inquiry in psychiatry and relevant disciplines, as well as the first-person experiences... (shrink)

Essentialism is one of the most pervasive problems in mental health research. Many psychiatrists still hold the view that their nosologies will enable them, sooner or later, to carve nature at its joints and to identify and chart the essence of mental disorders. Moreover, according to recent research in social psychology, some laypeople tend to think along similar essentialist lines. The main aim of this article is to highlight a number of processes that possibly explain the persistent presence (...) and popularity of essentialist conceptions of mental disorders. One such process is the general tendency of laypeople to essentialize conceptual structures, including biological, social, and psychiatric categories. Another process involves the allure of biological psychiatry. Advocating a categorical and biological approach, this strand of psychiatry probably reinforced the already existing lay essentialism about mental disorders. As such, the question regarding why we essentialize mental disorders is a salient example of how cultural trends zero in on natural tendencies, and vice versa, and how both can boost each other. (shrink)

I stipulate and motivate the overlooked problem of demarcating radical skeptics (perceptual and moral) from mentally disordered persons, given that both deny that they know ordinary Moorean propositions (e.g., that they have hands or that killing for fun is morally wrong). Call this ‘the demarcation problem’. In response to the demarcation problem, I develop a novel way to demarcate between mentally disordered persons and radical skeptics in an extensionally adequate way that saves the appearance that radical skeptics are not mentally (...) disordered persons (at least not typically). Finally, I examine how a Moorean, non-skeptical epistemologist would compare radical skeptics with the mentally disordered in terms of what Plantinga calls internal and external rationality. Perhaps surprisingly, by Moorean lights, the mentally disordered fare better than the radical skeptic in terms of (internal) rationality. The upshot is that for Mooreans skeptical philosophy is more of an epistemic evil than mental disorder. (shrink)

"Grapples with the legacy of Jerome Wakefield, one of the most influential critics of modern psychiatry and the use of the DSM for psychiatric diagnosis"--.

This paper will be about the relationship between mental disorder and physical disorder. I shall also be concerned with the connection between these notions and the notion of ‘illness’.

Worries about the potential medicalization of social and moral problems has propelled the debate on the nature of mental disorder, with normativists insisting that psychiatric classification is inherently value-laden and naturalists maintaining that a purely descriptive account of disease is possible. In recent work, some authors take a different path, accepting that the concepts of disease and mental disorder are value-laden but maintaining that this does not prevent objective truths regarding mental disorder attribution. This paper explores two (...) such accounts and the important steps they provide toward rethinking the nature and metaphysical status of mental disorder. The challenges raised in this paper are meant to contribute to the further development of this stimulating work. (shrink)

In this dissertation, I examine our mental health concepts to see what work they are currently doing as well as what work they could be doing. In 1976, Christopher Boorse stated that the mental health literature is a “web of obscurities” (p. 51). To resolve some of this confusion, I argue that we need to consider the goals we should have for our mental health concepts and then give accounts of those concepts that meet our stated goals. (...) I argue that our goals for our mental health concepts should be twofold: first, we need concepts that will work to alleviate the stigmatization of mental disorder as this stigmatization gets in the way of providing and receiving medical help, and second, we need concepts that will be useful tools for medical practitioners to use in their diagnosis and treatment practices. -/- I begin by arguing that our mental disorder concept is not currently a useful tool for medical practitioners. Moreover, I argue that our mental disorder concept is confused in such a way that it is unlikely that it could ever be a useful tool for medical practitioners. If we cannot give an account of the mental disorder concept that is a useful tool for medical practitioners, then perhaps we can give an account of the mental disorder concept that can be used toward our goal of alleviating the stigmatization of mental disorder. Before we can do that, however, we need an account of the stigmatization concept so that we can understand what our mental disorder concept needs to be alleviating. -/- I argue that stigmatization is a process whereby some entity becomes marked as disgraceful or shameful. This stigmatization process includes (1) an attitude against the entity for reasons found in the social ideology, and (2) acts against the entity. I then argue that acts of stigmatization take two forms: direct stigmatization (where stigmatizors take acts against the stigmatized entity) and indirect stigmatization (where potential victims of stigmatization take acts to avoid becoming victims of stigmatization). With that in mind, we learn that if we are to alleviate the stigmatization of mental disorder, we need to work on alleviating both direct and indirect stigmatization. It is at this point that I argue for a new account of our mental disorder concept that can be utilized to alleviate the direct and indirect stigmatization of mental disorder. With our mental disorder concept redesigned to achieve that goal, I turn to the goal of providing medical help for persons that need that help. I argue that we need to reconceptualize what it means to be a ‘diagnosable condition’ so that we can develop a new framework for diagnosis and treatment that will be more efficacious than our current system. In conclusion, I suggest that we can untangle the current confusion that is the mental health literature by imbuing our mental health concepts with specific purposes and then utilizing them to achieve those purposes as I outline in this dissertation. (shrink)

A person suffering a mental illness or disorder may differ dramatically from his or her previous well self. Family and close friends who knew the person before the onset of illness tend to regard the illness as obscuring their loved one's true self and see the goal of treatment as the restoration of that self. ‘He is not really like this,’ they will say with increasing desperation. Treatment teams and others, who have no acquaintance with the person when well, (...) respond to what they see in front of them and do sometimes make harmful judgments of character based on the person's presentation when ill. (shrink)

Mental disorders are often thought to be harmful dysfunctions. Jerome Wakefield has argued that such dysfunctions should be understood as failures of naturally selected functions. This suggests, implicitly, that evolutionary biology and other Darwinian disciplines hold important information for anyone working on answering the philosophical question, 'what is a mental disorder?'. In this article, the author argues that Darwinian theory is not only relevant to the understanding of the disrupted functions, but it also sheds light on the disruption (...) itself, as well as on the harm that attends the disruption. The arguments advanced here are partially based on the view that a core feature of Darwinism is that it stresses the environmental relativity of functions and dysfunctions. These arguments show a very close empirical connection between social judgments and dysfunctions, which is of interest for psychiatric theory. Philosophically, they lead to the conclusion that the concept of mental disorder is identical to the concept of mental dysfunction. Consequently, it is both misleading and redundant to conceptualize mental disorders as 'harmful dysfunctions', and not simply as 'mental dysfunctions'. (shrink)

Many individuals who have mental disorders often report negative experiences of a distinctively epistemic sort, such as not being listened to, not being taken seriously, or not being considered credible because of their psychiatric conditions. In an attempt to articulate and interpret these reports we present Fricker’s concepts of epistemic injustice (Fricker, 2007, p. 1) and then focus on testimonial injustice and hermeneutic injustice as it applies to individuals with mental disorders. The clinical impact of these concepts on (...) quality of care is discussed. Within the clinical domain, we contrast epistemic injustice with epistemic privilege and authority. We then argue that testimonial and hermeneutic injustices also affect individuals with mental disorders not only when communicating with their caregivers but also in the social context as they attempt to reintegrate into the general society and assume responsibilities as productive citizens. Following the trend of the movement of mental health care to the community, the testimonies of people with mental disorders should not be restricted to issues involving their own personal mental states. (shrink)

This short contribution questions the ethics of basing the way we think and act in relation to mental disorder on beliefs and assumptions that are in the view of the author at best, unhelpful and at worst, simply incorrect.

It is now generally agreed that we have to rely on value judgments to distinguish mental disorders from other conditions, but it is not quite clear how. To clarify this, we need to know more than to what extent attributions of disorder are dependent on values. We also have to know (1) what kind of evaluations we have to rely on to identify the class of mental disorder; (2) whether attributions of disorder contain any implicit reference to some (...) specific evaluative standard; and (3) whether the concept of mental disorder is value laden in the definitional or in the epistemic sense. I will argue that the evaluations we have to rely on are mainly considerations of harm, but that we also need to rely on other evaluations; that there should be no references to specific evaluative standards; and that even though mental disorders are necessarily undesirable, "mental disorder" may well be a descriptive phrase. (shrink)

What is it to have a mental disorder? The paper proposes an ability-based view of mental disorder. It argues that such a view is preferable to biological dysfunction views such as Wakefield’s Harmful Dysfunction Analysis and Boorse’s Biostatistical Theory. According to the proposed view, having a mental disorder is basically a matter of having a certain type of inability (or: an ability that is not sufficiently high): the inability to respond adequately to some of one’s available reasons (...) in some of one’s reasons-sensitive attitudes or actions, where the threshold of inability is determined by one’s being harmed. The relevant concepts of inability, reasons, and harm are sketched. The paper argues that the proposed view evades some problems of biological dysfunction views by remaining neutral on questions of causation and the evolution of the mind. Furthermore, it can capture better what is distinctively “mental” about mental disorder. On the proposed view, it is the rational relations among an individual’s attitudes and actions that are “disordered” and the relevant norms in mental disorder are the norms of reasons. As further merits, the view can account for degrees of disorder, incorporate biological as well as social aspects, and elucidate the relations among disorders, symptoms, and their causes. (shrink)

Understanding Mental Disorders aims to help current and future psychiatrists, and those who work with them, to think critically about the ethical, conceptual, and methodological questions that are raised by the theory and practice of psychiatry. It considers questions that concern the mind’s relationship to the brain, the origins of our norms for thinking and behavior, and the place of psychiatry in medicine, and in society more generally. With a focus on the current debates around psychiatry’s diagnostic categories, the (...) authors ask where these categories come from, if psychiatry should be looking to find new categories that are based more immediately on observations of the brain, and whether psychiatrists need to employ any diagnostic categories at all. (shrink)

In this brief commentary, I would like to discuss two reservations I have about the article by Bergner and Bunford. Before doing so let me make some preliminary remarks.Their hypothesis that the concept of disability unites the various mental disorder constructs that have been proposed over the centuries and across cultures is reasonable and accords well with common sense. The concept of disability does a lot of good work in helping us to understand mental disorders.With respect to the (...) authors’ contrast between the disability conception versus the behavioral conception of mental disorder, the notion that counting behaviors alone justifies diagnosing a psychiatric disorder is worth critiquing. Claiming that everyone... (shrink)

Meaning-making plays a central role in how we deal with experiences of suffering, including those due to mental disorder. And for many, religious beliefs, experiences, and practices (hereafter, religious engagement) play a central role in informing this meaning-making. However, a crucial facet of the relationship between experiences of mental disorder and religious engagement remains underexplored—namely the potentially positive effects of mental disorder on religious engagement (e.g. experiences of bipolar disorder increasing sense of God’s presence). In what follows, (...) I will present empirical findings from two recent studies of mine which shed light on the extent to which participants experienced these positive effects, specific components of these effects, and how they fit into their understanding of their mental disorder and its relationship to their religious identity. In doing so, I will draw on and expand Tasia Scrutton’s Potentially Transformative view (2015a, 2015b, 2020) according to which mental disorders may provide opportunities for spiritual growth. My empirical results align with and help deepen an account according to which mental disorders are potentially spiritually transformative by providing further insight into such instances: specifically, which symptoms and internal and external factors are often involved, as well as which religious beliefs, experiences, and/or practices are often affected. After presenting these results and articulating their relevance for a potentially transformative view of mental disorder, I will then address some potential objections to the theoretical account as well as some limitations of the empirical work, before sketching possible promising directions for future research. (shrink)

This is a reply to Gipps' commentary on my 'The Concept of Mental Disorder'.

The Philosophy of Psychiatry is a unique area of research because the nature of the subject matter leads to quite distinct methodological issues. Naturalism, Interpretation, and Mental Disorder is an original new work focusing on the challenges we face when trying to interpret and understand mental illness. The book integrates a hermeneutical perspective, and shows how such an approach can reveal important facts about historical sources in psychiatry and the nature of dialogue in the therapeutic encounter. In addition, (...) the book demonstrates how such an approach can be valuable for understanding the concept of mental disorder itself. Naturalism, Interpretation, and Mental Disorder brings fresh thinking to the philosophy of psychiatry, and will be of interest to students and scholars in the fields of Mental Health and Philosophy. (shrink)

In this paper I argue that thinking in terms of process metaphysics and seeing the mind and mental disorders as processual in nature allows for a more complete understanding of mental disorders than is allowed by non-processual frameworks, while it also allows us to incorporate what we currently know about them. In addition, it can address problems in psychiatry that arise when we ask the wrong kinds of questions that naturally arise within a non-processual metaphysical framework. In this (...) paper I address the problems of reductionism, essentialism and dualism. -/- . (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mental Disorder and Moral Responsibility:Disorders of Personhood as Harmful Dysfunctions, With Special Reference to AlcoholismJerome C. Wakefield (bio)Keywordsalcohol dependence, philosophy of psychiatry, mental disorder, harmful dysfunction, psychiatric diagnosis, person, moral responsibilityIn his paper, Ethical Decisions in the Classification of Mental Conditions as Mental Illness, Craig Edwards grapples with a profound problem: why is it that when we classify a mental condition as a (...) class='Hi'>mental disorder, that tends to take the condition out of the sphere of moral responsibility or virtuousness of character? For example, it is not uncommon when someone commits suicide and the question is raised as to why he or she did it, that instead of a reason or character trait that would place the act within a moral calculus, one is offered the explanation "she was clinically depressed" or "he was bipolar," and this tends to terminate discussion and make reasons and moral evaluation superfluous. Why does such a comment have that effect?As Edwards notes, this can get complicated as the moral and the disordered interact. Certainly people are sometimes morally responsible for acting on their disordered impulses (as in pedophilia), and they are responsible for putting themselves in the way of disorder, as when someone imbibes in a way likely to lead to alcoholism. But at the normal/disorder divide, there seems to be a consistent lifting of some responsibility, reflecting the application of the sick role. For example, the rough equivalent of our current category of post-traumatic stress disorder (PTSD) was recognized as a disorder in earlier wars ("shell shock," "war neurosis"), but often considered an expression of cowardice; the cowardice was morally evaluable as a failure of virtue (even if, like many personality traits, being a coward is not within the person's direct voluntary control) and led to contempt for those with PTSD, but nonetheless—except in cases thought to be malingering—the PTSD that resulted constituted a disorder for which the individual was [End Page 91] not in the same direct sense blameworthy. This moral shift requires explanation.This topic also has important social ramifications. Relief from responsibility may sound like a good thing, and it is trumpeted by mental health advocates as a reason for supporting the classification of many conditions as disorders. But as Edwards is aware, it is a two-edged sword. Disordered status may allow escape from censure and offer the protections of the sick role, but it also changes the relationship of the agent to his or her own actions and imposes the responsibility of the sick role on the individual to attempt to change ("get better"). The sick role allows for no defense of an idiosyncrasy based on normal variation ("It takes all kinds…") or the individual's eccentric vision or steadfast integrity, for that vision or sense of integrity are now seen as pathological and not morally legitimate. The individual is subjected to endless entreaties to seek help and it is implied that not to do so is irresponsible, so that a decision to embrace one's nature and remain as one is becomes illegitimate. Moreover, the sick role allows for no explanation in terms of the individual's normal defensive response to unjust, deprived, or challenging social or environmental circumstances, thus weakening the motives for social change rather than individual intervention.In sum, there is an inevitable sense in which being placed in the sick role inherently stigmatizes the "sick" condition in virtue of the special moral attitudes extended to the disordered. Cultures can thus easily exploit the sick role and its much-touted relief from responsibility to extend the reach of social control processes. This is one reason why the distinction between disorder and non-disorder is so important, and why it is crucial to identify when non-disordered conditions are mislabeled as disorders—as when, for example, psychiatry gets it wrong about the distinction between normal and disordered sadness (Horwitz and Wakefield, 2007). Such overpathologization can redefine the boundaries of our moral universe on mistaken grounds.Edwards offers two provocative answers—not entirely at ease with each other—to the question of why mental disorders relieve the patient from moral responsibility: (1) mental disorders are... (shrink)

In this paper, I consider the debates surrounding the prevention of mental disorder and the promotion of mental health. In so doing, I offer some provisional insights into the wider notion of wellb...

This paper discusses the representation and explanation of relationships between phenomena that are important in psychiatric contexts. After a general discussion of complexity in the philosophy of science, I distinguish zooming-out approaches from zooming-in approaches. Zooming-out has to do with seeing complex mental illnesses as abstract models for the purposes of both explanation and reduction. Zooming-in involves breaking complex mental illnesses into simple components and trying to explain those components independently in terms of specific causes. Connections between existing (...) practice and zooming-out are drawn, and zooming-in is criticised. (shrink)

The aim of this chapter is to argue against the idea that there needs to be a polar opposition between "biological" and "humanistic" psychiatry. The basis for this idea lies in the philosophical tradition-the view that "mind" and "brain" must be conceived either as two separate "substances" or as one and the same. It is argued that this ontological conception of the problem should be replaced with a phenomenological description of what is actually meant by talk of human mental (...) life. In particular, Merleau-Ponty's account of human beings as "body-subjects" enables us to explain some aspects of some mental disorders as manifestations of neurological dysfunction, others as human responses to traumatic situations, and others as both. (shrink)

While the UK Home Office’s proposals to preventively detain people with what it has called dangerous severe personality disorder have been subjected to debate and criticism the deeply troubling jurisprudential issues in these proposals have not yet entered into public debate in a way that their seriousness deserves.1 It is good that a commentator as well known as Professor Szasz is speaking out on this issue.Professor Szasz focuses upon a crucial question by calling into question the medicalisation of terms like (...) dangerousness and mental illness.2 There is a great temptation for legislators and the public to treat these terms as if they are purely scientific terms and to think of risk assessment as a precise science. I don’t share Professor’s Szasz’s worry about how psychiatry is using these terms but I think there are some important questions about how these concepts function in the public sphere.This issue is important enough to justify the use of some rhetorical claims because such claims can serve to bring out what are neglected and important issues. In raising the following objections I am not attempting to refute the message that is in Szasz’s article or to say that he is not making an important point but rather to attempt to sharpen the issues and to suggest ways that we can respond to Professor Szasz’s challenge.Psychiatry has progressed in a number of ways since Professor Szasz wrote The Myth of Mental Illness.3 The science is much better, we have much better medications, and psychiatrists are acutely aware of the tension between treating their patient and their obligations to the public interest.So when Professor Szasz says: “Psychiatrists offer to relieve the disturbed person of the burden of coping …. (shrink)

The publication of DSM-5 has been accompanied by a fair amount of controversy. Amongst DSM’s most vocal ‘insider’ critics has been Thomas Insel, Director of the US National Institute of Mental Health. Insel has publicly criticised DSM’s adherence to a symptom-based classification of mental disorder, and used the weight of the NIMH to back a rival research strategy aimed at a more biology-based diagnostic classification. This strategy is part of Insel’s vision of a future, more preventative psychiatry in (...) which mental disorders are not only understood as biological disorders of the brain, but also as neurodevelopmental disorders. This paper examines the interest and merit of Insel’s views of mental and neurodevelopmental disorder for the philosophy of psychopathology, with a special focus of his neurodevelopmental model of schizophrenia. Pitman’s ‘moderate materialism’ will be used both as a philosophical lens through which to examine Insel’s position, as well as an example of a philosophical framework that may require updating and revision in the light of moves towards a neurodevelopmental conception of mental disorder. (shrink)

This new edition of Mind, Meaning, and Mental Disorder addresses key issues in the philosophy of psychiatry, drawing on both philosophical and scientific theory. The main idea of the book is that causal models of mental disorders have to include meaningful processes as well as any possible lower-level physical causes, and this propsoal is illustrated with detailed discussion of current models of common mental health problems. First published in 1996, this volume played an important role in bridging (...) the gap between philosophy and psychiatry, and introducing those in psychiatry to philosophical ideas somewhat neglected in their field. Completely updated, the new edition of this acclaimed volume draws on the strengths of the first edition, and will be a central text in the burgeoning field of philosophy of psychiatry. (shrink)