We may be at the brink of a Kuhnian paradigm shift when it comes to the categorical classification system of mental disorders. Reviewing more than 30 years of critical literature on the categorical classification of personality disorders, Kueger, Hopwood, Wright, and Markon conclude that the Diagnostic and Statistical Manual of Mental Disorders is "fundamentally broken". Just before, the director of the National Institute of Mental Health declared that the institute will no longer support research that is based on DSM categories.The (...) critique on the categorical system of mental disorders consists of several arguments that are briefly mentioned as they have been... (shrink)

The comorbidity of personality disorders and mental disorders is commonly understood through three types of theoretical models: either a) personality disorders precede mental disorders, b) mental disorders precede personality disorders, c) mental disorders and personality disorders share common etiological grounds. Although these hypotheses differ with respect to their idea of causal direction, they all imply a latent variable perspective, in which it is assumed that either personality and mental disorders are latent variables that have certain causal relations [models a) and (...) b)]; or that, as in model c), the common etiology is in fact a latent variable that causes symptomatology of both personality and mental disorders. We aim to provide another perspective on the comorbidity between personality and mental disorders, namely a network perspective. To this end, we investigated Major Depression and Borderline Personality Disorder and hypothesized that symptoms of BPD and MD could interact with one another rather than being caused by a latent variable. To illustrate this theoretical network conceptualization of the comorbidity of BPD and MD we analyzed a cross-sectional clinical dataset of 376 patients who were asked to complete the Structured Clinical Interview for DSM-IV Axis II Disorders and the Beck Depression Inventory II. The results identify direct associations between symptoms of MD and BPD. If we take the links in this empirical network to be ‘substantive', this suggests a radical shift of our current conceptualization of the comorbidity of mental disorders and personality disorders. (shrink)

Zachar's commentary can be read as a sophisticated theoretical extension of the target article, and I am very pleased to see support for a relationalist turn in understanding mental disorders. Indeed, underlying causal properties are only an ingredient of essentialism and a more elaborate discussion of this issue brings us readily to the discourse on kinds and ontology. Zachar is an advocate for thinking of psychiatric constructs as practical kinds. This logically leads him to think that the problem with categorical (...) classification systems like the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases are practical problems (lack of... (shrink)

Is the Holocaust Vanishing? explores the ramifications of the passing of survivors for Holocaust studies, the removal of the Jew from Holocaust studies, and what all of this means for Jewish identity after the Holocaust. The book consists of years of reflection and wrestling with these issues on the part of a man who is a Holocaust survivor, a rabbi, and a professor of Holocaust studies.

After the introduction of the fifth Diagnostic and Statistical Manual of Mental Disorders, familiar voices were raised in protest. The voices stem from ideas of which, among others, and in different ways, Michel Foucault and Thomas Szasz were influential proponents: The movement was referred to as 'antipsychiatry.' This movement reacted, among other things, to the system of categorization of mental disorders. Diagnoses, in a system of classification, were thought to be vague, arbitrary, labelling, stigmatizing, and scientifically and clinically poorly validated. (...) In contemporary debates on DSM-5, similar critiques can be heard, expressed by a movement now referred to as 'critical psychiatry'... (shrink)

Despite spending more on health care than every other industrialized country, the U.S. ranks 37th in health outcomes. These differences cannot be explained away with differences in age and income, or even with quality of care. And, the rate of growth in health care spending in the U.S. continues to increase. The share of the Gross Domestic Product attributable to health care grew from 9% in 1980 to more than 17% in 2011. Health care costs are projected to account for (...) more than one-fifth of our economy by 2021. Despite spending more and more, the U.S. does not have better health outcomes than other countries. Worse, our increasing spending is largely attributable to preventable conditions. More than 85 cents of every dollar spent on health in the U.S. are spent on the treatment and management of chronic diseases, such as those caused by preventable conditions related to obesity and tobacco use. (shrink)

Two essays on utilitarianism, written from opposite points of view, by J. J. C. Smart and Bernard Williams. In the first part of the book Professor Smart advocates a modern and sophisticated version of classical utilitarianism; he tries to formulate a consistent and persuasive elaboration of the doctrine that the rightness and wrongness of actions is determined solely by their consequences, and in particular their consequences for the sum total of human happiness. In Part II Bernard Williams offers a sustained (...) and vigorous critique of utilitarian assumptions, arguments and ideals. He finds inadequate the theory of action implied by utilitarianism, and he argues that utilitarianism fails to engage at a serious level with the real problems of moral and political philosophy, and fails to make sense of notions such as integrity, or even human happiness itself. This book should be of interest to welfare economists, political scientists and decision-theorists. (shrink)

In their thought-provoking article, Sedlakova and Trachsel (2023) defend the view that the status—both epistemic and ethical—of Conversational Artificial Intelligence (CAI) used in psychotherapy is complicated. While therapeutic CAI seems to be more than a mere tool implementing particular therapeutic techniques, it falls short of being a “digital therapist.” One of the main arguments supporting the latter claim is that even though “the interaction with CAI happens in the course of conversation… the conversation is profoundly different from a conversation with (...) a human therapist” (Sedlakova and Trachsel 2023, 8). In particular, unlike a human therapist, CAI cannot help its users gain new insight and self-understanding (Sedlakova and Trachsel 2023). We agree that currently available therapeutic CAI cannot be considered a “digital therapist,” however, we think that the issue surrounding the acquisition of new self-understanding in the interaction with therapeutic CAI is more complicated than Sedlakova and Trachsel suggest. (shrink)

Growing demand for broadly accessible mental health care, together with the rapid development of new technologies, trigger discussions about the feasibility of psychotherapeutic interventions based on interactions with Conversational Artificial Intelligence (CAI). Many authors argue that while currently available CAI can be a useful supplement for human-delivered psychotherapy, it is not yet capable of delivering fully fledged psychotherapy on its own. The goal of this paper is to investigate what are the most important obstacles on our way to developing CAI (...) systems capable of delivering psychotherapy in the future. To this end, we formulate and discuss three challenges central to this quest. Firstly, we might not be able to develop effective AI-based psychotherapy unless we deepen our understanding of what makes human-delivered psychotherapy effective. Secondly, assuming that it requires building a therapeutic relationship, it is not clear whether psychotherapy can be delivered by non-human agents. Thirdly, conducting psychotherapy might be a problem too complicated for narrow AI, i.e., AI proficient in dealing with only relatively simple and well-delineated tasks. If this is the case, we should not expect CAI to be capable of delivering fully-fledged psychotherapy until the so-called “general” or “human-like” AI is developed. While we believe that all these challenges can ultimately be overcome, we think that being mindful of them is crucial to ensure well-balanced and steady progress on our path to AI-based psychotherapy. (shrink)

The majority of our linguistic exchanges, such as everyday conversations, are divided into turns; one party usually talks at a time, with only relatively rare occurrences of brief overlaps in which there are two simultaneous speakers. Moreover, conversational turn-taking tends to be very fast. We typically start producing our responses before the previous turn has finished, i.e., before we are confronted with the full content of our interlocutor’s utterance. This raises interesting questions about the nature of linguistic understanding. Philosophical theories (...) typically focus on linguistic understanding characterized either as an ability to grasp the contents of utterances in a given language or as outputs of this ability—mental states of one type or another. In this paper, I supplement these theories by developing an account of the process of understanding. I argue that it enables us to capture the dynamic and temporal aspect of understanding and reconcile philosophical investigations with empirical research on language comprehension. (shrink)

This chapter discusses author's view a Thomistic‐like dualism. Next, it lays out the details of his position and he argues that it has certain advantages over physicalist treatments of the human person, and, to a lesser degree, over alternate versions of substance dualism. Then, he responds to some objections against his position. He accepts constituent realism regarding properties (and relations), according to which properties (and relations) are universals that, when exemplified (and they need not be to exist), become constituents of (...) the ordinary particulars that have them. Furthermore, with the Thomistic framework in mind, the chapter offers his view of a human person. Finally, there is the argument that attempts to show that the unity of consciousness cannot be explained if one is a brain, because a brain is just an aggregate of different physical (separable) parts. (shrink)

Abstract: Might knowledge normatively govern conversations and not just their discrete constituent thoughts and (assertoric) actions? I answer yes, at least for a restricted class of conversations I call aimed conversations. On the view defended here, aimed conversations are governed by participatory know-how - viz., knowledge how to do what each interlocutor to the conversation shares a participatory intention to do by means of that conversation. In the specific case of conversations that are in the service of joint inquiry, the (...) view defended is that interlocutors (A, B, ... n) must intentionally inquire together into whether p, by means of an aimed conversation X, only if A,B, ... n know how to use X to find out together whether p. The view is supported by considerations about instrumental rationality, shared intentionality, the epistemology of intentional action, as well as linguistic data. (shrink)

It is often suggested that we are equipped with a set of cognitive tools that help us to filter out unreliable testimony. But are these tools effective? I answer this question in two steps. Firstly, I argue that they are not real-time effective. The process of filtering, which takes place simultaneously with or right after language comprehension, does not prevent a particular hearer on a particular occasion from forming beliefs based on false testimony. Secondly, I argue that they are long-term (...) effective. Some hearers sometimes detect false testimony, which increases speakers’ incentives for honesty and stabilizes the practice of human communication in which deception is risky and costly. In short, filtering prevents us from forming a large number of beliefs based on false testimony, not by turning each of us into a high-functioning polygraph but by turning the social environment of human communication into one in which such polygraphs are not required. Finally, I argue that these considerations support strong anti-reductionism about testimonial entitlement. (shrink)

According to the cognitive model of psychopathology, maladaptive beliefs about oneself, others, and the world are the main factors contributing to the development and persistence of various forms of mental suffering. Therefore, the key therapeutic process of Cognitive Behavioral Therapy (CBT)—a therapeutic approach rooted in the cognitive model—is cognitive restructuring, i.e., a process of revision of such maladaptive beliefs. In this paper, I examine the philosophical assumptions underlying CBT and offer theoretical reasons to think that the effectiveness of belief revision (...) in psychotherapy is very limited. This is the case, I argue, because the cognitive model wrongly assumes that our body of beliefs is unified, while it is in fact fragmented. (shrink)

Intentional action is, in some sense, non-accidental, and one common way action theorists have attempted to explain this is with reference to control. The idea, in short, is that intentional action implicates control, and control precludes accidentality. But in virtue of what, exactly, would exercising control over an action suffice to make it non-accidental in whatever sense is required for the action to be intentional? One interesting and prima facie plausible idea that we wish to explore in this paper is (...) that control is non-accidental in virtue of requiring knowledge—either knowledge-that or knowledge-how (e.g., Beddor and Pavese 2021; cf., Setiya 2008; 2012 and Habgood-Coote 2018). We review in detail some key recent work defending such knowledge-centric theories of control, and we show that none of these accounts holds water. We conclude with some discussion about how control opposes the sort of luck intentional action excludes without doing so by requiring knowledge (that- or how). (shrink)

Conversational Artificial Intelligence (CAI) systems (also known as AI “chatbots”) are among the most promising examples of the use of technology in mental health care. With already millions of users worldwide, CAI is likely to change the landscape of psychological help. Most researchers agree that existing CAIs are not “digital therapists” and using them is not a substitute for psychotherapy delivered by a human. But if they are not therapists, what are they, and what role can they play in mental (...) health care? To answer these questions, we appeal to two well-established and widely discussed concepts: cognitive and affective artifacts. Cognitive artifacts are artificial devices contributing functionally to the performance of a cognitive task. Affective artifacts are objects which have the capacity to alter subjects’ affective state. We argue that therapeutic CAIs are a kind of cognitive-affective artifacts which contribute to positive therapeutic change by (i) simulating a (quasi-)therapeutic interaction, (ii) supporting the performance of cognitive tasks, and (iii) altering the affective condition of their users. This sheds new light on why virtually all existing mental health CAIs implement principles and techniques of Cognitive Behavioral Therapy — a therapeutic orientation according to which affective change and, ultimately, positive therapeutic change is mediated by cognitive change. Simultaneously, it allows us to conceptualize better the potential and limitations of applying these technologies in therapy. (shrink)

The language of “participant-driven research,” “crowdsourcing” and “citizen science” is increasingly being used to encourage the public to become involved in research ventures as both subjects and scientists. Originally, these labels were invoked by volunteer research efforts propelled by amateurs outside of traditional research institutions and aimed at appealing to those looking for more “democratic,” “patient-centric,” or “lay” alternatives to the professional science establishment. As mainstream translational biomedical research requires increasingly larger participant pools, however, corporate, academic and governmental research programs (...) are embracing this populist rhetoric to encourage wider public participation. We examine the ethical and social implications of this recruitment strategy. We begin by surveying examples of “citizen science” outside of biomedicine, as paradigmatic of the aspirations this democratizing rhetoric was originally meant to embody. Next, we discuss the ways these aspirations become articulated in the biomedical context, with a view to drawing out the multiple and potentially conflicting meanings of “public engagement” when citizens are also the subjects of the science. We then illustrate two uses of public engagement rhetoric to gain public support for national biomedical research efforts: its post-hoc use in the “care.data” project of the National Health Service in England, and its proactive uses in the “Precision Medicine Initiative” of the United States White House. These examples will serve as the basis for a normative analysis, discussing the potential ethical and social ramifications of this rhetoric. We pay particular attention to the implications of government strategies that cultivate the idea that members of the public have a civic duty to participate in government-sponsored research initiatives. We argue that such initiatives should draw from policy frameworks that support normative analysis of the role of citizenry. And, we conclude it is imperative to make visible and clear the full spectrum of meanings of “citizen science,” the contexts in which it is used, and its demands with respect to participation, engagement, and governance. (shrink)

Artificial Neural Networks have reached “grandmaster” and even “super-human” performance across a variety of games, from those involving perfect information, such as Go, to those involving imperfect information, such as “Starcraft”. Such technological developments from artificial intelligence (AI) labs have ushered concomitant applications across the world of business, where an “AI” brand-tag is quickly becoming ubiquitous. A corollary of such widespread commercial deployment is that when AI gets things wrong—an autonomous vehicle crashes, a chatbot exhibits “racist” behavior, automated credit-scoring processes (...) “discriminate” on gender, etc.—there are often significant financial, legal, and brand consequences, and the incident becomes major news. As Judea Pearl sees it, the underlying reason for such mistakes is that “... all the impressive achievements of deep learning amount to just curve fitting.” The key, as Pearl suggests, is to replace “reasoning by association” with “causal reasoning” —the ability to infer causes from observed phenomena. It is a point that was echoed by Gary Marcus and Ernest Davis in a recent piece for theNew York Times: “we need to stop building computer systems that merely get better and better at detecting statistical patterns in data sets—often using an approach known as ‘Deep Learning’—and start building computer systems that from the moment of their assembly innately grasp three basic concepts: time, space, and causality.” In this paper, foregrounding what in 1949 Gilbert Ryle termed “a category mistake”, I will offer an alternative explanation for AI errors; it is not so much that AI machinery cannot “grasp” causality, but that AI machinery (qua computation) cannot understand anything at all. (shrink)

The appearance of consciousness in the world is an amazing and puzzling fact in its own right. Indeed, consciousness is one of the most mystifying features of the cosmos. The unity of consciousness is something that cries out for analysis and explanation as well. This chapter provides a way of relating the three types of unity: objectual phenomenal unity; subject phenomenal unity; and subsumptive phenomenal unity. According to Tim Bayne and David Chalmers, this sort of unity is irrelevant for investigating (...) the nature of consciousness' unity because it is trivially true by definition and tells us nothing about consciousness. Many thinkers, including Bayne himself, believe there is no self or subject that unifies consciousness. Bayne's position amounts to a bunch of mere assertions that allow him to avoid an obvious solution: substance dualism. (shrink)

The nature of linguistic understanding is a much-debated topic. Among the issues that have been discussed, two questions have recently received a lot of attention: (Q1) ‘Are states of understanding direct (i.e. represent solely what is said) or indirect (i.e. represent what is said as being said/asserted)?’ and (Q2) ‘What kind of mental attitude is linguistic understanding (e.g. knowledge, belief, seeming)?’ This paper argues that, contrary to what is commonly assumed, there is no straightforward answer to either of these questions. (...) This is because linguistic understanding cannot be identified with a single mental attitude towards a particular representation. Instead, we should characterize states of linguistic understanding as involving complex representational structures generated by a dual-stream process. The first stream operates on direct representations of what is said, while the second operates on representations of what is said as being said/asserted by a given source. Both these streams feed a situation model, i.e. a complex representation of a state of affairs described by a given piece of discourse. (shrink)

The thesis of instrumental convergence holds that a wide range of ends have common means: for instance, self preservation, desire preservation, self improvement, and resource acquisition. Bostrom contends that instrumental convergence gives us reason to think that "the default outcome of the creation of machine superintelligence is existential catastrophe". I use the tools of decision theory to investigate whether this thesis is true. I find that, even if intrinsic desires are randomly selected, instrumental rationality induces biases towards certain kinds of (...) choices. Firstly, a bias towards choices which leave less up to chance. Secondly, a bias towards desire preservation, in line with Bostrom's conjecture. And thirdly, a bias towards choices which afford more choices later on. I do not find biases towards any other of the convergent instrumental means on Bostrom's list. I conclude that the biases induced by instrumental rationality at best weakly support Bostrom's conclusion that machine superintelligence is likely to lead to existential catastrophe. (shrink)

This study’s objective was to understand Colombian adolescents’ experiences and preferences regarding access to sexual and reproductive health services (SRHS), either alone or accompanied. A mixed-method approach was used, involving a survey of 812 participants aged eleven to twenty-four years old and forty-five semi-structured interviews with participants aged fourteen to twenty-three. Previous research shows that adolescents prefer privacy when accessing SRHS and often do not want their parents involved. Such findings align with the longstanding tendency to frame the ethical principle (...) of autonomy as based on independence in decision-making. However, the present study shows that such a conceptualization and application of autonomy does not adequately explain Colombian adolescent participants’ preferences regarding access to SRHS. Participants shared a variety of preferences to access SRHS, with the majority of participants attaching great importance to having their parents involved, to varying degrees. What emerges is a more complex and non-homogenous conceptualization of autonomy that is not inherently grounded in independence from parental involvement in access to care. We thus argue that when developing policies involving adolescents, policymakers and health professionals should adopt a nuanced “relational autonomy” approach to better respect the myriad of preferences that Colombian (and other) adolescents may have regarding their access to SRHS. (shrink)

Ethical mysticism, by S. Coit.--The ethical import of history, by D. S. Muzzey.--The tragic and heroic in life, by W. M. Salter.--Distinctive features of the ethical movement, by A. W. Martin.--Ethical experience as the basis of religious education, by H. Neumann.--"All men are created equal," by G. E. O'Dell.--How far is art an aid to religion? by P. Chubb.--Evolution and the uniqueness of man, by H. J. Bridges.--The spiritual outlook on life, by H. J. Golding.--The ethics of Abu'l Ala al (...) Ma'arri, by N. Schmidt.--Life's unused moral force, by H. Snell.--Is the ideal real? by G. A. Smith.--Some ethical tendencies in the professions, by R. D. Kohn.--On the art of living, by W. Boerner.--The relation of the ethical ideal to social reform, by J. L. Elliott.--Concerning tolerance, by R. F. Dewey.--Ethical culture in Germany after the war, by R. Penzig.--A confession of faith, by S. B. Weston.--"Hearing the witnesses," by J. Gutmann. (shrink)

A common objection to Sosa’s epistemology is that it countenances, in an objectionable way, unsafe knowledge. This objection, under closer inspection, turns out to be in far worse shape than Sosa’s critics have realised. Sosa and his defenders have offered two central response types to the idea that allowing unsafe knowledge is problematic: one response type adverts to the animal/reflective knowledge distinction that is characteristic of bi-level virtue epistemology. The other less-discussed response type appeals to the threat of dream scepticism, (...) and in particular, to the idea that many of our everyday perceptual beliefs are unsafe through the nearness of the dream possibility. The latter dreaming response to the safety objection to Sosa’s virtue epistemology has largely flown under the radar in contemporary discussions of safety and knowledge. We think that, suitably articulated in view of research in the philosophy and science of dreaming, it has much more going for it than has been appreciated. This paper further develops, beyond what Sosa does himself, the dreaming argument in response to those who think safety (as traditionally understood) is a condition on knowledge and who object to Sosa’s account on the grounds that it fails this condition. The payoffs of further developing this argument will be not only a better understanding of the importance of insights about dreaming against safety as a condition on knowledge, but also some reason to think a weaker safety condition, one that is relativised to SSS (i.e., skill/shape/situation) conditions for competence exercise, gets better results all things considered as an anti-luck codicil on knowledge. (shrink)

First published in 2000. Routledge is an imprint of Taylor & Francis, an informa company.

Intellectual autonomy has long been identified as an epistemic virtue, one that has been championed influentially by (among others) Kant, Hume and Emerson. Manifesting intellectual autonomy, at least, in a virtuous way, does not require that we form our beliefs in cognitive isolation. Rather, as Roberts and Wood (Intellectual virtues: an essay in regulative epistemology, OUP Oxford, Oxford, pp. 259–260, 2007) note, intellectually virtuous autonomy involves reliance and outsourcing (e.g., on other individuals, technology, medicine, etc.) to an appropriate extent, while (...) at the same time maintaining intellectual self-direction. In this essay, I want to investigate the ramifications for intellectual autonomy of a particular kind of epistemic dependence: cognitive enhancement. Cognitive enhancements (as opposed to therapeutic cognitive improvements) involve the use of technology and medicine to improve cognitive capacities in healthy individuals, through mechanisms ranging from smart drugs to brain-computer interfaces. With reference to case studies in bioethics, as well as the philosophy of mind and cognitive science, it is shown that epistemic dependence, in this extreme form, poses a prima facie threat to the retention of intellectual autonomy, specifically, by threatening to undermine our intellectual self-direction. My aim will be to show why certain kinds of cognitive enhancements are subject to this objection from self-direction, while others are not. Once this is established, we’ll see that even some extreme kinds of cognitive enhancement might be not merely compatible with, but constitutive of, virtuous intellectual autonomy. (shrink)