In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further (...) questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

Principled discussions of civil rights became inherently less likely as a direct result of the observation by Earl Warren, in Brown v. Board of Education, that, respecting freedmen, “Education of Negroes was almost non-existent, and practically all of the race were illiterate,” and in proportion as that observation increasingly became the foundation of common opinion on the subject. Warren's observation was not true in any meaningful or non-trivial sense. Nevertheless, it served to perpetuate the myth of a backward people needing (...) help to catch up instead of the truth of a people being held back. That is the perspective – the disadvantaged group perspective – that ultimately infected all discussion of civil rights, even after the designation of so-called “disadvantaged groups” had been extended beyond American blacks. To define civil rights, we may well begin with what all mankind would likely recognize. Thus the dictionary definition of “civil rights” stands: “the rights that belong to all individuals in a nation or community touching property, marriage, and the like.” In that definition the term “rights” may be further expanded to mean “legitimate claims,” following the definition of right as law – as “a claim or title or interest in anything whatever that is enforceable by law.” This definition applies with minimal distinction of regimes intruding and, therefore, without the host of recent complications in the United States that create the impression that civil rights have something to do with pluralism. Previously, the generic definition was thought to exhaust the meaning of the term in the United States. (shrink)

Patient safety has only recently been subjected to wide-spread systematic study. Healthcare differs from other high risk industries in being more diverse and multi-contextual, and less certain and regulated. Also many patient safety problems are low-frequency events associated with many, varied contributing factors. The subject of this paper is the epistemology of patient safety (the science of the method of finding out about patient safety). Patient safety research is considered here on the background of a risk management framework which requires (...) researchers to: • Understand the context - as a subset of healthcare quality, services and systems research, with technical and human behavioural (cultural) components and a range of external and internal organisational influences, a wide range of research disciplines is necessary • Identify the risks - identify the things that go wrong and the frequency and nature of different types of incidents from sources such as medical record review, observational studies, audit, incident and medico-legal reports • Analyse the risks - deconstruct the things that go wrong, identifying contributing factors and trying to detect trends and patterns in contributing factors, detection, mitigation factors, ameliorating factors and actions taken to reduce risk • Evaluate the risks - decide on priorities, identifying preventive and corrective strategies and judging the risk- and cost-benefit of potential corrective strategies such as standardisation or simplification of a process or device • Manage the risk - evaluate and scope preventive and/or corrective strategies and then implement these, or place the problem on a risk register pending solution, or accept that what is needed is unaffordable • Communicate and consult - use interactive sessions, audit, on-going feedback, reminders and patient mediated prompts • Monitor and review the state of the problem - get baseline trends and patterns so that changes can be tracked and properly attributed to an intervention A hierarchy of levels of evidence has been proposed for clinical research and we argue that insufficient weighting has been given to lower ranked levels of research and to qualitative research, although critical interpretive synthesis is now gaining acceptance in mainstream thinking (e.g. by the Cochrane Collaboration). Fundamental challenges remain including how to grasp the elusive concept of patient safety, how to quantify, characterise and cost the problems, how to judge the extent to which harm can be attributed to errors, violations or system failures, how to identify contributing factors and the extent to which they can be implicated, how to judge whether incidents or their precursors are preventable, how to generate strong evidence to make healthcare safer and how to translate research into practice. Future directions include addressing the mundane as well as rare, dramatic events, and developing further research in non-hospital settings and in developing countries. In summary, a mixture of qualitative and quantitative methods, using information from all available data sources and combining retrospective, real time and prospective study designs, is necessary to address some of the more difficult patient safety problems. (shrink)

In this book, for the first time, authors try to introduce the concept of linguistic variables as a continuum of linguistic terms/elements/words in par or similar to a real continuum. For instance, we have the linguistic variable, say the heights of people, then we place the heights in the linguistic continuum [shortest, tallest] unlike the real continuum (–∞, ∞) where both –∞ or +∞ is only a non-included symbols of the real continuum, but in case of the linguistic continuum we (...) generally include the ends or to be more mathematical say it is a closed interval, where shortest denotes the shortest height of a person, maybe the born infant who is very short from usual and the tallest will denote the tallest one usually very tall; however this linguistic continuum [shortest, tallest] in the real continuum will be the closed interval say [1 foot, 8 feet] or [1, 8] the measurement in terms of feet. So, the real interval is a subinterval with which we have associated the real continuum in terms of qualifying unit feet and inches in this case. (shrink)

In this book, the authors systematically define the new notion of linguistic graphs associated with a linguistic set of a linguistic variable. We can also define the notion of directed linguistic graphs and linguistic-weighted graphs. Chapter two discusses all types of linguistic graphs, linguistic dyads, linguistic triads, linguistic wheels, complete linguistic graphs, linguistic connected graphs, disconnected linguistic graphs, linguistic components of the graphs and so on. Further, we define the notion of linguistic subgraphs of a linguistic graph. However, like usual (...) graphs, we will not be able to arbitrarily connect any two linguistic words of a linguistic set associated with a linguistic variable. They can be related or adjacent depending on the linguistic variable associated with the linguistic set. This is an exceptional feature of a linguistic graph. (shrink)

In this book, authors, for the first time, introduce the new notion of special subset linguistic topological spaces using linguistic square matrices. This book is organized into three chapters. Chapter One supplies the reader with the concept of ling set, ling variable, ling continuum, etc. Specific basic linguistic algebraic structures, like linguistic semigroup linguistic monoid, are introduced. Also, algebraic structures to linguistic square matrices are defined and described with examples. For the first time, non-commutative linguistic topological spaces are introduced. The (...) notion of a linguistic special subset of doubly non-commutative topological spaces of linguistic topological spaces is introduced in this book. (shrink)

As I had rejected en bloc references to Bacchanalia as indications of date, it was a mere chance which led me, after the above had left my hands, to look up Cas. 980 ‘ nunc Bacchae nullae ludunt,’ quoted in Schanz, R. Lit.3, p. 78. As this affords an excellent opportunity of testing my conclusions, perhaps a word or two will not be out of place.

First Published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.

In the Classical Review I quoted, for Petronius 77. 6 ‘assem habeas assem valeas,’ a proverb unnoticed as far as I know by other scholars—‘quantum habebis tantus eris; frange lunam et fac fortunam’—and suggested that we should invert and correct—‘frange lunam [et] fac fortunam; quantum habebis tanti eris’—thus getting an accentual trochaic tetra-meter, with rhyme in the first half , which could be added to the popular trochaics collected in Baehrens' Poet. Lat. Fragmenta.

One Morality or many? Liberal morality and Socialist morality; bourgeois morality and Georges Sorel's “morality of producers”; Protestant morality and Catholic; Greek morality and Christian; “aristocratic” morality and “slave” morality, “open” morality and “closed” morality—what, if any, is the relevance of such distinctions as these to moral philosophy?

"Bibliographical notes": pages [243]-244.

On Death, by the Epicurean philosopher Philodemus of Gadara, is among the most significant philosophical treatments of the theme surviving from the Greco-Roman world. The author was an influential figure in first-century B.C.E. Roman society, associated with poets such as Virgil and politicians such as the father-in-law of Julius Caesar. The surviving copies of his treatises were carbonized following the eruption of Vesuvius in 79 C.E. This edition contains the Greek text, newly reconstituted with the help of the infrared imaging (...) technology that has revolutionized the study of Philodemus’s works in the twenty-first century, and completely translated into English for the first time. An extensive introduction provides background on Philodemus and his writings, accompanying notes enrich the text, and forty-four pages of photographs illustrate the papyrus manuscript from which the translation is drawn. (shrink)

Is The Prelude a philosophical poem? It is, of course, many things besides: it is an autobiography; it contains profound reflections on psychology, education and politics; and there are passages of an almost purely lyrical character. Does it also contain philosophical poetry? On this question, the critics of Wordsworth are divided. Coleridge and Raleigh answer Yes; Arnold, Bradley, Dr. Leaves, from their different points of view, agree in answering No. I believe that the first answer is right, although it has (...) usually been supported by the wrong reasons. I believe the second answer to be wrong, although many of the arguments that are supposed to lead to it are in themselves sound enough. Those who say that The Prelude is not a philosophical poem, usually mean that it does not offer a coherent system of philosophy—that it expresses an original outlook and a personal wisdom, but that the only systematic philosophy in it comes at second-hand from Hartley or Coleridge and contributes not at all to the poem. And this is largely true. But the mistake is, to identify philosophy with system, philosophizing with “a philosophy.” This is a mistake that has been repudiated again and again by many of the greatest philosophers, from Socrates and Plato to Locke and Kant and others. I shall argue that The Prelude achieves philosophical poetry, because in it Wordsworth grapples with philosophical problems—problems which arise out of the story of his own early life—which are actually forced upon him by the poem itself; and because he tries to answer these problems in a way which would be possible only in poetry. (shrink)