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 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)

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)

The late Jacob Klein’s important book is, remarkably, a lucid presentation of esoteric argument. Dealing with the famed Platonic triad, Theaetetus, Sophist, and Statesman, Klein settles the dispute about the missing dialogue, "The Philosopher," by first denying that it is missing and second showing that it is unnecessary. He argues, in short, that the triad is a dyad. That argument is reinforced by the distinction Klein strongly implies between the Socratic Theaetetus and the Eleatic Sophist and Statesman. "We can now (...) understand why the conversations of the ‘trilogy’ occur in two, not three, days and why the Sophist, the Statesman, and the Philosopher are dealt with in two, not three, dialogues". (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)

W. B. Gallie; I *—The Presidential Address: Rationality and the Use of Force, Proceedings of the Aristotelian Society, Volume 71, Issue 1, 1 June 1971, Pages 1–.

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

Intellectual eminence apart, what did Kant, Clausewitz, Marx and Engels, and Tolstoy have in common? Professor Gallic argues that they made contributions to 'international theory' - to the understanding of the character and causes of war and of the possibility of peace between nations - which were of unrivalled originality in their own times and remain of undiminished importance in ours. But these contributions have been either ignored or much misunderstood ; chiefly because, as with all intellectual efforts in unexplored (...) fields, they were often imperfectly expressed, and were also overshadowed by their author's more striking achievements. Professor Gallic has sorted out, compared and contrasted, criticised and re-phrased the teachings of his chosen authors on peace and war. (shrink)