Psychiatric Taxonomy

In this paper, I examine Reinforcement Learning modelling practice in psychiatry, in the context of alcohol use disorders. I argue that the epistemic roles RL currently plays in the development of psychiatric classification and search for explanations of clinically relevant phenomena are best appreciated in terms of Chang’s account of epistemic iteration, and by distinguishing mechanistic and aetiological modes of computational explanation.

Crime is a serious social problem, but its causes are not exclusively social. There is growing consensus that explaining and preventing it requires interdisciplinary research efforts. Indeed, the landscape of contemporary criminology includes a variety of theoretical models that incorporate psychological, biological and sociological factors. These multi-disciplinary approaches, however, have yet to radically advance scientific understandings of crime and shed light on how to manage it. In this paper, using conceptual tools on offer in the philosophy of science in combination (...) with theoretical work represented in this special volume of Psychology, Crime and Law, I provide some perspective on why explanatory progress in criminology has remained elusive and evaluate some positive proposals for attaining it. -/- . (shrink)

Invited commentary on Nicole A. Vincent and Emma A. Jane, “Interrogating Incongruence: Conceptual and Normative Problems with ICD-11’s and DSM-5’s Diagnostic Categories for Transgender People” Australasian Philosophical Review, in press. -/- The core of Vincent and Jane’s Interrogating Incongruence is critical of the appeal to the concept of incongruence in DSM-5 and ICD-11 characterisations of trans people, a critique taken to be ground-clearing for more trans-positive, psychiatrically-infused medical interventions. I concur with Vincent and Jane’s ultimate goals but depart from the (...) view developed in the paper on two fronts. The first is that I remain sceptical about the overall prospects for truly trans-positive psychiatry. Trans should follow homosexuality and other categories of sexual orientation that have been abandoned rather than reformed as constituents of psychiatric diagnosis and categorisation. The second is that I think that the authors’ central criticisms of the appeal to incongruence are misplaced. (shrink)

Work on causation in psychopathology often emphasizes variation in the causes but variation in what is to be explained further complicates matters. Focusing on the protean nature of psychopathology, this chapter explores different ways that classificatory variation is generated. For example, choices about what features of disorders to foreground and background can produce variation. The chapter also examines, from the perspective of scientific conventionalism, how classificatory decisions made at choice points partly constitute what is classified, but not in the sense (...) of making it up. In contrast to the view that conventions are neither true nor false and thus isolated from the domain of facts, the chapter argues that scientific conventions are implemented to promote the discovery of facts. Scientific conventions must also answer to conceptual and factual constraints. The chapter concludes by looking at how classificatory choices can produce different versions of a psychiatric which may also result in variations in causal models across those versions. In agreement with ideas articulated by Putnam, the chapter argues that we cannot divide the language of psychopathology into a part that describes disorders as they are in themselves and a part that contains our conceptual contributions to what we know about disorders. (shrink)

Anorexia nervosa involves seemingly irrational beliefs about body size and the value of thinness. Historically, researchers and clinicians have avoided referring to such beliefs as delusions, instead opting for the label ‘overvalued ideas’. I discuss the relationship between the beliefs associated with anorexia nervosa and the distinction between delusions and overvalued ideas, as it is conceived in both European and American psychiatric traditions. In doing so, I question the benefit of applying the concepts of delusion and overvalued idea to anorexia (...) nervosa and raise some issues with contemporary use of the Brown Assessment of Beliefs scale for assessing the level of delusionality associated with the disorder. (shrink)

Despite many authors in psychiatry endorsing a naturalist view of the mind, many still consider that mental dysfunctions cannot be reduced to brain dysfunctions. This paper investigates the main reasons for this view. Some arguments rely on the analogy that the mind is like software while the brain is like hardware. The analogy suggests that just as software can malfunction independently of hardware malfunctions, similarly the mind can malfunction independently of any brain malfunction. This view has been critically examined in (...) recent literature. However, other less discussed reasons suggest that mental dysfunctions cannot be reduced to brain dysfunctions because mental dysfunctions are appropri- ately ascribed at the level of intentional mental states, while brain dysfunctions are solely related to abnormalities in anatomy and physiological processes. This paper questions why such a view would be upheld. The discussion is framed within the interface problem in the philosophy of cognitive science, which concerns the relationship between personal and subpersonal levels of explanation. The paper examines the view that an autonomist perspective on the personal/ subpersonal distinction could justify the separation of mental dysfunctions, described in intentional terms, from brain dysfunctions, described in anatomical or physiological terms. Ultimately, the paper argues that the autonomist view cannot be upheld in psychiatry and, consequently, does not provide a principled justification for rejecting the reduction of mental dysfunctions to brain dysfunctions. (shrink)

In ihrem Buch The Philosophy of Mental Disorder: An Ability-Based Approach gelingt Sanja Dembić eine analytisch scharfe, intellektuell herausfordernde und originelle Explikation des Begriffs der psychischen Störung. Es macht Spaß zu verfolgen, wie die verschiedenen Puzzleteile vorgestellt und dann zusammengefügt werden. Allerdings kann man vor lauter Puzzleteilen leicht den Überblick verlieren. Aus diesem Grund möchte ich ein paar Überlegungen anstellen, die die Möglichkeit geben sollen, den Ansatz sowie dessen Implikationen noch einmal zu verdeutlichen.

Scientists cannot devise theories, construct models, propose explanations, make predictions, or even carry out observations, without first classifying their subject matter. The goal of scientific taxonomy is to come up with classification schemes that conform to nature's own. Another way of putting this is that science aims to devise categories that correspond to 'natural kinds.' The interest in ascertaining the real kinds of things in nature is as old as philosophy itself, but it takes on a different guise when one (...) adopts a naturalist stance in philosophy, that is when one looks closely at scientific practice and takes it as a guide for identifying natural kinds and investigating their general features. This Element surveys existing philosophical accounts of natural kinds, defends a naturalist alternative, and applies it to case studies in a diverse set of sciences. This title is also available as Open Access on Cambridge Core. (shrink)

The cognitive science of belief is a burgeoning field, with insights ranging from detailing the fundamental structure of the mind, to explaining the spread of fake news. Here we highlight how new insights into belief acquisition, storage, and change can transform our understanding of psychiatric disorders. Although we focus on monothematic delusions, the conclusions apply more broadly. -/- .

Muhammad Ali Khalidi contends that because cognitive science casts a wider net than neuroscience in searching for the causes of cognition, it is in the superior position to discover “real” cognitive kinds. I argue that while Khalidi identifies appropriate norms for individuating cognitive kinds, these norms ground his characterization of taxonomic practices in cognitive science, rather than the other way around. If we instead treat Khalidi's norms not as descriptively accurate characterizations of taxonomic practices in cognitive science, but as a (...) set of best practices for kinding cognition, is cognitive science in and neuroscience definitively out of the cognitive kinding game? (shrink)

Are psychiatric disorders natural kinds? This question has received a lot of attention within present-day philosophy of psychiatry, where many authors debate the ontology and nature of mental disorders. Similarly, historians of psychiatry, dating back to Foucault, have debated whether psychiatric researchers conceived of mental disorders as natural kinds or not. However, historians of psychiatry have paid little to no attention to the influence of (a) theories within logic, and (b) theories within metaphysics on psychiatric accounts of proper method, and (...) on accounts of the nature and classification of mental disorders. Historically, however, logic and metaphysics have extensively shaped methods and interpretations of classifications in the natural sciences. This paper corrects this lacuna in the history of psychiatry, and demonstrates that theories within logic and metaphysics, articulated by Christian Wolff (1679-1754), have significantly shaped the conception of medical method and (psychiatric) nosology of the influential nosologist Boissier De Sauvages (1706-1767). After treating Sauvages, I discuss the method of the influential nosologist William Cullen (1710-1790), and demonstrate the continuity between the classificatory methods of Sauvages and Cullen. I show that both Sauvages and Cullen were essentialists concerning medical diseases in general and psychiatric disorders in particular, contributing to the history of conceptions of the ontology and nature of mental disorders. (shrink)

Marion Godman makes the argument that Pathological Withdrawal Syndrome (PWS) makes the case for psychiatric disorders as a natural kind. Godman argues that we can classify kinds according to their shared ‘grounding’, but we need not know what the grounding is to know that the natural is a natural kind. However, I argue that Godman erroneously classifies PWS as its own natural kind when it is in fact a variant of depression, which is its own natural kind. Cooper highlights culture-bound (...) syndromes, which can explain the discrepancy between the different diagnosis rates for psychiatric disorders among different cultures. Taking culture-bound syndromes into account, I conclude that PWS is a type of depression that is culture-specific. (shrink)

The Caraka Saṃhitā (ca. first century BCE–third century CE), the first classical Indian medical compendium, covers a wide variety of pharmacological and therapeutic treatment, while also sketching out a philosophical anthropology of the human subject who is the patient of the physicians for whom this text was composed. In this article, I outline some of the relevant aspects of this anthropology – in particular, its understanding of ‘mind’ and other elements that constitute the subject – before exploring two ways in (...) which it approaches ‘psychiatric’ disorder: one as ‘mental illness’ ( mānasa-roga), the other as ‘madness’ ( unmāda). I focus on two aspects of this approach. One concerns the moral relationship between the virtuous and the well life, or the moral and the medical dimensions of a patient’s subjectivity. The other is about the phenomenological relationship between the patient and the ecology within which the patient’s disturbance occurs. The aetiology of and responses to such disturbances helps us think more carefully about the very contours of subjectivity, about who we are and how we should understand ourselves. I locate this interpretation within a larger programme on the interpretation of the whole human being, which I have elsewhere called ‘ecological phenomenology’. (shrink)

The fast-developing field of neuroscience has given philosophy, as well as other disciplines and the public broadly, many new tools and perspectives for investigating one of our most pressing challenges: addressing the health and well-being of our mental lives. In some cases, neuroscientific innovation has led to clearer understanding of the mechanisms of mental illness and precise new modes of treatment. In other cases, features of neuroscience itself, such as the enticing nature of the data it produces compared to previous (...) behavioral methods, together with its costliness and “coldness” have complicated understanding of mental illness and decision making about mental illness. Taking neuroscientific information into account can leave practitioners in psychiatry and law with difficult questions, stemming not only from the complexity of these fields, but also from our rapidly evolving understanding of and facility with neuroscience. In this chapter, we will review several examples of the insights and dilemmas that have unfolded as mental illness has been examined through the lens of neuroscience, covering diagnoses such as obsessive-compulsive disorder (OCD), schizophrenia, addiction, and severe mood disorders. (shrink)

In this thesis, I investigated the self in autism using tools from philosophy and experimental cognitive science. Our self-representation shapes how we act in the world, and the feedback we receive in turn shapes how we represent ourselves. In the predictive processing framework I use, autism is characterised by differences in modelling or predicting the world under uncertainty which impacts both perception and action. Findings from the thesis show that individuals with more autistic traits are more prone to act early (...) in the face of rising uncertainty. The thesis also raises questions about the appropriate core features of autism. (shrink)

Jonathan Y. Tsou examines and defends positions on central issues in philosophy of psychiatry. The positions defended assume a naturalistic and realist perspective and are framed against skeptical perspectives on biological psychiatry. Issues addressed include the reality of mental disorders; mechanistic and disease explanations of abnormal behavior; definitions of mental disorder; natural and artificial kinds in psychiatry; biological essentialism and the projectability of psychiatric categories; looping effects and the stability of mental disorders; psychiatric classification; and the validity of the DSM's (...) diagnostic categories. The main argument defended by Tsou is that genuine mental disorders are biological kinds with harmful effects. This argument opposes the dogma that mental disorders are necessarily diseases that result from biological dysfunction. Tsou contends that the broader ideal of biological kinds offers a more promising and empirically ascertainable naturalistic standard for assessing the reality of mental disorders and the validity of psychiatric categories. (shrink)

What is it to be mentally healthy? In the ongoing movement to promote mental health, to reduce stigma, and to establish parity between mental and physical health, there is a clear enthusiasm about this concept and a recognition of its value in human life. However, it is often unclear what mental health means in all these efforts and whether there is a single concept underlying them. Sometimes, the initiatives for the sake of mental health are aimed just at reducing mental (...) illness, thus implicitly identifying mental health with the absence of diagnosable psychiatric disease. More ambitiously, there are high-profile proposals to adopt a positive definition, identifying mental health with psychic or even overall well-being. We argue against both: a definition of mental health as mere absence of mental illness is too thin, too undemanding, and too closely linked to psychiatric value judgments, while the definition in terms of well-being is too demanding and potentially oppressive. As a compromise, we sketch out a middle position. On this view, mental health is a primary good, that is, the psychological preconditions of pursuing any conception of the good life, including well-being, without being identical to well-being. (shrink)

Today the concept of 'schizophrenia' is often presented in psychiatric texts as a construct, a construct bringing together a diverse and, allegedly, independently assailable range of signs and symptoms. According to such a diagnostic scheme two patients may both be allowed to count as suffering from schizophrenia despite sharing hardly a single symptom. The validity of the concept has accordingly been contested by psychologists for its apparent lack of unity. In the absence of clear independent evidence of a unitary physiological (...) disease process underlying such diverse phenomena, a natural enough suggestion has been to... (shrink)

Recently there has been a trend of moving towards biological and neurocognitive based classifications of mental disorders that is motivated by a dissatisfaction with the syndrome-based classifications of mental disorders. The Research Domain Criteria (indicated with the acronym RDoC) represents a bold and systematic attempt to foster this advancement. However, RDoC faces theoretical and conceptual issues that need to be addressed. Some of these difficulties emerge when we reflect on the plausible reading of the slogan “mental disorders are brain disorders”, (...) that according to proponents of RDoC constitutes one of its main presuppositions. Some authors think that endorsing this idea commits RDoC to a form of biological reductionism. We offer empirical and theoretical considerations for concluding that the slogan above should not be read as a reductionist thesis. We argue, instead, that the slogan has a pragmatic function whose aim is to direct research in psychopathology. We show how this function might be captured in the framework of a Carnapian explication as a methodological tool for conceptual engineering. Thus, we argue that a charitable interpretation of the aims of the proponents of RDoC should be understood as an attempt at providing an explication of the concept of mental disorder in terms of brain disorder whose main goal is to provide a more precise and fruitful notion that is expected to have a beneficial impact on classification, research, and treatment of psychiatric conditions. (shrink)

Long-standing psychiatric practice confirms the pervasive use of pharmacological therapies for treating severe mental disorders. In many circumstances, drugs constitute the best allies of psychotherapeutic interventions. A robust scientific literature is oriented on finding the best strategies to improve therapeutic efficacy through different modes and timing of combined interventions. Nevertheless, we are far from triumphal therapeutic success. Despite the advances made by neuropsychiatry, this medical discipline remains lacking in terms of diagnostic and prognostic capabilities when compared to other branches of (...) medicine. An ethical principle remains as the guidance of therapeutic interventions: improving the quality of life for patients. Unfortunately, psychotropic drugs and psychotherapies do not always result in an efficient remission of symptoms. In this paper I corroborate the idea that therapists should provide drug-resistant patients with every effective and available treatment, even if some of such interventions could be invasive, like Electroconvulsive Therapy (ECT). ECT carries upon its shoulders a long and dramatic history that should be better investigated to provide new insights. In fact, ECT has attracted renewed interest in recent years. This is due to the fact that antidepressant drugs in younger patients show often scarce effectiveness and unpleasant side-effects. Moreover, I show that, thanks to modern advances, ECT may work as a successful form of treatment for specific and rare cases, such as severe depression (with suicide attempts) and catatonia. (shrink)

The Research Domani Criteria framework (RdoC) encourages research on specific impairments present across traditional nosological categories and suggests a list of biological and behavioral measures for assessing them. After a description of RdoC, in this article we focus on impairments of the ability of understanding others, specifically in Theory of Mind and empathy. We illustrate recent evidence on brain anomalies correlating with these deficits in Schizophrenia, Addiction Disorders and Mood Disorders populations. In the last section, we zoom out and consider (...) this kind of research vis-à-vis the objection of being reductionistic that is, in favoring mechanistic accounts of mental disorders. We argue that metaphysical reductionism and explanatory reductionism are not conceptually entailed by the RdoC framework. (shrink)

Confabulation is typically understood to be dysfunctional. But this understanding neglects the phenomenon’s potential benefits. In fact, we think that the benefits of non-clinical confabulation provide a better foundation for a general account of confabulation. In this paper, we start from these benefits to develop a social teleological account of confabulation. Central to our account is the idea that confabulation manifests a kind of willful ignorance. By understanding confabulation in this way, we can provide principled explanations for the difference between (...) clinical and non-clinical cases of confabulation and the extent to which confabulation is rational. (shrink)

In this paper, I will present and advocate a view about what we are doing when we attribute delusion, namely, say that someone is delusional. It is an “expressivist” view, roughly analogous to expressivism in meta-ethics. Just as meta-ethical expressivism accounts for certain key features of moral discourse, so does this expressivism account for certain key features of delusion attribution. And just as meta-ethical expressivism undermines factualism about moral properties, so does this expressivism, if correct, show that certain attempts to (...) objectively define delusion are misguided. I proceed as follows. I start by examining different attempts at defining delusion, separating broadly psychiatric attempts from epistemic ones. I then present a change of approach, according to which we question whether the term “delusion” is in the business of (merely) describing reality. I then support this proposal, first, by borrowing standard lines of argument from meta-ethics (including ontological reluctance, intrinsic motivation, and deep disagreement) but also, by inference to the best explanation of some the features we see when we try to theorise about delusion (namely that it is hard to define, and that our delusion attributions are elicited by a plurality of norms). (shrink)

In her 2006 book The Jumbled Jigsaw, Donna Williams, an autistic author and poet, presents an example of a list of traits associated with autism—one of many such lists commonly found in text books, academic publications, and information leaflets. Her list includes the following: a tendency to stick to well-tried routines and avoid change, a tendency to have a narrow range of interests, a tendency to develop irrational fears and anxieties, a tendency not to develop a sense of danger, a (...) tendency to demonstrate bizarre behaviors and mannerisms, a tendency to copy speech parrot fashion, and isolated areas of ability. "The problem with such a list," Williams explains, "is that the features of each of these areas can be... (shrink)

The field of mental health continues to struggle with the question of how best to structure its diagnostic systems. This issue is of considerable ethical importance, but the implications for public health approaches to mental health have yet to be explored in any detail. In this article I offer a preliminary treatment, drawing out several core issues while sounding a note of caution. A central strand of the debates over diagnosis has been the contrast between categorical and dimensional models, with (...) renewed attention due to recent publication of the DSM-5, launch of the RDoC, and ongoing work on the ICD-11. This dispute involves an interesting assortment of ethical and empirical considerations, many with direct relevance for public health. It has been proposed, for example, that dimensional diagnosis may be morally preferable because it can help reduce the stigma associated with mental disorder. This is a pressing concern, as preventive strategies are expanded in mental health, often operating under dimensional assumptions that target various risk factors. But this type of proposal relies upon an empirical claim and the scientific status of dimensionality remains unresolved, including its relation to stigma. I suggest, then, that the current state of the evidence does not yet warrant clear adjudication between competing frameworks, and thus any implications for public mental health remain highly provisional. More research is needed to help resolve these issues, including ethical analysis. (shrink)

Somogy Varga's criticisms and questions provide me with a welcome opportunity to clarify some key elements of my proposal. First, I briefly summarize my motivation and original proposal for a phenomenological–dimensional research program. Second, I address Varga's two challenges. Each challenge highlights an element of my proposal that was underdeveloped in the original article. I therefore provide a brief clarification of my proposal before responding directly to Varga's two challenges.My proposal is to shift phenomenological psychopathology toward a broadly dimensional, rather (...) than categorial, research program. This approach will allow phenomenologists to operate outside the constraints of... (shrink)

Contemporary psychiatry finds itself in the midst of a crisis of classification. The developments begun in the 1980s—with the third edition of the Diagnostic and Statistical Manual of Mental Disorders —successfully increased inter-rater reliability. However, these developments have done little to increase the predictive validity of our categories of disorder. A diagnosis based on DSM categories and criteria often fails to accurately anticipate course of illness or treatment response. In addition, there is little evidence that the DSM categories link up (...) with genetic findings, and even less evidence that they... (shrink)

Contemporary psychiatry faces serious challenges because it has failed to incorporate accumulated knowledge from basic neuroscience, neurophilosophy, and brain–mind relation studies. As a consequence, it has limited explanatory power, and effective treatment options are hard to come by. A new conceptual framework for understanding mental health based on underlying neurobiological spatial-temporal mechanisms of mental disorders (already gained by the experimental studies) is beginning to emerge.

In the introduction to a recent anthology of contemporary issues in philosophy of psychiatry, editors Jeffrey Poland and Şerife Tekin declare this to be a moment of crisis within the field. They suggest that the state of psychiatry today reflects Thomas Kuhn's conception of a period of extraordinary science, which occurs when anomalies begin to build up, confidence in the dominant paradigm is shook, competing theories arise, and philosophical questions come to the fore. Although perhaps not all would agree that (...) the field is in crisis, there is certainly an abundance of pessimism. Within the realm of research, a mood of explanatory pessimism has been growing, characterized by a... (shrink)

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)

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)

Recent literature has suggested that generics can harbor and propagate worrying ideologies in a manner which is often not appreciated by speakers. In this article, I argue that the use of generics to convey information about mental illness is unhelpful, whether the knowledge structure conveyed by the generic is 'accurate' or not. Inaccurate generics contribute to insidious forms of social stereotyping and stigma by encouraging us to simplistically generalize characteristics found in very few category members to other members of that (...) kind.Yet, even where the knowledge structure underlying the generic is accurate, generics remain an unhelpful way of talking about mental illness. This is because... (shrink)

The thesis of multiple realisation that Borsboom et al. are relying on should not be taken for granted. In dissolving the apparent multiple realisation, the reductionist research strategies in psychopathology research (the Research Domain Criteria [RDoC] framework, in particular) are bound to lead to eliminativism rather than reductionism. Therefore, Borsboom et al. seem to be aiming at a wrong target.

A significant portion of the scholarship in analytic philosophy of psychiatry has been devoted to the problem of what kind of kind psychiatric disorders are. Efforts have included descriptive projects, which aim to identify what psychiatrists in fact refer to when they diagnose, and prescriptive ones, which argue over that to which diagnostic categories should refer. In other words, philosophers have occupied themselves with what I call “diagnostic kinds”. However, the pride of place traditionally given to diagnostic kinds in psychiatric (...) research has recently come under attack, most notably by a recent initiative of the National Institute of Mental Health, the Research Domain Criteria Project, that seeks to exclude diagnostic categories from experimental designs and focus on other sorts of psychiatric kinds. I argue that philosophical accounts privileging diagnostic kinds must respond to this new line of criticism, and conclude that philosophers need to either counter psychiatrists’ growing suspicion about the hegemony of diagnostic categories in the clinic and the laboratory, or join in redirecting their efforts toward the development of robust accounts of other sorts of psychiatric objects and processes. (shrink)

Critical-philosophical commentary on theses defended in scientific articles may be guided by two distinct perspectives, each leading to inquiries and styles of responses that are both distinct and complementary: an internal perspective and an external perspective. The internal commentator belongs to the same epistemological field of the authors and, as such, shares the same categorical assumptions and the same Weltanschauung explored in the text. The dialogue with this commentator emphasizes the minutiae of the observation of the shared scientific reality and (...) points out the frontiers toward which the discussion of a scientific branch must advance. The external commentator, in contrast, emphasizes the categorical... (shrink)

This book explores the central questions and themes lying at the heart of a vibrant area of philosophical inquiry. Aligning core issues in psychiatry with traditional philosophical areas, it presents a focused overview of the historical and contemporary problems dominating the philosophy of psychiatry. -/- Beginning with an introduction to research issues, it addresses what psychiatry is and distinguishes it from other areas of medical practice, other health care professions and psychology. With each section of the companion corresponding to a (...) philosophical subject, contributors systematically relate themes in philosophy of psychiatry to topics in philosophy of mind, phenomenology, philosophy of science, ethics, social and political philosophy, metaphysics, epistemology, and philosophy of medicine. Looking ahead to new research directions, chapters address recent issues including the metaphysics of mental disorders, gender and race in psychiatry and psychiatric ethics. -/- Featuring discussion questions, suggestions for further reading and an annotated bibliography, The Bloomsbury Companion to Philosophy of Psychiatry is an accessible survey of the debates and developments in the field suitable for undergraduates in philosophy and professional philosophers new to philosophy of psychiatry. (shrink)

This chapter examines philosophical issues surrounding the classification of mental disorders by the Diagnostic and Statistical Manual of Mental Disorders (DSM). In particular, the chapter focuses on issues concerning the relative merits of descriptive versus theoretical approaches to psychiatric classification and whether the DSM should classify natural kinds. These issues are presented with reference to the history of the DSM, which has been published regularly by the American Psychiatric Association since 1952 and is currently in its fifth edition. While the (...) first two editions of the DSM adopted a theoretical (psychoanalytic) and etiological approach to classification, subsequent editions of the DSM have adopted an atheoretical and purely descriptive (“neo-Kraepelinian”) approach. It is argued that largest problem with the DSM at present—viz., its failure to provide valid diagnostic categories—is directly related to the purely descriptive methodology championed by the DSM since the third edition of the DSM. In light of this problem, the chapter discusses the prospects of a theoretical and causal approach to psychiatric classification and critically examines the assumption that the DSM should classify natural kinds. (shrink)

In psychiatry, many scientists desire to move from a classification system based on symptoms toward a system based on biological causes. The idea is that psychiatric diseases should be redefined such that each disease would be associated with specific biological causes. This desire is intelligible because causal disease models often facilitate understanding and identification of new ways to intervene in disease processes. In its attempt to move from syndromal to specific etiological definitions, psychiatry follows the trend of general medicine.Current psychiatric...

The publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has stirred many emotions both inside and outside of the psychiatric community. But when the director of the U.S. National Institute of Mental Health, Thomas Insel's, critique of the DSM-5 became public, even some antipsychiatrists were surprised. Insel argued that although the DSM's diagnostic categories have become the standard to obtain research grants and to conduct trials, they are not based on objective measures, lack validity, (...) do not make accurate predictions about illness trajectory, and fail to map onto findings from neuroscience and genetics. In contrast with the... (shrink)

The network approach to psychopathology is becoming increasingly popular. The motivation for this approach is to provide a replacement for the problematic common cause perspective and the associated latent variable model, where symptoms are taken to be mere effects of a common cause (the disorder itself). The idea is that the latent variable model is plausible for medical diseases, but unrealistic for mental disorders, which should rather be conceptualized as networks of directly interacting symptoms. We argue that this rationale for (...) the network approach is misguided. Latent variable (or common cause) models are not inherently problematic, and there is not even a clear boundary where network models end and latent variable (or common cause) models begin. We also argue that focusing on this contrast has led to an unrealistic view of testing and finding support for the network approach, as well as an oversimplified picture of the relationship between medical diseases and mental disorders. As an alternative, we point out more essential contrasts, such as the contrast between dynamic and static modeling approaches, that can provide a better framework for conceptualizing mental disorders. Finally, we discuss several topics and open problems that need to be addressed in order to make the network approach more concrete and to move the field of psychological network research forward. (shrink)

Dominic Murphy in several influential publications has formulated and defended what he calls the strong medical model of mental illness. At the core of this project is the objectivist requirement of classifying mental illness in terms of their aetiologies, preferably characterised by multilevel mechanistic explanations of dysfunctions in neurocomputational processes. We are sympathetic to this project and we devise an argument to support it based on a conception of psychiatric kinds. Murphy has, moreover, maintained that there are some open issues (...) concerning the applicability of his program to antisocial personality disorders and psychopathy. We argue that, as a matter of fact, there are already plausible and well-motivated classificatory proposals for these types of disorders that accommodate well within Murphy's strong medical model. (shrink)

In this chapter, I provide an overview of phenomenological approaches to psychiatric classification. My aim is to encourage and facilitate philosophical debate over the best ways to classify psychiatric disorders. First, I articulate phenomenological critiques of the dominant approach to classification and diagnosis—i.e., the operational approach employed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-10). Second, I describe the type or typification approach to psychiatric classification, which I distinguish into three different (...) versions: ideal types, essential types, and prototypes. I argue that despite their occasional conflation in the contemporary literature, there are important distinctions among these approaches. Third, I outline a new phenomenological-dimensional approach. I show how this approach, which starts from basic dimensions of human existence, allows us to investigate the full range of psychopathological conditions without accepting the validity of current diagnostic categories. (shrink)

The network approach to psychopathology has recently gen-erated enthusiasm in the research community. This is likely due in large part to network methods being promoted with the prom-ise of improving clinical prevention and intervention strategies by explicating the dynamic causal architecture of mental illness1. As a result, studies using network methods have proliferated with the aim of understanding causal interactions between psychiat-ric symptoms through empirical data.

This special issue of History of the Humane Sciences intends to shed light on a series of psychopathological entities that do not target well defined conditions and experiences, but rather aim at delimiting zones of uncertainty that defy psychopathology’s order of things: mild diagnoses or subthreshold disorders, borderline conditions, culture bound syndromes, or ideas of dimensions and dimensionality. While these categories have come to play an increasingly central role in psychiatric and psychological thinking during the last 50 years, historians and (...) social scientists have had remarkably little to say about how they have been created, what they have been used for, and what kind of realities they have helped to shape. In this introductory article we propose the concept of ‘psychopathological fringes’ to refer to these categories that are located somewhere at the border of psychopathological classifications and refer to zones of conceptual underdetermination. The notion of fringes serves to highlight both the conceptually and the socially marginal nature of the conditions, personal identities, and worlds delimited by these categories. The fringes of psychopathology are zones of vagueness, of epistemic uncertainty, and moral ambiguity. This introduction proposes a first incursion in these zones. It suggests some of the reason why they might have had attracted little interest in the past and why they may be more salient recently. It follows some analytical clues that might help chart a way through it and proposes a map through the collection of articles included in this issue. (shrink)