Thomas Szasz famously argued that mental illness is a myth. Less famously, Szasz argued that since mental illness is a myth, so too is psychotherapy. Szasz’ claim that mental illness is a myth has been much discussed, but much less attention has been paid to his claim that psychotherapy is a myth. In the first part of this essay, I critically examine Szasz’ discussion of psychotherapy in order to uncover the strongest version of his case for thinking that it is (...) a myth. As we’ll see, this involves an understanding of psychotherapeutic interventions as treatments of psychopathological problems. In the rest of this essay, I turn to this directly and argue that psychotherapy has an important non-pathocentric dimension. I argue that we fail to appreciate the nature and variety of psychotherapy if we concentrate only on its pathocentric dimensions. Though I use Szasz as a stalking horse, the substantive topic is the nature of psychotherapy. This enquiry falls into the philosophy of psychotherapy as distinct from the philosophy of psychiatry and the philosophy of psychoanalysis. (shrink)

The ethical theories employed in health care today assume, in the main, a modern Western philosophical framework. Yet the diversity of cultural and religious assumptions regarding human nature, health and illness, life and death, and the status of the individual suggest that a cross-cultural study of health care ethics is needed. A Cross-Cultural Dialogue on Health Care Ethics provides this study. It shows that ethical questions can be resolved by examining the ethical principles present in each culture, critically assessing each (...) value, and identifying common values found within all traditions, It encourages the development of global awareness and sensitivity to and respect for the diversity of peoples and their values and will advance understanding as well as help to foster a greater balance and a fuller truth in consideration of the human condition and what makes for health and wholeness. (shrink)

This chapter explores how far one can go accounting for the moral responsibility implications of several unusual mental conditions using a parsimonious quality-of-will account that relies on the way we talk about moral responsibility in more mundane situations. By contrasting situations involving epistemic irrationality versus cognitive impairment, it becomes clear that the presence of those often (but not always) excuses actions performed by unusual agents. The discussion turns to cases of clinical depression and sketches a way for quality-of-will accounts to (...) approach them. It is also argued that of some of these mental conditions, there is no particular reason to think that they excuse. There is also an argument against regarding the concept "mental disorder" and current DSM categories as critical to agency theory. (shrink)

The crucial problem in the philosophy of psychiatry is to determine under which conditions certain behaviors, mental states, and personality traits should be regarded as symptoms of mental illnesses. Participants in the debate can be placed on a continuum of positions. On the one side of the continuum, there are naturalists who maintain that the concept of mental illness can be explained by relying on the conceptual apparatus of the natural sciences, such as biology and neuroscience. On the other side (...) of the continuum, there are normativists who maintain that the appropriate characterization of the concept of mental illness cannot avoid reference to epistemic, moral and other social values. Although, this article is primarily an introduction to the debate, we stress the importance of the normativist positions. (shrink)

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. (...) This conception of health is as value-free as statements of biological function. The view that health is essentially value-laden, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to "positive" health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed. (shrink)

Cet article explore la classification des troubles psychiatriques dans la perspective du modèle des espèces pratiques. En nous basant sur certains travaux en philosophie des sciences qui soutiennent que les éléments chimiques et les espèces biologiques ne possèdent pas de véritables essences, nous affirmons que les troubles psychiatriques ne devraient pas être compris, eux non plus, de façon essentialiste. Les troubles psychiatriques sont des « espèces pratiques », non des « espèces naturelles ». Ce modèle représente une approche pragmatiste de (...) la classification qui pose, compte tenu de l’infinie complexité du monde, qu’une multitude de décisions peuvent jouer un rôle légitime dans la définition des limites des catégories. Il s’agit d’une approche nominaliste contemporaine qui considère les concepts et les catégories comme provisoires et partiels, sans toutefois rejeter l’idée qu’ils sont des espèces légitimes. Ce modèle rejette ce que Ian Hacking a nommé le structurisme inhérent, sans pour autant rejeter les espèces. Le modèle des espèces pratiques rejette aussi l’éliminativisme. Il est en accord avec les arguments non essentialistes offerts par les éliminativistes, mais il n’accepte pas leurs conclusions austères. Je discute finalement les complications et les imperfections du modèle.This article explores the classification of psychiatric disorders from the perspective of the practical kinds model. Based on work in the philosophy of science which argues that chemical elements and biological species do not have real essences, it is argued that psychiatric disorders should not be understood essentialistically either. Psychiatric disorders are practical, not natural kinds. This model represents a pragmatist approach to classification which holds that, because the world is so complex, a multitude of decisions can play legitimate roles in defining category boundaries. It is a contemporary nominalistic approach that views concepts and categories as provisional and partial, but does not reject the notion that there are legitimate kinds. It rejects what Ian Hacking has called inherent structurism, but not kinds. The practical kinds model is also anti-eliminativist. It agrees with the non-essentialistic arguments offered by eliminativists, but does not accept their austere conclusions. Complications and shortcomings of the model are discussed. (shrink)

The aim of the paper is to give an ontologically informed account of disease that can aid in the construction of disease ontologies. The paper begins by distinguishing cases of diseases from what are purely structural abnormalities, referred to as ‘disorders’. The paper then presents a causal model apt for the understanding of disease that distinguishes diseases from both their causes and their potential effects. The analysis of disease defended treats disease in terms of distortions of standard cellular network processes, (...) where those distortions are incapable of self remedy and produce biologically disadvantageous symptoms. (shrink)

It is a common aim of psychologists to construct a definition model with universal cultural applicability for mental health. These models can be divided into two types in terms of definition: One is the negative mental health definition model based on the absence of mental illness symptoms; the other is the definition model of positive mental health based on subjective feelings, such as happiness and social identity. However, neither of these definitions can properly explain Chinese people’s understanding of mental health (...) or how mental health is dealt with in Chinese culture. This paper proposes a Yin–Yang definition model of mental health based on the theory of personality of Confucianism and Taoism. This model not only properly describes the understanding of mental health in traditional Chinese culture, but also explains East Asian psychotherapy and mental health practices in the context of Chinese culture. (shrink)

It is often accepted that we may legitimately speak about voluntary euthanasia only in cases of persons who are suffering because they are incurably injured or have an incurable disease. This article argues that when we consider the moral acceptability of voluntary euthanasia, we have no good reason to concentrate only on persons who are ill or injured and suffering.

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

Commentary of Justin Garson, "Madness and idiocy: Reframing a basic problem of philosophy of psychiatry." Philosophy, Psychiatry, & Psychology.

In lieu of an abstract, here is a brief excerpt of the content:The Ambiguities of Mild Cognitive ImpairmentTim Thornton (bio)Keywordsclassification, disease, mild cognitive impairment, normative, valuesCorner and Bond's paper (2006) raises some key ethical questions about the classification and diagnosis of mild cognitive impairment (MCI). In this commentary, I wish to revise some of the general issues about the classification of mental disorder raised by this particular classificatory concept. The central issue raised is the connection between the pathologic status of (...) a condition and what I term the plain facts about the frequency and nature of its symptoms.There are a number of ethical questions raised by applying the label of MCI. Centrally, perhaps, is the concern, illustrated by the case vignettes, that a diagnosis carries negative repercussions that might outweigh the more narrowly medical advantages of an early diagnosis. But although that concern may be appropriate, such ethical complications are a danger of any psychiatric classification or diagnosis, even the most well grounded. Any psychiatric diagnosis can carry a danger of stigma, for example.What seems to make such ethical concerns more serious in this case—at least to a philosopher outsider—is the implicit further concern that MCI is not a real, objective, or, to use a more medical term, valid category or classification. If it is not valid, then any negative connotations of the diagnosis will not be outweighed by medical technological achievements. In other words, the further ethical issues are given much greater weight if the question of validity is not satisfactorily resolved.The question of the reality, objectivity, or validity of MCI can be divided into two issues:1. Is MCI a real, objective, or valid feature of psychological phenomenology?2. Is MCI a real, objective, or valid psychological illness, disease, or pathology?A condition might be a real, objective, or valid feature of psychological phenomenology without being a real illness. It might be some other aspect of human living. Szasz (1960) suggests that this is the case with mental illness (he might more properly say "so-called mental illness") as a whole. But, less controversially, the unusual ability to calculate, mentally and in a flash, the date of future Easter Sundays is a genuine feature of human living—some people possess the ability even if most do not—without either it, or its lack, being an illness. Being real as an illness is a very specific kind of being. It is this, I suggest, that raises difficulties in the case of MCI by contrast with the easier question of whether something is a genuine feature of human living in some other way. [End Page 21]From "normal" and "normative" to "correct" and "incorrect"Corner and Bond (2006) usefully suggest that the question of whether MCI is real is made more difficult by an ambiguity in the sense of the word normal. They suggest that although "physiologic and cognitive decline is assumed to be a normal experience" this still leaves "boundary problems" about "distinguishing normal aging from disease" (Corner and Bond 2006, 3–4). Thus, if the symptoms of MCI are continuous with the ordinary phenomena of physiologic and cognitive decline, then they might also be merely normal. But this does not settle the status of MCI because normal can mean either "normative, that is, usual; or it can mean nonpathologic" (Corner and Bond 2006, 4).On the assumption that MCI is at least continuous with phenomena that are normal, then its symptoms might be normal in the sense of usual but nevertheless pathologic: an inevitable illness. Or they might be usual and nonpathologic, that is, merely a feature of aging that, although regrettable, lacks the connotations of illness (e.g., the appropriateness, if not the possibility, of treatment). (In principle on the assumption in play—that the symptoms of MCI are normal—they might be unusual but nonpathologic akin, for example, to an improved ability to solve crosswords with age that might affect a small lucky proportion of the population. Perhaps such a crossword puzzler might be reassured by their doctor: "Well that is very unusual but there is no need to worry: it is not a symptom of any illness. You are perfectly normal.")Thus the question "Is MCI normal... (shrink)

Values based practice is a radical view of the place of values in medicine which develops from a philosophical analysis of values, illness and the role of ethical principles. It denies two attractive and traditional views of medicine: that diagnosis is a merely factual matter and that the values that should guide treatment and management can be codified in principles. But it goes further in the adoption of a radical liberal view: that right or good outcome should be replaced by (...) right process. I describe each of these three claims but caution against the third. (shrink)

Now available in a Harper Colophon edition, this classic book has revolutionized thinking throughout the Western world about the nature of the psychiatric profession and the moral implications of its practices. Book jacket.

The Council for Secular Humanism identifies Secular Humanism as a "way of thinking and living" committed to rejecting authoritarian beliefs and embracing "individual freedom and responsibility ... and cooperation." The paradigmatic practices of psychiatry are civil commitment and insanity defense, that is, depriving innocent persons of liberty and excusing guilty persons of their crimes: the consequences of both are confinement in institutions ostensibly devoted to the treatment of mental diseases. Black's Law Dictionary states: "Every confinement of the person is an (...) 'imprisonment,' whether it be in a common prison, or in private house, or in the stocks, or even by forcibly detaining one in the public streets." Accordingly, I maintain that Secular Humanism is incompatible with the principles and practices of psychiatry. (shrink)

Eating Disorders, particularly anorexia and bulimia, are of immense contemporary importance and interest. News stories depicting the tragic effects of eating disorders command wide attention. Almost everybody in society has been touched by eating disorders in one way or another, and contemporary obsession with body image and diet fuels fascination with this problem. It is unclear why people develop eating disorders. Clinical and sociological studies have provided important information relating to the relational systems in which eating disorders are mainly found. (...) This paper shows that their explanations are not conclusive and points out that the reasons why people develop eating disorders should not be found in the dysfunctional interactions occurring in both familial and social systems, but in the moral beliefs that underlie these interactions. Eating disorders are impossible to understand or explain, unless they are viewed in the light of these beliefs. A moral logic, that is a way of thinking of interpersonal relations in moral terms, gives shape to and justifies the clinical condition, and finds consistent expression in abnormal eating behaviour. The analysis offered here is not mainstream either in philosophy (eating disorders are in fact seldom the subject of philosophical investigation) or in clinical psychology (the methods of philosophical analysis are in fact seldom utilised in clinical psychology). However, this paper offers a important contribution to the understanding of such a dramatic and widespread condition, bringing to light the deepest reasons, which are moral in nature, that contribute to the explanation of this complex phenomenon. (shrink)

This article aims at grounding critical theories with the help of psy discourses. Even if the relationship between the two disciplines has always been a controversial one, the article argues that therapeutic knowledge that accesses empirical forms of social suffering may offer important insights for critical theory. This general argument is demonstrated by complementing the theories of Bourdieu and Habermas with a clinical description of depression. First, the limitations of the capabilities of these influential theories in terms of how they (...) can be used to conceptualize the variety of social suffering are introduced. Second, the psy discourses on depression are reviewed to identify and highlight latent references to the social. Third, by combining models of depressive suffering and various distortions of integration, an extended normative basis is elaborated. Instead of solely criticizing inequalities or distortions of communication, those social constellations are criticized that trap actors by producing a homogenous pattern of suffering. (shrink)

The work of psychiatrist R. D. Laing deserves recognition as a key contribution to sociological theory, in dialogue with the interactionist and interpretivist sociological traditions. Laing encourages us to identify meaningful social action in what would otherwise appear to be nonsocial phenomena. His interpretation of schizophrenia as a rational strategy of withdrawal reminds us of the threat that others can pose to the self and how social relations are implicated in even the most "private" and "internal" of experiences. He developed (...) a far-reaching critical theory of the self in modern society, which challenges the medicalization and biochemical reduction of human problems. Using the case of shyness as an example, the article seeks to demonstrate the importance of Laing's theories for examining the fragility of the self in relation to contemporary social order. (shrink)

Similarly to other accounts of disease, Christopher Boorse’s Biostatistical Theory (BST) is generally presented and considered as conceptual analysis, that is, as making claims about the meaning of currently used concepts. But conceptual analysis has been convincingly critiqued as relying on problematic assumptions about the existence, meaning, and use of concepts. Because of these problems, accounts of disease and health should be evaluated not as claims about current meaning, I argue, but instead as proposals about how to define and use (...) these terms in the future, a methodology suggested by Quine and Carnap. I begin this article by describing problems with conceptual analysis and advantages of “philosophical explication,” my favored approach. I then describe two attacks on the BST that also question the entire project of defining “disease.” Finally, I defend the BST as a philosophical explication by showing how it could define useful terms for medical science and ethics. (shrink)

Theorists of health have, to this point, focused exclusively on trying to define a state—health—that an organism might be in. I argue that they have overlooked the possibility of a comparativist theory of health, which would begin by defining a relation—healthier than—that holds between two organisms or two possible states of the same organism. I show that a comparativist approach to health has a number of attractive features, and has important implications for philosophers of medicine, bioethicists, health economists, and policy (...) makers. (shrink)

One of the most dramatic techniques for constructing accounts of "undiscovery" or incompetence in science involves the manipulative deception—in some accounts, the "hoaxing"—of the putatively incompetent researcher, ostensibly as an experiment to evaluate his or her methodology and the soundness of his or her knowledge claims. In this article, the author examines five cases in which such deceptions have been employed, noting the patterns of argument that typically follow these deceptions and the factors that seem to determine the power of (...) these arguments. The author suggests that the "hoaxer" in such cases is most likely to be successful when his or her views about the targeted researcher's methodology and knowledge claims are orthodox with respect to his or her intended audience. (shrink)

Psychiatry is becoming a cognitive neuroscience. This new paradigm not only aims to give new ways for explaining mental diseases by naturalizing them, but also to have an influence on different levels of psychiatric norms. We tried here to verify whether a biological paradigm is able to fulfill this normative goal. We analyzed three main normative assumptions that is to say the will of giving psychiatry a valid nosology, a rigorous definition of what is a mental disease, and new tools (...) for destigmatizing mentally ill patients. Although these different kinds of normativity are very heterogeneous, we must conclude that, in all these cases, biological psychiatry is a failure, in part because of a lack of epistemological conceptualization. (shrink)

Content analysis of three chapters of Jamison’s memoir, An Unquiet Mind, shows that depression, mania, and Bipolar Disorder have a common metaphoric core as a sequential process of suffering and adversity that is a form of malevolence and destruction. Depression was down and in, while mania was up, in and distant, circular and zigzag, a powerful force of quickness and motion, fieriness, strangeness, seduction, expansive extravagance, and acuity. Bipolar Disorder is down and away and a sequential and cyclical process that (...) partakes of the metaphors of its component moods. We conclude that metaphors of mood disorders share a number of structural features and are consistent across different authors. (shrink)

Philosophical discussions about health and disease often refer to a 'medical model' of bodily disease, in which diseases are regarded as causes of illness; diagnosis consists in identifying the disease affecting the patient, and this determines the appropriate treatment. This view is plausible only for diseases whose cause is known, though even in such instances the disease is the effect on the affected person, and must not be confused with its own cause. But in fact the medical diagnostic process which (...) progresses from recognition of patterns of symptoms and signs, through search for abnormalities of structure and/or function, towards knowledge of causation often stops short of this desirable end-point; and at whatever point it comes to a halt, its result is expressed in terms of 'diseases'. Thus in medical discourse the names of diseases are a convenient device by which the current conclusion of the diagnostic process can be stated briefly; and they have widely varying factual implications. This nominalist analysis of the medical usages of the names of diseases has consequences for definitions of health and disease, and for some problems in medical ethics. (shrink)

Psychopathy is often characterized in terms of what I call “the language of disorder.” I question whether such language is necessary for an accurate and precise characterization of psychopathy, and I consider the practical implications of how we characterize psychopathy—whether as a biological, or merely normative, disorder.

Medical professionals, including mental health professionals, largely agree that moral judgment should be kept out of clinical settings. The rationale is simple: moral judgment has the capacity to impair clinical judgment in ways that could harm the patient. However, when the patient is suffering from a "Cluster B" personality disorder, keeping moral judgment out of the clinic might appear impossible, not only in practice but also in theory. For the diagnostic criteria associated with these particular disorders (Antisocial, Borderline, Histrionic, Narcissistic) (...) are expressed in overtly moral language. I consider three proposals for dealing with this problem. The first is to eliminate the Cluster B disorders from the DSM on the grounds that they are moral, rather than mental, disorders. The second is to replace the morally laden language of the diagnostic criteria with morally neutral language. The third is to disambiguate the notion of moral judgment so as to respect the distinction between having morally disvalued traits and having moral responsibility for those traits. Sensitivity to this distinction enables the clinician, at least in theory, to employ morally laden diagnostic criteria without adopting the sort of morally judgmental (and potentially harmful) attitude that results from the tacit presumption of moral responsibility. I argue against the first two proposals and in favor of the third. In doing so, I appeal to Grice's distinction between conventional and conversational implicature. I close with a few brief remarks on the irony of retaining overtly moral language in an ostensibly medical manual for the diagnosis of mental disorders. (shrink)

This article introduces the concept of economic medicalization where non-medical problems are transformed into medical problems in order to achieve the objective of corporate shareholder wealth maximization. Following an overview of the differences in ethical norms applicable to medical ethics and business ethics, the economic medicalization of medical research practice and publication is examined in some detail. This motivates a general discussion of the problems involved in the ethical approval process for medical research that balances the interests of both business (...) and government in the market for medical products and services. (shrink)

It is commonly thought that mental disorder is a valid concept only in so far as it is an extension of or continuous with the concept of physical disorder. A valid extension has to meet two criteria: determination and coherence. Essentialists meet these criteria through necessary and sufficient conditions for being a disorder. Two Wittgensteinian alternatives to essentialism are considered and assessed against the two criteria. These are the family resemblance approach and the secondary sense approach. Where the focus is (...) solely on the characteristics or attributes of things, both these approaches seem to fail to meet the criteria for valid extension. However, this focus on attributes is mistaken. The criteria for valid extension are met in the case of family resemblance by the pattern of characteristics associated with a concept, and by the limits of intelligibility of applying a concept. Secondary sense, though it may have some claims to be a good account of the relation between physical and mental disorder, cannot claim to meet the two criteria of valid extension. (shrink)

Thomas Szasz, the radical critic of state-supported psychiatry, and root and branch sceptic about mental illness, died in September 2012. Based on the obituary1 and editorial comment in The Lancet2 and the response his work commonly elicits, it is evident that there will be mixed reviews of his impact and of the cogency of his position.Certainly, some have seen him as a notable figure from the past. There is a sense in which, as far as Szasz's critique of psychiatry goes, (...) it did not really change at all in its essence from the time it was first explicitly expressed in his writings of the 1960s right up to his last publications and talks in the 2010s. He started his 1960 paper The Myth of Mental Illness3 with the assertion that there is no such thing as mental illness, and this has been an underlying pedal note to all his many pronouncements in this area ever since. Personally, I have always found his written interventions in debates right up to the present to be highly readable and intellectually sharp; he was adept at creating variations on the Szaszian theme. In one of his earlier book length texts, The Manufacture of Madness,4 he likens the contemporary idea that people have mental illness to the historical idea that some people were witches, and he parallels the institutions of modern state-supported psychiatry to those of the Inquisition. In articles he later published in the Journal of Medical Ethics, he likened mental illness to ‘phlogiston’—the non-existent substance that supposedly explained combustion5 and claimed the term ‘mental …. (shrink)

Volume 52, Issue 7, July 2020, Page 709-715.

In this paper I demonstrate the connection between the single remark Wittgenstein made explicitly on Hans Vaihinger’s Die Philosophie des als ob and the remarks he made on Sir James George Frazer’s The Golden Bough. After a critical-genetic exposition of the relevant material, I offer an interpretation of that connection, which will require that I interpret the remark on the philosophy of “as if” relative to how Wittgenstein seems to regard Vaihinger’s fictionalism and relative to how Wittgenstein reads Frazer.

Lennard Davis’s Biocultural Critique of the alleged certainty of diagnosis (Davis Journal of Bioethical Inquiry 7:227−235, 2010) makes errors of fact concerning psychiatric diagnostic categories, misunderstands the role of power in the therapeutic relationship, and provides an unsubstantiated and vague alternative to the management of psychological distress via a conceptually outdated model of the relationships between physical and psychological disease and illness. This response demonstrates that diagnostic knowledge vouchsafes legitimate power to physicians, and via them relief to patients who suffer (...) from psychological distress. The history of medicine and psychiatry demonstrates that psychiatric diagnosis shares many features with physical diagnosis, while there is also reason to believe that the two types will continue to be distinct in some respects. Diagnostic categories in psychological medicine, like those in physical medicine, are provisional, probabilistic, and often uncertain. These features do not detract from the dependence on diagnosis of therapeutic efficacy in both domains. (shrink)