Neuroethics 12 (2):183-199 (2019)
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Abstract |
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.
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Keywords | mental health psychiatry dimensionality diagnosis DSM ICD-11 RDoC |
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DOI | 10.1007/s12152-018-9390-7 |
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References found in this work BETA
Stabilizing Constructs Through Collaboration Across Different Research Fields as a Way to Foster the Integrative Approach of the Research Domain Criteria (RDoC) Project.Jacqueline A. Sullivan - 2016 - Frontiers in Human Neuroscience (00):00.
The Right Not to Know: The Case of Psychiatric Disorders.Lisa Bortolotti & Heather Widdows - 2011 - Journal of Medical Ethics 37 (11):673-676.
The Six Most Essential Questions in Psychiatric Diagnosis: A Pluralogue Part 3: Issues of Utility and Alternative Approaches in Psychiatric Diagnosis. [REVIEW]Peter Zachar, Owen Whooley, GScott Waterman, Jerome C. Wakefield, Thomas Szasz, Michael A. Schwartz, Claire Pouncey, Douglas Porter, Harold A. Pincus, Ronald W. Pies, Joseph M. Pierre, Joel Paris, Aaron L. Mishara, Elliott B. Martin, Steven G. LoBello, Warren A. Kinghorn, Andrew C. Hinderliter, Gary Greenberg, Nassir Ghaemi, Michael B. First, Hannah S. Decker, John Chardavoyne, Michael A. Cerullo, Allen Frances & James Phillips - 2012 - Philosophy, Ethics, and Humanities in Medicine 7 (1):9-.
Too Similar, Too Different? The Paradoxical Dualism of Psychiatric Stigma.Tania Gergel - 2014 - The Psychiatric Bulletin 38 (4):148-151.
View all 9 references / Add more references
Citations of this work BETA
Beyond Surviving to Thriving: The Case for a ‘Compassion Towards Thriving’ Approach in Public Mental Health Ethics.Phil Bielby - forthcoming - Public Health Ethics:phab023.
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