The latest edition of the Diagnostic and Statistical Manual of Mental Disorders included the Social Communication Disorder as a new mental disorder characterized by deficits in pragmatic abilities. Although the introduction of SPCD in the psychiatry nosography depended on a variety of reasons—including bridging a nosological gap in the macro-category of Communication Disorders—in the last few years researchers have identified major issues in such revision. For instance, the symptomatology of SPCD is notably close to that of (...) Autism Spectrum Disorder. This opens up the possibility that individuals with very similar symptoms can be diagnosed differently and receive different clinical treatments and social support. The aim of this paper is to review recent debates on SPCD, particularly as regards its independence from ASD. In the first part, we outline the major aspects of the DSM-5 nosological revision involving ASD and SPCD. In the second part, we focus on the validity and reliability of SPCD. First, we analyze literature on three potential validators of SPCD, i.e., etiology, response to treatment, and measurability. Then, we turn to reliability issues connected with the introduction of the grandfather clause and the use of the concepts of spectrum and threshold in the definition of ASD. In the conclusion, we evaluate whether SPCD could play any role in contemporary psychiatry other than that of an independent mental disorder and discuss the role that non-epistemic factors could play in the delineation of the future psychiatry nosography. (shrink)

During the last years, there has been an important discussion on the concept of mental disorder. Several accounts of such a concept have been offered by theorists, although neither of these accounts seems to have successfully answered both the question of what it means for a certain mental condition to be a disorder and the question of what it means for a certain disorder to be mental. In this paper, I propose an (...) account of the concept of mental disorder that, if I am right, provides satisfactory answers to both of these questions. Furthermore, this account (unlike other accounts presented in the literature on the subject) meets the requirements for achieving a crucial goal underlying the project of sorting out the concept of mental disorder, namely the goal of allowing the existence of a dialogue between mental health professionals of different theoretical orientations. To achieve this goal, the account herein proposed is not based in any particular theoretical framework, but in both ordinary and technical theory-neutral concepts. In the last part of the paper, I argue that it follows from most accounts of the concept of mental disorder that the disciplines concerned with explaining some mental disorders are not branches of medicine, and that the treatment of some mental disorders is not a matter of medical intervention. (shrink)

In this paper, I argue for a new way to understand the integration of facts and values in the concept of mental disorder that has the potential to avoid the flaws of previous hybrid approaches. I import conceptual tools from the account of procedural objectivity defended by Helen Longino to resolve the controversy over the definition of mental disorder. My argument is threefold: I first sketch the history of the debate opposing objectivists and constructivists (...) and focus on the criticisms that led to the emergence of the debate. Second, I offer a reconstruction of the “Natural Function Approach” argument to make explicit an unsound assumption underlying this approach. The reconstruction will allow me to show that the NFO’s argument depends on the ideal of value-free science that I will criticize. Then I propose an alternative ideal for psychiatry: social objectivity. I argue that the concept of mental health should be seen as “socially objective” rather than value-free, moving the debate towards the social procedures by which the definition is produced rather than the normative and factual content of its definition. (shrink)

Philosophy of psychiatry is a philosophical discipline focused on fundamental theoretical and conceptual issues in contemporary psychiatry. One of such issues is the so-called demarcation problem, which can be understood as the question about the difference between mental illness and psychological functioning which is normal, or healthy. After a brief account of the standard criteria for such differentiation the dominant naturalistic understanding of psychiatry as well as the notion of mental illness proper to the latter are subjected to (...) scrutiny. Then, in turn, critical currents are investigated with their concept of psychiatry as a discipline of humanistic and normative character. Some of these currents, such as the antipsychiatry of Szasz, are of historical importance today. Still, however, many threads are discussed, especially in the context of the notion of mental disorder developed by the American Psychiatric Association. One may expect that such discussions will be fruitfully carried on, especially in those cases when particular disorders are philosophically investigated. (shrink)

Naturalistic accounts of mental disorder aim to identify an objective basis for attributions of mental disorder. This goal is important for demarcating genuine mental disorders from artificial or socially constructed disorders. The articulation of a demarcation criterion provides a means for assuring that attributions of 'mental disorder' are not merely pathologizing different forms of social deviance. The most influential naturalistic and hybrid definitions of mental disorder identify biological dysfunction as the objective (...) basis of mental disorders: genuine mental... (shrink)

Throughout its history, the insanity defense specifically and the more general concept of mental defect or incompetence have been grounded in the assumption that those people fit for the rule of law are able to give and to comprehend reasons for their actions. This chapter traces the evolution of perspectives on the nature of mental illness and the manner in which cultural and extra-scientific influences have shaped perspectives. These perspectives are most saliently expressed in statutory provisions (...) and relevant case law summarized here and covering historical developments from ancient Greece and Rome to the present. Significant interactions between law and psychiatry are further highlighted and informed by core and controversial philosophical assumptions. Attention is given to differences between juridical and medical conceptions of responsibility. (shrink)

At present, psychiatric disorders are characterized descriptively, as the standard within the scientific community for communication and, to a certain extent, for diagnosis, is the DSM, now at its fifth edition. The main reasons for descriptivism are the aim of achieving reliability of diagnosis and improving communication in a situation of theoretical disagreement, and the Ignorance argument, which starts with acknowledgment of the relative failure of the project of finding biomarkers for most mental disorders. Descriptivism has also the advantage (...) of capturing the phenomenology of mental disorders, which appears to be essential for diagnosis, though not exhaustive of the nature of the disease. I argue that if we rely on the distinction between conceptions (procedures of identification) and concepts (reference-fixing representations), which was introduced in the philosophical debate on the nature of concepts, we may understand a limited but valid role for descriptive characterizations, and reply to common objections addressed by those who advocate a theoretically informed approach to nosology. (shrink)

Since psychiatry remains a descriptive discipline, it is essential for its practitioners to understand how the language of psychiatry came to be formed. This important book, written by a psychiatrist-historian, traces the genesis of the descriptive categories of psychopathology and examines their interaction with the psychological and philosophical context within which they arose. The author explores particularly the language and ideas that have characterised descriptive psychopathology from the mid-nineteenth century to the present day. He presents a masterful survey of the (...) history of the main psychiatric symptoms, from the metaphysics of classical antiquity to the operational criteria of today. Tracing the evolution of concepts such as memory, consciousness, will and personality, and of symptoms ranging from catalepsy and aboulia to anxiety and self-harm, this book provides fascinating insights into the subjective nature of mental illness, and into the ideas of British, Continental and American authorities who sought to clarify and define it. (shrink)

Abstract: At present, psychiatric disorders are characterized descriptively, as the standard within the scientific community for communication and, to a cer- tain extent, for diagnosis, is the DSM, now at its fifth edition. The main rea- sons for descriptivism are the aim of achieving reliability of diagnosis and improving communication in a situation of theoretical disagreement, and the Ignorance argument, which starts with acknowledgment of the relative fail- ure of the project of finding biomarkers for most mental disorders. Descrip- (...) tivism has also the advantage of capturing the phenomenology of mental dis- orders, which appears to be essential for diagnosis, though not exhaustive of the nature of the disease. I argue that if we rely on the distinction between conceptions (procedures of identification) and concepts (reference-fixing representations), which was introduced in the philosophical debate on the nature of concepts, we may understand a limited but valid role for descrip- tive characterizations, and reply to common objections addressed by those who advocate a theoretically informed approach to nosology. (shrink)

B a c k g r o u n d. The article demonstrates the development and influence of the main diagnostic systems in psychiatry, such as the DSM and the ICD, on the concept of psychiatric diseases. The problem of classification of psychiatric disorders is one of the main topics that is the field of study of the philosophy of psychiatry. The correct diagnosis within a particular diagnostic system directly affects the choice of appropriate drug treatment, psychotherapy and social (...) support for people suffering from mental disorders. Misdiagnosis has not only negative medical but also social consequences, leading to stigmatization and avoidance of people suffering from mental disorders. M e t h o d s. The research uses an integrated approach to the analysis of psychiatric diagnostic systems, including historical, comparative and interdisciplinary methods. The application of the historical method contributed to a detailed study of the evolution of psychiatric diagnostic systems and changes in approaches to the classification of mental disorders. A comparative analysis of the main diagnostic systems was carried out, considering their structure, diagnostic criteria and interaction. The interdisciplinary method involves the integration of knowledge from psychiatry, philosophy, medical history, cultural studies, and psychology, providing a deep understanding of the medical, philosophical, social, and cultural aspects of mental disorders. R e s u l t s. The article analyzes the historical development of ideas and methodology for the classification of mental disorders from ancient Greece to the present. From Hippocrates and Plato to Sydenham, Kabanis, Pinel, and Eskierol, the authors trace the evolution of understanding of mental disorders, emphasizing the shift in emphasis from etiological theories to more descriptive and categorical models. The authors describe the current state of the DSM and ICD classification systems, which play a dominant role in psychiatric science and subsequent social support and welfare for people suffering from mental disorders. Changes that have occurred in these systems and their impact on psychiatric practice and research are discussed. Considerable emphasis is placed on the history of the diagnosis of post-traumatic stress disorder (PTSD), which becomes a symbolic indicator of the complexities and challenges associated with the modern classification of mental illness. The authors consider the phenomenological method as a tool for a deeper understanding of PTSD, especially in the context of the constant psychotraumatic factors of war, the consequences of which generate new challenges for Ukrainian psychiatric practice. The authors present a case study using the phenomenological approach to diagnose PTSD, which demonstrates the need for a detailed analysis of patients' internal experience for accurate diagnosis and effective treatment. C o n c l u s i o n s. The conclusions emphasize the importance of integrating philosophical methods into the diagnosis and analysis of mental illness in clinical practice. The authors call for the development of interdisciplinary research involving both philosophers and mental health professionals to develop more detailed and person-centered approaches to the diagnosis and treatment of mental disorders. (shrink)

Marcus Tullius Cicero, the great promoter of Greek thought to the Latin world, gives a very detailed presentation of the Stoic philosophy of mind and of mental disorder in his Tusculan Disputations. In an interesting way, this philosophy anticipates the modern philosophical theories of affections or emotions developed by, for instance, R.M. Gordon, which are based on the concepts of belief and desire. According to Cicero, having an affection is the same as having a belief about something which (...) one considers to be good or evil, either in the present or in the future. Cicero develops these ideas about affections within the context of a theory of mental disorder, claiming that all but the mildest affections are in fact species of mental disorder. This paper summarizes Cicero's theory of affection and disorder and indicates its relations to modern thinking in the philosophy of emotion and mental health. (shrink)

This commentary challenges Professor Lennard Nordenfelt's thesis that Cicero's The Tusculan Disputations has presented us with "the first Diagnostic Manual of Mental Disorders". In this short response I argue that by making his "peculiar" claim Nordenfelt is mistaken about the thrust of the stoic project and Cicero's presentation of it, and mistaken about the stoic view of irrational responses.

Stoic conception of mental disorders is still interesting and could be fruitful used in the current debate on psychiatric classification.

Mental disorders are often thought to be harmful dysfunctions. Jerome Wakefield has argued that such dysfunctions should be understood as failures of naturally selected functions. This suggests that evolutionary biology and other Darwinian disciplines hold important information for anyone working on answering the philosophical question, "What is a mental disorder?". In this article, the author argues that Darwinian theory is not only relevant to the understanding of the disrupted functions, but it also sheds light on the disruption (...) itself, as well as on the harm that attends the disruption. The arguments advanced here are partially based on the view that a core feature of Darwinism is that it stresses the environmental relativity of functions and dysfunctions. These arguments show a very close empirical connection between social judgments and dysfunctions, which is of interest for psychiatric theory. Philosophically, they lead to the conclusion that the concept of mental disorder is identical to the concept of mental dysfunction. Consequently, it is both misleading and redundant to conceptualize mental disorders as 'harmful dysfunctions', and not simply as 'mental dysfunctions'. (shrink)

According to the predominant view within contemporary philosophy of psychiatry, mental disorders involve essentially personal and societal values, and thus, the concept of mental disorder cannot, even in principle, be elucidated in a thoroughly objective manner. Several arguments have been adduced in support of this impossibility thesis. My critical examination of two master arguments advanced to this effect by Derek Bolton and Jerome Wakefield, respectively, raises serious doubts about their soundness. Furthermore, I articulate an alternative, thoroughly (...) objective, though in part normative, framework for the elucidation of the concept of mental disorder. The concepts of mental dysfunction and impairment of basic psychological capacities to satisfy one’s basic needs are the building blocks of this framework. I provide an argument for the objective harmfulness of genuine mental disorders as patterns of mental dysfunctions with objectively negative biotic values, as well as a formally correct definition of the concept of mental disorder. Contrary to the received view, this objective framework allows for the possibility of genuine mental disorders due to adverse social conditions, as well as for quasi-universal mental disorders. I conclude that overall, the project of providing an objective account of the concept of mental disorder is far from impossible, and moreover, that it is, at least in principle, feasible. (shrink)

In this thesis I develop an account of how processes of social understanding are implicated in experiences of mental disorder, critiquing the lack of examination of this phenomena along the way. First, I demonstrate how disorder concepts, as developed and deployed by psychiatric institutions, have the effect of shaping the cognition of individuals with psychopathology through setting expectations. Such expectation-setting can be harmful in some cases, I argue, and can perpetuate epistemic injustices. Having developed this view, I (...) criticise enactive accounts of mental disorder for failing to consider how such terms like ‘dysfunction’ are open to interpretation and can come embedded with normative expectations. Enactive accounts consequently run the risk of perpetuating injustices in their account of the sociality of mental disorder. Similar concerns arise when we consider the attachment of enactivism to the medical model, I argue. But by adapting enactivism to consider other experiences of disorder, such as those described as ‘madness’, enactive psychiatry may genuinely provide ethical groundwork for a better conception of disordered experience. Then, I consider a further concern with a distinctly medicalised conception of mental disorder from the perspective of self-illness ambiguity, arguing that self-illness ambiguities appear to form a special class of ambiguities due to their proximity to disorder concepts which mark them as appropriate targets for therapeutic treatment. However, I argue further that we should be critical of the idea that self-illness ambiguities necessitate disambiguation, as, in cases where self and illness are demarcated, individuals may still experience distress because simply having a mental disorder can be socially alienating. The medicalised focus in self-illness ambiguity, and the explicit need from the medical perspective to disambiguate it, might then exacerbate the distress someone experiences in mental disorder. Moreover, drawing on Mad Studies, I suggest that one might not need a coherent self-narrative to live well. Because of this, one may not need to adopt a medicalised view of the self in the case of selfillness ambiguity. In order to support this analysis, I provide a phenomenological account of language and argue that the very thoughts implicated in mental disorder shape the individual’s perception of the world due to the way that language foregrounds particular aspects of our world. This demands a critical examination of the language adopted and used by both clinicians and disordered individuals. I thus conclude with some thoughts on how to approach research and developing understanding of mental disorder given that we, as people, are always implicated in this process and therefore socialisation of some kind will always be taking place. (shrink)

In psychiatry, pharmacological drugs play an important experimental role in attempts to identify the neurobiological causes of mental disorders. Besides being developed in applied contexts as potential treatments for patients with mental disorders, pharmacological drugs play a crucial role in research contexts as experimental instruments that facilitate the formulation and revision of neurobiological theories of psychopathology. This paper examines the various epistemic functions that pharmacological drugs serve in the discovery, refinement, testing, and elaboration of neurobiological theories of (...) class='Hi'>mental disorders. I articulate this thesis with reference to the history of antipsychotic drugs and the evolution of the dopamine hypothesis of schizophrenia in the second half of the twentieth century. I argue that interventions with psychiatric patients through the medium of antipsychotic drugs provide researchers with information and evidence about the neurobiological causes of schizophrenia. This analysis highlights the importance of pharmacological drugs as research tools in the generation of psychiatric knowledge and the dynamic relationship between practical and theoretical contexts in psychiatry. (shrink)

In Patricia Churchland's 2006 essay on free will, she cites the case of a middle-aged man who, without any prior history of misbehavior, suddenly became obsessed with child pornography and started to molest his 8-year-old stepdaughter. He was subsequently discovered to have a brain tumor affecting the frontal lobes, and when it is successfully treated his aberrant behavior stopped.Thomas Szasz is famous for his denunciation of the concept of mental illness, and his critique is partly responsible for (...) instigating an enduring philosophical discourse about the nature of mental disorder. Szasz's key insight was the recognition that we find it important to distinguish between situations that are characterized by... (shrink)

This paper is a critical analysis of the concept of mental disorder recently advanced by Jerome Wakefield. Wakefield suggests that mental disorders are most aptly conceived as "harmful dysfunctions" involving two distinct and separable components: the failure of the mechanism in the person to perform a natural function for which the mechanism was designed by natural selection, and a value judgment that the dysfunction is undesirable.

The paper develops a framework for discussing concepts of health and disease along two dimensions. The first is the role of values in our disease concepts, and the second is the relationship between science and folk psychology. This framework is then applied to the concept of mental disorder. I argue that existing treatments of the concept yield too much authority to common sense, which produces a tension within the program of finding a scientific basis for our (...) ascriptions of mental disorder. The science should be given more authority, even if this leads to counterintuitive results. I conclude by identifying several smaller scale conceptual problems within the application of science to mental illness, and argue that the debate needs to shift towards dealing with such problems in an empirically informed way, rather than remaining at the level of conceptual analysis. 2012 APA, all rights reserved). (shrink)

The current experiments examine mental health clinicians’ beliefs about biological, psychological, and environmental bases of the DSM‐IV‐TR mental disorders and the consequences of those causal beliefs for judging treatment effectiveness. Study 1 found a large negative correlation between clinicians’ beliefs about biological bases and environmental/psychological bases, suggesting that clinicians conceptualize mental disorders along a single continuum spanning from highly biological disorders (e.g., autistic disorder) to highly nonbiological disorders (e.g., adjustment disorders). Study 2 replicated this finding by (...) having clinicians list what they thought were the specific causes of nine familiar mental disorders and rate their bio–psycho–environmental bases. Study 3 further found that clinicians believe medication to be more effective for biologically based mental disorders and psychotherapy to be more effective for psychosocially based mental disorders. These results demonstrate that even expert mental health clinicians make strong distinctions between psychological and biological phenomena. (shrink)

Patients suffering from mental disorders are often not treated on an equal basis with patients suffering from organic diseases. In Germany, for example, alcohol-dependent patients will be detoxified on a clinical ward to ensure that they survive acute alcohol withdrawal; however, medical insurances often do not cover treatment costs for a therapy for the addictive behavior that underlies the acute alcohol problem. While patients suffering from diabetes mellitus can also display personally harmful choices and, for example, consume sugar although (...) they know that this is detrimental for their health, medical insurances pay for the acute hyperglycemic shock treatment as well as for dietary and medical treatment of the .. (shrink)

Mental disorders are often thought to be harmful dysfunctions. Jerome Wakefield has argued that such dysfunctions should be understood as failures of naturally selected functions. This suggests, implicitly, that evolutionary biology and other Darwinian disciplines hold important information for anyone working on answering the philosophical question, ‘what is a mental disorder?’. In this article, the author argues that Darwinian theory is not only relevant to the understanding of the disrupted functions, but it also sheds light on the (...) disruption itself, as well as on the harm that attends the disruption. The arguments advanced here are partially based on the view that a core feature of Darwinism is that it stresses the environmental relativity of functions and dysfunctions. These arguments show a very close empirical connection between social judgments and dysfunctions , which is of interest for psychiatric theory. Philosophically, they lead to the conclusion that the concept of mental disorder is identical to the concept of mental dysfunction. Consequently, it is both misleading and redundant to conceptualize mental disorders as ‘harmful dysfunctions’, and not simply as ‘mental dysfunctions’. (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)

Mental disorders are often thought to be harmful dysfunctions. Jerome Wakefield has argued that such dysfunctions should be understood as failures of naturally selected functions. This suggests, implicitly, that evolutionary biology and other Darwinian disciplines hold important information for anyone working on answering the philosophical question, 'what is a mental disorder?'. In this article, the author argues that Darwinian theory is not only relevant to the understanding of the disrupted functions, but it also sheds light on the (...) disruption itself, as well as on the harm that attends the disruption. The arguments advanced here are partially based on the view that a core feature of Darwinism is that it stresses the environmental relativity of functions and dysfunctions. These arguments show a very close empirical connection between social judgments and dysfunctions, which is of interest for psychiatric theory. Philosophically, they lead to the conclusion that the concept of mental disorder is identical to the concept of mental dysfunction. Consequently, it is both misleading and redundant to conceptualize mental disorders as 'harmful dysfunctions', and not simply as 'mental dysfunctions'. (shrink)

The idea that in human history it is possible to recognize distinct ways of thinking is widespread in the literature. Sometimes, instead of the phrase ‘ways of thinking’, other labels are used, such as ‘forms of thought’, ‘modes of thinking’, ‘ways of knowing’, ‘ways of reasoning’, ‘mental attitudes’ or ‘worldviews’. At any rate, it is possible to say that there is a concept, that of ‘ways of thinking’, which has played a crucial role in philosophy at least (...) since the Enlightenment and has acquired considerable weight with the emergence of a French tradition in philosophy of science called historical epistemology. This concept appears in different versions, as if they were species of the same genus. In this chapter, I shall outline its history, from Vico to Hacking and beyond, and I shall show how and why its different species have been introduced. My account provides a guiding thread running through philosophy of science that unifies the researches of important authors such as Lévy-Bruhl, Brunschvicg, Metzger, Koyré, Fleck, Foucault, Kuhn, Hacking and others. This guiding thread is mainly constituted by the project of historicizing Kant’s a priori by replacing it with a given notion of ‘ways of thinking’. (shrink)

In this two-part analysis, I analyze Marc Lewis’s arguments against the brain-disease view of substance addiction and for a developmental-learning approach that demedicalizes addiction. I focus especially on the question of whether addiction is a medical disorder. In Part 1, I argued that, even if one accepts Lewis’s critique of the brain evidence presented for the brain-disease view, his arguments fail to establish that addiction is not a disorder. Relying on my harmful dysfunction analysis of disorder, I (...) defended the view that addiction is a medical disorder and a brain disorder. In Part 2, I consider some broader philosophical issues raised by Lewis’s arguments: I consider a larger puzzle, at the heart of the neo-Kraepelinian program in contemporary psychiatry, that is raised by Lewis’s argument that addiction is not a disorder because the brain displays no damage but only normal learning: must all mental disorders be brain disorders, or can mental disorders occur in normal brains? I argue that mental disorders can occur in normal brains. I critique Lewis’s response to the evolutionary “novel environment” approach to explaining why addiction is a disorder. Lewis agrees with brain-disease proponents that interpreting addiction as brain disorder relieves addicts of moral censure, but I argue that moral defect and brain disease are not exclusive. Finally, I consider Lewis’s “developmental-learning” account of addiction that encourages positive and empowering narrativizing of addiction, but I argue that the developmental-learning view is vacuous due to use of an overly broad notion of “development.”. (shrink)

This dissertation examines psychiatry from a philosophy of science perspective, focusing on issues of realism and classification. Questions addressed in the dissertation include: What evidence is there for the reality of mental disorders? Are any mental disorders natural kinds? When are disease explanations of abnormality warranted? How should mental disorders be classified? -/- In addressing issues concerning the reality of mental disorders, I draw on the accounts of realism defended by Ian Hacking and William Wimsatt, arguing (...) that biological research on mental disorders supports the inference that some mental disorders (e.g., schizophrenia, mood disorders, and anxiety disorders) are real theoretical entities, and that the evidence supporting this inference is causal and abductive. In explicating the nature of such entities, I argue that real mental disorders are natural kinds insofar as they are natural classes of abnormal behavior whose members share the same causal structure. I present this position in terms of Richard Boyd’s homeostatic cluster property theory of natural kinds, and argue that this perspective reveals limitations of Hacking’s account on the looping effects of human kinds, which suggests that the objects classified by psychiatrists are unstable entities. I subsequently argue that a subset of mental disorders (e.g., schizophrenia and Down syndrome) are mental illnesses insofar as they are disorders caused by a dysfunctional biological process that leads to harmful consequences for individuals. I present this analysis against Thomas Szasz’s argument that mental illness is a myth. -/- In addressing issues of psychiatric classification, my analysis focuses on the Diagnostic and Statistical Manual of Mental Disorders (DSM), which has been published regularly by the American Psychiatric Association since 1952, and is currently in its fourth edition. After examining the history of DSM in the twentieth century, and in particular, DSM’s shift to an atheoretical and purely descriptive system in the 1980s, I consider the relative merits of descriptive versus causal systems of classification. Drawing on Carl Hempel’s analysis of taxonomic systems in psychiatry, I argue that a causal classification system would provide a superior approach to psychiatric classification than the descriptive system currently favored by DSM. (shrink)

Originally published in 1971, this volume examines the relationship between the history and sociology of education. History does not stand in isolation, but has much to draw from and contribute to, other disciplines. The methods and concepts of sociology, in particular, are exerting increasing influence on historical studies, especially the history of education. Since education is considered to be part of the social system, historians and sociologists have come to survey similar fields; yet each discipline appears to (...) have its own aims and methodology. (shrink)

Why, for a long time, was there no linguistic means to distinguish between the concepts experience and experiment in many European languages, such as Italian, French, and Russian? Was the Russian case influenced by French culture? This article addresses these issues. The most important finding of the study is that no idea of personal experience existed in Russian literature before the second half of the eighteenth century, and the word opyt was later borrowed from the scientific lexicon for expressing the (...) meaning of experience. This is the opposite of what happened in other European languages. This suggests that the concept of experiment is more basic in the Russian mentality. Experience grows from experiment but not vice versa. All these aspects of the semantic history of “experiment” and “experience” are illustrated with extensive textual citations found in the Russian National Corpus and in the electronic library of Institute of Russian Literature. (shrink)

Authenticity has recently emerged as an important issue in discussions of mental disorder. We show, on the basis of personal accounts and empirical studies, that many people with psychological disorders are preoccupied with questions of authenticity. Most of the data considered in this paper are from studies of people with bipolar disorder and anorexia nervosa. We distinguish the various ways in which these people view the relationship between the disorder and their sense of their authentic self. (...) We discuss the principal modern ac-counts of authenticity within the analytic philosophical tradition. We argue that accounts based on autonomous, or wholehearted, endorsement of personal characteris-tics fail to provide an adequate analysis of authenticity in the context of mental disorder. Significant elements of true self accounts of authenticity are required. The concept of authenticity is a basic one that can be of particular value, in the context of self-development, to people with mental disorder and to others experiencing substantial inner conflict. (shrink)

Catatonia is a psychomotor disorder that has gone through numerous descriptions since 1874, reflecting the many changes in psychiatric disease conceptualization that have occurred within that time frame. Catatonia has been variously described as a distinct disease entity, as a part of schizophrenia, and as a nonspecific manifestation of many disorders. Because of its association with schizophrenia, the description of catatonia was particularly affected by the psychopharmacological era, beginning in the 1950s, and by the development of the Diagnostic and (...) Statistical Manual of Mental Disorders (DSM). Changing trends in psychiatric research—especially the brain-based disease model, research methods favoured by the evidence-based medicine movement, and the codes and categories of the DSM—also profoundly influenced the evolving concept of catatonia. This paper discusses these important factors that affected recognition, treatment, and study of catatonia in order to reveal the biases and assumptions made when constructing a disease concept. (shrink)

The early modern period is arguably the most pivotal of all in the study of the mind, teeming with a variety of conceptions of mind. Some of these posed serious questions for assumptions about the nature of the mind, many of which still depended on notions of the soul and God. It is an era that witnessed the emergence of theories and arguments that continue to animate the study of philosophy of mind, such as dualism, vitalism, materialism, and idealism. -/- (...) Covering pivotal figures in philosophy such as Descartes, Hobbes, Kant, Leibniz, Cavendish, and Spinoza, Philosophy of Mind in the Early Modern and Modern Ages provides an outstanding survey of philosophy of mind of the period. Following an introduction by Rebecca Copenhaver, sixteen specially commissioned chapters by an international team of contributors discuss key topics, thinkers, and debates, including: -/- Hobbes, Descartes’ philosophy of mind and its early critics, consciousness, the later Cartesians, Malebranche, Cavendish, Locke, Spinoza, Descartes and Leibniz, perception and sensation, desires, mental substance and mental activity, Hume, and Kant. Essential reading for students and researchers in philosophy of mind, enlightenment philosophy, and the history of philosophy, Philosophy of Mind in the Early Modern and Modern Ages is also a valuable resource for those in related disciplines such as religion, history of psychology, and history of science. (shrink)

The general concept of mental disorder specified in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is definitional in character: a mental disorder might be identified with a harmful dysfunction. The manual also contains the explicit claim that each individual mental disorder should meet the requirements posed by the definition. The aim of this article is two-fold. First, we shall analyze the definition of the superordinate concept of (...) mental disorder to better understand what necessary criteria actually characterize such a concept. Second, we shall consider the concepts of some individual mental disorders and show that they are in tension with the definition of the superordinate concept, taking pyromania and narcissistic personality disorder as case studies. Our main point is that an unexplained and not-operationalized dysfunction requirement that is included in the general definition, while being systematically violated by the diagnostic criteria of specific mental disorders, is a logical error. Then, either we unpack and operationalize the dysfunction requirement, and include explicit diagnostic criteria that can actually meet it, or we simply drop it. (shrink)

The aim of this paper is to present a solution to a problem that arises from the fact that people who commit crimes under the influence of serious mental disorders may still have a capacity to refuse treatment. Several ethicists have argued that the present legislation concerning involuntary treatment of people with mental disorder is discriminatory and should change to the effect that psychiatric patients can refuse care on the same grounds as patients in somatic care. However, (...) people with mental disorders who have committed crimes and been exempted from criminal responsibility would then fall outside the scope of criminal justice as well as that of the psychiatric institutions if they were to refuse care. In this paper, I present and develop a solution to how society should deal with this group of people, called Advance criminal responsibility. The basic idea being that if a person with a potentially responsibility exempting psychiatric condition refuses care, that person is responsible for any future criminal acts which are due to the mental disorder. (shrink)

The history of mental illnesses is as old as human history. Mental disorders are affected by changing social and cultural factors during the historical process, and have been conceptually restructured and their definitions and classifications have been changed. The evolution of obssessive-compulsive disorders with roots as old as human history into modern concepts took place in the 19th century. The first scientific views on the spiritual origin of OCD belong to S. Freud. Freud observed that (...) mental causes in OCD are different from other mental disorders, and he examined obsession as a separate and specific disorder. Over time, it has been understood that OCD is a very common disorder. The American Psychiatric Association (APA) has classified OCD under an independent title in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by removing it from the category of anxiety disorders. OCD is a mental disorder caused by mental actions such as obsessive thoughts (obsessions) and / or repetitive and compulsive behaviors (compulsion). The patient is often aware that such thoughts and behaviors are irrational and absurd. For this reason, he tries to get away obsessive thoughts that he finds contrary to his beliefs, opinions, moral values and logic from his mind. However, as he tries, obsessive thoughts become more and more frequent and create a great anxiety in the person. This time, the patient resorts to compulsions to alleviate the anxiety he feels or to get rid of it completely. As his compulsions repeat, his anxiety increases and he goes into a vicious circle. There are many symptom subgroups of OCD that seriously worsen the quality of life of the individual. One of these, and even the most overwhelming, is religious obsessions. It has been thought that there has been a relationship between religion and OCD for a long time in the psychology literature, and some remarkable studies have been conducted to clarify this relationship. Although there are many research findings showing that religion is an indispensable element in the protection of the mental health integrity of the individual, some forms of religious understanding and some experiences gained as a result of religious experiences may affect the concerns about OCD. This stage of religiosity is closely related to some sub-symptom groups of OCD. The explanations of the founder of the psychoanalytic method, Freud psychoanalytic method, and his followers made a great contribution to the understanding of OCD. However, since the psychoanalytic method exhibits a theoretically reductionist approach to religion, it is possible that the individual's devotion to religion is initially evaluated as a pathology or at least an important obstacle to insight. Today, cognitive behavioral psychotherapies are considered the most effective psychological treatment method for OCD, but their success rates in the treatment of religious OCD are low. Since religious OCD concerns often involve spiritual issues rather than concrete repeatable situations, behavioral methods can be quite difficult to apply in the treatment of religious OCD. Therefore, traditional psychotherapy approaches, even if they are not openly against religions, are insufficient to relieve the suffering in the lives of individuals with religious obsessions, as they generally neglect the religious dimension. Due to the vacuum that arises from restricting spiritual treatments to secular approaches, religious patients are threatened by the illegal practices of people who abuse religious feelings. Clinically, religious obsessions are more worrying and overwhelming. Therefore, their treatment is more difficult than others. Selective approaches that use different scientific disciplines together in the treatment of OCD and can stretch around religious beliefs and values can create more effective treatment models. Thus, the success rate in the treatment of religious OCD can be carried to higher levels thanks to the appropriate cooperation of the disciplines of medicine, psychology and theology. There is a rich religious cultural heritage that can support this collaboration in terms of theological disciplines. As an example, Abū Zayd al-Balkhī (d. 322/934), in his Maṣāliḥ al-abdān wa-l-anfus, probably made a clear distinction between neuroses and psychosis and classified neurotic disorders for the first time about ten centuries before Freud. In this study, the importance of approaching to religious obsessions as both a psychological disorder and a theological problem is emphasized. For this reason, cooperation of psychiatric and psychological approaches with spiritual counseling and guidance is recommended in the treatment of religious OCD. The difficulty in distinguishing whether the symptoms seen in a religious person are normal, natural religious thoughts and behaviors of religious life or abnormal appearances in the religious guise necessitates this interdisciplinary cooperation. (shrink)

BackgroundThe present study examined the efficacy of the Michigan Model of Infant Mental Health-Home Visiting infant mental health treatment to promote the socioemotional wellbeing of infants and young children. Science illuminates the role of parental “co-regulation” of infant emotion as a pathway to young children’s capacity for self-regulation. The synchrony of parent–infant interaction begins to shape the infant’s own nascent regulatory capacities. Parents with a history of childhood adversity, such as maltreatment or witnessing family violence, and who (...) struggle with symptoms of post-traumatic stress may have greater challenges in co-regulating their infant, thus increasing the risk of their children exhibiting social and emotional problems such as anxiety, aggression, and depression. Early intervention that targets the infant–parent relationship may help buffer the effect of parental risk on child outcomes.MethodsParticipants were 58 mother–infant/toddler dyads enrolled in a longitudinal randomized control trial testing the efficacy of the relationship-based IMH-HV treatment model. Families were eligible based on child age and endorsement of at least two of four socio-demographic factors commonly endorsed in community mental health settings: elevated depression symptoms, three or more Adverse Childhood Experiences parenting stress, and/or child behavior or development concerns. This study included dyads whose children were born at the time of study enrollment and completed 12-month post-baseline follow-up visits. Parents reported on their own history of ACEs and current posttraumatic stress disorder symptoms, as well as their toddler’s socioemotional development.ResultsMaternal ACEs predicted more toddler emotional problems through their effect on maternal PTSD symptoms. Parents who received IMH-HV treatment reported more positive toddler socioemotional wellbeing at follow-up relative to the control condition. The most positive socioemotional outcomes were for toddlers of mothers with low to moderate PTSD symptoms who received IMH-HV treatment.ConclusionResults indicate the efficacy of IMH-HV services in promoting more optimal child socioemotional wellbeing even when mothers reported mild to moderate PTSD symptoms. Results also highlight the need to assess parental trauma when infants and young children present with socioemotional difficulties. (shrink)

The concept 'health' is ambiguous [18,9, 11]. The concept 'mental health' is even more so. 'Health' compasses senses of well-being, wholeness, and sound ness that mean more than the simple freedom from illness - a fact appreci ated in the World Health Organization's definition of health as more than the absence of disease or infirmity [7]. The wide range of viewpoints of the con tributors to this volume attests to the scope of issues placed under the rubric (...) 'mental health. ' These papers, presented at the Fourth Symposium on Philos ophy and Medicine, were written and discussed within a broad context of interests concerning mental health. Moreover, in their diversity these papers point to the many descriptive, evaluative, and, in fact, performative functions of statements concerning mental health. Before introducing the substance of these papers in any detail, I want to indicate the profound commerce between philosophical and psychological ideas in theories of mental health and disease. This will be done in part by a consideration of some conceptual developments in the history of psychiatry, as well as through an analysis of some of the functions of the notions of mental illness and health. 'Mental health' lays a special stress on the wholeness of human intuition, emotion, thought, and action. (shrink)

This book offers an ability-based view of mental disorders. It develops a detailed analysis of the concept of inability that is relevant in the psychiatric and psychotherapeutic context by drawing on the most recent literature on the concepts of ability, reasons and harm. What is it to have a mental disorder? This book contends that an individual has a mental disorder if and only if (1) they are-in the relevant sense-unable to respond adequately to (...) their available (apparent) reasons in their thinking, feeling or acting and (2) they are harmed by the condition underlying or resulting from that inability. The author calls this the "Rehability View". This view can account for what is "mental" about mental disorders: it is the rational relations among an individual's attitudes and actions that is "disordered", and the relevant norms are the norms of reasons. This view is compatible with explanations of mental disorders in terms of biological dysfunctions, without reducing the former to the latter. The aim is not to offer just another conception of mental disorder, but to develop a systematic approach that incorporates insights from philosophy of psychiatry and adjacent philosophical disciplines. Philosophy of Mental Disorder will be of interest to scholars and advanced students working in philosophy of psychiatry, philosophy of mind, philosophy of action, ethics, and mental health. (shrink)

This main article for a Philosophy, Psychiatry, & Psychology philosophical case conference is intended to raise philosophical, psychiatric, and public policy issues concerning the relationship between concepts of criminality, mental disorder, and the classification of mental disorders. After introducing the basic problem of the confounding of “vice” and mental disorder concepts in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition—Text Revision, the author summarizes three different cases from the literature that illustrate the (...) problem of the vice–mental disorder relationship. Four general aspects of the conceptual issues are presented to frame the discussion, and general questions in a range of domains are posed for commentators. (shrink)

I provide an account of irrationality that takes the concept of an irrational action as more basic than that of an irrational belief. While explaining the various elements of the OSM-III-R definition of mental disorders, I show that even though ( 1) not all mental disorders involve irrational beliefs or delusions, (2) not all irrational actions are due to mental disorders, and (3) not all mental disorders lead to irrational actions, there is a close conceptual (...) connection between irrationality and mental disorders because both involve suffering or an increased risk of suffering an evil or harm, independent of the circumstances one is in. (shrink)

The stated purpose of the Diagnostic and Statistical Manual of Mental Disorders is to classify mental disorders. However, no tenable operational definition of mental disorder is offered in the manual. This leaves the possibility open that the behaviors labeled as disordered in the DSM are not members of a valid category. Attempts to define mental illness fall into the category of essentialist or relativist based, respectively, on the acceptance or denial of the existence of a (...) defining biological attribute that all mental disorders possess. However, the disorders in the DSM cannot be accounted for by either of these approaches making it unlikely that they represent a single valid concept. Simultaneous inclusion of brain illnesses and normal behaviors in the DSM are a likely explanation for the disparate nature of DSM disorders. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Should Clinicians’ Views of Mental Illness Influence the DSM?Elizabeth H. Flanagan (bio) and Roger K. Blashfield (bio)Keywordsclinicians, DSM, values, psychopathology, scienceThe relationship between clinicians and the DSM is complex. Clinicians are the primary intended audience of the DSM. However, as Widiger (2007) pointed out in his commentary, there is a tension associated with trying to meet the clinical goals of the DSM and also trying to optimize the (...) scientific goals of the DSM. Most commentators would agree that the recent editions of the DSM (from the DSM-III onward) have favored scientific values (e.g., Sadler 2005). Some commentators have taken sides and aligned themselves with either clinicians or with the science of classification. For instance, Garb (2005) has argued that clinicians should receive incentives to align themselves more closely with the science of the DSM. In contrast, Westen and Shedler (1999) have favored a clinician-based approach to the DSM and have argued that an ideal classification should be based on the prototypes that clinicians use to conceptualize diagnostic categories. Perhaps an extreme suggestion on how to deal with this tension between the values of clinicians and the values of scientists is to adopt the ICD-10 solution and create two versions of the next DSM. One version would be written for clinicians and another for researchers (Phillips et al. 2003).Widiger (2007) wondered whether the two of us as authors are on the fence about how the views of clinicians should affect the DSM. As clinical psychologists who are both clinicians and researchers, we understand his comment, especially in light of our attempt in our article not to overgeneralize from the time-consuming, labor-intensive, yet methodologically limited study we reported in our major paper.Nonetheless, our answer to the question asked in the title of this response, “Should clinicians’ views of mental illness influence the diagnostic manual?” is a clear and unequivocal yes. In our view, too much of the research literature stimulated by the recent DSMs has primarily used the diagnostic criteria in these DSMs to specify patient samples and then perform various experiments to study the DSM categories. We favor a different approach to research which is consistent with a comment once made by the philosopher of science, Karl Popper: “scientific theories originate from myths, and... a myth may contain important anticipations of scientific theories” (1963, 39). We believe that clinicians, with their years [End Page 285] of experience dealing with the ambiguities, the emotionality, and the chaos of psychopathology, have formed complex conceptual systems to try to understand the mysteries of abnormal behavior. We strongly support increased research attempts that will use clinicians as subjects and that will attempt to understand how clinicians use diagnostic concepts to understand patients.Although research on clinicians has not attracted a large amount of attention in the field, there is a long history of such research studies. For instance, in the 1970s, Overall used multivariate techniques to create graphical maps of how clinicians represented relationships among diagnoses (Overall et al. 1977). Widiger has used a similar strategy in some of his research (Widiger et al. 1987). In the early 1980s, a view of concept formation from cognitive psychology was used by Cantor et al. (1980) to look at psychiatric diagnoses as representing prototypes. Horowitz and colleagues extended this research. Blashfield and his colleagues had a grant to use the prototype model to study personality disorders and performed research investigating both case histories (Blashfield et al. 1985) and analyses of diagnostic criteria (Blashfield and Breen 1989; Davis, Blashfield, and McElroy 1993). Westen and colleagues have attempted to reconceptualize DSM personality disorder categories using the prototype model (Westen and Shedler 1999). Ahn and her colleagues (Ahn et al. 2006; Kim and Ahn 2002) have taken more recent applications of ideas from cognitive psychology to study how clinicians use and understand diagnostic categories. Finally, Flanagan and colleagues (Flanagan and Blashfield 2006; Flanagan, Keeley, and Blashfield, in press; Flanagan, Miller, and Davidson, submitted) have used qualitative and quantitative data analysis techniques to try to understand the diagnostic concepts held by experienced clinicians.Besides empirical studies of how clinicians use diagnostic concepts, we also support the increased interest in... (shrink)