The need for a model -- Currently available models in psychiatry -- Introduction to enactivism -- Body and mind - and world -- The existential dimension and its role in psychiatry -- Enriched enactivism : existential sense-making, values, and socio-cultural worlds -- Enactive psychiatry : psychiatric disorders are disorders of sense-making -- An enactive approach to causes, diagnosis and treatment of psychiatric disorders.

The philosophical and scientific foundations of psychiatry -- Psychiatric diagnosis and the DSM debates -- Grief, depression and the bereavement controversy -- Psychiatry in crisis -- Psychiatry and humane values.

A large and growing body of research in computational psychiatry draws on Bayesian modelling to illuminate the dysfunctions and aberrations that underlie psychiatric disorders. After identifying the chief attractions of this research programme, we argue that its typical focus on abstract, domain-general inferential processes is likely to obscure many of the distinctive ways in which the human mind can break down and malfunction. We illustrate this by appeal to psychosis and the social phenomenology of delusions.

Psychiatry widely assumes an internalist biomedical model of mental illness. I argue that many of psychiatry’s diagnostic categories involve an implicit commitment to constitutive externalism about mental illness. Some of these categories are socially externalist in nature.

In _ Psychiatry in the Scientific Image, _Dominic Murphy looks at psychiatry from the viewpoint of analytic philosophy of science, considering three issues: how we should conceive of, classify, and explain mental illness. If someone is said to have a mental illness, what about it is mental? What makes it an illness? How might we explain and classify it? A system of psychiatric classification settles these questions by distinguishing the mental illnesses and showing how they stand in relation to one (...) another. This book explores the philosophical issues raised by the project of explaining and classifying mental illness. Murphy argues that the current literature on mental illness -- exemplified by the Diagnostic and Statistical Manual of Mental Disorders -- is an impediment to research; it lacks a coherent concept of the mental and a satisfactory account of disorder, and yields too much authority to commonsense thought about the mind. He argues that the explanation of mental illness should meet the standards of good explanatory practice in the cognitive neurosciences, and that the classification of mental disorders should group symptoms into conditions based on the causal structure of the normal mind. (shrink)

Introduction to the study : unveiling the problematic -- The evolution of madness : a journey through time -- Modernity (1890-2014 ) : a journey through time, part two -- Probing the boss text : the DSM : what? whither? how? which? -- The beast/in the belly of the beast : pinioned by paper -- The psychiatric team -- Marching to pharmageddon : psychopharmacy unmasked -- Electroshock : not a healing option -- Dusting ourselves off and starting anew.

The dominance of the medical-model in American psychiatry over the last 30 years has resulted in the subsequent decline of the “talking cure”. In this paper, we identify a number of problems associated with medicalized psychiatry, focusing primarily on how it conceptualizes the self as a de-contextualized set of symptoms. Drawing on the tradition of hermeneutic phenomenology, we argue that medicalized psychiatry invariably overlooks the fact that our identities, and the meanings and values that matter to us, are created and (...) constituted by our dialogical relations with others. While acknowledging the importance of medical and pharmaceutical interventions, we suggest that it is only by means of the dialogical interplay of the talking cure that the client can both recognize unhealthy and self-defeating ways of being and be opened up to the possibility of new meanings and self-interpretations. (shrink)

Advance Praise: "A distillation of the wisdom accumulated over a lifetime by one of our leading thinkers in psychiatry. . . .It should interest. . .anyone who has thought seriously about the brain, the mind and the meaning of illness." --Albert J. Stunkard, M.D., Professor of Psychiatry, University of Pennsylvania.

"Psychiatry and Philosophy of Science" explores conceptual issues in psychiatry from the perspective of analytic philosophy of science. Through an examination of those features of psychiatry that distinguish it from other sciences - for example, its contested subject matter, its particular modes of explanation, its multiple different theoretical frameworks, and its research links with big business - Rachel Cooper explores some of the many conceptual, metaphysical and epistemological issues that arise in psychiatry. She shows how these pose interesting challenges for (...) the philosopher of science while also showing how ideas from the philosophy of science can help to solve conceptual problems within psychiatry. Cooper's discussion ranges over such topics as the nature of mental illnesses, the treatment decisions and diagnostic categories of psychiatry, the case-history as a form of explanation, how psychiatry might be value-laden, the claim that psychiatry is a multi-paradigm science, the distortion of psychiatric research by pharmaceutical industries, as well as engaging with the fundamental question whether the mind is reducible to something at the physical level. "Psychiatry and Philosophy of Science" demonstrates that cross-disciplinary contact between philosophy of science and psychiatry can be immensely productive for both subjects and it will be required reading for mental health professionals and philosophers alike. (shrink)

Neuroscience has long had an impact on the field of psychiatry, and over the last two decades, with the advent of cognitive neuroscience and functional neuroimaging, that influence has been most pronounced. However, many question whether psychopathology can be understood by relying on neuroscience alone, and highlight some of the perceived limits to the way in which neuroscience informs psychiatry. -/- Psychiatry as Cognitive Neuroscience is a philosophical analysis of the role of neuroscience in the study of psychopathology. The book (...) examines numerous cognitive neuroscientific methods, such as neuroimaging and the use of neuropsychological models, in the context of a variety of psychiatric disorders, including depression, schizophrenia, dependence syndrome, and personality disorders. -/- Psychiatry as Cognitive Neuroscience includes chapters on the nature of psychiatry as a science; the compatibility of the accounts of mental illness derived from neuroscience, information-processing, and folk psychology; the nature of mental illness; the impact of methods such as fMRI, neuropsychology, and neurochemistry, on psychiatry; the relationship between phenomenological accounts of mental illness and those provided by naturalistic explanations; the status of delusions and the continuity between delusions and ordinary beliefs; the interplay between clinical and empirical findings in psychopathology and issues in moral psychology and ethics. -/- With contributions from world class experts in philosophy and cognitive science, this book will be essential reading for those who have an interest in the importance and the limitations of cognitive neuroscience as an aid to understanding mental illness. (shrink)

Psychiatry is increasingly dominated by the reductionist claim that mental illness is caused by neurobiological abnormalities such as chemical imbalances in the brain. Critical psychiatry does not believe that this is the whole story and proposes a more ethical foundation for practice. This book describes an original framework for renewing mental health services in alliance with people with mental health problems. It is an advance over the polarization created by the "anti-psychiatry" of the past.

"Psychiatry and Philosophy of Science" explores conceptual issues in psychiatry from the perspective of analytic philosophy of science. Through an examination of those features of psychiatry that distinguish it from other sciences - for example, its contested subject matter, its particular modes of explanation, its multiple different theoretical frameworks, and its research links with big business - Rachel Cooper explores some of the many conceptual, metaphysical and epistemological issues that arise in psychiatry. She shows how these pose interesting challenges for (...) the philosopher of science while also showing how ideas from the philosophy of science can help to solve conceptual problems within psychiatry. Cooper's discussion ranges over such topics as the nature of mental illnesses, the treatment decisions and diagnostic categories of psychiatry, the case-history as a form of explanation, how psychiatry might be value-laden, the claim that psychiatry is a multi-paradigm science, the distortion of psychiatric research by pharmaceutical industries, as well as engaging with the fundamental question whether the mind is reducible to something at the physical level. "Psychiatry and Philosophy of Science" demonstrates that cross-disciplinary contact between philosophy of science and psychiatry can be immensely productive for both subjects and it will be required reading for mental health professionals and philosophers alike. (shrink)

Psychiatry’s inchoate wish for a paradigm shift and the biopsychosocial model of mental illness’ critically examines the much discussed goal of a paradigm shift in psychiatric taxonomy. The chapter first highlights some illustrative calls for such a change and then sets these against the Kuhnian account of science from which the idea is taken, highlighting the connection to incommensurability. Relative to a distinction drawn from Winch, between putative sciences where the self-understanding of subjects plays no role and those where it (...) is fundamental, psychiatry falls into the latter kind. This suggests that the wish for a paradigm shift in psychiatry is either incoherent or a wish for a radical but unpredictable overhaul of a significant aspect of our self-understanding as subjects and agents. The biopsychosocial model of mental illness is thus a helpful reminder of the cost of a paradigm shift in psychiatry. (shrink)

The catch 22 situation in psychiatry is that for precise diagnostic categories/criteria, we need precise investigative tests, and for precise investigative tests, we need precise diagnostic criteria/categories; and precision in both diagnostics and investigative tests is nonexistent at present. The effort to establish clarity often results in a fresh maze of evidence. In finding the way forward, it is tempting to abandon the scientific method, but that is not possible, since we deal with real human psychopathology, not just concepts to (...) speculate over. Search for clear-cut definitions/diagnostic criteria in psychiatry must be relentless. There is a greater need to be ruthless and blunt in this, rather than being accommodative of diverse opinions. Investigative tests - psychological, serum, CSF, or neuroimaging - are only corroborative at present; they need to become definitive. Medicalisation appears most prominent in psychiatry; so, diagnostic proliferation and fuzziness appear inevitable. And yet, the established diagnostic entities need to forward greater and conclusive precision. Also, the need for clarity and precision must outweigh pandering to and mollifying diverse interests, moreso in the upcoming revision of diagnostic manuals. This is specially because the DSM-5, being an Association manual, may need to accommodate powerful member lobbies; and ICD-11 may similarly need to cater to diverse country lobbies. Finding precise biological correlates of psychiatric phenomena, whether through neuroimaging, molecular neurobiology and/or neurogenomics, is the right way forward. It is in the 1.5-kg structure in the cranium that all secrets of psychiatric conditions lie. Social forces, behavioural modification, psychosocial restructuring, study of intrapsychic processes, and philosophical insights are not to be discounted, but they are supplementary to the primary goal - studying and deciphering those brain processes that result in psychiatric malfunction. Experimental breakthroughs, both in psychiatric aetiology and therapeutics, will come mainly from biology and its adjunct, psychopharmacology; while supplementary and complementary breakthroughs will come from the psychosocial, cognitive and behavioural approaches; the support base will come from phenomenology, epidemiology, nosology and diagnostics; while insights and leads can hopefully come from many fields, especially the psychosocial, the behavioural, the cognitive and the philosophical. Major energies must now be marshalled towards finding biomarkers and deciphering the precise phenotype-genotype-endophenotype axis of psychiatric disorders. Energies also need to be focussed on unravelling those critical processes in the brain that tip the scale towards psychiatric disorders. At how those critical processes are set into motion by forces de novo, in utero, in the genes and their expression, by the environment's psychopathological social forces - stress, peer pressure, poverty, deprivation, alienation, malnutrition, discrimination of various types (caste, gender, race, etc.), mass conflicts (war, terror attacks, etc.), disasters (natural and man-made), religious/ideological fascism - or social institutions like marriage, family, work place, political governance, etc. Ultimately, we must decipher how the brain goes into malfunction when such varied forces impinge on it, which precise cortical areas and neuronal cellular and molecular processes are involved in such malfunction and its manifestation, as also which of these are involved when malfunction ceases and health is restored, and the psychosocial processes and institutions which aid such health restoration, as also those which promote well-being and help in primary prevention. Emphasis on the brain and its intimate neurological and molecular mechanisms will not impinge on, or nullify, importance of the 'mind,' wherein subtle and gross brain functions in the form of behaviour, thought and emotions in all their ramifications will continue to be the focus of psychological, cognitive, sociological, psychopharmacological, behavioural and philosophical research. Progress in brain research must move in tandem with progress in 'mind' research. (shrink)

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

Psychiatric involvement in patient morality is controversial. If psychiatrists are tasked with shaping patient morality, the coercive potential of psychiatry is increased, treatment may be unfairly administered on the basis of patients’ moral beliefs rather than medical need, moral disputes could damage the therapeutic relationship and, in any case, we are often uncertain or conflicted about what is morally right. Yet, there is also a strong case for the view that psychiatry often works through improving patient morality and, therefore, should (...) aim to do so. Our goal is to offer a practical and ethical path through this conflict. We argue that the default psychiatric approach to patient morality should be procedural, whereby patients are helped to express their own moral beliefs. Such a procedural approach avoids the brunt of objections to psychiatric involvement in patient morality. However, in a small subset of cases where patients’ moral beliefs are sufficiently distorted or underdeveloped, we claim that psychiatrists should move to a substantive approach and shape thecontentof those beliefs when they are relevant to psychiatric outcomes. The substantive approach is prone to the above objections but we argue it is nevertheless justified in this subset of cases. (shrink)

In the last few decades, there has been a genuine ‘adaptive turn’ in psychiatry, resulting in evolutionary accounts for an increasing number of psychopathologies. In this paper, I explore the advantages and problems with the two main evolutionary approaches to depression, namely the mismatch and persistence accounts . I will argue that while both evolutionary theories of depression might provide some helpful perspectives, the accounts also harbor significant flaws that might question their authority and usefulness as explanations.

The integration of digital phenotyping in psychiatry promises unprecedented insights into mental health, particularly in college settings where mental well-being is a growing concern. The COVID-19...

Psychiatry has come up as one of the most dynamic branches of medicine in recent years. There are a lot of controversies regarding concepts, nosology, definitions and treatments in psychiatry, all of which are presently under a strict scanner. Differences are so many that even the meaning of psychiatry varies amongst individual psychiatrists. For us, it is an art to practice psychiatry and give the patient what he needs. Still, it should be practiced with great caution and utmost sincerity towards (...) the patient, based on scientific knowledge and not to be guided by individual conceptions alone. Ethics in psychiatry forms an integral part of its basic concept and meaning, and a tight balance should be maintained between professional advancement and patient benefit. In recent years, the scope of psychiatry has enlarged considerably, with wide ranging influences from Sociology, Anthropology and Philosophy on the one hand, and Neurology and Medicine on the other. (shrink)

In this paper, I will argue that the NIMH’s new Research Domain of Criteria is a useful test of the philosophical hypothesis of eliminative materialism and demonstrates the superiority of a moderate eliminativism over integrationism, which is a rival philosophical framework for the cognitive sciences. I begin by going over the motivation for RDOC, which rests on the problems with the existing Diagnostic and Statistical Manual of Mental Disorders framework in psychiatry. Then, I introduce the main tenets of RDoC before (...) discussing eliminativism and trying to show what a moderate eliminativism looks like through the example of addiction. I then contrast that approach with intregrationism to the latter’s detriment. I end by wondering whether the broadly political consequences of eliminativism give us non-scientific reasons for resisting it, as it threatens to rob ordinary people of important means of self-description. (shrink)

The introduction of the Diagnostic and statistical manual of mental disorders in May 2013 is being hailed as the biggest event in psychiatry in the last 10 years. In this paper I examine three important issues that arise from the new manual: Expanding nosology: Psychiatry has again broadened its nosology to include human experiences not previously under its purview . Consequence-based ethical concerns about this expansion are addressed, along with conceptual concerns about a confusion of “construct validity” and “conceptual validity” (...) and a failure to distinguish between “disorder” and “non disordered conditions for which we help people.” The role of claims about societal impact in changes in nosology: Several changes in the DSM-5 involved claims about societal impact in their rationales. This is due in part to a new online open comment period during DSM development. Examples include advancement of science, greater access to treatment, greater public awareness of condition, loss of identify or harm to those with removed disorders, stigmatization, offensiveness, etc. I identify and evaluate four importantly distinct ways in which claims about societal impact might operate in DSM development. Categorisation nosology to spectrum nosology: The move to “degrees of severity” of mental disorders, a major change for DSM-5, raises concerns about conceptual clarity and uniformity concerning what it means to have a severe form of a disorder, and ethical concerns about communication. (shrink)

Forensic psychiatry is a particular subspecialty within psychiatry, dedicated in applying psychiatric knowledge and psychiatric training for particular legal purposes. Given that within the scope of forensic psychiatry, a third party usually intervenes in the patient-doctor relationship, an amendment of the traditional ethical principles seems justified. Thus, 47 articles, two book chapters and the guidelines produced by the World Psychiatric Association, the American Association of Psychiatry and the Law, as well as by the Royal Australian and New Zealand College of (...) psychiatrists, were analyzed. The review revealed that the ethics of correctional forensic psychiatry and those of legal forensic psychiatry do not markedly differ from each other, but they are incongruent in terms of implementation. In an effort to better understand which ethical principles apply to forensic psychiatry, a chronological review of the literature published from 1950 to 2015 was carried out. The ethics of correctional forensic psychiatry are primarily deontological. The principle of justice translates into the principle of health care equivalence, the principle of beneficence into providing the best possible care to patients, and the principle of respect of autonomy into ensuring confidentiality and informed consent. The ethics of legal forensic psychiatry are rather consequentialist. In this latter setting, the principle of justice is mainly characterized by professionalism, the principle of beneficence by objectivity and impartiality, and the principle of respect of autonomy by informed consent. However, these two distinct fields of forensic psychiatry share in common the principle of non maleficence, defined as the non collaboration of the psychiatrist in any activity leading to inhuman and degrading treatment or to the death penalty. (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)

Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants’ locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant’s real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported by (...) a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas. (shrink)

_Choice Recommended Read_ _What Psychiatry Left Out of the DSM-5: Historical Mental Disorders Today_ covers the diagnoses that the _Diagnostic and Statistical Manual of Mental Disorders_ failed to include, along with diagnoses that should not have been included, but were. Psychiatry as a field is over two centuries old and over that time has gathered great wisdom about mental illnesses. Today, much of that knowledge has been ignored and we have diagnoses such as "schizophrenia" and "bipolar disorder" that do not (...) correspond to the diseases found in nature; we have also left out disease labels that on a historical basis may be real. Edward Shorter proposes a history-driven alternative to the DSM. (shrink)

These are the basic foundations of liberatory psychiatry.

In this paper, I will argue that the NIMH’s new Research Domain of Criteria is a useful test of the philosophical hypothesis of eliminative materialism and demonstrates the superiority of a moderate eliminativism over integrationism, which is a rival philosophical framework for the cognitive sciences. I begin by going over the motivation for RDOC, which rests on the problems with the existing Diagnostic and Statistical Manual of Mental Disorders framework in psychiatry. Then, I introduce the main tenets of RDoC before (...) discussing eliminativism and trying to show what a moderate eliminativism looks like through the example of addiction. I then contrast that approach with intregrationism to the latter’s detriment. I end by wondering whether the broadly political consequences of eliminativism give us non-scientific reasons for resisting it, as it threatens to rob ordinary people of important means of self-description. (shrink)

Contemporary psychiatry maintains the myth that it is value neutral by appeal to modern medical science for both its diagnostic categories and its therapeutic interventions, leaving the impression that it relies on reason—that is to say, reason divorced from tradition—to master human nature. Such a practice has a certain way of characterizing and defining humanity's lapses from acceptable human behavior—a lapse from human being. The modern practice of psychiatry applies a particular notion (largely influenced by Enlightenment ideals) of scientific instrumentation (...) to the human person in order to diagnose the ailment and manufacture a corresponding treatment in keeping with a hidden conception of human biological flourishing. This covert vision is an impoverished (and possibly dangerous) one. As much as the practice of psychiatry is constrained by the goals of the dominant moral tradition of our day, it becomes a tool (or technique) for achieving the transient and partial ends of modern individualism. Given this truncated view of human nature and human end, modern psychiatry fails to attend comprehensively to the unity of a life, missing altogether the essential relevance of character formation, and thereby forfeiting excellence in human flourishing. (shrink)

This article seeks to understand the origins of the Soviet concept of ‘sluggish schizophrenia’, a diagnostic category that was used to imprison political dissidents in the post-WWII era. It focuses on the 1920s and 1930s, a period when Soviet psychiatrists attempted to find ways to diagnose schizophrenia at its earliest stages. The new Soviet state supported these efforts, funding new institutions where clinicians encountered types of patients they had not previously studied. Conceptual disagreements arose about what symptoms could be used (...) to diagnose schizophrenia, and how it could be differentiated from other ‘borderline’ mental disorders such as neurosis and psychopathy. Several research groups used their findings to propose new clinical concepts, including ‘mild schizophrenia’ and sluggish schizophrenia. By the early 1930s Soviet psychiatrists no longer shared a basic consensus about schizophrenia. At the same time, the priorities of the Soviet government under Joseph Stalin ceased to support preventative psychiatry. The result was a 1936 ‘discussion’ at which the concept of mild schizophrenia was criticized and sluggish schizophrenia was held up as a model for how the discipline should develop in the future. (shrink)

Enactive approaches to psychiatry have recently argued for an understanding of psychiatric conditions based within relational interactions between individuals and their environments. A central motivation for these enactive approaches is the goal of social integration: the integration of a naturalistic approach to psychiatric conditions with their broader sociocultural dimensions. One possible issue, however, is whether appeals to the autonomy and authenticity of relationally constituted enactive individuals can provide a means of adjudicating between harmful and beneficial social constraints upon individual behaviour. (...) This paper seeks to provide enactive approaches to psychiatry with a possible means of evaluating normative influences of social contexts beyond direct interactions with relationally constituted individuals. Some of the most significant influences of the sociocultural dimension of psychiatric conditions consist not in direct interaction with individuals, but in setting the terms for interactions and interactants alike. Insofar as some social influences precede and predefine dyadic relations between individuals and their social context, these cannot be accounted for as features of interactions, but must be assessed as independent structures of the sociocultural dimension. I will provide one potential means for enactive models to assess social norms using Canguilhem’s distinction between health and pathology. I will argue that Canguilhem’s conceptualization of health in terms of adaptive normative structure provides a potential tool for social integration which strongly complements enactive approaches to psychiatry. (shrink)

The authors describe the arrival and treatment of 164 severe chronic psychiatric patients who were displaced from the Serbian army-controlled Jakes psychiatric hospital and off-loaded on the afternoon of 28th of May, 1992 at the gates of the Psychiatry Clinic in Tuzla. Through analysis of their incomplete medical records, which arrived with the patients in Tuzla, and analysis of their activities during and after the war, they found that 83 of the patients (50%) were males and 147 (89.6%) were admitted (...) to the Psychiatry Clinic in Tuzla. Of the patients, 86 (58.5%) were found to be Serbs. The majority of them were incapable of independent living and required ongoing medical and social care. They were from all regions of Bosnia-Herzegovina, 81.6% had schizophrenia and 70 (47.6%) were over 50 years of age. For its humanitarian work, its contribution to peace and for the maintenance of the multi-ethnic Bosnia-Herzegovina, the Psychiatry Clinic in Tuzla received the Golden Award for Peace from the International Legion of Humanists in May 1998. (shrink)

Reproduced here in facsimile, this volume was originally published in 1980 and is available individually. The collection is also available in a number of themed mini-sets of between 5 and 13 volumes, or as a complete collection.

The term “mental illness” implies that persons with such illnesses are more likely to be dangerous to themselves and/or others than are persons without such illnesses. This is the source of the psychiatrist’s traditional social obligation to control “harm to self and/or others,” that is, suicide and crime. The ethical dilemmas of psychiatry cannot be resolved as long as the contradictory functions of healing persons and protecting society are united in a single discipline.Life is full of dangers. Our highly developed (...) consciousness makes us, of all living forms in the universe, the most keenly aware of, and the most adept at protecting ourselves from, dangers. Magic and religion are mankind’s earliest warning systems. Science arrived on the scene only about 400 years ago, and scientific medicine only 200 years ago. Some time ago I suggested that “formerly, when religion was strong and science weak, men mistook magic for medicine; now, when science is strong and religion weak, men mistake medicine for magic”.1We flatter and deceive ourselves if we believe that we have outgrown the apotropaic use of language .Many people derive comfort from magical objects , and virtually everyone finds reassurance in magical words . The classic example of an apotropaic is the word “abracadabra,” which The American Heritage Dictionary of the English Language defines as “a magical charm or incantation having the power to ward off disease or disaster”. In the ancient world, abracadabra was a magic word, the letters of which were arranged in an inverted pyramid and worn as an amulet around the neck to protect the wearer against disease or trouble. One fewer letter appeared in each line of the pyramid, until only the letter “a” remained to form the vertex of the triangle. As …. (shrink)

With contributions from psychiatry, psychology, neuroscience, and philosophy, this book provides the most comprehensive account to date of the interplay between biological, psychological, and social factors in mental health and their ethical dimensions.

What kind of thing is a psychiatric disorder? At present, this is the central question in the philosophy of psychiatry. Answers tend toward one of two opposing views: realism, the view that psychiatric disorders are natural kinds, and constructivism, the view that disorders are products of classificatory conventions. The difficulties with each are well rehearsed. One compelling third-way solution, developed by Peter Zachar, holds that disorders are practical kinds. Proponents of this view are left with the difficult task of explaining (...) what makes practical kinds practical. Kendler, Zachar, and Craver have recently developed a new third-way solution, according to which psychiatric disorders are mechanistic property cluster kinds. This account, already influential in the philosophy of psychiatry, holds that the usefulness of psychiatric kinds is explained by the stability of multilevel mechanisms that generate psychiatric symptoms. We argue that this account, like any that purports to address the central question in the philosophy of psychiatry without first attending carefully to the nature of psychiatry and the difference between its constituent scientific and philosophical parts, will ultimately be committed to untenable views about the nature of psychiatric science, the aims and limitations of scientific inquiry and mechanistic explanations, and the role of values in psychiatry. (shrink)

Medicalization in contemporary psychopharmacology is increasingly dominated by commercial interests that threaten the scientific and ethical integrity of psychiatry. At the same time, the proliferation of new social media has altered the manner in which the social groups and institutions that have stakes in medicalization interact. Consumers are at once more powerful than ever before, but also more vulnerable. The upshot of all these developments is that medicalization is no longer simply the professed enemy of anti-psychiatry and its supporters. It (...) is now also an enemy of psychiatry. Once a welcome ally of psychiatry, medicalization appears to have turned into a fearsome enemy. (shrink)

This review essay explores recent historical and anthropological literature on the emergence and development of transcultural psychiatry in the second half of the twentieth century. It examines how postcolonial psychiatry attempted to remove itself from its erstwhile colonial frameworks and strove to introduce new concepts and paradigms to make itself relevant in the context of decolonization and postwar reconstruction. The essay looks at both continuities and discontinuities between colonial and post-colonial transcultural psychiatry, asking how the recent surge of scholarly literature (...) in this field engaged with these issues. It also aims to identify the most important avenues for future research. (shrink)

Externalist theories hold that a comprehensive understanding of mental disorder cannot be achieved unless we attend to factors that lie outside of the head: neural explanations alone will not fully capture the complex dependencies that exist between an individual’s psychiatric condition and her social, cultural, and material environment. Here, we firstly offer a taxonomy of ways in which the externalist viewpoint can be understood, and unpack its commitments concerning the nature and physical realization of mental disorder. Secondly, we apply a (...) strongly externalist approach to the case of Autistic Spectrum Disorder, and argue that this condition can be illuminated by appeal to the hypothesis of extended cognition. We conclude by briefly considering the significance this strongly externalist approach may have for psychiatric practice and pedagogy. (shrink)

Published in 1972, Anti‐Oedipus was the first of a number of collaborative works between the French philosopher, Gilles Deleuze, and the French psychoanalyst and political activist, Felix Guattari. As the first of a two‐volume body of work that bears the subtitle, Capitalism and Schizophrenia, Anti‐Oedipus is, to say the least, an unconventional work that should be understood, in part, as a product of its time – created as it was among the political and revolutionary fervour engendered by the events of (...) ‘May 1968’. However, this paper will suggest that Anti‐Oedipus – as a critique of psychoanalysis and the Oedipus complex, as well as being a study of the relationship between capitalism and schizophrenia – should also be understood in a less ‘time‐bound’ fashion. In particular, the paper will examine Deleuze and Guattari’s formulation of a concept of ‘desire’ and its employment in relation to subjectivity, time, capitalism, representation, and the radical ‘therapeutic’ practice that they refer to as ‘schizoanalysis’. Moreover, nearly 40 years after the events of May 1968 and against possible doubts concerning the contemporary relevance of psychoanalysis, it will be suggested that psychoanalysis and the Oedipus complex are to be understood as symptomatic of a wider ‘malaise’ that can be discerned within psychiatry, psychotherapy, and contemporary capitalist society itself, and that it is this that forms the broader target of the book’s critique. Accordingly, by providing an accessible and critical introduction to Anti‐Oedipus, the paper also hopes to stimulate further discussion and research regarding both the critique and the contribution that the work can make to contemporary psychiatry, psychotherapy, and mental health nursing generally. (shrink)

Substantially revised to include a wealth of new material, the second edition of this highly acclaimed work provides a concise, coherent introduction that brings structure to an increasingly fragmented and amorphous discipline. Paul R. McHugh and Phillip R. Slavney offer an approach that emphasizes psychiatry's unifying concepts while accommodating its diversity. Recognizing that there may never be a single, all-encompassing theory, the book distills psychiatric practice into four explanatory methods: diseases, dimensions of personality, goal-directed behaviors, and life stories. These perspectives, (...) argue the authors, underlie the principles and practice of all psychiatry. With an understanding of these fundamental methods, readers will be equipped to organize and evaluate psychiatric information and to develop a confident approach to practice and research. Praise for the original edition: "This brilliant book illuminates psychiatry more clearly than any other work I know.... This is the best (and the shortest) single volume on psychiatry that anyone could read."-- New England Journal of Medicine "Every psychiatry department, regardless of ideology, should build a course around this... work. Open-mindedness might become fashionable."-- Journal of Clinical Psychiatry "An elegantly reasoned and eloquently written book that enriches our understanding of clinical events.... [It provides] an opportunity to open our eyes to new possibilities."-- Hospital and Community Psychiatry. (shrink)

Psychiatry presents a unique array of difficult ethical questions. However, a major challenge is to approach psychiatry in a way that does justice to the real ethical issues. Recently there has been a growing body of research in empirical psychiatric ethics, and an increased interest in how empirical and philosophical methods can be combined. Empirical Ethics in Psychiatry demonstrates how ethics can engage more closely with the reality of psychiatric practice and shows how empirical methodologies from the social sciences can (...) help foster this link. -/- The book is divided into two sections. In the first section there are discussions of the possibility of empirical ethics from a theoretical standpoint and an overview of the history of empirical medical ethics in general. The second, larger section is made up of chapters, discussing specific research projects in empirical psychiatric ethics. The contributors reflect on their choice of method: how and why they combine empirical and philosophical work, and how the two approaches relate to each other. The chapters in the second part thus have two purposes. The first is to present examples of empirical ethics in psychiatry; the second is to reflect on the way in which empirical research can support ethical analysis. -/- Empirical Ethics in Psychiatry is a unique contribution to bioethics and will be fascinating reading for all those working within the field, as well as mental health care professionals. (shrink)

Machine generated contents note: -- Clinical Theory -- 1. Psychiatry on schizophrenia: clinical pictures of a sublime object -- 2. Schizophrenia: the sublime text of psychoanalysis -- Cultural Theory -- 3. Antipsychiatry: schizophrenic experience and the sublime -- 4. Anti-Oedipus and the politics of the schizophrenic sublime -- 5. Schizophrenia, modernity, postmodernity -- 6. Postmodern schizophrenia -- 7. Glamorama, postmodernity and the schizophrenic sublime -- Conclusion.

The introduction of the Diagnostic and Statistical Manual of Mental Disorders in May 2013 is being hailed as the biggest event in psychiatry in the last 10 years. In this paper I examine three important issues that arise from the new manual: Expanding nosology: Psychiatry has again broadened its nosology to include human experiences not previously under its purview. Consequence-based ethical concerns about this expansion are addressed, along with conceptual concerns about a confusion of "construct validity" and "conceptual validity" and (...) a failure to distinguish between "disorder" and "nondisordered conditions for which we help people." The role of claims about societal impact in changes in nosology: Several changes in the DSM-5 involved claims about societal impact in their rationales. This is due in part to a new online open comment period during DSM development. Examples include advancement of science, greater access to treatment, greater public awareness of condition, loss of identify or harm to those with removed disorders, stigmatization, offensiveness, etc. I identify and evaluate four importantly distinct ways in which claims about societal impact might operate in DSM development. Categorisation nosology to spectrum nosology: The move to "degrees of severity" of mental disorders, a major change for DSM-5, raises concerns about conceptual clarity and uniformity concerning what it means to have a severe form of a disorder, and ethical concerns about communication. (shrink)

The key objectives of this book are to demonstrate the applicability of issues in the philosophy of science to problems in psychiatry and to show how the conceptual issues raised by psychiatry should be considered more closely by philosophers of science. These are worthy aims: the philosophy of psychiatry needs to draw more thoughtfully upon contemporary philosophical debates and stimulating interest within the philosophy of science is a good way to do this.Cooper's book succeeds for both of these desiderata. The (...) first five chapters discuss the central issues in the philosophy of psychiatry: whether mental illness is a disease/natural kind and what follows from this. There is a large literature on these questions, some of which …. (shrink)