In lieu of an abstract, here is a brief excerpt of the content:Anthropological Perspectives in Psychiatric NosologyJuan J. López-Ibor Jr. (bio) and María-Inés López-Ibor (bio)KeywordsDSM, etiology, Aristotelian causes, social dramasPsychiatry and clinical psychology, as we learn in this paper, are disciplines in need of an ontological perspective. Very few branches of contemporary learning share this characteristic. Probably only theoretical physic and theology—as the rest have long ago given up trying to define and understand the essence of their object, for (...) example, life in the case of biology or mind in psychology. Consequently, the paper by Pérez-Álvarez, Sass and García-Montes, “The Ontology of Mental Disorders in Constructivist Perspective,” (2008) should be welcomed and indeed included in the reading lists for trainees in psychiatry and clinical psychology.The authors propose an approach to the understanding of mental disorders that is extremely attractive and well articulated, and which also has practical implications for clinicians. It is not just another “philosophical divertimento” devoid of scientific and practical importance. Let us analyze the article in an orderly way.Less DsmThe authors of the target paper disapprove of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III/IV approach to defining illnesses by starting from the symptoms that are present—on the grounds that this may lead clinicians to assume that their sole role is to identify, fight, and suppress the symptoms by whichever procedure. They propose an alternative that is dear to myself because it follows the path of the so-called “anthropological” psychiatry of Binswanger, von Gebsattel, Erwin Strauss, Zutt, López-Ibor, Sr., and others. In essence, this is a phenomenological approach to the meaning of mental diseases, one that emphasizes how the illness is revealed to the patient him- or herself.The target article’s criticism of DSM should be considered in the context of the abuses committed on its behalf. The DSM is not a textbook of psychiatric disorders, nor does it contain a definition of the diseases. The DSM does not tell what a disease is (Klerman et al. 1984)—something that is impossible with a classification system based on the manifestations of the diseases, the signs and symptoms. The DSM, as its title states, is just a diagnostic and statistical manual, which does not contain anything about the origin of [End Page 259] any disease nor an explanation of why it exists or what it means. The DSM is, in fact, just a tool to determine whether a disease is present, and therefore to facilitate communication between professionals and with other individuals, without saying anything about the disease’s aitia—a key term (associated with notions of essence as well as cause) to be discussed below. In theory, most clinicians should understand these limitations; it may be, however, that this is not really the case for many who read or use the DSM. In the world there are around 200,000 psychiatrists; since 1980 the number of DSM copies sold is in the order of several hundred thousand.The misuse of a classification system is even more noticeable in the International Classification of Diseases (ICD)-10 Research Version. The instructions for the use of this version recommend that the first step is to make an inventory of all the symptoms present, and then to construct a diagnosis based on them. This how all computer-assisted systems work. This procedure can, however, only be valid if the clinician has already reached a diagnostic conclusion by other means—a diagnosis then to be confirmed for research purposes. It may be that this is one of the reasons why the ICD-10 Research Version has almost never actually been used for research.Furthermore, the concept of symptoms in psychiatry applies only to organic mental disorders (Schneider 1959), conditions in which the patient’s attitude and way of experiencing the symptoms do not play the kind of role that they play in schizophrenia and other mental disorders. The quotation from the important paper by Sass and Parnas in this context is most appropriate. It is indeed that case that “subjective experience can play an important causal role in the progressive experiential transformations of a developing schizophrenic illness... (shrink)

Se presentan los resultados de una investigación cualitativa hermenéutica sobre la lingüística cognitiva y la lingüística aplicada, relacionadas con otras ciencias en un contexto específico de la comunidad científica especializada. Desde una visión integral y holística de las ciencias biomédicas y humanas, asimismo, se estudian los lenguajes técnico-científicos de la ciencia y de la tecnología para facilitar la interrelación cognitiva entre las diferentes disciplinas. Este estudio permite crear capacidades para evaluar el acervo léxico en contexto, útil para la transmisión y (...) la transformación del conocimiento en un lenguaje propio acorde a la exigencia del método científico. El objetivo consistió en indagar sobre la relación de la unidad léxica con su nexo cognitivo a una unidad terminológica de uso cotidiano en la información y en la comunicación académica de la práctica médico-legal forense. Los resultados establecen diferencia y precisan cierta comprensión de la significación de unidades léxicas ambiguas de mayor relevancia y frecuencia, utilizadas en este ámbito del conocimiento, en cuatro categorías de análisis; según las características propias de la disciplina en dialogo con otras ciencias en contexto. Se evidencia la importancia de educar durante el proceso enseñanza-aprendizaje significativo de la disciplina en contexto, desde la metalingüística del objeto de estudio dimensionado y relacionado con otros objetos de estudio, que permita el proceso cognitivo del lenguaje técnico-científico transdisciplinar, la apropiación social y la circulación del conocimiento aplicado a las prácticas médico legales integrales en relación entre la Psicofarmacología, la Psiquiatría, la Antropología y la Psicología, con las ciencias biomédicas y humanas. In this work results of a qualitive hermeneutic research about a cognitive and applied linguistic related to other sciences in an specific context of a given scientific community were presented, a technical and scientific language regarding science and technology was pointed out from an integral vision in order to facilitate cognitive relationship among different disciplines. This study also allows to create capacities in order to assess vocabulary in context, useful for the transmission and transformation of knowledge according to a scientific method. The objective was directed to know about the relationship between the lexical unit and its meaning in a given communicative context and in the academic communication of a medical - legal forensic practice. The importance of educate during the teaching learning process is also mentioned in this research and the main objective is to develop an assertive medical practice among Psychopharmacology, psychiatric, anthropology and psychology with biomedical and human sciences. (shrink)

This collection of 49 readings with extensive background description exposes students to the breadth of theoretical perspectives and issues in the field of medical anthropology. The text provides specific examples and case studies of research as it is applied to a range of health settings: from cross-cultural clinical encounters to cultural analysis of new biomedical technologies to the implementation of programs in global health settings.

The research program Spit For Science was launched at Virginia Commonwealth University (VCU) in 2011. Since then, more than 10,000 freshmen have been enrolled in the program, filling out extensive questionnaires about their drinking, general substance use, and related behaviors, and also contributing saliva for genotyping. The goals of the program, as initially stated by the investigators, were to find the genes underlying the heritability of alcohol use and related behaviors, and in addition to put genetic knowledge to work in (...) ways that might aid university administrators and mental health professionals in the prevention and treatment of substance abuse. We review every empirical paper involving genetic data that has emerged from the program, and reach a surprising conclusion: the study has never identified a single genetic effect of more than trivial magnitude. Although the quantitative results of the studies were reported transparently, the theoretical ramifications of the negligible results have never been acknowledged. To the contrary, most of the papers ignore the tiny effects, reaching optimistic conclusions about the prospects for future genetic explanations of alcohol use. We explore the implications of these results for the broader prospects of applied psychiatric genetics. (shrink)

The History of Reason in the Age of Madness revolves around three axes: the Foucauldian critical-historical method, its relationship with enlightenment critique, and the way this critique is implemented in Foucault's seminal work, History of Madness. Foucault's exploration of the origins of psychiatry applies his own theories of power, truth and reason and draws on Kant's philosophy, shedding new light on the way we perceive the birth and development of psychiatric practice. Following Foucault's adoption of 'limit attitude', which investigates (...) the limits of our thinking as points of disruption and renewal of established frames of reference, this book dispels the widely accepted belief that psychiatry represents the triumph of rationalism by somehow conquering madness and turning it into an object of neutral, scientific perception. It examines the birth of psychiatry in its full complexity: in the late eighteenth century, doctors were not simply rationalists but also alienists, philosophers of finitude who recognized madness as an experience at the limits of reason, introducing a discourse which conditioned the formation of psychiatry as a type of medical activity. Since that event, the same type of recognition, the same anthropological confrontation with madness has persisted beneath the calm development of psychiatric rationality, undermining the supposed linearity, absolute authority and steady progress of psychiatric positivism. Iliopoulos argues that Foucault's critique foregrounds this anthropological problematic as indispensable for psychiatry, encouraging psychiatrists to become aware of the epistemological limitations of their practice, and also to review the ethical and political issues which madness introduces into the apparent neutrality of current psychiatric discourse. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Aristotle Rules, OK?José M. Villagrán (bio) and Rogelio Luque (bio)KeywordsAristotle, causes, philosophy, psychiatry, psychopathologyPérez-Alvarez, Sass, and García-Montes (2008) propose a theoretical approach to the nature of mental disorders (MD) that attempts to explain the type of reality they constitute. In line with this approach, they argue that (1) MDs should be considered not from within psychology and psychiatry, but rather from the realm of philosophy, so as to avoid (...) what they call the Charcot effect; (2) the resulting theoretical model is in contrast to naturalist models such as that of internal dysfunction, and involves “strong” constructivist assumptions from which they develop an anthropological perspective based on the clinician–patient situation; 3) this model is applicable, in principle, to all MDs (“at least to some extent”); and (4) it is based on the Aristotelian theory of the four causes.We would argue, however, that (1) it is precisely from within psychology and psychiatry that conceptual models accounting for MDs should be proposed; (2) the naturalist–constructivist dichotomy in these models should be deconstructed, and primacy given not to the ontological approach but to the epistemological one; (3) a theoretical model of this scope should account not only for MDs but also for physical disorders; and (4) only in this way would the Aristotelian theory of causes, understood as types of explanation (and therefore as epistemological approaches) be useful.Approaches from within and from WithoutFor Berrios (2006), the theoretical discourse in relation to the conceptualization of MDs in a particular sociocultural context can be formulated in two ways: on the one hand, in a centripetal fashion, using established philosophical systems (be it phenomenology [Jaspers 1977], logical empiricism [Hempel 1994], or analytic philosophy [Fulford, Thornton, and Graham 2006]). This centripetal approach can be used both by professional philosophers and by psychiatrists/psychologists. When developed by professional philosophers, such proposals, despite their possible brilliance, run the risk of being tangential to the psychiatric issues owing to a lack of first-hand experience of them (Murphy 2006). When developed by psychiatrists and psychologists, the majority of the proposals simply mix fragments of different philosophical systems, in either a kind of syncretism or collage that fails to take into account the contradictions between fragments, or a kind of pluralism that reflects, without entering into analysis, a sort of consensus among the different paradigms (Ghaemi 2003; Kendler 2005).A second way of formulating this theoretical discourse (according to Berrios) would employ a centrifugal approach from the very core of the disciplines, through the reflection of professionals (primarily, although not only, psychiatrists/psychologists with philosophical training) who would conceptualize the problems from within and develop a specific metalanguage for analyzing [End Page 265] them (Lanteri-Laura 1991; Reznek 1991; Sass 1992). Not all problems are of the same type. For those that are extrinsic to psychiatry/psychology (definition of the mental, the mind–body relationship, the distinction between causes and reasons, or interdisciplinary reduction), the methods common to the philosophy of science and of the mind can be used. However, issues intrinsic to the disciplines themselves (the nature of mental symptoms and how they are generated, how to explain their heterogeneity, what a MD is, how to diagnose and classify it, or how to implement a psychopathological project) cannot be dealt with using preestablished formulas, and require new and original proposals that take into account the nature of the disciplines and their object of study (Villagrán 2007).The authors of the target article base their preference for the centripetal approach for responding to one of the intrinsic questions of psychiatry (what MDs are) on the consequences of what they call the Charcot effect, a kind of variant of observer bias applied to psychiatric diagnosis. They offer as an example the classic diagnosis ad iuvantibus in its postmodern version, namely, the efficacy of the pharmaceutical industry in contributing to creating nosological entities for which their drugs are indicated. Consequently, clinicians are not only unable to surmount the substantial epistemological obstacles that hamper attempts to theorize, but also find themselves doomed to assuming an ingenuous essentialism that considers MDs as natural kinds (such as apples, trees, or dogs) determined... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:EugenicsMary Carrington Coutts (bio) and Pat Milmoe McCarrick (bio)The word eugenics (from the Greek eugenes or well-born) was coined in 1883 by Francis Galton, an Englishman and cousin of Charles Darwin, who applied Darwinian science to develop theories about heredity and good or noble birth (I, Kevles 1985, p. x).The entry under "eugenics" in the Encyclopedia of Bioethics notes that the term has had different meanings in different (...) eras: "a science that investigates methods to ameliorate the genetic composition of the human race; a program to foster such betterment; a social movement; and in its perverted form, a pseudo-scientific retreat for bigots and racists" (V, Ludmerer 1978, p. 457). Kevles, who places a stronger emphasis than Ludmerer on the degeneration of eugenics, says that by 1935 it "had become 'hopelessly perverted' into a pseudoscientific facade for 'advocates of race and class prejudice, defenders of vested interests of church and state, Fascists, Hitlerites, and reactionaries generally'" (I, Kevles 1985, p. 164).Phrases such as "survival of the fittest" and "struggle for existence" came into use at the end of the nineteenth century when eugenics societies were created throughout the world to popularize genetic science. "Negative eugenics" utilized marriage restriction, sterilization, or custodial commitment of those thought to have unwanted characteristics. "Positive eugenics" tried to encourage the population perceived as "superior" to have more offspring (V, Ludmerer 1978, p. 459).In the United States, after World War I, new information, such as the importance of environmental influences and the more complex concept of multi-gene effects in inheritance, diminished the scientific justification for eugenics, but this knowledge did not decrease the pressure for legislation, judicial action, or immigration controls. The U.S. Immigration Restriction Act of 1924 favored immigration from northern Europe and greatly restricted the entry of persons from other areas referred to as "biologically inferior." Between 1907 and 1937, 32 [End Page 163] states required sterilization of various citizens viewed as undesirable: the mentally ill or handicapped; those convicted of sexual, drug, or alcohol crimes; and others viewed as "degenerate" (V, Larson 1991).In Germany, interest in eugenics flourished after the turn of the century when Dr. Alfred Ploetz founded the Archives of Race-Theory and Social Biology in 1904 and the German Society of Racial Hygiene in 1905. The German term Rassenhygiene or race hygiene encompassed more than the word "eugenics;" it included all attempts to improve hereditary qualities as well as measures directed at population increase (III, Weiss 1987). By the 1920s, various German textbooks incorporated ideas of heredity and racial hygiene, and German professors were participating in the international eugenics movement. The Kaiser Wilhelm Institute of Anthropology, Human Heredity, and Eugenics was founded in 1927; by 1933 a sterilization law, the Law for the Prevention of Congenitally Ill Progeny, which originally was entitled "Eugenics in the Service of Public Welfare," indicated compulsory sterilization "for the prevention of progeny with hereditary defects" in cases of "congenital mental defects, schizophrenia, manic-depressive psychosis, hereditary epilepsy... and severe alcoholism." (III, Müller-Hill 1988, p. 10).The co-mingling of science, politics, and Weltanschauung (ideological or religious world view) caused the darkest period for eugenics when Nazi Germans embarked on their "final solution" to the Jewish "problem", or the Holocaust. The Nazi racial-hygiene program began with involuntary sterilizations and ended with genocide. Beginning with the 1933 Law for the Prevention of Congenitally Ill Progeny, 350,000 schizophrenic and other mentally ill persons were involuntarily sterilized, and marriage or sexual contact between Jews and other Germans was banned. Several hundred black children and 30,000 German Gypsies were sterilized. By 1945, when the allies liberated those remaining in Nazi concentration camps, six million Jews, 750,000 Gypsies, and 70,000 German psychiatric patients had been killed by the Nazis (III, Müller-Hill 1992, p. 47). As a result of the German experience, eugenic thought dropped to its nadir, and to the present day, the term "eugenics" invokes a sense of horror in some people.Great Britain, the United States, and Germany were the countries most involved with eugenic science in the first half of this century, but interest was present in Europe and other... (shrink)

Introduction The bioethics literature reflects significant interest in and concern with the use of genetic and genomic information in various settings. Because psychiatric treatment and research raises unique ethical, legal, and social issues, we conducted a scoping review of the biomedical, bioethics, and psychology literature regarding the application of genetic and genomic tools to psychiatric disorders (as listed in the DSM-5) and two associated behaviors or symptoms to provide a more detailed overview of the state of the field. (...) Objectives The primary objective was to examine the available bioethics, biomedical, and psychology literature on applying genetic and genomic tools to psychiatric disorders (other than neurodevelopmental disorders) and two behaviors or symptoms sometimes associated with them (aggression or violence and suicidality) to identify the disorders to which these tools have been applied, the contexts in or purposes for which they have been applied, the ethical, legal, or social concerns associated with those uses, and proposed recommendations for mitigating those concerns. Methods We used Arksey and O’Malley’s scoping review framework: (1) identify the research question; (2) identify relevant studies; (3) select studies; (4) chart the data; and (5) collate, summarize, and report results (2005). We relied on Levac et al. to inform our application of the framework (2010). The PRISMA extension for scoping reviews checklist informed our reporting (2018). We searched three electronic databases MEDLINE (PubMed), Embase, and PsycInfo (EbscoHost) for peer-reviewed journal articles in English to identify relevant literature. One author screened the initial results and additional screening was done in consultation with other authors. A data extraction form using DSM-5 diagnostic categories (excluding neurodevelopmental disorders) was developed and two authors independently each reviewed approximately half of the articles. Inter-rater reliability was ensured by double-coding approximately 10% of the papers. An additional author independently coded 10% of the articles to audit the data. Results In 365 coded publications, we identified 15 DSM-5 diagnostic categories in addition to the two pre-selected behaviors or symptoms (aggression or violence and suicidality) to which genetic or genomic tools have been applied. We identified 11 settings in or purposes for which these tools were applied. Twenty-two types of ethical, legal, or social concerns associated with the application of genetic or genomic tools to these disorders or behaviors/symptoms were identified along with 13 practices or policies that could mitigate these concerns. Conclusion Genetic and genomic tools have been applied to a wide range of psychiatric disorders. These raise a range of ethical, legal, and social concerns. Additional research is warranted to better understand the concerns and effective ways to address them. Advancing the literature to identify relevant ethical, legal, or social concerns and solutions to those problems likely requires greater attention to specific applications of genetic or genomic tools to particular psychiatric disorders and associated behaviors/symptoms as well as broad stakeholder engagement. (shrink)

This chapter contains sections titled: The Second Part of Morals Defining Features of Pragmatic Anthology Anthropology: Pragmatic versus Moral Defining Features of Moral Anthropology Hindrances and Helps Moral Weltkenntnis Moral Education and Character Development The Vocation of the Human Species Assessing Kant's Moral Anthropology.

This book suggests a bold comparative approach to broad cultural differences between Africa and Melanesia. Its theme is personhood, understood in terms of what anthropologists call embodiment. These concepts are applied to questions ranging from the meanings of spirit possession, to the logics of witchcraft and kinship relations, the use of rituals in healing, and even the impact of capitalism. Questioning common assumptions about the huge differences among these discrete areas, the contributions document surprising continuities.

In 1970 a coalition of student activists opposing the Vietnam War circulated documents revealing the involvement of several prominent social scientists in U.S. counterinsurgency activities in Thailand--activities that could cause harm to the people who were the subject of the scholars' research. The disclosure of these materials, which detailed meetings with the Agency for International Development and the Defense Department, prompted two members of the Ethics Committee of the American Anthropological Association to issue an unauthorized rebuke of the accused. Over (...) the next two years, the AAA agonized over the allegations and the appropriate response to them. Within an academic community already polarized by the war, political and professional acrimony reached unprecedented levels. Although the association ultimately passed a code of ethics, the key issues raised in the process were never fully resolved. Now back in print, Eric Wakin's Anthropology Goes to War is the first comprehensive study of what became known as the Thailand Controversy--and a timely reminder of a debate whose echoes may be heard in our own time. (shrink)

The most accepted definition of urgency in psychiatry is that of a situation of acute and severe mental and behavioral suffering, which requires immediate treatment. Therefore, in the situation defined as “psychiatric urgency”, a descriptive and nosographic element (acute), a prognostic element (severity) and a therapeutic element (need for immediate treatment) coexists. In any case, it remains difficult and complex, sometimes enigmatic, to understand the acute episode within the course of a specific pathology. It is a matter of having (...) to oscillate in front of the patient “between the madness of a moment and the madness of an existence” [1]. By the way, contribution from philosophical discourse may be helpful to clarify the psychopathological structure of acute psychiatric urgencies. (shrink)

Privacy issues are frequently discussed amongst researchers, practitioners and patients in healthcare. However, psychiatric patients’ privacy issues get less attention in information system development (ISD), whereby they are one of the most important stakeholders. This paper applies Carew and Stapleton’s ISD privacy framework to psychiatric monitoring systems to understand the issues that are related to monitoring psychiatric patients’ behaviour. By understanding the privacy issues amongst patients, the research will be able to provide guidance to system developers to (...) produce a privacy-sensitive system that can contribute to the system engineering for international stability. We will elaborate each factor in the framework (physical, social, psychological and informational) and then explain the relationship to the privacy of psychiatric patient. (shrink)

The British mass-market publisher Penguin produced a number of texts on psychiatric topics in the period c.1950– c.1980. Investigation of editorial files relating to a sample of these volumes reveals that they were shaped as much by the commercial imperatives and changing aspirations of the publisher as by developments and debates in psychiatry itself. A number of economic imperatives influenced the publishing process, including the perennial difficulty in finding psychiatrists willing and able to enter the popular book market; the (...) economic pressures exerted on peer-review protocols; and the identification of a niche market in popular psychiatry, latterly of a politically radical flavour. As well as offering a materialist standpoint for the study of popular psychiatric texts, this investigation allows an opportunity to adapt, apply and assess theoretical approaches to mass-market publishing by psychiatrists. (shrink)

The British mass-market publisher Penguin produced a number of texts on psychiatric topics in the period c.1950– c.1980. Investigation of editorial files relating to a sample of these volumes reveals that they were shaped as much by the commercial imperatives and changing aspirations of the publisher as by developments and debates in psychiatry itself. A number of economic imperatives influenced the publishing process, including the perennial difficulty in finding psychiatrists willing and able to enter the popular book market; the (...) economic pressures exerted on peer-review protocols; and the identification of a niche market in popular psychiatry, latterly of a politically radical flavour. As well as offering a materialist standpoint for the study of popular psychiatric texts, this investigation allows an opportunity to adapt, apply and assess theoretical approaches to mass-market publishing by psychiatrists. (shrink)

Paul Ricœur is rightly regarded as one of the greatest representants of the hermeneutical tradition, at the crossroads of epistemological filiation from Schleiermacher and Dilthey and the ontological filiation of Heidegger to Gadamer. Johann Michel's bias in this article is to explore a third way of hermeneutics under the guise of an interpretative anthropology. Before being a set of scholarly techniques applied to specific fields, hermeneutics derives originally from ordinary techniques of interpretation at work in the world of (...) life. The purpose of the contribution is to show how Ricoeur's hermeneutics can give serious directions for elaborating such an interpretive anthropology, in which case it also needs to be supplemented by other intellectual traditions to achieve this goal. (shrink)

Australia has one of the harshest regimes for the processing of asylum seekers, people who have applied for refugee status but are still awaiting an answer. It has received sharp rebuke for its policies from international human rights bodies but continues to exercise its resolve to protect its borders from those seeking protection. One means of doing so is the detention of asylum seekers who arrive in Australia by boat. Health care providers who care for asylum seekers in these (...) conditions experience a conflict of “dual loyalty,” whereby their role in preserving and maintaining the health of patients can run counter to their employment in detention facilities. Many psychiatrists who have worked in the detention setting engage in forms of political activism in order to change the process of seeking refuge. (shrink)

In the context of psychiatric diagnosis, operationists claim that mental disorders are nothing more than the satisfying of objective diagnostic criteria, whereas realists claim that mental disorders are latent entities that are detected by applying those criteria. The implications of this distinction are substantial in actual clinical situations, such as in the co-occurrence of disorders that may interfere with one another's detection, or when patients falsify their symptoms. Realist and operationist conceptions of diagnosis may lead to different clinical decisions (...) in these situations, affecting treatment efficacy and ultimate patient outcomes. (shrink)

Action Anthropology and Sol Tax are both important chapters in the development of contemporary anthropology and applied social science. Although unknown or forgotten by most, both continue to be revered and applied by a group of intellectual descendants who will not let die either the man or the approach to helping commu-nities. In 2010 and 2011, former students, colleagues, the two Tax daughters--both academic professionals--and others came together to explore the relevance of Action Anthropology and (...) Sol Tax to applied social science today. In reflecting on the history of the man and the intellectual tradition that he inspired, the authors document the many contributions made by Tax and his student-colleague cohorts. Using examples from contemporary applications, the contributors also demonstrate the present-day power of the ideas and approaches developed over the first 75 years. Time will tell whether Action Anthropology and Sol Tax in 2012: The Final Word? will close this important chapter in the development of applied social science research. Regardless, the tenets of Action Anthropology, detailed and explicated throughout this volume, will continue to provide a foundation for all applied scientists interested in social justice, indigenous decolonization, and improving the human condition. (shrink)

Informed consent is reviewed as it applies to psychiatric patients. Although new legislation, such as the Mental Health Act 1983, provides a useful safeguard for the protection of the civil rights of patients, it could actually reduce their humane care unless applied with sensitivity for the nature of their unique difficulties. In order to guard against this possibility, we suggest that legal requirements should be considered in light of the ethical principles which underlie them. Three principles are considered: (...) those of autonomy (freedom); beneficence (paternalism); and the fiduciary principle (partnership). Psychotherapy is offered as a model for informed consent, which might be generalised to other clinical situations. (shrink)

At the time of writing, euthanasia for psychiatric conditions is legal in Belgium and the Netherlands, in cases that are judged to involve unbearable and untreatable suffering. There is a difference between ‘euthanasia’ and ‘assisted suicide’ or ‘assisted dying’. Although I will refer for the most part to ‘psychiatric euthanasia,’ my points apply equally to assisted dying. Even where these practices are legal, they are highly controversial. One case, in particular, received considerable media attention. In the Netherlands, on (...) January 26, 2018, a 29-year-old woman called Aurelia Brouwers ended her life... (shrink)

In the Netherlands and Belgium, it is lawful for voluntary euthanasia to be offered on the grounds of psychiatric suffering. A recent case that has sparked much debate is that of Aurelia Brouwers, who was helped to die in the Netherlands on account of her suffering from borderline personality disorder. It is sometimes claimed that whether or not a mentally ill person’s wish to die is valid hinges on whether or not that wish is a symptom of the person’s (...) mental disorder. This article addresses the philosophical problems raised by this claim, with a specific focus on the diagnosis of borderline personality disorder. After considering descriptivist and causal conceptualizations of mental disorder, I argue that the current approach to borderline personality disorder in psychiatry precludes the possibility of dissociating the wish to die from the disorder. I then examine the implications of this analysis for the question of whether or not the request for voluntary euthanasia in the case of borderline personality disorder can be considered valid. Ultimately, I conclude that the inability to dissociate the wish to die from the disorder does not invalidate the wish in the case of borderline personality disorder. (shrink)

There is a ‘catch 22’ situation about applying coercion in psychiatric care. Autonomous choices undeniably are rights of patients. However, emphasizing rights for a mentally-ill patient could jeopardize the chances of the patient receiving care or endanger the public. Conversely, the beneficial effects of coercion are difficult to predict. Thus, applying coercion in psychiatric care requires delicate balancing of individual-rights, individual well-being and public safety, which has not been achieved by current frameworks. Two current frameworks may be distinguished: (...) the civil liberty approach and the Stone model. Both frameworks are restrictive, and not respectful of human dignity. In a civil liberty approach, individuals who are severely mentally-ill but not dangerous would be denied care because they do not meet the dangerousness threshold or because the use of coercion will not lead to rebirthing of autonomy. This is unsatisfactory. Albeit involuntary interventions such as talk therapies, peer-support etc., may not always lead to rebirthing of autonomy or free patients from mental illness; they can however help to maintain the dignity of each mentally ill patient. In place of these frameworks, this study proposes a new ethical framework for applying coercion in psychiatric care that is respectful of human dignity. Specifically, it draws on insights from the African ethico-cultural system by using the Yoruba concept Omo-olu-iwabi to develop this new framework. This way, the study shows that only a more respectful approach for applying coercion in psychiatric care can lead to the careful balancing of the competing interests of individual's rights, individual's well-being and public safety. (shrink)

This article presents the notions of ethos and eidos as field level concepts for the sociology of morality and the anthropology of ethics. This is accomplished in the context of Bourdieuan social theory and, therefore, from the broad standpoint of practice theory. In the first instance these terms are used to refer to the normative structures of social fields and are conceived so as to represent the way in which such structures fall between two planes, that of the implicit (...) and the explicit. Subsequently, they are used to further understand a distinction between morality—roughly, the implicit moral order of a social field—and ethics—the more explicit and often codified elements of a social field’s normative structure. When presented in relation to academic philosophical inquiries into the ethical issues in healthcare and the life sciences—meaning the disciplines of applied ethics in general and applied ethics in particular—the analytic perspective these terms facilitate enables us to represent the fundamental conditions required for academic enquiry; taken together the ethos and eidos of an intellectual field constitute the requisite background of its normative epistemic and methodological commitments, thereby providing the structures of disciplined intellectual practices. Seen in this light it not only becomes possible to grasp applied ethics as a socially structured practice but to understand it in terms that can also be used to frame our everyday moral practices. In this way applied ethics can be acknowledged as a relatively unique part of our contemporary moral culture. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Psychiatric Treatment and the Problem of Equality:Whose Justice, Which Rationality?Floris Tomasini (bio)KeywordsInvoluntary treatment, democracy, equality, impartialityCraig Edwards in his article "Ethical Decisions in the Classification of Mental Conditions As Mental Illness" provides the reader with a socially normative, rather than a naturalistic understanding of mental illness, one that, in particular, promotes a normative understanding of mental illness as a form of evaluating dysfunctional personhood. In doing so, Edwards (...) is not interested in undermining psychiatric expertise, but exploring some of the practical consequences that flow from it, such as involuntary psychiatric treatment.My concern about psychiatric treatment in general and involuntary psychiatric treatment in particular, is three-fold, the third concern adding to the arguments already rehearsed by Edwards and others. The first concern is about the value neutrality of mental illness. Any dysfunctional conception of mental illness is not value neutral according to Fulford; dysfunction is, straightaway, a normative concept and is heavily influenced by a patient's desires and values. The second concern is about competing and conflicting values that arise in a person's psychiatric treatment. Again, there exists a legitimate variation in people's evaluative judgments about mental health conditions, for which a degree of democratic compromise might be required in negotiating conflicting values in a person's psychiatric treatment (Fulford and Colombo 2004). Without wishing to examine any of the philosophical foundations or counter-arguments to these claims in this short discussion paper, my third concern is about how to ethically negotiate between conflicting values in a person's psychiatric treatment. In other words, what might democratic compromise consist in? How might democratic compromise be implemented in terms of an ethically relevant principle?Any democratic enterprise, by definition, favors or is characterized by social equality and is egalitarian in nature (New Oxford English Dictionary 1999, 490). To be able to negotiate in the spirit of democratic compromise between competing and conflicting values in the process of psychiatric treatment, a principle of equal consideration of interests is vital.The essence of the principle of equal consideration of interests is that we give equal weight in our [End Page 101] moral deliberation to the like interests of all those affected by our actions (Singer 1979, 19). In other words, an interest is an interest whoever's interest that may be. So, for example, if the principle is about relieving pain, then the moral principle is about relieving the undesirability of pain as such, and not the undesirability of A's pain, which might be different from the undesirability of B's pain. Naturally, one may be able to distinguish that A's pain is greater than B's pain, in which case, under the equal consideration of interests principle, A's pain should be given greater weighting than B's pain in any conflict of interests. In short, in the evaluation of like interests, major interests outweigh minor interests.The significance of the principle of equal consideration of interests in decisions about mental health treatment in general, and about involuntary psychiatric detention and treatment more specifically, is that it should be possible (in theory at least) to able to democratically arbitrate on the basis of utility, whose interests take precedence when legitimate conflicts arise. The great practical advantage to the principle of equal consideration of interests is that it weighs' interests impartially—like well-balanced weighing scales; they favor where the interest is stronger or where several interests combine to outweigh a smaller number of similar interests. Most important, in the case of psychiatric treatment, it is a principle that takes no account of whose interests they are, avoiding any discriminatory stigma that may arise because of having made certain assumptions about being mentally ill. From the point of view of the equal consideration of interests, who the bearer is and how they are classified is, in itself, incidental to what the actual bearer's interests are and how they compete and conflict with others who have like interests. There are a number of practical consequences that flow from the principle of equal consideration when applied to psychiatric treatment (voluntary and involuntary) that need to be pinned down.Simple Negative DiscriminationClearly... (shrink)

Applying a necessary condition communication theory formalism roughly similar to that of Dretske, but focused entirely on the statistical properties of long sequences of signals emitted by the interacting cognitive modules of human biology, we explore the regularities apparent in comorbid psychiatric and chronic physical disorders using an extension of recent perspectives on autoimmune disease. We find that structured psychosocial stress can literally write a distorted image of itself onto child development, resulting in a life course trajectory to characteristic (...) forms of comorbid mind/body dysfunction affecting both dominant and subordinate populations within a pathogenic social hierarchy. (shrink)

This book explores the role and implications of responsibility for anthropology, asking how responsibility is recognised and invoked in the world, what relations it draws upon, and how it comes to define notions of the person, institutional practices, ways of knowing and modes of evaluation. The category of responsibility has a long genealogy within the discipline of anthropology and it surfaces in contemporary debates as well as in anthropologists' collaboration with other disciplines, including when anthropology is (...) class='Hi'>applied in fields such as development, medicine, and humanitarian response. As a category that unsettles, challenges and critically engages with political, ethical and epistemological questions, responsibility is central to anthropological theory, ethnographic practice, collaborative research, and applied engagement. With chapters focused on a variety of cultural contexts, this volume considers how anthropology can contribute to a better understanding of responsibility, including the 'responsibility of anthropology' and the responsibility of anthropologists to specific others. (shrink)

This paper analyses ethical issues in forensic psychiatric research on mentally disordered offenders, especially those detained in the psychiatric treatment system. The idea of a 'dual role' dilemma afflicting forensic psychiatry is more complicated than acknowledged. Our suggestion acknowledges the good of criminal law and crime prevention as a part that should be balanced against familiar research ethical considerations. Research aiming at improvements of criminal justice and treatment is a societal priority, and the total benefit of studies has (...) to be balanced against the risks for research subjects inferred by almost all systematic studies. Direct substantial risks must be balanced by health benefits, and normal informed consent requirements apply. When direct risks are slight, as in register-based epidemiology, lack of consent may be counter-balanced by special measures to protect integrity and the general benefit of better understanding of susceptibility, treatment and prevention. Special requirements on consent procedures in the forensic psychiatric context are suggested, and the issue of the relation between decision competence and legal accountability is found to be in need of further study. The major ethical hazard in forensic psychiatric research connects to the role of researchers as assessors and consultants in a society entertaining strong prejudices against mentally disordered offenders. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Deflating Psychiatric ClassificationClaudio E. M. Banzato (bio)Keywordsnosography, comorbidity, utility, pragmatismSystems of classification bring order into the world. They are a key part of the informational working infrastructure of the world we inhabit (Bowker and Star 1999). Thus, much of the human interaction hinges on these ordering—pattern identifying and creating—systems. Formal or informal, standardized or ad hoc, visible or invisible, enforced or optional, there are a myriad of classifications (...) we necessarily live by.Typically, classifications convey representations of states of affairs to make interventions on them feasible and, to some extent, predictable. In other words, classificatory systems and schemes try to confer intelligibility to the world. By succeeding in such task, they may provide rational grounds to human operation on reality (toward the most diverse ends). This account fully applies to medical classifications, which struggle to sort out all kinds of diseases, ailments, complaints, and sufferings that can possibly be targeted by medical interventions. This means classifications are instrumental to the ends pursued by medicine, quintessential modificatory activity. In sum, classifications are cognitive tools devised to build up knowledge by making relevant distinctions, which may prove helpful to guide human action.By working well, classifications eventually tend to become invisible. They end up looking just natural, as if they were carved by nature itself. But indeed purpose is the touchstone here. Even if a given class of objects fully qualifies as a 'natural kind' and necessary and sufficient criteria for class membership can be definitely established, it does not entail that it constitutes the best way to classify these objects irrespective of the context. Peter Zachar (2002) offers a compelling example from natural sciences, the utmost practical importance of distinguishing between hydrogen and its isotopes (hydrogen, deuterium, and tritium). In this case, the classificatory thrust stretches beyond the shared atomic number. In his words, "A crucial factor in recognizing them as distinct is that they are used in distinct activities and practices. We get a better neutron bounce with heavy water or D2O. Deciding what aspects of internal structure are important therefore cannot be isolated from external factors." (p. 220)In contemporary psychiatry, diagnostic classification has been center stage for several reasons. But before addressing them, however, a brief historical detour is necessary. Back in the nineteenth century, putting forward a new classification of mental diseases was taken somewhat as a token of psychiatric proficiency according to the witty remark by the French physician and publicist Philippe Buchez: "Upon believing that they have [End Page 23] completed their studies, rhetoricians will compose a tragedy and alienists a classification" (Berrios 1999, 152). By the middle of the twentieth century, many psychiatric classifications (based on diverse principles and underlying theoretical orientations) were still used across the world. The British psychiatrist Erwin Stengel (1959), in his influential report on classification of mental disorders, pointed out that the issue of difficulty of communication was then the order of the day for psychiatry, because it was widely perceived as one of the most serious obstacles to the progress in the field.The broad, worldwide survey carried out by Stengel made it clear that classifications of all shapes were used in different contexts, but they were seldom appealing outside the boundaries of the respective centers that generated them. Such diversity of classifications reflected not only different functions or purposes they were meant to serve, but also the role played by the history of a given problem within a particular medical tradition and cultural background. Thus, Stengel's aims for an acceptable statistical international classification were relatively modest: it should simply ground epidemiological work.Stengel's stance on classification was frankly pragmatic and utilitarian. He understood well the difficulties posed by the 'disease entity' assumption in psychiatry and asked the straight question: "Firstly, what do we classify in this field? Are we classifying diseases or people?", to which he offered a compromised answer: "It may be said that the material the psychiatrist has to classify consists neither of diseases nor of people but of a variety of disorders or reactions, a material which does not readily lend itself to classification" (Stengel 1959, 612). For him, the pursued agreement on the... (shrink)

This unique book applies concepts from the field of anthropology to clinical settings to result in a powerful and dynamic model/theory of clinical anthropology.

We cannot apply the principles of morla law and obligation without intimate knowledge of the subject - the human being, who has to act morally. This text argues that an anthropology is required to provide accurate information of human nature in its relationship to moral science if the universal principals are to be located in their total human context.

Anna Kawalec ABSTRACT: Through a detailed case study of investigations on beauty, I demonstrate that a thoughtful consideration of empirical evidence can lead to the disclosure of the fundamental assumptions entrenched in a philosophical discipline. I present a contrastive examination of two empirically oriented approaches to art and beauty, namely, the anthropology of art and ….

Can a planetary anthropology cope with both the "provincial cosmopolitanism" of alternative anthropologies and the "metropolitan provincialism" of hegemonic schools? How might the resulting "world anthropologies" challenge the current panorama in which certain allegedly national anthropological traditions have more paradigmatic weight--and hence more power--than others? Critically examining the international dissemination of anthropology within and across national power fields, contributors address these questions and many others.

This article aims to clarify the notion of a psychiatric disability. The article uses conceptual analysis, examining and applying established definitions of (general) disability to psychiatric disabilities. This analysis reveals that disability as inability to perform according to expectations or norms is related to impairment as deviation from the (statistical) norm, while disability as inability to achieve (personal) goals is related to impairment as deviation from the (personal) ideal. These two views of impairment and disability are distinct from (...) the self-organization view of impairment as disrupted self-creation or disrupted self-repair and of disability as disrupted whole person self-compensation (in relation to an impairment). All these three views of disability pertain to psychiatric disability. Although there is nothing necessarily psychiatric about psychiatric disability other than the psychiatric impairment related to it, the life course and life circumstances typical of many people with (severe) psychiatric disorders may lead to disability and may thus confer some (psychiatric) specificity on this disability. This analysis may facilitate research on specific psychiatric disabilities and a broader scope for psychiatric rehabilitation. (shrink)

Purpose of the article is to reconstruct the legal sources of Christian anthropology. Theoretical basis. The methodological basis of the article is the understanding of the fundamental foundations of Christian anthropology in the context of Roman legal understanding. Originality. From the point of view of the Christian religion, man is a dual being: his body is part of the material world, but his soul is not from this world, he is born directly from God. The transcendent origin of (...) the soul gives it the right to communicate with God, but this right can be realized only with the help of the Church, which is seen as the "bride of the Lamb" and the mystical "body of Christ". Interpretations of the essence of church organization correlate with the principles of organization of the Roman community. The principle of universal priesthood correlates with the idea of "post-Tarquinian democracy", recognizing the people of Rome as the supreme bearer of the empire of Jupiter; catholicity – with the idea of the senate as a meeting of the most deserving leaders of the community; apostolic succession – with the institution of republican magistrates, who even though received their power from the community, but through "consultations with the gods". In essence, Christian dogmatism is Roman law applied to the Middle Eastern religion; the Bible was interpreted as a legal document, and theologians acted as lawyers. Conclusions. In the ancient Churches the ideal of Roman law was realized as the right of impersonal law, standing outside and above the individual. The latter has no ontological value, it is a "servant of God", but the union of men into the mystical "body of Christ" makes the latter empowered to represent God on earth and to act on his behalf. The Renaissance paved the way for the Reformation, in which a powerful "Greek" lobby declared itself. Despite the fact that many leaders of the Reformation had a personal dislike for philosophy, they were spontaneous philosophers, believing themselves entitled to interpret the will of God independently, regardless of the authority of the councils. They were strict rationalists who only changed the object of their reason: if the ancient Greeks tried to comprehend the world rationally, the Protestants set themselves the goal of rationally comprehending the Book. Ultimately, the main question of Christian theology is the question of man’s attitude to God, and the differences between the anthropological systems within Christianity are the options for answering this question. (shrink)

: This contribution aims to address epistemological issues at the crossroads of philosophy of science and psychiatry by reflecting on the notions of organization and resilience. Referring to the debate on the notion of “organization” and its explanatory relevance in philosophical neo-mechanistic theories, I consider how such positions hold up when tentatively applied to the mental health context. More specifically, I show how reflections on psychiatric resilience, cognitive reserve, and accommodation strategies challenge attempts to embrace a mechanistic perspective (...) on mental disorders. A deeper focus on these aspects of mental health is relevant to theoretical discussions on explanatory models as well as for clinical practice, diagnosis, and treatment. Keywords: Psychiatric resilience; Cognitive Reserve; Organization; Mechanism Il ruolo esplicativo dell’organizzazione e la resilienza psichiatrica: sfide ad un approccio meccanicistico alla malattia mentale Riassunto: Questo articolo intende discutere alcuni temi epistemologici all’incrocio tra la filosofia della scienza e la psichiatria, riflettendo sulle nozioni di organizzazione e resilienza. Muovendo dalle riflessioni sulla nozione di “organizzazione” sviluppate nell’ambito delle teorie neo-meccaniciste, e dalla difesa del suo ruolo esplicativo, il lavoro analizza la possibilità di estendere alcune posizioni relative alla spiegazione scientifica al contesto delle scienze della salute mentale. Più nello specifico, si illustra come le indagini sulla resilienza psichiatrica, la riserva cognitiva e le strategie di compensazione possano mettere in discussione i tentativi di abbracciare una prospettiva meccanicistica quando si affronta il tema del disturbo psichiatrico. Una maggiore attenzione ai suddetti filoni di ricerca può avere un impatto significativo sia sulla discussione relativa ai modelli teorici di spiegazione della malattia mentale sia sui processi clinici di diagnosi e terapia. Parole chiave: Resilienza psichiatrica; Riserva cognitiva; Organizzazione; Meccanicismo. (shrink)

Purpose. The paper is aimed at studying the specificity of anthropological problematics in pragmatism from the perspective of its ability to be the source of analytic philosophy evolution in the socio-humanitarian direction. Theoretical basis of the research is determined by the works of the representatives of classical pragmatism, neopragmatism, post-pragmatism and analytic pragmatism. Their works give a clear understanding of the important place of anthropological searches in the theory of pragmatism. Originality. On the basis of the analysis of logical, epistemological (...) and metaphysical ideas formulated by representatives of pragmatism, it is proved that pragmatic methodology is anthropocentric. It is established that the ideological and social foundations of pragmatism can be determined as pluralistic ones due to the attention to the human person. It is revealed that theoretical and methodological searches of pragmatism can be effective in the formation of the socio-humanitarian concepts in analytic philosophy through the specification of strategies for the cognition of human existence in such terms as experience or self and the development of practical ways to justify the truth of knowledge. Conclusions. Pragmatists criticized impersonal, formal thinking, which cannot be an effective means of cognition. Thinking has a social basis and is entirely personal. Justifying its dependence on the socio-cultural sphere and the internal intentions of the subject, it is possible to develop an effective logical theory that operates symbols not only at the syntactic or semantic level but also takes into account the pragmatic aspect of language. Anthropological problematics is also important in the theory of knowledge, the core of which is the notion of pragmatic belief, which enables truth and religious beliefs, since the foundation of the theory of truth is determined by the principle of humanism, and the truth is interpreted as a value orientation. Knowing the external world, we find in it the similarity with us – that’s why the metaphysical foundations of being, according to pragmatism, are personified, and the methodology is defined in anthropomorphic terms. Applying it, the study of human existence is specified in the analysis of psychological and socio-cultural dimensions of such concepts as experience or self. Attempts to comprehend the nature of human existence in pragmatism are empirically grounded. Appealing to science, methodological pluralism, the search for socio-cultural background for thinking and suitable linguistic forms of expression of human experience are the achievements of pragmatism, which are the basis for the socio-humanitarian redescription of analytic methodology. (shrink)