The public, mental health consumers, as well as mental health practitioners wonder about what kinds of values mental health professionals hold, and what kinds of values influence psychiatric diagnosis. Are mental disorders socio-political, practical, or scientific concepts? Is psychiatric diagnosis value-neutral? What role does the fundamental philosophical question "How should I live?" play in mental health care? In his carefully nuanced and exhaustively referenced monograph, psychiatrist and philosopher of psychiatry John Z. Sadler describes the manifold kinds of values (...) and value judgements involved in psychiatric diagnosis and classification systems like the DSM. Professor Sadler takes the reader on a fascinating conceptual tour of the inner workings of psychiatric diagnosis, considering the role of science, culture, sexuality, politics, gender, technology, human nature, patienthood, and professions in building his vision of a more humane psychiatric diagnostic process. (shrink)

Medicalization has been a process articulated primarily by social scientists, historians, and cultural critics. Comparatively little is written about the role of bioethics in appraising medicalization as a social process. The authors consider what medicalization means, its definition, functions, and criteria for assessment. A series of brief case sketches illustrate how bioethics can contribute to the analysis and public policy discussion of medicalization.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.4 (2004) 357-359 [Access article in PDF] A Madness for the Philosophy of Psychiatry John Z. Sadler His enthusiasm brimming over with the rich set of ideas and problems he has discovered, Louis Charland's essay on identity, ethics, and the Internet should be grist for the philosophy of psychiatry mill for years. Indeed, a brief commentary cannot answer the many questions raised by (...) his paper. In response, I would like to focus on two general issues for this essay. Labels, Diagnoses, Reference, Experiences Many psychiatrists will take issue with Charland's use of the term label in reference to mental disorder concepts in this paper. I did not, but his relatively uncritical use of the labels and labeling terms in his essay prompts me to unpack some concepts that lurk behind the many other conceptual issues raised here. Psychiatric "labels" and "labeling" have a derogatory sense for many psychiatrists, because they are associated with a virulent antipsychiatry temperament dating back to the 1960s, at least in the United States (Sadler 2003). For many clinicians (as well as others) labeling implies that there is nothing more to psychiatric diagnosis and "mental illness" than the names given to various sorts of human diversity. This sort of psychiatric nominalism, the viewpoint goes, serves to pigeonhole people for the purposes, primarily, of political control or power. Charland's own viewpoint is more subtle than this, illustrated by his discussion of Hacking's "looping effects" and the related idea that social factors are influential in the manifestations, even causation, of mental disorders, but are not exhaustive in explaining mental disorders. However, because the whole matter of social construction of clinical phenomena is at the heart of Charland's discussion, further consideration of this metaphysical territory is warranted.The notion of a mental disorder concept as "label" betrays little about what, substantively, mental disorders are. A label on a can of peas tells us little, ultimately, about the nature of the contents; indeed, it is only a clue. When we shift labeling from a can of peas to a person—a self—then such a shallow clue to the "contents" of a person is an offensive simplification of a person's identity and selfhood. Hence the railing against psychiatric labeling in the 1960s through today.The general goals for psychiatric diagnosis and classification in systems like DSM-IV is are multiple, but at minimum, such denotations of clinical conditions are intended to advance the generation of knowledge about the conditions as well as provide a "shorthand" for clinicians in communicating about and understanding patients' conditions. How successful these diagnostic classification systems are for these and other purposes is a discussion for another time, but the [End Page 357] point here is that some sort of method of characterizing people's distresses is a precondition for understanding and explaining such distresses. The scientific processes of validation of psychiatric categories, at core, are to ensure that, as Gorenstein notes (1992), our clinical concepts are not empty, self-fulfilling prophecies, but rather refer to other, hopefully predictable, features of the patient's distress. Such validation of clinical "constructs" is the basis for developing and testing specific treatments, as well as understanding more richly and deeply the clinical phenomenon. To have a label, then, under this view, is to have an empty nominalization, which is offensive and scientifically vapid. To have a diagnostic construct—a disorder—is to have a concept which empirically refers to, as Paul Meehl put it, a "nomological network" of predictable, lawlike, implications (Sadler 2004a).However, as Charland, Hacking, and others have noted, the reflexivity of the human self and our ultimately crude ways of characterizing selves leads to a serious problem, even for the most rigorously validated psychological categories. That problem is the changeability of the self, the capacity of people to remake themselves according to their own ideas along with the sociocultural ether of ideas that surrounds us all. This means that our understanding of mental disorders, both as aggregates of features, and well as individual patients over time, are "moving targets," the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.4 (2005) 307-310 [Access article in PDF] Aesthetics, Criticism, and Psychotherapy John Z. Sadler Keywords aesthetics, psychiatry, psychotherapy, Sibley In his wide-ranging survey of how Kantian aesthetic theory is implicated in psychothera-py, John Callender has raised at least a dozen potentially profound and rewarding possibilities in applying aesthetic theory to psychiatry and psychotherapy. Although the idea of marrying aesthetic theory to psychiatry (...) and psychotherapy is not new, Callender's direction of the merger is distinctively novel. The mid-twentieth century had a distinct literature in applying psychoanalytic and psychiatric theory to aesthetic experience, summarized by the sizable bibliography by Norman Kiell, Psychiatry and Psychology in the Visual Arts and Aesthetics: A Bibliography (1965). This line of interdisciplinary work influenced a later generation of art historians and literary theorists in applying (particularly) psychoanalytic theory to interpretation and appreciation of the arts, contributions that are still being developed today, along with the emergence of complementary viewpoints from cognitive neuroscience (Peretz and Zatorre 2003; Rose 2004; Zeki 1999). Callender's project, however, is quite the converse—he wishes to show how philosophical aesthetics can contribute to psychiatry and clinical psychology. Exploring the aesthetics of psychiatry is the innovation.Before focusing my own comments on a few of Callender's points, I wish to call attention to the substantive questions he has directly raised or implied by his discussions. These questions are worthy of further development in this and other journals, and I hope that Callender will succeed in engaging the minds of his readers and inspire them to work in this exciting area in the philosophy of psychiatry. In his elegant review of Kant's key theoretical points of aesthetics, his discussion provokes us to consider the kinds of evaluations that patients make of themselves (moral? aesthetic? others?), as well as the kinds of evaluations clinicians make in their judgments of psychopathology. Evolutionists may wonder about the adaptive significance of aesthetic capacities (e.g., derivatives of grooming? mating displays?). In presenting Kant's notion of "disinterestedness" or contemplative judgment, readers may wonder about overlap with notions of therapist neutrality and unconditional positive regard. Should therapist relationships with patients be dominated by a similar aesthetic sensibility? What does the aesthetic posture have to do with the therapist posture?Importantly, Callender notes the connections and ambiguities between moral values and aesthetic values. This is borne out in his later discussions of clinical case material (considered again below). He focuses primarily on the duplication of aesthetic and moral values in the same terms of praise (honesty, integrity, originality), but there is no question that aesthetic experiences are had by viewers of art exhibiting perverse or depraved [End Page 307] imagery (consider, for instance, Francis Bacon's "3 Screaming Popes" or, even more extremely, the grotesque staged photographs of Joel-Peter Witkin). The implication here is that (as an example) to understand the aesthetics of sadomasochistic art may help us to understand the psychology of sadomasochistic people.By the time he introduces his case material, Callender has raised the issue of intersubjectivity in aesthetic experience, an experience that may be devoid of discursive cognitive content but may be profound with emotional content, thus challenging tenets of cognitive psychology and psychotherapy. His discussion of cases reflecting elements of Kant's components of aesthetic judgment point toward new ways of understanding psychopathology as disturbances in aesthetic self-appraisal.I would like to return to the problem of moral and aesthetic judgments in psychotherapy and in psychopathology. Dr. Callender presents three cases—a woman who has been traumatized by multiple instances of sexual abuse, a young girl with postpartum depression with fears of losing her child because of bad mothering, and a third patient with anorexia nervosa who demonstrates the typically distorted body self-image. I suggest that the aesthetic nature of these patients' self-judgments is not so clear cut as Callender suggests. His sexual abuse case summary certainly suggests a woman consumed by shame. Because shame is a typical "moral emotion," the question is raised of moral badness being involved in her self-concept as well as, or perhaps... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.4 (2003) 295 [Access article in PDF] Agency, Narrative, and Self:A Philosophical Case Conference John Z. Sadler and K. W. M. Fulford This issue of PPP features our second "philosophical case conference," which addresses three important and interrelated concepts in the philosophy of psychiatry. Our first philosophical case conference (Philosophy, Psychiatry, and Psychology Volume 5, Number 2, 1998) featured detailed case material concerning (...) the manifold issues involved in psychiatric euthanasia. For this issue, guest edited by J. Melvin Woody, the rich cases supplied by Lloyd Wells provide the foundation for a discussion of narrative accounts of the self and what it means to be an agent.Philosophical case conferences are an occasional feature of PPP, and develop topics to satisfy one or more criteria: to provide discussions that are important to clinical practice or research, to embed current or perennial philosophical debates in the nitty gritty of clinical practice and personal experience, and/or to provide a clinical testing ground for new conceptual developments relevant to the philosophy of psychiatry.The format for this issue involves four feature articles, the first by Wells, presenting detailed case material of several patients, followed by discussions (by Kennett & Matthews, Phillips, and Woody) inspired by, or addressing explicitly, the philosophical questions implied in such cases. Following these four feature articles, a panel of commentators (Glas, Hardcastle, Radden, Thornton, Weiner, Woodbridge) respond to the four feature articles as they wish, providing the variations on the agency, narrative, and self themes. We think you will find this issue of PPP to be a fine example of what the philosophy of psychiatry can do, and we give our abundant thanks to Mel Woody for putting this issue together.... (shrink)

The philosophy of medicine and psychiatry has considered the defining of disease, illness, and disorder an important project for over three decades. Within this literature, accounts based on adaptive "functions" have been prominent, particularly in the DSM nosology. In response to this trend, Jerome Wakefield has presented a view of mental disorder as "harmful dysfunction." In this view, "harm" contributes the value-element to disorder concepts, while "dysfunction" implies a value-free foundation as long as the latter is grounded in evolutionary biology. (...) In a critical review of Wakefield's and others' functionalist arguments for disorder concepts, we make four major points. We recommend a shift away from the definition of value-free disorder concepts, instead emphasizing the analysis of the logical features and the value commitments in nosological categories. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Concurrent Contents: Recent and Classic References at the Interface of Philosophy, Psychiatry, and PsychologyArticlesAntonak, R. J., C. R. Fielder, and J. A. Mulick. 1993. A scale of attitudes toward the application of eugenics to the treatment of people with mental retardation. Journal of Intellect Disabilities Research 37:75–83.Arens, K. 1996. Commentary on “Lumps and bumps.” Philosophy, Psychiatry, & Psychology 3:15–16.Bavidge, M. 1996. Commentary on “Minds, memes, and multiples.” Philosophy, Psychiatry, (...) & Psychology 3:29–30.Blashfield, R. K. 1973. Evaluation of the DSM-II classification of schizophrenia as a nomenclature. Journal of Abnormal Psychology 85(2):140–150.Braude, S. E. 1996. Multiple personality and moral responsibility. Philosophy, Psychiatry, & Psychology 3:37–54.Broverman, I. K., S. R. Vogel, D. M. Broverman et al. 1972. Sex-role stereotypes: a current appraisal. Journal of Social Issues 28:59–78.Broverman, I. K., D. M. Broverman, P. E. Clarkson et al. 1975. Sex-role stereotypes and clinical judgments of mental health. Journal of Consulting and Clinical Psychology 34:1–7.Checkland, D., and M. Silberfeld. 1996. Mental competence and the question of beneficient intervention. Theoretical Medicine 17(2):121–134.Clark, S. R. L. 1996. Commentary on “Multiple personality and moral responsibility.” Philosophy, Psychiatry, & Psychology 3:55–57.Clark, S. R. L. 1996. Minds, memes, and multiples. Philosophy, Psychiatry, & Psychology 3:21–28.Dickenson, D., and D. Jones. 1995. True wishes: The philosophy and developmental psychology of children’s informed consent. Philosophy, Psychiatry, & Psychology 2:287–303.Donaldson, T. 1978. Psychoanalyzing the practical inference model. Philosophical Research Archives 4:1215.Eekelaar, J. 1995. Commentary on “True wishes.” Philosophy, Psychiatry, & Psychology 2:305–307.Fisher, S., and R. P. Greenberg. 1993. How sound is the double-blind design for evaluating psychotropic drugs? Journal of Nervous and Mental Disease 181:345–350.Fulwiler, C., and M. F. Folstein. 1995. Commentary on “Chris Walker’s interpretation of Karl Jaspers’ phenomenology.” Philosophy, Psychiatry, & Psychology 2:345–346.Heinze, M. 1995. Commentary on “Moralist or therapist?” Philosophy, Psychiatry, & Psychology 2:31–32.Iturrate, M. 1977. Man’s freedom: Freud’s therapeutic goal. Review of Existential Psychology and Psychiatry 15:32–45.Littlewood, R. 1991. From diseae to illness and back again. Lancet 337:1013–1015.Maddox, J. 1993. New genetics means no new ethics. Nature 364:97.McCormick, S. 1995. Commentary on “True wishes.” Philosophy, Psychiatry, & Psychology 2:309–310.Murray, T. H. 1995. Commentary on “True wishes.” Philosophy, Psychiatry, & Psychology 2:311–312.Muzika, E. G. 1989. Object relations theory, Buddhism, and the self-synthesis of eastern and western approaches. International Philosophical Quarterly 30(1):59–74.Parker, M. 1995. Commentary on “True wishes.” Philosophy, Psychiatry, & Psychology 2:313–314.Phillips, J. 1996. Key concepts: Hermeneutics. Philosophy, Psychiatry, & Psychology 3:61–69.Pole, D. 1970. Self and personality. The Journal of the British Society for Phenomenology 1:30–36.Priebe, S. 1989. On the subjectivity of psychiatric diagnosis. Psychiatric Praxis 16:86–89.Radden, J. 1996. Lumps and bumps: Kantian faculty psychology, phrenology, and twentieth-century psychiatric classification. Philosophy, Psychiatry, & Psychology 3:1–14.Sampson, E. E. 1981. Cognitive psychology as ideology. American Psychologist 36:730–743.Sarbin, T. R. 1976. Contextualism: A worldview for modern psychology. Nebraska Symposium on Motivation 24:1–41.Senft, P. A. 1975. The self-contradictions (antinomies) of psychotherapy: Is a solution in social action possible? The Human Context 7:367–372.Shuman, D. W. 1996. Commentary on “Multiple personality and moral responsibility.” Philosophy, Psychiatry, & Psychology 3:59–60.Sprigge, T. 1996. Commentary on “Minds, memes, and multiples.” Philosophy, Psychiatry, & Psychology 3:31–36.Wallace, K. 1996. Commentary on “Lumps and bumps.” Philosophy, Psychiatry, & Psychology 3:17–20.Wells, L. A. 1995. Commentary on “True wishes.” Philosophy, Psychiatry, & Psychology 2:315–317.Wiggins, O. P., and M. A. Schwartz. 1995. Chris Walker’s interpretation of Karl Jaspers’ phenomenology: a critique. Philosophy, Psychiatry, & Psychology 2:319–343.BooksAmerican Hospital Association. 1994. Values in conflict: Resolving ethical issues in health care. 2nd ed. Chicago: American Hospital Association.American Medical Association. 1992. Code of medical ethics: Annotated current opinions of the council on ethical and judicial affairs. Chicago: American Medical Association.———. 1994. Council on ethical and judicial affairs... (shrink)

Contemporary philosophy of science tells us that scientific theories are “underdetermined” by their accompanying data in a variety of ways. Briefly put, theories are not constructed on data alone. Psychiatric classification is subject to this same kind of underdetermination. Theories may be determined by a combination of data, historical factors, practical constraints, value commitments, and other factors. While practical constraints (like user-friendliness or compatibility across diagnostic systems) are commonly admitted to be influential in shaping psychiatric classification, the idea that values (...) shape psychiatric classification is still a controversial one. This article addresses this controversy by (1) defining a particular domain or type of value commitment (epistemic values), (2) showing how they might be assumed in psychiatric classification, (3) developing a set of conceptual tools to analyze epistemic value content, and (4) applying this set of tools to concretely illustrate how this type of value is “at work” in shaping classification. A classic paper on the dispute between categorical and dimensional models for personality disorders is systematically examined to illustrate this “epistemic value” rubric. (shrink)

The Oxford Handbook of Psychiatric Ethics is the most comprehensive treatment of the field in history. The volume is organized into ten sections which survey the scope of the text: Introduction, People Come First, Specific Populations, Philosophy and Psychiatric Ethics, Religious Contexts of Psychiatric Ethics, Social Contexts of Psychiatric Ethics, Ethics in Psychiatric Citizenship and the Law, Ethics of Psychiatric Research, Ethics and Values in Psychiatric Assessment and Diagnosis, Ethics and Values in Psychiatric Treatment. Written and edited by an international (...) team of experts, this landmark book provides a powerful and compelling review of psychiatric ethics in the 21st Century. (shrink)

The essays on obesity in this issue frequently refer to the recent American Medical Association (AMA) declaration of obesity as a disease. In response to these essays, I describe and explore the significance of ‘risk–factor medicalization’ and how negative unintended consequences with this approach to disease modeling are exemplified in many of the essays. I also relate the essays’ content to the issue of physician hubris in the face of their own helplessness in aiding the obese patient.

The concept of vice-wrongful or criminal conduct-poses a metaphysical clash with the non-moral values of impairment, injury, and incapacity that drive illness/disorder concepts. Nevertheless, vice and disorder concepts have interpenetrated psychiatry past and present through practical social-service interactions between the mental health, adult and juvenile criminal justice, and intellectual disability systems. This chapter will unpack and briefly review the philosophical issues, including considerations of moral and legal responsibility, diagnostic constructs, and the medicalization of vice in contemporary psychiatry.

A recent literature review of commentaries and ‘state of the art’ articles from researchers in psychiatric genetics (PMG) offers a consensus about progress in the science of genetics, disappointments in the discovery of new and effective treatments, and a general optimism about the future of the field. I argue that optimism for the field of psychiatric molecular genetics (PMG) is overwrought, and consider progress in the field in reference to a sample estimate of US National Institute of Mental Health funding (...) for this paradigm for the years 2008 and 2009. I conclude that the amounts of financial investment in PMG is questionable from an ethical perspective, given other research and clinical needs in the USA. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Introduction to the 30th Anniversary Issue of Philosophy, Psychiatry, & PsychologyJohn Z. Sadler (bio)This issue marks the 30th anniversary of Philosophy, Psychiatry, and Psychology (PPP). All of us at the journal are grateful to our authors, readers, editors, and publishers for enabling this landmark. To commemorate this event, I invited our Founding Editor and Chair of the Advisory Board, K.W.M. "Bill" Fulford to write a brief essay, along (...) with our panel of smart and industrious senior editors. Their instructions were simple: 500 words on PPP past, present, and/or future. These essays appear in the pages to follow. As Editor-in-Chief, I write about PPP's early commitments as a scholarly journal, situate these in the history of academic publishing, and muse over our current moment.Bill Fulford briefly discusses the early years of the journal in his essay. My perspective emerges from an editor's perspective. As co-editors in the early years, Bill and I were committed to an international authorship with comparable editorial oversight. We wanted to build a journal that would equally recognize clinical science and practice and philosophy, maintaining the rigor of each field. We saw philosophers and mental health practitioners as equal partners, collaborators, innovators, and educators. More important, PPP was intended to offer up the best criticism of the mental health and related fields.The scattershot history of scholarly editing has identified several functions of the editor over the centuries following Gutenberg's invention of the printing press in the mid-1440s. The earliest editors took liberties with the language of the Bible, trying to make it more accessible to the public; the printing press permitted fast and inexpensive reproduction. Not surprisingly, this popularizing of the Bible led to praise as well as outrage. The printing of other scholarly works followed quickly. In 1470, only about 25 years after the invention of the printing press, Niccolo Perroni called for Pope Paul II to censor Andrea Bussi's edition of Pliny the Elder's Natural History, an anthology of then-ancient writings about the natural world. This marked the first recorded instance of censorship of a more-or-less secular scholarly work (Monfasani, 1988). In the ensuing centuries, "editors" initially were the popularizers, and later the gatekeepers of texts worth (and not worth) reading. In the [End Page 1] ensuing centuries into the present, editors have been venerated both as defenders of good reading and reviled as censors or intellectual selfaggrandizers.The current moment, in my view, represents a crisis in the history of editing and editorship. Digital communications have liberated communications worldwide. However, this liberty has come at the cost of colossal amounts of material not worth reading and an explosion of divisive, destructive discourse. Even worse, internet "trolls" on social media have moved bullying out of the schoolyard and into international cyberspace. Determining what is worth reading has moved away from a cluster of (hopefully) responsible editors to anyone who wants to go to the small effort of silencing others through online harassment and even violent threats. Such cyberbullying does not eliminate elitism, but instead substitutes a toxic online "elite" without principle other than self-promotion and the alienation of others. Our contemporary online culture has yet to figure out how to shape what is, and is not, worth reading.My wish and intent for the future of PPP is to maintain and grow our place of rational, deliberative, and open discourse, even in the face of such disruptive cultural change.John Z. Sadler John Z. Sadler, MD, is the Editor-in-Chief of PPP. He is the Daniel W. Foster, MD, Professor of Medical Ethics at the University of Texas Southwestern Medical Center, as well as a Professor of Psychiatry there. He has been a PPP editor since its inception.ReferenceMonfasani, J. (1988). The first call for press censorship: Niccolo Perotti, Giovanni Andrea Bussi, Antonio Moreto, and the editing of Pliny's Natural History. Renaissance Quarterly, 41, 1–31. Google ScholarCopyright © 2023 Johns Hopkins University Press... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Recent and Classic References at the Interface of Philosophy, Psychiatry, and Abnormal PsychologyArticlesAggernaes, A. 1972. The expanded reality of hallucinations and other psychological phenomena. Acta Psychiatrica Scandinavica 48: 220–238.Anonymous. 1991. Child sexual abuse and the limits of responsibility. Lancet 337: 890.Anonymous. 1993. Mental incapacity and medical treatment. Lancet 341: 1123–1124.Appelbaum, M. D., and A. Creer. 1993. Confidentiality in group therapy. Hospital and Community Psychiatry 44: 311–312.Beatson, J. A. 1993. (...) The psychiatrist and peer review—a psychodynamic review of the literature. Australia and New Zealand Journal of Psychiatry 27: 311–318.Berrios, G. E. 1987. Dementia during the seventeenth and eighteenth centuries: a conceptual history. Psychological Medicine 17: 829–837.Blackburn, R. 1988. On moral judgments and personality disorders: the myth of psychopathic personality revisited. British Journal of Psychiatry 153: 505–512.Blackmon, W. D. 1993. Are psychoanalytic billing practices ethical? American Journal of Psychotherapy 47: 613–620.Blashfield, R. K., and J. G. Draguns. 1976. Evaluative criteria for psychiatric classification. Journal of Abnormal Psychology 85, no. 2: 140–150.Blashfield, R. K., J. Sprock, and A. K. Fuller. 1990. Suggested guidelines for including or excluding categories in the DSM-IV. Comprehensive Psychiatry 31, no. 1: 15–19.Blashfield, R. K., J. Sprock, D. Haymaker et al. 1989. The family resemblance hypothesis applied to psychiatric classification. Journal of Nervous and Mental Disease 177: 492–497.Borys, D. S. 1994. Maintaining therapeutic boundaries: the motive is therapeutic effectiveness not defensive practice. Ethics and Behavior 4, no. 3: 267–273.Brown, W. M. 1985. On defining disease. Journal of Medicine and Philosophy 10: 311–328.Bub, J. 1994a. Is cognitive neuropsychology possible? Proceedings of the Biennial Meetings of the Philosophy of Science Association 1: 417–427.Bub, J. 1994b. Testing models of cognition through the analysis of brain-damaged performance. British Journal of Philosophy of Science 45, no. 3: 837–855.Buck, C. 1989. Problems with the Popperian approach: A response to Pearce and Crawford-Brown. Journal of Clinical Epidemiology 42: 185–187.Buck, R. 1994. The neuropsychology of communication: spontaneous and symbolic aspects. Journal of Pragmatics 22, no. 3-4: 265–278.Camp, N. M. 1993. The Vietnam war and the ethics of combat psychiatry. American Journal of Psychiatry 150: 1000–1009.Crockett, C. 1961. Ethics, metaphysics, and psychoanalysis. Inquiry 4: 37–52.Dalton, E., K. Hopper, and S. Reiner. 1976. Ethical issues in behavior control. Values and Ethics in Health Care 2: 1–40.Faust, D. 1993a. Use and then prove, or prove and then use? Some thoughts on the ethics of mental health professionals’ courtroom involvement. Ethics and Behavior 3, no. 3-4: 359–380.Fodor, J., and E. Lepore. 1994. What is the connection principle? Philosophy and Phenomenological Research 54: 4.Foss, L. 1994. Putting the mind back into the body: a successor scientific medical model. Theoretical Medicine 15, no. 3: 291–313.Galletly, C. A. 1993. Psychiatrist-patient sexual relationships: the ethical dilemmas. Australia and New Zealand Journal of Psychiatry 27: 133–139.Glymour, C. 1994. On the methods of cognitive neuropsychology. British Journal of Philosophy of Science 45, no. 3: 815–835.Gottlieb, M. C. 1994. Ethical decision making, boundaries, and treatment effectiveness: a reprise. Ethics and Behavior 4, no. 3: 287–293.Gutheil, T. G. 1994. Discussion of Lazarus’s “How certain boundaries and ethics diminish therapeutic effectiveness”. Ethics and Behavior 4, no. 3: 295–298.Helme, T. 1993. A special defence—a psychiatric approach to formalising euthanasia. British Journal of Psychiatry 163: 456–466.Kovel, J. 1976–77. Therapy in late capitalism. Telos 30: 73–92.Lazarus, A. A. 1994a. How certain boundaries and ethics diminish therapeutic effectiveness. Ethics and Behavior 4, no. 3: 255–261.Lazarus, A. A. 1994b. The illusion of the therapist’s power and the patient’s fragility: my rejoinder. Ethics and Behavior 4, no. 3: 299–306.Lehrman, N. S. 1980. Psychiatric power and responsibility: Abuse and abdication, a proposed corrective conference. The Humanist 40: 9–13.Lockhart, T. 1992. Professions, confidentiality, and moral uncertainty. Professional Ethics: A Multidisciplinary Journal 1, no. 3-4: 33–52.Margolin, S. G. 1964. The scientific status of psychoanalytic clinical evidence (II). Inquiry 7: 37... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 4.1 (1997) 91-93 Concurrent Contents: Recent and Classic References at the Interface of Philosophy, Psychiatry, and Psychology Articles Allen, J. F., J. Hallperin, and R. Friend. 1985. Removal and diversion tactics and the control of auditory hallucinations. Behavior Research and Therapy 23:601-605.Baker, H. D. 1995. Psychoanalysis and ideology: Bakhtin, Lacan, and Zizek. History of European Ideas 20:499-504.Bernet, R. 1994. Derrida-Husserl-Freud: The trace of transference. Southern (...) Journal of Philosophy 32 suppl.:141-158.Boden, M. A. 1996. Commentary on "Towards a design-based analysis of emotional episodes." Philosophy, Psychiatry, & Psychology 3, no. 2:135-136.Castelfranchi, C., and M. Miceli. 1996. Commentary on "Towards a design-based analysis of emotional episodes." Philosophy, Psychiatry, & Psychology, no. 2:129-133.Fowes, B. J., and F. C. Richardson. 1996. Why is multiculturalism good? American Psychologist 51, no. 6:609-621.Frith, C. 1996. Commentary on "Free will in the light of neuropsychiatry." Philosophy, Psychiatry, & Psychology 3, no. 2:91-93.Forde, R. 1996. Inclusion of psychosocial conditions in clinical practice and the problem of medicalization. Theoretical Medicine 17, no. 2:151-161.Gaylin, W., and D. Doukas. 1995. The second-hand suicide threat. Hastings Center Report 25:20-22.Gillet, G. 1995. Consciousness, thought, and neurological integrity. Journal of Mind and Behavior 16, no. 3:215-233.Haskell, R. E. 1993. Realpolitik in the addictions field: Treatment-professional, popular-culture ideology, and scientific research. Journal of Mind and Behavior 14, no. 3:257-276.Kuys, T. 1995. The tally argument again. Methodological Science 28, nos. 2-3:43-55.Lear, J. 1995. The heterogeneity of the mental: Sebastian Gardner's irrationality and the philosophy of psychoanalysis. Mind: A Quarterly Review of Psychology and Philosophy 104:863-879.Libet, B. 1996. Commentary on "Free will in the light of neuropsychiatry." Philosophy, Psychiatry, & Psychology 2, no. 3:95-96.Lloyd, D. 1996. Commentary on "Toward a design-based analysis of emotional episodes." Philosophy, Psychiatry, & Psychology 3, no. 2:127-128.Pepper-Smith, R., W. R. C. Harvey, and M. Silberfeld. 1996. Competency and practical judgment. Theoretical Medicine 17, no. 2:135-150. [End Page 91]Spence, S. A. 1996a. Free will in the light of neuropsychiatry. Philosophy, Psychiatry, & Psychology 3, no. 2:75-90.------. 1996b. Response to the commentaries. Philosophy, Psychiatry, & Psychology 3, no. 2:99-100.Stein, D. J. 1996. The philosophy of psychopathy. Perspectives in Biology and Medicine 39:569-580.Stephens, G. L. 1996. Commentary on "Free will in the light of neuropsychiatry." Philosophy, Psychiatry, & Psychology 3, no. 2:97-98.Varela, C. R. 1995. Ethnogenic theory and psychoanalysis: The unconscious as a social construction and a failed explanatory concept. Journal for the Theory of Social Behavior 25:4.Weisberger, A. M. 1995. The ethics of the broader usage of Prozac: Social choice or social bias? International Journal of Applied Philosophy 10, no. 1:69-74.Wright, I., A. Sloman, and L. Beaudoin. 1996a. Response to the commentaries. Philosophy, Psychiatry, & Psychology 3, no. 2:137.------. 1996b. Towards a design-based analysis of emotional episodes. Philosophy, Psychiatry, & Psychology 3, no. 2:101-126. Books American Psychiatric Association. Task Force on Consent to Voluntary Hospitalization. 1993. Consent to voluntary hospitalization. Washington, DC: American Psychiatric Association.Christiansen, H. D. 1972. Ethics in counseling: Problem situations. Tucson: University of Arizona Press.Clark, P., and C. Wright, eds. 1988. Mind, psychoanalysis and science. New York: Blackwell.Comerchero, V., ed. 1970. Values in conflict: Christianity, marxism, psychoanalysis, existentialism. New York: Appleton-Century-Crofts.Epstein, R. S. 1994. Keeping boundaries: Maintaining safety and integrity in the psychotherapeutic process. Washington, DC: American Psychiatric Press.Fairbairn, G. J. 1995. Contemplating suicide: The language and ethics of self harm. New York: Routledge.Grubb, A., ed. 1991. Decision-making and problems of incompetence. New York: John Wiley & Sons.Haas, L. J., and J. L. Malouf. 1995. Keeping up the good work: A practitioner's guide to mental health ethics. 2nd ed. Sarasota: Professional Resource Exchange.Hacking, I. 1995. Rewriting the soul: Multiple personality and the sciences of memory. Princeton: Princeton University... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 3.2 (1996) 139-142 Concurrent Contents: Recent and Classic References at the Interface of Philosophy, Psychiatry, & Psychology Articles Abramowitz, S., C. Abramowitz, C. Jackson et al. 1973. The politics of clinical judgment. Journal of Consulting and Clinical Psychology 41: 385-391.Audi, R. N. 1972. Psychoanalytic explanation and the concept of rational action. The Monist 56: 444- 464.Barondess, J. A. 1979. Disease and illness--a crucial distinction. American (...) Journal of Medicine 66: 375-376.Barrett, R. J. 1988. Interpretations of schizophrenia. Culture, Medicine and Psychiatry 12: 357-388.Bechtel, W. 1993. The case for connectionism. Philosophical Studies 7: 119-154.Belzen, J. A. 1995. The impact of phenomenology on classical psychiatry: Rümke's position between Jaspers and Kraepelin. History of Psychiatry 6: 349-385.Benda, C. E. 1967. Neuroses of conscience. Journal of Existentialism 7: 425-442.Binns, P. 1995. Commentary on "Contentless consciousness." Philosophy, Psychiatry, & Psychology 2: 61-63.Blankenburg, W. 1980. Phenomenology and psychopathology. Journal of Phenomenological Psychology 11: 50-78.Bloomfield, T. M. 1979. Psychoanalysis: A human science? Journal for the Theory of Social Behavior 9: 271-287.Blumenfeld, D. 1972. Free action and unconscious motivation. The Monist 56: 426-443.Boudreaux, G. 1977. Freud on the nature of unconscious mental processes. Philosophy of the Social Sciences 7: 1-32.Bracken, P. J. 1995. Beyond liberation: Michael Foucault and the notion of a critical psychiatry. Philosophy, Psychiatry, & Psychology 2, no. 1: 1-13.Brazier, M. 1995. Commentary on "Who should be committable?." Philosophy, Psychiatry, & Psychology 2, no. 1: 49-50.Bursztajn, J., and A. Brodsky. 1995. Authenticity and autonomy in the managed-care era: Forensic psychiatric perspectives. Journal of Clinical Ethics 5, no. 3: 237-242.Byrnes, J. F. 1979. Suggestions on writing the history of psychological data. History and Theory 16: 297-305.Campbell, E. J., J. G. Scadding, and R. J. Roberts. 1979. The concept of disease. British Medical Journal 2: 757-762.Carveth, D. 1988. In reply to Eagle's reply on "The epistemological foundations of psychoanalysis." Philosophy of the Social Sciences 18: 377-378.Chadwick, R. F. 1995. Commentary on "Karl Jaspers and Edmund Husserl." Philosophy, Psychiatry, & Psychology 2, no. 1: 83-84.Christiansen, B. 1964. The scientific status of psychoanalytic clinical evidence (III). Inquiry 7: 47-79.Davis, M. 1987. Realistic utilitarianism and the social conditions of cognitive psychotherapy. Social Theory & Practice 13: 237-259.Dega, W., et al. 1978. Ethics and mental health: Discussion. Dialectics and Humanism 5: 219-235.Dingle, H. 1949. The logical status of psycho-analysis. Analysis 9: 63-66.Dupeau, J. 1977. Freud and degeneracy. Diogenes Spring: 43-64.Eagle, M. 1988. A reply to Carveth's "The epistemological foundations of psychoanalysis. Philosophy of the Social Sciences 18: 371-375.Elevitch, B. 1974-75. Reasons, motives and psychoanalysis. Philosophical Forum (Boston) 6: 143- 162.Elliot, P. 1995. Policies, identity, and social change: Contested grounds in psychoanalytic feminism. Hypatia 10: 41-55.Fabrega Jr, H. 1980. The position of psychiatric illness in biomedical theory: A cultural analysis. Journal of Medicine and Philosophy 5: 145-168.Fisk, G. 1993. Accreditation of psychotherapists. British Journal of Hospital Medicine 50: 437-438.Flynn, B. G. 1985. Reading Habermas reading Freud. Human Studies 8: 57-76.Forrow, L., R. M. Arnold, and J. Frader. 1991. Teaching clinical ethics in the residency years--preparing competent professionals. Journal of Medicine and Philosophy 16: 93-112.Friedman, M. 1982. Philosophical anthropology and psychotherapy. Philosophical Context 12: 9-19.Galdston, I. 1969. The ontologic foundations of morality. Existential Psychiatry 7: 69-75.Gardner, S. 1995a. Commentary on "Irrationality and the dynamic unconscious." Philosophy, Psychiatry, & Psychology 2, no. 2: 175-176.Gardner, S. 1995b. Psychoanalysis, science, and commonsense. Philosophy, Psychiatry, & Psychology 2, no. 2: 93-113.Handelsman, M. M. et al. 1995. Does legally mandated consent to psychotherapy ensure ethical appropriateness? The Colorado experience. Ethics and Behavior 5, no. 2: 119-129.Hanlon, M. D. 1977. Commentary on Dunham's "Psychiatry, Sociology and Civil Liberties." Values and Ethics in Health Care 2: 275-278.Heaton, J. M. 1972. Insight in... (shrink)

Readers, please welcome the new Philosophy, Psychiatry, & Psychology editorial team of Senior Editors and our Managing Editor. We are grateful to keep our veteran Senior Editors Tim Thornton, Nancy Potter, Mona Gupta, and Werdie van Staden. However, we are equally grateful to have our new cohort of Senior editors, Awais Aftab, Anna Bergqvist, Derek Strijbos, and Michael Wong, revitalize our efforts. Many of you already know our efficient and capable Managing Editor, Sébastien Arviset, who has been with us for (...) several years now. This new influx of talent and energy we hope will invigorate the Journal and keep our editorial operations smooth and efficient. In alphabetical order, our editors can tell you a little... (shrink)

Friends, family, and the Association of the Advancement of Philosophy and Psychiatry community mourn the death of Osborne "Ozzie" Wiggins this past May 18. In many ways, his story contributes a large portion to the founding of the AAPP, this journal, and the philosophy/psychiatry community worldwide.I met Professor Wiggins as a sophomore at Southern Methodist University in Dallas in 1974. I was a student in his twentieth-century humanities class. I didn't know at the time that he was in his early (...) years as an academic, having recently obtained his PhD in philosophy from the New School for Social Research in New York. Moreover, I hadn't yet encountered a teacher who was so audacious as to tell his students on... (shrink)

In his response to Szasz' Secular Humanism and Scientific Psychiatry, the author considers the use of rhetorical devices in Szasz' work, Szasz' avoidance of acknowledging psychiatry's scientific distinctions, and Szaszian libertarianism versus liberalism.

This essay introduces a thematic issue focused on the contributions to clinical ethics and the philosophy of medicine by Richard M. Zaner. We consider the apparent divorce of Zaners philosophical roots from his recent narrative immersions into the blooming, buzzing confusions of clinical-moral lifeworlds. Our considerations of the Zanerian context and origins of the clinical encounter introduce the fundamental questions faced by Zaner and his commentators in this issue, questions about the role of ethics consultants, moral authority, and clinical truths.

Philosophy has much to offer psychiatry, not least regarding ethical issues, but also issues regarding the mind, identity, values, and volition. This has become only more important as we have witnessed the growth and power of the pharmaceutical industry, accompanied by developments in the neurosciences. However, too few practising psychiatrists are familiar with the literature in this area. -/- The Oxford Handbook of Philosophy and Psychiatry offers the most comprehensive reference resource for this area ever published. It assembles challenging and (...) insightful contributions from key philosophers and others to the interactive fields of philosophy and psychiatry. Each contributions is original, stimulating, thorough, and clearly and engagingly written - with no potentially significant philosophical stone left unturned. Broad in scope, the book includes coverage of several areas of philosophy, including philosophy of mind, science, and ethics. For philosophers and psychiatrists, The Oxford Handbook of Philosophy and Psychiatry is a landmark publication in the field - one that will be of value to both students and researchers in this rapidly growing area. (shrink)

Philosophers have hitherto only interpreted the world in various ways; the point is to change it.Karl marx’s distinction between interpreting the world and changing it points by extension to the state of contemporary philosophy and psychiatry. The 1990s resurgence of interdisciplinary work in this area was driven equally by phenomenological scholarship and by initiatives in analytic philosophy. The former reflected the focus in phenomenology on ‘what it is like’ to experience a given mental symptom with the aim of reconstructing the (...) life-worlds of people experiencing mental disorders, while the latter reflected directly or indirectly the influence of J. L. Austin and others from... (shrink)

Psychotherapy is a well-established, efficacious, and fully accepted treatment for mental disorders and psychological problems. Psychotherapy is an interpersonal practice engaging patient values, interests, and personal meanings at every step. Thereby, psychotherapy abounds with moral issues. In psychotherapy ethics, numerous moral issues converge, including self-determination or autonomy, decision-making capacity and freedom of choice, coercion and constraint, medical paternalism, boundaries between health and illness, insight into illness and the need for therapy, dignity, under- and overtreatment, and much more. The Oxford Handbook (...) of Psychotherapy Ethics covers the whole range of ethical issues in the heterogenous field of psychotherapy, closing a commonly perceived gap between ethical sensitivity, technical language, and knowledge among psychotherapists. The primary audience is psychotherapists in clinical practice. Furthermore, the Oxford Handbook of Psychotherapy Ethics addresses the whole range of professionals providing mental health services beyond psychology and medicine including counselors, social workers, nurses, or ministers. The Oxford Handbook of Psychotherapy Ethics is not only intended for a clinical audience but also for a philosophical/ethical audience. The goal of the is to explicitly link the two disciplines by fostering a productive dialogue between them, enriching both the psychotherapeutic encounter and the ethical analysis and sensitivity within and outside the clinic. (shrink)

Nature and Narrative is the launch volume in a new series of books entitled International Perspectives in Philosophy and Psychiatry. The series will aim to build links between the sciences and humanities in psychiatry. Our ability to decipher mental disorders depends to a unique extent on both the sciences and the humanities. Science provides insight into the 'causes' of a problem, enabling us to formulate an 'explanation', and the humanities provide insight into its 'meanings' and helps with our 'understanding'. Psychiatry, (...) if it is to develop as a balanced discipline, must draw on input from both of these spheres. Nature (for causes) and Narrative (for meanings) will help define the series as a whole by touching on a range of issues relevant to this 'border country'. With contributions from an international star-studded cast, representing the field of psychiatry, psychology and philosophy, this volume will set the scene for this new interdisciplinary field. This will be of interest to all those with practical experience of mental health issues, whether as providers or as users/consumers of services, as well as to philosophers, social scientists, and bioethicists. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Editors’ IntroductionK. W. M. Fulford and John Z. SadlerThe editors are delighted to present the debut of a new feature in Philosophy, Psychiatry, & Psychology, “Clinical Anecdotes.” Clinical Anecdotes are short narrative essays that present, in concise fashion, several philosophical/conceptual issues concerning the experience of psychiatric practice in a realistic, nitty-gritty story format. A Clinical Anecdote essay serves as a stimulus to selected commentators from diverse fields, who (...) will prepare short responses that address any feature of the anecdote that captures their interest and imagination. Clinical Anecdote authors may then conclude the section with their own brief response, if desired.We encourage anyone (clinicians, patients, philosophers, others) interested in the conceptual aspects of psychiatric practice to submit their own Clinical Anecdotes for publication. Submissions should be formatted as a PPP Main Paper, with no requirement for references or an abstract. Clinical Anecdotes should not exceed a 1,500-word limit, and should have an original title relevant to the narrative content of the piece.How will Clinical Anecdotes submissions be evaluated? They will be sent out for peer review as with any other PPP main article, however, what reviewers will be looking for is:• a vivid, engaging, and compelling writing style,• a story that generates multiple areas of conceptual, philosophical, or ethical interest,• relevance to the editorial focus of PPP, and• novelty of theme (the submission addresses issues that have not previously been considered as a Clinical Anecdote).We hope you will find this inaugural essay from Dr. Christopher Bailey thought provoking. [End Page 221]Copyright © 2009 The Johns Hopkins University Press... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Cause, Fault, NormJohn Z. Sadler (bio)Keywordscriminality, mental disorder, responsibilityThanks to the commentators for their fine work. In my brief comments I cannot address all that is raised, but can touch upon everyone’s discussion briefly.In her commentary, Gwen Adshead reflects on her experience as a forensic psychiatrist and therapist for violent offenders. Although Adshead discusses a number of important points, I found her insight into why some vices find (...) their way into psychiatric classification particularly compelling and thought provoking. I will here interpret these in my own terms. Dr. Adshead implies that a (perhaps) assumed folk psychology underlies our motivation to classify (as disorder) some, but not all vices. The contribution of this folk psychology does not depend on particular details, but rather, the folk psychology concerns the degree to which the vice–actor’s actions are amenable to explanation, or are transparently understandable or interpretable. We (think we) understand why prostitutes sell themselves and why tax evaders cheat; their folk psychologies are variously constituted by moralistic constructs like desperation, oppression, licentiousness, greed, opportunism, and indignation. In contrast, some offenses step outside our empathic realm: the pedophile, or the serial killer, or even the persistently acting-out child provoke onlookers to wonder, “There has to be something wrong with a person who does that!” “Loud” symptoms in themselves do not qualify; seemingly incomprehensible loud symptoms fit better into the “sick” category. Indeed, in a recent translation of Foucault’s lectures at the College de France, Foucault describes the “monster” as combining “the impossible and the forbidden.” (Foucault 1999, 56) When confronted with the impossible and forbidden, the lust for classification is irresistible.Adshead’s wonderment about the use of “really” to question the explanation of wrongful conduct (what’s “really” going on) leads naturally to Michael First’s discussion. The Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV really tries to make a firm distinction between vice and mental disorder, and First describes the DSM approach.Drawing on his experience as the DSM-IV Text Editor, Dr. First provides a particularly lucid presentation of the distinction between what I call “vice” and mental disorder. He supplies vivid examples to illustrate his points. The DSM key for distinguishing disorder from vice is whether “the deviance or conflict is a symptom of a dysfunction in the individual.” As other commentators point out later, First notes that the “vice action” (a term coined by Morse in his own commentary following) may disguise a number of possible explanations: the car thief may simply be seeking thrills and profit, or may be motivated by a delusion—leading to alternative explanations for the behavior. Sometimes the explanation for vice actions are transparent—as in the red Mustang example, but other times they are not so clear. The DSM approach requires the clinician to [End Page 51] make an explanatory claim in order to distinguish the appearance of vice versus the appearance of disorder. I think everyone would agree that an explanation of the phenomenon is required in distinguishing vice from disorder, so that much can be accepted.In my view, the problems with the DSM account are three: (1) The requirement for an internal psychological dysfunction is an easy claim to make for virtually any vice condition. The prostitute’s vice may be attributable to childhood trauma, deviant social learning, pathological desire to sexually control others, and so on. The tax evader may in turn have a pathological resentment of authority combined with a desperate financial situation and a pathological denial and avoidance of paying taxes. Every misbehavior has its psychology, and if we proclaim this psychology is abnormal or deviant, then we have an “internal dysfunction.” Indeed, it is easy to proclaim a psychology as abnormal if it is less than an ideal response to circumstances, or even an adequate response to circumstances; after all, not everyone who is exposed to sexual trauma becomes a prostitute nor does every financially desperate individual cheat on taxes. The DSM’s overinclusiveness on this account defaults to an arbitrariness about what counts as a legitimate (or not) internal dysfunction. Here there will be great argument.(2) First (and later, Wells) admits there... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reasons CountJohn Z. Sadler (bio)Keywordscriminality, mental disorder, responsibilityAs a fourth-year psychiatry resident many years ago, I encountered a patient on the psychiatric emergency service whom I have never forgotten, because my experience with him jelled a distinction about the importance of explaining violence. Brought in involuntarily by the police for being “dangerous,” he was a fearsome visage: six feet four, shaven head, angular jaw, the triangular build of (...) an athlete, a history of paranoid schizophrenia and violence. I’ll call him Mr. Big. His court order papers explained that he had threatened to kill his brother-in-law.Mr. Big’s story, in brief, was that he was a veteran on disability, and that he had purchased, some years ago, a small home using his wits and savings from his pension. Although he admitted that he could be, and had been, violent off his medications, he explained that he had been taking his medicines reliably for two years and had never had any trouble over that period—until now. His brother-in-law, according to Mr. Big, had moved in and appropriated his home while the patient was away on a trip to see a friend, and now refused to leave, to the chagrin of both the patient and his sister. Mr. Big had threatened to kill the brother-in-law in indignation with the in-law’s behavior. The brother-in-law never called or appeared. The sister, it turns out, corroborated the story, and after an examination revealed only minimal idiosyncrasies of thought and affect, the patient was referred for legal counseling, released, and the family was warned. We all hoped that justice could be found peacefully.Wilson and Adshead emphasize in their thoughtful discussion of violence and psychiatric symptoms that the explanation for the violent act is crucial to assessing its pertinence to mental disorder. What was elegant in Mr. Big’s case was that the motivation for threats of violence was proximate, morally comprehensible, corroborated by at least one other, insightful, and most of all, clear-cut. Although these features for distinguishing violence due to normative motivation versus violence due to mental disorder are addressed by Wilson and Adshead, they would agree that, unfortunately, these tools of proximity, comprehensibility, ordinariness of motivation, insight, and corroboration are often absent, unobtainable, or inadequate.But these considerations are helpful in ruling out violence as symptom, which is the lesson Mr. Big taught me—reasons count. Wilson and Adshead go on to critically consider the features that may be positive identifications for violence as symptom. With “deplorability,” they identify a feature of the violence that exceeds what I have termed “normative motivation,” which defies our empathic ability to understand the perpetrator’s point of view. However, deplorable events are perpetrated by soldiers and police in their socially approved work, so even deplorability has limits in its utility. Indeed, social psychologists’ research has shown, as Susan Fiske and colleagues put it, “Virtually anyone can be aggressive if sufficiently [End Page 73] provoked, stressed, disgruntled, or hot” (Fiske et al. 2004, 1482). Also, like “normative” motivation, deplorability is culture—and politically—relative, another limit to its utility.Even with complex causality, the INUS approach of Mackie’s offers a way to link symptoms to a more complex causal network while admitting that the social components of the causal network may exhibit particular moral and pragmatic interests. For medicine, the INUS approach is sensible and coherent with biomedicine’s intellectual culture of multifactorial causation of disease. However, criminal culpability in law is usually a dichotomous decision; any taint of choice links the offender to the whole culpability package (Sadler 2002).The conclusion one is left with is that no failsafe tools permit us to distinguish violence provoked by mental disorder versus normatively motivated violence. I tend to agree that, for some cases, we will never be able to broker the distinction between disordered violence versus nondisordered violence. My pessimism is based on the technical limitations of parsing mental life retrospectively in a way that will always allow for the kind of clear-cut distinction described in the case of Mr. Big (Sadler 2002). That is, how, after the... (shrink)

Here we develop a view of language as a form of material engagement, one that foregrounds its embodied and ecological character. Achieving such a view, however, requires disabusing ourselves of certain received and deeply entrenched notions. We present a thought experiment meant to illuminate the materiality of language, as a technological activity on par with the construction and manipulation of artifacts. We explore its implications, justifying the comparison with actual languages while emphasizing revealing differences. Ultimately, we hope to expose the (...) embodied and enactive nature of language, offering a view of language as continuous with our engagement with the environment, as opposed to a picture of language as an essentially symbolic system or code. (shrink)