" This book has been carefully crafted in that spirit.

Comment by Aaron L. Mackler on “‘Through Her I Too Shall Bear a Child’: Birth Surrogates in Jewish Law” by Elie Spitz Reply by Elie Kaplan Spitz Research Note by G. Scott Davis.

Organ donation and transplantation touch on profound, and at times elusive, values and beliefs. These involve personal identity, embodiment, the relationship between the individual and the community, and death. Different cultural and religious perspectives, reflecting deeply ingrained but often unspoken assumptions about human identity and responsibilities, subtly but profoundly affect attitudes to donation and transplantation.

Comment by Aaron L. Mackler on “‘Through Her I Too Shall Bear a Child’: Birth Surrogates in Jewish Law” by Elie Spitz Reply by Elie Kaplan Spitz Research Note by G. Scott Davis.

Judaism has understood procreation as representing a partnership between God and humans, calling for both human reverence and action. The development of in vitro fertilization raises questions about the implications of this partnership and applications of this technology. A holistic approach to Jewish ethics, drawing on traditional sources, suggests that it can be appropriate for an infertile couple to utilize IVF using their own sperm and egg to have a child. The use of donated sperm, eggs, and embryos raises significant (...) challenges that the couple must consider and address, but these procedures would be acceptable in appropriate cases. Additional issues, including preimplantation genetic testing and freezing embryos, must be considered in light of traditional precedents, ethical values, biomedical developments, and experience with the procedures. (shrink)

This paper develops the traditional Jewish understanding of justice (tzedakah) and support for the needy, especially as related to the provision of medical care. After an examination of justice in the Hebrew Bible, the values and institutions of tzedakah in Rabbinic Judaism are explored, with a focus on legal codes and enforceable obligations. A standard of societal responsibility to provide for the basic needs of all, with a special obligation to save lives, emerges. A Jewish view of justice in access (...) to health care is developed on the basis of this general standard, as well as explicit discussion in legal sources. Society is responsible for the securing of access to all health care needed by any individual. Elucidation of this standard of need and corresponding societal obligations, and the significance of the Jewish model for the contemporary United States, are considered. (shrink)

In addressing issues of access to health care and rationing, Jewish and Roman Catholic writers identify similar guiding values and specific concerns. Moral thinkers in each tradition tend to support the guarantee of universal access to at least a basic level of health care for all members of society, based on such values as human dignity, justice, and healing. Catholic writers are more likely to frame their arguments in terms of the common good and to be more accepting of rationing (...) that denies beneficial and needed health care to some persons. Jewish writers are more likely to consider individual responsibility for illness in allocation decisions and to accept differences in the health care that different members of society receive. The article considers the relevance of both shared and complementary perspectives for deliberations in nations such as the United States. (shrink)

In their target article, McKay & Dennett (M&D) conclude that only “positive illusions” are adaptive misbeliefs. Relying on overly strict conceptual schisms (deficit vs. motivational, functional vs. organic, perception vs. belief), they prematurely discount delusions asbiologicallyadaptive. In contrast to their view that “motivation” plays a psychological but not a biological function in a two-factor model of the forming and maintenance of delusions, we propose asingleimpairment in prediction-error–driven (i.e., motivational) learning in three stages in which delusions play a biologically adaptive role.

In The Democratic Soul, Aaron L. Herold argues that liberal democracy's current crisis—of extreme polarization, rising populism, and disillusionment with political institutions—must be understood as the culmination of a deeper dissatisfaction with the liberal Enlightenment. Major elements of both the Left and the Right now reject the Enlightenment's emphasis on rights as theoretically unfounded and morally undesirable and have sought to recover a contrasting politics of obligation. But this has re-opened questions about the relationship between politics and religion long (...) thought settled. To address our situation, Herold examines the political thought of Spinoza and Tocqueville, two authors united in support of liberal democracy but with differing assessments of the Enlightenment. Through an original reading of Spinoza's Theologico-Political Treatise, Herold uncovers the theological foundation of liberal democracy: a comprehensive moral teaching rehabilitating human self-interest, denigrating "devotion" as a relic of "superstition," and cultivating a pride in living, acting, and thinking for oneself. In his political vision, Spinoza articulates our highest hopes for liberalism, for he is confident such an outlook will produce both intellectual flourishing and a paradoxical recovery of community. But Spinoza's project contains tensions which continue to trouble democracy today. As Herold shows via a new interpretation of Tocqueville's Democracy in America, the dissatisfactions now destabilizing democracy can be traced to the Enlightenment's failure to find a place for religious longings whose existence it largely denied. In particular, Tocqueville described a natural human desire for a kind of happiness found, at least partly, in self-sacrifice. Because modernity weakens religion precisely as it makes democracy stronger than liberalism, it permits this desire to find new and dangerous outlets. Tocqueville thus sought to design a "new political science" which could rectify this problem and which therefore remains indispensable today in recovering the moderation lacking in contemporary politics. (shrink)

The work of Hussefl and Freud had common sources in the philosophy, psychology and physiology of the nineteenth century. Herbart, Brentano, Helmholtz, Fechner, Wundt and Mach were among the towering figures in their common background who had influence on their respective work. 1 Although contemporaries who had little concern for the other's professional interest, Husserl and Freud nevertheless struggled with some common problems. One of these is the relationship of sensation to memory and to the experience of time. The concepts (...) of sensation, memory and time were, in fact, artifacts which the empirical methods of nerve-physiology, the psychophysical testing of sensory thresholds, as well as the metaphysics and positivism of the late nineteenth century had left them. (shrink)

This paper uses Pierre Bourdieu’s field theory to develop tools for analyzing interdisciplinary scientific fields. Interdisciplinary fields are scientific spaces where no single form of scientific capital has a monopoly and therefore multiple forms of scientific capital constitute the structures and stakes of scientific competition. Scientists compete to accumulate and define forms of scientific capital and also to set the rates of exchange between them. The paper illustrates this framework by applying it to the interdisciplinary field of behavior genetics. Most (...) behavior geneticists envision their participation in the field as a means to compete for scientific capital in other fields. However, the scientific capital of behavior genetics has different values for scientists attempting to deploy it in different neighboring fields. These values depend on situations in each field and the ways behavior genetics mediates relationships among them. The pattern of relationships of exchange helps explain the social hierarchy and several features of knowledge production within behavior genetics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 8.4 (2001) 317-322 [Access article in PDF] On Wolfgang Blankenburg, Common Sense, and Schizophrenia Aaron L. Mishara Introduction In its increasing openness to neuroscience (Cowan, Harter, and Kandel 2000) and other of its neighboring disciplines, mainstream biological psychiatry has allowed psychopathology, philosophy, and philosophical approaches to psychopathology to play an increased role in current research interests. Given this new openness, and the acknowledgment of (...) the severity of one of psychiatry's most debilitating, costly, and intractable disorders, 1 the translation of W. Blankenburg's 1969 article concerning the psychopathology of common sense does not merely serve historical interest. It is an exceptional example of a not well-known trend in German- and French-speaking psychiatry to apply philosophical phenomenology and existentialism to psychopathological research. This trend, which reached a peak in the late 1950s and was strong well into the 1970s, has dwindling, but nevertheless, current representatives in Heidelberg and Zurich and is scattered in a few other places in Europe, Japan, the United States, and South America. The view of the Zeitgeist—which may sound astonishing, even antiquated to contemporary readers—was highly ambitious: Conceptual approaches, such as philosophical ("transcendental") phenomenology, were expected to supply knowledge about the structure of consciousness and its disturbance in various mental disorders.Following the lead of Binswanger and Szilasi, who viewed schizophrenia as an "experiment of nature" that enables us to view underlying processes otherwise hidden to "natural, everyday consciousness," Blankenburg believed that it may be possible to map the formal properties of the psychopathology of schizophrenia—precisely in the loss of common sense—as a disturbance to the basic organization of conscious experience. Any attempt to summarize this rather abstract and complex approach in a brief commentary would be ill advised. In passing, rather, I will remark that such efforts could have profound relevance to the current research of schizophrenia and its underlying neurobiology. This research has gradually acknowledged the importance of taking the patient's subjective experience of the disorder into account (Mishara, Parnas, and Naudin 1998). In this commentary, I will first give an account of the biographical and clinical reasons that led Blankenburg to turn to the problem of common sense and its relevance for schizophrenia. I will then explore what implications [End Page 317] his work may have for more recent findings concerning schizophrenia. Blankenburg's Intellectual Development Born in 1928, W. Blankenburg, the son of a Lufthansa pilot who pioneered transatlantic commercial flights, began his studies in Freiburg im Breisgau in 1947. While at Freiburg, Blankenburg heard lectures in philosophy given by E. Fink (the former assistant to Husserl) and Max Mueller, and in psychology, by R. Heiss and others. After three years, Blankenburg turned to the study of medicine, producing a dissertation in 1956 on an application of Daseinsanalysis (Heidegger and Binswanger) to a case of paranoid schizophrenia. Binswanger wrote the forward to the publication. Between 1956 and 1958, Blankenburg studied internal medicine in Heidelberg with the accomplished phenomenologist of bodily experience (Leibphaenomenologer) and student of V. von Weizsaecker Herbert Pluegge. He spent one semester in Goettingen where he attended lectures by the ontological philosopher Nicolai Hartmann, who provided for Blankenburg a more useful approach to the problem of nature and natural science than Heidegger's primary emphasis on the question of Being. During his Freiburg years, Blankenburg attended small seminars led by Heidegger in the Schwarzwald forest. (Heidegger had been forbidden to teach after the end of World War II.) Blankenburg recalls that the participants would sit on logs in an open field as if to invoke Heidegger's concept of the clearing (Lichtung) of Being. While not entirely sympathetic with Heidegger's philosophy, Blankenburg learned to carefully "listen"—as Heidegger would repeatedly emphasize—to language, not merely poetic or philosophical language, but the language of the patients he would meet in clinical practice.During this time, Blankenburg heard lectures by W. Szilasi, the philosopher-scientist who held Husserl's and Heidegger's chair in the department of philosophy. Szilasi collaborated with the phenomenological psychiatrist, L. Binswanger. Their effort to apply concepts from Husserl's... (shrink)

This article argues that the sociology of knowledge as a critical subfield of sociology and the artist Marcel Duchamp are engaged in epistemologically analogous projects. Two sets of claims demonstrate the analogy: that Duchamp and the sociology of knowledge both have the same conception of and attitude toward their objects, and that they both mount similar critiques of the institutions they occupy. A set of similar practices leads both to adopt an attitude of reflexivity which courts self-refutation by changing the (...) ontological status of their objects and the epistemological status of their own practices. The analogy implies some new ways of thinking about the institutional role of the sociology of knowledge, the practice and epistemology of sociology, and perhaps the epistemic character of modernism. (shrink)

The current project introduces a general theory and supporting models that offer a plausible explanation and viable mechanism for generating and perpetuating prosocial behavior. The proposed mechanism is preferential detachment and the theory proposed is that agents utilizing preferential detachment will sort themselves into social arrangements such that the agents who contribute a benefit to the members of their group also do better for themselves in the long run. Agents can do this with minimal information about their environment, the other (...) agents, the future, and with minimal cognitive/computational ability. The conclusion is that self-organizing into groups that maintain prosocial behaviors may be simpler and more robust than previously thought. The primary contribution of this research is that a single, simple mechanism operating in different contexts generates the conceptually distinct prosocial behaviors achieved by other models, and in a manner that is more amenable to evolutionary explanations. It also bears importantly on explanations of the evolution of our moral experiences and their connection with prosociality. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Wilhelm Griesinger”Aaron L. Mishara (bio)Arens situates Wilhelm Griesinger in a historical context with which we are no longer familiar. In doing so, she has performed an important task for contemporary clinicians, philosophers, and historians. We find ourselves working and thinking (both in everyday clinical practice and in the construction of our models of mental disorder) with the same categories that Griesinger struggled to sort out and (...) redefine; we often do so, however, without awareness of their history or lack of permanence. Ackerknecht writes that all the dominant trends in modern psychiatry can be traced back to Griesinger; he states that Griesinger is the “founder of neuropsychiatry,” a “merging of the two disciplines” neurology and psychiatry. Griesinger presents us with a “systematic synthesis of the anatomical, physiological, psychological and clinical points of view” (Ackerknecht 1959, 63). Somewhat contrarily, Karl Jaspers, in his General Psychopathology, groups Griesinger with the great observers and describers of clinical experience rather than among the systematic analyzers (Jaspers 1963, 849–50). Although Griesinger is best known for his identification of mental disorders as a subset of brain diseases, Karl Bonhoeffer, a successor to Griesinger as director of the Charité Clinic in Berlin, cautions that Griesinger “continued to see in psychological causes the most frequent and abundant source of mental disorders” (Bonhoeffer 1911, 53). Kales, Kales, and Vela-Bueno, however, write, “Griesinger was representative of a clinical movement that minimized the value of psychological concepts in the understanding of mental diseases” (Kales, Kales, and Vela-Bueno 1990, 15). Precisely because of his importance, contention surrounds his legacy.If Griesinger is the pioneer of empirical approaches in biological neuropsychiatry (as Ackerknecht and others claim), he is also precursor to philosophical criticisms of their limits. It is not so easy to lump Griesinger to one side of the oppositions with which we think today: Griesinger’s scientific psychiatry (formed on the basis of the newly emergent empirical physiology) was meant to steer between the Scylla of the previously reigning overspeculative romantic medicine and the Charybdis of the antitheoretical and “positivistic” materialism of Magendie. As Arens suggests, even during the same generation of university psychiatry which Griesinger was critical in forming, he was posthumously denounced as belonging to the Hegelian idealists; later, he was proclaimed to be an empiricist. Griesinger’s work contained both idealism and empiricism in a fragile synthesis that soon broke asunder.Hermeneutic theory points out that we inevitably interpret an author, in this case, Griesinger, in terms of the prejudices of our own present context of understanding and our current problems of application to clinical practice (Gadamer 1993). On the one hand, we benefit from the advantage of seeing all that follows Griesinger’s work and are able to “understand the author [End Page 165] better than he understood himself.” We are able to see what he only anticipates but is still not able to explicitly articulate as the unpredicted effects of his work. On the other hand, our interpretations are encumbered by the sedimentations of the views of his successors: his work lies buried under the subsequent interpretations and vicissitudes of a reception with its own agendas, contexts of interpretation, and realms of application. It would be easier if we could simply assign him to one side of our current debates concerning mind/body, individual/culture, and explanation/understanding rather than seeing that our present quandaries in understanding, classifying, and treating mental disorder result precisely from a reading of Griesinger that is not careful enough. It is here that Arens can help us develop our present views further by reviewing their past.Although Griesinger is heralded as the pioneer of an empirical physiological approach which employs a natural scientific concept of mechanism (Ackerknecht, O. Marx, Verwey), Arens situates him in the tradition of Kant and German idealism. It is perhaps this solution of being both philosophical and empirical which seems hard for us, today, to understand. We have come to view these directions as contradictory, to be necessarily in a mutually exclusive relationship. (But that is rather the expression of the present impasse and not the way that Griesinger originally approached these problems.) Arens ambitiously retraces the genealogy of Griesinger’s model... (shrink)

In addition to discussing some philosophical accounts of common sense, this article considers several ways in which common sense can be altered or disturbed in psychopathology. Common sense can be defined as practical understanding, capacity to see and take things in their right light, sound judgment, or ordinary mental capacity. The philosopher Vico described it as the ability to distinguish the probable from the improbable. Goethe understood common sense as an "organ" that is formed in communication for the purpose of (...) communication. Common sense is rooted in the intersubjective constitution of the life-world. Obsessive-compulsive patients show relatively mild disturbances of common sense. Patients with major affective psychoses, in their premorbid personality structure, are overly attached to common sense. In schizophrenia, however, there seems to be a true abdication of common sense involving a loss of "natural self-evidence." Even in premorbid states, such persons often lose both the sense of tact and the ability to "take things in their right light." Although logic, and the ability to engage in theoretical discussion, may be preserved, there is a loss of interpretive skills and the "faculty of judgment"; this results in an inability to cope with everyday practical and social activity. There is also a characteristic sense of perplexity, a sense of amazement before that which would normally seem self-evident and a frequent tendency to reflect upon the conditions of possibility of existence that otherwise remain concealed. The author suggests that the fragility of common sense should not be seen as a mere deficiency state. Rather, it derives from a basic vulnerability inherent in the very structure of being human. (Abstract written by special issue editor: L.A.S.). (shrink)

Decades ago, several authors have proposed that disorders in automatic processing lead to intrusive symptoms or abnormal contents in the consciousness of people with schizophrenia. However, since then, studies have mainly highlighted difficulties in patients’ conscious experiencing and processing but rarely explored how unconscious and conscious mechanisms may interact in producing this experience. We report three lines of research, focusing on the processing of spatial frequencies, unpleasant information, and time-event structure that suggest that impairments occur at both the unconscious and (...) conscious level.We argue that focusing on unconscious, physiological and automatic processing of information in patients, while contrasting that processing with conscious processing, is a first required step before understanding how distortions or other impairments emerge at the conscious level. We then indicate that the phenomenological tradition of psychiatry supports a similar claim and provides a theoretical framework helping to understand the relationship between the impairments and clinical symptoms. We base our argument on the presence of disorders in the minimal self in patients with schizophrenia. The minimal self is tacit and non-verbal and refers to the sense of bodily presence. We argue this sense is shaped by unconscious processes, whose alteration may thus affect the feeling of being a unique individual. This justifies a focus on unconscious mechanisms and a distinction from those associated with consciousness. (shrink)

Kafka's writings are frequently interpreted as representing the historical period of modernism in which he was writing. Little attention has been paid, however, to the possibility that his writings may reflect neural mechanisms in the processing of self during hypnagogic (i.e., between waking and sleep) states. Kafka suffered from dream-like, hypnagogic hallucinations during a sleep-deprived state while writing. This paper discusses reasons (phenomenological and neurobiological) why the self projects an imaginary double (autoscopy) in its spontaneous hallucinations and how Kafka's writings (...) help to elucidate the underlying cognitive and neural mechanisms. I further discuss how the proposed mechanisms may be relevant to understanding paranoid delusions in schizophrenia. Literature documents and records cognitive and neural processes of self with an intimacy that may be otherwise unavailable to neuroscience. To elucidate this approach, I contrast it with the apparently popularizing view that the symptoms of schizophrenia result from what has been called an operative (i.e., pre-reflective) hyper-reflexivity. The latter approach claims that pre-reflective self-awareness (diminished in schizophrenia) pervades all conscious experience (however, in a manner that remains unverifiable for both phenomenological and experimental methods). This contribution argues the opposite: the. (shrink)

Book review of "New Morning: Emerson for the 21st Century".

Human motor learning is governed by a suite of interacting mechanisms each one of which modifies behavior in distinct ways and rely on different neural circuits. In recent years, much attention has been given to one type of motor learning, called motor adaptation. Here, the field has generally focused on the interactions of three mechanisms: sensory prediction error SPE-driven, explicit, and reinforcement learning. Studies of these mechanisms have largely treated them as modular, aiming to model how the outputs of each (...) are combined in the production of overt behavior. However, when examined closely the results of some studies also suggest the existence of additional interactions between the sub-components of each learning mechanism. In this perspective, we propose that these sub-component interactions represent a critical means through which different motor learning mechanisms are combined to produce movement; understanding such interactions is critical to advancing our knowledge of how humans learn new behaviors. We review current literature studying interactions between SPE-driven, explicit, and reinforcement mechanisms of motor learning. We then present evidence of sub-component interactions between SPE-driven and reinforcement learning as well as between SPE-driven and explicit learning from studies of people with cerebellar degeneration. Finally, we discuss the implications of interactions between learning mechanism sub-components for future research in human motor learning. (shrink)

This paper argues against the continued practice of Confucian familism, even in its moderate form, in East Asian hospitals. According to moderate familism, a physician acting in concert with the patient's family may withhold diagnostic information from the patient, and may give it to the patient's family members without her prior approval. There are two main approaches to defend moderate familism: one argues that it can uphold patient's autonomy and protect her best interests; the other appeals to cultural relativism by (...) construing the principle of ‘family autonomy’ to be incommensurable with that of individual autonomy. We respond to the first approach by explaining how the familist arguments either depend on some unreasonable assumptions or simply fail to articulate. The critique of the second approach is based on our recent survey showing that there is no dichotomy of relevant values between the East and the West: we believe that the result can effectively block the familist's reliance on certain traditional or cultural values to explain their resistance to the incorporation of pluralist values. Despite our disagreement with familism, we consider the Eastern emphasis on the family to be conducive to the communication between patient, family members and medical personnel, which is indispensible to the patient's well being and autonomy. We conclude that respect for patient autonomy is perfectly consistent with the involvement of the family in making medical decision as long as the family plays a merely consultant role. (shrink)

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further (...) questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined. (shrink)

The mind-body problem lies at the heart of the clinical practice of both psychiatry and psychosomatic medicine. In their recent publication, Schwartz and Wiggins address the question of how to understand life as central to the mind-body problem. Drawing on their own use of the phenomenological method, we propose that the mind-body problem is not resolved by a general, evocative appeal to an all encompassing life-concept, but rather falters precisely at the insurmountable difference between.

The DSM-5 Alternative Model for Personality Disorders dimensionally defines personality pathology using severity of dysfunction and maladaptive style. As the empirical literature on the clinical utility of the AMPD grows, there is a need to examine changes in diagnostic profiles and personality expression in treatment over time. Assessing these changes in individuals diagnosed with borderline personality disorder is complicated by the tendency for patients to cycle through multiple therapists over the course of treatment leaving the potential for muddled diagnostic clarity (...) and disjointed case conceptualizations. Following patient trajectories across therapists offers a unique opportunity to examine the AMPD’s sensitivity to and utility for capturing personality stability and change over time for patients with BPD. This article demonstrates the utility of the AMPD for two clinical cases in three distinct ways: highlighting heterogeneity in BPD between patients, comparing improvements in personality severity and style over time, and elucidating profile change across therapist ratings. We present two patients diagnosed with DSM-5 Section II BPD, crossing between two therapists over the course of 3 years of psychodynamic psychotherapy. Treating clinicians rated patients for their respective treatment phases using the Level of Personality Functioning Scale, capturing severity, and the Personality Inventory for the DSM-5, capturing style. AMPD diagnostic profiles differentiated patients with BPD in both severity and style, and captured within-patient change beyond within-therapist response bias. Results indicated greater improvements in personality severity while personality style remained more stable. Implications for the patients’ treatment progress and associated challenges are discussed, as are considerations for the utility of the AMPD in therapy. (shrink)

We identify a species of experiment—Kon-Tiki experiments—used to demonstrate the competence of a cause to produce a certain effect, and we examine their role in the historical sciences. We argue that Kon-Tiki experiments are used to test middle-range theory, to test assumptions within historical narratives, and to open new avenues of inquiry. We show how the results of Kon-Tiki experiments are involved in projective inferences, and we argue that reliance on projective inferences does not provide historical scientists with any special (...) protection against the problem of unconceived alternatives. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

Here we focus on two questions: What is the proper semantics for deontic modal expressions in English? And what is the connection between true deontic modal statements and normative reasons? Our contribution towards thinking about the first, which makes up the bulk of our paper, considers a representative sample of recent challenges to a Kratzer-style formal semantics for modal expressions, as well as the rival views—Fabrizio Cariani’s contrastivism, John MacFarlane’s relativism, and Mark Schroeder’s ambiguity theory—those challenges are thought to motivate. (...) These include the Professor Procrastinate challenge to Inheritance (the principle that ‘If ought p and p entails q, then ought q), as well as Parfit’s miners puzzle regarding information-sensitive deontic modals. Here we argue that a Kratzer-style view is able to meet all of the challenges we’ll consider. In addition, we’ll identify challenges for each of those rival views. Our overall conclusion is that a Kratzer-style semantics remains the one to beat. With this assumption in place, we then ask how we should understand the relationship between true deontic modal statements and normative reasons. Should, for example, we hold that the truth of such a statement entails the existence of a normative reason for some agent to comply? Here we argue that, in many cases, acceptance of Kratzer’s semantics for deontic modals leaves open for substantive normative theorizing the question of whether an agent has a normative reason to comply with what she ought to do. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

This collection of essays is the first of its kind to focus on the relationship between composition and identity. Twelve original articles--written by internationally renowned scholars and rising stars in the field--argue for and against the controversial doctrine that composition is identity.--Provided by publisher.