Because psychiatry deals specifically with ‘mental’ suffering, its efforts are always centrally involved with the meaningful world of human reality. As such, it sits at the interface of a number of discourses: genetics and neuroscience, psychology and sociology, anthropology, philosophy, and the humanities. Each of these provides frameworks, concepts, and examples that seek to assist our attempts to understand mental distress and how it might be helped. However, these discourses work with different assumptions, methodologies, values, and priorities. Some are in (...) dispute with one another. At various times in the history of psychiatry, a particular form of understanding has become dominant and worked to marginalize .. (shrink)

We are very grateful to both Matthew Ratcliffe and Thomas Szasz for taking the time to read and respond to our paper. Ratcliffe is broadly sympathetic to our efforts and provides a very convincing argument against mind–body dualisms by drawing on work from the phenomenological tradition. His comments extend rather than challenge our central thesis. Szasz, however, is dismissive of our position. As a result, most of our response is directed to his commentary. Ratcliffe uses the work of van der (...) Berg to make the case that any easy distinction between bodily and mental illness or suffering is false to our lived reality as human beings. Of course, in the day-to- day world of contemporary medical practice .. (shrink)

In English medical law, it is something of an axiom that adult competent patients have an absolute right to refuse all and any medical treatment, including potentially life-saving and life-sustaining treatment. This legal proposition, which is embedded in the doctrine of consent, has for the last few decades been regarded as the expression of the philosophical principle of personal autonomy and ethical right of self-determination. The Western ethical and legal traditions places heavy emphasis on notions of personal sovereignty reflected in (...) the strong rhetorical entrenchment of patient autonomy in judicial determinations of treatment refusal cases. In a spate of legal cases in the 1980s and 1990s judicial rhetoric .. (shrink)

I am delighted that Zachar and Potter have chosen to refer to my work on the DSM-IV cluster B personality disorders in their very interesting and ambitious target article. Their suggestion that we turn to virtue ethics rather than traditional moral theory to understand the relation between moral and nonmoral factors in personality disorders is certainly original and worth pursuing. Yet, in the final instance, I am not entirely sure about the exact scope of their proposed analysis. I also worry (...) whether they may have inadvertently presented a slightly inaccurate account of my views on the cluster B personality disorders, as they seek to formulate and defend their own views, which seem to be far wider in scope. I .. (shrink)

INTERDISCIPLINARY WORK OF the sort attempted in my paper is fraught with risks and obstacles. One especially pernicious obstacle is the short-sighted prejudice that insists we should always divide a problem into its various components, allocate different parts to their respective disciplines, publish each separately, and, above all, keep the ethics separate from the rest. Although this may sometimes constitute good tactical advice in the mature stages of inquiry on a complex topic, it begs the question in the early initial (...) stages of discussion on a subject like the present one, which is tangled and complex and not suited to the traditional disciplinary boundaries of professional journals. I am grateful that both my commentators have generously overlooked the many weaknesses in my paper and focused instead on the most pressing issue of substance. This is the thesis that the issues described are important to psychiatry and deserve to be discussed more thoroughly. I therefore feel vindicated in assuming the risks I did, despite knowing there is so much more to be done; notably, moving from anecdotal data to more reliable forms of evidence. The entire episode speaks pointedly to the need for journals like Philosophy, Psychiatry, & Psychology and its innovative mandate. Before I address the remarks of my commentators, some background information on the circumstances that led to the writing of the paper might help readers to understand its wide inter-. (shrink)

In this commentary, I respond to several criticisms of my prior article arguing that, for purposes of assigning moral responsibility, we should understand psychopaths as persons who lack the ability to treat actions as affecting relationships. I discuss the implications of different kinds of psychopaths and the corresponding levels of moral responsibility. I also briefly discuss the legal implications of a psychopath’s diminished moral responsibility.

In this paper, I argue that the responsibility-affecting defect of psychopaths is their incapacity for responding to acts within relationships. I begin with Piers Benn's account of psychopaths as incapable of forming participant reactive attitudes. Benn argues that participant reactive attitudes are essentially communicative and the ability to form and understand participant reactive attitudes is crucial to being a member of the moral community. Against Benn, I argue, though participant reactive attitudes can be communicative, they are not essentially communicative. Instead, (...) they can be simply expressive. Therefore, we must consider psychopaths members of the moral community, in Benn’s sense; however, psychopaths fail to interpret their actions as part of relationships. This inability renders punishment, as an attempt to rectify wrong relationships, inappropriate for psychopaths. Psychopaths have diminished responsibility, insofar as they have forfeited some rights by committing an offense, but are not appropriate candidates for punishment because they cannot understand its significance. (shrink)

The use of coercive measures in mental health care is an issue of ongoing concern (Cf. Fisher 1994; Janssen et al. 2008; Paterson and Duxbury 2007; Prinsen and Van Delden 2009; Widdershoven and Berghmans 2007; Wynn 2006). On the one hand, coercive interventions seem to infringe the patient’s right to self-determination (principle of autonomy). However, professionals are also committed to providing the care they deem necessary (principle of beneficence). In other words, professionals in mental health care are often caught between (...) the two (opposing) ideals of beneficence and autonomy. In medical practice, the right of self-determination is operationalized in the principle of informed consent. A medical physician is .. (shrink)

This is a reply to Gipps' commentary on my 'The Concept of Mental Disorder'.

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

A BSTRACT: I argue that theory theory approaches to autism offer a wholly inadequate explanation of autistic symptoms because they offer a wholly inadequate account of the non-autistic understanding of others. As an alternative I outline interaction theory, which incorporates evidence from both developmental and phenomenological studies to show that humans are endowed with important capacities for intersubjective understanding from birth or early infancy. As part of a neurophenomenological analysis of autism, interaction theory offers an account of interpersonal problems that (...) is fully consistent with the variety of social and nonsocial symptoms found in autism. (shrink)

Nativists about syntactic processing have argued that linguisticprocessing, understood as the implementation of a rule-basedcomputational architecture, is spared in Williams syndrome, (WMS)subjects – and hence that it provides evidence for a geneticallyspecified language module. This argument is bolstered by treatingSpecific Language Impairments (SLI) and WMS as a developmental doubledissociation which identifies a syntax module. Neuroconstructivists haveargued that the cognitive deficits of a developmental disorder cannot beadequately distinguished using the standard gross behavioural tests ofneuropsychology and that the linguistic abilities of the (...) WMS subject canbe equally well explained by a constructivist strategy of neurallearning in the individual, with linguisitic functions implemented in anassociationist architecture. The neuroconstructivist interpretation ofWMS undermines the hypothesis of a double dissociation between SLI andWMS, leaving unresolved the question of nativism about syntax. Theapparent linguistic virtuosity of WMS subjects is an artefact ofenhanced phonological processing, a fact which is easier to demonstratevia the associationist computational model embraced byneuroconstructivism. (shrink)