Online research in philosophy

Abstract Recently, some philosophers of psychiatry (viz., Rachel Cooper and Dominic Murphy) have analyzed the issue of psychiatric classification. This paper expands upon these analyses and seeks to demonstrate that a consideration of the history of the Diagnostic and Statistical Manual of Mental Disorders (DSM) can provide a rich and informative philosophical perspective for critically examining the issue of psychiatric classification. This case is intended to demonstrate the importance of history for philosophy of psychiatry, and more generally, the potential benefits of historically-informed approaches to philosophy of science.

The only commonality between the various psychiatric disorders is that they reflect contemporary problematic behaviors. Some psychiatric disorders have a substantial genetic component, whereas others are essentially shaped by prevailing environmental factors. Because psychiatric ailments are so heterogeneous, any universal explanation of mental illness is not likely to have any clinical or theoretical utility. (Published Online November 9 2006).

Evidence-based psychiatry (EBP) has arisen through the application of evidence-based medicine (EBM) to psychiatry. However, there may be aspects of psychiatric disorders and treatments that do not conform well to the assumptions of EBM. This paper reviews the ongoing debate about evidence-based psychiatry and investigates the applicability, to psychiatry, of two basic methodological features of EBM: prognostic homogeneity of clinical trial groups and quantification of trial outcomes. This paper argues that EBM may not be the best way to pursue psychiatric knowledge given the particular features of psychiatric disorders and their treatments. As a result, psychiatry may have to develop its own standards for rigour and validity. This paper concludes that EBM has had a powerful influence on how psychiatry investigates and understands mental disorders. Psychiatry could influence EBM in return, reshaping it in ways that are more clinically useful and congruent with patients’ needs.

Philosophy of psychiatry has boomed in the last few years. We are now seeing a growing literature on the nature of psychiatric explanation, including work that makes contact with longstanding disputes in the philosophy of science as well as more specific work on mental disorders. This paper looks at some recent work on both representing and explaining mental illness. An emerging picture sees explanation of mental disorder as first constructing causal-statistical networks that represent disease pathways as they unfold in time, and then choosing strategies for causal explanation. The epistemic problems in psychiatry are huge, and they arise from the extreme variety in the causes and trajectories of mental disorders across patients. Existing concepts of levels of explanation and mechanism may seem like an obvious epistemic armoury, but they may not fit psychiatry very well, and philosophical theories of psychiatric explanation stress different ways of trying to understand robust patterns amid the individual variation.

Commentary on the editorial by D Stein et al.'s "What is a Mental/Psychiatric Disorder? From DSM-IV to DSM-V".

Toward a definition of mental disorder -- From normality to mental health -- Physical diseases and mental disorders : should they be differentiated? -- Conceptual cacophony in psychiatry.

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

Neuroscience and psychiatry -- Psychotherapy and psychiatry -- Diagnosis in psychiatry -- The boundaries of mental disorders -- Mood and mental illness -- Psychiatry's problem children -- Evidence-based psychiatry -- Psychiatric drugs: miracles and limitations -- Talk therapies: the need for a unified method -- Psychiatry in practice -- Training psychiatrists -- Psychiatry and society -- The future of psychiatry.

This dissertation examines psychiatry from a philosophy of science perspective, focusing on issues of realism and classification. Questions addressed in the dissertation include: What evidence is there for the reality of mental disorders? Are any mental disorders natural kinds? When are disease explanations of abnormality warranted? How should mental disorders be classified?

In addressing issues concerning the reality of mental disorders, I draw on the accounts of realism defended by Ian Hacking and William Wimsatt, arguing that biological research on mental disorders supports the inference that some mental disorders (e.g., schizophrenia, mood disorders, and anxiety disorders) are real theoretical entities, and that the evidence supporting this inference is causal and abductive. In explicating the nature of such entities, I argue that real mental disorders are natural kinds insofar as they are natural classes of abnormal behavior whose members share the same causal structure. I present this position in terms of Richard Boyd’s homeostatic cluster property theory of natural kinds, and argue that this perspective reveals limitations of Hacking’s account on the looping effects of human kinds, which suggests that the objects classified by psychiatrists are unstable entities. I subsequently argue that a subset of mental disorders (e.g., schizophrenia and Down syndrome) are mental illnesses insofar as they are disorders caused by a dysfunctional biological process that leads to harmful consequences for individuals. I present this analysis against Thomas Szasz’s argument that mental illness is a myth.

In addressing issues of psychiatric classification, my analysis focuses on the Diagnostic and Statistical Manual of Mental Disorders (DSM), which has been published regularly by the American Psychiatric Association since 1952, and is currently in its fourth edition. After examining the history of DSM in the twentieth century, and in particular, DSM’s shift to an atheoretical and purely descriptive system in the 1980s, I consider the relative merits of descriptive versus causal systems of classification. Drawing on Carl Hempel’s analysis of taxonomic systems in psychiatry, I argue that a causal classification system would provide a superior approach to psychiatric classification than the descriptive system currently favored by DSM.

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.