Philosophical counseling offers a depathologizing practice that can benefit both the practitioner and the client. Philosopher Michel Foucault’s account of biopower is a useful analytic of the psychopathologization of everyday life, and can show the social signif­icance of philosophical practice. This essay critiques the conflation, by some philosophical practitioners, of the medical disease model and all psychotherapeutic methods. Foucault’s conflation of human normativity and normalization is also critiqued. Historian of science Georges Canguilhem’s alternative account of human normativity within the medical (...) disease model is offered as an antidote to the conflations by these philosophical practitioners and Foucault. Philosophical practitioners ought to give up objectivist claims to value neutrality and acknowledge that the interventions of philosophical counseling in clinical diagnostic discourses are normative, theory-laden, and politically significant. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Rationality, Irrationality, and Depathologizing OCDBrent Kious, MD, PhD (bio)Pablo Hubacher argues that some persons with obsessive-compulsive disorder (OCD) do not, in virtue of OCD itself, exhibit what he calls “epistemic irrationality,” which is a matter of violating rational norms related to belief and inquiry (Hubacher, 2023). The argument is complex and meticulous, but ultimately not persuasive. I outline the argument, show how it is unsound, and articulate its most (...) troubling consequences. I end by inquiring about the goal of projects like this, which, I believe, is to examine the rationality of mental illnesses in order to show that they are or are not illnesses.Hubacher starts by noting that (some) persons with OCD appear “doxastically irrational”: when they exhibit obsessions, they err in how they form beliefs. Specifically, they seem to “jump to conclusions,” inferring that a feared outcome is probable or certain from scant evidence. However, psychological research shows that persons with OCD are not more likely to jump to conclusions than others. Hubacher also observes that jumping to conclusions involves the inference, “possibly P, therefore definitely P.” This inference is irrational but not specific to people with OCD, because many of us do it, and an account of the irrationality of OCD should identify OCD-specific deviations. Hubacher concludes that persons with OCD are not doxastically irrational. He next considers whether they exhibit “zetetic” irrationality, which involves violating epistemic norms of inquiry. This might identify the irrationality of OCD, since compulsions like repeatedly checking the stove are basically ways of getting evidence. But Hubacher introduces the phenomenon of sexually focused OCD, or S-OCD. Persons with S-OCD worry about whether they have sexual desires they regard as inappropriate—for instance, incestuous desires or homosexual desires. Hubacher does not think people with S-OCD are zetetically irrational, however. Their endless doubts are actually reasonable, since it is possible—even common—for people to have repressed sexual desires when those desires are stigmatized. If a person with S-OCD worries about having incestuous desires, the bare fact that he does not feel those desires in the usual way should not be reassuring to him: those desires could simply be repressed. Hubacher adds that [End Page 151] people with OCD have high intolerance of uncertainty, which he takes to mean that they approach inquiries with high standards for confirmation; they are not satisfied with evidence others would see as compelling. He concludes that people with S-OCD are neither zetetically nor doxastically irrational, and so not epistemically irrational.This is a surprising conclusion, but it results from an unsound argument. An initial problem is his assumption that the only way persons with OCD can be doxastically irrational is by jumping to conclusions. This ignores other possible ways of being doxastically irrational. For instance, it would be irrational to retain beliefs that have been disconfirmed by evidence (Hubacher might call this zetetic irrationality, but surely, my beliefs can be disconfirmed without active inquiry). Irrationally retaining disconfirmed beliefs might even capture what happens in OCD: the person with OCD thinks something awful is likely to be true, even though she gets copious disconfirming evidence.A second problem is in Hubacher’s interpretation of the psychological evidence about whether persons with OCD jump to conclusions. He cites two studies involving a very specific psychological test, the bead task, wherein a subject is asked to determine whether a random sequence of colored beads have been drawn from a jar with a preponderance of one color or another. A “jumping to conclusions bias” is taken to be an inclination to guess the jar after no more than two beads are revealed (Huq & Garety et al., 1988). Although a few studies have shown that persons with OCD do not have this jumping to conclusions bias, we cannot conclude that they do not often jump to conclusions in real life. One might imagine, for instance, that people with OCD are still quite likely to jump to conclusions with respect to their obsessions (i.e., things that are highly anxiety-provoking, where the anxiety affects the conclusions drawn). And most people with OCD are not obsessed about the colors of beads.A third... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Promoting Health and Social Progress by Accepting and Depathologizing Benign Intersex TraitsHida ViloriaI was born with ambiguous genitalia and it was a doctor who, by honoring my bodily integrity and not “fixing” me, gave me the greatest gift I’ve ever received. Because my body and its sexual traits are a positive, fundamental part of my experience and identity as a human being, I know that having my genitals removed (...) or altered according to someone else’s vision would have deeply damaged me, both physically and psychologically.The doctor who protected my autonomy was, unsurprisingly, my father. I say “unsurprisingly” because in my experience parents are typically more protective of their children than doctors are of their patients. Also, doctors do not discuss cases with other doctors in the same way they do with laypeople, as doctors know more about medical issues such as the risks involved in infant genital surgery.Other than having clitoromegaly (a large clitoris), my reproductive anatomy is typically female, and so I was assigned female and raised as such without incident. My parents didn’t discuss my intersex traits with me, and I grew up thinking of myself and being accepted as, a girl.When I began menstruating, my father told me I’d need to take pills to “grow taller.” I thought this unusual, as I wasn’t short, and later overheard my mother arguing with him, saying that the pills were “experimental”. I was reminded of this discussion years later, when she told me that the pills had actually been hormones to make my breasts grow. I never took them though as she convinced my father not to make me.Article 7 of The International Covenant on Civil and Political Rights states that, “No one shall be subjected without his free consent to medical or scientific experimentation,” and I’m grateful to both my parents for protecting my civil rights as they protected my health.Due to my Catholic upbringing and schooling, I had no opportunity to compare my genitals to other girls’, and it wasn’t until the age of twelve that I realized, while perusing magazines with friends, that I have atypical sex anatomy. Contrary to common speculation however, this awareness didn’t make me question being female. I simply assumed there must be some genital variation in humans.I feel my parents made the wisest decision possible by registering me as one of the two accepted, available genders but allowing me to live, physically and behaviorally, as who I am. Despite not having developed a stereotypically curvaceous female figure, I was popular and excelled in typically feminine social activities, as well as sports and academics. For example, I was one of four girls selected out of one hundred twenty–five that competed for a spot on my high school cheerleading [End Page 114] squad when I tried out to help a friend who needed a tryout partner.Other than escaping IGM (Intersex Genital Mutilation) and estrogen therapy, I’ve had only a few experiences pertaining to my medical care around being intersex. These experiences fall into two categories: seeing medical doctors who treated me the same after discovering that I have ambiguous genitalia, and seeing ones who didn’t. I feel incredibly blessed that my experiences in the former category vastly outweigh the latter.My first experience came at the age of twenty, when a gynecologist asked me if my clitoris had always been as large as it is. I responded that it had, and she said, while looking at me disapprovingly, that she’d like to do some tests. When I asked her what they were for though, she wouldn’t respond directly. She said I’d reported having some upper lip hair, and acne, on my intake forms. I replied that neither were above average, and asked if there were health issues I should be concerned about. She reluctantly said no. I asked what reason there was then for undergoing tests because of the size of my clitoris.She finally responded, “It’s just not normal.”Fortunately, I’d had positive reactions to my sex traits from the people I’d dated. For example, the first... (shrink)

Political debate regarding trans youth’s access to gender-affirming care (GAC) has pushed many to advocate for GAC by pointing to tragic, pathological outcomes of non-treatment, namely suicide. However, these pathologized arguments are a harmful ethical “shortcut” which should be replaced by a meaningful engagement with the ethics of providing GAC to youth.

There have been ongoing debates as to how, or even whether, we should clinically classify gender diversity in children through clinical classification manuals. So‐called ‘depathologizing’ is argued as being vital to address the stigma that these children are somehow disordered or sick. Yet one argument in favour of continued clinical classification for transgender and gender non‐conforming children is that it better facilitates access to specialist psychological support. I argue that whilst continued clinical classification offers a seemingly pragmatic solution to ensuring (...) access, it does in fact obscure our understanding of the individual needs of these children. In this paper I address fundamental issues that aim to better our understanding of need and thus why a child may benefit from specialist support. I do so by critiquing a paper I nearly wrote, which argued for the ongoing continued classification of gender incongruence in children. Ultimately, I argue that specialist psychological support and care should be driven by the needs of the individual child, as determined by the child and those involved with their care. By bettering our understanding as to why specialist psychological support may be beneficial for some, we move past the focus of such specialist support being provided because of the child’s gender diversity. Methodologically the paper may be unusual, in comparison to traditional normative counter‐argumentative bioethical position papers, but by presenting an argument for depathologization of gender diversity of children in this way there is also an alternative insight into the methods of bioethics. (shrink)

This response to Kariyawasam and Rai affirms their critique of the pathologization of trans youth but forecasts a foreseeable negative outcome of their proposed elimination of diagnosis as a prerequisite to gender-affirming care (GAC) — the risk of removing GAC entirely from the medical sphere and compromising the wellbeing of those transgender individuals for whom GAC is deeply affirming. We suggest an ethical framework of GAC that expands past a focus on autonomy to incorporate a principle of respect for persons (...) that affirms the dignity and diversity of trans youth — recognizing the need to facilitate both medical assistance and social change. (shrink)

This article develops the concept of wrongful depathologization, in which a psychiatric disorder is simultaneously stigmatized and trivialized. We use OCD as a case study to argue that cumulatively these two effects generate a profound epistemic injustice to OCD sufferers, and possibly to those with other mental disorders. We show that even seemingly positive stereotypes attached to mental disorders give rise to both testimonial injustice and wilful hermeneutical ignorance. We thus expose an insidious form of epistemic harm that has (...) been overlooked in the literature. (shrink)

This article provides a historical perspective on how both American and European psychiatrists have conceptualized and categorized sexual deviance throughout the past 150 years. During this time, quite a number of sexual preferences, desires, and behaviors have been pathologized and depathologized at will, thus revealing psychiatry's constant struggle to distinguish mental disorder--in other words, the "perversions," "sexual deviations," or "paraphilias"--from immoral, unethical, or illegal behavior. This struggle is apparent in the works of 19th- and early-20th-century psychiatrists and sexologists, but it (...) is also present in the more recent psychiatric textbooks and diagnostic manuals, such as the consecutive editions of the Diagnostic and Statistical Manual of Mental Disorders. While much of the historical literature revolves around the controversy over homosexuality, this article also reviews the recent medicohistorical and sociohistorical work on other forms of sexual deviance, including the diagnostic categories listed in the latest edition, the DSM-IV-TR: exhibitionism, voyeurism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, and transvestic fetishism. (shrink)

This paper makes an argument for greater consideration of negativity in queer engagements with biological or natural systems. Focusing on one particular paper by Karen Barad – “Nature’s Queer Performativity ” – I argue that this work tends to under-read the negativity and confusion that queer entails, and so it renders nature, and the politics we might extract from it, more palatable than perhaps they should be. What interests me is that Barad’s argument about nature’s queer performativity begins and ends (...) with sodomy. While it has been a highly cathected site of analysis for some early and influential work in queer theory, sodomy has been little discussed in feminist and queer science studies where Barad’s work has been so influential. I argue that sodomy spoils any identitarian queer politics that attempt to depathologize or reaffirm the natural world. (shrink)

"I have the worst birth defect a woman can have: I was born with a penis and a pair of testicles." Thus we meet Hera, who shares her reason for starting psychoanalysis and whose statement embodies the debate over transgenderism, rigorously dissected in _Please Select Your Gender_. Is it a mental disorder, as some would claim, or a matter of sexual identity? An orientation or a life choice? Despite differing opinions, transgenderism has lost much of its stigma over the past (...) decade or so – though perhaps none of its shock value. Nevertheless, the door is open for a reformulation of the hysterical question, "Am I a man or a woman?" Utilizing rich clinical vignettes and elements of Lacanian theory, Patricia Gherovici demonstrates how the transgender discourse has both reoriented psychoanalytic practice and reframed debates about gender in American society at large. She traverses historical, theoretical, and clinical grounds to explore what has been termed the "democratizing of gender" – for what could be more democratic than the choice of one’s own gender, now able to be changed on demand? Arguing for the depathologization of transgenderism, _Please Select Your Gender_ aims to revise current notions of human sexuality in general. In doing so, it challenges the theory and practice of psychoanalysis with questions typically addressed only indirectly, but which are themselves transforming how analysis is done, advancing new ideas for the clinic that can be extrapolated to social and intellectual contexts in an effort to engage the broader dialogues of gender and sexuality. (shrink)

Developments in the sociology of the body and the sociology of health impel us to investigate embodiment resistances against hegemonic biomedical definitions of normativity. Bearing in mind that the body is a social object defined by institutions, the analysis of body itineraries leads us to glimpse modes of subversion, resistance and destabilization of biomedical definitions. This article deals with the role of modern science and technology in the observation and diagnosis of the body and its consequences in the definition of (...) health and disease, the normal and the pathological. Second, biomedicine is analysed as an institution that orders gender and underpins sexual dimorphism through debates on depathologization and dysnormality. The implications of technology and medicine in the processes of neoliberal subjectivation promoted by body optimization practices are also discussed. (shrink)

Recent conceptual developments in psychiatric diagnosis have the potential for catastrophic results, particularly for Christians in the mental health field, but also for all persons who have a vested interest in the identification and treatment of mental disorder. I explore these theoretical developments by focusing on the manner in which dysphoria has been situated in the dominant contemporary system of psychiatric nosology, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. I target for discussion, primarily, two specific consequences of (...) dysphoria’s new place in contemporary psychiatry, namely, the explicit depathologizing of Pedophilia and the introduction of “Gender Dysphoria” as a new diagnostic category. Although Pedophilia and Gender Dysphoria share the characteristic of not being designated as mental disorders by the American Psychiatric Association (APA), they interestingly differ insofar as a sufficient degree of dysphoria is believed to have the ability to transform Pedophilia from a “condition” to a psychiatric disorder (namely, “Pedophilic Disorder”), while no amount of dysphoria, it is believed, is capable of transforming the diagnosis of Gender Dysphoria into an explicit psychiatric disorder. I trace some of the likely motivations for the APA’s having made these changes, discuss some of these changes’ untoward theoretical and practical consequences, and attempt to forge a coherent path to a more general theory of psychopathology. (shrink)