It is far too early to say what global impact the neurocognitive and neuropsychiatric sciences will have on our intuitions about moral responsibility. And it is far too early to say whether the notion of moral responsibility will survive this impact (and if so, in what form). But it is certainly worth starting to think about the local impact that these sciences can or should have on some of our distinctions and criteria. It might be possible to use some of (...) the tools offered by these sciences in order to refine or revise some of the categories currently used, without – for the time being at least – worrying too much about the fate of the notion of moral responsibility. This is an area where a piecemeal approach might be more productive: only after an evaluation of many distinct cases and situations it will be possible to say something general about the current notion of moral responsibility. In this article, we will focus on a single clinical case: a young man who has been convicted for assault on a neighbour and whose sentence was affected by a pre-existing diagnosis of mentalillness. We will use this case, and an analysis of the similarities and differences between this case and other possible cases, in order to raise some (local but important) issues about the implications that discoveries in neuropsychology and neuropsychiatry can have for the way moral responsibility is attributed to agents and, more specifically, to agents with diagnoses of mental illnesses. (shrink)
Introduction : the existence of mentalillness -- The likeness argument -- The categorical argument -- Metaphor -- Two metaphors from physical medicine -- The metaphor of mentalillness -- Attention deficit hyperactivity disorder, social construction, and metaphor -- Metaphors and models.
This book is psychiatry's reply to the diverse group of antipsychiatrists, including Laing, Foucault, Goffman, Szasz and Bassaglia, that has made fashionable the view that mentalillness is merely socially deviant behaviour and that psychiatrists are agents of the capitalist society seeking to repress such behaviour. It establishes, by the use of evidence from historical and transcultural studies, that mentalillness has been recognised in all cultures since the beginning of history and goes on to explore (...) the philosophical and medical basis for psychiatry's diagnosis and treatment of mentalillness. Finally, it tackles two issues where psychiatry has recently been seen as at odds with the values prevailing in society: involuntary hospitalization and the insanity defence. The Reality of MentalIllness does not pretend to offer simple answers to the complex problems it discusses, but will leave the reader with a much greater understanding of psychiatry's aims, practices and problems. (shrink)
Conceiving mental disorder -- Disorder of mental disorder -- On being skeptical about mental disorder -- Seeking norms for mental disorder -- An original position -- Addiction and responsibility for self -- Reality lost and found -- Minding the missing me.
I shall begin with the "anti-psychiatry" view that the lack of a physical basis excludes many familiar mental disorders from the category of "illness". My response to this argument will be that anti-psychiatrists are probably right to hold that most mental disorders do not involve any physical disorder, but that they are wrong to conclude from this that these mental disorders are not illnesses.
Until recently there has been little contact between the mind-brain debate in philosophy and the debate in psychiatry about the nature of mentalillness. In this paper some of the analogies and disanalogies between the two debates are explored. It is noted in particular that the emphasis in modern philosophy of mind on the importance of the concept of action has been matched by a recent shift in the debate about mentalillness from analyses of disease (...) in terms of failure of functioning to analyses of illness in terms of failure of action. The concept of action thus provides a natural conduit for two-way exchanges of ideas between philosophy and psychiatry. The potential fruitfulness of such exchanges is illustrated with an outline of the mutual heuristic significance of psychiatric work on delusions and philosophical accounts of Intentionality. (shrink)
In a series of recent works, Ian Hacking has produced a model of social causation in mentalillness and begun to sketch in outline how this might be integrated with the medical model of psychiatry. This article elaborates and revises Hacking's model of social forces, criticizes him for attempting a merely semantic resolution of the tension between the social and the biological, and sketches an alternative approach that builds upon his substantial insights.
The status quo: dogmatism, the biopsychosocial model, and alternatives -- What there is: of mind and brain -- How we know: understanding the mind -- What is scientific method? -- Reading Karl Jaspers's General Psychopathology -- What is scientific method in psychiatry? -- Darwin's dangerous method: the essentialist fallacy -- What we value: the ethics of psychiatry -- Desire and self: Hellenistic and Islamic approaches -- On the nature of mentalillness: disease or myth? -- Order out of (...) chaos: from insanity to DSM-III to a pluralistic nosology -- A theory of DSM-IV: ideal types -- Dimensions versus categories -- The perils of belief: psychosis -- The slings and arrows of outrageous fortune: depression -- Life's rollercoaster: mania -- Being self-aware: insight -- Calvinism or hedonism? -- Truth and statistics: problems of empirical psychiatry -- A climate of opinion: what remains of psychoanalysis -- Being there: existential psychotherapy -- Beyond eclecticism: teaching psychotherapy in the twenty-first century -- Bridging the biology/psychology dichotomy: the hopes of integrationism -- Why it is hard to be pluralist. (shrink)
In this surprising book, Allan V. Horwitz argues that our current conceptions of mentalillness as a disease fit only a small number of serious psychological conditions and that most conditions currently regarded as mentalillness are cultural constructions, normal reactions to stressful social circumstances, or simply forms of deviant behavior.
This chapter offers a novel defence of Szasz’s claim that mentalillness is a myth by bringing to bear a standard type of thought experiment used in philosophical discussions of the meaning of natural kind concepts. This makes it possible to accept Szasz’s conclusion that mentalillness involves problems of living, some of which may be moral in nature, while bypassing the debate about the meaning of the concept of illness. The chapter then considers the (...) nature of schizophrenia and the personality disorders (PDs) within this framework. It argues that neither is likely to constitute a scientifically valid category, but that nonetheless their symptoms can be scientifically explained. It concludes with a discussion of the way in which Cluster B or ‘bad’ PDs involve failures of virtue or character, and argues that this does not preclude them from being appropriately treated within contemporary, multidisciplinary, mental health services. (shrink)
Radical psychiatrists and others assert that mentalillness is a myth. The opening and closing portions of the paper deal with the impact such argument has had in law and psychiatry. The body of the paper discusses the five versions of the myth argument prevalent in radical psychiatry: (A) that there is no such thing as mentalillness; (B) that those called ?mentally ill? are really as rational as everyone else, only with different aims; that the (...) only reasons anyone ever thought differently was (C) because of unsophisticated category mistakes or (D) because of an adherence to the epistemology of a sick society; and (E) that the phrase ?mentalillness? is used to mask value judgments about others? behavior in pseudo?scientific respectability. Reasons are given for rejecting each of these versions of the argument that mentalillness is a myth. (shrink)
In ?Some Myths about ?MentalIllness'? (Inquiry, Vol. 18 , No. 3), Michael Moore attempts to clarify and refute what he takes to be the radical (existential) position concerning the nature and diagnosis of mentalillness. Moore's dissatisfaction with certain formulations and conceptualizations of the radical position is endorsed; as also the need to introduce greater rigor and precision into the discussion of mentalillness. But Moore's clarifications are really misunderstandings and, in consequence, his (...) refutations do not succeed. Moore's five?fold interpretative classification of the radical thesis is retained. (shrink)
Many of the world’s mental health acts, including all Australian legislation, allow for the coercive detention and treatment of people with mental illnesses if they are deemed likely to harm themselves or others. Numerous authors have argued that legislated powers to impose coercive treatment in psychiatric illness should pivot on the presence or absence of capacity not likely harm, but no Australian act uses this criterion. In this paper, I add a novel element to these arguments by (...) comparing the use of the harm to others justification for coercive treatment in mentalillness with its use in illness due to infectious disease, and suggest a double standard applies. People with mentalillness are subjected to coercive treatments at levels of risk to others far, far lower than would precipitate coercive treatment in people with influenza. In effect, this element of mental health legislation represents an example of sanism—state-sanctioned discrimination against people with mental illnesses. (shrink)
At this point in time, it is hard to say which consequences for the concept of mentalillness result from modern genetics. Current research projects are trying to find significant statistical correlations between the diagnosis of a disease and a gene locus or an endophenotype. Up until now, there has not been any identification of alleles or mutations causing mentalillness. In the meantime, the relations between the genetic basis and the disease are given the term (...) genetic vulnerability as a placeholder; this concept simplifies the complex relations between the DNA and even the simplest cell functions observed in modern genetics. According to complex gene models like the systemic theory of DNA, it will not be possible to identify the genetic factors without a precise knowledge of the factors which modulate the gene expression. The significance of genetics as part of the concept of mentalillness will not be able to be defined without further progress in developmental biology and psychology. Currently, psychological theory fails to acknowledge the complexity of the relationship between the DNA and the environment. Some starting points from which to develop such an understanding can be received from developmental studies and studies of the psychophylogenesis . An interdisciplinary concept of the biological basis of the psyche is needed. (shrink)
In considering the argument that Thomas Szasz advances on behalf of his claim that there is no mentalillness, it becomes evident that despite his stated assumptions, moral valuations are necessarily tied up with assessment of disease. By following his remarks about differential diagnosis, it becomes evident that behavior is the occasion for differential diagnosis, that behavior determines which anatomical deviations are counted as diseases, and that Szasz's insistence on autonomy introduces his own moral assumptions into the concept (...) of disease. Consequently, although none of these considerations disproves Szasz's conclusions about the existence of mentalillness, neither can his argument support the weight of that conclusion. CiteULike Connotea Del.icio.us What's this? (shrink)
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 mentalillness 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. (shrink)
The effects of mental disorder are apparent and pervasive, in suffering, loss of freedom and life opportunities, negative impacts on education, work satisfaction and productivity, complications in law, institutions of healthcare, and more. With a new edition of the 'bible' of psychiatric diagnosis - the DSM - under developmental, it is timely to take a step back and re-evalutate exactly how we diagnose and define mental disorder. This new book by Derek Bolton tackles the problems involved in the (...) definition and boundaries of mental disorder. It addresses two main questions regarding mentalillness. Firstly, what is the basis of the standards or norms by which we judge that a person has a mental disorder - that the person's mind is not working as it should, that their mental functioning is abnormal? Controversies about these questions have been dominated by the contrast between norms that are medical, scientific or natural, on the one hand, and social norms on the other. The norms that define mental disorder seem to belong to psychiatry, to be medical and scientific, but are they really social norms, hijacked and disguised by the medical profession? Secondly, what is the validity of the distinction between mental disorder and order, between abnormal and normal mental functioning? To what extent, notwithstanding appearances, does mental disorder involve meaningful reactions and problem-solving? These responses may be to normal problems of living, or to not so normal problems - to severe psycho-social challenges. Is there after all order in mental disorder? With the closing of asylums and the appearance of care in the community, mental disorder is now in our midst. While attempts have been made to define clearly a concept of mental disorder that is truly medical as opposed to social, there is increasing evidence that such a distinction is unviable - there is no clear line between what is normal in the population and what is abnormal. 'What is Mental Disorder?' reviews these various crucial developments and their profound impact for the concept and its boundaries in a provocative and timely book. (shrink)
Since psychiatry remains a descriptive discipline, it is essential for its practitioners to understand how the language of psychiatry came to be formed. This important book, written by a psychiatrist-historian, traces the genesis of the descriptive categories of psychopathology and examines their interaction with the psychological and philosophical context within which they arose. The author explores particularly the language and ideas that have characterised descriptive psychopathology from the mid-nineteenth century to the present day. He presents a masterful survey of the (...) history of the main psychiatric symptoms, from the metaphysics of classical antiquity to the operational criteria of today. Tracing the evolution of concepts such as memory, consciousness, will and personality, and of symptoms ranging from catalepsy and aboulia to anxiety and self-harm, this book provides fascinating insights into the subjective nature of mentalillness, and into the ideas of British, Continental and American authorities who sought to clarify and define it. (shrink)
Over the past 60 years Thomas Szasz (1960, 1961, 2008) has forcefully argued that mental illnesses are mythical since all medical diseases are located in the body and, thus, have somatic causes. This has been accompanied by a scathing and coruscating critique of the whole mental health profession?particularly, those psychologists, psychiatrists and psychotherapists who collude in and exploit the alleged mythology of counterfeit mental disorders and often (unwittingly or deliberately) justify coercion, oppression and pharmacological manipulation of so-called (...) ?mental patients? in the name of ?treatments?. Since mindfulness practitioners?perhaps especially teachers of mindfulness-based cognitive therapy, mindfulness-based stress reduction and related programmes?may, by association, be partially implicated in Szasz's allegations, this article seeks to explore and examine the implications for theory and practice in the field. It will be suggested that the strong foundational, theoretical, research and teaching bases of mindfulness-based interventions offer practitioners a solid defence against the general critique offered by Szasz, and more specific challenges advanced by critics such as Boysen (2007) and Whitaker (2010). However, there may still be potential pitfalls for those mindfulness-based interventions which are too closely allied to the psychiatric/pscychotheraputic establishment, and some suggestions for avoiding such obstacles will be offered through recommendations for maintaining connections between mindfulness and its Buddhist origins. (shrink)
The word stigma comes from ancient Greece, and was initially used in reference to signs or symbols physically cut into or burned onto the bodies of those deemed to be of an inferior status. It was a marking of one's tarnished and flawed character. Today, stigma is more often attached to one's social standing, personality traits, or psychological makeup. "People are no longer physically branded; instead they are societally labeled—as poor, as criminal, homosexual, mentally ill, and so on. These labels (...) influence public perceptions and behavior and lead to devaluation and denigration of those who are so labeled" (Wahl 1999, 11–12).The modern usage of the term stigma and contemporary focus on the concept as a topic of .. (shrink)
We argue that cognitive empathy and other instances of mental state attribution are a byproduct of self-awareness. Evidence is brought to bear on this proposition from comparative psychology, early child development, neuropsychology, and abnormal behavior.
This paper argues for psychological realism in the conception of psychiatric disorders. We review the following contemporary ways of understanding the future of psychiatry: (1) psychiatric classification cannot be successfully reduced to neurobiology, and thus psychiatric disorders should not be conceived of as biological kinds; (2) psychiatric classification can be successfully reduced to neurobiology, and thus psychiatric disorders should be conceived of as biological kinds. Position (1) can lead either to instrumentalism or to eliminativism about psychiatry, depending on whether psychiatric (...) classification is regarded as useful. Position (2), which is inspired by the growing interest in neuroscience within scientific psychiatry, leads to biological realism or essentialism. In this paper we endorse a different realist position, which we label psychological realism. Psychiatric disorders are identified and addressed on the basis of their psychological manifestations which are often described as violations of epistemic, moral or social norms. A couple of examples are proposed by reference to the pathological aspects of delusions, and the factors contributing to their formation. (shrink)
Psychiatry is plagued with philosophical questions. What is a mentalillness? Is it different from brain disease? Is there any objective way of determining whether behaviors such as criminal activity are mental illnesses? Should we explain "abnormal" behavior by reference to psychological forces, learning processes, social factors, or disease processes? This book aspires to answer these and other questions. Broadly divided into two halves, the first analyzes the arguments of psychiatry's critics and covers the philosophical ideas of (...) such thinkers as Freud, Eysenck, Laing, Szasz, Sedgewick, and Foucault. The second aims to provide a resolution to the problems raised in the first half by establishing a philosophical defense of the theory and practice of psychiatry. Dr. Reznek's stimulating work is the first to provide a comprehensive philosophical account of the main issues in psychiatry, including free will and responsibility, the excusing power of mentalillness, and involuntary hospitalization. (shrink)
Twenty years ago, the biopsychosocial model was proposed by George Engel to be the new paradigm for medicine and psychiatry. The model assumed a hierarchical structure of the biological, psychological and social system and simple interactions between the participating systems. This article holds the thesis that the original biopsychosocial model cannot depict psychiatry's reality and problems. The clinical validity of the biopsychosocial model has to be questioned. It is argued that psychiatric interventions can only stimulate but not determine their target (...) systems, because intervention and outcome are only loosely coupled. Thus, psychiatric interventions have in principle limited ranges which differ according to the type of intervention and according to the system to be stimulated. Psychosocial interventions face far more obstacles to be overcome than psychopharmacogical therapy. (shrink)
The debate about ECT in Ireland in recent times has been vibrant and often polarised. The uniqueness of the Irish situation is that the psychiatric profession is protected by legislation whereby ECT treatment can be authorized by two consultant psychiatrists without the consent of the patient. This paper will consider if ECT is ever ethically justified, and if so, under what circumstances. The proposal is to investigate ECT from an ethical perspective with reference to the UNESCO Universal Declaration on Bioethics (...) and Human Rights. The enquiry will begin with an historical context to the origin and development of ECT as a treatment for severe mentalillness. The application of various ethical principles will be considered in conjunction with the relevant literature before arriving at a conclusion. (shrink)
The paper involves an attempt to draw out the implications of a ‘moderate materialism’ for the understanding of mentalillness. The argument of the paper is that once a moderate materialism which navigates carefully between the poles of (materialist) reductionism and dualism has been unpacked, the relations between the manifestations, bases, aetiologies and treatments of mental illnesses emerge as being considerably more complex than is often allowed for. Specifically, the conceptual tools required within a moderate materialist position (...) about the mind allow us to expose potential fallacies in thinking about the nature of mental illnesses, in inferences drawn from these ‘natures’ to ideal modes of treatment, and in inferences drawn from treatment response. It is concluded that moderate materialism undermines the oversimplifications which tend to cloud ‘biophysical versus psychosocial’ debates in the field of psychopathology, in part because psychological change is physiological change, and because physiological change and/or intervention need not ‘cure’ by removing a physiological cause. (shrink)
In this paper, I develop a phenomenological description of lived autonomy and describe possible alterations of lived autonomy associated with chronic depression as they relate to specific psychopathological symptoms. I will distinguish between two types of lived autonomy, a pre-reflective type and a reflective type, which differ with respect to the explicitness of the action that is willed into existence; and I will relate these types to the classical distinction between freedom of intentional action and freedom of the will. I (...) will then describe how a chronically depressed person habitually discloses her experiential workspace with an impaired scope of perceivable action-properties, and pre-reflectively values many of these perceived action-properties as demanding or devalues these properties as well as her own abilities and drive to perform the respective actions (‘depressive habituality’). These alterations, typically experienced in a passive manner, imply an impairment of both types of lived autonomy. Drawing on first-hand accounts, I will then argue that small islands of lived autonomy, even of the reflective type, are possible if the afflicted identifies with at least some of her ‘depressive disabilities’ (i.e., her levelled amount of daily activities, her social retreat in certain periods). Lastly, I will compare this manner of life-conduct with the constellation of includence (Inkludenz), as described by Tellenbach, and discuss the limitations of this study. (shrink)
Two lecture styles were examined to determine which was more effective for enhancing content learning in college students. The same experienced guest lecturer presented information about bipolar disorder (a combination of depression and mania) to college students in human service-related fields. Students in classes assigned to the control group received a standard, didactic lecture. In classes assigned to the experimental group, the presenter began the lecture by informing the students that she had bipolar disorder and enhanced the standard didactic lecture (...) by interspersing descriptions of her personal experiences living with bipolar disorder. Content-specific pre-tests and post-tests developed by the researchers were used to compare acquisition of knowledge about the disorder across groups of students. Results showed that students who received the personal/experiential lecture acquired significantly more knowledge about bipolar disorder than did students who received the standard, didactic lecture. Theories and procedures that may enhance student learning and thinking in related areas are discussed. (shrink)
The first edition of The Mind and its Discontents was a powerful analysis of how, as a society, we view mentalillness. In the ten years since the first edition, there has been growing interest in the philosophy of psychiatry, and a new edition of this text is more timely and important than ever. -/- In The Mind and its Discontents, Grant Gillett argues that an understanding of mentalillness requires more than just a study of (...) biological models of mental processes and pathologies. As intensely social animals, he argues, we need to look for the causes of human mental disorders in our interactions with others; in social rule-following and its role in the organization of mental content; in the power relations embedded within social structures and cultural norms; in the way that our mental life is inscribed by a cumulative life of encounters with others. Drawing upon work from within the philosophy of mind, epistemology, post-modern continental philosophy, and philosophy of language, he tries to elucidate the nature of psychiatric phenomena involving disorders of thought, perception, emotion, moral sense, and action. Within this framework, a series of chapters analyse important psychiatric disorders such as depression, attention deficiency, autism, schizophrenia, and anorexia. Along the way, Gillett explores the nature of memory and identity; of hysteria and what constitutes rational behaviour; and of what causes us to label someone a psychopath or deviant. -/- Updated, available in paperback, and more accessible than before, the new edition of this fascinating book will provide readers with important insights into the causes and nature of psychosis. In addition, Gillett's arguments have considerable implications for the way in which we understand and treat people suffering from psychiatric disorders. The Mind and its Discontents will be read by researchers and postgraduate students in a range of academic areas, including psychiatry, bioethics, philosophy of mind, social theory, and clinical psychology. It will also be of considerable interest to practising psychiatrists. (shrink)
Questioning reality -- The hair of the dog -- Good/bad -- Resistance and the side effect -- Putting resistance on the couch -- Modern medicine : a health report -- Psychotherapeutic paradox -- Loops -- Dialectics -- Paradox within the home -- The staying-with-it principle -- Immunization and immunotherapy -- A little poison is good for you -- The strange obsession of Dr. Hahnemann -- From gods to genes -- RPM -- Such stuff as dreams -- The attack of the (...) evil things -- Becoming well. (shrink)