À partir de l’observatoire d’une « consultation antialcoolique » ouverte en 1954 dans le 13e arrondissement de Paris, cet article étudie la manière dont le travail social a investi le nouveau champ d’action du suivi psychiatrique de l’alcoolisme, dans un contexte de mutations de la prise en charge médicale de cette maladie. Le contenu autant que la structure des dossiers de patients de la consultation, que nous mettons en regard avec des publications issues de revues médicales et de travail (...) social, permettent d’approcher le travail quotidien des assistantes sociales, au plus près des alcooliques et de leurs familles. Nous montrons que l’action de l’assistante sociale, devenue centrale bien que subordonnée à celle du médecin psychiatre, s’enrichit d’une dimension psychothérapique et se caractérise par la recherche de la confiance du malade et de son adhésion au traitement, marquant ainsi une inflexion nette dans le rapport aux populations assistées. Cependant, ces évolutions ne suffisent pas à débarrasser le travail social de ses ambiguïtés constitutives et notamment de ses fonctions de contrôle et de surveillance, sources de difficultés, de malentendus et de conflits avec les malades et leurs proches. (shrink)

Is social psychiatry at a tipping point, acknowledging that many normal types of behavior are being over-medicalized? What notions of enchantment can we glean from Max Weber's social thought as they relate to our modern, rational, bureaucratic world? Giedraitis explores these issues using the German economist and sociologist Max Weber's theories of rationalization and disenchantment, and connects them to the dangers of bureaucratizing mental health. Giedraitis conducts an innovative study using psychotherapists as respondents to measure varying degrees (...) of "rational" thought in their clients, thereby indirectly measuring Weberian rational thought as related to certain types of depression. This book is recommended to those who would like an introduction to Weberian notions of rationality and disenchantment, or general Weberian socio-economic theory. This book is also suggested to those seeking to understand a possible connection between Weberian rationalization, disenchantment, bureaucratization and mental health. (shrink)

A large and growing body of research in computational psychiatry draws on Bayesian modelling to illuminate the dysfunctions and aberrations that underlie psychiatric disorders. After identifying the chief attractions of this research programme, we argue that its typical focus on abstract, domain-general inferential processes is likely to obscure many of the distinctive ways in which the human mind can break down and malfunction. We illustrate this by appeal to psychosis and the social phenomenology of delusions.

Exploring phenomenological philosophy as it relates to psychiatry and the social world, this book establishes a common language between psychiatrists, anti-psychiatrists, psychologists and social workers. It is an inter-disciplinary work by phenomenological philosophers, psychiatrists, and psychologists to discover the essence and foundations of social psychiatry. Using the phenomenology of Husserl as a point of departure, the meanings of empathy, interpersonal understanding, we-intentionality, ethics, citizenship and social inclusion are investigated in relation to psychopathology, nosology, and (...) clinical research. This work, drawing upon the rich classical and contemporary phenomenological tradition, touching on a broad range of thinkers such as Deleuze, Levinas, and R.D. Laing, also explicates how phenomenology is a method capable of capturing the human condition and its intricate relation to the social world and mental illness. (shrink)

Psychiatry’s inchoate wish for a paradigm shift and the biopsychosocial model of mental illness’ critically examines the much discussed goal of a paradigm shift in psychiatric taxonomy. The chapter first highlights some illustrative calls for such a change and then sets these against the Kuhnian account of science from which the idea is taken, highlighting the connection to incommensurability. Relative to a distinction drawn from Winch, between putative sciences where the self-understanding of subjects plays no role and those where (...) it is fundamental, psychiatry falls into the latter kind. This suggests that the wish for a paradigm shift in psychiatry is either incoherent or a wish for a radical but unpredictable overhaul of a significant aspect of our self-understanding as subjects and agents. The biopsychosocial model of mental illness is thus a helpful reminder of the cost of a paradigm shift in psychiatry. (shrink)

Enactive approaches to psychiatry have recently argued for an understanding of psychiatric conditions based within relational interactions between individuals and their environments. A central motivation for these enactive approaches is the goal of social integration: the integration of a naturalistic approach to psychiatric conditions with their broader sociocultural dimensions. One possible issue, however, is whether appeals to the autonomy and authenticity of relationally constituted enactive individuals can provide a means of adjudicating between harmful and beneficial social constraints (...) upon individual behaviour. This paper seeks to provide enactive approaches to psychiatry with a possible means of evaluating normative influences of social contexts beyond direct interactions with relationally constituted individuals. Some of the most significant influences of the sociocultural dimension of psychiatric conditions consist not in direct interaction with individuals, but in setting the terms for interactions and interactants alike. Insofar as some social influences precede and predefine dyadic relations between individuals and their social context, these cannot be accounted for as features of interactions, but must be assessed as independent structures of the sociocultural dimension. I will provide one potential means for enactive models to assess social norms using Canguilhem’s distinction between health and pathology. I will argue that Canguilhem’s conceptualization of health in terms of adaptive normative structure provides a potential tool for social integration which strongly complements enactive approaches to psychiatry. (shrink)

Thinking through other minds encompasses new dimensions in computational psychiatry: social interaction and mutual sense-making. It questions the nature of psychiatric manifestations in light of recent data on social interaction in neuroscience. We propose the concept of “social physiology” in response to the call by the conceivers of TTOM for the renewal of computational psychiatry.

In this article we address the social value of bioethics research and show how a participatory approach can achieve social impact for a wide audience of stakeholders, involving them in a process of joint moral learning. Participatory bioethics recognizes that research co-produced with stakeholders is more likely to have impact on healthcare practice. These approaches aim to engage multiple stakeholders and interested partners throughout the whole research process, including the framing of ideas and research questions, so that outcomes (...) are tailored to the interests and context, and the type of impact stakeholders envisage. There is an emphasis on realizing social change through the conduct of the research, and it is believed that the engagement of stakeholders in the research process will promote their intrinsic motivation to change their practice. Another distinctive feature of participatory bioethics research is that its central normative commitment is to reflection and dialogue, not to a particular substantive ethical approach. In reflection and dialogue there is an emphasis on inclusion and the co-production of knowledge. Furthermore, empirical and normative research are combined, and there is a deliberate attempt to give voice to otherwise marginalized positions. This provides a model of social impact which is relevant not only for bioethics research, but also for other areas of health care research. We will show the merits of a participatory approach to bioethics research with a case example. It concerns the reduction of coercion and in particular seclusion in Dutch mental healthcare. (shrink)

It is common to note that social environment and cultural formation shape mental disorders. The details of this claim are, however, not well understood. The paper takes a look at the claim that culture has an impact on psychiatry from the perspective of metaphysics and the philosophy of science. Its aim is to offer, in a general fashion, partial explications of some significant versions of the thesis that culture and social environment shape mental disorders and to highlight (...) some of the consequences social constructionism about psychiatry has for psychiatric explanation. In particular, it will be argued that the alleged dependence of facts about particular mental disorders and about the second order property of being a mental disorder on social facts amounts to a robust form of constructivism, whereas the view that clinician–patient interaction is influenced by cultural facts is perfectly compatible with an anti-constructivist stance. (shrink)

Psychiatry widely assumes an internalist biomedical model of mental illness. I argue that many of psychiatry’s diagnostic categories involve an implicit commitment to constitutive externalism about mental illness. Some of these categories are socially externalist in nature.

An ideal in mental health care is user participation. This implies inclusion and facilitation by clinicians to enable users to participate in decisions about themselves and in the design of suitable treatment. However, much of the work of clinicians consists of handovers and other meetings where patients are not present. It is therefore interesting to study how the patient perspective is handled in such meetings and whether it forms a basis for user participation. We conducted fieldwork in three different inpatient (...) wards in Norwegian District Psychiatric Centres. We used an interactional perspective in our analysis, where speech acts, framing and footing were key concepts. The findings show that the talk in the handovers and meetings contained five main themes and that there was a clear correlation between what was said and how it was said, and whether clinicians related to the content in a decisive, person‐centred or indecisive manner. We discuss potential participation statuses for patients and their limited opportunity to influence the talk and possible decisions about themselves. Our conclusion is that handover meetings primarily function as an aid in organising clinicians' work and could ultimately be seen as counteracting user participation. (shrink)

I suggest that the diagnosis that an individual self-diagnoses with can be influenced by levels of public awareness. Accurate diagnosis requires consideration of multiple diagnoses. Sometimes, different diagnoses can overlap with one another and can only be differentiated in subtle and nuanced ways, but particular diagnoses vary considerably in levels of public awareness. As such, an individual may meet the diagnostic criteria for one diagnosis but self-diagnoses with a different diagnosis because it is better known. I then outline a potential (...) negative consequence of this. Psychiatric diagnoses can grant access to what I call social resources, namely, political advocacy, campaigning for support, participating in scientific research, building diagnostic cultures, and opportunity for social interactions with people who have the same diagnosis. The strength of the social resources for a particular diagnosis can be made stronger when more people have that diagnosis. As such, inaccurate self-diagnosis can result in the social resources for one diagnosis being strengthened whilst not being strengthened in relation to another diagnosis in comparison to accurate diagnosis. This shows how inaccurate self-diagnosis can alter the distribution of social resources. We need to consider whether this is unfair to people who are diagnosed with less well-known conditions. (shrink)

These are the basic foundations of liberatory psychiatry.

Psychiatry is increasingly dominated by the reductionist claim that mental illness is caused by neurobiological abnormalities such as chemical imbalances in the brain. Critical psychiatry does not believe that this is the whole story and proposes a more ethical foundation for practice. This book describes an original framework for renewing mental health services in alliance with people with mental health problems. It is an advance over the polarization created by the "anti-psychiatry" of the past.

Common mental health disorders are rising globally, creating a strain on public healthcare systems. This has led to a renewed interest in the role that digital technologies may have for improving mental health outcomes. One result of this interest is the development and use of artificial intelligence for assessing, diagnosing, and treating mental health issues, which we refer to as ‘digital psychiatry’. This article focuses on the increasing use of digital psychiatry outside of clinical settings, in the following (...) sectors: education, employment, financial services, social media, and the digital well-being industry. We analyse the ethical risks of deploying digital psychiatry in these sectors, emphasising key problems and opportunities for public health, and offer recommendations for protecting and promoting public health and well-being in information societies. (shrink)

The catch 22 situation in psychiatry is that for precise diagnostic categories/criteria, we need precise investigative tests, and for precise investigative tests, we need precise diagnostic criteria/categories; and precision in both diagnostics and investigative tests is nonexistent at present. The effort to establish clarity often results in a fresh maze of evidence. In finding the way forward, it is tempting to abandon the scientific method, but that is not possible, since we deal with real human psychopathology, not just concepts (...) to speculate over. Search for clear-cut definitions/diagnostic criteria in psychiatry must be relentless. There is a greater need to be ruthless and blunt in this, rather than being accommodative of diverse opinions. Investigative tests - psychological, serum, CSF, or neuroimaging - are only corroborative at present; they need to become definitive. Medicalisation appears most prominent in psychiatry; so, diagnostic proliferation and fuzziness appear inevitable. And yet, the established diagnostic entities need to forward greater and conclusive precision. Also, the need for clarity and precision must outweigh pandering to and mollifying diverse interests, moreso in the upcoming revision of diagnostic manuals. This is specially because the DSM-5, being an Association manual, may need to accommodate powerful member lobbies; and ICD-11 may similarly need to cater to diverse country lobbies. Finding precise biological correlates of psychiatric phenomena, whether through neuroimaging, molecular neurobiology and/or neurogenomics, is the right way forward. It is in the 1.5-kg structure in the cranium that all secrets of psychiatric conditions lie. Social forces, behavioural modification, psychosocial restructuring, study of intrapsychic processes, and philosophical insights are not to be discounted, but they are supplementary to the primary goal - studying and deciphering those brain processes that result in psychiatric malfunction. Experimental breakthroughs, both in psychiatric aetiology and therapeutics, will come mainly from biology and its adjunct, psychopharmacology; while supplementary and complementary breakthroughs will come from the psychosocial, cognitive and behavioural approaches; the support base will come from phenomenology, epidemiology, nosology and diagnostics; while insights and leads can hopefully come from many fields, especially the psychosocial, the behavioural, the cognitive and the philosophical. Major energies must now be marshalled towards finding biomarkers and deciphering the precise phenotype-genotype-endophenotype axis of psychiatric disorders. Energies also need to be focussed on unravelling those critical processes in the brain that tip the scale towards psychiatric disorders. At how those critical processes are set into motion by forces de novo, in utero, in the genes and their expression, by the environment's psychopathological social forces - stress, peer pressure, poverty, deprivation, alienation, malnutrition, discrimination of various types (caste, gender, race, etc.), mass conflicts (war, terror attacks, etc.), disasters (natural and man-made), religious/ideological fascism - or social institutions like marriage, family, work place, political governance, etc. Ultimately, we must decipher how the brain goes into malfunction when such varied forces impinge on it, which precise cortical areas and neuronal cellular and molecular processes are involved in such malfunction and its manifestation, as also which of these are involved when malfunction ceases and health is restored, and the psychosocial processes and institutions which aid such health restoration, as also those which promote well-being and help in primary prevention. Emphasis on the brain and its intimate neurological and molecular mechanisms will not impinge on, or nullify, importance of the 'mind,' wherein subtle and gross brain functions in the form of behaviour, thought and emotions in all their ramifications will continue to be the focus of psychological, cognitive, sociological, psychopharmacological, behavioural and philosophical research. Progress in brain research must move in tandem with progress in 'mind' research. (shrink)

I propound a mechanistic theory of natural kinds in the human sciences. By examining a culture- bound psychiatric disorder, bulimia nervosa, I illustrate how partially socially constructed phenomena raise a serious challenge to traditional theories of natural kinds. As a solution to the challenge, I show how the mechanistic approach allows us to include real but partly socially sustained phenomena among natural kinds. This is desirable because the theory of natural kinds supplies the human sciences with a clear normative account (...) of concept formation. Furthermore, my theory suggests a conceptual framework for interdisciplinary research on complex phenomena. As a prerequisite for the mechanistic approach, the concept of natural kind in the philosophy of science must be distinguished from the use of the notion in other parts of philosophy. (shrink)

In the last few decades, there has been a genuine ‘adaptive turn’ in psychiatry, resulting in evolutionary accounts for an increasing number of psychopathologies. In this paper, I explore the advantages and problems with the two main evolutionary approaches to depression, namely the mismatch and persistence accounts . I will argue that while both evolutionary theories of depression might provide some helpful perspectives, the accounts also harbor significant flaws that might question their authority and usefulness as explanations.

Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants’ locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant’s real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported (...) by a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas. (shrink)

The authors describe the arrival and treatment of 164 severe chronic psychiatric patients who were displaced from the Serbian army-controlled Jakes psychiatric hospital and off-loaded on the afternoon of 28th of May, 1992 at the gates of the Psychiatry Clinic in Tuzla. Through analysis of their incomplete medical records, which arrived with the patients in Tuzla, and analysis of their activities during and after the war, they found that 83 of the patients (50%) were males and 147 (89.6%) were (...) admitted to the Psychiatry Clinic in Tuzla. Of the patients, 86 (58.5%) were found to be Serbs. The majority of them were incapable of independent living and required ongoing medical and social care. They were from all regions of Bosnia-Herzegovina, 81.6% had schizophrenia and 70 (47.6%) were over 50 years of age. For its humanitarian work, its contribution to peace and for the maintenance of the multi-ethnic Bosnia-Herzegovina, the Psychiatry Clinic in Tuzla received the Golden Award for Peace from the International Legion of Humanists in May 1998. (shrink)

With contributions from psychiatry, psychology, neuroscience, and philosophy, this book provides the most comprehensive account to date of the interplay between biological, psychological, and social factors in mental health and their ethical dimensions.

Psychiatry presents a unique array of difficult ethical questions. However, a major challenge is to approach psychiatry in a way that does justice to the real ethical issues. Recently there has been a growing body of research in empirical psychiatric ethics, and an increased interest in how empirical and philosophical methods can be combined. Empirical Ethics in Psychiatry demonstrates how ethics can engage more closely with the reality of psychiatric practice and shows how empirical methodologies from the (...) social sciences can help foster this link. -/- The book is divided into two sections. In the first section there are discussions of the possibility of empirical ethics from a theoretical standpoint and an overview of the history of empirical medical ethics in general. The second, larger section is made up of chapters, discussing specific research projects in empirical psychiatric ethics. The contributors reflect on their choice of method: how and why they combine empirical and philosophical work, and how the two approaches relate to each other. The chapters in the second part thus have two purposes. The first is to present examples of empirical ethics in psychiatry; the second is to reflect on the way in which empirical research can support ethical analysis. -/- Empirical Ethics in Psychiatry is a unique contribution to bioethics and will be fascinating reading for all those working within the field, as well as mental health care professionals. (shrink)

The term “mental illness” implies that persons with such illnesses are more likely to be dangerous to themselves and/or others than are persons without such illnesses. This is the source of the psychiatrist’s traditional social obligation to control “harm to self and/or others,” that is, suicide and crime. The ethical dilemmas of psychiatry cannot be resolved as long as the contradictory functions of healing persons and protecting society are united in a single discipline.Life is full of dangers. Our (...) highly developed consciousness makes us, of all living forms in the universe, the most keenly aware of, and the most adept at protecting ourselves from, dangers. Magic and religion are mankind’s earliest warning systems. Science arrived on the scene only about 400 years ago, and scientific medicine only 200 years ago. Some time ago I suggested that “formerly, when religion was strong and science weak, men mistook magic for medicine; now, when science is strong and religion weak, men mistake medicine for magic”.1We flatter and deceive ourselves if we believe that we have outgrown the apotropaic use of language .Many people derive comfort from magical objects , and virtually everyone finds reassurance in magical words . The classic example of an apotropaic is the word “abracadabra,” which The American Heritage Dictionary of the English Language defines as “a magical charm or incantation having the power to ward off disease or disaster”. In the ancient world, abracadabra was a magic word, the letters of which were arranged in an inverted pyramid and worn as an amulet around the neck to protect the wearer against disease or trouble. One fewer letter appeared in each line of the pyramid, until only the letter “a” remained to form the vertex of the triangle. As …. (shrink)

Externalist theories hold that a comprehensive understanding of mental disorder cannot be achieved unless we attend to factors that lie outside of the head: neural explanations alone will not fully capture the complex dependencies that exist between an individual’s psychiatric condition and her social, cultural, and material environment. Here, we firstly offer a taxonomy of ways in which the externalist viewpoint can be understood, and unpack its commitments concerning the nature and physical realization of mental disorder. Secondly, we apply (...) a strongly externalist approach to the case of Autistic Spectrum Disorder, and argue that this condition can be illuminated by appeal to the hypothesis of extended cognition. We conclude by briefly considering the significance this strongly externalist approach may have for psychiatric practice and pedagogy. (shrink)

Medicalization in contemporary psychopharmacology is increasingly dominated by commercial interests that threaten the scientific and ethical integrity of psychiatry. At the same time, the proliferation of new social media has altered the manner in which the social groups and institutions that have stakes in medicalization interact. Consumers are at once more powerful than ever before, but also more vulnerable. The upshot of all these developments is that medicalization is no longer simply the professed enemy of anti-psychiatry (...) and its supporters. It is now also an enemy of psychiatry. Once a welcome ally of psychiatry, medicalization appears to have turned into a fearsome enemy. (shrink)

Psychiatry, as a subspecialty of medicine, is a quintessentially modernist project. Yet across the main campus, throughout the humanities and social sciences, there is increasing postmodern consensus that modernism is a deeply flawed project. Psychiatry, the closest of the medical specialties to the humanities and social sciences, will be the first to encounter postmodern theory. From my reading, psychiatry, though likely defensive at first, will eventually emerge from a postmodern critique, not only intact, but rejuvenated. (...) Postmodern theory, at its best, provides a liberating effect on modernist practices, freeing them from an enslavement to Method and Objectivity in order to allow the more human (all charges of antihumanism not withstanding) to emerge as valued and respected. The net result could be the evolution of a new postmodern psychiatry and a new model of medicine which would be much more enjoyable to practice and much more connected to the concerns of patients. (shrink)

_Disaster Psychiatry: Intervening When Nightmares Come True_ captures the state of disaster psychiatry in the aftermath of the terrorist attacks of September 11, 2001. This emergent psychiatric specialty, which is increasingly separated from trauma and grief psychiatry on one hand and military psychiatry on the other, provides psychotherapeutic assistance to victims during, and in the weeks and months following, major disasters. As such, disaster psychiatrists must operate in the widely varying locales in which natural and man-made (...) disasters occur, and they must establish their role among the chaotic array of organizations involved in direct disaster response. Editors Anand Pandya and Craig Katz have captured the challenge and promise of disaster psychiatry through first-person narratives. We hear from psychiatrists who have encountered disasters at various stages of their career and in widely varying social, political, and personal contexts. Accounts of psychiatric involvement with adults and children during and after 9/11 have understandable pride of place in this collection. But they are balanced by richly informative narratives about other domestic and international disasters. Fraught with the drama attendant to the events they describe, these essays delineate the dizzying array of challenges that confront the disaster psychiatrist. They range from the intense emotional responses that are part of the aftermath of any disaster, to the need to legitimize a psychiatric presence within diverse cultural and medical contexts, to the subtle task of providing therapeutic boundaries at a time when all rules seem to be suspended. Special attention is given to the daunting task of working with children whose parents' are disaster victims. What emerges from these testimonies is compelling documentation of skilled and compassionate psychiatrists at the outer limits of their specialty, pursuing their calling into uncharted realms of therapeutic engagement. (shrink)

Whereas classical Critical Theory has tended to view phenomenology as inherently uncritical, the recent upsurge of what has become known as critical phenomenology has attempted to show that phenomenological concepts and methods can be used in critical analyses of social and political issues. A recent landmark publication, 50 Concepts for Critical Phenomenology, contains no reference to psychiatry and psychopathology, however. This is an unfortunate omission, since the tradition of phenomenological psychiatry—as we will demonstrate in the present article (...) by surveying and discussing the contribution of Jaspers, Minkowski, Laing, Basaglia, and Fanon—from the outset has practiced critical thinking, be it at the theoretical, interpersonal, institutional, or political level. Fanon is today a recognized figure in critical phenomenology, even if his role in psychiatry might not yet have been appreciated as thoroughly as his anticolonial and antiracist contributions. But as we show, he is part of a long history of critical approaches in psychopathology and psychiatry, which has firm roots in the phenomenological tradition, and which keeps up its critical work today. (shrink)

Psychiatry is enormously complex. One of its main difficulties is how to connect the wide diversity of factors that may cause or contribute to the problems at hand, factors ranging from traumatic experiences, dysfunctional neurotransmitters, existential worries, economic deprivation, and social exclusion, to genetic bad luck. Interventions are also diverse, with options including chemical or electrical treatment, therapies aimed at behavior change and those promoting insight. Much is still unknown: what are the causal pathways, which interventions work best (...) for which patients and why?In practice, many mental health care professionals work holistically in a pragmatic and eclectic way. Without using any explicit... (shrink)

Psychiatry uncomfortably spans biological, psychological, and social perspectives on mental illness. As a branch of medicine, psychiatry is under pressure to conform to a biomedical model, according to which diseases are characterized primarily in biological terms. But psychiatry also draws on the psychotherapeutic tradition, which explains mental distress in terms of life experience and social influences.These approaches ought to complement each other, but historically this has not happened. With no theory creating global, systematic links between (...) the two approaches, psychiatry is divided... (shrink)

In psychiatry there is no sharp boundary between the normal and the pathological. Although clear cases abound, it is often indeterminate whether a particular condition does or does not qualify as a mental disorder. For example, definitions of ‘subthreshold disorders’ and of the ‘prodromal stages’ of diseases are notoriously contentious. -/- Philosophers and linguists call concepts that lack sharp boundaries, and thus admit of borderline cases, ‘vague’. Although blurred boundaries between the normal and the pathological are a recurrent theme (...) in many publications concerned with the classification of mental disorders, systematic approaches that take into account philosophical reflections on vagueness are rare. This book provides interdisciplinary discussions about vagueness in psychiatry by bringing together scholars from psychiatry, psychology, philosophy, history, and law. It draws together various lines of inquiry into the nature of gradations between mental health and disease and discusses the individual and societal consequences of dealing with blurred boundaries in medical practice, forensic psychiatry, and beyond. -/- Part I starts with an overview chapter that helps readers to navigate through the philosophy of vagueness and through the various debates surrounding demarcation problems in the classification and diagnosis of mental illness. Part II encompasses historical and recent philosophical positions on gradualist approaches to health and disease. Part III approaches the vagueness of present psychiatric classification systems, and the debates concerning their revisions by scrutinizing controversial categories, such as posttraumatic stress disorder, and the difficulties of day-to-day diagnostic and therapeutic practice. Part IV finally focuses on social, moral, and legal implications that arise when being mentally ill is a matter of degree. (shrink)

_Moving in early career from public health physician to psychiatrist gives me a public health view of psychiatry and an interest in pursuing the goals of widening access to community-based services for people with mental disorders and promoting mental health in communities. Training in social medicine in the UK and psychiatry in Australia lead to studies of homelessness in people living with psychotic disorders, the health of family caregivers, assessing quality of life and mental health promotion. Work (...) with the World Health Organization (WHO) in the Western Pacific Region and the World Psychiatric Association (WPA) worldwide has given me opportunities to work with psychiatrists, mental health workers, service users and others in governments and non-government organisations implementing the recommendations of the World Health Report 2001 in countries with limited resources. My work as WPA Secretary for Publications seeks to improve information exchange in countries irrespective of their wealth. This is an exciting time to be working in a global village with technical capacity to reach into its furthest corners. Psychiatrists supported by WPA can help ensure that vulnerable people and communities and people living with mental disorders are well served in this new environment and no longer left out and left behind._. (shrink)

Launched in 1971, _Adolescent Psychiatry,_ in the words of founding coeditors Sherman C. Feinstein, Peter L. Giovacchinni, and Arthur A. Miller, promised "to explore adolescence as a process... to enter challenging and exciting areas that may have profound effects on our basic concepts." Further, they promised "a series that will provide a forum for the expression of ideas and problems that plague and excite so many of us working in this enigmatic but fascinating field." For over two decades, Adolescent (...) Psychiatry has fulfilled this promise. The repository of a wealth of original studies by preeminent clinicians, developmental researchers, and social scientists specializing in this stage of life, the series has become an essential resource for all mental health practitioners working with youth. With volume 22, the editorship of _Adolescent Psychiatry_ passes to Aaron E. Esman, a distinguished clinician and educator whose wide-ranging sensibilities gain expression in a collection rich in clinical, developmental, and scholarly insight. Encompassing developmental topics timely clinical issues, historical commentaries, and a special section on "ambient genocide and adolescence," volume 22 ably meets the needs of professional and scholarly readers interested in this vitally important stage of life. (shrink)

Background: Psychedelics are known for their powerful mental effects due to the activation of 5HT-2A receptors in the brain. During the 1950s and 1960s, research was conducted on these molecules until their criminalization. However, their clinical investigation as therapeutic tools for psychiatric disorders has revived the deontological ethics surrounding this subject. Questions arise as research on their therapeutic outcome becomes a reality. We aim to explore deontological ethics to understand the implications of psychedelics for the clinician, patient, and society. Results: (...) A total of 42 articles were considered for this review. Methods: A methodological search of psychedelic studies from 2017 to 2022 was conducted in PubMed, Scopus, EBSCOhost, and ScienceDirect to address the deontological ethics of clinical psychedelic use. Conclusion: Psychedelics need to be culturally contextualized, epistemic harm minimized and represented to ensure informed consent. Open data and commissions are needed to ensure safe and equal distribution. (shrink)

For political reasons, the social control functions of psychiatry are not openly recognized as such but are disguised as benevolent medical treatment. The roots of this disguise may be traced to the political revolutions in which the rule of man was replaced by the rule of law. This transformation generated a conflict between the desire for freedom under law and the desire for a greater degree of social control than is provided by law. Involuntary mental hospitalization is (...) the neurotic resolution of this conflict by society. The social control functions of psychiatry are disguised and justified by the medical model which describes the moral action of both psychiatrist and patient in the ostensibly value neutral language of science and medicine. The cost of this disguise is great. It negates individuals as moral agents and obscures the moral nature of the problems that psychiatrists seek to understand which, in turn, handicaps them in helping the persons they seek to assist. The task of the philosopher in this situation is honestly and critically to analyze and evaluate psychiatric language, psychiatric practices and the moral issues involved. (shrink)

Psychiatry is plagued with philosophical questions. What is a mental illness? 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 mental illness, and involuntary hospitalization. (shrink)