The epistemological principles underlying randomized, controlled trials and evidence-based medicine generally have not received the attention they require. Broadly speaking, they are the application of work done over several centuries in philosophy and scientific method. The epistemological base is sound, but it also implies internal limitations, having to do with decreasing generality, which particularly affect application to psychological problems. The principles also have nothing to say about values. The question of the 'objective validity' of scientific method is briefly discussed.

The distinction between explanation and understanding was foundational to Jaspers’ ‘phenomenological’ approach to psychiatry. It makes sense that those now calling for a phenomenological approach to psychiatry would look to Jaspers for inspiration, and that in doing so, they would take up this distinction. However, I argue that it is and was a mistake to use the distinction in work on psychiatry: adhering to the distinction now would undermine, rather than support, the goals of those advocating a (...) phenomenological approach to psychiatry; furthermore, if the distinction had been adhered to, then contemporary psychiatry and its patients would be worse off. (shrink)

This paper focuses on one of the original moments of the development of the “phenomenological” current of psychiatry, namely, the psychopathological research of Ludwig Binswanger. By means of the clinical and conceptual problem of schizophrenia as it was conceived and developed at the beginning of the twentieth century, I will try to outline and analyze Binswanger’s perspective from a both historical and epistemological point of view. Binswanger’s own way means of approaching and conceiving schizophrenia within the scientific, medical, and (...) psychiatric context of that time will lead us to grasp the epistemological stakes at the origins of his project of reforming psychiatry by means of phenomenology. I will finally attempt to upgrade and update Binswanger’s project in light of the current reappraisal of phenomenology within the ongoing debate on psychopathology engaged by studies in the field of science and philosophy of mind. (shrink)

Current health care standards, in many countries, Australia included, are regrettably poor. Surprisingly, practitioners and treating teams alike in mental health and disability sectors, in particular, make far too many basic care-related mistakes, in addition to the already abundant diagnostic mistakes that cause and amplify great harm. In part, too many practitioners also fail to distinguish adverse effects for what they are and all too often treat adverse effects, instead, as comorbidities. Diagnostic failures are dangerous, the result of which generates (...) and perpetuates harms that are extremely costly in terms of patient welfare, in addition to the financial burden placed on everyone. In this essay, I contend that the authority bestowed upon psychiatry is misplaced. Subsequently, this misplaced authority affects the governing and investigatory institutions reliant and informed by psychiatry. The examination process undertaken in this investigation traces the metaphysics of psychiatric disorders relative to the Diagnostic-Statistical-Manual (DSM) in all its iterations and to the epistemological construction process that serves to underpin the fundamentals of psychiatric practice. There exists a crisis of confidence in psychiatric practice and I urge drastic reform be undertaken to arrest the damage. (shrink)

This book explores the central questions and themes lying at the heart of a vibrant area of philosophical inquiry. Aligning core issues in psychiatry with traditional philosophical areas, it presents a focused overview of the historical and contemporary problems dominating the philosophy of psychiatry. -/- Beginning with an introduction to research issues, it addresses what psychiatry is and distinguishes it from other areas of medical practice, other health care professions and psychology. With each section of the companion (...) corresponding to a philosophical subject, contributors systematically relate themes in philosophy of psychiatry to topics in philosophy of mind, phenomenology, philosophy of science, ethics, social and political philosophy, metaphysics, epistemology, and philosophy of medicine. Looking ahead to new research directions, chapters address recent issues including the metaphysics of mental disorders, gender and race in psychiatry and psychiatric ethics. -/- Featuring discussion questions, suggestions for further reading and an annotated bibliography, The Bloomsbury Companion to Philosophy of Psychiatry is an accessible survey of the debates and developments in the field suitable for undergraduates in philosophy and professional philosophers new to philosophy of psychiatry. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Close Enemies: The Relationship of Psychiatry and Psychology in the Assessment of Mental DisordersPhilippe Le Moigne, PhDAs Peter Zachar rightly points out in his comment, the assessment of mental disorders underwent new developments with the release of the Diagnostic and Statistical Manual of Mental Disorders-V in 2013 (American Psychiatric Association, 2013). Whereas in 1980, the manual had been thought of in a rigorously categorical way, on the basis (...) of distinct and closed syndromic entities, this new version advocated the development of a radically dimensionalist approach, with the diagnosis aiming this time to restore the whole symptomatological picture of the patient on a spectrum of ratings are supposed to cover the entirety of psychiatric semiology (American Psychiatric Association, 2013).For its part, my article aimed to show how standardized assessment, guided by the return of psychiatry’s authority and the assertion of its legitimacy in the diagnostic field, gave the ascendancy in the 1980s to the classificatory tradition and thus to the categorical model, to the detriment of personality approach and test psychology which offered a competing solution here. This perspective, historically dated, may have led the reader to think that there is an antagonism that cannot be overcome here. Rather, it should be seen as a form of structuring opposition, or even a “complementarity inscribed in rivalry,” between psychiatry and psychology, which is naturally susceptible to change over time.Indeed, the reversal operated by the Diagnostic and Statistical Manual of Mental Disorders-V is not total because it cannot be total. The defense of the dimensionalist approach, dear to the psychological testing tradition, was intended here to allow the identification of co-morbidities, present in most patients but poorly apprehended by the categorical approach, and to open up diagnosis to prevention by screening for minor manifestations of psychopathology when they suggest the [End Page 259] development of a manifest episode of the disease in the more or less long term. The risk here is that we end up with overdiagnosis and thus an over-representation of false positives (Wakefield, 2015). In other words, this type of approach does not escape the obligation to determine threshold scores, likely to indicate the lower limit of the disorder, and thus to resort to a categorical approach. There is a first affinity between the two perspectives which obeys, beyond the divergences in principle, a technical requirement.But the two approaches have even more in common when we look at their epistemological background: they share the idea that the representation and the intervention on mental disorder, to use Ian Hacking’s expression (1983), must be based on the model proposed by the physical and natural sciences. And as Greta Kaluzeviciute aptly points out in her comment, this orientation leads to the idea of measuring mental disorder in particular to conduct elaborate quantification operations to determine, for example, whether two entities are statistically distinct or whether a drug has a significant effect on the evolution of a pathology.This is in fact an old question that can be formulated as follows, to use the expression of the psychometrician Joel Michell (1999): are psychological dimensions metric? In other words, if we want to apply the language of numbers to mental disorders, they must share its properties, two of which seem essential: it must be possible to establish that each mental disorder, in the same way as qualities attributable to length for example, has a zero and can be divided by means of gradients (or degrees of intensity) whose interval is constant (Le Moigne, 2018; Michell, 1999). For lack of space, let us only address the second condition. This one has already been denied by many, starting with Bergson at the end of the nineteenth century (1889). He does not believe in the quantification of psychological expressions, starting with sensations. What is the common point, he wrote, between the feeling of a mild pain, as one feels a stiffness, and the sensation of a needle being hammered into your flesh? For him, one and the other of these intensities are incomparable, so that they do not belong to a similar register of sensations that one could stage from a 0 toward a... (shrink)

Introduction to the study : unveiling the problematic -- The evolution of madness : a journey through time -- Modernity (1890-2014 ) : a journey through time, part two -- Probing the boss text : the DSM : what? whither? how? which? -- The beast/in the belly of the beast : pinioned by paper -- The psychiatric team -- Marching to pharmageddon : psychopharmacy unmasked -- Electroshock : not a healing option -- Dusting ourselves off and starting anew.

Extant philosophical accounts of schizophrenic alien thought neglect three clinically signifi cant features of the phenomenon. First, not only thoughts, but also impulses and feelings, are experienced as alien. Second, only a select array of thoughts, impulses, and feelings are experienced as alien. Th ird, empathy with experiences of alienation is possible. I provide an account of disownership that does justice to these features by drawing on recent work on delusions and selfknowledge. Th e key idea is that disownership occurs (...) when there is a failure of rational control over one’s mind. Th is produces a clash between the deliverances of introspection and practical enquiry as ways of knowing one’s mind. Th is explanation places disownership on a continuum with more common aspects of our psychological life, such as addiction, akrasia, obsessional thinking, and immoral, selfi sh or shameful thoughts. I conclude by addressing objections, and exploring the relevance of my account to questions in the philosophy of psychiatry concerning the validity of our current taxonomy of symptoms, and the nature of psychiatric classifi cation.. (shrink)

The History of Reason in the Age of Madness revolves around three axes: the Foucauldian critical-historical method, its relationship with enlightenment critique, and the way this critique is implemented in Foucault's seminal work, History of Madness. Foucault's exploration of the origins of psychiatry applies his own theories of power, truth and reason and draws on Kant's philosophy, shedding new light on the way we perceive the birth and development of psychiatric practice. Following Foucault's adoption of 'limit attitude', which investigates (...) the limits of our thinking as points of disruption and renewal of established frames of reference, this book dispels the widely accepted belief that psychiatry represents the triumph of rationalism by somehow conquering madness and turning it into an object of neutral, scientific perception. It examines the birth of psychiatry in its full complexity: in the late eighteenth century, doctors were not simply rationalists but also alienists, philosophers of finitude who recognized madness as an experience at the limits of reason, introducing a discourse which conditioned the formation of psychiatry as a type of medical activity. Since that event, the same type of recognition, the same anthropological confrontation with madness has persisted beneath the calm development of psychiatric rationality, undermining the supposed linearity, absolute authority and steady progress of psychiatric positivism. Iliopoulos argues that Foucault's critique foregrounds this anthropological problematic as indispensable for psychiatry, encouraging psychiatrists to become aware of the epistemological limitations of their practice, and also to review the ethical and political issues which madness introduces into the apparent neutrality of current psychiatric discourse. (shrink)

"Psychiatry and Philosophy of Science" explores conceptual issues in psychiatry from the perspective of analytic philosophy of science. Through an examination of those features of psychiatry that distinguish it from other sciences - for example, its contested subject matter, its particular modes of explanation, its multiple different theoretical frameworks, and its research links with big business - Rachel Cooper explores some of the many conceptual, metaphysical and epistemological issues that arise in psychiatry. She shows how these (...) pose interesting challenges for the philosopher of science while also showing how ideas from the philosophy of science can help to solve conceptual problems within psychiatry. Cooper's discussion ranges over such topics as the nature of mental illnesses, the treatment decisions and diagnostic categories of psychiatry, the case-history as a form of explanation, how psychiatry might be value-laden, the claim that psychiatry is a multi-paradigm science, the distortion of psychiatric research by pharmaceutical industries, as well as engaging with the fundamental question whether the mind is reducible to something at the physical level. "Psychiatry and Philosophy of Science" demonstrates that cross-disciplinary contact between philosophy of science and psychiatry can be immensely productive for both subjects and it will be required reading for mental health professionals and philosophers alike. (shrink)

Intersubjectivity, the cooperation of two or more minds, is basic to human behavior, yet eludes the grasp of psychiatry. This paper traces the dilemma to the problem of other minds assumed with the epistemologies of modern science. It presents the solution of Wittgenstein's later philosophy, known for his treatment of other minds in terms of human agreement in language.Unlike recent studies of Wittgenstein's psychology, this one reviews the Philosophical Investigations' private language argument, the crux of his mature views on (...) mind. It reads that argument as recording his shift from the modern egocentric paradigm of mind to an intersubjective one. (shrink)

Intersubjectivity, the cooperation of two or more minds, is basic to human behavior, yet eludes the grasp of psychiatry. This paper traces the dilemma to the “problem of other minds” assumed with the epistemologies of modern science. It presents the solution of Wittgenstein's later philosophy, known for his treatment of other minds in terms of “human agreement in language.”Unlike recent studies of “Wittgenstein's psychology,” this one reviews the Philosophical Investigations' “private language argument,” the crux of his mature views on (...) mind. It reads that argument as recording his shift from the modern egocentric paradigm of mind to an intersubjective one.The paper contrasts the merits of Wittgenstein's reduction of subject and object to grammar with the problems of Freud's metapsychological reduction. It shows how Wittgenstein's intersubjective method avoids the excesses of behaviorism and phenomenology, offering a specifically human way to adapt mechanistic and interpretive means to the communicative ends of psychiatry. (shrink)

"Psychiatry and Philosophy of Science" explores conceptual issues in psychiatry from the perspective of analytic philosophy of science. Through an examination of those features of psychiatry that distinguish it from other sciences - for example, its contested subject matter, its particular modes of explanation, its multiple different theoretical frameworks, and its research links with big business - Rachel Cooper explores some of the many conceptual, metaphysical and epistemological issues that arise in psychiatry. She shows how these (...) pose interesting challenges for the philosopher of science while also showing how ideas from the philosophy of science can help to solve conceptual problems within psychiatry. Cooper's discussion ranges over such topics as the nature of mental illnesses, the treatment decisions and diagnostic categories of psychiatry, the case-history as a form of explanation, how psychiatry might be value-laden, the claim that psychiatry is a multi-paradigm science, the distortion of psychiatric research by pharmaceutical industries, as well as engaging with the fundamental question whether the mind is reducible to something at the physical level. "Psychiatry and Philosophy of Science" demonstrates that cross-disciplinary contact between philosophy of science and psychiatry can be immensely productive for both subjects and it will be required reading for mental health professionals and philosophers alike. (shrink)

Contemporary biological psychiatry is in a seemingly inchoate state. I assert that this state of biological psychiatry is due to its violation of an epistemological criterion of rationality, i.e., the relevance criterion; that is, contemporary biological psychiatry is irrational as it adopts a conception irrelevant to the psychobiological domain. This conception is mechanistic. The irrationality of biological psychiatry is manifest as the dominance of neurochemical explanations of psychopharmacological correlations, resulting in predictive sterility and, correspondingly, in the (...) dominance of serendipity. I suggest a rationalization of biological psychiatry through a conception relevant to the psychobiological domain. This conception is hierarchical. Keywords: criterion of relevance, epistemology, hierarchical conception, mechanistic conception, rationality CiteULike Connotea Del.icio.us What's this? (shrink)

Diagnoses are central to the practice of medicine, where they serve a variety of functions for clinicians, patients, and society. They aid communication, explain symptoms, inform predictions, guide therapeutic interventions, legitimize sickness, and authorize access to resources. Insofar as psychiatry is a discipline whose practice is shaped by medical conventions, its diagnoses are sometimes presented as if they serve the same sorts of function as diagnoses in bodily medicine. However, there are philosophical problems that cast doubt on whether the (...) functions of psychiatric diagnoses can legitimately be considered to be equivalent to those of medical diagnoses. The aim of this chapter is to explicate some of these problems, particularly conceptual and epistemological problems pertaining to the roles of diagnoses as explanations. I begin with an overview of the various functions that medical diagnoses normally serve and suggest that many of these functions receive justificatory support from the explanatory roles of the diagnoses. I then present issues regarding the epistemic functions of psychiatric diagnoses and how these issues have featured in the arguments of prominent critics of psychiatry. (shrink)

The dominant conception of delusion in psychiatry (in textbooks, research papers, diagnostic manuals, etc.) is predominantly epistemic. Delusions are almost always characterized in terms of their epistemic defects, i.e., defects with respect to evidence, reasoning, judgment, etc. However, there is an individualistic bias in the epistemic conception; the alleged epistemic defects and abnormalities in delusions relate to individualistic epistemic processes rather than social epistemic processes. We endorse the social epistemological turn in recent philosophical epistemology, and claim that a (...) corresponding turn is needed in the study of delusions. It is a turn from the (purely) individualistic conception, which characterizes delusions only by individualistic epistemic defects and abnormalities, to the (partially) social epistemic conception, which characterizes delusions by individualistic as well as social epistemic defects and abnormalities. This paper is intended as an initial step toward such a social epistemological turn. In particular, we will develop a new model of the development of delusions according to which testimonial abnormalities, including testimonial isolation and testimonial discount, are a causal factor in the development of delusions. (shrink)

In this paper I focus on the emergence of the concept of the “historical a priori” at the origin of Foucault’s archeology. I emphasize the methodological function of this concept within Foucault’s archaeology, and I maintain that despite the different thesis it entails as compared to its philosophical sources, it pertains to one of the main issues of phenomenology, that is, the problematization of the relation between reality as it appears in its historicity, and transcendentality. I start from the interest (...) of the young Foucault in existential psychiatry, and I focus on the French philosophical context in which Foucault’s Introduction to Ludwig Binswanger’s “Dream and Existence” (1954) was conceived. My aim is to show that the first “phenomenological” phase of Foucault’s work is coherent, from a methodological point of view, with the development of archaeology intended as “historical epistemology.” I conclude by arguing that Foucault’s archaeology is methodologically linked to Canguilhem’s epistemology, in that the latter presents itself as an important attempt at linking together historicity and transcendentality. (shrink)

In the United States, the National Institute of Mental Health is seeking to encourage researchers to move away from diagnostic tools like the Diagnostic and Statistical Manual of Mental Disorders. A key mechanism for this is the “Research Domain Criteria” initiative, closely associated with former NIMH Director Thomas Insel. This article examines how key figures in US psychiatry construct the purpose, nature, and implications of the ambiguous RDoC project; that is, how its novelty is constituted through discourse. In this (...) paper, I explore and analyze these actors’ accounts of what is new, important, or desirable about RDoC, demonstrating how they are constituted through institutional context and personal affects. In my interviews with mental health opinion leaders, RDoC is presented as overly reliant on neurobiological epistemologies, distant from clinical imaginaries and imperatives, and introduced in a top-down manner inconsistent with the professional norms of scientific research. Ultimately, the article aims to add empirical depth to current understandings about the epistemological and ontological politics of contemporary psychiatry and to contribute to science and technology studies debates about “the new” in technoscience. Accordingly, I use discussions about RDoC as a case study in the sociology of novelty. (shrink)

The first edition of The Mind and its Discontents was a powerful analysis of how, as a society, we view mental illness. 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 mental illness 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)

The ongoing economic overhaul of medicine creates two basic imperatives – boosting profits and containing costs – that pose special ethical and philosophical challenges for psychiatry. Because insurance coverage still favors inpatient care, pressures to raise renevues translate into a corresponding pressure on psychiatry as a whole to expand its diagnostic categories, and on individual psychiatrists to ascribe these diagnoses liberally and to hospitalize as many patients as possible. Reciprocally, cost containment requires all physicians to justify their care (...) as clearly as possible and to eliminate those interventions that are not of demonstrable value. Scientific outcome studies are markedly more difficult in psychiatry than elsewhere in medicine, particularly for psychotherapeutic as opposed to pharmacologic modes of care. An emphasis on biological over psychological conceptions of mental illness and treatment might result, not because it is more likely to be correct, but because it is easier to document in conventional ways and less expensive to deliver. An economicsdriven reorganization of psychiatry therefore poses serious philosophical challenges, not only for the profession and its future, but for the clinical care of patients. Keywords: cost containment, epistemology, ethics, economics, metaphysics, psychiatry CiteULike Connotea Del.icio.us What's this? (shrink)

In this contribution, I comment on Raffaella Campaner’s defense of explanatory pluralism in psychiatry (in this volume). In her paper, Campaner focuses primarily on explanatory pluralism in contrast to explanatory reductionism. Furthermore, she distinguishes between pluralists who consider pluralism to be a temporary state on the one hand and pluralists who consider it to be a persisting state on the other hand. I suggest that it would be helpful to distinguish more than those two versions of pluralism – different (...) understandings of explanatory pluralism both within philosophy of science and psychiatry – namely moderate/temporary pluralism, anything goes pluralism, isolationist pluralism, integrative pluralism and interactive pluralism. Next, I discuss the pros and cons of these different understandings of explanatory pluralism. Finally, I raise the question of how to implement or operationalize explanatory pluralism in scientific practice; how to structure the “genuine dialogue” or shape “the pluralistic attitude” Campaner is referring to. As tentative answers, I explore a question-based framework for explanatory pluralism as well as social-epistemological procedures for interaction among competing approaches and explanations. (shrink)

This article develops a phenomenological contribution to biological psychiatry. Grounded in the principles of transformation, heterogeneity, proportionality and particularity, a paradigm of phenomenological orientation allocates to biology a role different from that assumed by official Cartesian psychiatry. First, no clear definition of what is biological may be established a priori—as a general application, and useful to each and every studied phenomenon. Biology may be understood only as the experience of ununderstandable elements within consciousness, and as belonging necessarily to (...) a whole unity of conscious experience. Second, the research agenda in biological psychiatry necessarily intersects with the investigation of the particularities of each individual clinical case with its unique characteristics. Without this, the very notion of biological psychiatry becomes merely a theoretical abstraction. Finally, the continuity of the biological agenda needs to resume the construction and investigation of psychopathological categories that cohere with the reality of the mental universe. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.4 (2002) 353-358 [Access article in PDF] The Application of Nondual Epistemology to Anomalous Experience in Psychosis Caroline Brett THE COMMENTARIES PROVIDED by Marzanski and Bratton, and McGhee have drawn my attention to several ways in which my analysis could benefit from clarification or supplementation, and the range of the specific phenomena to which it can be applied. Since writing this paper nearly (...) 3 years ago, my own views of the area have developed, and in some aspects, shifted; nevertheless, within this response I shall comment on the specific aspects of the original paper that I feel may have been misunderstood or overlooked by the commentators, and those aspects that benefit from the broader perspective they provided.To clarify the direction of the original paper: I would describe it as an attempt to make a deeper examination of processes involved in some kinds of anomalous experience than is provided by the "cognitive problem-solving model"; in other words, to supplement rather than challenge or undermine this perspective. Moreover, the focus is intended to be more on identifying the point at which the experience, or the response to the experience (more on the relation between these two below) becomes pathological, than on cleanly distinguishing a psychotic state from a mystical one. However, because I do use these terms contrastively throughout the paper, I concede that these aims become blurred and may in fact be indistinguishable.Third, the paper concerns only a relatively narrow arena of both mystical and psychotic phenomenology, selected for the purpose of a tight conceptual analysis and comparability, and possibly suffers a lack of generalizability or scope of application as a result. Most notably, I leave aside the paranoid or persecutory interpretative framework often seen as paradigmatic of the psychotic state (although a brief mention of how emotionally relevant themes may arise out of anomalous cognition is included), focussing instead on the more "Schneiderian" aspects of psychotic phenomenology, in which there is a self-observed alteration of normal experience. 1 It may be an important point of contrast that I do not specifically focus on "hallucinations, voices, and visions" as described by McGhee and, to an extent, Jackson and Fulford. It may also be worth [End Page 353] flagging up the fact that I do not focus on "delusional beliefs" at all, instead choosing to focus on the "delusional mood," which notably does not involve crystallized delusions as such. As a result, the main aim is not to compare two descriptively defined states of mind, as seems to be suggested by McGhee in his commentary, but rather to see to what extent a certain form of experience can be understood within a particular epistemological structure, and the implications of this.Further to this issue, Marzanski and Bratton raise an objection to a view in which a common core of mystical experience is posited; one which could be identified interculturally and independently of "the language and tradition in which the self is formed." They make an important point that the perspective gained by applying the epistemology of Zen Buddhism or Advaita Vedanta may have no authority in helping to understand the locus of pathology in anomalous experiences that have occurred in an individual who is not established in these cultures or traditions or for a person who does not accept these epistemologies in the first place. The issue of the existence of some core mystical experiences that are translated into religious experiences in different cultures is a matter of comparative religion and theology, and outside the scope of this paper (although my own opinion is that such a core exists). In the absence of any argument to support this opinion, it must be conceded that this may severely limit the applicability of my analysis, especially if irreconcilable differences are thought to exist between the epistemologies of, for example, theistic and monistic philosophies. However, I would suggest that whatever wisdom can be gleaned from the various spiritual doctrines in existence around the world with regard to unusual and/or distressing states of mind should be absorbed where... (shrink)

Psychiatry is becoming a cognitive neuroscience. This new paradigm not only aims to give new ways for explaining mental diseases by naturalizing them, but also to have an influence on different levels of psychiatric norms. We tried here to verify whether a biological paradigm is able to fulfill this normative goal. We analyzed three main normative assumptions that is to say the will of giving psychiatry a valid nosology, a rigorous definition of what is a mental disease, and (...) new tools for destigmatizing mentally ill patients. Although these different kinds of normativity are very heterogeneous, we must conclude that, in all these cases, biological psychiatry is a failure, in part because of a lack of epistemological conceptualization. (shrink)

Eugen Bleuler, in 1911, renamed the group of mental disorders with poor prognosis which Emil Kraepel in had called ``dementia praecox'' ``group of schizophrenias'',because for him the splitting of personality was the main symptom.Biographical, scientific and methodological influences on Bleuler's concept of schizophrenia are shown with special reference to Kraepelin and Freud.Bleuler was a passionate and very experienced clinician. He lived with his patients, taking care of them and writing down his observations. Methodologically he was an empiricist and an eclecticist (...) with a wide reading knowledge.In an impaired association of ideas, in disordered affectivity, in marked ambivalence and autism Bleuler saw the main symptoms of schizophrenia. For him these so-called pathological phenomena actually seemed to be only exaggerations of normal psychic functions. So there were only a quantitative, not a qualitative difference between schizophrenia and normal psychic processes and studies on schizophrenic ``pathology'' –seen as a disturbance, not as a disease – might analogously illustrate normal psychic reactions and vice versa.In etiology as well as in therapy Bleuler took into account psychological and (neuro)physiological(somatic) mechanisms – thus combining organicism and dynamic psychiatry and coming very close to modern concepts, e.g. the one of stress and vulnerability. Bleuler's main merit is the stressing of an idiographic ``understanding'' of the patient and a plausible and subtle explanation of schizophrenia which helped to reduce the alienation of the affected persons. (shrink)

As one aspect of China's modernization, the importation of Western psychiatric ideas poses a mystery. How are such ideas integrated with traditional assumptions? The apparently wholesale adoption of Western psychiatric categories runs counter to the fact that the Chinese have been generally reluctant to define problems in highly individualized psychiatric terms. Our lack of knowledge as to how the Chinese and Western medical models interface raises questions about the cross-cultural applicability of psychiatric theory. Ironically, the very conceptual categories intended to (...) facilitate professional discourse obscure cultural, political, and epistemological differences between Chinese and Western thought.This paper focuses on certain incongruities in psychiatric theory and practice in order to underscore many unresolved issues that still exist with respect to our cross-cultural understandings of mental illness. Insofar as the trend has been towards standardizing methodology, taxonomies have been generated without a corresponding development in textured comparison. Originating from Western theoretical frameworks, comparative analyses have been otherwise devoid of culture-specific knowledge. (shrink)

Husserlian reduction is a rigorous method for describing the foundations of psychiatric experience. With Jaspers we consider three main principles inspired by phenomenological reduction: direct givenness, absence of presuppositions, re-presentation. But with Binswanger alone we refer to eidetic and transcendental reduction: to establish a critical epistemology; to directly investigate the constitutive processes of mental phenomena and their disturbances, freed from their nosological background; to question the constitution of our own experience when facing a person with mental illness. Regarding the (...) last item, we suggest a specific kind of reduction, typically intersubjective from the start, which we call the ‘looking-glass reduction'. The schizophrenic experience -- understood as a ‘loss of taken-for-grantedness’ implying the constitutions of the body, of the other, and of internal time -- is a real ‘epochal provocation’ for the psychiatrist. As the horizon it opens seems to be both corporeal and narrative, this ‘provoking’ of an epoche in the attitude of the psychiatrist himself and the resistances it implies raise important issues regarding the general constitution of human experience. (shrink)

Clinicians in their everyday practice of psychiatry face permanently the following epistemological and methodological problem: currently available psychiatric knowledge, like all types of scientific and technological knowledge, is general—at least in certain respects—in sharp contrast with the obvious particularities and even idiosyncrasies of each real individual mental patient they meet in the clinical encounter. This problem is admittedly the source of a permanent tension in the practice and above all in the philosophy of psychiatry. In the practice of (...) psychiatry, conscientious clinicians always try to find a necessarily pragmatic solution to this problem, mainly with the means of their psychiatric knowledge .. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 3.2 (1996) 139-142 Concurrent Contents: Recent and Classic References at the Interface of Philosophy, Psychiatry, & Psychology Articles Abramowitz, S., C. Abramowitz, C. Jackson et al. 1973. The politics of clinical judgment. Journal of Consulting and Clinical Psychology 41: 385-391.Audi, R. N. 1972. Psychoanalytic explanation and the concept of rational action. The Monist 56: 444- 464.Barondess, J. A. 1979. Disease and illness--a crucial (...) distinction. American Journal of Medicine 66: 375-376.Barrett, R. J. 1988. Interpretations of schizophrenia. Culture, Medicine and Psychiatry 12: 357-388.Bechtel, W. 1993. The case for connectionism. Philosophical Studies 7: 119-154.Belzen, J. A. 1995. The impact of phenomenology on classical psychiatry: Rümke's position between Jaspers and Kraepelin. History of Psychiatry 6: 349-385.Benda, C. E. 1967. Neuroses of conscience. Journal of Existentialism 7: 425-442.Binns, P. 1995. Commentary on "Contentless consciousness." Philosophy, Psychiatry, & Psychology 2: 61-63.Blankenburg, W. 1980. Phenomenology and psychopathology. Journal of Phenomenological Psychology 11: 50-78.Bloomfield, T. M. 1979. Psychoanalysis: A human science? Journal for the Theory of Social Behavior 9: 271-287.Blumenfeld, D. 1972. Free action and unconscious motivation. The Monist 56: 426-443.Boudreaux, G. 1977. Freud on the nature of unconscious mental processes. Philosophy of the Social Sciences 7: 1-32.Bracken, P. J. 1995. Beyond liberation: Michael Foucault and the notion of a critical psychiatry. Philosophy, Psychiatry, & Psychology 2, no. 1: 1-13.Brazier, M. 1995. Commentary on "Who should be committable?." Philosophy, Psychiatry, & Psychology 2, no. 1: 49-50.Bursztajn, J., and A. Brodsky. 1995. Authenticity and autonomy in the managed-care era: Forensic psychiatric perspectives. Journal of Clinical Ethics 5, no. 3: 237-242.Byrnes, J. F. 1979. Suggestions on writing the history of psychological data. History and Theory 16: 297-305.Campbell, E. J., J. G. Scadding, and R. J. Roberts. 1979. The concept of disease. British Medical Journal 2: 757-762.Carveth, D. 1988. In reply to Eagle's reply on "The epistemological foundations of psychoanalysis." Philosophy of the Social Sciences 18: 377-378.Chadwick, R. F. 1995. Commentary on "Karl Jaspers and Edmund Husserl." Philosophy, Psychiatry, & Psychology 2, no. 1: 83-84.Christiansen, B. 1964. The scientific status of psychoanalytic clinical evidence (III). Inquiry 7: 47-79.Davis, M. 1987. Realistic utilitarianism and the social conditions of cognitive psychotherapy. Social Theory & Practice 13: 237-259.Dega, W., et al. 1978. Ethics and mental health: Discussion. Dialectics and Humanism 5: 219-235.Dingle, H. 1949. The logical status of psycho-analysis. Analysis 9: 63-66.Dupeau, J. 1977. Freud and degeneracy. Diogenes Spring: 43-64.Eagle, M. 1988. A reply to Carveth's "The epistemological foundations of psychoanalysis. Philosophy of the Social Sciences 18: 371-375.Elevitch, B. 1974-75. Reasons, motives and psychoanalysis. Philosophical Forum (Boston) 6: 143- 162.Elliot, P. 1995. Policies, identity, and social change: Contested grounds in psychoanalytic feminism. Hypatia 10: 41-55.Fabrega Jr, H. 1980. The position of psychiatric illness in biomedical theory: A cultural analysis. Journal of Medicine and Philosophy 5: 145-168.Fisk, G. 1993. Accreditation of psychotherapists. British Journal of Hospital Medicine 50: 437-438.Flynn, B. G. 1985. Reading Habermas reading Freud. Human Studies 8: 57-76.Forrow, L., R. M. Arnold, and J. Frader. 1991. Teaching clinical ethics in the residency years--preparing competent professionals. Journal of Medicine and Philosophy 16: 93-112.Friedman, M. 1982. Philosophical anthropology and psychotherapy. Philosophical Context 12: 9-19.Galdston, I. 1969. The ontologic foundations of morality. Existential Psychiatry 7: 69-75.Gardner, S. 1995a. Commentary on "Irrationality and the dynamic unconscious." Philosophy, Psychiatry, & Psychology 2, no. 2: 175-176.Gardner, S. 1995b. Psychoanalysis, science, and commonsense. Philosophy, Psychiatry, & Psychology 2, no. 2: 93-113.Handelsman, M. M. et al. 1995. Does legally mandated consent to psychotherapy ensure ethical appropriateness? The Colorado experience. Ethics and Behavior 5, no. 2: 119-129.Hanlon, M. D. 1977. Commentary on Dunham's "Psychiatry, Sociology and Civil Liberties." Values and Ethics in Health Care 2: 275-278.Heaton, J. M. 1972. Insight in... (shrink)

Medicalization was the theme of the 29th European Conference on Philosophy of Medicine and Health Care that included a panel session on the DSM and mental health. Philosophical critiques of the medical model in psychiatry suffer from endemic assumptions that fail to acknowledge the real world challenges of psychiatric nosology. The descriptive model of classification of the DSM 3-5 serves a valid purpose in the absence of known etiologies for the majority of psychiatric conditions. However, a consequence of the (...) “atheoretical” approach of the DSM is rampant epistemological confusion, a shortcoming that can be ameliorated by importing perspectives from the work of Jaspers and McHugh. Finally, contemporary psychiatry’s over-reliance on neuroscience and pharmacotherapy has led to a reductionist agenda that is antagonistic to the inherently pluralistic nature of psychiatry. As a result, the field has suffered a loss of knowledge that may be difficult to recover. (shrink)

Delusions are typically regarded as beliefs of a certain kind, both by psychiatrists and by lay people. In “Double Bookkeeping and Doxasticism about Delusion,” Porcher formulates and assesses two kinds of arguments against doxasticism about delusions, the theoretical stance according to which delusions are a kind of belief. Those arguments, which Porcher calls “the argument from action guidance and the argument from phenomenology” are motivated by a phenomenon sometimes associated with delusions: double bookkeeping, a kind of ambivalence of patients, who (...) “often appear to be living in two parallel but separate worlds: consensual reality and the realm of their hallucinations and delusions” (Sass, 1994, p.... (shrink)

Originally put forward to defend history from the encroachment of physics, the distinction between understanding and explanation was built into the foundations of Karl Jaspers’ ‘phenomenological’ psychiatry, and it is revised, used and defended by many still working in that tradition. On the face of it, this is rather curious. I examine what this notion of ‘understanding’ amounts to, why it entered and remains influential in psychiatry, and what insights for contemporary psychiatry are buried in the notion. (...) I argue that it is unhelpfully associated with the view that the mental is epistemologically and methodologically autonomous, but that it nevertheless highlights an important lacuna in many views of psychiatry and the scientific study of humans more generally. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 41, no. 2. © 2015 by Feminist Studies, Inc. 259 Chloë Taylor Female Sexual Dysfunction, Feminist Sexology, and the Psychiatry of the Normal It is really weird that doctors should be the reigning experts on sex. —Leonore Tiefer1 The first volume of Michel Foucault’s The History of Sexuality provides a compelling and influential critique of the “sciences of sex.” In this work, Foucault suggests that there (...) is little that is scientific about the disciplines of psychoanalysis, psychiatry, and sexology that emerged in the nineteenth and twentieth centuries.2 In each case, Foucault argues that the authority of science is exploited to facilitate the regulation of sexuality in a biopolitical era in which the sex life of the population has become a crucial political stake.3 Sex, according to Foucault, is managed by doctors not so much to cure health problems as to enforce social norms, and sexual science does not provide the truth of sex or make people healthy, but naturalizes the monogamous, heterosexual, nuclear family.4 1. Leonore Tiefer, Sex Is Not a Natural Act and Other Essays (Cambridge, MA: Westview Press, 2004), 180. 2. Michel Foucault, The History of Sexuality: An Introduction (New York: Vintage, 1978). 3. Michel Foucault, The History of Sexuality: 133–160. See also Michel Foucault, Psychiatric Power: Lectures at the Collège de France 1973–1974 (New York: Palgrave -MacMillan, 2006) and Michel Foucault, Abnormal: Lectures at the Collège de France 1974–1975 (New York: Picador, 2003). 4. This is not to say that for Foucault doctors do not ever cure health problems or that their intentions are not to cure health problems. However, Foucault 260 Chloë Taylor Feminism has also posed powerful critiques of the sexual sciences. As Janice Irvine notes, feminist epistemology has rejected the purported neutrality of science, especially of the sciences that claim knowledge about sex and gender.5 Feminist and queer political theorists and activists have, moreover, “underscored the hollowness of solutions based on techniques” that are favored by sexologists; teaching men skills to resist premature ejaculation or to better stimulate their wives’ clitorises are not adequate resolutions to widespread and profound dissatisfactions with sex, gender, and marriage in a heterosexist and patriarchal society.6 As Irvine writes, Feminism and lesbian/gay liberation…challenged power inequalities between men and women and questioned the very concepts of maleness and femaleness, masculinity and femininity.…They presented alternatives to tradition and to expert power and authority. Therein lay their threat to American sexology.7 Given this antagonistic relationship, combining feminism and sexology has proved controversial. The work of feminist sexologist Shere Hite in the 1970s and 1980s was critiqued by sexologists and feminists alike: sexologists complained that the 1976 Hite Report was political and thus undermined the scientific prestige of sexology, while feminists criticized Hite for aspiring to a masculine scientific authority.8 Describing the relationship between feminism and sexology, Irvine notes that “the incompatibility of their concerns—science and market, on the one hand, versus shows that what we consider “healthy” is thoroughly political and that the effect of doctors’ practices is normalizing whatever their intentions may be. For two recent Foucauldian studies of the ways that medical and sexual science function to sexually normalize individuals and populations, see Ladelle McWhorter, Bodies and Pleasures: Foucault and the Politics of Sexual Normalization (Bloomington: Indiana University Press, 1999); and Ladelle McWhorter, Racism and Sexual Oppression in Anglo-America: A Genealogy (Bloomington: Indiana University Press, 2009). 5. Janice Irvine, Disorders of Desire: Sexuality and Gender in Modern American Sexology, rev. ed. (1990; repr., Philadelphia, PA: Temple University Press, 2005), 101. 6. Ibid. 7. Ibid. 8. Ibid., 117. Chloë Taylor 261 progressive political change, on the other—led…to a contentious and emotionally charged history.”9 Drawing on both Foucauldian and feminist perspectives, this article explores a new chapter in this history, examining self-described feminist sexologists’ responses to the psychiatric diagnoses of Female Sexual Dysfunction (FSD). While psychologists had pathologized female sexuality under the label of frigidity since the nineteenth century, sexual dysfunctions were relatively marginal in the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), published in 1952. In the DSM-1, frigidity (like impotence) was... (shrink)

This paper challenges the exclusion of patients from epistemic practices in psychiatry by examining the creation and revision processes of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a document produced by the American Psychiatric Association that identifies the properties of mental disorders and thereby guides research, diagnosis, treatment, and various administrative tasks. It argues there are epistemic—rather than exclusively social/political—reasons for including patients in the DSM revision process. Individuals with mental disorders are indispensable resources to enhance psychiatric (...) epistemology, especially in the context of the crisis, controversy, and uncertainty surrounding mental health research and treatment. (shrink)

Introduction -- The epistemology of human development -- Culture and cultural psychology -- Mind, psyche and consciousness -- Brain -- Mind : brain : culture -- Index.