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.
We argue that contemporary psychiatry adopts a defensive strategy vis-à-vis various external sources of pressure. We will identify two of these sources – the plea for individual autonomy and the idea of Managed Care – and explain how they have promoted a strict biomedical conception of disease. The demand for objectivity, however, does not take into account the complexity of mentalillness. It ignores that the psychiatrist’s profession is essentially characterized by fragility: fluctuating between scientific reduction and the (...) irreducible complexity of reality. Therefore, the psychiatrist is not in need of hard and fast rules, but of judgment. At the end, we suggest that philosophy could inject some healthy uncertainty within psychiatry in order to restore its fragile identity. Our examples are drawn from the Dutch situation but we are confident that they apply to other countries as well. (shrink)
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)
Evidence-based practice (EBP), a derivative of evidence-based medicine (EBM), is ascendant in the United States’ mental health system; the findings of randomized controlled trials and other experimental research are widely considered authoritative in mental health practice and policy. The concept of recovery from mentalillness is similarly pervasive in mental health programming and advocacy, and it emphasizes consumer expertise and self-determination. What is the relationship between these two powerful and potentially incompatible forces for mental (...) health reform?This paper identifies four attempts, in the mental health literature, to delineate the role of “evidence” in recovery. One is the strong version of evidence-based practice—an applied science model—and three others address weaknesses in the first by limiting the authority of probabilistic findings. The paper also offers a fifth version, based on the concept of communicative accountability, which is derived from Habermas’ work on communicative action. The fifth version responds to the other four and emphasizes learning, disclosure and respect in clinical and other helping relationships. (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.
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)
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)
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)
A number of prominent writers on the concept of mentalillness/disease are committed to accounts which involve rejecting certain plausible widely held beliefs, namely: that it is part of the meaning of illness that it is bad for its possessor, so the concept of illness is essentially evaluative; that if a person has a mentalillness, that is a fact about him; and that the same concept of illness is applicable in the case (...) of mentalillness as in that of physical illness. Methodologically this is unattractive. We should seek accounts of concepts which preserve our pre-theoretical beliefs so far as is possible. In this paper I argue that these writers are driven to this pass because they accept certain underlying metaphysical commitments including, in particular, the fact-value distinction. I then claim that there is an alternative account of mentalillness (defended more fully elsewhere) which preserves our pre-theoretical beliefs, and that this account can be further buttressed because it coheres with a metaphysical picture which does not involve the metaphysical assumptions which led to the unattractive results noted above. The metaphysical picture and the account of mentalillness are thus mutually supportive and suggest that there is good reason to reject the supposed fact-value distinction. (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)
Background Offering financial incentives to achieve medication adherence in patients with severe mentalillness is controversial. Aims To explore the views of different stakeholders on the ethical acceptability of the practice. Method Focus group study consisting of 25 groups with different stakeholders. Results Eleven themes dominated the discussions and fell into four categories: (1) ‘wider concerns’, including the value of medication, source of funding, how patients would use the money, and a presumed government agenda behind the idea; (2) (...) ‘problems requiring clear policies’, comprising of practicalities and assurance that incentives are only one part of a tool kit; (3) ‘challenges for research and experience’, including effectiveness, the possibility of perverse incentives, and impact on the therapeutic relationship; (4) ‘inherent dilemmas’ around fairness and potential coercion. Conclusions The use of financial incentives is likely to raise similar concerns in most stakeholders, only some of which can be addressed by empirical research and clear policies. (shrink)
In an earlier edition of CambridgeQuarterly, in the section (CQ Vol 9, No 4), Larry Gottlieb sought advice on ethics committee assembly and policy implementation for a community mental health center. One concern mentioned is that staff members frequently encounter ethical issuesregarding the care of clients whose decisionmaking abilities are impaired by chronic mentalillness and/or substance abuse. My response offers a suggestion for policy development and implementation, which may be integrated into guiding staff members of community (...)mental health centers toward a model of care planning that is centered on clients' experiences of their treatments and on relationship-building among clients, community members, and mental health professionals. (shrink)
Medical accounts of the absence of conscience are intriguing for the way they seem disposed to drift away from the ideal of scientific objectivity and towards fictional representations of the subject. I examine here several contemporary accounts of psychopathy by Robert Hare and Paul Babiak. I first note how they locate the truth about their subject in fiction, then go on to contend that their accounts ought to be thought of as a “mythos,” for they betray a telling uncertainty about (...) where “fact” ends and “fantasy” begins, as well as the means of distinguishing mental health from mentalillness in regard to some social roles. (shrink)
Several studies reveal that positive attitudes towards individuals with a mentalillness are correlated with knowledge about mentalillness. The aim of this study was to explore and describe psychiatric nurses’ experiences of living next to people with mental health problems. In addition, it sought to identify and describe how they handle situations arising in a neighbourhood where people with a mentalillness live. Two men and seven women participated in the study. The (...) constant comparative method of grounded theory was used for data collection and analysis. The process of ‘behaving as a nurse or not’ was identified as a core category. Four subcategories were identified: ‘receiving involuntary information’, ‘to take action or not’, ‘behaving as a mediator in the neighbourhood’ and ‘the freedom of choice’. The findings show that psychiatric nurses with professional knowledge about mentalillness have moral concerns about their role as nurses during their leisure time. In conclusion, it is not obvious that psychiatric nurses want to live in the same neighbourhood as persons with a mentalillness. However, this study shows that their knowledge about mentalillness creates for them a moral dilemma consisting of a conflict between whether to care for these mentally ill persons or to preserve their own leisure time. (shrink)
Although the quality and effectiveness of mental health treatments and services have improved greatly over the past 50 years, therapeutic revolutions in psychiatry have not yet been able to reduce stigma. Stigma is a risk factor leading to negative mental health outcomes. It is responsible for treatment seeking delays and reduces the likelihood that a mentally ill patient will receive adequate care. It is evident that delay due to stigma can have devastating consequences. This review will discuss the (...) causes and consequences of stigma related to mentalillness. (shrink)
In physics, we use the same laws to explain why airplanes fly, and why they crash. In psychiatry, we use one set of laws to explain sane behaviour, which we attribute to reasons (choices), and another set of laws to explain insane behaviour, which we attribute to causes (diseases). God, man's idea of moral perfection, judges human deeds without distinguishing between sane persons responsible for their behaviour and insane persons deserving to be excused for their evil deeds. It is hubris (...) to pretend that the insanity defence is compassionate, just, or scientific. Mentalillness is to psychiatry as phlogiston was to chemistry. Establishing chemistry as a science of the nature of matter required the recognition of the non-existence of phlogiston. Establishing psychiatry as a science of the nature of human behaviour requires the recognition of the non-existence of mentalillness. (shrink)
In this paper I provide an account of the metaphysical foundations of mentalillness in terms of a realism debate. I motivate the importance of such metaphysical analysis as a means of avoiding some intractable problems that beset discussion of the concept of mentalillness. I apply aspects of the framework developed by Crispin Wright for realism debates in order to examine the ontological commitments to mentalillness as a property that humans may exhibit (...) and to examine the various arguments that realists and anti-realists can use to defend their position on mentalillness. I pay particular attention to characterising Szasz's account of mentalillness as that of an anti-realist error-theory and present ways in which a realist may counter such a position. Ultimately I argue that in order to hold a realist position on mentalillness one would have to adopt some form of realism towards values, such as moral realism. (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)
Background: There has for some time now been recognition that there was a relationship between exceptional creative talent and mental disorder. The works of Andreasen (2008) and others in this area have been very significant. However, most of the research has been carried out in USA and Europe. Very little has come out of Africa on the subject. Aim : To survey the beliefs of different groups within an African society, concerning the possibility of a relationship between creative talent (...) and mental disorder. To assess creativity within a community of people with a formal diagnosis of mental disorder. Materials and Methods: Some of the mythology of the Yoruba was examined for content, concerning the behaviour of certain notable individuals and the existence of psychopathology based on modern-day criteria. The beliefs of members of the general public and mental health professionals concerning the existence of a relationship between creative talent and psychopathology were surveyed using a questionnaire designed for the project. A sample of patients with formal diagnoses of affective disorder or schizophrenia drawn from two units, the Lagos State University Teaching Hospital and the Federal Neuropsychiatric Hospital Yaba, were assessed for 'Creativity.' Results : Although there are notable 'eccentric' figures in local mythology, the overwhelming majority of the people surveyed do not believe there is any relationship between creativity and mentalillness. They however believe that engaging in creative activities helps the mentally ill to recover from illness. The mental health professionals, who were clinical psychologists and psychiatrists, had a significant minority who believed that a relationship does exist, and they also strongly assert that creative activity has a therapeutic effect for the mentally ill. A survey of in-patients diagnosed with schizophrenia and affective disorder failed to show a significant difference in the creativity of the two populations, as measured by the originality score of the Rorschach scale. The survey of patients is inconclusive, based on small sample size (ten patients with a diagnosis of schizophrenia, ten with bipolar affective disorder.). The linkage between formal mental disorder is only recognised by a significant minority of mental health professionals. A significant proportion of the population believe that creative activity aids recovery from mentalillness. More research is required into this important subject in Africa. (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)