In this article I examine some of the issues involved in taking psychiatric disorders as natural kinds. I begin by introducing a permissive model of natural kind-hood that at least prima facie seems to allow psychiatric disorders to be natural kinds. The model, however, hinges on there in principle being some grounding that is shared by all members of a kind, which explain all or most of the additional shared projectible properties. This leads us to the (...) following question: what grounding do psychiatric disorders qua natural kinds have? My principal method for examining the issue is a case study of a particular psychiatric disorder: the so-called “apathetic children.” I argue that there appear to be at least two competing models that both appeal to non-organic a grounding of the disorder. However, for other psychiatric disorders, such as Alzheimer’s disease, the evidence points toward an organic explanation of the disorder. I contend that what unites psychiatric disorders is not a distinctive type of grounding that all psychiatric disorders share, but the distinctive set of determinable properties that is shared by all psychiatric disorders. (shrink)

A large campaign has sought to destigmatize psychiatric disorders by disseminating the view that they are in fact brain disorders. But when psychiatric disorders are associated with neurobiological correlates, laypeople's attitudes toward patients are harsher, and the prognoses seem poorer. Here, we ask whether these misconceptions could result from the essentialist presumption that brain disorders are innate. To this end, we invited laypeople to reason about psychiatric disorders that are diagnosed by either (...) a brain or a behavioral test that were strictly matched for their informative value. Participants viewed disorders as more likely to be innate and immutable when the diagnosis was supported by a brain test as compared to a behavioral test. These results show for the first time that people spontaneously essentialize psychiatric conditions that are linked to the brain, even when the brain probe offers no additional diagnostic or genetic information. This bias suggests that people consider the biological essence of living things as materially embodied. (shrink)

Borsboom and colleagues have recently proposed a “network theory” of psychiatric disorders that conceptualizes psychiatric disorders as relatively stable networks of causally interacting symptoms. They have also claimed that the network theory should include non-symptom variables such as environmental factors. How are environmental factors incorporated in the network theory, and what kind of explanations of psychiatric disorders can such an “extended” network theory provide? The aim of this article is to critically examine what explanatory (...) strategies the network theory that includes both symptoms and environmental factors can accommodate. We first analyze how proponents of the network theory conceptualize the relations between symptoms and between symptoms and environmental factors. Their claims suggest that the network theory could provide insight into the causal mechanisms underlying psychiatric disorders. We assess these claims in light of network analysis, Woodward’s interventionist theory, and mechanistic explanation, and show that they can only be satisfied with additional assumptions and requirements. Then, we examine their claim that network characteristics may explain the dynamics of psychiatric disorders by means of a topological explanatory strategy. We argue that the network theory could accommodate topological explanations of symptom networks, but we also point out that this poses some difficulties. Finally, we suggest that a multilayer network account of psychiatric disorders might allow for the integration of symptoms and non-symptom factors related to psychiatric disorders and could accommodate both causal/mechanistic and topological explanations. (shrink)

Social cognition is a broad term, incorporating all aspects of social functioning from perceiving emotional stimuli to attributional style and theory of mind. Not distinguishing between these different capacities may confound the interpretation of the data deriving from studies of the relationship between psychiatric disorders and the social brain. The distinction between cognitive and affective components of social cognition is clearly exemplified by the abnormalities observed in psychopathy and Williams syndrome.

Objective—In Switzerland, as in some other European countries, medical doctors may breach patient confidentiality and report to police authorities any patient who seems prone to automobile accidents or traffic violations. The aim of this study was to see if those patients reported to authorities actually represent a higher risk than drivers not reported to the police.Design—This study was designed following a case-control study comparing the characteristics of a group of psychiatric patients who were reported to authorities for preventive purposes, (...) with the characteristics of another group of people who had disorders that were noticed at the time of an accident or traffic violation.Results—The results show that medical doctors tended to report male patients, patients with a low level of education, and patients with a severe psychiatric background. The subjects of the control group, who had often been involved in accidents or committed traffic violations in the past, did not possess these characteristics.Conclusions—The breach of medical confidentiality by doctors in reporting to authorities patients who are allegedly at risk is ethically questionable as long as the evaluation of driving performance does not rely on objective bases. (shrink)

Tilmes concludes his interesting and informative piece with the sentence that “analysis of psychiatric vagueness merits further consideration.” I agree with this point, as well as with his earlier assertion that how one understands psychiatric vagueness may implicate the diagnostic model that one adopts, and the research that one pursues. Fortunately, there has been recent attention to vagueness in psychiatry, addressing both degree-vagueness and combinatorial vagueness. Vagueness in psychiatry is related to a range of nosological debates, including about (...) the... (shrink)

Does DBS change a patient’s personality? This is one of the central questions in the debate on the ethics of treatment with Deep Brain Stimulation (DBS). At the moment, however, this important debate is hampered by the fact that there is relatively little data available concerning what patients actually experience following DBS treatment. There are a few qualitative studies with patients with Parkinson’s disease and Primary Dystonia and some case reports, but there has been no qualitative study yet with patients (...) suffering from psychiatric disorders. In this paper, we present the experiences of 18 patients with Obsessive-Compulsive Disorder (OCD) who are undergoing treatment with DBS. We will also discuss the inherent difficulties of how to define and assess changes in personality, in particular for patients with psychiatric disorders. We end with a discussion of the data and how these shed new light on the conceptual debate about how to define personality. (shrink)

There is a steadily growing literature on the role of the immune system in psychiatric disorders. So far, these advances have largely taken the form of correlations between specific aspects of inflammation (e.g. blood plasma levels of inflammatory markers, genetic mutations in immune pathways, viral or bacterial infection) with the development of neuropsychiatric conditions such as autism, bipolar disorder, schizophrenia and depression. A fundamental question remains open: why are psychiatric disorders and immune responses intertwined? To address (...) this would require a step back from a historical mind–body dualism that has created such a dichotomy. We propose three contributions of active inference when addressing this question: translation, unification, and simulation. To illustrate these contributions, we consider the following questions. Is there an immunological analogue of sensory attenuation? Is there a common generative model that the brain and immune system jointly optimise? Can the immune response and psychiatric illness both be explained in terms of self-organising systems responding to threatening stimuli in their external environment, whether those stimuli happen to be pathogens, predators, or people? Does false inference at an immunological level alter the message passing at a psychological level (or vice versa) through a principled exchange between the two systems? (shrink)

Advances in emotion and affective science have yet to translate routinely into psychiatric research and practice. This is unfortunate since emotion and affect are fundamental components of many psychiatric conditions. Rectifying this lack of interdisciplinary integration could thus be a potential avenue for improving psychiatric diagnosis and treatment. In this contribution, we propose and discuss an ontological framework for explicitly capturing the complex interrelations between affective entities and psychiatric disorders, in order to facilitate mapping and (...) integration between affective science and psychiatric diagnostics. We build on and enhance the categorisation of emotion, affect and mood within the previously developed Emotion Ontology, and that of psychiatric disorders in the Mental Disease Ontology. This effort further draws on developments in formal ontology regarding the distinction between normal and abnormal in order to formalize the interconnections. This operational semantic framework is relevant for applications including clarifying psychiatric diagnostic categories, clinical information systems, and the integration and translation of research results across disciplines. (shrink)

Deep brain stimulation (DBS), a surgical procedure involving the implantation of electrodes in the brain, has rekindled the medical community’s interest in psychosurgery. Whereas many researchers argue DBS is substantially different from psychosurgery, we argue psychiatric DBS—though a much more precise and refined treatment than its predecessors—is nevertheless a form of psychosurgery, which raises both old and new ethical and legal concerns that have not been given proper attention. Learning from the ethical and regulatory failures of older forms of (...) psychosurgery can help shed light on how to address the regulatory gaps that exist currently in DBS research. To show why it is important to address the current regulatory gaps within psychiatric DBS, we draw on the motivations underlying the regulation of earlier forms of psychosurgery in the US. We begin by providing a brief history of psychosurgery and electrical brain stimulation in the US. Against this backdrop, we introduce psychiatric DBS, exploring current research and ongoing clinical trials. We then draw out the ethical and regulatory similarities between earlier forms of psychosurgery and psychiatric DBS. As we will show, the factors that motivated strict regulation of earlier psychosurgical procedures mirror concerns with psychiatric DBS today. We offer three recommendations for psychiatric DBS regulation, which echo earlier motivations for regulating psychosurgery, along with new considerations that reflect the novel technologies used in DBS. (shrink)

BackgroundTranscranial direct current stimulation is a non-invasive, non-convulsive technique for modulating brain function. In contrast to other non-invasive brain stimulation techniques, where costs, clinical applicability, and availability limit their large-scale use in clinical practices, the low-cost, portable, and easy-to-use tDCS devices may overcome these restrictions.ObjectiveDespite numerous clinical applications in large numbers of patients suffering from psychiatric disorders, it is not quite clear how tDCS influences the mentally affected human brain. In order to decipher potential neural mechanisms of action (...) of tDCS in patients with psychiatric conditions, we focused on the combination of tDCS with neuroimaging techniques.DesignWe propose a contemporary overview on the currently available neurophysiological and neuroimaging data where tDCS has been used as a research or treatment tool in patients with psychiatric disorders.ResultsOver a reasonably short period of time, tDCS has been b... (shrink)

ABSTRACT The paper is a discussion of moral responsibility and excuses in regard to psychiatric disorders involving abnormal desires (e.g. impulse control disorders such as kleptomania and pyromania, psychosexual disorders such as exhibitionism, obsessive‐compulsive disorder and others). It points out problems with previous approaches to the question of whether or not to excuse persons with these disorders, and offers a new approach based on the concept of duress. There is a discussion of duress in regard (...) to non‐psychiatric cases based on the core notion of duress involving a choice between undesirables, and the paper concludes with an argument that moral blame for individuals with these sorts of disorders should often be lessened and in some cases removed entirely. (shrink)

The various jurisdictions worldwide that now legally permit assisted suicide (or voluntary euthanasia) vary concerning the medical conditions needed to be legally eligible for assisted suicide. Some jurisdictions require that an individual be suffering from an unbearable and futile medical condition that cannot be alleviated. Others require that individuals must be suffering from a terminal illness that will result in death within a specified timeframe, such as six months. -/- Popular and academic discourse about assisted suicide paradigmatically focuses on individuals (...) with ‘physical,’ i.e., non-psychiatric medical conditions, such as cancer or AIDS. Here I defend analyses of the notions of unbearable suffering, futility, and terminality that imply that, regardless of which of these medical conditions is invoked, at least some individuals with severe and persistent psychiatric illnesses satisfy these conditions and ought to be classified as legally eligible for assisted suicide. The legal and moral case for a right to assisted suicide is therefore not in principle weaker for the severely psychiatrically disordered than for those with ‘typical’ terminal or futile medical conditions. (shrink)

Central and peripheral biomarkers can be used to diagnose, treat, and potentially prevent major psychiatric disorders. But there is uncertainty about the role of these biological signatures in neural pathophysiology, and their clinical significance has yet to be firmly established. Psychomotor, cognitive, affective, and volitional impairment in these disorders results from the interaction between neural, immune, endocrine, and enteric systems, which in turn are influenced by a person’s interaction with the environment. Biomarkers may be a critical component (...) of this process. The identification and interpretation of biomarkers also raise ethical and social questions. This article analyzes and discusses these aspects of biomarkers and how advances in biomarker research could contribute to personalized psychiatry that could prevent or mitigate the effects of these disorders. (shrink)

In healthcare ethics there is a discussion regarding whether autonomy of personal preferences, what sometimes is referred to as authenticity, is necessary for autonomous decision-making. It has been argued that patients’ decisions that lack sufficient authenticity could be deemed as non-autonomous and be justifiably overruled by healthcare staff. The present paper discusses this issue in relation certain psychiatric disorders. It takes its starting point in recent qualitative studies of the experiences and thoughts of patients’ with anorexia nervosa where (...) issues related to authenticity seem particularly relevant. The paper examines different interpretations of authenticity relevant for autonomy and concludes that the concept, as it has been elaborated in recent debate, is highly problematic to use as a criterion for autonomous decision-making in healthcare. (shrink)

Psychiatric treatment and diagnosis rests upon a richer conception of normativity than, for example, cognitive neuropsychology. This paper explores the role that considerations of rationality can play in defining this richer conception of normativity. It distinguishes two types of rationality and considers how each type can break down in different ways in delusional psychiatric disorders.

Self-reflection plays a key role in healthy human adaptation. Self-reflection might involve different capacities which may be impaired to different degrees relatively independently of one another. Variation in abilities for different forms of self-reflection are commonly seen as key aspects of many adult mental disorders. Yet little has been written about whether there are different kinds of deficits in self-reflection found in mental illness, how those deficits should be distinguished from one another and how to characterize the extent to (...) which they are interrelated. We review clinical and experimental literature and suggest four different forms of deficits in self-reflection: sense of ownership of one’s own thoughts and actions, emotional awareness, distinction between fantasy and reality and the integration of a range of different views of oneself and others. We propose how these different impairments in self-reflection are linked with one another. (shrink)

Mitochondrial ATP synthesis, calcium buffering, and trafficking affect neuronal function and survival. Several genes implicated in mitochondrial functions map within the genomic region associated with 22q11.2 deletion syndrome (22q11DS), which is a key genetic cause of neuropsychiatric diseases. Although neuropsychiatric diseases impose a serious health and economic burden, their etiology and pathogenesis remain largely unknown because of the dearth of valid animal models and the challenges in investigating the pathophysiology in neuronal circuits. Mouse models of 22q11DS are becoming valid tools (...) for studying human psychiatric diseases, because they have hemizygous deletions of the genes that are deleted in patients and exhibit neuronal and behavioral abnormalities consistent with neuropsychiatric disease. The deletion of some 22q11DS genes implicated in mitochondrial function leads to abnormal neuronal and synaptic function. Herein, we summarize recent findings on mitochondrial dysfunction in 22q11DS and extend those findings to the larger context of schizophrenia and other neuropsychiatric diseases. (shrink)

There is a spectrum of child psychiatric and neurological disorders, in all of which a comorbidity with obsessive-compulsive disorder and ritualized behavior is very common. Therefore, they may appear as a basis for the rituals in children that cross into adolescence and adulthood. Resolving the nature of these disorders may help us to better understand “Why ritualized behavior?” (Published Online February 8 2007).

The publication of the DSM-5 awakened the interest in the classification of mental disorders and in factors which influence the production of a classification and its use. Among these are the debates about the limits between mental disorders and normality, the impact of vested interest in the publication of a revised version of a classification or its postponement, the problems of making those concerned use the classification and numerous others. The chapter discusses these issues and makes suggestions about (...) the way forward. (shrink)

In this chapter, I first review and assess evidence regarding brain damage or neural abnormalities associated with some psychopathologies and cognitive deficits, such as hemispatial neglect, agnosias, amnesia, somatoparaphrenia, and others. It becomes clear just how closely normal mental functioning and consciousness depend upon normal brain functioning as well as how some very specific mental changes occur when, and only when, very specific brain damage occurs. I then explore the metaphysical implications of these results with respect to the nature of (...) mind and consciousness. In particular, I examine the plausibility of materialism, roughly the view that mental processes are brain processes, in light of the evidence discussed and in contrast to a dualist conception of the mind (whereby mental states are not physical in some sense). I also explore the prospects for a conscious afterlife based both on the brain damage evidence adduced and the metaphysical implications discussed. (shrink)

This paper will consider the right not to know in the context of psychiatric disorders. It will outline the arguments for and against acquiring knowledge about the results of genetic testing for conditions such as breast cancer and Huntington’s disease, and examine whether similar considerations apply to disclosing to clients the results of genetic testing for psychiatric disorders such as depression and Alzheimer’s disease. The right not to know will also be examined in the context of (...) the diagnosis of psychiatric disorders that are associated with stigma or for which there is no effective treatment. (shrink)

The main objective in this chapter is to examine the role of judgments of rationality in the current understanding of psychiatric disorders. To what extent are the criteria for classification and diagnosis independent of judgments of rationality? The typical symptoms of many psychiatric disorders are described as instances of epistemic, procedural, or emotional irrationality, and references to such forms of irrationality are frequently made in the current classificatory and diagnostic criteria for schizophrenia, dementia, depression, and personality (...) disorders. That said, the chapter defend the view that irrationality is neither necessary nor sufficient for a behavior to be characterized as symptomatic of a psychiatric disorder. (shrink)

Neurosurgery for psychiatric disorders, also sometimes referred to as psychosurgery, is rapidly evolving, with new techniques and indications being investigated actively. Many within the field have suggested that some form of guidelines or regulations are needed to help ensure that a promising field develops safely. Multiple countries have enacted specific laws regulating NPD. This article reviews NPD-specific laws drawn from North and South America, Asia and Europe, in order to identify the typical form and contents of these laws (...) and to set the groundwork for the design of an optimal regulation for the field. Key challenges for this design that are revealed by the review are how to define the scope of the law, what types of regulations are required, and how to approach international harmonization given the potential migration of researchers and patients. (shrink)

It is proposed that happiness be classified as a psychiatric disorder and be included in future editions of the major diagnostic manuals under the new name: major affective disorder, pleasant type. In a review of the relevant literature it is shown that happiness is statistically abnormal, consists of a discrete cluster of symptoms, is associated with a range of cognitive abnormalities, and probably reflects the abnormal functioning of the central nervous system. One possible objection to this proposal remains--that happiness (...) is not negatively valued. However, this objection is dismissed as scientifically irrelevant. (shrink)

e understanding of the etiology and pathogenesis of these psyc hiatric disorders such as schizophrenia and depression is still n ot completely clear. At present, there is a lack of objective ne urobiological markers that can be used in clinical routine work such as clinical diagnosis, curative effect evaluation and progn osis evaluation of psychiatric disorders. Therefore, it is of great clinical significance to find biomarkers to improve the diagnos is level and evaluate the curative effect. Electroencephalogram (...) (EEG) is a non-invasive technique to record the potential activi ty of biological brain, through which researchers can analyze th e mechanisms underlying psychiatric disorders. In addition, mac hine learning can be used to further verify the role of these el ectrophysiological indicators in clinical diagnosis and curative e ffect evaluation of psychiatric disorders. The goal of this resear ch topic is to advance research on neurobiomarkers and EEG/ MEG-based diagnostic methods for mental disorders. We hope to conduct in-depth research on the pathogenesis and diagnostic measures of mental diseases such as schizophrenia and depressi ve disorder through EEG/MEG, in order to improve the perfor mance of artificial intelligence for mental diseases diagnosing.Under this research theme, the following is a brief overview of nine published articles, which respectively studied the diagnosis, The work in this special issue may fall into three categories of research: 1) method... (shrink)

Deep brain stimulation (DBS) of the globus pallidus interna and subthalamic nucleus has restored some degree of motor control in many patients in advanced stages of Parkinson’s disease. DBS has also been used to treat dystonia, essential tremor (progressive neurological condition causing trembling), chronic pain, obsessive-compulsive disorder, Tourette’s syndrome, major depressive disorder, obesity, cerebral palsy, and the minimally conscious state. Although the underlying mechanisms of the technique are still not clear, DBS can modulate underactive or overactive neural circuits and restore (...) disrupted communication between and among groups of neurons in interacting regions of the brain. This can control and relieve many symptoms associated with a range of neurological and psychiatric disorders.But the procedures of implanting and stimulating the electrodes are brain-invasive and entail significant risks. Some patients receiving DBS have experienced intracerebral hemorrhage, infection, cognitive disturbances such as impulsive behavior, and affective disturbances such as mania. It is not known whether continuous electrical stimulation of the brain would reshape synaptic connectivity and permanently alter neural circuits in ways that may not be salutary. The risk of these effects indicates that DBS should be used only when a patient’s condition is refractory to all other interventions and when there is a high probability that the technique will benefit the patient and improve his or her quality of life. If a patient’s quality of life is poor and all other treatment options have been exhausted, then the likelihood of benefit can justify physicians’ exposing patients to some risk. The clinical and ethical significance of the risk in DBS underscores the obligation of physicians to obtain fully informed consent from patients undergoing the procedure. (shrink)

ObjectiveIn Belgium, people with an incurable psychiatric disorder can file a request for euthanasia claiming unbearable psychic suffering. For the request to be accepted, it has to meet stringent legal criteria. One of the requirements is that the patient possesses decision-making capacity. The patient’s decision-making capacity is assessed by physicians.The objective of our study is to provide insight in the assessment of decision-making capacity in the context of euthanasia for patients with psychic suffering caused by a psychiatric disorder.MethodTwenty-two (...) semistructured interviews with psychiatrists and neurologists were analysed with NVivo, a qualitative analysis software to code and organise transcribed data.ResultsDifferent views and approaches regarding decision-making capacity in the context of euthanasia emerged from the data.Most of the physicians have some knowledge of the cognitive ability approach on decision-making capacity. According to this approach, four abilities constitute decision-making capacity: communication, understanding, appreciation and reasoning. We observed differences in the way these abilities are valued in relation to competence. Some physicians take additional elements into consideration when assessing decision-making capacity.Physicians acquired their knowledge on the subject in many different ways. Most of the physicians reported that decision-making capacity was not part of their training.ConclusionWe conclude that physicians assess decision-making capacity in different ways and that personal values and beliefs influence their approach. As such, a common approach in assessing the decision-making capacity of a patient among the interviewed physicians is lacking. Less arbitrariness could be obtained by consistently implementing the cognitive ability approach. (shrink)

Backgrounds: Transcranial direct current stimulation is a non-invasive brain stimulation technique for the treatment of several psychiatric disorders, e.g., mood disorders and schizophrenia. Therapeutic effects of tDCS are suggested to be produced by bi-directional changes in cortical activities, i.e., increased/decreased cortical excitability via anodal/cathodal stimulation. Although tDCS provides a promising approach for the treatment of psychiatric disorders, its neurobiological mechanisms remain to be explored.Objectives: To review recent findings from neurophysiological, chemical, and brain-network studies, and consider (...) how tDCS ameliorates psychiatric conditions.Findings: Enhancement of excitatory synaptic transmissions through anodal tDCS stimulation is likely to facilitate glutamate transmission and suppress gamma-aminobutyric acid transmission in the cortex. On the other hand, it positively or negatively modulates the activities of dopamine, serotonin, and acetylcholine transmissions in the central nervous system. These neural events by tDCS may change the balance between excitatory and inhibitory inputs. Specifically, multi-session tDCS is thought to promote/regulate information processing efficiency in the cerebral cortical circuit, which induces long-term potentiation by synthesizing various proteins.Conclusions: This review will help understand putative mechanisms underlying the clinical benefits of tDCS from the perspective of neurotransmitters, network dynamics, intracellular events, and related modalities of the brain function. (shrink)

Although euthanasia and assisted suicide in people with psychiatric disorders is relatively rare, the increasing incidence of EAS requests has given rise to public and political debate. This study aimed to explore support of the public and physicians for euthanasia and assisted suicide in people with psychiatric disorders and examine factors associated with acceptance and conceivability of performing EAS in these patients. A survey was distributed amongst a random sample of Dutch 2641 citizens and 3000 physicians. (...) Acceptance and conceivability of performing EAS, demographics, health status and professional characteristics were measured. Multivariable logistic regression analyses were performed. Of the general public 53% were of the opinion that people with psychiatric disorders should be eligible for EAS, 15% was opposed to this, and 32% remained neutral. Higher educational level, Dutch ethnicity, and higher urbanization level were associated with higher acceptability of EAS whilst a religious life stance and good health were associated with lower acceptability. The percentage of physicians who considered performing EAS in people with psychiatric disorders conceivable ranged between 20% amongst medical specialists and 47% amongst general practitioners. Having received EAS requests from psychiatric patients before was associated with considering performing EAS conceivable. Being female, religious, medical specialist, or psychiatrist were associated with lower conceivability. The majority of the psychiatrists were of the opinion that it is possible to establish whether a psychiatric patient’s suffering is unbearable and without prospect and whether the request is well-considered. The general public shows more support than opposition as to whether patients suffering from a psychiatric disorder should be eligible for EAS, even though one third of the respondents remained neutral. Physicians’ support depends on their specialization; 39% of psychiatrists considered performing EAS in psychiatric patients conceivable. The relatively low conceivability is possibly explained by psychiatric patients often not meeting the eligibility criteria. (shrink)

Executive function has become an important concept in explanations of psychiatric disorders, but we currently lack comprehensive models of normal executive function and of its malfunctions. Here we illustrate how defeasible logical analysis can aid progress in this area. We illustrate using autism and attention deficit hyperactivity disorder (ADHD) as example disorders, and show how logical analysis reveals commonalities between linguistic and non-linguistic behaviours within each disorder, and how contrasting sub-components of executive function are involved across (...) class='Hi'>disorders. This analysis reveals how logical analysis is as applicable to fast, automatic and unconscious reasoning as it is to slow deliberate cogitation. (shrink)

We compare astronomers' removal of Pluto from the listing of planets and psychiatrists' removal of homosexuality from the listing of mental disorders. Although the political maneuverings that emerged in both controversies are less than scientifically ideal, we argue that competition for "scientific authority" among competing groups is a normal part of scientific progress. In both cases, a complicated relationship between abstract constructs and evidence made the classification problem thorny.

In game theory, the word ‘game’ is used to describe any interdependence between interacting parties, and the Nash equilibrium is a prominent tool for analysing such interactions. I argue that the concept of the Nash equilibrium may also be used in non-gaming contexts. An individual is in a Nash equilibrium if his or her beliefs are consistent with his or her actions. Given that discordance between beliefs and behaviour is a typical cause of psychiatric disorders, individuals who are (...) not in a Nash equilibrium are likely to be affected by such disorders. In this regard, the concept of the Nash equilibrium could aptly be introduced into the medical practitioner’s vocabulary for describing a patient’s mental health status. (shrink)

Abstract:The titular question, of what makes a disorder 'mental,' has an obvious answer: mental disorders are disorders of the mind. I argue that this is not so, before proposing a positive theory of what makes a disorder 'mental,' that what makes a disorder 'mental' is its relationship to psychiatry. The overall thrust of my argument is that mental disorder is mental in name only—to have a mental disorder is not to have a disorder of the mind. Instead, mental (...) disorder is psychiatric disorder, a class of conditions grouped together not because of anything to do with the mind, but because of their relationship to psychiatry, a concrete group of methods, practices, and institutions. (shrink)