The application of human right frameworks is an increasingly important part of efforts to accelerate progress in global mental health. Much of this has been driven by several influential legal and policy instruments, most notably the United Nations’ Convention on the Rights of Persons with Disabilities, as well as the World Health Organization’s QualityRights Tool Kit and Mental Health Action Plan. Despite these significant developments, however, much more needs to be done to prevent human rights violations. This chapter focuses on (...) a critical component of this broader challenge, which is the question of how best to regulate and reduce the use of coercive measures. The recent literature on coercion in psychiatry – which addresses involuntary commitment, seclusion, restraint, and forced medication – represents a useful resource that can help guide tractable solutions in global mental health. These issues are evaluated from the perspective of global health governance, and several general recommendations are made in order to improve monitoring and enforcement, provide guidance for domestic legislative reform, and strengthen health systems. (shrink)

This chapter examines philosophical issues surrounding the classification of mental disorders by the Diagnostic and Statistical Manual of Mental Disorders (DSM). In particular, the chapter focuses on issues concerning the relative merits of descriptive versus theoretical approaches to psychiatric classification and whether the DSM should classify natural kinds. These issues are presented with reference to the history of the DSM, which has been published regularly by the American Psychiatric Association since 1952 and is currently in its fifth edition. While the (...) first two editions of the DSM adopted a theoretical (psychoanalytic) and etiological approach to classification, subsequent editions of the DSM have adopted an atheoretical and purely descriptive (“neo-Kraepelinian”) approach. It is argued that largest problem with the DSM at present—viz., its failure to provide valid diagnostic categories—is directly related to the purely descriptive methodology championed by the DSM since the third edition of the DSM. In light of this problem, the chapter discusses the prospects of a theoretical and causal approach to psychiatric classification and critically examines the assumption that the DSM should classify natural kinds. (shrink)

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

ArgumentNeuroscience research has created multiple versions of the human brain. The “social brain” is one version and it is the subject of this paper. Most image-based research in the field of social neuroscience is task-driven: the brain is asked to respond to a cognitive stimulus. The tasks are derived from theories, operational models, and back-stories now circulating in social neuroscience. The social brain comes with a distinctive back-story, an evolutionary history organized around three, interconnected themes: mind-reading, empathy, and the emergence (...) of self-consciousness. This paper focuses on how empathy has been incorporated into the social brain and redefined via parallel research streams, employing a shared, imaging technology. The concluding section describes how these developments can be understood as signaling the emergence of a new version of human nature and the unconscious. My argument is not that empathy in the social brain is a myth, but rather that it is served by a myth consonant with the canons of science. (shrink)

This article makes the case for the largely unacknowledged relevance of the thought of the French psychoanalyst, Jacques Lacan, for the emerging field of the medical and/or health humanities. From the 1930s all the way through to the late 1970s, Lacan was deeply concerned with the ethical and political consequences of then-dominant conceptions of the human in the ‘psy’ disciplines. His attempt to ‘humanise’ these disciplines involved an emphasis on humans as symbolic beings, inevitably entangled in the structures of speech (...) and the ‘logic of the signifier.’ This article explores the implications of Lacan’s linguistic framework for his understanding of trauma. It argues that the Lacanian concept of trauma offers a timely antidote to dominant psychiatric notions of trauma today, linked as they are to the questionable politics of ‘Post-Traumatic Stress Disorder’ and, more recently, of ‘Post-Traumatic Growth.’. (shrink)

In this article, I argue that the history and philosophy of autism need to account for two kinds of autism. Contemporary autism research and practice is structured, directed and connected by an ‘ontological understanding of disease’. This implies that autism is understood as a disease like any other medical disease, existing independently of its particular manifestations in individual patients. In contrast, autism in the 1950s and 1960s was structured by a psychoanalytical framework and an ‘individual understanding of disease’. This implied (...) that autism was not a distinct disease but an idiosyncratic and meaningful response of the child to a disturbed development of the ego. These two kinds of autism are embedded in and reveal two very different ‘styles of psychiatric thought’. (shrink)

Although clinicians and researchers working in the field of autism are generally not concerned with philosophical categories of kinds, a model for understanding the nature of autism is important for guiding research and clinical practice. Contemporary research in the field of autism is guided by the depiction of autism as a scientific object that can be identified with systematic neuroscientific investigation. This image of autism is compatible with a permissive account of natural kinds: the mechanistic property cluster (MPC) account of (...) natural kinds, recently proposed as the model for understanding psychiatric disorders. Despite the heterogeneity, multicausality and fuzzy boundaries that complicate autism research, a permissive account of natural kinds (MPC kinds) provides prescriptive guidance for the investigation of objective causal mechanisms that should inform nosologists in their attempt to carve autism’s boundaries at its natural joints. However, this essay will argue that a mechanistic model of autism is limited since it disregards the way in which autism relates to ideas about what kind of behavior is abnormal. As historical studies and definitions of autism show, normative issues concerning disability, impairment and societal needs have been and still are inextricably linked to how we recognize and understand autism. The current search for autism’s unity in neurobiological mechanisms ignores the values, social norms and various perspectives on mental pathology that play a significant role in 'the thing called autism’. Autism research needs to engage with these issues in order to achieve more success in the effort to become clinically valuable. (shrink)

The myriad controversies embroiling the mental health field—heightened in the lead-up to the release of DSM-5 —merit a close analysis of the field and its epistemological underpinnings. By using DSM as a starting point, this paper develops to overview the entire mental health field. Beginning with a history of the field and its recent crises, the troubles of the past “external crisis” are compared to the contemporary “internal crisis.” In an effort to examine why crises have recurred, the internal dynamics (...) of the field are assessed: applying Kuhn’s paradigmatic framework, crises are appraised to situate the differences between the natural sciences and the mental health field. Next, a Foucauldian analysis examines the functioning of the field’s power over the body, which is disproportionate in comparison to its scientific grounding. This is followed by investigating the field’s combination of contested scientific grounding and significant power, through a Latourian consideration of the assumptions and meaning behind the mental health field’s deployment of science. This includes scrutinizing the history of the classification of Post-Traumatic Stress Disorder. The paper closes by assessing the field’s potential to address these issues effectively. (shrink)

I begin by examining how genetics drivesschizophrenia research, and raise both familiar andrelatively novel criticisms of the evidence putativelysupporting the genetic basis of schizophrenia. Inparticular, I call attention to a set of concernsabout the effects of placentation on concordance ratesof schizophrenia in monozygotic twins, which furtherweakens the case for schizophrenia''s so-called stronggenetic component. I then underscore two criticalpoints. First, I emphasize the importance of takingseriously considerations about the complexity of bothontogenesis and the development of hereditarydiseases. The recognition of developmentalconstraints and (...) supports is crucial, for attention todevelopment exposes the naivete of too many models ofgene action in the aetiology of disease. Secondly, Iattend to those schizophreniologists who ignoremethodological criticisms and thus presume a geneticbasis for schizophrenia, and then seek the schizophrenic genotype lacking an adequatephenotype. In response I attempt to demonstrate thenecessity of a sustained effort at characterizing thephenotype of schizophrenia as an enabling conditionfor the whole enterprise of psychiatric genetics – andfor psychiatry itself. Without the organism-levelphenotype, research at the level of genes will remainunproductive – assuming of course that research at thegenetic level is appropriate at all. (shrink)

The emotional state of war-affected populations has become a central concern for international policy-makers in the last decade. Growing interest in war trauma is influenced by contemporary Anglo-American emotionology, or emotional norms, which tends to pathologize ordinary responses to distress, including anger related to survival strategies. The article critically analyses the ascendancy of a therapeutic security paradigm in international politics, which seeks to explain the prevailing political, economic and social conditions in terms of cycles of emotional dysfunctionalism. The article contends (...) that international therapeutic governance pathologizes waraffected populations as emotionally dysfunctional and problematizes their right to self-government, leading to extensive external intervention. However, international therapeutic governance may be detrimental to postwar recovery as well legitimizing a denial of self-government. (shrink)

ABSTRACTThis article introduces the challenges of providing psychological assessments of people seeking asylum in the wake of their reported torture. These challenges invite professionals to consider ontology and epistemology. Critical realism is well-positioned to underlabour for the process of understanding a human rights violation, in which the complainant is both the key, and often sole, witness and claimed victim. For instance, the layered reality of critical realism allows practitioners to use retroduction to describe deeper structures and mechanisms of torture. The (...) judgemental rationality of critical realism allows practitioners to distinguish between competing interpretations of the evidence. Critical realism also avoids both the positivistic assumption that assessors can be value-free; and the relativist social constructionist position that, because assessors cannot av... (shrink)

The article investigates the relevance of the concepts of truth and truthfulness in culturalistic, psychoanalytical and neuro-biological theories of trauma from a philosophical point of view. The background for this is the recent claim of some brain scientists to produce an overall view of the human situation. This claim is shown to be false. The article comes to the conclusion that the subjective perception of a traumatic event is indispensable in order to understand the phenomena of post-traumatic stress disorder (PTSD). (...) History and other moral sciences are always concerned with the reconstruction of past internal perspectives. The example of trauma shows that this work is indispensable wherever brain research might lead us to. (shrink)

This article is concerned with theories and therapeutic practices that interpret post-traumatic combat stress as a ‘moral injury’ produced by the shock of carrying out lethal violence in uncertain battlefield conditions. While moral injury is said to share many symptoms with post-traumatic stress disorder (PTSD), its proponents – military and Veterans Health Administration clinical psychologists, chaplains, and some psychiatrists – are concerned by PTSD’s inability to account for the meaning-based moral and ethical distress that counterinsurgency battlefields in Iraq and Afghanistan (...) are allegedly especially prone to produce in US soldiers. Moral injury theorists seem to want to describe a phenomenon that is both more profound than PTSD but which, as clinical psychologists Shira Maguen and Brett Litz state, is not itself a mental disorder. In this article, I examine the links between moral injury theory’s fringe diagnostic status and the fringe status of the kinds of violence it understands as uniquely injurious to soldiers’ psyches. Moral injury valorizes war-fighting and military culture while casting war as a source of almost inevitable psychopathology. I argue that moral injury theory represents an effort to carve out a distinct domain of psychological expertise but also a negotiation of the tension between war violence’s ‘normal’ practice and its excessive or morally hazardous manifestations – both of which link mental illness directly to the politics of war violence and post-war care. (shrink)

What sets someone on a life trajectory? This question is at the heart of studies of 21st-century neurosciences that build on scientific models developed over the last 150 years that attempt to link psychopathology risk and human development. Historically, this research has documented persistent effects of singular, negative life experiences on people’s subsequent development. More recently, studies have documented neuromolecular effects of early life adversity on life trajectories, resulting in models that frame lives as disproportionately affected by early negative experiences. (...) This view is dominant, despite little evidence of the stability of the presumably early-developed molecular traits and their potential effects on phenotypes. We argue that in the context of gaps in knowledge and the need for scientists to reason across molecular and phenotypic scales, as well as time spans that can extend beyond an individual’s life, specific interpretative frameworks shape the ways in which individual scientific findings are assessed. In the process, scientific reasoning oscillates between understandings of cellular homeostasis and organisms’ homeorhesis, or life trajectory. Biologist and historian François Jacob described this framework as the “attitude” that researchers bring to bear on their “objects” of study. Through an analysis of, first, historical and contemporary scientific literature and then ethnographic research with neuroscientists, we consider how early life trauma came to be associated with specific psychological and neurobiological effects grounded in understandings of life trajectories. We conclude with a consideration of the conceptual, ontological, and ethical implications of interpreting life trajectories as the result of the persistence of long-embodied biological traits, persistent life environments, or both. (shrink)

The value of the notion of ‘indeterminacy in the past’ continues to be contested. Ian Hacking’s claim that the notion is perspicuous in the examination of historical instances is questioned through discussion of the possibility of retrospective application of the relatively recent diagnostic category ‘Post-traumatic stress disorder’. Kevin McMillan maintains that there are deeper philosophical merits to the idea–particularly with respect to questions of truth–but neither Hacking’s treatment of historical cases nor McMillan’s directly philosophical elaboration of Hacking’s position sustain this (...) claim. (shrink)

In February 2010, the American Psychiatric Association (APA) launched their DSM-5 website with details about the development of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The APA invited “the general public” to review the draft diagnostic criteria and provide written comments and suggestions. This revision marks the first time the APA has solicited public review of their diagnostic manual. This article analyzes reported speech on the DSM-5 draft diagnostic criteria for the classification Posttraumatic Stress (...) Disorder. It demonstrates how textual standardization facilitates the cultural portability of the DSM-5 diagnostic criteria such that a community of speakers beyond the borders of the APA come to be seen as exemplary speakers, writers, and revisers of the professional style. Furthermore, analysis shows how co-authoring practices recontextualize the “voice” and persona of putative patient reported speech on Criterion D2. As a consequence of textual standardization, spoken discourse becomes recontextualized as the product of scientific inquiry and the organization of psychiatric knowledge. (shrink)

The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, currently in its fourth edition and considered the reference for the characterization and diagnosis of mental disorders, has undergone various developments since its inception in the mid-twentieth century. With the fifth edition of the DSM presently in field trials for release in 2013, there is renewed discussion and debate over the extent of its relative successes - and shortcomings - at iteratively incorporating scientific evidence on the often ambiguous nature (...) and etiology of mental illness. Given the power that the DSM has exerted both within psychiatry and society at large, this essay seeks to analyze variations in content and context of various editions of the DSM, address contributory influences and repercussion of such variations on the evolving landscape of psychiatry as discipline and practice over the past sixty years. Specifically, we document major modifications in the definition, characterization, and classification of mental disorders throughout successive editions of the DSM, in light of shifting trends in the conceptualization of psychopathology within evolving schools of thought in psychiatry, and in the context of progress in behavioral and psychopharmacological therapeutics over time. We touch upon the social, political, and financial environments in which these changes took places, address the significance of these changes with respect to the legitimacy (and legitimization) of what constitutes mental illness and health, and examine the impact and implications of these changes on psychiatric practice, research, and teaching. We argue that problematic issues in psychiatry, arguably reflecting the large-scale adoption of the DSM, may be linked to difficulties in formulating a standardized nosology of psychopathology. In this light, we highlight 1) issues relating to attempts to align the DSM with the medical model, with regard to increasing specificity in the characterization of discrete mental disease entities and the incorporation of neurogenetic, neurochemical and neuroimaging data in its nosological framework; 2) controversies surrounding the medicalization of cognition, emotion, and behavior, and the interpretation of subjective variables as 'normal' or 'abnormal' in the context of society and culture; and 3) what constitutes treatment, enablement, or enhancement - and what metrics, guidelines, and policies may need to be established to clarify such criteria. (shrink)

In light of the great interest in interdisciplinary trauma research, this article explores the philosophical-literary concept of cultural trauma from the perspective of psychiatric and psychoanalytical studies of the long-term consequences of the Holocaust. The extensive literature on the psychological after-effects of the Final Solution offers an exceptional opportunity to study the aftermath of extreme violence from different subject positions, including the perspectives of survivors, perpetrators, bystanders, and their descendants. Moving from the epicenter of the historical event of the Holocaust (...) to its psychological periphery, the survey reveals how much the concept of trauma has changed in the course of five decades as a result of political and cultural developments. But the review of the literature also demonstrates that none of the existing concepts of Holocaust trauma is well suited to explain the effects of Holocaust representations on individuals or collectives who encounter the Final Solution only as a media event for educational or entertainment purposes. (shrink)

Hospital admission and mortality statistics suggested that peptic ulcer reached a peak prevalence in the mid-1950s. During the Second World War, against this background of serious and common pathology, an epidemic of dyspepsia afflicted both service personnel and civilians alike. In the absence of reliable diagnostic techniques, physicians struggled to distinguish between life-threatening illness and mild, temporary disorders. This article explores the context in which non-ulcer stomach conditions flourished. At a time when fear was considered defeatist and overt psychological disorder (...) attracted stigma, both soldiers and civilians exposed to frightening events may have unconsciously translated their distress into gastrointestinal disorders. While the nature of army food was initially identified as the cause of duodenal ulcer in servicemen, the pre-war idea that conscientious and anxious individuals were at high risk gathered support and fed into post-war beliefs that this was a stress-related illness. Diet continued to be employed as a means of management at a time when the nation was preoccupied by food because of the constraints imposed by rationing. The peptic ulcer phenomenon set much of the medical agenda for the war years and conflicted with the commonly held view that the British people had never been healthier. (shrink)

The voices and visions experienced by Emanuel Swedenborg remain a topic of much debate. The present article offers a reconsideration of these experiences in relation to changes in psychiatric practice. First, the phenomenology of Swedenborg's experiences is reviewed through an examination of his writings. The varying conceptualizations of these experiences by Swedenborg and his contemporaries, and by psychiatrists of later generations, are examined. We show how attempts by 19th- and 20th-century psychiatrists to explain Swedenborg's condition as the result of either (...) schizophrenia or epilepsy are unable to account for his experiences. We then demonstrate that the re-emergence of the 19th-century concept of `hallucinations in the sane' offers an alternative way to understand Swedenborg's experiences outside typical discourses of mental illness. Finally we argue that Swedenborg's experiences should be understood as exemplifying phenomena which we term `hallucinations without mental disorder', and investigate how conceiving of Swedenborg in this way can inform future research into the experience and clinical significance of hallucinations. (shrink)

In 1995, a Swedish pilot study of Dialectical Behaviour Therapy (DBT) was launched to investigate its therapeutic efficacy and cost-effectiveness as treatment for Borderline Personality Disorder (BPD) in suicidal women. In the same year, a sweeping reform of psychiatric care commenced, dramatically reducing the number of beds by the end of the decade. The psychiatry reform was presented as an important factor prompting the need for a community-based treatment for Borderline patients. This article suggests that the introduction of DBT in (...) Sweden, and its relationship to the reform, can only be adequately explained with reference to the wider political shift occurring at the time, whereby the Swedish welfare state and its guiding ethos of egalitarianism were abandoned in favour of a neoliberal ‘choice revolution’. With the new liberalism, hard work and individual responsibility replaced the idea of a Swedish ‘people’s home’, a nationwide community and social support network. This language was reflected in DBT, which sought to teach patients the ‘skills’ necessary ‘to create a life worth living’. In this context, therapy was constituted as a form of ‘work’ that the patient had to undertake to improve. Moreover, DBT rejected the prevailing view of Borderline patients as ‘manipulative’ and ‘aggressive’, suggesting instead that they were ‘helpless’, ‘weak’ and unable to regulate their emotions. This new Borderline persona fit neatly into the new liberal discourse: she could be taught to become a rational and independent person able to cope in a society that valued individual responsibility over social support. (shrink)

The concept of trauma has recently expanded its reach to include what otherwise might be understood as intimate experience. This overextension represents a threat to our ability to conceptualize intimate experiences, hence to use concepts to engage in intimate communication. An analysis of Wallace Stevens’s poem “The Auroras of Autumn”, demonstrates how poetry provides a supplemental vehicle for the communication of intimate experiences. Poetry is therefore characterized as an essential element in ethical life.

This article examines three key aetiological theories of autism, which emerged within cognitive psychology in the latter half of the 1980s. Drawing upon Foucault’s notion of ‘forms of possible knowledge’, and in particular his concept of savoir or depth knowledge, two key claims are made. First, it is argued that a particular production of autism became available to questions of truth and falsity following a radical reconstruction of ‘the social’ in which human sociality was taken both to exclusively concern interpersonal (...) interaction and to be continuous with non-social cognition. Second, it is suggested that this reconstruction of the social has affected the contemporary cultural experience of autism, shifting attention towards previously unacknowledged cognitive aspects of the condition. The article concludes by situating these claims in relation to other historical accounts of the emergence of autism and ongoing debates surrounding changing articulations of social action in the psy disciplines. (shrink)

The subject of this paper is the problematisation of depression in today’s mental health care. It is based on a study of the professional discussion on depression in Finland from the mid-1980s to the 1990s. The ways in which Finnish mental health experts define the object of depression treatment bring out an ambivalence that stems from the discrepancy between two parallel but incongruent notions of what depression is: the psychopharmacological and the psychotherapeutic. The analysis of the discussion demonstrates how clinical (...) and practical rationales of today’s mental health care are formed in the space between the two poles. Two tendencies of these rationales are also pointed out: first, the DSM paradigm of depressive illness inclines to become problematic and to dissolve in the actual practices. Second, they insinuate emphasis on antidepressant medication and overall neuropsychiatric approach in the treatment of depressive disorders, although in an ambivalent way. (shrink)

Between 2001 and 2006 there was an ‘epidemic’ of complete withdrawal from daily life among numerous children in refugee families seeking asylum in Sweden. It became embedded in many distinct controversies, including the politics of immigration, and acrimonious disagreements between pediatricians dealing with individual families, and government-employed sociologists commissioned to report on what was going on. Most of the cases resolved themselves when an amnesty was agreed in 2006, although there remain many doubts about the statistics. After describing this phenomenon, (...) the paper proposes a model called Imitation & Internalisation. Most of the children may have begun by imitating others who had fallen ill, but soon internalized it to the extent that it became an integral part of their psychophysical and social constitution. The model can be applied to phenomena as diverse as hypnotism, the placebo effect, and catching faith by association with believers. (shrink)

RÉSUMÉ: L’observation de populations spécifiques d’agents épistémiques révèle que la présomption d’identité au sein de communautés épistémiques peut mener à certaines omissions cognitives. Les victimes de violence sexuelle en sont un bon exemple. Cette étude de cas offre selon nous une nouvelle perspective sur le débat entre les internalistes et les externalistes en épistémologie en proposant une nouvelle perspective sur les dimensions psychologiques complexes dans la formation des croyances et sur leur implication dans une épistémologie qui nécessite que les raisons (...) soient accessibles à la première personne. (shrink)

This essay explores the epistemological significance of the kinds of beliefs that grow out of traumatic experiences, such as the rape survivor's belief that she is never safe. On current theories of justification, beliefs like this one are generally dismissed due to either insufficient evidence or insufficient propositional content. Here, Freedman distinguishes two discrete sides of the aftermath of psychic trauma, the shattered self and the shattered worldview. This move enables us to see these beliefs as beliefs; in other words, (...) as having cognitive content. Freedman argues that what we then need is a theory of justification that allows us to handpick reliable sources of information on sexual violence, and give credibility where deemed appropriate. She advances a mix of reliabilism and coherentism that privileges feminism. On this account, the evidence for the class of beliefs in question will depend on an act of sexual violence (or testimony, or statistics) to the extent that the act is a reliable indication of the prevalence of sexual violence against women. (shrink)

In their well-known paper, John Gardner and Stephen Shute (2000) propose a pure case of rape, in which a woman is raped while unconscious and the rape, for a variety of stipulated reasons, never comes to light. This makes the pure case a harmless case of rape, or so they argue. In this paper I show that their argument hinges on an outdated conception of trauma, one which conflates evaluative responses that arise in the aftermath of rape with the non-deliberative (...) somatic responses of a central nervous system to a threatening event. In the first part of this paper, I elaborate this objection by drawing on the neurobiological model of trauma. This gives me an opportunity to illustrate the different ways that rape harms its victims, including the central way, what I call ‘threat-circuitry harm.’ This discussion of trauma invites us to rethink the wrong of rape, and sets the groundwork for my argument, in the second part of the paper, that the wrong of rape consists in its central harm. (shrink)

Dans ce texte, nous proposons un cadre, qui vise à intégrer les contributions des approches constructionnistes et biologiques dans un domaine précis, celui des maladies mentales. Pour ce faire, nous utiliserons quelques propositions récentes faites par des philosophes de la biologie — plus spécifiquement les idées avancées par les tenants de la « théorie des systèmes développementaux » ainsi que la notion d’« enracinement génératif » .In this paper, we are proposing a framework to integrate the core insights of the (...) constructivist and biological approaches of mental illness. In order to do so, we will use some recent propositions by philosophers of biology, specifically ideas put forth by «developmental system theory» and the notion of «generative entrenchment». (shrink)

In this paper, I explain why evolutionary psychiatry is not where the next revolution in psychiatry will come from. I will proceed as follows. Firstly, I will review some of the problems commonly attributed to current nosologies, more specifically to the DSM. One of these problems is the lack of a clear and consensual definition of mental disorder; I will then examine specific attempts to spell out such a definition that use the evolutionary framework. One definition that deserves particular attention, (...) is one put forward by Jerome Wakefield. Despite my sympathy for his position, I must indicate a few reasons why I think his attempt might not be able to resolve the problems related to current nosologies. I suggest that it might be wiser for an evolutionary psychiatrist to adopt the more integrative framework of “treatable conditions”. As it is thought that an evolutionary approach can contribute to transforming the way we look at mental disorders, I will provide the reader with a brief sketch of the basic tenets of evolutionary psychology. The picture of the architecture of the human mind that emerges from evolutionary psychology is thought by some to be the crucial backdrop to identifying specific mental disorders and distinguishing them from normal conditions. I will also provide two examples of how evolutionary thinking is supposed to change our thinking about some disorders. Using the case of depression, I will then show what kind of problems evolutionary explanations of particular psychopathologies encounter. In conclusion, I will evaluate where evolutionary thinking leaves us in regard to what I identify as the main problems of our current nosologies. I’ll then argue that the prospects of evolutionary psychiatry are not good. (shrink)

The DSM is the main classification of mental disorders used by psychiatrists in the United States and, increasingly, around the world. Although widely used, the DSM has come in for fierce criticism, with many commentators believing it to be conceptually flawed in a variety of ways. This paper assesses some of these philosophical worries. The first half of the paper asks whether the project of constructing a classification of mental disorders that ‘cuts nature at the joints’ makes sense. What is (...) mental disorder? Are types of mental disorder natural kinds (that is, are the distinctions between them objective and of fundamental theoretical importance, as are, say, the distinctions between the chemical elements)? The second half of the paper addresses epistemic worries. Even if types of mental disorder are natural kinds there may be reason to doubt that the DSM will come to reflect their natural structure. In particular, I examine the extent to which the DSM is theory-laden, and look at how it has been shaped by social and financial factors. Ultimately, I conclude that although the DSM is of immense practical importance it is not likely to become the best possible classification of mental disorders. (shrink)