BackgroundAlthough values have increasingly received attention in psychiatric literature over the last three decades, their role has been only partially acknowledged in psychiatric classification endeavors. The review process of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders received harsh criticism, and was even considered secretive by some authors. Also, it lacked an official discussion of values at play. In this perspective paper we briefly discuss the interplay of some values in the scientific and non-scientific debate around (...) one of the most debated DSM-5 category proposals, the Attenuated Psychosis Syndrome. Then, we point out some ethical consequences of a facts-plus-values perspective in psychiatric classification.DiscussionDifferent stakeholders participated in the APS-debate and for analytical purposes we divided them into four groups: researchers in the field of high-risk mental states; the DSM-5 Psychotic Disorders Work Group; patient, carers and advocacy groups; and external stakeholders, not related to the previous groups, but which also publicly expressed their opinions about APS inclusion in DSM-5. We found that each group differently stressed the role of values we examined in the APS-debate. These values were ethical, but also epistemic, political, economic and ontological. The prominence given to some values, and the lack of discussion about others, generated divergent positions among stakeholders in the debate.SummaryAs exemplified by the APS discussion, although medicine is primarily an ethical endeavor, values of different kinds that take part in it also shape to a large extent the profession. Thus, it may be strategic to openly discuss values at play in the elaboration of diagnostic tools and classificatory systems. This task, more than scientifically or politically significant, is ethically important. (shrink)

Although values have increasingly received attention in psychiatric literature over the last three decades, their role has been only partially acknowledged in psychiatric classification endeavors. The review p..

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