Mental health research and care in the twenty first century faces a series of conceptual and ethical challenges arising from unprecedented advances in the neurosciences, combined with radical cultural and organisational change. The Oxford Textbook of Philosophy of Psychiatry is aimed at all those responding to these challenges, from professionals in health and social care, managers, lawyers and policy makers; service users, informal carers and others in the voluntary sector; through to philosophers, neuroscientists and clinical researchers. Organised around a series (...) of case studies in five key topic areas - concepts of disorder, the philosophical history of psychopathology, philosophy of science, ethics and philosophical value theory, and philosophy of mind - the book provides a detailed introduction to the field and a framework for study and skill development. Each case study is supported by selected readings from both philosophy and mental health, thinking skills exercises, self-test questions, key learning points and detailed guides to further reading. There is an introduction for philosophers to classification and descriptive psychopathology, and for practitioners to philosophical methods (including logic). The philosophical topics covered include philosophical methods (analytic and Continental); phenomenology, hermeneutics and existentialism, logical empiricism and its successors; idealism and realism; reasons and causes; and modern theories of mind and brain, free will and personal identity. Topics from mental health include psychiatry and 'anti-psychiatry'; Jaspers' psychopathology and the new neurosciences; the future of psychiatric classifications; strengths-based approaches, recovery practice, social inclusion and diversity; and key topics in psychopathology, such as delusion, autism, disorders of volition, thought insertion and other experiences in schizophrenia. The Oxford Textbook of Philosophy of Psychiatry aims to secure the skills-base of the discipline by bringing philosophers closer to the realities of practice in mental health, and mental health practitioners closer to the resources of philosophy as a partner to the sciences in responding to the challenges of twenty-first century mental health and social care. (shrink)

I examine whether or not it is apt to attribute knowledge to groups of scientists. I argue that though research teams can be aptly described as having knowledge, communities of scientists identified with research fields, and the scientific community as a whole are not capable of knowing. Scientists involved in research teams are dependent on each other, and are organized in a manner to advance a goal. Such teams also adopt views that may not be identical to the views of (...) the individual members of the group. (shrink)

Philosophy has much to offer psychiatry, not least regarding ethical issues, but also issues regarding the mind, identity, values, and volition. This has become only more important as we have witnessed the growth and power of the pharmaceutical industry, accompanied by developments in the neurosciences. However, too few practising psychiatrists are familiar with the literature in this area. -/- The Oxford Handbook of Philosophy and Psychiatry offers the most comprehensive reference resource for this area ever published. It assembles challenging and (...) insightful contributions from key philosophers and others to the interactive fields of philosophy and psychiatry. Each contributions is original, stimulating, thorough, and clearly and engagingly written - with no potentially significant philosophical stone left unturned. Broad in scope, the book includes coverage of several areas of philosophy, including philosophy of mind, science, and ethics. For philosophers and psychiatrists, The Oxford Handbook of Philosophy and Psychiatry is a landmark publication in the field - one that will be of value to both students and researchers in this rapidly growing area. (shrink)

My aim is to evaluate a new realist strategy for addressing the pessimistic induction, Ludwig Fahrbach’s (Synthese 180:139–155, 2011) appeal to the exponential growth of science. Fahrbach aims to show that, given the exponential growth of science, the history of science supports realism. I argue that Fahrbach is mistaken. I aim to show that earlier generations of scientists could construct a similar argument, but one that aims to show that the theories that they accepted are likely true. The problem with (...) this is that from our perspective on the history of science we know their argument is flawed. Consequently, we should not be impressed or persuaded by Fahrbach’s argument. Fahrbach has failed to identify a difference that matters between today’s theories and past theories. But realists need to find such a difference if they are to undermine the pessimistic induction. (shrink)

The anti-realist argument from underconsideration focuses on the fact that, when scientists evaluate theories, they only ever consider a subset of the theories that can account for the available data. As a result, when scientists judge one theory to be superior to competitor theories, they are not warranted in drawing the conclusion that the superior theory is likely true with respect to what it says about unobservable entities and processes. I defend the argument from underconsideration from the objections of Peter (...) Lipton. I argue that the inconsistency that Lipton claims to find in the argument vanishes once we understand what the anti-realist means when she claims that scientists are reliable. I also argue that collapsing the distinction between relative and absolute evaluations, as Lipton recommends, has its costs. Finally, I briefly examine Richard Boyd's influential defence of realism. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Spiritual Experience and PsychopathologyMike Jackson and K. W. M. Fulford (bio)AbstractA recent study of the relationship between spiritual experience and psychopathology (reported in detail elsewhere) suggested that psychotic phenomena could occur in the context of spiritual experiences rather than mental illness. In the present paper, this finding is illustrated with three detailed case histories. Its implications are then explored for psychopathology, for psychiatric classification, and for our understanding of (...) the concept of mental illness. It is argued that pathological and spiritual psychotic phenomena cannot be distinguished by 1) form and content alone (as in traditional psychopathology), 2) by their relationship either with other symptoms or with pathological causes (as in psychiatric classification), or 3) by reference to the descriptive criteria of mental illness implied by the “medical” model. The distinction is shown to depend, rather, on the way in which psychotic phenomena themselves are embedded in the values and beliefs of the person concerned. This in turn is shown to have implications for diagnosis (it shows the need for clinicians to attend to the values and beliefs of individual patients), for treatment (it points to a cognitive problem-solving model), and for research in psychopathology (especially as related to the emerging sciences of dynamic brain imaging and cognitive neuroscience).Keywordsfirst rank symptoms, schizophrenia, delusion, hallucination, thought disorder, religious experience, mystical experienceIntroductionThis paper explores some of the conceptual and practical implications of the finding that phenomena which in a medical context would probably be diagnosed as psychotic symptoms, may occur in the context of non-pathological, and indeed essentially benign, spiritual experiences.The existence of non-pathological psychotic experiences of this kind (we will call them “psychotic phenomena” as distinct from “psychotic symptoms”—see also Endnote 1, terminology) was a key finding in a study carried out by one of us (MJ) at the Alister Hardy Research Centre (AHRC) in Oxford. Details are given elsewhere both of the overall empirical findings of the study, including the relationship between spiritual experience and personality variables, and of a hypothetical cognitive problem-solving model of these phenomena (Jackson 1991, and forthcoming a and b). In the present paper, 1) the background to the study is described briefly in relation to earlier work on the possible links between spiritual experience and psychopathology; 2) some of the psychotic phenomena identified are illustrated with three detailed case histories; 3) the significance of these phenomena is reviewed for our understanding respectively of psychopathology, of diagnostic syndromes, and of the concept of mental illness; and 4) some of the practical implications of the study for clinical work and research in psychiatry are indicated.BackgroundIt has long been recognized that there are similarities between spiritual and psychotic experiences. [End Page 41] William James (1902), for example, argued that “in delusional insanity, paranoia as they sometimes call it, we may have a kind of diabolical mysticism, a sort of religious mysticism turned upside down” (426). Other commentators have noted a wide variety of phenomena, such as time distortion, synesthesias, loss of self-object boundaries and the transition from a state of conflict and anxiety to one of sudden “understanding,” all of which are reported in both spiritual and psychotic experiences (Buckley 1981; Watson 1982; Wapnick 1969; and Wootton and Allen 1983).Yet the similarities notwithstanding, the distinction between these two kinds of experience can be crucially important. Spiritual experiences, whether welcome or unwelcome, and whether or not they are psychotic in form, have nothing (directly) to do with medicine (Fulford 1996a). It would be quite wrong, then, to “treat” spiritual psychotic experiences with neuroleptic drugs, just as it is quite wrong to “treat” political dissidents as though they were ill (Fulford, Smirnoff and Snow, 1993). Pathological psychotic experiences, on the other hand, or psychotic symptoms, are by definition a proper object of medical treatment, sometimes even against the wishes of the person concerned. Hence it would be both negligent and, as Wing (1978) put it, morally “repellent,” to leave untreated someone who is genuinely ill (244).Given how much turns on the distinction between spiritual experience and psychopathology, it is perhaps not surprising that scholarly discussion of the relationship between them has at times... (shrink)

This chapter identifies and explores a series of challenges raised by the clinical concept of delusion for theories which conceive autonomy as an agency rather than a status concept. The first challenge is to address the autonomy-impairing nature of delusions consistently with their role as grounds for full legal and ethical excuse, on the one hand, and psychopathological significance as key symptoms of psychoses, on the other. The second challenge is to take into account the full logical range of delusions, (...) which may take the form of true or false factual beliefs, positive or negative evaluations, as well as the paradoxical delusion of mental illness. The third and final challenge is to make room for non-pathological or, autonomy-preserving delusions and to offer a credible way of distinguishing between these and pathological or, autonomy-impairing delusions. By setting out these challenges, we are able to, firstly, distinguish between two separate conceptions of objectivity that may be at work in existing accounts of delusions and, secondly, to put a spotlight on an elusive yet inescapable notion of agential success that underlies our thinking about autonomy as well as mental disorder. (shrink)

The covariant Klein-Gordon equation requires twice the boundary conditions of the Schrödinger equation and does not have an accepted single-particle interpretation. Instead of interpreting its solution as a probability wave determined by an initial boundary condition, this paper considers the possibility that the solutions are determined by both an initial and a final boundary condition. By constructing an invariant joint probability distribution from the size of the solution space, it is shown that the usual measurement probabilities can nearly be recovered (...) in the non-relativistic limit, provided that neither boundary constrains the energy to a precision near ℏ/t 0 (where t 0 is the time duration between the boundary conditions). Otherwise, deviations from standard quantum mechanics are predicted. (shrink)

Philosophers have hitherto only interpreted the world in various ways; the point is to change it.Karl marx’s distinction between interpreting the world and changing it points by extension to the state of contemporary philosophy and psychiatry. The 1990s resurgence of interdisciplinary work in this area was driven equally by phenomenological scholarship and by initiatives in analytic philosophy. The former reflected the focus in phenomenology on ‘what it is like’ to experience a given mental symptom with the aim of reconstructing the (...) life-worlds of people experiencing mental disorders, while the latter reflected directly or indirectly the influence of J. L. Austin and others from... (shrink)

Realists and anti-realists disagree about whether contemporary scientists are epistemically privileged. Because the issue of epistemic privilege figures in arguments in support of and against theoretical knowledge in science, it is worth examining whether or not there is any basis for assuming such privilege. I show that arguments that try to explain the success of science by appeal to some sort of epistemic privilege have, so far, failed. They have failed to give us reason to believe (i) that scientists are (...) prone to develop theories that are true, (ii) that our current theories are not apt to be replaced in the future, and (iii) that science is nearing its completion. (shrink)

Zaman, düşünce tarihinde üzerinde çokça tartışılmış ve muhtelif tanımlamaları yapılmış bir kavramdır. Bu makale de zamanın tanımlamasından ziyade onun üzerinde özellikle an kavramı merkezli bir düşünce etkinliği ortaya konulmaya çalışılmıştır. Bilhassa zaman ve an kavramları arasındaki farka değinilmiştir. Zamanın hareketin olduğu yerde var olduğunu, anın ise hem hareketin hem de durağanlığın olduğu her yerde karşımıza çıktığını belirterek zamanın akışkan hayatı ölçülebilir kılma çabasında var oluşuyla, anın ise bu akışkanlığın her safhasında var olduğuna temas edilmiştir. Aynı zamanda anın varoluş ile mütemadiyen (...) yan yana olduğu, algılanışının ise bireylerin tecrübeleriyle zuhur ettiği görüşü ortaya konulmuştur. An’ın insan tecrübesiyle anlam kazanması ve insanın anı nasıl değerlendirmesi gerektiği hususunda konu, kanaatimizce Asr Suresi ve Hz. Peygamberin (s.a.v) buyruğu ile temellendirilmiştir. Bahsi geçen konu, çeşitli filozofların görüşleri ile de desteklenmiştir. Daha sonra makalemizde modern düşüncenin insanı anı kaliteli yaşamaktan ziyade daha iyi gelecek vaadiyle kaygı ve huzursuzluğa sevk ettiğini ifade ettik. Makalemizin sonunda ise İslam’ın bu modern düşüncenin aksine insana akışkanlık içerisinde yaşarken anın kendisine sunduğu akışkanlığın her bir aşamasını en güzel şekilde değerlendirmesini emrettiği ve onu değerli bir maden gibi tavında işlemesi gerektiği mesajıyla sonuçlandırdık. (shrink)

Analyses of biological concepts of disease and social conceptions of health indicate that they are structurally interdependent. This in turn suggests the need for a bridge theory of illness. The main features of such a theory are an emphasis on the logical properties of value terms, close attention to the features of the experience of illness, and an analysis of this experience as action failure, drawing directly on the internal structure of action. The practical applications of this theory are outlined (...) for a number of problems in each of the three main practical areas, clinical work, teaching and research. In each case the resources of the theory suggest new models and generate new results. The full practical significance of the theory, however, is shown to consist in the way in which it ties together biological and social theories into an integrated picture of the conceptual structure of medicine as a whole. It is argued, finally, that practical efficiency of this kind is a test of theory not only in the philosophy of medicine but also in general philosophy. (shrink)

A time-symmetric formulation of nonrelativistic quantum mechanics is developed by applying two consecutive boundary conditions onto solutions of a time- symmetrized wave equation. From known probabilities in ordinary quantum mechanics, a time-symmetric parameter P0 is then derived that properly weights the likelihood of any complete sequence of measurement outcomes on a quantum system. The results appear to match standard quantum mechanics, but do so without requiring a time-asymmetric collapse of the wavefunction upon measurement, thereby realigning quantum mechanics with an important (...) fundamental symmetry. (shrink)

This volume illustrates the central importance of diversity of human values throughout healthcare. The readings are organized around the main stages of the clinical encounter from the patient's perspective. They run from staying well and 'first contact' through to either recovery or to long-term illness, death and dying.

I compare the epistemic culture of Wikipedia with the epistemic culture of science, with special attention to the culture of collaborative research in science. The two cultures differ markedly with respect to (1) the knowledge produced, (2) who produces the knowledge, and (3) the processes by which knowledge is produced. Wikipedia has created a community of inquirers that are governed by norms very different from those that govern scientists. Those who contribute to Wikipedia do not ground their claims on their (...) reputations as knowers, for they stand to lose nothing if and when their contributions are found to be misleading or false. And the immediacy of the medium encourages gossip and jokes. Hence, though we have some reason to believe that an invisible hand aids scientists in realizing their epistemic goals, we cannot ground our confidence in what is reported on Wikipedia on the fact that an invisible hand ensures quality. Nor is the information on Wikipedia aptly justified in a manner similar to the way testimony can be justified. (shrink)

Over the past two decades, Victor and Cullen's (Adm Sci Q 33:101-125, 1988) typology of ethical climates has been employed by many academics in research on issues of ethical climates. However, little is known about how managerial practices such as communication and empowerment influence ethical climates, especially from a functional perspective. The current study used a survey of employees from Taiwan's top 100 patent-owning companies to examine how communication and empowerment affect organizational ethical climates. The results confirm the relationship between (...) these two managerial practices and organizational ethical climates. We discuss our results and their implications for both future academic research and practice. (shrink)

OBJECTIVES: To study the resources available and resources needed for ethics teaching to medical students in UK medical schools as required by the new GMC core curriculum. DESIGN: A structured questionnaire was piloted and then circulated to deans of medical schools. SETTING: All UK medical schools. RESULTS: Eighteen out of 28 schools completed the questionnaire, the remainder either indicating that their arrangements were "under review" (4) or not responding (6). Among those responding: 1) library resources, including video and information technology (...) were found to be fairly well developed; 2) many schools had a good supply of handouts and sample cases for teaching; 3) most had a written syllabus, and 4) two-thirds examined in the subject. However, many schools indicated that there was an urgent need for: 1) full-time teachers (most ethics teaching is still by part-time and voluntary staff); funding for books and journals, and 3) additional teaching materials (including further case vignettes, handouts and sample exam questions). CONCLUSIONS: There has been a considerable overall improvement in resources for medical ethics teaching since the time of the last national survey (The Pond Report). However, provision varies widely from medical school to medical school. The particular needs identified were for full-time teachers, library resources and teaching materials. Wider use of existing organisations concerned with medical ethics could help to meet these needs. (shrink)

My aim in this paper is to re-examine specialization in science. I argue that we need to acknowledge the role that conceptual changes can play in the creation of new specialties. Whereas earlier sociological accounts focus on social and instrumental changes as the cause of the creation of new specialties, I argue that conceptual changes play an important role in the creation of some scientific specialties. Specifically, I argue that conceptual developments played an important role in the creation of both (...) endocrinology and virology. (shrink)

In this paper some of the general issues surrounding recently published guidelines for the practice of research ethics committees are outlined, concentrating in particular on the difficulties raised by research with psychiatric patients. Research is distinguished from ordinary clinical practice by the intention to advance knowledge. So defined, research with psychiatric patients should be governed by the same four principles as research with any other group--knowledge, necessity, benefit and consent. In applying these principles, however, particularly the principle of consent, many (...) acute difficulties are raised by psychiatric patients. A number of proposals for addressing these difficulties are discussed. It is suggested that, notwithstanding the value of published guidelines, and the help that may be available from research ethics committees, the primary responsibility for maintaining high standards of practice in research rests with research workers themselves. (shrink)

This collection examines prevalent assumptions in moral reasoning which are often accepted uncritically in medical ethics. It introduces a range of perspectives from philosophy and medicine on the nature of moral reasoning and relates these to illustrative problems, such as New Reproductive Technologies, the treatment of sick children, the assessment of quality of life, genetics, involuntary psychiatric treatment and abortion. In each case, the contributors address the nature and worth of the moral theories involved in discussions of the relevant issues, (...) and focus on the types of reasoning which are employed. 'Medical ethics is in danger of becoming a subject kept afloat by a series of platitudes about respect for persons or the importance of autonomy. This book is a bold and imaginative attempt to break away from such rhetoric into genuine informative dialogue between philosophers and doctors, with no search after consensus.' Mary Warnock. (shrink)

Nature and Narrative is the launch volume in a new series of books entitled International Perspectives in Philosophy and Psychiatry. Nature(representing interest in the causes of a problem) and Narrative (for understanding its meanings) will introduce the field and the series, by touching on a range of issue relevant to this interdisciplinary 'border country'.

This article sets out a manifesto for the development of an international values-based practice fully engaged with the diversity of cultural values and implemented through the resources of the international movement in philosophy and psychiatry. Anticipated by mid-twentieth century ordinary language philosophy of the “Oxford School,” the last three decades have witnessed a remarkable flowering of cross-disciplinary work between philosophy and psychiatry. The article indicates the scope and scale of this work and then describes the emergence of contemporary values-based practice (...) as its philosophy-into-practice cutting edge. Values-based practice although originating in philosophy and psychiatry is currently being developed mainly in areas of bodily medicine such as surgery. As such, it has been criticized for focusing, as contemporary health care has largely focused, on the individual at the expense of cultural values. Hence arises the need for extending values-based practice internationally. The resources available from international philosophy and psychiatry for so extending values-based practice are outlined and some of the challenges are indicated. The article concludes with the hope that psychiatry in supporting the development of international values-based practice will by the same token take poll position in the development of contemporary science-led clinical care. (shrink)

This article sets out key contributions to the long-running debate about mental disorder from the ordinary language philosophy of the ‘Oxford School’. The distinction between definition and use of concepts underpinning ordinary language philosophy reframes the debate as a debate not just about mental disorder but about disorder in general, bodily as well as mental. The field work of ordinary language philosophy (focusing on the use of concepts as a guide to their meanings) shows that, attempts at elimination notwithstanding, there (...) is an essential evaluative element in the meaning of disorder, bodily as well as mental. The concept of disorder in the debate thus reframed presents a double challenge for analysis: to explain why disorder has evaluative connotations used of mental conditions but descriptive connotations used of bodily conditions. Philosophical value theory, derived by applying ordinary language philosophy to the language of values, provides a rich resource of ideas for meeting this double challenge. It meets the double challenge at the level of theory by allowing both aspects of the double challenge of disorder to be derived from a logical property that disorder shares with all other value terms. It meets the double challenge at the level of practice by supporting the development of a new approach to working with values alongside evidence in healthcare called values-based practice. Ordinary language philosophy, notwithstanding these several contributions, is no panacea. It helps us to make a start, no more and no less, in understanding mental disorder. (shrink)

This study analyzed 16 potential ethics-related problems associated with use and abuse of video news releases (VNRs) by public relations practitioners and electronic journalists. Causes and possible solutions to the problems were suggested and model ethics code guidelines were developed. Moral rules, moral ideals, theories of ethics, public relations theories, and electronic journalism theories were used to provide a general foundation for the analysis. A more specific foundation was provided by guidelines from a variety of media codes of ethics.

In the target article, Kirby (2014) explores conditions under which gestational surrogacy in developing countries (in this case India) may (or may not) be considered as exploitative. The author pro...

In the current climate of dramatic advances in the neurosciences, it has been widely assumed that the diagnosis of mental disorder is a matter exclusively for value-free science. Starting from a detailed case history, this paper describes how, to the contrary, values come into the diagnosis of mental disorders, directly through the criteria at the heart of psychiatry's most scientifically grounded classification, the American Psychiatric Association's DSM (Diagnostic and Statistical Manual). Various possible interpretations of the prominence of values in psychiatric (...) diagnosis are outlined. Drawing on work in the Oxford analytic tradition of philosophy, it is shown that, properly understood, the prominence of psychiatric diagnostic values reflects the necessary engagement of psychiatry with the diversity of individual human values. This interpretation opens up psychiatric diagnostic assessment to the resources of a new skills-based approach to working with complex and conflicting values (also derived from analytic philosophy) called 'values-based practice.' Developments in values-based practice in training, policy and research in mental health are briefly outlined. The paper concludes with an indication of how the integration of values-based with evidence-based approaches provides the basis for psychiatric practice in the twenty-first century that is both science-based and person-centred. (shrink)

The role of an expert witness in ethics, as part of a legal proceeding, is examined in this essay. The essay argues that the use of such expertise rests on confusions about normative and non-normative ethics compounded by misunderstandings about the challenges of moral argument in secular, morally pluralistic societies.

This edited volume illustrates the central importance of diversity of human values throughout healthcare. The readings are organised around the main stages of the clinical encounter from the patient's perspective. This introductory chapter opens up crucial issues of methodology and of practical application in this highly innovative approach to the role of ethics in healthcare.

The idea of moral reform requires that morality be more than a description of what people do value, for there has to be some measure against which to assess progress. Otherwise, any change is not reform, but simply difference. Therefore, I discuss moral reform in relation to two prescriptive approaches to common morality, which I distinguish as the foundational and the pragmatic. A foundational approach to common morality (e.g., Bernard Gert’s) suggests that there is no reform of morality , but (...) of beliefs, values, customs, and practices so as to conform with an unchanging, foundational morality. If, however, there were revision in its foundation (e.g., in rationality), then reform in morality itself would be possible. On a pragmatic view, on the other hand, common morality is relative to human flourishing, and its justification consists in its effectiveness in promoting flourishing. Morality is dependent on what in fact does promote human flourishing and therefore, could be reformed. However, a pragmatic approach, which appears more open to the possibility of moral reform, would need a more robust account of norms by which reform is measured. (shrink)

Background Machine learning (ML) is utilized increasingly in health care, and can pose harms to patients, clinicians, health systems, and the public. In response, regulators have proposed an approach that would shift more responsibility to ML developers for mitigating potential harms. To be effective, this approach requires ML developers to recognize, accept, and act on responsibility for mitigating harms. However, little is known regarding the perspectives of developers themselves regarding their obligations to mitigate harms.Methods We conducted 40 semi-structured interviews with (...) developers of ML predictive analytics applications for health care in the United States.Results Participants varied widely in their perspectives on personal responsibility and included examples of both moral engagement and disengagement, albeit in a variety of forms. While most (70%) of participants made a statement indicative of moral engagement, most of these statements reflected an awareness of moral issues, while only a subset of these included additional elements of engagement such as recognizing responsibility, alignment with personal values, addressing conflicts of interests, and opportunities for action. Further, we identified eight distinct categories of moral disengagement reflecting efforts to minimize potential harms or deflect personal responsibility for preventing or mitigating harms.Conclusions These findings suggest possible facilitators and barriers to the development of ethical ML that could act by encouraging moral engagement or discouraging moral disengagement. Regulatory approaches that depend on the ability of ML developers to recognize, accept, and act on responsibility for mitigating harms might have limited success without education and guidance for ML developers about the extent of their responsibilities and how to implement them. (shrink)