In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)
In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)
In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further (...) questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined. (shrink)
" This, explains Pies, "is the keystone in the arch of Stoic philosophy." In a sense, then, the rest of the book is an extended meditation on how we might avoid letting things touch our souls too much.
The ethics of medically-authorized limb amputation in individuals with Body integrity identity disorder (BIID) remains extremely controversial. One factor to consider is the putative locus of a disease process, and whether the proposed treatment--in this case, limb amputation—reasonably addresses the issue of what organ is mediating the patient’s complaint.
We address two points. First, one must explain how different, rare mutations ultimately lead to common psychopathological conditions. The developmental instability model offers one solution. Second, Keller & Miller perhaps miss the major processes other than variation fueled by rare deleterious mutations that account for interesting genetic variation in psychopathology, particularly when single alleles have non-negligible effects: Red Queen processes.
There is considerable controversy, both within and outside the field of psychiatry, regarding the boundaries of normal sadness and clinical depression. Furthermore, while there are frequent calls for a "pluralistic", comprehensive approach to understanding depression, few writers have tried to integrate insights from the spiritual, philosophical, and neurobiological literature. The author proposes that such a synthesis is possible, and that our understanding of ordinary sorrow and clinical depression is enriched by drawing from these disparate sources. In particular, a phenomenological analysis (...) of sorrow and depression reveals two overlapping but distinct "lifeworlds". These differ in the relational, temporal, dialectical, and intentional realms. Recent brain imaging studies are also beginning to reveal the neurobiological correlates of sorrow and depression. As we come to understand the neurobiology of these states, we may be able to correlate specific alterations in "neurocircuitry" with their phenomenological expressions. (shrink)
The burgeoning field of medical ethics raises complicated questions for mental health researchers. The critical issues of risk assessment, beneficence, and the moral duties researchers owe their patients are analyzed in James DuBois's well written Ethics in Mental Health Research.
This 'user's guide' to becoming a better person takes readers through a process of personal growth by means of modern-day vignettes that draw upon the Talmud's ancient wisdom. Readers of any or no faith learn what it takes to become a 'mensch' —- a decent and honorable human being.
For 60 years, Herbert Schneider has been making notable contributions to philosophy. In 1972, at a surprise party for his 80th birthday, friends presented him with a collection of essays on areas of philosophy in which he himself had done pioneering work. These essays, together with five previously published but difficult-to-find papers written by Schneider himself, are included in the present book, along with a biographical sketch of Schneider prepared by the editors and a list of Schneider’s writings. Among the (...) better-known contributors are Joseph L. Blau, Max Fisch, Lewis Hahn, George Kline, Paul Kurtz, and Richard H. Popkin. The essays include historical studies in ancient and modern philosophy as well as analytical studies in social theory and problems of education. (shrink)
In some recent theological writing, imagination is presented as a power of the mind with crucial importance for religion, but one whose role has often suffered neglect. Its fuller acknowledgment has become a live issue today. ‘Theologians’, wrote Professor J. P. Mackey, ‘have recently taken to symbol and metaphor, poetry and story, with an enthusiasm which contrasts very strikingly with their all-but-recent avoidance of such matters’ . As well as relevant writings by Eliade and Ricoeur, there have been treatments of (...) religious imagination by Professor John Mclntyre in his Faith, Theology and Imagination and in J. P. Mackey's composite volume entitled Religious Imagination. (shrink)
The article considers the changing status of natural beauty in the twentieth century. This situation is presented with reference to extreme changes of interest connected with this field of value. The article begins by exploring some current theoretical presuppositions concerning this field . The focus of the following sections is on a pioneering text, which ended a long period of indifference to natural beauty – namely, Ronald W. Hepburn’s “Contemporary Aesthetics and the Neglect of Natural Beauty” . This famous (...) essay is considered in relation to both the general problem of the distinction and the subsequent development of models of the aesthetic appreciation of nature in the second half of the twentieth century , which were profoundly anticipated by Hepburn. (shrink)