« On tend à définir aujourd’hui la Théorie critique de l’École de Francfort comme une philosophie sociale proposant un “diagnostic” portant sur des “pathologies sociales”. Or ces termes recouvrent en réalité une pluralité de démarches. Le propos de l’article est d’en interroger la continuité, depuis la position de Horkheimer et Adorno pour lesquels le mal social est plutôt identifié à la barbarie ou à l’irrationalité, les maladies psychiques de l’individu étant l’indice d’un tout social malade, jusqu’à l’analyse par (...) Honneth des évolutions pathologiques ou manquées du social, qui font état d’obstacles à l’intégration sociale, en passant par l’analyse habermassienne des pathologies. L’article étudie plus précisément deux variantes très différentes de l’analyse du rapport entre le normal et le pathologique, selon que la pathologie est prise en un sens métaphorique ou plus littéral. Dans chaque cas, la question de la thérapeutique se pose différemment. ». (shrink)

The foundations of psychoanalysis in the German idealist concepts of the reflexive human self have been the subject of detailed investigations devoted to the intertwined processes of introspection,...

This article investigates the origins of the experiences involved in the diagnostics (detection and normative evaluation) of biological entities in image-based medical praxis. Our specific research aim presupposes a vast discussion regarding the origins of knowledge in general, but is narrowed down to the alternatives of anthropomorphism and biomorphism. Accordingly, in the subsequent chapters we will make an attempt to investigate and illustrate what holds the diagnostic experiential situation together—biological regularities, manifestation via movement, conscious synthesis, causal categories, or something (...) else. We argue that as long as knowledge originates out of practices, a promising way forward is to oscillate between the prominent although controversial ideas of the history of philosophy and observations of concrete human practices, such as, in our chosen example, image-based medical diagnostics of biological pathologies. Although a number of thinkers are involved in the discussion, Aristotle and Husserl are most important here as the representatives of historical paradigms on the matter. The body in this research was not taken solely as the physical entity (Körper) but rather as a transcendental, constitutive structure where diagnostic and biological processes synchronize in teleological movement (Leib). However, philosophical speculations are illustrated by actual radiograms, the interpretation of which brings us back to the aforementioned question of primacy regarding cognition. (shrink)

A philosophical question divides the field of addiction research. Can a psychological disorder count as an addiction absent a common underlying physical basis (neurological or genetic) for every case of the disorder in the category? Or is it appropriate to categorize a disorder as an addiction if the symptoms of and diagnostic criteria for it are sufficiently similar to those of other disorders also classified as addictions—regardless of whether there is some underlying physical basis common to each case of (...) the disorder? The question concerns the scope and validity of the scientific concept of addiction and, more broadly, what is required for a psychological concept to count as scientific. The case of pathological gambling (PG) raises this question nicely. ‘‘Should pathological gambling be considered an addiction?’’ asks Howard Shaffer (2003, 176). He specifies the question further (2003, 177–178): ‘‘When clinicians and scientists identify a behavior pattern as an addiction, even if they can identify it reliably according to DSM criteria, how do they know that it is indeed an addiction?’’ He warns that, as it stands, ‘‘the concept of addiction represents a troublesome tautology’’ (2003, 178): a subject S is addicted if and only if S engages in repetitive behavior with negative consequences against S’s better judgment. The problem with this concept is that it provides no way to distinguish behavior that cannot be controlled from behavior that is merely in fact not controlled. This ‘‘lay’’ concept is of little scientific value, Shaffer (2003, 179) argues, saying that ‘‘for addiction to emerge as a viable scientific construct . . . investigators need to establish a ‘gold standard’ against which the presence or absence of the disorder can be judged.’’ PG has no such gold standard, says Shaffer. What would such a gold standard be? Shaffer suggests ‘‘neurogenetic or biobehavioral attributes’’ (ibid.).. (shrink)

Although the network model represents a promising new approach to conceptualizing comorbidity in psychiatric diagnosis, the model applies most directly to Axis I symptom disorders; the degree to which the model generalizes to Axis II disorders remains open to question. This commentary addresses that issue, discussing opportunities and challenges in applying the network model to DSM-diagnosed personality pathology.

Aside from the systematic theory of recognition, Honneth’s work in the last decade has also centered around a less commented-upon theme: the critical social theoretic diagnosis of social pathologies. This paper claims first that his diverse diagnoses of specific social pathologies can be productively united through the conceptual structure evinced by second-order disorders, where there are substantial disconnects, of various kinds, between first-order contents and second-order reflexive understandings of those contents. The second major claim of the paper is (...) that once we understand social pathologies as second-order disorders, it becomes apparent that critical social theory must do more than accurately identify and explicate these disorders at the phenomenological and action-theoretic levels. It must further engage in insightful sociological explanations of the social causes of those pathologies in order to further the prognostic and therapeutic tasks implied by the aim of developing a social theory with emancipatory intent. The paper argues that the identificatory and explicative components of diagnostic social theory have been fulfilled by Honneth to a much greater degree than the latter components of explanation, prognosis and therapy. (shrink)

In most areas of medicine, the physician's primary task is to diagnose the patient's presenting problem by correctly identifying the underlying pathology causing that problem. Diagnoses are established through a process of correlating the information obtained from an interview with the patient about his history of illness and circumstances, with additional evidence of the underlying disease derived from physical examination findings and/or the results of laboratory investigations and diagnostic imaging. In contemporary health care, various movements that call for a (...) shift in clinical care away from underlying disease pathology toward understanding people and their experience of disease are receiving growing... (shrink)

Pathologizing ugliness refers to the framing of unattractive features as a type of disease or deformity. By framing ugliness as pathology, cosmetic procedures are reframed as therapy rather than enhancement, thereby potentially avoiding ethical critiques regularly levelled against cosmetic surgery. As such, the practice of pathologizing ugliness and the ensuing therapeuticalization of cosmetic procedures require an ethical analysis that goes beyond that offered by current enhancement critiques. In this article, I propose using a thick description of the goals of medicine (...) as an ethical framework for evaluating problematic medical practices. I first describe the goals of medicine based on Daniel Callahan's account. I then propose that the goals work best in conjunction with ancillary ethical concepts, namely medical knowledge and skills, standards of practice and medical duties and virtues. Next, I apply the thick description of the goals of medicine in critiquing the practice of framing ugliness as disease. Here, I demonstrate ethical conflicts between aesthetic judgments that underpin the practice of pathologizing ugliness and medical judgments that inform ethical medical practices. In particular, the thick description of the goals of medicine helps reveal ethical conflicts in at least three key domains common to clinical practices, which include (a) disease determination, (b) diagnostic evaluation and (c) establishing clinical indications. My analysis offers a novel way of critiquing the practice of pathologizing ugliness in cosmetic surgery, which tends to be neglected by enhancement critiques. (shrink)

This article provides a historical perspective on how both American and European psychiatrists have conceptualized and categorized sexual deviance throughout the past 150 years. During this time, quite a number of sexual preferences, desires, and behaviors have been pathologized and depathologized at will, thus revealing psychiatry's constant struggle to distinguish mental disorder--in other words, the "perversions," "sexual deviations," or "paraphilias"--from immoral, unethical, or illegal behavior. This struggle is apparent in the works of 19th- and early-20th-century psychiatrists and sexologists, but it (...) is also present in the more recent psychiatric textbooks and diagnostic manuals, such as the consecutive editions of the Diagnostic and Statistical Manual of Mental Disorders. While much of the historical literature revolves around the controversy over homosexuality, this article also reviews the recent medicohistorical and sociohistorical work on other forms of sexual deviance, including the diagnostic categories listed in the latest edition, the DSM-IV-TR: exhibitionism, voyeurism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, and transvestic fetishism. (shrink)

Just as sadness is not always a symptom of mood disorder, irrational beliefs are not always symptoms of illness. Pathological irrational beliefs are distinguished from non-pathological ones by considering whether their existence is best explained by assuming some underlying dysfunctions. The features from which to infer the pathological nature of irrational beliefs are: un-understandability of their progression; uniqueness; coexistence with other psycho-physiological disturbances and/or concurrent decreased levels of functioning; bizarreness of content; preceding organic diseases known to be associated with irrational (...) beliefs; treatment response to medical intervention, etc. Severe irrationality is sometimes caused by normal human motivation rather than by mental or physical dysfunction. Pure forms of self-deception may satisfy the diagnostic criteria of delusional disorder, but there may be no evidence that suggests that they are caused by illness. Although those with pathological delusions do not recognize their delusions as symptomatic of illness, differentiating pathological beliefs from normal irrational beliefs is vitally important: If a belief is pathological, psychiatrists must seriously consider treating the patient against her will. If it is not pathological, conversely, involuntary treatments are prohibited because they offend her basic autonomy. (shrink)

This article addresses the precarious place of transgender and gender non-cis persons in relation to their discrimination-protections in recent legal, medical, and ethical policies in the United States. At present, there exists a contradiction such that trans persons are considered "pathological" enough that they are included in the latest iteration of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-V) as "gender dysphoric," but they are not included in the category of "disabled" under the Americans with Disabilities Act (ADA). (...) As such, trans persons in America are subject to the stigma of pathology (albeit with medical treatment) without the full protections of the ADA. By contrast, transgender and non-cis-gender Americans find their queer cohorts who are HIV-positive to be fully protected by the ADA. We ask whether transgender and non-cis-gender persons should embrace their (already pathologized) personhood as a disability. Sometimes "choosing disability" affords more rights than it deploys stigma. (shrink)

Pathology and laboratory medicine are a key component of a patient’s healthcare. From academic care centres, community hospitals, to clinics across the country, pathology data are a crucial component of patient care. But for much of the modern era, pathology and laboratory medicine have been absent from health policy conversations. Though select members in the field have advocated for an enhanced presence of these specialists in policy conversations, little work has been done to thoroughly evaluate the moral and ethical obligations (...) of the pathologist and the role they play in healthcare justice and access to care. In order to make any substantive improvements in access to care, pathology and laboratory medicine must have a seat at the table. Specifically, pathologists and laboratorians can assist in bringing about change through improving clinician test choice, continuing laboratory improvement programmes, promoting just advanced diagnostic distribution, triage testing and be good stewards of healthcare dollars, and recruiting a more robust laboratory workforce. In order to get to that point, much work has to be done in pathology education and the laboratory personnel training pipeline but there also needs to be adjustments at the system level to better involve this invaluable group of specialists in these policy conversations. (shrink)

The Diagnostic and Statistical Manual of Mental Disorders-IV-TR treats dissociation as a disruption in the usually integrated functions of consciousness (American Psychiatric Association, 2000). Survey instruments used to measure dissociation incorporate questions that focus on depersonalization, de-realization, and dissociative-identity disorder (DID). The self-administered Structured Clinical Interview for DepersonalizationDerealization Spectrum (SCI-DER) asks a subject if they ever felt that your body did not seem to belong you or you were outside your body (Mula et al. 2008). This last question references (...) what is also known as the out-of-body experience (OBE). In some cultures and religious practices OBE is considered desirable. Research has shown that OBE can be induced. For users of the virtual world Second Life, OBE is the default point of view (POV). Users are represented as avatars that look unreal and one's surroundings look unreal. Yet reality testing is intact (American Psychiatric Association, 2000). Many users have multiple avatars, which enact distinct identities or personalities, and this fits the criteria for dissociative identity disorder. To experience any of these disorders in real life may be considered undesirable, even pathological. But for users of Second Life such dissociative experiences are considered normal, liberating, and even transcendent. (shrink)

Murphy (2006) criticizes psychiatric nosology from the perspective of the philosophy of science, arguing that the model of pathology as encapsulated in the Diagnostic and Statistical Manual of Mental Disorders reflects a folk conception of the mental, and of malfunctioning, that is inadequately integrated with cognitive and behavioral neuroscience. The present paper supports this view through a case study of research on pathological gambling. It argues that recent modeling based on fMRI studies and behavioral genetics suggests a stipulative, non-seamless (...) reduction of pathological gambling to a specific disorder of the mesolimbic dopamine system. This argument is agnostic as between prior philosophical commitments to realism or empiricism. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Vulnerabilization and De-pathologizationTwo Philosophical SuggestionsHavi Carel, PhD (bio)Alastair Morgan raises useful and interesting philosophical critiques of the 'power-threat-meaning' framework proposed by Johnstone et al. (2018). In what follows I make two suggestions that may clarify some aspects of the debate. First, to broaden the notion of threat: we can think more broadly about adverse life events as the source of mental suffering by broadening the notion of threat to (...) what I term (in joint work with Ian James Kidd) Vulnerabilization. Second, I offer a distinction between de-pathologizing psychiatric disorders (i.e., removing stigma and negative stereotypes) and de-medicalizing such disorders (i.e., rescinding them from a diagnostic manual), in order to suggest that de-medicalizing on its own does not solve the problem of stigma, but de-pathologizing is a better candidate for achieving that.Threat and VulnerabilizationMorgan argues that the notion of threat is too limited to cover the breadth of psychiatric conditions and presentations. Threat and power may often be present, but how they lead to the appearance of behaviors that meet certain diagnostic criteria, is, as Morgan states, unclear at best and only a partial explanation for psychiatric disorders (it explains some behaviors, not all). I suggest we view threat as one type of a broader category, which I propose to term 'Vulnerabilization' (Carel & Kidd, 2021).Vulnerabilization refers to the effects of interactions and actions that impact on people by harming them and making them more vulnerable to future adversity. For example, removing a struggling child from a classroom causes them to miss the lesson, and if done repeatedly, harms their capacity to continue studying. Leaving a weak patient unsupervised in the wrong kind of bed may cause them to fall and become more vulnerable to disease and infection. Failing to organize accommodation for an inmate about to be released from prison forces them onto the streets and makes them more vulnerable to reoffending. The point of the term is to draw attention to the fact that one is not born vulnerable, to paraphrase de Beauvoir, [End Page 73] but becomes vulnerabilized through acts and omissions of others. Such acts and omissions often take place under the auspices of an institution—health care, social care, education, criminal justice, and so on—and are therefore intimately tied to ethoi and conduct of institutions (for a full analysis see Carel & Kidd, 2021).Vulnerabilization is a common theme in the testimonies of people who have negative experiences of social institutions, including, of course, health care institutions. Ideally, health care systems, schools, courts, and other major institutions scaffold and protect our agency, efficiently support our endeavors, and fairly and reliably disperse social and epistemic resources. But while some people have reliably satisfying experiences of social institutions, others find that many, if not all, of the institutions they encounter abandon, ignore, silence, harm, or even kill them and people like them (this is not an exaggeration: inquiries such as the Francis Report (2013) on the Mid Staffordshire patient neglect case and the Sheldon Review (n.d.) provide plentiful examples of that).1 When vulnerable people encounter institutions, they are often at an epistemic and communicative disadvantage that makes their interactions with institutions a source of suffering and injustice and indeed makes such people even more vulnerabilized. They may be affected by poverty, disability (especially mental ill health and learning disabilities), trauma, domestic violence, ill health, racism, sexism, ageism, or other sources of disadvantage, prejudice and discrimination; and, of course, they can be disadvantaged by a combination of such factors. Seeing power as the source of much suffering, social injustice and poor mental health is, of course, entirely in line with this view and I agree with Morgan that Johnstone et al. (2018) identified an important source of suffering.De-Medicalizing Versus De-PathologizingAnother important issue about psychiatric diagnoses is the stigma and negative stereotypes surrounding mental illness. Calls to de-medicalize a specific or all mental disorders is, in part, a call to remove stigma and negative stereotype from the behaviors and mental states that characterize a mental disorder. However, to de-medicalize... (shrink)

The self allows us to reflect on our own behavior and to imagine what others think of us. Clinical experience suggests that these abilities may be impaired in people with personality disorders. They do not recognize the impact that their behavior has on others, and they have difficulty understanding how they are seen by others. We collected information regarding pathological personality traits—using both self and peer report measures—from groups of people who knew each other well . In previous papers, we (...) have reported that agreement between self-report and peer-report is only modest. In this paper, we address the question: Do people know that others disagree with their own perceptions of themselves? We found that expected peer scores predicted variability in peer report over and above self-report for all 10 diagnostic traits. People do have some incremental knowledge of how they are viewed by others, but they do not tell you about it unless you ask them to do so; the knowledge is not reflected in ordinary self-report data. Among participants who expect their peers to describe them as narcissistic, those who agree with this assessment are viewed as being less narcissistic by their peers than those who deny being narcissistic. It therefore appears that insight into how one is viewed by others can moderate negative impressions fostered by PD traits. (shrink)

This paper examines the role of modality resources (e.g., “may”, “often”) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in representing behavioral pathology focusing, in particular, on Attention Deficit Hyperactivity Disorder (ADHD). ADHD diagnosis requires reports of non-practitioners (e.g., carers and teachers); an effective understanding of behavioral descriptors by the lay community is thus of paramount importance. The study combines qualitative linguistic discourse analysis and a corpus approach to study the presence and functions of modality, adopting a (...) Systemic Functional perspective towards language. The study argues that in the DSM-5 modality is an important linguistic resource for conveying clinical significance, inferred from graduations of recurrence and probability. However, adopting features of professional discourse in representing behavioral pathology for non-experts, especially when those resources are inherently evaluative, stresses the need of health literacy among the lay social community and accessibility in health communication materials, particularly when non-practitioners are involved in the diagnosis practice. (shrink)

A RELATIVISTIC THEORY OF PHENOMENOLOCICAL CONSTITUTION: A SELF-REFERENTIAL, TRANSCENDENTAL APPROACH TO CONCEPTUAL PATHOLOGY. (Vol. I: French; Vol. II: English) -/- Steven James Bartlett -/- Doctoral dissertation director: Paul Ricoeur, Université de Paris Other doctoral committee members: Jean Ladrière and Alphonse de Waehlens, Université Catholique de Louvain Defended publically at the Université Catholique de Louvain, January, 1971. -/- Universite de Paris X (France), 1971. 797pp. -/- The principal objective of the work is to construct an analytically precise methodology which can serve (...) to identify, eliminate, and avoid a certain widespread _conceptual fault_ or _misconstruction_, called a "projective misconstruction" or "projection" by the author. It is argued that this variety of error in our thinking (i) infects a great number of our everyday, scientific, and philosophical concepts, claims, and theories, (ii) has largely been undetected, and (iii), when remedied, leads to a less controversial and more rigorous elucidation of the transcendental preconditions of human knowledge than has traditionally been possible. The dissertation identifies, perhaps for the first time, a _projective_ variety of self-referential inconsistency, and proposes an innovative, self-reflexive approach to transcendental argument in a logical and phenomenological context. The strength of the approach lies, it is claimed, in the fact that a rejection of the approach is possible only on pain of self-referential inconsistency. The argument is developed in the following stages: A general introduction identifies the central theme of the work, defines the scope of applicability of the results reached, and sketches the direction of the studies that follow. The preliminary discussion culminates in a recognition of the need for a _critique of impure reason_. The body of the work is divided into two parts: Section I seeks to develop a methodology, on a purely formal basis, which is, on the one hand, capable of being used to study the transcendental foundations of the special sciences, including its own proper transcendental foundation. On the other hand, the methodology proposed is intended as a diagnostic and therapeutic tool for dealing with _projective_ uses of concepts. The approach initiates an analysis of concepts from a perspective which views _knowledge as coordination_. Section I describes formal structures that possess the status of preconditions in such a coordinative account of knowledge. Special attention is given to the preconditions of _identifying reference_ to logical particulars. The first section attempts, then, to provide a self-referential, transcendental methodology which is essentially revisionary in that it is motivated by a concern for conceptual error-elimination. Phenomenology, considered in its unique capacity as a self-referential, transcendental discipline, is of special relevance to the study. Section II accordingly examines a group of concepts which come into question in connection with the central theme of _phenomenological constitution_. The "_de-projective methodology_" developed in Section I is applied to these concepts that have a foundational importance in transcendental phenomenology. A translation is, in effect, proposed from the language of consciousness to a language in which preconditions of referring are investigated. The result achieved is the elimination of self-defeating, projective concepts from a rigorous, phenomenological study of the constitutive foundations of science. The dissertation was presented in a two volume, double-language format for the convenience of French and English researchers. Each volume contains an analytical index. (shrink)

The critical theory of the Frankfurt School starts with an explanatory-diagnostic analysis of the social pathologies of the present followed by anticipatory-utopian reflection on possible treatments for these disorders. This approach draws extensively on parallels to medicine. I argue that the ideas of social pathology and crisis that pervade the methodological writings of the Frankfurt School help to explain critical theory’s contention that the object of critique identifies itself when social institutions cease to function smoothly. However, in reflecting (...) on the role that reason and self-awareness play in the second stage of social criticism, I contend that this model is actually better conceptualized through the lens of the psychoanalyst rather than the physician. Although the first generation’s explicit commitment to psychoanalysis has dissipated in recent critical theory, faith in a rationalized ‘talking cure’ leading to greater self-awareness of existing pathologies remains at the core of the Frankfurt School. (shrink)

If the healthy and the pathological are not merely judgments qualifiers, but real phenomena, it must be possible to define both of them positively, which, in this context, means as factual contraries. On the other hand, only a privative definition, either of the pathological as 'non-healthy', or of the healthy as 'non-pathological', can rationally circumscribe all possible states of an organism. This fluctuation between two meanings of the 'healthy'-'pathological' opposition, factual vs. rational, characterizes the ordinary usage of these concepts and (...) puts all philosophical definitions in a hopeless situation. Although a scientific definition may conceal this equivocation by adequately setting out the terms of the problem of discriminating between the 'healthy' and the 'pathological', it could explain some of the difficulties met in determining 'gold standards', in the choice of separators, and in the assessment of the diagnostic qualities of tests. (shrink)

: In direct opposition to the dominant nativist perspective tracing back to Descartes, William James suggested that the sense of self is constructed through a never-ending process of reflexivity. In more recent years, empirical data from various psychological domains have further strengthened this constructivist perspective. Notably, Gergely and Watson’s social biofeedback model has been proposed as a central mechanism in the development of emotional introspection, which itself constitutes a crucial step in the process leading to a mature sense of self. (...) In accordance with the social biofeedback model, it has been suggested that reiterated failures in biofeedback mechanisms predispose an individual to mental suffering. While borderline personality disorder and antisocial behavior have received the most attention, here I make a preliminary attempt to examine the impact of dysfunctional biofeedback on the pathogenesis of narcissism, suggesting that some central features of pathological narcissism may result from serious and reiterated disruptions in social biofeedback. This preliminary exploration aims to deepen our understanding of the origins of psychological suffering. In this sense, my effort could contribute to the construction of a causal model going beyond the purely categorical, atheoretical analysis of mental diseases typical of the diagnostic and statistical manuals. Keywords: Self; Self-ing Process; Social Biofeedback Model; Narcissism Il farsi e il disfarsi del sé. Biofeedback sociale, meccanismi causali e narcisismo patologico Riassunto: La prospettiva costruttivista sullo sviluppo del sé, efficacemente difesa da William James in opposizione all’innatismo di stampo cartesiano, è oggi ulteriormente avvalorata da numerosi dati empirici provenienti da diversi ambiti della psicologia. Il modello del biofeedback sociale di Gergely e Watson è stato proposto quale meccanismo centrale nello sviluppo dell’introspezione emotiva. In accordo a tale modello, ripetuti gravi fallimenti del biofeedback predispongono al disturbo mentale, segnatamente al disturbo borderline di personalità e al comportamento antisociale. In questo saggio mi occuperò di disturbo narcisistico di personalità, suggerendo che anche alcuni dei sintomi principali di questa patologia potrebbero derivare da disfunzioni gravi e reiterate del biofeedback. Nonostante la sua natura preliminare, la mia indagine si inscrive nell’alveo di quelle ricerche che mirano costruzione di un modello causale che vada oltre l’analisi puramente categoriale e ateoretica tipica dei manuali statistico-diagnostici. Parole chiave: Self; Identità personale; Social Biofeedback Model; Disturbo narcisistico di personalità. (shrink)

Speech is a primary means of human communication and one of the most basic features of human conduct. Voice is an important part of its subsystems. A speech disorder is a condition that affects the ability of a person to speak normally, which occasionally results in voice impairment with psychological and emotional consequences. Early detection of voice problems is a crucial factor. Computer-based procedures are less costly and easier to administer for such purposes than traditional methods. This study highlights the (...) following issues: recent studies, methods of voice pathology detection, machine learning and deep learning (DL) methods used in data classification, main datasets utilized, and the role of Internet of things (IoT) systems employed in voice pathology diagnosis. Moreover, this study presents different applications, open challenges, and recommendations for future directions of IoT systems and artificial intelligence (AI) approaches in the voice pathology diagnosis. Finally, this study highlights some limitations of voice pathology datasets in comparison with the role of IoT in the healthcare sector, which shows the urgent need to provide efficient approaches and easy and ideal medical diagnostic procedures and treatments of disease identification for doctors and patients. This review covered voice pathology taxonomy, detection techniques, open challenges, limitations, and recommendations for future directions to provide a clear background for doctors and patients. Standard databases, including the Massachusetts Eye and Ear Infirmary, Saarbruecken Voice Database, and the Arabic Voice Pathology Database, were used in most articles reviewed in this article. The classes, features, and main purpose for voice pathology identification are also highlighted. This study focuses on the extraction of voice pathology features, especially speech analysis, extends feature vectors comprising static and dynamic features, and converts these extended feature vectors into solid vectors before passing them to the recognizer. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.4 (2002) 387-394 [Access article in PDF] Psychosis Good and Bad:Values-Based Practice and the Distinction Between Pathological and Nonpathological Forms of Psychotic Experience Mike C. Jackson and K. W. M. Fulford IN TWO PAPERS in this issue of Philosophy, Psychiatry, and Psychology, Marek Marzanski and Mark Bratton (2002) and Caroline Brett (2002) develop important critiques, from the perspectives respectively of Christian theology and Eastern philosophy, (...) of our 1997 analysis of the distinction between pathological and nonpathological forms of psychotic experience (Jackson and Fulford 1997).In this response, we briefly summarize the main points from our 1997 analysis; we consider, separately, the important although very different challenges to that analysis from the perspectives of our two critics; and we briefly indicate the main lines of recent developments in policy, practice, and research in mental health as they relate to this important area of human experience. The Jackson and Fulford (1997) Analysis In our 1997 paper, we presented three case studies from a larger series (Jackson 1991, 1997, 2001) selected with the express aim of bringing into focus the conceptual difficulties that arise at the borderline between psychotic illness and what we called benign spiritual experience. On the basis of these case studies we argued thatspiritual experiences, which are essentially benign, can involve explicitly psychotic phenomenology; traditional psychiatric diagnostic methods, which focus on the form and content of beliefs and experiences, are not capable of distinguishing between pathological and nonpathological forms of such psychotic experiences; [End Page 387]evaluation of such experiences (and claims about "illness" and health more generally) necessarily involves value judgments as well as judgments about matters of fact (specifically, the "facts" of traditional descriptive psychopathology); and more specifically, the distinction between pathological and nonpathological phenomena concerns the way in which they are embedded in the structure of the values and beliefs by which the actions of the subjects concerned are defined: "In the case of pathological psychotic phenomena," we argued, "there is a radical failure of action.... In the case of spiritual psychotic phenomena, action is radically enhanced" (Jackson and Fulford 1997, 55).We then proposed a cognitive problem-solving model of psychotic experiences. This model suggests that such experiences can be a normal and adaptive psychological response to existential crises, such as loss of meaning or purpose in life, coming to terms with death or bereavement, and so on (Batson and Ventis 1982; Jackson, 1991, 1997, 2001). The model is consistent with a subsequent position paper published by the British Psychological Society arguing the case for a psychological formulation of psychotic experiences and cognitive-behavioural methods in their management (2000).In the case of nonpathological psychotic experience, the psychotic elements of the experience promote a paradigm shift in the individual's underlying assumptions, which effectively resolves their impasse and allows them to move forward. This is normally a self-limiting process, in that when the individual is able to utilize their insight, it acts to resolve the stress which triggered it. In pathological psychosis, this process fails for various possible reasons, which were not explored in any depth in that paper (but see Jackson 2001 for a more detailed discussion). The Challenge From Marzanski and Bratton Marek Marzanski and Mark Bratton reexamine the questions raised by our cases from a Christian theological perspective (Marzanski and Bratton 2002). They suggest a theologically based definition of spiritual experience according to which the criteria for "genuine" experience concerns its context within the development of the individual's religious faith. In Bratton and Marzanski's account, these criteria are based on a Christian value system.They present three cases of their own, which, in contrast to the three cases in our 1997 paper, vividly illustrate how phenomena that may be valued negatively from a medical perspective (i.e., as defined by us in terms of their consequences for action), may, at one and the same time, be valued positively from a religious perspective (i.e., in terms of their consequences for the... (shrink)

If the healthy and the pathological are not merely judgments qualifiers, but real phenomena, it must be possible to define both of them positively, which, in this context, means as factual contraries. On the other hand, only a privative definition, either of the pathological as ‘non-healthy’, or of the healthy as ‘non-pathological’, can rationally circumscribe all possible states of an organism. This fluctuation between two meanings of the ‘healthy’–‘pathological’ opposition, factual vs. rational, characterizes the ordinary usage of these concepts and (...) puts all philosophical definitions in a hopeless situation. Although a scientific definition may conceal this equivocation by adequately setting out the terms of the problem of discriminating between the ‘healthy’ and the ‘pathological’, it could explain some of the difficulties met in determining ‘gold standards’, in the choice of separators, and in the assessment of the diagnostic qualities of tests. (shrink)

ArgumentIn August of 1977, Australian pathologist David W. Buntine delivered a presentation at the Annual Meeting of the Royal College of Pathologists of Australia in Melbourne, Victoria. In this presentation, he used the diagnostic category of “Eskimoma,” to describe a unique set of salivary gland tumors he had observed over the past five years within Winnipeg’s Health Sciences Center. Only found amongst Inuit patients, these tumors were said to have unique histological, clinical, and epidemiological features and were unlike any (...) other disease category that had ever been encountered before. To understand where this nosological category came from, and its long-term impact, this paper traces the historical trajectory of the “Eskimoma.” In addition to discussing the methods and infrastructures that were essential to making the idea of Inuit cancer “visible,” to the pathologist, the epidemiologist, and to society at large, this paper discusses how Inuit tissue samples obtained, stored, and analyzed in Winnipeg, Manitoba, came to be codified into a new, racially based disease category – one that has guided Canadian and international understandings of circumpolar cancer trends and shaped northern healthcare service delivery for the past sixty years. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Vice, Mental Disorder, and the Role of Underlying Pathological ProcessesNancy Nyquist Potter (bio) and Peter Zachar (bio)Keywordsresponsibility, virtue theory, cultural norms, psychopathologyThe issues discussed by John Sadler are among the most complicated in the philosophy of psychiatry, if for no other reason than that they highlight an area where disciplinary fault lines between clinical psychiatry/ psychology and philosophy seem most evident. We spent a year writing an article on (...) the relationship between the assessment of personality disorders and moral evaluations, and these fault lines became manifest not only between ourselves, but also when discussing our ideas with members of the various disciplines.Many practicing psychiatrists acknowledge that moral attributions (such as manipulativity) might be made about people with certain disorders (such as borderline personality disorder), but also find the argument that psychiatric diagnoses are moral rather than medical conditions to be a ludicrous bit of antipsychiatry in the Szaszian tradition. Philosophers, on the other hand, are less involved with these diagnostic categories in their day-to-day work and are more willing to be skeptical. Whether they are doing philosophy of psychiatry, moral theory, or sociopolitical philosophy, they are interested in digging a little bit deeper and are not impressed by arguments to the effect that—it’s obvious that these are really disorders. Being “obvious” is not a persuasive philosophical argument.The metaphysical task of determining what belongs in the category of criminality compared with other ways of sorting behavior has parallels in moral philosophy: Why is fraud, or theft, criminalized whereas (most) lying is not? Why is one set of moral norms enforceable, whereas a second set is aspirational? Does the difference involve property, where infractions of property are thought to be more serious wrongs than lying, which is “only” psychological rather than material? Are the “most serious” wrongs the ones we mark as crimes? Why is sodomy still criminalized in some areas but betraying one’s lifelong love is viewed as morally reprehensible but not criminal? Both actions are private, and only one seems to do harm—unfaithfulness—yet that is the one that is not criminalized. The point here is that, regardless of domain, our classification systems need to be justifiable, yet justification is most often mystifying. [End Page 27]The same is true for classifying mental disorders. The class of mental disorders appears to be a somewhat inconsistent collection of heterogeneous conditions and does not form a natural kind (Zachar 2000). At the most, the class of mental disorders names a family of loosely related conditions and the reasons for inclusion can shift from disorder to disorder.If the class of mental disorders does not specify an internally coherent kind akin to gold, deciding on the scope of psychiatric practice becomes an important problem. As Sadler asks, for what reasons do we classify pedophilia with schizophrenia—both as disorders—but omit sadism? This is an important question of disciplinary scope.This question of scope is itself ethically charged because, on the one hand, bringing a condition under the purview of psychiatry offers the possibility for treatment, and at least establishes the goal of improving the lives of people with specific kinds of problems. Making lives better is one of the humanistic justifications for science itself; clearly it is a raison d’être of psychiatry. On the other hand, medicalization sets up the conditions for a certain kind of social control. Hospitalization, educational services, day treatment, and disability payments are all contingent upon psychiatric diagnostic practices. These programs and the institutions that manage them are both socially available and socially prescribed. The diagnosed behaviors can now be considered to be entities, and explanations of them can be developed. New technologies for altering them will also be introduced. Such practices have been associated with dehumanization (Phillips 2009).Two important questions also need to be distinguished. The first is a question for moral philosophy—What degree of responsibility do people with putative mental disorders have for their behaviors? For example, should people with psychotic disorders or personality disorders be held responsible for crimes they commit? If so, under what conditions? Should responsibility for certain behavior be mitigated? If so, under what conditions? Moral philosophy... (shrink)

Scholars in language and social interaction have long been concerned with the role of texts in institutional settings, studying, for example, how interview schedules actively shape conversational dynamics between participants. While texts have been acknowledged as active in this way, their generative capacity remains largely overlooked. This article argues that like human subjects, texts in interaction enact agency. One text in particular, a screening form used to diagnose the learning disability attention deficit/hyperactivity disorder, is analyzed to claim that this text (...) brings about the very condition it is designed to measure: a learning disability. Drawing from work in discursive psychology, I show how the measurement requires the client to adopt certain speaking positions, which then enables the text to speak for the client. I also demonstrate how the text constructs otherwise normal behavior as pathological through punctuation and nominalization. Finally, I illustrate how the spatial organization of the text constrains clients’ choices for interacting with it. This article claims that texts produce, rather than reflect, cognitive phenomena, and it moreover encourages that the notion of text as agent be taken seriously, especially when it presents the capacity to disable. (shrink)

This paper will examine Choir Boy, a trans coming-of-age novel by Charlie Anders, to disrupt historically rooted medical narratives of gender transition. Through a disability studies lens, this paper locates vocal performance as a means of speaking back to gatekeeping practices held in place by medical authorities since the inception of transsexuality as a classificatory category. Offering imaginative alternatives to “wrong body” diagnostics, this analysis places cultural texts in conversation with disability theory to reframe the trans self as a singing (...) body that cannot be reduced to normalizing biomedical practices. Choir Boy frames vocal performance as a mode of gender expression and as a survival strategy against violence. The trans counter-narratives offered by Anders resist the medicalization of trans bodies and the classification of some bodies as not “trans enough” to qualify for transition. Choir Boy locates vocal performance and not binary gender identification as impetus for transition, thereby advocating for trans self-determination over medical access. (shrink)

In 1889, TheBritish Medical Journalpublished a piece titled, “Detective Medicine,” which describes feats of medical detection performed by physicians attending malingering prisoners. Though simulating illness had a long history, the medicalization of malingering at thefin de siècleled to a proliferation of such case histories and cheerful records of pathological feigners thwarted.

During the mid 1980s, the renowned American documentary filmmaker Fred Wiseman produced a four-part series of films that sought to record the operations of institutions in Talladega, Alabama, devoted to the care and training of people with disabilities. These films—designated as the Multi-handicapped Series—have received much less attention than Wiseman's earlier work, as if films about disability mark a drastic departure from his previous award-winning productions, such as Titicut Follies (1965) and Hospital (1970). The Multi-handicapped Series takes up general categories (...) of disabled populations as discrete documentary topics, Deaf (1986), Blind (1986), Multi-handicapped (1986) and Adjustment & Work (1986) as opposed to a specific location as in his earlier films. As a result, the latter series of films identify social and interpersonal structures developed in the name of specific conditions. Like Foucault's research on disciplinary tactics, Wiseman's films seek out many of the segregated social spaces typically occupied by persons classified as deviant: prisons, hospitals, charity networks, sheltered workshops, resident facilities, and vocational training structures. The Multi-handicapped Series focuses on the activities of professions and practitioners in education, administration, and therapy, as well as the institutional roles designed for bodies marked as disabled. Unlike its 19th century predecessor classification, feebleminded, the latter twentieth century U.S. policy answer has been waged as a matter of dividing disabilities into a binary structure of orthopedic or cognitive categories. Such a development has left many crossover bodies in a diagnostic no-body's-land. To analyze the history of these developments, this essay recognizes the formation of today's disability category as an effect of new regimes of power; a form of domination based upon the application of particularized diagnostic pathologies that provide the basis for cordoning off bodies which fail to fit neatly within the cognitive/orthopedic binary. As documents of the social spaces that are occupied by disabled people, Wiseman's films offer a rare contemplation of institutional practices and their application to populations viewed as nonnormative. (shrink)

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) uses the conceptualization of psychopathology to make psychiatric diagnoses operational. The use of explicit operational criteria appears to be based on an implicit neo-positivist epistemology. Operationalism involves an excessive focus on quantitative descriptions of behavior manifestations, contesting that psychopathology is understood as a deviation from the normal or the average in a given population. Consequently, the normal and the psychopathological become homogeneous. Our analysis investigates if this neo-positivist epistemology (...) narrows psychopathology conceptualization and endanger integration with the hybrid biopsychosocial model of psychiatry. Based on Georges Canguilhem’s theorization of a qualitative approach to the individual organism who is in a state of morbidity, we show that the (psychiatric) pathology also contains differences in quality. Moreover, that humans are norm-producing organisms that actively respond to changes in their internal and external environment. In this regard, the operationalization of mental disorders could include the normativity in humans, i.e., the ability to produce norms. We argue this will mitigate the one-sided psychopathology conceptualization and strengthen the relationship between psychiatric nosology and psychiatry’s hybrid biopsychosocial model. (shrink)

The fifth text-revised iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) defines paraphilia as “any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners”. Paraphilic disorders specifically denote a paraphilia that is “currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others”. A diagnosis of paraphilic disorder either demands the (...) personal distress and/or impairment of function that is caused by the atypical sexual urges and fantasies to be present, or the status of non-consent of the other person that these sexual fantasies and urges are directed towards when acted upon by the patient. This paper discusses how consent not only becomes the standard for permissible and legal sexual activity with other persons, but also, when the diagnostic criteria are taken at face-value, for sexual pathology in the DSM-5-TR when the patient acts on their sexual urges. After a close investigation of various possible interpretations of the element of non-consensuality in the diagnostic criteria for paraphilic disorders, this paper concludes that the DSM-5-TR does not offer a clarifying explanation on how mental health professionals should under-stand its approach to diagnosing paraphilic disorders, leaving us with an ambiguous, unclear and unsettled conceptualisation of what it would mean to fulfil its diagnostic criteria. (shrink)

This paper suggests that the practice of anamnesis—the taking of a patient history in preparation for making a diagnosis, as well as the related form of investigation, historia—offers a way to understand the role of medical collections in generating medical knowledge. Anamnesis derives from ancient Greek “recollecting” or “opening of memory,” and “taking a history” from historia, an ancient and early modern epistemic practice of gathering empirical observations from the past and present. Doctors and medical researchers perform, this paper argues, (...) a form of anamnesis when they access collections—of pathological organs, experimental animals, diagnostic slides, samples, and data—and the collections may in turn be seen as constituting institutional and disciplinary memories. It moreover shows that doctors and medical researchers in their work with collections negotiate two ways of organizing observations that are also present in an anamnesis. One way clusters and classifies observations, while the other traces developments and requires significant past observations to understand the present. This double nature plays out in different ways in different historical collections. Last, the paper itself may also be seen as performing an anamnesis: looking for patterns and tracing a development in medical history. It “opens the memory” of medical collection practices, and shows that medicine is past-heavy and that the past plays a central role in modern biomedicine. Anamnesis is thus used as a historiographical stance that seeks to understand present practices of generating knowledge about diseases through an inquiry into the past. (shrink)

This thesis investigates the nature of psychiatric disorders, and to what extent they can form a basis for classification, explanation, and treatment interventions. These questions are important in the light of the “crisis of validity” in psychiatry, according to which current diagnostic categories do not pick out real disorders. I address the questions by defending an account of psychiatric disorders that can better accommodate social aspects and non-epistemic values than the symptom-based model of the Diagnostic and Statistical Manual (...) of Mental Disorders (DSM) and the brain disease model of the biomedical approach, including the Research Domain Criteria (RDoC). I concentrate on three ways that psychiatric disorders can differ from prototypical natural kinds, such as biological species and chemical elements. First, the concept of psychiatric disorder or mental disorder is partly value-laden and cannot be defined based only on scientific facts. Second, the objects of psychiatric classifications are interactive human kinds because people with disorders respond to their classifications through looping effects. Third, sociocultural factors can shape disorders in complex ways, which is indicated by their cross-cultural variation. I argue that these challenges can be overcome with a pluralistic explanatory account that grants an explicit role to value-sensitive considerations and social scientific research. Based on this, I argue that particular disorders can in principle support inductive inferences. ------------------------------------------------------------------------------------------ My key argument is that although whether a condition is considered pathological is partly a value-laden question, this does not rule out a realist account of particular psychiatric disorders as homeostatic property cluster kinds (HPC). I assert that causal mechanisms responsible for psychiatric kinds can be understood non-metaphysically based on the contrastive-counterfactual and interventionist theories of explanation. An advantage of this account is that it can address the concern that psychiatric explanations require one to relate heterogeneous causal factors on different levels, such as genetic, neurological, psychological, and social. My novel argument is that mechanistic explanations of scientific kinds have applicability domains over which they account for specific aspects of kinds and warrant inductive inferences. That is, identifying the applicability domain of an explanation spells out the conditions under which the explanation is expected to be reliable and when it can break down. This helps to understand how different discipline approaches, including social and cultural ones, can be complementary and make an explanation of a psychiatric kind more reliable. On the other hand, the account also shows how the complex nature of psychiatric kinds can license re-classifications for different epistemic and non-epistemic purposes. Finally, in the light of the social implications of psychiatric classifications, I suggest a value-sensitive or ameliorative approach to engineering the concept of psychiatric disorder. In conclusion, my account shows that research on the social and cultural factors that shape psychiatric disorders, and weighing the non-epistemic values that influence classificatory practices, can and should inform classificatory choices as well as policy and treatment interventions. (shrink)

Current diagnostic criteria for schizophrenia place emphasis on delusions and hallucinations, whereas the classical descriptions of schizophrenia by Kraepelin and Bleuler emphasized disorganization and impoverishment of mental activity. Despite the availability of antipsychotic medication for treating delusions and hallucinations, many patients continue to experience persisting disability. Improving treatment requires a better understanding of the processes leading to persisting disability. We recently introduced the term classical schizophrenia to describe cases with disorganized and impoverished mental activity, cognitive impairment and predisposition to (...) persisting disability. Recent evidence reveals that a polygenic score indicating risk for schizophrenia predicts severity of the features of classical schizophrenia: disorganization, and to a lesser extent, impoverishment of mental activity and cognitive impairment. Current understanding of brain function attributes a cardinal role to predictive coding: the process of generating models of the world that are successively updated in light of confirmation or contradiction by subsequent sensory information. It has been proposed that abnormalities of these predictive processes account for delusions and hallucinations. Here we examine the evidence provided by electrophysiology and fMRI indicating that imprecise predictive coding is the core pathological process in classical schizophrenia, accounting for disorganization, psychomotor poverty and cognitive impairment. Functional imaging reveals aberrant brain activity at network hubs engaged during encoding of predictions. We discuss the possibility that frequent prediction errors might promote excess release of the neurotransmitter, dopamine, thereby accounting for the occurrence of episodes of florid psychotic symptoms including delusions and hallucinations in classical schizophrenia. While the predictive coding hypotheses partially accounts for the time-course of classical schizophrenia, the overall body of evidence indicates that environmental factors also contribute. We discuss the evidence that chronic inflammation is a mechanism that might link diverse genetic and environmental etiological factors, and contribute to the proposed imprecision of predictive coding. (shrink)

In this paper, I enquire into the nature of the influence culture has on the experience of trauma. I begin with a brief elaboration of the dominant conceptualisation of post-traumatic experiences: the diagnostic category of PTSD as it can be found in the DSM. Then, I scrutinise the nature and extent to which cultural factors may influence the phenomenology of the experience of certain events as traumatic and subsequent symptoms of post-traumatic stress. It seems that cultural circumstances alter the (...) way in which trauma is experienced; it is not clear whether there is in fact a core pathology of PTSD, as the DSM assumes, or whether the structure of the experience of trauma is too multifaceted to be summarised in one diagnostic category. Finally, I show that phenomenological enquiry promises to identify the structural similarities that would justify the delineation of a distinct diagnostic category. (shrink)

This article addresses the issues related to the problem of classification of mental disorders in psychiatry in the context of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. First, some background information is provided on the history of the classification of mental disorders and the evolution that DSM has had over time is shown. Secondly, the delimitation of the normal and the pathological in psychiatry is investigated through Canguilhem's medical-philosophical thought. Thirdly, the biopolitical management of (...) psychic sufferings is reflected in the diagnostic criteria of the DSM-V and its increasing medicalization. Finally, an approach to the concepts of health and disease in Canguilhem is made as it incorporates existential and experiential variables absent in the DSM-V classifications and in the psychiatric diagnosis. (shrink)

Taking care of a hyperactive child at school gives 2 meanings to the word ‘care’: worrying about a vulnerable person and health care with the recognition of his behaviour disorder, the unruly pupil becomes a disabled pupil. But how does an undisciplined pupil become a psychiatric case? How do you recognise a hyperactive child at school, that is, from a medical point of view, a child with ADD/ADHD (Attention Deficient Disorder with or without Hyperactivity)? Teachers contribute to the medical diagnosis (...) by filling in behavioural tests. Then, in order to be taken care of, the child will need to have his hyperactivity recognised as a disability. To help the teacher, the doctor will give them advice on how to teach the child. Nevertheless, this desirable partnership raises difficulties. Between a paramedical support teacher and an educationalist doctor isn’t there a risk of witnessing a dilution of roles? The lifting of doctor-patient confidentiality called for by some teachers is emblematic of this confusion. Canguilhem’s distinction between normal and pathological will guide our reflection on the medical care of the hyperactive child at school. This case arouses an ethical issue about the medicalisation of our society. (shrink)

Data indicate the ubiquity and rapid increase of depression wherever war, want and social upheaval are found. The goal of this paper is to clarify such claims and draw conceptual distinctions separating the depressive states that are pathological from those that are normal and normative responses to misfortune. I do so by appeal to early modern writing on melancholy by Robert Burton, where the inchoate and boundless nature of melancholy symptoms are emphasized; universal suffering is separated from the disease states (...) known as melancholy or melancholia, and normal temperamental variation is placed in contrast to such disease states. In Burton's time these distinctions and characterizations could be secured by the anchoring tenets of humoral theory. Without such anchoring, and in light of the findings and assumptions of today's biological diagnostic psychiatry, we must re-visit each of them. My goals here are to show the need for analytic foundations when claims are made about depression such as those cited above, and to draw attention to some contemporary attempts that may help provide those foundations, particularly, attempts to define disorder or disease. With adjustments, one of these (Cooper 2002) is shown to take us some way toward that goal. (shrink)

Les avancées de la médecine comme ses risques, excès ou dysfonctionnements conduisent à nous interroger sur la primauté affichée du techno-scientisme dans le champ de la santé, sur les idéaux de performance et les idéologies de la toute-puissance rationnelle de la biomédecine. A chaque étape de la recherche, du diagnostic, de la thérapie et du soin, la médecine n'est-elle pas toujours confrontée à la totalité d'un être vivant, à la complexité des pathologies, à l'ambivalence des thérapies, à la (...) singularité personnelle du patient? Pour valoriser pleinement le potentiel de savoirs et de savoirs-faire, issu de ses progrès, la médecine ne devrait-elle pas ré-humaniser l'homme malade, pour mobiliser toutes ses ressources biologiques, psychiques et mentales sans lesquelles la médecine risque de manquer ses buts, la santé d'une personne humaine. A l'opposé d'une polémique agressive et d'un scepticisme hostile, l'ouvrage tente de retisser des liens entre la froideur et la surenchère des technosciences de la santé et l'humanisme du soin, centré sur la psychologie relationnelle, l'éthique de la personne vulnérable, dam le contexte d'une anthropologie de l'homme intégral. (shrink)

In this essay I argue that epistemic injustices can be understood and explained as social pathologies of recognition, and that this way of conceptualizing epistemic injustices can help us develop proper diagnostic and corrective treatments for them. I distinguish between two different kinds of recognition deficiency—quantitative recognition deficits and misrecognitions—and I ague that while the rectification of the former simply requires more recognition, the rectification of the latter calls for a shift in the mode of recognition, that is, (...) a deep transformation of the recognition dynamics so that other forms of recognition can emerge. Arguing against incremental recognitional approaches that aim only at increasing social visibility/audibility, I examine communicative dysfunctions around the phenomenon of racist violence in order to show how problems of misrecognition persist and become recalcitrant even when quantitative recognition deficits disappear. (shrink)

In clinical medicine, a diagnosis can offer an explanation of a patient's symptoms by specifying the pathology that is causing them. Diagnoses in psychiatry are also sometimes presented in clinical texts as if they pick out pathological processes that cause sets of symptoms. However, current evidence suggests the possibility that many diagnostic categories in psychiatry are highly causally heterogeneous. For example, major depressive disorder may not be associated with a single type of underlying pathological process, but with a range (...) of different causal pathways, each involving complex interactions of various biological, psychological, and social factors. This paper explores the implications of causal heterogeneity for whether psychiatric diagnoses can be said to serve causal explanatory roles in clinical practice. I argue that while they may fall short of picking out a specific cause of the patient's symptoms, they can nonetheless supply different sorts of clinically relevant causal information. In particular, I suggest that some psychiatric diagnoses provide negative information that rules out certain causes, some provide approximate or disjunctive information about the range of possible causal processes, and some provide causal information about the relations between the symptoms themselves. (shrink)

In this volume, leading philosophers of psychiatry examine psychiatric classification systems, including the Diagnostic and Statistical Manual of Mental Disorders, asking whether current systems are sufficient for effective diagnosis, treatment, and research. Doing so, they take up the question of whether mental disorders are natural kinds, grounded in something in the outside world. Psychiatric categories based on natural kinds should group phenomena in such a way that they are subject to the same type of causal explanations and respond similarly (...) to the same type of causal interventions. When these categories do not evince such groupings, there is reason to revise existing classifications. The contributors all question current psychiatric classifications systems and the assumptions on which they are based. They differ, however, as to why and to what extent the categories are inadequate and how to address the problem. Topics discussed include taxometric methods for identifying natural kinds, the error and bias inherent in DSM categories, and the complexities involved in classifying such specific mental disorders as "oppositional defiance disorder" and pathological gambling. -/- Contributors George Graham, Nick Haslam, Allan Horwitz, Harold Kincaid, Dominic Murphy, Jeffrey Poland, Nancy Nyquist Potter, Don Ross, Dan Stein, Jacqueline Sullivan, Serife Tekin, Peter Zachar. (shrink)

This paper explores the position that moral enhancement interventions could be medically indicated in cases where they provide a remedy for a lack of empathy, when such a deficit is considered pathological. In order to argue this claim, the question as to whether a deficit of empathy could be considered to be pathological is examined, taking into account the difficulty of defining illness and disorder generally, and especially in the case of mental health. Following this, Psychopathy and a fictionalised mental (...) disorder are explored with a view to consider moral enhancement techniques as possible treatments for both conditions. At this juncture, having asserted and defended the position that moral enhancement interventions could, under certain circumstances, be considered medically indicated, this paper then goes on to briefly explore some of the consequences of this assertion. First, it is acknowledged that this broadening of diagnostic criteria in light of new interventions could fall foul of claims of medicalisation. It is then briefly noted that considering moral enhancement technologies to be akin to therapies in certain circumstances could lead to ethical and legal consequences and questions, such as those regarding regulation, access, and even consent. (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)

Losing an intimate other to death belongs to the most uprooting experiences in human life. Not only is it accompanied by a range of negative emotions such as sorrow, longing, anger etc., but profound grief is a limit experience that causes a rupture in the sense of self of the bereaved. This experience is often expressed in identity statements such as ‘I no longer feel like myself’ or ‘I am missing part of myself’. Although such experiences are richly reported in (...) empirical studies on grief and implemented in diagnostic criteria for pathological grief, their experiential meaning is largely left unexplored. In this article, I suggest that being bereaved of an intimate other is self-alienating because our sense of self is a distributed phenomenon relying on daily confirmation through interaction with our habitual environment. When our lives are intertwined with intimate others, this habitual identity become a dyadic structure, relying on a heteronomy. Being bereaved of this intimate other leads to a profound impoverishment of the habituated sense of self, leading to self-alienation. Finally, I discuss the process of returning to a non-alienating state and suggest that this is not exclusively a cognitive process, but equally an embodied process of appropriating a habitual identity. (shrink)

Losing an intimate other to death belongs to the most uprooting experiences in human life. Not only is it accompanied by a range of negative emotions such as sorrow, longing, anger etc., but profound grief is a limit experience that causes a rupture in the sense of self of the bereaved. This experience is often expressed in identity statements such as ‘I no longer feel like myself’ or ‘I am missing part of myself’. Although such experiences are richly reported in (...) empirical studies on grief and implemented in diagnostic criteria for pathological grief, their experiential meaning is largely left unexplored. In this article, I suggest that being bereaved of an intimate other is self-alienating because our sense of self is a distributed phenomenon relying on daily confirmation through interaction with our habitual environment. When our lives are intertwined with intimate others, this habitual identity become a dyadic structure, relying on a heteronomy. Being bereaved of this intimate other leads to a profound impoverishment of the habituated sense of self, leading to self-alienation. Finally, I discuss the process of returning to a non-alienating state and suggest that this is not exclusively a cognitive process, but equally an embodied process of appropriating a habitual identity. (shrink)

Some researchers and autistic activists have recently suggested that because some ‘autism-related’ behavioural atypicalities have a function or purpose they may be desirable rather than undesirable. Examples of such behavioural atypicalities include hand-flapping, repeatedly ordering objects (e.g., toys) in rows, and profoundly restricted routines. A common view, as represented in the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV-TR (APA, 2000), is that many of these behaviours lack adaptive function or purpose, interfere with learning, and constitute the non-social (...) behavioural dysfunctions of those disorders making up the Autism Spectrum. As the DSM IV-TR continues to be the reference source of choice for professionals working with individuals with psychiatric difficulties, its characterization of the Autism Spectrum holds significant sway. We will suggest Extended Mind and Enactive Cognition Theories, which theorize that mind (or cognition) is embodied and environmentally embedded, as coherent conceptual and theoretical spaces within which to investigate the possibility that certain repetitive behaviours exhibited by autistics possess functions or purposes that make them desirable. As lenses through which to re-examine ‘autism-related’ behavioral atypicalities, these theories not only open up explanatory possibilities underdeveloped in the research literature, but also cohere with how some autistics describe their own experience. Our position navigates a middle way between the view of autism as understood in terms of impairment, deficit and dysfunction and one that seeks to de-pathologize the Spectrum. In so doing we seek to contribute to a continuing dialogue between researchers, clinicians and self- or parent advocates. (shrink)