Prof. Cohen and I answer six questions: (1) Why do we lock people up? (2) How can involuntary civil commitment be reconciled with people's constitutional right to liberty? (3) Why don't we treat homicide as a public health threat? (4) What is the difference between legal and medical approaches to mentalillness? (5) Why is mentalillness required for involuntary commitment? (6) Where are we in our efforts to understand the causes of mentalillness?
The crucial problem in the philosophy of psychiatry is to determine under which conditions certain behaviors, mental states, and personality traits should be regarded as symptoms of mental illnesses. Participants in the debate can be placed on a continuum of positions. On the one side of the continuum, there are naturalists who maintain that the concept of mentalillness can be explained by relying on the conceptual apparatus of the natural sciences, such as biology and neuroscience. (...) On the other side of the continuum, there are normativists who maintain that the appropriate characterization of the concept of mentalillness cannot avoid reference to epistemic, moral and other social values. Although, this article is primarily an introduction to the debate, we stress the importance of the normativist positions. (shrink)
It is far too early to say what global impact the neurocognitive and neuropsychiatric sciences will have on our intuitions about moral responsibility. And it is far too early to say whether the notion of moral responsibility will survive this impact (and if so, in what form). But it is certainly worth starting to think about the local impact that these sciences can or should have on some of our distinctions and criteria. It might be possible to use some of (...) the tools offered by these sciences in order to refine or revise some of the categories currently used, without – for the time being at least – worrying too much about the fate of the notion of moral responsibility. This is an area where a piecemeal approach might be more productive: only after an evaluation of many distinct cases and situations it will be possible to say something general about the current notion of moral responsibility. In this article, we will focus on a single clinical case: a young man who has been convicted for assault on a neighbour and whose sentence was affected by a pre-existing diagnosis of mentalillness. We will use this case, and an analysis of the similarities and differences between this case and other possible cases, in order to raise some (local but important) issues about the implications that discoveries in neuropsychology and neuropsychiatry can have for the way moral responsibility is attributed to agents and, more specifically, to agents with diagnoses of mental illnesses. (shrink)
This chapter has two aims. The first aim is to compare and contrast three different conceptual-explanatory models for thinking about mentalillness with an eye towards identifying the assumptions upon which each model is based, and exploring the model’s advantages and limitations in clinical contexts. Major Depressive Disorder is used as an example to illustrate these points. The second aim is to address the question of what conceptual-theoretical framework for thinking about mentalillness is most likely (...) to facilitate the discovery of causes and treatments of mentalillness in research contexts. To this end, the National Institute of Mental Health’s Research Domain Criteria (RDoC) Project is briefly considered. (shrink)
Philosophy of MentalIllness The Philosophy of MentalIllness is an interdisciplinary field of study that combines views and methods from the philosophy of mind, psychology, neuroscience, and moral philosophy in order to analyze the nature of mentalillness. Philosophers of mentalillness are concerned with examining the ontological, epistemological, and normative issues arising from […].
"George Graham is contemporary philosophy’s most gifted and humane writer. _The Disordered Mind_ is a wise, deep, and thorough inquiry into the nature of the human mind and the various ‘creaks, cracks, and crevices’ into which it is prone sometimes to wander." _Owen Flanagan, Duke University, USA_ "The book is a success, it is consistently insightful and humane, and conveys a clear understanding not only of relevant philosophical topics, but also of a much more difficult issue, the relevance of those (...) topics to understanding mentalillness." _Philip Gerrans, University of Adelaide, Australia_ "_The Disordered Mind_ is a must read for anyone who is a psychiatrist, psychologist, philosopher, neurologist, or mental health worker. Indeed, it is a must read for any thoughtful person who simply desires to understand more deeply and more realistically the workings of their own mind as well as the workings of the human mind in general." _Richard Garrett, Bentley University, USA_ Mental disorder raises profound questions about the nature of the mind. _The Disordered Mind: An Introduction to Philosophy of Mind and Mental Illness_ is the first book to systematically examine and explain, from a philosophical standpoint, what mental disorder is: its reality, causes, consequences, and more. It is also an outstanding introduction to philosophy of mind from the perspective of mental disorder. Each chapter explores a central question or problem about mental disorder, including: What is mental disorder and can it be distinguished from neurological disorder? What roles should reference to psychological, cultural, and social factors play in the medical/scientific understanding of mental disorder? What makes mental disorders undesirable? Are they diseases? Mental disorder and the mind–body problem Is mental disorder a breakdown of rationality? What is a rational mind? Addiction, responsibility and compulsion Ethical dilemmas posed by mental disorder, including questions of dignity and self-respect. Each topic is clearly explained and placed in both a clinical and philosophical context. Mental disorders discussed include clinical depression, dissociative identity disorder, anxiety, religious delusions, and paranoia. Several non-mental neurological disorders that possess psychological symptoms are also examined, including Alzheimer’s disease, Down’s syndrome, and Tourette’s syndrome. Additional features, such as chapter summaries and annotated further reading, provide helpful tools for those coming to the subject for the first time. Throughout, George Graham draws expertly on issues that cut across philosophy, science, and psychiatry. As such, _The Disordered Mind_ is a superb introduction to the philosophy of mental disorder for students of philosophy, psychology, psychiatry, and related mental health professions. PHILOSOPHY/PSYCHOLOGY. (shrink)
The paper develops a framework for discussing concepts of health and disease along two dimensions. The first is the role of values in our disease concepts, and the second is the relationship between science and folk psychology. This framework is then applied to the concept of mental disorder. I argue that existing treatments of the concept yield too much authority to common sense, which produces a tension within the program of finding a scientific basis for our ascriptions of (...) class='Hi'>mental disorder. The science should be given more authority, even if this leads to counterintuitive results. I conclude by identifying several smaller scale conceptual problems within the application of science to mentalillness, and argue that the debate needs to shift towards dealing with such problems in an empirically informed way, rather than remaining at the level of conceptual analysis. 2012 APA, all rights reserved). (shrink)
We argue that contemporary psychiatry adopts a defensive strategy vis-à-vis various external sources of pressure. We will identify two of these sources – the plea for individual autonomy and the idea of Managed Care – and explain how they have promoted a strict biomedical conception of disease. The demand for objectivity, however, does not take into account the complexity of mentalillness. It ignores that the psychiatrist’s profession is essentially characterized by fragility: fluctuating between scientific reduction and the (...) irreducible complexity of reality. Therefore, the psychiatrist is not in need of hard and fast rules, but of judgment. At the end, we suggest that philosophy could inject some healthy uncertainty within psychiatry in order to restore its fragile identity. Our examples are drawn from the Dutch situation but we are confident that they apply to other countries as well. (shrink)
Evidence-based practice (EBP), a derivative of evidence-based medicine (EBM), is ascendant in the United States’ mental health system; the findings of randomized controlled trials and other experimental research are widely considered authoritative in mental health practice and policy. The concept of recovery from mentalillness is similarly pervasive in mental health programming and advocacy, and it emphasizes consumer expertise and self-determination. What is the relationship between these two powerful and potentially incompatible forces for mental (...) health reform?This paper identifies four attempts, in the mental health literature, to delineate the role of “evidence” in recovery. One is the strong version of evidence-based practice—an applied science model—and three others address weaknesses in the first by limiting the authority of probabilistic findings. The paper also offers a fifth version, based on the concept of communicative accountability, which is derived from Habermas’ work on communicative action. The fifth version responds to the other four and emphasizes learning, disclosure and respect in clinical and other helping relationships. (shrink)
What mental disorder means is controversial. I attempt to solve that controversy by applying the method of defining a phenomenon in terms of the goals we have for demarcating that phenomenon from other phenomena to the case of mental disorder. I thus address the question about the nature of mental disorder by paying attention to the goals we have for demarcating mental disorder. I maintain that these goals, which embody the reasons why we consider mental (...) disorder a significant phenomenon for us, have a common denominator: they refer to psychological capacity for autonomy. I present a conceptual foundation for defining mental disorder on the basis of that psychological capacity and argue that this way of understanding the nature of mental disorder avoids the main problems of the central contemporary theories of mental disorder. Then I explain why this conception of the nature of mental disorder is not undermined by anti-psychiatric criticisms to the effect that mentalillness does not exist, that the mentally ill should not be treated differently from others, and that seeing problems of the mentally disordered as psychiatric problems is unjustified medicalization. I conclude by suggesting that the presented conceptual foundation for defining mental disorder would benefit from being complemented by results of empirical psychology. (shrink)
This book is psychiatry's reply to the diverse group of antipsychiatrists, including Laing, Foucault, Goffman, Szasz and Bassaglia, that has made fashionable the view that mentalillness is merely socially deviant behaviour and that psychiatrists are agents of the capitalist society seeking to repress such behaviour. It establishes, by the use of evidence from historical and transcultural studies, that mentalillness has been recognised in all cultures since the beginning of history and goes on to explore (...) the philosophical and medical basis for psychiatry's diagnosis and treatment of mentalillness. Finally, it tackles two issues where psychiatry has recently been seen as at odds with the values prevailing in society: involuntary hospitalization and the insanity defence. The Reality of MentalIllness does not pretend to offer simple answers to the complex problems it discusses, but will leave the reader with a much greater understanding of psychiatry's aims, practices and problems. (shrink)
Introduction : the existence of mentalillness -- The likeness argument -- The categorical argument -- Metaphor -- Two metaphors from physical medicine -- The metaphor of mentalillness -- Attention deficit hyperactivity disorder, social construction, and metaphor -- Metaphors and models.
In this chapter, I consider the idea that physician-assisted death might come into question in the cases of psychiatric patients who are incapable of making autonomous choices about ending their lives. I maintain that the main arguments for physician-assisted death found in recent medical ethical literature support physician-assisted death in some of those cases. After assessing several possible criticisms of what I have argued, I conclude that the idea that physicianassisted death can be acceptable in some cases of psychiatric patients (...) who lack autonomy ought to be taken into account in assessing the moral and legal acceptability of physician-assisted death. (shrink)
Twenty years ago, the biopsychosocial model was proposed by George Engel to be the new paradigm for medicine and psychiatry. The model assumed a hierarchical structure of the biological, psychological and social system and simple interactions between the participating systems. This article holds the thesis that the original biopsychosocial model cannot depict psychiatry's reality and problems. The clinical validity of the biopsychosocial model has to be questioned. It is argued that psychiatric interventions can only stimulate but not determine their target (...) systems, because intervention and outcome are only loosely coupled. Thus, psychiatric interventions have in principle limited ranges which differ according to the type of intervention and according to the system to be stimulated. Psychosocial interventions face far more obstacles to be overcome than psychopharmacogical therapy. (shrink)
I shall begin with the "anti-psychiatry" view that the lack of a physical basis excludes many familiar mental disorders from the category of "illness". My response to this argument will be that anti-psychiatrists are probably right to hold that most mental disorders do not involve any physical disorder, but that they are wrong to conclude from this that these mental disorders are not illnesses.
Many of the world’s mental health acts, including all Australian legislation, allow for the coercive detention and treatment of people with mental illnesses if they are deemed likely to harm themselves or others. Numerous authors have argued that legislated powers to impose coercive treatment in psychiatric illness should pivot on the presence or absence of capacity not likely harm, but no Australian act uses this criterion. In this paper, I add a novel element to these arguments by (...) comparing the use of the harm to others justification for coercive treatment in mentalillness with its use in illness due to infectious disease, and suggest a double standard applies. People with mentalillness are subjected to coercive treatments at levels of risk to others far, far lower than would precipitate coercive treatment in people with influenza. In effect, this element of mental health legislation represents an example of sanism—state-sanctioned discrimination against people with mental illnesses. (shrink)
This seminal early work of Foucault is indispensable to understanding his development as a thinker. Written in 1954 and revised in 1962, _Mental Illness and Psychology _delineates the shift that occurred in Foucault's thought during this period. The first iteration reflects the philosopher's early interest in and respect for Freud and the psychoanalytic tradition. The second part, rewritten in 1962, marks a dramatic change in Foucault's thinking. Examining the history of madness as a social and cultural construct, he moves (...) outside of the psychoanalytic tradition into the radical critique of Freud that was to dominate his later work. _Mental Illness and Psychology _is an important document tracing the intellectual evolution of this influential thinker. A foreword by Foucault scholar Hubert Dreyfus situates the book within the framework of Foucault's entire body of work. (shrink)
Does having a mental disorder, in general, affect whether someone is morally responsible for an action? Many people seem to think so, holding that mental disorders nearly always mitigate responsibility. Against this Naïve view, we argue for a Nuanced account. The problem is not just that different theories of responsibility yield different verdicts about particular cases. Even when all reasonable theories agree about what's relevant to responsibility, the ways mentalillness can affect behavior are so varied (...) that a more nuanced approach is needed. (shrink)
In this surprising book, Allan V. Horwitz argues that our current conceptions of mentalillness as a disease fit only a small number of serious psychological conditions and that most conditions currently regarded as mentalillness are cultural constructions, normal reactions to stressful social circumstances, or simply forms of deviant behavior.
In physics, we use the same laws to explain why airplanes fly, and why they crash. In psychiatry, we use one set of laws to explain sane behaviour, which we attribute to reasons (choices), and another set of laws to explain insane behaviour, which we attribute to causes (diseases). God, man's idea of moral perfection, judges human deeds without distinguishing between sane persons responsible for their behaviour and insane persons deserving to be excused for their evil deeds. It is hubris (...) to pretend that the insanity defence is compassionate, just, or scientific. Mentalillness is to psychiatry as phlogiston was to chemistry. Establishing chemistry as a science of the nature of matter required the recognition of the non-existence of phlogiston. Establishing psychiatry as a science of the nature of human behaviour requires the recognition of the non-existence of mentalillness. (shrink)
The status quo: dogmatism, the biopsychosocial model, and alternatives -- What there is: of mind and brain -- How we know: understanding the mind -- What is scientific method? -- Reading Karl Jaspers's General Psychopathology -- What is scientific method in psychiatry? -- Darwin's dangerous method: the essentialist fallacy -- What we value: the ethics of psychiatry -- Desire and self: Hellenistic and Islamic approaches -- On the nature of mentalillness: disease or myth? -- Order out of (...) chaos: from insanity to DSM-III to a pluralistic nosology -- A theory of DSM-IV: ideal types -- Dimensions versus categories -- The perils of belief: psychosis -- The slings and arrows of outrageous fortune: depression -- Life's rollercoaster: mania -- Being self-aware: insight -- Calvinism or hedonism? -- Truth and statistics: problems of empirical psychiatry -- A climate of opinion: what remains of psychoanalysis -- Being there: existential psychotherapy -- Beyond eclecticism: teaching psychotherapy in the twenty-first century -- Bridging the biology/psychology dichotomy: the hopes of integrationism -- Why it is hard to be pluralist. (shrink)
This chapter offers a novel defence of Szasz’s claim that mentalillness is a myth by bringing to bear a standard type of thought experiment used in philosophical discussions of the meaning of natural kind concepts. This makes it possible to accept Szasz’s conclusion that mentalillness involves problems of living, some of which may be moral in nature, while bypassing the debate about the meaning of the concept of illness. The chapter then considers the (...) nature of schizophrenia and the personality disorders (PDs) within this framework. It argues that neither is likely to constitute a scientifically valid category, but that nonetheless their symptoms can be scientifically explained. It concludes with a discussion of the way in which Cluster B or ‘bad’ PDs involve failures of virtue or character, and argues that this does not preclude them from being appropriately treated within contemporary, multidisciplinary, mental health services. (shrink)
Although the quality and effectiveness of mental health treatments and services have improved greatly over the past 50 years, therapeutic revolutions in psychiatry have not yet been able to reduce stigma. Stigma is a risk factor leading to negative mental health outcomes. It is responsible for treatment seeking delays and reduces the likelihood that a mentally ill patient will receive adequate care. It is evident that delay due to stigma can have devastating consequences. This review will discuss the (...) causes and consequences of stigma related to mentalillness. (shrink)
The potential for artificial intelligences and robotics in achieving the capacity of consciousness, sentience and rationality offers the prospect that these agents have minds. If so, then there may be a potential for these minds to become dysfunctional, or for artificial intelligences and robots to suffer from mentalillness. The existence of artificially intelligent psychopathology can be interpreted through the philosophical perspectives of mentalillness. This offers new insights into what it means to have either robot (...) or human mental disorders, but may also offer a platform on which to examine the mechanisms of biological or artificially intelligent psychiatric disease. The possibility of mental illnesses occurring in artificially intelligent individuals necessitates the consideration that at some level, they may have achieved a mental capability of consciousness, sentience and rationality such that they can subsequently become dysfunctional. The deeper philosophical understanding of these conditions in mankind and artificial intelligences might therefore offer reciprocal insights into mental health and mechanisms that may lead to the prevention of mental dysfunction. (shrink)
The term “mentalillness” implies that persons with such illnesses are more likely to be dangerous to themselves and/or others than are persons without such illnesses. This is the source of the psychiatrist’s traditional social obligation to control “harm to self and/or others,” that is, suicide and crime. The ethical dilemmas of psychiatry cannot be resolved as long as the contradictory functions of healing persons and protecting society are united in a single discipline.Life is full of dangers. Our (...) highly developed consciousness makes us, of all living forms in the universe, the most keenly aware of, and the most adept at protecting ourselves from, dangers. Magic and religion are mankind’s earliest warning systems. Science arrived on the scene only about 400 years ago, and scientific medicine only 200 years ago. Some time ago I suggested that “formerly, when religion was strong and science weak, men mistook magic for medicine; now, when science is strong and religion weak, men mistake medicine for magic”.1We flatter and deceive ourselves if we believe that we have outgrown the apotropaic use of language .Many people derive comfort from magical objects , and virtually everyone finds reassurance in magical words . The classic example of an apotropaic is the word “abracadabra,” which The American Heritage Dictionary of the English Language defines as “a magical charm or incantation having the power to ward off disease or disaster”. In the ancient world, abracadabra was a magic word, the letters of which were arranged in an inverted pyramid and worn as an amulet around the neck to protect the wearer against disease or trouble. One fewer letter appeared in each line of the pyramid, until only the letter “a” remained to form the vertex of the triangle. As …. (shrink)
The present paper constitutes a development of the position that illness, whether bodily or mental, should be analyzed as an incapacitating failure of bodily or mental capacities, respectively, to realize their functions. The paper undertakes this development by responding to two critics. It addresses first Szasz’s continued claims that (1) physical illness is the paradigm concept of illness and (2) a philosophical analysis of mentalillness does not shed any light on the social (...) and legal role of the idea. Then, in reply to Wakefield, the aim is to defend the account as an interpretation of Aristotle and to argue that this Aristotelian view of mentalillness is preferable to one that rests on a supposed value free account of human function. More generally the discussion points to the fact that both Wakefield and Szasz rely on a number of metaphysical assumptions about the supposedly empirical nature of medical diagnosis, about the relation between facts and values, and about mind and body (among others), which are open to challenge. In particular the paper indicates an aristotelian approach to the fusion, in the natural world, of so-called facts and values, and the relevance of this fusion to the analysis of the concept of illness. This suggests the debate over distinct conceptions of that concept must both illumine and be illuminated by these deeper metaphysical questions. (shrink)
Failure to follow prescribed treatment has devastating consequences for those who are seriously and persistently mentally ill. Nurses, therefore, try to get clients to take psychotropic medication on a long-term basis. The goal is either compliance or adherence. Although current nursing literature has abandoned the term compliance because of its implications of coercion, in psychiatric nursing practice with patients suffering from serious long-term mentalillness compliance and adherence are in fact different goals. The ideal goal is adherence, which (...) requires the patient to be an active participant in the team. This goal is consistent with nurses’ ethical values, but for such patients this is frequently unrealistic. If the person is severely psychotic, treatment may be involuntary and the goal compliance. Psychiatric nurses participate in involuntary treatment and thus should acknowledge the ethical implications of compliance as a goal and not obscure the issue by calling compliance adherence. (shrink)
In a series of recent works, Ian Hacking has produced a model of social causation in mentalillness and begun to sketch in outline how this might be integrated with the medical model of psychiatry. This article elaborates and revises Hacking 's model of social forces, criticizes him for attempting a merely semantic resolution of the tension between the social and the biological, and sketches an alternative approach that builds upon his substantial insights.
When it is considered to be in their best interests, withholding and withdrawing life-supporting treatment from non-competent physically ill or injured patients – non-voluntary passive euthanasia, as it has been called – is generally accepted. A central reason in support of the procedures relates to the perceived manner of death they involve: in non-voluntary passive euthanasia death is seen to come about naturally. When a non-competent psychiatric patient attempts to kill herself, the mental health care providers treating her are (...) obligated to try to stop her. Yet it has been suggested that death by suicide can be a part of the natural course of a severe mentalillness. Accordingly, if the perceived naturalness of the deaths occurring in connection with non-voluntary passive euthanasia speaks for their moral permissibility, it could be taken that a similar reason can support the moral acceptability of the suicidal deaths of non-competent psychiatric patients. In this article, I consider whether the suicidal death of a non-competent psychiatric patient would necessarily be less natural than those of physically ill or injured patients who die as a result of non-voluntary passive euthanasia. I argue that it would not. (shrink)
The question "What is mentalillness?" raises many issues in many contexts, personal, social, legal, and scientific. This chapter reviews mental health problems as they appear to the person with the problems, and to family and friends-before the person attends the clinic and is given a diagnosis-a time in which whether there really is a problem, as opposed to life's normal troubles and variations, is undecided, as also the nature of the problem, if such it be, and (...) the related matter what kind of expert advice should be sought. Once at the clinic, a diagnosis may be given-using criteria well-worked-out in the diagnostic manuals. The chapter discusses the conceptualizations of mental disorder in the diagnostic manuals, their rationale, and what can and cannot be reasonably expected of them. There are more position statements than definitions, and while they signal many dilemmas, they do not resolve them. Attempts to do so in the surrounding literature on the concept of mentalillness are reviewed in the chapter, with conclusions favoring the features emphasized in the diagnostic manuals: distress and impairment. Finally the chapter considers how far the science may help draw boundaries around mentalillness. (shrink)
It is a matter of some irony that psychiatry's most trenchant critic for over four decades is himself a psychiatrist. I refer to Thomas S. Szasz. Szasz's core thesis may be succinctly rendered: mentalillness is a “myth”, a “metaphor” which serves only to obscure the social and ethical “problems in living” we face as human beings. This paper reconsiders the conceptual bases of Szasz's assault on psychiatry and assesses recent counter-arguments of his critical interlocutors. It presents a (...) defence of the Szaszian conception and emphasises the continuing relevance of his earliest work. Additionally, the paper discusses Szasz's thesis in light of the work of the influential French philosopher of medicine, Georges Canguilhem. (shrink)
Background Offering financial incentives to achieve medication adherence in patients with severe mentalillness is controversial. Aims To explore the views of different stakeholders on the ethical acceptability of the practice. Method Focus group study consisting of 25 groups with different stakeholders. Results Eleven themes dominated the discussions and fell into four categories: (1) ‘wider concerns’, including the value of medication, source of funding, how patients would use the money, and a presumed government agenda behind the idea; (2) (...) ‘problems requiring clear policies’, comprising of practicalities and assurance that incentives are only one part of a tool kit; (3) ‘challenges for research and experience’, including effectiveness, the possibility of perverse incentives, and impact on the therapeutic relationship; (4) ‘inherent dilemmas’ around fairness and potential coercion. Conclusions The use of financial incentives is likely to raise similar concerns in most stakeholders, only some of which can be addressed by empirical research and clear policies. (shrink)
This paper, the brain is defined as biological constructs, the soul is defined as propositions or narrative constructs. Advocates non-biological mentalillness - such as depression and schizophrenia - not causal entity , just the thought of the group symptoms given name. The disease is suspected the source of beliefs, values and assumptions. This conclusion is, whether mild or severe, or so-called "clinical" mentalillness, as long as the body on the non-biological, can be treated through (...) a philosophy, or even "cure." Many psychological treatment has been to "talk therapy" in the name of successful application of the philosophy. For clinical mental health care providers, philosophy of education will help to improve its treatment capacity. This essay offers a definition of brain as biological, and mind as a propositional or narrative construct. It is argued that non-biological mental illnesses such as depression and schizophrenia are not causal entities. They are simply the names given to symptom clusters. They originate in problematic beliefs, values, and assumptions. This leads to the conclusion that both mild and serious, or so-called 'clinical', mental illnesses can be treated and even 'cured' with philosophy as long as their ontology is non-biological. Much of psychotherapy already successfully applies philosophy under the term 'talk therapy.' An education in philosophy will help the therapeutic competence of clinical mental health care providers. (shrink)
With advances in genetic technology, there are increasing concerns about the way in which genetic information may be abused, particularly in people at increased genetic risk of developing certain disorders. In a recent case in Hong Kong, the court ruled that it was unlawful for the civil service to discriminate in employment, for the sake of public safety, against people with a family history of mentalillness. The plaintiffs showed no signs of any mental health problems and (...) no genetic testing was performed. This was the first case concerning genetic discrimination in common law jurisdictions, therefore the court's judgment has implications for how genetic discrimination cases may be considered in the future. The court considered it inappropriate to apply population statistics or lifetime risks to individuals while examining fitness for work. It recommended an individualised assessment of specific risks within the job, relative to other risks posed by that workplace. (shrink)
Until recently there has been little contact between the mind-brain debate in philosophy and the debate in psychiatry about the nature of mentalillness. In this paper some of the analogies and disanalogies between the two debates are explored. It is noted in particular that the emphasis in modern philosophy of mind on the importance of the concept of action has been matched by a recent shift in the debate about mentalillness from analyses of disease (...) in terms of failure of functioning to analyses of illness in terms of failure of action. The concept of action thus provides a natural conduit for two-way exchanges of ideas between philosophy and psychiatry. The potential fruitfulness of such exchanges is illustrated with an outline of the mutual heuristic significance of psychiatric work on delusions and philosophical accounts of Intentionality. (shrink)
In this paper, I propose an existentialist-phenomenological model that conceives of mentalillness through the terminology of Heidegger’s Being and Time. In particular, the concepts of existentiality, disturbance and the relation between ‘being-with’ and ‘the one’, will be implemented in order to reconstruct the experience of mentalillness. The proposed model understands mentalillness as a disturbance of a person’s existentiality. More precisely, mentalillness is conceptualized as the disturbance of a person’s (...) existential structure, the process of which leads to a becoming explicit of the otherwise implicit dynamical structure that constitutes a person’s experience. In particular, the existential component of ‘being-with’ comes to play a central role in the disturbance of existentiality, thus, I will claim, that it enables a person’s structure of experience to be ‘open for normativity’. By adopting a pragmatist stance on Heideggerian phenomenology, the suggested model proves compatible with naturalist and normativist theories of mentalillness while still offering a phenomenological description of the phenomenon. (shrink)
In ?Some Myths about ?MentalIllness'? (Inquiry, Vol. 18 , No. 3), Michael Moore attempts to clarify and refute what he takes to be the radical (existential) position concerning the nature and diagnosis of mentalillness. Moore's dissatisfaction with certain formulations and conceptualizations of the radical position is endorsed; as also the need to introduce greater rigor and precision into the discussion of mentalillness. But Moore's clarifications are really misunderstandings and, in consequence, his (...) refutations do not succeed. Moore's five?fold interpretative classification of the radical thesis is retained. (shrink)
An evaluation of mental capacity is critical to a clinician's judgment about whether or not persons can make medical treatment decisions on their own behalf, and uncertainty about their ability to meaningfully participate in that process is one of the more common reasons an ethics consult is requested. The care of decisionally incapable patients—particularly those who lack advance care documents and no living relative who can speak for them—presents a quandary to healthcare personnel attempting to plan care in their (...) best interest, especially when options are multiple but none are ideal. These situations can be further complicated if involving a patient with a dual diagnosis of mental retardation and mentalillness living in a community group home. (shrink)
Radical psychiatrists and others assert that mentalillness is a myth. The opening and closing portions of the paper deal with the impact such argument has had in law and psychiatry. The body of the paper discusses the five versions of the myth argument prevalent in radical psychiatry: (A) that there is no such thing as mentalillness; (B) that those called ?mentally ill? are really as rational as everyone else, only with different aims; that the (...) only reasons anyone ever thought differently was (C) because of unsophisticated category mistakes or (D) because of an adherence to the epistemology of a sick society; and (E) that the phrase ?mentalillness? is used to mask value judgments about others? behavior in pseudo?scientific respectability. Reasons are given for rejecting each of these versions of the argument that mentalillness is a myth. (shrink)
A number of prominent writers on the concept of mentalillness/disease are committed to accounts which involve rejecting certain plausible widely held beliefs, namely: that it is part of the meaning of illness that it is bad for its possessor, so the concept of illness is essentially evaluative; that if a person has a mentalillness, that is a fact about him; and that the same concept of illness is applicable in the case (...) of mentalillness as in that of physical illness. Methodologically this is unattractive. We should seek accounts of concepts which preserve our pre-theoretical beliefs so far as is possible. In this paper I argue that these writers are driven to this pass because they accept certain underlying metaphysical commitments including, in particular, the fact-value distinction. I then claim that there is an alternative account of mentalillness (defended more fully elsewhere) which preserves our pre-theoretical beliefs, and that this account can be further buttressed because it coheres with a metaphysical picture which does not involve the metaphysical assumptions which led to the unattractive results noted above. The metaphysical picture and the account of mentalillness are thus mutually supportive and suggest that there is good reason to reject the supposed fact-value distinction. (shrink)
Medical accounts of the absence of conscience are intriguing for the way they seem disposed to drift away from the ideal of scientific objectivity and towards fictional representations of the subject. I examine here several contemporary accounts of psychopathy by Robert Hare and Paul Babiak. I first note how they locate the truth about their subject in fiction, then go on to contend that their accounts ought to be thought of as a “mythos,” for they betray a telling uncertainty about (...) where “fact” ends and “fantasy” begins, as well as the means of distinguishing mental health from mentalillness in regard to some social roles. (shrink)