Now available in a Harper Colophon edition, this classic book has revolutionized thinking throughout the Western world about the nature of the psychiatric profession and the moral implications of its practices. Book jacket.

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: mental illness 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)

In ?Some Myths about ?Mental Illness'? (Inquiry, Vol. 18 [1975], No. 3), Michael Moore attempts to clarify and refute what he takes to be the radical (existential) position concerning the nature and diagnosis of mental illness. 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 mental illness. 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)

Radical psychiatrists and others assert that mental illness 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 mental illness; (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 ?mental illness? 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 mental illness is a myth. (shrink)

Thomas Szasz has wrestled with the following question: Does mental illness even exist? Here, I sketch two provocative papers by Szasz and detail his reasons for criticizing the concept ‘mental illness.’ I will proceed to highlight where I think Szasz’s writing is philosophically dubious, despite its role in forcing us to think critically about ‘mental illness.’ I will conclude that his argument is best left behind as an antiquated take on neurodivergence. Finally, I will (...) propose what I think is a more promising alternative to Szasz’s view that there is a myth around mental illness. There is a myth indeed, and it involves what is often meant by ‘mental.’ With new developments in embodied cognition, I will ask us to revisit the concept of ‘mental illness,’ to correctly diagnose the problematic myth that must be confronted by the psychiatric community, and to explore what the myth of the mental means for neurodivergence. (shrink)

This chapter offers a novel defence of Szasz’s claim that mental illness 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 mental illness 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)

In lieu of an abstract, here is a brief excerpt of the content:Should Clinicians’ Views of Mental Illness Influence the DSM?Elizabeth H. Flanagan (bio) and Roger K. Blashfield (bio)Keywordsclinicians, DSM, values, psychopathology, scienceThe relationship between clinicians and the DSM is complex. Clinicians are the primary intended audience of the DSM. However, as Widiger (2007) pointed out in his commentary, there is a tension associated with trying to meet the clinical goals of the DSM and also trying to optimize (...) the scientific goals of the DSM. Most commentators would agree that the recent editions of the DSM (from the DSM-III onward) have favored scientific values (e.g., Sadler 2005). Some commentators have taken sides and aligned themselves with either clinicians or with the science of classification. For instance, Garb (2005) has argued that clinicians should receive incentives to align themselves more closely with the science of the DSM. In contrast, Westen and Shedler (1999) have favored a clinician-based approach to the DSM and have argued that an ideal classification should be based on the prototypes that clinicians use to conceptualize diagnostic categories. Perhaps an extreme suggestion on how to deal with this tension between the values of clinicians and the values of scientists is to adopt the ICD-10 solution and create two versions of the next DSM. One version would be written for clinicians and another for researchers (Phillips et al. 2003).Widiger (2007) wondered whether the two of us as authors are on the fence about how the views of clinicians should affect the DSM. As clinical psychologists who are both clinicians and researchers, we understand his comment, especially in light of our attempt in our article not to overgeneralize from the time-consuming, labor-intensive, yet methodologically limited study we reported in our major paper.Nonetheless, our answer to the question asked in the title of this response, “Should clinicians’ views of mental illness influence the diagnostic manual?” is a clear and unequivocal yes. In our view, too much of the research literature stimulated by the recent DSMs has primarily used the diagnostic criteria in these DSMs to specify patient samples and then perform various experiments to study the DSM categories. We favor a different approach to research which is consistent with a comment once made by the philosopher of science, Karl Popper: “scientific theories originate from myths, and... a myth may contain important anticipations of scientific theories” (1963, 39). We believe that clinicians, with their years [End Page 285] of experience dealing with the ambiguities, the emotionality, and the chaos of psychopathology, have formed complex conceptual systems to try to understand the mysteries of abnormal behavior. We strongly support increased research attempts that will use clinicians as subjects and that will attempt to understand how clinicians use diagnostic concepts to understand patients.Although research on clinicians has not attracted a large amount of attention in the field, there is a long history of such research studies. For instance, in the 1970s, Overall used multivariate techniques to create graphical maps of how clinicians represented relationships among diagnoses (Overall et al. 1977). Widiger has used a similar strategy in some of his research (Widiger et al. 1987). In the early 1980s, a view of concept formation from cognitive psychology was used by Cantor et al. (1980) to look at psychiatric diagnoses as representing prototypes. Horowitz and colleagues extended this research. Blashfield and his colleagues had a grant to use the prototype model to study personality disorders and performed research investigating both case histories (Blashfield et al. 1985) and analyses of diagnostic criteria (Blashfield and Breen 1989; Davis, Blashfield, and McElroy 1993). Westen and colleagues have attempted to reconceptualize DSM personality disorder categories using the prototype model (Westen and Shedler 1999). Ahn and her colleagues (Ahn et al. 2006; Kim and Ahn 2002) have taken more recent applications of ideas from cognitive psychology to study how clinicians use and understand diagnostic categories. Finally, Flanagan and colleagues (Flanagan and Blashfield 2006; Flanagan, Keeley, and Blashfield, in press; Flanagan, Miller, and Davidson, submitted) have used qualitative and quantitative data analysis techniques to try to understand the diagnostic concepts held by experienced clinicians.Besides empirical studies of how clinicians use diagnostic concepts, we also support the increased interest in... (shrink)

The Collective Unconscious in the Age of Neuroscience brings the connection between C.G. Jung's theory of a collective unconscious, neuroscience, and personal experiences of severe mental illness to life. Hallie B. Durchslag uses narrative analysis to examine four autobiographical accounts of mental illness, including her own, and illuminate the interplay between psychic material and human physiology that Jung intuited to exist. Durchslag's unique study considers the links between expressions of the collective unconscious, such as myth, (...) fairy tales, folk tales, and 'big dreams', and the experiences of those diagnosed with severe mental illnesses, such as schizophrenia and bipolar disorder. The author's personal narrative account of a psychotic episode is at its heart, bringing both an intimate foundation and exceptional insight to the book. With reference to neuroscientific and genetic research throughout, The Collective Unconscious in the Age of Neuroscience highlights the gap between depth psychological notions of etiology and treatment, highlights patterns of collective material in the qualitative experience of these genetic and biological disorders, and explores how the efficacy of pharmacological treatment sheds light on Jung's theoretical model. The Collective Unconscious in the Age of Neuroscience will be essential reading for academics and students of Jungian and post-Jungian studies, consciousness, neuroscience and mental health. It will also provide unique insight for analytical psychologists interested in severe mental illness and the collective unconscious. (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 mental illness: 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)

Thomas Szasz famously argued that mental illness is a myth. Less famously, Szasz argued that since mental illness is a myth, so too is psychotherapy. Szasz’ claim that mental illness is a myth has been much discussed, but much less attention has been paid to his claim that psychotherapy is a myth. In the first part of this essay, I critically examine Szasz’ discussion of psychotherapy in order to uncover the (...) strongest version of his case for thinking that it is a myth. As we’ll see, this involves an understanding of psychotherapeutic interventions as treatments of psychopathological problems. In the rest of this essay, I turn to this directly and argue that psychotherapy has an important non-pathocentric dimension. I argue that we fail to appreciate the nature and variety of psychotherapy if we concentrate only on its pathocentric dimensions. Though I use Szasz as a stalking horse, the substantive topic is the nature of psychotherapy. This enquiry falls into the philosophy of psychotherapy as distinct from the philosophy of psychiatry and the philosophy of psychoanalysis. (shrink)

The discussions about subject and validation in our late modernity tend to oscillate between the "weak" self of postmodernity ("empty" or "rhetorical") and neo-Cartesian versions trying, as they do, to recover a discredited foundation. Correspondingly, the solutions advanced range from calls for a "New Enlightenment" (in the face of the resurgence of myth and "the irrational") to attempts to "re-enchant the world" (in the face of the growing threat of an impersonal instrumental Reason).The present study seeks to respond theologically (...) to such a situation from the perspective of God's action in and towards the world by engaging two prominent philosophical/theological figures who continue to inform such discussions today, namely, Georg Friedrich Hegel and Paul Ricoeur. The upshot of this response points to a view of rationality that follows the drama of God's engagement with the world, thus involving both dying and resurrection, ascesis and abundance, suffering witness and eucharistic communion. (shrink)

When it was published in 1980, the Diagnostic and Statistical Manual of Mental Disorders, third edition - universally known as DSM-III - embodied a new method for identifying psychiatric illness. The manual's authors and their supporters claimed that DSM-III's development was guided by scientific principles and evidence and that its innovative approach to diagnosis greatly ameliorated the problem of the unreliability of psychiatric diagnoses. In this paper we challenge the conventional wisdom about the research data used to support (...) this claim. Specifically, we argue that the rhetoric of science, more than the scientific data, was used convincingly by the developers of DSM-III to promote their new manual. We offer a re-analysis of the data gathered in the original DSM-III field trials in light of the interpretations that had been offered earlier for the reliability studies of others. We demonstrate how the standards for interpreting reliability were dramatically shifted over time in a direction that made it easier to claim success with DSM-III when, in fact, the data were equivocal. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 41, no. 3. © 2015 by Feminist Studies, Inc. 509 Mytheli Sreenivas Birth Control in the Shadow of Empire: The Trials of Annie Besant, 1877–1878 In March 1877, two London activists provoked a debate about poverty and overpopulation that reverberated across metropole and colony. These activists, Annie Besant and Charles Bradlaugh, republished a book by the American physician Charles Knowlton that outlined methods to prevent conception. TheFruitsofPhilosophy,which (...) Bradlaugh and Besant provocatively subtitled An Essay on the Population Question, had been in limited circulation in Britain since 1833, but the book’s legality was called into question when its previous publisher was charged with obscenity in early 1877.1 Determined to establish the legal right to publish information about contraception, on March 23rd, 1877, Bradlaugh and Besant delivered copies of The Fruits of Philosophy to the police department, the city solicitor, and local magistrates, and they announced their intent to sell the book from their premises at the Freethought Publishing Company on Stonecutter Street in East London. The following day, a crowd filled the narrow space outside the publishing house, and the two activists sold hundreds of copies of Knowlton’s book. When no arrests were made, Besant and Bradlaugh renotified the authorities that they were selling a supposedly obscene book and were informed in turn that papers were 1. S. Chandrasekhar, “A Dirty, Filthy Book”: The Writings of Charles Knowlton and Annie Besant on Reproductive Physiology and Birth Control and an Account of the Bradlaugh-Besant Trial (Berkeley: University of California Press, 1981), 26. 510 Mytheli Sreenivas being prepared for their arrest and prosecution. On the 7th of April, 1877, Besant and Bradlaugh were arrested and taken into custody.2 In their subsequent trial, the two activists linked birth control advocacy to a Malthusian worldview. They argued that the urban working classes and the rural poor in Britain labored under the burden of overpopulation. Humanitarian concern for impoverished people, and not intent to promote obscenity, drove them to disseminate information about birth control. Besant and Bradlaugh were eventually acquitted on a legal technicality, and Bradlaugh moved on to other issues. Besant, however, was dissatisfied with The Fruits of Philosophy because its methods were outdated by the science of the day. She was determined to write a more up-to-date guide explaining contraceptive methods and went on to found a Malthusian League to disseminate birth control information. These events—the trial and Besant’s further campaigns promoting contraception —mark a watershed moment in the history of birth control activism.3 They would shape how reproduction came to be understood not as a private matter, but as a particular sort of social problem, whose implications reverberated from London to the empire in India and back again. To outside observers, Bradlaugh and Besant may have seemed an unlikely pair to set these events into motion. Bradlaugh, at age forty-four, had a long history of association with radical causes. A celebrated atheist and antimonarchical republican, he helped to shape a tradition of mid-nineteenth-century English radicalism that developed in the wake of Chartist decline. As a member of the National Reform League in the 1860s, he had participated in public demonstrations to extend the franchise. His leadership of the National Secular Society made him a popular lecturer among Freethinkers on issues of political democracy, anticlericalism, and occasionally on neo-Malthusianism.4 2. Anne Taylor, Annie Besant: A Biography (Oxford: Oxford University Press, 1992), 110–12. 3. The term “birth control” was coined in a meeting of Margaret Sanger and her associates in 1914, and thus would not have been in use in the late nineteenth century. The term contraception was not unknown, but had only limited circulation in scientific discourses. Nevertheless, I use both “birth control” and “contraception” interchangeably to mean methods to prevent conception. See Peter C. Engelman, A History of the Birth Control Movement in America (Santa Barbara, CA: Praeger, 2011), xviii. 4. Taylor, Annie Besant, 80–81. Mytheli Sreenivas 511 In comparison to Bradlaugh’s prominence, Besant was relatively unknown. Her public career began after a separation from her husband, the Anglican vicar Frank Besant. Perhaps the couple were ill-suited to each other from... (shrink)

Deep brain stimulation (DBS) represents a promising new frontier in medicine and neuroscience for managing disorders of mental health that represent an enormous burden of disease on our societies. The caution and significant restraint of leaders in the evolution of DBS today stand in sharp and refreshing contrast to previous episodes in history. In embracing the anticipatory and pragmatic problem-solving approach of neuroethics to clinical neuroscience, four significant paradoxes for DBS today come to the fore: caution and innovation, capacity (...) and allocation of resources, notions of wellness and disease, and the high-stakes/high-benefit imperative of communicating about science. Tackling these paradoxes is the focus of this article. (shrink)

This dissertation examines psychiatry from a philosophy of science perspective, focusing on issues of realism and classification. Questions addressed in the dissertation include: What evidence is there for the reality of mental disorders? Are any mental disorders natural kinds? When are disease explanations of abnormality warranted? How should mental disorders be classified? -/- In addressing issues concerning the reality of mental disorders, I draw on the accounts of realism defended by Ian Hacking and William Wimsatt, arguing (...) that biological research on mental disorders supports the inference that some mental disorders (e.g., schizophrenia, mood disorders, and anxiety disorders) are real theoretical entities, and that the evidence supporting this inference is causal and abductive. In explicating the nature of such entities, I argue that real mental disorders are natural kinds insofar as they are natural classes of abnormal behavior whose members share the same causal structure. I present this position in terms of Richard Boyd’s homeostatic cluster property theory of natural kinds, and argue that this perspective reveals limitations of Hacking’s account on the looping effects of human kinds, which suggests that the objects classified by psychiatrists are unstable entities. I subsequently argue that a subset of mental disorders (e.g., schizophrenia and Down syndrome) are mental illnesses insofar as they are disorders caused by a dysfunctional biological process that leads to harmful consequences for individuals. I present this analysis against Thomas Szasz’s argument that mental illness is a myth. -/- In addressing issues of psychiatric classification, my analysis focuses on the Diagnostic and Statistical Manual of Mental Disorders (DSM), which has been published regularly by the American Psychiatric Association since 1952, and is currently in its fourth edition. After examining the history of DSM in the twentieth century, and in particular, DSM’s shift to an atheoretical and purely descriptive system in the 1980s, I consider the relative merits of descriptive versus causal systems of classification. Drawing on Carl Hempel’s analysis of taxonomic systems in psychiatry, I argue that a causal classification system would provide a superior approach to psychiatric classification than the descriptive system currently favored by DSM. (shrink)

Environmental ethicists and experts in human health have raised concerns about the effects of hydraulic fracking to access natural oil and gas resources found deep in shale rock formations on surrounding ecosystems and communities. In this study, we analyzed the prevalence of discourse on brain and mental health, and ethics, in the peer-reviewed and grey literature in the five-year period between 2016 and 2022. A total of 84 articles met inclusion criteria for analysis. Seventy-six percent (76%) mentioned impacts on (...) brain (e.g., neural tube defects, neurological symptoms), and mental health (e.g., negative psychological effects, stress, depression) briefly; 11 reports dedicated substantive discourse to either or both together. References to safety (77%) dominated the ethics context. Discussion of environmental injustices as fracking sites disproportionately affect vulnerable communities appeared in 38% of the papers. We examine the findings through the lens of environmental neuroethics that brings human-made changes to the environment, brain and mental health, and ethics together into three interwoven lines of inquiry. (shrink)

Mental health care providers increasingly confront challenges posed by the introduction of new neurotechnology into the clinic, but little is known about the impact of such capabilities on practice patterns and relationships with patients. To address this important gap, we sought providers’ perspectives on the potential clinical translation of functional neuroimaging for prediction and diagnosis of mental illness. We conducted 32 semi-structured telephone interviews with mental health care providers representing psychiatry, psychology, family medicine, and allied (...) class='Hi'>mental health. Our results suggest that mental health providers have begun to re-conceptualize mental illness with a neuroscience gaze. They report an epistemic commitment to the value of a brain scan to provide a meaningful explanation of mental illness for their clients. If functional neuroimaging continues along its projected trajectory to translation, providers will ultimately have to negotiate its role in mental health. Their perspectives, therefore, enrich bioethical discourse surrounding neurotechnology and inform the translational pathway. (shrink)

The enduring psychiatric myth is that particular personal, interpersonal and social problems in living are manifestations of ‘mental illness’ or ‘mental disease’, which can only be addressed by ‘treatment’ with psychiatric drugs. Psychiatric drugs are used only to control ‘patient’ behaviour and do not ‘treat’ any specific pathology in the sense understood by physical medicine. Evidence that people, diagnosed with ‘serious’ forms of ‘mental illness’ can ‘recover’, without psychiatric drugs, has been marginalized by drug-focused (...) research, much of this funded by the pharmaceutical industry. The pervasive myth of psychiatric drugs dominates much of contemporary ‘mental health’ policy and practice and raises discrete ethical issues for nurses who claim to be focused on promoting or enabling the ‘mental health’ of the people in their care. (shrink)

This chapter has two aims. The first aim is to compare and contrast three different conceptual-explanatory models for thinking about mental illness 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 mental illness is most likely (...) to facilitate the discovery of causes and treatments of mental illness in research contexts. To this end, the National Institute of Mental Health’s Research Domain Criteria (RDoC) Project is briefly considered. (shrink)

The most important epistemological problem in psychiatry is the detection of malingering. This is a consequence of the fact that there is no objective way to confirm any psychiatric diagnosis. Psychiatric diagnosis is based on subjective complaints. The discovery of objective markers for psychiatric diagnosis is problematic because it presupposes we can tell valid from faked subjective symptoms. But this is the difficulty. If we use pervasive irrationality as a sign of mental illness, we encounter the problem of (...) identifying pervasive irrationality. To understand someone's behaviour, we have to assume it is largely rational. This precludes us from using behaviour to separate genuine from faked mental illness. There are a number of strategies used to solve any epistemological problem, and the most successful is the hypothetico-deductive method. If we use this, we can solve our epistemological problem. Genuine mental illness can be identified when it is the best explanation of the person's overall behaviour. Consilience of inductions is critical in supporting the validity of such explanations. This implies that it is merely a hypothesis that mental illness exists, and that we might discover that many mental illnesses, perhaps all, do not exist. We must embrace this possibility - only if we take a risk will we gain any knowledge. (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 mental illness. (shrink)

Introduction : the existence of mental illness -- The likeness argument -- The categorical argument -- Metaphor -- Two metaphors from physical medicine -- The metaphor of mental illness -- Attention deficit hyperactivity disorder, social construction, and metaphor -- Metaphors and models.

The consequences of stigma are preventable. We argue that individual attention should be provided to patients when dealing with stigma. Also, in order to deal with the impact of stigma on an individual basis, it needs to be assessed during routine clinical examinations, quantified and followed up to observe whether or not treatment can reduce its impact. A patient-centric anti-stigma programme that delivers the above is urgently needed. To this end, this review explores the experiences, treatment barriers and consequences due (...) to stigma. We also offer putative solutions to this problem. (shrink)

Psychiatry’s inchoate wish for a paradigm shift and the biopsychosocial model of mental illness’ critically examines the much discussed goal of a paradigm shift in psychiatric taxonomy. The chapter first highlights some illustrative calls for such a change and then sets these against the Kuhnian account of science from which the idea is taken, highlighting the connection to incommensurability. Relative to a distinction drawn from Winch, between putative sciences where the self-understanding of subjects plays no role and those (...) where it is fundamental, psychiatry falls into the latter kind. This suggests that the wish for a paradigm shift in psychiatry is either incoherent or a wish for a radical but unpredictable overhaul of a significant aspect of our self-understanding as subjects and agents. The biopsychosocial model of mental illness is thus a helpful reminder of the cost of a paradigm shift in psychiatry. (shrink)

This paper surveys some philosophical issues with the language surrounding mental illness, but is especially focused on pejoratives relating to mental illness. I argue that though 'crazy' and similar mental illness-based epithets (MI-epithets) are not best understood as slurs, they do function to isolate, exclude, and marginalize members of the targeted group in ways similar to the harmfulness of slurs more generally. While they do not generally express the hate/contempt characteristic of weaponized uses of (...) slurs, MI-epithets perpetuate epistemic injustice by portraying sufferers of mental illness as deserving minimal credibility. After outlining the ways in which these epithets can cause harm, I examine available legal and social remedies, and suggest that the best path going forward is to pursue a reclamation project rather than aiming to censure the use of MI-epithets. (shrink)

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)

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 mental illness 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 mental illness 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 mental illness. 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 Mental Illness 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)

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 mental illness, 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)

In this article I aim to make progress towards the philosophical goal of ascertaining what, if anything, all mental illnesses have in common, attempting to unify a large sub-set of them that have a relational or interpersonal dimension. One major claim is that, if we want a promising theory of mental illness, we must go beyond the dominant western accounts of mental illness/health, which focus on traits intrinsic to a person such as pain/pleasure, lethargy/liveliness, fragmentation/integration, (...) and falsehood/authenticity. A second major claim is that the relational facets of mental illness are plausibly understood theoretically in terms of a person’s inability to identify with others or to exhibit solidarity with them, relational values that are salient in the African philosophical tradition. I show that these two extrinsic properties well explain several intuitive instances of mental illness, including, amongst several others, being abusive, psychopathic, narcissistic, histrionic, paranoid, and phobic. (shrink)

The concept of mental illness is explored through an examination of four key foundational issues. These are the notion of the “mental” as it relates to psychopathology; the concept of illness; the relationship of mental illness to concepts of function and malfunction; and sociocultural dimensions of psychopathology. The problematic status of the concept of mental illness is investigated through locating it within the various discourses of biomedicine, psychology, law, and sociology and by (...) explicating and relating the philosophical underpinnings of those discourses. (shrink)

Psychiatrists assert that mental illness is a physiological brain disorder. The anti-psychiatry movement refutes this on grounds of lack of evidence claiming that mental illness is socially defined. Len Bowers offers a rational, objective and philosophical critique of the theories of mental illness as a social construct and concludes that, though sometimes misguided, they cannot be wholly rejected. This critical scrutiny of a controversial and keenly-debated issue will be of interest to psychologists, social workers, (...) psychiatrists, sociologists and professionals in paramedical disciplines. (shrink)

Someone afflicted by mental illness is neurotic if he sees his symptoms as symptoms and psychotic if does not. A neurosis is therefore an 'ego-dystonic' mental illness, meaning that the viewpoint embodied in one's symptoms is not the viewpoint of the ego of the afflicted party. And a psychosis is therefore an 'ego-syntonic' illness, meaning that the viewpoint embodied in the symptoms coincides with that of the afflicted party's ego. Whereas ego-syntonic illnesses are unqualifiedly debilitating, (...) ego-dystonic are sometimes adaptive and, within limits, may enhance the subject's ability to deploy his abilities. In this lecture, it is explained why this is so. (shrink)

Joseph Agassi, together with Yehuda Fried, presented the paradoxes of paranoia and proposed to explain and solve them by introducing innovative diagnostic criteria for psychosis as reflecting a specific kind of rationality. Their ethical-clinical framework however, discouraged discussion of placing impositions on the mentally ill, even when in danger. According to these very criteria, Agassi’s institutional individualism framework renders paranoiacs defective in autonomy. Introducing the idea of degrees of autonomy as a guiding principle for research and practice will promote responsible (...) commitment to the mentally ill and to all other persons in society. (shrink)

Joseph Agassi, together with Yehuda Fried, presented the paradoxes of paranoia and proposed to explain and solve them by introducing innovative diagnostic criteria for psychosis as reflecting a specific kind of rationality. Their ethical-clinical framework however, discouraged discussion of placing impositions on the mentally ill, even when in danger. According to these very criteria, Agassi’s institutional individualism framework renders paranoiacs defective in autonomy. Introducing the idea of degrees of autonomy as a guiding principle for research and practice will promote responsible (...) commitment to the mentally ill and to all other persons in society. (shrink)

My three main points are: Mental disease is a metaphor, but mental illness is not. Feeling ill and having a physical illness are logically related. If there were no such thing as feeling ill, there would be no such thing as suffering from a physical illness. Yet there is no logical connection between feeling ill and being mentally ill. Mental illness is manifested in various forms of behaviour, for example, suspiciousness, elation, depression, etc.; (...) if a form of behaviour is to count as mental illness, it has to be an insane form; yet it is possible to be mentally ill without being insane and it is possible to be insane without being mentally ill. (shrink)

This paper explores why ethical issues associated with mental illness have been generally neglected in the literature and texts of the discipline of bioethics. I argue that the reasons for this are both philosophical and structural, involving the philosophical framework of principlism in bioethics, in particular the privileging of the principle of autonomy, and the institutional location and disciplinary boundaries of bioethics as a profession. Other contributing factors include developments outside of bioethics, in medicine and law and in (...) the delivery patterns and funding sources of mental health services, and above all the pervasive stigma that attaches to mental illness. My goal is to show both how the attention bioethics could bring would benefit this neglected area of health care, and why attending to the issues surrounding mental illness would benefit bioethics in meeting its professional obligations as the public voice on matters of ethical significance in health care. (shrink)