The scene was pleasant on both sides. A cruder lover would have lost the view of her pretty ways and attitudes, and spoiled all by stupid attempts at caresses, utterly destructive of the drama. Grancourt preferred the drama. Gwendolen … found her spirits rising … as she played at reigning. Perhaps if Klesmer had seen more of her in this unconscious kind of acting, instead of when she was trying to be theatrical, he might have rated her chances [on stage] (...) higher.The histrionic personality disorder (HPD) stands at the intersection of ethics, ontology, and philosophy of psychiatry. Although HPD is a rarely probed diagnosis, it brings into relief the problems of gender and values in diagnosis, as well as nosological .. (shrink)

In this article, I argue for a reconsideration of the taxonomy of the Histrionic Personality Disorder. First, HPD does not carry the negative ethical implications of the other Cluster Bs, which are Anti-Social, Borderline, and Narcissistic. Using Aristotelian notions of character as a heuristic device, I argue that ontologically HPD is not a personality disorder, but instead a cultural disorder, a result of attitudes toward traditionally feminine styles of interaction. This explains the confusion in the research between (...) HPD and hysteria and also the curious paucity of literature on HPD itself in contrast to the other Cluster Bs. (shrink)

It is well known that taxonomists rely on many different methods and criteria for species delimitation, leading to different kinds of groups being recognised as species. While this state of relative disorder is widely acknowledged, there is no similar agreement about how it should be resolved. This paper considers the view that the disorder in species classification should be resolved by a system of taxonomic governance. I argue that such a system of governance is best seen as (...) a combination of standardisation, unification and regulation, each of which can be implemented in different forms. I investigate the forms that these three components should take for taxonomic governance by looking into two successfully governed classification systems, namely, virus classification and enzyme classification. The last part of the paper then defends the governance view against five objections. (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)

Periodic attacks of uncertain origin, where the clinical presentationresembles epilepsy but there is no evidence of a somatic disease, arecalled Pseudo-Epilepsy or Pseudo-Epileptic Attack Disorder (PEAD). PEADmay be called a `non-disease', i.e. a disorder on the fringes ofestablished disease patterns, because it lacks a rationalpathophysiological explanation. The first aim of this article is tocriticize the idea, common in medical science, that diseases are realentities which exist separately from the patient, waiting to bediscovered by the doctor. We argue that (...) doctor and patient construct adisease, and that the construction of the disease PEAD includes manynormative evaluations. The second aim is to provide insight into thesuffering of patients with PEAD. We focus on three aspects of thepatient, identity, autonomy and responsibility. We present somecharacteristic descriptions of (pseudo-)epileptic attacks by FjodorDostoevsky, Gustave Flaubert and Thomas Mann. We argue that diagnosingPEAD reduces a meaningful life event into an insignificant, thoughintriguing, medical phenomenon, and that the patient will not benefitfrom being diagnosed as having PEAD. (shrink)

The DSM-III, DSM-IV, DSM-IV-TR and ICD-10 have judiciously minimized discussion of etiologies to distance clinical psychiatry from Freudian psychoanalysis. With this goal mostly achieved, discussion of etiological factors should be reintroduced into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. A research agenda for the DSM-V advocated the "development of a pathophysiologically based classification system". The author critically reviews the neuroevolutionary literature on stress-induced and fear circuitry disorders and related amygdala-driven, species-atypical fear behaviors of clinical severity in adult (...) humans. Over 30 empirically testable/falsifiable predictions are presented. It is noted that in DSM-IV-TR and ICD-10, the classification of stress and fear circuitry disorders is neither mode-of-acquisition-based nor brain-evolution-based. For example, snake phobia and dog phobia are clustered together. Similarly, research on blood-injection-injury-type-specific phobia clusters two fears different in their innateness: 1) an arguably ontogenetic memory-trace-overconsolidation-based fear and 2) a hardwired fear of the sight of one's blood or a sharp object penetrating one's skin. Genetic architecture-charting of fear-circuitry-related traits has been challenging. Various, non-phenotype-based architectures can serve as targets for research. In this article, the author will propose one such alternative genetic architecture. This article was inspired by the following: A) Nesse's "Smoke-Detector Principle", B) the increasing suspicion that the "smooth" rather than "lumpy" distribution of complex psychiatric phenotypes may in some cases be accounted for by oligogenic transmission, and C) insights from the initial sequence of the chimpanzee genome and comparison with the human genome by the Chimpanzee Sequencing and Analysis Consortium published in late 2005. Neuroevolutionary insights relevant to fear circuitry symptoms that primarily emerge overconsolidationally are presented. Also introduced is a human-evolution-based principle for clustering innate fear traits. The "Neuroevolutionary Time-depth Principle" of innate fears proposed in this article may be useful in the development of a neuroevolution-based taxonomic re-clustering of stress-triggered and fear-circuitry disorders in DSM-V. Four broad clusters of evolved fear circuits are proposed based on their time-depths: 1) Mesozoic circuits hardwired by wild-type alleles driven to fixation by Mesozoic selective sweeps; 2) Cenozoic circuits relevant to many specific phobias; 3) mid Paleolithic and upper Paleolithic circuits ; 4) Neolithic circuits. More importantly, the author presents evolutionary perspectives on warzone-related PTSD, Combat-Stress Reaction, Combat-related Stress, Operational-Stress, and other deployment-stress-induced symptoms. The Neuroevolutionary Time-depth Principle presented in this article may help explain the dissimilar stress-resilience levels following different types of acute threat to survival of oneself or one's progency. PTSD rates following exposure to lethal inter-group violence are usually 5-10 times higher than rates following large-scale natural disasters such as forest fires, floods, hurricanes, volcanic eruptions, and earthquakes. The author predicts that both intentionally-caused large-scale bioevent-disasters, as well as natural bioevents such as SARS and avian flu pandemics will be an exception and are likely to be followed by PTSD rates approaching those that follow warzone exposure. During bioevents, Amygdala-driven and locus-coeruleus-driven epidemic pseudosomatic symptoms may be an order of magnitude more common than infection-caused cytokine-driven symptoms. Implications for the red cross and FEMA are discussed. It is also argued that hospital phobia as well as dog phobia, bird phobia and bat phobia require re-taxonomization in DSM-V in a new "overconsolidational disorders" category anchored around PTSD. The overconsolidational spectrum category may be conceptualized as straddling the fear circuitry spectrum disorders and the affective spectrum disorders categories, and may be a category for which Pitman's secondary prevention propranolol regimen may be specifically indicated as a "morning after pill" intervention. Predictions are presented regarding obsessive-compulsive disorder and "culture-bound" acute anxiety symptoms. Also discussed are insights relevant to pseudoneurological symptoms and to the forthcoming Dissociative-Conversive disorders category in DSM-V, including what the author terms fright-triggered acute pseudo-localized symptoms. Speculations based on studies of the human abnormal-spindle-like, microcephaly-associated gene, the microcephaly primary autosomal recessive gene, and the forkhead box p2 gene are made and incorporated into what is termed "The pre-FOXP2 Hypothesis of Blood-Injection-Injury Phobia." Finally, the author argues for a non-reductionistic fusion of "distal neurobiology" with clinical "proximal neurobiology," utilizing neurological heuristics. It is noted that the value of re-clustering fear traits based on behavioral ethology, human-phylogenomics-derived endophenotypes and on ontogenomics can be confirmed or disconfirmed using epidemiological or twin studies and psychiatric genomics. (shrink)

Lists of species underpin many fields of human endeavour, but there are currently no universally accepted principles for deciding which biological species should be accepted when there are alternative taxonomic treatments (and, by extension, which scientific names should be applied to those species). As improvements in information technology make it easier to communicate, access, and aggregate biodiversity information, there is a need for a framework that helps taxonomists and the users of taxonomy decide which taxa and names should be (...) used by society whilst continuing to encourage taxonomic research that leads to new species discoveries, new knowledge of species relationships, and the refinement of existing species concepts. Here, we present 10 principles that can underpin such a governance framework, namely (i) the species list must be based on science and free from nontaxonomic considerations and interference, (ii) governance of the species list must aim for community support and use, (iii) all decisions about list composition must be transparent, (iv) the governance of validated lists of species is separate from the governance of the names of taxa, (v) governance of lists of accepted species must not constrain academic freedom, (vi) the set of criteria considered sufficient to recognise species boundaries may appropriately vary between different taxonomic groups but should be consistent when possible, (vii) a global list must balance conflicting needs for currency and stability by having archived versions, (viii) contributors need appropriate recognition, (ix) list content should be traceable, and (x) a global listing process needs both to encompass global diversity and to accommodate local knowledge of that diversity. We conclude by outlining issues that must be resolved if such a system of taxonomic list governance and a unified list of accepted scientific names generated are to be universally adopted. (shrink)

The present work is focussed on the completeness of physics, or what is here called the Completeness Thesis: the claim that the domain of the physical is causally closed. Two major questions are tackled: How best is the Completeness Thesis to be formulated? What can be said in defence of the Completeness Thesis? My principal conclusions are that the Completeness Thesis can be coherently formulated, and that the evidence in favour if it significantly outweighs that against it. In opposition to (...) those who argue that formulation is impossible because no account of what is to count as physical can be provided, I argue that as long as the purpose of the argument in which the account is to be used are borne in mind there are no significant difficulties. The account of the physical which I develop holds as physical whatever is needed to fix the likelihood of pre-theoretically given physical effects, and hypothesises in addition that no chemical, biological or psychological factors will be needed in this way. The thus formulated Completeness Thesis is coherent, and has significant empirical content. In opposition to those who defend the doctrine of emergentism by means of philosophical arguments I contend that those arguments are flawed, setting up misleading dichotomies between needlessly attenuated alternatives and assuming the truth of what is to be proved. Against those who defend emergentism by appeal to the evidence, I argue that the history of science since the nineteenth century shows clearly that the empirical credentials of the view that the world is causally closed at the level of a small number of purely physical forces and types of energy is stronger than ever, and the credentials of emergentism correspondingly weaker. In opposition to those who argue that difficulties with reductionism point to the implausibility of the Completeness Thesis I argue that completeness in no way entails the kinds of reductionism which give rise to the difficulties in question. I argue further that the truth of the Completeness Thesis is in fact compatible with a great deal of taxonomic disorder and the impossibility of any general reduction of non-fundamental descriptions to fundamental ones. In opposition to those who argue that the epistemological credentials of fundamental physical laws are poor, and that those laws should in fact be seen as false, I contend that truth preserving accounts of fundamental laws can be developed. Developing such an account, I test it by considering cases of the composition of forces and causes, where what takes place is different to what is predicted by reference to any single law, and argue that viewing laws as tendencies allows their truth to be preserved, and sense to be made of both the experimental discovery of laws, and the fact that composition enables accurate prediction in at least some cases. (shrink)

In “Mad Narratives: Self-Constitutions Through the Diagnostic Looking Glass,” by using narrative approaches to the self, I explore how the diagnosis of mental disorder shapes personal identities and influences flourishing. My particular focus is the diagnosis grounded on the criteria provided by the Diagnostic Statistical Manual of Mental Disorders (DSM). I develop two connected accounts pertaining to the self and mental disorder. I use the memoirs and personal stories written by the subjects with a DSM diagnosis as illustrations (...) to bolster my claims. First, expanding on the narrative approaches to the self, I explain how narratives about a subject shape her self-constitution. I elucidate how this process is generated by drawing on research in developmental psychology, cognitive science, and social psychology. Next, using this account as a springboard, I argue that the DSM diagnosis of mental disorder serves as a source of narrative, entering into the patients’ autobiographical and social narratives. This plays an important role in the diagnosed subjects’ self-understanding, self-constitution and flourishing. In this vein, how mental disorders are classified is not only a theoretical question about accurately taxonomizing the various experiences related to mental distress but also an ethical question about which ways of talking about mental disorders will allow subjects to respond effectively to their psychological distress, to flourish and to live autonomous and fulfilling lives. Finally, I suggest that the DSM-based narratives wield a double-edged sword when it comes to the subject’s flourishing: On the one hand, there are problems with some DSM-based narratives that stem from the DSM diagnostic schema and the culture of DSM diagnoses. These problems render these DSM-based narratives unbeneficial for flourishing as they constrain the range of adoptive social, cognitive and emotional responses the subjects can give to their mental disorders. On the other hand, there are grounds to believe that some DSM-based narratives help subjects to flourish. For instance, they provide certainty to subjects' otherwise puzzling symptoms and help them reach out to others with similar experiences. Understanding how the DSM-based narratives can both benefit and harm will help us address problems with psychiatric diagnoses and the dissemination of knowledge about mental disorders in popular culture. The project aims to convince both philosophers and psychiatrists that no plausible theory of the self can be developed without attending to the topic of mental disorder and that no theory of mental disorder can be complete without devising the tools provided by the philosophical approaches to the self as well as developmental and social psychology. It also calls for methodological alterations in mental health ethics research, arguing that a careful scrutiny of mental disorder memoirs can advance the ethical underpinnings to the practice of psychiatry. (shrink)

A family of recent externalist approaches in philosophy of mind argues that our psychological capacities are synchronically and diachronically “scaffolded” by external resources. I consider how these “scaffolded” approaches might inform debates in phenomenological psychopathology. I first introduce the idea of “affective scaffolding” and make some taxonomic distinctions. Next, I use schizophrenia as a case study to argue—along with others in phenomenological psychopathology—that schizophrenia is fundamentally a self-disturbance. However, I offer a subtle reconfiguration of these approaches. I argue that (...) schizophrenia is not simply a disruption of ipseity or minimal self-consciousness but rather a disruption of the scaffolded self, established and regulated via its ongoing engagement with the world and others. I conclude by considering how this scaffolded framework indicates the need to consider new forms of intervention and treatment. (shrink)

‘Type’ in biology is a polysemous term. In a landmark article, Paul Farber (Journal of the History of Biology 9(1): 93–119, 1976) argued that this deceptively plain term had acquired three different meanings in early nineteenth century natural history alone. ‘Type’ was used in relation to three distinct type concepts, each of them associated with a different set of practices. Important as Farber’s analysis has been for the historiography of natural history, his account conceals an important dimension of early nineteenth (...) century ‘type talk.’ Farber’s taxonomy of type concepts passes over the fact that certain uses of ‘type’ began to take on a new meaning in this period. At the closing of the eighteenth century, terms like ‘type specimen,’ ‘type species,’ and ‘type genus’ were universally recognized as referring to typical, model members of their encompassing taxa. But in the course of the nineteenth century, the same terms were co-opted for a different purpose. As part of an effort to drive out nomenclatural synonymy – the confusing state of a taxon being known to different people by different names – these terms started to signify the fixed and potentially atypical name-bearing elements of taxa. A new type concept was born: the nomenclatural type. In this article, I retrace this perplexing nineteenth century shift in meaning of ‘type.’ I uncover the nomenclatural disorder that the new nomenclatural type concept dissolved, and expose the conceptual confusion it left in its tracks. What emerges is an account of how synonymy was suppressed through the coinage of a homonym. (shrink)

Epistemic peer disagreement raises interesting questions, both in epistemology and in philosophy of science. When is it reasonable to defer to the opinion of others, and when should we hold fast to our original beliefs? What can we learn from the fact that an epistemic peer disagrees with us? A question that has received relatively little attention in these debates is the value of epistemic peer disagreement—can it help us to further epistemic goals, and, if so, how? We investigate this (...) through a recent case in paleoanthropology: the debate on the taxonomic status of Homo floresiensis remains unresolved, with some authors arguing the fossils represent a novel hominin species, and others claiming that they are Homo sapiens with congenital growth disorders. Our examination of this case in the recent history of science provides insights into the value of peer disagreement, indicating that it is especially valuable if one does not straightaway defer to a peer’s conclusions, but nevertheless remains open to a peer’s evidence and arguments. (shrink)

Discussions of psychiatric nosology focus on a few popular examples of disorders, and on the validity of diagnostic criteria. Looking at Anorexia Nervosa, an example rarely mentioned in this literature, reveals a new problem: the DSM has a strict taxonomic structure, which assumes that disorders can only be located on one branch. This taxonomic assumption fails to fit the domain of psychopathology, resulting in obfuscation of cross-category connections. Poor outcomes for treatment of Anorexia may be due to it (...) being pigeonholed as an Eating Disorder, when a disturbance of body perception may be a more central symptom than food restriction. This paper explores the possibility of restructuring the DSM taxonomy to allow for a pluralist classification of disorders. This change could improve treatment and research without requiring any changes to diagnostic criteria. (shrink)

Background: SNOMED CT is a large terminology system designed to represent all aspects of healthcare. Its current form and content result from decades of bottom-up evolution. Due to SNOMED CT’s formal descriptions, it can be considered an ontology. The Basic Formal Ontology (BFO) is a foundational ontology that proposes a small set of disjoint, hierarchically ordered classes, supported by relations and axioms. In contrast, as a typical top-down endeavor, BFO was designed as a foundational framework for domain ontologies in the (...) natural sciences and related disciplines. Whereas it is mostly assumed that domain ontologies should be created as extensions of foundational ontologies, a post-hoc harmonization of consolidated domain ontologies in use, such as SNOMED CT, is known to be challenging. Methods: We explored the feasibility of harmonizing SNOMED CT with BFO, with a focus on the SNOMED CT Clinical Finding hierarchy. With more than 100,000 classes, it accounts for about one third of SNOMED CT’s content. In particular, we represented typical SNOMED CT finding/disorder concepts using description logics under BFO. Three representational patterns were created and the logical entailments analyzed. Results: Under a first scrutiny, the clinical intuition that diseases, disorders, signs and symptoms form a homogeneous ontological upper-level class appeared incompatible with BFO’s upper-level distinction into continuants and occurrents. The Clinical finding class seemed to be an umbrella for all kinds of entities of clinical interest, such as material entities, processes, states, dispositions, and qualities. This suggests the conclusion that Clinical finding would not be a suitable upper-level class from an BFO perspective. On closer inspection of the taxonomic links within this hierarchy and the implicit meaning derived thereof, it became clear that Clinical finding classes do not characterize the entity (e.g. a fracture, allergy, tumor, pain, hemorrhage, seizure, fever) in a literal sense but rather the condition of a patient having that fracture, allergy, pain etc. This gives sense to the current characteristic of the Clinical Finding hierarchy, in which complex classes are modeled as subclasses of their constituents. Most of these taxonomic links are inferred, as the consequence of the ‘role group’ design pattern, which is ubiquitous in SNOMED CT and has often been subject of controversy regarding its semantics. Conclusion: Our analyses resulted in the proposal of (i) equating SNOMED CT’s ‘role group’ property with the reflexive and transitive BFO relation ‘has occurrent part’; and (ii) reinterpreting Clinical Findings as Clinical Occurrents, i.e. temporally extended entities in an organism, having one or more occurrents as temporal parts that occur in continuants. This re-interpretation was corroborated by a manual analysis of classes under Clinical Finding, as well as the identification of similar modeling patterns in other ontologies. As a result, SNOMED CT does not require any content redesign to establish compatibility with BFO, apart from this re-interpretation, and a suggested re-labeling. Regarding the feasibility of harmonizing terminologies with principled foundational ontologies post-hoc, our results provide support to the assumption that this does not necessarily require major redesign efforts, but rather a careful analysis of the implicit assumptions of terminology curators and users. (shrink)

This article does not directly consider the feelings and emotions that occur in mental illness. Rather, it concerns a higher level methodological question: To what extent is an analysis of feelings and felt emotions of importance for psychiatric classification? Some claim that producing a phenomenologically informed descriptive psychopathology is a prerequisite for serious taxonomic endeavor. Others think that classifications of mental disorders may ignore subjective experience. A middle view holds that classification should at least map the contours of the (...) phenomenology of mental illness. This article examines these options. I conclude that it is not true that phenomenology is a logical prerequisite for classification, nor even that classification should necessarily respect phenomenological boundaries, but that detailed phenomenological examination can sometimes inform classification. (shrink)

Schizophrenia stands as one of the most studied and storied disorders in the history of clinical psychology; however, it remains a nexus of conflicting and competing conceptualizations. Patients endure great stigma, poor treatment outcomes, and condemnatory prognosis. Current conceptualizations suffer from unstable categorical borders, heterogeneity in presentation, outcome and etiology, and holes in etiological models. Taken in aggregate, research and clinical experience indicate that the class of psychopathologies oriented toward schizophrenia are best understood as spectra of phenomenological, cognitive, and behavioral (...) modalities. These apparently taxonomic expressions are rooted in normal human personality traits as described in both psychodynamic and Five Factor personality models, and more accurately represent explicable distress reactions to biopsychosocial stress and trauma. Current categorical approaches are internally hampered by axiomatic bias and systemic inertia rooted in the foundational history of psychological inquiry; however, when such axioms are schematically decentralized, convergent cross-disciplinary evidence outlines a more robust explanatory construct. By reconceptualizing these disorders under a dimensional and cybernetic model, the aforementioned issues of instability and inaccuracy may be resolved, while simultaneously opening avenues for both early detection and intervention, as well as for more targeted and effective treatment approaches. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Folk Taxonomies Versus Official TaxonomiesNick Haslam (bio)Keywordsclassification, DSM-IV, folk taxonomyFlanagan and Blashfield’s paper continues a highly original program of research on clinicians’ understandings of psychopathology. This work is unique in bringing concepts and methods from cognitive anthropology to bear on psychiatric classification. At first blush, it might seem questionable to treat clinicians’ beliefs about psychiatric disorders as folk taxonomies, no different in kind from classifications of birds produced by (...) members of a forest-dwelling tribe. Unlike birds and other natural objects of folk taxonomies, mental disorders are not concrete entities and they cannot be distinguished on perceptual grounds. Unlike tribespeople, clinicians are not simply “folk” whose naïve classifications can be compared with those of scientific authorities. They are, in fact, heavily exposed to the reigning official taxonomy during their professional training, and their thinking can hardly remain unaffected by it. It is a testament to Flanagan and Blashfield’s work that despite these apparent disanalogies, their folk-taxonomic approach manages to illuminate how clinicians carve up the psychiatric domain.This paper reports some careful, creative, and labor-intensive studies to make a few fundamental claims about how clinicians classify. First, the authors argue that clinicians hold simplified taxonomies compared with the official DSM-IV taxonomy: They encompass fewer disorders and classify them in a shallower hierarchy. Second, they claim that clinicians substantially agree in how they classify disorders, and that a consensus classification can therefore be extracted from their individual taxonomies. Third, they argue that clinicians’ taxonomies show only a modest consistency with DSM-IV, and that the discrepancies may be systematic and important. Notably, for example, clinicians did not preserve the fundamental divide between the DSM’s Axes I and II. My comments address the second and third claims.Is There a “Consensus” among the Clinicians?One of the main achievements of Flanagan and Blashfield’s paper is to develop a “consensual taxonomy,” which is laid out in their Table 2a. This taxonomy clearly distils how their clinicians tended to judge the relations among diagnoses. However, it is an exaggeration to present it as a consensus. If, by Romney, Weller, and Batchelder’s (1986) third criterion, “cultural consensus” requires that the primary factor in a principal components analysis accounts for “most” of the variance in clinicians’ judgments, then Flanagan and Blashfield’s analysis [End Page 281] fails to show consensus. Their first factor accounts for only twenty-five percent of the variance, well short of the required majority. This finding implies that there is three times as much inconsistency or variability among clinicians’ taxonomic judgments than there is consistency and commonality. The observed factor-analytic findings are compatible with the average correlation between pairs of clinicians being only about 0.2, a very weak level of agreement.This is not to say that there is no consistency among the clinicians, or that there is no value in summarizing that consistency, but it does indicate that there is a great deal of diversity as well. Clinicians’ folk taxonomies seem to be highly idiosyncratic, more a Babel of distinctive classifications than a chorus of agreement. It is therefore risky to draw strong generalizations about how clinicians classify, and to imply that there is a single consensual taxonomy.Several things are very interesting about this diversity of classifications. First, Flanagan and Blashfield show that it cannot be explained by the clinicians’ differing levels of experience or by the different methodologies used to elicit their taxonomies. The variability among clinicians must therefore have some other basis, which awaits further investigation. Second, the level of agreement (“consensus”) obtained here is significantly lower than what has been found in more orthodox studies of folk taxonomy. By implication, the classification of psychiatric disorders is a slipperier enterprise than the classification of animals and plants. People who have extensive professional experience and training in the field of psychopathology—vocational training that includes the standardizing forces of accrediting bodies and a dominant psychiatric nosology—nevertheless tend not to agree substantially about how to map that territory. One guess about why this might be is that clinicians’ folk taxonomies are not merely descriptive maps of the interrelations among diagnostic entities, but are... (shrink)

The Condition of Madness provides a comprehensive philosophical explanation of the conceptual assumptions in psychiatry. Brian Grant begins this work with a historical overview of psychiatry and a discussion of the prevalent views in the contemporary discipline. He then critically examines DSM-IV and argues that the taxonomical categories presently used in psychiatry are almost entirely arbitrary. The book draws on the philosophy of mind and provides discussions of the mind, the self, the will, and madness. It concludes with recommendations on (...) how to view psychiatry and explores what the future holds for the discipline. (shrink)

In a shift of position that has gone largely unnoticed by the great majority of commentators, Thomas Kuhn's version of the incommensurability thesis underwent a major transformation over the last decade and a half of his life. In his later work, Kuhn argued that incommensurability is a relation of translation failure between local subsets of interdefined theoretical terms, which encapsulate the taxonomic structure of a theory. Incommensurability arises because it is impossible to transfer the natural categories employed within one (...) taxonomic structure into the categorial system of another such structure. Apparently on the basis of such taxonomic incommensurability, Kuhn asserted a number of antirealist theses about truth, reference and reality. In this paper, it will be argued, however, that, far from leading to antirealist consequences about the relationship between theory and reality, the taxonomic incommensurability thesis may be incorporated unproblematically within a reasonably robust scientific realist framework. (shrink)

Our aim in this article is to bring some clarity to the clinical ethics expertise debate by critiquing and replacing the taxonomy offered by the Core Competencies report. The orienting question for our taxonomy is: Can clinical ethicists offer justified, normative recommendations for active patient cases? Views that answer “no” are characterized as a “negative” view of clinical ethics expertise and are further differentiated based on (a) why they think ethicists cannot give justified normative recommendations and (b) what they think (...) ethicists can offer, if they cannot offer recommendations. Views that answer “yes” to the orienting question are characterized as a “positive” view of clinical ethics expertise. Positive views are distinguished according to four additional questions. First (P1), how are those recommendations generated? Second (P2), what is the nature of the recommendations? Third (P3), we ask, how are the recommendations justified? And finally (P4), how are the recommendations communicated? (shrink)

This paper will be about the relationship between mental disorder and physical disorder. I shall also be concerned with the connection between these notions and the notion of ‘illness’.

_The Disordered Mind: An Introduction to Philosophy of Mind and Mental Illness, second edition_ examines and explains, 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. Revised and updated throughout, this _second edition_ includes new discussions of grief and psychopathy, the problems of the psychophysical basis of disorder, the nature of selfhood, and clarification of the relation (...) between rationality and 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 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. Containing chapter summaries and suggestions for further reading at the end of each chapter, _The Disordered Mind, second edition_ is a superb introduction to the philosophy of mental disorder for students of philosophy, psychology, psychiatry, and related mental health professions. (shrink)

The culture of global society commonly associates the word animal with vertebrates. Paradoxically, most of animal diversity is composed of small organisms that remain invisible in the global culture and are underrepresented in philosophy, science, and education. Twenty-first century science has revealed that many invertebrates have consciousness and the capacity to feel pain. These discoveries urge animal ethicists to be more inclusive and to reevaluate the participation of invertebrates in the moral community. Science also has warned of the disappearance of (...) small animal co-inhabitants that is occurring in the midst of the sixth mass extinction. This “invisible extinction” compels environmental philosophers to make visible invertebrates, whose existence is precious in itself and for the functioning of ecosystems on which biodiversity and human societies depend. With a biocultural approach that integrates the biophysical and cultural dimensions of biodiversity, I investigate the roots of taxonomic chauvinism associated with the under-representation and subordination of invertebrates in modern philosophy and science. The bad news is the confirmation of a marked vertebratism in animal imagery. The good news is that David Hume, Charles Darwin, and biocultural ethics provide conceptual foundations for cultivating an appreciation of the small co-inhabitants with whom we share our local habitats and the global biosphere. (shrink)

We present the first comprehensive taxonomic revision and review the biology of the olingos, the endemic Neotropical procyonid genus Bassaricyon, based on most specimens available in museums, and with data derived from anatomy, morphometrics, mitochondrial and nuclear DNA, field observations, and geographic range modeling. Species of Bassaricyon are primarily forest-living, arboreal, nocturnal, frugivorous, and solitary, and have one young at a time. We demonstrate that four olingo species can be recognized, including a Central American species (Bassaricyon gabbii), lowland species (...) with eastern, cis-Andean (Bassaricyon alleni) and western, trans-Andean (Bassaricyon medius) distributions, and a species endemic to cloud forests in the Andes. The oldest evolutionary divergence in the genus is between this last species, endemic to the Andes of Colombia and Ecuador, and all other species, which occur in lower elevation habitats. Surprisingly, this Andean endemic species, which we call the Olinguito, has never been previously described; it represents a new species in the order Carnivora and is the smallest living member of the family Procyonidae. We report on the biology of this new species based on information from museum specimens, niche modeling, and fieldwork in western Ecuador, and describe four Olinguito subspecies based on morphological distinctions across different regions of the Northern Andes. (shrink)

The author argues that there is no such thing as a unique and general taxonomy of non-at-issue contents. Accordingly, we ought to shun large categories such as “conventional implicature”, “F-implicature”, “CI”, “Class B” or the like. As an alternative, we may, first, describe the “semantic profile” of linguistic devices as accurately as possible. Second, we may explicitly tailor our categories to particular theoretical purposes.

Surprising as it may perhaps seem to many, I have found in the upshot of a fairly persistent series of trials that it is easier to define “life” in terms of “culture” than it is to define “culture” in terms of “life.” Searching logistic experiments show that the latter way is strewn with conceptual booby-traps in the shape of such terms as “physical,” “non-physical,” “material,” “immaterial,” “spiritual,” “ideal,” “natural,” “supernatural,” etc. Some important sectors of our intellectual culture have for generations (...) stultified themselves by attempting to account in such unserviceable and deceitful terms for manifest and institutionally important differences in natural phenomena and the practical human affairs to which they appertain. Such desperate jugglery as has been engaged in, although embraced in much received doctrine, is not conducive either to intellectual or to moral integrity. Such dualistic chimeras had best be abandoned, the more peremptorily the better, as leading only to self-contradiction, confusion, and serious temptation to futile logical expedients. (shrink)

The search for the “furniture of the mind” has acquired added impetus with the rise of new technologies to study the brain and identify its main structures and processes. Philosophers and scientists are increasingly concerned to understand the ways in which psychological functions relate to brain structures. Meanwhile, the taxonomic practices of cognitive scientists are coming under increased scrutiny, as researchers ask which of them identify the real kinds of cognition and which are mere vestiges of folk psychology. Muhammad (...) Ali Khalidi presents a naturalistic account of “real kinds” to validate some central taxonomic categories in the cognitive domain, including concepts, episodic memory, innateness, domain specificity, and cognitive bias. He argues that cognitive kinds are often individuated relationally, with reference to the environment and etiology of the thinking subject, whereas neural kinds tend to be individuated intrinsically, resulting in crosscutting relationships among cognitive and neural categories. (shrink)

In this article I examine some of the issues involved in taking psychiatric disorders as natural kinds. I begin by introducing a permissive model of natural kind-hood that at least prima facie seems to allow psychiatric disorders to be natural kinds. The model, however, hinges on there in principle being some grounding that is shared by all members of a kind, which explain all or most of the additional shared projectible properties. This leads us to the following question: what grounding (...) do psychiatric disorders qua natural kinds have? My principal method for examining the issue is a case study of a particular psychiatric disorder: the so-called “apathetic children.” I argue that there appear to be at least two competing models that both appeal to non-organic a grounding of the disorder. However, for other psychiatric disorders, such as Alzheimer’s disease, the evidence points toward an organic explanation of the disorder. I contend that what unites psychiatric disorders is not a distinctive type of grounding that all psychiatric disorders share, but the distinctive set of determinable properties that is shared by all psychiatric disorders. (shrink)

So much has been written on this vexed issue, that one hesitates to reopen it. Yet one has no other choice when one finds scholars accepting as generally agreed a view which rests on altogether insufficient evidence. I propose, therefore, to examine the main grounds on which recent authorities interpret the disorderly motion of Tm 30a, 52d–53b, and 69b as a mythical symbol. They are four: I. That the Timaios is a myth; II. The testimony of the Academy; III. That (...) motion could not antecede the creation of time; IV. That motion could not antecede the creation of soul. (shrink)

The publication of DSM-5 has been accompanied by a fair amount of controversy. Amongst DSM’s most vocal ‘insider’ critics has been Thomas Insel, Director of the US National Institute of Mental Health. Insel has publicly criticised DSM’s adherence to a symptom-based classification of mental disorder, and used the weight of the NIMH to back a rival research strategy aimed at a more biology-based diagnostic classification. This strategy is part of Insel’s vision of a future, more preventative psychiatry in which (...) mental disorders are not only understood as biological disorders of the brain, but also as neurodevelopmental disorders. This paper examines the interest and merit of Insel’s views of mental and neurodevelopmental disorder for the philosophy of psychopathology, with a special focus of his neurodevelopmental model of schizophrenia. Pitman’s ‘moderate materialism’ will be used both as a philosophical lens through which to examine Insel’s position, as well as an example of a philosophical framework that may require updating and revision in the light of moves towards a neurodevelopmental conception of mental disorder. (shrink)

In this chapter, we investigate whether psychopathy is a mental disorder. We argue that addressing this question requires engaging, at least, with three principal issues that have conceptual, empirical, and normative dimensions. First, it must be established whether current measures of psychopathy individuate a unitary class of individuals. By this we mean that persons classifed as psychopaths should share some relevant similarities that support explanation, prediction, and treatment. Second, it must be proven that psychopathy harms the person who has (...) it. Third, it must be established that the harm associated with psychopathy is relevant for the ascription of disorder status. Regarding this latter issue, we argue that psychopathy should be considered a disorder if its harmfulness derives from certain incapacities or limited capacities. These incapacities should affect basic competences that are justifably required for conducting a preferable type of life. Within this framework, we tentatively advance the hypothesis that some normatively justifed conclusions and empirical evidence about psychopathy, that needs nonetheless to be further investigated, might support the claim that people with psychopathy have a mental disorder. (shrink)

Types are fundamental for conceptual modeling and knowledge representation, being an essential construct in all major modeling languages in these fields. Despite that, from an ontological and cognitive point of view, there has been a lack of theoretical support for precisely defining a consensual view on types. As a consequence, there has been a lack of precise methodological support for users when choosing the best way to model general terms representing types that appear in a domain, and for building sound (...) taxonomic structures involving them. For over a decade now, a community of researchers has contributed to the development of the Unified Foundational Ontology (UFO) - aimed at providing foundations for all major conceptual modeling constructs. At the core of this enterprise, there has been a theory of types specially designed to address these issues. This theory is ontologically well- founded, psychologically informed, and formally characterized. These results have led to the development of a Conceptual Modelling language dubbed OntoUML, reflecting the ontological micro-theories comprising UFO. Over the years, UFO and OntoUML have been successfully employed on conceptual model design in a variety of domains including academic, industrial, and governmental settings. These experiences exposed improvement opportunities for both the OntoUML language and its underlying theory, UFO. In this paper, we revise the theory of types in UFO in response to empirical evidence. The new version of this theory shows that many of OntoUML’s meta-types (e.g. kind, role, phase, mixin) should be considered not as restricted to substantial types but instead should be applied to model endurant types in general, including relator types, quality types, and mode types. We also contribute with a formal characterization of this fragment of the theory, which is then used to advance a new metamodel for OntoUML (termed OntoUML 2). To demonstrate that the benefits of this approach are extended beyond OntoUML, the proposed formal theory is then employed to support the definition of UFO-based lightweight Semantic Web ontologies with ontological constraint checking in OWL. Additionally, we report on empirical evidence from the literature, mainly from cognitive psychology but also from linguistics, supporting some of the key claims made by this theory. Finally, we propose a computational support for this updated metamodel. (shrink)

Volume 19, Issue 11, November 2019, Page 62-63.

This book offers a comprehensive study of the views of ancient philosophers on mental disorders. Relying on the original Greek and Latin textual sources, the author describes and analyses how the ancient philosophers explained mental illness and its symptoms, including hallucinations, delusions, strange fears and inappropriate moods and how they accounted for the respective roles of body and mind in such disorders. Also considered are ethical questions relating to mental illness, approaches to treatment and the position of mentally ill people (...) in societies of the times. The volume opens with a historical overview that examines ancient medical accounts of mental illness, from Hippocrates' famous Sacred Disease to late antiquity medical authors. Separate chapters interpret in detail the writings of Plato, Aristotle, Galen and the Stoics and a final chapter summarises the views of various strains of Scepticism, the Epicurean school and the Middle and Neo-Platonists. Offering an important and useful contribution to the study of ancient philosophy, psychology and medicine. This volume sheds new light on the history of mental illness and presents a new angle on ancient philosophical psychology. (shrink)

A flood of new multidisciplinary work on the causes of depersonalization disorder provides a new way to think about the feeling that experiences “belong” to the self. In this paper I argue that this feeling, baptized “mineness” or “subjective presence” : 565–573, 2013) emerges from a multilevel interaction between emotional, affective and cognitive processing. The “self” to which experience is attributed is a predictive model made by the mind to explain the modulation of affect as the organism progresses through (...) the world. When the world no longer produces predicted affect the organism needs to explain this unpredicted absence of feeling. It is important to this account that cognition and perception are otherwise intact. Consequently the mind’s representation of the world and its emotionally salient properties are unchanged, leading the mind to predict a characteristic affective response. When that prediction is not fulfilled the organisms feels as if she is no longer present in experience. This is reported at the as feeling of depersonalization. (shrink)

Josh is a typical 27-year-old in a career that he enjoys and a successful marriage. Josh begins to exhibit the symptoms of a manic episode. He is soon diagnosed with bipolar disorder. While non-manic, Josh’s preferences are typical. While manic, his preferences change dramatically. He quits his job, cheats on his partner, and squanders his savings. These are behaviors that Josh, when non-manic (euthymic), would never agree to. When Josh returns to a euthymic state, he regrets these decisions. Should (...) those close to Josh have prevented him from making these decisions, or does his competence to decide persist despite his acute mania? In this paper, I examine the connections be-tween bipolar disorder and consent. I defend the view that many (although far from all) individuals with bipolar disorder are competent to consent to a wide variety of things when they are in a manic state. This means that mania should not be presumed to undermine competence in clinical settings. -/- I have several goals in this paper. I want to bring philosophy to bear on the connection between consent and bipolar disorder. Additionally, I intend this paper to contribute to the general debate about the conditions of informed consent. Bipolar disorder presents novel challenges to existing conceptions of competence to consent which require stable core of values for an agent to be competent. For example, Buchanan and Brock endorse such a view. In showing that shifting values do not undermine the competence of a person experiencing acute mania, I show that the aforementioned views of competence are false. Overall, this paper makes substantive contributions to the debate about competence to consent and presents the first sustained philosophical treatment of consent among people with bipolar disorder. (shrink)

Meaning-making plays a central role in how we deal with experiences of suffering, including those due to mental disorder. And for many, religious beliefs, experiences, and practices (hereafter, religious engagement) play a central role in informing this meaning-making. However, a crucial facet of the relationship between experiences of mental disorder and religious engagement remains underexplored—namely the potentially positive effects of mental disorder on religious engagement (e.g. experiences of bipolar disorder increasing sense of God’s presence). In what (...) follows, I will present empirical findings from two recent studies of mine which shed light on the extent to which participants experienced these positive effects, specific components of these effects, and how they fit into their understanding of their mental disorder and its relationship to their religious identity. In doing so, I will draw on and expand Tasia Scrutton’s Potentially Transformative view (2015a, 2015b, 2020) according to which mental disorders may provide opportunities for spiritual growth. My empirical results align with and help deepen an account according to which mental disorders are potentially spiritually transformative by providing further insight into such instances: specifically, which symptoms and internal and external factors are often involved, as well as which religious beliefs, experiences, and/or practices are often affected. After presenting these results and articulating their relevance for a potentially transformative view of mental disorder, I will then address some potential objections to the theoretical account as well as some limitations of the empirical work, before sketching possible promising directions for future research. (shrink)

As it emerged from philosophical analyses and cognitive research, most concepts exhibit typicality effects, and resist to the efforts of defining them in terms of necessary and sufficient conditions. This holds also in the case of many medical concepts. This is a problem for the design of computer science ontologies, since knowledge representation formalisms commonly adopted in this field (such as, in the first place, the Web Ontology Language - OWL) do not allow for the representation of concepts in terms (...) of typical traits. The need of representing concepts in terms of typical traits concerns almost every domain of real world knowledge, including medical domains. In particular, in this article we take into account the domain of mental disorders, starting from the DSM-5 descriptions of some specific disorders. We favour a hybrid approach to concept representation, in which ontology oriented formalisms are combined to a geometric representation of knowledge based on conceptual space. As a preliminary step to apply our proposal to mental disorder concepts, we started to develop an OWL ontology of the schizophrenia spectrum, which is as close as possible to the DSM-5 descriptions. (shrink)

The target article contains a number of distinct but interrelated claims about the cognitive nature of folk biology based in part on cross-cultural work with urbanized Americans and forest-dwelling Maya Indians. Folk biology consists universally of a ranked taxonomy centered on essence-based generic species. This taxonomy is domain-specific, perhaps an innately determined evolutionary adaptation. Folk biology also plays a special role in cultural evolution in general, and in the development of Western biological science in particular. Even in our culture, however, (...) it retains an autonomy from other domains of thought and from science. These claims are questioned and clarified. (shrink)

It is argued that medical science requires a classificatory system that (a) puts functions in the taxonomic center and (b) does justice ontologically to the difference between the processes which are the realizations of functions and the objects which are their bearers. We propose formulae for constructing such a system and describe some of its benefits. The arguments are general enough to be of interest to all the life sciences.

Some would say that philosophy can contribute more to the occurrence of mental disorder than to the study of it. Thinking too much does have its risks, but so do willful ignorance and selective inattention. Well, what can philosophy contribute? It is not equipped to enumerate the symptoms and varieties of disorder or to identify their diverse causes, much less offer cures (maybe it can do that-personal philosophical therapy is now available in the Netherlands). On the other hand, (...) the scientific study of mental disorder has a long way to go. There is much disagreement and uncertainty about the nature, causes, and treatment of many specific disorders, as is evident from DSM's classification of them in predominantly symptomatic terms. And even if what is reflected in DSM were a consensus rather than a compromise, still this shifts periodically with each new edition. Moreover, it is a notorious fact that many patients who clearly have psychiatric abnormalities do not fit any of the recognized diagnostic categories.1. (shrink)

With this manifesto, John Dupré systematically attacks the ideal of scientific unity by showing how its underlying assumptions are at odds with the central conclusions of science itself.