How do people understand the concepts of mental health and disorder? The objective of this paper is to examine the impact of several factors on people’s judgments about whether a condition constitutes a mental disorder or a healthy state. Specifically, this study examines the impact of the source of the condition, its outcome, individual valuation (i.e., the value the individual attaches to the condition), and group valuation (i.e., the value the relevant group attaches to the condition). While we find that (...) people’s health and disorder judgments are driven by perceived dysfunction, we also find that health and disorder judgments are impacted differently by these factors. Health judgements are impacted by outcome and individual valuation, and disorder judgments are impacted by condition source. These results suggest that the folk concept of mental health is positive (i.e., mental health is more than the absence of mental disorder) and normativist (i.e., value judgments play a significant role in determining whether a condition counts as healthy), while the concept of mental disorder aligns with a naturalist perspective, at least to the extent that dysfunction plays an important role in categorizing a condition as a disorder. However, our finding that people’s dysfunction judgments are influenced by individual valuation and outcomes poses a strong challenge to naturalist accounts. To provide access to our supplementary data, an appendix has been included. (shrink)

This chapter examines the history of philosophy of psychology and philosophy of psychiatry as subfields of philosophy of science that emerged in the late twentieth and early twenty-first century. The chapter also surveys related literatures that developed in psychology and psychiatry. Philosophy of psychology (or philosophy of cognitive science) has been a well-established subfield of philosophy of mind since the 1990s and 2000s. This field of philosophy of psychology is narrowly focused on issues in cognitive psychology and cognitive science. Compared (...) to the thriving subfield of philosophy of cognitive science, there has been a lack of corresponding interest among philosophers of science in broader methodological questions about different paradigms and fields of study in psychology. These broader methodological questions about psychology have been addressed in the field of theoretical psychology, which is a subfield of psychology that materialized in the 1980s and 1990s. Philosophy of psychiatry emerged as a subfield of philosophy of science in the mid-2000s. Compared to philosophy of psychology, the philosophy of psychiatry literature in philosophy of science engaged with issues examined in an older and more interdisciplinary tradition of philosophy of psychiatry that developed after the 1960s. The participation of philosophers of science in the literature on theoretical psychology, by contrast, has been limited. (shrink)

This thesis is a philosophical examination of the explanatory roles of diagnoses in psychiatry. In medicine, diagnoses normally serve as causal explanations of patients’ symptoms. Given that psychiatry is a discipline whose practice is shaped by medical traditions, it is often implied that its diagnoses also serve such explanatory functions. This is evident in clinical texts that portray psychiatric diagnoses as referring to diseases that cause symptoms. However, there are problems which cast doubt on whether such portrayals are justified. I (...) address these problems and examine whether psychiatric diagnoses provide explanations of symptoms. The first problem is conceptual. In diagnostic manuals, psychiatric diagnoses are defined by their symptoms. This suggests that invoking them as explanations of the symptoms amounts to circularity. I argue that this can be resolved with an appropriate conceptual framework that captures the complex semantic values of diagnostic terms and their different uses in clinical discourse. I put forward such a framework based on two-dimensional semantics. The second problem is ontological. Empirical research suggests that diagnostic categories in psychiatry do not correspond to invariant causal types, but are associated with variable combinations of diverse causes that interact across biological, psychological, and social levels. Given this heterogeneity, I argue that psychiatric diagnoses fall short of paradigmatic cases of causal explanation, but that some can still provide other sorts of useful causal explanatory information. The original contribution of this thesis is the illumination of the conceptual relations between diagnoses and symptoms. This philosophical work is important, because it can be brought to valuable application in modifying psychiatric practice. (shrink)

Researchers attempting to explain and treat psychiatric disorders have long discussed the need for new disorder categories. A common proposal is to develop a causal classification system whereby psychiatric disorders are classified according to the causal processes that produce and sustain them. I evaluate the prospects for causal classification of psychiatric disorders. First, I motivate the need for a causal classification system of psychiatric disorders. Second, I introduce one framework for causal classification, the exemplar model. Third, I examine multiple forms (...) of causal complexity that the exemplar model must successfully navigate if it is to be a viable classification model for psychiatry. I argue that the exemplar model can handle some issues of causal complexity but not others. I conclude that psychiatry should utilize two models of classification, the exemplar model and the network model, because each fulfills some, but not all, of the purposes of classification systems. (shrink)

This dissertation in Theory of Practical Knowledge contends that depression is a disorder of the self. Using the existential-phenomenology of Maurice Merleau-Ponty, I argue that if we want to disclose the basic structure of depressed experience, then we must likewise disclose how selfexperience is inseparable from depressed experience. However, even though depression is a contemporary psychiatric category of illness, it is nevertheless a historically and heterogenous concept. To make sense of depression in the context of contemporary psychiatric practice, I show (...) that depression has historically been characterized by two broad models of causation; that is, a phenomenon that is causally explained by either a biological dysfunction or a psychological conflict. But this stark characterization is not limited just to history; by conducting qualitative interviews with psychiatric professionals, I illustrate how this causal dichotomy remains prevalent in contemporary psychiatric practice. On one hand, the clinicians report dissatisfaction with the depression diagnostic criteria (i.e. it is impersonal or vague), while on the other hand, the clinicians also recognize that a depression diagnosis is useful insofar as a diagnosis facilitates access to various resources associated with psychiatric care. Consequently, clinicians have developed a coping strategy that is witnessed in their empathetic desire to distance patients from their depression diagnosis, which led to statements such as, “you are not the problem, the problem is depression.” One consequence of this approach is that depression is artificially cleaved from the person who experiences depression, which subsequently means that depression is viewed to be something independent of oneself. Because I argue that depression and the self are mutually implicated, it is crucial to disseminate some of the most influential contemporary models of selfhood. I show that the brainbound, situated, psychological, and narrative model of self, all have respective strengths and weaknesses. But I also go beyond these models and characterize selfhood as a developmental phenomenon that is expressed as an embodied-style. This style reflects the way in which we establish perceptual contact with the otherness, without which there could be no self-experience. (shrink)

The recurring claim that the construct of psychopathy is value laden often is not qualified in enough detail. The chapters in this part of the volume, instead, investigate in depth the role and significance of values in different aspects of the construct of psychopathy. Following these chapters, but also by offering a background to them, we show how certain values are involved in the characterisation of psychopathy, inform societal needs satisfied by this construct, and have a central role in determining (...) whether psychopathy is a mental disorder. Moreover, we relate this description to our criticism of the view that the entrenchment of the notion of psychopathy with values in principle renders it irreconcilable with sound psychiatric theory and practice. However, we also recognize that the value-ladenness of psychopathy leaves open other important challenges. Meeting them needs addressing interdisciplinary interrelated issues that have empirical, normative, and theoretical dimensions. (shrink)

I present two philosophical arguments that Antisocial Personality Disorder (ASPD) and Psychopathy can be expected to be culturally variable. I argue that the ways in which people with ASPD and psychopaths can be expected to act will vary with societal values and culture. In the second part of the chapter, I will briefly review some of the empirical literature on cross-cultural variation in ASPD and psychopathy and argue that it is consistent with my philosophical claims. My conclusion in this chapter (...) is that methods of diagnosis will need to be culturally specific. A diagnostic instrument (such as the PCL-R or DSM) should not be uncritically employed in cultures that are very different from those in which it was initially developed. (shrink)

We examine the philosophical and empirical issues related to the question whether psychopathy can be considered a psychiatric natural kind. Natural kinds refer to categories that are privileged because they the capture certain real divisions in nature. Generally, in philosophical debates regarding psychiatry, there is much scepticism about the possibility that psychiatric categories track natural kinds. We outline the main positions in the debate about natural kinds in psychiatry and examine whether psychopathy can be considered as a natural kind on (...) any of the proposed accounts. By examining the scientific literature on psychopathy, we draw two main conclusions: (1) the empirical data currently do not support the view that this condition is unified enough to be considered a natural kind; (2) the construct of psychopathy plays useful roles both in the context of scientific research and in forensic and clinical settings. These considerations bring us to our tentative conclusion about psychopathy as a kind in the making, a sort of “under construction” category with potential for improvement and refinement with further research. (shrink)

The paper considers whether psychiatric kinds can be natural kinds and concludes that they can. This depends, however, on a particular conception of ‘natural kind’. We briefly describe and reject two standard accounts – what we call the ‘stipulative account’ (according to which apparently a priori criteria, such as the possession of intrinsic essences, are laid down for natural kindhood) and the ‘Kripkean account’ (according to which the natural kinds are just those kinds that obey Kripkean semantics). We then rehearse (...) a more permissive account: Richard Boyd’s ‘homeostatic property cluster’ (HPC) account. We argue that psychiatric kinds can in principle count as natural kinds on the HPC account. Moreover, specific psychiatric kinds (Tourette’s, schizophrenia, etc.) can be natural kinds even if the category psychiatric disorder is not itself a natural kind. (shrink)

The aim of this paper is to analyze, from a philosophical perspective, the scientific robustness of the construct of psychopathy as measured by the Psychopathy Checklist Revised that was developed by Robert Hare (1991; 2003). The scientific robustness and validity of classifications are topics of many debates in philosophy of science and philosophy of psychiatry more specifically. The main problem consists in establishing whether scientific classifications reflect natural kinds where the concept of a natural kind refers to the existence of (...) some objective divisions in nature that do not depend exclusively on subjective judgments of the classifier. The construct of psychopathy is especially interesting since the diagnosis of psychopathy has substantial social consequences. In the light of the recent debates regarding the problem of natural kinds in philosophy of psychiatry, we advocate the following distinction between two types of scientific classifications: natural and practical kinds. Natural kinds refer to those categories that are united by common causal mechanisms or properties. Practical kinds refer to categories that fulfill some practical classificatory goals such as prediction. We argue that the construct of psychopathy can fulfill the role of a practical kind. In addition, we contend that our current scientific knowledge about psychopathy does not allow us to conclude that this category is a natural kind. (shrink)