Post-Traumatic Stress Disorder is a mental health condition in which the experience of a traumatic event causes a series of psychiatric and behavioral symptoms such as hypervigilance, insomnia, irritability, aggression, constricted affect, and self-destructive behavior. This paper investigates two case studies to argue that the experience of PTSD is not restricted to humans alone; we have good epistemic reason to hold that some animals can experience genuine PTSD, given our current and best clinical understanding of the disorder in humans. I (...) will use this evidence to argue for two claims. First, because the causal structure of PTSD plausibly requires reference to a traumatic conscious experience in order to explain subsequent behaviors, the fact that animals can have PTSD provides new evidence for animal consciousness. Second, the discovery of PTSD in animals puts pressure on accounts which hold that animal behavior can be fully explained without reference to subjective experience. (shrink)

Aims and Methods: The general conceptual issues involved in psychiatric classification seem to be increasingly neglected in contrast to a focus on specific and empirical aspects which appear to have come to dominate the study of classification in the field. This article explores how the psychiatric field (in the UK and US) has chosen to analyse classification over time. Publication trends of articles in both The American Journal of Psychiatry and The British Journal of Psychiatry over a fifty year period (...) (1960-2010) can be viewed as indicators of the levels of interest within the psychiatric field toward classification. In an exploratory analysis, articles explicitly focusing on classification were counted and further sub-divided according to whether they focused on empirical or conceptual aspects and whether they adopted a general perspective or focused on a more specific aspect of classification. Results: Interest in classification was apparent in a minority of published articles (4.7% of all published articles). Interest in conceptual aspects dropped throughout the fifty years and was found to be considerably less than for empirical approaches which steadily increased over time. General papers about classification have been gradually on the decline and have been increasingly outnumbered by more specifically-focused articles. Clinical Implication: Classification, as a foundational endeavour within the psychiatric field, requires increased attention in the literature. This literature should address conceptual as well as empirical issues. (shrink)

, Looping Effects, the Self, Psychopathology.

What was classification as it first took modern form in the eighteenth century, how did it work, and how did it relate to earlier describing and ordering? We offer new answers to these questions by considering an example less well known than that of botany or zoology, namely medicine, and by reconstructing practice on paper. The first and best-known disease classification is the “nosology” of the Montpellier physician François Boissier de Sauvages de Lacroix. Its several editions, we show, were less (...) products than process: published tools for building a classification system. The disorder of a hitherto unstudied notebook that Boissier de Sauvages kept throughout this process provided a way of breaking with the topical order of earlier physicians’ humanistic commonplace books of disease observation while sustaining the paper practices those earlier physicians—and Sauvages himself as a student—had used to order disease. This suggests a different picture of historical change than that of a scholarly world of ordered words giving way to a scientific one of ordered things. Classification, in the case of Sauvages’ nosology, arose through an incomplete break with, and intensified practice of, a past way of ordering the described world. The humanist paper practice that had made observationes, differently applied, now made species. Classification into genera and species by similarity and difference, which Sauvages’ nosology shared with botany, was an algorithm of paper and ink practice—in its operation more machine-like than humanist textual practice yet in its effects more creative and re-creative of categories and questions of relationship. Thus a new empiricism of generalizations arose out of the older, Renaissance empiricism of particulars. (shrink)

Cartwright and Munro argued that extrapolation of findings from randomized controlled trials to other settings can be difficult because information about the underlying causal structure and subgroups is often not available. They advocated the use of ‘capacities’ – that is fixed causal contributions – in predicting effects of interventions. In psychiatry, it is often not possible to determine what the fixed causal contributions are and one can only establish ‘approximate capacities’. However, using ‘approximate capacities’ does imply a different way of (...) evaluating health services, especially combined interventions. In health service research, if different studies, randomized controlled trials or other designs, have given different outcomes, the best way to investigate the effectiveness of a particular way of service organization is not to conduct more randomized controlled trials. It is preferable to study the effects of certain elements of the complex intervention, which have been tested before in other settings, that is investigating ‘approximate capacities’. One should check whether the separate elements do form a part of the complex intervention in practice and whether they have the same effect as in other studies and if not, why not. This enhances knowledge about the underlying causal structure and increases the possibility of extrapolation of the findings. (shrink)

Although clinicians and researchers working in the field of autism are generally not concerned with philosophical categories of kinds, a model for understanding the nature of autism is important for guiding research and clinical practice. Contemporary research in the field of autism is guided by the depiction of autism as a scientific object that can be identified with systematic neuroscientific investigation. This image of autism is compatible with a permissive account of natural kinds: the mechanistic property cluster (MPC) account of (...) natural kinds, recently proposed as the model for understanding psychiatric disorders. Despite the heterogeneity, multicausality and fuzzy boundaries that complicate autism research, a permissive account of natural kinds (MPC kinds) provides prescriptive guidance for the investigation of objective causal mechanisms that should inform nosologists in their attempt to carve autism’s boundaries at its natural joints. However, this essay will argue that a mechanistic model of autism is limited since it disregards the way in which autism relates to ideas about what kind of behavior is abnormal. As historical studies and definitions of autism show, normative issues concerning disability, impairment and societal needs have been and still are inextricably linked to how we recognize and understand autism. The current search for autism’s unity in neurobiological mechanisms ignores the values, social norms and various perspectives on mental pathology that play a significant role in 'the thing called autism’. Autism research needs to engage with these issues in order to achieve more success in the effort to become clinically valuable. (shrink)

The computational approach to psychiatric disorders, including delusions, promises explanation and treatment. Here, we argue that an information processing approach might be misleading to understand psychopathology and requires further refinement. We explore the claim of computational psychiatry being a bridge between phenomenology and physiology while focussing on the ontological commitments and corresponding methodology computational psychiatry is based on. Interconnecting ontological claims and methodological practices, the paper illustrates the structure of theory-building and testing in computational psychiatry.First, we will explain the ontological (...) commitments computational psychiatry is grounded in, theBayesian Brain hypothesis(BBH) of unconscious inference, paired with normative deontic approaches applied to gauge psychopathology. We then turn to the steps taken in empirical paradigms, from definitions, which are used as starting points, to the operationalisation and isolation of cognitive processes and hypothesis testing based on algorithmic models, to consecutive interpretations regarding the aetiology of psychiatric disorders. We outline how experimental paradigms in computational psychiatry are specifically designed to confirm aberrations in assumed inferential processes, which are thought of as being the underlyingcore invariant features.We will illustrate a gap between the ontological commitments of computational psychiatry and the operationalisation and testing of the cognition assumed to be relevant for psychopathology. This conceptual gap is of utmost importance when designing computational paradigms and may impede a crisp understanding of the approach. Lastly, in evaluating the conceptual gap, it becomes apparent that the information processing formalism used in computational psychiatry is still grounded in rational cognitive psychology. (shrink)

Personality disorders: illegitimate subject positions The diagnosis of personality disorder is common in mental health nurse settings and is a term often used without critical consideration. In clinical practice, the term personality disorder has pejorative connotations, which arise out of the way in which these behaviours are constructed as behavioural rather than psychiatric. The discursive construction of categories of personality disorder are inculcated into clinical practice and become taken‐for‐granted by those in practice culture. The construction of some personalities as disordered (...) and, therefore, illegitimate becomes natural. This paper provides a critical analysis of the diagnosis and suggests an approach to mental health nursing care that is more legitimising for those people who receive psychiatric diagnoses. (shrink)

This paper aims to show that the classification by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders of a distinct listing of disorders known as Culture-Bound Syndromes is misguided. I argue that the list of CBS comprises either genuine disorders that should be included within the main body of the DSM; or ersatz-disorders that serve a practical role for psychiatrists dealing with patients from certain cultures but will one day be eliminated or assimilated by bona (...) fide DSM classifications. In support of these views I draw on claims from two key themes in the philosophy of science: the claim that all folk explanations for phenomena are thoroughly theoretical and therefore fallible; and the occurrence of theoretical elimination in the history of science. I contend that any ersatz-disorders located in the DSM that are judged to be radically false do not differ in kind from eliminated theories in the history of pre-science. (shrink)

This study brings together socio-theoretical and ethnographic approaches to psychiatry, demonstrating the role of the clinic as a major consolidator of ideologies as well as the site where personal miseries are registered as markers of social failure. It focuses on innovation in psychiatric taxonomies, changes in the figurative language of the emotions, changes in conceptualizations of the self and how all of these relate to changing socio-economic events and circumstances.

La psiquiatría a lo largo de su historia y fundamentalmente desde la publicación del DSM-5, enfrenta diversas críticas por la falta de confiabilidad y validez en las clasificaciones de los trastornos mentales, esto debido a su incapacidad para integrar adecuadamente el conocimiento científico y la complejidad de las experiencias individuales. Este análisis, inspirado en la filosofía de Hegel, propone una nueva perspectiva que valora cada caso clínico como una entidad única, desafiando el enfoque reduccionista y promoviendo un entendimiento más profundo (...) y respetuoso de la psicopatología, enriquecido con una integración dialéctica del conocimiento científico y el concepto del universal concreto. (shrink)

The subject of this paper is the problematisation of depression in today’s mental health care. It is based on a study of the professional discussion on depression in Finland from the mid-1980s to the 1990s. The ways in which Finnish mental health experts define the object of depression treatment bring out an ambivalence that stems from the discrepancy between two parallel but incongruent notions of what depression is: the psychopharmacological and the psychotherapeutic. The analysis of the discussion demonstrates how clinical (...) and practical rationales of today’s mental health care are formed in the space between the two poles. Two tendencies of these rationales are also pointed out: first, the DSM paradigm of depressive illness inclines to become problematic and to dissolve in the actual practices. Second, they insinuate emphasis on antidepressant medication and overall neuropsychiatric approach in the treatment of depressive disorders, although in an ambivalent way. (shrink)

In current mental health care psychiatric conditions are defined as compilations of symptoms. These symptom-based disease categories have been severely criticised as contingent and boundless, facilitating the rise to epidemic proportions of such conditions as depression. In this article we look beyond symptoms and stress the role of epidemiology in explaining the current situation. By analysing the parallel development of cardiovascular disease and depression management in Finland, we argue, firstly, that current mental health care shares with the medicine of chronic (...) somatic conditions an attachment to risk factor epidemiology, which accentuates risk and prevention in disease management. However, secondly, due to the symptom-based definitions of psychiatric conditions, depression management cannot differentiate properly between symptoms, signs and risk factors such as, for example, cardiovascular medicine, but treats symptoms as signs or risk factors in contexts of treatment and prevention. Consequently, minor at-risk conditions have become difficult to separate from proper cases of depression. (shrink)

Posttraumatic stress disorder is a debilitating condition that results from the experience of a traumatic event. Natural kinds are mind-independent entities found in nature and are the objects of scientific inquiry. It is common to deny that PTSD is a natural kind, but extant denials assume a thesis of natural kinds that can be called “essentialism”. According to essentialism, many entities are not natural kinds that one would expect should be natural kinds. The homeostatic cluster view of natural kinds offers (...) an alternative that accommodates these cases, including, superficially, the claim that PTSD is a natural kind. I introduce two novel objections to this claim and recommend a distinction aimed to resolve the newly introduced problems. (shrink)

This study brings together socio-theoretical and ethnographic approaches to psychiatry, demonstrating the role of the clinic as a major consolidator of ideologies as well as the site where personal miseries are registered as markers of social failure. It focuses on innovation in psychiatric taxonomies, changes in the figurative language of the emotions, changes in conceptualizations of the self and how all of these relate to changing socio-economic events and circumstances.