This dissertation seeks to examine the validity of the justification commonly offered for a coercive (1) psychiatric intervention, namely that the intervention was in the ‘best interests’ of the subject and/or that the subject posed a danger to others. As a first step,it was decided to analyse justifications based on ‘best interests’ [the ‘Stage 1’ argument] separately from those based on dangerousness [the ‘Stage 2’ argument]. Justifications based on both were the focus of the ‘Stage 3’ argument. Legal and philosophical (...) analyses of coercive psychiatric interventions generally regard such interventions as embodying a benign paternalism occasioning slight, if any, ethical concern. Whilst there are some dissenting voices even at the very heart of academic and professional psychiatry, the majority of psychiatrists also appear to share such views. The aim of this dissertation is to show that such a perspective is mistaken and that such interventions raise philosophical and ethical questions of the profoundest importance.(2) The philosophical well-spring of the Stage 1 dissertation argument lay in an observation made by Philippa Foot (3) that the “… right to be let free from unwanted interference” is one of the most fundamental and distinctive rights of persons, a right which takes precedence over any “… action we would dearly like to take for his sake.” This – in conjunction with the recognition that some coercive psychiatric interventions are of a gravity as to result in the personhood of the subject being severely damaged if not destroyed – suggested that the concept of personhood play a central role in the formulation of the dissertation argument. For ease of analysis it was presumed that the term ‘person’ could be defined by a set of necessary and sufficient conditions of which ‘minimum levels of rationality’ and ‘ability to communicate’ were the only conditions relevant to the formulation of justifications for coercive psychiatric interventions. This presumption was explicated into a number of postulates which enabled the construction of a rigorous foundation on which to develop the dissertation argument. This argument then sought to determine whether psychiatric assessments of irrationality were accurate and reliable. In furtherance of this analysis it was necessary to examine the reliability of psychiatric determinations in other areas of claimed expertise namely diagnosis, treatment and assessment of dangerousness. This ‘crossing of the disciplinary threshold’ brought to light the dearth of studies on psychiatric misdiagnosis and iatrogenic harm. A variant of the Precautionary Principle was developed to enable the extent of such harms to be estimated. The not insignificant levels of psychiatric misdiagnosis and iatrogenic harm and erroneous assessments of dangerousness which were thus found are of considerable relevance to any ethical analysis of the justification for coercive psychiatric intervention and serve to undermine simple paternalistic justifications. --- (1)The term ‘coercive’ (rather than ‘non-consensual’) is used to indicate an intervention carried out against the explicit and contemporaneous objections of the subject (2)Not least because the number of individuals detained in Irish psychiatric hospitals is of a comparable order of magnitude to the number detained in Irish prisons subsequent to a criminal conviction (3)See Foot (1977), p.102. (shrink)

Starting with the reference to “Plato’s dictum” that Freud added in the second last page of the first edition of The Interpretation of Dreams, the author explains the convergences between the conception of dreams expounded by Plato in the Republic and Freud’s fundamental insights. The analysis of bibliographic sources used by Freud, and of his interests, allow than to suppose not only that Freud omitted to acknowledge the Plato’s theoretical genealogy of “the Via Regia to the unconscious”, but also the (...) possibility that the Republic constituted a tacit source of inspiration for the composition of The Interpretations of dreams. -/- Muovendo dal richiamo al «detto di Platone» inserito nella penultima pagina della prima edizione de "L’interpretazione dei sogni" di Freud (1899), vengono preliminarmente esposte le convergenze tra la concezione del sogno di Platone esposta ne "La Repubblica" e le intuizioni poste alla base dell’edificio freudiano. Alla luce delle fonti testuali citate e utilizzate da Freud, e dei suoi interessi, viene poi avanzata l’ipotesi che egli non soltanto abbia omesso di riconoscere la genealogia teoretica platonica della «via regia che porta alla conoscenza dell’inconscio» (p. 282), ma che l’antico dialogo abbia potuto rappresentare una fonte tacita di ispirazione per la composizione de "L’interpretazione dei sogni". (shrink)

Understood in their historical context, current debates about psychiatric classification, prompted by the publication of the DSM-5, open up new opportunities for improved translational research in psychiatry. In this paper, we draw lessons for translational research from three time slices of 20th century psychiatry. From the first time slice, 1913 and the publication of Jaspers’ General Psychopathology, the lesson is that translational research in psychiatry requires a pluralistic approach encompassing equally the sciences of mind (including the social sciences) and of (...) brain. From the second time slice, 1953 and a conference in New York from which our present symptom-based classifications are derived, the lesson is that, while reliability remains the basis of psychiatry as an observational science, validity too is essential to effective translation. From the third time slice, 1997 and a conference on psychiatric classification in Dallas that brought together patients and carers with researchers and clinicians, the lesson is that we need to build further on collaborative models of research combining expertise-by-training with expertise-by-experience. This is important if we are to meet the specific challenges to translation presented by the complexity of the concept of mental disorder, particularly as reflected in the diversity of desired treatment outcomes. Taken together, these three lessons – a pluralistic approach, reliability and validity, and closer collaboration – provide an emerging framework for more effective translation of research into practice in 21st century psychiatry. (shrink)

I argue that Plato holds a medical model of virtue as health which does not have themorally unacceptable implications which have led some to describe it as authoritarian.This model, which draws on the educational virtues of the elenchos, lacks anyimplication that all criminals are mad or all mad people criminals – this implication beingat the source of many criticisms of Plato’s analogy of virtue and health. After setting upthe analogy and the model, I defend my argument against two objections. The (...) firstclaims that Plato's picture of virtue as health is unacceptable because it entails that vice isa defect and therefore that criminals are all mad. The second resists Kenny'sinterpretation but does so by attacking its first premise, i.e. that Plato believes virtue issome kind of health. I reply that both objections are misguided. (shrink)

Simon Evnine examines various epistemic aspects of what it is to be a person. Persons are defined as finite beings that have beliefs, including second-order beliefs about their own and others' beliefs, and are agents, capable of making long-term plans. It is argued that for any being meeting these conditions, a number of epistemic consequences obtain. First, all such beings must have certain logical concepts and be able to use them in certain ways. Secondly, there are at least two principles (...) governing belief that it is rational for persons to satisfy and are such that nothing can be a person at all unless it satisfies them to a large extent. These principles are that one believe the conjunction of one's beliefs and that one treat one's future beliefs as, by and large, better than one's current beliefs. Thirdly, persons both occupy epistemic points of view on the world and show up within those views. This makes it impossible for them to be completely objective about their own beliefs. Ideals of rationality that require such objectivity, while not necessarily wrong, are intrinsically problematic for persons. This "aspectual dualism" is characteristic of treatments of persons in the Kantian tradition. In sum, these epistemic consequences support a traditional view of the nature of persons, one in opposition to much recent theorizing. (shrink)