A significant portion of the scholarship in analytic philosophy of psychiatry has been devoted to the problem of what kind of kind psychiatric disorders are. Efforts have included descriptive projects, which aim to identify what psychiatrists in fact refer to when they diagnose, and prescriptive ones, which argue over that to which diagnostic categories should refer. In other words, philosophers have occupied themselves with what I call “diagnostic kinds”. However, the pride of place traditionally given to diagnostic kinds in psychiatric (...) research has recently come under attack, most notably by a recent initiative of the National Institute of Mental Health, the Research Domain Criteria Project, that seeks to exclude diagnostic categories from experimental designs and focus on other sorts of psychiatric kinds. I argue that philosophical accounts privileging diagnostic kinds must respond to this new line of criticism, and conclude that philosophers need to either counter psychiatrists’ growing suspicion about the hegemony of diagnostic categories in the clinic and the laboratory, or join in redirecting their efforts toward the development of robust accounts of other sorts of psychiatric objects and processes. (shrink)

This paper addresses philosophical issues concerning whether mental disorders are natural kinds and how the DSM should classify mental disorders. I argue that some mental disorders (e.g., schizophrenia, depression) are natural kinds in the sense that they are natural classes constituted by a set of stable biological mechanisms. I subsequently argue that a theoretical and causal approach to classification would provide a superior method for classifying natural kinds than the purely descriptive approach adopted by the DSM since DSM-III. My argument (...) suggests that the DSM should classify natural kinds in order to provide predictively useful (i.e., projectable) diagnostic categories and that a causal approach to classification would provide a more promising method for formulating valid diagnostic categories. (shrink)

Contemporary psychiatry finds itself in the midst of a crisis of classification. The developments begun in the 1980s—with the third edition of the Diagnostic and Statistical Manual of Mental Disorders —successfully increased inter-rater reliability. However, these developments have done little to increase the predictive validity of our categories of disorder. A diagnosis based on DSM categories and criteria often fails to accurately anticipate course of illness or treatment response. In addition, there is little evidence that the DSM categories link up (...) with genetic findings, and even less evidence that they... (shrink)

Causal selection has to do with the distinction we make between background conditions and “the” true cause or causes of some outcome of interest. A longstanding consensus in philosophy views causal selection as lacking any objective rationale and as guided, instead, by arbitrary, pragmatic, and non-scientific considerations. I argue against this position in the context of causal selection for disease traits. In this domain, causes are selected on the basis of the type of causal control they exhibit over a disease (...) of interest. My analysis clarifies the principled rationale that guides this selection and how it involves both pragmatic and objective considerations, which have been overlooked in the extant literature. (shrink)

Recent trends in psychiatry involve a transition from categorical to dimensional frameworks, in which the boundary between health and pathology is understood as a difference in degree rather than as a difference in kind. A major tenet of dimensional approaches is that no qualitative distinction can be made between health and pathology. As a consequence, these approaches tend to characterize such a threshold as pragmatic or conventional in nature. However, dimensional approaches to psychopathology raise several epistemological and ontological issues. First, (...) we review major sources of evidence usually recruited in support of the dimensional trend (focusing on clinical observation and biological data), and we show that these are connected to different conceptualizations of how dimensional traits extend across health and pathology. Second, we criticize two unquestioned assumptions that stand at the core of the dimensional trend: a) that there is continuity from health to pathology at the symptomatic level; b) that such continuity reflects an underlying continuity in the genetic liability for pathological conditions. Third, we argue against the idea of a conventional threshold by showing that such a view implies a linear relationship between the genotype and the phenotype. Fourth, drawing on epigenetics and developmental biology, we offer a characterization of mental disorders as stable and dynamic constellations of multi-level variables that differ qualitatively from ‘healthy states’. We conclude by showing that our account has several theoretical advantages over both categorical and dimensional approaches. Notably, it provides crucial insights into psychological development over time and individual differences, with major implications in terms of intervention and clinical decision-making. (shrink)

The model of human intelligence that is most widely adopted derives from psychometrics and behavioral genetics. This standard approach conceives intelligence as a general cognitive ability that is genetically highly heritable and describable using quantitative traits analysis. The paper analyzes intelligence within the debate on natural kinds and contends that the general intelligence conceptualization does not carve psychological nature at its joints. Moreover, I argue that this model assumes an essentialist perspective. As an alternative, I consider an HPC theory of (...) intelligence and evaluate how it deals with essentialism and with intuitions coming from cognitive science. Finally, I highlight some concerns about the HPC model as well, and conclude by suggesting that it is unnecessary to treat intelligence as a kind in any sense. (shrink)

Recent attempts to reconcile the ontic and epistemic approaches to explanation propose that our best explanations simply fulfill epistemic and ontic norms simultaneously. I aim to upset this armistice. Epistemic norms of attaining general and systematic explanations are, I argue, autonomous of ontic norms: they cannot be fulfilled simultaneously or in simple conjunction with ontic norms, and plausibly have priority over them. One result is that central arguments put forth by ontic theorists against epistemic theorists are revealed as not only (...) question-begging, but ultimately self-defeating. Another result is that a more nuanced reconciliation of the epistemic and ontic views is required: we should regard good explanatory practice as a dynamic process with distinct phases of epistemic and ontic success. (shrink)

This chapter examines philosophical issues surrounding the classification of mental disorders by the Diagnostic and Statistical Manual of Mental Disorders (DSM). In particular, the chapter focuses on issues concerning the relative merits of descriptive versus theoretical approaches to psychiatric classification and whether the DSM should classify natural kinds. These issues are presented with reference to the history of the DSM, which has been published regularly by the American Psychiatric Association since 1952 and is currently in its fifth edition. While the (...) first two editions of the DSM adopted a theoretical (psychoanalytic) and etiological approach to classification, subsequent editions of the DSM have adopted an atheoretical and purely descriptive (“neo-Kraepelinian”) approach. It is argued that largest problem with the DSM at present—viz., its failure to provide valid diagnostic categories—is directly related to the purely descriptive methodology championed by the DSM since the third edition of the DSM. In light of this problem, the chapter discusses the prospects of a theoretical and causal approach to psychiatric classification and critically examines the assumption that the DSM should classify natural kinds. (shrink)

Psychiatric classification is highly controversial, as could be witnessed again with the latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM). These controversies comprise multiple kinds of critiques by a variety of actors. It is unlikely that all these issues will be overcome by one perfect solution in the future. Rather, it is precisely the DSM’s “one-size-fits-all-approach” that lies at the root of many of the current problems. To restore the scientific and public credibility of psychiatric classification, (...) a multi-dimensional pluralist response is thus needed: (1) theoretical pluralism, meaning a promotion of different research projects and heuristic strategies, (2) taxonomic pluralism, which allows for different classifications used in research versus clinical practice, and (3) participatory pluralism, which concerns the diversity of perspectives and stakeholders in DSM-revisions. (shrink)

Scientists represent their world, grouping and organizing phenomena into classes by means of concepts. Philosophers of science have historically been interested in the nature of these concepts, the criteria that inform their application and the nature of the kinds that the concepts individuate. They also have sought to understand whether and how different systems of classification are related and more recently, how investigative practices shape conceptual development and change. Our aim in this paper is to provide a critical overview of (...) some of the key developments in this philosophical literature and identify some interesting issues it raises about the prospects of the so-called “special sciences”, including psychiatry, psychology, and the mind-brain sciences more generally, to discover natural kinds. (shrink)

As an alternative to linear and unidimensional perspectives focused mainly on either organic or psychological processes, the enactive approach to life and mind—a branch of 4-E cognitive theories—offers an integrative framework to study mental disorders that encompasses and articulates organic, sensorimotor, and intersubjective dimensions of embodiment. These three domains are deeply entangled in a non-trivial manner. A question remains on how this systemic and multi-dimensional approach may be applied to our understanding of mental disorders and symptomatic behavior. Drawing on Gilbert (...) Simondon’s philosophy of individuation, we provide some enactive conceptual tools to better understand the dynamic, interactive, and multi-dimensional nature of human bodies in mental disorders and psychopathological symptoms. One of such tools cursiva is sense-making, a key notion that captures the relational process of generating meaning by interacting with the sociomaterial environment. The article analyzes five aspects related to sense-making: temporality, adaptivity, the multiplicity of normativities it involves, the fundamental role of tension, and its participatory character. On this basis, we draw certain implications for our understanding of mental disorders and diverse symptoms, and suggest their interpretation in terms of difficulties to transform tensions and perform individuation processes, which result in a reduction of the field of potentialities for self-individuation and sense-making. (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)

Can scientific evidence prompt us to revise philosophical theories or folk theoretical accounts of phenomena of the mind? We will argue that it can—but only under the condition that they make a so-called ‘ontological commitment’ to something that is actually subject to empirical inquiry. In other words, scientific evidence pertaining to neuroanatomical structure or causal processes only has a refuting effect if philosophical theories and folk notions subscribe to either account. We will illustrate the importance of ‘ontological commitment’ with the (...) ‘neuroanatomical approach’ to amusement as proposed in a recent paper by Palencik :419–434, 2007). We will show that the scientific evidence presented in said neuroanatomical approach has no bearing on the conceptual issues, in that the philosophical theories and folk distinction that are criticized do not subscribe to any account of the underlying neuroanatomical structure or causal processes. Our suggestions in this paper are not limited to philosophical accounts of humor but apply to the relationship of philosophy, common sense and science in general. (shrink)

Mental disorder (earlier entitled “illness” or “disease”) is ascribed to deviations from normal thoughts, reasoning, feelings, attitudes, and actions that are considered socially or personally dysfunctional and apt for treatment. Schizophrenia, depression, and bipolar disorder are core examples. The concept of mental disorder plays a role in many domains, including medicine, social sciences such as psychology and anthropology, and the humanities, including literature and philosophy. Philosophical discussions are the primary focus of the present entry, which differs from the entry on (...) Philosophy of Psychiatry in noting several different approaches—not only those of the philosophy of science and mind, but also those arising from phenomenology and social theory. -/- Mental disorder is a widely contested concept and there are longstanding debates on whether disorders are biological or social in nature. Even uncontroversial disorders, such as those listed above, were not always regarded as disorders in the past (Porter 2002). Moreover, the status of mental disorder has frequently indicated ethical, as much as other deficiency (Irwin 2013). Such reminders direct our attention to contemporary medical psychiatry’s sometimes uncompromisingly neurobiological, and avowedly value-free “medical model”, with its incumbent analogies and assumptions, and to the general question of how the taxa of psychiatric classifications are to be viewed as objects of natural science. This model has received intensive philosophical scrutiny, including arguments that deny these conditions are deficiencies at all. Along with issues arising from cognitive psychology and the neurosciences, such foundational matters make up much of the following entry. Because of their focus on issues central to the philosophy of mind and ethics (e.g., the mind-body problem, moral responsibility, agency and identity), analyses of mental disorder have extensive implications for those fields. As clinical phenomena, they also reflect an inescapable, everyday, social reality, giving theoretical inquiries additionally urgent practical, moral, and legal implications. (shrink)

This dissertation is a contribution to the contemporary field of phenomenological psychopathology, or the phenomenological study of psychiatric disorders. The work proceeds with two major aims. The first is to show how a phenomenological approach can clarify and illuminate the nature of psychopathology—specifically those conditions typically labeled as major depressive disorder and bipolar disorder. The second is to show how engaging with psychopathological conditions can challenge and undermine many phenomenological presuppositions, especially phenomenology’s status as a transcendental philosophy and its corresponding (...) anti-naturalistic outlook. In the opening chapter, I articulate the three layers of the subject matter of phenomenological research—what I refer to as “existentials,” “modes,” and “prejudices.” As I argue, while each layer contributes to what we might call the “structure” of human existence, they do not do so in the same way, or to the same degree. Because phenomenological psychopathology—and applied phenomenology in general—aims to characterize how the structure of human existence can change and alter, it is paramount that these layers be adequately delineated and defined before investigating these changes. In chapters two through five, I conduct hermeneutic and phenomenological investigations of psychopathological phenomena typically labeled as major depressive disorder or bipolar disorder. These investigations address the affective aspects of depression and mania, and the embodied aspects of depression. In addition to clearly articulating the nature of these phenomena, I show how certain psychopathological conditions involve changes in the deepest or most fundamental layer of human existence—what I refer to as existentials. As I argue, many of the classical phenomenologists (including Husserl and Heidegger) believed that these structural features were necessary, unchanging, and universal. However, this presupposition is challenged through the examination of psychopathological and neuropathological conditions, undermining the status of phenomenology as a transcendental philosophy. While this challenge to classical phenomenology is only sketched in the early chapters, in chapters six and seven I develop it in more detail in order to achieve two distinct ends. In chapter six I argue that psychopathology and neuropathology not only challenge phenomenology’s status as a transcendental philosophy, but also supply a key to developing a phenomenological naturalism (which I contrast with a naturalized phenomenology). Phenomenological naturalism, as I articulate it, is a position in which phenomenology is not subsumed by the metaphysical and methodological framework of the natural sciences, but nonetheless maintains the capacity to investigate how the natural world stands independent of human subjectivity (and how events in the natural world can bring about changes in the most fundamental structures of human existence). In the seventh chapter I argue that a phenomenology in which existentials are contingent and variable rather than necessary and unchanging allows phenomenologists to contribute to new dimensional approaches to psychiatric classification. Rather than begin from distinct categories of disorder, these approaches begin from distinct core features of human existence. These features, referred to as either dimensions or constructs, can vary in degree and are studied in both normal and pathological forms. (shrink)

Are mental disorders natural kinds or socially constructed categories? What is at stake if either of these views prove to be true? This paper offers a qualified defence for the view that there may be natural kinds of mental disorder, but also that the implications of this claim are generally overestimated. Especially concerns about over-inclusiveness of diagnostic categories and medicalisation of abnormal behaviour are not addressed by the debate. To arrive at these conclusions the paper opens with a discussion of (...) kind formation in science, followed by an analysis of natural kinds. Seven principled and empirically informed objections to the possibility of natural kinds of mental disorder are considered and rejected. The paper ends with a reflection on diagnostics of mental health problems that don’t fall into natural kinds. Despite the defence of the possibility of natural kinds of mental disorder, this is likely to be the majority of cases. (shrink)

In this paper, we want to take a critical stance towards Tsou’s recent proposal that a neuro-oriented version of the homeostatic property cluster kind model (MPCK) should be an ideal for the DSM. Our strategy will be to discuss the creation of the Social Pragmatic Communication Disorder (SPCD) in DSM-5 to show the limits of MPCK as an ideal for the next DSM deliberations over a set of diagnoses revisions. We argue that an ideal model for the DSM should address (...) the issues of deep uncertainties and pragmatic considerations to be useful in this context. (shrink)

Die forensische Psychiatrie und insbesondere ihr klinischer Bereich, der Maßregelvollzug, sind im Hinblick auf Forschung noch weitgehend eine terra incognita. Steigende Unterbringungszahlen und Gesetzesreformen belasten die klinische Arbeit des Maßregelvollzugs. Zugleich hat der Fall Mollath Fragen an der Zuverlässigkeit forensisch-psychiatrischer Prognosen aufgeworfen. Gerade im zentralen Arbeitsbereich der Kriminal- und Gefährlichkeitsprognose fehlen epidemiologische und Verlaufsdaten. Auch zur Effizienz der Therapieprogramme und der Frage, welche Maßnahmen letztlich zu einer Verbesserung der Prognose bei Maßregelvollzugspatienten führen, gibt es keine einheitlichen Daten. Vor dem Hintergrund (...) des Doppelmandates der Besserung und Sicherung und des Anspruchs der Gesellschaft, vor gefährlichen, psychisch kranken Straftätern geschützt zu werden, ist es sowohl fachlich wie ethisch geboten, über die Frage der Effizienz der forensisch-psychiatrischen Arbeit zu forschen. Hiermit will sich die vorliegende Arbeit auseinandersetzen und die fachlichen sowie ethischen Aspekte diskutieren. Ansätze aus der Sozialethik können hier Argumente für eine ethisch verantwortbare Forschung auf diesem Gebiet liefern. (shrink)

Se le llama ‘psiquiatría biológica’ a la vertiente de la investigación psiquiátrica que busca establecer asociaciones estables entre condiciones psiquiátricas y factores biológicos específicos. La búsqueda de tales asociaciones está motivada por lo que llamo el “compromiso causal” de la psiquiatría biológica, que es la presunción de que factores biológicos específicos son las causas principales de las condiciones psiquiátricas. En este artículo argüiré que dicho compromiso es una presunción implausible sobre esas condiciones, pues la mejor evidencia psiquiátrico-biológica disponible no lo (...) respalda y es dudoso que la evidencia futura lo hará. (shrink)

This thesis explores the use of the concept 'realization' in the philosophy of mind. The primary focus is on the role realization plays in assessing or opposing identity theory. The history of the use of the concept of realization in the philosophy of mind is reviewed, and from that a set of desiderata to be used for assessing accounts of realization is extracted. The desiderata are applied to a sample account of realization proposed by Sydney Shoemaker. (2007) Next the application (...) of 'realization' in contemporary contexts is considered, focusing on the idea that mental kinds are, potentially, multiply realized. Based on interpretations of results from research in the relevant sciences this thesis considers two kinds of strategies used to object to multiple realization, (1) arguments against the concept of multiple realization: the Grain Argument (Bechtel and Mundale 1999), and Shapiro's Dilemma (Shapiro 2000), and (2) defeaters for alleged cases/examples of multiple realization proposed by Lawrence Shapiro and Thomas Polger: unification, individual differences, kind splitting, and abstraction and idealization. (Polger and Shapiro 2016) The thesis argues that, ultimately, these arguments hinge on the claim that there is no empirical evidence of multiply realized mental kinds. In response to this claim, the fourth chapter presents novel examples of multiple realization drawn from research in the cognitive neuroscience of language. There are three aspects from the study of language that are presented as examples of multiple realization: (1) language lateralization, (2) reading acquisition, and (3) second/multi- language learning. The analysis of these case studies applies Shoemaker's account of realization as a framework for describing the empirical data as cases of multiple realization. Objections to, and defeaters for, these cases are considered and rejected. The thesis concludes by raising the possibility that mental kinds are realized by mechanisms. This proposal involves drawing connections between traditional questions/views from the philosophy of mind with a current research program from the philosophy of science; the view is particularly important in the philosophy of neuroscience and the philosophy of biology, known as 'new mechanism'. (shrink)

In recent years both philosophers and scientists have asked whether or not our current kinds of mental disorder—e.g., schizophrenia, depression, bipolar disorder—are natural kinds; and, moreover, whether or not the search for natural kinds of mental disorder is a realistic desideratum for psychiatry. In this dissertation I clarify the sense in which a kind can be said to be “natural” or “real” and argue that, despite a few notable exceptions, kinds of mental disorder cannot be considered natural kinds. Furthermore, I (...) contend that psychopathological phenomena do not cluster together into kinds in the way that paradigmatic natural kinds (e.g., chemical kinds and species) do; and, in light of this fact, I conclude that the normative ideal of natural classification—i.e. classifying real or natural kinds—is not appropriate as a general strategy for psychiatry. In the conclusion to this dissertation I propose an alternative way forward. Rather than assuming a priori that psychopathological phenomena cluster together into kinds, a more tractable and theoretically promising approach would be to first explain how particular kinds of experiences and behaviours—e.g, hallucinations, delusions, disorganized thinking, mania, low mood, etc.—are produced. (shrink)