This “open letter” to Christopher Boorse is a response to his influential naturalist analysis of disease from the perspective of linguistic-analytic value theory. The key linguistic-analytic point against Boorse is that, although defining disease value free, he continue to use the term with clear evaluative connotations. A descriptivist analysis of disease would allow value-free definition consistently with value-laden use: but descriptivism fails when applied to mental disorder because it depends on shared values whereas the values relevant to mental disorders are (...) highly diverse. A part-function analysis, similarly, although initially persuasive for physical disorders, fails with the psychotic mental disorders because these, characteristically, involve disturbances of the rationality of the person as a whole. The difficulties encountered in applying naturalism to mental disorders point, linguistic-analytically, to the possibility that there is, after all, an evaluative element of meaning, deeply hidden but still logically operative, in the concept of disease. (shrink)

In this experimental piece of writing I want to think about the pedagogy of contact and the plight of the hikikomori or social recluse in Japan. I am interested in exploring how the hikikomori practices a kind of contactlessness or what I will call a deadly ipseity of desire. What does it mean to resist contact, to be without contact, to be without desire? What does it mean to risk contact, to risk being tactile with the other, to risk affirming (...) one’s desires? I want to generate a discussion about what has happened to desire, to its promise and possibility and why it is so difficult to anticipate or forecast what is to come. For me the BwO of hikikomori is the ruin of desire, the collapse of desire, a disaster of desire. I am pursuing a line of thought which highlights the loss of the possibility of processual schizophrenic breakthrough and in its place the becoming-autistic of the self, the perilous breakdown of the self. (shrink)

Jonathan Y. Tsou examines and defends positions on central issues in philosophy of psychiatry. The positions defended assume a naturalistic and realist perspective and are framed against skeptical perspectives on biological psychiatry. Issues addressed include the reality of mental disorders; mechanistic and disease explanations of abnormal behavior; definitions of mental disorder; natural and artificial kinds in psychiatry; biological essentialism and the projectability of psychiatric categories; looping effects and the stability of mental disorders; psychiatric classification; and the validity of the DSM's (...) diagnostic categories. The main argument defended by Tsou is that genuine mental disorders are biological kinds with harmful effects. This argument opposes the dogma that mental disorders are necessarily diseases that result from biological dysfunction. Tsou contends that the broader ideal of biological kinds offers a more promising and empirically ascertainable naturalistic standard for assessing the reality of mental disorders and the validity of psychiatric categories. (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)

From 19th century insane asylums to state sponsored eugenic programs in the 20th century, the state has been an incongruous leader and provider of mental health policy and practice. Current practices that include such treatments as confinement, restraints, forced medication and electro-convulsive therapy continue to raise issues of social justice and humane treatment. Since the 1970s a diverse group of consumers of mental health services from political and radical emancipatory movements to consumer and family initiatives have emerged to question, inform (...) and influence federal and state policies and services. Today state administrators and consumer-advocates meet in formal settings in which they exchange ideas as they work to affect and develop mental health policy and practice. However, such exchanges have raised new questions regarding the relationship between these two groups and their ability, in light of past practices to effectively work together to develop mental health policy and practice. The purpose of this study is to compare how state administrators and consumer-advocates perceive mental illness and how these perceptions impact policy and practice. Through a qualitative research study, the researcher compared and contrasted the perceptions of five consumer-advocates and five state administrators who are involved in major mental health policy in a rural state in order to consider how their perceptions of mental health affect policy and treatment. This study shows an emerging relationship between state administrators and consumer-advocates but a relationship that lacks communication and trust as their discourse attempts to span the gap between their two symbolic universes. The focus of consumer-advocates on the importance of their role in battling pervasive stigma and the need for people with lived experience to be central in the mental health system can be seen as an effort to overcome a historical pattern of coercion and abuse of mental health patients by the state. The focus of state administrators to remain relevant in a mental health system in which consumer-advocates challenge the status quo can be seen as their effort to retain legitimacy as well as their historic control over the mental health system. State administrators and consumer-advocates know that they exist in a new, shared world of mental health care and both groups agreed that the relationship between them needs to improve. (shrink)

I use Ian Hacking 's views to explore ways of classifying people, exploiting his distinction between indifferent kinds and interactive kinds, and his accounts of how we 'make up' people. The natural kind/essentialist approach to indifferent kinds is explored in some depth. I relate this to debates in psychiatry about the existence of mental illness, and to educational controversies about the credentials of learner classifications such as 'dyslexic'. Claims about the 'existence' of learning disabilities cannot be given a clear, simple (...) and unambiguous interpretation. In particular I show that science cannot deliver a definitive taxonomy of learner categories, and that this has important implications for teachers and policy makers. (shrink)

It is a matter of some irony that psychiatry's most trenchant critic for over four decades is himself a psychiatrist. I refer to Thomas S. Szasz. Szasz's core thesis may be succinctly rendered: mental illness is a “myth”, a “metaphor” which serves only to obscure the social and ethical “problems in living” we face as human beings. This paper reconsiders the conceptual bases of Szasz's assault on psychiatry and assesses recent counter-arguments of his critical interlocutors. It presents a defence of (...) the Szaszian conception and emphasises the continuing relevance of his earliest work. Additionally, the paper discusses Szasz's thesis in light of the work of the influential French philosopher of medicine, Georges Canguilhem. (shrink)

This report explores the relationship between philosophy and medicine in the U.K. We note that medical training involves very little formal instruction in philosophy and ethics, and that, with few exceptions, philosophers in the U.K. do not contribute to the instruction of physicians or the philosophy of medicine. However, reviewing the problems arising out of recent developments within scientific medicine we find a pressing need for future philosophical analysis in the following areas: psychiatry, organ transplantation, abortion, euthanasia, experiments on living (...) subjects, consent, confidentiality, the relationship between medicine and political authority, and the provisions for social justice in medicine. (shrink)

Diagnostic terms in psychiatry like ‘schizophrenia’ and ‘bipolar disorder’ are deeply contested in the professional community, by mental health activists and the public. In this paper, we provide a theoretical framework for considering diagnostic terms as ordinary linguistic expressions and illustrate this approach by a corpus linguistic analysis of ‘schizophrenia.’ Our aim is to show how a focus on language itself can inform current and future debates about psychiatric terminology and provide new insights on relevant processes concerning their actual usage (...) and change over time. We hope that this contributes to enhancing mutual understanding between different discourse spheres and stakeholders. (shrink)

There has been much debate about whether the concept of disease articulated in Boorse’s biostatistical theory is value-neutral or value-laden. Here, I want to examine whether this debate matters. I suggest that there are two basic respects in which value-ladenness might be important: it could threaten either scientific legitimacy or moral permissibility. I argue that value-ladenness does not threaten the scientific legitimacy of our disease-concept because the concept makes little difference to the formulation and testing of scientific hypotheses. Likewise, even (...) if our disease-concept is value-laden, this does not show it is morally impermissible. To determine its permissibility, we must regard it as a tool to structure social institutions. Seen in that way, whether our disease-concept is morally permissible is a consequentialist matter and depends exquisitely on unanswered empirical questions. (shrink)