This issue of The Journal of Medicine and Philosophy assesses the deep and abiding tensions that exist among the competing epistemic perspectives that bear on medicine and morality. Concepts of health and disease, as well as the theoretical framing of medical ethics and health care policy, intersect with an overlapping set of culturally situated communities, striving to understand and manipulate the world in ways that each finds explanatory, appropriate, or otherwise befitting. The articles explore the complexities of framing public health (...) care policy to guide bioethical decision making in the face of the plurality of ethical viewpoints and moral rationalities—including health enhancing supplements, continuous sedation until death, medical futility, the protection of vulnerable populations, and competing professional obligations. (shrink)

BRADLEY SK and CARTER B. Nursing Inquiry 2011; 18: 303–312 Deconstructing child and adolescent mental health: questioning the ‘taken‐for‐granted’…We present a critical deconstructive reading, seeking to problematise ‘taken‐for‐granted’ assumptions in child and adolescent mental health (CAMH). The start point for this critical reading is conventional ‘history‐telling’ within CAMH. The aim is not to take issue with the detail in such histories but to critically examine the texts, so as to highlight constructions that structure the presentation of conventional histories and possible (...) purposes that such constructions may serve. The argument is that such conventional histories leave key questions not just unanswered, but unconsidered – a tendency that can be seen throughout the CAMH literature more generally. Therefore, we then pursue critical discussion of how ‘taken‐for‐granted’ constructions of CAMH enabled psychiatry to successfully expand its power and influence to establish hegemony over ‘problem children’. We do not claim any closure to this critical reading; that is, we do not claim that our critical deconstructive reading is the only reading possible. Similarly, it is not presented in any sense as ‘final word’. Rather our hope for this work is that it might stimulate readers to question the ‘taken‐for‐granteds’ that we present, and indeed others that they might identify themselves. In so doing, it is our hope that creative dialogue might ensue. (shrink)

This paper argues that the medical conception of health as absence of disease is a value-free theoretical notion. Its main elements are biological function and statistical normality, in contrast to various other ideas prominent in the literature on health. Apart from universal environmental injuries, diseases are internal states that depress a functional ability below species-typical levels. Health as freedom from disease is then statistical normality of function, i.e., the ability to perform all typical physiological functions with at least typical efficiency. (...) This conception of health is as value-free as statements of biological function. The view that health is essentially value-laden, held by most writers on the topic, seems to have one of two sources: an assumption that health judgments must be practical judgments about the treatment of patients, or a commitment to "positive" health beyond the absence of disease. I suggest that the assumption is mistaken, the commitment possibly misdescribed. (shrink)

Abstract This paper explores gender and mental health with particular reference to the emerging philosophical field of critical realism. This philosophy suggests a shared ontology and epistemology for the natural and social sciences. Until recently, most of the debate surrounding gender and mental health has been guided either implicitly or explicitly within a positivist or constructivist philosophy. With this in mind, key areas of critical realism are explored in relation to gender and mental health, and contrasted with the positions of (...) positivism and constructivism. It is argued that critical realism offers an alternative philosophical framework for the exploration of gender issues within mental health care. (shrink)

It is proposed that happiness be classified as a psychiatric disorder and be included in future editions of the major diagnostic manuals under the new name: major affective disorder, pleasant type. In a review of the relevant literature it is shown that happiness is statistically abnormal, consists of a discrete cluster of symptoms, is associated with a range of cognitive abnormalities, and probably reflects the abnormal functioning of the central nervous system. One possible objection to this proposal remains--that happiness is (...) not negatively valued. However, this objection is dismissed as scientifically irrelevant. (shrink)

As nursing moves towards a holistic approach to care, its publications on sexuality have proliferated. 'Sexuality' and 'Gender' are concepts which are extremely difficult to define. While sex refers to the physical differences of the body, gender concerns the psychological and sociocultural differences between females and males. This distinction between sex and gender is fundamental, since many differences between females and males are not biological in origin. And, when a person's gender and sex fall together in accordance with social norms, (...) it may not necessarily be a similar correlation for every individual. The nature of these similarities is essentially threefold. First, Thomas, Savage and Webb accept that there should be a nursing definition of sexuality. In different ways they acknowledge and refer to it as an integral part of a person's being and self concept. Secondly, the authors underline some of the complexities and difficulties nurses have defining and dealing with it in professional relationships as well as on the level of self reflection, knowledge, attitudes and beliefs. Thirdly, all three surveys show why such difficulties prevail, and go on to make suggestions for change in nursing interventions and training. This article summarizes these contributions and discusses the ethical problems which nurses face in dealing with the sexuality of their patients. Pendant que les soins deviennent plus complet, les publications sur la sexualité se sont multipliés. Sexualité et genre sont des idées qui sont difficiles à définir. Pendant que 'sexualité' fait allusion aux différences entre les corps, 'genre' regarde les différences psychologiques et socioculturelles entre femmes et hommes. Cette distinction entre sexualité et genre est fondamentale, puisque beaucoup des différences entre femmes et hommes ne sont pas d'origine biologique. Et quand le genre et la sexualité d'une personne sont en accord avec les normes sociaux, il n'y a toujours pas une même correlation pour chaque individu. La nature de ces ressemblances est triple: premièrement, Thomas, Savage et Webb acceptent qu'une définition pour infirmiers/ères de las sexualité devrait exister. De plusières manières ils l'acceptent, et en réfèrent comme à un part total de l'être et idée de soi de la personne. Deuxièmement, les auteurs soulignent quelques-unes des difficultés et complexités que les infirmier/ères rencontrent dans leurs relations professionnelles aussi bien que dans leurs reflexions, compréhensions, attitudes et convictions personelles. Troisièmement, les trois études montrent pourquoi ces difficultès continuent encore, et suggèrent des changements en interventions et formation professionnelle. L'article-ci résume ces contributions et discute les problèmes éthiques des infirmier/ères vis-à-vis de la sexualité de leurs malades. Weil sich die ganzheitliche Pflege vermehrt, vermehren sich auch die Veröffentli chungen über Sexualität. Sexualität und Geschlecht sind Begriffe, die sehr schwierig zu beschreiben sind. Sexualität bezieht sich auf die physikalischen, und Geschlecht auf die psychologischen und kulturellen Unterschiede zwischen Frauen und Männern. Diese Unterschiede zwischen Sexualität und Geschlecht sind grundsätzlich, denn viele Verschiedenheiten zwischen Frauen und Männern haben keinen biologischen Ursprung. Wenn die Sexualität und das Geschlecht einer Person zusammen fallen mit den gesellschaftlichen Normen, bedeutet es noch nicht, dass es sich für alle solche Leute auf das selbe hinbezieht. Das bedeutende dieser Aehnlichkeiten ist dreifach: erstens, Thomas, Savage und Webb akzeptieren dass es eine Definition der Sexualität für die Krankenpflege geben sollte. Auf verschiedene Arten bestätigen sie sie, und weisen auf das Wesen der Person und deren Selbst-Vorstellung als etwas Vollständiges hin. Zweitens, diese Autoren betonen die Verwicklungen und Schwierigkeiten, die das Krankenpflegepersonal hat mit der Sexualität in beruflichen Beziehungen wie auch in persönlichem Nachdenken, Einstellungen und Ueberzeugungen. Drittens, alle drei Ueberblicke zeigen warum solche Schwierigkeiten weiterhin bestehen, und machen Vorschläge für Aenderungen in Pflegeeingriffen und Unterricht. Dieser Artikel fasst diese Beiträge zusammen und diskutiert die ethischen Probleme die das Krankenpflegepersonal hat mit der Sexualität der Patienten. (shrink)

As it has historically been the case with many pandemics, the Covid-19 experience will induce many philosophers to reconsider the value of medical practice. This should be a good opportunity to critically scrutinize the way medical research and medical interventions are carried out. For much of its history, medicine has been very inefficient. But, even in its contemporary forms, a review of common protocols in medical research and medical interventions reveal many shortcomings, especially related to methodological flaws, and more importantly, (...) conflicts of interests due to profit incentives. In the face of these problems, we propose a program of “gentle medicine”. This term, originally formulated by philosopher Jacob Stegenga, describes a form of medicine in which physicians intervene less than they currently do. As part of this general program, we advance a series of reform recommendations that could be enacted both by medical staff in their everyday practice, but also by public health officials and policymakers. (shrink)

This article claims that health promotion is best practised in the light of an Aristotelian conception of the good life for humans and of the place of health within it.

With the increasingly close relationship between the pharmaceutical industry and the American Psychiatric Association (APA) there has been a growing tendency in the mental health professions to interpret everyday emotional suffering and behavior as a medical condition that can be treated with a particular drug. In this paper, I suggest that hermeneutic phenomenology is uniquely suited to challenge the core assumptions of medicalization by expanding psychiatry's narrow conception of the self as an enclosed, biological individual and recognizing the ways in (...) which our experience of things--including mental illness--is shaped by the socio-historical situation in which we grow. Informed by hermeneutic phenomenology, psychiatry's first priority is to suspend the prejudices that come with being a medical doctor in order to hear what the patient is saying. To this end, psychiatry can begin to understand the patient not as a static, material body with a clearly defined brain dysfunction but as an unfolding, situation existence already involved in an irreducibly complex social world, an involvement that allows the patient to experience, feel, and make sense of their emotional suffering. (shrink)

By examining an exemplar sample of mental health nursing educational policies and related legislation, in this article, we trace the discursive production of madness as an “othered” identity category. We engage in a critical discourse analysis of mental health nursing education in Canada, drawing on provincial and federal policies and legislation as the main sources of data. Theoretically framed by critical posthumanism and mad studies, this article outlines how the mad subjectivity becomes decontextualized out of its identity‐based understanding and recontextualized (...) as an inferior category of “the human,” circulating within discourses of pedagogy, economics, law, and psychiatry. The article maps the intertextual nexus of the discourse of mental health nursing education, making visible the complex, the arbitrary, and the sometimes‐contradictory nature of the discipline's grappling with identity‐based mental health concepts. We close with several implications for nursing policy, education, and practice. (shrink)

The crucial problem in the philosophy of psychiatry is to determine under which conditions certain behaviors, mental states, and personality traits should be regarded as symptoms of mental illnesses. Participants in the debate can be placed on a continuum of positions. On the one side of the continuum, there are naturalists who maintain that the concept of mental illness can be explained by relying on the conceptual apparatus of the natural sciences, such as biology and neuroscience. On the other side (...) of the continuum, there are normativists who maintain that the appropriate characterization of the concept of mental illness cannot avoid reference to epistemic, moral and other social values. Although, this article is primarily an introduction to the debate, we stress the importance of the normativist positions. (shrink)

Though the divide between reason-based and causal-explanatory approaches in psychiatry and psychopathology is old and deeply rooted, current trends involving multi-factorial explanatory models and evidence-based approaches to interpersonal psychotherapy, show that it has already been implicitly bridged. These trends require a philosophical reconsideration of how reasons can be causes. This paper contributes to that trajectory by arguing that Donald Davidson’s classic paradigm of 1963 is still a valid option.

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (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)

Cet article explore la classification des troubles psychiatriques dans la perspective du modèle des espèces pratiques. En nous basant sur certains travaux en philosophie des sciences qui soutiennent que les éléments chimiques et les espèces biologiques ne possèdent pas de véritables essences, nous affirmons que les troubles psychiatriques ne devraient pas être compris, eux non plus, de façon essentialiste. Les troubles psychiatriques sont des « espèces pratiques », non des « espèces naturelles ». Ce modèle représente une approche pragmatiste de (...) la classification qui pose, compte tenu de l’infinie complexité du monde, qu’une multitude de décisions peuvent jouer un rôle légitime dans la définition des limites des catégories. Il s’agit d’une approche nominaliste contemporaine qui considère les concepts et les catégories comme provisoires et partiels, sans toutefois rejeter l’idée qu’ils sont des espèces légitimes. Ce modèle rejette ce que Ian Hacking a nommé le structurisme inhérent, sans pour autant rejeter les espèces. Le modèle des espèces pratiques rejette aussi l’éliminativisme. Il est en accord avec les arguments non essentialistes offerts par les éliminativistes, mais il n’accepte pas leurs conclusions austères. Je discute finalement les complications et les imperfections du modèle.This article explores the classification of psychiatric disorders from the perspective of the practical kinds model. Based on work in the philosophy of science which argues that chemical elements and biological species do not have real essences, it is argued that psychiatric disorders should not be understood essentialistically either. Psychiatric disorders are practical, not natural kinds. This model represents a pragmatist approach to classification which holds that, because the world is so complex, a multitude of decisions can play legitimate roles in defining category boundaries. It is a contemporary nominalistic approach that views concepts and categories as provisional and partial, but does not reject the notion that there are legitimate kinds. It rejects what Ian Hacking has called inherent structurism, but not kinds. The practical kinds model is also anti-eliminativist. It agrees with the non-essentialistic arguments offered by eliminativists, but does not accept their austere conclusions. Complications and shortcomings of the model are discussed. (shrink)

The aim of the paper is to give an ontologically informed account of disease that can aid in the construction of disease ontologies. The paper begins by distinguishing cases of diseases from what are purely structural abnormalities, referred to as ‘disorders’. The paper then presents a causal model apt for the understanding of disease that distinguishes diseases from both their causes and their potential effects. The analysis of disease defended treats disease in terms of distortions of standard cellular network processes, (...) where those distortions are incapable of self remedy and produce biologically disadvantageous symptoms. (shrink)

Due to several socio-political factors, to many psychiatrists only a strictly objective definition of mental disorder, free of value components, seems really acceptable. In this paper, I will explore a variant of such an objectivist approach to defining metal disorder, natural function objectivism. Proponents of this approach make recourse to the notion of natural function in order to reach a value-free definition of mental disorder. The exploration of Christopher Boorse's 'biostatistical' account of natural function (1) will be followed an investigation (...) of the 'hybrid naturalism' approach to natural functions by Jerome Wakefield (2). In the third part, I will explore two proposals that call into question the whole attempt to define mental disorder (3). I will conclude that while 'natural function objectivism' accounts fail to provide the backdrop for a reliable definition of mental disorder, there is no compelling reason to conclude that a definition cannot be achieved. (shrink)

My three main points are: Mental disease is a metaphor, but mental illness is not. Feeling ill and having a physical illness are logically related. If there were no such thing as feeling ill, there would be no such thing as suffering from a physical illness. Yet there is no logical connection between feeling ill and being mentally ill. Mental illness is manifested in various forms of behaviour, for example, suspiciousness, elation, depression, etc.; if a form of behaviour is to (...) count as mental illness, it has to be an insane form; yet it is possible to be mentally ill without being insane and it is possible to be insane without being mentally ill. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Ambiguities of Mild Cognitive ImpairmentTim Thornton (bio)Keywordsclassification, disease, mild cognitive impairment, normative, valuesCorner and Bond's paper (2006) raises some key ethical questions about the classification and diagnosis of mild cognitive impairment (MCI). In this commentary, I wish to revise some of the general issues about the classification of mental disorder raised by this particular classificatory concept. The central issue raised is the connection between the pathologic status of (...) a condition and what I term the plain facts about the frequency and nature of its symptoms.There are a number of ethical questions raised by applying the label of MCI. Centrally, perhaps, is the concern, illustrated by the case vignettes, that a diagnosis carries negative repercussions that might outweigh the more narrowly medical advantages of an early diagnosis. But although that concern may be appropriate, such ethical complications are a danger of any psychiatric classification or diagnosis, even the most well grounded. Any psychiatric diagnosis can carry a danger of stigma, for example.What seems to make such ethical concerns more serious in this case—at least to a philosopher outsider—is the implicit further concern that MCI is not a real, objective, or, to use a more medical term, valid category or classification. If it is not valid, then any negative connotations of the diagnosis will not be outweighed by medical technological achievements. In other words, the further ethical issues are given much greater weight if the question of validity is not satisfactorily resolved.The question of the reality, objectivity, or validity of MCI can be divided into two issues:1. Is MCI a real, objective, or valid feature of psychological phenomenology?2. Is MCI a real, objective, or valid psychological illness, disease, or pathology?A condition might be a real, objective, or valid feature of psychological phenomenology without being a real illness. It might be some other aspect of human living. Szasz (1960) suggests that this is the case with mental illness (he might more properly say "so-called mental illness") as a whole. But, less controversially, the unusual ability to calculate, mentally and in a flash, the date of future Easter Sundays is a genuine feature of human living—some people possess the ability even if most do not—without either it, or its lack, being an illness. Being real as an illness is a very specific kind of being. It is this, I suggest, that raises difficulties in the case of MCI by contrast with the easier question of whether something is a genuine feature of human living in some other way. [End Page 21]From "normal" and "normative" to "correct" and "incorrect"Corner and Bond (2006) usefully suggest that the question of whether MCI is real is made more difficult by an ambiguity in the sense of the word normal. They suggest that although "physiologic and cognitive decline is assumed to be a normal experience" this still leaves "boundary problems" about "distinguishing normal aging from disease" (Corner and Bond 2006, 3–4). Thus, if the symptoms of MCI are continuous with the ordinary phenomena of physiologic and cognitive decline, then they might also be merely normal. But this does not settle the status of MCI because normal can mean either "normative, that is, usual; or it can mean nonpathologic" (Corner and Bond 2006, 4).On the assumption that MCI is at least continuous with phenomena that are normal, then its symptoms might be normal in the sense of usual but nevertheless pathologic: an inevitable illness. Or they might be usual and nonpathologic, that is, merely a feature of aging that, although regrettable, lacks the connotations of illness (e.g., the appropriateness, if not the possibility, of treatment). (In principle on the assumption in play—that the symptoms of MCI are normal—they might be unusual but nonpathologic akin, for example, to an improved ability to solve crosswords with age that might affect a small lucky proportion of the population. Perhaps such a crossword puzzler might be reassured by their doctor: "Well that is very unusual but there is no need to worry: it is not a symptom of any illness. You are perfectly normal.")Thus the question "Is MCI normal... (shrink)

The Council for Secular Humanism identifies Secular Humanism as a "way of thinking and living" committed to rejecting authoritarian beliefs and embracing "individual freedom and responsibility ... and cooperation." The paradigmatic practices of psychiatry are civil commitment and insanity defense, that is, depriving innocent persons of liberty and excusing guilty persons of their crimes: the consequences of both are confinement in institutions ostensibly devoted to the treatment of mental diseases. Black's Law Dictionary states: "Every confinement of the person is an (...) 'imprisonment,' whether it be in a common prison, or in private house, or in the stocks, or even by forcibly detaining one in the public streets." Accordingly, I maintain that Secular Humanism is incompatible with the principles and practices of psychiatry. (shrink)

A principle of paternalism must be able to answer three questions. Who are the persons who are the proper object of paternalism? Which actions should we prevent persons from doing or induce them to perform? What should our goals be when acting paternalistically toward these persons? A satisfactory principle will also be reasonably precise in distinguishing appropriate from inappropriate instances of paternalism, and it will be comprehensive, speaking to most potential cases, including suicide. My purpose is not to reach a (...) conclusion about the acceptability of paternalistic restrictions on suicide. Rather, because such a conclusion will follow from the way in which a principle of paternalism is formulated, I want to examine several liberal attempts at formulation and the theoretical background underlying these attempts. (shrink)

Eating Disorders, particularly anorexia and bulimia, are of immense contemporary importance and interest. News stories depicting the tragic effects of eating disorders command wide attention. Almost everybody in society has been touched by eating disorders in one way or another, and contemporary obsession with body image and diet fuels fascination with this problem. It is unclear why people develop eating disorders. Clinical and sociological studies have provided important information relating to the relational systems in which eating disorders are mainly found. (...) This paper shows that their explanations are not conclusive and points out that the reasons why people develop eating disorders should not be found in the dysfunctional interactions occurring in both familial and social systems, but in the moral beliefs that underlie these interactions. Eating disorders are impossible to understand or explain, unless they are viewed in the light of these beliefs. A moral logic, that is a way of thinking of interpersonal relations in moral terms, gives shape to and justifies the clinical condition, and finds consistent expression in abnormal eating behaviour. The analysis offered here is not mainstream either in philosophy (eating disorders are in fact seldom the subject of philosophical investigation) or in clinical psychology (the methods of philosophical analysis are in fact seldom utilised in clinical psychology). However, this paper offers a important contribution to the understanding of such a dramatic and widespread condition, bringing to light the deepest reasons, which are moral in nature, that contribute to the explanation of this complex phenomenon. (shrink)

This article aims at grounding critical theories with the help of psy discourses. Even if the relationship between the two disciplines has always been a controversial one, the article argues that therapeutic knowledge that accesses empirical forms of social suffering may offer important insights for critical theory. This general argument is demonstrated by complementing the theories of Bourdieu and Habermas with a clinical description of depression. First, the limitations of the capabilities of these influential theories in terms of how they (...) can be used to conceptualize the variety of social suffering are introduced. Second, the psy discourses on depression are reviewed to identify and highlight latent references to the social. Third, by combining models of depressive suffering and various distortions of integration, an extended normative basis is elaborated. Instead of solely criticizing inequalities or distortions of communication, those social constellations are criticized that trap actors by producing a homogenous pattern of suffering. (shrink)

The work of psychiatrist R. D. Laing deserves recognition as a key contribution to sociological theory, in dialogue with the interactionist and interpretivist sociological traditions. Laing encourages us to identify meaningful social action in what would otherwise appear to be nonsocial phenomena. His interpretation of schizophrenia as a rational strategy of withdrawal reminds us of the threat that others can pose to the self and how social relations are implicated in even the most "private" and "internal" of experiences. He developed (...) a far-reaching critical theory of the self in modern society, which challenges the medicalization and biochemical reduction of human problems. Using the case of shyness as an example, the article seeks to demonstrate the importance of Laing's theories for examining the fragility of the self in relation to contemporary social order. (shrink)

Similarly to other accounts of disease, Christopher Boorse’s Biostatistical Theory (BST) is generally presented and considered as conceptual analysis, that is, as making claims about the meaning of currently used concepts. But conceptual analysis has been convincingly critiqued as relying on problematic assumptions about the existence, meaning, and use of concepts. Because of these problems, accounts of disease and health should be evaluated not as claims about current meaning, I argue, but instead as proposals about how to define and use (...) these terms in the future, a methodology suggested by Quine and Carnap. I begin this article by describing problems with conceptual analysis and advantages of “philosophical explication,” my favored approach. I then describe two attacks on the BST that also question the entire project of defining “disease.” Finally, I defend the BST as a philosophical explication by showing how it could define useful terms for medical science and ethics. (shrink)

Theorists of health have, to this point, focused exclusively on trying to define a state—health—that an organism might be in. I argue that they have overlooked the possibility of a comparativist theory of health, which would begin by defining a relation—healthier than—that holds between two organisms or two possible states of the same organism. I show that a comparativist approach to health has a number of attractive features, and has important implications for philosophers of medicine, bioethicists, health economists, and policy (...) makers. (shrink)

One of the most dramatic techniques for constructing accounts of "undiscovery" or incompetence in science involves the manipulative deception—in some accounts, the "hoaxing"—of the putatively incompetent researcher, ostensibly as an experiment to evaluate his or her methodology and the soundness of his or her knowledge claims. In this article, the author examines five cases in which such deceptions have been employed, noting the patterns of argument that typically follow these deceptions and the factors that seem to determine the power of (...) these arguments. The author suggests that the "hoaxer" in such cases is most likely to be successful when his or her views about the targeted researcher's methodology and knowledge claims are orthodox with respect to his or her intended audience. (shrink)

Psychiatry is becoming a cognitive neuroscience. This new paradigm not only aims to give new ways for explaining mental diseases by naturalizing them, but also to have an influence on different levels of psychiatric norms. We tried here to verify whether a biological paradigm is able to fulfill this normative goal. We analyzed three main normative assumptions that is to say the will of giving psychiatry a valid nosology, a rigorous definition of what is a mental disease, and new tools (...) for destigmatizing mentally ill patients. Although these different kinds of normativity are very heterogeneous, we must conclude that, in all these cases, biological psychiatry is a failure, in part because of a lack of epistemological conceptualization. (shrink)

Content analysis of three chapters of Jamison’s memoir, An Unquiet Mind, shows that depression, mania, and Bipolar Disorder have a common metaphoric core as a sequential process of suffering and adversity that is a form of malevolence and destruction. Depression was down and in, while mania was up, in and distant, circular and zigzag, a powerful force of quickness and motion, fieriness, strangeness, seduction, expansive extravagance, and acuity. Bipolar Disorder is down and away and a sequential and cyclical process that (...) partakes of the metaphors of its component moods. We conclude that metaphors of mood disorders share a number of structural features and are consistent across different authors. (shrink)

Philosophical discussions about health and disease often refer to a 'medical model' of bodily disease, in which diseases are regarded as causes of illness; diagnosis consists in identifying the disease affecting the patient, and this determines the appropriate treatment. This view is plausible only for diseases whose cause is known, though even in such instances the disease is the effect on the affected person, and must not be confused with its own cause. But in fact the medical diagnostic process which (...) progresses from recognition of patterns of symptoms and signs, through search for abnormalities of structure and/or function, towards knowledge of causation often stops short of this desirable end-point; and at whatever point it comes to a halt, its result is expressed in terms of 'diseases'. Thus in medical discourse the names of diseases are a convenient device by which the current conclusion of the diagnostic process can be stated briefly; and they have widely varying factual implications. This nominalist analysis of the medical usages of the names of diseases has consequences for definitions of health and disease, and for some problems in medical ethics. (shrink)

This study, based on three years of research and over 40 hours of videotaped interaction in psychiatry, investigates the issue of insanity ascription/exoneration in psychiatric interviews. Following Sacks's model of membership categorization analysis, this article analyzes the discursive resources that psychiatrists may draw on to achieve some conclusion regarding their patients' psychopathological status. As it turns out, psychiatrists' invocation of patients' putative membership categories plays a crucial role in the achievement of such a conclusion. I examine some fragments of psychiatric (...) intake interviews and subsequent psychiatric interviews. The analysis shows that the process that may lead to insanity ascription/exoneration in psychiatric interviews basically involves the use of mundane, commonsense reasoning. (shrink)

This paper develops and defends a deflationary analysis of existence claims involving psychiatric disorders. According to this analysis, a given psychiatric disorder exists if, and only if, there are people who have the disorder. The implications of this analysis are spelled out for our views of nosological decision making, and for the relationship between claims about the existence of psychiatric disorders and claims about their reality. A pragmatic view of psychiatric nosology is defended and it is argued that worries about (...) the “reality” of any given disorder have to be distinguished clearly from questions about its existence. (shrink)

Psychopathy is often characterized in terms of what I call “the language of disorder.” I question whether such language is necessary for an accurate and precise characterization of psychopathy, and I consider the practical implications of how we characterize psychopathy—whether as a biological, or merely normative, disorder.