Philosophical debates about the concept of disease, particularly of mental disease, might benefit from reconsideration and a closer look at the established terminology and conceptual structure of contemporary medical pathology and clinical nosology. The concepts and principles of medicine differ, to a considerable extent, from the ideas and notions of philosophical theories of disease. In medical theory, the concepts of disease entity and pathologicity are, besides the concept of disease itself, of fundamental importance, and they are essentially connected to the (...) concepts cause of disease or etiological factor, natural course or natural history of disease, and pathological disposition. It is the concept of disease entity that is of key importance for understanding medical pathology and theory of disease. Its central role is shown by a short reconstruction of its main features and its intrinsic connection to the concept of pathologicity. The meaning of pathologicity is elucidated by explicating the underlying criteria. (shrink)

Creating a space for recovery‐focused psychiatric nursing care Within contemporary mental health‐care, power relationships are regularly played out between psychiatric nurses and service users. These power relationships are often imperceptible to the practicing nurse. For instance, in times of distress, service users often turn to or/and ‘construct’ discourses, beliefs and knowledge that are at odds with those which psychiatric nurses rely on to inform them of the mental status of the service user. The psychiatric nurse is in the position to (...) impose knowledge onto service users, usually in concurrence with ‘traditional or bio‐psychiatry’, without realizing or failing to acknowledge that the service user may have an alternative explanation of his/her mental health problems/experiences. In this paper, practice examples, based on the experiences of the four authors (from within and outside of services), are used to illustrate this ‘hidden’ power relationship. The authors use Foucault's ideas about: (i) government; (ii) the knowledge/power nexus and resistance; (iii) and his analytic tool of genealogy to help unravel this paradox within psychiatric nursing practice. The authors also use the emerging discourse of recovery as an alternative (and challenge) to ‘traditional bio‐psychiatry’ and consider the implications for psychiatric nursing practice. (shrink)

Thomas Szasz, the radical critic of state-supported psychiatry, and root and branch sceptic about mental illness, died in September 2012. Based on the obituary1 and editorial comment in The Lancet2 and the response his work commonly elicits, it is evident that there will be mixed reviews of his impact and of the cogency of his position.Certainly, some have seen him as a notable figure from the past. There is a sense in which, as far as Szasz's critique of psychiatry goes, (...) it did not really change at all in its essence from the time it was first explicitly expressed in his writings of the 1960s right up to his last publications and talks in the 2010s. He started his 1960 paper The Myth of Mental Illness3 with the assertion that there is no such thing as mental illness, and this has been an underlying pedal note to all his many pronouncements in this area ever since. Personally, I have always found his written interventions in debates right up to the present to be highly readable and intellectually sharp; he was adept at creating variations on the Szaszian theme. In one of his earlier book length texts, The Manufacture of Madness,4 he likens the contemporary idea that people have mental illness to the historical idea that some people were witches, and he parallels the institutions of modern state-supported psychiatry to those of the Inquisition. In articles he later published in the Journal of Medical Ethics, he likened mental illness to ‘phlogiston’—the non-existent substance that supposedly explained combustion5 and claimed the term ‘mental …. (shrink)

Factitious disorder is the deliberate simulation of illness for the purpose of seeking the sick role. It is a 20th-century diagnosis, though the grounds for its introduction are uncertain. While previous authors have considered the social changes contributing to growth in the disorder, this article looks at some of the pressures on doctors that may have created the diagnostic need for a disorder between hysteria and malingering. The recent history of those disorders suggests that malingering would no longer be acceptable (...) when applied to the potentially larger numbers involved in workers’ compensation or in mass conscription. Equally, the absolution given to hysteria on the basis of the Freudian subconscious would survive only as long as that model retained credibility. Growing egalitarianism and changing doctor—patient relationships in the 20th century would no longer tolerate a sharp division between culpable malingering and exculpated hysteria, which may previously have been made on grounds of class or gender. They would contribute to the need for a mediating diagnosis, such as factitious disorder. (shrink)

This article critically interrogates contemporary forms of addiction medicine that are portrayed by policy-makers as providing a ‘rational’ or politically neutral approach to dealing with drug use and related social problems. In particular, it examines the historical origins of the biological facts that are today understood to provide a foundation for contemporary understandings of addiction as a ‘disease of the brain’. Drawing upon classic and contemporary work on ‘styles of thought’, it documents how, in the period between the mid-1960s and (...) the mid-1970s, such facts emerged in relation to new neurobiological styles of explaining and managing social problems associated with drug abuse, and an alliance between a relatively marginal group of researchers and American policy-makers who were launching the ‘War on Drugs’. Beyond illustrating the political and material conditions necessary for the rise of addiction neuroscience, the article highlights the productivity of neurobiological thought styles, by focusing on the new biological objects, treatments and hopes that have emerged within the field of addiction studies over the last several decades. (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)

In the mid-1970s, the biomedical model of medicine gave way to the biopsychosocial model of medicine; it was billed as a more comprehensive and compassionate model of medicine. After more than a century of disentangling medicine from religion, the medicine and spirituality movement is attempting to bring religion and spirituality back into medicine. It is doing so under a biopsychosociospiritual model. I unpack one model for allowing religion back into medicine called the RCOPE. RCOPE is an instrument designed to categorize (...) religion and spirituality as psychological coping mechanisms. I explore how such instruments are related to the history of statistical measurement and demonstrate the political impetus that governs such enterprises. The biopsychosociospiritual medicine is billed as a more holistic and comprehensive model. This new model of medicine offers total care. However, I demonstrate how this total care becomes totalizing, indeed totalitarian, admitting religion and spirituality back into the fold of medicine under a new secularized medical control. (shrink)

This paper examines Ian Hacking's analysis of the looping effects of psychiatric classifications, focusing on his recent account of interactive and indifferent kinds. After explicating Hacking's distinction between 'interactive kinds' (human kinds) and 'indifferent kinds' (natural kinds), I argue that Hacking cannot claim that there are 'interactive and indifferent kinds,' given the way that he introduces the interactive-indifferent distinction. Hacking is also ambiguous on whether his notion of interactive and indifferent kinds is supposed to offer an account of classifications or (...) objects of classification. I argue that these conceptual difficulties show that Hacking's account of interactive and indifferent kinds cannot be based on - and should be clearly separated from - his distinction between interactive kinds and indifferent kinds. In clarifying Hacking's account, I argue that interactive and indifferent kinds should be regarded as objects of classification (i.e., kinds of people) that can be identified with reference to a law-like biological regularity and are aware of how they are classified. Schizophrenia and depression are discussed as examples. I subsequently offer reasons for resisting Hacking's claim that the objects of classification in the human sciences - as a result of looping effects - are 'moving targets'. (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)

Some skeptics question the very possibility of moral bioenhancement by arguing that if we lack a widely acceptable notion of morality, we will not be able to accept the use of a biotechnological technique as a tool for moral bioenhancement. I will examine this skepticism and argue that the assessment of moral bioenhancement does not require such a notion of morality. In particular, I will demonstrate that this skepticism can be neutralized in the case of recent neurofeedback techniques. This goal (...) will be accomplished in four steps. First, I will draw an outline of the skepticism against the possibility of moral bioenhancement and point out that a long-lasting dispute among moral philosophers nourishes this skepticism. Second, I will survey recent neurofeedback techniques and outline their three features: the variety of the target human faculties, such as emotion, cognition, and behavior; the flexibility or personalizability of the target brain state; and the nonclinical application of neurofeedback techniques. Third, I will argue that, by virtue of these three unique features, neurofeedback techniques can be a tool for moral bioenhancement without adopting any specific notion of morality. Fourth, I will examine the advantages and threats that neurofeedback-based moral enhancement may have. Finally, I will conclude that neurofeedback-based moral enhancement can become a new and promising tool for moral bioenhancement and requires further ethical investigations on its unique features. (shrink)

Why are the diagnostic criteria of some psychiatric disorders standardised by gender while others are not? Why standardise symptom questionnaires by gender but not other personal characteristics such as ethnicity, socioeconomic class or sexual orientation? And how might our changing attitudes towards gender, born from scientific research and changing societal narratives, alter our opinion of these questions? This paper approaches these dilemmas by assessing the concept of diagnosis in psychiatry itself, before analysing two common approaches to the study of psychiatric (...) diagnosis; the naturalist and constructivist views. The paper assesses the relative merits and significance of each, before turning its attention to the nature of gender and its relevance to psychiatry. The paper introduces a framework to approach gender-based diagnostic bias and concludes by drawing a distinction between qualitative and quantitative standardisation, arguing that gender standardisation of psychiatric diagnoses is ethically justified in the former but not the latter. (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)

This article will briefly explore some of the ways in which the past has been used as a means to talk about psychotherapy as a practice and as a profession, its impact on individuals and society, and the ethical debates at stake. It will show how, despite the multiple and competing claims about psychotherapy’s history and its meanings, historians themselves have, to a large degree, not attended to the intellectual and cultural development of many therapeutic approaches. This absence has the (...) potential consequence of implying that therapies have emerged as value-free techniques, outside of a social, economic and political context. The relative neglect of psychotherapy, by contrast with the attention historians have paid to other professions, particularly psychiatry, has also underplayed its societal impact. This article will foreground some of the instances where psychotherapy has become an object of emerging historical interest, including the new research that forms the substance of this special issue of History of the Human Sciences. (shrink)

This article aims: (1) to introduce the wider philosophy of Aristotle to nurses and healthcare practitioners; (2) to show that Aristotle's philosophical system is an interdependent whole; and (3) to defend its plausibility and usefulness despite its ancient and alien origins.Aristotle's system can be set out as a hierarchy, with metaphysics at the top and methodology running throughout. Beneath metaphysics are the sciences, with theoretical, practical and productive (or craft) sciences in hierarchical order. This hierarchy does not imply that, say, (...) metaphysics is superior to biology or nursing, but rather that metaphysics can be understood without reference to the other two but, as we shall see, notvice versa.Two themes run through Aristotelian philosophy. The first is Aristotle's method of inquiry, central to which is that our starting point is not pure empirical data, but rather current puzzles; complementing this method is a realist philosophy. The second theme is teleology, the understanding of action in the world in terms of ends, as when we say a plant grows roots to reach water and nutrients.Implications for nursing. Good health is the good functioning of the material aspect of humans; flourishing is good functioning of humansper se. The goals of nursing, which are based on health, are subsumed by the overall human goal of flourishing, and this helps us to understand and set boundaries to health care. Two examples illustrate this. The first is that mental illness is strongly within the purview of nursing and health care whereas bad decisions, such as smoking, are only marginally so. The second is ethics, where it is argued that the attempt to describe ethical decision‐making as in addition to and separate from the decisions made within nursing and health care itself cannot be sustained. (shrink)

In this paper I discuss the scientific respectability of delusion as a psychiatric category. First, I present the essentialist objection to the natural kindhood of psychiatric categories, as well as non-essentialism about natural kinds as a response to that objection. Second, I present a nuanced classification of kinds of kinds. Third, drawing on the claim that the attribution of delusion relies on a folk psychological underpinning, I present the mind-dependence objection to the natural kind status of delusion. Finally, I argue (...) that even if delusion as a generic kind stands little chance of being vindicated as a non-essentialist natural kind, we stand to gain from a natural kind methodology regarding subtypes of delusion for which there is evidence of genuine causal signatures and mechanisms. (shrink)

ABSTRACTThis article engages Bhaskar's category of absence and Foucault's notion of problematization in the context of explaining an example of the historical emergence of political activism. Specifically, it considers the emergence of the ‘psychiatric survivors’ social movement in the UK, with a focus on the ‘politics of self-harm’. The politics of self-harm refers to acts of self-injurious behaviour, such as drug over-dosage or self-laceration, which do not result in death and which bring individuals to the attention of psychiatric services. For (...) many years survivors have protested about the harmful treatment they receive from such services and have campaigned for their reform and for new, non-psychiatric understandings of the meaning of self-harm. The article explains how such activism emerged in the late 1980s. Its contribution is at the interface of critical realism and social movement studies. (shrink)

Medicalization was the theme of the 29th European Conference on Philosophy of Medicine and Health Care that included a panel session on the DSM and mental health. Philosophical critiques of the medical model in psychiatry suffer from endemic assumptions that fail to acknowledge the real world challenges of psychiatric nosology. The descriptive model of classification of the DSM 3-5 serves a valid purpose in the absence of known etiologies for the majority of psychiatric conditions. However, a consequence of the “atheoretical” (...) approach of the DSM is rampant epistemological confusion, a shortcoming that can be ameliorated by importing perspectives from the work of Jaspers and McHugh. Finally, contemporary psychiatry’s over-reliance on neuroscience and pharmacotherapy has led to a reductionist agenda that is antagonistic to the inherently pluralistic nature of psychiatry. As a result, the field has suffered a loss of knowledge that may be difficult to recover. (shrink)

Major depression (MD) is a highly heterogeneous diagnostic category. Diverse symptoms such as sad mood, anhedonia, and fatigue are routinely added to an unweighted sum-score, and cutoffs are used to distinguish between depressed participants and healthy controls. Researchers then investigate outcome variables like MD risk factors, biomarkers, and treatment response in such samples. These practices presuppose that (1) depression is a discrete condition, and that (2) symptoms are interchangeable indicators of this latent disorder. Here I review these two assumptions, elucidate (...) their historical roots, show how deeply engrained they are in psychological and psychiatric research, and document that they contrast with evidence. Depression is not a consistent syndrome with clearly demarcated boundaries, and depression symptoms are not interchangeable indicators of an underlying disorder. Current research practices lump individuals with very different problems into one category, which has contributed to the remarkably slow progress in key research domains such as the development of efficacious antidepressants or the identification of biomarkers for depression. The recently proposed network framework offers an alternative to the problematic assumptions. MD is not understood as a distinct condition, but as heterogeneous symptom cluster that substantially overlaps with other syndromes such as anxiety disorders. MD is not framed as an underlying disease with a number of equivalent indicators, but as a network of symptoms that have direct causal influence on each other: insomnia can cause fatigue which then triggers concentration and psychomotor problems. This approach offers new opportunities for constructing an empirically based classification system and has broad implications for future research. (shrink)

Elimination controversies are ubiquitous in philosophy and the human sciences. For example, it has been suggested that human races, hysteria, intelligence, mental disorder, propositional attitudes such as beliefs and desires, the self, and the super-ego should be eliminated from the list of respectable entities in the human sciences. I argue that eliminativist proposals are often presented in the framework of an oversimplified “phlogiston model” and suggest an alternative account that describes ontological elimination on a gradual scale between criticism of empirical (...) assumptions and conceptual choices. (shrink)

Fleck's Genesis and Development of a Scientific Fact foregrounds claims traditionally excluded from reception, often regarded as opposed to fact, scientific claims that are increasingly seldom discussed in connection with philosophy of science save as examples of pseudoscience. I am especially concerned with scientists who question the epidemiological link between HIV and AIDS and who are thereby discounted—no matter their credentials, no matter the cogency of their arguments, no matter the sobriety of their statistics—but also with other classic examples of (...) so-called pseudoscience including homeopathy and other sciences, such as cold fusion. The pseudoscience version of the demarcation problem turns out to include some of the details that Latour articulates multifariously under a variety of species or kinds in his essay/interactive research project/monograph, ‘Biography of an Investigation’. Given the economic constraints of the current day, especially in the academy, the growing trend in almost all disc.. (shrink)

ResumoNo início do século xviii, Isaac Newton publicou seu principal trabalho sobre óptica, o Opticks. Impregnado por uma perspectiva indutiva, o livro logo se tornou a principal referência para os estudos sobre a luz e as cores, sendo amplamente popularizado pelos seguidores de Newton. Neste artigo, analisamos como dois importantes livros contribuíram para essa popularização e também qual era a imagem de ciência que tencionavam propagar, o Élements de la philosophie de Newton de Voltaire e o Newtonianismo per le dame (...) de Algarotti. Será possível perceber que ambos os autores distorceram o conteúdo do livro de Newton, no intuito de propagar uma imagem idealizada das ideias newtonianas e da própria filosofia natural.In the beginning of 18th century, Newton published his main work about light and colors, the Opticks. Impregnated by an inductive perspective, the book became the major reference for the studies about light and colors, being widely popularized by Newton's followers. In this article, we analyze how two important works contributed to this process of popularization and also what image of science they intended to propagate: Voltaire's Elements of Newton's philosophie and Algarotti's Sir Isaac Newton's philosophy explain'd for the use of the ladies. We will be notice that both authors distorted the content of the Opticks, in order to propagate an idealized image of Newtonian ideas and natural philosophy itself. (shrink)

Can we learn something interesting about knowledge by examining our concept of knowledge? Quite a bit, many argue. My own view, however, is that the concept of knowledge is of little epistemological interest. In this paper, I critically examine one particularly interesting defense of the view that the concept of knowledge is of great epistemological interest: Edward Craig's Knowledge and the State of Nature. A minimalist view about the value of examining our concept of knowledge is defended.

This article questions a number of widely held views of the role of values in psychotherapy. It begins with a discussion of the now largely discredited view that psychotherapy can be value free. It also broadens this challenge to question the popular idea that values form an inescapable part of the therapeutic encounter. While this view is correct in outline, it is necessary to reject the underlying conception of values as largely arbitrary preferences that the client and the therapist bring (...) to the encounter, as this fails to do justice to the inherently ethical nature of psychotherapy. It argues that we should recover the Greek notion of therapy as essentially concerned with the character of a person. In other words, the goal of therapy is virtue. (shrink)

The enduring psychiatric myth is that particular personal, interpersonal and social problems in living are manifestations of ‘mental illness’ or ‘mental disease’, which can only be addressed by ‘treatment’ with psychiatric drugs. Psychiatric drugs are used only to control ‘patient’ behaviour and do not ‘treat’ any specific pathology in the sense understood by physical medicine. Evidence that people, diagnosed with ‘serious’ forms of ‘mental illness’ can ‘recover’, without psychiatric drugs, has been marginalized by drug-focused research, much of this funded by (...) the pharmaceutical industry. The pervasive myth of psychiatric drugs dominates much of contemporary ‘mental health’ policy and practice and raises discrete ethical issues for nurses who claim to be focused on promoting or enabling the ‘mental health’ of the people in their care. (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)

The intellectual journey on which I am about to embark, although not an unusual one in philosophy, may at first seem strange to those who are in the habit of looking to science for the answers to their big questions, including their philosophical questions. For I propose to shed light on the problematic relationship between two things, namely, mental illness and physical illness, by comparing their relationship to the relationship between two other things, namely, a rhyme for the eye—which will (...) be explained shortly for the benefit of anyone unfamiliar with this concept—and a rhyme for the ear. Yet these two pairs of things are not related in any way by subject-matter. In philosophy, however, this sort of deliberate dislocation can be beneficial. As Wittgenstein himself once remarked, ‘A philosophical] problem can be solved only in the right surrounding, we must give the problem a new surrounding, we must compare it to cases we are not used to compare [sic] it with.’. (shrink)

Since the revolutionary mood of the 1960s, patient-centered mental health care and a research emphasis on service users as experts by experience have emerged hand in hand with a view of service users as consumers. What happens to knowledge derived from firsthand experience when mental health users become experts and actively choose care? What kind of perspective do service users pursue on psychological distress? These are important questions in a field where psychiatric expertise on mental illness is socially structured and (...) constrained as an intra-personal disturbance of the mind. We argue that experience experts have lost a coherent perspective on care and health. We illustrate this by rationally reconstructing how the interpersonal view of mental health first gained and then lost coherence between the conception of mental health, the practice of mental health care, and the user experience. Harry Stack Sullivan’s interpersonal theory was a paradigm case for such coherence. The inclusion of mental health consumers as ‘experts by experience’ in the mental health field took place at the cost of Sullivan’s coherent interpersonal theory. Service users who interact side by side with medical experts as experience experts are constrained by the evidence-based imperative and consumerism. Service users are caught up in a race among experts to gain knowledge about mental problems from a third-person perspective instead of from first-person experience. To make a contribution service users have more to gain from a research approach that appreciates that they are persons among persons rather than experts among experts. (shrink)

The myriad controversies embroiling the mental health field—heightened in the lead-up to the release of DSM-5 —merit a close analysis of the field and its epistemological underpinnings. By using DSM as a starting point, this paper develops to overview the entire mental health field. Beginning with a history of the field and its recent crises, the troubles of the past “external crisis” are compared to the contemporary “internal crisis.” In an effort to examine why crises have recurred, the internal dynamics (...) of the field are assessed: applying Kuhn’s paradigmatic framework, crises are appraised to situate the differences between the natural sciences and the mental health field. Next, a Foucauldian analysis examines the functioning of the field’s power over the body, which is disproportionate in comparison to its scientific grounding. This is followed by investigating the field’s combination of contested scientific grounding and significant power, through a Latourian consideration of the assumptions and meaning behind the mental health field’s deployment of science. This includes scrutinizing the history of the classification of Post-Traumatic Stress Disorder. The paper closes by assessing the field’s potential to address these issues effectively. (shrink)

This article offers a critique and reconstruction of the concept of medicalization. Most researchers describe medicalization as the redefinition of social problems as medical concerns, and track its spread by the proliferation of disease language and diagnostic categories. Forensic psychiatry and disorders like psychopathy are often cited in these debates. I argue that focusing on discourse overlooks how medical language can justify or mask non-medical practices and outcomes, and lead researchers to identify medicalization where it has not occurred. Building on (...) other critiques of medicalization and recent studies of medical and legal expertise, I propose an alternative conception based on conditions for the performance of medical practice and other forms of expert labor. I distinguish the participation or intervention of medical practitioners from the medicalization of expert practice and identify several institutional factors that facilitate the latter. I illustrate this approach using a critical historical case: the first adult penal psychiatric clinic in the United States, founded by the eminent psychopathologist Bernard Glueck at New York’s Sing Sing Prison in 1916. Glueck’s extensive writings reveal little evidence of medicalization: psychopaths were largely defined and diagnosed according to penal rather than medical criteria, and they received additional punishment rather than treatment. A review of recent research confirms that psychopathy remains primarily a penal rather than medical condition. I conclude that focusing studies of medicalization on practice rather than discourse clarifies the concept and avoids reifying the notion of a medicalized society. (shrink)

Buddhism has always produced epistemological systems, and those of the Mahāyāna, in particular, always showed knowledge and perception to be inherently delusive. “Higher” forms of Buddhism have a degenerative philosophy of history according to which a sort of Golden Age was disrupted by the rise and gradual development of knowledge and the delusion inherent in it, which have reached their apex in our time – the final phase of the “Era of Darkness.” From this standpoint, this paper intends to show (...) science, in which Marcuse saw an inherent instrumental/technological interest, to have been developed by delusion and to have simultaneously furthered the development of delusion, to the point at which they begot the deadly ecological crisis proper to this concluding phase of the Era of Darkness – which reveals as such the delusion at its root, achieving the latter’s empirical reductio ad absurdum and offering us the possibility of eradicating it and thus healing our minds and, hopefully, our world. (shrink)

Knowing, either by the light of natural reason or by the light of Christian revelation, that homosexuality is a disordered condition is not sufficient for its being ethically permissible to direct self-identified homosexual persons toward just any treatment that aims to modify sexual orientation. For example, such an undertaking would be morally impermissible in cases where the available “treatments” are known to be both futile and potentially damaging to persons undertaking them. I, therefore, introduce this edition of Christian Bioethics by (...) reflecting on (a) the position of homosexuality in our current psychiatric nosology, (b) problems with drawing causal inferences from the outcomes of psychotherapy studies, and (c) the advantages and disadvantages of appealing to traditional categories of sexual orientation in this discussion, all with an eye toward more deeply elucidating core ethical concerns involving the intentional psychotherapeutic modification of sexual orientation. (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.

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)

Since the early 1970s humanistic psychology has struggled to remain a relevant force in the social and psychological sciences, we attribute this in part to a conceptualisation of the self rooted in theoretically outmoded thinking. In response to the issue of relevancy a sociocultural turn has been called for within humanistic psychology, which draws directly and indirectly on the conceptual insights of Michel Foucault. However, this growing body of research lacks a unifying conceptual base that is able to encompass its (...) new perspectives and the movement’s theoretical antecedents. This analysis suggests a way forward by offering a potential reconceptualisation of the self in humanistic psychology through the existential-phenomenology of Martin Heidegger. We argue that Heidegger’s conception of the self takes account of subjectivities produced in discourse and institutional practice, while acknowledging the human capacity for actualisation in his concept of the authentic-self. (shrink)

One clear reason why human agents often act badly is because they are insufficiently attentive to moral considerations and concerns, or tempted to ignore these in pursuit of more immediate satisfactions. In so far as madness, insanity or mental instability may be regarded as undermining moral agency, it might also be supposed that such madness attaches more to the non-moral than the moral reasons or motives of agents. Still, the well-known quote from Chesterton at the start of this paper may (...) give pause to conventional thought on this matter. With reference to the ideas of Plato and Freud, as well as attention to literary and cinematic "case studies," this paper argues that moral reasons and motives – of an apparently Chestertonian kind – may be a prime source of morally "insane" conduct. (shrink)

Hysteria is thought to involve the unconscious production of symptoms that resemble neurological disorders. However, it is not usually possible to distinguish this from deception, leading some authors to advocate dropping the distinction. In this paper, I argue that deception is not a unitary concept, so that hysteria may indeed involve a form of deception without necessarily the ethical implications of lying. The evidence for and against deception in hysteria is considered, and a taxonomy of deception outlined. The evidence is (...) argued to support deception as a sufficient model for hysteria, though not necessarily in the form of lying, and not such as to exclude other models for much of their behavior. An appreciation of the distinct forms of deception may help clinicians to clarify their relationships with their patients with hysteria, and clarify the distinction from malingering. (shrink)

As visual technologies become increasingly networked online, websites like YouTube provide a space to share vlogs online, suggest related content for viewers, and help in/form virtual communities, including those of mental illness. Within this space, vlogs of schizophrenia and comments generated about them by other users can represent transitional, dialogical states of illness that speak back to the analog body and affect a body’s way of being in the world. Moreover, as vlogs create resistance against static definitions of schizophrenia, they (...) may foster a creativity, experimentation, and inventiveness that transforms understandings of schizophrenia within the sciences and humanities. (shrink)

A growing, interdisciplinary field of cognitive linguistics has developed in recent decades, bringing together research from many fields to explore the ways that metaphors provide structure and semantic content to thought and language. In this article, the American public school disability emotional/behavioral disorder (E/BD) is examined in regard to the primary metaphors that frame the basic concepts of the disorder. The metaphors of 2 versions of E/BD, psychodynamic and behavioral, are investigated. A series of critical questions about the E/BD construct (...) are posed, and possibilities for new metaphors are proposed. (shrink)

There is an increased controversy surrounding Westerners' use of ayahuasca. One issue of importance is psychological resiliency of users and lack of screening by ayahuasca tourism groups in the Amazon. Given the powerful effects of ayahuasca coupled with lack of cultural support, Western users are at increased risk for psychological distress. Many Westerners who experience psychological distress following ayahuasca ceremonies report concurrently profound spiritual experiences. Because of this, it may be helpful to consider these episodes "spiritual emergencies," or crises resulting (...) from intense and transformative spiritual experiences. Although the author warns readers to avoid romantic comparisons of Western ayahuasca users to shamans, ethnographic data on indigenous shamanic initiates along with theory on liminality may be of some use to understand difficult experiences that accompany ayahuasca use. Given that psychotherapy is culturally sanctioned, therapists trained in treating spiritual crises can help Western ayahuasca users make meaning of their distress. Three case studies are offered as examples of individuals working through various sorts of crises following ayahuasca ceremonies. (shrink)

In this article I discuss the emergence of Female Sexual Dysfunction (FSD) within American psychiatry and beyond in the postwar period, setting out what I believe to be important and suggestive questions neglected in existing scholarship. Tracing the nomenclature within successive editions of the American Psychiatric Association’s Diagnostic and Statistical Manual ( DSM), I consider the reification of the term ‘FSD’, and the activism and scholarship that the rise of the category has occasioned. I suggest that analysis of FSD benefits (...) from scrutiny of a wider range of sources (especially since the popular and scientific cross-pollinate). I explore the multiplicity of FSD that emerges when one examines this wider range, but I also underscore a reinscribing of anxieties about psychogenic aetiologies. I then argue that what makes the FSD case additionally interesting, over and above other conditions with a contested status, is the historically complex relationship between psychiatry and feminism that is at work in contemporary debates. I suggest that existing literature on FSD has not yet posed some of the most important and salient questions at stake in writing about women’s sexual problems in this period, and can only do this when the relationship between ‘second-wave’ feminism, ‘post-feminism’, psychiatry and psychoanalysis becomes part of the terrain to be analysed, rather than the medium through which analysis is conducted. (shrink)

It is a common assumption that lack of autonomy is incompatible with decisional capacity and mental health. However, there are two general conceptions of autonomy, one value-neutral and the other value-laden, which imply different notions of mental health. I argue that the value-neutral notion of autonomy is independently inadequate and that it also provides an inadequate foundation for judging whether someone is decisionally incapable or mentally disordered. I propose an alternative, value-laden account which posits ten capabilities required for basic human (...) functioning. I then defend this account against objections and highlight its practical utility in designing optimal treatment. (shrink)