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

Various traditions in mental health care, such as phenomenological, and existential and cognitive-behavioral psychotherapy, implicitly or explicitly acknowledge that a disruption of the self, or the person, or the agent is among the common denominators of different mental disorders. They often emphasize the importance of understanding patients as reasonsresponsive, in their full mental health relevant complexity, if their mental disorder is to be treated successfully. The centrality of the concept of the self is not mirrored in the mainstream scientific approaches (...) in psychiatry however; the self has rarely been considered as the object of scientific research, the empirical investigation of which might yield successful explanations of and interventions in mental disorders. Thus, even though self-related phenomena are clinically relevant in so far as they give important information about a mental disorder to the clinician and help the development of effective interventions, they are not considered among the scientifically relevant properties of mental disorders. Leaving the self-related phenomena out of the scientific research on mental disorders can be attributed to the presupposition that the self is not empirically tractable and its use will hinder psychiatry’s goal to be scientific. In this paper, taking issue with this, I argue the self is empirically tractable, and its use as a target of research will not hinder psychiatry’s scientific commitments. (shrink)

The distinction between ‘disease’ and ‘illness’ has played an important role in the debate between naturalism and normativism. Both employ these notions, yet disagree on whether to assign priority to ‘disease’ or ‘illness’. I argue that this discussion suffers from implicit differences in the underlying interpretations: While for naturalists the distinction between ‘disease’ and ‘illness’ is one between a descriptive and a prescriptive notion, for normativists it is one between cause and effect. This discrepancy is connected to different interpretations of (...) priority, which also tend to be conflated in the debate. I disambiguate these different usages and develop a distinction between ‘disease’ and ‘illness’ that is theoretically neutral with regard to naturalism or normativism. Moreover, I propose a concept of heuristic priority that could serve as a common focus. This framework can avoid common confusions by providing a shared terminology and thereby help to make debates on disease-concepts more fruitful. (shrink)

Psychiatric classification, as exemplified by the Diagnostic and Statistical Manual of Mental Disorders, is dealing with a lack of trust and credibility—in the scientific, but also in the public realm. Regarding the latter in particular, one possible remedial measure for this crisis in trust lies in an increased integration of patients into the DSM revision process. The DSM, as a manual for clinical practice, is forced to make decisions that exceed available data and involve value-judgments. Regarding such decisions, public epistemic (...) trustworthiness requires that these value-judgments should be representative of those of the affected public, and that the public has a reason to believe such a representation to be realized. Due to the long tradition of distrust in psychiatry, such a reason can in this case best be provided by an actual integration of patients into the decision-making process, rather than by their representation through scientific experts. (shrink)

This article supports calls for an increased integration of patients into taxonomic decision making in psychiatry by arguing that their exclusion constitutes a special kind of epistemic injustice: preemptive testimonial injustice, which precludes the opportunity for testimony due to a wrongly presumed irrelevance or lack of expertise. Here, this presumption is misguided for two reasons: the role of values in psychiatric classification and the potential function of first-person knowledge as a corrective means against implicitly value-laden, inaccurate, or incomplete diagnostic criteria (...) sets. This kind of epistemic injustice leads to preventable epistemic losses in psychiatric classification, diagnosis, and treatment. (shrink)

The Diagnostic and Statistical Manual of Mental Disorders has elicited numerous criticisms throughout its history. Its particularly controversial status has not been resolved by the recent release of the DSM-5 ; rather, the new edition has amplified debates in psychiatry as well as philosophy and the wider public. To a certain extent, such controversies are to be expected because of the influential role the DSM plays in science and health care. Researchers have often been required to use the DSM classification (...) to get funded and published, clinicians need to use it for diagnosis, and patients need a DSM code to get reimbursed for treatment.1 Classification in psychiatry shapes the course of research... (shrink)

Recently, several authors have argued that assisted dying may be ethically appropriate when requested by a person who suffers from serious depression unresponsive to treatment. We here present four arguments to the contrary. First, the arguments made by proponents of assisted dying rely on notions of “treatment-resistant depression” that are problematic. Second, an individual patient suffering from depression may not be justified in believing that chances of recovery are minimal. Third, the therapeutic significance of hope must be acknowledged; when mental (...) healthcare opens up the door to admitting hopelessness, there is a danger of a self-fulfilling prophecy. Finally, proponents of assisted dying in mental healthcare overlook the dangers posed to mental-health services by the institutionalization of assisted dying. (shrink)

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