Résumé Cet article expose les tendances actuelles de ce nouveau domaine de recherche qu’est la « philosophie de la psychiatrie » à travers son évolution dans la dernière décade. La première partie se concentre sur le passage d’une approche strictement conceptuelle des thèses issues du savoir psychiatrique à une approche qui prend en compte également les dimensions sociales, pratiques et cliniques de cette discipline. La seconde partie de l’article montre comment l’exigence d’un engagement mutuel de la philosophie et de la (...) psychiatrie a été diversement perçue selon les pays engagés dans le programme de la philosophie de la psychiatrie. L’article s’intéresse en particulier à la France, où l’enthousiasme pour la « nouvelle philosophie de la psychiatrie » n’a pas eu le même retentissement sur la scène philosophique que dans les pays anglophones. Enfin cette contribution montre comment le domaine de la philosophie de la psychiatrie se présente comme un terrain fécond pour de nouvelles formes d’interaction entre la tradition analytique et la tradition continentale, en particulier à partir de la réflexion sur les thèmes de la normativité, du langage et de l’interprétation. (shrink)

In this two-part analysis, I analyze Marc Lewis’s arguments against the brain-disease view of substance addiction and for a developmental-learning approach that demedicalizes addiction. I focus especially on the question of whether addiction is a medical disorder. Addiction is currently classified as a medical disorder in DSM-5 and ICD-10. It is further labeled a brain disease by NIDA, based on observed brain changes in addicts that are interpreted as brain damage. Lewis argues that the changes result instead from normal neuroplasticity (...) and learning in response to the intense rewards provided by addictive substances, thus that addiction is not a brain disease and by implication not a medical disorder at all. I argue that even if one accepts Lewis’s reinterpretation of the brain evidence, his conclusions do not follow. Relying on my harmful-dysfunction analysis of medical disorder, I defend the view that substance addiction is in fact a medical disorder and a brain disorder. In Part 1, I identify five arguments Lewis puts forward against the brain-disease view and evaluate them as arguments that addiction is not a disorder: Addiction is not a chronic, relapsing condition; There is no clear boundary between addiction and other strong desires; Negative consequences are not unique to disorders; The brain disease model does not account for behavioral addictions; and, Addiction is like love. I argue that Lewis’s arguments are invalid because they fail to take account of the context of addiction and its relation to biological design. (shrink)

One way in which bioethicists can benefit the medical community is by clarifying the concept of disorder. Since insurance companies refer to the DSM for whether a patient should receive assistance, one must consider the consequences of one’s concept of disorder for who should be provided with care. I offer a refinement of Jerome Wakefield’s hybrid concept of disorder, the harmful dysfunction analysis. I criticize both the factual component and the value component of Wakefield’s account and suggest how they might (...) be improved. I propose that the factual component should be statistical variation analyzed in multilevel and chronological compilations of physiological data. I propose that the value component should prioritize the individual’s authority regarding the experience of suffering from a physiological condition. My account preserves the insight of using a factual and a value component while avoiding the problems that Wakefield’s original account faces. (shrink)