Recently Kenneth Kendler and Peter Zachar have raised doubts about the correspondence theory of truth and scientific realism in psychopathology. They argue that coherentist or pragmatist approaches to truth are better suited for understanding the reality of psychiatric disorders. In this article, I show that rejecting realism based on the correspondence theory is deeply problematic: It makes psychopathology categorically different from other sciences, and results in an implausible view of scientific discovery and progress. As an alternative, I suggest a robustness-based (...) approach that can accommodate the significance of coherence and pragmatic factors without rejecting scientific realism and the correspondence theory of truth. (shrink)

A modest opposition to the brain disease concept of addiction has been mounting for at least the last decade. Despite the good intentions behind the brain disease rhetoric – to secure more biomedical funding for addiction, to combat “stigma,” and to soften criminal approaches – the very concept of addiction as a brain disease is deeply conceptually confused. We question whether Lewis goes far enough in his challenge, robust as it is, of the brain disease concept. For one thing, the (...) notion that addiction is a disease is challenging to refute or confirm because the disease concept itself is poorly defined in medical and psychological nosology. More important, quibbling over what kind of disease addiction is unlikely to be productive. The rational response to adjudicating whether addiction is a brain disease is not to engage in potentially fruitless debates over the question of disease classification but rather to view addiction as an enormously complex set of behaviors that operate on several dimensions, ranging from molecular function and structure and brain physiology to psychology, the psychosocial environment, and social and cultural relations. (shrink)

Science and technology have vastly expanded the realm of medicine. The numbers of and knowledge about diseases has greatly increased, and we can help more people in many more ways than ever before. At the same time, the extensive expansion has also augmented harms, professional responsibility, and ethical concerns. While these challenges have been studied from a wide range of perspectives, the problems prevail. This article adds value to previous analyses by identifying how the moral imperative of medicine has expanded (...) in three ways: (1) from targeting experienced phenomena, such as pain and suffering, to non-experienced phenomena (paraclinical signs and indicators); (2) from addressing present pain to potential future suffering; and (3) from reducing negative wellbeing (pain and suffering) to promoting positive wellbeing. These expansions create and aggravate problems in medicine: medicalization, overdiagnosis, overtreatment, risk aversion, stigmatization, and healthism. Moreover, they threaten to infringe ethical principles, to distract attention and responsibility from other competent agents and institutions, to enhance the power and responsibility of professionals, and to change the professional-beneficiary relationship. In order to find ways to manage the moral expansion of medicine, four traditional ways of setting limits are analyzed and dismissed. However, basic asymmetries in ethics suggest that it is more justified to address people’s negative wellbeing (pain and suffering) than their positive wellbeing. Moreover, differences in epistemology, indicate that it is less uncertain to address present pain and suffering than future wellbeing and happiness. Based on these insights the article concludes that the moral imperative of medicine has a gradient from pain and suffering to wellbeing and happiness, and from the present to the future. Hence, in general present pain and suffering have normative priority over future positive wellbeing. (shrink)

This Editorial introduces the thematic series on 'Toward a New Psychiatry: Philosophical and Ethical Issues in Classification, Diagnosis and Care' http://www.biomedcentral.com/series/newpsychiatry.

This contribution focuses on what type of question “Are mental disorders brain disorders?” is and what task Anneli Jefferson performs in her book with the same title. I distinguish between conceptual engineering and conceptual choice, the former involving the individuation of an adequate concept for a specific goal, and the latter involving the normative problem of whether we should employ the concept at hand. I contend that Anneli Jefferson’s book is a work of conceptual engineering, which is valuable in and (...) of itself, but that this is insufficient to answer an equally essential version of the question, “Are mental disorders brain disorders?”, namely, whether we should adopt the newly engineered concept or not, considering a broader range of goals for mental health research and practice. (shrink)

Scientific activities strongly depend on concepts and classifications to represent the world in an orderly and workable manner. This creates a trade-off. On the one hand, it is important to leave space for conceptual and classificatory criticism. On the other hand, agreement on which concepts and classifications to use, is often crucial for communication and the integration of research and ideas. In this paper, we show that this trade-off can sometimes best be resolved through conceptual governance, in which scientific institutions (...) set a collective conceptual standard, and that voting can be a reasonable way to implement that governance. Voting is a means to aggregate among conflicting values, preferences and priorities that often underpin conceptual or classificatory debates, all while signaling ongoing disagreement. We also discuss how the legitimacy of the voting process and its outcome can be ensured. (shrink)

This article addresses the theme of diagnostic reduction in psychiatry, a process by which necessarily complex and multifactorial situations are reduced to medical conditions. This process presents obvious pitfalls, but also certain functions, in particular that of circumscribing what the psychiatric judgment can legitimately or not focus upon. In parallel, I will discuss the distinctions between narrative and pathological suffering, as well as the moral and medical judgments that may be associated with them. This will lead me to argue in (...) favour of a pragmatic attitude with regard to psychiatric diagnostic classification, i.e., with regard to the standardized term used to categorize and identify so-called mental health disorders. I will then highlight the implications for clinical practice, notably that a transparent discussion of these aspects with certain patients can benefit the therapeutic relationship and allow people with mental disorders to envisage a narrative that does not have to be limited to a psychiatric condition or be constituted by the rejection of the latter, but which can leave it a legitimate place. Ultimately, I hope that raising clinicians’ awareness of the ethical issues inherent in psychiatric diagnosis will limit the potentially pejorative and dehumanizing nature of diagnostic reduction, by allowing them to adopt reflexive and transparent attitudes on these issues. (shrink)