It is now generally agreed that we have to rely on value judgments to distinguish mental disorders from other conditions, but it is not quite clear how. To clarify this, we need to know more than to what extent attributions of disorder are dependent on values. We also have to know (1) what kind of evaluations we have to rely on to identify the class of mental disorder; (2) whether attributions of disorder contain any implicit reference to some specific evaluative (...) standard; and (3) whether the concept of mental disorder is value laden in the definitional or in the epistemic sense. I will argue that the evaluations we have to rely on are mainly considerations of harm, but that we also need to rely on other evaluations; that there should be no references to specific evaluative standards; and that even though mental disorders are necessarily undesirable, "mental disorder" may well be a descriptive phrase. (shrink)

This book is a contribution to the general philosophy of action and the philosophy of welfare. The author makes separate analyses of concepts such as action, ability, interaction, action-explanation, happiness, health, illness and disability. At the same time he explores and substantiates the idea of a strong interdependence between the concept of action and some of the central concepts of welfare, in particular health and illness and related concepts.

Contemporary philosophy of health has been quite focused on the problem of determining the nature of the concepts of health, illness and disease from a scientific point of view. Some theorists claim and argue that these concepts are value-free and descriptive in the same sense as the concepts of atom, metal and rain are value-free and descriptive. To say that a person has a certain disease or that he or she is unhealthy is thus to objectively describe this person. On (...) the other hand it certainly does not preclude an additional evaluation of the state of affairs as undesirable or bad. The basic scientific description and the evaluation are, however, two independent matters, according to this kind of theory. Other philosophers claim that the concept of health, together with the other medical concepts, is essentially value-laden. To establish that a person is healthy does not just entail some objective inspection and measurement. It presupposes also an evaluation of the general state of the person. A statement that he or she is healthy does not merely imply certain scientific facts regarding the person’s body or mind but implies also a (positive) evaluation of the person’s bodily and mental state. My task in this paper will be, first, to present the two principal rival types of theories and present what I take to be the main kind of reasoning by which we could assess these theories, and second, to present a deeper characterization of the principal rival theories of health and illness. (shrink)

The first edition of The Mind and its Discontents was a powerful analysis of how, as a society, we view mental illness. In the ten years since the first edition, there has been growing interest in the philosophy of psychiatry, and a new edition of this text is more timely and important than ever. -/- In The Mind and its Discontents, Grant Gillett argues that an understanding of mental illness requires more than just a study of biological models of mental (...) processes and pathologies. As intensely social animals, he argues, we need to look for the causes of human mental disorders in our interactions with others; in social rule-following and its role in the organization of mental content; in the power relations embedded within social structures and cultural norms; in the way that our mental life is inscribed by a cumulative life of encounters with others. Drawing upon work from within the philosophy of mind, epistemology, post-modern continental philosophy, and philosophy of language, he tries to elucidate the nature of psychiatric phenomena involving disorders of thought, perception, emotion, moral sense, and action. Within this framework, a series of chapters analyse important psychiatric disorders such as depression, attention deficiency, autism, schizophrenia, and anorexia. Along the way, Gillett explores the nature of memory and identity; of hysteria and what constitutes rational behaviour; and of what causes us to label someone a psychopath or deviant. -/- Updated, available in paperback, and more accessible than before, the new edition of this fascinating book will provide readers with important insights into the causes and nature of psychosis. In addition, Gillett's arguments have considerable implications for the way in which we understand and treat people suffering from psychiatric disorders. The Mind and its Discontents will be read by researchers and postgraduate students in a range of academic areas, including psychiatry, bioethics, philosophy of mind, social theory, and clinical psychology. It will also be of considerable interest to practising psychiatrists. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Art and Science, Facts and KnowledgeBengt Brülde (bio)Keywordsart, definitions, epistemology, facts and values, mental disorder, metaphysical realism, nominalism, physical disorder, social constructivismThe main purpose of my original article was to find out how the evaluative content of the concept of mental disorder, i.e. its "value component," should be characterized. Both Tyreman and Ross are focusing on other things, however. Tyreman seems to agree with my analysis, and his primary (...) objective is to find out whether my general analytical approach can be extended to other areas, e.g. whether it can be used to analyze the concept of physical disorder or the concept of art. It is hard to tell whether Ross agrees with my view, since her entire commentary is focused on a few assumptions I made in the beginning of the paper, mainly in passing, to make my evaluative investigation more manageable. In short, the main content of my original paper is never really challenged, and I do not think I have to revise my view on the evaluative content of the concept of mental disorder. Both commentaries give rise to questions that are interesting in their own right, however, e.g. questions about art and science, and about facts and knowledge. This gives me the opportunity to develop my views on a number of topics that I never touched upon in the original article, e.g. the purpose of defining "mental disorder," the factual component of the concept, the connection between ontological and epistemological issues, and the value-neutrality of science. I am very grateful to the editors for allowing me to give such an extensive reply.My Reply to TyremanTyreman wants to know whether the same kind of analysis given in my original paper can be applied just as usefully to other areas of health care. That is, the question is whether the same type of analytical approach can be extended to other areas where evaluative considerations seem to play a crucial part. In his commentary, Tyreman has mainly four areas in mind, namely physical disorder, art, good art, and good (competent) clinical practice. Or more specifically, the question is whether the kind of evaluative analysis I used in my original paper can help us answer the following four questions: (a) How should we define the concept of physical disorder, i.e. according to what criteria should we draw the line between physical disorders and other physical conditions? (b) How should we define the concept of art, i.e. according to what criteria should we draw the line between art and other artifacts and performances? (c) What is good art, i.e. according to what criteria should we evaluate those artifacts (etc.) that we have decided to categorize as works of art? (d) What makes a clinical performance or practice good or competent, according to what criteria should we evaluate such practices?The first two questions are conceptual, i.e. the question is how certain concepts should be [End Page 111] defined, and in what way or ways values enter the picture. The last two questions are straightforwardly evaluative, however, and it goes without saying that we have to rely on value judgments to answer these questions. This difference suggests that the conceptual analyses needed in the first two cases are somewhat different from the evaluative analyses needed in the last two cases. It is also far more likely that my analysis of mental disorder can be extended to the first two cases. After all, my approach is designed to capture the evaluative content of concepts that are not purely evaluative. (We will return to this below.)To see whether my analysis can be of any help in any of Tyreman's four cases, we need to recapitulate what it is all about. The analysis in question is specifically concerned with how the evaluative content of the concept of mental disorder should be characterized, i.e. how and to what extent we have to rely on value judgments to distinguish mental disorders from other conditions. The first part of the analysis consists in the formulation of four questions that any reasonably complete account needs to answer. These questions are: (0... (shrink)

The long ongoing and partly heated debate on the concept of disease has not led to any consensus on the status of this apparently essential concept for modern health care. The arguments range from claims that the disease concept is vague, slippery, elusive, or complex, and to statements that the concept is indefinable and unnecessary. The unsettled status of the concept of disease is challenging not only to health care where diagnosing, treating, and curing disease are core aims, but also (...) to the branch of philosophy that tries to clarify concepts. This article discusses three claims about the concept of disease: that it is vague, complex, and that it is indefinable. It investigates (a) what is meant by these claims (b) what their implications are, and (c) whether the claims are sound or not. It is argued that some of the arguments are flawed and miss important points about concept analysis. This does not mean, however, that disease is a clear concept with a crisp definition. It only rules out speculative claims that disease necessarily is vague, complex, and indefinable. It appears at least as hard to show that disease is indefinable as it is to define it. (shrink)

One INTRODUCTION 1. Background The theory of the nature of health and disease, or of the concepts of health and disease, has been central in modem ...

The long ongoing and partly heated debate on the concept of disease has not led to any consensus on the status of this apparently essential concept for modern health care. The arguments range from claims that the disease concept is vague, slippery, elusive, or complex, and to statements that the concept is indefinable and unnecessary. The unsettled status of the concept of disease is challenging not only to health care where diagnosing, treating, and curing disease are core aims, but also (...) to the branch of philosophy that tries to clarify concepts. This article discusses three claims about the concept of disease: that it is vague, complex, and that it is indefinable. It investigates what is meant by these claims, what their implications are, and whether the claims are sound or not. It is argued that some of the arguments are flawed and miss important points about concept analysis. This does not mean, however, that disease is a clear concept with a crisp definition. It only rules out speculative claims that disease necessarily is vague, complex, and indefinable. It appears at least as hard to show that disease is indefinable as it is to define it. (shrink)

The starting point for the contemporary debate about theories of health should be the holistic theory of Lennart Nordenfelt, claims George Khushf, not the refuted theory of Christopher Boorse. The present paper is an attempt to challenge Nordenfelt and to present an alternative theory to his and other theories, including Boorse’s. The main problems with Nordenfelt’s theory are that it is relativistic, that it leads to counter-intuitive results as to what goals can count as healthy, that it focuses on the (...) wrong kind of abilities, that it makes measuring health extra difficult, and that it does not give us a sufficient account of health, at most a necessary one. The alternative theory proposed is two-dimensional. First, health is to have developed the abilities and dispositions that members of one’s culture typically develop, and be able to use them, in acceptable circumstances; and second, health is to experience positive moods and sensations, the kinds that have internal causes. The theory solves the problems attached to Nordenfelt’s theory by not being individual relativistic, by eliminating the goals in the definition, by giving an alternative interpretation of “ability,” by making health easier to measure, and by adding the dimension of well-being that, together with health as ability, not only gives us a necessary, but also a sufficient, account of health. (shrink)

The method of appealing to considered judgments in Wide Reflective Equilibrium has been thought to have unwelcome relativistic or ethnocentric implications. This belief, which is widely held, is, I shall argue, mistaken. Wide Reflective equilibrium has no such untoward implications. I shall first specify what I am talking about in speaking of relativism, then generally characterize WRE, then deploy some central arguments for it and finally try to show that it has no relativistic implications.