The latest edition of the Diagnostic and Statistical Manual of Mental Disorders included the Social Communication Disorder as a new mental disorder characterized by deficits in pragmatic abilities. Although the introduction of SPCD in the psychiatry nosography depended on a variety of reasons—including bridging a nosological gap in the macro-category of Communication Disorders—in the last few years researchers have identified major issues in such revision. For instance, the symptomatology of SPCD is notably close to that of (...) Autism Spectrum Disorder. This opens up the possibility that individuals with very similar symptoms can be diagnosed differently and receive different clinical treatments and social support. The aim of this paper is to review recent debates on SPCD, particularly as regards its independence from ASD. In the first part, we outline the major aspects of the DSM-5 nosological revision involving ASD and SPCD. In the second part, we focus on the validity and reliability of SPCD. First, we analyze literature on three potential validators of SPCD, i.e., etiology, response to treatment, and measurability. Then, we turn to reliability issues connected with the introduction of the grandfather clause and the use of the concepts of spectrum and threshold in the definition of ASD. In the conclusion, we evaluate whether SPCD could play any role in contemporary psychiatry other than that of an independent mental disorder and discuss the role that non-epistemic factors could play in the delineation of the future psychiatry nosography. (shrink)

In view of the publication of the DSM-V researchers were asked to discuss the theoretical implications of the definition of mental disorders. The reasons for the use, in the DSM-III, of the term disorder instead of disease are considered. The analysis of these reasons clarifies the distinction between the general definition of disorder and its implicit, technical meaning which arises from concrete use in DSM disorders. The characteristics and limits of this technical meaning are discussed and contrasted (...) to alternative definitions, like Wakefield’s harmful/dysfunction analysis. It is shown that Wakefield’s analysis faces internal theoretical problems in addition to practical limits for its acceptance in the DSM-V. In particular, it is shown that: a) the term dysfunction is not purely factual but intrinsically normative/evaluative; b) it is difficult to clarify what dysfunctions are in the psychiatric context (the dysfunctional mechanism involved being unknown in most cases and the use of evolutionary theory being even more problematic); c) the use of conceptual analysis and commonsense intuition to define dysfunctions leaves unsatisfied empiricists; d) it is unlikely that the authors of the DSM-V will accept Wakefield’s suggestion to revise the diagnostic criteria of any single DSM disorder in accordance with his analysis, because this is an excessively extensive change and also because this would probably reduce DSM reliability. In conclusion, it is pointed up in which sense DSM mental disorders have to be conceived as constructs, and that this undermines the realistic search for a clear-cut demarcation criterion between what is disorder and what is not. (shrink)

Naturalistic accounts of mental disorder aim to identify an objective basis for attributions of mental disorder. This goal is important for demarcating genuine mental disorders from artificial or socially constructed disorders. The articulation of a demarcation criterion provides a means for assuring that attributions of 'mental disorder' are not merely pathologizing different forms of social deviance. The most influential naturalistic and hybrid definitions of mental disorder identify biological dysfunction as the objective (...) basis of mental disorders: genuine mental... (shrink)

Are psychiatric disorders natural kinds? This question has received a lot of attention within present-day philosophy of psychiatry, where many authors debate the ontology and nature of mental disorders. Similarly, historians of psychiatry, dating back to Foucault, have debated whether psychiatric researchers conceived of mental disorders as natural kinds or not. However, historians of psychiatry have paid little to no attention to the influence of (a) theories within logic, and (b) theories within metaphysics on psychiatric accounts of proper (...) method, and on accounts of the nature and classification of mental disorders. Historically, however, logic and metaphysics have extensively shaped methods and interpretations of classifications in the natural sciences. This paper corrects this lacuna in the history of psychiatry, and demonstrates that theories within logic and metaphysics, articulated by Christian Wolff (1679-1754), have significantly shaped the conception of medical method and (psychiatric) nosology of the influential nosologist Boissier De Sauvages (1706-1767). After treating Sauvages, I discuss the method of the influential nosologist William Cullen (1710-1790), and demonstrate the continuity between the classificatory methods of Sauvages and Cullen. I show that both Sauvages and Cullen were essentialists concerning medical diseases in general and psychiatric disorders in particular, contributing to the history of conceptions of the ontology and nature of mental disorders. (shrink)

At present, psychiatric disorders are characterized descriptively, as the standard within the scientific community for communication and, to a certain extent, for diagnosis, is the DSM, now at its fifth edition. The main reasons for descriptivism are the aim of achieving reliability of diagnosis and improving communication in a situation of theoretical disagreement, and the Ignorance argument, which starts with acknowledgment of the relative failure of the project of finding biomarkers for most mental disorders. Descriptivism has also the advantage (...) of capturing the phenomenology of mental disorders, which appears to be essential for diagnosis, though not exhaustive of the nature of the disease. I argue that if we rely on the distinction between conceptions (procedures of identification) and concepts (reference-fixing representations), which was introduced in the philosophical debate on the nature of concepts, we may understand a limited but valid role for descriptive characterizations, and reply to common objections addressed by those who advocate a theoretically informed approach to nosology. (shrink)

Abstract: At present, psychiatric disorders are characterized descriptively, as the standard within the scientific community for communication and, to a cer- tain extent, for diagnosis, is the DSM, now at its fifth edition. The main rea- sons for descriptivism are the aim of achieving reliability of diagnosis and improving communication in a situation of theoretical disagreement, and the Ignorance argument, which starts with acknowledgment of the relative fail- ure of the project of finding biomarkers for most mental disorders. Descrip- (...) tivism has also the advantage of capturing the phenomenology of mental dis- orders, which appears to be essential for diagnosis, though not exhaustive of the nature of the disease. I argue that if we rely on the distinction between conceptions (procedures of identification) and concepts (reference-fixing representations), which was introduced in the philosophical debate on the nature of concepts, we may understand a limited but valid role for descrip- tive characterizations, and reply to common objections addressed by those who advocate a theoretically informed approach to nosology. (shrink)

In psychiatry, pharmacological drugs play an important experimental role in attempts to identify the neurobiological causes of mental disorders. Besides being developed in applied contexts as potential treatments for patients with mental disorders, pharmacological drugs play a crucial role in research contexts as experimental instruments that facilitate the formulation and revision of neurobiological theories of psychopathology. This paper examines the various epistemic functions that pharmacological drugs serve in the discovery, refinement, testing, and elaboration of neurobiological theories of (...) class='Hi'>mental disorders. I articulate this thesis with reference to the history of antipsychotic drugs and the evolution of the dopamine hypothesis of schizophrenia in the second half of the twentieth century. I argue that interventions with psychiatric patients through the medium of antipsychotic drugs provide researchers with information and evidence about the neurobiological causes of schizophrenia. This analysis highlights the importance of pharmacological drugs as research tools in the generation of psychiatric knowledge and the dynamic relationship between practical and theoretical contexts in psychiatry. (shrink)

In this thesis I develop an account of how processes of social understanding are implicated in experiences of mental disorder, critiquing the lack of examination of this phenomena along the way. First, I demonstrate how disorder concepts, as developed and deployed by psychiatric institutions, have the effect of shaping the cognition of individuals with psychopathology through setting expectations. Such expectation-setting can be harmful in some cases, I argue, and can perpetuate epistemic injustices. Having developed this view, I (...) criticise enactive accounts of mental disorder for failing to consider how such terms like ‘dysfunction’ are open to interpretation and can come embedded with normative expectations. Enactive accounts consequently run the risk of perpetuating injustices in their account of the sociality of mental disorder. Similar concerns arise when we consider the attachment of enactivism to the medical model, I argue. But by adapting enactivism to consider other experiences of disorder, such as those described as ‘madness’, enactive psychiatry may genuinely provide ethical groundwork for a better conception of disordered experience. Then, I consider a further concern with a distinctly medicalised conception of mental disorder from the perspective of self-illness ambiguity, arguing that self-illness ambiguities appear to form a special class of ambiguities due to their proximity to disorder concepts which mark them as appropriate targets for therapeutic treatment. However, I argue further that we should be critical of the idea that self-illness ambiguities necessitate disambiguation, as, in cases where self and illness are demarcated, individuals may still experience distress because simply having a mental disorder can be socially alienating. The medicalised focus in self-illness ambiguity, and the explicit need from the medical perspective to disambiguate it, might then exacerbate the distress someone experiences in mental disorder. Moreover, drawing on Mad Studies, I suggest that one might not need a coherent self-narrative to live well. Because of this, one may not need to adopt a medicalised view of the self in the case of selfillness ambiguity. In order to support this analysis, I provide a phenomenological account of language and argue that the very thoughts implicated in mental disorder shape the individual’s perception of the world due to the way that language foregrounds particular aspects of our world. This demands a critical examination of the language adopted and used by both clinicians and disordered individuals. I thus conclude with some thoughts on how to approach research and developing understanding of mental disorder given that we, as people, are always implicated in this process and therefore socialisation of some kind will always be taking place. (shrink)

The idea that in human history it is possible to recognize distinct ways of thinking is widespread in the literature. Sometimes, instead of the phrase ‘ways of thinking’, other labels are used, such as ‘forms of thought’, ‘modes of thinking’, ‘ways of knowing’, ‘ways of reasoning’, ‘mental attitudes’ or ‘worldviews’. At any rate, it is possible to say that there is a concept, that of ‘ways of thinking’, which has played a crucial role in philosophy at least (...) since the Enlightenment and has acquired considerable weight with the emergence of a French tradition in philosophy of science called historical epistemology. This concept appears in different versions, as if they were species of the same genus. In this chapter, I shall outline its history, from Vico to Hacking and beyond, and I shall show how and why its different species have been introduced. My account provides a guiding thread running through philosophy of science that unifies the researches of important authors such as Lévy-Bruhl, Brunschvicg, Metzger, Koyré, Fleck, Foucault, Kuhn, Hacking and others. This guiding thread is mainly constituted by the project of historicizing Kant’s a priori by replacing it with a given notion of ‘ways of thinking’. (shrink)

This paper explores how the diagnosis of mental disorder may affect the diagnosed subject’s self-concept by supplying an account that emphasizes the influence of autobiographical and social narratives on self-understanding. It focuses primarily on the diagnoses made according to the criteria provided by the Diagnostic Statistical Manual of Mental Disorders (DSM), and suggests that the DSM diagnosis may function as a source of narrative that affects the subject’s self-concept. Engaging in this analysis by appealing to (...) autobiographies and memoirs written by people diagnosed with mental disorder, the paper concludes that a DSM diagnosis is a double-edged sword for self- concept. On the one hand, it sets the subject’s experience in an established classificatory system which can facilitate self-understanding by providing insight into subject’s condition and guiding her personal growth, as well as treatment and recovery. In this sense, the DSM diagnosis may have positive repercussions on self-development. On the other hand, however, given the DSM’s symptom-based approach and its adoption of the Biomedical Disease model, a diagnosis may force the subject to make sense of her condition divorced from other elements in her life that may be affecting her mental- health. It may lead her frame her experience only as an irreversible imbalance. This form of self-understanding may set limits on the subject’s hopes of recovery and may create impediments to her flourishing. (shrink)

Our main objective is to locate and analyze some philosophical issues about the concept of mental illness and the manner it is used, especially in contemporary psychiatry. It is even difficult to find a standard meaning in the main psychiatric textbooks; and, when there is some exposition of the concept, it is sparse, uncritical and vague. As an immediate consequence of these issues, practical guidelines and protocols for the clinic arise, which become almost “automatic”, unreflective behaviors, practices (...) translated as health interventions and public mental health policies. An example is the problem of overdiagnosis, in which the use of medical technology (categories, drugs, clinical exams, etc.) has generated more harm and risks to the subject's health than benefits. Exposing these issues from a philosophical perspective can eventually contribute to the field of mental health. For this work, the main manuals and textbooks of psychiatry were selected to analyze how they deal with the concept of mental illness or disorder, in addition to locating the present discussion in authors from both philosophy and the psychiatric field and how they contribute to its clarification. (shrink)

Pierre-Henri Castel provides a short but richly argued precis of his recently published two-volume 1,000-page masterwork on the history of obsessive-compulsive disorder. Having not read the as-yet-untranslated books, I write this commentary from Plato’s cave, trying to infer the reality of Castel’s analysis from expository shadows. I am unlikely to be more successful than Plato’s poor troglodytes, so I apologize ahead of time for any misunderstandings. Moreover, I cannot assess Castel’s detailed evidential case for his substantive theses.1 I (...) thus focus on some key philosophical issues that impinge on an area of my concern, the concept of mental disorder. Castel is a rare breed of French.. (shrink)

Recently there has been a trend of moving towards biological and neurocognitive based classifications of mental disorders that is motivated by a dissatisfaction with the syndrome-based classifications of mental disorders. The Research Domain Criteria (indicated with the acronym RDoC) represents a bold and systematic attempt to foster this advancement. However, RDoC faces theoretical and conceptual issues that need to be addressed. Some of these difficulties emerge when we reflect on the plausible reading of the slogan “mental disorders (...) are brain disorders”, that according to proponents of RDoC constitutes one of its main presuppositions. Some authors think that endorsing this idea commits RDoC to a form of biological reductionism. We offer empirical and theoretical considerations for concluding that the slogan above should not be read as a reductionist thesis. We argue, instead, that the slogan has a pragmatic function whose aim is to direct research in psychopathology. We show how this function might be captured in the framework of a Carnapian explication as a methodological tool for conceptual engineering. Thus, we argue that a charitable interpretation of the aims of the proponents of RDoC should be understood as an attempt at providing an explication of the concept of mental disorder in terms of brain disorder whose main goal is to provide a more precise and fruitful notion that is expected to have a beneficial impact on classification, research, and treatment of psychiatric conditions. (shrink)

The mental disorder concept has not been paid due attention to. The aim of this paper is twofold: first, to assess how much space has been given to the mental disorder concept in textbooks of psychiatry, and second, to show in how many domains both within and beyond psychiatry the mental disorder concept plays a key role. A number of textbooks written in English, German, French, Spanish, and Italian, selected as examples, (...) have been scanned so as to see if there is a chapter dealing with mental disorder, in particular with its definition. Also, the fields in which the mental disorder plays a major role have been identified, and the reasons why the concept of mental disorder is relevant for them have been explored. There is no chapter dealing with the definition of mental disorder in some textbooks of psychiatry in English, German, French, Spanish, and Italian that have been selected as examples. Yet there are numerous domains, directly or indirectly related to psychiatry, in which the mental disorder concept is a substantial element. The results show that the concept of mental disorder should be kept high on psychiatric agenda and given due space in textbooks of psychiatry accordingly. (shrink)

This paper provides a historical analysis of a shift in the way animal models of mental disorders were conceptualized: the shift from the mid-twentieth-century view, adopted by some, that animal models model syndromes classified in manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), to the later widespread view that animal models model component parts of psychiatric syndromes. I argue that in the middle of the twentieth century the attempt to maximize the face validity of (...) animal models sometimes led to the pursuit of the ideal of an animal model that represented a behaviorally defined psychiatric syndrome as described in manuals such as the DSM. I show how developments within psychiatric genetics and related criticism of the DSM in the 1990s and 2000s led to the rejection of this ideal and how researchers in the first decade of the twenty-first century came to believe that animal models of mental disorders should model component parts of mental disorders, adopting a so-called endophenotype approach. (shrink)

Sometimes it happens that the same concept is discussed independently but, at the same time, in different disciplinary fields. The recent dominance of neuroscientific research has reintroduced into the experimental realm the importance of the experimental subject’s self-evaluation to be correlated to detectable changes into brain activity. For example, the experimental subjects are instructed to press a button or move a finger when they perceive or feel something, or they fill questionnaires supposed to measure their experience; all these “data” (...) are then statistically correlated to measures of brain functioning. (shrink)

The notion of harm is frequently used in the discussion of the nature of mental disorder. Harm also plays important roles in the prominent diagnostic manuals such as DSM and ICD. Recently, however, Cristina Amoretti and Elisabetta Lalumera have questioned the idea that harm should be a necessary constituent of mental disorders. They argue that the notion of harm is underspecified and potentially leads to false negatives in diagnosing mental disorders. Given that harm plays significant roles (...) in medical diagnosis and treatment indicates that we should be reluctant to remove it as a criterion for deciding whether some condition is a mental disorder. Instead, we argue that harm should be understood in the prudential sense and harm in this sense provides a way of responding to worries raised by Amoretti and Lalumera, while staying true to the conception of harm that is relevant for psychiatric practice. (shrink)

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)

In this paper, it is argued that the late twentieth century conception of consciousness in analytic philosophy emerged from the idea of consciousness as givenness, via the behaviourist idea of “raw feels”. In the post-behaviourist period in philosophy, this resulted in the division of states of mind into essentially unconscious propositional attitudes plus the phenomenal residue of qualia: intrinsic, ineffable and inefficacious sensory states. It is striking how little in the important questions about consciousness depends on this conception, or on (...) this particular division of mental states. So accepting this division and its associated conceptions of intentionality and consciousness is not an obligatory starting point for the philosophy of mind. A historical investigation of how these ideas came to be seen as inevitable can also help us see how we might reasonably reject them. (shrink)

Beyond its captivating narratives and stunning visuals, Japanese anime offers audiences worldwide a unique window into Japan’s rich history, culture, philosophy and values. Within this vast and diverse universe, there exists a recurring and multifaceted thematic exploration — theodicy and the philosophy of ‘evil’. This study aims to comprehensively deconstruct and examine the portrayal of ‘evil’ in Japanese anime emphasizing its substantial relevance within the broader discourse of Japan's soft power. Characters’ behaviors, actions, curses, lability, suffering, natural disasters, wars, (...) natural humanity, monsters are presented in a way that prompts viewers to question the true nature of evil, if there is any. Fundamental to this study is the notion that 'evil' in anime is not an absolute, fixed concept, but rather an ephemeral perspective. Moreover, sometimes anime delves into the unconventional portrayal of the supreme beings as evil, challenging traditional dichotomies of g(o)od and (d)evil, which from a certain reality-level do not exist anymore. In anime, the only things that exist are will and power, the way that they are used being a matter of perspective. What is the systematic cycle of evil in anime and how will it affect the next generation’s mentality? (shrink)

Perhaps the philosophical thesis most commonly associated with Brentano is that intentionality is the mark of the mental. But in fact Brentano often and centrally uses also what he calls ‘inner perception’ to demarcate the mental. In this paper, I offer a new interpretation of Brentano’s conception of the interrelations between mentality, intentionality, and inner perception. According to this interpretation, Brentano took the concept of mind to be a natural-kind concept, with intentionality constituting the underlying nature (...) of the mental and inner-perceivability serving as the concept’s reference-fixer. (shrink)

This paper offers a philosophical analysis of mental illness as a concept and attempts to provide an understanding of what contributes to the instability of this concept. Mental illness is argued to be susceptible to looping effects, which means that the behaviours of those diagnosed is affected by their classification. This idea of looping is a contributor to mental illness being an unstable category as it affects the behaviours of those classified and the classifications themselves. (...) Specific mental disorders such as anxiety and depression are particularly vulnerable to looping effects due to their value-laden and subjective diagnostic criteria, argued by many anti-psychiatrists such as Rosenhan, Foucault and Szasz. These looping effects are more relevant than ever, with the increased awareness of mental illnesses on social media, overgeneralized information surrounding the symptoms of disorder, the glamorisation and self-assessments which inspire self-diagnosis. Whilst mental illness should not be abandoned as a concept, ‘mental illness’ has deviated from the proper use of ‘mental disorder’ due to overdiagnosis and looping effects and this conceptual instability is a bad thing due to the long-term consequences of over-prescribing antidepressants, preventing access to treatment, political and social implications and a looping trap: which is the idea that an individual cannot escape from their classification once identified. This paper gives a conceptual analysis of ‘mental illness’ and argues that looping effects are mainly responsible for its instability and in order to avoid the negative consequences of such an instability, we should be aware of these effects and attempt to find a basic framework which presents a clear understanding of what we mean by ‘abnormal’ or ‘disordered’ behaviours. (shrink)

It is important to note that certain mental health disorders are classified as rare conditions, and they have their own ‘cultural concepts of distress’ as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5). Cultural concepts of distress are a recent attempt to understand psychological distress influenced by culture, separate from biomedical diagnoses that require equal attention and support for individuals and their families, both physically and emotionally. [1].

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)

The Philosophy of Psychiatry is a unique area of research because the nature of the subject matter leads to quite distinct methodological issues. Naturalism, Interpretation, and Mental Disorder is an original new work focusing on the challenges we face when trying to interpret and understand mental illness. The book integrates a hermeneutical perspective, and shows how such an approach can reveal important facts about historical sources in psychiatry and the nature of dialogue in the therapeutic encounter. In (...) addition, the book demonstrates how such an approach can be valuable for understanding the concept of mental disorder itself. Naturalism, Interpretation, and Mental Disorder brings fresh thinking to the philosophy of psychiatry, and will be of interest to students and scholars in the fields of Mental Health and Philosophy. (shrink)

The tendency to draw mind-brain dichotomies and evaluate mental disorders dualistically arises in both laypeople and mental health professionals, leads to biased judgments, and contributes to mental health stigmatization. This paper offers a theory identifying an underlying source of these evaluations in social practice. According to this theory, dualistic evaluations are rooted in two mechanisms by which we represent and evaluate the beliefs of others in folk psychology and theory of mind: the doxastic conception of mental (...) disorders and doxastic voluntarism. Tracing these origins contributes to our understanding of mental state representation in cognitive science and philosophy of psychiatry, the concept of belief in philosophy of mind, and may help improve patient experience and treatment in light of social stigmatization and bias toward mental illness. (shrink)

The book is a history of the concept of experience in philosophy. Minakov focuses mainly on Western 19-20th century philosophical movements and their use of the experience concept. Author uses topological method to describe growth of the conseptual content of experience, as well as decline in its use in the end of 20th century.

A pressing need for interrater reliability in the diagnosis of mental disorders emerged during the mid-twentieth century, prompted in part by the development of diverse new treatments. The Diagnostic and Statistical Manual of Mental Disorders (DSM), third edition answered this need by introducing operationalized diagnostic criteria that were field-tested for interrater reliability. Unfortunately, the focus on reliability came at a time when the scientific understanding of mental disorders was embryonic and could not yield valid disease definitions. Based (...) on accreting problems with the current DSM-fourth edition (DSM-IV) classification, it is apparent that validity will not be achieved simply by refining criteria for existing disorders or by the addition of new disorders. Yet DSM-IV diagnostic criteria dominate thinking about mental disorders in clinical practice, research, treatment development, and law. As a result, the modernDSMsystem, intended to create a shared language, also creates epistemic blinders that impede progress toward valid diagnoses. Insights that are beginning to emerge from psychology, neuroscience, and genetics suggest possible strategies for moving forward. (shrink)

As it emerged from philosophical analyses and cognitive research, most concepts exhibit typicality effects, and resist to the efforts of defining them in terms of necessary and sufficient conditions. This holds also in the case of many medical concepts. This is a problem for the design of computer science ontologies, since knowledge representation formalisms commonly adopted in this field do not allow for the representation of concepts in terms of typical traits. However, the need of representing concepts in terms of (...) typical traits concerns almost every domain of real world knowledge, including medical domains. In particular, in this article we take into account the domain of mental disorders, starting from the DSM-5 descriptions of some specific mental disorders. On this respect, we favor a hybrid approach to the representation of psychiatric concepts, in which ontology oriented formalisms are combined to a geometric representation of knowledge based on conceptual spaces. (shrink)

Abstract Recently, some philosophers of psychiatry (viz., Rachel Cooper and Dominic Murphy) have analyzed the issue of psychiatric classification. This paper expands upon these analyses and seeks to demonstrate that a consideration of the history of the Diagnostic and Statistical Manual of Mental Disorders (DSM) can provide a rich and informative philosophical perspective for critically examining the issue of psychiatric classification. This case is intended to demonstrate the importance of history for philosophy of psychiatry, and more generally, (...) the potential benefits of historically-informed approaches to philosophy of science. (shrink)

This paper is a tentative step towards a historical cognitive science, in the domain of memory and personal identity. I treat theoretical models of memory in history as specimens of the way cultural norms and artifacts can permeate ('proto')scientific views of inner processes. I apply this analysis to the topic of psychological control over one's own body, brain, and mind. Some metaphors and models for memory and mental representation signal the projection inside of external aids. Overtly at least, (...) medieval and Renaissance theorists agreed that such models had to allow for, or even guarantee, some conception of cognitive order and discipline. Individual memory traces had to be independent, not mixed up or interfering with others. The long tradition of improving or bypassing 'natural memory' by deliberately internalizing artefactual models was part of an arduous process of self-fashioning. Moral panic about confusion and mixture features centrally in the imposition of cognitive discipline in local memory traditions. (shrink)

The conception of truth-making, albeit in a rudimentary form, could already be discerned in the writings of G. E. Moore and E. Husserl in the early 1900s. A few years later it was more extensively exploited by William James. It was Wittgenstein, however, who gave the concept a precise meaning. In 1913/1914 Wittgenstein advanced a theory of possible worlds, only one of which was real. Every proposition suggests a part of a possible world which does or does not correspond (...) to parts of the real world. In the first case the proposition is true, in the second case false. Moreover, the part of the real world makes the sentence true. This part is a truth-maker, and the sentence is a truth-bearer. Surprisingly enough, Wittgenstein’s concept of truth-making had its family resemblance with William James’s conception of truth. In 1915 Wittgenstein stopped using the concept of truth-making—it was also not men-tioned in the Tractatus. Unfortunately, Russell did not notice this and in 1918 he adopted the concept of truth-making. In the 1930s, it was used by some second generation analytic philosophers (Schlick, Stebbing, and Wisdom). However, it became rather popular among analytic philosophers only in the 1980s. (shrink)

Increasing life expectancy may explain why more elderly candidates appear to be running for office. This raises general questions regarding the specific risks of old age and frailty in demanding political positions. Therefore, I tried to give important contemporary examples of elderly leaders, study the mean age of leading political figures over the last 3 decades and present historical examples of heads of state with age-associated brain diseases and cognitive deficits. I reviewed the literature on mental illness and politics (...) and analyzed the ages of international political leaders in 1990, 2000, 2010 and 2020. Summary: There are several impressive contemporary examples of elderly politicians. The mean age of political leaders has not increased significantly in most parts of the world over the last 3 decades with the exception of the Gulf States and sub-Saharan Africa. Health problems of heads of state in earlier centuries had not been primarily age associated. After 1900, dementia but also mild cognitive and mild behavioral impairment became important issues in politically critical situations, for example international peace negotiations, the rise of Nazi Germany, the breakup of communism, the Arab Spring and others. This paper collects anecdotal evidence of cognitive frailty in ageing politicians; it is not an in-depth analysis of political history. Observations confirm that a very long time in power may obviously increase the risk of age-associated problems; dynamic revolutionary or entrepreneurial idols may be misled to rely on their irreplaceable charisma for too long. However, caution must be exercised against ageism on one side versus silent acquiescence towards leaders with failing mental powers on the other, who may become victims of obscure parties and their decompensating personality disorders. Current news nurture the impression that large and important states are governed by elderly people, and oc- casional reports indicate that there is a number of lesser known countries ruled by rather seasoned leaders. (shrink)

Sensations can occur in the absence of perception and yet be experienced ‘as if’ seen, heard, tasted, or otherwise perceived. Two concepts used to investigate types of these sensory-like mental phenomena (SLMP) are mental imagery and hallucinations. Mental imagery is used as a concept for investigating those SLMP that merely resemble perception in some way. Meanwhile, the concept of hallucinations is used to investigate those SLMP that are, in some sense, compellingly like perception. This may (...) be a difference of degree. Attempts to reliably differentiate between instances of each type of SLMP remain unresolved. Despite this, the concepts of mental imagery and hallucinations are each routinely used independently of the other. These uses are especially interesting in those published accounts of experiments where equivalent findings about the neuroanatomical correlates of SLMP are reported in support of diverging knowledge-claims about the role of SLMP in neurocognitive processes. This practice presents a puzzle. To examine one aspect of this puzzle, I compare the uses of these two scientific concepts in three ways: examining their roles in differentiating between types of SLMP; exploring how their respective historical developments intersect; and analysing their contributions in neuroimaging experiments. In presenting this series of comparative analyses, I will draw on three themes from historical, philosophical, and social studies of scientific practices: interest in material contributions to knowledge; accounts of how concepts are used in experiments; and explorations of the historical conditions within which current practices emerge. Building on this literature, my comparative analyses supports five related claims. My first claim is that the concepts of mental imagery and hallucinations are each used as independent tools in neuroimaging experiments. My second claim is that, as experimental tools, the concepts of mental imagery and hallucinations are each used for investigating discrete epistemic goals. My third claim is that there are implicit interdependent associations that structure the uses of these two concepts as tools for independently investigating these discrete epistemic goals in neuroimaging experiments. This third claim rests on my analyses of both past and present uses of each concept. Firstly, as seen in their intersecting histories, there are disciplined performances of using the concepts of mental imagery and hallucinations that carry-along shared associations about the mediating role of SLMP in thought. Secondly, these interdependent ‘mediator-view’ associations continue to structure the independent uses of each concept as a tool for investigating SLMP in pursuit of specific goals. Taking this further, my fourth claim is that recognising the structured uses of the concepts of mental imagery and hallucinations can help to account for how equivalent SLMP-neuro-correlates are generated in support of diverging knowledge-claims. Finally, my fifth claim is that the structured uses of these concepts as tools can contribute to experiments in ways analogous to, yet not equivalent with, the active contributions of material instruments. Bringing these claims together, I argue that the concepts of mental imagery and hallucinations operate as structured tools that can actively contribute to the knowledge generated by neuroimaging experiments. In presenting this argument I seek to demonstrate that examining the structured uses of concepts as tools can complement existing approaches to studying how the heterogeneous dynamics of experimental practices can come to contribute to scientific knowledge in unintended ways. (shrink)

The essay questions the role of neurons in the concept of mind. The mind is considered as an emerging but physical property of the brain: a mental brain configuration does exist. This configuration is relatively resistant to brain damage, coma, hypoxia and normal (electro)physiological brain states and is envisioned as a relatively stable (nearly anatomical) structure. Consistent with this idea is that, despite the lifetime turnover of their constituents (e.g. proteins and nucleotides) and morphological changes, brain neurons do (...) not divide. Brain neurons are continuously modified, for example by lifetime experiences: genetic and epigenetic support for this thesis is provided. The presumed mental brain configuration guarantees lifetime storage of information, but does not imply that this information and memories remain unmodified during aging. In principle, neurons permanently affected by mental processes can be identified in vitro or in vivo, despite anticipated practical problems. This essay may help to scientifically legitimate complementary neurobiological ad psychotherapeutic approaches in psychiatry. (shrink)

The role of alexithymia in eating disorders has been exstensively studied in Western cultures. On the contrary, studies on alexithymia in the Far East are rare, and its possible role in eating disorders is yet unstudied. After discussing the history and the meaning of the concept of alexithymia in Western cultures, the present paper poses the anthropological question whether alexithymia has a different meaning in Western and Eastern cultures. The sinologist literature on the topic of emotions in China (...) is fi rstly addressed, followed by a review of empirical studies on eating disorders in China. Finally, the results of a preliminary study that compared the role of alexithymia in Italian and Chinese eating disorders are discussed, stressing that the signifi cantly lower alexithymia scores in Chinese eating disorders might be interpreted as strictly connected with the native culture, that is the tendency of Chinese girls to give socially desirable answers. Accordingly, a relevant pathoplastic role of the native culture not only on symptoms, but even on basic traits like alexithymia is suggested. (shrink)

Many worry about the over-medicalisation of mental illness, and some even argue that we should abandon the term mental illness altogether. Yet, this is a commonly used term in popular discourse, in policy making, and in research. In this paper I argue that if we distinguish between disease, illness, and sickness (where illness refers to the first-personal, subjective experience of the sufferer), then the concept of mental illness is a useful way of understanding a type of (...) human experience, inasmuch as the term is (i) apt or accurate, (ii) a useful hermeneutical resource for interpreting and communicating experience, and (iii) can be a good way for at least some of us to establish a liveable personal identity within our culture. (shrink)

How do people understand the concepts of mental health and disorder? The objective of this paper is to examine the impact of several factors on people’s judgments about whether a condition constitutes a mental disorder or a healthy state. Specifically, this study examines the impact of the source of the condition, its outcome, individual valuation (i.e., the value the individual attaches to the condition), and group valuation (i.e., the value the relevant group attaches to the condition). (...) While we find that people’s health and disorder judgments are driven by perceived dysfunction, we also find that health and disorder judgments are impacted differently by these factors. Health judgements are impacted by outcome and individual valuation, and disorder judgments are impacted by condition source. These results suggest that the folk concept of mental health is positive (i.e., mental health is more than the absence of mental disorder) and normativist (i.e., value judgments play a significant role in determining whether a condition counts as healthy), while the concept of mental disorder aligns with a naturalist perspective, at least to the extent that dysfunction plays an important role in categorizing a condition as a disorder. However, our finding that people’s dysfunction judgments are influenced by individual valuation and outcomes poses a strong challenge to naturalist accounts. To provide access to our supplementary data, an appendix has been included. (shrink)

In this paper, I present the case of the discovery of complex numbers by Girolamo Cardano. Cardano acquires the concepts of (specific) complex numbers, complex addition, and complex multiplication. His understanding of these concepts is incomplete. I show that his acquisition of these concepts cannot be explained on the basis of Christopher Peacocke’s Conceptual Role Theory of concept possession. I argue that Strong Conceptual Role Theories that are committed to specifying a set of transitions that is both necessary and (...) sufficient for possession of mathematical concepts will always face counterexamples of the kind illustrated by Cardano. I close by suggesting that we should rely more heavily on resources of Anti-Individualism as a framework for understanding the acquisition and possession of concepts of abstract subject matters. (shrink)

Husserl introduces a phenomenological concept called “motivation” early in the First Investigation of his magnum opus, the Logical Investigations. The importance of this concept has been overlooked since Husserl passes over it rather quickly on his way to an analysis of the meaningful nature of expression. I argue, however, that motivation is essential to Husserl’s overall project, even if it is not essen- tial for defining expression in the First Investigation. For Husserl, motivation is a relation between (...) class='Hi'>mental acts whereby the content of one act make some fur- ther meaningful content probable. I explicate the nature of this relation in terms of “evidentiary weight” and differentiate it from Husserl’s notion of Evidenz, often translated as “self-evidence”. I elucidate the importance of motivation in Husserl’s overall phenomenological project by focusing on his analyses of thing-perception and empathy. Through these examples, we can better understand the continuity between the Logical Investigations and Husserl’s later work. (shrink)

In this Introduction, I situate the underlying project “Autonomy and Mental Disorder” with reference to current debates on autonomy in moral and political philosophy, and the philosophy of action. I then offer an overview of the individual contributions. More specifically, I begin by identifying three points of convergence in the debates at issue, stating that autonomy is: 1) a fundamentally liberal concept; 2) an agency concept and; 3) incompatible with (severe) mental disorder. Next, I (...) explore, in the context of decisional capacity assessments, the difficulties to reconcile 1) and 2) with 3) which they at the same time seem to imply. Having clarified the centrality of a cogent notion of mental disorder for addressing these difficulties, I comment on three promising lines of inquiry about the nature and scope of autonomy that emerge from the following chapters. (shrink)

The antipsychiatrists in the 1960's, specifically Thomas Szasz, have claimed that mental illness does not exist. This argument was based on a specific definition of physical disease that, Szasz argued, could not be applied to mental illness. Thus, by problematizing mental illness, the spotlight had turned to physical disease. Since then, philosophers of medicine have proposed definitions applying both to pathophysiological and psychopathological conditions. This paper analyzes prominent naturalist definitions which aim to provide value-free accounts of pathological (...) conditions, as well as normative accounts that propose value-laden accounts. The approaches surveyed differ not only in terms of value, but also in terms of their perspective. This perspective concerns whether the concept of health, illness or disease/disorder is emphasized. The emphasis on health or illness is holistic as it looks at the human being as a whole, while focus on disease or disorder is analytic as it considers part functions. I will here argue in favor of holism and will propose a definition of mental health based on Sartre's existential psychoanalysis of Gustave Flaubert. (shrink)

In the Netherlands and Belgium, it is lawful for voluntary euthanasia to be offered on the grounds of psychiatric suffering. A recent case that has sparked much debate is that of Aurelia Brouwers, who was helped to die in the Netherlands on account of her suffering from borderline personality disorder. It is sometimes claimed that whether or not a mentally ill person’s wish to die is valid hinges on whether or not that wish is a symptom of the person’s (...) mental disorder. This article addresses the philosophical problems raised by this claim, with a specific focus on the diagnosis of borderline personality disorder. After considering descriptivist and causal conceptualizations of mental disorder, I argue that the current approach to borderline personality disorder in psychiatry precludes the possibility of dissociating the wish to die from the disorder. I then examine the implications of this analysis for the question of whether or not the request for voluntary euthanasia in the case of borderline personality disorder can be considered valid. Ultimately, I conclude that the inability to dissociate the wish to die from the disorder does not invalidate the wish in the case of borderline personality disorder. (shrink)

The scientific concepts of mental imagery and hallucinations are each used independently of the other in experiments; uses that simultaneously evoke and obscure their historical connections. To highlight one of these connections, I will begin by sketching episodes from the largely separate developmental trajectories of each concept. Considering these historical sketches side-by-side, I will argue that the independent uses of these concepts each inherited a shared set of interdependent associations. In doing so, I seek to illustrate the value (...) of examining historical connections between mental imagery and hallucinations for studying the current uses of these two concepts in neuroimaging experiments. (shrink)

Recent trends in psychiatry involve a transition from categorical to dimensional frameworks, in which the boundary between health and pathology is understood as a difference in degree rather than as a difference in kind. A major tenet of dimensional approaches is that no qualitative distinction can be made between health and pathology. As a consequence, these approaches tend to characterize such a threshold as pragmatic or conventional in nature. However, dimensional approaches to psychopathology raise several epistemological and ontological issues. First, (...) we review major sources of evidence usually recruited in support of the dimensional trend (focusing on clinical observation and biological data), and we show that these are connected to different conceptualizations of how dimensional traits extend across health and pathology. Second, we criticize two unquestioned assumptions that stand at the core of the dimensional trend: a) that there is continuity from health to pathology at the symptomatic level; b) that such continuity reflects an underlying continuity in the genetic liability for pathological conditions. Third, we argue against the idea of a conventional threshold by showing that such a view implies a linear relationship between the genotype and the phenotype. Fourth, drawing on epigenetics and developmental biology, we offer a characterization of mental disorders as stable and dynamic constellations of multi-level variables that differ qualitatively from ‘healthy states’. We conclude by showing that our account has several theoretical advantages over both categorical and dimensional approaches. Notably, it provides crucial insights into psychological development over time and individual differences, with major implications in terms of intervention and clinical decision-making. (shrink)

The concept of similar systems arose in physics, and appears to have originated with Newton in the seventeenth century. This chapter provides a critical history of the concept of physically similar systems, the twentieth century concept into which it developed. The concept was used in the nineteenth century in various fields of engineering, theoretical physics and theoretical and experimental hydrodynamics. In 1914, it was articulated in terms of ideas developed in the eighteenth century and used (...) in nineteenth century mathematics and mechanics: equations, functions and dimensional analysis. The terminology physically similar systems was proposed for this new characterization of similar systems by the physicist Edgar Buckingham. Related work by Vaschy, Bertrand, and Riabouchinsky had appeared by then. The concept is very powerful in studying physical phenomena both theoretically and experimentally. As it is not currently part of the core curricula of STEM disciplines or philosophy of science, it is not as well known as it ought to be. (shrink)

From 1965, the Swedish penal law does not require accountability as a condition for criminal responsibility. Instead, severely mentally disordered offenders are sentenced to forensic psychiatric care. The process that led to the present legislation had its origins in a critique of the concept of accountability that was first launched 50 years earlier by the founding father of Swedish forensic psychiatry, Olof Kinberg. The concept severe mental disorder is part of the Criminal Code as well as (...) the Compulsory Mental Act. The medical conditions for being sentenced to forensic psychiatric care are supposed to be the same as those for being admitted to involuntary psychiatric care. What these conditions are is not regulated in any law. For the guidance of the courts and others, there is a collection of examples in the government bill drafting the legislation in question. On the basis of these examples the content of the concept of severe mental disorder is chiselled out. However, the purposes of imposing penal law sanction and admitting someone to psychiatric care are not the same, and therefore the content of the concept severe mental disorder is bound to differ accordingly. Severe mental disorder is a legal concept that masks as a psychiatric one. In its applications in penal law, the court determines its content. But for the forensic psychiatrist it is more natural to interpret the term as a medical one. This creates a tension that has led to several controversies in recent criminal cases in Sweden. The best way to alleviate the situation is to discard the concept of severe mental disorder from criminal law. This will allow for a better separation of the roles of the psychiatrist and the court. (shrink)

The subject of mental processes or mental states is usually assumed to be an individual, and hence the boundaries of mental features – in a strict or metaphorical sense – are naturally regarded as reaching no further than the boundaries of the individual. This chapter addresses various philosophical developments in the 20th and 21st century that questioned this natural assumption. I will frame this discussion by fi rst presenting a historically infl uential commitment to the individualistic nature (...) of the mental in Descartes’ theory. I identify various elements in the Cartesian conception of the mind that were subsequently criticized and rejected by various externalist theories, advocates of the extended mind hypothesis and defenders of embodied cognition. Then I will indicate the main trends in these critiques. (shrink)