Common mental health disorders are rising globally, creating a strain on public healthcare systems. This has led to a renewed interest in the role that digital technologies may have for improving mental health outcomes. One result of this interest is the development and use of artificial intelligence for assessing, diagnosing, and treating mental health issues, which we refer to as ‘digital psychiatry’. This article focuses on the increasing use of digital psychiatry outside of clinical settings, in the following (...) sectors: education, employment, financial services, social media, and the digital well-being industry. We analyse the ethical risks of deploying digital psychiatry in these sectors, emphasising key problems and opportunities for public health, and offer recommendations for protecting and promoting public health and well-being in information societies. (shrink)

Jonathan Y. Tsou examines and defends positions on central issues in philosophy of psychiatry. The positions defended assume a naturalistic and realist perspective and are framed against skeptical perspectives on biological psychiatry. Issues addressed include the reality of mental disorders; mechanistic and disease explanations of abnormal behavior; definitions of mental disorder; natural and artificial kinds in psychiatry; biological essentialism and the projectability of psychiatric categories; looping effects and the stability of mental disorders; psychiatric classification; and the validity (...) of the DSM's diagnostic categories. The main argument defended by Tsou is that genuine mental disorders are biological kinds with harmful effects. This argument opposes the dogma that mental disorders are necessarily diseases that result from biological dysfunction. Tsou contends that the broader ideal of biological kinds offers a more promising and empirically ascertainable naturalistic standard for assessing the reality of mental disorders and the validity of psychiatric categories. (shrink)

Externalist theories hold that a comprehensive understanding of mental disorder cannot be achieved unless we attend to factors that lie outside of the head: neural explanations alone will not fully capture the complex dependencies that exist between an individual’s psychiatric condition and her social, cultural, and material environment. Here, we firstly offer a taxonomy of ways in which the externalist viewpoint can be understood, and unpack its commitments concerning the nature and physical realization of mental disorder. Secondly, we apply a (...) strongly externalist approach to the case of Autistic Spectrum Disorder, and argue that this condition can be illuminated by appeal to the hypothesis of extended cognition. We conclude by briefly considering the significance this strongly externalist approach may have for psychiatric practice and pedagogy. (shrink)

This chapter examines the history of philosophy of psychology and philosophy of psychiatry as subfields of philosophy of science that emerged in the late twentieth and early twenty-first century. The chapter also surveys related literatures that developed in psychology and psychiatry. Philosophy of psychology (or philosophy of cognitive science) has been a well-established subfield of philosophy of mind since the 1990s and 2000s. This field of philosophy of psychology is narrowly focused on issues in cognitive psychology and cognitive (...) science. Compared to the thriving subfield of philosophy of cognitive science, there has been a lack of corresponding interest among philosophers of science in broader methodological questions about different paradigms and fields of study in psychology. These broader methodological questions about psychology have been addressed in the field of theoretical psychology, which is a subfield of psychology that materialized in the 1980s and 1990s. Philosophy of psychiatry emerged as a subfield of philosophy of science in the mid-2000s. Compared to philosophy of psychology, the philosophy of psychiatry literature in philosophy of science engaged with issues examined in an older and more interdisciplinary tradition of philosophy of psychiatry that developed after the 1960s. The participation of philosophers of science in the literature on theoretical psychology, by contrast, has been limited. (shrink)

This paper argues that psychoanalysis enables us to see mental disorder as rooted in emotional conflicts, particularly concerning aggression, to which our species has a natural liability. These can be traced in development, and seem rooted in both parent-offspring conflict and in-group cooperation for out-group conflict. In light of this we may hope that work in psychoanalysis and neuroscience will converge in indicating the most likely paths to a better neurobiological understanding of mental disorder.

The ills of psychiatry are currently diagnoses with the aid of deficient etiologies. The currently proposed prescriptions for psychiatry are practically impossible. The defective part of the profession is its leadership which in its very defensiveness sticks to the status quo, thereby owning the worst defects and impeding all possible cure. The current discussions of the matter are pretentious and thus woolly. The minimal requirement from the profession as a whole and from each of its individual members is (...) that they be not defensive and clear. In this vein I offer here preliminary discussions of propriety, of responsibility and of science. (shrink)

A large part of the controversy surrounding the publication of DSM-5 stems from the possibility of replacing the purely descriptive approach to classification favored by the DSM since 1980. This paper examines the question of how mental disorders should be classified, focusing on the issue of whether the DSM should adopt a purely descriptive or theoretical approach. I argue that the DSM should replace its purely descriptive approach with a theoretical approach that integrates causal information into the DSM’s descriptive diagnostic (...) categories. The paper proceeds in three sections. In the first section, I examine the goals (viz., guiding treatment, facilitating research, and improving communication) associated with the DSM’s purely descriptive approach. In the second section, I suggest that the DSM’s purely descriptive approach is best suited for improving communication among mental health professionals; however, theoretical approaches would be superior for purposes of treatment and research. In the third section, I outline steps required to move the DSM towards a hybrid system of classification that can accommodate the benefits of descriptive and theoretical approaches, and I discuss how the DSM’s descriptive categories could be revised to incorporate theoretical information regarding the causes of disorders. I argue that the DSM should reconceive of its goals more narrowly such that it functions primarily as an epistemic hub that mediates among various contexts of use in which definitions of mental disorders appear. My analysis emphasizes the importance of pluralism as a methodological means for avoiding theoretical dogmatism and ensuring that the DSM is a reflexive and self-correcting manual. (shrink)

This chapter offers an interpretation of Jaspers’ distinction between explaining and understanding, which relates this distinction to that between general and singular causal claims. Put briefly, I suggest that when Jaspers talks about (mere) explanation, what he has in mind are general causal claims linking types of events. Understanding, by contrast, is concerned with singular causation in the psychological domain. Furthermore, I also suggest that Jaspers thinks that only understanding makes manifest what causation between one element of a person’s mental (...) life and another ultimately consists in – that is, the particular way in which one psychic event can emerge from or arise out of another. I contrast the resulting view both with a view on causation in psychiatry recently put forward by John Campbell, and also with another view that is the target of Campbell’s attack, which is due to Donald Davidson and Daniel Dennett. (shrink)

[This download contains the introductory chapter.] People confabulate when they make an ill-grounded claim that they honestly believe is true, for example in claiming to recall an event from their childhood that never actually happened. This interdisciplinary book brings together some of the leading thinkers on confabulation in neuroscience, psychiatry, psychology, and philosophy.

In the second half of the last century, Albanian society adopted a totalitarian way of communist thinking, that could not have spared medical disciplines. Psychiatry was and probably remains a stigmatized field, whose problems almost never were discussed openly. Specialized writings on psychiatry were available and could shed light on the themes and questions of concern. A periodical journal entitled Psychoneurological Works circulated in its print edition, with its first issue of 1959, its tenth issue of 1984 till (...) it ceased publishing some years later. The journal was a mixture of neurological and psychiatric contributions, with the latter reflecting consistent time-related shifts in thematic, terminology, and data exposure. The panegyric and enthusiastic statements served as a good disguise for the immense ailing of patients and the ethical challenges that psychiatrists were facing, while exerting their profession in the time of severe dictatorship, when the disrespect of human being reached its apogee. (shrink)

Though the divide between reason-based and causal-explanatory approaches in psychiatry and psychopathology is old and deeply rooted, current trends involving multi-factorial explanatory models and evidence-based approaches to interpersonal psychotherapy, show that it has already been implicitly bridged. These trends require a philosophical reconsideration of how reasons can be causes. This paper contributes to that trajectory by arguing that Donald Davidson’s classic paradigm of 1963 is still a valid option.

In this paper, we argue that there are reasons to believe that an implicit bias for normalcy influences what are considered medically necessary treatments in psychiatry. First, we outline two prima facie reasons to suspect that this is the case. A bias for ‘the normal’ is already documented in disability studies; it is reasonable to suspect that it affects psychiatry too, since psychiatric patients, like disabled people, are often perceived as ‘weird’ by others. Secondly, psychiatry's explicitly endorsed (...) values of well-being and function are hard to measure directly, which is why we see simpler box-ticking conceptions of recovery used in large research studies. This need not be problematic, but might lead to researchers and clinicians focusing too much on treatments that promote easy-to-measure proxies for recovery, instead of what actually matters to psychiatric patients themselves. Next, we provide examples of treatments and treatment decisions within two areas – self-injury and psychosis – which are hard to explain unless we assume that an implicit and harmful normalcy bias is at work. We conclude with some suggestions for clinicians and future research. (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)

Violence risk assessment tools are increasingly used within criminal justice and forensic psychiatry, however there is little relevant, reliable and unbiased data regarding their predictive accuracy. We argue that such data are needed to (i) prevent excessive reliance on risk assessment scores, (ii) allow matching of different risk assessment tools to different contexts of application, (iii) protect against problematic forms of discrimination and stigmatisation, and (iv) ensure that contentious demographic variables are not prematurely removed from risk assessment tools.

The aim of this paper is to analyze, from a philosophical perspective, the scientific robustness of the construct of psychopathy as measured by the Psychopathy Checklist Revised that was developed by Robert Hare (1991; 2003). The scientific robustness and validity of classifications are topics of many debates in philosophy of science and philosophy of psychiatry more specifically. The main problem consists in establishing whether scientific classifications reflect natural kinds where the concept of a natural kind refers to the existence (...) of some objective divisions in nature that do not depend exclusively on subjective judgments of the classifier. The construct of psychopathy is especially interesting since the diagnosis of psychopathy has substantial social consequences. In the light of the recent debates regarding the problem of natural kinds in philosophy of psychiatry, we advocate the following distinction between two types of scientific classifications: natural and practical kinds. Natural kinds refer to those categories that are united by common causal mechanisms or properties. Practical kinds refer to categories that fulfill some practical classificatory goals such as prediction. We argue that the construct of psychopathy can fulfill the role of a practical kind. In addition, we contend that our current scientific knowledge about psychopathy does not allow us to conclude that this category is a natural kind. (shrink)

David Tomasi presents new, groundbreaking research on the science and application of Mind-Body Medicine strategies to improve clinical outcomes in inpatient psychiatry settings. Much more than a list of therapeutic recommendations, this book is a thorough description of how Mind-Body Medicine can be successfully applied, from a therapeutic as well as from an organizational, cost-effective analysis viewpoint, to the full spectrum of psychiatric treatments. Furthermore, this study examines the role of multidisciplinary and interdisciplinary treatment teams, with a special focus (...) on the profession and the role of psychotherapists and group therapists, thereby providing solid scientific evidence of the benefits of patient-provider therapeutic alliances. In this sense, this book serves as a guide for professionals and institutions both in the private and the public sphere, to learn effective treatment and management strategies. About the Author Psychotherapist, Researcher, and Philosopher Dr. David Låg Tomasi is the author of Medical Philosophy (ibidem, 2016) and the co-author of Positive Patient Response to a Structured Exercise Program Delivered in Inpatient Psychiatry (Global Advances in Health and Medicine, 2019), the most-read research item from the University of Vermont (Researchgate, 2019). A member of several national and international Academies of Sciences, Dr. Tomasi works in the Inpatient Psychiatry Unit at the UVM Medical Center, and teaches at the University of Vermont and the Community College of Vermont. ---- Ibidem / Columbia University Press. (shrink)

In clinical medicine, a diagnosis can offer an explanation of a patient's symptoms by specifying the pathology that is causing them. Diagnoses in psychiatry are also sometimes presented in clinical texts as if they pick out pathological processes that cause sets of symptoms. However, current evidence suggests the possibility that many diagnostic categories in psychiatry are highly causally heterogeneous. For example, major depressive disorder may not be associated with a single type of underlying pathological process, but with a (...) range of different causal pathways, each involving complex interactions of various biological, psychological, and social factors. This paper explores the implications of causal heterogeneity for whether psychiatric diagnoses can be said to serve causal explanatory roles in clinical practice. I argue that while they may fall short of picking out a specific cause of the patient's symptoms, they can nonetheless supply different sorts of clinically relevant causal information. In particular, I suggest that some psychiatric diagnoses provide negative information that rules out certain causes, some provide approximate or disjunctive information about the range of possible causal processes, and some provide causal information about the relations between the symptoms themselves. (shrink)

It is often claimed in parts of the psychiatric literature that neuroscientific research into the biological basis of mental disorder undermines dualism in the philosophy of mind. This paper shows that such a claim does not apply to all forms of dualism. Focusing on Kenneth Kendler’s discussion of the mind–body problem in biological psychiatry, I argue that such criticism of dualism often conflates the psychological and phenomenal concepts of the mental. Moreover, it fails to acknowledge that there are different (...) varieties of dualism, and so overlooks the important metaphysical insights of contemporary dualist philosophers. I argue that while the neuroscientific research underpinning biological psychiatry challenges the traditional dualism of René Descartes, it does not pose any problem for the more modern dualism of David Chalmers. It is possible to take seriously the scientific claims of biological psychiatry while holding that this latter form of dualism is true. This has implications for the positioning of the mind–body problem in psychiatry. While the “easy” problem of explaining psychological processes is relevant to the aims of biological psychiatry, psychiatrists need not worry about the “hard” problem of consciousness. (shrink)

Diagnoses are central to the practice of medicine, where they serve a variety of functions for clinicians, patients, and society. They aid communication, explain symptoms, inform predictions, guide therapeutic interventions, legitimize sickness, and authorize access to resources. Insofar as psychiatry is a discipline whose practice is shaped by medical conventions, its diagnoses are sometimes presented as if they serve the same sorts of function as diagnoses in bodily medicine. However, there are philosophical problems that cast doubt on whether the (...) functions of psychiatric diagnoses can legitimately be considered to be equivalent to those of medical diagnoses. The aim of this chapter is to explicate some of these problems, particularly conceptual and epistemological problems pertaining to the roles of diagnoses as explanations. I begin with an overview of the various functions that medical diagnoses normally serve and suggest that many of these functions receive justificatory support from the explanatory roles of the diagnoses. I then present issues regarding the epistemic functions of psychiatric diagnoses and how these issues have featured in the arguments of prominent critics of psychiatry. (shrink)

Digital phenotyping will potentially enable earlier detection and prediction of mental illness by monitoring human interaction with and through digital devices. Notwithstanding its promises, it is certain that a person’s digital phenotype will at times be at odds with their first-person testimony of their psychological states. In this paper, we argue that there are features of digital phenotyping in the context of psychiatry which have the potential to exacerbate the tendency to dismiss patients’ testimony and treatment preferences, which can (...) be instances of epistemic injustice. We first explain what epistemic injustice is, and why it is argued to be an extensive problem in health and disability settings. We then explain why epistemic injustice is more likely to apply with even greater force in psychiatric contexts, and especially where digital phenotyping may be involved. Finally, we offer some tentative suggestions of how epistemic injustice can be minimised in digital psychiatry. (shrink)

Invited commentary on Nicole A. Vincent and Emma A. Jane, “Interrogating Incongruence: Conceptual and Normative Problems with ICD-11’s and DSM-5’s Diagnostic Categories for Transgender People” Australasian Philosophical Review, in press. -/- The core of Vincent and Jane’s Interrogating Incongruence is critical of the appeal to the concept of incongruence in DSM-5 and ICD-11 characterisations of trans people, a critique taken to be ground-clearing for more trans-positive, psychiatrically-infused medical interventions. I concur with Vincent and Jane’s ultimate goals but depart from the (...) view developed in the paper on two fronts. The first is that I remain sceptical about the overall prospects for truly trans-positive psychiatry. Trans should follow homosexuality and other categories of sexual orientation that have been abandoned rather than reformed as constituents of psychiatric diagnosis and categorisation. The second is that I think that the authors’ central criticisms of the appeal to incongruence are misplaced. (shrink)

Current health care standards, in many countries, Australia included, are regrettably poor. Surprisingly, practitioners and treating teams alike in mental health and disability sectors, in particular, make far too many basic care-related mistakes, in addition to the already abundant diagnostic mistakes that cause and amplify great harm. In part, too many practitioners also fail to distinguish adverse effects for what they are and all too often treat adverse effects, instead, as comorbidities. Diagnostic failures are dangerous, the result of which generates (...) and perpetuates harms that are extremely costly in terms of patient welfare, in addition to the financial burden placed on everyone. In this essay, I contend that the authority bestowed upon psychiatry is misplaced. Subsequently, this misplaced authority affects the governing and investigatory institutions reliant and informed by psychiatry. The examination process undertaken in this investigation traces the metaphysics of psychiatric disorders relative to the Diagnostic-Statistical-Manual (DSM) in all its iterations and to the epistemological construction process that serves to underpin the fundamentals of psychiatric practice. There exists a crisis of confidence in psychiatric practice and I urge drastic reform be undertaken to arrest the damage. (shrink)

In this paper, we explore the conceptual problems arising when using network analysis in person- centered care (PCC) in psychiatry. Personalized network models are potentially helpful tools for PCC, but we argue that using them in psychiatric practice raises boundary problems, i.e., problems in demarcating what should and should not be included in the model, which may limit their ability to provide clinically-relevant knowledge. Models can have explanatory and representational boundaries, among others. We argue that we can make more (...) explicit what kind of questions personalized network models can address in PCC, given their representational and explanatory boundaries, using perspectival reasoning. (shrink)

Das sinnvolle Leben ist nicht nur in der gegenwärtigen Philosophie wieder verstärkt ein Thema, sondern auch in Psychiatrie und Psychotherapie. Bereits seit langer Zeit jedoch spielt es eine zentrale Rolle in der Existenzanalyse und Logotherapie, die der Psychiater Viktor E. Frankl entwickelt hat. Frankls eigenständige Sinntheorie wird in der gegenwärtigen philosophischen Sinndebatte allerdings weitestgehend ignoriert. Das Ziel dieses Artikels ist es, diesen Zustand zu beenden und die heutige philosophische Sinndebatte mit Frankl ins Gespräch zu bringen. Einerseits geht es darum, Frankls (...) Sinntheorie im Lichte der philosophischen Sinndebatte zu verstehen und zu bewerten: Was für eine Art von Sinntheorie vertritt er? Wie ist sie einzuordnen? Wie steht es um ihre innere Kohärenz, die Plausibilität seiner sinntheoretischen Überzeugungen und die Qualität ihrer Begründung? Andererseits soll geprüft werden, inwiefern Frankls Ansatz die gegenwärtige philosophische Sinndiskussion voranbringen kann: Gibt es bei ihm theoretische Elemente, die in der Philosophie zu wenig Beachtung finden? Kann er der philosophischen Sinntheorie wichtige Impulse geben? Die Analyse folgt in ihrer Struktur wesentlichen Elementen der Frankl’schen Sinntheorie, von den grundlegenden formalen und metaethischen Aspekten hin zu inhaltlichen Bestimmungen des Sinns und dem individuellen Umgang mit ihm: Zunächst wird die zentrale Bedeutung des Sinns für das menschliche Leben thematisiert, dann Fragen nach der metaethischen Einordnung, nämlich nach der subjektivistischen oder objektivistischen Ausrichtung sowie der Rolle des Supernaturalismus. Dann stehen mit der Selbsttranszendenz und dem Wertebezug sowie den drei Wertkategorien wesentliche Elemente der Sinnkonstituierung im Fokus der Betrachtung. Die Ergebnisse werden im Schlusskapitel zusammengefasst. Es zeigt sich, dass der theoretische Austausch in beide Richtungen fruchtbar sein kann, Frankls Denken allerdings auch einige Hindernisse bereithält. Sein Ansatz entpuppt sich mit seinem objektivistischen Charakter und der zentralen Rolle von Selbsttranszendenz und Wertbezug als an die heutige Sinndiskussion gut anschlussfähig, seine oftmals fehlenden Begründungen hingegen als gravierender methodischer Makel, bei dem eine Orientierung an modernen philosophischen Standards wünschenswert wäre. Wiederholt entsteht der Eindruck, dass seine Sinntheorie maßgeblich durch sein praktisches, therapeutisches Interesse geprägt ist. Einigen seiner Theoreme wird das Potential zugesprochen, die philosophische Sinntheorie bereichern zu können: Das sind die Situativität und Individualität des Sinns sowie die Gegebenheit der Sinnmöglichkeiten und die Verantwortung für ihre Verwirklichung. (shrink)

Dieser Aufsatz will zeigen, dass die Beiträge von Jakob Friedrich Fries (1773–1843) zur Psychiatrie leider (zu Unrecht) vergessen, aber überaus aktuell sind. Seine Überlegungen sowie die der Wissenschaftler, die ihm gefolgt sind, haben in den Darstellungen der Geschichte der Psychiatrie mehr Beachtung verdient.

Can psychiatry be read from an anthropological point of view? What is normal? What is pathological? Social order and pathos in question on this essay.

A brief critical notice of Dan J Stein's new book _Problems of Living: Perspectives from Philosophy, Psychiatry, and Cognitive-Affective Science_.

In this paper I review how the notion of gender is understood in psychiatry, specifically in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). First, I examine the contraposition between sex and gender, and argue that it is still retained by DSM-5, even though with some caveats. Second, I claim that, even if genderqueer people are not pathologized and gender pluralism is the background assumption, some diagnostic criteria still conceal a residue of gender dualism (...) and essentialism. Third, I consider gender dysphoria, which is characterized by an incongruence between one’s experienced or expressed gender and one’s assigned gender; since this condition pertains to distress and disability, not to the incongruence per se, it does not pathologize transgender people. Still, I contend that it should be removed from DSM-5 for theoretical reasons. (shrink)

This dissertation is a contribution to the contemporary field of phenomenological psychopathology, or the phenomenological study of psychiatric disorders. The work proceeds with two major aims. The first is to show how a phenomenological approach can clarify and illuminate the nature of psychopathology—specifically those conditions typically labeled as major depressive disorder and bipolar disorder. The second is to show how engaging with psychopathological conditions can challenge and undermine many phenomenological presuppositions, especially phenomenology’s status as a transcendental philosophy and its corresponding (...) anti-naturalistic outlook. In the opening chapter, I articulate the three layers of the subject matter of phenomenological research—what I refer to as “existentials,” “modes,” and “prejudices.” As I argue, while each layer contributes to what we might call the “structure” of human existence, they do not do so in the same way, or to the same degree. Because phenomenological psychopathology—and applied phenomenology in general—aims to characterize how the structure of human existence can change and alter, it is paramount that these layers be adequately delineated and defined before investigating these changes. In chapters two through five, I conduct hermeneutic and phenomenological investigations of psychopathological phenomena typically labeled as major depressive disorder or bipolar disorder. These investigations address the affective aspects of depression and mania, and the embodied aspects of depression. In addition to clearly articulating the nature of these phenomena, I show how certain psychopathological conditions involve changes in the deepest or most fundamental layer of human existence—what I refer to as existentials. As I argue, many of the classical phenomenologists (including Husserl and Heidegger) believed that these structural features were necessary, unchanging, and universal. However, this presupposition is challenged through the examination of psychopathological and neuropathological conditions, undermining the status of phenomenology as a transcendental philosophy. While this challenge to classical phenomenology is only sketched in the early chapters, in chapters six and seven I develop it in more detail in order to achieve two distinct ends. In chapter six I argue that psychopathology and neuropathology not only challenge phenomenology’s status as a transcendental philosophy, but also supply a key to developing a phenomenological naturalism (which I contrast with a naturalized phenomenology). Phenomenological naturalism, as I articulate it, is a position in which phenomenology is not subsumed by the metaphysical and methodological framework of the natural sciences, but nonetheless maintains the capacity to investigate how the natural world stands independent of human subjectivity (and how events in the natural world can bring about changes in the most fundamental structures of human existence). In the seventh chapter I argue that a phenomenology in which existentials are contingent and variable rather than necessary and unchanging allows phenomenologists to contribute to new dimensional approaches to psychiatric classification. Rather than begin from distinct categories of disorder, these approaches begin from distinct core features of human existence. These features, referred to as either dimensions or constructs, can vary in degree and are studied in both normal and pathological forms. (shrink)

If we already had a periodic table of mental illness in hand, there would be less need for a book of this type. Although some psychiatrists do think of themselves as chemists, the analogy is without warrant. Not only does psychiatry lack an analogue of the periodic table, its principal tool -- the Diagnostic and Statistical Manual of Mental Disorders (DSM) -- is a contentious document. Even subsequent to the publication of DSM-III in 1980, which was intended to serve (...) as an operational guideline for clinical practice, it and its heirs (DSM-V was published in 2013) have often fueled rather than quelled controversy. Although beginning with that third major revision of DSM a concerted effort has been made to ensure greater consistency in diagnoses, psychiatry remains beset by concerns that it is insufficiently scientific, unduly influenced by the pharmaceutical industry, indecisive as to whether it should focus on the mind or the brain, incapable of distinguishing among types of diseases, inclined to expand illness criteria without adequate justification, overly reliant on subjective judgments, wont to conflate clinical and ethical judgments, and engaged in indiscriminate use of psychoactive drugs. These worries concerning its scientific and ethical status are among the reasons that psychiatry attracts the attention of philosophers. (shrink)

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was published in 2013. This manual classifies all known mental disorders and provides operationalized criteria for their diagnosis. The goal of this manual is to facilitate communication, treatment and research with reliable and valid diagnoses. This article will provide a study of what this diagnostic validity actually entails. Firstly, it will include a discussion of the different conceptions of validity that have appeared in the literature so far. To (...) decide between these different conceptions, diagnostic validity will be defined as ”picking out a natural kind’. Secondly, two different accounts of natural and psychiatric kinds are examined, namely, essentialism and pragmatism. Both of these will be rejected in favor of conceiving natural kinds as causal-epistemic kinds. Thirdly, it is argued that the multidimensional complexity of psychiatric disorders does not exclude the possibility of psychiatric kinds being natural kinds. However, pragmatic considerations in classifying disorders have meant that the DSM most likely does not distinguish causal-epistemic kinds very well. I argue that the need to have a single classification both for clinicians and researchers and the priority given to reliability rather than validity has ultimately compromised the diagnostic validity of the DSM. (shrink)

Background: The complexity of diagnostic presentations of an inpatient psychiatry population requires an integrative approach to health and well-being. In this sense, the primary need of this research aims at developing clinical strategies and healthier coping skills for anger, anxiety, and depression; promoting self-esteem, healthier sleep, and anxiety reduction; as well as enhancing mood and emotional–behavioral regulation via exercise and nutrition education. Objectives: The primary objective is to promote exercise, fitness, and physical health in inpatient psychiatry patients. The (...) secondary objective includes therapeutic management of depressive symptoms and patient-centered approach to mania, angry outbursts, and generalized disruptive behavior. The tertiary objective is promoting research in the psychophysiological effectors of exercise and nutrition education in combination with psychotherapy. Method: Monitoring self-reported changes in mood and general well-being via administration of surveys and questionnaires pre- and postexercise sessions. Results: The research yielded positive outcomes in all areas investigated, suggesting the positive effects of exercise and mind–body strategies in the context of psychotherapy in inpatient psychiatry. Conclusion: Physical exercise may be a helpful way to reduce mental health disorders in the context of inpatient psychiatry by targeting anxiety, depression, anger, psychomotor agitation, and muscle tension and addressing stressors and triggers and to develop a more balanced and integrated sense of self. (shrink)

In spite of a considerable progress in comorbidity research and huge literature on it, this phenomenon is one of the greatest epistemological, research and clinical challenges to contemporary psychiatry and medicine. Mental disorders are very often comorbidly expressed, both among themselves and with various sorts of somatic diseases and illnesses. Therefore, comorbidity studies have been expected to be an impetus to research on the validity of current diagnostic systems as well as on establishing more effective and effi cient treatment (...) within the frame of person centered transdisciplinary psychiatry and integrative medicine. This review focuses fi rst on conceptual chaos and different connotations, then on transdisciplinary perspectives of comorbidity and multimorbidity. The authors compiled an extensive set of various views and perspectives, dilemmas and controversies, in order to evaluate what we know and what we don’t about comorbidity, what comorbidity is and what comorbidity is not, what are facts and what are non-facts on comorbidity and multimorbidity. (shrink)

Fulford’s and Stanghellini’s concise and rich article is a mission-statement of an in- fluential direction in what they call the “third revolution” in late twentieth-century psychiatry. Values-based practice finds its intellectual mooring in phenomenology and analytic philosophy and is geared to handle the “complex and confl icting values” that are part of clinical decision-making.

Dear Editor, in a previous paper we have tried to delve into what validity means in the context of psychiatric nosology, arguing for a pragmatic view of it. Here we want to briefly reassert the basic points of our analysis, make a few clarifications and address some issues raised by commentators.

Three revolutions in psychiatry characterised the closing decade of the twentieth century: 1) in the neurosciences, 2) in patient-centred models of service delivery, and 3) in the emergence of a rapidly expanding new cross -disciplinary field of philosophy and psychiatry. Starting with a case history, the paper illustrates the impact of this third revolution - the new philosophy of psychiatry - on day-to-day clinical practice through training programmes and policy developments in what has become known as values (...) - based practice. Derived from philosophical value theory and phenomenology, values-based practice is a partner to evidencebased practice in supporting clinical decision-making in the highly complex environment of mental health care. The paper concludes by setting values-based practice in context with other potentially practical important areas of the new philosophy of psychiatry arguing that all three revolutions need to be brought together if psychiatry is to meet the challenges of the twenty-first century. (shrink)

In this critical notice, I review and critique ‘Psychiatric Casualties’ (2021) by Mark C. Russell and Charles Figley. In so doing, I analyze a natural experiment from WWII, which has previously only been misinterpreted. The natural experiment leads me to conclude that predisposition results in some individuals being far more likely than others to develop war stress disorders such as PTSD. This point puts me in disagreement with Russell and Figley, though I endorse the general message of their book: that (...) the military has failed in its responsibility to properly care for psychiatric casualties, and that there are steps which could be taken to improve the situation. (shrink)

Review of the collection "Responsibility and Psychopathy: Interfacing Law, Psychiatry and Philosophy", edited by Luca Malatesti and John McMillan.

This paper deals with a classical issue that remains at the core of the contemporary philosophical debate: the fact that the meaning of life is interlaced—in both negative and positive ways, with respect to morality—with happiness. On some historical conceptions, individual happiness must be sacrificed for the moral (universal, objective) good of a life, where the good fundamentally coincides with the meaning of life. On other approaches, happiness and flourishing (where flourishing is understood in terms of life’s meaningfulness) consist in (...) good action and a good life. On still other views, happiness, while equated with the meaning of life, is reduced to mere pleasure, to a sensorial state that can be influenced by outside forces. In the current literature, the prevailing interpretations of this question are largely deontological, eudaimonic or hedonic in character. Moving from the Schelerian theory of the stratification of the emotional life, and emphasizing the affective side of this broadly ethical question, this paper intends to examine this issue through the lens of phenomenology. From this perspective, the connection between happiness and the meaning not only of life but also of existence can be understood in light of what appears to underlie both phenomena: the entire existence of the individual, which is revealed most clearly in an act of personal love. Since this paper considers the condition humaine in all its complexity, that is to say, even in its fragility and vulnerability, within this framework I will also consider possible abnormal manifestations of happiness. Following Rümke’s clinical observations of pathological frameworks in which the feeling of happiness manifests itself, this paper shows how the deepest feeling of happiness, understood as a Schelerian personality feeling, can remain untouched by pathology. In his classic (but largely unappreciated) enquiry into the happiness syndrome, Rümke engages in a fruitful dialogue with Scheler, whose theory of the stratification of emotional life plays a crucial role in the former’s study of the phenomenology and the clinical aspects of happiness. Not only is Rümke’s Zur Phänomenologie und Klinik des Glücksgefühls an excellent example of applied phenomenology, but it also confirms the results of Scheler’s research on affective life. (shrink)

In “The myth of mental illness” Thomas Szasz challenges the idea that mental illnesses are diseases in the biomedical sense. In his view they are more similar to a foreign language and for this reason they cannot be treated by means of biomedical therapies. The present article explores the semiotic implications of Szasz’s view of the hysterical symptoms as an iconic language. Following Reichenbach, Szasz distinguishes three classes of signs: indexical, iconic and symbolic. The somatic language of the hysteric person (...) would be an iconic protolanguage which is more primordial than the objective language. Nevertheless, it retains all the basic functions of the language: to transmit information, to induce mood, and to promote action. Five different but intertwined reasons for the use of such an iconic form of communication are discussed. In conclusion, the hysterical symptom speaks its proper language and our ethical commitment is primarily to empathically listen to it. (shrink)

In a rather long piece which an exhibition catalog has called „catholic propaganda”(Busch & Maisak, 2013, p. 342), Guido Görres reflected on madness and art, using Kaulbach’s iconic 1835 drawing of asylum inmates (Das Narrenhaus) as pretext. Görres wrote of “this hospital of the human spirit (…), this charnel ground of the living, who like specters roam, wearing on their foreheads the faded and almost illegible traces of their former names.”1(1836, p. 9). Overdramatic prose, but unlikely to strike one as (...) unprecedented. If anything, it has long been customary to exhibit a mix of fascination and revulsion when discussing the institutions which in the past two centuries at the same time sheltered and shattered those deemed mentally ill. (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 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 psychiatry, pharmacological research has played a crucial role in the formulation, revision, and refinement of neurobiological theories of psychopathology. Besides being utilized as potential treatments for various mental disorders, pharmacological drugs play an important epistemic role as experimental instruments that help scientists uncover the neurobiological underpinnings of mental disorders (Tsou, 2012). Interventions with psychiatric patients using pharmacological drugs provide researchers with information about the neurobiological causes of mental disorders that cannot be obtained in other ways. This important source (...) of evidence for the biological causes of mental disorder is often overlooked in philosophical analyses of psychiatry, especially in skeptical analyses that debase the biological aspects of psychopathology (e.g., Szasz, 1960; Scheff, 1963; Laing, 1967). In discussing pharmacological interventions as a form of evidence for the physical basis of mental disorders, this paper aims to clarify the nature, reliability, and limitations of this evidence. In addition, it illustrates the central role that pharmacological findings in applied clinical contexts play in the acquisition of neurobiological knowledge in research contexts. (shrink)

The failure of psychiatry to validate its diagnostic constructs is often attributed to the prioritizing of reliability over validity in the structure and content of the Diagnostic and Statistical Manual of Mental Disorders. Here I argue that in fact what has retarded biomedical approaches to psychopathology is unwarranted optimism about diagnostic discrimination: the assumption that our diagnostic tests group patients together in ways that allow for relevant facts about mental disorder to be discovered. I consider the Research Domain Criteria (...) framework as a new paradigm for classifying objects of psychiatric research that solves some of the challenges brought on by this assumption. (shrink)