INTERNISTS OF THE MIND OR PHYSICIANS OF THE SOUL: DOES PSYCHIATRY NEED A PUBLIC PHILOSOPHY?

Although psychiatry is interested in what both body and mind contribute to behavior, it sometimes emphasizes one more than the other. Since the early 1980s, American psychiatry has shifted its interest from mind and psyche to body and brain. Neuroscience and psychopharmacology are increasingly at the core of psychiatry. Some experts claim that psychiatry is no longer interested in problems in living and positive goals such as mental health, happiness, and morality but rather has narrowed its focus to mental disorders addressed with psychotropic drugs. In view of this trend, psychiatry needs to confront two questions in social philosophy. If it is no longer directly concerned with health and happiness, how does it relate to these positive goals? And how does it relate as a medical institution to religious institutions, schools, and other organizations that directly promote health, happiness, morality, and the purposes of life? It is not enough for psychiatry to renounce its moral role; its practices still shape cultural values. Psychiatry should take more responsibility for developing a public philosophy that addresses these issues.     

Mental disorders,brain disorders,neurodevelopmental disorders: challenges for the philosophy of psychopathology after DSM-5

The publication of DSM-5 has been accompanied by a fair amount of controversy. Amongst DSM's most vocal ‘insider’ critics has been Thomas Insel, Director of the US National Institute of Mental Health. Insel has publicly criticised DSM's adherence to a symptom-based classification of mental disorder, and used the weight of the NIMH to back a rival research strategy aimed at a more biology-based diagnostic classification. This strategy is part of Insel's vision of a future, more preventative psychiatry in which mental disorders are not only understood as biological disorders of the brain, but also as neurodevelopmental disorders. This paper examines the interest and merit of Insel's views of mental and neurodevelopmental disorder for the philosophy of psychopathology, with a special focus of his neurodevelopmental model of schizophrenia. Pitman's ‘moderate materialism’ will be used both as a philosophical lens through which to examine Insel's position, as well as an example of a philosophical framework that may require updating and revision in the light of moves towards a neurodevelopmental conception of mental disorder.     

Challenges of patient‐led mental health services to psychoanalytic clinicians

This paper considers implications to psychoanalytic psychotherapy of the British Government's decision to implement a patient choice agenda for state‐funded mental health services in England and Wales. It places the patient choice agenda in the context of consumerist society and argues that the complex nature of psychoanalytic psychotherapy leaves it more vulnerable than other psychological therapy modalities to compete in the current reality of ‘consumer’‐led public mental health, which, in turn reflects a profoundly changed social context from that to which psychoanalysis traces its roots. Unless psychoanalytic clinicians recognize and find ways to adjust to this context they will jeopardize the survival of psychoanalytic psychotherapy in an increasingly market‐orientated model of mental healthcare provision in the public sector, eager to promote more ‘consumer friendly’ psychological therapy models.     

Role Responsibility

This article is about ‘role responsibility’ as understood by H. L. A. Hart in his taxonomy of responsibility concepts in his book, Punishment and Responsibility. More particularly, it focuses on what I call ‘public, institutional role responsibility’. The main arguments are that (1) such role responsibility is based on authority and power rather than physical and mental capacity; and (2) the foundation of role responsibility in authority has significant implications for what Hart referred to as ‘liability–responsibility’, which I unpack in terms of ‘attribution’, ‘accountability’ and ‘liability’. The article addresses possible objections to the authority-based analysis of role responsibility based on the concept of ‘moral’ responsibility, and on understandings of what types of question are ‘philosophical.’     

Some myths about ‘mental illness’

Radical psychiatrists and others assert that mental illness is a myth. The opening and closing portions of the paper deal with the impact such argument has had in law and psychiatry. The body of the paper discusses the five versions of the myth argument prevalent in radical psychiatry: (A) that there is no such thing as mental illness; (B) that those called ‘mentally ill’ are really as rational as everyone else, only with different aims; that the only reasons anyone ever thought differently was (C) because of unsophisticated category mistakes or (D) because of an adherence to the epistemology of a sick society; and (E) that the phrase ‘mental illness’ is used to mask value judgments about others’ behavior in pseudo‐scientific respectability. Reasons are given for rejecting each of these versions of the argument that mental illness is a myth.     

Food Fight! The Swedish Low-Carb/High Fat (LCHF) Movement and the Turning of Science Popularisation Against the Scientists

Science popularisation is widely recognised as having its ‘political uses’ and as serving as a conventional means for buttressing the epistemic authority of the institutions of science in society. By separating the work of producing new knowledge from its dissemination, popularisation promotes public understanding and appreciation of science placed beyond public reach and influence. However, simply by insisting upon such a separation, so popularisation remains vulnerable to ‘capture’ by skilled and resourceful communicators intent on turning it against the established authority of scientists. This is a phenomenon which can be analysed in relation to the communicative strategies pursued by a collection of general practitioners, diabetics and self-styled dietary experts in Sweden championing a low-carbohydrate/high fat (LCHF) dietetics akin to the Diet Revolution initiated by Robert Atkins in the early 1970s. By dedicating themselves to achieving an overwhelming public presence in the propagation of simplified accounts of dietary science, the LCHF movement has been able to fashion science popularisation into a weapon capable of being turned back upon established dietary expertise in Sweden. In this effort they have proceeded on two fronts; firstly by debunking established dietary advice for failing to live up to idealised standards of ‘sound science’, and secondly, by effectively mobilising the personal testimony and endorsements of dieters themselves in order to publicly confirm the authenticity and trustworthiness of the LCHF regimen.     

Children’s mental health: Time to stop using psychiatric diagnosis

Hegemonic mental health service approaches stress the need for ‘accurate’ diagnosis in order to understand what the correct ‘treatment’ should be. I review the evidence on how far diagnosis in psychiatry has helped advance scientific knowledge and clinical practice and conclude that it hasn’t. I then examine how National Institute for Health and Care Excellence (NICE) guidelines in relation to children’s behaviour problems reflects the lack of progress that results from adopting a diagnostic approach. Taking mental health practice beyond reliance on narrow non-evidence-based diagnostic algorithms can be developed by adopting existing projects such as the Partners for Change Outcome Management Systems project.     

Resource Document on Access to Firearms by People with Mental Disorders

The American Psychiatric Association, (“APA”), with more than 36,000 members at present, is the Nation's leading organization of physicians who specialize in psychiatry. APA provides for education and advocacy and develops policy through Position Statements. It promotes enhanced knowledge of particular topics relevant to psychiatric practice and patient care through Resource Documents. Since 1993, the APA has developed various positions and resource materials related to firearms and mental illness, incorporating evolving themes as new issues emerge. This paper reflects the APA's 2014 Resource Document on “Access to Firearms by People with Mental Disorders.” This article is derived from work done on behalf of American Psychiatric Association and remains the property of APA. It has been altered only in response to the requirements of peer review. Copyright © 2015 American Psychiatric Association. Published with permission (original adopted by the American Psychiatric Association 2014).     

Vulnerability of Individuals With Mental Disorders to Epistemic Injustice in Both Clinical and Social Domains

Many individuals who have mental disorders often report negative experiences of a distinctively epistemic sort, such as not being listened to, not being taken seriously, or not being considered credible because of their psychiatric conditions. In an attempt to articulate and interpret these reports we present Fricker’s concepts of epistemic injustice (Fricker, 2007, p. 1) and then focus on testimonial injustice and hermeneutic injustice as it applies to individuals with mental disorders. The clinical impact of these concepts on quality of care is discussed. Within the clinical domain, we contrast epistemic injustice with epistemic privilege and authority. We then argue that testimonial and hermeneutic injustices also affect individuals with mental disorders not only when communicating with their caregivers but also in the social context as they attempt to reintegrate into the general society and assume responsibilities as productive citizens. Following the trend of the movement of mental health care to the community, the testimonies of people with mental disorders should not be restricted to issues involving their own personal mental states.     

A brief historicity of the <Emphasis Type="Italic">Diagnostic and Statistical Manual of Mental Disorders</Emphasis>: Issues and implications for the future of psychiatric canon and practice

The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, currently in its fourth edition and considered the reference for the characterization and diagnosis of mental disorders, has undergone various developments since its inception in the mid-twentieth century. With the fifth edition of the DSM presently in field trials for release in 2013, there is renewed discussion and debate over the extent of its relative successes - and shortcomings - at iteratively incorporating scientific evidence on the often ambiguous nature and etiology of mental illness. Given the power that the DSM has exerted both within psychiatry and society at large, this essay seeks to analyze variations in content and context of various editions of the DSM, address contributory influences and repercussion of such variations on the evolving landscape of psychiatry as discipline and practice over the past sixty years. Specifically, we document major modifications in the definition, characterization, and classification of mental disorders throughout successive editions of the DSM, in light of shifting trends in the conceptualization of psychopathology within evolving schools of thought in psychiatry, and in the context of progress in behavioral and psychopharmacological therapeutics over time. We touch upon the social, political, and financial environments in which these changes took places, address the significance of these changes with respect to the legitimacy (and legitimization) of what constitutes mental illness and health, and examine the impact and implications of these changes on psychiatric practice, research, and teaching. We argue that problematic issues in psychiatry, arguably reflecting the large-scale adoption of the DSM, may be linked to difficulties in formulating a standardized nosology of psychopathology. In this light, we highlight 1) issues relating to attempts to align the DSM with the medical model, with regard to increasing specificity in the characterization of discrete mental disease entities and the incorporation of neurogenetic, neurochemical and neuroimaging data in its nosological framework; 2) controversies surrounding the medicalization of cognition, emotion, and behavior, and the interpretation of subjective variables as 'normal' or 'abnormal' in the context of society and culture; and 3) what constitutes treatment, enablement, or enhancement - and what metrics, guidelines, and policies may need to be established to clarify such criteria.     

Psychiatry and Psychology in the Writings of L. Ron Hubbard

Objectives: Celebrity followers of the Church of Scientology have recently used their public forum to attack the modern practice of mental health. The practice of Scientology is rooted in the religious writings of its founder, L. Ron Hubbard. This paper will review the religious writings of L Ron Hubbard to understand Scientology’s position on mental health. Method: This paper reviews four of the major religious books written by L Ron Hubbard, in addition to a comprehensive overview of Scientology compiled by Scientology staff. Results: Hubbard’s theory of mind borrowed heavily from the earlier writings of Freud, until Hubbard’s psychological theory extended to include a spiritual existence that goes beyond the material world. The goal of Hubbard’s psychology and religion were to optimize the freedom of the individual, and he viewed psychiatry and psychology as inherently anti-spiritual and opposed to personal freedom and self-realization. Ultimately Hubbard presents a world view of potential nuclear world cataclysm, fueled by the geopolitical climate and mental health theories that dominated the mid 20th century. Conclusions: Hubbard’s writings mirrored the times in which he lived. His views that mental health practices are inherently anti-religious, freedom-inhibiting, and brain damaging do not reflect the modern-day practices of mental health. Dr. McCall is presently Professor and Chairman of the Department of Psychiatry and Behavioral Medicine at the Wake Forest University School of Medicine. He completed his medical degree and post-graduate psychiatric training at Duke University. He completed a Masters degree in Epidemiology from Wake Forest University. He is board certified in general psychiatry, geriatric psychiatry, and sleep disorders medicine. His research interests include depression, electroconvulsive therapy, quality of life, and insomnia. His research has been continuously funded by the National Institute of Mental Health since 1995, and he is author of more than 100 peer-reviewed journal articles. He is Editor of the Journal of ECT, Immediate-Past President of the Association for Convulsive Therapy, and a prior Director of the Board of the American Academy of Sleep Medicine.     

Embodying the psychological attitude: types of consciousness in the transformation of culture

It is time to reclaim C.G. Jung’s vision of psychology as the foundational science upon which all sciences and institutions would be based, and as the discipline, theory, and practice necessary for fostering humanity’s overall psychocultural development. Jung identified eight distinct ‘types’ of consciousness through which humankind engages its emerging psychological attitude. Jung’s view of psychological development as hingeing on the differentiation of function-attitudes provides the means for understanding not only ourselves and each other, but our society as well. This paper offers an example of such an analysis by focusing on the current conflict within American political culture. The goal is as lofty as it is necessary: the operationalization of Jung’s vision of psychology as the powerful influencer of human cultural evolution that it has the potential to be. The immediate goal is to instigate the first step toward this vision of Jung’s ‘complex psychology’ by stimulating conversations among Jungians about how they can foster that vision, leading them towards taking up roles as ‘citizen therapists’, actively involved in their communities in cultivating greater empathy and the withdrawal of projections in the interest of furthering ‘collective consciousness’.     

The protestant secular in the study of American religion: reappraisal and suggestions

This article provides a theoretical and historiographical overview of secularism in the study of American religion. It focuses on how scholars have used the concept of the ‘Protestant secular’ in works on law, politics, and culture. Although it has been useful, we argue that this concept has lost some of its analytical utility in the effort to explain secularism predominantly in terms of its Protestant nature. In turn, this article looks to literature on secularism globally in order to suggest ways forward. Refocusing on secularism as a strategy of state governance ought to bring precision to both ‘Protestantism’ and ‘the secular,’ as well as shift attention toward state power and the high stakes of classification. An analysis of this strategy requires investigation into how states produce and police the category ‘religion’ and its neighboring concepts – for example, the ‘secular’ and the ‘superstitious’ – in order to render, manage, and colonize various populations.     

What Is It Like to Be an Alien?

This brief article is concerned with an aspect of Jonathan Glover's book, Alien Landscapes?. After reflecting a little on the book as a whole, the question that is taken up is, ‘Why might a book that seeks to help those without mental disorders understand what they are like “from the inside” be of interest to laymen and practitioners in the criminal law?’. One answer lies in part in the way that ‘what it is like from the inside’ might interact with judgements of criminal responsibility. Taking its cue from examples used by Glover the article considers, and puts pressure on, the ‘dual view’ he proposes: that when dealing with those with mental disorders we should treat them as responsible agents in the sense of not withholding from them Strawson's ‘reactive attitudes’, while nevertheless accepting that their personalities and behaviours are the results of large doses of ‘bad luck’.     

American Psychiatric Association: Position Statement on Firearm Access,Acts of Violence and the Relationship to Mental Illness and Mental Health Services

The American Psychiatric Association, (“APA”), with more than 36,000 members at present, is the Nation's leading organization of physicians who specialize in psychiatry. APA provides for education and advocacy and develops policy through Position Statements. It promotes enhanced knowledge of particular topics relevant to psychiatric practice and patient care through Resource Documents. Since 1993, the APA has developed various positions and resource materials related to firearms and mental illness, incorporating evolving themes as new issues emerge. This paper reflects the APA's 2014 Position Statement on Firearm Access, Acts of Violence and the Relationship to Mental Illness and Mental Health Services.     

The insanity plea: Szaszian ethics and epistemology

The traditional legal verdict of ‘not guilty by reason of insanity’ as well as the more recent verdict of ‘guilty but mentally ill’ rest on often unquestioned epistemological assumptions about human behavior and its causes, unjustified reliance on forensic psychiatrists, and questionable, if not deplorable ethical standards. This paper offers a critique of legal perspectives on insanity, historical and current, based on the altermative epistemological and ethical assumptions of Thomas S. Szasz. In addition, we examine Szasz's unique rhetorical analysis of ‘mental illness’ and its implications for forensic psychiatry.     

Understanding ‘relevance’ in psychology

Since the 1970s, psychologists around the world have questioned the ‘social relevance’ of psychology in their societies. Curiously, the matter of ‘social relevance’ is under-theorized in the discipline, a state of affairs this paper attempts to correct. First, it describes how disagreements about psychology's cognitive interest – and subject matter – create an environment in which accusations of ‘social irrelevance’ can flourish. Second, it asserts that applied psychology's reliance on basic psychology for its scientific authority makes debates about ‘social relevance’ inevitable. And third, it claims that the discipline's longstanding antithesis to the social domain leaves it vulnerable to these debates – particularly in recent decades that have witnessed rapid social change. The paper reflects further on the rise of ‘market relevance’ in the global academy and its significance for psychology today.     

New interpretative styles: Progress or contamination? Psychoanalysis and phenomenological psychopathology1

Psychoanalysis has started to recoup, often quite implicitly, a more phenomenological stance, ever since psychoanalysts have started working with borderline and psychotic patients. As many of these patients have commonly been through traumatic experiences, psychoanalysts have been using an approach that questions the role of traditional psychoanalytical interpretation and pays more attention to the patient's inner conscious experiences; this approach is characteristic of a specifi c form of contemporary psychiatry: phenomenological psychopathology, founded by Karl Jaspers in 1913 and developed into a form of psychotherapy by Ludwig Binswanger, with his Daseinsanalyse. If what we could call a phenomenological ‘temptation’ has been spreading over psychoanalysis, so too has a psychoanalytical ‘temptation’ always been present in phenomenological psychopathology. In fact, even though this branch of psychiatry has led us towards a deeper understanding of the characteristics of psychotic being‐in‐the‐world, its therapeutic applications have never been adequately formalised, much less have they evolved into a specifi c technique or a structured psychotherapeutic approach. Likewise, phenomenological psychotherapy has always held an anaclitic attitude towards psychoanalysis, accepting its procedures but refusing its theoretical basis because it is too close to that of the objectifying natural sciences. Psychoanalytic ‘temptation’ and phenomenological ‘temptation’ can thus be considered as two sides of the same coin and outline a trend in psychoanalytic and phenomenological literature which points out the fundamental role of the patient's inner conscious experiences in the treatment of borderline and psychotic patients.     

Does Evidence-Based Medicine Apply to Psychiatry?

Evidence-based psychiatry (EBP) has arisen through the application of evidence-based medicine (EBM) to psychiatry. However, there may be aspects of psychiatric disorders and treatments that do not conform well to the assumptions of EBM. This paper reviews the ongoing debate about evidence-based psychiatry and investigates the applicability, to psychiatry, of two basic methodological features of EBM: prognostic homogeneity of clinical trial groups and quantification of trial outcomes. This paper argues that EBM may not be the best way to pursue psychiatric knowledge given the particular features of psychiatric disorders and their treatments. As a result, psychiatry may have to develop its own standards for rigour and validity. This paper concludes that EBM has had a powerful influence on how psychiatry investigates and understands mental disorders. Psychiatry could influence EBM in return, reshaping it in ways that are more clinically useful and congruent with patients’ needs.