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A Theory of Feelings Anger and Forgiveness"My Madness Saved Me"10 Good Questions about Life and Death12 Modern Philosophers50 Reasons People Give for Believing in a GodA Cabinet of Philosophical CuriositiesA Case for IronyA Companion to BioethicsA Companion to Buddhist PhilosophyA Companion to FoucaultA Companion to GenethicsA Companion to GenethicsA Companion to HumeA Companion to KantA Companion to Phenomenology and ExistentialismA Companion to PragmatismA Companion to the Philosophy of ActionA Companion to the Philosophy of BiologyA Companion to the Philosophy of LiteratureA Conceptual History of PsychologyA Critique of Naturalistic Philosophies of MindA Cursing Brain?A Delicate BalanceA Farewell to AlmsA Frightening LoveA Future for PresentismA Guide to the Good LifeA History of PsychiatryA History of the MindA Life Worth LivingA Manual of Experimental PhilosophyA Map of the MindA Metaphysics of PsychopathologyA Mind So RareA Natural History of Human MoralityA Natural History of Human ThinkingA Natural History of VisionA Parliament of MindsA Philosopher Looks at The Sense of HumorA Philosophical DiseaseA Philosophy of BoredomA Philosophy of Cinematic ArtA Philosophy of CultureA Philosophy of EmptinessA Philosophy of FearA Philosophy of PainA Physicalist ManifestoA Place for ConsciousnessA Question of TrustA Research Agenda for DSM-VA Revolution of the MindA Sentimentalist Theory of the MindA Stroll With William JamesA Tear is an Intellectual ThingA Theory of FreedomA Thousand MachinesA Universe of ConsciousnessA Very Bad WizardA Virtue EpistemologyA World Full of GodsA World Without ValuesAbout FaceAbout the Beginning of the Hermeneutics of the SelfAction and ResponsibilityAction in ContextAction Theory, Rationality and CompulsionAction, Contemplation, and HappinessAction, Emotion and WillAdam SmithAdaptive DynamicsAddictionAddictionAddiction and ResponsibilityAddiction Is a ChoiceAdvances in Identity Theory and ResearchAftermathAfterwarAgainst AdaptationAgainst AutonomyAgainst BioethicsAgainst HappinessAgainst HealthAgency and ActionAgency and AnswerabilityAgency and EmbodimentAgency and ResponsibilityAgency, Freedom, and Moral ResponsibilityAl-JununAlain BadiouAlain BadiouAlasdair MacIntyreAlien Landscapes?Altered EgosAn Anthology of Psychiatric EthicsAn Ethics for TodayAn Intellectual History of CannibalismAn Interpretation of DesireAn Introduction to EthicsAn Introduction to Kant's Moral Philosophy An Introduction to Philosophy of EducationAn Introduction to the Philosophy of MindAn Introduction to the Philosophy of MindAn Introduction to the Philosophy of PsychologyAn Introductory Philosophy of MedicineAn Odd Kind of FameAnalytic FreudAnalytic Philosophy in AmericaAncient AngerAncient Models of MindAncient Philosophy of the SelfAngerAnimal LessonsAnimal MindsAnimals Like UsAnnihilationAnother PlanetAnswers for AristotleAnti-ExternalismAnti-Individualism and KnowledgeAntigone’s ClaimAntipsychiatryAre We Hardwired?Are Women Human?Arguing about DisabilityArguing About Human NatureAristotle and the Philosophy of FriendshipAristotle on Practical WisdomAristotle's ChildrenAristotle's Ethics and Moral ResponsibilityAristotle, Emotions, and EducationArt & MoralityArt After Conceptual ArtArt in Three DimensionsArt, Self and KnowledgeArtificial ConsciousnessArtificial HappinessAspects of PsychologismAsylum to ActionAtonement and ForgivenessAttention is Cognitive UnisonAutobiography as PhilosophyAutonomyAutonomy and Mental DisorderAutonomy and the Challenges to LiberalismBabies by DesignBackslidingBadiouBadiou's DeleuzeBadiou, Balibar, Ranciere: Rethinking EmancipationBare Facts And Naked TruthsBasic Desert, Reactive Attitudes and Free WillBattlestar Galactica and PhilosophyBeautyBecoming a SubjectBecoming HumanBehavingBehavioral Genetics in the Postgenomic EraBeing AmoralBeing HumanBeing Mentally Ill: A Sociological Theory Being No OneBeing Realistic about ReasonsBeing ReducedBeing YourselfBelief's Own EthicsBending Over BackwardsBerlin Childhood around 1900Bernard WilliamsBertrand RussellBetter than BothBetter Than WellBetween Two WorldsBeyond HealthBeyond Hegel and NietzscheBeyond KuhnBeyond LossBeyond Moral JudgmentBeyond PostmodernismBeyond ReductionBeyond the DSM StoryBioethicsBioethics and the BrainBioethics in the ClinicBiological Complexity and Integrative PluralismBiology Is TechnologyBiosBipolar ExpeditionsBlackwell Companion to the Philosophy of EducationBlindsight & The Nature of ConsciousnessBlues - Philosophy for EveryoneBlushBob Dylan and PhilosophyBody ConsciousnessBody Image And Body SchemaBody ImagesBody LanguageBody MattersBody WorkBody-Subjects and Disordered MindsBoundBoundaries of the MindBoyleBrain Evolution and CognitionBrain FictionBrain, Mind, and Human Behavior in Contemporary Cognitive ScienceBrain-WiseBrainchildrenBrains, Buddhas, and BelievingBrainstormingBrave New WorldsBreakdown of WillBrief Child Therapy Homework PlannerBrief Inquiry into the Meaning of Sin and FaithBrief Therapy Homework PlannerBritain on the CouchBrute RationalityBuffy the Vampire Slayer and PhilosophyBut Is It Art?Camus and SartreCartesian LinguisticsCartographies of the MindCarving Nature at Its JointsCase Studies in Biomedical Research EthicsCassandra's DaughterCato's TearsCausation and CounterfactualsCauses, Laws, and Free WillChanging Conceptions of the Child from the Renaissance to Post-ModernityChanging the SubjectChaosophyCharacter and Moral Psychology Character as Moral FictionCharles DarwinCherishmentChildhood and the Philosophy of EducationChildrenChildren, Families, and Health Care Decision MakingChoices and ConflictChoosing Not to ChooseChristmas - Philosophy for EveryoneCinema, Philosophy, BergmanCinematic MythmakingCity and Soul in Plato's RepublicClassifying MadnessClear and Queer ThinkingClinical EthicsClinical Psychiatry in Imperial GermanyCodependent ForevermoreCoffee - Philosophy for EveryoneCognition and the BrainCognition of Value in Aristotle's EthicsCognition Through Understanding: Self-Knowledge, Interlocution, Reasoning, ReflectionCognitive BiologyCognitive FictionsCognitive Neuroscience of EmotionCognitive Systems and the Extended MindCognitive Systems and the Extended Mind Cognitive Theories of Mental IllnessCoherence in Thought and ActionCollected Papers, Volume 1Collected Papers, Volume 2College SexComedy IncarnateCommitmentCommunicative Action and Rational ChoiceCompetence, Condemnation, and CommitmentConcealment And ExposureConceptual Analysis and Philosophical NaturalismConceptual Art and PaintingConceptual Issues in Evolutionary BiologyConfessionsConfucianismConnected, or What It Means to Live in the Network SocietyConquest of AbundanceConscience and ConvenienceConsciousnessConsciousnessConsciousnessConsciousness ConsciousnessConsciousness and Its Place in NatureConsciousness and LanguageConsciousness and Mental LifeConsciousness and MindConsciousness and the NovelConsciousness and the SelfConsciousness EmergingConsciousness EvolvingConsciousness ExplainedConsciousness in ActionConsciousness RecoveredConsciousness RevisitedConsciousness, Color, and ContentConsole and ClassifyConstructing the WorldConstructive AnalysisContemporary Debates In Applied EthicsContemporary Debates in Moral TheoryContemporary Debates in Philosophy of BiologyContemporary Debates in Philosophy of MindContemporary Debates in Political PhilosophyContemporary Debates in Social PhilosophyContemporary Perspectives on Natural LawContested Knowledge: Social Theory TodayContesting PsychiatryContext and the AttitudesContinental Philosophy of ScienceControlControlling Our DestiniesConversations About Psychology and Sexual OrientationCopernicus, Darwin and FreudCrazy for YouCreating a Life of Meaning and CompassionCreating ConsilienceCreating HysteriaCreating Mental IllnessCreating Scientific ConceptsCreating the American JunkieCreation, Rationality and AutonomyCreatures Like Us?Crime and CulpabilityCrime, Punishment, and Mental IllnessCrimes of ReasonCritical New Perspectives on Attention Deficit/Hyperactivity DisorderCritical PsychiatryCritical PsychologyCritical ResistanceCritical Thinking About PsychologyCritical VisionsCross and KhoraCruel CompassionCTRL [SPACE]Cultural Psychology of the SelfCultural Theory: An IntroductionCulture and Psychiatric DiagnosisCulture and Subjective Well-BeingCulture of DeathCultures of NeurastheniaCurious EmotionsCurrent Controversies in Experimental PhilosophyCustom and Reason in HumeCustomers and Patrons of the Mad-TradeCutting God in Half - And Putting the Pieces Together AgainCylons in AmericaDamaged IdentitiesDamasio's Error and Descartes' TruthDangerous EmotionsDaniel DennettDaniel DennettDark AgesDarwin and DesignDarwin's Dangerous IdeaDarwin's LegacyDarwin, God and the Meaning of LifeDarwinian PsychiatryDarwinian ReductionismDarwinizing CultureDating: Philosophy for EveryoneDeathDeathDeath and CharacterDeath and CompassionDeath and the AfterlifeDebating DesignDebating HumanismDecision Making, Personhood and DementiaDecomposing the WillDeconstructing PsychotherapyDeconstruction and DemocracyDeeper Than DarwinDeeper than ReasonDefending Science - within ReasonDefining Psychopathology in the 21st CenturyDegrees of BeliefDelusion and Self-DeceptionDelusions and Other Irrational BeliefsDelusions and the Madness of the MassesDementiaDemons, Dreamers, and MadmenDennett and Ricoeur on the Narrative SelfDennett’s PhilosophyDepression Is a ChoiceDepression, Emotion and the SelfDepthDerrida, Deleuze, PsychoanalysisDescartesDescartes and the Passionate MindDescartes' CogitoDescartes's Changing MindDescartes's Concept of MindDescribing Inner Experience?Descriptions and PrescriptionsDesembodied Spirits and Deanimated Bodies Desert Islands and Other Texts (1953-1974)Desire and AffectDesire, Practical Reason, and the GoodDiagnosing the Diagnostic and Statistical Manual of Mental DisordersDialectics of the SelfDid My Neurons Make Me Do It?Difference and IdentityDigital SoulDimensional Models of Personality DisordersDisability, Difference, DiscriminationDisjunctivismDisorders of VolitionDisorientation and Moral LifeDispatches from the Freud WarsDisrupted LivesDistractionDisturbed ConsciousnessDivided Minds and Successive SelvesDo Apes Read Minds?Do Fish Feel Pain?Do We Still Need Doctors?Does Consciousness Cause Behavior?Does the Woman Exist?Doing without ConceptsDon't Believe Everything You ThinkDonald DavidsonDonald Davidson on Truth, Meaning, and the MentalDoubting Darwin?Dreaming and Other Involuntary MentationDSM-IV SourcebookDSM-IV SourcebookDSM-IV-TR CasebookDworkin and His CriticsDying to KnowDynamics in ActionDysthymia and the Spectrum of Chronic DepressionsEccentricsEducational MetamorphosesEffective IntentionsElbow Room: The Varieties of Free Will Worth WantingEmbodied Minds in ActionEmbodied RhetoricsEmbodied Selves and Divided MindsEmbryos under the MicroscopeEmergencies in Mental Health PracticeEmerging Conceptual, Ethical and Policy Issues in BionanotechnologyEmotionEmotion and ConsciousnessEmotion and PsycheEmotion ExperienceEmotion RegulationEmotion, Evolution, And RationalityEmotional IntelligenceEmotional ReasonEmotional ReasonEmotional TruthEmotions in Humans and ArtifactsEmotions in the Moral LifeEmotions in the Moral LifeEmpathyEmpathy and AgencyEmpathy and Moral DevelopmentEmpathy and MoralityEmpathy in the Context of PhilosophyEmpirical Ethics in PsychiatryEnchanted LoomsEngaging BuddhismEngineering the Human GermlineEnjoymentEnvyEpicureanismEpistemic LuckEpistemologyEpistemology and EmotionsEpistemology and the Psychology of Human JudgmentEros and the GoodErotic MoralityEssays in Social NeuroscienceEssays in the Metaphysics of Mind Essays on Derek Parfit's On What MattersEssays on Free Will and Moral ResponsibilityEssays on Nonconceptual ContentEssays on Philosophical CounselingEssays on Reference, Language, and MindEssays on the Concept of Mind in Early-Modern PhilosophyEssential Sources in the Scientific Study of ConsciousnessEsssential Philosophy of PsychiatryEternal Sunshine of the Spotless MindEthical Conflicts in PsychologyEthical Issues in Forensic Mental Health ResearchEthical Issues in Human CloningEthical TheoryEthicsEthicsEthics and the A PrioriEthics and the Metaphysics of MedicineEthics and Values in PsychotherapyEthics Done RightEthics ExpertiseEthics in Plain EnglishEthics in PracticeEthics in Psychiatric ResearchEthics of PsychiatryEthics without OntologyEuropean Review of Philosophy. Vol. 5Everyday IrrationalityEvil in Modern ThoughtEvolutionEvolution and the Human MindEvolution's RainbowEvolutionary Origins of MoralityEvolutionary PsychologyExamined LifeExamined LivesExistential AmericaExistentialismExistentialism and Romantic LoveExperimental PhilosophyExperimental PhilosophyExperimental PhilosophyExperimental Philosophy, Rationalism, and NaturalismExperiments in EthicsExplaining ConsciousnessExplaining the BrainExplaining the Computational MindExplanatory PluralismExploding the Gene MythExploring HappinessExploring the SelfExpression and the InnerExpressions of JudgmentFaces of IntentionFact and ValueFact and Value in EmotionFacts, Values, and NormsFads and Fallacies in the Social SciencesFaith and Wisdom in ScienceFatherhoodFear of KnowledgeFearless SpeechFeeling Pain and Being in PainFeelings and EmotionsFeelings of BeingFellow-Feeling and the Moral LifeFeminism and Its DiscontentsFeminism and Philosophy of ScienceFeminist Ethics and Social and Political PhilosophyFeminist Interpretations of Rene DescartesFeminist TheoryField Notes from ElsewhereFinding Consciousness in the BrainFingerprints of GodFlesh in the Age of ReasonFolk Psychological NarrativesFolk Psychology Re-AssessedForces of HabitForgivenessForgiveness and LoveForgiveness and RetributionFoucault 2.0Foucault and PhilosophyFoucault NowFoucault, Psychology and the Analytics of PowerFoundational Issues in Human Brain MappingFoundations of Ethical Practice, Research, and Teaching in PsychologyFour Views on Free WillFree WillFree WillFree WillFree WillFree Will and Action ExplanationFree Will and LuckFree Will And Moral ResponsibilityFree Will as an Open Scientific ProblemFree Will, Agency, and Meaning in LifeFree: Why Science Hasn't Disproved Free WillFreedomFreedom and DeterminismFreedom And NeurobiologyFreedom and ResponsibiltyFreedom and ValueFreedom EvolvesFreedom RegainedFreedom vs. InterventionFreedom, Fame, Lying, and BetrayalFreudFreud and the Question of PseudoscienceFreud As PhilosopherFreud's AnswerFreud, the Reluctant PhilosopherFriedrich NietzscheFrom Chance to ChoiceFrom Clinic to ClassroomFrom Complexity to LifeFrom Enlightenment to ReceptivityFrom Knowledge to Wisdom: A Revolution for Science and the HumanitiesFrom Morality to Mental HealthFrom Passions to EmotionsFrom Philosophy to PsychotherapyFrontiers of ConsciousnessFrontiers of JusticeFurnishing the MindGalileo in PittsburghGenderGender and Mental HealthGender in the MirrorGender TroubleGenesGenes, Women, EqualityGenetic Nature/CultureGenetic ProspectsGenetic ProspectsGenetic SecretsGenocide's AftermathGenomes and What to Make of ThemGerman Idealism and the JewGerman PhilosophyGetting HookedGilles DeleuzeGlobal PhilosophyGluttonyGod and Phenomenal ConsciousnessGoffman's LegacyGoing Amiss in Experimental ResearchGoodness & AdviceGrassroots SpiritualityGrave MattersGrave MattersGreedGreek Models of Mind and SelfGut ReactionsHabilitation, Health, and AgencyHabits of MindHallucinationHandbook of BioethicsHandbook of EmotionsHappinessHappinessHappinessHappinessHappiness and EducationHappiness and the Good LifeHappiness Is OverratedHappiness, Death, and the Remainder of LifeHard LuckHarmful ThoughtsHaving the World in ViewHealing PsychiatryHealing the Soul in the Age of the BrainHealth, Illness and DiseaseHealth, Science, and Ordinary LanguageHegelHeidegger and a Metaphysics of FeelingHeidegger, Metaphysics and the Univocity of BeingHermann von Helmholtz's MechanismHermeneutics As PoliticsHeterophobiaHeterosyncraciesHeuristics and BiasesHeuristics and the LawHidden ResourcesHidden SelvesHiding from HumanityHigh Art LiteHistorical OntologyHistory of Psychiatry and Medical PsychologyHistory, Historicity And ScienceHobbesHomosexualitiesHope and Dread in PsychoanalysisHot ThoughtHow Can I Be Trusted?How Can the Human Mind Occur in the Physical Universe?How Children Learn the Meanings of WordsHow Could Conscious Experiences Affect Brains?How Do We Know Who We Are?How Emotions WorkHow Emotions WorkHow History Made the MindHow Images ThinkHow is Nature Possible?How Propaganda WorksHow Science WorksHow Scientific Practices MatterHow Scientists Explain DiseaseHow The Body Shapes The MindHow the Body Shapes the Way We ThinkHow the Mind Explains BehaviorHow the Mind Uses the BrainHow to Make Opportunity EqualHow to Solve the Mind-Body Problemhow to stop timeHow to Think More About SexHow We HopeHow We ReasonHuman CloningHuman Development, Language and the Future of MankindHuman EnhancementHuman Evolution, Reproduction, and MoralityHuman GoodnessHuman Identity and BioethicsHuman NatureHuman NatureHuman Nature and the Limits of ScienceHuman-Built WorldHumanismHumanism, What's That?HumanityHumans, Animals, MachinesHumeHumeHume on Motivation and VirtueHusserlHystoriesI of the VortexI Was WrongIdeas that MatterIdentifying the MindIdentity and Agency in Cultural WorldsIgnorance and ImaginationIllnessImagination and Its PathologiesImagination and the Meaningful BrainImagining NumbersImmortal RemainsImproving Nature?In Defense of an Evolutionary Concept of HealthIn Defense of SentimentalityIn Love With LifeIn Praise of Athletic BeautyIn Praise of the WhipIn Pursuit of HappinessIn Search of HappinessIn the Name of GodIn the Name of IdentityIn the Space of ReasonsIn Two MindsIncompatibilism's AllureIndividual Differences in Conscious ExperienceInfinity and PerspectiveInformation ArtsInformed Consent in Medical ResearchIngmar Bergman, Cinematic PhilosopherInhuman ThoughtsInner PresenceInsanityIntegrating Psychotherapy and PharmacotherapyIntegrity and the Fragile SelfIntelligent VirtueIntentionIntentionality, Deliberation and AutonomyIntentions and IntentionalityIntentions and IntentionalityInterpreting MindsInterpreting NietzscheIntroducing Greek PhilosophyIntrospection and ConsciousnessIntrospection VindicatedIntuition, Imagination, and Philosophical MethodologyIntuitionismInvestigating the Psychological WorldIrrationalityIrrationalityIs Academic Feminism Dead?Is It Me or My Meds?Is Long-Term Therapy Unethical?Is Oedipus Online?Is Science Neurotic?Is Science Value Free?Is the Visual World a Grand Illusion?Is There a Duty to Die?Issues in Philosophical CounselingJacques LacanJacques RancièreJacques RanciereJean-Paul SartreJohn McDowellJohn SearleJohn Searle's Ideas About Social RealityJohn Stuart MillJohn Stuart Mill and the Writing of CharacterJoint AttentionJokesJonathan EdwardsJudging and UnderstandingJustice for ChildrenJustice in RobesJustice, Luck, and KnowledgeKantKant and MiltonKant and the Fate of AutonomyKant and the Limits of AutonomyKant and the Role of Pleasure in Moral ActionKant on Freedom, Law, and HappinessKant on Moral AutonomyKant's Anatomy of EvilKant's Anatomy of the Intelligent MindKant's Theory of VirtueKarl JaspersKarl PopperKey Concepts in PhilosophyKierkegaardKierkegaard as PhenomenologistKierkegaard's Concept of DespairKinds of MindsKinds, Things, and StuffKnowing, Knowledge and BeliefsKnowledge MonopoliesKnowledge, Belief, and CharacterKnowledge, Possibility, and ConsciousnessLacanLack of CharacterLack of CharacterLanguageLanguage in ContextLanguage, Consciousness, CultureLanguage, Culture, and MindLanguage, Vision, and MusicLaw and the BrainLaw, Liberty, and PsychiatryLaws, Mind, and Free WillLeaving YouLectures on the History of Political PhilosophyLevelling the Playing FieldLiberal Education in a Knowledge SocietyLiberatory PsychiatryLife and ActionLife at the Texas State Lunatic Asylum, 1857-1997Life Is Not a Game of PerfectLife of the MindLife's FormLife, Death, & MeaningLife, Death, and Meaning: Key Philosophical Readings on the Big Questions Life, Liberty, and the Pursuit of UtilityLife, Sex, and IdeasLight in the Dark RoomLike a Splinter in Your MindLiving and Dying WellLiving NarrativeLiving Outside Mental IllnessLiving with DarwinLiving With One’s PastLockeLocke LockeLogic and the Art of Memory Loneliness in Philosophy, Psychology, and LiteratureLooking for SpinozaLooking for The StrangerLost SoulsLOT 2LoveLoveLove's ConfusionsLove's VisionLove, Friendship, and the SelfLove, Sex & TragedyLuckyLudwig WittgensteinLustLyingMachine ConsciousnessMad for FoucaultMad TravelersMade with WordsMadness And Death In PhilosophyMadness and DemocracyMadness at HomeMadness Is CivilizationMaking Natural KnowledgeMaking Sense of EvolutionMaking Sense of Freedom and ResponsibilityMaking the DSM-5Making the Social WorldMaking TruthMale Female EmailMan, Beast, and ZombieMandated Reporting of Suspected Child AbuseManiaManic Depression and CreativityMapping the Edges and the In-betweenMapping the Future of BiologyMarcus AureliusMaster PassionsMatters of the MindMe++Meaning and Moral OrderMeaning and Value in a Secular AgeMeaning in LifeMeaning in Life and Why It MattersMeaning, Basic Self-Knowledge, and MindMeasuring HappinessMeasuring PsychopathologyMedia MadnessMedical Enhancement and PosthumanityMedicine and Philosophy in Classical AntiquityMedicine of the PersonMedicine, Mental Health, Religion, Science and Well-BeingMelancholy And the Care of the SoulMelancholy and the Otherness of GodMementoMemory and NarrativeMental ActionsMental CausationMental Causation and OntologyMental HealthMental Health At The CrossroadsMental Health Policy in BritainMerit, Meaning, and Human BondageMerleau-PontyMerleau-Ponty and the Possibilities of PhilosophyMetacognition and Theory of MindMetacreationMetaethical SubjectivismMetaethicsMetal and FleshMetaphors of MemoryMetapoliticsMethods in MindMichel FoucaultMill's UtilitarianismMindMindMind and ConsciousnessMind and CosmosMind and MechanismMind GamesMind in a Physical WorldMind in Everyday Life and Cognitive ScienceMind in LifeMind TimeMind's LandscapeMind, Brain and the Elusive SoulMind, Brain, and Free WillMind, Reason and ImaginationMinding MindsMindreadersMindreading AnimalsMinds and PersonsMinds, Brains, and LawMinds, Ethics, and ConditionalsMindshapingMindsightMindworldsMirror, MirrorMixed FeelingsMockingbird YearsModels of the SelfModern Social ImaginariesModern Theories of JusticeModernity and SubjectivityModernity and TechnologyMoody Minds DistemperedMoral DimensionsMoral FailureMoral ImaginationMoral LiteracyMoral MachinesMoral ParticularismMoral PsychologyMoral Psychology and Human AgencyMoral Psychology, Volume 1Moral Psychology, Volume 2Moral Psychology, Volume 3Moral Psychology: Volume IVMoral RepairMoral Responsibility and Alternative PossibilitiesMoral TribesMoral Value and Human DiversityMorality and Self-InterestMorality in a Natural WorldMorality, Moral Luck and ResponsibilityMotherhoodMotive and RightnessMoving Beyond Prozac, DSM, and the New PsychiatryMultiple Analogies in Science and PhilosophyMultiple Identities & False MemoriesMusic, Madness, and the Unworking of LanguageMy Brain Made Me Do ItMy Double UnveiledMy WayNarrativeNarrative and IdentityNarrative MedicineNarrative PsychiatryNarrative Theory and the Cognitive SciencesNatural Ethical FactsNatural Kinds and Conceptual ChangeNatural MindsNatural-Born CybogsNaturalism and the First-Person PerspectiveNaturalism and the Human ConditionNaturalism in the Philosophy of HealthNaturalism in the Philosophy of HealthNaturalized BioethicsNaturalizing the MindNatureNature and NarrativeNear Death ExperienceNeither Bad nor MadNeither Victim nor SurvivorNeuro-Philosophy and the Healthy MindNeuroethicsNeuroethicsNeurological Foundations of Cognitive Neuroscience Neurophilosophy at WorkNeurophilosophy of Free WillNeuropoliticsNeuropsychoanalysis in PracticeNeuroscience and PhilosophyNew Essays on the Explanation of ActionNew Philosophy for a New MediaNew Versions of VictimsNew Waves in Philosophy of ActionNietzscheNietzsche and Buddhist PhilosophyNietzsche on Ethics and PoliticsNietzsche's TherapyNietzsche, Culture and EducationNietzsche: The Man and His PhilosophyNihil UnboundNoir AnxietyNormative EthicsNormativityNorms of NatureNotebooks 1951-1959Notes Toward a Performative Theory of AssemblyNothing So AbsurdOblivionOn AnxietyOn ApologyOn Being AuthenticOn Being AuthenticOn BeliefOn BullshitOn DelusionOn DesireOn EmotionsOn HashishOn Human RightsOn Loving Our EnemiesOn Nature and LanguageOn PersonalityOn ReflectionOn Romantic LoveOn the EmotionsOn the Freud WatchOn the Government of the LivingOn the Human ConditionOn the InternetOn the Meaning of LifeOn the Philosophy of LawOn the Pragmatics of CommunicationOn the Punitive SocietyOn TruthOn Virtue EthicsOn What MattersOn What We Owe to Each OtherOne Hundred DaysOnflowOnly a Promise of HappinessOntology of ConsciousnessOpen MindedOpen Your EyesOrgans without BodiesOther MindsOur Last Great IllusionOur Own MindsOur Posthuman FutureOur StoriesOut of Its MindOut of Our HeadsOxford Guide to the MindOxford Handbook of Psychiatric EthicsOxford Textbook of Philosophy of PsychiatryPanic DisorderPanpsychism in the WestPartialityPassionate EnginesPassionate EnginesPathologies of BeliefPathologies of ReasonPatient Autonomy and the Ethics of ResponsibilityPC, M.D.Perceiving the WorldPerception & CognitionPerception and Basic BeliefsPerception, Hallucination, and IllusionPerceptual ExperiencePerfecting VirtuePerplexities of ConsciousnessPersistencePersonal AutonomyPersonal Autonomy in SocietyPersonal IdentityPersonal Identity and EthicsPersonal Identity and Fractured SelvesPersonhood and Health CarePersonsPersons and BodiesPersons, Humanity, and the Definition of DeathPersons, Souls and DeathPerspectives on ImitationPerspectives on PragmatismPessimismPhenomenal Concepts and Phenomenal KnowledgePhenomenal ConsciousnessPhenomenal IntentionalityPhenomenology and ExistentialismPhenomenology and Philosophy of MindPhilosophersPhilosophers on MusicPhilosophers without GodsPhilosophical CounselingPhilosophical Counselling and the UnconsciousPhilosophical DevicesPhilosophical Foundations of NeurosciencePhilosophical History and the Problem of ConsciousnessPhilosophical Issues in PsychiatryPhilosophical Issues in PsychiatryPhilosophical Issues in Psychiatry IIPhilosophical MethodologyPhilosophical MidwiferyPhilosophical Myths of the FallPhilosophical Perspectives on DepictionPhilosophical Perspectives on Technology and PsychiatryPhilosophical PracticePhilosophical Reflections on DisabilityPhilosophizing About Sex Philosophizing the EverydayPhilosophy and HappinessPhilosophy and LivingPhilosophy and PsychiatryPhilosophy and PsychotherapyPhilosophy and Science FictionPhilosophy and the EmotionsPhilosophy and the EmotionsPhilosophy and the Interpretation of Pop CulturePhilosophy and the Moving ImagePhilosophy and the NeurosciencesPhilosophy and This Actual WorldPhilosophy As FictionPhilosophy BitesPhilosophy Bites BackPhilosophy for Counselling and PsychotherapyPhilosophy for LifePhilosophy in a New CenturyPhilosophy in an Age of SciencePhilosophy in Children's LiteraturePhilosophy of ActionPhilosophy of ActionPhilosophy of BiologyPhilosophy of BiologyPhilosophy of BiologyPhilosophy of BiologyPhilosophy of BodyPhilosophy of Film and Motion PicturesPhilosophy of LovePhilosophy of Love, Sex, and MarriagePhilosophy of MindPhilosophy of Mind and CognitionPhilosophy of Personal Identity and Multiple PersonalityPhilosophy of PsychologyPhilosophy of Public HealthPhilosophy of SciencePhilosophy of SciencePhilosophy of Technology: The Technological ConditionPhilosophy of the Social SciencesPhilosophy on TapPhilosophy PracticePhilosophy the Day after TomorrowPhilosophy's Role in Counseling and PsychotherapyPhilosophy, Neuroscience and ConsciousnessPhilosophy, Politics, DemocracyPhotography and PhilosophyPhysical RealizationPhysicalism and Its DiscontentsPhysicalism and Mental CausationPhysicalism, or Something Near EnoughPhysician-Assisted DyingPillar of SaltPin-up GrrrlsPlatoPlatoPlato, Not Prozac!Platonic Ethics, Old and NewPluralistic CasuistryPolarities of ExperiencesPolitical EmotionsPopper, Objectivity and the Growth of KnowledgePornPorn StudiesPornography, Sex, and FeminismPortrait of the Psychiatrist as a Young ManPostcolonial DisordersPostpsychiatryPosttraumatic Stress DisorderPower and the SelfPower SplitPractical Autonomy and BioethicsPractical ConflictsPractical Identity and Narrative AgencyPractical PhilosophyPractical RulesPractical Tortoise RaisingPractically ProfoundPracticing Feminist Ethics in PsychologyPragmatic BioethicsPragmatismPragmatism, Old And NewPraise and BlamePredicative MindsPreferences and Well-BeingPrescriptions for the MindPresocraticsPrimary and Secondary QualitiesPrimates and PhilosophersPrivacyPrivileged AccessProblems in MindProblems of RationalityProzac As a Way of LifeProzac BacklashProzac on the CouchPsyche and SomaPsychiatric Aspects of Justification, Excuse and Mitigation in Anglo-American Criminal Law Psychiatric Cultures ComparedPsychiatric Diagnosis and ClassificationPsychiatric EthicsPsychiatric PowerPsychiatric SlaveryPsychiatry and Philosophy of SciencePsychiatry and ReligionPsychiatry as a Human SciencePsychiatry as Cognitive NeurosciencePsychiatry in SocietyPsychiatry in the New MilleniumPsychiatry in the Scientific ImagePsychiatry, Psychoanalysis, And The New Biology Of MindPsycho-Physical Dualism TodayPsychoanalysis and Narrative MedicinePsychoanalysis and the Philosophy of SciencePsychological Concepts and Biological PsychiatryPsychology and PhilosophyPsychology and the Question of AgencyPsychology's Interpretive TurnPsychology, Psychotherapy, Psychoanalysis, and the Politics of Human RelationshipsPsychotherapy and ConfidentialityPsychotherapy As PraxisPublic PhilosophyPunishmentPure ImmanencePurple HazePursuing MeaningQuality of Life and Human DifferenceQueer PhilosophyQuestions for FreudQuestions for FreudQuine and Davidson on Language, Thought and RealityRaceRace in Contemporary MedicineRadiant CoolRadical AlterityRadical ExternalismRadical HopeRational and Social AgencyRational CausationRational Choice in an Uncertain WorldRationality + Consciousness = Free WillRationality and FreedomRationality and the Reflective MindRationality in ActionRawls, Dewey, and ConstructivismRe-creating MedicineRe-EmergenceRe-Engineering Philosophy for Limited BeingsReading AutobiographyReading Bernard WilliamsReading SartreReadings in the Philosophy of TechnologyReal MaterialismReal Natures and Familiar ObjectsReal ScienceRealism in ActionReason & EmancipationReason in ActionReason in PhilosophyReason's GriefReasonably ViciousReasoning About Rational AgentsReasoning in Biological DiscoveriesReasons from WithinReasons without RationalismReclaiming CognitionReclaiming the SoulReconceiving SchizophreniaReconstructing Reason and RepresentationReconstructing the Cognitive WorldRecreative MindsRediscovering EmotionRediscovering EmpathyReference and ExistenceReference and the Rational MindReflections On How We LiveReframing Disease ContextuallyRefusing CareRegulating SexReinventing the SoulRelativism and Human RightsRelativism and the Foundations of PhilosophyRelativism and the Foundations of PhilosophyReliable ReasoningReligion without GodRelying on OthersRemembering HomeResponsibility and PunishmentResponsibility and PunishmentResponsibility from the MarginsRestraining RageRethinking ExpertiseRethinking IntrospectionRethinking Mental Health and DisorderRethinking RapeRethinking the DSMRethinking the Sociology of Mental HealthRethinking the Western Understanding of the SelfReturn to ReasonRevolt, She SaidRichard RortyRichard RortyRichard RortyRichard RortyRichard RortyRichard Rorty's New PragmatismRightsRights, Democracy, and Fulfillment in the Era of Identity PoliticsRise And Fall of Soul And SelfRitalin NationRobert NozickRousseauRousseau and the Dilemmas of Modernity Routledge Philosophy Guidebook to Derrida on DeconstructionRules, Reason, and Self-KnowledgeSaints, Scholars, and Schizophrenics: Mental Illness in Rural IrelandSartreSartreSartreSartre in Search of an EthicsSatisficing and MaximizingSaving GodScandalous KnowledgeSchizophreniaSchizophrenia and the Fate of the SelfSchizophrenia: A Scientific Delusion?SchopenhauerSchopenhauer's TelescopeScienceScience and EthicsScience and Pseudoscience in Clinical PsychologyScience and SpiritualityScience and the Pursuit of WisdomScience Fiction and PhilosophyScience Fiction and PhilosophyScience in Civil SocietyScience in DemocracyScience RulesScience WarsScience, Consciousness and Ultimate RealityScience, Policy, and the Value-Free IdealSciences from BelowScientific EvidenceScientific IrrationalismScientific PerspectivismScientific PluralismScientific Realism and the Rationality of ScienceScratching the Surface of BioethicsSecond NatureSecond OpinionsSecond PhilosophySecrets of the MindSecular Philosophy and the Religious TemperamentSecurity, Territory, PopulationSeeing and VisualizingSeeing DoubleSeeing Fictions in FilmSeeing RedSeeing Wittgenstein AnewSeeing, Doing, And KnowingSelfSelf and OtherSelf and SubjectivitySelf, No Self?Self-ConsciousnessSelf-ConstitutionSelf-ExpressionSelf-FulfillmentSelf-Knowledge and ResentmentSelf-Knowledge and Self-DeceptionSelf-Made MadnessSelf-Reference and Self-AwarenessSelf-Representational Approaches to ConsciousnessSelvesSentimental RulesSexing the BodySexualized BrainsShades of LonelinessShame and GuiltShame and NecessityShame and PhilosophyShop Class as SoulcraftShynessSigns, Mind, And RealitySimone de BeauvoirSimple MindednessSimulating MindsSimulation and SimilaritySinging in the FireSisyphus's BoulderSituating SemanticsSix Questions of SocratesSkeptical FeminismSkepticismSketch for a Theory of the EmotionsSleeping With Extra-TerrestrialsSlothSocial EpistemologySocial PhenomenologySocializing MetaphysicsSociological Perspectives on the New GeneticsSocratesSocrates CafeSocrates in LoveSocratic Moral PsychologySoft SubversionsSoren KierkegaardSorting Things OutSoul 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Descriptions and PrescriptionsReview - Descriptions and Prescriptions
Values, Mental Disorders, and the DSMs
by John Z. Sadler (Editor)
Johns Hopkins University Press, 2002
Review by Peter Zachar, Ph.D.
Feb 3rd 2003 (Volume 7, Issue 6)

Descriptions and Prescriptions is a sophisticated exploration of the various evaluative decisions that could reasonably influence the development of the diagnostic manual used by psychiatrists, psychologists, social workers, and allied mental health professionals in the United States.  Also explored are the different values that are expressed in the manual itself.  The book’s purpose is to encourage a thoroughly rigorous attempt to create the best diagnostic manual possible.  As John Sadler suggests in his introductory chapter, rigor involves more than collecting data.

It has become a truism among philosophers of science that the thinkers of the Enlightenment period were mistaken in advocating a radical distinction between facts and values.  It is not that we invent facts; rather there are too many facts available to us.  We therefore need some guidelines for deciding which facts to study, and how to interpret them. These guidelines involve assumptions about what count as good data, what count as good explanations, and what count as good solutions to problems.  The inevitable use of the word ‘good’ means that evaluations cannot be isolated from the scientific process.

In addition to scientific values, the very concept of psychiatric disorder is inherently evaluative - it depends on what philosophers call normative assumptions.  Normative assumptions include notions of what is normal or what ought to be, for example, to assert that something has gone wrong with a person who hears a voice in her head that is making a running commentary on her behavior, we need to have some notion of what she ‘should’ or ‘ought’ to be like instead.

Let me note that the book is not titled “Descriptions or Prescriptions?”  As Christian Perring points out in his chapter, the debate about values has been decided in favor of thinkers such as Bill Fulford, who have taken the lead in arguing that the notion of mental illness/mental disorder cannot be value-free.  For the most part, this book doesn’t involve debates about whether the disorders listed in psychiatric manuals are descriptions of actual conditions or lists of behaviors that have been evaluated to be socially undesirable.  The authors in this volume differ in emphasis with respect to how much description is desirable and how much prescription is acceptable, but they generally agree that understanding psychiatric disorders requires both description and prescription.

When the American Psychiatric Association revolutionized diagnostic practice in 1980 with the publication of the DSM-III, it did so by providing a concrete and systematic description of each psychiatric disorder.  This revolution evolved into a search for the most reliable criteria for identifying these disorders, and is currently focused on an evaluation of the evidence for the scientific legitimacy of each disorder.  Sadler refers to this as descriptive rigor.  What has been lacking, however, is an equally systematic analysis of all the evaluative decisions that are made in defining disorders.  The inclusion of evaluative rigor would clearly make the process of revising diagnostic manuals more thorough than it has been in the past.  Exploring what could be called the Sadler-Agich notion of evaluative rigor is the putative justification for this collection of papers. 

Their concurrence regarding the presence of values in diagnostic practice does not mean that the contributors to this volume constitute a happy family who all agree about basic issues - they don’t. They agree that it is important to develop the best manual possible, and they all want to make a contribution toward that end, but there are significant disputes about fundamentals.

One group of thinkers concedes that values play a role in the construction of diagnostic manuals and are part of the meaning of ‘disorder,’ but they also believe that the goal of psychiatry should be to maximize the scientific attributes of the manual.  They tend to see values as potentially corrupting influences.  This group includes those who were among the architects of the DSM-IV - Thomas Widiger and Harold Pincus & Laurie McQueen. 

Any reader inclined to view the DSM architects as unreconstructed positivists or scientistic thinkers of a narrow-minded bent is advised to read their chapters. Those pejorative descriptions are exaggerations. The DSM architects are (generally) a pretty sophisticated bunch, and are well-aware of the complexities involved in constructing and using manuals.  I’m convinced they have a more elaborate understanding of classificatory pragmatics than many users of the manual.

The issue of whether or not values constitute corrupting influences that should be minimized even if they can’t be eliminated is a contentious one.  Another apparent member of the ‘science maximization’ group is Lee Anna Clark.  What is especially interesting about her contribution is that she makes it clear that ‘science maximization’ is how she was trained to think - it is what her profession brings to the table.  That profession is clinical psychology, and more specifically, the clinical-scientist tradition (as opposed to scientist-practitioner).  Trained to be scientific researchers first and foremost, clinical scientists learn to identify when questions can be answered empirically, and gain the skills to develop and run studies that will answer those questions.  As George Agich might say, because that is what they are trained to do, that is what they are likely to value in the DSM.  Clark’s point is also a good one; when there is empirical information relevant to answering questions such as ‘what counts as extreme,’ we should seek it out. 

  Also important to the ‘science maximization’ proponents, especially Widiger, are some non-empirical assumptions, specifically, that psychiatrists and psychologists are supposed to be finding out what psychiatric disorders really are, that progress is equated with being ‘more true’, and that discovering the truth is what scientific research does.

 With respect to these philosophical assumptions, a second group of thinkers represented in this volume are inclined to be querulous.  They reject the contamination metaphor when discussing values and believe that evaluations guide the process of knowledge generation.   They are more comfortable defining progress in terms of improvement. Whatever else they might be, categories such as schizophrenia and depression are instruments that psychiatrists and psychologists use to help their patients.  Certain members of this group also understand truth as a species of the good, i.e., an evaluative term.  The true is the name of whatever proves itself to be good in the way of belief as William James famously defined it.   Included in this collection are philosophers who specialize in psychiatric issues and mental health professionals who are philosophically minded (and trained).  Among them are John Sadler, George Agich, Bill Fulford, Jennifer Radden, Christian Perring, Michael Schwartz and Osborne Wiggins - all luminaries in the field.  Although I’m lumping them together, the chapters written by members of this second group are diverse, detailed, and incisive.  They compromise the core of the book. 

Another prominent presence, and one who is harder to classify, is Jerome Wakefield.  He is a quintessential description and prescription proponent, claiming as he does that any legitimate disorder has to be an objective dysfunction that is evaluated by society or an individual as causing harm.  His harmful dysfunction model of mental disorder considers the value-neutral view and the value-only view to be fallacies, which he names the essentialist and normativist fallacies, respectively.  Wakefield, however, is not an instrumentalist.  He believes that we can correctly specify what we mean by mental disorder, and we have a moral obligation to not confuse a true mental disorder with a merely harmful condition.  He also doggedly maintains that ‘dysfunction’ is value neutral.  The harmful dysfunction model neatly accepts some of Thomas Szasz’s claims about the evaluative elements in attribution of mental illness without accepting the claim that mental illness is ill a myth. Wakefield’s chapter highlights the importance of making these distinctions with respect to disorders of childhood and adolescence. 

There is also a conscious and pervasive radical edge to the book, and it makes for some of the more eye opening chapters.  A fundamental insight driving the radical analyses is expressed by Schwartz and Wiggins, who argue that it is the idea of Science or the promise of scientific knowledge that has afforded the DSM-III, III-R, IV (and IV-TR) so much influence.  Applications of scientific thinking have taught us that the earth is round, that it revolves around the sun, and that life on this planet has changed systematically for millions of years.  They have brought us more food, more warmth, more knowledge, more entertainment, better health and longer life.  The conceptualizing of scientific knowledge as a valuable resource that needs to be supported is firmly entrenched in Western culture, and that cultural value inevitably drives the attempt to create better diagnostic manuals.

So what’s the problem?  The problem is something that has been recognized on a small scale by social psychologists and on a larger scale by social-political philosophers, particularly post-structuralists (or post-modernists) and critial social theorists.  Our notion of science, what science does, and how it works is a popular cultural story. It includes mini-stories such as Galileo’s house arrest, the Scopes monkey trial, and the discovery of penicillin.  The larger meta-narrative expresses group values.  We tend to conform to and understand the world in terms of the grander narrative, but no narrative can tell the whole story.  Even the mini-narratives such as what happened to Galileo are simplified and interpreted evaluatively. The parts of the story not told, the facts left out, and the experiences not acknowledged, are marginalized.

The DSM is an official story about psychiatric disorders. It is a story about how American psychiatry became scientific without abandoning its clinical roots.  Subplots within the bigger story are found in the different sections of the manual and in all of their background assumptions.  This includes the technical details, for example, the reasons for implementing the positive versus negative symptom distinction in schizophrenia comprise a story.  As stated, the DSM also carries a stamp of legitimacy; its users therefore tend to see both psychopathology and problems-in-living through its lenses.  Some of ways in which this happens is described in a chapter by Berrenkotter and Ravotas.

Any psychiatrist or psychologist willing to step outside their professional role and look beyond the conventional goods they pursue, defined in terms of their profession’s goals, would find it informative to adopt the viewpoint of the social critic.  Once they do this, there are various attitudes they can take toward the problem of grand narratives and totalizing discourse. The attitude most people are familiar with is what Ian Hacking has called the revolutionary attitude - often seen in postmodernist critiques.  The revolutionary attitude holds that the grand narrative is a harmful force that must be overthrown.  That attitude is barely evident in this book. 

More evident is what Hacking has termed a reformist attitude. The reformist attitude views grand narratives as partly resulting from what social psychologists call group think.  Reformists reject the charge that the ruling narratives are simply the creation of villains at the top of the social hierarchy who are cynically manipulating the discourse for their own personal interests; rather, they claim that these narratives are historical products, created and recreated by the group.  John Sadler refers to it as the politics of concordance.  The reformers seek to moderate the negative consequences of this massive kind of group think. 

Two noteworthy chapters reflecting the radical approach are contributed by the physician James Phillips and the philosopher Allyson Skene.  Phillips critiques a set of assumptions about what counts as a good scientific explanation, especially assumptions that are associated with an evaluative preference for technological reason.  To my mind this echoes Horkheimer and Adorno, but he obviously got it from Gadamer.  The basic idea is that the technological model of rationality leads us to expect that good explanations are mindless and algorithmic, and once you really understand any natural phenomenon, you should be able to devise a set of rules or formulae which - when correctly applied - will solve the problem.  He argues that even though some of the DSM architects are aware of this affront to complex problem solving, the operationalized polythetic criteria model encourages it.

Allyson Skene suggests that the Agich and Fulford attempt to conceptualize psychiatric disorders as both descriptions and prescriptions fails to provide a legitimate alternative to the prescription-laden view of the anti-psychiatry movement.  Actually, Szasz must feel he has won the day with respect to characterizing our talk about schizophrenia because most noticeable complaints about him from psychiatrists and psychologists emphasize what an immoral and irresponsible theory he has proposed.  Christian Perring’s and Skene’s chapters both imply that questioning Szasz’s rugged libertarian politics would be a more effective argument strategy with respect to disputing the issues he values.  Skene shows that, in contrast to the anti-psychiatrists, Foucault offers a more refined articulation of strong normativism in which negatively valued conditions can be said to exist, and cannot be reduced to creations of powerful forces that want them repressed.

A crucial section of the book provides a voice to non-specialists - those who are not professionally engaged in studying the philosophical aspects of psychiatric classification. These will be the easiest chapters for most readers to understand, but they will also have the most bite for those who already worked through the philosophical arguments in the previous sections of the book.  A chapter by Cathy Leak makes several interesting points, one of which is that rather than using case studies to illustrate and conform to DSM diagnosis, case studies would be more valuable if they challenged the diagnosis and showed us aspects of the person to which the diagnosis is blind. 

Speaking on behalf of the National Alliance for the Mentally Ill is neuroscientist Laura Lee Hall.  If anyone understands the political and evaluative consequences of psychiatric diagnostic manuals it is those who have had a family member diagnosed with a major mental illness.  Hall argues that the manual mistakenly avoids making distinctions between major mental illness and other more ‘neurotic’ conditions.  The reason this is a mistake is that when they are all lumped together as ‘mental disorders’ it makes it easier for legislators and lobbyist rich insurance companies to not treat major mental illness as seriously as they should.

The attorney Daniel Shuman, an expert on using psychology in the courtroom, contributes an argument that should give proponents of the Sadler-Agich call for evaluative rigor some pause.  Shuman claims that it would be better with respect to forensic applications if the DSM emphasized its scientific attributes and not the value elements.  This is because the courts historically have a tendency to accept professional clinical opinion as fact - but this practice has been attenuated in recent years due to the standards articulated in the Daubert decision.  Daubert asks the courts to consider the quality of the reasoning underlying scientific expertise, with quality including publication in peer-reviewed journals and falsifiable propositions.  If the DSM architects were to make the value dimensions more explicit, the public may come to see it as a manual of opinion and partisan agenda, and Daubert could be undermined.  If psychiatrists and psychologists were to be philosophically honest regarding the complex nature of psychiatric disorders, their scientific credentials would be put at a forensic disadvantage.  I suspect that this disadvantage would be accentuated should psychiatric expertise ever be compared to the expertise of the social, biological, and physical sciences, and to the law itself which will still wrap themselves in a flag of common sense objectivity and value neutral-knowledge.  Makes you think.

There are 21 chapters; each quite good.  Nor could I fit them all into the plan I adopted for summarizing the book. For example, Chris Mace writes a chapter for philosophers of science, suggesting that Thomas Kuhn’s and Karl Popper’s theories have become the new received view.  He reminds us that there are alternative models that might usefully be applied to our understanding of the process of nosological revision, specifically Stephen Toulmin’s concept-based and evolutionary model of scientific progress.  It’s an excellent point.

Philosopher of science Patricia Ross proposes an objectivity maximization view, but one that views objectivity as a community project rather than the result of an individual correctly applying the appropriate method. She doubts that the process of revising the DSM could be organized as the kind of social process that leads to objective knowledge, but makes some suggestions for organizing the DSM work groups that could increase intersubjective agreement as opposed to the kind of grudging consensus that has been settled for in the past.

One of my favorite thinkers, Irving Gottesman, writes about the role that genetic information should occupy in the diagnostic manuals of the future.  He proposes adding an Axis VI for coding genetic markers.  Acknowledging that this would be valuable scientifically and diagnostically, and also - socially harmful, he suggests that the information on Axis VI be encrypted.  It should be made available only to those who would use it for good (professionals), and not to those who would use it for ill (employers and insurance companies).  Thought-provoking point, but I don’t think we can assume that all mental health professionals will be benign and liberally-minded.

In my graduate classes I use a Gottesman & Meehl-like theory regarding the genetics of schizophrenia as a model for psychiatric disorders in general.  In his chapter Gottesman reviews the genetics of Alzheimer’s disease, and it follows a chapter in which Kenneth Schaffner suggests that Alzheimer’s disease be used as a model for understanding psychiatric disorders in general.  Schaffner concretizes another theme running throughout the book, the notion that the atheoretical descriptive diagnosis and non-etiological model used in the current DSM is scientifically implausible. He proposes a general theory of causation that would be consistent with psychiatry’s traditional acceptance of multiple levels of analysis - biological, psychological, behavioral, interpersonal, and cultural. As Schaffner and Gottesman suggest with respect to genetics and Jennifer Radden suggests with respect to the concept of ‘incapability’ itself, if we have good reasons for conceptualizing a particular condition in causal terms, we should be able to implement those models and those data into the manual. 

I claimed earlier that the putative justification for this volume was the Sadler-Agich call to expose evaluative decisions to more systematic and explicit study.  I used ‘putative’ because there is another, deeper, justification for this book - specifically, the question of how much and what kind of authority should scientific knowledge have with respect to understanding and explaining the world.  This is not a simple question, and in the form of the ‘culture wars’ and the ‘clash of civilizations,’ it may be a question that dominates the early 21st century intellectual landscape.

It is less daunting to address the question if it is focused, for example, ‘what authority does scientific knowledge have with respect to the development and use of psychiatric diagnostic manuals?’  It depends, of course, on what counts as ‘scientific.’  To sidestep that debate for a moment, we can say that in American psychiatry, ‘scientific’ currently refers to an experiment-oriented medical model approach, increasingly biomedical, augmented by the psychometric tradition in scientific psychology with its emphasis on reliability, validity and operationalized constructs, and evaluated whenever possible using statistical methods and research designs developed in epidemiology.  Now the question becomes how much and what kind of authority should we give THAT?  

Most people’s answer about how to balance description and prescription will probably have parallels to their answers about the nature and limits of scientific authority, but not necessarily.  John Sadler would grant authority to a process, the inclusive process of a rigorous democracy - one that is reluctant to make compromises with respect to the values of openness, accountability, sensitivity to diversity, and encouragement of participation.   If what some people identify as scientific knowledge emerges from that process in a privileged position, so be it, but he does not want to grant it a priori authority. 

The question regarding the authority of science has implications extending far beyond psychiatric classification and the philosophy of psychiatry.  I only vaguely know what my answer to the authority question is, and these chapters have encouraged me to think about that problem more deeply. 

In conclusion, this is an excellent book.  It has been thoughtfully edited, and is best read in order from beginning to end.  Some edited books are hodgepodge collections and others are more integrated - this one is remarkably integrated.  There is an experience of complexity, nuance, and an unresolvable yet undeniably rich confrontation of perspectives that emerges by reading the chapters in order.  Those with less training in philosophical evaluation are going to struggle with being presented so much abstract and multifaceted information, but Descriptions and Prescriptions has the comprehensiveness that only interdisciplinary cooperation can bring - a Fulford & Sadler hallmark.  Anyone who believes that developing the best diagnostic manual possible is an important and complicated task, and also wants to contribute to the process in a scholarly and reflective way, is well-advised to study these chapters.

 

© 2003 Peter Zachar

 

Peter Zachar, Ph.D. is an associate professor of psychology at Auburn University Montgomery.  He is a licensed psychologist with additional specializations in psychological measurement, the philosophy of science, and the philosophy of psychiatry.  He is the author of Psychological Concepts and Biological Psychiatry: A Philosophical Analysis. 


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