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Anger and Forgiveness"Are You There Alone?"10 Good Questions about Life and DeathA Casebook of Ethical Challenges in NeuropsychologyA Companion to BioethicsA Companion to BioethicsA Companion to GenethicsA Companion to GenethicsA Companion to Muslim EthicsA Cooperative SpeciesA Critique of the Moral Defense of VegetarianismA Delicate BalanceA Fragile LifeA Life for a LifeA Life-Centered Approach to BioethicsA Matter of SecurityA Natural History of Human MoralityA Philosophical DiseaseA Practical Guide to Clinical Ethics ConsultingA Question of TrustA Sentimentalist Theory of the MindA Short Stay in SwitzerlandA Tapestry of ValuesA Very Bad WizardA World Without ValuesAction and ResponsibilityAction Theory, Rationality and CompulsionActs of ConscienceAddiction and ResponsibilityAddiction NeuroethicsAdvance Directives in Mental HealthAfter HarmAftermathAgainst AutonomyAgainst BioethicsAgainst HealthAgainst Moral ResponsibilityAgency and AnswerabilityAgency and ResponsibilityAgency, Freedom, and Moral ResponsibilityAging, Biotechnology, and the FutureAlbert Schweitzer's Reverence for LifeAlphavilleAltruismAltruismAmerican EugenicsAmerican PsychosisAn American SicknessAn Anthology of Psychiatric EthicsAn Introduction to EthicsAn Introduction to Evolutionary EthicsAn Introduction to Kant's Moral Philosophy And a Time to DieAnimal LessonsAnimal RightsAnimals Like UsApplied Ethics in Mental Health CareAre Women Human?Aristotle on Practical WisdomAristotle's Ethics and Moral ResponsibilityAssisted Suicide and the Right to DieAutonomyAutonomy and the Challenges to LiberalismAutonomy, Consent and the LawBabies by DesignBackslidingBad PharmaBad SoulsBasic Desert, Reactive Attitudes and Free WillBeauty JunkiesBefore ForgivingBeing AmoralBeing YourselfBending Over BackwardsBending ScienceBernard WilliamsBetter Humans?Better Than WellBeyond ChoiceBeyond GeneticsBeyond HatredBeyond Humanity?Beyond LossBeyond LossBeyond Moral JudgmentBeyond the DSM StoryBias in Psychiatric DiagnosisBioethicsBioethicsBioethics and the BrainBioethics at the MoviesBioethics Beyond the HeadlinesBioethics Critically ReconsideredBioethics in a Liberal SocietyBioethics in the ClinicBiomedical EthicsBiomedical EthicsBiomedical EthicsBiomedical EthicsBiomedical Research and BeyondBiosBioscience EthicsBipolar ChildrenBluebirdBodies out of BoundsBodies, Commodities, and BiotechnologiesBody BazaarBoundBoundaries and Boundary Violations in PsychoanalysisBraintrustBrandedBreaking the SilenceBuffy the Vampire Slayer and PhilosophyCapital PunishmentCase Studies in Biomedical Research EthicsChallenging the Stigma of Mental IllnessCharacter and Moral Psychology Character as Moral FictionChild Well-BeingChildrenChildren's RightsChoosing ChildrenChoosing Not to ChooseClinical Dilemmas in PsychotherapyClinical EthicsCloningClose toYouCoercion as CureCoercive Treatment in PsychiatryCognition of Value in Aristotle's EthicsCognitive Disability and Its Challenge to Moral Philosophy Comfortably NumbCommonsense RebellionCommunicative Action and Rational ChoiceCompetence, Condemnation, and CommitmentComprehending CareConducting Insanity EvaluationsConfidential RelationshipsConfidentiality and Mental HealthConflict of Interest in the ProfessionsConsuming KidsContemporary Debates In Applied EthicsContemporary Debates in Moral TheoryContemporary Debates in Social PhilosophyContentious IssuesContesting PsychiatryCrazy in AmericaCreating CapabilitiesCreatures Like Us?Crime and CulpabilityCrime, Punishment, and Mental IllnessCritical Perspectives in Public HealthCritical PsychiatryCrueltyCultural Assessment in Clinical PsychiatryCurrent Controversies in Values and ScienceCutting to the CoreCyborg CitizenDamaged IdentitiesDeaf Identities in the MakingDeath Is That Man Taking NamesDebating ProcreationDebating Same-Sex MarriageDecision Making, Personhood and DementiaDecoding the Ethics CodeDefining DifferenceDefining Right and Wrong in Brain ScienceDefining the Beginning and End of LifeDelusions of GenderDementiaDemocracy in What State?Demons of the Modern WorldDescriptions and PrescriptionsDesert and VirtueDesire, Practical Reason, and the GoodDestructive Trends in Mental HealthDeveloping the VirtuesDid My Neurons Make Me Do It?Difference and IdentityDigital HemlockDigital SoulDignityDisability BioethicsDisability, Difference, DiscriminationDisordered Personalities and CrimeDisorders of VolitionDisorientation and Moral LifeDivided Minds and Successive SelvesDoes Feminism Discriminate against Men?Does Torture Work?Double Standards in Medical Research in Developing CountriesDrugs and JusticeDworkin and His CriticsDying in the Twenty-First CenturyEarly WarningEconomics and Youth ViolenceEmbodied RhetoricsEmerging Conceptual, Ethical and Policy Issues in BionanotechnologyEmotional ReasonEmotions in the Moral LifeEmotions in the Moral LifeEmpathyEmpathy and Moral DevelopmentEmpathy and MoralityEmpirical Ethics in PsychiatryEncountering NatureEncountering the Sacred in PsychotherapyEngendering International HealthEnhancing EvolutionEnhancing Human CapacitiesEnoughEros and the GoodErotic InnocenceErotic MoralityEssays on Derek Parfit's On What MattersEssays on Free Will and Moral ResponsibilityEthical Choices in Contemporary MedicineEthical Conflicts in PsychologyEthical Dilemmas in PediatricsEthical Issues in Behavioral ResearchEthical Issues in Dementia CareEthical Issues in Forensic Mental Health ResearchEthical Issues in the New GeneticsEthical LifeEthical Reasoning for Mental Health ProfessionalsEthical TheoryEthical WillsEthically Challenged ProfessionsEthicsEthicsEthicsEthics and AnimalsEthics and ScienceEthics and the A PrioriEthics and the Discovery of the UnconsciousEthics and the Metaphysics of MedicineEthics at the CinemaEthics Case Book of the American Psychoanalytic AssociationEthics Done RightEthics ExpertiseEthics for EveryoneEthics for PsychologistsEthics for the New MillenniumEthics in CyberspaceEthics in Health CareEthics In Health Services ManagementEthics in Mental Health ResearchEthics in PracticeEthics in PsychiatryEthics in PsychologyEthics in Psychotherapy and CounselingEthics of PsychiatryEthics without OntologyEthics, Culture, and PsychiatryEthics, Sexual Orientation, and Choices about ChildrenEvaluating the Science and Ethics of Research on HumansEvilEvil GenesEvil in Modern ThoughtEvil in Modern ThoughtEvolution, Gender, and RapeEvolutionary Ethics and Contemporary BiologyEvolutionary Psychology and ViolenceEvolved MoralityExperiments in EthicsExploding the Gene MythExploiting ChildhoodFacing Human SufferingFact and ValueFaking ItFalse-Memory Creation in Children and AdultsFat ShameFatal FreedomFellow-Feeling and the Moral LifeFeminism and Its DiscontentsFeminist Ethics and Social and Political PhilosophyFeminist TheoryFinal ExamFirst Do No HarmFirst, Do No HarmFlashpointFlesh WoundsForced to CareForgivenessForgivenessForgiveness and LoveForgiveness and ReconciliationForgiveness and RetributionFoucault and the Government of DisabilityFoundational Issues in Human Brain MappingFoundations of Forensic Mental Health AssessmentFree WillFree Will And Moral ResponsibilityFree Will and Reactive AttitudesFree Will, Agency, and Meaning in LifeFree?Freedom and ValueFreedom vs. InterventionFriendshipFrom Darwin to HitlerFrom Disgust to HumanityFrom Enlightenment to ReceptivityFrom Morality to Mental HealthFrom Silence to VoiceFrom Valuing to ValueFrontiers of JusticeGender in the MirrorGenetic PoliticsGenetic ProspectsGenetic ProspectsGenetics of Original SinGenetics of Original SinGenocide's AftermathGetting RealGluttonyGood WorkGoodness & AdviceGreedGroups in ConflictGrowing Up GirlGut FeminismHabilitation, Health, and AgencyHandbook for Health Care Ethics CommitteesHandbook of BioethicsHandbook of Children's RightsHandbook of PsychopathyHappinessHappiness and the Good LifeHappiness Is OverratedHard FeelingsHard LuckHardwired BehaviorHarmful ThoughtsHeal & ForgiveHealing PsychiatryHealth Care Ethics for PsychologistsHeterosyncraciesHistorical and Philosophical Perspectives on Biomedical EthicsHoly WarHookedHookedHow Can I Be Trusted?How Propaganda WorksHow to Do Things with Pornography How to Make Opportunity EqualHow Universities Can Help Create a Wiser WorldHow We HopeHow We Think About DementiaHuman BondingHuman EnhancementHuman GoodnessHuman Identity and BioethicsHuman TrialsHumanism, What's That?Humanitarian ReasonHumanityHumanizing MadnessI am Not Sick I Don't Need Help!I Was WrongIdentifying Hyperactive ChildrenIf That Ever Happens to MeImproving Nature?In Defense of FloggingIn Defense of SinIn Love With LifeIn Our Own ImageIn the FamilyIn the Land of the DeafIn the Name of IdentityIn the Wake of 9/11In Two MindsInclusive EthicsInformed Consent in Medical ResearchInnovation in Medical TechnologyInside Assisted LivingInside EthicsIntelligence, Race, and GeneticsIntensive CareInto the Gray ZoneIs Human Nature Obsolete?Is Long-Term Therapy Unethical?Is There a Duty to Die?Is There an Ethicist in the House?Issues in Philosophical CounselingJudging Children As ChildrenJust a DogJust BabiesJust CareJustice for ChildrenJustice for HedgehogsJustice in RobesJustice, Luck, and KnowledgeJustifiable ConductKant on Moral AutonomyKant's Theory of VirtueKids of CharacterKilling McVeighLack of CharacterLack of CharacterLaw and the BrainLearning About School ViolenceLearning from Baby PLeaving YouLectures on the History of Political PhilosophyLegal and Ethical Aspects of HealthcareLegal Aspects of Mental CapacityLegal ConceptionsLegal InsanityLegalizing ProstitutionLet Them Eat ProzacLevelling the Playing FieldLiberal Education in a Knowledge SocietyLiberal EugenicsLife After FaithLife at the BottomLife, Sex, and IdeasListening to the WhispersLiving ProfessionalismLosing Matt ShepardLostLuckyMad in AmericaMad PrideMadhouseMaking Another World PossibleMaking Babies, Making FamiliesMaking Genes, Making WavesMaking Sense of Freedom and ResponsibilityMalignantMasculinity Studies and Feminist TheoryMeaning and Moral OrderMeaning in LifeMeaning in Life and Why It MattersMeans, Ends, and PersonsMeans, Ends, and PersonsMedical Enhancement and PosthumanityMedical Research for HireMedicalized MasculinitiesMedically Assisted DeathMeditations for the HumanistMelancholia and MoralismMental Health Professionals, Minorities and the PoorMental Illness, Medicine and LawMerit, Meaning, and Human BondageMetaethical SubjectivismMill's UtilitarianismMind FieldsMind WarsMind WarsModern Theories of JusticeModernity and TechnologyMoney ShotMonsterMoral Acquaintances and Moral DecisionsMoral BrainsMoral ClarityMoral CultivationMoral Development and RealityMoral Dilemmas in Real LifeMoral DimensionsMoral EntanglementsMoral FailureMoral LiteracyMoral MachinesMoral MindsMoral OriginsMoral Panics, Sex PanicsMoral ParticularismMoral PerceptionMoral PsychologyMoral Psychology: Volume IVMoral RealismMoral RelativismMoral RepairMoral Responsibility and Alternative PossibilitiesMoral Status and Human LifeMoral StealthMoral Theory at the MoviesMoral TribesMoral Value and Human DiversityMoral, Immoral, AmoralMoralismMorality and Self-InterestMorality in a Natural WorldMorality, Moral Luck and ResponsibilityMorals, Rights and Practice in the Human ServicesMorals, Rights and Practice in the Human ServicesMore Than HumanMotive and RightnessMovies and the Moral Adventure of LifeMurder in the InnMy Body PoliticMy Brain Made Me Do ItMy Sister's KeeperMy Sister's KeeperMy WayNano-Bio-EthicsNarrative MedicineNarrative ProsthesisNatural Ethical FactsNatural-Born CybogsNaturalized BioethicsNeither Bad nor MadNeoconservatismNeonatal BioethicsNeurobiology and the Development of Human MoralityNeuroethicsNeuroethicsNeuroethicsNew Takes in Film-PhilosophyNew Waves in EthicsNew Waves in MetaethicsNietzsche on Ethics and PoliticsNo Child Left DifferentNo Impact ManNormative EthicsNormativityNothing about us, without us!Oath BetrayedOf War and LawOn ApologyOn Being AuthenticOn EvilOn Human RightsOn The Stigma Of Mental IllnessOn the TakeOn Virtue EthicsOn What MattersOn What We Owe to Each OtherOne ChildOne Nation Under TherapyOne World NowOne World NowOur Bodies, Whose Property?Our Bodies, Whose Property?Our Daily MedsOur Faithfulness to the PastOur Posthuman FutureOut of EdenOut of Its MindOut of the ShadowsOverdosed AmericaOxford Handbook of Psychiatric EthicsOxford Textbook of Philosophy of PsychiatryPassionate DeliberationPatient Autonomy and the Ethics of ResponsibilityPC, M.D.Perfecting VirtuePersonal AutonomyPersonal Autonomy in SocietyPersonal Identity and EthicsPersonalities on the PlatePersonhood and Health CarePersons, Humanity, and the Definition of DeathPerspectives On Health And Human RightsPharmacracyPharmageddonPhilosophy and This Actual WorldPhilosophy of BiologyPhilosophy of Technology: The Technological ConditionPhysician-Assisted DyingPicturing DisabilityPilgrim at Tinker CreekPlaying God?Playing God?Political EmotionsPornlandPowerful MedicinesPractical Autonomy and BioethicsPractical EthicsPractical Ethics for PsychologistsPractical RulesPragmatic BioethicsPragmatic BioethicsPragmatic NeuroethicsPraise and BlamePreferences and Well-BeingPrimates and PhilosophersPro-Life, Pro-ChoiceProcreation and ParenthoodProfits Before People?Progress in BioethicsProperty in the BodyProzac As a Way of LifeProzac on the CouchPsychiatric Aspects of Justification, Excuse and Mitigation in Anglo-American Criminal Law Psychiatric EthicsPsychiatry and EmpirePsychological Concepts and Biological PsychiatryPsychology and Consumer CulturePsychology and LawPsychotropic Drug Prescriber's Survival GuidePublic Health LawPublic Health Law and EthicsPublic PhilosophyPunishing the Mentally IllPunishmentPursuits of WisdomPutting Morality Back Into PoliticsPutting on VirtueQuality of Life and Human DifferenceRaceRadical HopeRadical VirtuesRape Is RapeRe-creating MedicineRe-Engineering Philosophy for Limited BeingsReason's GriefReasonably ViciousReckoning With HomelessnessReconceiving Medical EthicsRecovery from SchizophreniaRedefining RapeRedesigning HumansReducing the Stigma of Mental IllnessReflections On How We LiveReframing Disease ContextuallyRefusing CareRefuting Peter Singer's Ethical TheoryRelative JusticeRelativism and Human RightsReligion ExplainedReprogeneticsRescuing JeffreyResponsibilityResponsibility and PsychopathyResponsibility and PunishmentResponsibility and PunishmentResponsibility from the MarginsResponsible GeneticsRethinking CommodificationRethinking Informed Consent in BioethicsRethinking Mental Health and DisorderRethinking RapeReturn to ReasonRevolution in PsychologyRightsRights, Democracy, and Fulfillment in the Era of Identity PoliticsRisk and Luck in Medical EthicsRobert NozickRousseau and the Dilemmas of Modernity Rule of Law, Misrule of MenRun, Spot, RunRunning on RitalinSatisficing and MaximizingSchizophrenia, Culture, and SubjectivityScience and EthicsScience in the Private InterestScience, Policy, and the Value-Free IdealScience, Seeds and CyborgsScratching the Surface of BioethicsSecular Philosophy and the Religious TemperamentSeeing the LightSelf-ConstitutionSelf-Made MadnessSelf-Trust and Reproductive AutonomySentimental RulesSex Fiends, Perverts, and PedophilesSex OffendersSex, Family, and the Culture WarsSexual DevianceSexual EthicsSexual PredatorsSexualized BrainsShaping Our SelvesShock TherapyShould I Medicate My Child?ShunnedSick to Death and Not Going to Take It AnymoreSickoSide EffectsSidewalk StoriesSister CitizenSkeptical FeminismSocial Inclusion of People with Mental IllnessSocial JusticeSociological Perspectives on the New GeneticsSome We Love, Some We Hate, Some We EatSovereign VirtueSpeech MattersSpiral of EntrapmentSplit DecisionsSticks and StonesStories MatterSubjectivity and Being SomebodySuffering, Death, and IdentitySuicide ProhibitionSurgery JunkiesSurgically Shaping ChildrenTaking Morality SeriouslyTaming the Troublesome ChildTechnology and the Good Life?TestimonyText and Materials on International Human RightsThe Aims of Higher EducationThe Almost MoonThe Altruistic BrainThe American Psychiatric Publishing Textbook of Forensic PsychiatryThe Animal ManifestoThe Animals' AgendaThe Art of LivingThe Autonomy of MoralityThe Beloved SelfThe Best Things in LifeThe Big FixThe Bioethics ReaderThe Biology and Psychology of Moral AgencyThe Blackwell Guide to Medical EthicsThe Body SilentThe BondThe Book of LifeThe Burden of SympathyThe Cambridge Companion to Virtue EthicsThe Cambridge Companion to Virtue EthicsThe Cambridge Textbook of BioethicsThe Case against Assisted SuicideThe Case Against PerfectionThe Case Against PunishmentThe Case for PerfectionThe Case of Terri SchiavoThe Challenge of Human RightsThe Code for Global EthicsThe Colonization Of Psychic SpaceThe Commercialization of Intimate LifeThe Common ThreadThe Connected SelfThe Constitution of AgencyThe Creation of PsychopharmacologyThe Criminal BrainThe Decency WarsThe Difficult-to-Treat Psychiatric PatientThe Disability PendulumThe Disability Rights Movement: From Charity to ConfrontationThe Domain of ReasonsThe Double-Edged HelixThe Duty to ProtectThe Emotional Construction of MoralsThe End of Ethics in a Technological SocietyThe End of Stigma?The Essentials of New York Mental Health LawThe Ethical BrainThe Ethical Dimensions of the Biological and Health SciencesThe Ethics of BioethicsThe Ethics of Human EnhancementThe Ethics of ParenthoodThe Ethics of SightseeingThe Ethics of the FamilyThe Ethics of the Family in SenecaThe Ethics of the LieThe Ethics of TransplantsThe Ethics of WarThe Ethics ToolkitThe Evolution of Mental Health LawThe Evolution of MoralityThe FamilyThe Fat Studies ReaderThe Forgiveness ProjectThe Form of Practical KnowledgeThe Fountain of YouthThe Freedom ParadoxThe Future of Assisted Suicide and EuthanasiaThe Future of Human NatureThe Good BookThe Good LifeThe Great BetrayalThe Handbook of Disability StudiesThe Healing VirtuesThe High Price of MaterialismThe History of Human RightsThe HorizonThe Idea of JusticeThe Ideal of NatureThe Illusion of Freedom and EqualityThe Immortal Life of Henrietta LacksThe Importance of Being UnderstoodThe Insanity OffenseThe Joy of SecularismThe Language PoliceThe Last Normal ChildThe Last UtopiaThe Limits of MedicineThe LobotomistThe Love CureThe Lucifer EffectThe Manual of EpictetusThe Mark of ShameThe Meaning of NiceThe Medicalization of SocietyThe Merck DruggernautThe Mind Has MountainsThe Modern Art of DyingThe Modern SavageThe Moral ArcThe Moral BrainThe Moral Demands of MemoryThe Moral FoolThe Moral MindThe Moral Psychology HandbookThe Moral, Social, and Commercial Imperatives of Genetic Testing and ScreeningThe Most Good You Can DoThe Myth of ChoiceThe Myth of the Moral BrainThe Nature of NormativityThe New Disability HistoryThe New Genetic MedicineThe New Religious IntoleranceThe Offensive InternetThe Origins of FairnessThe Oxford Handbook of Animal EthicsThe Oxford Handbook of Ethics at the End of LifeThe Perfect BabyThe Philosophy of NeedThe Philosophy of PornographyThe Philosophy of PsychiatryThe Politics Of LustThe Portable Ethicist for Mental Health Professionals The Power of Religion in the Public SphereThe Price of PerfectionThe Price of TruthThe Problem of PunishmentThe Prosthetic ImpulseThe Psychology of Good and EvilThe Psychology of Good and EvilThe PsychopathThe Purity MythThe Pursuit of PerfectionThe Relevance of Philosophy to LifeThe Right Road to Radical FreedomThe Right to Be ParentsThe Righteous MindThe Root of All EvilThe Rules of InsanityThe Second SexismThe Second-Person StandpointThe Silent World of Doctor and PatientThe Sleep of ReasonThe Social Psychology of Good and EvilThe Social Psychology of MoralityThe Social Psychology of MoralityThe Speed of DarkThe Stem Cell ControversyThe Stem Cell ControversyThe Story of Cruel and UnusualThe Story WithinThe Stubborn System of Moral ResponsibilityThe Suicide TouristThe Terrible GiftThe Theory of OptionsThe Therapy of DesireThe Trauma of Psychological TortureThe Trauma of Psychological TortureThe Triple HelixThe Trolley Problem MysteriesThe Trouble with DiversityThe Truth About the Drug CompaniesThe Ugly LawsThe Varieties of Religious ExperienceThe Virtue of Defiance and Psychiatric EngagementThe Virtues of FreedomThe Virtues of HappinessThe Virtuous Life in Greek EthicsThe Virtuous PsychiatristThe Voice of Breast Cancer in Medicine and BioethicsThe War Against BoysThe War for Children's MindsThe Whole ChildThe Woman RacketThe Worldwide Practice of TortureTherapy with ChildrenThieves of VirtueThree Generations, No ImbecilesTimes of Triumph, Times of DoubtTolerance Among The VirtuesTolerance and the Ethical LifeTolerationToxic PsychiatryTrauma, Truth and ReconciliationTreatment Kind and FairTrusting on the EdgeTry to RememberUltimate JudgementUnborn in the USA: Inside the War on AbortionUndermining ScienceUnderstanding AbortionUnderstanding CloningUnderstanding EmotionsUnderstanding EvilUnderstanding Kant's EthicsUnderstanding Moral ObligationUnderstanding Physician-Pharmaceutical Industry InteractionsUnderstanding TerrorismUnderstanding the GenomeUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnhingedUnprincipled VirtueUnsanctifying Human Life: Essays on EthicsUnspeakable Acts, Ordinary PeopleUp in FlamesUpheavals of ThoughtUsers and Abusers of PsychiatryValue-Free Science?Values and Psychiatric DiagnosisValues in ConflictVegetarianismViolence and Mental DisorderVirtue EthicsVirtue, Rules, and JusticeVirtue, Vice, and PersonalityVirtues and Their VicesVulnerability, Autonomy, and Applied EthicsWar Against the WeakWar, Torture and TerrorismWarrior's DishonourWeaknessWelfare and Rational CareWhat Genes Can't DoWhat Have We DoneWhat Is a Human?What Is Good and WhyWhat Is Good and WhyWhat Is the Good Life?What Price Better Health?What Should I Do?What We Owe to Each OtherWhat Would Aristotle Do?What's Good on TVWhat's Normal?What's Wrong with Children's RightsWhat's Wrong with Homosexuality?What's Wrong With Morality?When Is Discrimination Wrong?Who Holds the Moral High Ground?Who Owns YouWho Qualifies for Rights?Whose America?Whose View of Life?Why Animals MatterWhy Animals MatterWhy I Burned My Book and Other Essays on DisabilityWhy Not Kill Them All?Why Punish? How Much?Why Some Things Should Not Be for SaleWisdom, Intuition and EthicsWithout ConscienceWomen and Borderline Personality DisorderWomen and MadnessWondergenesWould You Kill the Fat Man?Wrestling with Behavioral GeneticsWriting About PatientsYou Must Be DreamingYour Genetic DestinyYour Inner FishYouth Offending and Youth Justice Yuck!
This formidable two volume work comprises ten sections of ninety-four articles. And these two volumes have as their "sister volume, the Oxford Handbook of Philosophy and Psychiatry." (Eds. K. W. M. Fulford, M. Davies, R. G. Gipps, G. Graham, G. Stranghellini and T. Thorton, Oxford University Press 2015 (Hereafter PP), which has eight sections in one volume comprising seventy three articles and 1291 pages. These works are part of the Oxford series dealing with "International Perspectives in Philosophy and Psychiatry" in an inter-disciplinary manner. To assist the reader the PP has an introduction to each of its eight sections, while the former two volumes of PE has a very welcome detailed table of contents regarding each of the ninety-four articles. PP is characterized as "we hope a cross-section of the new field" and is "primarily philosophical in focus," while PE extends this self-reflection. Other relevant works in the field include The Oxord Textbook of Philosophy and Psychiatry. Eds. B. Fulford, T. Thorton, and G. Graham. Oxford: Oxford University Press, 2006, and The Philosophy of Psychiatry. Ed. J. Radden. Oxford: Oxford University Press, 2004
Our present two volumes are as "proactive" as the Oxford TextBook was said to be. They are meant to provoke new lines of thought. Unlike the Oxford Textbook" our volumes are not case studies, but anchored, broadly speaking, in clinical encounters.
This new philosophy of psychiatry, which psychiatry presupposes does not put grand theories, but rather deals in as Okasha states in the TextBook: "the best that we can hope for...is many small explanations from a variety of explanatory perspectives, each addressing part of the complex processes underlying "normality or disorder."
As a new mode of research in PP experts work in scholarly exploration of diverse areas of psychiatry. As a result these volumes are not composed of summaries or introductions to different areas. Instead they present a more concrete individualistic approach in response to live issues thrown up by real cases psychiatrists have to deal with.
One must note that the notion of "Handbook" employed is a new form of presentation for philosophy and psychiatry. Oxford has furnished us with something more than an anthology, and less than a multi-volume Encyclopaedia. Just as the field of psychiatry this series on philosophy and psychiatry is a challenging work in progress. The most likely audience of readers for the volumes for PE are psychiatrists, philosophers, and those in the therapeutic field. One might best employ The Oxford Handbook of Psychiatric Ethics as a work to be perused or read for certain areas of interest.
How should these volumes be read? Let me suggest reading the volumes dipping in and out roughly in the following sequence of sections. Each reader will, no doubt, find her own way. I will not unfairly pick out too many individual articles because that would do an injustice to those not mentioned.
To set the context read Section I "The Introduction" first. The first article by the editors "Why an Oxford Handbook of Psychiatric Ethics" justifies the rationale for the two volumes. The values-based approach is argued for immediately in article four. Follow with Section IV "Philosophy and Psychiatric Ethics" which encompasses some of the main ethics theories: principalism, utilitarianism, values, autonomy, and virtue ethics among others. Given the orientation of the volumes these theories are profiled against Sadler's "Value-based Psychiatric Ethics." After this Section 2 "People Come First" can be used to remind us of those who sought and found or did not find resolution in therapy. For an understanding of the patient's point of view we possess an article by O. Flanagan that is very informative (PP. pp. 865-888, ,and many good books by patients: K. Jamieson on bipolar disorder An Unquiet Mind; E. Saks on schizophrenia The Centre Cannot Hold; A. Solomon on depression The Noonday Demon; S. Stoessel on anxiety
My Age of Anxiety; and C. Knapp Drinking: A Love Story. )
Then more specifically delve into Section IX "Ethics and Values in Psychiatric Assessment and Diagnosis." All articles in this section are indispensable. New diagnoses in psychiatry have crucially significant real world effects in creating new classifications and categorizations of human beings which ironically may only last as long as the life-time of the European International Classification of Mental and Behavioral Disorders (ICD) or American Diagnostic and Statistical Manual (DSM) publications. The diagnosis is crucial because it is entrance into the intimate psychiatrist-patient relationship. The clinical and deeply human encounter begins here. For this reason diagnosis is not a neutral one-off. It is on-going and open to revision with contributions by both psychiatrist and patient.
For the psychiatrist thinking about her area ethically is to enter a relationship with a patient. The process of diagnosis opens up this relationship, which is non-linear, asymmetrical, and dynamic. If evidence-based, then the evidence is not merely scientific (ratified by random clinical trials, or committees of psychiatrists (Cf DSM) but also phenomenological. And so empathy and sympathy are deeply involved in the exploration in the psychiatric setting. The difficult question of the difference between normal and abnormal, of functional and dysfunctional has individual, familial, community, societal, and cultural dimensions. Diagnosis is in many ways a "whale" category. Who is Moby Dick and who is Ahab and who is Ishmael? Who is the voice of psychiatry and philosophy? Who?
The next section X "Ethics and Values in Psychiatric Treatment." I suggest this contains the pertinent ethical themes for the moment. The intention is to heal or cure as much as possible, secondarily to understand or explain. Issues regarding professional boundaries and pharmacology are just some of the many themes touched on here.
Next read Section VI "The Social Context of Psychiatric Ethics." I propose that this section should include the schizophrenic-like division in modern psychiatry itself. (Cf Of Two Minds: The Growing Disorder in American Psychiatry by T.M. Luhrmann; less controversially Cf E. Shorter A History of Psychiatry). Psychiatry has mutated from the psychoanalytic to the current biomedical model which finds its aspirational expression in ICD and DSM, and in the notion that psychiatry should be like the science of internal medicine. Importantly some reflection upon the cultural context and the education of psychiatrists should be included. And one has to acknowledge that 80% of psychiatric diagnoses and treatment are carried out by primary care physicians.
Following on this, section VII "Ethics in Psychiatric Citizenship and the Law," the articles on involuntary seclusion and forensic psychiatry disclose the fine line psychiatry must walk. An insightful wide-ranging discussion is conducted in section VIII on the "Ethics of Psychiatric Research" embracing the staple of consent, but also animal research. Penultimately, I would place section III "Specific Populations" at the end because of the particularity of the evidential groups. Nonetheless we should note that those in penal institutions–Los Angeles Holding Centre and New York's Ryckers Island–contain the largest concentrations of the mentally ill in the America. And finally we should acknowledge the the psychiatrist who herself/himself, requires psychiatric help. Their status as Nouwen's "wounded healers" opens a bridge into deeper therapeutic relationships.
Section V on the "Religious Contexts of Psychiatric Ethics" may be premature. The section on religion needs to tackle the notion of psychiatry as a secular religion before exploring this global area. Section V is broadly sketched. What needs to be addressed head on is the replacement of religion with psychiatrists in curing/healing/making holy the human condition.. Is psychiatry subject to the criticism that it a secular religion, with a messianic, albeit minor, complex of its own? Is psychiatry a new religion, and a bourgeois one at that?
The Evidence-based approach permeates all the sections of these two volumes. But the model is more diversified by the varying content, context, and cultures by implication. All articles deal with evidence. The meaning of evidence is equivocal. Talk-evidence in a psychiatric setting is not addressed. One should note that such evidence is by report, or expression, or both.
More substantively two themes guide the approach in PE , and by implication the Oxford project in its International Perspectives in Philosophy and Psychiatry. PE is rooted in the Anglo-American analytic approach or Oxford school of philosophy ordinary theory of J.L. Austen. The practitioners deploy a pragmatic Wittgenstein-like toolkit to access meaning in the extremes of human behaviour. Precision and exactitude is not necessarily desirable here for human beings are rather messy and untidy in their lives, given to incoherences that somehow cohere to get most us through if not felicitously, then at least enough.
Despite some adversions to hermeneutical phenomenology, PE follows Hume in a deep sense. Given the diversity of content, the subject-matter is "evidence-based," or about, I suggest, the facts. Given all the viewpoints expressed the method for PE as an ethical reflective work is value-based. PE is not only evidence-based and value-based, but it is centrally these as its controlling principles: facts and values.
I suggest that the evidence-base is formulated utilizing as its lineage the Kraepelinian biophysical model. Psychiatry is a science. ICD and DSM seem to be lurking in the background here. The role of subjective or phenomenological evidence in its diversity including embodied consciousness is not explicitly dealt with. Since the facts do not speak for themselves we cannot simply "listen to the evidence" as is implied. There is no controlling ethical description telling us what to do to be gleaned from the evidence.
The objective or subjective facts of being human are opaque, ambiguous, contingent, and mysterious. Human beings need to be empathized with to be interpreted, and empathetically understood sympathetically. But there are always remain some who are inaccessible. So an evidence-based approach could, inadvertently) be guilty of an unintended overreach (especially if randomized controlled trials and committee define what mental illness, mental disorder etc... are.) All these evidence-based hypotheses of psychiatry might not a thesis make.
PE does not adjudicate whether psychiatry is medical in the strong sense of hard science? Regarding randomized clinical trials (Rcts) a power curve distribution would show most people are not happy yet most likely content. In ethics for Aristotle the average person is morally/ethically weak. This fits in with a power curve distribution. Rcts are based in part on the bell/Gaussian curve and standard deviation. This ignores fat-tails and outliers. It smooths discontinuities which human life seems to be about. But the patient group for psychiatry seem to be outliers from the mean and the median. Their's is not the standard deviation. On the contrary it is non-linear and non-standard.
The value component in PE said to be value-based indicates the value of health. But what is health? Tellingly, Aristotle uses health as a pros en equivocal in Aristotle to explain the good, or good functioning. Well-being is both non-moral and moral/ethical. This is not captured in the notion of value-based.
In consequence, what mental disease or disorder or illness is a fuzzy concept. Is it a discrete entity or part of a continuum? We have a "science" of psychiatry dealing with symptoms/effects but we have no defined causes for the effects. Psychiatry is more like pattern recognition when it comes to categorizing someone with a mental disorder.
Or what type of sign is mental disorder? There is an important place for semiotics in evidence-based psychiatry. What does it express, and is the expressive relationship best understood causally? PE presupposes philosophy, but not in foundational or coherentist terms, but rather in analytic and pragmatic terms.
One area of science left out despite two articles on it in PE is cognitive and especially affective neuroscience, psychiatry, and ethics. Neuroscience is addressed in an Oxford handbook devoted solely to neuroscience. (Cf The Oxford Handbook of Neuroscience. Ed. J. Bickle. Oxford: Oxford University Press, 2013. 618 pages). PP noted that "The philosophy of psychiatry...for all its recent burgeoning, remains a minnow to the neuroscience whale." (p.8)
In addition greater attention needs to be paid to women as psychiatrists and patients, and to those who are mentally ill but incarcerated in penal institutions. Not doing so diverts psychiatry as it is practiced in north America and the UK into a kind of methodological individualism. The patient has to encouraged to express and "own" her mental disorder, not merely report on it. Here the methodological individualism of psychiatry discloses itself. Is the we of the therapeutic context simply the doctor and the patient, or is the family, or a group, or the community included as well? This seems to be culturally variable.
We possess evidence of clinically important impairment. Human beings suffer real distress—emotionally and mentally. This is expressed symptomatically. But the suffering person lives in this distress. The standard in psychiatry must be the mysterious person as patient and as a subject. Is the patient the patient (passive?) or the person, individual, self, subject, or human being (active)? Who is she? It is her whoness that appears to be problematic. The individuation of the patient goes against the grain of too strong a statistical or stochastic evidence-based approach.
As a patient I recognize that no one is fully autonomous. I/We require a good (in)depency to function well. Yes psychiatry presupposes philosophical reflection–simply to recognize the limits of psychiatry. There is no treatment for being human. But there are treatments for some aspects of the human condition. Psychiatry at the points of human suffering and extremes darkly illuminates who we are. The struggle continues.
In all though, these two volumes are a welcome addition to the Oxford series in Philosophy and Psychiatry. You will find great breadth and depth here, and as the editors, know this is an on-going project in our aspiration to explore the human condition in all its forms.
© 2016 James Kow
James Kow, King's University College, London, Ontario, Canada