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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 Critical Overview of Biological FunctionsA Critique of Naturalistic Philosophies of MindA Cursing Brain?A Delicate BalanceA Farewell to AlmsA Fragile LifeA 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 Tapestry of ValuesA Tear is an Intellectual ThingA Theory of FreedomA Thousand MachinesA Universe of ConsciousnessA Very Bad WizardA Very Bad Wizard: Morality Behind the CurtainA 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 ActionAt the Existentialist CaféAtonement 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 PhilosophyBe Like the FoxBeautyBecoming a SubjectBecoming HumanBefore ConsciousnessBehavingBehavioral 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 MelancholyBeyond Moral JudgmentBeyond PostmodernismBeyond ReductionBeyond SchizophreniaBeyond 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 CouchBritish Idealism and the Concept of the SelfBrute 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 PhilosophyCurrent Controversies in Values and ScienceCustom 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, Love, and IdentityDesire, Practical Reason, and the GoodDeveloping the VirtuesDiagnosing 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 LifeEmotions, Value, and AgencyEmpathyEmpathy 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 JudgmentExtraordinary Science and PsychiatryFaces 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 WillFrank Ramsey (1903-1930)Free 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 PsychotherapyFrom Valuing to ValueFrontiers 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 Natural PhilosophyIn Praise of the WhipIn Pursuit of HappinessIn Search of HappinessIn the Name of GodIn the Name of IdentityIn the Space of ReasonsIn the SwarmIn Two MindsInclusive EthicsIncompatibilism'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 DespairKierkegaard's MuseKinds 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 MindMeanings of ArtMeasuring 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 BrainsMoral 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 BetrayalOn 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 DisorderPanpsychismPanpsychism 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 GrrrlsPlant MindsPlatoPlatoPlato, 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 HegemonyPsychiatric 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 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Philosophy and PsychiatryReview - Philosophy and Psychiatry
Problems, Intersections and New Perspectives
by Daniel D. Moseley and Gary Gala (Editors)
Routledge, 2015
Review by Anya Daly
Sep 6th 2016 (Volume 20, Issue 36)

Philosophy, psychiatry and avoiding ‘real mischief’

 

"What is Dr. Monro? A mad-doctor; and pray what great matter is that? What can mad-doctors do? Prescribe purging, physic, letting of blood, a vomit, cold bath, and a regular diet?  How many incurables are there?... physicians …. are often poor helps; and if they mistake the distemper, which is not seldom the case, they do real mischief."

Alexander Crudden, The Adventures of Alexander the Corrector,

London 1754 [Quoted by Andrew Scull at the beginning of his chapter "The mad-doctor and his craft", in The Insanity of Place/ The Place of Insanity, London, New York: Routledge 2006]

What can philosophy offer psychiatry?  What can psychiatry offer philosophy? Simply, there is nothing as harmful as a bad theory put into practice and conversely the constraints of practice and the recalcitrance of the realities of anomalous experiences offer instructive challenges to theory.  We know well that the history of medicine and psychiatry have many examples of bad theory having been put into practice often with tragic consequences. Equally the extremes of armchair philosophy and far-fetched thought experiments, while keeping some philosophers busy chasing zombies or possible worlds in which minds can be uploaded into a computer hard-drives, leave philosophy open to accusations of irrelevance and obfuscation.

Andrew Scull, and he is not the first, calls our attention to the political, economic and social dimensions of insanity, he writes: "For the lunatic, the madman, the psychotic, the schizophrenic, call them what you will, suffer a sort of social and moral death.  Their wishes and will, their very status as moral actors, as agents capable of expressing valid preferences, and exercising autonomous choice are deeply suspect in light of their presumed pathology, as the often dark history of their treatment under confinement abundantly shows." (Scull, The Insanity of Place – The Place of Insanity, 2006: 52). The stakes are thus immeasurably high and our efforts to avoid 'real mischief' demand critical appraisals of both philosophy and psychiatry, critical appraisals internal to each discipline and between these disciplines.

The collection of original essays in Philosophy and Psychiatry: Problems, intersections, and new perspectives, edited by Daniel D. Moseley and Gary J. Gala brings together diverse philosophers and psychiatrists in this effort of mutual critical engagement spanning the domains of phenomenology[αα], psychoanalysis, neuroscience, neuroethics, behavioral economics, evolutionary psychiatry, biopsychosocial models and virtue theory. In Part 1, Psychiatric Diagnosis and Agency and Part 2, Ethical Dimensions of Psychiatric Treatment, philosophers reply to the essays of psychiatrists and vice versa, addressing key issues in psychiatric practice and also the wider ethical implications of confinement and treatment. Part 3, Philosophy Out of Psychiatry, takes the discussion in a socio-cultural direction. The collection of essays brought together here goes to the heart of the many heated and often fraught debates within psychiatry about the autonomy of the psychiatric patient, the status of the mental disorder, the ethics of committing a person to psychiatric care, and of imposed medication and treatment. These issues all gear into the objectivism versus constructivism debate questioning whether psychiatric diagnosis is some absolute declaration of reliable authority on the part of psychiatric specialists on the state and status of an individual presenting with anomalous experience or whether this is an overt or covert mechanism of reinforcing social norms.  Both the expertise of the psychiatrists and the benignity of the system within which they work and from which they draw authority, are called into question by constructivists.  The question of moral responsibility of the patient also renders these investigations urgent as psychiatrists and those working in cognate disciplines are called on for expert testimony in courtrooms across the globe.

What is particularly heartening and interesting about this volume is that each of the contributors offers their analyses and critiques for the most part from outside of the domain of their interlocutor as they seek to address the theoretical and practical intersections galvanized by those with non-normal experiences of themselves, others and the world.  They thus approach the task set by the editors with a freshness and openness increasingly less often encountered in academia wherein 'expertise' is not only reified but has also become yet another fetish of exchange in a so-called knowledge economy reliant on 'market forces'.  As the editors explicitly state, their aim is to invigorate the conversations across the disciplines of philosophy and psychiatry so as to make a positive contribution to the advancement of research, care and service.  This volume in no way represents a comprehensive nor final statement on the issues under investigation and this is in fact a key feature of its modus operandi – final statements are impossible and if claimed become immediately suspect.  The domain perhaps more than any other academic domain is characterized by inherent contingencies, evolution and fruitful intersections.  Psychiatrists who ignore philosophy as much as philosophers of mind who ignore psychiatry do so to the detriment of their discipline and to their duty of care to patients, to students and to the wider society.

In the Introduction, the editors define the differentiation between the disciplines of psychiatry and philosophy in terms of their methodologies and subject matters. They propose psychiatry "include[s] the statistical and scientific tools of psychology, medicine, epidemiology, neuroscience and genetics. [Whereas] the methods of philosophy include the tools of conceptual, linguistic and logical analysis and the theories and interpretive techniques that have developed in the various traditions of philosophy" (p.2). This differentiation is in my view my first point of critique.  Firstly, the neat distinctions they seek to draw here do not in fact hold up to scrutiny.  These days there is much cross-fertilization between domains and furthermore this differentiation seems at odds with both the very project they are engaged in with this book and also with some of the claims of contributors. Secondly, crucial elements are missing in setting out the methods and subject matters. In the description of psychiatry the significant contributions of phenomenology have been overlooked and correlatively the research in perception, embodiment, empathy and intentionality in philosophy.  These last are key conceptions in the phenomenological tradition of Husserl, Stein, Scheler, Jaspers, Schneider and Merleau-Ponty, all of whom engaged with either aspects of philosophy of mind and/ or neurology and psychopathology and none of whom appear in the index. There is also a conspicuous absence of any of the current philosophers and psychiatrists working in the domain of phenomenological psychiatry.  Thomas Fuchs, Shaun Gallagher, Dan Zahavi, Josef Parnas, Lisa Bortolotti, Matthew Broome, Chris Frith, Matthew Ratcliffe, to name a few that immediately come to mind.

Nicholas Kontos, Assistant Professor of Psychiatry at Harvard Medical School launches the exchanges with his thought-provoking article "Can what's in your head be 'all in your head'?: Possibilities and problems of psychological symptom amplification (PSA)". He notes that the central problem of psychiatric diagnosis is that it suffers from inherent contingencies and uncertainties.  This is due in large part to the inevitable reliance on the testimonies of both patient and family as well as due to the lack of reliable biomarkers apart from those that indicate the more definitive states of catatonia and other motor disturbances. Symptoms and signs comprise the core of any medical diagnosis and the signs are now bolstered with the information afforded via the various technologies of blood tests, scans and genetic screening etcetera. These latter provide the more 'objective' measures and the former, while crucial, are always subject to revision and doubt.

Kontos describes the especially fraught challenge the psychiatrist faces in establishing a diagnosis with any confidence.  Despite the fact that our strongly-held assumption that symptoms, the interior experience, of the patient should figure prominently in diagnosis, much of what is reported defies the classifications offered by manuals such as the DSM.  Kontos presents us with some concerning statistics that reveal that the on-the-ground practice of psychiatrists is less symptom dependent than supposed and, furthermore, that the process of psychiatric diagnosis suffers from a circularity which renders unexplained symptoms impossibilities (p.8). Kantos' essay invites us to consider the controversial question as to whether the idea of a medically unexplainable symptom can be usefully transposed into the domain of psychiatry.  He writes: "this means asking if there exists a psychological analogue of somatizing" (p.8) and this would be "psychological symptom amplification".  Importantly, Kantos acknowledges that not only does this issue concern the reliability of diagnosis and the patient-doctor relationship, but is also underpinned by more metaphysical concerns of identity and dualism. 

Kontos' begins his analyses by explaining the medical concept of Somatic Symptom Amplification and highlights the contested nature of the terms used to describe this. The terms 'medically', 'unexplained' and 'symptoms' are all open to interpretation and this again brings to the fore the question of underpinning metaphysical assumptions. He then goes on to discuss how the notion of somatization has evolved drawing on key developments in psychiatric history up until its official recognition with DSM-III and beyond to the now predominant integrative model.  Kontos offers an insightful discussion of the psycho-social, politico-cultural dimensions in the endeavor of gaining 'sick-role status', drawing out the covert and complex motivations on both sides of the equation, whether as diagnosing psychiatrist or as diagnosed patient. Kontos empathically asks – "who among us could not at one time or another use a little absolution, release and nurturing?" (p.12).

Returning to the issue of underlying metaphysical assumptions, Kontos proposes that "there are few card-carrying dualists on the record in psychiatry" (p.15). Nonetheless, despite this claim, dualist thinking still continues to inform much of the conceptual analyses of psychiatry in general which tends to draw on the conceptual frameworks of the mainstream analytic philosophical tradition rather than with the more complementary tradition of phenomenology.  Puzzling? Paradoxical? Or just politics?

Kontos' concluding remarks bring us back to the conundrum that faces psychiatrists – do they assert an absolute authority to make the call on whether the symptoms of the patient are veridical or not, or do they give the 'benefit of the doubt' to all the patients' claims? Ultimately, neither approach is satisfactory.

Philosopher, Justin Garson, provides the response to the essay by Kontos and declares he has nothing in the way of criticism but that he would offer a complementary essay that provides more of the historical context for the debates addressed. Garson is particularly concerned with the issues around what he calls "the hiddenness of psychological symptom amplification", which he rightly argues has deep historical and institutional origins (p.29). Garson notes that the ascendency of the view that symptoms were indications of inner dysfunction as opposed to the preceding view which regarded them as means for coping with untenable external situations, has effectively elided PSA from psychiatric consideration. Trainee psychiatrists are not trained to ask whether the patient might be faking it or exaggerating their symptoms or erroneously identifying non-existent symptoms.  Their role is in the alleviation of suffering and confusion, and if they have medical means at their disposal to make the patient feel better, they will understandably pursue this path.  The medicalization of everyday problems is yet another cause of the hiddenness of PSA according to Garson.  Quoting Thomas Szasz, he writes that medicalization occurs when 'problems of living' transmogrify into 'medical problems' (p.30).  While this has had positive benefits for the destigmatization of mental illness, it has also led to an explosion of people seeking 'sick role status' for the benefits this affords.  Garson then goes on to track the historical and institutional factors that have contributed to the hiddenness of PSA in American psychiatry.

The second pairing of thinkers, Marc Lange - Theda Perdue Distinguished Professor of Philosophy at the University of North Carolina at Chapel Hill and Abraham M. Nussbaum – Assistant Professor in Psychiatry at the University of Colorado Medical School, tackle the specificities of mental illnesses, 'How are mental illnesses different?' – (1) from one another, (2) as opposed to mental health, (3) in distinction from unhealthy mental states that are not in themselves illnesses, and also (4) in differentiation from somatic illnesses.

As Lange notes with regard to the first difference, mental illness is regarded as a medical natural kind when what is discovered persists across all instances independent of context and discoverer, thus avoiding the critiques of constructivists (p.37). Such facts can then be used to determine whether one patient shares the same illness as another, and by extension if this is so, then the treatment of one will be just as effective for the other. Lange proposes that the second distinction between mental health and mental illness could be teased out according to whether, as he puts it, "unwellness [is understood as] a departure from statistically normal functioning, or [a] reduction of evolutionary fitness, or [an] interference with human flourishing, or [a] deviation from prevailing cultural ideals" (p. 37). He chooses not to pursue these lines of investigation because he wishes to focus specifically on etiologies as set out with the first differentiation. With regard to the third differentiation, between mental diseases and pathological mental conditions that are not in themselves diseases, Lange suggests this will only become clear once the first issue is addressed.  Finally, the fourth differentiation gears into all the previous issues.  Lange writes: "I will examine whether mental and somatic illnesses differ in the grounds of their individuation, their status as medical natural kinds, and their distinction from pathological conditions that are not diseases" (p.37).

Throughout his analyses, Lange makes pertinent comparisons between disease as understood in general medical contexts and those in psychiatric contexts so as to more effectively draw out the specificities of psychopathology and these comparisons hinge on whether the disease in question can be considered a natural kind.  Importantly, Lange stresses that manuals such as the DSM serve to provide diagnostic criteria and do not provide definitions as such.  In this way the heterogeneity of mental disease can be accommodated without reductivism. In his concluding remarks, Lange suggests that the very notion of disease will play a lesser role in both medical and psychiatric diagnosis as molecular medicine gains increased currency.

Nussbaum, as a practicing physician, brings Lange's philosophical interrogations into the clinic to test where they meet or fall short of the practical requirements of diagnosis and treatment.  Can the specificities of general medical disease be translated effectively into the psychiatric domain?  Nussbaum affirms Lange's claim that it is in virtue of being incapacitating that general medical diseases overlap with those of mental diseases, but he challenges Lange on the claim that not all incapacities are diseases (p.54).  Nussbaum takes Lange to task on his discussion about mental disease and agency because this then gives mental disease the same status as mere somatic disease and in so doing fails to adequately acknowledge the pervasive stigma that attaches to mental disease.  Nussbaum rightly highlights the stigmatization that almost inevitably accompanies the diagnosis of mental disease in contrast with the diagnosis of medical disease which may alleviate the distress of the patient, giving them some surety.  Drawing on the work of Lisa Bortolotti, Nussbaum situates mental disease understood as irrationality in the social wherein norms of rationality have erroneously tended to dictate the terms of debate.  Nussbaum, in agreement with Bortolotti, suggests that irrationality is "neither a necessary or sufficient definition" (p.55) of what it means to have a mental disease; much that is irrational does not qualify as disease.  Rather they suggest neuroscience may be better equipped to offer definitive answers to the questions of the underlying conditions of mental disease. Nussbaum returns at the end of his essay to the issue of agency and acknowledges that this notion requires  a more nuanced understanding in that agency is not an all-or-nothing capacity.

The third exchange between Assistant Professor of Psychiatry, Warren Kinghorn and Professor of Philosophy, Christian Perring returns us to the vexed domain of diagnosis and the justifications of the highly controversial DSM-5 as a diagnostic tool.  Kinghorn recounts the restrained reception of the book by clinicians who nonetheless have noted that "the DSM is too categorical in its diagnoses (as opposed to dimensional and narrative), too formal and cookbookish, too quick to pathologize, too fixed on static and stigmatizing labels, too focused on experience and behavior rather than quantifiable biomarkers where these exist, and too broad-brush in its categories – to name only a few complaints" (p.60).  At the far extreme of the criticism is Gary Greenberg's - The book of woe: the DSM and the unmaking of psychiatry, New York: Blue Rider Press (2013) - which chronicles the evolution and devolution of psychiatry's principle reference and diagnostic tool.  This is an informative but ultimately damning account of the latest version - the DSM-5 – and in addition to all the criticisms listed above, Greenberg exposes what he regards as the dubious ethics underpinning this particular iteration which effectively underwrites the commodification of suffering.  Kinghorn's essay thus serves as a corrective to Greenberg's extreme account.  Notwithstanding the legitimacy of some of the criticisms, Kinghorn asserts that the DSM is still an "important clinical and moral document" (p.61) despite the fact that it cannot claim objective and timeless status.  As he writes: "It is not apolitical or timeless.  It is not value-free or culturally neutral.  It is not a document that 'cuts nature at the joints' in an objective apolitical way, and therefore stands as a pinnacle of psychiatric progress.  It is none of these things – which is to say that many, if not most, of the most common critiques of the DSM, are valid" (p.61). 

Kinghorn aligns his inquiries with those of the philosopher Alisdair MacIntyre, who rejects both the grand ethical accounts of the 19th century and the deconstructivist genealogies of Nietzsche and Foucault in seeking a situated, progressive ethical theory.  Kinghorn proposes this approach honors the strengths of the DSM while not ignoring its deficiencies.  Kinghorn begins by tracking the major evolutions of the DSM and its more infamous 'outings' and ommisions.  He highlights the fact the one of the outstanding virtues of the DSM has been in the facilitation of communication between clinicians and patients, between different clinicians, between clinicians and the various health care systems, between clinicians and the pharmaceutical industry.  This standardization of diagnostic language has informed the delivery of care, education and training, and research. And to be clear, this standardization has been the source of much controversy also. Politics at the levels of institutions and individuals have all come under scrutiny, thus muddying the waters of clear and dispassionate debate.  Kinghorn questions why it is that these issues and documents arouse such outrage and indignation. He proposes that they go to the heart of very deep ethical issues and that thus the DSM must be analysed as much as a moral document, situated in time and place, as a document to facilitate diagnosis and interchange.

Perring while acknowledging the appeal and plausibility of Kinghorn's defence of the DSM-5, proposes that the serious failings of DSM-5 have nonetheless not been exonerated.  Perring challenges Kinghorn's account on a number of fronts. Just as the Bible is known to be one of the most bastardized documents in history, so too the 'the bible of psychiatry', the DSM, is a highly political document.  Nonetheless, those who refer to it do not generally accept it letter and verse; it is always open to interpretation.  While acknowledging the DSM facilitates teaching, research and treatment, Perring is understandably suspicious of those who seek to downplay or co-opt the socio-political dimensions of psychiatry. As I mentioned in the beginning of this review – the stakes are immeasurably high and 'avoiding real mischief' should always be at the forefront of consideration in addressing the sufferings of those who seek and need psychiatric care.  Perring offers a through-going analysis of the terms and claims which Kinghorn aims to defend, revealing ambiguities and dismantling arguments.

Underpinning Perring's criticisms is his rejection of Kinghorn's adoption of MacIntyre's tradition approach; that is, the understanding of the DSM as a contingent tradition subject to historical and political forces without any absolutist claims to objectivity.  While Kinghorn upholds these are reasons to defend the DSM, Perring takes the opposite view that they are cause for alarm and we must apply stringent standards of critical appraisals to each and every classification.  Perring closes his essay on a conciliatory note, but again asserts the need for criticism and skepticism to be brought to the fore in our use of the DSM.  He writes: "We can admire and respect the sincerity and good will of so many who work in psychiatric and mental health professions who use the DSM and do the research that supports research around it, and we may even hold a grudging respect for the tenacity of the DSM itself.  However, we should maintain a critical and skeptical stance towards it, given its historical context" (p.87).

The above three pairings of essays are the opening exchanges in this collection which subsequently branches out into debates regarding ethics, free-will and responsibility, the justification of confinement and coercion in psychiatric treatment, the notions of self, autonomy and agency, and how all of these debates come to be represented in the media and film. One of the many virtues of this collection is the diversity of voices and the challenge to dominant assumptions across the domains of psychiatry and the philosophy of psychiatry.

The problem of dualism underpins a number of the issues in this volume and so it is surprising and disappointing that the contributors have not availed themselves of the rich and incisive critiques of dualism and mind/ body monism (aka physicalism or identity theory) on the part of phenomenologists so as to inform their analyses.  Notably Merleau-Ponty is the stand-out phenomenologist who tackled this problem and established the first viable non-dualist ontology in Western philosophy. So too, for those who bemoan the limitations of the DSM, perhaps they could usefully investigate and employ the 'phenomenological interview' and 'Shaun Gallagher's 'Pattern theory of self' [ΒΒ] as alternative methods of anti-classification.

This collection of essays would make a valuable contribution to courses in philosophy of mind and psychiatry.  The writing across all the contributions is generally clear and accessible to the non-specialist.  These cross-disciplinary conversations will undoubtedly contribute positively to improved research, care, service and also help to guard against the dangers of 'real mischief'.

Roy Porter reinforces the earlier call for caution from Crudden, Scull and Perring - he writes:

"All societies judge some people mad: any strict clinical justification aside, it is part of the business of marking out the different, deviant and perhaps dangerous…. Stigmatizing – the creation of spoiled identity – involves projecting onto an individual or group judgements as to what is inferior, repugnant or disgraceful. It may thus translate disgust into the disgusting and fears into the fearful, first by singling out difference, next by calling it inferiority, and finally by blaming 'victims' for their otherness…. The construction of such 'them-and-us' oppositions reinforces our fragile sense of self-identity and self-worth through the pathologization of pariahs."  Roy Porter, Madness: A Brief History, 2002: 62 & 63

 

Notes.

αα According to G. Berrios, "Phenomenology, psychopathology and Jaspers: a conceptual history", History of Psychiatry 1991, 3: 303 -   the term phenomenology has four possible meanings:

1.    Phenomenology as referring to 'signs and symptoms'.  It is this interpretation to which contributors in this volume refer or just more generally the analytic philosophical use of this term.  This usage seems to reduce 'phenomenology' to merely a synonym for 'experience' without the historical or ontological significances attached to the term found in the tradition, past and present, of Phenomenology.

2.    The second – is merely a catalogue of the history of usages of the term.

3.    The third concerns Jasper's use of the term to refer to a description of mental states from an empathic and conceptually neutral standpoint.

4.    Phenomenology according to the father of phenomenology Edmund Husserl and those who took up this tradition of philosophical analysis.

 

ΒΒ Shaun Gallagher, 'A pattern Theory of Self', Frontiers in Human Neuroscience, 2013, Vol. 7  Article 443;J. Parnas & Dan Zahavi, 'The role of phenomenology in psychiatric classification and diagnosis' In Psychiatric Diagnosis and Classification, M.Maj, W. Graebel & J.J. Lopez-Ibor (eds), Chichester: John Wiley pp137-62; Ratcliffe, M. (2009) 'Understanding existential changes in Psychiatric Illness: The Indispensibility of Phenomenology', In Psychiatry as Cognitive Neuroscience: Philosophical Perspectives,  M.R. Broome & L.Bortolotti (eds), Oxford: Oxford University Press, pp.224-44.

 

© 2016 Anya Daly

 

Anya Daly, University of Melbourne.


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