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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 Mirror Is for ReflectionA Mirror Is for ReflectionA 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 MarriageAgainst Moral 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Challenged ProfessionsEthicsEthicsEthicsEthics and AnimalsEthics and ScienceEthics and the A PrioriEthics and the Discovery of the UnconsciousEthics and the Metaphysics of MedicineEthics at the CinemaEthics at the End of LifeEthics Case Book of the American Psychoanalytic AssociationEthics Done RightEthics ExpertiseEthics for EveryoneEthics for PsychologistsEthics for the New MillenniumEthics in CyberspaceEthics in Everyday PlacesEthics 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 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AmericaOxford Handbook of Psychiatric EthicsOxford Studies in Normative EthicsOxford Studies in Normative Ethics, Volume 7Oxford 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 RightsPharmaceutical FreedomPharmacracyPharmageddonPhilosophy 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 Ethics and ResponsibilityReflections On How We LiveReframing Disease 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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 VicesVoracious Science and Vulnerable AnimalsVulnerability, Autonomy, and Applied EthicsWar Against the WeakWar, Torture and TerrorismWarrior's DishonourWeaknessWelfare and Rational CareWhat are you staring at?What 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 Does Inequality Matter?Why Honor MattersWhy 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!
In Values and Psychiatric
Diagnosis John Sadler analyses the "values structure" of the Diagnostic
and Statistical Manual of Mental Disorders (D.S.M.), the classification of
mental disorders published by the American Psychiatric Association and now used
worldwide. Sadler examines the explicit and implicit values that have shaped
the D.S.M. classification, and considers how an adoption of different values
might improve future editions. Chapters consider how the D.S.M. has been shaped
by particular assumptions regarding sex, culture, the medical profession,
politics, science and basic metaphysics.
Sadler's project is ambitious, and Values
and Psychiatric Diagnosis is correspondingly long. Though his prose is as
simple and elegant as academic writing can be, getting through the 550 pages is
hard work. The book is written for mental health professionals with a serious
interest in classification rather than for the casual reader.
For those who can get through it, Sadler's
book repays study. Most of the issues discussed by Sadler will be familiar to
those who have followed the D.S.M. debates, but his book manages to bring
together these issues within a unifying framework for the first time. Sadler
develops an account of the different roles values can play in shaping science
and sees all the debates about the D.S.M. in these terms. His notion of "values"
is broad. Many think of ethics, aesthetics, and political philosophy when they
talk of values, but Sadler is also happy to see value commitments in
metaphysical positions. To me talking of "individualism" or "essentialism"
as a value commitment sounds odd. These positions make claims about the nature
of reality, not about what is good or bad. As such, I'd find it more natural to
talk of "assumptions behind the D.S.M." rather than so broadly of "values
commitments". This, however, is merely a terminological quibble, and doesn't
affect the substance of Sadler's claims.
Many of the issues discussed by
Sadler have been discussed elsewhere. Familiar topics include a discussion of
gender-roles, whether the categories can be applied cross-culturally, whether
relational diagnoses should be included in the D.S.M., and the criticisms of
those who adopt a hermeneutic approach to mental disorder. However much
previous discussion has been heated and shrill. A major strength of Sadler's
work is that he manages to discuss the views of those who produced the D.S.M. and
the views of their most ardent opponents with equal generosity and
good-sense. The resulting balance ensures that if one is going to read one book
on the D.S.M., this is the book to read.
Sadler makes many sensible claims
in the course of his book. I think the most novel and interesting are in
chapters nine and ten, on technology and politics respectively. In Chapter
Nine, Sadler uses work on the philosophy of technology to make sense of the
ways in which technologies tempt us to forget our ultimate ends and get wrapped
up in means instead. Rather than making use of technologies we all too easily
become slaves to them. Sadler suggests that those who make and use the D.S.M.
can fall into this error. Instead of remembering that their aim is to help
patients and seeing the D.S.M as a guide, clinicians can end up thinking of
hard-to-diagnose patients as problems who cannot be made to fit within
the D.S.M. framework. The wish to use the technology efficiently comes to
obscure the end goals of medical care.
In Chapter Ten, Sadler suggests
that the processes by which the D.S.M. was produced were implicitly modelled on
decision processes employed in democratic governance. In seeking to have
representatives of different interested groups on working groups, and in its
policies of openness and accountability, the D.S.M. sought to mimic the good
practices of good government. Similarly, the different committees of the A.P.A.
involved in producing the D.S.M. acted to check and balance the decisions of
one another, in the same kind of way as does the fragmentation of the roles of
government between different institutions. Sadler goes on to discuss the
necessary problems of democracy, and how these feed in to creates tensions in
the decision procedures of the D.S.M. revision process.
In the final chapter, Sadler
considers positive recommendations for the next DSM. These are modest and
sensible. For example, Sadler suggests the current D.S.M. has erred in trying
to satisfy too many groups -- presently it is intended to be used by clinicians,
researchers, and administrators, and is also readily available to lay people.
He suggests that the different needs of these groups can not be met by one
classification system, and that specialist systems might be developed for each.
In addition, Sadler recommends that patient groups should have a greater input
into the next D.S.M., and that a more explicit awareness of the values that
shape the D.S.M. would be beneficial.
Overall, Values and Psychiatric
Diagnosis is a valuable addition to the growing literature on the
philosophy of psychiatry. It will become a key text for mental health
professionals with an interest in classification.
Cooper, Ph.D., Lecturer in Philosophy, Institute for Environment, Philosophy
and Public Policy, Furness College, Lancaster
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