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A Metaphysics of Psychopathology

Peter Zachar

Publication Year: 2014

In psychiatry, few question the legitimacy of asking whether a given psychiatric disorder is real; similarly, in psychology, scholars debate the reality of such theoretical entities as general intelligence, superegos, and personality traits. And yet in both disciplines, little thought is given to what is meant by the rather abstract philosophical concept of "real." Indeed, certain psychiatric disorders have passed from real to imaginary (as in the case of multiple personality disorder) and from imaginary to real (as in the case of post-traumatic stress disorder). In this book, Peter Zachar considers such terms as "real" and "reality" -- invoked in psychiatry but often obscure and remote from their instances -- as abstract philosophical concepts. He then examines the implications of his approach for psychiatric classification and psychopathology. Proposing what he calls a scientifically inspired pragmatism, Zachar considers such topics as the essentialist bias, diagnostic literalism, and the concepts of natural kind and social construct. Turning explicitly to psychiatric topics, he proposes a new model for the domain of psychiatric disorders, the <I>imperfect community</I> model, which avoids both relativism and essentialism. He uses this model to understand such recent controversies as the attempt to eliminate narcissistic personality disorder from the DSM-5. Returning to such concepts as real, true, and objective, Zachar argues that not only should we use these metaphysical concepts to think philosophically about other concepts, we should think philosophically about them.

Published by: The MIT Press

Title Page, Series Page, Copyright, Dedication

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Contents

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pp. vii-viii

Preface and Acknowledgments

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pp. ix-xii

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1. Introduction: Science Wars, Psychiatry, and the Problem of Realism

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pp. 1-22

When I was in graduate school the most dramatic psychiatric condition we studied was multiple personality disorder (MPD). I remember being fascinated while listening to a local psychiatrist report on his cases and also hearing about how some of my fellow graduate students encountered these patients at their training sites. Like others, I looked forward to encountering such cases myself...

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2. A Scientifically Inspired Pragmatism

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pp. 23-40

One of my chief aims in this book is to write about the classification of psychiatric disorders in a way that is accurate, informative, and that stirs readers to ponder the topic philosophically. To do so, it is important to bring some order to the mass of information by offering a point of view. In this chapter and the next I intend to lay the groundwork for the point of view I have adopted...

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3. Instrumental Nominalism

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pp. 41-54

Before explicating a nominalist approach to thinking about philosophical concepts, I would like to address the a priori skepticism toward nominalism that some readers may harbor. This skepticism is understandable given claims such as: the only feature that unites the different animals we call dogs into a single kind is the name “dog.” This literal definition of “name-ism” represents a simplification of nominalism that is often put forward by its opponents...

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4. Psychological and Scientific Essentialism

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pp. 55-72

For empiricists, positivists, and postmodernists, calling someone an essentialist is a term of art for “unsophisticated.” In the United States, an example of unsophisticated essentialism is the popular contrast between “real American” and “anti-American.” In almost all instances this contrast is not based on a representative survey of political beliefs and proclamations historically made by citizens of the United States...

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5. Misplaced Literalism

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pp. 73-84

Ursala LeGuin’s Earthsea stories take place in a magical world inhabited by dragons and wizards. In this world using magic requires learning the true names of things, which are encoded in an ancient, original language. The wizards must protect themselves by keeping their own true names hidden, and some of them devote their entire careers to discovering the true name of one single thing, thus contributing to the written list of names in the textbooks of magic...

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6. Literalism and the Distrust of Authority

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pp. 85-98

The most common contrast to “literal” is “figurative.” When Hank Williams sings “How can I free your doubtful mind and melt your cold, cold heart” it would be a mistake to believe that his estranged wife’s heart is literally frozen. This kind of literalism is associated with young children, low intellectual functioning, or limited education. It is the literalism of Forrest Gump and the character of Jim in Huckleberry Finn...

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7. The Objective Within, Not Beyond, Experience

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pp. 99-114

Let us return, briefly, to the concept of being in the middle that was introduced in chapter 3. By the time we are at an age to adopt a critical perspective on our own belief systems, we have already been inculcated with a mass of opinions, ready formed. For an individual there is no going back to the beginning and constructing our belief systems anew any more than we can go back to our first year and live our lives anew...

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8. Classification and the Concept of Psychiatric Disorder

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pp. 115-136

One of differences between the WHO’s International Classification of Diseases (ICD-10) and the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is that the DSM provides a conceptual definition of psychiatric disorder. In brief, a DSM disorder is: ...

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9. Four Conceptual Abstractions: Natural Kind, Historical Concept, Normative Concept, and Practical Kind

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pp. 137-156

Social constructs have been described as invented, manufactured, and fabricated. To the extent they are dependent on transitory social processes, it has been inferred that social constructs are not real. Such inferences can be readily disputed. Money and governments are socially constructed but arguably real; that is, currency printed by the U.S. Treasury is real, whereas...

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10. Can Grief Really Be a Disorder?

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pp. 157-180

Closely associated with emotional depth, the capacity to tolerate sadness is an important psychological ability. Consider people who live relatively charmed lives, with limited experience of loss or significant failure and who tend to lack empathy for the misfortunes of others. If it comes about that they encounter an unsettling loss or failure, they may develop more empathy for others—and if this new capacity does not disappear after their own...

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11. Is Narcissistic Personality Disorder Real?

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pp. 181-202

Personality disorders are problematic members of the psychiatric domain, with many important questions about their validity outstanding—including questions about the nature of personality itself. Although we readily perceive consistency between the childhood and adult versions of those we know well, there is also inconsistency. Many people have the experience of growing up with a sibling who comes to have the same personality as...

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12. Psychiatry, Progress, and Metaphysics

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pp. 203-230

According to the historian Edward Shorter (2009), the history of psychiatry is one of scientists and clinicians learning to identify real disorders only to have this knowledge supplanted by fads such as psychoanalysis, ill-conceived paradigm shifts such as the DSM-III revolution, or economic and political developments such as the rise of the pharmaceutical industry. Under normal circumstances, claims Shorter, a field such as psychiatry...

Notes

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pp. 231-236

Glossary

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pp. 237-240

References

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pp. 241-270

Index

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pp. 271-274


E-ISBN-13: 9780262322270
E-ISBN-10: 0262322277
Print-ISBN-13: 9780262027045

Page Count: 288
Publication Year: 2014

Series Title: Philosophical Psychopathology