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Philosophical Psychopathology

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Philosophical Psychopathology

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Being Amoral

Psychopathy and Moral Incapacity

Thomas Schramme

Psychopathy has been the subject of investigations in both philosophy and psychiatry and yet the conceptual issues remain largely unresolved. This volume approaches psychopathy by considering the question of what psychopaths lack. The contributors investigate specific moral dysfunctions or deficits, shedding light on the capacities people need to be moral by examining cases of real people who seem to lack those capacities. The volume proceeds from the basic assumption that psychopathy is not characterized by a single deficit--for example, the lack of empathy, as some philosophers have proposed -- but by a range of them. Thus contributors address specific deficits that include impairments in rationality, language, fellow-feeling, volition, evaluation, and sympathy. They also consider such issues in moral psychology as moral motivation, moral emotions, and moral character; and they examine social aspects of psychopathic behavior, including ascriptions of moral responsibility, justification of moral blame, and social and legal responses to people perceived to be dangerous. As this volume demonstrates, philosophers will be better equipped to determine what they mean by "the moral point of view" when they connect debates in moral philosophy to the psychiatric notion of psychopathy, which provides some guidance on what humans need in order be able to feel the normative pull of morality. And the empirical work done by psychiatrists and researchers in psychopathy can benefit from the conceptual clarifications offered by philosophy.ContributorsGwen Adshead, Piers Benn, John Deigh, Alan Felthous, Kerrin Jacobs, Heidi Maibom, Eric Matthews, Henning Sass, Thomas Schramme, Susie Scott, David Shoemaker, Walter Sinnott-Armstrong, Matthew Talbert

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Classifying Psychopathology

Mental Kinds and Natural Kinds

Harold Kincaid

In this volume, leading philosophers of psychiatry examine psychiatric classification systems, including the <I>Diagnostic and Statistical Manual of Mental Disorders </I>(DSM), asking whether current systems are sufficient for effective diagnosis, treatment, and research. Doing so, they take up the question of whether mental disorders are natural kinds, grounded in something in the outside world. Psychiatric categories based on natural kinds should group phenomena in such a way that they are subject to the same type of causal explanations and respond similarly to the same type of causal interventions. When these categories do not evince such groupings, there is reason to revise existing classifications. The contributors all question current psychiatric classifications systems and the assumptions on which they are based. They differ, however, as to why and to what extent the categories are inadequate and how to address the problem. Topics discussed include taxometric methods for identifying natural kinds, the error and bias inherent in DSM categories, and the complexities involved in classifying such specific mental disorders as "oppositional defiance disorder" and pathological gambling.<B>Contributors</B>George Graham, Nick Haslam, Allan Horwitz, Harold Kincaid, Dominic Murphy, Jeffrey Poland, Nancy Nyquist Potter, Don Ross, Dan Stein, Jacqueline Sullivan, Serife Tekin, Peter Zachar

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The Ethical Treatment of Depression

Autonomy through Psychotherapy

Paul Biegler

A philosopher argues there is an ethical imperative to provide psychotherapy to depressed patients because the insights gained from it promote autonomy.

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Extraordinary Science and Psychiatry

Responses to the Crisis in Mental Health Research

Jeffrey Poland

Psychiatry and mental health research is in crisis, with tensions between psychiatry's clinical and research aims and controversies over diagnosis, treatment, and scientific constructs for studying mental disorders. At the center of these controversies is the Diagnostic and Statistical Manual of Mental Disorders (DSM), which -- especially after the publication of DSM-5 -- many have found seriously flawed as a guide for research. This book addresses the crisis and the associated "extraordinary science" (Thomas Kuhn's term for scientific research during a state of crisis) from the perspective of philosophy of science. The goal is to help reconcile the competing claims of science and phenomenology within psychiatry and to offer new insights for the philosophy of science. The contributors discuss the epistemological origins of the current crisis, the nature of evidence in psychiatric research, and the National Institute for Mental Health's Research Domain Criteria project. They consider particular research practices in psychiatry -- computational, personalized, mechanistic, and user-led -- and the specific categories of schizophrenia, depressive disorder, and bipolar disorder. Finally, they examine the DSM's dubious practice of pathologizing normality.ContributorsRichard P. Bentall, John Bickle, Robyn Bluhm, Rachel Cooper, Kelso Cratsley, Owen Flanagan, Michael Frank, George Graham, Ginger A. Hoffman, Harold Kincaid, Aaron Kostko, Edouard Machery, Jeffrey Poland, Claire Pouncey, Serife Tekin, Peter Zachar

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A Metaphysics of Psychopathology

Peter Zachar

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.

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Real Hallucinations

Psychiatric Illness, Intentionality, and the Interpersonal World

Matthew Ratcliffe

In Real Hallucinations, Matthew Ratcliffe offers a philosophical examination of the structure of human experience, its vulnerability to disruption, and how it is shaped by relations with other people. He focuses on the seemingly simple question of how we manage to distinguish among our experiences of perceiving, remembering, imagining, and thinking. To answer this question, he first develops a detailed analysis of auditory verbal hallucinations (usually defined as hearing a voice in the absence of a speaker) and thought insertion (somehow experiencing one's own thoughts as someone else's). He shows how thought insertion and many of those experiences labeled as "hallucinations" consist of disturbances in a person's senseof being in one type of intentional state rather than another.

Ratcliffe goes on to argue that such experiences occur against a backdrop of less pronounced but wider-ranging alterations in the structure of intentionality. In so doing, he considers forms of experience associated with trauma, schizophrenia, and profound grief.

The overall position arrived at is that experience has an essentially temporal structure, involving patterns of anticipation and fulfillment that are specific to types of intentional states and serve to distinguish them phenomenologically. Disturbances of this structure can lead to various kinds of anomalous experience. Importantly, anticipation-fulfillment patterns are sustained, regulated, and disrupted by interpersonal experience and interaction. It follows that the integrity of human experience, including the most basic sense of self, is inseparable from how we relate to other people and to the social world as a whole.

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