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  • An Ethics Review Panel for the DSMA Worthwhile Challenge
  • Tamara Kayali Browne (bio)

Psychiatric classification, psychiatric nosology, values, mental disorders, ethics

I am grateful to the commentators for their thoughts on my paper. The commentaries present a variety of views on the proposal, ranging from the view that it has too much teeth, to the view that it does not have enough teeth, and come from a range of perspectives, reflecting the spirit of the panel I propose. I respond to the commentaries in themes, clarifying certain points along the way.

The Value of Training in the Humanities and Social Sciences

Some commentators have interpreted me as implying that philosophers have a 'royal road to the truth' or that they are confined to armchair philosophizing, yet I believe neither. In these disciplines, as in other disciplines, strong arguments are based on both sound logic and evidence, and there would need to be evidence underlying the predictions and judgments made by the panel. An argument does not cease to be philosophical once evidence is invoked to support it. Further, different conclusions can be drawn depending on which forms of evidence are privileged, and this, in turn, depends on the disciplinary backgrounds of those making the assessment. This point is exemplified by the case of premenstrual dysphoric disorder (PMDD), in which it is unclear if the sociological studies on PMDD were considered alongside the clinical studies, or how and why they ultimately did not inform its revision in the Diagnostic and Statistical Manual of Mental Disorders (DSM), because the reasons behind the decisions were not made public. Experts from different disciplines not only provide different perspectives, but also bring different evidence to the fore. Including a greater variety of perspectives and evidence would then provide a more holistic picture of the issues underlying proposed revisions.

Thus, it is not that I believe philosophers and sociologists have some sort of privileged access to values. Rather, it is that explicit discussions about values are their bread and butter. They are specifically trained in such fields in a way that scientists may not be, and the theories and evidence they can draw on from their fields could add to the scientific theories and evidence presented by the DSM committees. It is not that specialist training makes people in these fields better people, or more moral than others. If my assumption was that ethical judgments of the sort made in psychiatric nosology [End Page 235] would be best made by the most moral people, I may be better off suggesting people such as the Dalai Lama for the panel. Such a belief would also make me a virtue ethicist but, as Potter observes, I have consequentialist leanings. Rather, by including people from these disciplines on the panel, it becomes a forum in which the values implicit in DSM revisions can be addressed explicitly in a way that science alone cannot do. The sciences and social sciences would inform such discussions, just as they often do in applied philosophy.

I also do not claim that philosophers and sociologists are free from their own biases, as Carel (2017) has interpreted. However, part of their training is to recognize how science is colored by the social and cultural context of the humans undertaking it. If they are good philosophers and sociologists, they should at least be reflexive. Psychiatrists are not free from bias either, but currently occupy a privileged position in psychiatric nosology. Bias inevitably creeps in to everyone's judgments, but having as much diversity on the panel as possible should reduce the effects of such bias.

The assertion made by some of the commentators that being trained in ethics does not provide one with any advantage when it comes to applying that training to ethical judgments in real cases1 begs the question as to why anyone trains in ethics at all. Moreover, if such training cannot be applied to policies or real cases, it would render clinical ethicists and ethicists who work to inform public policy redundant, and 'applied ethics' an empty term. In contrast, Lieberman shows how conceptual, ethical, and sociological issues exist even in a...