Luc Faucher Dans cet article, je soulèverai un problème qui a été négligé jusqu’ici dans les écrits portant sur la philosophie de la psychiatrie au sujet du Research Domain Criteria : le fait que l’initiative découle des priorités de recherche du National Institute of Mental Health et que l’orientation de celles-ci ne permet pas de traiter certains aspects des conditions des patients qui sont jugés essentiels par ceux-ci. Après avoir démontré l’existence de ce problème, je vais tenter de voir par (...) quel moyen on pourrait l’éviter. Pour ce faire, je considérerai un programme, européen cette fois, le Roadmap for Mental Health Research in Europe et sa méthode pour intégrer une diversité de voix, dont celles des patients, dans le processus d’établissement des priorités de recherche. Je me livrerai ainsi à un exercice d’épistémologie sociale comparée en montrant comment certaines caractéristiques organisationnelles d’un des programmes possèdent des vertus épistémiques qui font défaut à l’autre et comment une plus grande justice épistémique pourrait être obtenue par l’implantation de certains mécanismes qui permettent à la voix des patients d’être entendue. (shrink)

It is common to note that social environment and cultural formation shape mental disorders. The details of this claim are, however, not well understood. The paper takes a look at the claim that culture has an impact on psychiatry from the perspective of metaphysics and the philosophy of science. Its aim is to offer, in a general fashion, partial explications of some significant versions of the thesis that culture and social environment shape mental disorders and to highlight some of (...) the consequences social constructionism about psychiatry has for psychiatric explanation. In particular, it will be argued that the alleged dependence of facts about particular mental disorders and about the second order property of being a mental disorder on social facts amounts to a robust form of constructivism, whereas the view that clinician–patient interaction is influenced by cultural facts is perfectly compatible with an anti-constructivist stance. (shrink)

Psychiatry, as a subspecialty of medicine, is a quintessentially modernist project. Yet across the main campus, throughout the humanities and social sciences, there is increasing postmodern consensus that modernism is a deeply flawed project. Psychiatry, the closest of the medical specialties to the humanities and social sciences, will be the first to encounter postmodern theory. From my reading, psychiatry, though likely defensive at first, will eventually emerge from a postmodern critique, not only intact, but rejuvenated. Postmodern theory, at its best, (...) provides a liberating effect on modernist practices, freeing them from an enslavement to Method and Objectivity in order to allow the more human (all charges of antihumanism not withstanding) to emerge as valued and respected. The net result could be the evolution of a new postmodern psychiatry and a new model of medicine which would be much more enjoyable to practice and much more connected to the concerns of patients. (shrink)

Deux courants de pensée jouent un rôle important dans la philosophie des mathématiques contemporaine. Le structuralisme, s’il n’est pas une idée nouvelle, continue de se déployer en des directions multiples – de la pratique mathématique jusqu’à ses dimensions ontologiques –, et de faire l’objet d’études, par exemple en direction des modalités de sa genèse. L’épistémologie historique, dont la conception classique a été largement enrichie récemment, est également au cœur de débats qui renouvellent la philosophie des sciences bien au-delà (...) de ses problématiques classiques. Son usage en mathématiques requiert toutefois des analyses spécifiques du fait de leurs idiosyncrasies, des notions comme celle de rigueur, d’expérience ou d’ontologie y ayant un sens et une charge historique différentes de celles qu’elles ont dans les sciences de la nature. Le propos de cet article sera de mettre en situation certains de ces débats en se concentrant sur un des phénomènes les plus significatifs du xxe siècle mathématique: le structuralisme de Bourbaki. Il s’intéressera en particulier aux potentialités de l’épistémologie historique, en cherchant à montrer que ses outils permettent de mieux comprendre certains enjeux du structuralisme. L’accent sera mis en particulier sur deux notions clés dans les travaux de Rheinberger, Daston et Hacking, celles d’objets et de concepts épistémiques. (shrink)

Comment expliquer que les savoirs de sciences humaines et sociales soient à ce point contestés voire ignorés dans les lieux où ils pourraient pourtant éclairer la réflexion et l'action? Comment expliquer la défiance et l'incompréhension qu'ils suscitent parfois? Les savoirs de sciences humaines et sociales ont la particularité de circuler dans des espaces variés et de devoir composer avec une critique prompte à remettre en cause leur validité et leur légitimité. Leur acceptabilité sociale ne se joue pas dans la seule (...) communauté savante mais bien dans les multiples réinterprétations et traductions auxquelles ils donnent lieu. Les études réunies dans ce volume analysent sept controverses ayant pour enjeu le sort réservé à des savoirs issus de la réflexion philosophique, sociologique, psychologique ou se revendiquant d'une économie hétérodoxe. Elles montrent que les résistances qu'ils rencontrent sont la marque paradoxale de leur vigueur et de leur capacité à bousculer les évidences partagées. Contributeurs : Elisabeth Chatel, Sandra Laugier, Frédéric Lebaron, Alexandra Oeser, Etienne Penissat, Sophie Richardot, Sabine Rozier. (shrink)

Psychiatry presents a unique array of difficult ethical questions. However, a major challenge is to approach psychiatry in a way that does justice to the real ethical issues. Recently there has been a growing body of research in empirical psychiatric ethics, and an increased interest in how empirical and philosophical methods can be combined. Empirical Ethics in Psychiatry demonstrates how ethics can engage more closely with the reality of psychiatric practice and shows how empirical methodologies from the social sciences can (...) help foster this link. -/- The book is divided into two sections. In the first section there are discussions of the possibility of empirical ethics from a theoretical standpoint and an overview of the history of empirical medical ethics in general. The second, larger section is made up of chapters, discussing specific research projects in empirical psychiatric ethics. The contributors reflect on their choice of method: how and why they combine empirical and philosophical work, and how the two approaches relate to each other. The chapters in the second part thus have two purposes. The first is to present examples of empirical ethics in psychiatry; the second is to reflect on the way in which empirical research can support ethical analysis. -/- Empirical Ethics in Psychiatry is a unique contribution to bioethics and will be fascinating reading for all those working within the field, as well as mental health care professionals. (shrink)

L'ouvrage offre toute une palette de réflexions qui concernent aussi bien l'épistémologie de l'histoire que la sociologie des institutions et l'anthropologie sociale du soi.

One of paradoxes of current mental health care is that we never have known more about mental disorder and at the same time been more uncertain about the conceptual basis—and, therefore, the legitimacy—of psychiatry.This is remarkable. Psychiatry as a science flourishes. Over the last three decades, there has been an enormous increase in empirical research on the genetic, neurobiological, psychological, and social determinants of mental disorder. At the same time, mental health care has improved a lot, at least in (...) most Western countries. Reform in legislation and in the organization of care has led to more autonomy of the patient, more control on the process and outcome of therapy... (shrink)

Les modèles basés sur des agents en interactions, constituent des systèmes sociaux complexes, qui peuvent être simulés par informatiques. Ils se répandent dans les sciences économiques et sociales - comme dans la plupart des sciences des systèmes complexes. Des énigmes épistémologiques (ré)apparaissent. On a souvent opposé modèles et investigations empiriques : d’un côté, on considère les sciences empiriques fondées sur une observation méthodique (enquêtes, expériences) tandis que de l’autre, on conçoit les approches théoriques et la modélisation comme s’appuyant sur une (...) approche conceptuelle ou hypothético-déductive. la simulation a de son coté souvent été comparée à une forme d’expérience ou à une méthode intermédiaire entre la théorie et l’expérience. Tesfatsion a parlé de « laboratoire computationnel » comme d’une manière d’étudier « les comportements des systèmes complexes au moyen d’expériences sous contrôle qu’on peut répéter (réplicable)» et Axelrod a proclamé que la simulation serait « une troisième manière de pratiquer la science dans les sciences sociales », entre l’induction et la déduction. Nous introduisons de nouveaux concepts épistémologiques afin de montrer dans quelle mesure les auteurs ont raison lorsqu'ils se concentrent sur une signification empirique, instrumentale ou conceptuelle de leur modèle ou simulation. La première partie du chapitre discute plus particulièrement de l'épistémologie des modèles économiques à partir des travaux d’Hausman, Guala, Mäki, Sugden, Schelling etc. pour expliquer les divergences entre modèles et simulations. En distinguant entre modèles et simulations, comme entre entre types de modèles, types de simulations informatiques et types d'empiricité obtenue par une simulation, la seconde partie donne la possibilité de comprendre plus précisément - et ensuite de justifier - la diversité des positions épistémologiques présentées dans la première partie. En utilisant les notion de sous-symbolisation (due à Smolensky) et, de hiérarchie dénotationnelle (due à Goodman), une attention particulière est accordée à la multiplicité des pouvoirs dénotationnels des symboles en jeu dans les modèles complexes et les simulations informatiques. Selon cette grille d'analyse, on peut déterminer, dans chaque cas particulier son statut épistémique et la crédibilité qui peut y être associée. -/- Ce chapitre est une traduction (par Gilles Campagnolo) réviséee et augmentée par les auteurs de : Agent-Based Models and Simulations in Economics and Social Sciences: From Conceptual Exploration to Distinct Ways of Experimenting, Journal of Artificial Societies and Social Simulation 13 (1) 5 DOI: 10.18564/jasss.1532. (shrink)

For the most part, American sociology has accepted the appealing formula of neutrality with regard to political and ideological values, a formula especially put forward by the functionalist school. It has the golden merit of posing issues in a seemingly natural science manner. The sociologist can adopt the physicist's pose toward his work. We provide society with carefully sifted information, comparative analysis of social structures, and at the upper range, the likely consequences of performing or not performing an action (...) in terms of the given diagnosis. The social scientist using a functionalist philosophy can feel free of responsibility at a decision making level. Whether society decides to employ or ignore the provided data is held to be a matter of indifference, a situation requiring moral wisdom rather than social theory. Without minimizing the sound contributions of the function-Structure approach, particularly in overcoming the provincialism and conceit of the pre-functionalist schools of anthropology, there is a sure moral undercurrent in a method which sees the social scientist as diagnostician and society as a patient. It has the appearance of satisfying the historic identification of social theory to social welfare, and no less an emotional identification with a neutral-objective image culled from physics. Social history becomes a variable in the preparation of trend reports and thereby trivialized into a moment in the functionalist scheme. (shrink)

For political reasons, the social control functions of psychiatry are not openly recognized as such but are disguised as benevolent medical treatment. The roots of this disguise may be traced to the political revolutions in which the rule of man was replaced by the rule of law. This transformation generated a conflict between the desire for freedom under law and the desire for a greater degree of social control than is provided by law. Involuntary mental hospitalization is the neurotic resolution (...) of this conflict by society. The social control functions of psychiatry are disguised and justified by the medical model which describes the moral action of both psychiatrist and patient in the ostensibly value neutral language of science and medicine. The cost of this disguise is great. It negates individuals as moral agents and obscures the moral nature of the problems that psychiatrists seek to understand which, in turn, handicaps them in helping the persons they seek to assist. The task of the philosopher in this situation is honestly and critically to analyze and evaluate psychiatric language, psychiatric practices and the moral issues involved. (shrink)

Coercion is still highly prevalent in contemporary psychiatry. Qualitative research indicates, however, that patients and psychiatric staff have different understandings of what they mean by ‘coercion’. Psychiatric staff primarily employ the concept as referring to instances of formal coercion regulated by law, such as involuntary hospital admission or treatment. Patients, on the other hand, use a broader concept, which also understands many instances of informal psychological pressure as coercive. We point out that the predominance of a narrow concept of coercion (...) in psychiatry can have negative consequences for patients, and argue that this difference in how the concept ‘coercion’ is used is both grounded in epistemic oppression and reinforces such oppression. Epistemic oppression, as defined by Dotson, refers to the persistent epistemic exclusion of members of marginalized groups from participation in practices of knowledge production. We first demonstrate how patients may experience inferential inertia when communicating their experiences of coercion. We then show that the resulting predominance of a narrow concept of coercion in psychiatry can be described as a case of hermeneutical injustice in a context shaped by institutional hermeneutical ignorance. We argue for a change in institutional practices in psychiatry that allows for the adequate consideration of patients’ perspectives on coercion. (shrink)

Dans ce texte, je suggère que les personnes souffrant d’anorexie mentale s’infligent une forme particulière de violence épistémique lorsqu’elles ignorent volontairement les symptômes de leur maladie. Pour ce faire, dans une démarche inspirée par celle de Havi Carel, je présente d’abord le rapport particulier qu’entretiennent les personnes souffrant d’anorexie avec leur corps, et ce, à l’aide de trois axes d’analyse empruntés à Susan Bordo, soit le dualisme Corps/Esprit, les idéaux de contrôle et d’autonomie, et les rapports de genre. Je propose (...) ensuite le concept de violence épistémique auto-infligée en montrant que l’ignorance volontaire de la faim a pour objectif de préserver l’identité des personnes vivant avec cette maladie comme autonomes et en contrôle, autrement dit comme n’étant pas « malades ». (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Contingent Object of PsychiatryDavid McCallum (bio)Keywordsmental illness, dangerousness, law, genealogyWilson and Adhead’s plea that the British Government’s proposed new mental health legislation might entail a misappropriation of psychiatry’s true mission will strike a chord in numerous jurisdictions. Many European countries during the last northern summer will adopt mental health legislation that moves in the opposite direction to the United Nations Convention on Human Rights for persons with disabilities, (...) and will allow for compulsory mental health treatment. In this author’s home state of Victoria, Australia, the Mental Health Act has five criteria that must be met for someone to be made an involuntary patient in an institution or hospital, in the community, or in one’s own home (Victoria 2003, s.6). One of the criteria is that the person is judged to be at risk of danger to themselves or others. Once made an involuntary patient, one looses the right to refuse medical treatment. At present, in various parts of the world, medical practitioners are being required to assess a person’s level of dangerousness with immediate consequences for that person’s liberty.From the point of view of a historian of the human sciences, these events propel psychiatry into a dialogue with its recent past. The project of Western psychiatry is usually characterized as a breaking down of the walls of the old asylum that contained the lunatic in its dark recesses, and the subsequent unveiling of the mental patient thanks to the rational, liberatory practices of medicine. But modern psychiatry has also been shaped by the coming into being of particular conceptions of mental illness that are not all its own making. This entailed the removal over time of the mental defective and the mental deficient, the moral imbecile, the epileptic, the alcoholic, the chronically insane, and so on, from spaces in which psychiatry would seek to define it object—populations that psychiatry would determine to be “not amenable to treatment.” If we were to see this shaping in a Foucauldian sense, we would also want to include earlier eighteenth- and nineteenth-century separations of the lunatic and the criminal (Foucault 1965, 1979). Moreover, we might want to insist that the marking out of the modern mental health patient is first and foremost an administrative act—an act of separation and management within a bounded population—which then serves as a condition of possibility for the emergence of knowledges in psychiatric medicine, with the latter following rather than preceding the arrangement of bodies in the asylum/hospital.The psychiatrist in public medicine may well be encouraged to shape a new mission according to the requirements of an administration concerned with managing dangerousness. A shift in the social vocation of the psychiatric expert has been observed over several decades, and may represent a profound departure from the traditions [End Page 69] of mental medicine (Castel 1991). Those “dirty words”—risk assessment—involve new strategies where face-to-face relations between carer and cared are displaced by an activity of calculating abstract factors deemed liable to produce risk—“a transition from the clinic of the subject to an ‘epidemiological’ clinic” (Castel 1991, 282). The broad contours of this shift sees the specialist medical carer take a back seat while the manager/ administrator assumes a more autonomous role of allocating individuals into various categories of risk. It is in this sense that the psychiatrist does not make a diagnosis as such, but rather contributes to a list of factors compiled to measure a level of riskiness. Risk assessment forms part of social surveillance that dispenses with the actual presence of the carer and the cared, and provides for a form of systematic predetection rather than treatment. As Castel (1991, 288) presents it,(t)here is, in fact, no longer a relation of immediacy with a subject because there is no longer a subject. What the new preventative policies primarily address is no longer individuals but factors, statistical correlations of heterogeneous elements. They deconstruct the concrete subject of intervention, and reconstruct a combination of factors liable to produce risk. Their primary aim is not to confront a concrete dangerous situation, but to anticipate... (shrink)

The task of being oneself lies at the heart of human existence and entails the possibility of not being oneself. In the case of schizophrenia, this possibility may come to the fore in a disturbing way. Patients often report that they feel alienated from themselves. Therefore, it is perhaps unsurprising that schizophrenia sometimes has been described with the heideggerian notion of inauthenticity. The aim of this paper is to explore if this description is adequate. We discuss two phenomenological accounts of (...) schizophrenia: Binswanger’s account of schizophrenia as a form of inauthenticity and Blankenburg’s account of schizophrenia as a loss of common sense, which seems construable as a loss of inauthenticity. We argue that the accounts are highlighting aspects of the same underlying phenomenon, viz. schizophrenic autism. Moreover, we argue that Binswanger’s description of schizophrenia as a form of inauthenticity is inadequate and we discuss experiences of self-alienation in schizophrenia. (shrink)

Within psychiatric research, the field of 'technotherapy' has been centred primarily on attempts to assess the computer as a treatment tool. The situation of daily clinical usage is, however, often ignored within such research, as for instance in controlled clinical trials. Our empirical study illustrates how health professionals and clients use different concepts of science and health in the attempts of formulating standards for using computers in psychiatric practice. The psychiatrists at a major psychiatric hospital decided and justified clients' (...) use of computers on the basis of a 'techno-medical' quality assurance. At the same hospital the occupational therapists stressed the improvement of social relations as a treatment goal. And, at a psychiatric outside clinic the clients used concepts of 'normality' for articulating quality in computer use. Our study exemplifies how the use of computers is a multifaceted 'performance'. What is called for is a kind of research not limited by artificial borders of 'the context' and the 'user-perspective'. In much humanistic research as well as in action research concepts of 'context' and 'user-perspective' imply a somehow romantic view on practice as pure and uncontaminated by the outside world contrasted to a 'general' or an 'objective' way of knowing the world. These sharp distinctions were however difficult to maintain in our study, where health professionals and clients took local contingencies into account when they interpreted computer use, while they simultaneously drew on a socio-historical reservoir of resources. (shrink)

Introduction: Mental health nursing is dependent on nurses’ ability to engage in therapeutic relationships with patients. The ability to manage professional boundaries is equally important, but less explored. This study aims to address the following research questions: How do nurses define their professional, personal, and private roles? What are nurses’ experiences with professional boundaries? What are the implications of nurses’ understanding of these boundaries? Background: Nurse–patient relationships are characterized by asymmetrical power dynamics, which places the responsibility of delineating professional boundaries (...) on the nurse. While ethical codes offer guidance, nurses must identify appropriate boundaries in a dynamic process that relies on the clinical context. Research design: This study used critical discursive psychological analysis to examine data from participant observations, individual interviews, and focus group discussions. Participants and research context: We included 16 nurses working in mental health care in this study, comprising 12 in specialist mental health care and 4 in community mental health care. Ethical considerations: The study was registered with Norwegian Social Science Data Services. Results: Nurses defined professionalism as being an educated caregiver who prioritizes patients’ needs. Professionalism involves personal engagement, while some personal matters remain private. However, nurses experienced challenges in maintaining professional boundaries, facing dilemmas due to the subjective nature of boundaries and patients’ unpredictable responses. Conclusions: While nurses prioritize patients’ needs and best interests, this study demonstrated that personal engagement is considered part of professionalism. However, nurses encounter complex dilemmas in setting professional boundaries. Additionally, these boundaries can either emphasize or de-emphasize the power differential in nurse-patient relationships. (shrink)

This paper proposes that eight positive emotions: awe, love , trust , compassion, gratitude, forgiveness, joy and hope constitute what we mean by spirituality. These emotions have been grossly ignored by psychiatry. The two sciences that I shall employ to demonstrate this definition of spirituality will be ethology and neuroscience. They are both very new. I will argue that spirituality is not about ideas, sacred texts and theology; rather, spirituality is all about emotion and social connection. Specific religions, for all (...) their limitations, are often the portal through which positive emotions are brought into conscious attention. Neither Freud nor psychiatric textbooks ever mention emotions like joy and gratitude. Hymns and psalms give these emotions pride of place. Our whole concept of psychotherapy might change if clinicians set about enhancing positive emotions rather than focusing only on negative emotions. (shrink)

Une grande partie des changements produits par l’informatique et le numérique concerne notre manière d’acquérir des connaissances. Wikipédia est ainsi devenue une source très populaire d’informations. Dans cet article, nous nous proposons d’analyser en quoi les possibilités techniques introduites par l’informatique personnelle et le Web influencent certaines questions de philosophie de la connaissance.

Face à la diversité et à la complexification des modes de formalisation, une épistémologie des méthodes scientifiques doit confronter directement ses analyses à une pluralité d’études de cas comparatives. C’est l’objectif de cet ouvrage. -/- Aussi, dans une première partie, propose-t-il d’abord une classification large et raisonnée des différentes fonctions de connaissance des théories, des modèles et des simulations (de fait, cette partie constitue un panorama d’épistémologie générale particulièrement poussé). C’est ensuite à la lumière de cette classification que (...) les deux parties centrales analysent et distinguent les assises conceptuelles et épistémologiques des principaux types de formalisation en géographie avant et après l’ordinateur (théories des localisations, modèles gravitaires, loi rang-taille). En employant toujours la même méthode analytique et comparative, la dernière partie se concentre sur l’explication épistémologique des trois révolutions computationnelles récentes : l’analyse des données, la présentation des données et enfin l’analyse par simulation computationnelle. -/- Au travers de cette enquête approfondie, la géographie apparaît non seulement comme une discipline carrefour, ayant pour cela donné des exemples de presque tous les types de modèles scientifiques, mais aussi comme une science innovante en termes épistémologiques. Car ce qui a d’abord été pour elle un frein à la formalisation -– sa sensibilité au caractère multifactoriel comme à la dimension irréductiblement spatiale des phénomènes sociaux – et qui l’obligea longtemps à inféoder ses théories et modèles à des disciplines plus aisément formalisables comme la géomorphologie, l’économie, la sociologie, la démographie, ou bien encore la thermodynamique et la théorie des systèmes, devient aujourd’hui un atout dès lors que, parmi les sciences humaines et sociales, elle peut développer une épistémologie non seulement pluraliste mais aussi combinatoire et intégrative. -/- Préface de Denise Pumain (Université Paris 1). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Can The Psychopathologized Speak?Notes on Social Objectivity and Psychiatric ScienceAwais Aftab*, MD (bio)In "Exclusion of Psychopathologized Standpoints Due to Hermeneutical Ignorance Undermines Psychiatric Objectivity" (2022), Bennett Knox offers a compelling argument that failure of psychiatric community to engage with the "psychopathologized" in processes such as the revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) constitutes a form of epistemic injustice and threatens the social objectivity (...) of psychiatric science. I find myself in agreement with the central thesis and I am glad to see it articulated so well by Knox. While it is clear that the exclusion of psychopathologized standpoints in psychiatric science cannot be justified, there are issues that arise that require further clarification, and may generate disagreements, when we consider the complexities of how this inclusion is to take place, what requirements can be imposed on this process of inclusion, and the relationship between the DSM and psychiatric science broadly when it comes to social objectivity.The Methodological Objectivity of the DSM Does Not Exhaust the Methodological Objectivity of Psychiatric ScienceThe DSM is a nosological project within a particular historical context, operating with a certain set of assumptions (Aftab & Ryznar, 2021). The DSM has limitations in terms of what sorts of perspectives it can meaningfully incorporate, but the limitations of the DSM are not the limitations of psychiatric science. This is because psychiatric science is a pluralistic domain and includes many different methodologies and perspectives (Jerotic & Aftab, 2021). As one example, the DSM is poorly equipped to capture the phenomenology of psychiatric conditions. It is not something that it sets out to do. This, however, only becomes a serious problem if we adopt the attitude "if it's not in the DSM then it doesn't really count." Unfortunately, many in the psychiatric community have [End Page 267] adopted this sort of attitude, at least implicitly, resulting in a serious neglect of phenomenology (and various other perspectives, including those of the psychopathologized), leading Nancy Andreasen to bemoan the "death of phenomenology." (Andreasen, 2007) The DSM is methodologically limited by design; there are things that it will fail to do. The appropriate response is to acknowledge these inherent limitations. Other perspectives such as neurodiversity or Hearing Voices Movement also bring their own sets of assumptions and limitations. The DSM is simply one element, one perspective, one methodology in a scientific field that is capable of and ought to adopt a plurality of perspectives and methodologies. This is worth pointing out because Knox appears to assume that if it proves difficult or impossible for the DSM to include radically diverse perspectives, then "all the worse for psychiatry's objectivity." If it is impossible for the DSM, that does not mean that it is also impossible for psychiatric science.1In Determining What Counts as Inappropriate Exclusion, What Is the Role of Scientific Expertise?Longino herself brings up this question: "in determining what counts as inappropriate exclusion of dissenting perspectives, does it matter what kind of issue is involved? Are the duties of inclusion different when the question is, Should we be trying to learn about such and such, for example, atomic fission? than when it is, Is atomic fission a controllable or uncontrollable process?" (Longino, 2002, p. 133) The danger that needs to be averted here is that of trivializing expertise and placing experts on an equal footing with non-experts, a danger that is strikingly illustrated by our social response to the coronavirus disease 2019 pandemic.Take an example from medicine. Individuals with lung cancer have a lot to offer when it comes to the treatment of lung cancer, including their experiences of care, and choice of, say, aggressive chemotherapy vs palliative comfort care, etc. but how much do they have to contribute on the matter of the histopathological classification of lung cancer? Consider the Hierarchical Taxonomy of Psychopathology (HiTOP) (Kotov et al., 2021). This quantitative nosological project has a very specific aim: to determine the patterns of covariation among psychiatric symptoms using statistical techniques such as factor analysis. This... (shrink)

This paper challenges the exclusion of patients from epistemic practices in psychiatry by examining the creation and revision processes of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a document produced by the American Psychiatric Association that identifies the properties of mental disorders and thereby guides research, diagnosis, treatment, and various administrative tasks. It argues there are epistemic—rather than exclusively social/political—reasons for including patients in the DSM revision process. Individuals with mental disorders are indispensable resources to enhance psychiatric epistemology, (...) especially in the context of the crisis, controversy, and uncertainty surrounding mental health research and treatment. (shrink)

Zaner, R. M. Eidos and science.--Tiryakian, E. A. Durkheim and Husserl.--Ricoeur, P. Can there be a scientific concept of ideology?--Natanson, M. The problem of anonymity in the thought of Alfred Schutz. -- Dallmayr, F. R. Genesis and validation of social knowledge.

Using the example of the feminist magazine Courage, the article shows how its participatory production process enabled a psy-feminist knowledge generation that also included women with psychiatric experience. The magazine makers combined the women’s observations, perceptions and interpretations with visual representations and a canon of literature that extended far beyond the field of psychiatry (criticism). Instead of medical psychopathologies, the women of Courage implemented writing styles and visual languages, which emphasised the experience of mental suffering and alterity and related it (...) to the social position of women. At the same time, Courage also presented alternative feminist treatments and therapies. The Courage’s critique of psychiatry was characterised by a multi-perspective approach that removed the topic of “women in psychiatry” from the narrow field of psychiatry, psychology and psychotherapy and expanded it to include artistic, patient- and experience-oriented and socio-critical perspectives. (shrink)

Dans cet essai, je compte me concentrer sur certains aspects épistémologiques de l’expertise car le risque engendre de nouveaux et difficiles défis dans ce domaine. Ma question sera d’identifier et de circonscrire des facteurs qui diminuent la confiance qu’un agent cognitif pourrait avoir envers un expert et ce, en contexte de risque. Ceci n’exclut bien sûr pas que d’autres aspects (par exemple sociaux et politiques) soient importants et je renvoie le lecteur à la vaste littérature sur le sujet. De (...) manière concrète, je mettrai en évidence comment la question du risque accentue le problème du rôle des valeurs contextuelles en épistémologie. Pour ce faire, dans la première section, je compte brièvement expliquer comment l’expertise scientifique implique une forme aigüe du problème de la connaissance par témoignage. Dans la deuxième section, j’exposerai comment la notion de risque introduit le problème des valeurs non-épistémiques en science et ce, de deux façons : par l’évaluation et la valorisation. La troisième section sera consacrée à exposer quelques approches pour sauvegarder l’intégrité et la crédibilité de l’expertise scientifique en contexte de risque. (shrink)

Abstract:This article brings together considerations from philosophical work on standpoint epistemology, feminist philosophy of science, and epistemic injustice to examine a particular problem facing contemporary psychiatry: the conflict between the conceptual resources of psychiatric medicine and alternative conceptualizations like those of the neurodiversity movement and psychiatric abolitionism. I argue that resistance to fully considering such alternative conceptualizations in processes such as the revision of the Diagnostic and Statistical Manual of Mental Disorders emerges in part from a particular form of (...) epistemic injustice (hermeneutical ignorance) leveled against a particular social group (which I call the "psychopathologized"). Further, insofar as the objectivity which psychiatry should aspire to is a kind of "social objectivity" which requires incorporation of various normative perspectives, this particular form of epistemic injustice threatens to undermine its scientific objectivity. Although many questions regarding implementation remain, this implies that psychiatry must grapple substantively with radical reconceptualizations of its domain if it is to achieve legitimate scientific objectivity. (shrink)

Le philosophe Charles Peirce a accordé un rôle prépondérant à la communauté des enquêteurs, à la fois comme groupe de chercheurs et comme idéal conduisant vers la vérité. Si Peirce parlait pour sa part de « théorie sociale de la réalité », les trois textes qui suivent – inédits en français, et en anglais pour le dernier – justifient d’y voir une véritable épistémologie sociale. Ils montrent dans quelle mesure la connaissance scientifique, et même commune, trouve son fondement dans (...) une composante nécessairement sociale. La rationalité probable n’a pas de sens à l’échelle individuelle (premier texte) ; la science est une entreprise collective (deuxième texte) ; et la vérité se définit en fonction de la communauté (troisième texte). (shrink)

La réflexion philosophique, dont l'ouverture à l'univers dans lequel nous nous découvrons - avec une acuité proportionnelle à un étonnement renouvelé - n'a pas de limites, n'en est que plus tributaire des sciences et des techniques, des arts et de multiples activités qui régissent plus ou moins fructueusement notre expérience. Or, au sein des sciences humaines, privilégiées pour éclairer une condition que nous ne saurions cesser d'interpréter, peu d'oeuvres du dernier siècle auront enrichi en le précisant notre être-au-monde, comme la (...) théorie linguistique de Gustave Guillaume, assez solitaire, et les recherches multiformes de Jean Piaget - où la psychologie de l'enfant a souvent occulté la visée épistémologique et son enracinement biologique (cf Biologie et connaissance, 1967) et ses prolongements pédagogiques, voire éthiques. Le Cinquantenaire et le Trentenaire de leur disparition appelaient un hommage d'autant plus impératif qu'ils sont restés marginaux ou ignorés dans les milieux philosophiques, malgré la centralité de leurs élucidations. Leur commune orientation génétique et structurale n'ayant suscité aucun échange, pendant la contemporanéité de publications d'un tiers de siècle (1923-1960), mesurer leur complémentarité s'impose d'autant plus. S'ils peuvent aider à repenser la condition humaine, c'est qu'ils auront contribué à dissiper le "mystère de la pensée". L'un cherchant à habiliter les caractères systématique et cinétique des langues, irremplaçables moyens de penser ; l'autre dans un vis-à-vis cognitif et opératoire de Freud, en relavant sur les plans épistémologique et logique, notamment, l'élan révolutionnaire de la seconde modernité, autour de l'évolutionnisme. Mais les thèmes majeurs du constructivisme, du schème et de la symbolisation - et plus largement du temps et du langage - auront sans doute aidé à spécifier les mutations autorisées par la révolution critique. Entre l'Instant du je parle et un décentrement exigible pratiquement (éthique) comme théoriquement (épistémique), c'est bien la condition humaine dans son ensemble qui est concernée. Si repenser cette Condition s'impose en permanence, il importe de ne pas manquer des oeuvres qui, par-delà toute mode, proposent à notre expérience des fondations résistant à d'inéluctables vicissitudes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Wilhelm Griesinger: Psychiatry between Philosophy and PraxisKatherine Arens (bio)AbstractThis essay discusses Wilhelm Griesinger’s seminal work on mental illness, Mental Pathology and Therapeutics (1867, trans. 1882), in the context of transcendental idealism, as an outgrowth of the work of Kant, Herbart, and Hegel. Griesinger drew on an adaptation of Hegel’s dialectical model of history and science to offer both a new way to interpret mental illness as a product (...) of an individual’s long-term interactions with both nature and culture and a new norm for therapeutic practice based on the patient’s role in his community and history.Mental Pathology and Therapeutics rests on Griesinger’s adaptation of the Hegelian dialectic to the context of pragmatic science, first by adopting its model of the mind, then by describing the etiology of mental disease and a taxonomy of its forms. Griesinger’s work thus stands in a largely unacknowledged tradition alive as late as Sigmund Freud and Jacques Lacan.KeywordsGriesinger, history of psychiatry/psychology, idealism, Hegel, dialecticIn the nineteenth century, Wilhelm Griesinger (1817–68) emerged as a leader in a range of fields: modern-day psychiatric clinical practice, neuropathology, and diagnostics of mental diseases. 1 Griesinger was a theoretician, a clinician, a textbook author, and the founding editor of major professional organs in his field during the political and social ferment in the German-speaking world that allowed new, more socially responsible institutional practices to be considered by intellectual communities. As a consequence of 1849 German civil reforms, theory and practice became mutually enlightening, actually allowing Griesinger to implement his theories into concrete institutional reforms in the German mental health system.Wilhelm Griesinger’s education and career were in many ways typical for his generation. He enrolled at the University of Tübingen in 1834 as a medical student; there, he became politically active (as a member of a forbidden fraternity), and, like many of his contemporaries, became familiar with Hegelian philosophy. After holding several private positions, he was appointed an associate professor (ausserordentlicher Professor) for pathology, “materia medica” and history of medicine at Tübingen in 1847. In 1848, he was called to Kiel; in 1850, to Egypt. Tübingen reappointed him as a full professor for clinical medicine and head of the university clinic in 1854. By 1860, he had moved to Zurich in a professorship for the medical clinic, where, starting in 1863, he was a key person in the planning of a new clinic for mental diseases—the Burghölzli, where Jung later worked. By 1865, he went to Berlin, as director of the Charité (mental institution), among other positions, and he wrote extensively about reform in asylum practice until his premature death in 1868.To a degree, the eminence of this career is contradicted today by his reputation. Contemporary wisdom describes Griesinger as a synthesizer [End Page 147] rather than an innovator, a man who mixed medical psychology with psychology and psychiatric practice, allowing neurology to take a major role in the treatment of mental disease. 2 In one version, Griesinger simply pulled the clinic and the laboratory together, and so bridged Romanticism (i.e., speculative natural philosophy) and materialism (i.e., empirical science) while failing to effect crucial modern reforms. 3 In other descriptions, Griesinger is identified as an activist (Doerner 1981), a key player in the debates between the Hegelian left and right about the reformulation of public institutions (cf. Verwey 1985), 4 or a typical (but effective) member of the intellectual elite of his age. 5 None of these options explains the attractive or threatening aspects of his clinical practice, or suggests why a psychiatrist of his rank could have been so thoroughly refuted after his death. 6The discussion which follows will try to remedy this lack by setting Griesinger’s approach to mental illness in the context of a transformation of a model from philosophy into medical practice. Griesinger’s scientific context strongly combined philosophical theorizing and empirical practice, a synthesis that later generations tended to denigrate as a “speculative” approach to a branch of medicine that required a more empirical foundation. Drawing on an adaptation of Hegel’s dialectical model of history and... (shrink)

1 Analyse sociale de la connaissance et études de cas L’épistémologie sociale est un domaine de recherche en construction. L’usage généralisé de cette expression trouve son origine dans la philosophie analytique contemporaine, bien que des auteurs en sociologie des sciences puissent également l’utiliser. L’épistémologie sociale répond à une exigence d’utilité publique, à un souci d’application de la philosophie de la connaissance à des problèmes de société. Mais son développement répond égale...

In clinical medicine, a diagnosis can offer an explanation of a patient's symptoms by specifying the pathology that is causing them. Diagnoses in psychiatry are also sometimes presented in clinical texts as if they pick out pathological processes that cause sets of symptoms. However, current evidence suggests the possibility that many diagnostic categories in psychiatry are highly causally heterogeneous. For example, major depressive disorder may not be associated with a single type of underlying pathological process, but with a range of (...) different causal pathways, each involving complex interactions of various biological, psychological, and social factors. This paper explores the implications of causal heterogeneity for whether psychiatric diagnoses can be said to serve causal explanatory roles in clinical practice. I argue that while they may fall short of picking out a specific cause of the patient's symptoms, they can nonetheless supply different sorts of clinically relevant causal information. In particular, I suggest that some psychiatric diagnoses provide negative information that rules out certain causes, some provide approximate or disjunctive information about the range of possible causal processes, and some provide causal information about the relations between the symptoms themselves. (shrink)

Machine learning algorithms have begun to enter clinical settings traditionally resistant to digitalisation, such as psychiatry. This raises questions around how algorithms will be incorporated in professionals’ practices, and with what implications for care provision. This paper addresses such questions by examining the pilot of an algorithm for the prediction of inpatient violence in two acute psychiatric clinics in the Netherlands. Violence is a prominent risk in acute psychiatry, and professional sensemaking, corrective measures (such as patient isolation and sedation), and (...) quantification instruments (such as the Brøset Violence Checklist, henceforth BVC) have previously been developed to deal with it. We juxtapose the different ways in which psychiatric nurses, the BVC, and algorithmic scores navigate assessments of the potential of future inpatient violence. We find that nurses approach violence assessment with an attitude of doubt and precaution: they aim to understand warning signs and probe alternative explanations to them, so as not to punish patients when not necessary. Being in charge of quantitative capture, they incorporate this attitude of doubt in the BVC scores. Conversely, the algorithmic risk scores import a logic of pre-emption into the clinic: they attempt to flag targets before warning signs manifests and are noticed by nurses. Pre-emption translates into punitive attitudes towards patients, to which nurses refuse to subscribe. During the pilots, nurses solely engage with algorithmic scores by attempting to reinstate doubt in them. We argue that pre-emption can hardly be incorporated into professional decision-making without importing punitive attitudes. As such, algorithmic outputs targeting ethically laden instances of decision-making are a cause for academic and political concern. (shrink)

This article investigates “impaired insight,” a controversial psychiatric category describing a mad person unable to know his or her madness. Like “moral insanity” and other concepts before it, impaired insight offers a way to link the disparate logics of human responsibility in psychiatry and the law. I attribute its development to changes wrought by deinstitutionalization, the rise of antipsychotic medication, and patient incarceration in penal settings. In a system that aims to govern psychiatric patients through their freedom, the logic of (...) impaired insight introduces a wrinkle: can a person make an informed choice to refuse treatment if madness itself impairs awareness of illness? Drawing on tools from the sociology of science, I trace the process by which researchers recast psychodynamic “denial” as a neurological and therefore non-volitional “impairment” in the 1990s. I then show how social movement actors mobilized the materialized form in the legal and policy fields in the 2000s, bringing insight science to bear upon the very questions of custodial management and patient rights that gave birth to it. At stake is this dilemma: how can societies that simultaneously privilege individual responsibility and somatic accounts of behavior govern those at the border of legal capacity, and with what justification? (shrink)

There are a number of important links and similarities between public health and safety. In this extended essay, Gregg D. Caruso defends and expands his public health-quarantine model, which is a non-retributive alternative for addressing criminal behavior that draws on the public health framework and prioritizes prevention and social justice. In developing his account, he explores the relationship between public health and safety, focusing on how social inequalities and systemic injustices affect health outcomes and crime rates, how poverty affects brain (...) development, how offenders often have pre-existing medical conditions (especially mental health issues), how involvement in the criminal justice system itself can lead to or worsen health and cognitive problems, how treatment and rehabilitation methods can best be employed to reduce recidivism and reintegrate offenders back into society, and how a public health approach could be successfully applied within the criminal justice system. Caruso's approach draws on research from the health sciences, social sciences, public policy, law, psychiatry, medical ethics, neuroscience, and philosophy, and he delivers a set of ethically defensible and practically workable proposals for implementing the public health-quarantine model. The essay begins by discussing recent empirical findings in psychology, neuroscience, and the social sciences that provide us with an increased understanding of the social and neurological determinants of health and criminal behavior. It then turns to Caruso's public health-quarantine model and argues that the model provides the most justified, humane, and effective approach for addressing criminal behavior. Caruso concludes by proposing a capability approach to social justice grounded in six key features of human well-being. He argues that we cannot successfully address concerns over public health and safety without simultaneously addressing issues of social justice—including the social determinants of health (SDH) and the social determinants of criminal behavior (SDCB)—and he recommends eight general policy proposals consistent with his model. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Memory and the Instituting Social ImaginaryNancy Nyquist Potter*, PhD (bio)Emily Walsh's Article on the way that colonialism is perpetuated in psychiatry through dominant collective memory is simultaneously exciting and challenging, and merits active engagement toward making changes (Walsh, 2022). This presents a challenge to clinicians to address entrenched, often subconscious, ways of being with and helping racialized people with historical memories and current experiences.Such changes are necessary in that (...) dominant collective memory is contributory to mental illness, as Walsh writes. It also contributes to what Walsh calls a traumatic loop, whichinvolves feeling unwell due to racist abuse or the effects racialization has on the psyche, then being unable to voice these concerns to the practitioners who desire to help you. Not having the opportunity to voice these concerns can make patients feel as though these memories are not important, thereby invalidating their own negative experiences of racialization.(Walsh, 2022, p. 232)For these reasons, it is crucial that psychiatrists fully understand the harm they can do by reproducing dominant collective memories and work to change this in themselves and in the institutional systems in which they see patients/service users.I focus on one question briefly and then turn to the heart of active engagement.The question concerns what the content of dominant collective memory is and how it might play out in a particular interaction in psychiatry. This is important for clinicians who want to learn what sorts of changes need to be made in order not to continue to enact colonialism and to avoid doing harm. Walsh does a fine job setting out forms of memory and how Fanon (and she) suggest that clinicians can assist patients toward liberation from dominant collective memory. Yet I am left with uncertainty about what sorts of dominant memory serve to deny the violence in the colonized. A bit of filling out on this idea would help the motivated to move toward change.A pressing question is how to facilitate such changes. Both the limitations and the possibilities of the social imaginary can help us understand why change is so difficult and yet how it nevertheless is possible and, in fact, necessary. The social imaginary, as Code explains it, "refers to implicit but effective systems" of values, meanings, interpretations of reality, norms for living, what counts as knowing and who can be knowers, that are found in a social-political order in ways that shape our sense of self, our ways of relating to others, our responsibilities, and a sense of place (Code, 2008, pp. 31–32). The instituted social imaginary, then, tells us what sorts of persons we should be and [End Page 241] how we should see and treat others. It shapes memories and limits which memories—and whose memories—get acknowledged and which ones and whose memories are erased or ignored. It is difficult to see for what it is because it is implicit and assumed to be fixed and natural. However, this is the instituted social imaginary, where the content of the imaginary is taken as given and is naturalized. It trades in stereotypes of Black and Indigenous and other people of color as well as stereotypes of queers, people living with disabilities, the homeless, and others. It is harmful in that it perpetuates those stereotypes, controls patients/ service users, negates their own personal and community identities, and erases episodic memory. It is difficult to change because it is entrenched and often not questioned. Nevertheless, the instituted social imaginary is not totalizing. There is hope, and energy, and excitement to be found in active engagement with an instituting social imaginary. Here, we find people and communities working to critique the given, the naturalized, and even ourselves: "Imaginatively initiated counterpossibilities interrogate the social structure to destabilize its pretensions to naturalness and wholeness, to initiate a new making" (Code, 2008, pp. 34–35). In the final section, I begin to fill out these moves in relation to Walsh's work on memory and psychiatry.Clinicians are trained to be good listeners, and many of them already practice good listening skills in interacting with their patients/service users. However, many patients' experiences... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Misprision of IdentityHarold Merskey (bio)Misprision the deliberate concealment of one's knowledge of a crime...A misreading, misunderstanding, etc.A failure to appreciate the value of a thing...(Concise Oxford Dictionary)There are options in the forms of identity that Charland's subjects assume. There are options as well in the meaning of this title, which may apply severally or individually to the choices under consideration. Are those who change their identity with labels—or reject (...) labels—correctly assuming accurate descriptions, or incorrectly misleading themselves and some others? In which of these cases are observation and intervention ethical, and do they pose demands on medical ethicists, or should they simply be ignored?Types of AutonomyParticipants in chat rooms on the Internet may justifiably be considered to be individuals who are seeking a current method of communication to promote a view of themselves, or ideas that they possess, or projects that they endorse. In this they may resemble others who have used more traditional methods of presenting their ideas, their claims, their wares, hard merchandise, literary material, or political or philosophical propositions to the public at large. These others may be sales persons, advertisers, poets, singers, clowns, buskers, politicians, preachers, missionaries, learned public speakers, television presenters, news commentators (but not necessarily reporters), and anyone indeed who talks to other people in public about matters that she or he wishes to bring forward. They have a point they want to make. They may be grouping themselves as 'survivors' or pro-anorexia, or Multiple Personality Disorder victims, but they are not necessarily operating as patients who are looking for a fiduciary relationship with physicians or other health care practitioners. It is thus a long step to turn them into individuals who may have a claim on the doctor–patient relationship.Do we wish to undertake research on them? Research or study in the first instance for these circumstances must be in the field of social science. The rules of what it is ethical for a sociologist to do apply first. The rules of situations where one person has more power and the other depends on that individual for assistance without exploitation may differ considerably from case to case. In so far as there may be some special rules as to what is fair, reasonable, just, kind, merciful, or prudent to study individuals who expose themselves and their interests publicly, this is perhaps best done first by reference to standards for journalists.That criterion may be too lenient a standard for most health professionals because journalists seem to be quite willing to expose the subjects of their observations to public obloquy and to [End Page 351] present information about many individuals—information that the persons themselves do not consent to see in the public domain, but that the journalist, having acquired, feels entitled to make known. Still there are believed to be some standards that journalists observe and these tend to protect the weak and the more vulnerable, although that does not mean that they are regularly followed. They tend to emphasize not printing material that is salacious or very lewd and would have personal reference, but they do not withhold comparable information if they consider that it is accurate and describes the behavior of individuals who are of interest to the public which, in certain circumstances, may mean almost anybody.So up to this point it seems that our normal respect for the autonomy of the individual in chat rooms can be balanced against our interest in freedom of speech, which leads to open and very broadly based publication of information and observations.The Burden of the LabelOnce the medical label is affixed, a different level of stringency begins to apply to what may be studied or published. Because we feel that individuals' self-esteem is at risk and perhaps their lives, we hesitate to make cutting or pejorative comments about distressed people. Such diagnoses as cancer or depression may be held back from the patient (and, certainly, in the case of depression, even more may be kept from others around the patient). Likewise unspoken thoughts may be automatically acknowledged and, like radical material, may be carefully segregated and... (shrink)

There is no profession where social change receives more approbation and less application than psychiatry. It is considered salubrious for patients and clinicians alike. This zeal for the innovative has produced an amazing proliferation of therapies. Beyond this psychiatry even preempts a trailblazing role among the behavioral sciences for its evolutionary approach. Freud's social side has been resurrected and now it is acknowledged that the founding father devoted considerable attention to the social aspects of psychoanalysis. That this tendency is alive (...) and prospering is inferred from the emergence of psychohistory, which may even replace community psychiatry—whose lustre has faded —as an example. However, before the profession is crowned with laurel, it might be well to determine whether this appraisal is apparent or real. A more critical analysis seems to indicate that psychiatry has incorporated social influences—up to a point. At first the social component was given consideration. (shrink)

We have made huge progress in understanding the biology of mental illnesses, but comparatively little in interpreting them at the psychological level. The eminent philosopher Jonathan Glover believes that there is real hope of progress in the human interpretation of disordered minds. -/- The challenge is that the inner worlds of people with psychiatric disorders can seem strange, like alien landscapes, and this strangeness can deter attempts at understanding. Do people with disorders share enough psychology with other people to make (...) interpretation possible? To explore this question, Glover tackles the hard cases—the inner worlds of hospitalized violent criminals, of people with delusions, and of those diagnosed with autism or schizophrenia. Their first-person accounts offer glimpses of inner worlds behind apparently bizarre psychiatric conditions and allow us to begin to learn the “language” used to express psychiatric disturbance. Art by psychiatric patients, or by such complex figures as van Gogh and William Blake, give insight when interpreted from Glover’s unique perspective. He also draws on dark chapters in psychiatry’s past to show the importance of not medicalizing behavior that merely transgresses social norms. And finally, Glover suggests values, especially those linked with agency and identity, to guide how the boundaries of psychiatry should be drawn. -/- Seamlessly blending philosophy, science, literature, and art, Alien Landscapes? is both a sustained defense of humanistic psychological interpretation and a compelling example of the rich and generous approach to mental life for which it argues. (shrink)

Linda Morrison brings the voices and issues of a little-known, complex social movement to the attention of sociologists, mental health professionals, and the general public. The members of this social movement work to gain voice for their own experience, to raise consciousness of injustice and inequality, to expose the darker side of psychiatry, and to promote alternatives for people in emotional distress. Talking Back to Psychiatry explores the movement's history, its complex membership, its strategies and goals, and the varied response (...) it has received from psychiatry, policy makers, and the public at large. (shrink)

Deux grandes manières de faire de l’épistémologie sociale se sont développées depuis une trentaine d’années. L’une relève de la philosophie analytique, l’autre hérite de la sociologie des sciences. Tandis que le relativisme menace celle-ci, la première souffre d’un parti pris fondamentalement individualiste. Ces limites ont servi de base à une critique réciproque qui a viré à la concurrence, voire à l’hostilité. Le présent article suggère qu’en appliquant leurs propres méthodes d’analyse à l’opposition même des épistémologies sociales, leurs représentants auraient (...) dû privilégier à la compétition la visée d’un accord de la communauté des chercheurs. (shrink)

L’épistémologie des croyances religieuses qui pose la question de la rationalité des croyances peut être mise en question en introduisant des éléments de sciences sociales des religions et vice-versa. Un modèle épistémologique souligne que les croyances peuvent être garanties sans examen réflexif de la part du croyant. Mais dans un contexte pluraliste où la croyance particulière est mise en débat, l’exigence critique d’examen est une condition nécessaire de rationalité. En cela, l’épistémologie retrouve certains aspects de la sociologie de (...) la critique dans sa compréhension des manières de croire. Cependant, l’épistémologie dépasse l’approche de la sociologie pragma- tique car elle ne renonce pas à l’évaluation de la rationalité des croyances religieuses en évaluant les arguments pro et contra. (shrink)

According to many researchers, it is inevitable and obvious that psychiatric illnesses are biological in nature, and that this is the rationale behind the numerous neuroimaging studies of individuals diagnosed with mental disorders. Scholars looking at the history of psychiatry have pointed out that in the past, the origins and motivations behind the search for biological causes, correlates, and cures for mental disorders are thoroughly social and historically rooted, particularly when the diagnostic category in question is the subject of controversy (...) within psychiatry. This is obscured by neuroimaging studies that drive researchers to proclaim 'revolutions' in psychiatry, namely in the DSM. Providing neuroimaging evidence to support the contention that a condition is 'real' is likely to be extremely influential, as has been extensively discussed in the neuroethics literature. This type of evidence will also reinforce the pre-existing beliefs of those researchers or clinicians who are already expecting a biological description. The uncritical credence given to neuroimaging research is an ethical issue, not in its potential for contributing to misdiagnosis per se but because of the motivations that often drive this research. My claim is that this research should proceed with an awareness of presumptions and motivations underlying the field as a whole, in addition to an explicit focus on the past and potential future consequences of classification and diagnosis on the groups of individuals under study. (shrink)

The US Food and Drug Administration (FDA) is fraught with controversies over the role of values and politics in regulatory science, especially with drugs in the realm of reproductive health. Philosophers and science studies scholars have investigated the ways in which social context shapes medical knowledge through value judgments, and feminist scholars and activists have criticized sexism and injustice in reproductive medicine. Nonetheless, there has been no systematic study of values and gender norms in FDA drug regulation. I (...) focus on three questions about values in regulatory science. First, how have societal values and gender norms shaped the way that the FDA regulates drugs in the realm of reproductive health, specifically with drug labels? Second, what are the ethical, epistemic, and social consequences of these influences on regulation for women and other marginalized groups? Third, which societal values and gender norms ought to influence drug regulation about reproductive health, and how ought this happen? Integrating philosophical analysis with historical archival research and in-depth interviews, I conduct three case studies of drug labeling about reproductive health: (1) the “drug fact” about the mechanism of the morning-after pill; (2) the package inserts for patients about the health risks of oral contraceptives; and (3) the special physician labels made for prescribing drugs to pregnant women. I identify three challenges for the FDA and suggest ways to reduce the influence of sexist values and facilitate feminist alternatives. First, across these cases, I have found that there are many ways in which other concerns in reproductive medicine (such as zygotic life, fetal health, and population control) have devalued women’s health. Second, both knowledge and ignorance xvi about their reproductive health have contributed to women’s oppression, especially poor women and women of color. Finally, by avoiding the epistemic dimensions of ethics, powerful, mostly male parties in medicine (such as doctors, pharmaceutical companies, and religious institutions) have misused “informed consent,” “religious freedom,” and “paternalism” for unethical purposes. For improvement, I suggest extracting sexist values and gender norms from regulatory science that cause epistemic injustices, and I point to success stories for reforming sexism with feminism at the FDA. (shrink)

S’il est un champ de la philosophie qui a connu un essor considérable dans les pays anglo-saxons et qui demeure encore trop peu exploré en France, c’est bien celui de la philosophie économique. Ce terme ne désigne pas une « épistémologie » de la science économique, même si certains spécialistes de « philosophie économique » peuvent travailler aussi ce domaine, mais plutôt une approche philosophique des problèmes économiques et sociaux, en dialogue avec les débats des économistes, en (...) particuli.. (shrink)

Enactive approaches to psychiatry have recently argued for an understanding of psychiatric conditions based within relational interactions between individuals and their environments. A central motivation for these enactive approaches is the goal of social integration: the integration of a naturalistic approach to psychiatric conditions with their broader sociocultural dimensions. One possible issue, however, is whether appeals to the autonomy and authenticity of relationally constituted enactive individuals can provide a means of adjudicating between harmful and beneficial social constraints upon individual behaviour. (...) This paper seeks to provide enactive approaches to psychiatry with a possible means of evaluating normative influences of social contexts beyond direct interactions with relationally constituted individuals. Some of the most significant influences of the sociocultural dimension of psychiatric conditions consist not in direct interaction with individuals, but in setting the terms for interactions and interactants alike. Insofar as some social influences precede and predefine dyadic relations between individuals and their social context, these cannot be accounted for as features of interactions, but must be assessed as independent structures of the sociocultural dimension. I will provide one potential means for enactive models to assess social norms using Canguilhem’s distinction between health and pathology. I will argue that Canguilhem’s conceptualization of health in terms of adaptive normative structure provides a potential tool for social integration which strongly complements enactive approaches to psychiatry. (shrink)

Understood in their historical context, current debates about psychiatric classification, prompted by the publication of the DSM-5, open up new opportunities for improved translational research in psychiatry. In this paper, we draw lessons for translational research from three time slices of 20th century psychiatry. From the first time slice, 1913 and the publication of Jaspers’ General Psychopathology, the lesson is that translational research in psychiatry requires a pluralistic approach encompassing equally the sciences of mind (including the social sciences) and of (...) brain. From the second time slice, 1953 and a conference in New York from which our present symptom-based classifications are derived, the lesson is that, while reliability remains the basis of psychiatry as an observational science, validity too is essential to effective translation. From the third time slice, 1997 and a conference on psychiatric classification in Dallas that brought together patients and carers with researchers and clinicians, the lesson is that we need to build further on collaborative models of research combining expertise-by-training with expertise-by-experience. This is important if we are to meet the specific challenges to translation presented by the complexity of the concept of mental disorder, particularly as reflected in the diversity of desired treatment outcomes. Taken together, these three lessons – a pluralistic approach, reliability and validity, and closer collaboration – provide an emerging framework for more effective translation of research into practice in 21st century psychiatry. (shrink)

An ideal in mental health care is user participation. This implies inclusion and facilitation by clinicians to enable users to participate in decisions about themselves and in the design of suitable treatment. However, much of the work of clinicians consists of handovers and other meetings where patients are not present. It is therefore interesting to study how the patient perspective is handled in such meetings and whether it forms a basis for user participation. We conducted fieldwork in three different inpatient (...) wards in Norwegian District Psychiatric Centres. We used an interactional perspective in our analysis, where speech acts, framing and footing were key concepts. The findings show that the talk in the handovers and meetings contained five main themes and that there was a clear correlation between what was said and how it was said, and whether clinicians related to the content in a decisive, person‐centred or indecisive manner. We discuss potential participation statuses for patients and their limited opportunity to influence the talk and possible decisions about themselves. Our conclusion is that handover meetings primarily function as an aid in organising clinicians' work and could ultimately be seen as counteracting user participation. (shrink)

Another book on Marcuse... is it really necessary? Few things in life are necessary, but this particular work is certainly very helpful. It is written by one of France's more important, younger, social philosophers who is more than sufficiently acquainted with the cultural, literary, and historical background to produce a high quality, scholarly work of this sort. For some years Raulet has been a codirector of the annual Praxis gathering in Dubrovnik and the director of the Weimar Cultural Study Group (...) at the Maison des sciences de l'homme in Paris. His previous writings in a variety of languages show both a wide breath of interest and a serious understanding of the European intellectual movements from the eighteenth century to the present. (shrink)