Psychiatry’s little other: DSM-5 and debates over psychiatric science (original) (raw)
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Psychiatry and the DSM: Cracks in an epistemic empire
In this article it is argued that the ontological integrity of psychiatry as a medical science remains deeply problematic. Psychiatric practice and attendant descriptive methodology in the form of the Diagnostic and Statistical Manual of Mental Disorders (DSM) have come under mounting scrutiny and criticism. Some of the most strident criticisms of psychiatric practice and theory have come from within its esteemed quarters (see Szasz, 1970) and have been reinvigorated through a recent publication by Allen Frances, the head of the DSM-IV Taskforce. The arguments put forward by Frances are not new but carry added significance in that they stem from one of the professions most revered voices. Frances heretical attack on psychiatry’s ‘bible’, the DSM, offers the reader a glimpse into the operations taking place within the ‘inner sanctum’ of psychiatry, the DSM Taskforce. It is argued that psychiatry’s co-option by Big Pharma is reflective of a form hegemonic alignment that is consistent with the historical and political functioning of the ‘psy-complex’ in modern bureaucratic society. This article provides a breviloquent review of this history. The paper closes with an ironic resolve by offering a new discursive architecture for the profession of psychiatry.
philsci-archive.pitt.edu
The contemporary epistemic status of mental health disciplines does not allow the cross validation of mental disorders among various genetic markers, biochemical pathway or mechanisms, and clinical assessments in neuroscience explanations. We attempt to provide a meta-empirical analysis of the contemporary status of the cross-disciplinary issues existing between neuro-biology and psychopathology. Our case studies take as an established medical mode an example cross validation between biological sciences and clinical cardiology in the case of myocardial infarction. This is then contrasted with the incoherence between neuroscience and psychiatry in the case of bipolar disorders. We examine some methodological problems arising from the neuro-imaging studies, specifically the experimental paradigm introduced by the team of Wayne Drevets. Several theoretical objections are raised: temporal discordance, state independence, and queries about the reliability and specificity, and failure of convergent validity of the inter-1 disciplinary attempt. Both modern neuroscience and clinical psychology taken as separate fields have failed to reveal the explanatory mechanisms underlying mental disorders. The data acquired inside the mono-disciplinary matrices of neurobiology and psychopathology are deeply insufficient concerning their validity, reliability, and utility.
In Quest for Scientific Psychiatry: Toward Bridging the Explanatory Gap
Philosophy, Psychiatry, & Psychology, 2013
The contemporary epistemic status of mental health disciplines does not allow the cross validation of mental disorders among various genetic markers, biochemical pathway or mechanisms, and clinical assessments in neuroscience explanations. We attempt to provide a meta-empirical analysis of the contemporary status of the cross-disciplinary issues existing between neuro-biology and psychopathology. Our case studies take as an established medical mode an example cross validation between biological sciences and clinical cardiology in the case of myocardial infarction. This is then contrasted with the incoherence between neuroscience and psychiatry in the case of bipolar disorders. We examine some methodological problems arising from the neuro-imaging studies, specifically the experimental paradigm introduced by the team of Wayne Drevets.
In quest for scientific psychiatry: towards bridging the explanatory gap
2009
The contemporary epistemic status of mental health disciplines does not allow the cross validation of mental disorders among various genetic markers, biochemical pathway or mechanisms, and clinical assessments in neuroscience explanations. We attempt to provide a meta-empirical analysis of the contemporary status of the cross-disciplinary issues existing between neuro-biology and psychopathology. Our case studies take as an established medical mode an example cross validation between biological sciences and clinical cardiology in the case of myocardial infarction. This is then contrasted with the incoherence between neuroscience and psychiatry in the case of bipolar disorders. We examine some methodological problems arising from the neuro-imaging studies, specifically the experimental paradigm introduced by the team of Wayne Drevets.
Psychiatry as Cognitive Neuroscience: Philosophical Perspectives
2009
Sample chapter available for download! CONTENTS Introduction - Psychiatry as Cognitive Neuroscience: An Overview (M.R. Broome and L. Bortolotti) Psychiatry as Science Chapter 1. Is Psychiatric Research Scientific? (R. Cooper) Chapter 2. A Secret History of ICD and the Hidden Future of DSM. (K.W.M. Fulford and N. Sartorius) Chapter 3. Delusion as a Natural Kind. (R. Samuels) The Nature of Mental Illness Chapter 4. Mental Illness is Indeed a Myth. (H. Pickard) Chapter 5. Psychiatry and the Concept of Disease as Pathology. (D. Murphy) Reconciling Paradigms Chapter 6. On the Interface Problem in Philosophy and Psychiatry. (T. Thornton) Chapter 7. What does Rationality Have to Do with Psychological Causation? Propositional attitudes as Mechanisms and as Control Variables. (J. Campbell) Chapter 8. Mad Scientists or Unreliable Autobiographers? Dopamine Dysregulation and Delusion. (P. Gerrans) Psychiatry and the Neurosciences Chapter 9. When Time is Out of Joint: Schizophrenia and Functional Neuroimaging. (D. Lloyd) Chapter 10. Philosophy and Cognitive-Affective Neurogenetics. (D. Stein) Chapter 11. An Addictive Lesson: A Case Study in Psychiatry as Cognitive Neuroscience. (L. Stephens and G. Graham) Phenomenology and Scientific Explanation Chapter 12. Understanding Existential Changes in Psychiatric Illness: The Indispensability of Phenomenology. (M. Ratcliffe) Chapter 13. Delusional realities. (S. Gallagher) Delusions and Cognition Chapter 14. Delusions: a Two-Level Framework. (K. Frankish) Chapter 15. Explaining Pathologies of Belief. (A.M. Aimola Davies and M. Davies) Moral Psychology and Psychopathology Chapter 16. Mental Time Travel, Agency and Responsibility. (J. Kennett and S. Matthews) Chapter 17. Motivation, Depression and Character. (I. Law) Conclusion: The Future of Scientific Psychiatry. (L. Bortolotti and M.R. Broome) One of the best books of 2009 for the Guardian, according to Mary Warnock: http://www.guardian.co.uk/books/2009/nov/22/books-of-the-year-2009\. For reviews and other information about the book, go to: http://sites.google.com/site/lisabortolottiphilosophy/books/psychiatry
Hermeneutics, Understanding, and Interpretation in Psychiatry
The Philosophy of Psychiatry: A Companion. Edited by Jennifer Radden. Oxford University Press, 2004, pps. 351-363., 2004
Psychopathology and Psychotherapy in Present-Day Psychiatry: Psychiatry is moving through a period in which its basic subject matter, namely, the experiential world of its patients, seems inaccessible and unknowable. Contemporary psychiatry does claim that there are certain aspects of mental disorders that we can know. Indeed, psychiatry is experiencing a time of steady growth of knowledge in particular areas. Neurobiology and psychopharmacology seem to be based on firm scientific foundations, and these important fields constitute a considerable part of the picture of psychiatric understanding and treatment. Moreover, psychiatry has developed manuals of diagnostic categories, the Diagnostic and Statistical Manual of Mental Disorders and ICD-10, which are highly regarded for the rigorous procedures by which they have been constructed and revised. It is inevitable, then, that traditional psychiatric concerns like psychopathology and psychotherapy would fall within the shadow cast by these steadily advancing fields. What is not inevitable, we think, is that in comparison with these other fields psychopathology and psychotherapy would fall into the disrepute into which they have in fact fallen. This disrepute is not due to the intrinsic merits of psychopathology and psychotherapy. We believe that, for a large part, it is due to political and economic forces that today powerfully shape the reality of psychiatry. Economic forces impose limitations on the time psychiatrists can spend with patients, and political pressures enforce these limitations by dictating treatments that take no longer than the little time allowed (Schwartz et al, 2002). Aiding the economic and political forces, however, is a particular view of psychiatric " science. " It is assumed in many quarters – even in those quarters unhappy with the assumption – that the methodology used in drug trials on large populations of subjects along with the methodology employed in neurobiology are the sole scientific methodologies. Or, if the field of scientific proof is admitted to reach further, the natural sciences – sometimes called " the hard sciences " – still define the paradigm. Since it is impossible to adapt these methodologies so that they can be applied in psychopathology and psychotherapy, the latter two fields are assumed to be doomed to unscientific stagnation. Much is lost, however, with the withering away of psychopathology and psychotherapy: namely, a large part of the understanding of mental disorders is forfeited. Moreover, with the loss of this understanding comes a fragmentation and incoherence in psychiatric conceptualization and treatment. Psychiatrists sometimes deal with this incoherence and fragmentation by claiming that they are " pragmatists " : they do " whatever works. " This, of course, is only a direct admission that they have little understanding of what they are doing. Before, however, we entirely despair of the possibility of placing psychopathology and psychotherapy on respectable foundations, we think it wise to reexamine the subject matters of these areas in order to try to determine how an understanding of them might be attainable.
Psychiatry as a Science: What Epistemological Foundations is Its Practice Based On?
2017
The aim of science is observing the nature and extract from it conclusions concerning its reality. However, science has the formal status of systematic thinking, founded on Cartesian method (Descartes, 1991). In Descartes’ dual view, the mind does not belong to the part of the nature that contains the extensive elements (res cogitans), i.e., elements that can be subjected to mensuration, even though they are mental attributes experienced within the subject. Psychiatry is the human practice that treats the mental diseases in first instance. This point is discussed in this paper, referring to the possibility of Psychiatry, nowadays, to be a science, once Psychiatry does not deal with a universe of formally extensive elements, considering the methodological problems related to the application of the empirical method on the attributes of mind. We develop our argument by starting from the original problem of empirical science, related to the absolute knowledge of any extensive element, d...
Bridging the Divide: Towards a unified and interdisciplinary Psychiatry
My core claims in this paper are (1) that mental illnesses are irreducible to biology and the brain sciences, and (2) that the future of psychiatry lies in a pluralist, interdisciplinary approach. I take as my point of departure, the so-called ‘crisis’ of contemporary psychiatry – that scientific research has failed to uncover the source of madness. The mainstream response to this crisis has been to place all hopes in a reductive research program. This faith in reductionism is, I argue, misplaced due to the fundamentally irreducible nature of mental illness. Instead, it is through interdisciplinary collaboration that we might hope to unravel the threads of consciousness and achieve greater understanding of mental illness. On the basis of (1) and (2), I argue that (3) phenomenology must form an integral part of that psychiatric pluralism. These three claims are mutually supportive and interlinked. Phenomenology is uniquely equipped to provide invaluable insight into the experience and development of mental illness and as such is indispensable to the psychiatric endeavor.
What Neuroscience Tells Us About Mental Illness: Scientific Realism in the Biomedical Sciences
RHV. An International Journal of Philosophy, 2022
Our philosophical understanding of mental illness is being shaped by neuroscience. However, it has the paradoxical effect of igniting two radically opposed groups of philosophical views. On one side, skepticism and denialism assume that, lacking clear biological mechanisms and etiologies for most mental illnesses, we should infer they are constructions best explained by means of social factors. This is strongly associated with medical nihilism: it considers psychiatry more harmful than benign. On the other side of the divide, naturalism and reductionism are on the look for failures in the biological functioning of the organism whenever a genuine mental illness occurs. Psychiatry as currently practiced, accordingly, exhibits the gaps of an ongoing research programme; a yet to be completed neuroscience would link mental illnesses with identifiable biological mechanisms. Both sides of this divide claim to be fostered by scientific discoveries and advances in neuroscience, when taken at face value. Against this background, we argue instead for a modest view. To that end, we draw attention to some nuances in the scientific realism debate. While contending that neuroscientific theories and models aim to provide true representations of their target systems, and can justifiably claim to have attained some, we argue that our confidence should not be placed beforehand in specific features of these scientific representations. Hence, it would be unwarranted to extract morals for psychiatry from posits (or their absence) in neuroscientific explanations of mental illnesses. To illustrate our position, we examine some recent discoveries in neuroscience concerning bipolar disorder. We conclude by linking our topic to a broader issue in the philosophy of medicine: insofar as psychiatry is a biomedical specialty, its classifications of health and disease are guided by pragmatic concerns, as well as by scientific discoveries.