In this paper, I examine the connections between bipolar disorder and consent. I defend the view that many (although far from all) individuals with bipolar disorder are competent to consent to a wide variety of things when they are in a manic state.

I shall begin with the "anti-psychiatry" view that the lack of a physical basis excludes many familiar mental disorders from the category of "illness". My response to this argument will be that anti-psychiatrists are probably right to hold that most mental disorders do not involve any physical disorder, but that they are wrong to conclude from this that these mental disorders are not illnesses.

Objective—In Switzerland, as in some other European countries, medical doctors may breach patient confidentiality and report to police authorities any patient who seems prone to automobile accidents or traffic violations. The aim of this study was to see if those patients reported to authorities actually represent a higher risk than drivers not reported to the police.Design—This study was designed following a case-control study comparing the characteristics of a group of psychiatric patients who were reported to authorities for preventive purposes, with (...) the characteristics of another group of people who had disorders that were noticed at the time of an accident or traffic violation.Results—The results show that medical doctors tended to report male patients, patients with a low level of education, and patients with a severe psychiatric background. The subjects of the control group, who had often been involved in accidents or committed traffic violations in the past, did not possess these characteristics.Conclusions—The breach of medical confidentiality by doctors in reporting to authorities patients who are allegedly at risk is ethically questionable as long as the evaluation of driving performance does not rely on objective bases. (shrink)

The aim of this chapter is to argue against the idea that there needs to be a polar opposition between "biological" and "humanistic" psychiatry. The basis for this idea lies in the philosophical tradition-the view that "mind" and "brain" must be conceived either as two separate "substances" or as one and the same. It is argued that this ontological conception of the problem should be replaced with a phenomenological description of what is actually meant by talk of human mental life. (...) In particular, Merleau-Ponty's account of human beings as "body-subjects" enables us to explain some aspects of some mental disorders as manifestations of neurological dysfunction, others as human responses to traumatic situations, and others as both. (shrink)

I argue that despite the merits of Jefferson’s account of a brain disorder, which are many, the notion of function she deploys is unsuitable to the overall goals of that account. In particular, Jefferson accepts Cummins’ causal role theory of function and dysfunction. As the causal role view, in its standard elaborations, is wedded to human interests, goals, and values, it cannot serve as a value-neutral anchor for her hybrid “harm-dysfunction” account of disorder. I argue that the selected effects theory, (...) or some comparably value-neutral account, would serve her purposes better. (shrink)

This article critically examines Louis Charland’s claim that personality disorders are moral rather than medical kinds by exploring the relationship between personality disorders and virtue ethics. We propose that the conceptual resources of virtue theory can inform psychiatry’s thinking about personality disorders, but also that virtue theory as understood by Aristotle cannot be reduced to the narrow domain of ‘the moral’ in the modern sense of the term. Some overlap between the moral domain’s notion of character-based ethics (...) and the medical domain’s notion of character-based disorders is unavoidable. We also apply a modified version of John Sadler’s “moral wrongfulness test” to borderline and narcissistic personality disorders. With respect to both diagnoses, we argue that they involve negative moral evaluations, but may also have indispensable nonmoral features and, therefore, classify legitimate psychiatric disorders. (shrink)

So much has been written on this vexed issue, that one hesitates to reopen it. Yet one has no other choice when one finds scholars accepting as generally agreed a view which rests on altogether insufficient evidence. I propose, therefore, to examine the main grounds on which recent authorities interpret the disorderly motion of Tm 30a, 52d–53b, and 69b as a mythical symbol. They are four: I. That the Timaios is a myth; II. The testimony of the Academy; III. That (...) motion could not antecede the creation of time; IV. That motion could not antecede the creation of soul. (shrink)

Some would say that philosophy can contribute more to the occurrence of mental disorder than to the study of it. Thinking too much does have its risks, but so do willful ignorance and selective inattention. Well, what can philosophy contribute? It is not equipped to enumerate the symptoms and varieties of disorder or to identify their diverse causes, much less offer cures (maybe it can do that-personal philosophical therapy is now available in the Netherlands). On the other hand, the scientific (...) study of mental disorder has a long way to go. There is much disagreement and uncertainty about the nature, causes, and treatment of many specific disorders, as is evident from DSM's classification of them in predominantly symptomatic terms. And even if what is reflected in DSM were a consensus rather than a compromise, still this shifts periodically with each new edition. Moreover, it is a notorious fact that many patients who clearly have psychiatric abnormalities do not fit any of the recognized diagnostic categories.1. (shrink)

It is now generally agreed that we have to rely on value judgments to distinguish mental disorders from other conditions, but it is not quite clear how. To clarify this, we need to know more than to what extent attributions of disorder are dependent on values. We also have to know (1) what kind of evaluations we have to rely on to identify the class of mental disorder; (2) whether attributions of disorder contain any implicit reference to some specific (...) evaluative standard; and (3) whether the concept of mental disorder is value laden in the definitional or in the epistemic sense. I will argue that the evaluations we have to rely on are mainly considerations of harm, but that we also need to rely on other evaluations; that there should be no references to specific evaluative standards; and that even though mental disorders are necessarily undesirable, "mental disorder" may well be a descriptive phrase. (shrink)

Worries about the potential medicalization of social and moral problems has propelled the debate on the nature of mental disorder, with normativists insisting that psychiatric classification is inherently value-laden and naturalists maintaining that a purely descriptive account of disease is possible. In recent work, some authors take a different path, accepting that the concepts of disease and mental disorder are value-laden but maintaining that this does not prevent objective truths regarding mental disorder attribution. This paper explores two such accounts and (...) the important steps they provide toward rethinking the nature and metaphysical status of mental disorder. The challenges raised in this paper are meant to contribute to the further development of this stimulating work. (shrink)

In this paper I argue that thinking in terms of process metaphysics and seeing the mind and mental disorders as processual in nature allows for a more complete understanding of mental disorders than is allowed by non-processual frameworks, while it also allows us to incorporate what we currently know about them. In addition, it can address problems in psychiatry that arise when we ask the wrong kinds of questions that naturally arise within a non-processual metaphysical framework. In this (...) paper I address the problems of reductionism, essentialism and dualism. -/- . (shrink)

In this paper I aim to provide a characterisation of emotional disorder. I begin by criticising the thought that an agent can be judged to be experiencing an emotional disorder if his emotion causes him some type of harm. This then leads me to develop the claim that emotional disorder relates to sufficiently inappropriate emotion, where (sufficiently) inappropriate emotion relates to emotion that fails to be (sufficiently) responsive to the agent's beliefs and/or desires. Finally, I conclude the paper by suggesting (...) that if an essentially non‐cognitivist conception of emotion is accepted then – on the characterisation of emotional disorder that I defend – there may exist strong grounds for thinking that cognitive therapy will be an inappropriate form of treatment in cases of emotional disorder.1. (shrink)

Plato tries to explain the becoming of the cosmos by referring to the concepts of order and disorder. Scholars have usually focused on the relationship between the cosmos and the demiurge that Plato puts forward to explain the reasonable development. Along these lines, scholarship has examined the providential role played by both the demiurge and the soul of the world. Yet, an interesting prob­lem still remains open: what exactly is the function of disorder? What is the sense of the concept (...) of a perfectly established order if we do not know the manner in which it is achieved, since we have no understand­ing of the conditions that make it possible? Pursuing this line of thought, one may point to a providential role of the disorder given the balance of forces that operates in Plato’s cosmic becoming. (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)

A person suffering a mental illness or disorder may differ dramatically from his or her previous well self. Family and close friends who knew the person before the onset of illness tend to regard the illness as obscuring their loved one's true self and see the goal of treatment as the restoration of that self. ‘He is not really like this,’ they will say with increasing desperation. Treatment teams and others, who have no acquaintance with the person when well, respond (...) to what they see in front of them and do sometimes make harmful judgments of character based on the person's presentation when ill. (shrink)

This commentary discusses the logic of inferring modularity or the lack of modularity from observed patterns of developmental disorders.

Certain things should never be taken for granted, among them... the precise meaning of words that are at the heart of your discipline.For a large class of cases - though not for all - in which we employ the word ‘‘meaning’’ it can be defined thus: the meaning of a word is its use in the language.The prevailing state of affairs in the mental health field is one in which we have been unable to agree on a definition of our (...) central concept, that of ‘mental disorder’. That is to say, we have not achieved consensus in the matter of what criteria constitute the... (shrink)

Reimer ( Neuroethics 2008 ) believes that how we use language to characterize psychopathy may affect our judgments of moral responsibility. If we say a psychopath has a disorder we may reduce their responsibility for moral failure. If we say a psychopath is merely different, we may not reduce their responsibility. Vincent ( Neuroethics 2008 ) argues that if this were the case, a diagnosis of disorder would be both necessary and sufficient to reduce the responsibility of some agent for (...) moral failure. Vincent presents two examples to suggest that a disorder is neither necessary nor sufficient to exculpate an individual for moral failure: childhood and hypomania. Vincent suggests instead that our judgments of moral responsibility ought to be based on the individual’s capacity for moral agency. I will side with Vincent in this debate, but argue that the example she uses, hypomania, does not work. I will argue that a diagnosis of hypomania, part of Bipolar II Disorder, is sufficient to exculpate an individual for some moral failure. This is because there are responsibility-relevant capacities missing: the capacities for self-awareness and to control ones abilities. Without these capacities, the individual is not a responsible moral agent. Vincent will need to provide an alternative example to show that the presence of a disorder is not sufficient to exculpate an individual for moral failure. Whilst our use of language is important, that use reflects our judgments of the individual’s capacities for moral agency. Responsibilities are determined not only by capacities, but by the right kind of capacities, and this should be reflected in our moral judgments, and our use of language. (shrink)

What is it to have a mental disorder? The paper proposes an ability-based view of mental disorder. It argues that such a view is preferable to biological dysfunction views such as Wakefield’s Harmful Dysfunction Analysis and Boorse’s Biostatistical Theory. According to the proposed view, having a mental disorder is basically a matter of having a certain type of inability (or: an ability that is not sufficiently high): the inability to respond adequately to some of one’s available reasons in some of (...) one’s reasons-sensitive attitudes or actions, where the threshold of inability is determined by one’s being harmed. The relevant concepts of inability, reasons, and harm are sketched. The paper argues that the proposed view evades some problems of biological dysfunction views by remaining neutral on questions of causation and the evolution of the mind. Furthermore, it can capture better what is distinctively “mental” about mental disorder. On the proposed view, it is the rational relations among an individual’s attitudes and actions that are “disordered” and the relevant norms in mental disorder are the norms of reasons. As further merits, the view can account for degrees of disorder, incorporate biological as well as social aspects, and elucidate the relations among disorders, symptoms, and their causes. (shrink)

In this dissertation, I examine our mental health concepts to see what work they are currently doing as well as what work they could be doing. In 1976, Christopher Boorse stated that the mental health literature is a “web of obscurities” (p. 51). To resolve some of this confusion, I argue that we need to consider the goals we should have for our mental health concepts and then give accounts of those concepts that meet our stated goals. I argue that (...) our goals for our mental health concepts should be twofold: first, we need concepts that will work to alleviate the stigmatization of mental disorder as this stigmatization gets in the way of providing and receiving medical help, and second, we need concepts that will be useful tools for medical practitioners to use in their diagnosis and treatment practices. -/- I begin by arguing that our mental disorder concept is not currently a useful tool for medical practitioners. Moreover, I argue that our mental disorder concept is confused in such a way that it is unlikely that it could ever be a useful tool for medical practitioners. If we cannot give an account of the mental disorder concept that is a useful tool for medical practitioners, then perhaps we can give an account of the mental disorder concept that can be used toward our goal of alleviating the stigmatization of mental disorder. Before we can do that, however, we need an account of the stigmatization concept so that we can understand what our mental disorder concept needs to be alleviating. -/- I argue that stigmatization is a process whereby some entity becomes marked as disgraceful or shameful. This stigmatization process includes (1) an attitude against the entity for reasons found in the social ideology, and (2) acts against the entity. I then argue that acts of stigmatization take two forms: direct stigmatization (where stigmatizors take acts against the stigmatized entity) and indirect stigmatization (where potential victims of stigmatization take acts to avoid becoming victims of stigmatization). With that in mind, we learn that if we are to alleviate the stigmatization of mental disorder, we need to work on alleviating both direct and indirect stigmatization. It is at this point that I argue for a new account of our mental disorder concept that can be utilized to alleviate the direct and indirect stigmatization of mental disorder. With our mental disorder concept redesigned to achieve that goal, I turn to the goal of providing medical help for persons that need that help. I argue that we need to reconceptualize what it means to be a ‘diagnosable condition’ so that we can develop a new framework for diagnosis and treatment that will be more efficacious than our current system. In conclusion, I suggest that we can untangle the current confusion that is the mental health literature by imbuing our mental health concepts with specific purposes and then utilizing them to achieve those purposes as I outline in this dissertation. (shrink)

First published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.

For every legal concept X, there are clear instances exemplifying an X and clear instances exemplifying a non-X. The cases that come before courts are those that seem to lie in between, being neither clearly an X nor clearly a non-X. It is tempting to think that, being in-between, they should receive an in-between treatment, that is, to the extent that they are an X they should be treated as an X. If they are sixty percent toward being an X, (...) they should get sixty percent of the treatment due an X. But this presupposes that in-between cases can be rank-ordered at least roughly according to the degree of their X-ness. This Article explains why that generally cannot be done and why courts therefore go for an either/or approach: something gets treated either as an X or as a non-X. The explanation is rooted in the kind of phenomena explored in the theory of social choice and multi-criterial decision-making. (shrink)

This paper offers a philosophical analysis of the connection between mental disorder and suicide risk. In contemporary psychiatry, it is commonly suggested that this connection is a causal connection that has been established through empirical discovery. Herein, I examine the extent to which this claim can be sustained. I argue that the connection between mental disorder and increased suicide risk is not wholly causal but is partly conceptual. This in part relates to the way suicidality is built into the definitions (...) of some psychiatric diagnoses. It also relates to the broader normative assumption that suicidal behavior is by definition mentally disordered behavior. The above has significant epistemological implications, which I explore. I propose that the claim that suicide is connected with mental disorder cannot be justified solely by appealing to empirical evidence but also warrants a justification on conceptual and normative grounds. (shrink)

In this paper, I respond to commentaries on my book “Are Mental Disorders Brain Disorders?”. The topics I discuss are: accounts of function and dysfunction, constraints on the relationship between processes at the level of the brain and the mind, externalism in psychiatry, implications for moral responsibility and the question whether my account is a form of conceptual engineering. I defend my account and argue that the key criterion for whether mental disorders are brain disorders is (...) whether we can map dysfunctional psychological processes onto specific differences in brain function. I also acknowledge that my commentators have identified points where my account needs further development. (shrink)

Meaning-making plays a central role in how we deal with experiences of suffering, including those due to mental disorder. And for many, religious beliefs, experiences, and practices (hereafter, religious engagement) play a central role in informing this meaning-making. However, a crucial facet of the relationship between experiences of mental disorder and religious engagement remains underexplored—namely the potentially positive effects of mental disorder on religious engagement (e.g. experiences of bipolar disorder increasing sense of God’s presence). In what follows, I will present (...) empirical findings from two recent studies of mine which shed light on the extent to which participants experienced these positive effects, specific components of these effects, and how they fit into their understanding of their mental disorder and its relationship to their religious identity. In doing so, I will draw on and expand Tasia Scrutton’s Potentially Transformative view (2015a, 2015b, 2020) according to which mental disorders may provide opportunities for spiritual growth. My empirical results align with and help deepen an account according to which mental disorders are potentially spiritually transformative by providing further insight into such instances: specifically, which symptoms and internal and external factors are often involved, as well as which religious beliefs, experiences, and/or practices are often affected. After presenting these results and articulating their relevance for a potentially transformative view of mental disorder, I will then address some potential objections to the theoretical account as well as some limitations of the empirical work, before sketching possible promising directions for future research. (shrink)

In the past decades, reductionism has dominated both research directions and funding policies in clinical psychology and psychiatry. The intense search for the biological basis of mental disorders, however, has not resulted in conclusive reductionist explanations of psychopathology. Recently, network models have been proposed as an alternative framework for the analysis of mental disorders, in which mental disorders arise from the causal interplay between symptoms. In this target article, we show that this conceptualization can help explain why (...) reductionist approaches in psychiatry and clinical psychology are on the wrong track. First, symptom networks preclude the identification of a common cause of symptomatology with a neurobiological condition; in symptom networks, there is no such common cause. Second, symptom network relations depend on the content of mental states and, as such, feature intentionality. Third, the strength of network relations is highly likely to depend partially on cultural and historical contexts as well as external mechanisms in the environment. Taken together, these properties suggest that, if mental disorders are indeed networks of causally related symptoms, reductionist accounts cannot achieve the level of success associated with reductionist disease models in modern medicine. As an alternative strategy, we propose to interpret network structures in terms of D. C. Dennett's (1987) notion ofreal patterns, and suggest that, instead of being reducible to a biological basis, mental disorders feature biological and psychological factors that are deeply intertwined in feedback loops. This suggests that neither psychological nor biological levels can claim causal or explanatory priority, and that a holistic research strategy is necessary for progress in the study of mental disorders. (shrink)

The effects of mental disorder are apparent and pervasive, in suffering, loss of freedom and life opportunities, negative impacts on education, work satisfaction and productivity, complications in law, institutions of healthcare, and more. With a new edition of the 'bible' of psychiatric diagnosis - the DSM - under developmental, it is timely to take a step back and re-evalutate exactly how we diagnose and define mental disorder. This new book by Derek Bolton tackles the problems involved in the definition and (...) boundaries of mental disorder. It addresses two main questions regarding mental illness. Firstly, what is the basis of the standards or norms by which we judge that a person has a mental disorder - that the person's mind is not working as it should, that their mental functioning is abnormal? Controversies about these questions have been dominated by the contrast between norms that are medical, scientific or natural, on the one hand, and social norms on the other. The norms that define mental disorder seem to belong to psychiatry, to be medical and scientific, but are they really social norms, hijacked and disguised by the medical profession? Secondly, what is the validity of the distinction between mental disorder and order, between abnormal and normal mental functioning? To what extent, notwithstanding appearances, does mental disorder involve meaningful reactions and problem-solving? These responses may be to normal problems of living, or to not so normal problems - to severe psycho-social challenges. Is there after all order in mental disorder? With the closing of asylums and the appearance of care in the community, mental disorder is now in our midst. While attempts have been made to define clearly a concept of mental disorder that is truly medical as opposed to social, there is increasing evidence that such a distinction is unviable - there is no clear line between what is normal in the population and what is abnormal. 'What is Mental Disorder?' reviews these various crucial developments and their profound impact for the concept and its boundaries in a provocative and timely book. (shrink)

As it emerged from philosophical analyses and cognitive research, most concepts exhibit typicality effects, and resist to the efforts of defining them in terms of necessary and sufficient conditions. This holds also in the case of many medical concepts. This is a problem for the design of computer science ontologies, since knowledge representation formalisms commonly adopted in this field (such as, in the first place, the Web Ontology Language - OWL) do not allow for the representation of concepts in terms (...) of typical traits. The need of representing concepts in terms of typical traits concerns almost every domain of real world knowledge, including medical domains. In particular, in this article we take into account the domain of mental disorders, starting from the DSM-5 descriptions of some specific disorders. We favour a hybrid approach to concept representation, in which ontology oriented formalisms are combined to a geometric representation of knowledge based on conceptual space. As a preliminary step to apply our proposal to mental disorder concepts, we started to develop an OWL ontology of the schizophrenia spectrum, which is as close as possible to the DSM-5 descriptions. (shrink)

This book offers a comprehensive study of the views of ancient philosophers on mental disorders. Relying on the original Greek and Latin textual sources, the author describes and analyses how the ancient philosophers explained mental illness and its symptoms, including hallucinations, delusions, strange fears and inappropriate moods and how they accounted for the respective roles of body and mind in such disorders. Also considered are ethical questions relating to mental illness, approaches to treatment and the position of mentally (...) ill people in societies of the times. The volume opens with a historical overview that examines ancient medical accounts of mental illness, from Hippocrates' famous Sacred Disease to late antiquity medical authors. Separate chapters interpret in detail the writings of Plato, Aristotle, Galen and the Stoics and a final chapter summarises the views of various strains of Scepticism, the Epicurean school and the Middle and Neo-Platonists. Offering an important and useful contribution to the study of ancient philosophy, psychology and medicine. This volume sheds new light on the history of mental illness and presents a new angle on ancient philosophical psychology. (shrink)

Asian American women demonstrate higher rates of disordered eating than other women of color and comparable rates to European American women. Research suggests that leading sociocultural predictors, namely pressures for thinness and thin-ideal internalization, are predictive of disordered eating in Asian American women; however, no known studies have tested the intersection of sociocultural and culture-specific variables (e.g., ethnic identity, biculturalism, acculturative stress) to further elucidate disordered eating risk in this vulnerable, understudied group. Accordingly, this project used path analysis to simultaneously (...) examine the role of sociocultural and culture-specific effects on disordered eating in Asian American college women (N = 430). Self-report measures assessing disordered eating, sociocultural (pressures for thinness; thin-ideal internalization) and culture-specific (ethnic identity, biculturalism, acculturative stress) variables revealed that a number of sociocultural and culture-specific factors are predictive of disordered eating. Consistent with prior research, heightened perceived pressures for thinness and thin-ideal internalization were predictive of disordered eating, and thin-ideal internalization partially mediated the relationship between pressures for thinness and disordered eating. Acculturative stress predicted disordered eating and fully accounted for the inverse relationship between biculturalism and disordered eating. Overall, findings highlighted the salience of sociocultural predictors for disordered eating in Asian American women and identified biculturalism and acculturative stress as culture-specific contributors that may uniquely impact vulnerability to disordered eating in Asian American women. Thus, the combined consideration of sociocultural and culture-specific factors may be important in disordered eating research and in the development of individualized treatment plans for Asian American women. (shrink)