In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further (...) questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

In this book, Harold Langsam argues that consciousness is intelligible -- that there are substantive facts about consciousness that can be known a priori -- and that it is the intelligibility of consciousness that is the source of its ...

This essay ranges widely, using selected ideas from microeconomics, ethics, and elementary game theory in an effort to gain some understanding of the controversial issue of bribery in international markets. Its goal is partial charification of the issue and increased awareness of alternative remedy strategies.

In this paper we argue that to adequately capture the complicated relationship between Descartes' work and late medieval thought, philosophers need to think not only about his ideas but also about his presentation and choice of genre. Reading the Meditations as a mere discursive treatise containing a progressive and consistent set of arguments intended to establish a particular philosophical position fails to appreciate the eponymous genre that Descartes explicitly chose to employ in writing them. Instead, we argue that reading the (...) text in light of the long tradition of contemplative meditative literature opens up a radically new way of interpreting the Meditations as a “mystagogical” project of spiritual edification and epistemic and volitional transformation. During such a transformation, the meditator undergoes a series of revelatory experiences structurally similar to those we find in various so-called “mystical” or “mystagogical”literature, in the Christian West. We show how paying attention to these mystagogical aspects of the Meditations can open up new avenues for understanding the connection between the theoretical, practical, and theological aspects of Descartes' thought. Such a reading resolves a number of seemingly glaring problems and peculiarities in the Meditations including the Cartesian circle, and the tension in the Cartesian notion of the freedom of the will. We also argue that the odd detours the meditator takes in the Sixth Meditation through physiology are not mere digressions but rather mark an often overlooked aspect of the mystagogical story – the return to embodiment as a transformed self. Indeed, the overly intellectualist emphasis of contemporary scholars on both the contemplative aspects of mystagogical literature and the epistemological focus of Descartes' project in the Meditations have caused them to largely overlook the ways in which the aim of both medieval and Cartesian meditation involves a transformative re-orientation of the whole person and their understanding of the world – one which has practical, moral, and social consequences that have gone underexplored in discussions of these texts. (shrink)

Examination of the target article for its relevance to the analysis of private behavior leads to three concerns: the absence of a new methodology for studying private behavior, the undisclosed possibility of interactions, and insufficient attention to the social context of idea generation. Regardless of these concerns, a larger issue remains: Can a science of n = 1 be credible?

The Search for the Legacy of the USPHS Syphilis Study at Tuskegee is a collection of essays from experts in a variety of fields seeking to redefine the legacy of the infamous Tuskegee Syphilis Study. The essayists place the legacy of the study within the evolution of racial and ethnic relations in the United States. Contributors include two leading historians on the study, two former United States Surgeons General, and other prominent scholars from a wide range of fields.