Volume 24, Issue 12, December 2024, Page 59-62.

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)

The DSM-5 Alternative Model for Personality Disorders dimensionally defines personality pathology using severity of dysfunction and maladaptive style. As the empirical literature on the clinical utility of the AMPD grows, there is a need to examine changes in diagnostic profiles and personality expression in treatment over time. Assessing these changes in individuals diagnosed with borderline personality disorder is complicated by the tendency for patients to cycle through multiple therapists over the course of treatment leaving the potential for muddled diagnostic clarity (...) and disjointed case conceptualizations. Following patient trajectories across therapists offers a unique opportunity to examine the AMPD’s sensitivity to and utility for capturing personality stability and change over time for patients with BPD. This article demonstrates the utility of the AMPD for two clinical cases in three distinct ways: highlighting heterogeneity in BPD between patients, comparing improvements in personality severity and style over time, and elucidating profile change across therapist ratings. We present two patients diagnosed with DSM-5 Section II BPD, crossing between two therapists over the course of 3 years of psychodynamic psychotherapy. Treating clinicians rated patients for their respective treatment phases using the Level of Personality Functioning Scale, capturing severity, and the Personality Inventory for the DSM-5, capturing style. AMPD diagnostic profiles differentiated patients with BPD in both severity and style, and captured within-patient change beyond within-therapist response bias. Results indicated greater improvements in personality severity while personality style remained more stable. Implications for the patients’ treatment progress and associated challenges are discussed, as are considerations for the utility of the AMPD in therapy. (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 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 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)

The old ritual word macte was only vaguely understood even in Republican times. As is well known, the ancient critics connected the word with magis, magnus, and explained it as magis auctus. A glance at Walde's Wörterbuch reveals that many attempts have been made in modern times to solve the mystery; but the formidable equipment of the modern philologist has yielded little better results than the popular etymology of the ancients, the most favoured view to-day seeing in mactus the PPP (...) of a verb mago with macto as the frequentative which replaces it. The supposed semantic development of this verb, originally meaning ‘to increase’, has been set forth by Warde Fowler in a well-known passage, to which recent authorities have accorded their assent and praise: ‘the vitality of the deity … was really increased by placing on the altar the organs of life of the victim’. But this is a solution which ignores half the problem: macte and mactare are used not only of the deities but also of the victim. One can perhaps understand lovem mactare as ‘to magnify J.’, but not even by the most superficial analogy can we find a transition from here to the meaning typified in mactare vinum. Yet this is one of the most frequent usages of the word. So deep a gulf lies between the two semantic spheres of the verb that some scholars have sought to find in it two different verbs. But this is a counsel of despair which the editor of the Thesaurus dismisses with a non recte. We must agree, then, with Hey that the modern explanation is ‘sicher eine unrichtige’ and with Meillet-Ernout that there exists ‘aucune étymologie claire’. It is, therefore, surprising that so ill-founded a preconception should lead investigators to ignore or even dismiss important evidence which the ancient authorities offer for the solution of this problem. (shrink)

In order to get out of present day discussions between determinism and free will, creationism and evolution, bios and zoē, human existence and biological life – those dead end binaries of our present day thinking into which we have manoeuvred ourselves – we need to revisit the Ancient discussions relating to the care of the soul and human existence. I will draw together these two themes from Jan Patočka’s writings by anchor-ing them in his account of Socrates who was the (...) first to emphasise the idea of human re-sponsibility not only for thinking but also for human acting in the world. I will argue that the significant common feature – the care for our own being, our existence – brings Patočka’s reflections on the care for the soul and care for our human existence together. While, according to Patočka, the notion of the care for the soul was displaced from the philosophical reflection by the modern scientific venture, the idea of human existence is, although problematic from the scientific point of view, still a part of our experience.Para librarnos de discusiones contemporáneas entre determinismo y libre albedrío, creacionismo y evolución, bios y zoē, existencia humana y vida biológica, estos binomios, callejones de salida del pensamiento de hoy en los que nos hemos metido, tenemos que volver a escuchar las discusiones de la Antigüedad sobre el cuidado del alma y la existencia humana. Voy a recuperar estos dos temas de escritos de Jan Patočka, anclándolos en su interpretación de Sócrates, el primero en poner énfasis en la idea de responsabilidad humana no solo de su pensamiento sino también de su actuar en el mundo. Argumentaré que el significativo rasgo común, esto es, el cuidado por nuestro propio ser, nuestra existencia, es lo que une las reflexiones de Patočka sobre el cuidado del alma y el cuidado de la exitencia humana. Mientras que, según Patočka, la noción del cuidado del alma ha sido desplazada de la reflexión filosófica por la empresa científica moderna, la idea de la existencia humana, a pesar de lo problemático que puede resultar desde un punto de vista científi-co, todavía forma parte de nuestra experiencia. (shrink)

Hanlester Network v. Shalala ) marks the first test of the application of the Medicare-Medicaid anti-kickback statute to physician self-referral joint ventures. The most recent development in this ongoing litigation was the April 6, 1995 decision of the Ninth Circuit Court of Appeals, holding the Hanlester Network vicariously liable for its marketing vice president's knowing and willful violation of the antikickback statute. The vice president had offered to pay physician-investors in order to induce their referrals of program-related business.The Hanlester Network (...) was a California general partnership comprised of corporations, clinical laboratories, and individual investors. In April 1987, it entered into a management agreement on behalf of the clinical laboratories with SmithKline BioScience Laboratories. (shrink)

The level of medical care to patients and the success of the implementation of the national project "Health" depend on the health status and doctor's professionalism. Modern healthcare reform is being implemented by optimizing costs, merging medical organizations, closing ineffective hospitals, expanding the use of high-tech care and informatization of the doctor's activities. All this makes it necessary to assess the health of doctors. Scientists have studied the quality of life and identified the professional burnout of doctors in children's clinics (...) in different age groups. Primary care pediatricians have a higher quality of life score when compared to the standard [1]. However, all groups have a high level of professional burnout. The pre-retirement group of doctors has more unfavorable profile. They are highly professional specialists but may experience emotional discomfort because the pension system has been reformed. This situation requires the introduction of preventive work with doctors of this age as a group with great potential and capable of professional longevity. (shrink)

This article uses two concepts—trying on gender and local gender regime—to examine adolescent gendering processes for 26 girls from two northeastern communities. Based on a four-year study, the author found that the process of becoming a woman is much more provisional than previously thought. Adolescent girls resist, experiment, and practice gender in a trying-on process; gender, race, and class structures in the communities mutually reinforce particular kinds of femininities. This article describes the gender regime of each community and examines how (...) the gender regimes differentially shape the process of trying on gender as these girls make the transition to womanhood. (shrink)

The question addressed here is whether evidence concerning defendants' past criminal records should be introduced at their trials because such evidence reveals their character and thus reveals whether they are the kinds of persons likely to have committed the crimes with which they are currently charged. I strongly caution against the introduction of such evidence for a number of reasons. First, the link between defendants' past criminal records and claims about their standing dispositions to think and act is tenuous, at (...) best. Second, noncharacter, or trace, evidence should have primacy in determining the guilt or innocence of defendants. Third, character evidence will vary in its freshness and specificity. Other things being equal, only relatively fresh and specific character evidence has probative value. Moreover, such evidence will have greater probative value in criminal cases where the issue before the court is whether a crime has been committed than in cases where the issue is whether it was the defendant who committed the crime. Finally, we might be more sanguine about the introduction of fresh and specific character evidence under conditions likely to work against its misuse or misinterpretation. However, the relevant conditions may not often be satisfied in the real world of criminal trials and defendants. (shrink)

Jean Philiponus s'est toujours opposé à la notion nestorienne des anges servant les hommes à la place de Dieu. Jean Philiponus s'inscrit dans le courant égyptien critique de la fin du VIe siècle de certains récits apocryphes des anges dans l'univers primitif. L'argumentation de Philoponus est anti-dyophysite. Il s'attache à démontrer que l'univers que nous percevons est peuplé d'entités non corporelles puissantes, au service de Dieu et dont le rôle est de faire passer des messages aux êtres humains. Ces entités (...) ont été créées par le Dieu trinitaire avant l'acte divin de création. (shrink)

v. 1. De l'ineffable et de l'Un -- v. 2. De la triade et de l'unifié -- v. 3. De la procession.

The distance in conceptual space between the philosophical pragmatism of William James and the narrative theologies of Hans Frei and Stanley Hauerwas would appear at first glance to be significant. Hauerwas himself has measured that distance in public, when his extended critique of James supplied a good portion of the agenda for his Gifford Lectures, delivered in 2001 at St. Andrews and subsequently published as With the Grain of the Universe: The Church's Witness and Natural Theology. In this book, Jacob (...) Goodson dramatically closes the distance, appealing consistently to James's pragmatism as a resource not only for understanding the thought of contemporary narrative theologians but also for productively... (shrink)

Let A₁,..., An, An+1 be a finite sequence of algebras of sets given on a set X, $\cup _{k=1}^{n}{\cal A}_{k}\neq \germ{P}(X)$, with more than $\frac{4}{3}n$ pairwise disjoint sets not belonging to An+1. It was shown in [4] and [5] that in this case $\cup _{k=1}^{n+1}{\cal A}_{k}\neq \germ{P}(X)$. Let us consider, instead An+1, a finite sequence of algebras An+1,..., An+l. It turns out that if for each natural i ≤ l there exist no less than $\frac{4}{3}(n+l)-\frac{l}{24}$ pairwise disjoint sets not belonging (...) to An+i, then $\cup _{k=1}^{n+1}{\cal A}_{k}\neq \germ{P}(X)$. But if l ≥ 195 and if for each natural i ≤ l there exist no less than $\frac{4}{3}(n+l)-\frac{l}{15}$ pairwise disjoint sets not belonging to An+i, then $\cup _{k=1}^{n+1}{\cal A}_{k}\neq \germ{P}(X)$. After consideration of finite sequences of algebras, it is natural to consider countable sequences of algebras. We obtained two essentially important theorems on a countable sequence of almost σ-algebras (the concept of almost σ-algebra was introduced in [4]). (shrink)

A lecture concerned with women as philosophers and as philosophical thinkers. Some bibliographical information in the footnotes.