In lieu of an abstract, here is a brief excerpt of the content:Back to the Nineteenth Century Is ProgressJeffrey L. Geller (bio)Keywordshistory, monomania, impulse control disorders, DSMJohn Sadler Eloquently Makes the case that the phenomena of criminality, wrongful conduct, and mental illness are befuddled in current diagnostic manuals, for example, the Diagnostic and Statistical Manual (DSM)-IV-TR. The lack of clarity in the “vice–mental disorder relationship” reflects centuries old struggles to create clear demarcations between “mad” and “bad.” Sadler points out that (...) the DSMs have been and are both the products of historical, cultural, and social forces and the purveyors of defining boundaries that shape contemporary psychiatric and judicial practices. Sadler does American psychiatry a great service by resurrecting a discussion that was quite rich in the nineteenth century, but generally dormant in the twentieth. I thought I could best use this commentary by bringing to the attention the readers of Philosophy, Psychiatry & Psychology the scope of the debate amongst Sadler’s nineteenth-century predecessors.Sadler’s PredecessorsPhilippe Pinel, who presented the first clear modern description of the form of mental illness subsequently named moral insanity appeared well aware, in the early years of the nineteenth century, of the difficulties there would be accepting the concept of a limited or partial moral mania:There are certain rare examples of a peculiar turbulent and embittered character, who otherwise show no evidence of disturbed reason. Ought they to be included under the heading of “mania without delirium?” At any rate the authorities have preferred to have them admitted to asylums rather than let them mix with delinquents in houses of correction.(As cited by Walk 1954, 821)James Cowles Prichard, a British physician, is credited with “inventing” the term moral insanity, which he defined as “a morbid perversion of the feelings, affections, and active powers, without any illusion or erroneous conviction impressed upon the understanding” (Prichard 1837, 20; 1842). Prichard warned against the failure to recognize this form of insanity, illustrating his point with what we might now refer to as pyromania:Many lunatics, whose disorder was merely a destructive propensity, have set fire to houses or public buildings, and it is not to be doubted that men have been occasionally executed as criminals for such actions, who, if they had been kept in confinement, would have proved to be insane. Until the existence of moral insanity is distinctly recognized, there will always be a danger of this event ensuing in the trials of mischievous lunatics.(Prichard 1837, 287)Prichard referred to such acts as “instinctive madness” (Prichard 1842). [End Page 19]Isaac Ray, the first American to specifically address these matters (in the first edition of his Treatise on The Medical Jurisprudence of Insanity (1838), defined “partial moral mania,” indicating that, “In this form of insanity, the derangement is confined to one or a few of the affective faculties, the rest of the moral and intellectual constitution preserving its ordinary integrity” (p. 186). Ray highlighted those partial moral mania he considered to “have the most important legal relations” (p. 187): “an irresistible propensity to steal,” “an inordinate propensity to lying,” “erotic mania,” “a morbid propensity to incendiarism,” and “homicidal insanity” or “homicidal monomania” (pp. 187–234). Ray cogently described what we would categorize today as an impulse disorder: “Amid the rapid and tumultuous succession of feelings that rush into his mind, the reflective powers are paralyzed, and his movements are solely the result of a blind, automatic impulse with which the reason has as little to do, as with the movements of a newborn infant” (p. 261). Ray believed these monomanias “completely annulled... all moral responsibility for acts committed under their influence,” and consequently “the laws can rightfully inflict no punishment on their unfortunate subjects” (p. 276).Ray, like his European predecessors, was not insensitive to the conundrum these partial moral manias would likely produce:True, cases of a disputable character sometimes occur—cases in which we may well doubt whether the active principle is depravity or disease. I have no wish to conceal any difficulty which this subject may present(Ray 1861, 120).The English translation of Esquirol’s treatise in 1854 supported Ray’s views. In a lengthy chapter on the different forms of... (shrink)

Psychopathy fascinates. Modernist writers construct out of it an image of alienated individualism pursuing the moment, killing they know not why, exploiting in passing, troubled, if troubled at all, not by guilt, but by perplexity (Camus 1989; Gide 1995; Mailer 1957; Musil 1996). Psychiatrists and psychologists—even those who should know better—are drawn by it to take off into philosophical speculation about morality, evil, and the beast in man (Mullen 1992; Simon 1996). Philosophers succumb to the temptation of attempting to ground (...) speculation in the supposed facticity of psychopathy. -/- Psychopathy is a cultural construct with roots going back to the eighteenth century, but which only came to full flower over the last fifty years (Hare 1998; Lewis 1974). The currently fashionable constructions of psychopathy find wide acceptance among clinicians and academics. The problem is, however, whether the concept has connections that have been established to the behavior, psychopathology, or the structure and function of brain worthy of according even a modest level of scientific status. There is little point in basing an argument on some supposed scientific gold standard if what glitters is iron pyrites (fools' gold). -/- Neil Levy's opening paragraph contains the statement "Yet in other respects they seem quite irrational; so much so that the term moral insanity has sometimes been applied to them" (p. 129). This both asserts that there is a category "them," namely the psychopaths, and connects them to "moral insanity." Moral insanity entered the language of psychiatry when Pritchard chose to use the term to translate Pinel's category of mania sans deliré (Pritchard 1836). Pinel was attempting to conceptualize a range of disorders that bordered on insanity in the sense of severe disturbances of affect, judgment, and behavior, but that were not accompanied by hallucinations or delusions (Pinel 1798/1964). In today's terminology, the cases he described would probably fall into diagnostic groups, including major depression, bipolar disorder, epilepsy, and a range of personality disorders. A number of his more striking case histories involved antisocial and even murderous behavior, which probably reflected Pinel's role in assessing offenders for the criminal courts of Paris. Pritchard's use of the English word "moral" reflected an appeal first to its use at the time to designate something which was like or similar, but not identical (a usage the OED labels "vulgar"), and second moral in the sense of ethical, conforming to virtuous behavior. Anglophones seized on the latter meaning, although Pinel emphasized the former. Forty years later, Henry Maudsley, the most widely read psychiatrist of his generation, could assert that moral insanity was as real as Colour blindness, some people being Colour blind and some moral blind (Maudsley 1879). Moral insanity became connected variously to phrenology with its own bump over the underlying moral cortex, with the twisted genetics of degeneration, with atavistic theories of criminality, and with a range of disorders of brain from epilepsy to frontal lobe damage (Combed 1853; Ellis 1890; Pick 1989). Although it is anachronistic to use the terms "psychopathy" and "moral insanity" together, it is clear they occupied a similar social and psychiatric space, albeit in different era. This should caution against too ready acceptance of psychopathy which may turn out to be as empty and dangerous a conceptualization as moral insanity. Why dangerous? Dangerous to those labeled, because the morally insane and the moral imbeciles were placed in preventive detention in asylums and prisons, and even sterilized in some jurisdictions. Dangerous to society, because it gave a spurious scientific justification for viewing crime not as reflecting the social evils of deprivation, ignorance, and inequality but as the ravages of the born criminals. -/- Psychopaths are not, as Levy asserts, "(causally) responsible for … more than fifty percent of violent crime" (p. 129). A proportion of violent offenders, which varies widely between observers, are labeled psychopaths. This is often on the basis of Hare's psychopathy checklist, which is a subjective, albeit through training aspiring to be reproducible, and to some extent self-sustaining, evaluation system (Hare 1980, 2003). Part of the checklist gathers data on prior antisocial behavior; part constrains the examiner to subjectively estimate such matters as glibness and callousness, part requires judgments about whether the... (shrink)

Equipoise is advocated as a means of achieving high scientific and ethical standards in randomised trials. As used in the context of research the word describes a state of uncertainty characterised by the belief that in a trial no arm is known to offer greater harm or benefit than any other arm. Clinicians who lack personal equipoise are advised to accept clinical or communal equipoise, based on current unresolved disagreement among the medical profession. Equipoise is mainly discussed in the literature (...) as an issue for senior doctors and research directors. Limitations of professional equipoise are reviewed, and data on the neglected topic of patients' equipoise are reported using the example of breast cancer trials. In theory, a patient who gives informed and voluntary consent to enter a randomised trial has achieved the equilibrium of equipoise. In practice, equipoise among patients ranges from personal to proxy acceptance. (shrink)

The Nuremberg Trials of leading National Socialists established the principle that individuals may be legally punished, even by death, for obeying the laws of their country. Is there then a higher law by which enacted valid positive laws may be judged, so that persons subject to such laws would be duty-bound to defy them? In recent years the theory of natural law has been revived by a number of philosophers and jurists, who however often disagree sharply among themselves about the (...) proper methods for defining and deriving natural law. Howard Kainz surveys the history of natural law from its foreshadowing in ancient Greece down to the most recent controversies. Natural Law both introduces the subject to newcomers and sheds fresh light on such figures as Plato, Aristotle, Hume, Kant, Veatch, McInerny, Grisez, and Finnis. (shrink)

Context: This conceptual paper tries to tackle the advantages and the limitations that might arise from including second-order science into global climate change sciences, a research area that traditionally focuses on first-order approaches and that is currently attracting a lot of media and public attention. Problem: The high profile of climate change research seems to provoke a certain dilemma for scientists: despite the slowly increasing realization within the sciences that our knowledge is temporary, tentative, uncertain, and far from stable, the (...) public expectations towards science and scientific knowledge are still the opposite: that scientific results should prove to be objective, reliable, and authoritative. As a way to handle the uncertainty, scientists tend to produce “varieties of scenarios” instead of clear statements, as well as reports that articulate different scientific opinions about the causes and dynamics of change for this specific field of research. (shrink)

As the United States is currently prosecuting two wars, it is important to consider whether those wars, and the resulting noncombatantcasualties, can be morally justified. Such consideration can be initiated by considering some of Alan Donagan’s work in his book The Theory of Morality. In that book Donagan sets out to develop, as a philosophical system, that part of the common morality according to the Hebrew-Christian tradition, which does not depend on any theistic beliefs. According to that tradition it is (...) sometimes morally permissible to resort to war. This poses a problem because also part of the tradition is a near absolute prohibition on harming innocent people. Since innocent people die in war, there is a tension here.Donagan claims that this problem can be solved by assigning the blame for some such deaths to the aggressor, thereby permitting (some) resorts to war. This paper shows that this solution is inadequate; and defends a more plausible (and more traditional) justification for some innocent deaths. This justification is consistent with the system Donagan develops, and thus may have application in the consideration of the justification of the two wars currently being prosecuted by the United States. (shrink)

This practical and essential text, co-authored by an engineer and an ethicist, covers ethical dilemmas that any engineer might encounter on the job, emphasizing the responsibility of a practicing engineer to act in an ethical manner. To illustrate the complexities involved, the authors present characters who encounter situations that test the engineering code of ethics. The dialogue between the characters highlights different perspectives of each dilemma. As they proceed through the book, students see how the code of ethics can help (...) in decision making, as well as the implications of various decisions. The philosophical theory that supports the ethical situations encountered is presented as boxed material following each section. Important Notice: Media content referenced within the product description or the product text may not be available in the ebook version. (shrink)

The author clarifies the existential philosophy that is implicit in Kurt Goldstein's philosophy of organism (Goldstein, 1963; 1995). Situated in response to the growing trend that psychological phenomena are reducible to the nervous system, the author argues for the reverse: that the significance of nervous system activity can only be understood by viewing it as background to foreground performances. Like the organization of perception into meaningful figure-- ground Gestalts, the existential modes of embodiment, sociality, temporality, spatiality, and attunement are organized (...) together to accomplish foreground performances. It is only within this context that the activity of the nervous system may be understood as significant or insignificant. Speech is given as an example. The article concludes with a commentary on how the trend of reducing psychological phenomena to neurological phenomena has impaired our understanding of brain disorders and psychological disorders. (shrink)

A questionnaire on the attitudes towards the functions of research ethical committees was sent to members of selected research ethical committees in Wessex and some controls. Almost all respondents felt there was a need for ethical review of research projects; 42 per cent thought there was a need for some training before joining a committee; 67 per cent thought the system could be improved and 47 per cent thought that monitoring or follow-up procedures should be adopted. Ethical committees were thought (...) to be purely advisory, as opposed to mandatory, by 33 per cent, and 63 per cent thought they should restrict their review to ethical problems as opposed to scientific or design problems. Views about the function of non-medical members ranged from 'none at all' to 'very important'. Of the 10 controls who were asked whether they would become a member of an ethical committee if asked, seven said that on balance they would and the reasons stated varied from the view that it was a 'very important committee' to the feeling that it was 'a necessary but irksome job'. (shrink)