Philosophy of Psychiatry: A Contemporary Introduction (Routledge Contemporary Introductions to Philosophy)

This is the first introductory textbook of its kind devoted to philosophy of psychiatry, offering a thorough and accessible investigation of the conceptual and philosophical problems at the heart of psychiatric practice and research. While it applies some of the long-standing concerns of philosophy to the mental health professions, it also investigates philosophical problems and issues that have arisen more recently from careful examination of psychiatric phenomena. Divided into two parts, Philosophy of Psychiatric Practice and Research and Philosophy and Psychopathology , the book’s 12 chapters cover topics like the ontological status of mental illness, philosophical issues in diagnosis, the role of culture in psychiatry and the relationship between mental illness and personal identity, as well as explore foundational problems in studying well-known psychopathologies like schizophrenia, depression and addiction. All chapters include initial overviews and concluding summaries and a list of suggested readings. Key Features Two-part structure – divided between (1) philosophy of psychiatric practice and research, and (2) philosophy and psychopathology – presents a clear, yet distinctive picture of the field Offers a unified style and vision throughout, with easy-to-follow segues from chapter to chapter Pedagogical features include chapter overviews and summaries, discussion questions and sections for further reading Cover Half Title Series Title Copyright Contents Preface Acknowledgements 1 Introduction: what is philosophy of psychiatry and why does it matter? 1.1 Philosophy of x 1.2 Psychiatry broadly construed 1.3 Why does the philosophy of psychiatry matter? 1.3.1 It improves understanding and treatment of mental illness 1.3.2 It improves the way our institutions function 1.3.3 It improves our societal responses to mental illness 1.3.4 It gets to the heart of what makes us human Summary Note Further reading Part 1 Philosophy of Psychiatric Practice and Research 2 What is mental illness? 2.1 Illness, disease and neighbouring notions 2.1.1 Illness, disease, disorder and sickness 2.1.2 Illness versus disability 2.1.3 Illness, difference and diversity 2.2 Philosophical accounts of illness 2.2.1 Mapping the terrain 2.2.2 How viable is objectivism? 2.2.3 Hybrid accounts 2.2.4 Values-based accounts 2.3 Is mental illness a myth? 2.3.1 Szasz’s argument against the existence of mental illness 2.3.2 What does the myth achieve? 2.3.3 Taking stock: is mental illness real? Summary Notes Further reading 3 Psychiatric diagnosis and the medical model 3.1 Diagnosis and the medical model 3.1.1 The relationship between diagnosis and the medical model 3.1.2 Motivations for the medical model 3.1.3 What is diagnosis? 3.1.4 Current practices of Western psychiatric diagnosis: the DSM and the ICD 3.1.5 Strong versus minimal medical models 3.2 Issues in psychiatric diagnosis 3.2.1 Causalism versus descriptivism 3.2.2 Essentialism versus pragmatism 3.2.3 Objectivism versus evaluativism 3.2.4 Internalism versus externalism 3.2.5 Categories versus dimensions 3.2.7 Taking stock 3.3 Challenges and alternatives to diagnosis 3.3.1 Concerns about the impact of psychiatric diagnosis 3.3.2 Theoretical concerns with diagnosis 3.3.3 Alternatives to diagnosis 3.3.4 To diagnose or not to diagnose? Summary Further reading 4 Mental illness, moral responsibility and the boundaries of the person 4.1 Introducing the issue 4.1.1 Responsibility and related notions 4.1.2 A variety of concrete examples 4.2 Approaches to mental illness and moral responsibility 4.2.1 Mental illness and legal responsibility: “the insanity defence” 4.2.2 Incidental versus intrinsic accounts 4.3 Requirements for responsibility 4.3.1 A simple view: information and control 4.3.2 The Deep Self View 4.3.3 The Sane Deep Self View 4.3.4 Taking stock 4.4 Mental illness revisited 4.4.1 Objectivism and the incidental view 4.4.2 Values-based accounts and the intrinsic view 4.4.3 Fictionalism about mental illness and morality 4.4.4 Narratives of illness, responsibility and personhood Summary Notes Further reading 5 Religion, culture and pathology 5.1 The controversial exemption of religious belief 5.2 Safety in numbers 5.2.1 Epistemic considerations for widely held belief 5.2.2 Practical considerations for widely held belief 5.2.3 Biomedical considerations for widely held belief 5.2.4 Taking stock: the intelligence of the masses? 5.3 Is religion special? 5.3.1 A values-based approach: religion as life-enhancing 5.3.2 An objectivist approach: the cognitive science of religion 5.4 The challenge of cultural sensitivity 5.4.1 An objectivist approach 5.4.2 A values-based approach 5.4.3 The social kindling hypothesis 5.4.4 Context of formation versus context of evaluation Summary Further reading 6 Scientific explanation in psychiatry 6.1 The challenge of scientific psychiatry 6.2 The nature of explanation 6.2.1 The formal-logical view 6.2.2 The ontological view 6.2.3 The pragmatic view 6.2.4 Taking stock 6.3 Levels and kinds of explanation 6.3.1 Levels of explanation: an ambiguity 6.3.2 Levels and kinds of explanation: two separate constraints 6.3.3 A comment on personal explanation 6.3.4 Some examples 6.4 Related issues 6.4.1 Accuracy and explanatory power 6.4.2 Two kinds of reductionism Summary Notes Further reading Part 2 Philosophy and Psychopathology 7 Schizophrenia 7.1 The concept of schizophrenia 7.1.1 A brief history of “schizophrenia” 7.1.2 “Psychosis” 7.1.3 The relationship between schizophrenia and psychosis 7.2 The phenomenon itself 7.2.1 Diagnosing schizophrenia 7.2.2 Epidemiology of schizophrenia 7.3 Mechanistic accounts 7.3.1 Source-monitoring accounts 7.3.2 Self-monitoring accounts 7.3.3 The dopamine hypothesis 7.3.4 Introducing the predictive processing framework 7.3.5 Predictive processing accounts of psychosis 7.4 Phenomenological approaches 7.4.1 Big P versus Little p phenomenology 7.4.2 Ipseity accounts of schizophrenia 7.4.3 Psychosis as disruption to the anticipatory structure of experience 7.4.4 The explanatory contribution of phenomenological approaches 7.5 The case against schizophrenia 7.5.1 Socio-political critiques 7.5.2 Scientific critiques 7.5.3 Pragmatic critiques 7.5.4 Where does this leave us? Summary Notes Further reading 8 Hearing voices 8.1 The varieties of voice hearing 8.1.1 Varieties in context 8.1.2 Varieties in phenomenology 8.1.3 Varieties of underlying mechanism 8.2 The self-monitoring account 8.2.1 Introducing self-monitoring 8.2.2 Inner speech-based self-monitoring accounts 8.2.3 Arguments in favour of inner speech-based self-monitoring accounts 8.2.4 Problems and further developments 8.2.5 Self-monitoring without inner speech? 8.3 Alternative accounts 8.3.1 Spontaneous activation accounts 8.3.2 Memory-based accounts 8.3.3 Social deafferentation accounts 8.3.4 Taking stock 8.4 From self-monitoring to predictive processing 8.4.1 The problem of hypervigilance hallucinations 8.4.2 Prediction is pervasive in all cognition, not just action monitoring 8.4.3 A predictive processing account of AVH 8.4.4 Remaining challenges and future directions Summary Notes Further reading 9 Delusion 9.1 The concept of delusion 9.1.1 Delusion as a diagnostically important psychiatric concept 9.1.2 Delusions as epistemically defective mental states 9.1.3 A change of approach 9.2 Examples of clinical delusions 9.2.1 Schizophrenia spectrum and other psychotic disorders 9.2.2 Delusions and mood disorders 9.2.3 Delusion and brain injury 9.2.4 Taking stock: taxonomies of delusion 9.3 Explanatory accounts of delusion 9.3.1 Delusions in psychotic disorders 9.3.2 The classic bottom-up account of Capgras delusion (Ellis and Young 1990) 9.3.3 Explanationist versus endorsement models 9.3.4 One-factor versus two-factor accounts 9.3.5 An alternative approach: top-down accounts 9.3.6 Tracking accounts 9.4 Delusion and belief 9.4.1 Why might (some) delusions not be beliefs? 9.4.2 What is belief? 9.4.3 So do delusional patients fail to be believers? Summary Notes Further reading 10 Depression 10.1 Introducing depression 10.1.1 Depression in the DSM 10.1.2 The phenomenology of depression 10.1.3 Who gets depressed? 10.2 Delineating depression 10.2.1 Is depression an extreme version of something familiar? 10.2.2 How do we distinguish pathological depression from “healthy” sadness? 10.2.3 Depression and dysthymia 10.2.4 Depression, melancholia and cross-cultural variation 10.3 Explaining depression 10.3.1 Phenomenological explanations 10.3.2 Neuroscientific and cognitive approaches 10.3.3 Predictive processing accounts 10.3.4 Depression and motivation Summary Note Further reading 11 Addiction 11.1 Introducing addiction 11.2 What is addiction? 11.2.1 The Lay View of addiction 11.2.2 Addiction as a brain disease 11.2.3 Addiction as a mental illness 11.2.4 Addiction and self-control 11.2.5 A socio-pragmatic account 11.3 The science of addiction 11.3.1 Addiction as evolutionary mismatch 11.3.2 Addiction as dysfunctional reward learning 11.3.3 Addiction as incentive salience 11.3.3 Predictive processing accounts 11.4 Remaining philosophical issues 11.4.1 Addiction and rationality 11.4.2 Addiction, responsibility and blame 11.4.3 Addiction and pathology Summary Notes Further reading 12 The future of philosophy of psychiatry 12.1 Overlooked phenomena 12.1.1 Post-traumatic stress disorder 12.1.2 Anorexia nervosa 12.1.3 Personality disorders 12.2 Mental well-being in a digital world 12.2.1 The self and self-esteem online 12.2.2 Loneliness and togetherness online 12.2.3 Internet addiction 12.3 The rise of computational psychiatry 12.3.1 Clinical computational neuroscience 12.3.2 Computational psychiatric epidemiology 12.3.3 Deep learning in diagnostics and early intervention 12.4 Externalistic psychiatry 12.4.1 Embodied psychiatry 12.4.2 Embedded psychiatry 12.4.3 Extended psychiatry 12.4.4 Enactive psychiatry 12.4.5 Clinical consequences of externalistic psychiatry 12.5 Understanding psychiatric discourse 12.5.1 Beyond realism and anti-realism: expressivism, fictionalism, constructivism 12.5.2 The ameliorativist agenda: optimising discourse for scientific progress and social justice Summary Further reading References Index