Kim Cornish and John Wilding
- Published in print:
- 2010
- Published Online:
- September 2010
- ISBN:
- 9780195179941
- eISBN:
- 9780199864652
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195179941.003.0005
- Subject:
- Neuroscience, Behavioral Neuroscience, Development
Chapter 5 emphasizes the importance of examining attention at both the behavioral and cognitive levels. The current range of attention rating scales and more general Executive Function scales is ...
More
Chapter 5 emphasizes the importance of examining attention at both the behavioral and cognitive levels. The current range of attention rating scales and more general Executive Function scales is assessed and it is argued that, although these scales are an important tool in capturing the range of severity of inattentive behaviors in ADHD, they are less effective in discriminating inattentive behaviors in disorders that also present with significant cognitive impairment. Thus more sensitive rating tools are needed to explore the range and severity of attention signatures at the behavioral level across different neurodevelopmental disorders and across development. Knowledge thus gained will complement the current cognitive research on disorders of attention. Attention must be regarded as a continuum, thus allowing a broader understanding of variation in attention phenotypes.Less
Chapter 5 emphasizes the importance of examining attention at both the behavioral and cognitive levels. The current range of attention rating scales and more general Executive Function scales is assessed and it is argued that, although these scales are an important tool in capturing the range of severity of inattentive behaviors in ADHD, they are less effective in discriminating inattentive behaviors in disorders that also present with significant cognitive impairment. Thus more sensitive rating tools are needed to explore the range and severity of attention signatures at the behavioral level across different neurodevelopmental disorders and across development. Knowledge thus gained will complement the current cognitive research on disorders of attention. Attention must be regarded as a continuum, thus allowing a broader understanding of variation in attention phenotypes.
Jennifer Radden (ed.)
- Published in print:
- 2004
- Published Online:
- January 2009
- ISBN:
- 9780195149531
- eISBN:
- 9780199870943
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195149531.003.0005
- Subject:
- Philosophy, Philosophy of Mind
This chapter explores the concept of paraphilia as defined in the third and current fourth edition of the handbook of the American Psychiatric Association—the Diagnostic and Statistical Manual of ...
More
This chapter explores the concept of paraphilia as defined in the third and current fourth edition of the handbook of the American Psychiatric Association—the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). DSM-IV has excluded homosexual orientation from the sexual mental disorders, and eschewed the pejorative “perversion” in favor of the clinical “paraphilia” in naming other sexualities. It is argued that DSM-IV embodies cultural biases “masquerading” as scientific medical truth, but also expresses a more liberal view of human sexuality.Less
This chapter explores the concept of paraphilia as defined in the third and current fourth edition of the handbook of the American Psychiatric Association—the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). DSM-IV has excluded homosexual orientation from the sexual mental disorders, and eschewed the pejorative “perversion” in favor of the clinical “paraphilia” in naming other sexualities. It is argued that DSM-IV embodies cultural biases “masquerading” as scientific medical truth, but also expresses a more liberal view of human sexuality.
Jennifer Radden (ed.)
- Published in print:
- 2004
- Published Online:
- January 2009
- ISBN:
- 9780195149531
- eISBN:
- 9780199870943
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195149531.003.0031
- Subject:
- Philosophy, Philosophy of Mind
This chapter discusses the “official” definition of mental disorders found in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It defends the DSM definition ...
More
This chapter discusses the “official” definition of mental disorders found in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It defends the DSM definition against criticisms and shows its virtues in contrast to Wakefield's influential alternative definition of mental disorder.Less
This chapter discusses the “official” definition of mental disorders found in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). It defends the DSM definition against criticisms and shows its virtues in contrast to Wakefield's influential alternative definition of mental disorder.
Peter Zachar
- Published in print:
- 2014
- Published Online:
- September 2014
- ISBN:
- 9780262027045
- eISBN:
- 9780262322270
- Item type:
- book
- Publisher:
- The MIT Press
- DOI:
- 10.7551/mitpress/9780262027045.001.0001
- Subject:
- Psychology, Clinical Psychology
In psychiatry, almost no one questions the legitimacy of asking whether a given psychiatric disorder is real. Similarly, in psychology, scholars debate the reality of such theoretical entities as ...
More
In psychiatry, almost no one questions the legitimacy of asking whether a given psychiatric disorder is real. Similarly, in psychology, scholars debate the reality of such theoretical entities as general intelligence, superegos, and personality traits. And yet in both disciplines, little thought is given to what is meant by the rather abstract philosophical concept of “real.” Indeed, certain psychiatric disorders have passed from real to imaginary (as in the case of multiple personality disorder) and from imaginary to real (as in the case of post-traumatic stress disorder). Although metaphysical terms such as “real “ and “objective” are readily invoked in psychiatry and psychology, they are often obscure, lofty abstractions. In this book, Peter Zachar argues that metaphysical concepts are important and useful conceptual tools, but should not be treated as all-purpose blunt instruments.From the perspective of a scientifically inspired pragmatism, Zachar explores the essentialist bias, diagnostic literalism, and the concepts of natural kind and social construct. He also proposes a new model for the domain of psychiatric disorders, the imperfect community model, which avoids both relativism and essentialism. He uses this model to understand such recent controversies as the elimination of the bereavement exclusion for depression and the attempt to eliminate narcissistic personality disorder from the DSM-5.Less
In psychiatry, almost no one questions the legitimacy of asking whether a given psychiatric disorder is real. Similarly, in psychology, scholars debate the reality of such theoretical entities as general intelligence, superegos, and personality traits. And yet in both disciplines, little thought is given to what is meant by the rather abstract philosophical concept of “real.” Indeed, certain psychiatric disorders have passed from real to imaginary (as in the case of multiple personality disorder) and from imaginary to real (as in the case of post-traumatic stress disorder). Although metaphysical terms such as “real “ and “objective” are readily invoked in psychiatry and psychology, they are often obscure, lofty abstractions. In this book, Peter Zachar argues that metaphysical concepts are important and useful conceptual tools, but should not be treated as all-purpose blunt instruments.From the perspective of a scientifically inspired pragmatism, Zachar explores the essentialist bias, diagnostic literalism, and the concepts of natural kind and social construct. He also proposes a new model for the domain of psychiatric disorders, the imperfect community model, which avoids both relativism and essentialism. He uses this model to understand such recent controversies as the elimination of the bereavement exclusion for depression and the attempt to eliminate narcissistic personality disorder from the DSM-5.
Jeffrey Poland and Serife Tekin (eds)
- Published in print:
- 2017
- Published Online:
- September 2017
- ISBN:
- 9780262035484
- eISBN:
- 9780262341752
- Item type:
- book
- Publisher:
- The MIT Press
- DOI:
- 10.7551/mitpress/9780262035484.001.0001
- Subject:
- Psychology, Clinical Psychology
The subject of the book is the culture of crisis and controversy that exists in contemporary mental health research, following the publication of the fifth edition of the Diagnostic and Statistical ...
More
The subject of the book is the culture of crisis and controversy that exists in contemporary mental health research, following the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the National Institute of Mental Health’s declaration of it as unfit for guiding research in psychiatry. The book explores both the nature and sources of the crisis as well as whether and, if so, how, it can be overcome. It brings together a collection of original articles that develop and apply various analytical ideas and strategies from the philosophy of science, and from other relevant areas of philosophy and science, with the aim of clarifying some aspects of the current crisis and the associated extraordinary science. The themes of the chapters include understanding the research domain of mental illness, clarifying the nature of the problems that constitute the current crisis, identifying key substantive and methodological assumptions concerning classification and research focused on the domain of mental illness, identifying ideas bearing on how best to respond to the current crisis with respect to the scientific research agenda, and constructively addressing the tension between pursuing a progressive scientific research program concerning mental illness and maintaining a place of prominence for individual persons and their contexts.Less
The subject of the book is the culture of crisis and controversy that exists in contemporary mental health research, following the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the National Institute of Mental Health’s declaration of it as unfit for guiding research in psychiatry. The book explores both the nature and sources of the crisis as well as whether and, if so, how, it can be overcome. It brings together a collection of original articles that develop and apply various analytical ideas and strategies from the philosophy of science, and from other relevant areas of philosophy and science, with the aim of clarifying some aspects of the current crisis and the associated extraordinary science. The themes of the chapters include understanding the research domain of mental illness, clarifying the nature of the problems that constitute the current crisis, identifying key substantive and methodological assumptions concerning classification and research focused on the domain of mental illness, identifying ideas bearing on how best to respond to the current crisis with respect to the scientific research agenda, and constructively addressing the tension between pursuing a progressive scientific research program concerning mental illness and maintaining a place of prominence for individual persons and their contexts.
James C. Raines (ed.)
- Published in print:
- 2019
- Published Online:
- August 2019
- ISBN:
- 9780190886578
- eISBN:
- 9780190943851
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/oso/9780190886578.001.0001
- Subject:
- Social Work, Children and Families, Health and Mental Health
Schools have become the default mental health providers for children and adolescents, but they are often poorly equipped to meet the mental health needs of their students. The introduction tackles ...
More
Schools have become the default mental health providers for children and adolescents, but they are often poorly equipped to meet the mental health needs of their students. The introduction tackles how to make students eligible for school-based services using the Individuals with Disabilities Education Act or Section 504 of the Rehabilitation Act. Using the new DSM-5 as an organizing principle, this book then addresses the 12 most common mental disorders of childhood and adolescence, ages 3–18. While there are many books that address child and adolescent psychopathology, this book focuses on how to help students with mental disorders in pre-K–12 schools. Each chapter addresses the prevalence of a disorder in school-age populations, appropriate diagnostic criteria, differential diagnosis, comorbid disorders, rapid assessment instruments available, school-based interventions using multitiered systems of support, and easy-to-follow suggestions for progress monitoring. Unique to this book, each chapter has detailed suggestions for how school-based clinicians can collaborate with teachers, parents, and community providers to address the needs of youth with mental health problems so that school, home, and community work together. Each chapter ends with a list of extensive web resources and a real-life case example drawn from the clinical practice of the authors. The final chapter addresses two newly proposed diagnoses for self-harm in the DSM-5 and brings a cautious and sensible approach to assessing and helping students who may be at risk for serious self-injury or suicide.Less
Schools have become the default mental health providers for children and adolescents, but they are often poorly equipped to meet the mental health needs of their students. The introduction tackles how to make students eligible for school-based services using the Individuals with Disabilities Education Act or Section 504 of the Rehabilitation Act. Using the new DSM-5 as an organizing principle, this book then addresses the 12 most common mental disorders of childhood and adolescence, ages 3–18. While there are many books that address child and adolescent psychopathology, this book focuses on how to help students with mental disorders in pre-K–12 schools. Each chapter addresses the prevalence of a disorder in school-age populations, appropriate diagnostic criteria, differential diagnosis, comorbid disorders, rapid assessment instruments available, school-based interventions using multitiered systems of support, and easy-to-follow suggestions for progress monitoring. Unique to this book, each chapter has detailed suggestions for how school-based clinicians can collaborate with teachers, parents, and community providers to address the needs of youth with mental health problems so that school, home, and community work together. Each chapter ends with a list of extensive web resources and a real-life case example drawn from the clinical practice of the authors. The final chapter addresses two newly proposed diagnoses for self-harm in the DSM-5 and brings a cautious and sensible approach to assessing and helping students who may be at risk for serious self-injury or suicide.
Joseph E. Davis
- Published in print:
- 2020
- Published Online:
- September 2020
- ISBN:
- 9780226686547
- eISBN:
- 9780226686714
- Item type:
- chapter
- Publisher:
- University of Chicago Press
- DOI:
- 10.7208/chicago/9780226686714.003.0003
- Subject:
- Sociology, Health, Illness, and Medicine
To express, explain, and validate their suffering and frame intervention, many people draw upon a “grammar” of institutionalized medical concepts and practices. The source of this grammar, the focus ...
More
To express, explain, and validate their suffering and frame intervention, many people draw upon a “grammar” of institutionalized medical concepts and practices. The source of this grammar, the focus of the chapter, is a biomedical landscape of meaning—a “healthscape” of ideas, symbols, and institutionalized practices—that began to emerge in the 1950s with Freudian ideas about the neuroses and the explosive public reception of the “minor tranquilizers” like Miltown and Valium. By the early 1970s, people were using psychotropic drugs at rates comparable to today but doing so within a broadly psychosocial frame of reference, with little recourse to somatic theories, disease models, or even medical diagnoses. This began to change in the 1970s, when, especially in light of existing drug use, psychiatry began a decisive change centered in the development of a new diagnostic language of mental disorders. The 1980 edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM, was shaped by biological rather than Freudian theories. Powered subsequently by Prozac and the SSRI class of antidepressants, it shifted practice decisively toward medication, including for children, and short-term behavioral therapies, and reoriented the field toward neuroscience. The new categories were powerfully institutionalized and effectively reified.Less
To express, explain, and validate their suffering and frame intervention, many people draw upon a “grammar” of institutionalized medical concepts and practices. The source of this grammar, the focus of the chapter, is a biomedical landscape of meaning—a “healthscape” of ideas, symbols, and institutionalized practices—that began to emerge in the 1950s with Freudian ideas about the neuroses and the explosive public reception of the “minor tranquilizers” like Miltown and Valium. By the early 1970s, people were using psychotropic drugs at rates comparable to today but doing so within a broadly psychosocial frame of reference, with little recourse to somatic theories, disease models, or even medical diagnoses. This began to change in the 1970s, when, especially in light of existing drug use, psychiatry began a decisive change centered in the development of a new diagnostic language of mental disorders. The 1980 edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM, was shaped by biological rather than Freudian theories. Powered subsequently by Prozac and the SSRI class of antidepressants, it shifted practice decisively toward medication, including for children, and short-term behavioral therapies, and reoriented the field toward neuroscience. The new categories were powerfully institutionalized and effectively reified.
Stefan Vogler
- Published in print:
- 2021
- Published Online:
- January 2022
- ISBN:
- 9780226769165
- eISBN:
- 9780226776934
- Item type:
- chapter
- Publisher:
- University of Chicago Press
- DOI:
- 10.7208/chicago/9780226776934.003.0002
- Subject:
- Sociology, Gender and Sexuality
This chapter traces the historical emergence of the “sexual deviant” in late-19th and early-20th century sexology and medicine. Notions of both homosexuality and sex crimes took shape during this ...
More
This chapter traces the historical emergence of the “sexual deviant” in late-19th and early-20th century sexology and medicine. Notions of both homosexuality and sex crimes took shape during this period, and at the time both were considered part of the same phenomenon. The same body of laws targeted homosexuals, pedophiles, and rapists alike. Though some early thinkers argued that homosexuality was “benign variation” and advocated for the decriminalization and depathologization of homosexuality, it was not until the mid-20th century that conceptualizations of homosexuality and other categories of sexual deviancy began to diverge significantly. The removal of homosexuality from the DSM helped this process, but stereotypes of the “homosexual pedophile” continue even today. This chapter therefore contends that it would be wrong to see no enduring relationship between the legal and knowledge politics of queerness and sexual crimes today. Indeed, 21st century approaches to studying sexuality—attempts to “locate” pedophilia and homosexuality in the same areas of the brain, for instance—keep this specter alive.Less
This chapter traces the historical emergence of the “sexual deviant” in late-19th and early-20th century sexology and medicine. Notions of both homosexuality and sex crimes took shape during this period, and at the time both were considered part of the same phenomenon. The same body of laws targeted homosexuals, pedophiles, and rapists alike. Though some early thinkers argued that homosexuality was “benign variation” and advocated for the decriminalization and depathologization of homosexuality, it was not until the mid-20th century that conceptualizations of homosexuality and other categories of sexual deviancy began to diverge significantly. The removal of homosexuality from the DSM helped this process, but stereotypes of the “homosexual pedophile” continue even today. This chapter therefore contends that it would be wrong to see no enduring relationship between the legal and knowledge politics of queerness and sexual crimes today. Indeed, 21st century approaches to studying sexuality—attempts to “locate” pedophilia and homosexuality in the same areas of the brain, for instance—keep this specter alive.
Stefan Vogler
- Published in print:
- 2021
- Published Online:
- January 2022
- ISBN:
- 9780226769165
- eISBN:
- 9780226776934
- Item type:
- chapter
- Publisher:
- University of Chicago Press
- DOI:
- 10.7208/chicago/9780226776934.003.0007
- Subject:
- Sociology, Gender and Sexuality
Chapter 6 takes an in-depth look at the forensic assessment of sex offenders’ sexualities. One step in this process is determining exactly what the offender is sexually attracted to and whether that ...
More
Chapter 6 takes an in-depth look at the forensic assessment of sex offenders’ sexualities. One step in this process is determining exactly what the offender is sexually attracted to and whether that attraction warrants a diagnosis from the Diagnostic and Statistical Manual (DSM) that will legally brand him with a pathological sexual identity. This chapter considers how forensic psychologists, and ultimately courts, make such decisions. I argue that determining the sexuality of a potential “sexually violent predator” depends on an epistemic logic that suggests sexuality is directly discernable through bodily measures, such as those provided by polygraphs and penile plethysmographs, and other technologies meant to distill one’s subjective state into objective indicators. As one neuropsychologist I spoke with stated, his ideal goal is to never have to “talk to the guy at all—just plug his brain and penis into a machine.”Less
Chapter 6 takes an in-depth look at the forensic assessment of sex offenders’ sexualities. One step in this process is determining exactly what the offender is sexually attracted to and whether that attraction warrants a diagnosis from the Diagnostic and Statistical Manual (DSM) that will legally brand him with a pathological sexual identity. This chapter considers how forensic psychologists, and ultimately courts, make such decisions. I argue that determining the sexuality of a potential “sexually violent predator” depends on an epistemic logic that suggests sexuality is directly discernable through bodily measures, such as those provided by polygraphs and penile plethysmographs, and other technologies meant to distill one’s subjective state into objective indicators. As one neuropsychologist I spoke with stated, his ideal goal is to never have to “talk to the guy at all—just plug his brain and penis into a machine.”
Robert N. McCauley and George Graham
- Published in print:
- 2020
- Published Online:
- May 2020
- ISBN:
- 9780190091149
- eISBN:
- 9780190091170
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/oso/9780190091149.001.0001
- Subject:
- Religion, Philosophy of Religion, Religious Studies
This book endorses an ecumenical naturalism toward all cognition, which will illuminate the long-recognized and striking similarities between features of mental disorders and features of religions. ...
More
This book endorses an ecumenical naturalism toward all cognition, which will illuminate the long-recognized and striking similarities between features of mental disorders and features of religions. The authors emphasize underlying cognitive continuities between familiar features of religiosity, of mental disorders, and of everyday thinking and action. They contend that much religious thought and behavior can be explained in terms of the cultural activation of maturationally natural cognitive systems, which address fundamental problems of human survival, encompassing such capacities as hazard precautions, agency detection, language processing, and theory of mind. The associated skills are not taught and appear independent of general intelligence. Religions’ representations cue such systems’ operations. The authors hypothesize that in doing so they sometimes elicit responses that mimic features of cognition and conduct associated with mental disorders. Both in schizophrenia and in religions some people hear alien voices. The inability of depressed participants to communicate with or sense their religions’ powerful, caring gods can exacerbate their depression. Often religions can domesticate the concerns and compulsions of people with OCD. Religions’ rituals and pronouncements about moral thought-action fusion can temporarily evoke similar obsessions and compulsions in the general population. A chapter is devoted to each of these and to the exception that proves the rule. The authors argue that if autistic spectrum disorder involves theory-of mind-deficits, then people with ASD will lack intuitive insight and find inferences with many religious representations challenging. Ecumenical naturalism’s approach to mental abnormalities and religiosity promises both explanatory and therapeutic understanding.Less
This book endorses an ecumenical naturalism toward all cognition, which will illuminate the long-recognized and striking similarities between features of mental disorders and features of religions. The authors emphasize underlying cognitive continuities between familiar features of religiosity, of mental disorders, and of everyday thinking and action. They contend that much religious thought and behavior can be explained in terms of the cultural activation of maturationally natural cognitive systems, which address fundamental problems of human survival, encompassing such capacities as hazard precautions, agency detection, language processing, and theory of mind. The associated skills are not taught and appear independent of general intelligence. Religions’ representations cue such systems’ operations. The authors hypothesize that in doing so they sometimes elicit responses that mimic features of cognition and conduct associated with mental disorders. Both in schizophrenia and in religions some people hear alien voices. The inability of depressed participants to communicate with or sense their religions’ powerful, caring gods can exacerbate their depression. Often religions can domesticate the concerns and compulsions of people with OCD. Religions’ rituals and pronouncements about moral thought-action fusion can temporarily evoke similar obsessions and compulsions in the general population. A chapter is devoted to each of these and to the exception that proves the rule. The authors argue that if autistic spectrum disorder involves theory-of mind-deficits, then people with ASD will lack intuitive insight and find inferences with many religious representations challenging. Ecumenical naturalism’s approach to mental abnormalities and religiosity promises both explanatory and therapeutic understanding.
Tara Fickle
- Published in print:
- 2019
- Published Online:
- May 2020
- ISBN:
- 9781479868551
- eISBN:
- 9781479805686
- Item type:
- chapter
- Publisher:
- NYU Press
- DOI:
- 10.18574/nyu/9781479868551.003.0007
- Subject:
- Society and Culture, Media Studies
This chapter examines recent controversies over internet addiction and Chinese gold farmers, players of World of Warcraft who make a living acquiring in-game virtual currency and selling it for real ...
More
This chapter examines recent controversies over internet addiction and Chinese gold farmers, players of World of Warcraft who make a living acquiring in-game virtual currency and selling it for real money to (mostly Western) players looking to accelerate the tedious “grind” of the leveling-up process. The chapter shows how “cheap play” has been revived as a tool for condemning Chinese “cheap labor,” powerfully informing how internet game addiction is itself culturally and spatially represented in popular and psychiatric discourse. Using Cory Doctorow’s story “Anda’s Game” as a case study, it considers how twenty-first-century American anxieties about ludic immersion, compounded by the nation’s own destabilized position in the global economy, have led American game developers as well as medical professionals to pathologize gold farming as exclusionists had Chinese gambling: as symptomatic of an “Asian” psychosis that fails to respect normative boundaries between play and work, virtual and real world.Less
This chapter examines recent controversies over internet addiction and Chinese gold farmers, players of World of Warcraft who make a living acquiring in-game virtual currency and selling it for real money to (mostly Western) players looking to accelerate the tedious “grind” of the leveling-up process. The chapter shows how “cheap play” has been revived as a tool for condemning Chinese “cheap labor,” powerfully informing how internet game addiction is itself culturally and spatially represented in popular and psychiatric discourse. Using Cory Doctorow’s story “Anda’s Game” as a case study, it considers how twenty-first-century American anxieties about ludic immersion, compounded by the nation’s own destabilized position in the global economy, have led American game developers as well as medical professionals to pathologize gold farming as exclusionists had Chinese gambling: as symptomatic of an “Asian” psychosis that fails to respect normative boundaries between play and work, virtual and real world.
Justin Garson
- Published in print:
- 2022
- Published Online:
- March 2022
- ISBN:
- 9780197613832
- eISBN:
- 9780197613863
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/oso/9780197613832.003.0015
- Subject:
- Philosophy, Philosophy of Science
The third edition of the Diagnostic and Statistical Manual of Mental Disorders, of 1980, is often said to have marked a revolution in American psychiatric thought. But what is the nature of this ...
More
The third edition of the Diagnostic and Statistical Manual of Mental Disorders, of 1980, is often said to have marked a revolution in American psychiatric thought. But what is the nature of this revolution? This chapter argues that the DSM-III does not represent the victory of biological over psychoanalytic psychiatry, but the victory of madness-as-dysfunction over madness-as-strategy. The DSM-I of 1952 was infused with teleology; one task of the DSM-II and DSM-III was to strip teleology from psychiatric classification and to instill dysfunction as its organizing principle. But what does it mean to say that a person’s mind, or brain, is “dysfunctional”? This chapter considers the work of psychiatrists who, in the 1970s and 1980s, sought to answer that question in evolutionary terms. This requires conceptualizing the mad person, in the first place, as a wounded organism. The chapter also considers the recent Research Domain Criteria (RDoC) approach to classification.Less
The third edition of the Diagnostic and Statistical Manual of Mental Disorders, of 1980, is often said to have marked a revolution in American psychiatric thought. But what is the nature of this revolution? This chapter argues that the DSM-III does not represent the victory of biological over psychoanalytic psychiatry, but the victory of madness-as-dysfunction over madness-as-strategy. The DSM-I of 1952 was infused with teleology; one task of the DSM-II and DSM-III was to strip teleology from psychiatric classification and to instill dysfunction as its organizing principle. But what does it mean to say that a person’s mind, or brain, is “dysfunctional”? This chapter considers the work of psychiatrists who, in the 1970s and 1980s, sought to answer that question in evolutionary terms. This requires conceptualizing the mad person, in the first place, as a wounded organism. The chapter also considers the recent Research Domain Criteria (RDoC) approach to classification.
Martha J. Farah and Seth J. Gillihan
- Published in print:
- 2013
- Published Online:
- May 2013
- ISBN:
- 9780195389784
- eISBN:
- 9780199979233
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195389784.003.0011
- Subject:
- Neuroscience, Behavioral Neuroscience
Diagnoses in psychiatry are based entirely on behavioral, not biological, criteria: though a small number of practitioners use functional brain imaging as a diagnostic tool, most psychiatrists ...
More
Diagnoses in psychiatry are based entirely on behavioral, not biological, criteria: though a small number of practitioners use functional brain imaging as a diagnostic tool, most psychiatrists believe that imaging has no role beyond potential medically apparent causes of a patient’s condition and make no use of this resource for routine clinical care. Although biological psychiatry has had a huge impact on the overall field since the 1960s, some tools are privileged over others. This chapter considers the plausibility and potential of imaging techniques as an aid for diagnosing, categorizing, and treating psychiatric illness by considering SPECT clinics, DSM classifications (and limitations), patient receptiveness, and other current developments. It evaluates to what extent neuroimaging can act as diagnostic agent, predictor of incipient illness, and even cure unto itself.Less
Diagnoses in psychiatry are based entirely on behavioral, not biological, criteria: though a small number of practitioners use functional brain imaging as a diagnostic tool, most psychiatrists believe that imaging has no role beyond potential medically apparent causes of a patient’s condition and make no use of this resource for routine clinical care. Although biological psychiatry has had a huge impact on the overall field since the 1960s, some tools are privileged over others. This chapter considers the plausibility and potential of imaging techniques as an aid for diagnosing, categorizing, and treating psychiatric illness by considering SPECT clinics, DSM classifications (and limitations), patient receptiveness, and other current developments. It evaluates to what extent neuroimaging can act as diagnostic agent, predictor of incipient illness, and even cure unto itself.
Max Fink MD
- Published in print:
- 2010
- Published Online:
- November 2020
- ISBN:
- 9780195365740
- eISBN:
- 9780197562604
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/oso/9780195365740.003.0016
- Subject:
- Clinical Medicine and Allied Health, Psychiatry
Interest in electricity in medicine, especially in psychiatric conditions, is as old as our knowledge of electricity as a controllable phenomenon. At the end of the eighteenth and the beginning of ...
More
Interest in electricity in medicine, especially in psychiatric conditions, is as old as our knowledge of electricity as a controllable phenomenon. At the end of the eighteenth and the beginning of the nineteenth centuries, Benjamin Franklin and Anton Mesmer were among many students who used electric currents to stimulate paralyzed limbs and to relieve hysterical states. Giovanni Aldini, the nephew of Luigi Galvani, a principal early student of electricity, applied electric currents to mentally ill patients. In the original Aldini publication, the figures show one electrode applied to the top of the head and a second to the hand. The text states that the electrodes were connected to earrings. Much of Aldini’s work was done on fresh cadavers to show that electricity stimulated motor movements. There is no evidence that he produced seizures for therapeutic purposes. From the onset of the introduction of ECT, the importance of the grand mal seizure to the treatment has been questioned. Many people followed popular science beliefs in the potency of electricity alone and administered low-energy electric currents without inducing a seizure. When scientists compared sham treatments to real ECT in seeking benefits for patients, they found the sham currents to be ineffective. Low-energy electric currents delivered from a battery with electrodes on the scalp to either alert or sleeping subjects (electrosleep) were without benefit. Some applications of electricity in medicine have been truly innovative. At the end of every grand mal seizure, brain waves (measured by the EEG) flatten out, with markedly reduced rhythmic activity. Such activity can be simulated by anesthesia using a chemical called isoflurane. Isoelectric narcotherapy (isoflurane anesthesia therapy) is a brain-stimulation technique that seeks to induce long periods of electro-cerebral silence or markedly decreased electrical activity in the brain. An hour of isoelectric brain electrical activity under anesthesia was once thought to relieve depression in a fashion similar to ECT, but an attempt at replication in six subjects failed. Without independent confirmation, the technique has been abandoned. In the past two decades, three physical interventions have been enthusiastically promoted as replacements for ECT, that is, as ways to induce the same benefits without seizures.
Less
Interest in electricity in medicine, especially in psychiatric conditions, is as old as our knowledge of electricity as a controllable phenomenon. At the end of the eighteenth and the beginning of the nineteenth centuries, Benjamin Franklin and Anton Mesmer were among many students who used electric currents to stimulate paralyzed limbs and to relieve hysterical states. Giovanni Aldini, the nephew of Luigi Galvani, a principal early student of electricity, applied electric currents to mentally ill patients. In the original Aldini publication, the figures show one electrode applied to the top of the head and a second to the hand. The text states that the electrodes were connected to earrings. Much of Aldini’s work was done on fresh cadavers to show that electricity stimulated motor movements. There is no evidence that he produced seizures for therapeutic purposes. From the onset of the introduction of ECT, the importance of the grand mal seizure to the treatment has been questioned. Many people followed popular science beliefs in the potency of electricity alone and administered low-energy electric currents without inducing a seizure. When scientists compared sham treatments to real ECT in seeking benefits for patients, they found the sham currents to be ineffective. Low-energy electric currents delivered from a battery with electrodes on the scalp to either alert or sleeping subjects (electrosleep) were without benefit. Some applications of electricity in medicine have been truly innovative. At the end of every grand mal seizure, brain waves (measured by the EEG) flatten out, with markedly reduced rhythmic activity. Such activity can be simulated by anesthesia using a chemical called isoflurane. Isoelectric narcotherapy (isoflurane anesthesia therapy) is a brain-stimulation technique that seeks to induce long periods of electro-cerebral silence or markedly decreased electrical activity in the brain. An hour of isoelectric brain electrical activity under anesthesia was once thought to relieve depression in a fashion similar to ECT, but an attempt at replication in six subjects failed. Without independent confirmation, the technique has been abandoned. In the past two decades, three physical interventions have been enthusiastically promoted as replacements for ECT, that is, as ways to induce the same benefits without seizures.
Stephen E. Gilman and Jessica R. Marden
- Published in print:
- 2013
- Published Online:
- January 2014
- ISBN:
- 9780199657018
- eISBN:
- 9780191748097
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199657018.003.0020
- Subject:
- Public Health and Epidemiology, Public Health
Psychiatric epidemiology has for decades been searching for the environmental origins of psychiatric disorders. If it is ultimately determined that environmental correlates of disorders are causes, ...
More
Psychiatric epidemiology has for decades been searching for the environmental origins of psychiatric disorders. If it is ultimately determined that environmental correlates of disorders are causes, interventions targeting environmental risk factors could reduce the public health burden of psychopathology. This chapter systematically reviews the evidence linking exposures in the social environment over the life course with the risk of psychiatric disorders. Only those studies that are prospective and that define psychiatric disorders according to DSM-IV criteria have been included. The search identified 26 studies that met these inclusion criteria. These studies investigated the risk of mood, anxiety, and substance disorders following exposure to specific stressors (e.g. childhood maltreatment, parental divorce) and to the number of stressful life events during a given time-period (e.g. early childhood, past-year). Effect sizes reported in relative risk terms varied considerably across studies and ranged from 1.1 to 2.5. Topics discussed include the specificity of the associations between environmental exposures and subsequent psychiatric disorders, the consistency of associations with disorder onset and disorder recurrence, the clustering of environmental exposures, and the implications of these findings for clinical practice.Less
Psychiatric epidemiology has for decades been searching for the environmental origins of psychiatric disorders. If it is ultimately determined that environmental correlates of disorders are causes, interventions targeting environmental risk factors could reduce the public health burden of psychopathology. This chapter systematically reviews the evidence linking exposures in the social environment over the life course with the risk of psychiatric disorders. Only those studies that are prospective and that define psychiatric disorders according to DSM-IV criteria have been included. The search identified 26 studies that met these inclusion criteria. These studies investigated the risk of mood, anxiety, and substance disorders following exposure to specific stressors (e.g. childhood maltreatment, parental divorce) and to the number of stressful life events during a given time-period (e.g. early childhood, past-year). Effect sizes reported in relative risk terms varied considerably across studies and ranged from 1.1 to 2.5. Topics discussed include the specificity of the associations between environmental exposures and subsequent psychiatric disorders, the consistency of associations with disorder onset and disorder recurrence, the clustering of environmental exposures, and the implications of these findings for clinical practice.
Scott Herring
- Published in print:
- 2014
- Published Online:
- May 2015
- ISBN:
- 9780226171685
- eISBN:
- 9780226171852
- Item type:
- chapter
- Publisher:
- University of Chicago Press
- DOI:
- 10.7208/chicago/9780226171852.003.0001
- Subject:
- Society and Culture, Cultural Studies
This Introduction refutes the claim that hoarding is a mental illness. It first surveys psychology texts and argues that hoarding has been incorrectly seen as a pathology whose classification can be ...
More
This Introduction refutes the claim that hoarding is a mental illness. It first surveys psychology texts and argues that hoarding has been incorrectly seen as a pathology whose classification can be found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Contrary to this reception, the Introduction suggests that hoarding in America is a modern moral panic over things such as clutter and inappropriate keepsakes. Examining the sensationalism that hoarders incite across media, the Introduction contests this depiction and outlines how to think critically and ethically about the psychopathology of material life. It maintains that we should not treat hoarding as a neurological malfunction or as a specialized anxiety disorder but that we must historicize why hoarding seems disreputable in the United States.Less
This Introduction refutes the claim that hoarding is a mental illness. It first surveys psychology texts and argues that hoarding has been incorrectly seen as a pathology whose classification can be found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Contrary to this reception, the Introduction suggests that hoarding in America is a modern moral panic over things such as clutter and inappropriate keepsakes. Examining the sensationalism that hoarders incite across media, the Introduction contests this depiction and outlines how to think critically and ethically about the psychopathology of material life. It maintains that we should not treat hoarding as a neurological malfunction or as a specialized anxiety disorder but that we must historicize why hoarding seems disreputable in the United States.
Peter Zachar
- Published in print:
- 2014
- Published Online:
- September 2014
- ISBN:
- 9780262027045
- eISBN:
- 9780262322270
- Item type:
- chapter
- Publisher:
- The MIT Press
- DOI:
- 10.7551/mitpress/9780262027045.003.0011
- Subject:
- Psychology, Clinical Psychology
This chapter examines the diagnosis of personality disorder in general and narcissistic personality disorder (NPD) in particular. After reviewing the history of the construct of NPD, the reasons why ...
More
This chapter examines the diagnosis of personality disorder in general and narcissistic personality disorder (NPD) in particular. After reviewing the history of the construct of NPD, the reasons why it was targeted for elimination in the DSM-5 and the counter-arguments against its elimination are described. NPD was originally eliminated from the manual because it was not considered to be real, but was later reinserted. Opinions differ about whether it was reinserted because it had some clinical reality, or put back in for only political reasons. The chapter concludes by looking at why constructs for personality disorder such as NPD are included in the domain of psychiatry disorder. It is argued that competing versions of the essentialist bias interfered with the implementation in the DSM-5 of a competition between categories and dimensions that would have set up conditions in which progress would have had a better chance of occurring.Less
This chapter examines the diagnosis of personality disorder in general and narcissistic personality disorder (NPD) in particular. After reviewing the history of the construct of NPD, the reasons why it was targeted for elimination in the DSM-5 and the counter-arguments against its elimination are described. NPD was originally eliminated from the manual because it was not considered to be real, but was later reinserted. Opinions differ about whether it was reinserted because it had some clinical reality, or put back in for only political reasons. The chapter concludes by looking at why constructs for personality disorder such as NPD are included in the domain of psychiatry disorder. It is argued that competing versions of the essentialist bias interfered with the implementation in the DSM-5 of a competition between categories and dimensions that would have set up conditions in which progress would have had a better chance of occurring.
Jeffrey Poland and Şerife Tekin (eds)
- Published in print:
- 2017
- Published Online:
- September 2017
- ISBN:
- 9780262035484
- eISBN:
- 9780262341752
- Item type:
- chapter
- Publisher:
- The MIT Press
- DOI:
- 10.7551/mitpress/9780262035484.003.0001
- Subject:
- Psychology, Clinical Psychology
This chapter introduces the core thematic ideas of the present volume: that psychiatric research is in crisis, that it has entered a period of extraordinary science, and that a fully adequate ...
More
This chapter introduces the core thematic ideas of the present volume: that psychiatric research is in crisis, that it has entered a period of extraordinary science, and that a fully adequate response to the crisis should be responsive to the perspectives and interests of persons. We identify various sources of the crisis, drawing special attention to controversies concerning the role of the DSM in psychiatric research. And, we identify different strategies of response to the current crisis, including approaches that emphasize the importance of personal perspectives and the needs of the clinic and those that emphasize the important role of various scientific research programs. Further, we survey various developments (e.g., debates over fundamentals and a role for philosophical analysis, probing of the problems of the DSM framework, relaxation of standard forms of research practice, the introduction of the Research Domain Criteria initiative and other novel research programs) that are jointly suggestive of Thomas Kuhn’s characterization of periods of crisis that can arise in scientific research and of the “extraordinary science” that ensues. We suggest that this Kuhnian framework is useful for understanding the state of psychiatric research and it provides a framework for thinking about responses to the current crisis. We conclude with brief overviews of the contributions to the volume, each of which provides such a response.Less
This chapter introduces the core thematic ideas of the present volume: that psychiatric research is in crisis, that it has entered a period of extraordinary science, and that a fully adequate response to the crisis should be responsive to the perspectives and interests of persons. We identify various sources of the crisis, drawing special attention to controversies concerning the role of the DSM in psychiatric research. And, we identify different strategies of response to the current crisis, including approaches that emphasize the importance of personal perspectives and the needs of the clinic and those that emphasize the important role of various scientific research programs. Further, we survey various developments (e.g., debates over fundamentals and a role for philosophical analysis, probing of the problems of the DSM framework, relaxation of standard forms of research practice, the introduction of the Research Domain Criteria initiative and other novel research programs) that are jointly suggestive of Thomas Kuhn’s characterization of periods of crisis that can arise in scientific research and of the “extraordinary science” that ensues. We suggest that this Kuhnian framework is useful for understanding the state of psychiatric research and it provides a framework for thinking about responses to the current crisis. We conclude with brief overviews of the contributions to the volume, each of which provides such a response.
Ginger A. Hoffman and Peter Zachar
- Published in print:
- 2017
- Published Online:
- September 2017
- ISBN:
- 9780262035484
- eISBN:
- 9780262341752
- Item type:
- chapter
- Publisher:
- The MIT Press
- DOI:
- 10.7551/mitpress/9780262035484.003.0004
- Subject:
- Psychology, Clinical Psychology
Critics contend that the categories within the DSM are fueling the current crisis in psychiatry because they are not valid. As a remedy, NIMH has established RDoC, a framework of psychological and ...
More
Critics contend that the categories within the DSM are fueling the current crisis in psychiatry because they are not valid. As a remedy, NIMH has established RDoC, a framework of psychological and behavioral constructs that will — they believe — better guide the search for the biological mechanisms of psychopathology. Here, we assess the ability of RDoC to rescue psychiatry from its crisis, not only by 1) evaluating its promise of increased validity, but 2) recognizing that psychiatric diagnosis can have an impact on patients’ lives independent of its validity. To assess the former, we delineate possible interpretations of validity relevant to psychiatry, and argue that RDoC faces difficult challenges in achieving what is known as etiopathological validity. To assess the latter, we suggest how the very challenge RDoC faces with respect to validity may counterintuitively serve as a benefit to patients, by reducing the extent to which patients reductionistically re-shape their identities.Less
Critics contend that the categories within the DSM are fueling the current crisis in psychiatry because they are not valid. As a remedy, NIMH has established RDoC, a framework of psychological and behavioral constructs that will — they believe — better guide the search for the biological mechanisms of psychopathology. Here, we assess the ability of RDoC to rescue psychiatry from its crisis, not only by 1) evaluating its promise of increased validity, but 2) recognizing that psychiatric diagnosis can have an impact on patients’ lives independent of its validity. To assess the former, we delineate possible interpretations of validity relevant to psychiatry, and argue that RDoC faces difficult challenges in achieving what is known as etiopathological validity. To assess the latter, we suggest how the very challenge RDoC faces with respect to validity may counterintuitively serve as a benefit to patients, by reducing the extent to which patients reductionistically re-shape their identities.
Owen Flanagan and George Graham
- Published in print:
- 2017
- Published Online:
- September 2017
- ISBN:
- 9780262035484
- eISBN:
- 9780262341752
- Item type:
- chapter
- Publisher:
- The MIT Press
- DOI:
- 10.7551/mitpress/9780262035484.003.0013
- Subject:
- Psychology, Clinical Psychology
We criticize a worrisome trend in contemporary psychiatry that pathologizes normalcy on dubious epistemic grounds, on the naïve premise that mental health has some sort of clear, precise, and firm ...
More
We criticize a worrisome trend in contemporary psychiatry that pathologizes normalcy on dubious epistemic grounds, on the naïve premise that mental health has some sort of clear, precise, and firm link to true belief and conversely that mental disease or disorder has some clear, precise and firm link to false or misbegotten belief. We deny this premise and show how it should make us worry that we understand what makes illusions, delusions, and hallucinations unhealthy or abnormal. In fact, we deny that illusions, delusions, and hallucinations are categorically or even typically unhealthy or abnormal.Less
We criticize a worrisome trend in contemporary psychiatry that pathologizes normalcy on dubious epistemic grounds, on the naïve premise that mental health has some sort of clear, precise, and firm link to true belief and conversely that mental disease or disorder has some clear, precise and firm link to false or misbegotten belief. We deny this premise and show how it should make us worry that we understand what makes illusions, delusions, and hallucinations unhealthy or abnormal. In fact, we deny that illusions, delusions, and hallucinations are categorically or even typically unhealthy or abnormal.
