via international psychiatry - Google Blog Search by Damiaan Denys on 11/28/07
In their recent paper, Natalie Banner and Tim Thornton evaluate seven volumes of the Oxford University Press series “International Perspectives in Philosophy and Psychiatry,” an international book series begun in 2003 focusing on the ...
via BEHAVIOR AND LAW - General, Forensic and Prison Psychiatry News by Mike Nova on 7/21/12
Op-Ed Contributor
Learning From Norway’s Tragedy
By JONAS GAHR STORE
Published: July 19, 2012
One year ago Sunday, Norway experienced one of the worst extremist attacks Western Europe has witnessed since World War II when Anders Behring Breivik systematically killed 77 people and injured hundreds of others.
Erlend Aas Norway Out/European Pressphoto Agency
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Prime Minister Jens Stoltenberg’s reaction was unequivocal. He declared that Norway’s strongest weapon in responding to this was to employ more openness and more democracy.
Norwegians took up his call. Neither politicians nor the media turned it into a partisan political issue. The public reacted with grief but did not call for extraordinary measures. And the state chose to prosecute Brevik in an ordinary public court with full media coverage.
Many outside Norway have questioned this. Does not responding with openness allow an extremist to broadcast his fanatical views? Does it not risk strengthening extremist movements? Why not create a special, closed legal setting?
As Norway’s foreign minister, I have been frequently confronted with these questions over the past year. Without prejudice to the ongoing legal proceedings, I believe these are key questions. How we, as independent nations and as an international community, should fight violent political extremism is at the heart of politics in the 21st century. I also believe that Norway’s experience after the attack has important lessons that may be relevant beyond our borders.
The last decade has shown us that ideology can never fully explain why specific groups or individuals commit unimaginable acts. Social, psychological and individual factors always play crucial roles. Yet political extremism does not grow in a vacuum. Ideas are the oxygen that allows it to flourish and spread. Extremist perspectives win sympathy and recruits because they offer narratives that claim to identify deep injustices and enemies.
Without this fuel, the blaze of extremism is quickly extinguished. Al Qaeda networks were nourished by the ideas of Islamic fundamentalists just as Breivik invoked and may have drawn sustenance from the ideas and stories of other Western extremists.
Confronting and undermining the narratives and ideas of extremism must therefore be one of our key tasks. To do this, we must retain the courage of our convictions in the face of extremism.
Virtually all modern forms of extremism accuse liberal Western democratic systems of being hypocritical and, ultimately, weak. Al Qaeda portrays the West as anti-Islamic imperialists masquerading as promoters of democracy. Right wing extremism suggests the West is committing cultural suicide through its lax judicial system and naïve multiculturalism.
Both have committed horrific acts designed to bait us into betraying our values and making them martyrs. In fact, it is remarkable to see the many similarities between these two sorts of extremism in their disdain for diversity and their indiscriminate violence against civilians.
In this context, it is a mistake to treat crimes committed by extremists as exceptions, subject to special processes. They must be held accountable in accordance with and to the full extent of the law. Hiding suspects from public view merely dehumanizes the perpetrators and undermines any moral or judicial lessons.
By contrast, prosecuting extremists who have committed crimes in a public courtroom makes it all the more shockingly clear that their horrific acts were undertaken by human beings, and that all of us must work every day to combat the ideas of extremism.
It has been remarkable to observe that the younger generation of Norwegiens — and especially the young survivors of the island massacre — have expressed their trust in Norway’s open approach to dealing with the affair. They know that a political system based on the rule of law cannot turn its back on its standard procedures on an ad hoc basis; that doing so would only provide extremists with evidence of the supposed double standards of democracy.
I believe that the same basic principle holds true in the global fight against terrorism. Osama bin Laden successfully provoked the West into using exceptional powers in ways that sometimes have been in conflict with its commitment to human rights and democracy. This only strengthened the case of extremists, and it shows that we should try to avoid exceptionalism and instead trust in the open system we are defending.
This is not a soft approach. It requires and allows for tough security measures. But it is firmly anchored in the rule of law and the values of democracy and accountability.
That the open public square can be an impressive antidote to extremism should not be surprising. This is not only a bedrock democratic principle. We also have ample historic evidence that extremist views thrive best when confined to the gutter.
Open debate is our strongest tool in standing up to extremism. The far more dangerous avenue is to force extremist ideas underground, where they can fester without competition.
Besides, in a globalized world where ideas and networks circulate beyond the control of states, we have little choice but to forcefully present our strongest counter-arguments and embrace the challenge of fighting extremism in the open.
Jonas Gahr Store is the Norwegian minister of foreign affairs.
A version of this op-ed appeared in print on July 20, 2012, in The International Herald Tribune.
via psychiatric diagnosis - Google Blog Search by Brendan B. Lupetin, Esq on 7/17/12
On Dec. 3, Foster saw psychiatrist Sarah Hicks in Philadelphia. Hicks diagnosed Foster with hypochondriacal panic attacks and prescribed Zyprexa. Foster continued treating with Hicks through 2002, at which point he was still ...
via psychiatric diagnosis - Google Blog Search by teen health - Google News on 7/18/12
The AtlanticHow Thoughts Become a Psychiatric DiagnosisThe AtlanticLloyd Sederer, MD, is medical director of the New York State Office of Mental Health and Adjunct Professor at the Columbia/Mailman School of Public ...
via BEHAVIOR AND LAW - General, Forensic and Prison Psychiatry News by Mike Nova on 7/21/12
July 16, 2012
Mental Illness Cited in Challenge to Terror Case
http://www.nytimes.com/2012/07/17/nyregion/mansour-arbabsiars-lawyers-cite-mental-illness-in-challenge-to-charges.html?src=rechp&pagewanted=print
By BENJAMIN WEISER
Lawyers for an Iranian-American man charged in a 2011 plot to assassinate Saudi Arabia’s ambassador to the United States asked a judge in Manhattan on Monday to order the suppression at trial of statements their client made during interrogation on the ground that he was suffering from serious mental illness, a new court filing shows.
In the filing, two experts retained by the defense each said they had diagnosed bipolar disorder in the defendant, Mansour J. Arbabsiar, a former used-car salesman from Corpus Christi, Tex., who was arrested last fall at Kennedy Airport and was said to have confessed to his role in the plot during the first 12 days he was in custody.
The filing was part of a heavily redacted motion asking Judge John F. Keenan of Federal District Court to dismiss all charges.
Prosecutors have said Mr. Arbabsiar “knowingly and voluntarily” waived his rights to remain silent, to have a lawyer present and to be quickly taken before a judge. But the filing shows the defense will challenge whether those decisions were voluntary.
Dr. Michael B. First, a professor of clinical psychiatry at Columbia University, said he had concluded that Mr. Arbabsiar “was likely cycling in and out of manic episodes during the period” of his interrogation. Professor First said he had examined Mr. Arbabsiar several times at the Metropolitan Correctional Center, where he is being held pending trial.
“Because I believe that Mr. Arbabsiar was suffering from episodes of mania while he was being questioned by the F.B.I.,” Professor First wrote, “there are serious questions as to whether any decisions made by him during this period were made rationally, with a full understanding of the consequences. Indeed, it is likely that his decisions were influenced, at least in part, by his mental illness.”
He said individuals with bipolar disorder who are in a manic state often “display feelings of invincibility and grandiosity,” and such feelings “may cause them to enter into agreements that they would not otherwise enter into.”
The second expert, Dr. Joel E. Morgan, a clinical neuropsychologist in private practice in Madison, N.J., said an M.R.I. of Mr. Arbabsiar’s brain “indicated abnormalities.”
Mr. Arbabsiar’s lawyers and prosecutors declined to comment.
via BEHAVIOR AND LAW - General, Forensic and Prison Psychiatry News by Mike Nova on 7/21/12
CommentaryHow new is the new philosophy of psychiatry?
http://www.peh-med.com/content/2/1/22/
Damiaan Denys
- Correspondence: Damiaan Denys d.denys@amc.nl
Department of Psychiatry, AMC, University of Amsterdam, PA.2-179, PO Box 75867, 1070 AW Amsterdam, The Netherlands
The electronic version of this article is the complete one and can be found online at: http://www.peh-med.com/content/2/1/22
| Received: | 8 October 2007 |
| Accepted: | 20 October 2007 |
| Published: | 20 October 2007 |
© 2007 Denys; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
In their recent paper, Natalie Banner and Tim Thornton evaluate seven volumes of the Oxford University Press series “International Perspectives in Philosophy and Psychiatry,” an international book series begun in 2003 focusing on the emerging interdisciplinary field at the interface of philosophy and psychiatry. According to Natalie Banner and Tim Thornton, the series represents a clear indication that the interdisciplinary field of philosophy of psychiatry has been flourishing lately. Philosophers and psychiatrists face a “new philosophy of psychiatry”. However, the optimism which the “new” philosophy of psychiatry celebrates is precisely the exiling of philosophy from the foundations of psychiatry. The 150 year old belief that psychopathology cannot do without philosophical reflection has virtually disappeared from common psychiatric education and daily clinical practice. Though the discipline of psychiatry is particularly suited to contributions from philosophy, the impact of philosophy on psychiatry nowadays remains limited. With some exceptions, philosophical papers are embedded in a philosophical context inscrutable to ordinary psychiatrists. Much current philosophical work is perceived by psychiatrists as negativistic. I would encourage the field of psychiatry to incorporate once again basic philosophical attitudes which render possible true dialogue with philosophy and enrich both disciplines. The views developed here should not discredit the value and importance of Natalie Banner and Tim Thornton’s paper and the excellent series “International Perspectives in Philosophy and Psychiatry.” As Jaspers said “Everybody inclined to disregard philosophy will be overwhelmed by philosophy in an unperceived way”.
Commentary
In their recent paper, Natalie Banner and Tim Thornton evaluate seven volumes of the Oxford University Press series "International Perspectives in Philosophy and Psychiatry". Launched in 2003, "International Perspectives in Philosophy and Psychiatry" is an international book series focusing on the emerging interdisciplinary field at the interface of philosophy and psychiatry.
Natalie Banner and Tim Thornton identify three broad interconnected themes in the series: the role of values in psychiatric diagnosis and treatment; the question of the place of understanding subjects' experiences, their meanings and the relationship of understanding to natural scientific explanation, and the scientific status of the 'facts' or 'evidence' that contribute towards psychiatric diagnoses. The three themes correspond with the three main parts of Tim Thornton's new book "Essential Philosophy of Psychiatry" meant to be a concise introduction to the growing field of philosophy of psychiatry. The first part, Values, outlines the debate about whether diagnosis of mental illness is essentially value-laden and argues that the prospects for reducing illness or disease to plainly factual matters are poor. The second part, Meanings, examines the central role of understanding and a shared first person perspective, both against attempts to reduce meaning to basic information-processing mechanisms and to explain away the difficulties of understanding psychopathology. The third part, Facts, shows the importance of uncodified clinical judgments, both in assessing the validity of psychiatric taxonomy and in the application of Evidence Based Medicine.
According to Natalie Banner and Tim Thornton, the series represents a clear indication that the interdisciplinary field of philosophy of psychiatry has been flourishing lately. There has been recent growth in the philosophy of psychiatry during the past fifteen years. Philosophers and psychiatrists face a "new philosophy of psychiatry" in addition to analytic philosophy and to the broader interpretation of mental health care.
How new is this new philosophy of psychiatry? Does the new philosophy really impact on the field of psychiatry? Should we share Natalie Banner and Tim Thornton's optimism?
Since psychiatry has been established as a field of medicine, psychiatric literature has always been full of philosophical thought and direct reference to philosophy. "Just meditations for the philosopher who, liberated from the daily turmoil, walks through a psychiatric hospital! He will find the same ideas, the same errors, the same passions, the same ill-fated: it's the same world, but in this house, traits are more pronounced, nuances much sharper, colors more vivid, lives more shattered, because man are naked, they don't conceal their thoughts, hide their shortcomings, they don't draw on their passions to articulate charming seduction, on their vices to express deceiving appearances" [1]. The broad themes: values, meanings and facts identified by Natalie Banner and Tim Thornton in the recent series have been examined in psychiatry for many years. Bertrand Morel discusses in his "Traité des maladies mentales" (1850) the role of political and religious values in psychiatry referring to Rousseau and Locke [2]. Jaspers' project of the General Psychopathology (1913) originally aimed at examining facts and perspectives in psychiatry thereby using "meaning" from Dilthey (1900) as a methodological tool [3]. The validity of psychiatric diagnoses, the relation between scientific explanation and human understanding, and the scientific status of psychiatric facts have been studied extensively by Continental phenomenological psychiatrists. For my part, the recent themes of the new philosophy of psychiatry are just an extension or repetition of earlier work of the last centuries. There has always been a longstanding debate on truth, method and the scientific status of psychiatric knowledge, and questions about the possibility of true knowledge in psychiatry are inherent to psychiatric thinking.
Nevertheless, I agree with Natalie Banner and Tim Thornton that something has radically changed within the field of psychiatry and philosophy during the past fifteen years. The novelty is not that philosophy has reconquered psychiatry, but that psychiatry has lost philosophy. Philosophical thinking used to be embedded in psychiatry. This was self-evident since psychiatry and philosophy share interest in the same matters – reality, freedom, personal identity, social reality, perception, free will, thought and affect. However, the belief that psychopathology cannot do without philosophical reflection, so obvious the last 150 years, has recently vanished. Reflecting, conceptual thinking, questioning, and criticizing have all virtually disappeared from common psychiatric education and daily clinical practice. Jaspers was a resident in psychiatry and not a philosopher when he wrote his "General Psychopathology." Unfortunately, the vital, basic philosophical attitude of naive astonishment towards psychiatric phenomena is no longer part of residency training. Philosophy has left the psychiatric building. It is exiled from psychiatry, externalized and sequestered in the "new" philosophy of psychiatry.
The loss of critical philosophical thinking in psychiatry has led on one hand to the shameful conclusion that zoologists are much more accurate and subtle than psychiatrists in the observation of behavior. "The available analysis of the phenomenology of compulsive rituals pales before elegant observations of analogous behaviors in fish and birds" Thomas Insel (1988) [4]. The loss has led on the other hand to the necessity of two different disciplines both struggling to detect a fruitful crossover. I agree with Natalie Banner and Tim Thornton that the discipline of psychiatry is particularly suited to contributions from philosophy. However, the impact of philosophy on psychiatry is still limited. Though the conditions for systematic thought over the last decades have changed fundamentally – not only phenomenology is at our disposal but the philosophy of mind – they have not yet been used widely to deal with psychopathological problems. The focus in training is on scientific knowledge, such as clinical neuroscience, behavioural and social sciences. There is very little content devoted to anthropology and philosophy in relation to psychiatry [5]. The language of academic philosophy is not the language of bedside psychiatry. With some exceptions, philosophical papers are so dense, so laden with jargon, and so embedded in a philosophical context inscrutable to the ordinary psychiatrist that their message is lost. Moreover, much of current philosophical work is criticism, emphasizing the limitations of modernist thinking and rejecting its claims, and critically analyzing the conceptual foundations of academic psychiatry. The majority of the reviewed seven volumes of the Oxford University Press series "International Perspectives in Philosophy and Psychiatry" criticize present psychiatric values, meanings and facts. Coming from outside, the criticism is perceived by psychiatrists as negativistic and the deconstruction as destructive.
In my opinion, neuroscience is currently much more successful in embracing philosophy than psychiatry. Philosophy interacts positively with neuroscience and the philosophy of neuroscience is accepted as a natural result. The emerging area of philosophy of neuroscience certainly was spurred by remarkable recent growth in the neurosciences. Cognitive neuroscience continues to encroach upon issues traditionally addressed within philosophy, including the nature of consciousness, action, knowledge, and morality. Examining the implications of neurological syndromes for the concept of a unified self as well as studying the neural systems underlying appraisal and its relevance to the self is one example [6]. Other examples (among many) include: The concept of neurophenomenology, introduced by Francesco Varela into neuroscience, in which observers examine their conscious experience using scientifically verifiable methods [7]. The use of deep brain electrical stimulation to modulate behavioral responsiveness in a patient who remains in a minimal conscious state (thereby offering a new tool to comprehend consciousness) [8]. Another topic examines threatened morality and physical cleansing, or the neural constituents of moral cognition [9]. Or the investigation of subjective certainty and its relationship to dopamine alterations in the striatum [10].
In closing, I agree that we live in interesting philosophical times in which there is potential for a fruitful crossover between the disciplines of philosophy and psychiatry. However, I disagree that there needs be a "new" cross-over between philosophy and psychiatry as regards values, meaning and facts. These three themes must necessarily be – as they have historically been – intrinsic to psychiatric thinking, as their "self evidence" has shaped psychiatry as a distinctive medical science. I would encourage the field of psychiatry to incorporate once again basic philosophical attitudes which render possible true dialogue with philosophy and consequently enrich both disciplines. At the moment, for most practicing psychiatrists, philosophy is a bridge too far.
The views that I develop here should not discredit the value and importance of Natalie Banner and Tim Thornton's paper and the excellent series "International Perspectives in Philosophy and Psychiatry." I hope that my comments that were inspired by their thoughtful paper may help emphasize the importance of philosophical reflection within psychiatry. As Jaspers said "Everybody inclined to disregard philosophy will be overwhelmed by philosophy in an unperceived way".
Competing interests
The author(s) declare that they have no competing interests.
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- Jaspers K: Allgemeine Psychoptahologie. Berlin, Springer; 1913.
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Full text | How new is the new philosophy of psychiatry?
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