Tuesday, May 15, 2012

James Phillips - Key Concepts: Hermeneutics - Philosophy, Psychiatry, & Psychology 3:1

James Phillips - Key Concepts: Hermeneutics - Philosophy, Psychiatry, & Psychology 3:1

Philosophy, Psychiatry, & Psychology 3.1 (1996) 61-69



Key Concepts: Hermeneutics


James Phillips




Keywords: psychoanalysis, philosophy of science, nosology, classification
Hermeneutics is a concept whose breadth and significance have continued to grow in contemporary thought--and in psychiatry. Since its scope can be best appreciated through an historical overview of its development, I will begin there and then proceed to a discussion of its place in psychiatry. Derived from the Greek verb hermeneuein, which means "to interpret," and the noun hermemeia, "interpretation" (and both associated with the god Hermes), the word was first used in the seventeenth century to mean biblical exegesis (Palmer 1969). The Protestant Reformation created a need to interpret the scriptures without the aid of church authority, and with the plurality of possible interpretations for any biblical text, a need arose to establish the principles of correct interpretation. Hermeneutics was the study of such principles. While the scope and content of the hermeneutical enterprise have changed vastly since these beginnings in biblical exegesis, the concept of hermeneutics retains its initial reference to the art and science of interpreting. In Palmer's words, "Whenever rules and systems of explaining, understanding, or deciphering texts arise--there is hermeneutics" (1981, 458).
The scope of hermeneutics was broadened significantly in the nineteenth century through the philosophers Friedrich Schleiermacher and Wilhelm Dilthey, who moved the focus of hermeneutical understanding from texts to all human productions--verbal and nonverbal, historical and current. For Dilthey the task was to respond to the nineteenth-century challenge that all knowledge must follow the model of the burgeoning physical sciences. He sought to secure for the humanist or cultural disciplines such as literature and history (the Geisteswissenschaften) a status that was different from but on par with that of the physical sciences (the Naturwissenschaften). To accomplish this he set about formulating the principles of understanding in each of the two kinds of disciplines. The methodology of understanding in the cultural sciences was modeled on the interpretation of a text and became the expanded notion of hermeneutics.
For Dilthey the core difference between the natural and cultural sciences lies in their respective objects of study--on the one hand an object in the world, on the other hand another person--and in the way we understand each. He summarized the difference with his categories of "explanation" (Erklären) and "understanding" (Verstehen). "The sciences explain nature, the human studies understand expressions of life" (1924, 144). Explanation [End Page 61] in the natural sciences comprehends its object through causal connections; it "knows" its object from the outside. The object remains alien to the human scientist. In contrast, understanding "knows" its object, a human being or a human production, from the inside. That is, I can know the inner life of another person because I also am a person. This is not a knowledge of causal connections but rather of a network of meanings, analogous to the network of meanings by which I understand myself (Dilthey 1883/1989).
Two points must be underlined about Dilthey's treatment of hermeneutics as the methodology of understanding in the humanities. The first is that the understanding does not take place through introspection or intuition. I do not understand myself through introspection, and I do not understand the other through intuition. Rather, it is the nature of life to express itself, and it is through an understanding of these objectifications of inner life that we understand ourselves and others. Hermeneutics is then the study and method of understanding human expression. For Dilthey the triad of "life, expression, and understanding" defines the field of the human sciences. The second point is that because human life, lived experience, is temporal, the categories by which we understand man and human productions will have to involve this temporality. Self-understanding in the present, for instance, involves a historical reflection on those fixed expressions of others that form our common past.
Hermeneutic methodology as developed by Schleiermacher and Dilthey generated a series of unique concerns that characterize the hermeneutic approach to understanding. The first is that of the hermeneutic circle or round. At each level of hermeneutic investigation--a literary text, a historical monument, a person's life--there is a part-whole structure in the understanding of meaning networks that is different from the causal analyses of the natural sciences. That is, in the meaning gestalt that comprises a novel, for instance, the part is understood in terms of the whole and the whole in terms of the part. We are not inclined to say that one chapter causes another but rather that it is related to it, and to the whole novel, in such-and-such ways. The same is true of the coherence of a human life. The apparent contradiction of the hermeneutic circle--understanding part and whole in terms of the other--is overcome by the way in which we in fact do plunge into a work, somehow grasping the part and the whole in terms of one another and at the same time. Other specifically hermeneutic concerns are a focus on the historical and psychological context of the author or agent and an emphasis on the individuality of the object of study.
The ever-widening scope of hermeneutics was taken to a new level in the twentieth century by the philosopher Martin Heidegger and his pupil Hans-Georg Gadamer. While influenced by his reading of Dilthey, Heidegger moved beyond hermeneutics as the method of the human studies and in his Being and Time (1927/1962) gave it an ontological dimension by describing understanding and interpretation as essential features of man's (Dasein's) being. He could then say both that Dasein is hermeneutic in his very nature or being and that he, Heidegger, in his analysis was offering a "hermeneutic of Dasein."
It was left to Gadamer to develop the full implications of Heidegger's ontological reformulation of hermeneutics. He did this in his magnum opus, Truth and Method (1960/1975). For Gadamer the emphasis in hermeneutics falls on historicity. The interpreter does not interpret and understand from an Archimedean point but is always immersed in his or her own historicity. Hermeneutics is an encounter between the researcher of the present, aware of his or her historically conditioned categories of understanding, and a past that presents itself for interpretation. From this perspective the very notion of an "historical object," separate from myself as the interpreter, does not make sense. In Gadamer's words, "a text is understood only if it is understood in a different way every time" (1975, 275­276). In Truth and Method this process of hermeneutic understanding is described as a "fusion of horizons." A horizon is "the range of vision that includes everything that can be seen from a particular vantage point" (1975, 269). Abstractly, there is a horizon of the present, the categories of understanding which we cannot see beyond, and [End Page 62] a horizon of the historical epoch that is being studied, the standpoint of the historical figure. But this is an abstraction. We do not disconnect ourselves from the past. The horizons of present and past overlap and fuse into one great horizon. Finally, the fusion of horizons is framed in terms of what Gadamer calls the logic of question and answer. The text engages us in a dialogue about its subject matter. The text, as a response to an implicit question, challenges us to address the same implicit question that it has confronted. Hermeneutic understanding of the past is then not a simple reconstruction of the context in which the historical text emerged; it is rather a conversation with the tradition in which the issues that exercised the particular epoch continue to exercise us.
The direction in which Heidegger and Gadamer took hermeneutics has been debated in recent decades. However, this debate does not represent the final chapter in our historical overview of hermeneutics. That distinction goes to the recent changes that have occurred in the philosophy of science. What has been called the "post-empiricist philosophy and history of science" (Hesse 1980) was initiated with the publication of Thomas Kuhn's enormously influential The Structure of Scientific Revolutions in 1962 (1962/1970). Kuhn challenged the traditional view of scientific progress as unidirectional and progressive with his distinction between "normal science," in which science advances incrementally within the established procedures, and "revolutionary" science, in which anomalies occurring in the accepted practices prompt scientists to question those practices and, in breaking with the usual procedures to accomodate the anomalies, create new norms by which science is done. The moment of crisis thus occurs when an innovative scientist encounters a problem that cannot be resolved within the current disciplinary matrix. Science then becomes revolutionary as new norms and a new disciplinary matrix are formulated. A significant part of any scientific tradition is the existence of exemplary problem-solving models--paradigms in the sense that Kuhn wishes to reserve for this term (1977, 293)--that provide training exercises and standards for students working within a particular disciplinary matrix. The discovery that generates the new disciplinary matrix will also generate new exemplars or paradigms for doing science. Of great significance is the fact that the terminology of the earlier tradition is not commensurate with the one that replaces it, and some kind of translation is therefore called for.
With his theory Kuhn rejected the traditional view that later scientific theories offer "progress" or a more truthful representation of reality and replaced it with the more modest position that later theories offer better solutions to certain puzzles. From this he drew the logical conclusion that progress in science is similar to, not different from, progress in nonscientific fields. In science as in the humanities the practitioner works out of a particular perspective and does not fully transcend his or her own history. In his first book Kuhn acknowledged borrowing notions of progress from the humanist disciplines, and in his later writings he declared his method to be hermeneutic. "What I as a physicist had to discover for myself, most historians learn by example in the course of professional training. Consciously or not, they are all practitioners of the hermeneutic method. In my case, however, the discovery of hermeneutics did more than make history seem consequential. Its most immediate and decisive effect was instead on my view of science" (1977, xiii).
With Kuhn's assertion that scientific progress is historically contingent and thus hermeneutic, the rigid Diltheyan opposition of science and the humanities was shown to be invalid. The perspectivism that was felt to be unique to the human studies was found in the natural sciences as well. With the collapse of a rigid distinction between hermeneutics and the scientific method, Kuhn's conclusions called for a revised understanding of hermeneutics. This was accomplished by the philosopher Richard Rorty in his (also quite influential) Philosophy and the Mirror of Nature (1979). Rorty argued that hermeneutics is not at all about the difference between science and the humanities but rather about incommensurability in any domain. Echoing Kuhn's conclusion that there is no single "correct" scientific account of reality, Rorty issued a challenge to [End Page 63] "epistemological foundationalism" in philosophy--that is, the conviction that one can reach a neutral ground from which to judge differing positions in epistemology. Rorty generalized Kuhn's distinction between normal and revolutionary science to that of normal and abnormal discourse in any discipline. Normal discourse is that in which there is agreement about terms and rules of adjudication. A disagreement can be resolved by reasonable people. Abnormal discourse, on the other hand, is that in which there is not agreement about terms and rules of adjudication. Abnormal discourse means incommensurability, and hermeneutics is now simply the effort to communicate, and continue to communicate, in the face of incommensurability. As a corollary of this redefinition of hermeneutics, "objectivity" for Rorty no longer carries an ontological claim of correspondence to reality but refers simply to the agreement among discussants.
As we turn from this historical review to the matter of hermeneutics in clinical theory and practice, it will prove useful to distinguish hermeneutics in psychoanalysis from hermeneutics in general psychiatry. The discussion regarding psychoanalysis has been fairly explicit (Phillips 1991; Strenger 1991), while the discussion concerning hermeneutics in general psychiatry remains inchoate and often more implicit than explicit.
The consideration of hermeneutics in psychoanalysis has transpired in three stages. The first was the challenge issued to traditional psychoanalysis three decades ago by psychoanalytic theoreticians like George Klein (1976) and Merton Gill (1976), who, while not working formally within the European hermeneutic tradition, questioned psychoanalysis' status as a natural science and argued that it had more to do with the understanding of meaning and purpose than with causal analyses. This effort to reformulate psychoanalysis rested on making a distinction between the clinical theory and the metapsychology in Freud's writings. The metapsychology was judged to be a superstructure of pseudoscience, while the clinical theory was considered to retain what is important in psychoanalytic experience. For Klein especially, the clinical theory is an explanation of behavior in terms of meanings, purposes, and intentions that is linked "more closely to the humanistic disciplines than to a natural science" (1976, 30). This effort to purify psychoanalysis of its pseudoscientific, metapsychological trappings is thus quite close to Dilthey's view of hermeneutics in the human sciences.
A second stage in the treatment of hermeneutics in psychoanalysis was the formal assimilation of psychoanalysis to the hermeneutic disciplines by the major philosophers Jurgen Habermas (1968/1971)--together with his associate Karl-Otto Apel (1979/1984)--and Paul Ricoeur (1965/1970, 1969/1974, 1981). It is to be noted, however, that while each of these philosophers argued for the hermeneutic status of psychoanalysis, each argued also that psychoanalysis is only partially a hermeneutic discipline, that it also contains features that are better treated with the categories of the natural sciences. For Ricoeur this means that the patient is not only someone involved in a network of meanings but also someone caught up in a field of mechanistic forces. The patient is thus to be treated both like a text to be interpreted and like an organism that is subject to causal mechanisms. For both Ricoeur and Habermas, then, psychoanalysis becomes a paradigm of the disciplines that contest any rigid separation of the hermeneutic and scientific methods.
A third stage in the hermeneutics/psychoanalysis discussion is represented by a more open recognition of hermeneutic principles by working psychoanalysts. A significant document in this regard is the final 1994 issue of The International Journal of Psycho-Analysis (Tuckett 1994). For the 75th Anniversary Edition of the Journal the editors organized a symposium on the subject of "The Conceptualization and Communication of Clinical Facts in Psychoanalysis." Given the assumption of virtually all the articles in this 300 page issue that there are no theory-free facts in psychoanalysis, this document might be regarded as the official death notice of positivism, and the official birth announcement of hermeneutics in psychoanalysis (Phillips 1995). Within the psychoanalytic community, Roy Schafer (1983, 1992) has stood out as the psychoanalytic theoretician who has most openly and articulately espoused a hermeneutic point of view. He has encompassed [End Page 64] all the complexity of the hermeneutic discussion in his writing: on the one hand a treatment of psychoanalysis as involved in the interpretation of meaning that carries the older view of hermeneutics, and on the other hand a discussion à la Kuhn and Rorty that addresses the theoretical pluralism--with competing and possibly incommensurable models--that has beset psychoanalysis. Focusing on the analyst's reworking (along with the patient) of the presenting narrative into a more psychoanalytically framed narrative, Schafer recognizes, one, that narratives are meaning structures and not force fields, and two, that the narrative developed by each psychoanalyst will be determined by the model from which he or she is working.
The consideration of hermeneutics in clinical psychiatry is more varied than the discussion in psychoanalysis. To begin with, hermeneutics entered psychiatry early with Karl Jaspers' adoption of Dilthey's concept of understanding (Verstehen) as the primary mode of comprehension for some psychiatric conditions, such as reactive states and some of the neuroses (Jaspers 1963). Then there is the fact that issues central to hermeneutics have emerged in psychiatry throughout the modern era, albeit not always in the explicit language of hermeneutics. One route of entry has been general medicine, where a humanist tradition has always accorded the "art" or "craft" of medicine a status equal to that of the "science" of medicine, and where a considerable literature in the philosophy of medicine has associated the "art" dimension with the hermeneutic tradition (Wulff, Pedersen, and Rosenberg 1986; Leder 1990). The same humanist tradition has of course been present in modern psychiatry and has given voice to aspects of clinical psychiatry that are here being labeled hermeneutic. In contrast, then, to the case of psychoanalysis, where it is relatively easy to review the major signposts in its dialogue with hermeneutics, the dialogue in general psychiatry has been more complex, and we will have to settle for a representative sampling of its encounter with hermeneutics.
It will aid our discussion to bear in mind the distinction made above between hermeneutics in the older sense, focused on the uniqueness of the human studies as contrasted with the positive sciences, and hermeneutics in the sense developed by Kuhn and Rorty, focused on the differences among researchers in any discipline. A particular discussion in psychiatry may emphasize one or the other of these approaches.
To begin with the older hermeneutic tradition, its Jasperian expression has been sustained throughout the decades, most forcefully in recent years by Schwartz and Wiggins (1987, 1988), who have argued for the continuing relevance of Jasper's use of ideal types (borrowed from Weber) in psychiatry, as well as Jaspers' distinction between conditions that require a causal, disease-oriented explanation and those that lend themselves to interpretative understanding of meaning structures. Also in this tradition are the publications of McHugh and Slavney (1986, 1987) on perspectives in psychiatry, in which they differentiate a life-story perspective (a dimension of meaning) from a perspective of disease. While these writers all provide a contemporary voice for the tradition of Dilthey and Jaspers, they also point to the limitations of a Diltheyan hermeneutics resting on a rigid distinction between causal explanation and interpretation of meaning. As they note, we cannot in fact divide psychiatric conditions neatly into those that call for a purely causal approach and those that require a meaning-oriented approach. We do find much to talk about with our schizophrenics and bipolars, and we find biological vulnerabilities in our neurotic and personality-disordered patients. Rather than holding on to the neurotic and personality disorders as meaning-oriented conditions and turning over the major psychotic disorders to the biologists, the task of hermeneutics is to sort out, in each of these groups, where is the place for understanding of meaning and where is the place for causal explanation.
But while it is not useful to maintain a rigid distinction between disorders on the basis of "cause" versus "meaning," a case can still be made--contra Kuhn and Rorty--for the uniqueness of the human studies, including psychiatry--and thus for the continuing relevance of Diltheyan hermeneutics. Unlike the object of scientific investigation, the object of the human studies comes [End Page 65] pre-interpreted. That is, people have ideas about themselves before we reinterpret them. Charles Taylor has developed this theme at length, distinguishing psychology from the natural sciences by virtue of the fact that the "object" of the former, human beings, are "self-interpreting animals" (Taylor 1985). Anthony Giddens has described this feature of the human studies as a double hermeneutic (Giddens 1977). That is, the human subject is always involved in self-interpretation, and this interpretation is then subjected to a second-level interpretation by the "professional" interpreter.
The application of these issues to clinical practice in psychiatry can be spelled out a bit. In situations in which questions of biological disorder, causal mechanisms, etc., are minimal, the clinical experience may take place virtually entirely at the level of psychodynamics and meaning structures. Much of the hermeneutic discussion in psychoanalysis is applicable here. The patient brings in a life-story, a self-interpreted narrative, that is intimately involved with his or her suffering. How the patient organizes his or her world meaningfully and what makes him or her suffer are virtually the same question. The goal of the therapy becomes then the reorganization of these meaning structures. With and through the therapist a new set of meanings, a new narrative, is developed.
In contrast to this situation is that in which there is a heavy biological loading in the patient's condition. The obvious examples are schizophrenia and bipolar illness. In this kind of clinical experience, issues of meaning are still relevant albeit different. The illness, although biologically loaded, still means something to the patient; it comes pre-interpreted. Questions of meaning and psychodynamics are thus relevant to how the patient regards the psychiatric condition. An obvious issue--and one that is evaluated differently in each case--is the extent to which the patient can take distance from the illness and talk about it. Is the meaning the patient gives the illness somewhat independent of the illness or is it a product of the illness? In still other terms, is the patient's thinking always thought-disordered? There is an obvious difference between a schizophrenic who can discuss his or her illness and another whose thinking is so invaded by the illness that such discussion is not realistic. It is also the case that a seemingly more disturbed schizophrenic may be more able to take distance from the illness than a character-disordered patient who cannot step back from his or her lying and self-deception. It is the clinician's task to sort out these questions, since issues like compliance with treatment hinge on them.
In contrast to this discussion arising out of the Diltheyan tradition in hermeneutics, a different set of issues emerges in association with the sense of hermeneutics that I am associating with the names of Kuhn and Rorty. Conscious of the radical historicity of any psychiatric enterprise, hermeneutics now becomes the art of recognizing (and exposing) different perspectives and assumptions, the art of promoting "conversation" among the different perspectives, and finally the art of navigating among the perspectives and models in the concrete situation, with the ability to switch from one model to the other and to integrate them into an optimal treatment plan.
One aspect of this hermeneutic inquiry is the question whether we can formulate definitions of mental illness (and of particular psychiatric conditions) that are not value-laden. In this regard Fulford has attempted to demonstrate the inevitable injection of current values into any conception of mental illness (Fulford 1989, 1991). Another aspect of this hermeneutics is the effort to bring multiple perspectives to bear on the individual patient. An example is Engel's work with the biopsychosocial model (Engel 1977, 1980), in which he attempts to make room for these three dimensions in the understanding and formulation of each clinical case. In still another approach to this hermeneutics of multiple perspectives, namely the tacking among different models, Sadler and Hulgus (1991) have offered an exemplary exposition of hermeneutics in action, showing with a specific case study how different theoretical orientations generate different data and different treatment protocols, but also how a flexibility in switching from one model to the other can result in a successful, more nuanced treatment.
Nowhere in contemporary psychiatry does this hermeneutics of historicity, of multiple perspectives, [End Page 66] and of the exposure of hidden assumptions, emerge more forcefully than in the area of diagnosis. It is appropriate then that the first AAPP sponsored monograph should be entitled Philosophical Perspectives on Psychiatric Diagnostic Classification (Sadler, Wiggins, and Schwartz 1994). Indeed, psychiatric nosology and the DSMs provide a vast arena for what are, explicitly or not, hermeneutic deliberations. The progression from one DSM to the next is itself a strong reminder that these are historical documents that do not transcend their historical conditions. Hermeneutic considerations are engaged at the opening bell with the famous (or infamous) statement that the DSM's diagnostic statements are atheoretical. The notion of an atheoretical diagnosis is, of course, an oxymoron hermeneutically. Appropriately, the statement has been challenged vigorously (Agich 1994; Goodman 1994). Then there is the hidden bias in favor of biologically based illnesses, as well as that in favor of individual pathology, as opposed to family or societally located disorders. Issues such as a multi-axial approach, the particular axes of DSM-III and DSM-IV, a categorical versus a dimensional approach, the use of operational definitions and diagnostic criteria, the privileging of reliability over validity, and of objective signs and isolated symptoms over subjective unities of experience--all are decided in a manner that is inevitably arbitrary and value laden. All must be the subject matter of ongoing discussion, for there is nothing inherently right about the position taken by the DSMs regarding any of these issues. Regarding the DSM-IV, one can take either of two positions: that it represents the best conclusions of a group of historically conditioned experts engaged in conversation à la Rorty about how best to classify psychiatric disorders; or that it represents the prejudices of a group of experts who currently hold power in the psychiatric establishment. Certainly we want it to be more the former than the latter. The position we cannot take is that the DSM-IV--or any other possible diagnostic system--is, purely and simply, the truth. Which is to acknowledge that we cannot transcend the hermeneutic discussion.
Finally, in addition to the two dimensions of hermeneutics in psychiatry just presented, I would like to underline a third aspect of a hermeneutic orientation, namely that of psychiatry as practical knowledge. Remember, after all, that psychiatry like the rest of medicine is involved in the treatment of individuals; all psychiatric theory and knowledge ends up, figuratively speaking, at the bedside. This aspect of hermeneutics has been emphasized by Gadamer, for whom hermeneutics involves not only understanding and interpretation but also application. For him application is not an add-on that may or may not accompany understanding and interpretation; the three form an indissoluble unity. Hermeneutic understanding is thus in its essence practical. To understand and interpret something is to see its relation to praxis. It is because of this integration of application into the process of understanding and interpretation that Gadamer accords to legal and theological hermeneutics a priority over literary hermeneutics as models of understanding in the human sciences. And it is this issue of application and praxis that brings Gadamer (1960/1975, 278) to Aristotle's Nicomachean Ethics and the latter's notion of "practical knowledge," or phronesis--for Gadamer an early forerunner of hermeneutics.
According to Aristotle (1941), what is unique about practical knowledge is that it deals in particulars--how a particular man should act in a particular situation. Practical knowledge always involves a dialectic of the general principle and the particular case, and practical wisdom is precisely the ability to accomplish this application. Finally, Aristotle notes that since each kind of knowledge enjoys the degree of exactness that its subject-matter allows, practical knowledge, because it deals with particulars, admits of only inexact knowledge.
The relevance of these ideas to psychiatric practice is clear; psychiatry is practical in the sense both of Gadamer and Aristotle. Psychiatric theory is oriented toward application and practice, and the psychiatrist is dramatically engaged in a dialectic of the general and the particular. The latter is indeed even more true of psychiatry than medicine (which Aristotle takes as an example of practical knowledge). If the internist can at times legitimately remain at the level of the universal, treating the patient as a case of such-and-such illness, this is rarely true of the psychiatrist. Treating [End Page 67] the patient, for instance, as a borderline, rather than as this person with this life and borderline pathology, will not make for good treatment. Knowing the diagnosis is generally a small part of knowing (and treating) the patient. This is of course the reason why courses and chapters on "The Treatment of Diagnosis X" are always of limited value. Finally, following Aristotle, we must recognize that the practical, individual-directed nature of psychiatric practice renders psychiatry an inexact science. It is as inexact as people are different. As practical knowledge, this inexactness is not a defect that can be overcome with more progress in the field.
In concluding this review I would like to summarize what I consider the major features of a hermeneutic orientation in psychiatry. (1) A hermeneutic approach will focus on those conditions, and those aspects of any condition, that call for an interpretation of the meaning structures that play a significant role in the condition. It will also evince a sensitivity to the boundaries between meaning-oriented and other explanatory modalities. (2) This approach will emphasize the historicity of any theoretical point of view, any diagnostic system, and any therapeutic modality in psychiatry. This involves a recognition that there is no value-free or presuppositionless orientation in this field. One of the challenges of the hermeneutic effort is to promote "conversation" among the differing approaches, both at theoretical level and at the level of treatment of the individual patient. (3) The hermeneutic approach will subordinate the universal to the particular--that is, theory takes second place to the understanding and care of the individual patient. Psychiatric knowledge is thus practical and organized for treatment of the individual patient. (4) Finally, as a practical discipline, directed toward the care of the individual patient and allowing an inevitable plurality of perspectives in the provision of that care, psychiatric knowledge is finite, limited, and subject to ongoing revision.
James Phillips, Associate Clinical Professor of Psychiatry, Yale School of Medicine, New Haven, CT 06520, USA.

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Tuckett, D. (Ed.). 1994. The conceptualization and communication of clinical facts in psychoanalysis. Internal Journal of Psycho-Analysis 75: 865­1297.
Wulff, H. R., S. A. Pedersen, and R. Rosenberg. 1986. Philosophy of Medicine. Oxford: Blackwell Scientific Publications.

Monday, May 14, 2012

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Comprehensive interdisciplinary collection of links to news and journal articles on General, Forensic and Prison Psychiatry and Psychology and the issues of Behavior and Law with occasional notes and comments by Michael ...

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Mike Nova: Individual, group and social psychopathology can be viewed and conceptualised on the same biopsychosocial continuum. "Erich Fromm proposed that, not just individuals, but entire societies "may be lacking in ...

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Mike Nova: Individual, group and social psychopathology can be viewed and conceptualised on the same biopsychosocial continuum. "Erich Fromm proposed that, not just individuals, but entire societies "may be lacking in ...

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Mike Nova: American Psychiatry should broaden its theoretical and conceptual outlook beyond the narrow professional concerns about diagnostic systems and classifications (at this time, with all the enormous importance of ...

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Mike Nova: American Psychiatry At The Crossroads: "It should broaden its theoretical and conceptual outlook... it should assume its rightful leadership role in World Psychiatry... by discarding the outdated stereotypes, not ...

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Mike Nova: Individual, group and social psychopathology can be viewed and conceptualised on the same biopsychosocial continuum. "Erich Fromm proposed that, not just individuals, but entire societies "may be lacking in ...

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Please share this article with others using the link below, ... Behavioral Forensics Review - 4.28.12. Google Reader - Behavioral Forensics Behavioral Forensics "Behavioral Forensics" bundle created by Mike Nova A bundle .

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On April 25, Connecticut Governor Dannel Malloy (pictured) signed into law a bill that replaces the death penalty with life without parole. Connecticut is the fifth state in five years, and the 17th overall, to do away with capital ...

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Mike Nova: Some open questions in Breivik Trial What is the role of the mysterious Belorussian woman whom Breivik met in Belarus and who... General Psychiatry News Review - 5.2.12 - Mike Nova's starred items. General ...

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Breivik Trial - Latest News Review - Mike Nova's starred items - 6:43 PM 4/17/2012 ... Mike Nova: Breivik Trial and The Crisis Of Psychiatry As A Science. via Forensic Psychiatry News by Mike Nova on 4/17/12. Mike Nova ...

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Mike Nova: What makes Breivik's thinking and concepts abnormal and delusional? Although arising from "legitimate" and relatively common concerns about the vicissitudes of "multiculturalism", Breivic's thinking, appearing ...

Journals print ads that extol the virtues of medications; the Psychiatric Times and the APA Newspaper print articles that are pleasing to the drug companies, the FDA considers the pharmaceutical companies their best ...

via Real Psychiatry by George Dawson, MD, DFAPA on 5/14/12
Allen Frances has been a public critic of the DSM process and as an expert he frequently get his opinions out in the media. Today he has an op-ed piece on the New York Times that is a more general version of a more detailed post on the Health Care blog. His main contention is the stakeholder argument and that is that there are too many stakeholders both public and professional to allow the American Psychiatric Association to maintain its "monopoly" on psychiatric diagnosis. I will attempt to deconstruct his argument.
 

Lesbian In N.C. Arrested After Attempt To Get Marriage License

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Lesbian In N.C. Arrested After Attempt To Get Marriage License

‎Today, ‎May ‎14, ‎2012, ‏‎15 hours ago | webmaster@jbs.org (R. Cort Kirkwood)Go to full article
lesbian-in-nc-arrested-after-attempt-to-get-marriage-license Police in Winston-Salem North Carolina put the cuffs on a woman who refused to leave a government office after officials told the woman, who is a lesbian, that the state would not issue her a license to marry another woman because homosexual marriage is against the law.

California Bill Would Ban or Restrict Homosexual Conversion Therapy

‎Today, ‎May ‎14, ‎2012, ‏‎20 hours ago | webmaster@jbs.org (Dave Bohon)Go to full article
california-bill-would-ban-or-restrict-homosexual-conversion-therapy If California State Senator Ted Lieu (D) has his way, parents whose children struggle with unwanted same-sex attraction will not be able to seek help for their children through reparative therapy — treatment that has been found effective in helping individuals overcome homosexual tendencies.

Critics Blast Big Psychiatry for Invented and Redefined Mental Illnesses

‎Yesterday, ‎May ‎13, ‎2012, ‏‎8:00:00 PM | webmaster@jbs.org (Alex Newman)Go to full article
critics-blast-big-psychiatry-for-invented-and-redefined-mental-illnesses Unlike in conventional medicine where objective diagnoses and treatments are made based on observable biological evidence, psychiatrists get together every so often to decide what should or should not be considered a “mental illness.” And they do not always agree, as evidenced by the more than 13,000 professionals from around the world who recently signed an open letter demanding that the upcoming edition of the psychiatry industry’s “diagnostic manual” DSM be put on hold and reconsidered.

As the elite of the nation’s psychiatric establishment work in the shadows to fully revise the highly controversial handbook labeling various behaviors and emotional states as “illnesses,” experts across the board are crying foul.

UN Seeking Global “Mental Health” Plan

UN Seeking Global “Mental Health” Plan

Monday, 30 January 2012 17:35

UN Seeking Global “Mental Health” Plan

Written by

On January 20, the WHO Executive Board released a resolution entitled “Global Burden of Mental Disorders and the need for a comprehensive, coordinated response at the country level.” The document calls for, among other measures, collaboration between national governments and the global health body in developing a “comprehensive mental health action plan” for the world.
The resolution asks the WHO Director-General to draft a “comprehensive” plan which includes model legislation and policy measures for member states. The program would encompass everything from education and human rights to health-care delivery and employment, with the WHO boss instructed to integrate all relevant sectors of society and government into the “comprehensive” scheme.
Just a few days before the WHO released its controversial resolution, a team of academics published a peer-reviewed paper in the journal PLoS Medicine calling for exactly what the global health body envisions: An international regime to deal with mental health. Led by Vikram Patel of the London School of Hygiene and Tropical Medicine and Judith Bass from Johns Hopkins School of Public Health, the authors even called for a world “People's Charter for Mental Health."
“The time has come for recognition at the highest levels of global development, namely the U.N. General Assembly, of the urgent need for a global strategy to address the global burden of MNS [mental, neurological, and substance-abuse] disorders,” the authors wrote, citing data on global mental-health trends. “The fact that MNS disorders affect people in all countries should offer considerable incentive for investments by both public and private sectors in this initiative."
Meanwhile, the government of India was among the busiest promoters of the global scheme. It was joined by the Obama administration and other governments around the world in helping to advance the WHO’s resolution, according to Indian media reports.
Critics, however, slammed the developing push to grant the UN and its organs more authority over mental health. Across the political spectrum, commentators actually worried about giving global bodies and the massively powerful psychiatry industry any expanded powers — let alone the ability to craft global policy. And as the debate heats up, scrutiny is expected to continue growing.
“Even within individual national boundaries, the Psychiatric/Psychological complex has vastly more authority that it needs or deserves,” noted Brandon Turbeville in a widely publicized report, blasting the track records of both the UN and the psychiatric industry. “When one multiplies that oppressive authority with the global jurisdiction of the United Nations, as well as the U.N’s tendency to introduce tyrannical guidelines in its own right, we can see a clear recipe for disaster.”
Turbeville, the author of “Codex Alimentarius The End of Health Freedom” — a book exposing a well-developed UN plot to limit the availability of vitamins and promote controversial genetically modified food — also highlighted an array of global bodies working to implement oppressive policies. And a UN mental-health program would almost certainly follow in their footsteps, he warned.
Another organization which regularly criticizes the UN offered a dire warning about the emerging mental-health scheme, too. According to analysts at the Daily Bell, the sudden onslaught of “propaganda” promoting a global psychiatric plan managed by world bodies is no surprise — but it definitely has the potential to become a threat to individual liberty and national sovereignty.
“It's merely the latest example of a fear-based, power-elite dominant social theme,” noted a Daily Bell staff report, pointing out that powerful forces are continually seeking to consolidate control at the global level. “First the elites create the ‘problem’ via various kinds of social chaos and war; then the problem is documented in an elite ‘scientific journal;’ and finally, an elite globalist facility is trotted out as a resource — one that will create yet another layer of bureaucracy that will further expand elite, globalist control.”
The analysis also noted that, in a worst-case scenario, the UN and its emerging “mental-health” apparatus could conceivably even seek the power to lock certain people away in mental institutions or send them to “re-education camps.” However, with the Internet exposing the machinations of the world elite, it is becoming increasingly difficult to transform authoritarian propaganda into action, the commentators wrote.
Still, the UN has been expanding its power and domain since it was created. It already has agencies and bureaus dealing with every imaginable area of human life, from war and food to the environment and economic development. The UN’s global health regime, the WHO — despite suffering a major setback in public opinion following its discredited swine-flu hysteria — still wields immense authority.
Critics also point to the mindset and beliefs of key players within the global bodies. The first director of the WHO, Brock Chisholm, for example, is widely reported to have said something along the lines of: “To achieve world government, it is necessary to remove from the minds of men their individualism, their loyalty to family traditions and national identification.”
Other senior UN personalities have for decades made statements which are equally alarming to critics. Meanwhile, almost all elements of the increasingly powerful UN’s operations have come under fire — from UN troops raping and massacring civilians around the world to massive corruption scandals among top officials to controversial “population control” efforts and everything in between.
The UN, of course, is a collection of the world’s governments — most of which are led by tyrants of various persuasions and more than a few of which still use bogus psychiatric labels to imprison dissidents. Giving such an entity the power to govern global mental-health policy, critics say, would be absolutely insane.

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Prison Planet.com » Critics Blast Big Psychiatry for Invented and Redefined Mental Illnesses

Sunday, 13 May 2012 20:00

Critics Blast Big Psychiatry for Invented and Redefined Mental Illnesses

Critics Blast Big Psychiatry for Invented and Redefined Mental Illnesses
Unlike in conventional medicine where objective diagnoses and treatments are made based on observable biological evidence, psychiatrists get together every so often to decide what should or should not be considered a “mental illness.” And they do not always agree, as evidenced by the more than 13,000 professionals from around the world who recently signed an open letter demanding that the upcoming edition of the psychiatry industry’s “diagnostic manual” DSM be put on hold and reconsidered.

As the elite of the nation’s psychiatric establishment work in the shadows to fully revise the highly controversial handbook labeling various behaviors and emotional states as “illnesses,” experts across the board are crying foul.

Prison Planet.com » Critics Blast Big Psychiatry for Invented and Redefined Mental Illnesses

Critics Blast Big Psychiatry for Invented and Redefined Mental Illnesses
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Alex Newman
New American
May 14, 2012
Unlike in conventional medicine where objective diagnoses and treatments are made based on observable biological evidence, psychiatrists get together every so often to decide what should or should not be considered a “mental illness.” And they do not always agree, as evidenced by the more than 13,000 professionals from around the world who recently signed an open letter demanding that the upcoming edition of the psychiatry industry’s “diagnostic manual” be put on hold and reconsidered.
As the elite of the nation’s psychiatric establishment work in the shadows to fully revise the highly controversial handbook labeling various behaviors and emotional states as “illnesses,” experts across the board are crying foul. A handful of new potential mental disorders and the revised definitions for others have caused a particularly fierce uproar among some psychiatrists and mental health professionals. At least 25,000 comments have already been submitted about the proposals.
The debate and its resolutions, of course, will have serious repercussions. Depending on the outcome of the ongoing conflict, millions of people may suddenly find out that they are afflicted with newly created “diseases,” while others — especially certain individuals diagnosed with forms of autism — may no longer qualify under the new definitions. Tens of millions more may soon be officially considered “addicts” under the revised definition for addiction, too.
The proposed changes would have broad implications affecting everything from treatment regimens to welfare programs, criminal law, and even education. But around the world, psychiatrists and mental health professionals are fighting back hard, urging the American Psychiatric Association (APA) to hold off on the revisions until more discussion and research can take place.
Known as the “Diagnostic and Statistical Manual of Mental Disorders” (DSM), the controversial handbook is widely used around the globe by the mental health industry, governments, insurance companies, and more. If all goes as planned, the fifth edition of the so-called “Bible” of psychiatry is set to be distributed in May of next year after the first major revision in over a decade.
However, if some of the more controversial proposed changes are not re-considered — and the controversies addressed in an adequate manner — the manual’s influence is expected to wane significantly. And even as it stands today, not all experts are convinced about its usefulness or reliability in the field.
“[The DSM] is wrong in principle, based as it is on redefining a whole range of understandable reactions to life circumstances as ‘illnesses,’ which then become a target for toxic medications heavily promoted by the pharmaceutical industry,” clinical psychologist Lucy Johnstone with a Health Board in Wales told Reuters. “The DSM project cannot be justified, in principle or in practice. It must be abandoned so that we can find more humane and effective ways of responding to mental distress.”
Countless other experts agree, according to recent news reports, with many questioning whether a private group of individuals who stand to benefit by creating more diseases should really be writing the manual in the first place. Among the most vocal critics of the new proposals is Duke University psychiatry Prof. Allen Frances, who told the New York Times that the overly broad and vague definitions would create more “false epidemics” and increase the “medicalization of everyday behavior.”
“The DSM is distinct from all other diagnostic manuals because it has an enormous, perhaps too large, impact on society and millions of people’s lives,” explained Dr. Frances, who oversaw the writing of the current version of the diagnostic handbook and also worked on previous editions. “Unlike many other fields, psychiatric illnesses have no clear biological gold standard for diagnosing them.”
Predictably, his criticism has attracted a vicious response from the APA, which has been suggesting that he may have ulterior motives for questioning the latest revision process. But the negative publicity surrounding the updated manual has become so serious that the APA actually hired a public-relations expert who previously worked at the Department of Defense to drum up support for the controversial new DSM while attacking critics like Dr. Frances.
“This is an appropriate choice for an association that substitutes a fortress mentality and warrior bluster for substantive discussion,”observed Dr. Frances in a piece for Psychology Today about the group’s decision to go on a PR offensive using a former DoD propagandist. “My motivation for taking on this unpleasant task is simple — to prevent DSM 5 from promoting a general diagnostic inflation that will result in the mislabeling of millions of people as mentally disordered.”
And despite the attacks, Frances — noting that misdiagnosing people often results in unwarranted “treatment” with dangerous medicines — is not backing down. In his recent piece about the ongoing controversy, he again raised 12 serious questions that APA has so far refused to properly address. And he is hardly alone in demanding answers.
One of the most vigorously contested new “diseases” proposed for the new edition would have been called “attenuated psychosis syndrome.” If it had been approved, it would have been used to label and “treat” and medicate people believed to be at risk of developing mental illness at some point in the future. The furious outcry, however, led the APA to back down on including the new “illness” last week.
Another highly controversial label – “mixed anxiety depressive disorder” – would have resulted in a diagnosis of a new mental illness in people who exhibited relatively mild symptoms of both “depression” and “anxiety.” But with the reduced threshold, experts blasted the proposal as unscientific and unneeded. Last week, APA backed down on that one as well.
The definition of depression was modified slightly, too, in an effort to placate critics who say too many normal people are being diagnosed as “mentally ill” merely for feeling temporary sadness over an event or loss in their lives. But despite the minor revisions to deal with opponents, countless experts are still not satisfied.
“Fundamentally, it remains a bad system,” clinical psychology Prof. Peter Kinderman at Britain’s Liverpool University told Reuters, adding his voice to the growing chorus of thousands of professionals who are speaking out. “The very minor revisions … do not constitute the wholesale revision that is called for.”
Another area that has caused serious debate surrounds the APA’s agreement to revise and expand the definition of “addictions,” a decision which the New York Times reported could be one of its most far-reaching yet. Not only would the changes lower the threshold for what constitutes an addiction — possibly classifying tens of millions more people as addicts with broad consequences for health insurers and taxpayers — the proposal also seeks to label excessive gambling as an addiction for the first time.
Meanwhile, a new category of addiction dubbed “behavioral addiction — not otherwise specified” would serve as a sort of catch-all diagnosis for a broad range of activities. According to news reports, experts fear that psychiatrists might abuse the new classification to misdiagnose people who simply spend a lot of time shopping, using the internet, or playing video games as “addicts.”
“The chances of getting a diagnosis are going to be much greater, and this will artificially inflate the statistics considerably,” saidpsychiatric epidemiologist Thomas Babor at the University of Connecticut, who also serves as an editor for the international journalAddiction. “These sorts of diagnoses could be a real embarrassment.”
Others experts also worry about conflicts of interest among the people on the panels re-writing the manual. Some two-thirds of the DMS’s “advisory task force,” for example, reported financial conflicts such as links to “Big Pharma,” which countless analysts believe could influence their decisions on creating new illnesses for the benefit of their drug-pushing clients.
“The ties between the DSM panel members and the pharmaceutical industry are so extensive that there is the real risk of corrupting the public health mission of the manual,” explained Dr. Lisa Cosgrove, a fellow at the Edmond J. Safra Center for Ethics at Harvard, who published a widely cited study this year exposing some of the conflicts of interest among the APA’s panels.
An open letter from 13,000 health experts around the world raised similar concerns. “We believe it is time for an independent group of scientists and scholars, who have no vested interest in the outcome, to do an external, independent review of the controversial portions of the DSM-5,” they wrote. “We consider this especially important in light of the unprecedented criticism of the proposed DSM-5 by thousands of mental health professionals, as well as mental health organizations, in the United States and Europe.”
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‎Today, ‎May ‎14, ‎2012, ‏‎5 hours ago | ElmGo to full article
Although we may not know it, we have, in our day,
witnessed the birth of the Therapeutic State. This is perhaps the major
implication of psychiatry as an institution of social control.
–Thomas S. Szasz, Law, Liberty, and Psychiatry:
An Inquiry Into the Social Uses of Mental Health Practices,
The Macmillan Company, New York, 1963, p. 212.
“…Over the centuries, medical men and their supporters have been involved, argues Szasz,
in a self-serving ‘manufacture of madness.’ In this, he indicts both the pretensions of
organic psychiatry and the psychodynamic followers of Freud, whose notion of the
‘unconscious’ in effect breathed new life into the obsolete metaphysical Cartesian dualism.
For Szasz, any expectation of finding the etiology of mental illness in body or mind —
above all in some mental underworld — must be a lost cause, a dead-end, a linguistic error,
and even an exercise in bad faith. ‘Mental illness’ or the ‘unconscious’ are not realities
but at best metaphors. In promoting such ideas, psychiatrists have either been involved in
improper cognitive imperialism or have rather naively pictorialized the psyche — reifying
the fictive substance behind the substantive. Properly speaking, contends Szasz, insanity
is not a disease with origins to be excavated, but a behavior with meanings to be decoded.” [Thomas S. Szasz]

By: Phantom

‎Today, ‎May ‎14, ‎2012, ‏‎7 hours ago | PhantomGo to full article
To understand insane, we first have to understand sane.
Who is sane enough to say someone else is insane.

By: Phantom

‎Today, ‎May ‎14, ‎2012, ‏‎7 hours ago | PhantomGo to full article
everyone has a right to trial even the so called insane.
a trial to prove they are insane.

By: Master

‎Today, ‎May ‎14, ‎2012, ‏‎10 hours ago | MasterGo to full article
if you believe in the gold standard or that climate change is fake, it’s considered a mental illness
they just make it up folks, drug them & lock them in a padded room & call it therpy, how is that helping ?
we could micro-chip people & then they could find out what really goes on
that’s their answer to most things …

By: Menzoberranzandweller

‎Today, ‎May ‎14, ‎2012, ‏‎11 hours ago | MenzoberranzandwellerGo to full article
I left out antidepressants such as Paxil, Effexor, and a shitload of other useless, dangerous meds.

By: Menzoberranzandweller

‎Today, ‎May ‎14, ‎2012, ‏‎11 hours ago | MenzoberranzandwellerGo to full article
Do not let these quacks prescribe atypical anti-psychotics such as Seroquel, Abilify etc.., amphetamines such as Ritalin or Adderall, etc.., benzodiazepines such as Xanax, Valium, etc.. to your children! Look this shit up! Use your brains! They’ll kill or seroiusly screw up your children!

By: Super Duper Man 1776

‎Today, ‎May ‎14, ‎2012, ‏‎13 hours ago | Super Duper Man 1776Go to full article
I LIKE THEIR NEW ILLNESS
OTHER UNCLASSIFIED MISC MENTAL ILLNESS
HA HA HA HA
WHAT KOOKS.