Thursday, November 12, 2009

American Philosophical Association

After several years of ambivalance, I decided this year to not renew my dues to the APA. I'm not on the job market, I don't plan to go any APA meetings, and it provides no other useful services for me. As a department chair, I could do with plenty of help on the creation of outcomes assessment for philosophy courses, but so far as I can tell, the APA has done nothing useful on this front. I prefer to spend my money on other things.

Nevertheless, it makes me feel a little further removed from the mainstream of philosophy. I imagine I'll return to the fold in a few years.

Friday, October 9, 2009

Neuroethics at ASBH

Here's the program for Neuroethics at the ASBH meeting this year.

Neuroethics Affinity Group Agenda for October 16:

11:45 AM Welcome and Introductions

11:50 AM Announcements
NIH update - Chen
Brain Matters - Krahn
Penn Update - Powers
CBS Update - Ford
Other updates

12:10 PM Mini Presentations
Jayna Bonfini, Carnegie Mellon University, "Alice in Wonderland: Ethical and Social Implications of Adults with Autism in the Legal System."

John Z. Sadler, M.D., University of Texas Southwestern Medical Center, "Neuroethics and the Philosophy of Psychiatry - A Natural Affinity."

12:20 PM Future Directions and Networking

12:40 PM Wrap-up

ASBH 2009
Neuroethics Sessions

Thursday, October 15

2:45 – 3:45 The President’s Council on Bioethics Panel Session (103)
“White Paper on Determining Death”: Where Does it Leave Us?

2:45 – 3:45 Severe Brain Injury and Sexuality Panel Session (104)

4:00 – 5:30 Vulnerability, Moral Experience and Paper Session (108)
Decision-Making: Clinical Ethics through the lens of Open-Uterine
Surgery to Repair Spina Bifida

Friday, October 16

11:45-12:45 Neuroethics Affinity Group (221)

1:00 – 2:30 Perspectives on Mental Illness Paper Session (226)
Understanding Suffering in Mental Illness: Sarah Kane’s 4.48 Psychosis

1:00 – 2:30 Molecules, Mind, and the Law: Workshop Session (227)
The Intersection of Free Will, Biologic Determinism, and Criminal Responsibility

1:00 – 2:30 Empirical Approaches to Morality Paper Session (229)
· Cognitive Science and the Myth of the Standard Body: Some Epistemological and Ethical Considerations
· Translating our Differences: Can Empirical Moral Psychology Help Us Understand (and Eventually Address) Our Normative Differences?
· Sexing the Brain: Gender and Autism
· Functional Neuroimaging, Free Will, and Privacy

2:45 – 3:45 Translating “Brain Death”: An American Philosophical Association Committee on Philosophy and Medicine Panel Panel Session (232)

2:45 – 3:45 Discourse on Enhancement and Disability Panel Session (233) Cognitive Enhancement: The Promise, the Perils, and the role of Medicine

8:00-10:00 Film: The English Surgeon (ES6) (About a brain surgeon in the Ukraine)

Sunday, October 18

11:00-12:00 Moral Responsibility and the Panel Session (419)
Neuroscience of Self-Governance

I'm especially interested in that last session on self-governance. Here's the line up for it.

Hilary Bok, PhD, Johns Hopkins Berman Institute of Bioethics,
Baltimore, MD
Alisa Carse, PhD, Georgetown University, Washington, DC
Martha Farah, PhD, University of Pennsylvania, Philadelphia, PA
Jordan Grafman, PhD, National Institute of Neurological Disorders and
Stroke, Bethesda, MD

With 4 speakers in an hour, it promises to be compressed.

I wish I could go. But the $400 registration plus travel and hotel costs is too rich for me.

Saturday, October 3, 2009


CFP: Madness & Literature
“Madness and Literature”
The Institute of Mental Health is hosting The 1st International Health Humanities Conference at The University of Nottingham, UK from Friday 6th to Sunday 8th AUGUST 2010.
More details at

Friday, August 28, 2009

Kant on mental disorder

Patrick Frierson
Kant on mental disorder. Part 1: An overview
History of Psychiatry 2009 20: 267-289
Kant on mental disorder. Part 2: Philosophical implications of Kant’s account
History of Psychiatry 2009 20: 290-310

I didn't even know that Kant had written anything directly on mental illness, so this pair of papers is especially welcome.

Wednesday, August 19, 2009

Review of Scanlon's Moral Dimensions: Permissibility, Meaning, Blame

Forthcoming in Philosophy in Review. Vol. 29 no. 4. Pages 58-60.

T. M. Scanlon Moral Dimensions: Permissibility, Meaning, Blame. Cambridge, MA: Harvard University Press 2008. Pp. 227. US$29.95 (cloth ISBN-13: 978-0-674-03178-4).

Following in the steps of What We Owe to Each Other (Harvard University Press 1999), this new, slimmer volume will garner plenty of attention in moral philosophy. It consists of four interconnected chapters, the last, on blame, substantially longer than the others, and an especially substantial contribution to the literature.

The first chapter criticizes the doctrine of double effect, arguing that it rests on a mistake about the role of intention in the permissibility of actions. The doctrine makes the following sort of contrast: in wartime, while it would be wrong to bomb an enemy with the intention of killing civilians in order to demoralize the populace in order to bring about a swifter end to the war, it would be morally permissible to bomb a military target such as a munitions factory, knowing that doing so would result in the deaths of an equal number of civilians. The contrast is between what we intend to achieve and what results from the foreseen but unintended effects of our actions. Scanlon holds that while the agent’s intentions may be relevant to the moral assessment of some actions, they are not directly relevant. Scanlon’s first criticism of the doctrine is that it is implausible to hold that the moral permissibility of a decision to bomb a munitions factory and thereby kill a number of civilians depends on one’s intentions. He argues that it is not the intention that matters directly in central cases, but rather what one does and whether one’s actions violate moral principles. He makes this argument by drawing a distinction between the deliberative use of a principle to decide whether an action is ethically permissible, and its critical use to assess how the agent made his or her decision. It is possible that a person’s (or organization’s) intentions will have an effect on how they carry out their actions, and how they would react in the case of changing circumstances. But when the action itself is fixed, and the effects of the action are known, then in assessing its morality, we need to look at the moral principles that apply. The distinction between intended effects and unintended but foreseen effects has no direct relevance, according to Scanlon.

The arguments in this first chapter are hardly conclusive, as they rest largely on unargued intuitions. Scanlon’s opponents can insist that how we understand what an agent did crucially depends on what her intentions were. Scanlon has not provided enough analysis of the concept of an action, or indeed of the sources of moral responsibility, to show his opponents’ view is incoherent. The main value of this first chapter lies in its statement of an alternative view, and Scanlon is right in saying that once one adopts that view, the claims of the doctrine of double effect look ‘bizarre’ when applied to familiar cases of trolley problems and of sacrificing one person to harvest her organs to save the lives of five other people. However, we also have strong intuitions that one’s intentions are relevant in assessing the permissibility of one’s actions, and Scanlon needs to show that his view has a place for these intuitions, in order to avoid having his own view look bizarre too.

The second chapter goes further in setting out an argument for his position. Scanlon agrees that intentions are indeed central in determining what action a person has performed, but he insists that it is the action and not the agent’s intent or understanding of morality that is crucial to the action’s permissibility. Scanlon provides an array of cases where he agrees that a person’s intentions make a difference, such as when a person who apparently does good is actually acting out of selfish or dishonorable motives. However, he argues that these cases can be explained by considering what he calls the ‘meaning’ of the actions. The meaning of an action does depend on the reason the agent did it, but it is not the same thing as the reason. One action can have different meanings for different people, but Scanlon emphasizes his view that the meaning is not purely subjective. People can be mistaken about the meaning of an action for them; they are not fixed by a person's emotions or beliefs, but instead depend on context. For example, Angela may regard Tom's action as a betrayal, but the actual meaning of Tom's action for Angela may in fact be different. To help explain his specialized conception of meaning here, Scanlon gives plenty of examples. Whether he succeeds in clarifying his concept of meaning is debatable.
The third chapter attempts to understand the idea that we should not treat people merely as a means to an end. Scanlon endorses a sense in which treating a person as an end can be used as a general criterion of moral rightness, but shows that this is different from the sense in which we generally mean that it is wrong to use people. He makes a strong case for this, and the chapter will be especially useful to those who work on the morality of using people.

The final chapter, on blame, draws on some distinctions from the prior chapters, but it largely stands alone. It not only has the most innovative and interesting claims of the book, but is also much clearer and supplies a stronger more sustained argument. On his view, blame is not simply an evaluative attitude or an emotion; rather, when one blames another, one judges her blameworthy and, crucially, takes one’s relationship with her to be impaired; one’s attitudes towards the blamed person change. To blame a person is not the converse of praising them; rather, it is closer to the converse of being grateful to another person. It follows, with some further argument, that it is reasonable to blame people for actions even in cases where they could not have done otherwise.

Paradigms of blaming on this account will be in cases where the blamer has a close personal relationship with the person she blames, and Scanlon focuses on blame in friendships and families. He spells out what dispositions are required for people in a good moral relationship. Yet it is possible to blame someone whom one has not met personally. To explain this fact, Scanlon holds that one has a relationship with everyone. Naturally, since one does not have a personal relationship with that person, the impairment in the relationship is different from the blame that occurs between close friends.

Scanlon argues that his account of blame explains several features. (a) Not every wrong action is blameworthy. For example, lack of ambition is a fault of character, but is not blameworthy in itself. (b) The blameworthiness of an action does directly depend on the intentions with which the action was performed, because the agent’s reasons constitute his attitude towards others. (c) We apply blame to young children differently, because of the inequality of the relationship between adults and children, in which adults are teaching the children to become good. Scanlon’s approach to blameworthiness is distinctive in focusing on the relationship between people, and particular actions are relevant insofar as they bear on those relationships. Indeed, blame can be independent of any particular blameworthy action. He acknowledges that this may be in tension with some common understanding of blame, but he argues that our ordinary intuitions are mixed, so no coherent theory can match them all.
People do not normally choose their characters, but since on Scanlon’s view our relationships with them are largely based on their character, this lack of choice does not mean that we should not blame them. The fact that a callous killer had a terrible childhood may alter the way we treat her, but it does not make her exempt from blame. Scanlon considers arguments that we should not hold people morally responsible for their actions when they lack choice about their nature, but maintains that such views rest on the idea that there is a real self that would be uncovered under the right circumstances, and he can make little sense of this. He emphasizes that we have to base our relationships with people on how they actually are, not how they might have been under different circumstances. Whatever the causes of their current attitudes, those are the ones that constitute their relations with other people.

One could retain many of Scanlon's insights about blaming but reject his claim that the change in relationship is partially constitutive; instead one could say that blaming expresses an evaluative attitude towards a person’s action that causes changes in our relationship with her.

Nevertheless, the great value of his proposal is his emphasis on the importance of relationships in understanding blaming. This brings ethics closer to addressing our everyday interactions with colleagues, friends and family. Scanlon’s writing style can make it difficult to pin down exactly how his arguments are meant to go or how they relate to other, well-known positions in this area, since he does not give much discussion of the relevant literature. Nevertheless, this book, and especially the chapter on blame, deserves and will repay careful study.

Christian Perring
Dowling College

Thursday, July 30, 2009

Recent popular media

This week there was an excellent show on BBC Radio 4 in their Mind Changers series, hosted by Claudia Hammond on David Rosenhan's famous Pseudo-Patient Study reported in "Being Sane in Insane Places." It features interviews with his colleagues and discussion about the implications and validity of the experiment.

I see next week there is a Radio 4 show on DSM-V, which promises to be interesting.

While on the topic of Radio 4, it's worth mentioning that All in the Mind remains the best (and maybe only) radio show about mental health in either the USA or the UK.

As the debate over the secrecy of the process of creating DSM-V heats up, Christopher Lane's recent piece in Slate, Bitterness, Compulsive Shopping, and Internet Addiction: The diagnostic madness of DSM-V, gives a quick summary.

If you search blogs and news for 'dsm-v' you'll find plenty of commentary. The Psychiatric Times blog has lots of helpful info.

Monday, June 15, 2009

Ethics and Values in Contemporary Psychiatry

This one passed me by, but I just stumbled on it.

Ethics and Values in Contemporary Psychiatry
Harvard Review of Psychiatry, Volume 16 Issue 6 2008

Interesting ToC: in particular, I noted:
The Use of Palliative Sedation for Existential Distress: A Psychiatric Perspective Zev Schuman-Olivier; David H. Brendel; Marshall Forstein; Bruce H. Price Pages 339 – 351
Character Virtues in Psychiatric Practice Jennifer Radden; John Z. Sadler Pages 373 – 380
Off the Radar: Truth Telling in Psychiatry Nancy Nyquist Potter Pages 381 – 387

I look forward to reading the papers: unfortunately my college library only gets access to them when they are a year old, so I'll have to wait.

Wednesday, June 3, 2009


2 new articles in the APA NEWSLETTER ON PHILOSOPHY AND MEDICINE of particular interest:

"Classifying Dysthymia," by Jennifer Radden

"Nosologic Validity and the Intuitively Accessible View of Natural Kinds," by Claire Pouncey

Volume 08, Number 2 Spring 2009
Available online at

Friday, May 8, 2009

Recent publications

An article and a journal issue:

A role for ownership and authorship in the analysis of thought insertion
Lisa Bortolotti and Matthew Broome
Phenomenology and the Cognitive Sciences
Volume 8, Number 2 / June, 2009
Abstract Philosophers are interested in the phenomenon of thought insertion because it challenges the common assumption that one can ascribe to oneself the thoughts that one can access first-personally. In the standard philosophical analysis of thought insertion, the subject owns the ‘inserted’ thought but lacks a sense of agency towards it. In this paper we want to provide an alternative analysis of the condition, according to which subjects typically lack both ownership and authorship of the ‘inserted’ thoughts. We argue that by appealing to a failure of ownership and authorship we can describe more accurately the phenomenology of thought insertion, and distinguish it from that of non-delusional beliefs that have not been deliberated about, and of other delusions of passivity. We can also start developing a more psychologically realistic account of the relation between intentionality, rationality and self knowledge in normal and abnormal cognition.

And another issue of PPP: that's 3 in 2 months.

Philosophy, Psychiatry, & Psychology
Volume 15, Number 4, December 2008

Target articles:
Delusions, Certainty, and the Background
John Rhodes and Richard G. T. Gipps
pp. 295-310
with commentaries by Giovanni Stanghellini and S. Nassir Ghaemi

The Concept of Mental Disorder: A Proposal
Alfredo Gaete
pp. 327-339
with commentary by Richard G. T. Gipps

Thursday, April 30, 2009

New Art

A relatively rare non-philosophy post.

I wandered around some Chelsea galleries yesterday, as I regularly do, before going to Pat Kitcher's talk on Kant on theoretical and practical reasoning at CUNY (which didn't inspire me to go and read more Kant).

The previous times I've been around the galleries this year, I was uninspired. But for some reason, this time, there were several exhibits that impressed me a great deal, so I thought I'd mention them.

At Margaret Thatcher Projects (not the British ex-PM) there was another showing of Robert Sagerman's work. This one had the title "On and On: Inquiries into Indeterminacy." (In fact it starts today, but I saw it up. I had seen his work there previously, and I'd liked it a great deal then. Looking at his work on the web, his works look rather dull, but when you see them close up, the thick three dimensional use of paint is stunning. You can see it better on the Marcia Wood Gallery page.

It was fun to see John Water's Rear Projection show at the Marianne Boesky Gallery. Nothing very stunning there, but it was refreshingly silly.

The piece The Sound of Silence by Alfredo Jaar at Galerie Lelong was, in sharp contrast, very depressing. The main work was a sculpture and film installation. The 8-minute film was about famine, South African aparteid, the suicide of a photojournalist, and the ownership of images by one of Bill Gates' companies. There's an interview with the artist in the latest issue of The Brooklyn Rail.

At P-P-O-W there was quite a strange installation: Bill Smith's Intuitive Visualization of the Unseen. You walk through a black curtain into a room with hanging sculptures. There's a sign saying that the way to experience the main item, "an epidemiological model of the perfect infectious disease (evolved growth system)," is to lie on the floor and look up, but I chickened out of that. But it was a very intriguing network of wires in spherical form, and then the lights went down, to show that the joints were luminous. It was both surprising and amazing as a visual effect, completely changing the experience of the object. It felt a bit like being Jodi Forster during her trip to another galaxy in Contact: well, just a little. It was certainly on the psycedelic side.

The highlight of the afternoon was Dustin Yellin's Dust in the Brain Attic at Robert Miller. His website is at but I had trouble viewing it: I found Opera worked a little better, but still with problems. The gallery website works fine though. There are biological themes, as with Bill Smith's work, but this reminded me more of the Bodies exhibit in New York (I realize there is controversy about the morality of the possible use of the cadavers of Chinese political prisoners there). The works by Yellin included anatomical depictions of the human body using paint in layers of glass fused together, based on CAT scans and magnetic resonance imaging. They were visually fascinating, and I loved the artistic use of science, raising the questions of the meanings of the information we get from modern scanning. These works were also quite playful, with, for example, an extraterrestial landscape. I especially liked that while the images looked three dimensional from the front, they gradually disappeared as you moved to the side, showing empty glass.

Saturday, April 25, 2009

Review of Rachel Cooper: Psychiatry and Philosophy of Science

Forthcoming in Philosophy in Review. Volume XXIX no. 2 (April 2009). Pages 19-21.

Rachel Cooper Psychiatry and Philosophy of Science. McGill-Queen’s University Press 2007. Pp. 240. US$90.00 (cloth ISBN-13: 978-0-7735-3386-8); US$27.95 (paper ISBN-13: 978-0-7735-3387-5).

This book surveys four main issues: the nature of mental illness, psychiatric explanation, relations between different psychiatric theories, and the role of values in psychiatric theory and practice. Each of these issues has two chapters devoted to them, and this provides readers with an overview of how central theoretical questions in psychiatry are approached in philosophy of science, broadly construed. Inevitably in such a book, Cooper devotes single chapters to topics on which others have written whole books, and so she often goes quickly, not pausing for details. Yet at some points she does take the trouble to spell out the arguments in some detail, and she often presents her own perspectives and occasionally presents original research. Her writing is consistently clear and straightforward, and chapters are structured logically. This is a rich and much needed book that will serve as an introduction to one side of philosophy of psychiatry, which amply demonstrates how its debates are deeply connected with those in related areas, and how interesting the area is. It would be appropriate for upper level undergraduate courses, graduate courses, and will be helpful to professional philosophers and mental health care professionals wanting to orient themselves in the current literature.
Cooper starts out, as many others do, by addressing anti-psychiatry, with a survey of Foucault, R. D. Laing and Thomas Szasz. While she defends the view that mental illness is real and psychiatry is a legitimate enterprise, she is surprisingly sympathetic to many of the claims of its critics, and suggests that there is much of value in their work, and that they are not as radical as they often seem to be. Her characterization of early Foucault as ‘W. V. Quine plus history’ is indeed helpful, and Cooper shows that a historical perspective on psychiatry is important in understanding the field, even though most current philosophy tends to be ahistorical in its approach to psychiatry.
The next chapter compares Boorse’s biological account, Fulford’s action-based account, and Aristotelian accounts of disorder. She argues that none of these is successful on its own, but that a ‘messy’ account that combines different theories could do the trick. She cites her own previous suggestion that takes elements from the Aristotelian approach that a disorder must be a harm for a person in some sense, and adds that the sufferer both could reasonably have expected to be better off and could in principle be treated medically, if not at present, then at some point in the future of medicine. She also cites Reznek’s claim that a condition is pathological ‘if and only if it is an abnormal bodily/mental condition that requires medical intervention and that harms standard members of the species in standard conditions’ (40). Both these ideas face the challenge of providing a non-circular definition of ‘medicine’, in non-ad hoc ways that justify the special status of medical disorders in our society.
The chapter on natural kinds argues that mental disorders can be scientific kinds, even if they do not have essences. She summarizes much of the literature and focuses Hacking’s objections; she argues that the concept of natural kind is broad enough to include the phenomena he describes of temporally transient disorders and looping effects in the relation between the medical description of disorders and people having those disorders. Cooper resists the worries of Dupré that categorizing people and their problems will lead to conservative politics by saying that ethics cannot drive metaphysics. She does not address some pragmatist approaches that do precisely that, viz. allow ethics to influence our decisions about how to conceptualize human problems. Given that pragmatist approaches to categorization have gained a good deal of support in recent years, this is an unfortunate omission.
One of the most original chapters makes an argument that individual case histories can be explanatorily helpful because they help us simulate other case histories by providing us with scaffolding. Cooper sketches a portion of simulation theory and explains her suggestion with some examples. This is an interesting idea that deserves further attention given the importance of narratives in clinical psychology and the tendency of those who support the ‘scientific approach’ to dismiss narratives as secondary to a scientific understanding.
In the first chapter on relations between theories, Cooper argues that in the psychological sciences there are different paradigms competing at the same time, and although Kuhn said that different paradigms are incommensurable, it is possible to achieve genuine communication between different approaches if enough effort is made. The second chapter in this section asks if reductionist theories are incompatible with our ordinary understanding of people. Cooper examines dualism, identity theory, functionalism and anomalous monism and concludes that most psychiatric explanation is largely independent of these theories. Only eliminative materialism is genuinely incompatible with standard psychiatric explanation involving propositional attitudes. Both these chapters are rather quick and rough in their arguments, but the conclusions are plausible.
The final two chapters address the role of ethics. The first of these spells out the ways in which psychiatric science can be value-laden, and it does so very effectively by using the example of how race was treated in the American Journal of Psychiatry between 1844 and 1962. From this, Cooper shows how values shape the scientific project from start to finish. She proceeds to critically evaluate suggestions for how to avoid the problems of bad values infecting science, including making science value-neutral, making sure science is laden with good values, and adopting standpoint epistemology. She finds each of these proposals limited, and suggests that the best bet is to get a diverse body of researchers and to encourage debate about the science. The second chapter is far more specialized, addressing recent problems for psychiatry and medicine generally in the conduct of randomized controlled trials of new treatments. Cooper argues that large corporations have become so involved in these trials that the public has lost its trust in psychiatry, especially with regard to medication. She argues that the methods for policing scientific testimony have broken down, and in order to repair them, new regulations and initiatives need to be introduced. Again, as with most of the rest of this book, Cooper’s arguments here are interesting and plausible.

Thursday, April 23, 2009

Recent Papers Relevant to Philosophy of Psychiatry

"From Descartes to Desipramine: Psychopharmacology and the Self"
Ian Gold, McGill University and Lauren Olin, McGill University
Despite the remarkably widespread use of the new generation of antidepressants, almost everything we know about their effects comes from animal studies and clinical trials in which the sole parameter of interest is depressive symptomatology. Almost nothing is known about the effects that antidepressants have on cognition, affect, or motivation when used over a period of months or years. Nor do we understand what effects, if any, antidepressants have on what we think of as the self. In this article, we argue that neither psychiatry nor philosophy, in their current state, are well equipped to think about these issues. In order to explore this idea, we consider the neurobiology of romantic love and its relation to antidepressant neurochemistry. This case study, we suggest, supports the view that antidepressants are very likely to have significant effects on personhood as well as the suggestion that we are in need of new ways of thinking about the self and its pathologies.
Key Words: antidepressants • DSM-IV • philosophy • self • SSRIs
Transcultural Psychiatry, Vol. 46, No. 1, 38-59 (2009)

and, at the more empirical side,

"Pedophilia, Hebephilia, and the DSM-V"
Ray Blanchard, Amy D. Lykins, Diane Wherrett, Michael E. Kuban, James M. Cantor, Thomas Blak, Robert Dickey and Philip E. Klassen
The term pedophilia denotes the erotic preference for prepubescent children. The term hebephilia has been proposed to denote the erotic preference for pubescent children (roughly, ages 11 or 12–14), but it has not become widely used. The present study sought to validate the concept of hebephilia by examining the agreement between self-reported sexual interests and objectively recorded penile responses in the laboratory. The participants were 881 men who were referred for clinical assessment because of paraphilic, criminal, or otherwise problematic sexual behavior. Within-group comparisons showed that men who verbally reported maximum sexual attraction to pubescent children had greater penile responses to depictions of pubescent children than to depictions of younger or older persons. Between-groups comparisons showed that penile responding distinguished such men from those who reported maximum attraction to prepubescent children and from those who reported maximum attraction to fully grown persons. These results indicated that hebephilia exists as a discriminable erotic age-preference. The authors recommend various ways in which the DSM might be altered to accommodate the present findings. One possibility would be to replace the diagnosis of Pedophilia with Pedohebephilia and allow the clinician to specify one of three subtypes: Sexually Attracted to Children Younger than 11 (Pedophilic Type), Sexually Attracted to Children Age 11–14 (Hebephilic Type), or Sexually Attracted to Both (Pedohebephilic Type). We further recommend that the DSM-V encourage users to record the typical age of children who most attract the patient sexually as well as the gender of children who most attract the patient sexually.
Keywords DSM-V - Ephebophilia - Hebephilia - Paraphilia - Pedophilia - Penile plethysmography - Phallometry - Sexual offending - Sexual orientation - Teleiophilia
with 7 letters from various others and a reply from Ray Blanchard

There's also an editorial in the January 2009 issue of the American Journal of Psychiatry, "Child Psychiatry Growin’ Up" by Daniel S. Pine, M.D., and Robert Freedman, M.D. that is important but causes me some concern.
They discuss recent research, and especially fMRIs done on children, and conclude:
"These findings support the hypothesis that children’s relative lack of neural response to adverse or fearful stimuli predicts deviant adult behavioral profiles. Eventually, this information may be used to predict long-term outcomes and to tailor treatments individually targeted toward underlying neural dysfunction associated with different forms of behavior disorders. The consonance of the imaging findings in children with those from laboratory animals may provide models for discovery of new neurobiological treatments."
The assumption that neurological studies mandate neurobiological treatments strikes me as problematic.

And there's yet another new issue of PPP out. It's a special issue, on "Phenomenology, Behaviorism, and the Nature of Mental Disorders: Voices from Spain," edited by Marino Pérez-Álvarez and Louis A. Sass. Table of Contents at

Monday, April 13, 2009

News items

A few things came to my inbox in the last week.

From the latest issue of Medicine, Health Care and Philosophy Volume 12, Number 2 / May, 2009

The ethics of self-change: becoming oneself by way of antidepressants or psychotherapy?
Fredrik Svenaeus


Should or should not forensic psychiatrists think about free will?
Gerben Meynen

A very fancy website using the Adobe Flash Player for the
12th International Conference for Philosophy & Psychiatry 2009
on the generic topic of "Understanding Mental Disorders." October 22-24, 2009, Lisbon, Portugal.
(Personally I am not a fan of sites that make it impossible to copy their text.)
The deadline for abstracts is very late: 30 August 2009. Presumably this means that that notification of acceptance of abstracts is also very late. I'd normally expect to book airline tickets and make hotel reservations in August for an October conference. Maybe it is a safe bet that most abstracts will be accepted.

And finally, a call for papers:
Vol. 4, No. 1: IJFAB Special Issue: Feminist Perspectives on Ethics in Psychiatry
Guest Editors: Jennifer Hansen, Nancy Potter and Jennifer Radden
Deadline for Submission: March 1, 2010
I'll skip the rather long text, and just give the contact info:
For more information, please contact Jennifer Hansen:

Thursday, April 2, 2009

Another new issue of PPP

The issues of PPP are coming fast and furious now. Hot on the heels of the last, I just received 15(2), June 2008. At this rate, the journal dates will start to match the calendar dates. This one is so new, it is not yet listed on the PPP website at Project Muse.

It is a special issue devoted to the toic of "Values-Based Medicine, Evidence-Based Medicine." It's good to see PPP occasionally delve into the broader area of Philosophy of Medicine. It makes sense then that the editors (Wifstad, Falkum, Ayob and Thornton) are European, where the tradition of philosophy of medicine is strong. I have only browsed the issue, but one notable feature is that it breaks from the standard format, with one section on values-based medicine with five papers, another on evidence-based medicine with four papers, and then four commentaries that address general themes rather than single papers. There are no replies to the commentaries. Given my comments in the previous post on the inherent limitations of the peer commentary approach (which is especially apparent in the American Journal of Bioethics), it is good to see the PPP editors mixing it up and trying new ideas.

Wednesday, April 1, 2009

PPP Issue on Vice and Disorder

In the latest issue of PPP, John Sadler has put together a "philosophical case conference" on vice and the classification of mental disorders, which will be a great resource for future discussion of the area.
His target piece features discussion of some of the issues of classifying vice, by which he means criminal behavior and immoral attitudes. He sets out three cases. The first is a 12-year-old boy who is disobedient and troublesome, defying authority and lying. He gets diagnosed with conduct disorder. The second is of a mother who presents her mother who presents her child as ill and having breathing difficulties. It turns out that the mother smothered her child. She has a complicated case history, with a troubled past. The third case is Jeffrey Dahmer, who received diagnoses of Asperger's, paraphilias, alcohol abuse, depressive disorder not otherwise specified, and personality disorder not otherwise specified. The rest of the paper sets out some of the issues in dealing with the vice-mental disorder relationship in DSM-UV-TR, under the headings of "Inconsistencies in How Wrongful Conduct is Classified," "Impoverishment of Some Criteria Sets for Vice-Laden Disorders," "Hierarchical and Comorbidity Issues," and "Metaphysical Ambiguities." The main theme is that DSM-IV-TR is not consistent and is not clearly formulated when it comes to the relation between vices and disorders. The paper does not set out a theory of what this relation should be.

There is an unusual number of peer commentators for this target paper:
Jeffrey Geller (U Mass Medical School)
Gwen Adshead
Nancy Nyquist Potter and Peter Zachar
Christopher Heginbotham, University of Central Lancashire
Michael First
Christopher Williams
Lloyd Wells (Mayo Clinic)
Stephen Morse
It is a diverse collection of responses. I'm a little disappointed that there was not more discussion of the cases. Geller writes about some of the history of the topic. Adhead expands on the discussion of Case 2, which was her example in the first place. Potter and Zachar give a rather general discussion. Heginbotham gives a brief discussion of the cases and proposes an approach rooted in the social model of disability. First gives a more extensive discussion of the topic and the cases, allowing that vices can also be indicative of disorders. Williams sketches some issues in identifying the causes of behavior. Wells endorses an approach that mixes medicalization and moralization, and discusses this in several cases of his own. Morse emphasizes the difficulty of examining the issues in the absence of quite well developed theories of what counts as a mental disorder and a theory of morality.

Adshead complains about the "muddling" of social, psychological, and legal discourses, as if it were possible to keep them separate, but she is open to the possibility that vice and disorder need not be mutually exclusive. Yet even here, she seems to think that the mental disorder itself could not explain violence to others completely, and that one needs other elements in the explanation. She is especially sensitive to the danger that explaining an action with a diagnosis would take away a person's sense of agency. Adshead gives the impression that she needs a more fully fledged theory of action and mental disorder in order to avoid conceptual problems. Most of the other authors embrace the fact that the moral and the medical overlap, and that people can responsible for their symptomatic behavior even when they have mental illness.

With this and all the other commentaries, it is clearly impossible for them to set out a detailed view about such a complex area. So they are able to raise a few points but one does not get a strong sense of deep engagement with issues raised by the target article, and none of the authors sets out anything like the robust theories that Morse says are needed. This is all to the good, meaning that there is still plenty of work to be done in this area. Sadler ends with the suggestion that it might be possible to do without some theories, by taking a pragmatic stance. This is an idea that I'm sympathetic with, but I'm not sure that it is possible to bypass the theories altogether, and justifying the pragmatic stance without the theory is going to take lots of discussion, if not theorizing.

Monday, March 23, 2009

Channel 4 and Mental Illness

While on my trip to the UK, I took advantage of Channel 4's on demand service 4oD (which is only available in the UK).

I had been keen to see the Channel 4 production of Claire Allan's novel Poppy Shakespeare, which I reviewed in Metapsychology in 2007. The 2008 90-minute TV version was broadcast in 2008, with Naomie Harris as Poppy and an especially strong performance by Anna Maxwell Martin as N. It is true to the book, but with more fantasy scenes and playing up the absurdity of the patients' behavior. They have been institutionalized and it isn't clear if they really need help or are just milking the system. When there are cuts in services, the patients are ejected from the day ward, and they complain loudly. The mental health administrators are really only concerned with themselves and use administrative nonsense language to justify their decisions. It adds up to 1984 meeting One Flew Over the Cuckoo's Nest, with a strong dose of DaDa absurdism added. As such, it has something to offend everybody, but it makes for a robust drama. I wish it were more widely available.

I also stumbled across the Channel 4 series Psychos, which had 6 episodes, broadcast in 1999. It is set in a Glasgow psychiatric ward, and shows the daily struggles of the doctors, nurses, and patients. The lead character is Dr. Danny Nash, an unconventional but compassionate and insightful psychiatrist, who, it turns out, is also struggling with bipolar disorder. Nash is played by Douglas Henshall, whose website has a page devoted to the series. The series won some acclaim and awards, but also suffered serious criticism for its title, which was seen as stigmatizing, and also its portrayal of mental illness. Apparently there was also an offensive publicity campaign for the show at the time, with the tagline "It will blow your mind." A UK watchdog organization also condemned the trivialization of a sexual encounter between Nash and one of his patients. Despite initial plans for a second series, this criticism led to it being canceled.

The title of the series was clearly a major mistake -- what were they thinking? Yet viewing the 6 episodes makes it clear both how difficult it is to set a TV series in a psychiatric ward without succumbing to stereotypes and how much dramatic potential the idea has. There are moments here that are really interesting, with quandaries about how to help patients, working out what a doctor's responsibilities are, and when psychiatric power is being abused. In the last episode, a university mathematician patient starts quoting Thomas Szasz to the psychiatrists and questions their status in labeling him. A series such as this could serve a valuable role in educating the public on current psychiatric treatment and the experience of mentally ill people. However, the requirements of making it dramatically gripping and the worry about condemnation by advocacy groups for the mentally ill explain why it is unlikely that there will be any similar series in the UK or the USA in the near future.

Friday, March 20, 2009

Catching Up

My trip to the UK went well. The seminar at Newcastle University Policy, Ethics and Life Sciences Research Centre (PEALS) was interesting especially because a number of mental health service users came and gave helpful feedback on my presentation on the language of madness. Several supported what I was saying with their own experience: they found being called "clients" or "service users" patronizing, and they prefered language that was closer to their usage. One woman said she had a written contract with her doctor to allow him to tell her she was acting "crazy" or to use similar language when she going through an active phase of her mental illness, since she did not understand more polite neutral language at those times.

The workshop at Warwick University Medical School on Mental Disorder was well attended with about 40 people. The room was full to capacity, and we went from 10am to 6pm with a few short breaks. It was a strong collection of papers, and there were good exchanges during questions. Joan Busfield strongly expressed her dislike of the idea of relationship disorders in response to my discussion of the topic, and the sources of her disapproval became clearer in her talk -- it was a suspicion of psychiatry and a concern that psychiatric solutions tend to preclude more social solutions to people's problems. Derek Bolton pressed her on this in questions, emphasizing that there's no reason why psychiatric solutions cannot be combined with other approaches.

It was good to learn of the recent work on definining mental disorder: some people expanded on ideas they have presented elsewhere, but other papers presented work that was new (to me at least) -- I'm looking forward to learning more about Lisa Bortolotti's project on delusions. But one feature of the Warwick workshop I especially liked was the mix of philosophers with people from other departments, and I was glad to hear Liz Barry's paper on Samuel Beckett and Mental Disorder. I've been thinking about teaching my course on The Culture of Madness again soon, and it would be a very useful paper to include.

At Lancaster University Department of Philosophy, the workshop on Vices and Disorders had a good range of papers. Chris Megone expanded on his neo-Aristotelian view and his dialog with Rachel Cooper on whether it can successfully distinguish between disorders and moral failings. Havi Carel had a new project on eating disorders; she surveyed some of the literature and discussed how the line between moral judgment and medical judgment is drawn with anorexia and bulimia. It's an interesting project.

Talking with people while I was in the UK, they agreed that there are more events in philosophy of psychiatry this year than usual. It's an encourage trend, so I hope it continues.

Sunday, February 22, 2009

Talks and Conference

I've got a busy few weeks coming up. I'll be in the UK, giving a seminar at Newcastle and participating in a couple of workshops at Warwick and Lancaster.

On Wednesday, February 25, I'm doing a Policy, Ethics and Life Sciences Research Center seminar at the University of Newcastle, on "The Language of Madness: Medicalization and Counter-Narratives." There's info here.

On Friday March 6, I'll be participating in the the AHRC Mental Disorder workshop at the University of Warwick Medical School.

On Friday March 13, I'll be participating in the Vices and Disorders workshop at the University of Lancaster.

There's info about both these latter events here.

Then on May 16 & 17, there's the annual AAPP conference I've co-organized, on Philosophical Issues in Child and Adolescent Psychiatry, in San Francisco. There's a full program listed here.

Thursday, February 12, 2009

2 new journals

This week, I found two new journals have come into existence in the last few years, both of which have strong connections to philosophy of psychiatry and mental health.

One is The Journal of Ethics in Mental Health. It is an online journal, with free content. Articles are short and accessible to a diverse readership. Hosted by McMaster University, it started in 2006, and publishes twice a year. It looks like it would be especially useful as a teaching resource for courses in mental health ethics.

The other is BioSocieties. It is edtied by Professor Anne Harrington, Harvard University, USA, Professor Nikolas Rose, London School of Economics, UK, Dr Ilina Singh, London School of Economics, UK. Rose and Singh are core members of the BIOS center at the LSE. The journal started in 2006 and is published quarterly by Cambridge University Press. I haven't been able to read any of the articles because my college library does not have the appropriate subscription (and in the current economic climate, I doubt that we will get access to it) but the table of contents certainly looks interesting. It is interdisciplinary and critical, and promises to show the what can be achieved by bringing together work by people from different perspectives and trainings.

Tuesday, January 27, 2009

AAPP Bulletin

At the request of James Phillips, the editor of the AAPP Bulletin, I've put the 4 most recent issues online. They are at

There is excellent work in there:
Hopefully now that they are available online the work here will get wider exposure and can be useful to other researchers and teachers.

As an aside, it is worth emphasizing that membership of AAPP gets you a subscription to PPP and helps to support the main international organization devoted to scholarship in philosophy and psychiatry.

Thursday, January 22, 2009

Philosophy and Psychiatry in the Media

I forgot that I had these up online: 4 of my columns for the AAPP Bulletin on "Philosophy and Psychiatry in the Media", from 1999 to 2001.

Here they are.

Wednesday, January 21, 2009

BBC Radio 4: State of Mind

State of Mind is a series on BBC Radio 4 that traces the history of mental health treatment in the UK since the 1950s. There have been three episodes so far: Total Institution, Altered States, and Community Care? I was particularly impressed by the second show, Altered States, which in its discussion of antipsychiatry and critical psychiatry. There were clips from an old intereviewith R.D. Laing, and then it had an interview with Phil Thomas, (pictured), co-author of Postpsychiatry, and he talked about his involvement with Sharing Voices (Bradford). Radio 4 already has one long running show that focuses on mental health issues, All in the Mind, and its Science section has in recent years had many other programs that focus on psychology and mental health. It also has programs that address medical ethics: Inside the Ethics Committee is nearly all medical ethics and The Moral Maze often looks at medical/psychological issues. Many other programs on Radio 4 give a reasonably thorough discussion of controversies in psychiatry and psychology.

Apart from admiration for the work of Radio 4, this also highlights the lack of thorough and sustained investigation of such issues by radio stations in the USA. NPR and affiliated companies like American Public Radio pale in comparison with their coverage of these issues. The bulk of their coverage is in short items on their daily news shows, and then interviews (and phone-ins) with authors promoting their new books. It is disappointing that there isn't more room for coverage of new developments in psychology and mental health on public radio. The main show that addressed these issues was The Infinite Mind, which seems to be on hiatus now -- and I have never lived in an area where the public radio stations actually broadcast it.

Monday, January 19, 2009

New work on moral responsibility and psychopaths

Doing some reading on moral responsibility and following some leads has uncovered a few couple of recent papers relating to psychopathy.

Paul J. Litton. Responsibility Status of the Psychopath: On Moral Reasoning and Rational Self-Governance, Symposium: Living on the Edge: The Margins of Legal Personhood, 39 RUTGERS LAW JOURNAL 349 (2008). Available Online

Absent, Full and Partial Responsibility of the Psychopaths
Journal for the Theory of Social Behaviour, Volume 38, Number 1, March 2008 , pp. 87-103(17)

I just read "Moral Address, Moral Responsibility, and the Boundaries of the Moral Community" by David Shoemaker at Bowling Green State University. Ethics 118 (October 2007): 70-108.

Shoemaker is interested in what criterion we should use to demarcate our moral community, and he takes as his starting point the work of Peter Strawson and R. Jay Wallace on the participant reactive attitudes. He calls their approach the "Moral Reasons-Based Theory" and summarizes its basic claim as follows:
One is a member of the moral community, a moral agent eligible for moral responsibility and interpersonal relationships,if and only if (a) one has the capacity to recognize and apply moral reasons and (b) one has the capacity to control one's behavior in light of such reasons.

He considers a number of cases of people who are possibly at the borders of our moral community: people with psychopathy, moral fetishism, autism, and mild mental retardation. After each case, he amends the MRBT theory, and by the end he reaches

MRBT VERSION 5: One is a member of the moral community, a moral agent eligible for moral responsibility and interpersonal relationships, if and only if (a) one has the capacity to recognize and apply second-personal moral reasons one is capable of discovering via identifying empathy with either the affected party (or parties) of one's behavior or an appropriate representative, regardless of the method of identification and (b) one is capable of being motivated by those second-personal moral reasons because one is capable of caring about their source (viz., the affected party/parties or an appropriate representative), insofar as one is susceptible to being moved to identifying empathy with that source by the moral address expressible via the reactive attitudes in both its reason-based and emotional aspects.

It's an interesting paper, but I have to say that I found the method of argument especially flawed because of its crude approach to the borderline cases. Shoemaker's discussion of psychopathy is a good one with which to make my point. He starts off, quite sensibly, saying "we need to get clear on just what the nature of psychopathy is." Fair enough. Then he proceeds to lump it together with sociopathy under the DSM-IV disagnostic catetory for antisocial personality disorder. Astonishingly, in making this reference, he cites the website, rather than the DSM itself. In a footnote mentioning some disagreements on how to understand psychopathy, his source is Wikipedia (and he refers to the same source again later for more information about psychopaths). Shoemaker argues that psychopaths are able to recognize and follow moral rules, and he cites some philosophers (Jeffrey Murphy, Anthony Duff, Herbert Fingarette) to support his claim, and then he brings in his further evidence: fictional psychopaths, including Hannibal Lecter, Alex Delarge from A Clockwork Orange, and Eric Cartman from South Park.

It becomes clear that Shoemaker is not really interested in psychopathy as a real phenomenon, but rather whatever conceptually possible condition that will serve his purposes for his argument. Of course, he is assuming that psychopaths are not part of our moral community, which is a rather shakey assumption in real life, and is completely unsupported as a claim about his idealized concept of psychopathy that serves as his counterexample.

I find it surprising that anyone would use Wikipedia as a source of information for a scholarly paper, and especially troubling in this case because it leads to a great oversimplification and a neglect of scholarly discussion that is precisely relevant to the whole point of the paper, viz, how to understand psychopathy. It's only through understanding the psychiatric controversies over the nature of psychopathy and the responsibility of psychopaths, (as well as recent discussion in philosophy of psychiatry and neuroethics) that psychopathy can serve as a useful example for such discussion of moral responsibility.

Friday, January 9, 2009

Reciprocal Relations with Mentally Ill People

I just read Jeanette Kennett's paper "Mental Disorder, Moral Agency, and the Self" in the Oxford Handbook of Bioethics, edited by Bonnie Steinbock, Oxford University Press, 2007. (Incidentally, it is the first time I've read a whole article through Google books -- it saved me a few weeks, since I didn't have to get a copy through Inter Library Loan. Very useful.)

Kennett (pictured) here is discussing an issue I have been thinking about myself recently -- the apparent dilemma that one either treats mentally ill people as autonomous and thus subject to blame for when they are hurful and inconsiderate, or else treats them as nonautonomous, than thus as objects rather than ends-in-themselves. Either way, mentally ill people are in a bad position.

Her approach is rich, even if seems a little rambling. Her main example is Anne Deveson's son Jonathan, who she describes in her memoir Tell Me I'm Here. Jonathan had schizophrenia. Kennett says, using R. Jay Wallace, that on the standard account of moral agency, which requires that an agent be able to step back from his or her desires and examine them in the light of moral principles. She argues that Jonathan did not have that capacity. However, she gives contradictory evidence, since she points out that Deveson found notes written by Jonathan to himself saying "Don't hurt Anne," suggesting that he did regret his actions. It seems that Jonathan was able to assess his own actions at other times, but he was far less able to stop doing them. It is not so clear why Jonathan got so angry with Anne, but it does seem that he at least sometimes regretted his harmful actions. Kennett says that on standard accounts Jonathan cannout count as a responsible moral agent, but it's not so clear to me that this is true.

Kennett also talks about the visibility of the self. At first I thought this was a weak and unnecessary part of the paper, but on reflection it seems the richest part, because it is a new attempt to voice the difficult of people with mental disorders becoming objectified and invisible. She discusses Strawson's idea of participant attitudes, and the difficulties that people with serious mental illness have at being participants, as well as in planning for the future, and forming friendships. In these says, mentally ill people can become invisible. Kennett, quite rightly I think, argues that there is no neat seperation between the mentally ill person and their illness, when their illness has come to shape their identity. Obviously, she is concerned that mentally ill people can retain visibility.

The most philosophically interesting claim of the paper is that Strawson is wrong that we must take an objective stance towards people with chronic and severe mental illnesses. She says that it is not clear that there is a strong conceptual connection between occupying the participant stance and attributing responsible agency to people like Jonathan. She also points out that the participant stance is elastic. It might be available to some degree.

Kennett also focuses on the question whether a participant stance requires attributions of responsibility. She points out that one can have rich participant relationships with children -- not taking the objective stance towards them -- without holding them responsible for their actions. Using these sorts of analogies, she argues that we are not forced toward an objective stance toward the mentally ill. So the bottom line is that even if we do not hold mentally ill pepole responsible, we can still have rich interpersonal relationships with them, even if they are not a rich as with mentally well people.

The view taken by Kennett here is very appealing, and she makes a reasonable case for it. Maybe the conclusion is not very surprising to people who spend a great deal of time with mentally ill people, and Strawson's rather black and white position is quite an oversimplification. But I also think that Kennett's position is a little simplistic. Even with people with chronic severe mental illness, it may be possible for some people to have relationships with them where some mutual attitudes of holding each other responsible is possible. We can also hold people responsible for some things but not others. This is pretty clear with children and teens: they gradually grow into full responsibility. So we need to revise, or at least use with greater flexibility, the standard criterion of moral responsibility to take into account the complexities of life.

Sunday, January 4, 2009

Masters Degrees in Philosophy of Psychiatry thriving in the UK

The MSc in Philosophy of Mental Disorder at King's College London has been running successfully for over 10 years now. The MA / MSc in Philosophy and Ethics of Mental Health at Warwick University (now houses in their Medical School) is still running. Now the University of Central Lancashire has a masters program in Philosophy and Mental Health.

Yet here in the USA, there are no such programs, and there's little prospect of any starting in the near future. It's disappointing that the North American educational system is so conservative, and innovation is so difficult here. My main hope is that one of the current masters programs in bioethics will start to allow for specialization in mental health issues, or possibly that the rush of interest in neuroethics will translate into new masters programs in that area.