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

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