Marga Reimer

Medical professionals, including mental health professionals, largely agree that moral judgment should be kept out of clinical settings. The rationale is simple: moral judgment has the capacity to impair clinical judgment in ways that could harm the patient. However, when the patient is suffering from a "Cluster B" personality disorder, keeping moral judgment out of the clinic might appear impossible, not only in practice but also in theory. For the diagnostic criteria associated with these particular disorders (Antisocial, Borderline, Histrionic, Narcissistic) are expressed in overtly moral language. I consider three proposals for dealing with this problem. The first is to eliminate the Cluster B disorders from the DSM on the grounds that they are moral, rather than mental, disorders. The second is to replace the morally laden language of the diagnostic criteria with morally neutral language. The third is to disambiguate the notion of moral judgment so as to respect the distinction between having morally disvalued traits and having moral responsibility for those traits. Sensitivity to this distinction enables the clinician, at least in theory, to employ morally laden diagnostic criteria without adopting the sort of morally judgmental (and potentially harmful) attitude that results from the tacit presumption of moral responsibility. I argue against the first two proposals and in favor of the third. In doing so, I appeal to Grice's distinction between conventional and conversational implicature. I close with a few brief remarks on the irony of retaining overtly moral language in an ostensibly medical manual for the diagnosis of mental disorders.

The views of Davidson are being talked about, with increasing frequency, in the philosophy of psychiatry literature. His propositional attitude holism, in particular, has been much discussed in recent philosophical work on psychiatric delusions. The consensus is clear: Davidsonian holism, according to which rationality is constitutive of thought, is undermined by psychiatric delusions. The present chapter is an attempt to cast doubt on this consensus. It is argued that, properly interpreted, Davidsonian holism is quite compatible with the psychiatric phenomena invoked to discredit it. Appreciating this compatibility requires careful attention to the irrationality characteristic of psychiatric delusions.

In a recent paper Herman Cappelen and Ernie Lepore challenge an assumption that they rightly claim is pervasive among contemporary philosophers of language. According to this assumption (MA), an adequate semantic theory T for a language L should assign p as the semantic content of a sentence S in L if and only if in uttering S a speaker says that p. I claim that the arguments of Cappelen and Lepore are based upon an uncharitable interpretation of MA. If ‘saying’ is understood in a roughly Gricean sense, MA emerges as an eminently plausible assumption.

Kripke and Dummett disagree over whether or not there could have been unicorns. Kripke thinks that there could not have been; Dummett thinks otherwise. I argue that Kripke is correct: there are no counterfactual situations properly describable as ones in which there would have been unicorns. In attempting to establish this claim, I argue that Dummett's critique of an argument (reminiscent of an argument of Kripke's) to the conclusion that there could not have been unicorns, is vitiated by a conflation of two superficially similar, though importantly different, claims. I then attempt to provide an account of the counter-intuitiveness of Kripke's position, arguing that the claim that there could not have been unicorns is best understood as a semantic, rather than metaphysical, claim. Finally, I provide a brief argument on behalf of the semantics of species terms that appears to underpin Kripke's position.

In this paper, I argue against Davidson's (1986) view that our ability to understand malapropisms forces us to re-think the standard construal of literal word meaning as conventional meaning. Specially, I contend that the standard construal is not only intuitive but also well-motivated, for appeal to conventional meaning is necessary to understand why speakers utter the particular words they do. I also contend that, contra Davidson, we can preserve the intuitive distinction between what a speaker means and what his words mean, even while retaining the standard construal of literal word meaning as conventional.

In lieu of an abstract, here is a brief excerpt of the content:Reflections on InsightDilemmas, Paradoxes, and PuzzlesMarga Reimer (bio)Keywordsinsight, psychosis, treatment adherence, medical model, autonomy, open placebos, rationalityThe Practitioner's DilemmaThe psychiatrist aware of the potential intractability of what Jennifer Radden calls "insightlessness," faces a dilemma. Should she encourage her patient to embrace a medical model of his "troubles," a model whose adoption is likely to motivate treatment adherence? She might then be trying to do the impossible; she might also alienate her patient in the process. Should she instead encourage her insightless patient to embrace his own non-medical model, according to which treatment adherence makes no medical sense whatsoever? She might then see herself as encouraging a kind of uninformed consent: Her insightless patient might be taking powerful, potentially harmful, medication for reasons (such as sound sleep and "peace of mind") that would never medically justify adherence.In my original paper, I suggested that the way out of this dilemma might be to embrace the latter option, while characterizing the very real (and medically based) benefits of treatment adherence in non-medical terms. I now realize that my proposed resolution reflects an oversimplified understanding of what might be called the "practitioner's dilemma." As Michaela Amering (2010) makes clear, the situation for those with mental illness is improving dramatically. With "recovery orientation" as the "guiding principle of mental health policy," the emphasis is on "health promotion, individual strengths, and resilience." The question becomes: Can the practitioner encourage her insightless patient to partake in this "recovery" movement if she does not simultaneously encourage him to embrace a medicalized understanding of his "troubles"?Not obviously. For although a "recovery" model might eschew notions like illness1 and disease, pathology and dysfunction, and even schizophrenia, it will inevitably involve some medical notions. The patient who partakes in the "recovery movement" described by Amering, would seem to have no choice but to accept a model that is essentially medical. Consider the language used by Amering in characterizing that movement. She talks of mental health problems, therapeutic relations, patient self-determination, diagnosis and, of course, recovery. The concepts underlying such language are intrinsic to the patient-oriented movement Amering describes. The question becomes:How can the insightless patient rationally partake in such a movement without embracing some version of the medical model of mental illness? [End Page 85]This question suggests the importance of promoting some kind of insight, even if not insight "into psychosis." At the close of these comments, I consider briefly what such "revisionary" insight might involve.Paradoxes of Conditional and Relinquished AutonomyAutonomy among patients with psychosis presupposes the sort of clear-headedness that arguably comes only with treatment adherence. This may provide some justification for the "coercive treatments" that Anthony (2006) finds so offensive. For patients with psychosis, genuine autonomy is conditional, requiring some degree of insight: Recognition that their "troubles" are at least amenable to medical treatment. Once the patient recognizes this, he can choose freely to decline such treatment (regardless of whether that choice is ultimately respected). Call this the "paradox of conditional autonomy." The conditional nature of autonomy is a familiar point in philosophical discussions regarding free will. There is no genuine freedom without the sort of knowledge required for informed choices. What distinguishes the patient with psychosis from persons more generally is that his autonomy is further conditioned: The knowledge required for autonomous decision making arguably requires some degree of treatment adherence.However, the mentally ill patient has the right, as do all patients, to relinquish autonomy. He may opt for deference to, and dependency on, the relevant experts: Mental health care professionals (Campbell 1994). We are led once again to paradox. To respect the patient's autonomy, the mental health care professional must respect his right to forego autonomy in favor of deference and dependency. This paradoxical situation, involving a kind of deferred autonomy, is not unique to psychiatry but applies to medicine across the board. Indeed, it applies to the human service industry more generally where, as McGorry (1992) suggests, there is an implicit assumption that the service user is to defer to the expertise of the service provider.This assumption is rightly challenged. Suppose Justin and...

Standard attempts to defend Russell's Theory of Descriptions against the problem posed by incomplete descriptions, are discussed and dismissed as inadequate. It is then suggested that one such attempt, one which exploits the notion of a contextually delimited domain of quantification, may be applicable to incomplete quantifier expressions which are typically treated as quantificational: expressions of the form AllF's, NoF's, SomeF's, Exactly eightF's, etc. In this way, one is able to retain the plausible claim that such expressions ought to receive their usual quantificational analyses. The conclusion tentatively drawn is that perhaps definite descriptions arenot amenable to a (Russellian) quantificational analysis.

Three views of demonstrative reference are examined: contextual, intentional, and quasi-intentional. According to the first, such reference is determined entirely by certain publicly accessible features of the context. According to the second, speaker intentions are criterial in demonstrative reference. And according to the third, both contextual features and intentions come into play in the determination of demonstrative reference. The first two views (both of which enjoy current popularity) are rejected as implausible; the third (originally proposed by Kaplan in Dthat) is argued to be highly plausible.