Christian Perring

In response to recent concerns about the overmedication of children, this paper considers ethical and conceptual issues that arise in the issue of when children who are diagnosed with attention deficit hyperactivity disorder should be given stimulants such as the psychotropic drug Ritalin as part of their treatment. There is considerable resistance and worry about the possibility of overmedication. This is linked to the worry that the diagnosis of ADHD is overused, and the paper considers some reasons to worry about the overuse of the diagnosis itself. The paper then focuses on the resistance to the use of drugs, which is particularly strong for children in the gray area of diagnosis, where it is dubious whether the children really meet the strict diagnostic criteria. The reasons behind such resistance are often not well articulated, so part of the task of the paper is spell out what they might be. The reasons are given the following labels: side effects, unnaturalness, profit motives, thought control, competitiveness, and doctors' power. The paper ends in taking the polemical position that while there is some legitimate concern about possible short and long term side effects of children taking psychotropic drugs, the other reasons for resistance are not well‐founded.

Gold & Stoljar's target article is important because it shows the limitations of neurobiological theories of the mind more powerfully than previous philosophical criticisms, especially those that focus on the subjective nature of experience and those that use considerations from philosophy of language to argue for the holism of the mental. They use less controversial assumptions and clearer arguments, the conclusions of which are applicable to the whole of neuroscience. Their conclusions can be applied to psychiatry to argue that, contrary to many researchers' assumptions, the approaches to both understanding and treating mental disorders must be interdisciplinary.

Exactly when Philosophy of Psychiatry started as a subfield of Philosophy is hard to say. There are several different estimates of how old psychiatry itself is, from one hundred to three hundred years, and of course there has been discussion and treatment of mental illness for at least a couple of thousand years. A host of issues which could count as belonging to the field have been discussed just within the last hundred years. For instance, a large literature on the philosophy of psychoanalysis dates back to the beginning of the century, and in the last thirty years there has been discussion of amnesia and multiple personality in the philosophy of mind, bioethical debate about involuntary hospitalization and the ability of the mentally ill to give informed consent to drug trials, and recent continental philosophy has shown much interest in madness, civilization, capitalism and schizophrenia. However, I suggest that Philosophy of Psychiatry reached a sense of itself as a separate field only in the 1990s. In this time, it has gained its own association, journal, and a book series with a prestigious press. I refer to the American Association for Philosophy and Psychiatry, the associated journal, Philosophy, Psychiatry, and Psychology, and the MIT Press series, Philosophical Psychopathology: Disorders of Mind, edited by Owen Flanagan and George Graham. Jennifer Radden's Divided Minds and Successive Selves is the first book in that series

In this paper I argue that a Naturalist conception of personhood, such as the one defended by Derek Parfit, implies that there are degrees of personhood, i.e., that it makes sense to say one individual has a greater degree of personhood than another. I describe both criteria of general personhood, which distinguish between persons and non-persons, and criteria of particular personhood, which distinguish between one person and another. I examine some of the consequences for ethics, including the rights to life, self-determination, and treatment. There may be circumstances in medicine where we have to judge the value of a patient's life in order to decide what medical treatment, if any, to provide, and although it may be emotionally difficult and politically dangerous, one relevant factor is what degree of personhood that individual has

The debate in philosophy of science in the twentieth century over the theory-laden-ness of observation showed both that there are many ways in which scientific observation depends on theory, and also highlighted some ways in which it is blind to theoretical assumptions. Debates in the philosophy of medicine have shown how concepts and theories of illness are value-laden, especially in psychiatry. Kious in his helpful and stimulating target article argues that the mainstream approach to autonomy depends on assumptions about value, and this conclusion is surely correct. However, his focus on the concept of non-voluntariness is problematic, as I argue, and we are better off not seeing it as laden with.

J’explore de façon critique la supposition du DSM[1] et de théoriciens tels que Wakefield et Gert selon laquelle les troubles mentaux doivent être attribués à un individu plutôt qu’à un groupe de personnes. Cette supposition est particulièrement problématique en pédopsychiatrie où le système familial est très souvent au centre de l’attention clinique. Il y a bien sûr des éléments de preuve substantiels indiquant que certains troubles mentaux des individus sont causés par leurs relations avec les autres et que leur guérison est grandement facilitée en traitant le groupe, tel que la famille, comme un tout. Malgré cela, il y a eu beaucoup moins de travail conceptuel visant à définir ce que cela pourrait être pour un couple, une famille ou un autre groupe que de se voir attribuer un trouble mental. Pour traiter de cette question, j’utilise un débat entre Wakefield et Murphy et Woolfolk sur la question de savoir s’il fait partie du concept de trouble mental que celui-ci soit causé par une dysfonction interne de la personne. Je discute aussi de la proposition faite par Bolton d’abandonner complètement le concept de trouble mental et d’utiliser plutôt le concept, plus large, de problème de santé mentale. Je soutiens qu’en fin de compte le caractère individuel des troubles mentaux ne constitue pas une vérité conceptuelle a priori, et qu’il faut faire intervenir des considérations pragmatiques pour décider s’il est utile de nous limiter à une telle définition ou si nous pourrions être mieux servis par une définition plus extensive. Je fais le lien avec le pragmatisme et je soutiens qu’une approche pluraliste non réductive est particulièrement appropriée en pédopsychiatrie.I critically explore the assumption of the DSM and theorists such as Wakefield and Gert that mental disorder must be attributed to an individual rather than a group of people. This assumption is especially problematic in child and adolescent psychiatry where very often the focus of clinical attention is the family system. There is of course substantial evidence that some mental disorders of individuals are caused by their relationships with other people and that their recovery is greatly facilitated by treating the group, such as a family, as a whole. However, there has been much less conceptual work on defining what it might be for a couple, family or other group to itself be attributed a mental disorder. To address this issue, I employ a debate between Wakefield , Murphy and Woolfolk on whether it is part of the concept of a mental disorder that it is caused by an internal malfunction of a person. I also discuss the proposal of Bolton that we do away with the concept of mental disorder altogether and instead use a broader concept of mental health problem. I argue that ultimately it is not an a priori conceptual truth that mental disorders are individual, and we need to bring in pragmatic considerations to decide whether it is helpful to restrict ourselves to such a definition or whether we could be better served by a more expansive definition. I link this to the philosophical view of pragmatism and argue that a pluralistic nonreductive approach is especially appropriate in child and adolescent psychiatry