Peter Zachar

Thomas, Bracken, and Timimi (2012) make an important contribution in critiquing the extent to which the profession of psychiatry can be so bureaucratic that patients are treated as problems to be solved in an ‘efficient’ assembly line fashion rather than as individual persons. The trouble with bureaucracies is that they promote a cold and impersonal accounting approach in which critical reflection on purposes is circumvented by decision-making algorithms (Zachar and Bartlett 2009). Psychotherapy treatment manuals definitely satisfy the bureaucratic instinct, and the fifteen-minute medication management session even more so (Harris 2011). Ideally, evidence-based medicine (EBM) should be used to promote the goals of ..

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined

In lieu of an abstract, here is a brief excerpt of the content:Vice, Mental Disorder, and the Role of Underlying Pathological ProcessesNancy Nyquist Potter (bio) and Peter Zachar (bio)Keywordsresponsibility, virtue theory, cultural norms, psychopathologyThe issues discussed by John Sadler are among the most complicated in the philosophy of psychiatry, if for no other reason than that they highlight an area where disciplinary fault lines between clinical psychiatry/ psychology and philosophy seem most evident. We spent a year writing an article on the relationship between the assessment of personality disorders and moral evaluations, and these fault lines became manifest not only between ourselves, but also when discussing our ideas with members of the various disciplines.Many practicing psychiatrists acknowledge that moral attributions (such as manipulativity) might be made about people with certain disorders (such as borderline personality disorder), but also find the argument that psychiatric diagnoses are moral rather than medical conditions to be a ludicrous bit of antipsychiatry in the Szaszian tradition. Philosophers, on the other hand, are less involved with these diagnostic categories in their day-to-day work and are more willing to be skeptical. Whether they are doing philosophy of psychiatry, moral theory, or sociopolitical philosophy, they are interested in digging a little bit deeper and are not impressed by arguments to the effect that—it’s obvious that these are really disorders. Being “obvious” is not a persuasive philosophical argument.The metaphysical task of determining what belongs in the category of criminality compared with other ways of sorting behavior has parallels in moral philosophy: Why is fraud, or theft, criminalized whereas (most) lying is not? Why is one set of moral norms enforceable, whereas a second set is aspirational? Does the difference involve property, where infractions of property are thought to be more serious wrongs than lying, which is “only” psychological rather than material? Are the “most serious” wrongs the ones we mark as crimes? Why is sodomy still criminalized in some areas but betraying one’s lifelong love is viewed as morally reprehensible but not criminal? Both actions are private, and only one seems to do harm—unfaithfulness—yet that is the one that is not criminalized. The point here is that, regardless of domain, our classification systems need to be justifiable, yet justification is most often mystifying. [End Page 27]The same is true for classifying mental disorders. The class of mental disorders appears to be a somewhat inconsistent collection of heterogeneous conditions and does not form a natural kind (Zachar 2000). At the most, the class of mental disorders names a family of loosely related conditions and the reasons for inclusion can shift from disorder to disorder.If the class of mental disorders does not specify an internally coherent kind akin to gold, deciding on the scope of psychiatric practice becomes an important problem. As Sadler asks, for what reasons do we classify pedophilia with schizophrenia—both as disorders—but omit sadism? This is an important question of disciplinary scope.This question of scope is itself ethically charged because, on the one hand, bringing a condition under the purview of psychiatry offers the possibility for treatment, and at least establishes the goal of improving the lives of people with specific kinds of problems. Making lives better is one of the humanistic justifications for science itself; clearly it is a raison d’être of psychiatry. On the other hand, medicalization sets up the conditions for a certain kind of social control. Hospitalization, educational services, day treatment, and disability payments are all contingent upon psychiatric diagnostic practices. These programs and the institutions that manage them are both socially available and socially prescribed. The diagnosed behaviors can now be considered to be entities, and explanations of them can be developed. New technologies for altering them will also be introduced. Such practices have been associated with dehumanization (Phillips 2009).Two important questions also need to be distinguished. The first is a question for moral philosophy—What degree of responsibility do people with putative mental disorders have for their behaviors? For example, should people with psychotic disorders or personality disorders be held responsible for crimes they commit? If so, under what conditions? Should responsibility for certain behavior be mitigated? If so, under what conditions? Moral philosophy...

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.3 (2002) 219-227 [Access article in PDF] The Practical Kinds Model as a Pragmatist Theory of Classification Peter Zachar Pragmatist theories of scientific classification are intended to be pluralistic models that recognize different ways of cutting up the world as valuable, but do not require us to adopt whatever-goes relativism or metaphysical antirealism. How ironic that my application of pragmatism to psychopathology has been charged with not being sufficiently pluralistic because it tries to fit all psychiatric disorders into the Procrustean bed of practical kinds. The Practical Kinds Model in General As a point of clarification, the practical kinds model is not a description of a type of category combined with an argument that all psychiatric disorders should be seen as belonging to that type. If it were that kind of model, I would fully agree with Haslam that practical kinds, fuzzy kinds, and discrete kinds are all potential types of psychiatric disorders. Like Nick Haslam, I believe that there are many different things in the DSM-IV and the ICD-10, and they cannot neatly be classified as the same type of thing.Rather than identifying a type of category, the practical kinds model is a general theory of scientific classification. It is a nonessentialistic theory. Essentialism is the view that things have real essences. In the Aristotelian version of essentialism, an essence is an internal structure, and it is the internal structure that makes anything be the kind of thing it really is. In this classical category model, category members either have the essence or they do not, and everything that has the appropriate essence is a member of that category. The world is supposed to therefore have a well-defined structure, and the job of the scientist is to discover that structure. Ian Hacking (1999) has termed this view of categorization inherent structurism.The practical kinds model does not deny that things have internal structures; it only denies that internal structure by itself determines category membership. Internal structure is an important consideration in identifying categories, but external criteria can always play a role. External or relational criteria play more important roles in some cases than they do in others, but they cannot be eliminated once and for all. Essentialistic theories, which favor an almost exclusive focus on inherent structures, have the advantage of being more parsimonious, but they do so by ignoring real complexity.The best way to illustrate this point is to examine a category whose identification is heavily weighted in terms of internal criteria, or an inherent structure, such as a chemical element. [End Page 219] For example, hydrogen is defined as the element that has an atomic number of 1. This means that it has one proton in its nucleus and normally one electron orbiting its nucleus. The atomic number reflects an internal property, and anything that has an atomic number of 1 is hydrogen. The same is true for the other elements. Anything that has an atomic number of 79 is gold; anything that has an atomic number of 19 is potassium, and so on. Also part of the essentialistic view is the notion that all the important properties of an element are systematically (or lawfully) related to its internal structure.It would be foolish to deny the practical utility of the atomic theory of chemistry. But even in this strongest of cases, external criteria can potentially play a role in how we decide to carve up the world and what we identify as the relevant categories. The point can be clearly illustrated with a Gedanken experiment based on the ideas of Donnellan (1983). Assume that we were to make contact with extraterrestrial life, and the result of that contact was our initiation into a larger galactic community like those portrayed on Star Trek or Babylon 5. Fortunately for us, it turns out that all planets in the community use a gold-based currency, just like we do on Earth. What we call gold, however, is too common to be the galactic basis of a currency, but a particular isotope...