Hane Htut Maung

In clinical medicine, a diagnosis can offer an explanation of a patient's symptoms by specifying the pathology that is causing them. Diagnoses in psychiatry are also sometimes presented in clinical texts as if they pick out pathological processes that cause sets of symptoms. However, current evidence suggests the possibility that many diagnostic categories in psychiatry are highly causally heterogeneous. For example, major depressive disorder may not be associated with a single type of underlying pathological process, but with a range of different causal pathways, each involving complex interactions of various biological, psychological, and social factors. This paper explores the implications of causal heterogeneity for whether psychiatric diagnoses can be said to serve causal explanatory roles in clinical practice. I argue that while they may fall short of picking out a specific cause of the patient's symptoms, they can nonetheless supply different sorts of clinically relevant causal information. In particular, I suggest that some psychiatric diagnoses provide negative information that rules out certain causes, some provide approximate or disjunctive information about the range of possible causal processes, and some provide causal information about the relations between the symptoms themselves.

This paper addresses a philosophical problem concerning the ontological status of age classification. For various purposes, people are commonly classified into categories such as “young adulthood”, “middle adulthood”, and “older adulthood”, which are defined chronologically. These age categories prima facie seem to qualify as natural kinds under a homeostatic property cluster account of natural kindhood, insofar as they capture certain biological, psychological, and social properties of people that tend to cluster together due to causal processes. However, this is challenged by the observation that age categories are historically unstable. The properties that age categories are supposed to capture are affected by healthcare and cultural developments, such that people are staying biologically, psychologically, and socially young for longer. Furthermore, the act of classifying people into age categories can bring about changes in their behaviors, which in turn alter the biological, psychological, and social properties that the categories are supposed to capture. Accordingly, I propose that age categories are best understood as interactive kinds that are influenced in dynamic ways by looping effects. I consider some implications of these looping effects for our classificatory practices concerning age, including how different disciplines may need to review the ways they define and use age categories in their inductive inferences.

The necessity of origin suggests that a person’s identity is determined by the particular pair of gametes from which the person originated. An implication is that speculative scenarios concerning how we might otherwise have been had our gametic origins been different are dismissed as being metaphysically impossible. Given, however, that many of these speculations are intelligible and commonplace in the discourses of competent speakers, it is overhasty to dismiss them as mistakes. This paper offers a way of understanding these speculations that does not commit them to incoherence but aims to make the best sense of what they are expressing. Using the philosophical framework of two‐dimensional semantics, it proposes that the speculative scenarios are best analysed as epistemic possibilities, rather than as metaphysical possibilities. It then explores some implications of this analysis for the ethical challenges associated with the non‐identity problem.

In the Netherlands and Belgium, it is lawful for voluntary euthanasia to be offered on the grounds of psychiatric suffering. A recent case that has sparked much debate is that of Aurelia Brouwers, who was helped to die in the Netherlands on account of her suffering from borderline personality disorder. It is sometimes claimed that whether or not a mentally ill person’s wish to die is valid hinges on whether or not that wish is a symptom of the person’s mental disorder. This article addresses the philosophical problems raised by this claim, with a specific focus on the diagnosis of borderline personality disorder. After considering descriptivist and causal conceptualizations of mental disorder, I argue that the current approach to borderline personality disorder in psychiatry precludes the possibility of dissociating the wish to die from the disorder. I then examine the implications of this analysis for the question of whether or not the request for voluntary euthanasia in the case of borderline personality disorder can be considered valid. Ultimately, I conclude that the inability to dissociate the wish to die from the disorder does not invalidate the wish in the case of borderline personality disorder.