Gary Gala

Psychopathy is best understood as a specific deficit in moral understanding and not merely as a cluster of antisocial behaviors. Psychopathy is the absence of conscience. While popular culture depicts psychopaths as remorseless serial killers, many psychopaths never commit homicide, and conversely some killers (e.g., soldiers acting on moral convictions) retain a functioning conscience. What unites all psychopaths is their incapacity to grasp moral reasons for actions. In this paper, we clarify psychopathy’s conceptual contours; distinguish it from related conditions, such as, legal insanity, pragmatic criminality, and volitional disorders. We also critique the Hare Psychopathy Checklist–Revised (PCL-R) for its behavioral rather than motivational focus. We argue that psychopathy amounts to a congenital moral blindness, with signifi cant implications for diagnosis, treatment, and moral psychology.

Psychiatric disorders usually do not have characteristic physical exam findings, imaging, or lab values. Psychiatrists therefore diagnose and treat patients largely based on reported or observed behavior, which makes collateral information from a patient’s close contacts especially pertinent to an accurate diagnosis. The American Psychiatric Association considers communication with patients’ supports a best practice when the patient provides informed consent or does not object to the communication. However, situations arise in which a patient’s objection to such communication is the product of impaired decision-making and the benefits of obtaining collateral information represent best practice. In this article a framework for addressing these situations is proposed using a full decisional capacity evaluation, followed by an alternate decision-making process by concurrence from a second physician. It is recommended that a patient’s refusal to allow the gathering of collateral information should be addressed exactly like refusals for other diagnostic or treatment interventions.

This groundbreaking volume of original essays presents fresh avenues of inquiry at the intersection of philosophy and psychiatry. Contributors draw from a variety of fields, including evolutionary psychiatry, phenomenology, biopsychosocial models, psychoanalysis, neuroscience, neuroethics, behavioral economics, and virtue theory. Philosophy and Psychiatry’s unique structure consists of two parts: in the first, philosophers write five lead essays with replies from psychiatrists. In the second part, this arrangement is reversed. The result is an interdisciplinary exchange that allows for direct discourse, and a volume at the forefront of defining an emerging discipline. Philosophy and Psychiatry will be of interest to professionals in philosophy and psychiatry, as well as mental health researchers and clinicians

Decisional capacity evaluations (DCEs) occur in clinical settings where it is unclear whether a consumer of medical services has the capacity to make an informed decision about the relevant medical options. DCEs are localized interventions, not the global loss of competence, that assign a surrogate decision maker to make the decision on behalf of the medical consumer. We maintain that one important necessary condition for a DCE to be morally justified, in cases of medical necessity, is that the health care consumer under evaluation is incapable of expressing a preference for a certain outcome.

The paper by Bergnar and Bunford in this edition of Philosophy, Psychiatry, & Psychology is a sophisticated examination of a central question that has lacked consensus in the philosophy of psychiatry, namely, what is “the key aspect of the meaning of this fundamental term, mental disorder”? To settle this question, the authors use an empirical approach by surveying graduate students in clinical psychology. In this way, they attempt to invoke the Wittgensteinian method of determining the meaning of a term by seeing how it is used. The empirical results, the authors argue, serve as strong evidence in support of the position that the term ‘mental disorder’ designates disability...