M. Cristina Amoretti

In this paper I review how the notion of gender is understood in psychiatry, specifically in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). First, I examine the contraposition between sex and gender, and argue that it is still retained by DSM-5, even though with some caveats. Second, I claim that, even if genderqueer people are not pathologized and gender pluralism is the background assumption, some diagnostic criteria still conceal a residue of gender dualism and essentialism. Third, I consider gender dysphoria, which is characterized by an incongruence between one’s experienced or expressed gender and one’s assigned gender; since this condition pertains to distress and disability, not to the incongruence per se, it does not pathologize transgender people. Still, I contend that it should be removed from DSM-5 for theoretical reasons.

As it emerged from philosophical analyses and cognitive research, most concepts exhibit typicality effects, and resist to the efforts of defining them in terms of necessary and sufficient conditions. This holds also in the case of many medical concepts. This is a problem for the design of computer science ontologies, since knowledge representation formalisms commonly adopted in this field do not allow for the representation of concepts in terms of typical traits. However, the need of representing concepts in terms of typical traits concerns almost every domain of real world knowledge, including medical domains. In particular, in this article we take into account the domain of mental disorders, starting from the DSM-5 descriptions of some specific mental disorders. On this respect, we favor a hybrid approach to the representation of psychiatric concepts, in which ontology oriented formalisms are combined to a geometric representation of knowledge based on conceptual spaces.

In the present paper, we shall discuss the notion of prototype and show its benefits. First, we shall argue that the prototypes of common-sense concepts are necessary for making prompt and reliable categorisations and inferences. However, the features constituting the prototype of a particular concept are neither necessary nor sufficient conditions for determining category membership; in this sense, the prototype might lead to conclusions regarded as wrong from a theoretical perspective. That being said, the prototype remains essential to handling most ordinary situations and helps us to perform important cognitive tasks. To exemplify this point, we shall focus on disease concepts. Our analysis concludes that the prototypical conception of disease is needed to make important inferences from a practical and clinical point of view. Moreover, it can still be compatible with a classical definition of disease, given in terms of necessary and sufficient conditions. In the first section, we shall compare the notion of stereotype, as it has been introduced in philosophy of language by Hilary Putnam, with the notion of prototype, as it has been developed in the cognitive sciences. In the second section, we shall discuss the general role of prototypical information in cognition and stress its centrality. In the third section, we shall apply our previous discussion to the specific case of medical concepts, before briefly summarising our conclusions in section four.

In this paper we focus on some new normativist positions and compare them with traditional ones. In so doing, we claim that if normative judgments are involved in determining whether a condition is a disease only in the sense identified by new normativisms, then disease is normative only in a weak sense, which must be distinguished from the strong sense advocated by traditional normativisms. Specifically, we argue that weak and strong normativity are different to the point that one ‘normativist’ label ceases to be appropriate for the whole range of positions. If values and norms are not explicit components of the concept of disease, but only intervene in other explanatory roles, then the concept of disease is no more value-laden than many other scientific concepts, or even any other scientific concept. We call the newly identified position “value-conscious naturalism” about disease, and point to some of its theoretical and practical advantages.

As it emerged from philosophical analyses and cognitive research, most concepts exhibit typicality effects, and resist to the efforts of defining them in terms of necessary and sufficient conditions. This holds also in the case of many medical concepts. This is a problem for the design of computer science ontologies, since knowledge representation formalisms commonly adopted in this field (such as, in the first place, the Web Ontology Language - OWL) do not allow for the representation of concepts in terms of typical traits. The need of representing concepts in terms of typical traits concerns almost every domain of real world knowledge, including medical domains. In particular, in this article we take into account the domain of mental disorders, starting from the DSM-5 descriptions of some specific disorders. We favour a hybrid approach to concept representation, in which ontology oriented formalisms are combined to a geometric representation of knowledge based on conceptual space. As a preliminary step to apply our proposal to mental disorder concepts, we started to develop an OWL ontology of the schizophrenia spectrum, which is as close as possible to the DSM-5 descriptions.

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders included the Social Communication Disorder as a new mental disorder characterized by deficits in pragmatic abilities. Although the introduction of SPCD in the psychiatry nosography depended on a variety of reasons—including bridging a nosological gap in the macro-category of Communication Disorders—in the last few years researchers have identified major issues in such revision. For instance, the symptomatology of SPCD is notably close to that of Autism Spectrum Disorder. This opens up the possibility that individuals with very similar symptoms can be diagnosed differently and receive different clinical treatments and social support. The aim of this paper is to review recent debates on SPCD, particularly as regards its independence from ASD. In the first part, we outline the major aspects of the DSM-5 nosological revision involving ASD and SPCD. In the second part, we focus on the validity and reliability of SPCD. First, we analyze literature on three potential validators of SPCD, i.e., etiology, response to treatment, and measurability. Then, we turn to reliability issues connected with the introduction of the grandfather clause and the use of the concepts of spectrum and threshold in the definition of ASD. In the conclusion, we evaluate whether SPCD could play any role in contemporary psychiatry other than that of an independent mental disorder and discuss the role that non-epistemic factors could play in the delineation of the future psychiatry nosography.

Come è emerso dall’analisi filosofica e dalla ricerca nelle scienze cogni- tive, la maggior parte dei concetti, tra cui molti concetti medici, esibisce degli “effetti prototipici” e non riesce ad essere definita nei termini di condizioni necessarie e sufficienti. Questo aspetto rappresenta un problema per la pro- gettazione di ontologie in informatica, poiché i formalismi adottati per la rap- presentazione della conoscenza (a partire da OWL – Web Ontology Langua- ge) non sono in grado di rendere conto dei concetti nei termini dei loro tratti prototipici. Nel presente articolo ci concentriamo sulla classe dei disordini mentali facendo riferimento alle descrizioni che ne vengono date nel DSM-5. L’idea è quella di proporre un approccio ibrido, in cui i formalismi delle ontologie sono combinati a una rappresentazione geometrica della conoscenza basata sugli spazi concettuali.

Philosophers of medicine have formulated different accounts of the concept of disease. Which concept of disease one assumes has implications for what conditions count as diseases and, by extension, who may be regarded as having a disease and for who may be accorded the social privileges and personal responsibilities associated with being sick. In this article, we consider an ideal diagnostic test for coronavirus disease 2019 infection with respect to four groups of people—positive and asymptomatic; positive and symptomatic; negative; and untested—and show how different concepts of disease impact on the disease and sickness judgements for these groups. The suggestion is that sickness judgements and social measures akin to those experienced during the current COVID-19 outbreak presuppose a concept of disease containing social harm as a component. We indicate the problems that arise when adopting this kind of disease concept beyond a state of emergency.

Thanks to their heterogeneity, the nine essays in this volume offer a clear testimony of Donald Davidson's authority, and they undoubtedly show how much his work - even if it has raised many doubts and criticisms - has been, and still is, highly influential and significant in contemporary analytical philosophy for a wide range of subjects. Moreover, the various articles not only critically and carefully analyse Davidson's theses and arguments (in particular those concerning language and knowledge), but they also illustrate how such theories and ideas, despite their unavoidable difficulties, are still alive and potentially fruitful. Davidson's work is indeed an important and provocative starting point for discussing the future progress of philosophy.

In this paper, we discuss the conceptual structure of cocktail recipes. This topic involves engaging questions for philosophers and food theorists due to some peculiar characteristics of cocktail recipes, such as the fact that they are standardised by international associations but, nonetheless, vagueness in some elements of the recipes introduces a degree of variability between cocktails of the same type. Our proposal is that a classical theory of concepts is unable to account for such peculiar features. Thus, only a hybrid theoretical approach, combining definitional and prototypical aspects, can capture how cocktail recipes are usually conceptualised among bartenders and mixologists: while the spirit is usually a necessary (though not sufficient) condition for establishing whether an individual cocktail falls under a specific cocktail concept, all the other ingredients and procedures listed in recipes may vary to a certain extent. In order to assess whether variability in prototypical elements of cocktail recipes has any limitations, we exploit the notion of conceptual scheme applied to cocktail recipes and argue that, as long as the quality dimensions of a specific cocktail are respected, its identity remains unchanged regardless of changes in the ingredients or in its preparation.

The general concept of mental disorder specified in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is definitional in character: a mental disorder might be identified with a harmful dysfunction. The manual also contains the explicit claim that each individual mental disorder should meet the requirements posed by the definition. The aim of this article is two-fold. First, we shall analyze the definition of the superordinate concept of mental disorder to better understand what necessary criteria actually characterize such a concept. Second, we shall consider the concepts of some individual mental disorders and show that they are in tension with the definition of the superordinate concept, taking pyromania and narcissistic personality disorder as case studies. Our main point is that an unexplained and not-operationalized dysfunction requirement that is included in the general definition, while being systematically violated by the diagnostic criteria of specific mental disorders, is a logical error. Then, either we unpack and operationalize the dysfunction requirement, and include explicit diagnostic criteria that can actually meet it, or we simply drop it.

La discussione generale sulla filosofia della scienza contemporanea è complicata dal numero e dall’eterogeneità delle scienze, mentre lo studio di temi specifici porta inevitabilmente a dissertazioni specialistiche che mancano nel dare ragione della trama di senso sottostante. Questo Piccolo trattato di epistemologia intende occupare uno spazio vuoto, proponendo alcuni temi chiave per la comprensione dei meccanismi alla base della conoscenza scientifica: i rapporti tra filosofia e scienze, siano esse naturali o umane; la complessa relazione tra fatti e valori; la distinzione tra scoperta e giustificazione; la necessità di un discorso etico sulla ricerca, che chiami in causa categorie come fiducia, empatia, altruismo ed egoismo. Con un approccio chiaro e rigoroso, il volume intende rivolgersi a quell’ampia fascia di pubblico interessata alle tematiche centrali dell’epistemologia, della filosofia e delle scienze.

Reason and rationality represent crucial elements of the self-image of human beings and have unquestionably been among the most debated issues in Western philosophy, dating from ancient Greece, through the Middle Ages, and to the present day. Many words and thoughts have already been spent trying to define the nature and standards of reason and rationality, what they could or ought to be, and under what conditions something can be said to be rational. This volume focuses instead on the relationships of reason and rationality to some relevant specific topics, i.e., science, knowledge, gender, politics, ethics, religion, aesthetics, language, logic, and metaphysics, trying to uncover and clarify both the connections and differences in their various characterisations and uses.

The general definition of mental disorder stated in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders seems to identify a mental disorder with a harmful dysfunction. However, the presence of distress or disability, which may be bracketed as the presence of harm, is taken to be merely usual, and thus not a necessary requirement: a mental disorder can be diagnosed as such even if there is no harm at all. In this paper, we focus on the harm requirement. First, we clarify what it means to say that the harm requirement is not necessary for defining the general concept of mental disorder. In this respect, we briefly examine the two components of harm, distress and disability, and then trace a distinction between mental disorder tokens and mental disorder types. Second, we argue that the decision not to regard the harm requirement as a necessary criterion for mental disorder is tenable for a number of practical and theoretical reasons, some pertaining to conceptual issues surrounding the two components of harm and others pertaining to the problem of false negatives and the status of psychiatry vis-à-vis somatic medicine. However, we believe that the harm requirement can be maintained among the specific diagnostic criteria of certain individual mental disorders. More precisely, we argue that insofar as the harm requirement is needed among the specific diagnostic criteria of certain individual mental disorders, it should be unpacked and clarified.

Wines with geographical indication can be classified and represented by such features as designations of origin, producers, vintage years, alcoholic strength, and grape varieties; these features allow us to define wines in terms of a set of necessary and/or sufficient conditions. However, wines can also be identified by other characteristics, involving their look, smell, and taste; in this case, it is hard to define wines in terms of necessary and/or sufficient conditions, as wine concepts exhibit typicality effects. This is a setback for the design of computer science ontologies aiming to represent wine concepts, since knowledge representation formalisms commonly adopted in this field do not allow for the representation of concepts in terms of typical traits. To solve this problem, we propose to adopt a hybrid approach in which ontology-oriented formalisms are combined with a geometric representation of knowledge based on conceptual spaces. As in conceptual spaces, concepts are identified in terms of a number of quality dimensions. In order to determine those relevant for wine representation, we use the terminology developed by the Italian Association of Sommeliers to describe wines. This will allow us to understand typicality effects about wines, determine prototypes and better exemplars, and measure the degree of similarity between different wines.

Most of the epidemiological models of the Covid-19 pandemic contain the reproduction number as a parameter. In this article we focus on some shortcomings regarding its role in driving health policies and political decisions. First, we summarize what R is and what it is used for. Second, we introduce a three-question matrix for the evaluation of any construct or parameter within a model. We then review the main literature about R to highlight some of its shortcomings and apply to them our three-question matrix. Finally, we argue that these shortcomings are important for an epistemic and political evaluation of R.

This paper aims at considering the conceptual status of feeding and eating disorders (FEDs). Now that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has changed the classification and some relevant criteria of FEDs, it is particularly relevant to evaluate their psychiatric framework and their status as mental disorders. I focus my efforts on addressing only one specific question: Do FEDs fit the DSM-5 general definition of mental disorder? In DSM-5 a mental disorder is defined as a syndrome that reflects adysfunctionand is usually associated with significantdistress or disability. More importantly, there is an explicit statement saying thatallmental disorders listed in the manual must meet the requirements highlighted by the general definition. Thus, I evaluate whether or not FEDs are really meant to reflect a dysfunction and are usually associated with significant distress or disability.

This paper aims at considering the conceptual status of feeding and eating disorders (FEDs). Now that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has changed the classification and some relevant criteria of FEDs, it is particularly relevant to evaluate their psychiatric framework and their status as mental disorders. I focus my efforts on address- ing only one specific question: Do FEDs fit the DSM-5 general definition of mental disorder? In DSM-5 a mental disorder is defined as a syndrome that reflects a dysfunction and is usually associated with significant distress or disability. More importantly, there is an explicit statement saying that all mental disorders listed in the manual must meet the requirements highlighted by the general definition. Thus, I evaluate whether or not FEDs are really meant to reflect a dysfunction and are usually associated with significant distress or disability.

In this paper I focus on the connection between some of Stanley’s claims about propaganda and flawed ideologies, and the idea of the social situatedness or perspective-relativity of knowledge. More precisely, I will try to show how Stanley’s reflections on the nature of propaganda and its relationship with flawed ideologies push us towards the empiricists’ characterisation of the social situatedness of knowledge. Not only do these reflections reveal some important weaknesses of standpoint theories (that is, the claim of epistemic asymmetry between advantaged and negatively advantaged groups, and the necessity of actively achieving a standpoint), but they also support the request for the pluralism, rational critique, cooperation, fair discussion and epistemic integration fostered by social empiricism. This means that the broad idea of the social situatedness of knowledge should be defended and further developed along the lines sketched by social empiricism.

In Davidson’s opinion, the model of triangulation, which is a situation where two or more sufficiently similar interacting creatures respond to one another within a shared external environment, can give explanation to how concepts and mental contents are acquired and also clarify their very nature. In this paper, I will explore the model of triangulation, its various levels, and its specific role in concept acquisition. I will then assess the plausibility of Davidson’s account and suggest a few possible amendments to the model of triangulation, in order to make it effective in explaining the process of concept acquisition. Finally, I will argue that the model of triangulation cannot be disconnected from holism and will briefly sketch some consequences of this claim.

Riassunto: In questo contributo analizzeremo il criterio del danno, presente nella definizione generale di disturbo mentale del DSM. La questione ha rilevanza sia da un punto di vista filosofico, perché il danno è una componente normativa e valoriale, non oggettiva, sia da un punto di vista clinico, perché chi ha difeso il criterio del danno ha spesso sostenuto che in sua assenza avremmo troppi falsi positivi. Infine, ha importanza dal punto di vista socio-sanitario in relazione al rapporto tra la psichiatria e la medicina non psichiatrica, nello specifico tra il DSM e l’ICD. Sosterremo che ci sono buone ragioni per non mantenere il danno come criterio necessario nella definizione generale del disturbo mentale. Dopo una breve introduzione, forniremo una panoramica storica sul ruolo del criterio del danno nelle varie edizioni del DSM. Successivamente si illustrerà la principale obiezione contro l’inclusione del criterio del danno nella definizione generale di disturbo mentale, ossia il problema dei falsi negativi, per poi presentare e discutere ulteriori ragioni – medico-pratiche e concettuali – che depongono a sfavore dell’attribuzione di un forte peso al criterio del danno. In sede conclusiva ribadiamo come la decisione presa dalla task force del DSM-5 di escludere il criterio del danno dalla definizione generale di disturbo mentale debba essere sostenuta. Parole chiave: Danno; Disabilità; Disagio; Disturbo mentale; DSM “Harm” as Criterion for the Definition of Mental Disease in DSM. Some Epistemological Reflections: In this paper, we analyse the harm requirement in the general definition of mental disorder in the Diagnostic and Statistical Manual for Mental Disorders. This issue has both philosophical and clinical relevance: on the one hand the harm requirement is a normative, value-laden, non-objective component in the definition of mental disorder; on the other hand, the harm requirement has often been defended on the grounds that it prevents an increase in false positives. The issue is also important in assessing the relationship between psychiatry and somatic medicine, more precisely, between the DSM and the International Classification of Diseases. We argue that there are good reasons not to maintain the harm requirement in the general definition of mental disorder. After a brief introduction, we overview the history of the harm requirement across the various editions of the DSM. Then, we examine the main objection to the inclusion of the harm requirement in the general definition of mental disorder, that is, the problem of false negatives, and also present several other points – both practical and conceptual – that help demonstrate why the harm requirement is inadequate as a definiens of mental disorder. To conclude, we stress that the decision of the DSM-5 task force not to regard the harm requirement as a necessary component of mental disorder should be endorsed. Keywords: Harm; Disability, Distress; Mental Disorder; DSM

This volume breaks new grounds by bringing together a great variety of innovative contributions on triangulation, epistemology, and mind. The notion of triangulation, developed by Donald Davidson during the last two decades of his life, has changed our understanding of the relationship between subjective, intersubjective, and objective, and shed new light on concepts such as externalism, internalism, communication, interpretation, and language. At the same time, however, it has been strongly criticized for several aspects. The papers collected in this volume written by established contributors aim to provide new insights into the contemporary debate on triangulation. The upshot is not only a deeper understanding of Davidson s ideas but also a new appreciation of some central problems of epistemology and the philosophy of mind with regard to adjoining disciplines such as, for instance, cognitive sciences and the philosophy of language."

Nella pratica scientifica ci sono molte questioni di tipo concettuale che possono trarre vantaggio da uno specifico sguardo filosofico. Per esempio, qual è la differenza tra scienza e pseudoscienza? Le teorie scientifiche sono in grado di fornire una descrizione vera del mondo? In cosa consiste la spiegazione scientifica? In che misura l’impresa scientifica è influenzata da valori etici, politici, economici o religiosi? Prediligendo un approccio tematico, il volume introduce alla comprensione dei principali problemi teorici della filosofia della scienza attraverso l’analisi di venti parole o concetti chiave, così da permettere la lettura dei singoli capitoli in modo indipendente, pur in una fitta rete di importanti rimandi.