Abstract:This article defends the idea that colonialism still has a grasp on a valuable tool in the construction of our reality: memory. Developments in cognitive neuroscience and interdisciplinary memory studies propose that memory is far more creative and tied to one's imaginal capacities than we used to believe, suggesting that remembering is not simply a reproductive process, but a complex reconstructive process. Drawing on the psychiatric works of Frantz Fanon, in Alienation & Freedom; Black Skin, White Masks; and Wretched of the Earth, this article seeks to illustrate the ways in which colonialism continues to be involved in this reconstructive memory process. Colonialism has affected both episodic memories, the kind we have as individuals regarding our own past, and collective memories, the intersubjective shared narratives we possess in our societies. I argue that dominant collective memories ought to be rejected as a means of self-preservation for racialized individuals because these memories do not do justice to the violence of colonialism. Nevertheless, rejection of dominant collective memories comes at a significant personal cost in our societies, as it creates a traumatic loop for racialized individuals. I propose that psychiatry itself plays an instrumental role in the alienation experienced by racialized individuals because psychiatry has not yet appreciated the ways in which colonialism continues to have a hold on memory. Piecing together a theory of remembering in Fanon's texts, this article suggests that this cycle of alienation can be broken, if psychiatrists incorporate Fanon's insights regarding memory into their practice.
{"title":"Memory, Colonialism, and Psychiatry How Collective Memories Underwrite Madness","authors":"E. Walsh","doi":"10.1353/ppp.2022.0040","DOIUrl":"https://doi.org/10.1353/ppp.2022.0040","url":null,"abstract":"Abstract:This article defends the idea that colonialism still has a grasp on a valuable tool in the construction of our reality: memory. Developments in cognitive neuroscience and interdisciplinary memory studies propose that memory is far more creative and tied to one's imaginal capacities than we used to believe, suggesting that remembering is not simply a reproductive process, but a complex reconstructive process. Drawing on the psychiatric works of Frantz Fanon, in Alienation & Freedom; Black Skin, White Masks; and Wretched of the Earth, this article seeks to illustrate the ways in which colonialism continues to be involved in this reconstructive memory process. Colonialism has affected both episodic memories, the kind we have as individuals regarding our own past, and collective memories, the intersubjective shared narratives we possess in our societies. I argue that dominant collective memories ought to be rejected as a means of self-preservation for racialized individuals because these memories do not do justice to the violence of colonialism. Nevertheless, rejection of dominant collective memories comes at a significant personal cost in our societies, as it creates a traumatic loop for racialized individuals. I propose that psychiatry itself plays an instrumental role in the alienation experienced by racialized individuals because psychiatry has not yet appreciated the ways in which colonialism continues to have a hold on memory. Piecing together a theory of remembering in Fanon's texts, this article suggests that this cycle of alienation can be broken, if psychiatrists incorporate Fanon's insights regarding memory into their practice.","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"22 1","pages":"223 - 239"},"PeriodicalIF":2.3,"publicationDate":"2023-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83197184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Memory and the Instituting Social Imaginary","authors":"N. Potter","doi":"10.1353/ppp.2022.0041","DOIUrl":"https://doi.org/10.1353/ppp.2022.0041","url":null,"abstract":"","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"87 1","pages":"241 - 242"},"PeriodicalIF":2.3,"publicationDate":"2023-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85134325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Standards and Assumptions, the Limits of Inclusion, and Pluralism in Psychiatry","authors":"Bennett Knox","doi":"10.1353/ppp.2022.0047","DOIUrl":"https://doi.org/10.1353/ppp.2022.0047","url":null,"abstract":"","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"27 1","pages":"275 - 277"},"PeriodicalIF":2.3,"publicationDate":"2023-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73594364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract:This article brings together considerations from philosophical work on standpoint epistemology, feminist philosophy of science, and epistemic injustice to examine a particular problem facing contemporary psychiatry: the conflict between the conceptual resources of psychiatric medicine and alternative conceptualizations like those of the neurodiversity movement and psychiatric abolitionism. I argue that resistance to fully considering such alternative conceptualizations in processes such as the revision of the Diagnostic and Statistical Manual of Mental Disorders emerges in part from a particular form of epistemic injustice (hermeneutical ignorance) leveled against a particular social group (which I call the "psychopathologized"). Further, insofar as the objectivity which psychiatry should aspire to is a kind of "social objectivity" which requires incorporation of various normative perspectives, this particular form of epistemic injustice threatens to undermine its scientific objectivity. Although many questions regarding implementation remain, this implies that psychiatry must grapple substantively with radical reconceptualizations of its domain if it is to achieve legitimate scientific objectivity.
摘要:本文汇集了立场认识论、女性主义科学哲学和认识论不公正的哲学思想，探讨了当代精神病学面临的一个特殊问题:精神医学的概念资源与神经多样性运动和精神病学废除主义等另类概念之间的冲突。我认为，在《精神疾病诊断与统计手册》(Diagnostic and Statistical Manual of Mental Disorders)的修订等过程中，对充分考虑这些替代概念的抵制部分来自于针对特定社会群体(我称之为“精神病理化”)的一种特定形式的认知不公正(解释学上的无知)。此外，就精神病学应该追求的客观性而言，它是一种“社会客观性”，需要结合各种规范的观点，这种特殊形式的认识不公正可能会破坏它的科学客观性。尽管许多关于实施的问题仍然存在，但这意味着，如果精神病学要实现合理的科学客观性，就必须从本质上努力对其领域进行彻底的重新概念化。
{"title":"Exclusion of the Psychopathologized and Hermeneutical Ignorance Threaten Objectivity","authors":"Bennett Knox","doi":"10.1353/ppp.2022.0044","DOIUrl":"https://doi.org/10.1353/ppp.2022.0044","url":null,"abstract":"Abstract:This article brings together considerations from philosophical work on standpoint epistemology, feminist philosophy of science, and epistemic injustice to examine a particular problem facing contemporary psychiatry: the conflict between the conceptual resources of psychiatric medicine and alternative conceptualizations like those of the neurodiversity movement and psychiatric abolitionism. I argue that resistance to fully considering such alternative conceptualizations in processes such as the revision of the Diagnostic and Statistical Manual of Mental Disorders emerges in part from a particular form of epistemic injustice (hermeneutical ignorance) leveled against a particular social group (which I call the \"psychopathologized\"). Further, insofar as the objectivity which psychiatry should aspire to is a kind of \"social objectivity\" which requires incorporation of various normative perspectives, this particular form of epistemic injustice threatens to undermine its scientific objectivity. Although many questions regarding implementation remain, this implies that psychiatry must grapple substantively with radical reconceptualizations of its domain if it is to achieve legitimate scientific objectivity.","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"5 1","pages":"253 - 266"},"PeriodicalIF":2.3,"publicationDate":"2023-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72739680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tilmes concludes his interesting and informative piece with the sentence that “analysis of psychiatric vagueness merits further consideration.” I agree with this point, as well as with his earlier assertion that how one understands psychiatric vagueness may implicate the diagnostic model that one adopts, and the research that one pursues. Fortunately, there has been recent attention to vagueness in psychiatry, addressing both degree-vagueness (e.g., how much depression is required for a diagnosis of depression) and combinatorial vagueness (e.g., what sorts of symptoms are needed for this diagnosis) (Geert, Lara and Rico, 2017). Vagueness in psychiatry is related to a range of nosological debates, including about the value of categorical versus dimensional constructs. Notably, the editors of DSM-5 initially aimed to shift to a more dimensional approach, in keeping with the continuous nature of biological domains of function (Regier, Narrow, Kuhl, & Kupfer, 2009). Nevertheless, dimensional constructs can be reformulated as categories by using cut-points, symptoms of categories can be tallied up to form dimensions, and both categorical and dimensional measures are useful (Kessler, 2002). While many psychiatric traits are continuous, diagnostic categories have considerable clinical utility and were largely retained in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 (First, 2005). Tilmes divides theories of vagueness into semantic, epistemic, and ontic ones, and defends the claim that if there is a such a thing as psychiatric vagueness then some cases of such vagueness are least in part semantic. That is, that at least some of this indeterminacy is due to our descriptions of the world, rather than due to the state of the world or what we know about it. While it is entirely reasonable to study the language of diagnosis, I would want to emphasize the complex and intertwined relationships between our concepts and the world, and to point out that many other considerations are at stake here other than the use of language by different communities. It is notable, for example, that the International Classification of Disease (ICD)-11 made the decision to use clinical guidelines that avoid the “pseudo-precision” of the DSM-5 (Reed et al., 2019). Thus, for example, whereas for generalized anxiety disorder DSM-5 specifies that symptoms have lasted for 6 months, ICD-11 refers instead, rather more vaguely, to “several months.” It is not, however, the case that this vagueness indicates means that ICD-11 takes an anti-realist position on mental disorders (Tilmes equates semantic
{"title":"Psychiatric Disorders Are Soft Natural Kinds","authors":"D. Stein","doi":"10.1353/ppp.2022.0037","DOIUrl":"https://doi.org/10.1353/ppp.2022.0037","url":null,"abstract":"Tilmes concludes his interesting and informative piece with the sentence that “analysis of psychiatric vagueness merits further consideration.” I agree with this point, as well as with his earlier assertion that how one understands psychiatric vagueness may implicate the diagnostic model that one adopts, and the research that one pursues. Fortunately, there has been recent attention to vagueness in psychiatry, addressing both degree-vagueness (e.g., how much depression is required for a diagnosis of depression) and combinatorial vagueness (e.g., what sorts of symptoms are needed for this diagnosis) (Geert, Lara and Rico, 2017). Vagueness in psychiatry is related to a range of nosological debates, including about the value of categorical versus dimensional constructs. Notably, the editors of DSM-5 initially aimed to shift to a more dimensional approach, in keeping with the continuous nature of biological domains of function (Regier, Narrow, Kuhl, & Kupfer, 2009). Nevertheless, dimensional constructs can be reformulated as categories by using cut-points, symptoms of categories can be tallied up to form dimensions, and both categorical and dimensional measures are useful (Kessler, 2002). While many psychiatric traits are continuous, diagnostic categories have considerable clinical utility and were largely retained in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 (First, 2005). Tilmes divides theories of vagueness into semantic, epistemic, and ontic ones, and defends the claim that if there is a such a thing as psychiatric vagueness then some cases of such vagueness are least in part semantic. That is, that at least some of this indeterminacy is due to our descriptions of the world, rather than due to the state of the world or what we know about it. While it is entirely reasonable to study the language of diagnosis, I would want to emphasize the complex and intertwined relationships between our concepts and the world, and to point out that many other considerations are at stake here other than the use of language by different communities. It is notable, for example, that the International Classification of Disease (ICD)-11 made the decision to use clinical guidelines that avoid the “pseudo-precision” of the DSM-5 (Reed et al., 2019). Thus, for example, whereas for generalized anxiety disorder DSM-5 specifies that symptoms have lasted for 6 months, ICD-11 refers instead, rather more vaguely, to “several months.” It is not, however, the case that this vagueness indicates means that ICD-11 takes an anti-realist position on mental disorders (Tilmes equates semantic","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"1 1","pages":"183 - 185"},"PeriodicalIF":2.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89621150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract:Most mental health conditions, though appropriate targets of treatment, do not generate a moral obligation to seek treatment. Trauma, in contrast, is caused (at least in part) by an external event that can happen at any point in the individual’s life. Survivors often experience diverse and enduring symptoms that adversely affect their cognitive, social, emotional, and physical functioning (American Psychiatric Association, 2013). These global impairments diminish an individual’s ability to respond appropriately to morally relevant reasons and stimuli. Fortunately, symptoms of trauma respond well to treatment (Bradley, Greene, Russ, Dutra, & Westen, 2005). The external etiology and effectiveness of treatment allows us examine the moral duties of someone with impaired moral faculties due to trauma within a Kantian framework. The symptoms of trauma interfere with their ability to cultivate what Kant calls “natural powers” of spirit, soul, and body (DoV 6:444–6:445). Kant’s discussion of the natural powers implies that we must possess a baseline level of functioning in these areas in order to fulfill our moral duties (DoV 6:444–446). By Kant’s own reasoning it seems that individuals who experience impairments in any of the three powers are morally obligated to cultivate these capacities. Using Johnson’s (2011) discussion of Kant’s duties to self and careful analysis of available treatments for trauma, I argue that individuals who experience symptoms of trauma and suffer from impairments in Kantian natural powers have an imperfect duty to themselves to repair these powers through empirically informed trauma treatment.
{"title":"Symptoms of Trauma, Kantian Natural Powers, and the Duty to Seek Treatment","authors":"Katie Harster","doi":"10.1353/ppp.2022.0031","DOIUrl":"https://doi.org/10.1353/ppp.2022.0031","url":null,"abstract":"Abstract:Most mental health conditions, though appropriate targets of treatment, do not generate a moral obligation to seek treatment. Trauma, in contrast, is caused (at least in part) by an external event that can happen at any point in the individual’s life. Survivors often experience diverse and enduring symptoms that adversely affect their cognitive, social, emotional, and physical functioning (American Psychiatric Association, 2013). These global impairments diminish an individual’s ability to respond appropriately to morally relevant reasons and stimuli. Fortunately, symptoms of trauma respond well to treatment (Bradley, Greene, Russ, Dutra, & Westen, 2005). The external etiology and effectiveness of treatment allows us examine the moral duties of someone with impaired moral faculties due to trauma within a Kantian framework. The symptoms of trauma interfere with their ability to cultivate what Kant calls “natural powers” of spirit, soul, and body (DoV 6:444–6:445). Kant’s discussion of the natural powers implies that we must possess a baseline level of functioning in these areas in order to fulfill our moral duties (DoV 6:444–446). By Kant’s own reasoning it seems that individuals who experience impairments in any of the three powers are morally obligated to cultivate these capacities. Using Johnson’s (2011) discussion of Kant’s duties to self and careful analysis of available treatments for trauma, I argue that individuals who experience symptoms of trauma and suffer from impairments in Kantian natural powers have an imperfect duty to themselves to repair these powers through empirically informed trauma treatment.","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"56 1","pages":"147 - 157"},"PeriodicalIF":2.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90853228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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