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Values and Psychiatric Diagnosis


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Part 1: Introduction 1.1: Background 1.2: Why psychiatric diagnosis and classification? 1.3: A brief personal history of nosological controversy 1.4: Defining 'values' 1.5: Overview of the book Part 2: Methods 2.1: Background 2.2: Kuhn on scientific theory change 2.3: Values, value terms and value semantics 2.4: Five heuristic types of values 2.5: Unravelling the dense fabric of values Part 3: Science 3.1: Background - relations between medicine and science 3.2: Basics of classification 3.3: Science and psychiatric nosology Part 4: Patients, professions and guild 4.1: Background 4.2: Patients 4.3: Professions 4.4: Guild interests and classification 4.5: Potential professional conflicts of interest in the DSMs 4.6: Weighing patient, professional and guild interests in the DSMs Part 5: Space, time and being 5.1: Background 5.2: Defining mental disorder 5.3: World views, assumptions and ontological values 5.4: The constraint of ontological space - the transpersonal psychiatry critique 5.5: The constraint of ontological time - the developmentalist critique 5.6: Space and time recast - existential-phenomenological and social constructionist critiques 5.7: Three contrast cases for ontological values in psychiatry Part 6: Sex and gender 6.1: Background: the declassification of homosexuality 6.2: "Mad" vs "bad" in the bedroom 6.3: Mental disorder diagnosis and women: what are the issues? 6.4: Discrimination and stigma as negative value- consequences 6.5: Gender concepts as entailed ontological values 6.6: Medicalization and eudaimonia Part 7: Culture 7.1: The cultural challenge to mental disorder classification 7.2: DSM-IV approaches to the problem of culture 7.3: Ten weird things about Western psychiatry 7.4: Relativism, absolutism, and cross-cultural DSMs 7.5: Toward an ethics of cross-cultural psychiatric diagnosis Part 8: Genetic nosology 8.1: Background 8.2: Barest essentials of psychiatric genetics 8.3: Psychiatric genetic nosology 8.4: Value-structure of genetic vs clinical nosology 8.5: Implications of a rising psychiatric genetic nosology Part 9: Technology 9.1: Background: Heidegger, Dreyfus and technology 9.2: Insights from the philosophy of technology 9.3: Psychiatric classification as technological 9.4: Poietic vs technological diagnostic practice 9.5: Toward a balanced poietic-technological practice Part 10: Politics 10.1: Political meanings 10.2: "The politics-science dichotomy syndrome" 10.3: Externalist political landscapes and classification 10.4: Toward a political architecture for DSM-IV 10.5: Good politics for science and classification Part 11: Values and psychiatric diagnosis 11.1: What is diagnosis? 11.2: A gardener's allegory and the point of mental disorder classification 11.3: Grasping the whole of values in classification 11.4: Just how did values guide action in the DSM-IV? 11.5: Just how should values guide action in future DSMs?


As one who has little formal training in philosophy, but who has been practicing philosophy without a license (as do, surely, many respected colleagues who resort to the DSM codes primarily for reimbursement), I celebrate the birth of this book and wish it well. People in the field are all amateur philosophers, and they can use some professional help. The book would serve for a semester course in the last year of college and in graduate school. Every psychiatric residency and clinical psychology program should devote at least an annual grand rounds or case conference to this work. It should be required reading for anyone who has anything to do with the current use and the future development of the DSM. PsycCRITIQUES, Vol 50, No 15 This is a well written and rigorous examination of values and their effects on psychiatric diagnosis. It is complex and not intended for the casual reader. The author does an excellent job of explaining the philosophical language that he applies throughout the book and breaking down societal values into their core elements. His insights are provocative and compelling. He demonstrates the richness that can be psychiatry and suggests methods of improving both clinical practice and theory in light of the value judgements that are a part of classifying mental illness. Doody's Journal John Sadler mounts a persuasive argument that values, usually seen as subjective (and therefore fallable), are impossible to separate from those concepts, even "facts", we consider objective ... The bulk of his discussion concerns the Diagnostic and Statistical Manual of Mental Disorders and the ontological assumptions - as Sadler puts it, "assumptions about the way things are" - that underlie its efforts. He offers us what he calls "an alternative path", to better enable diagnosticians in understanding their own cultural assumptions and biases. This is no abstract exercise, especially now, when, as Sadler notes, "the term 'values' is often used to shore up all sorts of political agendas, social reform intentions, and voter turnout". It's a bracing approach, challenging to all struggling to reconcile the needs of clinical practice with the unsettling fear that categorisations of any sort merely serve the collective interest. The Lancet

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