Values and Psychiatric Diagnosis

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The public, mental health consumers, as well as mental health practitioners wonder about what kinds of values mental health professionals hold, and what kinds of values influence psychiatric diagnosis. Are mental disorders socio-political, practical, or scientific concepts? Is psychiatric diagnosis value-neutral? What role does the fundamental philosophical question "How should I live?" play in mental health care? In his carefully nuanced and exhaustively referenced monograph, psychiatrist and philosopher of psychiatry John Z. Sadler describes the manifold kinds of values and value judgements involved in psychiatric diagnosis and classification systems like the DSM. Professor Sadler takes the reader on a fascinating conceptual tour of the inner workings of psychiatric diagnosis, considering the role of science, culture, sexuality, politics, gender, technology, human nature, patienthood, and professions in building his vision of a more humane psychiatric diagnostic process.
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Editorial Reviews

Doody's Review Service
Reviewer: Brett C. Plyler, M.D.(Northwestern Memorial Hospital)
Description: This book examines the values attached to psychiatric diagnoses and how societal, moral, and ethical ideas affect psychiatric classification systems.
Purpose: The primary purpose is to examine and delineate the value judgments that shape psychiatric diagnoses.
Audience: It is written for psychiatrists, psychologists, philosophers, social scientists, and interested patients.
Features: The book explores the values of our society that impact psychiatric diagnoses and classification systems. It is a mix of philosophical discussion and analysis of these values and how they are derived from politics, technology, gender, culture, and science. The author examines each of these areas and defines the impact each one has on psychiatry. He examines the process of making a diagnosis and makes suggestions for improvement. He concludes with ideas on how values should enter into the next DSM and its formulations.
Assessment: 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 judgments that are a part of classifying mental illness.

3 Stars from Doody
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Product Details

Table of Contents

1. Introduction
1.1. Background
1.2. Why psychiatric diagnosis/classification?
1.3. A brief personal history of nosological controversy
1.4. Defining "values"
1.5. Overview of the book
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. Unraveling the dense fabric of values
3. Science
3.1. Background - relations between medicine and science
3.2. Basics of classification
3.3. Science and psychiatric nosology
4. Patients, professions and guilds
4.1. Background
4.2. Patients
4.3. Professions
4.4. Guild interests and classification
4.5. Weighing, patient, professional and guild interests
5. Space, time and being
5.1. Background
5.2. Defining mental disorder
5.3. World views, assumptions and ontological valaues
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
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
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 the cross-cultural use of the DSMs
7.5. Toward an ethic for cross-cultural psychiatric diagnosis
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
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 disgnostic practice
9.5. Toward a balanced technological/poietic practice
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 DSMs
10.5. Good politics for science and classification
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?

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