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

From the Publisher

"A major strength of Sadler's work is that he manages to discuss the views of those who produced the D.S.M. and the view of their most ardent opponents with equal generosity and good-sense. The resulting balance ensures that if one is going to read one book on the D.S.M., this is the book to read." --Metapsychology

"Needless to say, this is a big book. That is succeeds as well as it does is due as much to the author's wry, personal style as to his impressive breadth of knowledge." --Lancet

"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." --Doody's

"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. It should be required reading for anyone who has anything to do with the current use and the future development of the DSM." --PsycCRITIQUES

Advance praise for Values and Psychiatric Diagnosis "One thinks of the great cartographers at work in reading Dr Sadler's exploration of the values embedded in current psychiatric diagnostic classifications - the DSM-IV. This is a huge, ten-year, interdisciplinary undertaking. Usually, authors who cut across disciplines are at home in one, but inexpertly borrow from the others, their extractions somewhat derivative and impoverished. But Sadler enriches as he draws on science, clinical practice, cultural analysis, the history of science and philosophy. While exposing the changes in value assumptions in each of the successive DSMs through DSM-IV, Sadler doesn't unmask and demean the profession of psychiatry, but shows how it can grow rather than devour itself in its value permutations." William F. May, Fellow of the Institute for Practical Ethics and Public Life, University of Virginia

"Values and Psychiatric Diagnosis is interdisciplinary scholarship at its best. A wide range of readers will find this work filled with insights that Sadler's lively, yet precise writing style makes readily available. Sadler's analysis is clear and compelling. In this work, complex technical questions are discussed with wit and wisdom. Sadler has managed to define the function and significance of values across the entire field of psychiatric diagnosis; he has written a reliable guide to the wide range of issues involved." George J Agich, Chair Bioethics, Cleveland Clinic Foundation, Cleveland, USA

"At last we have in-depth understanding of the controversies that underline the passionate disagreements about the classification of mental disorders. If there is any doubt as to why psychiatry is the most fascinating and important specialty of medicine, Dr Sadler has put that to rest with this provocative in-depth discussion of the values that are intrinsic to psychiatry." Steven S Sharfstein, President-Elect of the American Psychiatric Association

"The long awaited volume is a worthy successor to John Sadler's ground-braking previous research on values in diagnostic classification. Impeccably argued and researched, Values and Psychiatric Diagnosis will prove an indispensable tool for anyone wishing to understand the nature, and importance, of psychiatry. In a readable, clear and unadorned style, Sadler skillfully develops his case that psychiatry is a value-saturated practice and persuades us that rather than its weakness, this is psychiatry's great strength." Jennifer Radden, Professor of Philosophy, University of Massachusets, Boston, USA

"...Sadler's new book on Values and Psychiatric Diagnosis is a great book. For anyone interested in the classification of psychopathology, in the thought processes behind the modern DSMs, or in the relationship of philosophy to psychiatric thought, Sadler's 2005 book will become a classic work."--The Journal of Nervous and Mental Disease

" important book."--MentalHealth Today

"...brilliant tour de force...This book deserves to be thoughtfully read and discussed by psychiatry's liveliest minds."--Journal of Clinical Psychiatry

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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