What Is Mental Disorder?: An Essay in Philosophy, Science, and Values

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The effects of mental disorder are apparent and pervasive, in suffering, loss of freedom and life opportunities, negative impacts on education, work satisfaction and productivity, complications in law, institutions of healthcare, and more. With a new edition of the 'bible' of psychiatric diagnosis - the DSM - under developmental, it is timely to take a step back and re-evalutate exactly how we diagnose and define mental disorder.

This new book by Derek Bolton tackles the problems involved in the definition and boundaries of mental disorder. It addresses two main questions regarding mental illness. Firstly, what is the basis of the standards or norms by which we judge that a person has a mental disorder - that the person's mind is not working as it should, that their mental functioning is abnormal? Controversies about these questions have been dominated by the contrast between norms that are medical, scientific or natural, on the one hand, and social norms on the other. The norms that define mental disorder seem to belong to psychiatry, to be medical and scientific, but are they really social norms, hijacked and disguised by the medical profession?

Secondly, what is the validity of the distinction between mental disorder and order, between abnormal and normal mental functioning? To what extent, notwithstanding appearances, does mental disorder involve meaningful reactions and problem-solving? These responses may be to normal problems of living, or to not so normal problems - to severe psycho-social challenges. Is there after all order in mental disorder?

With the closing of asylums and the appearance of care in the community, mental disorder is now in our midst. While attempts have been made to define clearly a concept of mental disorder that is truly medical as opposed to social, there is increasing evidence that such a distinction is unviable - there is no clear line between what is normal in the population and what is abnormal. 'What is Mental Disorder?' reviews these various crucial developments and their profound impact for the concept and its boundaries in a provocative and timely book.

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Editorial Reviews

From the Publisher
"This book provides an excellent discussion and philosophical critique of the use of the term 'mental disorder'...The book is cogent and well written. It is easily accessible and does not presuppose knowledge or education...This book will be useful to the inquiring mind that seeks to understand mental disorder from a wider perspective."—The Psychologist

"Highly recommended."—CHOICE

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Product Details

Meet the Author

Derek Bolton read philosophy at Cambridge University and completed a doctorate subsequently published as 'An Approach to Wittgenstein's Philosophy' in 1979. He subsequently trained in Clinical Psychology and has worked in the Institute of Psychiatry and Maudsley Hospital in London for many years. He is the author of many papers in clinical and scientific psychiatry, and on philosophical topics in psychiatry, and co-authored with Jonathan Hill Mind, Meaning, and Mental Disorder, published by Oxford University Press, 2e, 2004.

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Table of Contents

Introduction     xiii
Synopsis     xxi
The current diagnostic manuals: aims, methods, and questions     1
Introduction and diagnostic criteria     1
The projects of description, classification, and diagnosis     2
The problem of psychological normality/abnormality     7
Tension between reliability and validity of diagnosis     15
Criticisms of the mental disorder concept     22
Functions, strengths, and limitations of the manuals     29
Summary and outstanding questions     33
Annotated bibliography     36
Appendix: some illustrations of DSM-IV diagnostic criteria     37
The sciences on mental order/disorder and related concepts: normality, meaning, natural and social norms     47
Introduction and overview of chapter     47
Sciences 'basic to psychiatry': psychology, genetics, neuroscience, medicine     51
Mind and meaning in the new behavioural sciences     64
Varieties of explanation of disorder     70
Disorder in evolutionary context     76
Social order, deviance, and mental illness     82
Evolutionary psychology and social norms     91
Annotated bibliography     96
Mental disorder and human nature     103
The legacy of the 1960s crisis: natural and social norms     103
Statistical normality and the idealization of the normal     111
Wakefield's evolutionary theoretic naturalism: statement and outline of problems     116
Variety of causal pathways to psychopathology     126
Evolutionary theory and the reliability of clinical diagnosis     131
Options for reliability and validity of diagnosis of disorder     134
Can evolutionary naturalism be used as a demarcation criterion?     139
Evolutionary psychology and social norms: implications for evolutionary theoretic naturalism     151
Summary: problems with naturalism     159
Annotated bibliography     161
Clinical definition: distress, disability, and the need to treat     163
Definition of mental disorder in the psychiatric manuals - another look     163
Harmful dysfunction in the phenomena     175
Mental disorder as breakdown of meaningful connections     182
Diagnosis and the need to treat     189
The domain of healthcare     193
Late- or post-modern views of mental health problems     201
Summary and conclusions     217
Annotated bibliography     219
Boundaries and terminology in flux      221
How to draw the line?     221
Psychiatry and social control     224
Harm     228
Management of risk     233
Stakeholders in diagnosis and treatment     237
Mental disorder in the community     239
What's in a name?     247
Medicalization and other representations     254
Summary     262
Annotated bibliography     265
Some conclusions     267
References     279
Index     293
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