Philosophy of Psychiatry (Philosophy)

Phenomenology represents a mainstream in the philosophy of subjectivity as well as a rich tradition of inquiry in psychiatry. The conceptual and empirical study of language has become increasingly relevant for psychiatric research and practice. Schizophrenia is still the most enigmatic and most relevant mental disorder. This volume represents an attempt to bring specialists from different fields together in order to integrate various conceptual and empirical approaches for the benefit of schizophrenic research. We hope that it will facilitate discussions among members of such diverse fields as psychiatry, psychology, and philosophy.

Introduction: Obesity represents a major public health problem associated with medical and psychological impairment. Obesity is frequently studied with Binge Eating Disorder (BED) comorbidity. Less evidence is available for non-BED obesity, in spite of its correlation with psychological impairment and body image disturbance. In this study, we explored psychopathological features, eating behaviors, body image disturbance and self-identity impairment in patients with obesity and a control group. In patients, we also studied the relation between specific eating/body features and psychopathological symptoms. Finally, we explored the latent factorial structure that describes these features. Material and methods: The clinical sample was composed by twenty patients suffering from obesity without BED (16 females). The control group included twenty-eight healthy and normal-weight subjects (20 females) enrolled from the general population. All participants underwent a clinical interview and filled out questionnaires about body image and psychopathological symptoms.
Statistics: The Student t test was applied to compare obese patients and healthy controls in all psychological dimensions. In the clinical sample, gender differences were tested through multivariate analyses of variance (MANOVA). Then, correlational analyses explored the relation between specific eating/body features and psychopathological symptoms. Lastly, a principal-components factor analysis was performed to explore the existence of a latent factorial structure emerging from assessment evaluation in obese population. Results: Obese patients reported significantly higher scores than healthy controls in several psychopathological dimensions, i.e. Somatization, Obsessive-Compulsive, Depression, Hostility, Phobic Anxiety, and Psychoticism. Patients also reported higher body uneasiness and self-identity impairment resulting from some scores on Body Uneasiness Test and Identity and Eating Disorders questionnaire. Avoidant behaviours were more frequently reported in men whereas women reported higher body distress/dissatisfaction. In the clinical sample the questionnaires were correlated and a three-factor structure emerged: " Weight and body control " , " Weakness of Self-Identity " , and " Psychopathological distress ". Discussion: The present study found that obese patients might present several disturbances in body image, self-perception and general psychopathological distress. Clinicians should be aware of these issues to improve therapeutic strategy in the treatment of obesity.

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.