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Psychiatry Reborn: Biopsychosocial Psychiatry in Modern Medicine is a comprehensive collection of essays by leading experts in the field, and provides a timely reassessment of the biopsychosocial approach in psychiatry. Spanning the sciences and philosophy of psychiatry, the essays offer complementary perspectives on the ever more urgent importance of the biopsychosocial approach to modern medicine. The collection brings together ideas from the series of Loebel Lectures by world leaders in the field of psychiatry and associated Workshops at the University of Oxford, including revised versions of the Lectures themselves, and a wide range of related commentaries and position pieces. With contributions from psychiatry, psychology, neuroscience, and philosophy, the book provides the most comprehensive account to date of the interplay between biological, psychological, and social factors in mental health and their ethical dimensions. The 23 chapters of this multi-authored book review the history and place of the biopsychosocial model in medicine, and explore its strengths and shortcomings. In particular, it considers how understanding this interplay might lead to more effective treatments for mental health disorders, as developments in genomic and neurobiological medicine challenge traditional conceptions and approaches to the research and treatment of mental health disorders. The book explores the challenges and rewards of developing diagnostic tools and clinical interventions that take account of the inextricably intertwined bio-psycho-social domains, and the ethical implications of the conceptualization. It concludes with chapters drawing together the book's range of expertise to propose a best conception of the model, and how it might be adopted going forward in an age of exponentially increasing technological advances and of integrated/collaborative care. The volume is intended to present the BPS model as it stands today in the academy, the lab, and the clinic, and to start to address the challenges and potential that the model has for each.
A recent wave of research in psychiatry and neuroscience has re-examined the properties of “classic” psychedelic substances - also known as serotonergic hallucinogens - such as psilocybin, LSD, and DMT. Evidence to date suggests that psychedelics can be given safely in controlled conditions, at moderate to high doses, and may have potential as therapeutic agents in the treatment of various addictive and mood disorders. The main mechanism of action appears to be the induction of a dramatically altered state of consciousness, but the details of how psychedelic-assisted psychotherapy works are hotly debated, as are the relations between psychedelic experiences themselves and the neural changes induced by the drugs. Philosophical Perspectives on Psychedelic Psychiatry addresses the fascinating philosophical questions raised by the renewed psychiatric use of psychedelics, with chapters from leading philosophers of mind, science, and psychiatry centred around three main themes. Chapters in the “self and mind” section ask: what can we learn about the self and the mind from psychedelic science? Chapters in the “science and psychiatry” section address methodological, theoretical, and clinical questions concerning how psychedelics can best be studied scientifically and used therapeutically, and how they might work to relieve psychiatric suffering. Finally, chapters in the “ethics and spirituality” section address broader questions about the interpretation of psychedelic experience, its ethical implications, and its possible role(s) in the broader culture.
Vice and Psychiatric Diagnosis outlines the implications of vice concepts being incorporated into psychiatric diagnosis and clinical practice, leading to some of the vexing problems in mental health and social care.
Conversations in Critical Psychiatry brings together an edited selection of interviews from the series of the same name, published in the Psychiatric Times, with new and previously unpublished material. It explores critical and philosophical perspectives in psychiatry by engaging with prominent commentators within and outside the profession who have made meaningful criticisms of the status quo. By doing so, it advances our understanding of psychopathology and offers a pluralistic vision of psychiatric practice. The series started in May 2019; 33 interviews have been published to date and include many prominent psychiatrists and authors such as Allen Frances, Anne Harrington, Paul R. McHugh, S. Nassir Ghaemi, Lisa Cosgrove, Joanna Moncrieff, and Kenneth S. Kendler. Conversations in Critical Psychiatry brings together an edited selection of the most popular interviews along with some new material, including a detailed introductory essay “Psychiatry and the Critical Landscape”, previously unpublished interviews, and a new foreword.
This book applies a powerful framework in computational neuroscience (predictive coding and active inference) to explain psychiatric disorders that are characterised by pathologies of self-awareness. It shows how the self is best conceived of as an avatar or model made by the brain for the fundamental purpose of optimising basic bodily function. That avatar integrates and coordinates neurocomputation across the mind. It allows the mind to anticipate and respond to sensory information that bears on the organism’s prospects. The self is thus a model (avatar) made by the brain to allow the body to play the game of life. When activity in circuitry that implements the avatar is compromised a variety of psychiatric disorders result. Anatomy of an Avatar provides a theoretical framework for theories of embodied selfhood anchored in homoestatic regulation, as well as exploring psychiatric disorders involving the self and the empirical application of concepts of free energy minimisation, active inference and predictive processing. The book also includes key case studies in the cognitive neuropsychiatry of self awareness and test cases for philosophical concepts of self representation and the experience of self awareness. The book will be essential reading for those in the fields of psychology and consciousness, psychiatry, and philosophy.
2010 Outstanding Academic Title, Choice Magazine This is the first book-length historical critique of psychiatry’s mainstream ideology, the biopsychosocial (BPS) model. Developed in the twentieth century as an outgrowth of psychosomatic medicine, the biopsychosocial model is seen as an antidote to the constraints of the medical model of psychiatry. Nassir Ghaemi details the origins and evolution of the BPS model and explains how, where, and why it fails to live up to its promises. He analyzes the works of its founders, George Engel and Roy Grinker Sr., traces its rise in acceptance, and discusses its relation to the thought of William Osler and Karl Jaspers. In assessing the biopsychosocial model, Ghaemi provides a philosophically grounded evaluation of the concept of mental illness and the relation between evidence-based medicine and psychiatry. He argues that psychiatry's conceptual core is eclecticism, which in the face of too much freedom paradoxically leads many of its adherents to enact their own dogmas. Throughout, he makes the case for a new paradigm of medical humanism and method-based psychiatry that is consistent with modern science while incorporating humanistic aspects of the art of medicine. Ghaemi shows how the historical role of the BPS model as a reaction to biomedical reductionism is coming to an end and urges colleagues in the field to embrace other, less-eclectic perspectives.
Thought insertion is the delusion that one's thoughts are not one's own, which causes people to believe that external agents have inserted ideas or thoughts into their minds. More prevalent in schizophrenia, thought insertion has been regarded as one of the most complex psychiatric symptoms. It is easy to see why it is such an intriguing phenomenon, as it blurs our understanding of some of the most fundamental aspects of our mind. Typically, discussions around thought insertion have tended to be featured in the context of philosophical examinations of broader issues in philosophy and psychiatry, or treated as a footnote to discussions of more prominent topics such as motor agency or the structure of phenomenal consciousness. For this reason, discussion of the phenomenon is incomprehensive and scattered throughout the literature, making it difficult to keep track of. Intruders in the Mind is an interdisciplinary attempt to bring together high-quality contributions to some of the most fundamental debates arising from the comprehensive study of thought insertion. Making thought insertion its central topic, this compilation gathers a series of essays that, taken as a whole, offer a broad and thoughtful approach to the clinical, phenomenological, conceptual, and experimental aspects of the systematic study of the phenomenon.
The question of whether mental disorders are disorders of the brain has led to a long-running and controversial dispute within psychiatry, psychology and philosophy of mind and psychology. While recent work in neuroscience frequently tries to identify underlying brain dysfunction in mental disorders, detractors argue that labelling mental disorders as brain disorders is reductive and can result in harmful social effects. This book brings a much-needed philosophical perspective to bear on this important question. Anneli Jefferson argues that while there is widespread agreement on paradigmatic cases of brain disorder such as brain cancer, Parkinson's or Alzheimer’s dementia, there is far less clarity on what the general, defining characteristics of brain disorders are. She identifies influential notions of brain disorder and shows why these are problematic. On her own, alternative, account, what counts as dysfunctional at the level of the brain frequently depends on what counts as dysfunctional at the psychological level. On this notion of brain disorder, she argues, many of the consequences people often associate with the brain disorder label do not follow. She also explores the important practical question of how to deal with the fact that many people do draw unlicensed inferences about treatment, personal responsibility or etiology from the information that a condition is a brain disorder or involves brain dysfunction.
People with scrupulosity have rigorous, obsessive moral beliefs that lead them to perform extreme, compulsive moral acts. A waitress with this condition checks and rechecks levels of cleaners and solvents to avoid any risk of poisoning her customers. Another individual asks repeatedly whether he fasted correctly, despite swallowing his own saliva. Those with scrupulosity stretch out their prayers for hours to be sure that they have said nothing incorrectly. They worry constantly about cleanliness, sinfulness, and all the ways they could be falling short of perfection. Using a range of fascinating case studies, Jesse S. Summers and Walter Sinnott-Armstrong argue that scrupulosity constitutes a mental illness and not moral sainthood. In doing so, they consider several important philosophical questions: Do the moral beliefs and judgments of those with scrupulosity differ from ours, or are these individuals just stricter in their moral observance? Are they morally responsible for their actions? Should they be pressured into psychiatric treatment, even when therapy leads them to act in ways they find immoral? Summers and Sinnott-Armstrong illustrate how psychiatric cases can inform the way we think about these and other philosophical issues, particularly those surrounding responsibility, rationality, and the nature of belief, morality, and mental illness. Clean Hands? will fascinate psychiatrists who treat patients with scrupulosity, philosophers who study morality, and anyone who has ever wondered about and struggled with the obligations and limits of morality.
The very idea of mental illness is contested. Given its differences from physical illnesses, is it right to count it, and particular mental illnesses, as genuinely medical as opposed to moral matters? One debate concerns its value-ladenness, which has been used by anti-psychiatrists to argue that it does not exist. Recent attempts to define mental illness divide both on the presence of values and on their consequences. Philosophers and psychiatrists have explored the nature of the general kinds that mental illnesses might comprise, influenced by psychiatric taxonomies such as the Diagnostic and Statistical Manual and the International Classification of Diseases, and the rise of a rival biological 'meta-taxonomy': the Research Domain Criteria (RDoC). The assumption that the concept of mental illness has a culturally invariant core has also been questioned. This Element serves as a guide to these contested debates.