Chapter

Space, time, and being

Bill (KWM) Fulford, Katherine Morris, John Z Sadler and Giovanni Stanghellini

in Values and Psychiatric Diagnosis

Published on behalf of Oxford University Press

Published in print October 2004 | ISBN: 9780198526377
Published online March 2013 | e-ISBN: 9780191754357 | DOI: http://dx.doi.org/10.1093/med/9780198526377.003.0005

Series: International Perspectives in Philosophy & Psychiatry

Space, time, and being

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What kinds of things are mental disorders? Are they properties, narratives, processes, disturbed psychic structures, disease states, political epiphenomena, communication disturbances, curses, or just plain evils? If we examined closely the background assumptions and world-views that lay behind these ways of understanding mental disorders, we would see that the ‘nature’ or ‘being’ of mental disorders is subject to a bunch of rather discrepant viewpoints. Moreover, the kinds of things that mental disorders are have commonsense implications about what to do about them. Discrepant viewpoints about what something is lead to discrepant viewpoints about what to do about that something. For instance, conceiving mental disorders as demon-possession suggests exorcism as a ‘treatment,’ whereas conceiving them as communicationdeviance suggests talk therapy, and conceiving them as biogenetic derangements suggests gene therapy or pharmacotherapy. In Chapters 1 and 2, I noted that such belief-systems about the core nature of mental disorders convey a particular network of beliefs — ontological beliefs or assumptions — viewpoints about the nature of reality that are largely assumed, tightly held, and valued as the right, the true, and the natural. We noted then that ontological values are the values upon which people build their lives: how they justify their religious beliefs, how they choose their work, how they raise their children, how they construct their political views, how they apprehend reality. Ontological assumptions, beliefs about the nature of things, are built into every cultural artifact and life lived.

The encompassing pervasiveness of ontological values, and their indirect, ‘value-entailment’ quality,1 renders them particularly stubborn to recognition and negotiation.2 Yet precisely because of their encompassing character, such recognition of their power and influence becomes all the more important. Perhaps the best way to illuminate ontological assumptions and their entailed values is to contrast world-views; to characterize one world-view and then to compare it to others with different assumptions and values. This is what I have done with this chapter, and will, to some extent, do in Chapter 7 (Culture). I am quite sure I have omitted many ‘discussable’ viewpoints and world-views in considering the contrast-cases in this chapter; part of the reason for the choices I have made relates to the literature that has emerged in response to the DSMs. My discussion here is thus a review, a commentary, and, hopefully, an invitation to converse further about the role of ontological values in shaping classifications.

I begin by reviewing the work on defining the concept of ‘mental disorders,’ a project that has fascinated philosophers and like-minded psychiatrists for decades or more, and was brought into the mainstream consciousness of American psychiatry through the inclusion of a formal definition in the DSM-III’s Introduction, a definition that persists largely unchanged into the DSM-IV-TR. I then turn to two profound, but general, dimensions of human existence — what I call ontological space and ontological time — and cast two space- and time-related threads of DSM criticism into the ontological-values rubric. The point here is to show how beliefs, attitudes, and assumptions about what is existentially ‘fundamental’ underlie evaluative judgments of the DSM. I conclude by examining some of the ontological values associated with three common theoretical ‘orientations’ in psychiatry, and show how the current model DSMs lend themselves better to some orientations than others. The DSM criticisms offered from these three orientations to psychiatry are old ones; what is new is casting them into the ontological, entailed values rubric.

Chapter.  15373 words. 

Subjects: Psychiatry

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