The Virtue Of Defiance And Psychiatric Engagement

What is defiance, and when does defiant behaviour impede one's ability to aim at flourishing? People who are defiant can present perplexing challenges etiologically, diagnostically, and responsively. But in order to understand accurately when defiant behaviour is good, or bad, or neither (when it emerges out of mental illness), a fresh perspective on defiance is needed. This book offers a nuanced and complex look at defiance, taking seriously issues of dysfunction while also attending to social contexts in which defiant behaviour may arise. Those living in adverse conditions such as oppression, systematic disadvantages, and disability may act defiantly for good reasons. This perspective places defiance squarely within the moral domain; thus, it should not be assumed that when professionals come across defiant behaviour, it is a sign of mental dysfunction. Potter argues that defiance sometimes is a virtue, meaning that a disposition to be ready to be defiant when the situation calls for it is part of living a life with a realistic understanding of the aim of flourishing and its limits in our everyday world. Her work also offers theoretical work on problems in knowing that can impede understanding and responsiveness to those who are, or seem to be, defiant. Clinicians, teachers, social workers, nurses, and others working in helping professions are invited to engage in different ways with defiance so as to better understand and respond to people who express that defiance. Case studies, a framework for differentiating different forms of defiance, a realistic picture of phronesis-practical reasoning-and an explanation of how to give uptake well are some of the topics covered. The voices of service users strengthen the author's claims that defiance that is grounded in phronesis is just as much a part of moral life for those living with mental disabilities as for anyone else.

What is defiance, and when does defiant behaviour impede one's ability to aim at flourishing? People who are defiant can present perplexing challenges etiologically, diagnostically, and responsively. But in order to understand accurately when defiant behaviour is good, or bad, or neither (when it emerges out of mental illness), a fresh perspective on defiance is needed. This book offers a nuanced and complex look at defiance, taking seriously issues of dysfunction while also attending to social contexts in which defiant behaviour may arise. Those living in adverse conditions such as oppression, systematic disadvantages, and disability may act defiantly for good reasons. This perspective places defiance squarely within the moral domain; thus, it should not be assumed that when professionals come across defiant behaviour, it is a sign of mental dysfunction. Potter argues that defiance sometimes is a virtue, meaning that a disposition to be ready to be defiant when the situation calls for it is part of living a life with a realistic understanding of the aim of flourishing and its limits in our everyday world. Her work also offers theoretical work on problems in knowing that can impede understanding and responsiveness to those who are, or seem to be, defiant. Clinicians, teachers, social workers, nurses, and others working in helping professions are invited to engage in different ways with defiance so as to better understand and respond to people who express that defiance. Case studies, a framework for differentiating different forms of defiance, a realistic picture of phronesis-practical reasoning-and an explanation of how to give uptake well are some of the topics covered. The voices of service users strengthen the author's claims that defiance that is grounded in phronesis is just as much a part of moral life for those living with mental disabilities as for anyone else.

"While not traditionally named as a virtue, accountability plays a vital part in healthy relationships and in a morally integrated life. The idea that one is answerable to others besides oneself-to give others what they are due-places relational accountability within a frame of justice and serves to counterbalance the prevalent emphasis on autonomy in mental health and human flourishing. Welcoming responsibility to and caring about one's impact on others is basic to making personal relationships work over time. Without accountability, resentment and withdrawal from relationships would ensue. Accountability is also critical to the trust and cooperation needed for effective work with others. Moreover, accountability serves as a critical support to the integrity and wholeness of the morally virtuous person. Actively knowing to whom and for what one is accountable is clarifying in terms of connecting one's relational responsibilities with one's identity, direction and sense of purpose"--

A philosopher who has experienced psychosis argues that recovery requires regaining agency and autonomy within a therapeutic relationship based on mutual trust. In Mental Patient, philosopher Abigail Gosselin uses her personal experiences with psychosis and the process of recovery to explore often overlooked psychiatric ethics. For many people who struggle with psychosis, she argues, psychosis impairs agency and autonomy. She shows how clinicians can help psychiatric patients regain agency and autonomy through a positive therapeutic relationship characterized by mutual trust. Patients, she says, need to take an active role in regaining their agency and autonomy—specifically, by giving testimony, constructing a narrative of their experience to instill meaning, making choices about treatment, and deciding to show up and participate in life activities. Gosselin examines how psychotic experience is medicalized and describes what it is like to be a patient receiving mental health care treatment. In addition to mutual trust, she says, a productive therapeutic relationship requires the clinician’s empathetic understanding of the patient’s experiences and perspective. She also explains why psychotic patients sometimes feel ambivalent about recovery and struggle to stay committed to it. The psychiatric ethics issues she examines include the development of epistemic agency and credibility, epistemic justice, the use of coercion, therapeutic alliance, the significance of choice, and the taking of responsibility. Mental Patient differs from straightforward memoirs of psychiatric illness in that it analyses philosophic issues related to psychosis and recovery, and it differs from other books on psychiatric ethics in that its analyses are drawn from the author’s first-person experiences as a mental patient.

While resilience is traditionally understood as an inner trait that individuals possess inside themselves, Mental Health Resilience argues that resilience should be seen as the product of social factors, where other individuals and institutions provide the resources, opportunities, and support that enable resilience. Resilience is also partly a matter of justice, as people can only be resilient in addressing their vulnerabilities when they are given adequate resources and opportunities, and in just ways. Seen in this light, Abigail Gosselin examines what a person who has mental illness needs to have the resilience required for mental health recovery and for coping with life challenges in general. With its focus on the social and political conditions of resilience, Mental Health Resilience will appeal to fields such as social philosophy, feminist political philosophy, philosophy of psychiatry, medical humanities, bioethics, and disability studies.

This collection is dedicated to the diagnostic moment and its unrivaled influence on encompassment and exclusion in health care. Diagnosis is seen as both an expression and a vehicle of biomedical hegemony, yet it is also a necessary and speculative tool for the identification of and response to suffering in any healing system. Social scientific studies of medicalization and the production of medical knowledge have revealed tremendous controversy within, and factitiousness at the outer parameters of, diagnosable conditions. Yet the ethnographically rich and theoretically complex history of such studies has not yet congealed into a coherent structural critique of the process and broader implications of diagnosis. This volume meets that challenge, directing attention to three distinctive realms of diagnostic conflict: in the role of diagnosis to grant access to care, in processes of medicalization and resistance, and in the transforming and transformative position of diagnosis for 21st-century global health. Smith-Morris’s framework repositions diagnosis as central to critical global health inquiry. The collected authors question specific diagnoses (e.g., Lyme disease, Parkinson's, andropause, psychosis) as well as the structural and epistemological factors behind a disease’s naming and experience.

This book explores the central questions and themes lying at the heart of a vibrant area of philosophical inquiry. Aligning core issues in psychiatry with traditional philosophical areas, it presents a focused overview of the historical and contemporary problems dominating the philosophy of psychiatry. Beginning with an introduction to philosophy of psychiatry, the book addresses what psychiatry is and distinguishes it from other areas of medical practice, other health care professions and psychology. With each section of the companion corresponding to a philosophical subject, contributors systematically cover relevant topics in philosophy of mind, philosophy of science, ethics, social and political philosophy, metaphysics, epistemology, phenomenology, and philosophy of medicine. Looking ahead to new research directions, chapters address recent issues including the metaphysics of mental disorders, gender and race in psychiatry and psychiatric ethics. Featuring discussion questions, suggestions for further reading and an annotated bibliography, The Bloomsbury Companion to Philosophy of Psychiatry is an accessible survey of the debates and developments in the field suitable for undergraduates in philosophy and professional philosophers new to philosophy of psychiatry.

Vice and Psychiatric Diagnosis begins with the simple question of why some categories of mental disorder include immoral or criminal conduct as diagnostic features, while most mental disorders in the DSM and ICD do not involve such "vice-laden" concepts. While this initial puzzle seems to concern only the limited domain of psychiatric nosology, Sadler's expansive scholarship reveals that this simple question leads inexorably to complex questions about the role of "madness and morality" in intellectual history, and to today's many conflicts and contradictions in the policy and culture of mental health, criminal justice, and related social welfare efforts. The book 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. These issues include the fragmentation of care in social welfare efforts involving mentally ill people, criminal offenders, intellectually disabled individuals, and juvenile offenders. The analysis extends to cultural attitudes and policies as well: the insanity defense, managing the mentally ill criminal offender, the value of punishment in criminal justice, and derivative issues such as the ethics of forensic psychiatry, the growing problem of mass shootings, stigma, health literacy, and the difficulties in pursuing rigorous and consistent approaches to psychiatric diagnostic classification. In the pursuit of untangling these threads of vice and psychiatric diagnosis, Sadler provides a brief history of ideas about madness and morality, beginning in prehistory and extending into the late 20th century. The lessons from this history are applied in subsequent chapters, examining the "vice-mental disorder relationship" from the perspectives of philosophical/conceptual issues, the perspectives of criminal law and the criminal justice system, and the perspectives of public interest and public opinion. The concluding chapters formulate an alternative way of thinking about the vice-mental disorder relationship in clinical practice and public policy, culminating in "Forty Theses" which present the detailed conclusions and social implications for this monumental work.