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Mental Health and Morality

An Upper Level Undergraduate Philosophy Course

Christian Perring

Taught at Georgetown University, 1993

Course Description

We will examine moral issues that arise in clinical and abnormal psychology. These can be divided up roughly into three main questions. First, is there an objective, value-neutral definition of mental pathology, and if not, then to what extent is psychiatry a form of social control? Second, to what extent are people with mental problems and illnesses responsible for their behavior? Finally, under what conditions are the institutions of mental health justified in imposing treatment on people, and to what extent is society responsible for providing help for the mentally ill.

This course is designed for upper level undergraduates and graduate students. A background in philosophy is essential, and a familiarity with the basics of abnormal psychology would be extremely useful. Each student will be required to give at least two presentations (~30-45 minutes) summarizing debates in one of the topics. (10%) In addition, there will be three 8-page papers. (30% each). Class discussion and debate will be an important part of the course, and students will be encouraged to bring in their own areas of interest and knowledge.

Course Books:

Psychiatry and Ethics, edited by Rem B. Edwards (Prometheus, 1982) (E)

The Philosophical Defense of Psychiatry, by Laurie Reznek (Routledge, 1991) (Reznek)

Madness in the Streets, by Rael Jean Isaac & Virginia C. Armat (The Free Press, 1990) (I&A)

(optional) Psychiatric Ethics, second edition edited by S. Bloch and P. Chodoff, (Oxford U.P., 1991) (BC)

These and other books used in the course should be available on 24 hour reserve.


1. Basic Categories: Psychiatry and Diagnosis

Reznek: Introduction: Psychiatry in Crisis

I&A: Introduction

Robert Veatch: Psychiatry and the Control of Human Behavior, Chapter 10 of Case Studies in Medical Ethics

2. Philosophical Foundations: Personhood, Autonomy, and Moral Responsibility.

Harry Frankfurt: Freedom of the Will and the Concept of a Person

Patricia Greenspan: Unfreedom and Responsibility

3. Historical and Feminist Critiques of the Mental Health Profession

Michel Foucault: Madness and Civilization (Chapters 8 & 9)

Reznek: Chapter 8, Michel Foucault and the Civilizing of Madness

Elaine Showalter: The Female Malady (Introduction and Chapter 1)

Phyllis Chessler: Women and Madness, Chapter 3 (Doubleday, New York; 1972)

Sidney Bloch: The Political Misuse of Psychiatry in the Soviet Union (BC)

4. Conceptual and Theoretical Critiques of the Mental Health Profession

Thomas Szasz: The Myth of Mental Illness (E)

Michael S. Moore: Some "Myths" about Mental Illness (E)

Reznek: Chapter 5, Thomas Szasz and the Physicalzing of Disease

Christopher Boorse: What a Theory of Mental Health Should Be (E)

Robert Veatch: The Medical Model: Its Nature and Problems (E)

William Fulford: The Concept of Disease (BC)

Reznek : Chapters 1, 9, 10 and 11

5. Diagnosis and Homosexuality

Walter Reich: Psychiatric Diagnosis as an Ethical Problem (BC)

Ronald Bayer: Homosexuality and American Psychiatry (Ch. 1: From Abomination to Disease)

Christopher Boorse: Concepts of Health, in Health Care Ethics: An Introduction, edited by Donald VanDeVeer and Tom Regan (Temple University Press, Philadelphia; 1987)

6. Excuses for Behavior

Herbert Fingarette: Insanity and Responsibility (E)

Carl Elliott: Moral Responsibility, Psychiatric Disorders and Duress (J. App. Phil.; 1991)

Reznek: Chapter 12: Psychiatry and Responsibility

Richard Ferrell et al, Volitional Disability and Physician Attitudes Towards Noncompliance (J. Med. Phil. 1984)

7. Personhood and Psychopathology

Stephen Braude: First Person Plural, (Routledge, 1992) (Chapter 8)

Stephen Braude: Multiple Personality and Moral Responsibility

Louis Sass: Introspection, Schizophrenia, and the Fragmentation of Self (Representations, 1987)

Derek Parfit: The Psychological View, from Reasons and Persons (Clarendon Press, 1984)

8. Involuntary Hospitalization and Deinstitutionalization

Peter R. Breggin: Coercion of Voluntary Patients in an Open Hospital (E)

Robert Miller: The Ethics of Involuntary Commitment to Mental Health Treatment (E)

I&A: Part III. The Law Becomes Deranged

Reznek: Chapter 13; The Practice of Psychiatry

David Greenburg: Involuntary Psychiatric Commitments to Prevent Suicide (E)

Jonathon Borus: Deinstitutionalization of the Chronically Mentally Ill (E)

Allen Buchanan & Dan Brock: Deciding for Others, Chapter 7: The Mentally Ill, pp. 311-331

Rolf Sartorius: Paternalistic Grounds for Involuntary Civil Commitment: A Utilitarian Perspective, in Mental Illness: Law and Public Policy, eds B.A. Brody and H. Tristran Englehardt, Jr. (D. Reidel, 1980)

9. Psychosurgery, ECT, Psychotropic Drugs and the Right to Refuse Treatment

Peter Breggin: The Return of Lobotomy and Psychosurgery (E)

Peter Breggin: Toxic Psychiatry Chapter 11: Suppressing the Passion of Anxiety Overwhelm with Drugs, & Chapter 15: Psychiatry and the Psycho-Pharmaceutical Complex

Stephan Chorover: Psychosurgery: A Neuropsychological Perspective (E)

Ruth Macklin: Refusal of Psychiatric Treatment: Autonomy, Competence, and Paternalism

I&A: Part IV. The War Against Treatment (E)

Elliot S. Valenstein: Science-Fiction, Fantasy, and the Brain (E)

Allen Buchanan & Dan Brock: Deciding for Others, Chapter 7: The Mentally Ill, pp. 332-346

10. Molding Persons: Psychodynamic Talk Therapy and the Future of Psychopharmacology

Peter Kramer: Listening to Prozac Introduction and Chapter 9: The Message in the Capsule

Nancy Sherman: The Moral Perspective and the Psychoanalytic Quest

Joel Kovel: Values, Interests and Psychotherapy (in The Radical Spirit, Free Association Books, 1988)