Madness versus badness: the ethical tension between the recovery movement and forensic psychiatry.

The mental health recovery movement promotes patient self-determination and opposes coercive psychiatric treatment. While it has made great strides towards these ends, its rhetoric impairs its political efficacy. We illustrate how psychiatry can share recovery values and yet appear to violate them. In certain criminal proceedings, for example, forensic psychiatrists routinely argue that persons with mental illness who have committed crimes are not full moral agents. Such arguments align with the recovery movement's aim of providing appropriate treatment and services for people with severe mental illness, but contradict its fundamental principle of self-determination. We suggest that this contradiction should be addressed with some urgency, and we recommend a multidisciplinary collaborative effort involving ethics, law, psychiatry, and social policy to address this and other ethical questions that arise as the United States strives to implement recovery-oriented programs.

Philosophy of psychopathology.

PURPOSE OF REVIEW: Psychiatry is increasingly aware of its own conceptual foundations and the role that philosophy plays in shaping research and practice. This growing awareness is especially prominent in the area of psychopathology, where both philosophers and psychiatrists are actively investigating the basic assumptions and values that influence the science. RECENT FINDINGS: There is growing attention to the role of values in understanding both the concepts of psychopathology, and the philosophical assumptions that underlie research strategies for studying it. Provocative work is being done to clarify the concept of 'mental disorder', to identify the influence of values in the classification and diagnosis of psychopathology, and to use values to argue for comprehensive research efforts. Psychometricians increasingly question the interplay between the philosophical theory and empirical study of psychopathology. SUMMARY: Both epistemology and value theory are central to the conceptualization and research of psychopathology. This prominence is recognized not only by philosophers and psychiatrists interested in philosophy, but by investigators who must grapple with the mutual influence of philosophical concepts and research methods. By making our philosophical views explicit and maintaining our awareness of them, we are well poised to develop and question both our philosophical and our research methods in meaningful ways.