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Vice and Psychiatric Diagnosis : International Perspectives in Philosophy and Psychiatry - John Z. Sadler

Vice and Psychiatric Diagnosis

By: John Z. Sadler

Hardcover | 14 June 2024

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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.

Industry Reviews
In the perennial theoretical, clinical, legal, and political discourse between "mad and bad," Sadler has brought his characteristic conceptual rigor and psychiatric acumen to reconceptualizing the relationship between psychiatric diagnosis and behavior that is both wrongful and criminal (vice). In articulating and developing this "vice-mental-disorder-relationship" or VMDR, he has systematically and convincingly created a new paradigm for interrogating historical narratives regarding the interplay of mental illness, criminality, and immorality and generated a compelling framework with theoretical and practical applicability for today and for the future. * Rebecca Weintraub Brendel MD, JD, Director, Center for Bioethics and Associate Professor of Psychiatry and Global Health and Social Medicine, Harvard Medical School *
Vice and Psychiatric Diagnosis offers a compelling account of the relationship between criminality and mental disorders, through rigorous philosophical analysis, ample engagement with empirical evidence, and a sophisticated survey of the criminal law. A must-read for philosophers, clinicians, and policy makers. * Serife Tekin, Ph.D., Associate Professor of Philosophy, Director of Medical Humanities, University of Texas at San Antonio *
This work by Professor Sadler is quite literally a tour de force, in that it approaches complex questions of law, philosophy, and psychiatry with strength and sophistication. This extensively researched work offers deep and nuanced answers to questions about why some categories of mental disorder involve value judgements of wrongness and crime, and others do not; and the even deeper question of how mental disorder and vice or vicious action might relate. * Dr Gwen Adshead, Forensic Psychiatrist and Psychotherapist *
Some people are morally bad, whereas others are mad without being bad - so far, so good. However, there's a big and disconcerting grey area, represented by what Sadler calls the "vice-laden" DSM diagnoses. So, how do we draw the line? Must we always draw a line? Whether you agree with Sadler's conclusions or not, everyone should agree that the topic warrants an explicit discussion that doesn't shy away from all the difficulties and complications. * Sofia Jeppsson, Associate Professor of Philosophy at Umea University, Sweden *

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