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Values and Psychiatric Diagnosis
Am J Psychiatry 2006;163:943-944.
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by John Z. Sadler. Oxford, Oxford University Press, 2005, 557 pp, $59.50.

The book series International Perspectives in Philosophy and Psychiatry, launched by Oxford University Press in 2003, represents yet another clear indication that the interdisciplinary field of philosophy of psychiatry has been flourishing lately. Perhaps the most distinctive mark of the recent work in this area is aiming not just at illuminating the intricate philosophical problems inevitably faced by psychiatry but also at doing something about it. In other words, philosophical analytical rigor has been put to the service of building a more sophisticated conceptual framework for psychiatry, which is much needed as ever, in order to keep pace with the myriad of scientific and humanistic developments of such discipline.

Values and Psychiatric Diagnosis by John Z. Sadler is an important and remarkable book for several reasons. First, it addresses a number of thorny and controversial issues regarding the many roles played by values in the classification of psychopathology (and correlate issues) in a thoughtful, balanced, and nonpolemic manner, as Sadler truly seeks to engage the reader in a constructive dialogue. Second, even though the scope of the book is broad, the scholarship displayed is impressive, as the work is richly referenced and annotated and the author strives to be as fair-minded as possible with respect to the conflicting viewpoints discussed. This does not prevent him, however, from presenting his own perspectives. Third, despite the fact that treating values in the aggregate is a very tall order, Sadler’s analytical skills allow him to move swiftly in the messy world of psychiatric classification; diagnostic finesse always pays off.

The main thrust of the book is to identify and unpack the values-commitments of the profession (enshrined in the diagnostic manuals, arguably its benchmarks), which according to him remain largely unrecognized as such. By values, Sadler means the concepts that we use to guide our actions and lead us to be deserving of praise or blame, but also and mainly the concepts we use to describe blame/praiseworthy and action-guiding activities (value-language as description). In a systematic fashion, the author applies throughout the book the distinctions between value-terms (encompassing both thick and thin ones), value-semantics, value-commitments, value-entailments, and value-consequences. A heuristic typology of values, comprising aesthetic, ethical, pragmatic, epistemic, and ontological values, is prolifically used as well. Furthermore, the scrutiny of the six ontological assumptions underlying the DSM effort—namely, empiricism, hyponarrativity, individualism, naturalism, pragmatism, and traditionalism—renders more understandable several key nosological controversies.

Drawing on the analogy between the social features of science (openness, equality of opportunity, peer review, epistemic freedom, and criticism) and democratic values, Sadler advances a forceful argument for good politics for psychiatric classification, politics taken in the sense of seeking and maintaining a moral vision of aiding the mentally ill. Accordingly, a strong case is made in favor of a broadly based diagnostic practice. In sum, by offering a tentative road map for conceptual challenges and value-inquiries that are likely to play a prominent role in the forthcoming revisions of ICD and DSM, this is a timely contribution to the further development of a sensible and pluralistic psychiatry.




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