John Sadler

University of Texas Southwestern Medical Center | UT Southwestern · Department of Psychiatry

Building a culture of conceptual inquiry in psychiatric training requires the development of conceptual competence: the ability to identify and examine assumptions that constitute the philosophical foundations of clinical care and scientific investigation in psychiatry. In this article, we argue for the importance of such competence and illustrate...

This book addresses the philosophical, clinical, and social significance of mental disorders which are defined in terms of wrongful or criminal conduct (vice). It provides an account of why some mental disorders are defined in vice terms, while others are not, and considers the professional, clinical, social, and policy implications of vice concept...

This book addresses the philosophical, clinical, and social significance of mental disorders which are defined in terms of wrongful or criminal conduct (vice). It provides an account of why some mental disorders are defined in vice terms, while others are not, and considers the professional, clinical, social, and policy implications of vice concept...

This book addresses the philosophical, clinical, and social significance of mental disorders which are defined in terms of wrongful or criminal conduct (vice). It provides an account of why some mental disorders are defined in vice terms, while others are not, and considers the professional, clinical, social, and policy implications of vice concept...

This book addresses the philosophical, clinical, and social significance of mental disorders which are defined in terms of wrongful or criminal conduct (vice). It provides an account of why some mental disorders are defined in vice terms, while others are not, and considers the professional, clinical, social, and policy implications of vice concept...

This book addresses the philosophical, clinical, and social significance of mental disorders which are defined in terms of wrongful or criminal conduct (vice). It provides an account of why some mental disorders are defined in vice terms, while others are not, and considers the professional, clinical, social, and policy implications of vice concept...

This book addresses the philosophical, clinical, and social significance of mental disorders which are defined in terms of wrongful or criminal conduct (vice). It provides an account of why some mental disorders are defined in vice terms, while others are not, and considers the professional, clinical, social, and policy implications of vice concept...

This book addresses the philosophical, clinical, and social significance of mental disorders which are defined in terms of wrongful or criminal conduct (vice). It provides an account of why some mental disorders are defined in vice terms, while others are not, and considers the professional, clinical, social, and policy implications of vice concept...

This book addresses the philosophical, clinical, and social significance of mental disorders which are defined in terms of wrongful or criminal conduct (vice). It provides an account of why some mental disorders are defined in vice terms, while others are not, and considers the professional, clinical, social, and policy implications of vice concept...

This handbook is currently in development, with individual articles publishing online in advance of print publication. At this time, we cannot add information about unpublished articles in this handbook, however the table of contents will continue to grow as additional articles pass through the review process and are added to the site. Please note...

Philosophy and Human Flourishing explores two pressing questions: What is a thriving, fulfilling, flourishing human life? What practices, associations, and institutions produce flourishing lives? These questions—in essence, “What are flourishing lives and how can we lead them?”—are long central to philosophy. Now, however, they can be addressed in...

Influences of chronic homelessness on patients' conceptions of bodily integrity can conflict with clinicians' recommendations about clinically indicated interventions, such as dialysis or amputations. This article considers such conflict by drawing on a capabilities-based model to reframe health care as shared between a patient and clinical team.

The clinical practice of psychotherapy is saturated with ethics and moralities. Having an Oxford Handbook of Psychotherapy Ethics seems a necessity in a contemporary world where visions of the good seem up for grabs; subject to whomever shouts the loudest and the most often. The quiet exchanges behind (typically) closed doors, which consider what t...

Prior discussions of ethics in psychiatric diagnosis have focused on the development of classifications of psychopathology and the social features and implications of the use of psychiatric diagnostic categories. This chapter focuses instead on the ethics and values involved in the conduct of psychiatric diagnostic assessment ethics in the practice...

Ethical issues inherent in psychiatric research and clinical practice are invariably complex and multifaceted. Well-reasoned ethical decision-making is essential to deal effectively with patients and enhance their care. Drawing on the positive reception of Psychiatric Ethics since its first publication in 1981, this highly anticipated fifth edition...

Psychotherapy is a well-established, efficacious, and fully accepted treatment for mental disorders and psychological problems. Psychotherapy is an interpersonal practice engaging patient values, interests, and personal meanings at every step. Thereby, psychotherapy abounds with moral issues. In psychotherapy ethics, numerous moral issues converge,...

In a statement to the press, Dr. Hans Henri P. Kluge, World Health Organization (WHO) Regional Director for Europe, stressed that it is important not to lose sight of the mental health implications of Covid-19 for everyone, noting that “[i]t is absolutely natural for each of us to feel stress, anxiety, fear, and loneliness during this time” (1). If...

As COVID‐19 continues to challenge the practice of head and neck oncology, clinicians are forced to make new decisions in the setting of the pandemic that impact the safety of their patients, their institutions, and themselves. The difficulty inherent in these decisions is compounded by potentially serious ramifications to the welfare of patients a...

Objective Substance abuse in the context of the opioid crisis presents a major public health concern. Despite some evidence that medical students’ attitudes towards substance use disorders worsen during medical school, very few studies have examined how students’ early clinical experiences with substance use disorders shape their views of this clin...

As psychiatric practice becomes more embedded in social, cultural, and financial networks, it is hardly surprising that the scrutiny of psychiatrists by organizations and institutions grows almost daily. This chapter focuses on the scrutiny of psychiatric ethics. Seven papers are reviewed, ranging from the mid-1950s up to 2009. Topics considered in...

Navigating the future of psychiatry requires a firm understanding of its past. This book is intended as a guide for students and practitioners of psychiatry and psychology who seek to understand the evolution of psychiatry as a scientific discipline. Landmark papers covering a broad array of topics are described and their scientific contributions a...

This chapter considers the role of knowledge and evidence in comparing and contrasting the ethics of non-clinical counseling (NCC) and mainstream mental health care as practiced by psychiatry, clinical psychology, and social work. As helping traditions which mostly eschew diagnostic categorization and approach mental distress from different values,...

Phenomenon: Metonymy refers to the substitution of the name of an attribute or adjunct for the name of the object or person being described. In medical contexts, this may involve referring to a person as a disease, body part, or other health-related noun. In this study, we explore the use of metonymy in medical students’ reflective writing. Approac...

Purpose: Moral distress occurs when one identifies an ethically appropriate course of action but cannot carry it out. In this conceptualization, medical students may be particularly vulnerable to moral distress, but the literature on moral distress in medical trainees remains sparse. Method: Using content analysis of 802 reflective essays writte...

The idea that mental disorders are value-laden means that they harbor action-guiding meanings and are subject to praise or blame. This domain of values includes a specific kind of value—vice—which describes wrongful, immoral, or criminal thought or conduct (e.g., antisocial personality disorder, pedophilia, conduct disorder, intermittent explosive...

This anthology takes a multidisciplinary approach to examining the legacy of the controversial psychiatrist and libertarian philosopher Thomas Szasz (1920-2012), whose mordant criticism of psychiatry challenged the very concept of mental illness and the practice of coercive psychiatric treatment and some tenets of psychoanalysis and psychotherapy....

Introduction: Medical students' early clinical encounters may influence their perceptions of geriatrics. This study examines reflective essays written by 3rd year medical students on required clinical rotations. Methods: Using content analysis, the authors analyzed the essays' thematic content. The authors then used chi-square analysis to compar...

Understanding how institutional review boards/research ethics committees (IRBs/RECs) perform risk/benefit assessment is important to help improve their function. In environmental ethics, uncertainty about potential outcomes and the precautionary principle play important roles in regulatory oversight but have received little attention in the context...

This analysis of a case of a bereaved patient that poses two treatment options-watchful waiting or medication-focuses on five "polarities" in clinical practice: (1) the normal and the pathological, (2) the individual and the diagnostic collective, (3) the primary care physician and the consultant, (4) the expert and nonexpert, and (5) the moment an...

‘I give it two issues!’ said one reviewer dismissing our original proposal for PPP. Now, 20 years and some 80 issues on, we have much to celebrate: a wide variety of articles by both established and up-and-coming authors, a much valued article/commentary/response format, and a growing revenue especially since the introduction of JHUP’s Project Muse...

The University of Texas System established the Transformation in Medical Education (TIME) initiative to reconfigure and shorten medical education from college matriculation through medical school graduation. One of the key changes proposed as part of the TIME initiative was to begin emphasizing professional identity formation (PIF) at the premedica...

Clinical research ethics consultation services have been established across academic health centers over the past decade. This paper presents the results of collaboration within the CTSA consortium to develop a standard approach to the collection of research ethics consultation information to serve as a foundation for quality improvement, education...

Transplant patients require a multidisciplinary team approach, including transplant surgeons, critical care unit physicians, hospitalists, psychiatrists, psychologists, and care management. Transplantation involves major changes in patients' and families' lives. During every stage of transplantation - from screening to waiting to surgery and the po...

Since the disjunctive change of DSM-III, architects of the DSMs, including the recent DSM-5, have tended to ignore the problematic status of disorder categories limited by single symptoms or single symptom clusters. These disorders include kleptomania, pyromania, intermittent explosive disorder, paraphilic disorders, factitious disorder, among othe...

The essays on obesity in this issue frequently refer to the recent American Medical Association (AMA) declaration of obesity as a disease. In response to these essays, I describe and explore the significance of 'risk-factor medicalization' and how negative unintended consequences with this approach to disease modeling are exemplified in many of the...

Background: Legitimate concern for fetal safety often precludes women who are pregnant or planning to become pregnant from participating in randomized controlled trials (RCTs), preventing the development of an empirically-derived evidence base for the safety and efficacy of treatments. Perinatal science can only move forward when the research commu...

The development and release of DSM-III in 1980 [ 1 ] not only ushered in an era of descriptive diagnostic classifi cation, but also ushered in scholarly, critical analyses of diagnostic classifi cation systems and diagnostic practice. The reasons for these states of affairs should not be surprising. In retrospect the DSMs have served as an unique s...

Does the pharmaceutical industry influence medicine in general and psychiatry in particular? A direct assessment of physicians' and researchers' motivations requires "getting into people's heads"—an impossible task. Instead, beginning mainly in the 1990s, studies have looked for correlations between interactions or relationships with industry and t...

A recent literature review of commentaries and 'state of the art' articles from researchers in psychiatric genetics (PMG) offers a consensus about progress in the science of genetics, disappointments in the discovery of new and effective treatments, and a general optimism about the future of the field. I argue that optimism for the field of psychia...

The distinction between normality and psychopathology has long been subject to debate. DSM-III and DSM-IV provided a definition of mental disorder to help clinicians address this distinction. As part of the process of developing DSM-V, researchers have reviewed the concept of mental disorder and emphasized the need for additional work in this area....

Drawing on the role morality developed in previous applications of virtue ethics to professional practice, The Virtuous Psychiatrist shows that the ethical practice of psychiatry depends on the character of the practitioner. The book is built upon three key tenets: ethics is important to any professional practice, including psychiatry; the settings...

This chapter places psychiatric ethics within professional and biomedical ethics more generally, and introduces the “role morality” notion: that some ethical imperatives derive from particular social roles. Some differences between psychiatry and other medical practices are illustrated through three issues: questions of patient autonomy, rules gove...

Medicalization has been a process articulated primarily by social scientists, historians, and cultural critics. Comparatively little is written about the role of bioethics in appraising medicalization as a social process. The authors consider what medicalization means, its definition, functions, and criteria for assessment. A series of brief case s...

To review the background of current ethical standards for the conduct of perinatal mental health research and describe the ethical challenges in this research domain. Current literature reflects a growing sentiment in the scientific community that having no information regarding the impact of psychiatric treatment on the mother and developing fetus...

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In his response to Reynolds and colleagues' "The Future of Psychiatry as Clinical Neuroscience," the author considers three themes prominent in the history of psychiatry: stigma, conscience, and science, considering each in the past, present, and into the future. A series of conclusions follow these historical perspectives. One, unraveling the web...

This main article for a Philosophy, Psychiatry, & Psychology philosophical case conference is intended to raise philosophical, psychiatric, and public policy issues concerning the relationship between concepts of criminality, mental disorder, and the classification of mental disorders. After introducing the basic problem of the confounding of “vice...

Thanks to the commentators for their fine work. In my brief comments I cannot address all that is raised, but can touch upon everyone’s discussion briefly. In her commentary, Gwen Adshead reflects on her experience as a forensic psychiatrist and therapist for violent offenders. Although Adshead discusses a number of important points, I found her in...

As a fourth-year psychiatry resident many years ago, I encountered a patient on the psychiatric emergency service whom I have never forgotten, because my experience with him jelled a distinction about the importance of explaining violence. Brought in involuntarily by the police for being “dangerous,” he was a fearsome visage: six feet four, shaven...

The bipolar spectrum model suggests that several patient presentations not currently recognized by the DSM warrant consideration as part of a mood disorders continuum. These include hypomania or mania associated with antidepressants; manic symptoms which fall short of the current DSM threshold for hypomania; and depression attended by multiple non-...

The character-focused approach known as virtue ethics is especially well suited to understanding and promoting ethical psychiatric practice. Virtues are stable dispositions and responses attributed to character, and a virtue-based ethics is one in which people's selves or characters are at the center of moral assessment. In this discussion by a cli...

Drawing upon literature reviews in psychiatry, the social sciences, and philosophy, this article defines the concept of the "personal self" and briefly describes its importance to the following areas of psychiatry: (1) mental illness, (2) psychiatric ethics, (3) diagnosis, (4) the clinician, (5) clinical research, (6) psychiatric pluralism, and (7)...

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This article focuses on the kinds of evaluative judgments made when applying DSM-IV-TR diagnostic criteria within the diagnostic interview between clinician and patient. The authors name these kinds of value judgments in diagnosis "normative warrant" because they involve one or more justifications (warrants) for standard-bearing (normative) element...

In his response to Szasz' Secular Humanism and Scientific Psychiatry, the author considers the use of rhetorical devices in Szasz' work, Szasz' avoidance of acknowledging psychiatry's scientific distinctions, and Szaszian libertarianism versus liberalism.

Philosophy, Psychiatry, & Psychology 12.4 (2005) 307-310 In his wide-ranging survey of how Kantian aesthetic theory is implicated in psychothera-py, John Callender has raised at least a dozen potentially profound and rewarding possibilities in applying aesthetic theory to psychiatry and psychotherapy. Although the idea of marrying aesthetic theory...

Beginning with an acknowledgment of the scientific aspects of developing classifications for psychopathology, this essay describes how diagnostic classifications (DCs) also function as public policy. Using the methods of philosophical analysis and a brief review of pertinent literature, the paper describes the regulatory and prescriptive functions...

This essay introduces a thematic issue focused on the contributions to clinical ethics and the philosophy of medicine by Richard M. Zaner. We consider the apparent divorce of Zaner's philosophical roots from his recent narrative immersions into the blooming, buzzing confusions of clinical-moral lifeworlds. Our considerations of the Zanerian context...

Philosophy, Psychiatry, & Psychology 11.4 (2004) 357-359 His enthusiasm brimming over with the rich set of ideas and problems he has discovered, Louis Charland's essay on identity, ethics, and the Internet should be grist for the philosophy of psychiatry mill for years. Indeed, a brief commentary cannot answer the many questions raised by his paper...