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'Paraphilia' is the term used by professionals to indicate that a sexual fetish is severe enough to warrant being called a mental health disorder. Even after the release of the fifth edition of the DSM (DSM-5) paraphilias remain controversial. Although philosophers and scientists alike have argued that some paraphilias are just a way to medicalize sexual behavior that is simply abnormal by society's standards, these arguments typically target paraphilias that do not involve immoral or illegal behaviors. To my knowledge, philosophers have largely ignored the 'criminal paraphilias' (like pedophilia) in their arguments. In this paper, I attempt to fill this gap. I argue that the diagnostic criteria for some paraphilic disorders allows for criminal behavior to serve as a sufficient condition for diagnosis, blurring the line between criminal behavior and psychopathology. I argue that such an equivocation is undesirable in at least three ways: it is contrary to the goals of psychiatry; it allows for the rights of individuals being diagnosed to be routinely violated; and it perpetuates mental illness stigma. These objectionable aspects of including criminal behavior as a diagnostic criterion for criminal paraphilias, coupled with the lack of empirical evidence that shows criminal behavior is a legitimate symptom of paraphilic disorders, provide a strong argument in support of removing the criterion. Once removed, there will effectively be no difference between diagnostic criteria for the noncriminal and criminal paraphilias, and philosophers providing critiques of the former group will be pressed to also address the latter. / Master of Arts / ‘Paraphilia’ is the term used by mental health professionals to indicate that a sexual fetish is severe enough to warrant being called a mental health disorder. Even after the release of the fifth edition of the DSM (DSM-5) paraphilias remain controversial. Although some have argued that a subset of paraphilias are used inappropriately to medicalize sexual behavior that is simply abnormal by society’s standards, these arguments typically target paraphilias that do not involve immoral or illegal behaviors. To my knowledge, philosophers have largely ignored the ‘criminal paraphilias’ (like pedophilia) in their arguments. In this paper, I attempt to fill this gap. I argue that the diagnostic criteria for some paraphilic disorders allows for criminal behavior to serve as a sufficient condition for diagnosis (meaning that criminal behavior is all that is needed to warrant a diagnosis of a criminal paraphilic disorder), blurring the line between criminal behavior and psychopathology. I argue that such an equivocation is undesirable in at least three ways: it is contrary to the goals of psychiatry; it allows for the rights of individuals being diagnosed to be routinely violated; and it perpetuates mental illness stigma (negative beliefs about the mentally ill that cause fear, dislike, and avoidance). These objectionable aspects of including criminal behavior as a diagnostic criterion for criminal paraphilias, coupled with the lack of empirical evidence that shows criminal behavior is a legitimate symptom of paraphilic disorders, provide a strong argument in support of removing the criterion. Once removed, there will effectively be no difference between diagnostic criteria for the noncriminal and criminal paraphilias, and philosophers providing critiques of the former group will be pressed to also address the latter.

This thesis discusses epistemological and ethical issues in classifi cation and diagnosisof psychiatric conditions, and briefly discusses realism about psychiatric conditions. I use autism spectrum disorder (ASD) as a case study to examine whether the explanatory and predictive power of classi fication and diagnosis could be improved if psychiatry adopts a cause-based framework in place of a symptom-based framework. However, there is signifi cant debate regarding the sort of explanatory pattern that will adequately represent the complex causation involved in psychiatric conditions. I develop a preliminary list of criteria for adequate explanatory patterns in psychiatry, and use these criteria to analyze explanations of ASD. I show that explanatory patterns unable to meet these criteria limit the validity and reliability of diagnosis. However, I argue that an integrated pattern that includes biological, cognitive and social levels of explanation may meet the criteria. Thus, diagnosis of ASD could improve if psychiatry adopted a cause-based framework informed by an intergrated explanation pattern. More accurate diagnosis of ASD may allow earlier access to Intensive Behaviourial Intervention/Applied Behavioural Analysis treatment programs, which may increase the effectiveness of this treatment and reduce the amount of resources individuals with ASD require from governments over their lifespans. Explaining these conditions using an integrated pattern of explanation can further challenge myths regarding the causes of ASD, and may provide support for Canadian lawsuits petitioning for expanded public funding of IBI/ABA programs.

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This is a dissertation in philosophy of psychiatry and ethics focused on the question of how does one live and react responsibly to the experience of mood disorders such as depression and anxiety. In looking to the current state of psychiatry and cultural understandings of mental disorder, I identify what I call being “epistemically adrift” – the sense that individuals face too many conflicting opinions and a constant debate of how to live with depression that they are unable to process for themselves what their best options for living are. This feeling of being epistemically adrift is all the more complicated by the experience of mood disorder itself, which often makes individuals feel morally inadequate and pressured to do the right thing without clear direction. In the absence of a clear path regarding depression and anxiety, this dissertation proposes an ethics for depression and anxiety disorders – drawing a virtue theory from the existentialist tradition that focuses on the outskirts of mental disorder in order to create an inclusive ethical system for those generally excluded in moral philosophy. The first chapter outlines the general theory of being epistemically adrift in relation to depression and anxiety and how the themes of uncertainty in these conditions inherently lead to different epistemic insights. This chapter establishes the dissertation’s roots in existential phenomenology and epistemic injustice literature in order to sketch out how the combined uncertainty in interdisciplinary understanding of mental illness with the uncertainty experienced within mood disorders lead individuals to feeling adrift and unable to determine what they should do for themselves in living good lives. Meanwhile I argue that the insights of depression and anxiety attune individuals to the world in different ways than their non-depressed peers, which imports interesting questions regarding our responsibility toward one another. The second chapter explores a case study of this sort of insight, arguing that the experience of excessive or “delusional” guilt within depressive disorders can provide a deeper insight into our general moral responsibility towards one another. I compare this feeling of guilt to Karl Jaspers’ conception of “metaphysical” or collective guilt in his analysis of the German people after the Second World War and Holocaust. These sorts of guilt feelings within depression is often incapacitating and hard to make sense of for individuals, but it additionally has a transformative ability to reevaluate moral life. I argue that parallel to the concept of “depressive realism” where individuals with depression have different and sometimes better insights than others, depressive guilt differently attunes individuals to how they relate to others and the world at large. From there, the third chapter engages with how psychiatric diagnosis shapes and limits one’s perceptions of their freedom and agency. More specifically, this chapter employs an existentialist analysis of how one can react to their diagnosis in bad faith – deflecting their own responsibility either by indulging into diagnostic patterns as inherent destiny or denying the condition’s effect on their motivations. I argue that there must be a middle path where one takes responsibility for one’s situation as being depressed or anxious, which both acknowledges the condition but also sees it as a personal challenge to improve on one’s life. The final chapter of the dissertation culminates in the development of an ethical theory that directly centers itself within the experience of mood disorders. This theory stems from both existentialism for its commitment to projecting meaning on uncertainty and absurdity along with virtue theory which allows for a sense of imperfection and improvement over time. I have been developing a set of virtues for how to be responsible for one’s depression or anxiety. “Responsibility” in this sense is the question of how one responds to their moods and other symptoms related to mood disorders, that is, an account of responsibility that resists narratives of fault or blame. These virtues are meant to be a set of therapy-informed guidelines to help those with depression and anxiety counteract the worst feelings of being adrift and foster autonomy and dignity for themselves. / Philosophy

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This thesis is concerned with philosophical perspectives on the stigma of mental illness, with each chapter exploring different philosophical issues. Chapter one delineates the central concept around which the rest of the work revolves: the stigma of mental illness. It provides an outline of the stigma mechanism, how it applies to mental illness, why it is such a large public health concern and what has been done so far to combat it. Chapter two is concerned with the application of recent literature in the philosophy of implicit bias to the topic of mental illness. It suggests that we have hitherto been preoccupied with explicit formulations of the stigma mechanism, but argues that there are distinctive issues involved in combatting forms of discrimination in which the participants are not cognisant of their attitudes or actions, and that anti-stigma initiatives for mental illness should take note. Chapter three applies the philosophical literature concerning the ethics of our epistemic practices to the stigma of mental illness. It contains an analysis of how epistemic injustice- primarily in the forms of testimonial injustice and stereotype threat- affects those with mental illnesses. The fourth chapter brings in issues in the philosophy of science (particularly the philosophy of psychiatry) to explore the possibility of intervening on the stigma process to halt the stigma of mental illness. The first candidate (preventing labelling) is discounted, and the second (combatting stereotype) is tentatively endorsed. The fifth chapter is concerned with how language facilitates the stigma of mental illness. It suggests that using generics to talk about mental illness (whether the knowledge structure conveyed is inaccurate or accurate) is deeply problematic. In the former, it conveys insidious forms of social stereotyping. In the latter, it propagates misinformation by presenting the category as a quintessential one.

La catégorisation actuelle du trouble de l’addiction dans le DSM-V fait face à plusieurs problèmes théoriques. D’abord, la catégorie nommée « Troubles liés à l’abus de substance et troubles addictifs » met en évidence le problème de l’exclusion par son manque de justification à inclure certains troubles du comportement, mais à en exclure d’autres, dans sa caractérisation. Le chevauchement constitue le deuxième problème que pose la catégorie du DSM-V, dans la mesure où certaines catégories censées être distinctes se recoupent en réalité. Les problèmes d’exclusion et de chevauchement remettent en question le fait de tracer ainsi les frontières entre catégories et en révèlent leur manque de validité conceptuelle. Et alors que la catégorie du trouble de l’addiction se heurte à ces problèmes, on peut douter de son utilité dans le traitement et la prise en charge des patients. Donc, par souci de fournir une classification en psychiatrie qui est valide et utile, il est nécessaire de redéfinir le trouble de l’addiction. Cela nous permettra de le classer autrement et adéquatement. Ainsi, nous défendons la thèse, dans ce mémoire, selon laquelle l’addiction ne renvoie pas à une entité discrète mais plutôt à un continuum, où coexistent deux phénomènes qu’il faut toutefois séparer : la motivation addictive et le trouble de l’addiction. Selon la définition que nous proposons, une taxonomie dimensionnelle, plutôt que catégorielle, représente mieux le trouble de l’addiction. Une telle approche possède le potentiel d’offrir de meilleurs outils aux cliniciens et aux chercheurs dans le traitement des personnes atteintes du trouble de l’addiction. / The categorization of addiction in the DSM-V faces many theoretical problems. First, the category named “Substance-use disorders and addictive disorders” emphasizes the problem of exclusion by its lack of justification to include certain behavioral disorders, whilst also excluding many other ones. Second, the category also induces the problem of overlapping, which refers to the way certain categories expected to be distinct actually intersect with each other. These problems of exclusion and overlapping raise some questions about the way the boundaries between categories are traced and reveal their lack of conceptual validity. Moreover, as categorization faces these theoretical problems, we can also doubt the usefulness of the category of addiction in the treatment and care of patients. Therefore, it is necessary to redefine addictive disorder in order to offer a classification that is valid and useful. Thus, in this memoir, we want to argue that addiction refers not to a discrete entity but to a continuum where two distinct phenomena coexist: addictive motivation and addictive disorder. According to our definition, dimensions, rather than categories, are much more appropriate to represent as is the disorder of addiction. This approach has the potential to offer better tools to clinicians and researchers in the treatment of people suffering from an addictive disorder.

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