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Medicating the Eschatological Body: Psychiatric Technology for Christian Wayfarers by Warren Anderson Kinghorn Date:_______________________ Approved: ___________________________ Prof. Stanley Hauerwas, Supervisor ___________________________ Prof. Paul Griffiths ___________________________ Prof. Reinhard Huetter ___________________________ Prof. Keith Meador ___________________________ Prof. Allen Verhey Dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Theology in the Divinity School of Duke University 2011 ABSTRACT Medicating the Eschatological Body: Psychiatric Technology for Christian Wayfarers by Warren Anderson Kinghorn Date:_______________________ Approved: ___________________________ Prof. Stanley Hauerwas, Supervisor ___________________________ Prof. Paul Griffiths ___________________________ Prof. Reinhard Huetter ___________________________ Prof. Keith Meador ___________________________ Prof. Allen Verhey Dissertation abstract submitted in partial fulfillment of the requirements for the degree of Doctor of Theology in the Divinity School of Duke University 2011 Copyright by Warren Anderson Kinghorn 2011 Abstract Biological psychiatry, the mode of psychiatric practice dedicated to the effective application of medication and other somatic technology in the treatment of mental disorders, is an increasingly powerful conceptual lens by which disfavored experience and behavior is interpreted and through which the relationship of the body to experience and to moral agency is narrated. Psychiatric medications and other forms of psychiatric technology are commonly used by and increasingly accepted within the American population, and biological psychiatry has become the dominant political and methodological force within American psychiatry. Christians writing about psychiatry have often either uncritically accepted the language of biological psychiatry or have deferred judgment to those with expertise in the biomedical model. In this dissertation I argue that the use of psychiatric technology, while often helpful and necessary, is pervaded with ethical and teleological commitments which demand critical theological analysis if Christians are to use psychiatric technology appropriately. I also present the theological anthropology of St. Thomas Aquinas as a conceptual resource for constructive Christian engagement with biological psychiatry and psychiatric technology. After an introductory chapter (Chapter 1) which surveys the way that five contemporary American Christian communities of discourse engage biological psychiatry, the dissertation is divided into two methodologically distinct parts. Part One, comprising Chapters 2-5, is a philosophical engagement with contemporary psychiatric practice which shows that contemporary psychiatry both displays and requires ethical and iv teleological commitment. In Chapter 2, I argue that appropriate application of psychiatric technology cannot be specified by neurobiology alone; one must, in addition, have a model for disease classification, or nosology, which specifies instances of “mental disorder.” Critical engagement of psychiatric technology therefore requires critical engagement of the nosologies which legitimate the use of such technology. I briefly review the history of American psychiatric nosology as it has evolved within successive editions of the American Psychiatric Association‟s Diagnostic and Statistical Manual of Mental Disorders (DSM) and survey rival contemporary philosophical accounts of “mental disorder.” In Chapter 3, I engage Alasdair MacIntyre‟s threefold typology of versions of moral enquiry to argue that psychiatric nosologies, including the DSM, should be understood not in “encyclopedic” mode but rather as tradition-constituted forms of discourse. In Chapter 4, I argue that psychiatric diagnosis displays particular commitments regarding human teleology and also that any nosology adequate for clinical practice must be able to demarcate medical from non-medical failures of flourishing. The DSM ultimately fails at both because it necessarily displays teleological commitments and yet, situated within a late-modern culture lacking shared agreement about ends, it cannot name these commitments in sufficient detail to render its nosology coherent and therefore to demarcate the medical from the non-medical. In Chapter 5, I use the example of Post-Traumatic Stress Disorder (PTSD) to argue that psychiatric diagnosis is important not only because it legitimates the use of particular forms of psychiatric technology but also because it can construct the experience, and therefore the experiencing self, of those who receive and accept particular diagnoses. v Part Two, comprising Chapters 6 through 9, presents the theological anthropology of St. Thomas Aquinas as a helpful conceptual resource for Christians seeking to discern appropriate applications of psychiatric technology in the face of the aforementioned limitations of contemporary psychiatric nosology. In Chapters 6 and 7, I describe several contours of Aquinas‟ theological anthropology, arguing that Aquinas provides not only a nuanced and non-individualistic account of the relation of body and soul but also a means for contextualizing technological modification of the body within the larger structure of a well-lived life. In Chapter 8, I detail Aquinas‟ account in the Summa theologiae of the relationship between the body and personal moral agency and argue that the “health” of the body must be understood recursively, in the context of the virtuous operation of the person. In Chapter 9, I present a formal model of how Christians might discern appropriate uses of psychiatric technology. If close consideration of the moral- teleological context reveals that psychiatric technology might be justified, I argue that psychiatric technology may be used to the extent that it helps, and does not hinder, the embodied person‟s participation in the life of virtue. These decisions, however, require habituation into the virtue of prudence and require consideration of the communal- political context within which particular teleological judgments are intelligible. vi To Susan vii Contents Abstract .......................................................................................................................................... iv Contents ....................................................................................................................................... viii List of Figures ............................................................................................................................... xii 1 „Biological Psychiatry‟ and Its Christian Interlocutors ......................................................... 1 1.1 The Rise of „Biological Psychiatry‟ ............................................................................... 3 1.2 Biological Psychiatry in Five Contemporary American Christian Communities of Discourse ................................................................................................................................ 13 1.2.1 Biological Psychiatry in Pastoral Care and Counseling .............................................. 15 1.2.2 Biological Psychiatry in Psychological-Theological Integrationism .......................... 25 1.2.3 Biological Psychiatry in „Biblical Counseling.‟ .......................................................... 35 1.2.4 Biological Psychiatry in the “Christian Psychology” Movement ............................... 44 1.2.5 Biological Psychiatry in the work of the Institute for the Psychological Sciences ..... 50 1.3 Toward a Teleological Christian Paradigm for the Use of Psychiatric Technology 56 Part One: Toward a Traditioned, Teleological Account of Psychiatric Nosology ................ 64 2 What Counts as Mental Disorder? The Contested Languages of Modern Psychiatric Nosology ....................................................................................................................................................... 65 2.1 The Inability of Neurobiology to Ground Clinical Practice ........................................... 66 2.2 The DSM and Its Critics: A Brief History of Psychiatric Diagnostic Classification ....... 76 2.2.1 Psychiatric Nosology Before DSM-I .......................................................................... 76 2.2.2 DSM-I and DSM-II ..................................................................................................... 81 2.2.3 Forcing the Question: Psychiatry and Its Accusers, 1960-1980 ................................. 83 2.2.4 Psychiatric Diagnosis Clarified and Refined: Toward DSM-III and Beyond ............ 91 viii 2.2.5 Critics of Psychiatry After DSM-III .......................................................................... 104 2.3 What Is a Mental Disorder? Contemporary Philosophical and Clinical Debates .......... 112 2.3.1 “Naturalistic” Accounts of Mental Disorder ............................................................. 113 2.3.2 “Values-Based” Accounts of Mental Disorder .......................................................... 119 2.3.3 Pragmatist/Pluralist Accounts of Mental Disorder .............................................. 123 2.4 The Inescapable Politics of Psychiatric Practice ............................................................ 127 3 Psychiatric Diagnosis as Tradition-Constituted Discourse .................................................... 131 3.1 Encyclopedic Self-Conceptions Within the DSM Project .............................................
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