Some would say that philosophy can contribute more to the occurrence of mental disorder than to the study of it. Thinking too much does have its risks, but so do willful ignorance and selective inattention. Well, what can philosophy contribute? It is not equipped to enumerate the symptoms and varieties of disorder or to identify their diverse causes, much less offer cures (maybe it can do that-personal philosophical therapy is now available in the Netherlands). On the other hand, the scientific (...) study of mental disorder has a long way to go. There is much disagreement and uncertainty about the nature, causes, and treatment of many specific disorders, as is evident from DSM's classification of them in predominantly symptomatic terms. And even if what is reflected in DSM were a consensus rather than a compromise, still this shifts periodically with each new edition. Moreover, it is a notorious fact that many patients who clearly have psychiatric abnormalities do not fit any of the recognized diagnostic categories.1. (shrink)

This is a monograph which contributes to the debate on the nature of delusions and to the literature on the conditions for belief ascription. There are numerous challenges to the view that delusions are beliefs, and many of these are due to the conviction that there needs to be a background of rationality in the behaviour of the people we ascribe beliefs to: delusions cannot be beliefs because (a) they are badly integrated with the subject’s other intentional states; (b) they (...) are not supported by and responsive to the evidence available to the subject; (c) they are not consistently acted upon. Here I attempt to show that the arguments against the doxastic conception of delusions are misleading when they are based on an idealised notion of belief, and I present many examples of irrationality in paradigmatic cases of belief. As a result, I maintain that we should give up (once and for all) the assumption that belief ascription is hostage to the satisfaction of norms of rationality. By bringing together recent work in philosophy of mind, cognitive psychology and psychiatry, the book offers a comprehensive review of the philosophical issues raised by the psychology of normal and abnormal cognition, defends the doxastic conception of delusions, and develops a theory about the role of judgements of rationality and self-knowledge in belief ascription. (shrink)

This paper argues for psychological realism in the conception of psychiatric disorders. We review the following contemporary ways of understanding the future of psychiatry: (1) psychiatric classification cannot be successfully reduced to neurobiology, and thus psychiatric disorders should not be conceived of as biological kinds; (2) psychiatric classification can be successfully reduced to neurobiology, and thus psychiatric disorders should be conceived of as biological kinds. Position (1) can lead either to instrumentalism or to eliminativism about psychiatry, depending on whether psychiatric (...) classification is regarded as useful. Position (2), which is inspired by the growing interest in neuroscience within scientific psychiatry, leads to biological realism or essentialism. In this paper we endorse a different realist position, which we label psychological realism. Psychiatric disorders are identified and addressed on the basis of their psychological manifestations which are often described as violations of epistemic, moral or social norms. A couple of examples are proposed by reference to the pathological aspects of delusions, and the factors contributing to their formation. (shrink)

It is now generally agreed that we have to rely on value judgments to distinguish mental disorders from other conditions, but it is not quite clear how. To clarify this, we need to know more than to what extent attributions of disorder are dependent on values. We also have to know (1) what kind of evaluations we have to rely on to identify the class of mental disorder; (2) whether attributions of disorder contain any implicit reference to some specific evaluative (...) standard; and (3) whether the concept of mental disorder is value laden in the definitional or in the epistemic sense. I will argue that the evaluations we have to rely on are mainly considerations of harm, but that we also need to rely on other evaluations; that there should be no references to specific evaluative standards; and that even though mental disorders are necessarily undesirable, "mental disorder" may well be a descriptive phrase. (shrink)

The DSM is the main classification of mental disorders used by psychiatrists in the United States and, increasingly, around the world. Although widely used, the DSM has come in for fierce criticism, with many commentators believing it to be conceptually flawed in a variety of ways. This paper assesses some of these philosophical worries. The first half of the paper asks whether the project of constructing a classification of mental disorders that ‘cuts nature at the joints’ makes sense. What is (...) mental disorder? Are types of mental disorder natural kinds (that is, are the distinctions between them objective and of fundamental theoretical importance, as are, say, the distinctions between the chemical elements)? The second half of the paper addresses epistemic worries. Even if types of mental disorder are natural kinds there may be reason to doubt that the DSM will come to reflect their natural structure. In particular, I examine the extent to which the DSM is theory-laden, and look at how it has been shaped by social and financial factors. Ultimately, I conclude that although the DSM is of immense practical importance it is not likely to become the best possible classification of mental disorders. (shrink)

who are unrecognizable because they are in disguise. ¼ The person I see in the mirror is not really me. ¼ A person I knew who died is nevertheless in the hospital ward today. ¼ This arm [the speaker’s left arm] is not mine it is yours; you have..

1923; Young, this volume); the Cotard delusion (Cotard, 1882; Berrios and Luque, 1995; Young, this volume); the Fregoli delusion (Courbon and Fail, 1927; de Pauw, Szulecka and Poltock, 1987; Ellis, Whitley and Luaute´, 1994); the delusion of mirrored-self misidentifi- cation (Foley and Breslau, 1982; Breen et al., this volume); a delusion of reduplicative param- nesia (Benson, Gardner and Meadows, 1976; Breen et al., this volume); a delusion sometimes found in patients suffering from unilateral neglect (Bisiach, 1988); and the delusions of (...) alien control and of thought insertion, which are characteristic of schizophrenia (Frith, 1992). (shrink)

George Engel’s biopsychosocial model was associated with the critique of biomedical dogmatism and acknowledged the historical precedence of the work of Adolf Meyer. However, the importance of Meyer’s psychobiology is not always recognized. One of the reasons may be because of his tendency to compromise with biomedical attitudes. This paper restates the Meyerian perspective, explicitly acknowledging the split between biomedical and biopsychological approaches in the origin of modern psychiatry. Our present-day understanding of this conflict is confounded by reactions to ‘anti-psychiatry.’ (...) Neo-Meyerian principles can only be reestablished by a challenge to biomedicine that accepts, as did Meyer, the inherent uncertainty of medicine and psychiatry. (shrink)

We argue that cognitive empathy and other instances of mental state attribution are a byproduct of self-awareness. Evidence is brought to bear on this proposition from comparative psychology, early child development, neuropsychology, and abnormal behavior.

The status quo: dogmatism, the biopsychosocial model, and alternatives -- What there is: of mind and brain -- How we know: understanding the mind -- What is scientific method? -- Reading Karl Jaspers's General Psychopathology -- What is scientific method in psychiatry? -- Darwin's dangerous method: the essentialist fallacy -- What we value: the ethics of psychiatry -- Desire and self: Hellenistic and Islamic approaches -- On the nature of mental illness: disease or myth? -- Order out of chaos: from (...) insanity to DSM-III to a pluralistic nosology -- A theory of DSM-IV: ideal types -- Dimensions versus categories -- The perils of belief: psychosis -- The slings and arrows of outrageous fortune: depression -- Life's rollercoaster: mania -- Being self-aware: insight -- Calvinism or hedonism? -- Truth and statistics: problems of empirical psychiatry -- A climate of opinion: what remains of psychoanalysis -- Being there: existential psychotherapy -- Beyond eclecticism: teaching psychotherapy in the twenty-first century -- Bridging the biology/psychology dichotomy: the hopes of integrationism -- Why it is hard to be pluralist. (shrink)

This collection establishes the importance of this interdisciplinary approach and explores new directions in the "philosophy of psychiatry and psychology.

This first book-length study of confabulation breaks ground in both philosophy and cognitive science.

In this paper, I investigate in detail one theoretical approach to the symptom of thought insertion. This approach suggests that patients are lead to disown certain thoughts they are subjected to because they lack a sense of active participation in the occurrence of those thoughts. I examine one reading of this claim, according to which the patients’ anomalous experiences arise from a breakdown of cognitive mechanisms tracking the production of occurrent thoughts, before sketching an alternative reading, according to which their (...) experiences have to be explained in terms of a withdrawal, on the part of the patients themselves, from certain forms of active engagement in reasoning. I conclude with a discussion of the relationship between this view and the idea that patients’ reports of thought insertion reflect a situation in which the boundaries between the self and the world have become uncertain. (shrink)

In this surprising book, Allan V. Horwitz argues that our current conceptions of mental illness as a disease fit only a small number of serious psychological conditions and that most conditions currently regarded as mental illness are cultural constructions, normal reactions to stressful social circumstances, or simply forms of deviant behavior.

Recently I wrote a review for the Louisville Courier-Journal newspaper of Professor Elyn Saks' memoir of life while secretly suffering from schizophrenia. I did not mention the parallels between my life and Professor Saks'. I also have a successful career as a law professor. I accomplished it while harboring the secret I have the severe mental illness bipolar disorder (formerly known as "manic-depressive illness"). Why did I hide my condition for so long? Mainly I kept quiet due to the fear (...) of stigma. Sadly, people today stigmatize more than they did fifty years ago. They need to realize that a history of mental illness is not a moral failing, and that it is a chronic condition like any "physical" disease. Although most with severe mental illness pose no threat to anyone, stereotypes unduly link violence with mental illness. The vast majority of those with mental illness like Professor Saks and me are not violent; a very small portion of the level of violence in society is attributable to people with mental disorders. Why have I now chosen to tell my story? I write, as did Professor Saks, to show people can be effective members of society in high-level and often stressful jobs despite their psychiatric conditions. I wish to be accepted for who I am, a person with a full and satisfying professional and personal life, and not have to endure stigma or doubt as to my ability to perform. While not all with mental disorders flourish as Professor Saks and I have done, we show what is possible. How many other successful individuals with mental illness who for now remain silent, probably due to stigma concerns, are out there? Perhaps each of us should look at those in the offices next to us, or our friends and neighbors, and wonder which of these people secretly live with a severe mental condition. (shrink)

The question of the psychopath's responsibility for his or her wrongdoing has received considerable attention. Much of this attention has been directed toward whether psychopaths are a counterexample to motivational internalism (MI): Do they possess normal moral beliefs, which fail to motivate them? In this paper, I argue that this is a question that remains conceptually and empirically intractable, and that we ought to settle the psychopath's responsibility in some other way. I argue that recent empirical work on the moral (...) judgments of psychopaths provides us with good reason to think that they are not fully responsible agents, because their actions cannot express the kinds of ill-will toward others that grounds attributions of distinctively moral responsibility. I defend this view against objections, especially those due to an influential account of moral responsibility that holds that moral knowledge is not necessary for responsibility. (shrink)

Psychopaths are renowned for their immoral behavior. They are ideal candidates for testing the empirical plausibility of moral theories. Many think the source of their immorality is their emotional deficits. Psychopaths experience no guilt or remorse, feel no empathy, and appear to be perfectly rational. If this is true, sentimentalism is supported over rationalism. Here, I examine the nature of psychopathic practical reason and argue that it is impaired. The relevance to morality is discussed. I conclude that rationalists can explain (...) the moral deficits of psychopaths as well as sentimentalists. In the process, I identify psychological structures that underpin practical rationality. (shrink)

I distinguish three evolutionary explanations of mental illness: first, breakdowns in evolved computational systems; second, evolved systems performing their evolutionary function in a novel environment; third, evolved personality structures. I concentrate on the second and third explanations, as these are distinctive of an evolutionary psychopathology, with progressively less credulity in the light of the empirical evidence. General morals are drawn for evolutionary psychiatry.

In a series of recent works, Ian Hacking has produced a model of social causation in mental illness and begun to sketch in outline how this might be integrated with the medical model of psychiatry. This article elaborates and revises Hacking's model of social forces, criticizes him for attempting a merely semantic resolution of the tension between the social and the biological, and sketches an alternative approach that builds upon his substantial insights.

Recent years have witnessed a ground swell of interest in the application of evolutionary theory to issues in psychopathology (Nesse & Williams 1995, Stevens & Price 1996, McGuire & Troisi 1998). Much of this work has been aimed at finding adaptationist explanations for a variety of mental disorders ranging from phobias to depression to schizophrenia. There has, however, been relatively little discussion of the implications that the theories proposed by evolutionary psychologists might have for the classification of mental disorders. This (...) is the theme we propose to explore. We'll begin, in Section 2, by providing a brief overview of the account of the mind advanced by evolutionary psychologists. In Section 3 we'll explain why issues of taxonomy are important and why the dominant approach to the classification of mental disorders is radically and alarmingly unsatisfactory. We will also indicate why we think an alternative approach, based on theories in evolutionary psychology, is particularly promising. In Section 4 we'll try to illustrate some of the virtues of the evolutionary psychological approach to classification. The discussion in Section 4 will highlight a quite fundamental distinction between those disorders that arise from the malfunction of a component of the mind and those that can be traced to the fact that our minds must now function in environments that are very different from the environments in which they evolved. This mis-match between the current and ancestral environments can, we maintain, give rise to serious mental disorders despite the fact that, in one important sense, there is nothing at all wrong with the people suffering the disorder. Their minds are functioning exactly as Mother Nature intended them to. In Section 5, we'll give a brief overview of some of the ways in which the sorts of malfunctions catalogued in Section 4 might arise, and sketch two rather different strategies for incorporating this etiologically. (shrink)