It is argued that philosophers can contribute indirectly to the cure of psychopathology by helping to resolve problems that impede the development of effective treatments. Two such problems are discussed. The first arises because different schools of therapy use conflicting criteria in evaluating therapeutic outcomes. A theory of Defective Desires is developed to deal with this problem. The second issue, which divides the field of psychotherapy, concerns the need for experiments, especially in validating claims of therapeutic efficacy. An epistemological (...) foundation is developed to support the need for experiments. (shrink)
The "width" of the mind is an important topic in contemporary philosophical psychology. Support for active externalism derives from theoretical, engineering, and observational perspectives. Given the history of psychology, psychopathology is notable in its absence from the list of avenues of support for the idea that some cognitive processes extend beyond the physical bounds of the organism in question. The current project is to defend the possibility, plausibility, and desirability of externalist psychopathology. Doing so both adds to the (...) case for externalism and suggests ways of improving our study of cognitive dysfunction. I establish the possibility of externalist psychopathology through the development of models of wide cognitive processing, and, by implication, failure of such processing, from the work of S.L. Hurley and Robert Wilson. The plausibility of wide conceptualization and explanation of cognitive disorders is shown through an examination of apraxia, disorders of learned, skilled movements. The desirability of externalist psychopathology is suggested through a look at theoretical and therapeutic virtues, again drawing on Wilson's work. (shrink)
From 1959 until 1969, Heidegger lectured to psychiatrists and psychiatry students at the University of Zurich Psychiatric Clinic and in Zollikon. The transcriptions of these lectures were published as the Zollikon Seminars. In these seminars Heidegger is highly critical of psychoanalysis, because of its causal and objectifying approach to the human being. In general, Heidegger considers it an objectification or even an elimination of the human being to approach a patient from a causal perspective. In our view Heidegger has overlooked (...) the peculiar nature and complexity of psychotherapy and psychiatry, namely that psychiatry is not just a discipline that combines a hermeneutical approach and a natural science approach on a theoretical level, but it also deals with psychopathology in practice. We argue, also referring to Strawson and Gadamer, that in psychiatric practice causal explanation and hermeneutic understanding are no mutually exclusive approaches. We conclude that the encounter of philosophy and psychiatry in matters of causality and motivation could be particularly fruitful when the practical situation is addressed, recognizing the special character of psychopathology. (shrink)
This chapter examines the core explanatory strategies of cognitive science and their application to the study of psychopathology. In addition to providing a taxonomy of different strategies, we illustrate their application, with special attention to Autism Spectrum Disorder and Major Depressive Disorder. We conclude by considering two challenges to the prospects of a developed cognitive science of psychopathology.
Since psychiatry remains a descriptive discipline, it is essential for its practitioners to understand how the language of psychiatry came to be formed. This important book, written by a psychiatrist-historian, traces the genesis of the descriptive categories of psychopathology and examines their interaction with the psychological and philosophical context within which they arose. The author explores particularly the language and ideas that have characterised descriptive psychopathology from the mid-nineteenth century to the present day. He presents a masterful survey (...) of the history of the main psychiatric symptoms, from the metaphysics of classical antiquity to the operational criteria of today. Tracing the evolution of concepts such as memory, consciousness, will and personality, and of symptoms ranging from catalepsy and aboulia to anxiety and self-harm, this book provides fascinating insights into the subjective nature of mental illness, and into the ideas of British, Continental and American authorities who sought to clarify and define it. (shrink)
Many psychopathological disorders – clinical depression, borderline personality disorder, schizophrenia and autistic spectrum disorder (ASD) – are commonly classified as disorders of the self. In an intuitive sense this sort of classification is unproblematic. There can be no doubt that such disorders make a difference to one’s ability to form and maintain a coherent sense of oneself in various ways. However, any theoretically rigourous attempt to show that they relate to underlying problems with say, such things as minimal selves or, (...) even, so-called narrative selves – where these latter constructs are invoked to do genuine explanatory work – would require, inter alia, philosophical clarification of what it is that one is precisely committed to in talking of such things (if things they be). It would also require justification for believing in selves of these various kinds. I have elsewhere put on record some of my worries about proposed justifications for believing in minimal selves (Hutto 2008b). But – lest I be accused of favouritism – it should be noted that I also have concerns about the very idea of narrative selves. Several authors have made strong claims about the role of narratives in self constitution (e.g. Dennett 1991, Flanagan 1996, Schechtman 1996). Under standard interpretations these proposals are ambiguous, underdeveloped in key respects, embed obvious tensions or generate puzzles. For these reasons I think we should be cautious of lax talk of selves that are woven from narrative cloth. This is not to say that I agree with Strawson (2004) that adopting a narrative perspective might not be essential for being a self (or at least being a self of a certain sort – even an ethically interesting sort).1 It is rather that I think that before we get around to assessing such claims we need a better understanding of just what we are committed to in talking of selves in general. This is a major philosophical programme, and not one with which I will attempt to engage in this paper – not even in passing.. (shrink)
The reorganization of psychiatric knowledge at the turn of the twentieth century derived from Emil Kraepelin’s clinical classification of psychoses. Surprisingly, within just few years, Kraepelin’s simple dichotomy between dementia praecox (schizophrenias) and manic-depressive psychosis (bipolar disorders) succeeded in giving psychiatry a new framework that is still used until the present day. Unexpectedly, Kraepelin’s simple clinical scheme based on the dichotomy replaced the significantly more differentiated nosography that dominated psychiatric research in the last three decades of the nineteenth century (Janzarik (...) in Themen und Tendenzen der deutschsprachigen Psychiatrie. Springer, Berlin, 1974). Moreover, although all the components of the future development were already available shortly after 1868, the real course, which led to Kraepelin’s dichotomy, was unpredictable then. This paper explores the ways in which the unpredictability of psychiatric knowledge and the postulate of a rationality underlying psychopathological phenomena interacted in the debates regarding the classification of psychoses. It examines the “natural antagonism” between the practical aspirations of an increasingly specialized medical nosology and unitary conceptions, which, in a psychopathological countermovement, emphasized that no somatic criteria can be specified for the majority of psychic abnormalities and that all nosological distinctions are not binding (Janzarik 1974, 20). In this context, this paper investigates the revival of unitary theories of psychosis in postwar German psychiatry and seeks to understand why the forms of thinking that dominated nineteenth-century psychiatry have proved to be very lasting. Furthermore, this paper emphasizes the perspectivity underlying psychiatric research on psychoses and explores the ways in which writing the history of the schizophrenia concept involves inevitably writing the history of the entire psychiatry. (shrink)
This paper examines the account offered by Bolton and Hill (1996) of how reasons can be causes, and thus how symptoms of mental disorders can be both caused and carry meaning. The central problem is to reconcile the causal and rationalizing powers of content-laden mental states. I draw out these two aspects by putting them in the context of recent work in analytical philosophy, including Davidson's token identity theory and his account of mental disorder. The latter, however, can be used (...) to emphasize in a novel way what is becoming a familiar charge: that Davidson does not show how mental content, as opposed to the physical bearers of that content, can itself play a causal role. (edited). (shrink)
There is a 'philosophers' assumption that there is a problem with the very notion of an unconscious mental state.The paper begins by outlining how the problem is generated, and proceeds to argue that certain conditions need to be fulfilled if the unconscious is to qualify as mental. An explanation is required as to why we would ever expect these conditions to be fulfilled, and it is suggested that the Freudian concept of repression has an essential role to play in such (...) an explanation. Notoriously this concept brings with it a further puzzle: it looks as though repression serves a purpose, and so requires an agent to execute this purpose, a repressor. Paradox is avoided only if repression is viewed in biologicalfunctional terms.The result is that the notion of the unconscious is saved from the a priori objections often levelled at it by philosophers.This still leaves considerable theoretical work to be done by psychological science. (shrink)
The figure of the “double” or the other self is an important topic in the history of literature. Many centuries before Jean Paul Richter coined the term, “doppelgänger,” at the beginning of the Romantic Movement in the year 1796, it is possible to find the figure of the double in myths and legends. The issue of the double emphaszses the contradictory character of the human being and invokes a sinister dimension of the psychological world, what has been called in German (...) as “umheimlich.” However, does multiciplicity always involve pathology? Related to this figure in literary history, a new perspective from clinical psychology called “dialogical self” defines the self as a multi-voice reality. Along the same line, postmodernist psychology considers the self a discursive construction. From these perspectives, the “self” is situated a long way away from the classical essential conception of the self. In this paper, we review briefly some important landmarks of the figure of the double in the literature, and we compare the coincidences of the “double” experiencies described in literature with the experiences of our patients. Finally, we discuss how this literary tradition can help us to understand new psychological perspectives. (shrink)
The past twenty years have seen an increase in the importance of the body in psychology, neuroscience, and philosophy of mind. This 'embodied' trend challenges the orthodox view in cognitive science in several ways: it downplays the traditional 'mind-as-computer' approach and emphasizes the role of interactions between the brain, body, and environment. In this article, I review recent work in the area of embodied cognitive science and explore the approaches each takes to the ideas of consciousness, computation and representation. Finally, (...) I look at the current relationship between orthodox cognitive science and the study of mental disorder, and consider the implications that the embodied trend could have for issues in psychopathology. (shrink)
The paper first introduces the concept of implicit and explicit temporality, referring to time as pre-reflectively lived vs. consciously experienced. Implicit time is based on the constitutive synthesis of inner time consciousness on the one hand, and on the conative–affective dynamics of life on the other hand. Explicit time results from an interruption or negation of implicit time and unfolds itself in the dimensions of present, past and future. It is further shown that temporality, embodiment and intersubjectivity are closely connected: (...) While implicit temporality is characterised by tacit bodily functioning and by synchronisation with others, explicit temporality arises with states of desynchronisation, that is, of a retardation or acceleration of inner time in relation to external or social processes. These states often bring the body to awareness as an obstacle as well. On this basis, schizophrenia and melancholic depression are investigated as paradigm cases for a psychopathology of temporality. Major symptoms of schizophrenia such as thought disorder, thought insertion, hallucinations or passivity experiences may be regarded as manifesting a disturbance of the constitutive synthesis of time consciousness, closely connected with a weakening of the underlying pre-reflective self-awareness or ipseity. This results in a fragmentation of the intentional arc, a loss of self-coherence and the appearance of major self-disturbances. Depression, on the other hand, is mostly triggered by a desynchronisation from the social environment and further develops into an inhibition of the conative–affective dynamics of life. As will be shown, both mental illnesses bear witness of the close connection of temporality, embodiment and intersubjectivity. (shrink)
The phenomenological approach to schizophrenia has undergone something of a renaissance in Anglophone psychiatry in recent years. There has been a proliferation of works that focus on the nature of subjectivity in schizophrenia and related disorders, and that take inspiration from the work of such German and French philosophers as Husserl, Heidegger, and Merleau-Ponty, and such classical psychiatrists as Minkowski, Blankenburg, and Binswanger (Rulf 2003; Sass 2001a, 2001b). This trend includes predominantly theoretical articles, which typically incorporate clinical material as well (...) as reviews of empirical and experimental findings in psychopathology. Some very recent examples (since 2000) are studies of .. (shrink)
In this paper I wish to address the question of the nature of psychopathology. It might naturally be felt that we already know a great deal about psychopathology, and thus that such a paper would be primarily a review and discussion of the literature; I will argue, however, that the most fundamental form of the question concerning the nature of psychopathology is rarely posed in the literature, that it is prevented from being posed by presuppositions inherent in (...) standard theoretical approaches, and that, on those rare occasions when it does get addressed, it has received inadequate answers. Therefore, the paper will have more of the character of a conceptual explication and theoretical exegesis than it will of a review of the literature. (shrink)
This article discusses the prospects of quantum psychiatry from a Bohmian point of view, which provides an ontological interpretation of quantum theory, and extends such ontology to include mind. At first, we discuss the more general relevance of quantum theory to psychopathology. The basic idea is that because quantum theory emphasizes the role of wholeness, it might be relevant to psychopathology, where breakdown of unity in the mental domain is a key feature. We then discuss the role of (...) information in psychopathology, and consider the connections with quantum theory in this area. In particular, we discuss David Bohm’s notion of active information, which arises in the ontological interpretation of quantum theory, and is suggested to play a fundamental role as the bridge between mind and matter. Some such bridge is needed if we are to understand how subtle mental properties are able to influence more manifest physical properties in the brain (all the way to the molecular and possibly microtubular level), and how changes in those possibly quantum‐level physical processes are able to influence higher cognitive functions. We also consider the implications of the notion of active information for psychopathology. The prospects of implementing the Bohmian scheme in neuroquantal terms are then briefly considered. Finally, we discuss some possible therapeutic implications of Bohm’s approach to information and the relation of mind and matter. (shrink)
When philosophers want an example of a person who lacks the ability to do otherwise, they turn to psychopathology. Addicts, agoraphobics, kleptomaniacs, neurotics, obsessives, and even psychopathic serial murderers, are all purportedly subject to irresistible desires that compel the person to act: no alternative possibility is supposed to exist. I argue that this conception of psychopathology is false and offer an empirically and clinically informed understanding of disorders of agency which preserves the ability to do otherwise. First, I (...) appeal to standard clinical treatment for disorders of agency and argue that it undermines this conception of psychopathology. Second, I offer a detailed discussion of addiction, where our knowledge of the neurobiological mechanisms underpinning the disorder is relatively advanced. I argue that neurobiology notwithstanding, addiction is not a form of compulsion and I explain how addiction can impair behavioural control without extinguishing it. Third, I step back from addiction, and briefly sketch what the philosophical landscape more generally looks like without psychopathological compulsion: we lose our standard purported real-world example of psychologically determined action. I conclude by reflecting on the centrality of choice and free will to our concept of action, and their potency within clinical treatment for disorders of agency. (shrink)
Summary The aim of this paper is three-fold. Firstly, to briefly set out how strategic choices made about theorising about intentionality or content have actions at a distance for accounting for delusion. Secondly, to investigate how successfully a general difficulty facing a broadly interpretative approach to delusions might be eased by the application of any of three Wittgensteinian interpretative tools. Thirdly, to draw a general moral about how the later Wittgenstein gives more reason to be pessimistic than optimistic about the (...) prospects of a philosophical psychopathology aimed at empathic understanding of delusions. (shrink)
The structure of human embodiment is fundamentally characterized by a polarity or ambiguity between Leib and Körper, the subjective body and the objectified body, or between being-body and having-a-body. This ambiguity, emphasized, above all, by Helmuth Plessner and Maurice Merleau-Ponty, is also of crucial significance for psychopathology. Insofar as mental illnesses disturb or interrupt the unhindered conduct of one’s life, they also exacerbate the tension within embodiment that holds between being-body and having-a-body. In mental illnesses, there is a failure (...) of tacit mediations upon which one’s bodily being-toward-the-world is based. Instead of serving as a medium of relating to the world, the body makes .. (shrink)
Keller & Miller (K&M) propose that many psychiatric disorders are best explained in terms of a genetic watershed model. This view challenges traditional evolutionary accounts of psychiatric disorders, many of which have tried to argue in support of a presumed balanced polymorphism, implying some hidden adaptive advantage of the alleles predisposing people to psychiatric disorders. Does this mean that evolutionary ideas are no longer viable to explain psychiatric disorders? The answer is no. However, K&M's critical evaluation supports the view that (...) psychiatric disorders are not categorically distinct from normalcy, and that evolutionary psychopathology should be grounded in rigorous empirical testing. (Published Online November 9 2006). (shrink)
Apathy is the best-known feature of Stoicism; even Webster's records that a Stoic lives without passions.1 But it remains unclear what Stoic apathy amounts to, because it remains unclear what Stoics understand by passions and why they find passions problematic. In this essay, I start with four unsettled questions about the Stoic definition of passions, and to answer these questions, I explain the passions as central elements of Stoic psychopathology, that is, as defects relative to the Stoic account of (...) the psychological norm. This hypothesis, I claim, clarifies what the evidence by itself leaves uncertain. I close by bringing my conclusions to bear on the scope of Stoic apathy. Throughout, I focus on the account of the passions offered by the greatest Greek Stoic, Chrysippus of Soli, who headed the school in the third.. (shrink)
Psychopathology has two styles. On the one hand, a tradition of phenomenological inquiry, associated in particular with the work of Karl Jaspers, that may be considered as the continental way of approaching psychopathology. On the other hand, an empirical approach more associated with the English-speaking world, which emphasizes the need for objectivity of measurement, and is as close as psychiatry gets to dustbowl empiricism. Stanghellini’s book, Disembodied Spirits and Deanimated Bodies (2004), is undoubtedly in the first tradition. It (...) is part of the growing International Perspectives in Philosophy and Psychiatry series, the success of which suggests some recognition that much of importance in .. (shrink)
Emerging action perspectives on psychopathology depict individuals as actively shaping those environmental conditions that then impact on their risk for psychopathology, resilience in the face of it, and successful recovery from it. This view, although having important implications for research and clinical practice, has yet to be articulated in terms of its underlying philosophical framework. To begin to address this challenge, we situate action theory in the context of the writings of Deleuze and Guattari, who, in their seemingly (...) anti-psychiatric series entitled Capitalism and Schizophrenia, argue for the central role of human agency as a fundamentally active force in determining subjective life. Within this context, they propose an alternative approach to the current deficit focus of much psychopathology research, replacing the notion of deficit with a fundamentally productive notion of desire (what they call “desiring-production”). After our exposition of this philosophical perspective on human agency, implications of this approach for action-informed research and clinical practice are discussed. (shrink)
Philosophical psychopathology lies at the intersection of philosophy and psychiatry. The name is new. The field is not. This paper surveys work in the field since about 1980. Special attention is given to work on two topics: mental illness semantics and the metaphysics of disorders of self-consciousness.
Ethical guidelines are vague concerning how situations should be handled when researchers encounter participants in preexisting psychological distress. Ethical issues of beneficence, autonomy, and the nature of informed consent may arise in these situations. This study investigated the ethical practices and beliefs of 84 psychopathology researchers when confronting research participants in distress. Results indicated that psychopathology researchers in general engaged in diverse ethical practices in providing debriefing, treatment referrals, and providing for distressed participants. Characteristics of the designated studies (...) and of the researchers accounted for significant differences in ethical practices. In addition, the type of psychopathology being assessed accounted for significant differences in ethical practices and beliefs. Guidelines are offered to aid researchers who encounter participants in preexisting distress. (shrink)
Research on emotion and emotion regulation is expected to improve our understanding of psychopathology. However, achieving this understanding requires overcoming several obstacles, including the paucity of objective markers of specific emotions or psychiatric diagnoses, and the fact that emotion regulation is a concept that can be difficult to operationalize. We review affective neuroscience research that has addressed these issues by focusing on psychological and neural mechanisms implicated in approach and avoidance behaviors, as revealed by studies of fear, anxiety, and (...) reward processing. Dysfunction in these mechanisms may serve as risk markers for psychopathology, while emotion regulation research demonstrates that some of them are susceptible to volitional control. The conclusion acknowledges limitations of affective neuroscience and highlights goals for future work. (shrink)
Research on emotion and psychopathology has blossomed due in part to the translation of affective science theory and methods to the study of diverse disorders. This translational approach has helped the field to hone in more precisely on the nature of emotion deficits to identify antecedent causes and maintaining processes, and to develop promising new interventions. The future of emotion research in psychopathology will benefit from three inter-related areas, including an emphasis on emotion difficulties that cut across traditional (...) diagnostic boundaries (i.e., a transdiagnostic approach), the explicit linking of emotion and cognition in behavioral and neuroimaging studies in psychopathology, and continued translation of the latest conceptualizations of emotion to the study of psychopathology. (shrink)
Individual differences in inhibition-related functions have been implicated as risk factors for a broad range of psychopathology, including anxiety and depression. Delineating neural mechanisms of distinct inhibition-related functions may clarify their role in the development and maintenance of psychopathology. The present study tested the hypothesis that activity in common and distinct brain regions would be associated with an ecologically sensitive, self-report measure of inhibition and a laboratory performance measure of prepotent response inhibition. Results indicated that sub-regions of DLPFC (...) distinguished measures of inhibition, whereas left inferior frontal gyrus and bilateral inferior parietal cortex were associated with both types of inhibition. Additionally, co-occurring anxiety and depression modulated neural activity in select brain regions associated with response inhibition. Results imply that specific combinations of anxiety and depression dimensions are associated with failure to implement top-down attentional control as reflected in inefficient recruitment of posterior DLPFC and increased activation in regions associated with threat (MTG) and worry (BA10). Present findings elucidate possible neural mechanisms of interference that could help explain executive control deficits in psychopathology. (shrink)
Delusion is one of the most intriguing psychopathological phenomena and its conceptualization remains the subject of genuine debate. Claims that it is ill-defined, however, are typically grounded on essentialist expectations that a given definition should capture the core of every instance acknowledged as delusion in the clinical setting.
In 1910, Karl Jaspers wrote a seminal essay on morbid jealousy in which he laid the foundation for the psychopathological phenomenology that through his work and the work of Hans Gruhle and Kurt Schneider, among others, would become the ...
In this response to Wiggins and Schwartz, Ratcliffe, and Stanghellini, we first wish to express our gratitude to Philosophy, Psychiatry, and Psychology for providing us the space to clarify our views and to overcome certain misunderstandings. Ratcliffe notes that our critique is "harsh," whereas Wiggins and Schwartz lament the fact that the debate "has taken the form of sometimes acid formulations and rejoinders . . . that lack the tone of mutual appreciation" (2011, 31). We deplore the fact that this (...) exchange was at all necessary, and we share Wiggins and Schwartz's concerns. However, we need to recall here and emphasize that our article originated as a response. It originated as a response to an article that was .. (shrink)
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)