"How hard I find it to see what is right in front of my eyes!"A common part of doing science is acting as if our particular endeavor was ahistorical and unaffected by all external influences we would like the 'pursuit of truth' to be free of. To act under such a premise, or even to believe that it is valid, is in a sense understandable, possibly even necessary for any worthwhile scientific effort to take place. At the same time, however, (...) as we time and again come to realize, no amount of our conviction can prevent us (including us as scientists) from being contingent and historically situated.Sahanika Ratnayake concludes her conceptual and historical tour de force with the hope that the reader would find them... Read More. (shrink)

Within the psy- disciplines, Foucauldian discourse analysis has shown that those who exercise power in defining psychological experiences seek to maintain existing power hierarchies through this labeling. In that way, it is a fitting method to examine how the use of specific language constructs reality for individuals and society as a whole. Currently, the use of the word "triggered" has proliferated beyond the common mental health usage to refer to posttraumatic stress disorder or a re-experiencing symptom of a trauma. In (...) this qualitative investigation, we analyze "triggered" experiences written about in participants' vignettes to explore how using the word "triggered" does something in terms of power, hierarchy, and expression of vulnerability for individuals, and how this is impacted by the way they position themselves and others in speaking about their experiences. We understand the experience of being "triggered" to be constructed differently depending on the source of the trigger. The difference is particularly salient for those who use "triggered" to refer to a microaggression as opposed to those who are referring to a sexual assault. We discuss the tension between supporting a psychiatric status quo regarding trauma and the subversion of this status quo via the expanded use of the word "triggered.". (shrink)

Boredom is a frequently expressed feeling in anorexia. However, boredom is rarely a subject of study. We propose that boredom has a central place in the understanding of anorexia. Boredom, in that it reveals the ontological condition of each one, pushes the subject to face its existence and the burden it constitutes. Anorexia would thus be an attempt to fight against boredom to avoid this ontological encounter. Certain characteristics of existence proposed by Heidegger are thus brought to the forefront: ability-to-be, (...) temporality or the impossible banality. With the help of two clinical cases, we will see how boredom can also be a therapeutic lever in the treatment of anorexia. (shrink)

Thanks to the particularly pertinent comments of Moskalewicz and Hughes, we would like to point out that our proposals seem to echo, in another way, Castellini et al.'s recent work (2022). The authors propose that, in anorexia, difficulties in experiencing the first bodily experiences have numerous consequences, notably on a temporal or intersubjective level. Basically, if anorexia sufferers are unable to develop a coherent and meaningful subjectivity based on these fundamental experiences, they have to find the norm in the gaze (...) of others, which cannot be experienced subjectively. We understand here what Hughes was emphasizing, namely an experience of solitude, since the other and inter-subjectivity are experienced... Read More. (shrink)

Despite Martin Heidegger's famous analysis of Angst [anxiety] in Being and Time, contemporary phenomenologists have had surprisingly little to say about everyday experiences of anxiety—whether healthy or pathological. But Martin Vestergaard Kristiansen's recent work shows how phenomenology can provide a wealth of insight into the complexities and nuances of anxiety (Kristiansen, 2023a, 2023b). Moreover, his work demonstrates the central importance—perhaps even necessity—of conducting these studies empirically. The novelty of his insight is not found in armchair speculation or even critical reflection (...) on existing texts. The novelty comes from the qualitative data generated by his phenomenologically grounded... Read More. (shrink)

Thomas Szasz famously argued that mental illness is a myth. Less famously, Szasz argued that since mental illness is a myth, so too is psychotherapy. Szasz's claim that mental illness is a myth has been much discussed, but much less attention has been paid to his claim that psychotherapy is a myth. In the first part of this essay, I critically examine Szasz's discussion of psychotherapy to uncover the strongest version of his case for thinking that it is a myth. (...) As we'll see, this involves an understanding of psychotherapeutic interventions as treatments of psychopathological problems. In the rest of this essay, I turn to this directly and argue that psychotherapy has an important non-pathocentric dimension. I argue that we fail to appreciate the nature and variety of psychotherapy if we concentrate only on its pathocentric dimensions. Though I use Szasz as a stalking horse, the substantive topic is the nature of psychotherapy. This enquiry falls into the philosophy of psychotherapy as distinct from the philosophy of psychiatry and the philosophy of psychoanalysis. (shrink)

In phenomenological conceptions of anorexia, disordered eating practices have predominantly been interpreted according to disturbances of embodied intersubjectivity, demonstrated in feelings such as shame and disgust, a sense that one is extraneous to one's own body, and a heightened reliance upon the gaze of the other (Fuchs, 2022; Gaete & Fuchs, 2016; Legrand, 2010; Legrand & Briend, 2015; Stanghellini et al., 2012; Stanghellini et al., 2015). Through these alterations to the lived body, it is theorized that the body-as-subject becomes increasingly (...) objectified, defined in its alterity as a body-for-others to the extent that one becomes alienated from oneself, from others, and from the world.Building on these... Read More. (shrink)

In these two articles Sahanika Ratnayake attempts to unpack the history of cognitivebehavior therapy (CBT) and explain a course in which CBT became more prominent while psychoanalysis suffered a loss of prominence. In the first paper, "The Decline of Psychoanalysis and the Rise of Cognitive Behavioral Therapy. Part I: Dismantling the Legend of CBT," she describes the fracas in which Aaron Beck, the founder of CBT, attempted to both defend the merits of CBT and expose the demerits of psychoanalysis. Popper, (...) Grünbaum, and Eysenck enter this discussion.According to Ratnayake, Beck's argument against psychoanalysis (and psychoanalytic therapy) rests on a couple of factors: 1) that the psychoanalytic explanation of... Read More. (shrink)

The role of loneliness in shaping the interpersonal experience of patients with social anxiety disorder (SAD) is poorly understood. The present study begins to close this gap through phenomenological analysis of a series of experiential interviews with eight people suffering from SAD. The analysis shows that in socially anxious experiences, the sense of being an outsider to a seamlessly unfolding interpersonal situation constitutes the self-other relationship in which the patient finds themselves. In this experience of an unamendable separation from others, (...) there is profound loneliness. The impossibility of becoming absorbed in the interpersonal situation forces the patient to act as if they naturally belonged with others. This performative way of relating to others gives rise to anxiety, manifesting as the fear of being revealed as imposters. This conceptualization challenges the dominant cognitive-behavioral account of SAD by decentralizing fearfulness and underscoring loneliness as a constitutive aspect of the patient's interpersonal experiences. Further, it highlights the importance of considering a wider array of experiential manifestations in addition to thoughts and behaviors in conceptualizing the psychopathology of socially anxious patients. (shrink)

Interpretive debate lies at the heart of phenomenological explorations of the myriad variations of human experience and suffering. Merleau-Ponty's (1945/1982) reanalysis of the Schneider-case is a classic example; Young's (1980) critical revision of Straus's (1966) considerations on feminine corporeality is another. This kind of continuous scholarly dialogue is of special relevance in exploring anxiety in its complexity as Micali (2022) underscores in a recent philosophical exploration of the phenomenon. Capturing the nuances and inherent ambiguity of anxiety, Micali contends, requires a (...) phenomenologically polyphonous approach, bringing various philosophical voices together to articulate its essential qualities. It... Read More. (shrink)

Kristiansen's "Feeling like a perpetual outsider: relationality in Social Anxiety Disorder" offers a valuable analysis of loneliness within social anxiety disorder (SAD). Although phenomenological psychopathology has given extensive attention to conditions like schizophrenia, depression, and disordered eating, a more nuanced phenomenological examination of SAD is needed (Bortolan, 2023; Tanaka, 2020; Trigg, 2016). Kristiansen's work addresses this deficit and contributes to broader philosophical and phenomenological discussions of loneliness, including recent work on loneliness within psychopathology (e.g., Krueger et al., 2023; Motta, 2021; (...) Roberts & Krueger, 2021; Seemann, 2022).We propose that first-person... Read More. (shrink)

This paper offers a phenomenologically informed critique of the post-traumatic stress disorder (PTSD) model of trauma in cross-cultural contexts. Using the case of the Iranian political lifeworld, where the psychiatric discourse of trauma in delineations of various heterogenous experiences of distress is dominant, I demonstrate how trauma can be conceptualized and experienced as temporally extended and collectively shared—contrary to the paradigmatic understanding. First, the PTSD model of trauma as seen in the _Diagnostic and Statistical Manual of Mental Disorders_ (DSM) is (...) examined, where I highlight how the model fails to recognize the importance of sociocultural environments in bringing about states of psychological (ill)health. Second, using first-person accounts by Iranians, I examine how trauma finds meaning and significance within a particular sociocultural setting. Third, by revisiting the notion of continuous traumatic stress (CTS) as a feature of the social environment, I show how a re-coupling of environments and individuals within them can offer a more complete understanding of trauma and the distressing and/or pathological states it may give rise to. Highlighting the common threads with growing interest in enactive and extended approaches in philosophy of psychiatry, I therefore argue for the recognition of the socioculturally constructed conceptions of trauma in shaping experiences and responses to it. (shrink)

Heidegger's fundamental ontology is a powerful weapon, but that power comes with a price. It carries a totalizing capacity within, including the extinguishing of all parties partaking in a philosophical dispute. After all, there are no longer any "parties" involved, no selves or objects or aspects or qualities or anything actually. We initiate a quest beyond things.In their work, "Boredom and Anorexia," Alexandre Chapy and Corinne Gal (2025) deliberately reach for that weapon to demonstrate that anorexia is a failed attempt (...) at escaping the ontological condition. The weapon is more than accurate in its critical capacity and certainly much more effective than any conventional arsenal. It is no less than a tactical... Read More. (shrink)

The focus of Peyman's interesting paper is to make clear the distinction between mental imagery and sensory perception in such a way as to avoid rendering the former overly inclusive. He wants there to be a clear distinction between mental imagery and perceptual phenomena such as psychotic hallucinations and non-lucid dreaming. He could have emphasized this point by drawing attention to the finding that at least some of those with aphantasia experience visual dreams (Zeman, 2024). To the clinician who is (...) not specialist in the philosophy of perception, Peyman makes a good case, and the proposed definition of mental imagery could help establish whether a specific mental state is an instance of mental imagery or not.... Read More. (shrink)

In responding to Norman Poole's insightful commentary on my paper, I wish to express my appreciation for his thorough engagement with the concepts and definitions I have proposed. His observations and critiques highlight some challenges in distinguishing between mental imagery and related perceptual phenomena—a task that is both complex and crucial for advancing our understanding in both philosophical and clinical contexts. In the following, I will address some of his specific concerns and clarify the reasoning behind the positions I have (...) taken, while also acknowledging the broader implications that these distinctions may have for clinical practice.Regarding my attempts to refute the belief-based formulation of... Read More. (shrink)

In this paper, first, I will argue why the definition of mental imagery in terms of its stimulus (external vs. internal) does not capture some essential properties of mental imagery; second, I will offer an alternative in which I define it in terms of phenomenological similarities and differences between mental imagery and perception. There, I will argue that the fact that mental imagery is essentially neutral with respect to the spatial location of its object indicates a fundamental feature, which refers (...) to the fact that mental imagery, contrary to perception, does not necessarily represent its object as something located in space. This feature can explain some other important phenomenological differences mentioned in the literature, such as external phenomenology of perception as opposed to internal phenomenology of imagery, informativeness of perception as opposed to uninformativeness of imagery, and seeming reality of the percept as opposed to seeming nothingness of mental image. (shrink)

In the two papers charting the rise of cognitive-behavior therapy (CBT) and the decline of psychoanalysis, I adopted the framework of integrated history and philosophy of science. It was refreshing for a philosopher to adopt something of the historian's neutrality. Naturally, it is unclear whether there is such a thing as true neutrality, but to describe a historical transition and the conceptual accompanying changes without being drawn into whether they were positive or negative was liberating.Such a standpoint has its limitations. (...) As Banicki points out when discussing my claim that the idea of evidence for evaluating contemporary talking therapies (and indeed interventions more generally) has narrowed, such... Read More. (shrink)

This is the first of two papers charting the decline of psychoanalysis and the ascendancy of cognitivebehavioral therapy (CBT). In this paper, which adopts the methodology of integrated history and philosophy of science, I evaluate the 'origin story' presented by CBT proponents which describes the efforts of Aaron Beck to disprove the psychoanalytic theory of depression and present an alternate understanding of mental illness. I argue that contrary to the presentation of CBT as uniquely possessing evidence for its theoretical account (...) and its efficacy, there is a more complex disagreement between the two therapeutic modalities about what constitutes legitimate evidence. (shrink)

This is the second of two papers charting the decline of psychoanalysis and the ascendancy of cognitive-behavioral therapy (CBT). In this paper, which adopts the methodology of integrated history and philosophy of science (HPS), I consider the impact of psychopharmaceuticals on the decline of psychoanalysis and the ascendancy of CBT. I argue that contrary to certain accounts given of this period where psychopharmaceuticals straightforwardly supplanted psychoanalysis, their influence was largely related to the introduction of a new evidential standard, namely, clinical (...) trials. It is only once clinical trials become the accepted evidential standard and become institutionally entrenched that CBT rises to prominence. The paper concludes by considering the impact of this evidential shift on contemporary research on talking therapy and offers some methodological reflections. (shrink)

Turkheimer and Greer’s article “Spit for Science and the Limits of Applied Psychiatric Genetics” (2024) offers a devastating critique of the state of psychiatric genetics, using Spit for Science (S4S) as a case study. I have read the paper many times in the process of writing this commentary, and each time I am left inarticulate. Nonetheless, I hope that my comments, from the point of view of a practitioner who operates at the intersection of clinical psychiatry, psychiatric science, and philosophy (...) of psychiatry, will be of some value to the discussion. I have no substantial disagreements with Turkheimer and Greer. The main point I wish to convey is that there is reason to hope that findings from genetic research... Read More. (shrink)

The pstchologist Danielle Dick and psychiatrist Kenneth Kendler (DK) began an ongoing study in 2011 called Spit for Science (S4S) in which they obtained saliva as a peripheral source of DNA along with assessment of detailed self-report information on alcohol and other substance use, selected personality traits, and psychosocial history about the students entering a large university (Dick et al., 2014). They hoped to identify the genes underlying the heritability of alcohol use and related behaviors to inform students about their (...) individual risk, and thereby to promote increased self-awareness and health. The students were highly cooperative volunteers, and many peer-reviewed research papers have been published from... Read More. (shrink)

In their paper “Spit for Science and the Limits of Applied Psychiatric Genetics,” Turkheimer and Rodock Greer use results from the Spit for Science (S4S) project to argue that the idea of psychiatric genetics1 yielding actionable results is a folly. Although there is much about which Turkheimer and I agree (I took my first psychology class from him 30 years ago), we fundamentally disagree about the outlook of psychiatric genetics. His paper suggests that our differing conclusions arise from the authors (...) misunderstanding the nature of the S4S project and a difference in our views on the broader purpose of psychiatric genetics.It is the characterization of S4S as a “program of research” that is the foundation for the... Read More. (shrink)

Here we articulate a negative answer to Turkheimer and Greer’s question: “Is it possible to envision a genetically informed program that ethically intervenes on campus drinking?” (Turkheimer & Greer, 2024). However, first, we note that the authors cover an immense amount of ground in their paper. They lend insight into how psychiatric genetics, at its very core, is conducted through their detailed examination of a large body of work in one specific area of this large field. A main result of (...) this is to explain the gulf between results and conclusions, work that provides an invaluable service not just to various areas in philosophy and bioethics, but that are deserving of readership by a very wide audience. This gulf... Read More. (shrink)

Eugen Bleuler introduced the concept of double bookkeeping in schizophrenia to describe the tendency for people who experience delusions to simultaneously be convinced of the delusional content and yet to act as if the delusion(s) was untrue/irrelevant or be unbothered by discrepancies. We open the question of whether there exists a double reality in individuals with addiction and whether double bookkeeping can be applied to addiction. While double bookkeeping has primarily been explored in schizophrenia, this concept may hold promise in (...) elucidating insight deficits in individuals with substance use disorders. We propose two forms of addiction double bookkeeping: 1) Partial compartmentalization: individuals demonstrate some awareness of the deleterious consequences of drug use, but continue to engage in addictive behaviors; and 2) Total compartmentalization: individuals who act as if the negative consequences of addiction do not exist, reflecting a more generalized and deeper lack of awareness into their own actions. We propose that a basic alteration in the individual’s sense of self occurs in addiction double bookkeeping as it does in schizophrenic double bookkeeping. We describe the proposed double reality in addiction from first-person and third-person perspectives, accounting for their differences. Three clinical exemplar cases are presented, and conceptual implications are explored. (shrink)

Research in the philosophy of addiction commonly explores how agency is impacted in addiction by focusing on moments of apparent loss of control over addictive behavior and seeking to explain how such moments result from the effects of psychoactive substance use on cognition and volition. Recently, Glackin et al. (2021) have suggested that agency in addiction can be helpfully analyzed using the concept of affordances. They argue that addicted agents experience addiction-related affordances, such as action possibilities relating to drugs, drug (...) paraphernalia, and drug-related activities, as aberrantly salient motivations for action. Building on this approach, we present a novel two-tiered affordance model of addiction. In doing so, we suggest that what is significant about the addicted person’s world is not simply _what_ affordances are experienced as salient, but also the _way_ in which the addicted person’s world is shaped by a dominant concern. It is not only that addiction-related affordances become more prominent as addiction progresses but that one’s plurality of concerns become monopolized by and funneled through addiction. Our model endorses Glackin et al.’s idea that addiction-related affordances become aberrantly salient, while proposing why they become and remain so. This way of viewing agency in addiction also brings to light important implications for recovery and treatment. For, if an addicted person adopts a new, even “socially approved,” dominant concern, there is a risk that the _shape_ of addiction is preserved, even though the content changes, leaving an individual at the risk of addiction substitution or relapse. (shrink)

Turkheimer and Greer (2024) (henceforth “T&G”) make some fair points about problems in the scientific profession, including the regrettable tendency to promise practical applications of research that then never materialize. However, T&G’s sustained critique of a body of work associated with one particular researcher to make these general points struck us as uncharitable. More pressingly, we feel that the far-reaching conclusions that T&G attempt to draw from the results they review from the Spit for Science (S4S) cohort are unjustified and (...) risk misleading readers that psychiatric and behavioral genetics is in a parlous state.T&G state that S4S “produced a clear answer to the question it was designed to address,”... Read More. (shrink)

Theorists commonly maintain that addiction involves compulsion or diminished self-control. Some enactivist theorists have conceptualized this disruption to autonomous agency in terms of embodied habits that become overly rigid, so that an agent enacts this pattern of behavior even in circumstances that call for the activation of a very different set of habits. What is more, because addiction crowds out other goals and priorities, agents may become more one-dimensional and begin to lose a hold on values and commitments that are (...) important to them. Rather than engaging in self-regulation to balance competing priorities and gain a better understanding of how different aspects of their identity relate to one another, agent’s lives become dominated by addictive behavior. I argue that enactivist notions of _habit_ and _self-equilibration_ can help to make sense of how the disruptions to autonomous agency characteristic of addiction are linked to diminished self-insight. (shrink)

Back in 2011, I wrote a paper for the Journal of Bioethical Inquiry, an Australian journal, for a special issue dedicated to ethical issues associated with psychiatric genetics research. The editor was particularly excited by the recent findings of the 5-HTT allele in psychiatric illness. I had different ideas about what I wanted to write about, and the editor, Michael Robertson, graciously considered them and ultimately published the paper. At the time I was interested in the colossal investment of National (...) Institutes of Mental Health (NIMH) research dollars in psychiatric genetic research; at the time I was troubled at the lack of on-the-ground clinical implications of this research investment, and figured an... Read More. (shrink)

The research program Spit For Science was launched at Virginia Commonwealth University (VCU) in 2011. Since then, more than 10,000 freshmen have been enrolled in the program, filling out extensive questionnaires about their drinking, general substance use, and related behaviors, and also contributing saliva for genotyping. The goals of the program, as initially stated by the investigators, were to find the genes underlying the heritability of alcohol use and related behaviors, and in addition to put genetic knowledge to work in (...) ways that might aid university administrators and mental health professionals in the prevention and treatment of substance abuse. We review every empirical paper involving genetic data that has emerged from the program, and reach a surprising conclusion: the study has never identified a single genetic effect of more than trivial magnitude. Although the quantitative results of the studies were reported transparently, the theoretical ramifications of the negligible results have never been acknowledged. To the contrary, most of the papers ignore the tiny effects, reaching optimistic conclusions about the prospects for future genetic explanations of alcohol use. We explore the implications of these results for the broader prospects of applied psychiatric genetics. (shrink)

We are grateful for the opportunity to respond to such a varied and challenging set of commentaries. They range from highly supportive to quite disputatious; we will repay the supportive ones ironically, by discussing them only briefly. That will allow us to expand a bit on the more difficult comments, and of course the thoughtful reply from Dr. Dick.Knox, Allen, and Downes imagine a world in which effective polygenic scores for alcohol use exist and conclude that even then there would (...) be no way to use them ethically. We agree, for the most part, but there are several distinctions to consider. The first is among physical, medical, psychiatric, and normal-range behavioral phenotypes. Effective polygenic scores exist... Read More. (shrink)