Mental Disorders, Misc

Philosophers have long been fascinated by the stream of consciousness––thoughts, images, and bits of inner speech that dance across the inner stage. Yet for centuries, such “mind-wandering” was deemed private and thus resistant to empirical investigation. Recent developments in psychology and neuroscience have reinvigorated scientific interest in the stream of thought, leading some researchers to dub this “the era of the wandering mind”. Despite this flurry of progress, scientists have stressed that mind-wandering research requires firmer philosophical foundations. The time is (...) therefore ripe for the philosophy of mind-wandering. Our review begins with a foundational question: what is mind-wandering? We then investigate the significance of mind-wandering for general philosophical topics, namely mental action, introspection, and the norms of thinking and attention. (shrink)

Wittgenstein’s concepts shed light on the phenomenon of schizophrenia in at least three different ways: with a view to empathy, scientific explanation, or philosophical clarification. I consider two different “positive” wittgensteinian accounts―Campbell’s idea that delusions involve a mechanism of which different framework propositions are parts, Sass’ proposal that the schizophrenic patient can be described as a solipsist, and a Rhodes’ and Gipp’s account, where epistemic aspects of schizophrenia are explained as failures in the ordinary background of certainties. I argue that (...) none of them amounts to empathic-phenomenological understanding, but they provide examples of how philosophical concepts can contribute to scientific explanation, and to philosophical clarification respectively. (shrink)

Fear to contamination is an easy-to-provoke, intense, hard-to-control, and extraordinarily persistent fear. A worsening of preexisting psychiatric disorders was observed during the COVID-19 outbreak, and several studies suggest that those with obsessive–compulsive disorder may be more affected than any other group of people. In the face of worsening OCD symptoms, there is a need for mental health professionals to provide the support needed not only to treat patients who still report symptoms, but also to improve relapse prevention. In this line, (...) it is recommended to improve alternative strategies such as online consultations and digital psychiatry. The aim of this study is to develop augmented reality stimuli that are clinically relevant for patients with cleaning OCD and assess their efficiency to obtain emotionally significant responses. Four AR stimuli were developed: a plastic bag full of garbage, a piece of bread with mold, a dirty sports shoe, and a piece of rotten meat. All stimuli were shown to a clinical group and a control group. Relevant results were the design of the AR stimuli. These stimuli were validated with the statistical difference in perceived anxiety in the meat stimuli between the clinical and control groups. Nevertheless, when looking at effect sizes, all stimuli present effect sizes from small to large, with both shoe and bread between small and medium effect sizes. These results are a valuable support for the clinical use of these AR stimuli in the treatment of cleaning OCD. (shrink)

Although not identical, this article suggests that complex posttraumatic stress disorder, depersonalization and schizophrenia share at least one feature: in all these cases, the body becomes a defective tool, an IT. In turn, those suffering from them can no longer be-in-the-world through the living body but rather experience their body as an object; they manage their lives on the level of body image.The next section outlines some cognitive and phenomenological concepts such as body schema, body image, body-as-subject and body-as-object. Thereafter, (...) the article explores the phenomenology of C-PTSD, depersonalization, and schizophrenia, finally suggesting that in each of these cases the body... (shrink)

In her 2006 book The Jumbled Jigsaw, Donna Williams, an autistic author and poet, presents an example of a list of traits associated with autism—one of many such lists commonly found in text books, academic publications, and information leaflets. Her list includes the following: a tendency to stick to well-tried routines and avoid change, a tendency to have a narrow range of interests, a tendency to develop irrational fears and anxieties, a tendency not to develop a sense of danger, a (...) tendency to demonstrate bizarre behaviors and mannerisms, a tendency to copy speech parrot fashion, and isolated areas of ability. "The problem with such a list," Williams explains, "is that the features of each of these areas can be... (shrink)

We are pleased with the thought-provoking discussion that our article has stimulated. All of the discussants agree that the state of education and infusion of ethical principles and practices into psychiatric decision making is currently suboptimal. The ethical questions raised by the discussants, writ large, have been analyzed, reduced to a seemingly manageable 'core,' or expanded to capture nuance and subtlety, and it is invaluable for clinicians, patients, and others to explore them together.In modern times, where the prevailing Western ethical (...) theories were developed, the aim of ethics was to do the right thing. For example, we ought to aim to maximize overall usefulness based on consequences of actions, or to... (shrink)

The principles that usually direct ethical decision making are not easily or straightforwardly applicable to the care and treatment of anorexia nervosa, particularly the care and treatment of severe and enduring anorexia nervosa, where the sufferer seems to be recalcitrant to treatment and where the condition has become life-threatening.There are exceptional circumstances that characterize this puzzling and still scarcely understood condition; I suggest that these exceptional circumstances provide moral reasons for partial derogation from the usual principles of ethical decision making.In (...) what follows I argue... (shrink)

Understanding Mental Disorders aims to help current and future psychiatrists, and those who work with them, to think critically about the ethical, conceptual, and methodological questions that are raised by the theory and practice of psychiatry. It considers questions that concern the mind’s relationship to the brain, the origins of our norms for thinking and behavior, and the place of psychiatry in medicine, and in society more generally. With a focus on the current debates around psychiatry’s diagnostic categories, the authors (...) ask where these categories come from, if psychiatry should be looking to find new categories that are based more immediately on observations of the brain, and whether psychiatrists need to employ any diagnostic categories at all. (shrink)

Although clinical understandings of self-injury, the deliberate mutilation of body tissue, have developed significantly since the phenomenon was first studied, the predominant stereotype of who self-injures is still White, teenage girls.1 White girls as well as White women are, indeed, at risk for SI, and sociocultural explanations appealing to oppressive socialization—particularly the influence of Western beauty norms—have been offered to explain their high rates of SI. Yet evidence exists to challenge this conception that SI is exclusively a White, female issue: (...) Black women, South... (shrink)

Recent literature has suggested that generics can harbor and propagate worrying ideologies in a manner which is often not appreciated by speakers. In this article, I argue that the use of generics to convey information about mental illness is unhelpful, whether the knowledge structure conveyed by the generic is 'accurate' or not. Inaccurate generics contribute to insidious forms of social stereotyping and stigma by encouraging us to simplistically generalize characteristics found in very few category members to other members of that (...) kind.Yet, even where the knowledge structure underlying the generic is accurate, generics remain an unhelpful way of talking about mental illness. This is because... (shrink)

Psychiatry uncomfortably spans biological, psychological, and social perspectives on mental illness. As a branch of medicine, psychiatry is under pressure to conform to a biomedical model, according to which diseases are characterized primarily in biological terms. But psychiatry also draws on the psychotherapeutic tradition, which explains mental distress in terms of life experience and social influences.These approaches ought to complement each other, but historically this has not happened. With no theory creating global, systematic links between the two approaches, psychiatry is (...) divided... (shrink)

The network approach to psychopathology posits that mental disorders can be conceptualized and studied as causal systems of mutually reinforcing symptoms. This approach, first posited in 2008, has grown substantially over the past decade and is now a full-fledged area of psychiatric research. In this article, we provide an overview and critical analysis of 363 articles produced in the first decade of this research program, with a focus on key theoretical, methodological, and empirical contributions. In addition, we turn our attention (...) to the next decade of the network approach and propose critical avenues for future research in each of these domains. We argue that this program of research will be best served by working toward two overarching aims: (a) the identification of robust empirical phenomena and (b) the development of formal theories that can explain those phenomena. We recommend specific steps forward within this broad framework and argue that these steps are necessary if the network approach is to develop into a progressive program of research capable of producing a cumulative body of knowledge about how specific mental disorders operate as causal systems. (shrink)

People with Scrupulosity have rigorous, obsessive moral beliefs that lead to extreme and compulsive moral acts. These fascinating outliers raise profound questions about human nature, mental illness, moral belief, responsibility, and psychiatric treatment. Clean Hands? Uses a range of case studies to examine this condition and its philosophical implications.

The article discusses the actual problem of social support for people with mental health problems, which has an important place in the study field of social psychology and social work.The article also deals with the definition of the concept of “mental health”, the problem of introducing the term “mental health problems” as a way to avoid stigmatization, and the spread of a humanistic attitude to persons with a psychiatric diagnosis. It also discussed modern theoretical approaches that offer an understanding of (...) the contribution of biological, social, and psychological factors into the cause of mental health problems. -/- The problem of mental illness is common to all countries of the world, as WHO data evidenced the number of people with mental disorders among the world’s population, ranging from 4–5 %. According to researchers P. Voloshin and N. Maruta, the spread of mental and behavioral disorders in Ukraine is characterized by a slow increase of about 2.9 % in every 10 years. Researchers argue that in subsequent years, according to the prognostic data, there will be an increase in these indicators. The issue of providing social support to people with PDS in Ukrainian society is very relevant, which is complicated by their social isolation in the process of recovery after the treatment. The results of scientific research in the context of different cultures and relatively diverse life events (hospitalization, mental illness, unemployment, old age) generally confirm the positive results of using social support to promote mental and physical health. Instead, there are no studies in Ukrainian science related to the phenomenon of social support of people with mental health problems. -/- It is important to define the concepts of “mental health” and “mental health problems” in the process of studying the features of social support for people with mental health problems. The term “mental health” combines the medical and psychological fields of science and practice, but modern psychology offers a comprehensive approach to assessing the psychological health of a person, the psychological norm, its limits, taking into account the criteria of mental health. The description of the mental health given by the Psychological Dictionary points out the components of awareness and the sense of continuity, continuity and identity of their physical and mental “I”; sense of continuity and identity of experiences in similar situations; critical to yourself and your mental activity and its results; the adequacy of psychic reactions of force and frequency of environmental influences; the ability to manage their behavior in accordance with social norms; planning personal activities and implementing them; changing the way of behavior depending on the changing circumstances of life. -/- The concept of “mental health problem” was taken as a term that denotes all the symptoms classified in ICD-10 and DSM-IV, which are recommended by experts to clients for appropriate treatment and care. Scientists and mental health practitioners point out that mental health problems can affect the way an individual thinks, feels, and behaves; affects self-service, fulfills professional duties, social, family roles, and household behavior, which is usually deeply affected by the quality of life of the individual. Numerous results of the research show that there are specific psychological and personality factors apart from the biological causes of mental disorders (genetic factors that contribute to the imbalance of chemicals in the brain) that make people vulnerable to occurrences of the mental health problems. -/- Several modern theoretical approaches offer an understanding of the contribution of biological, social, and psychological factors to the induction of mental health problems: the traditional medical model, the rehabilitation model, the interface model, the social model, and the biopsychosocial approach. Only biopsychosocial and social models are consistent with the definition of WHO disability and emphasize the impact social aspects of mental health and the quality of life of people with mental health problems. -/- Individuals with PPP, as a social community, have specific needs that differentiate them from other members of society, one of which is the need for constant socio-psychological support. So, the contribution of psychology and social work to the quality of life of people with mental disorder lies in the application of professional approaches and methods based on the biopsychosocial (social) model, which emphasize the need for socio-psychological support. An example of such a technique is the model of modern social work practice “people-in-environment”, which serves as a guiding principle of social work and emphasizes the importance of understanding the persons with disorder and their behavior in the light of the multiple context of the social environment in which these persons live and act. Specialists of social work and psychology make interventions at three levels: individual, at the family level, and at the community level, by means of intensifying the support of the environment within the cognitive-behavioral and other approaches, which contribute to the process of reintegrating people with mental health problems into community. (shrink)

Background and Objective: Understanding how trauma impacts the self-structure of individuals suffering from the Post-Traumatic Stress Disorder (PTSD) symptoms is a complex matter and despite several attempts to explain the relationship between trauma and the “Self”, this issue still lacks clarity. Therefore, adopting a new theoretical perspective may help understand PTSD deeper and to shed light on the underlying psychophysiological mechanisms. Methods: In this study, we employed the “three-dimensional construct model of the experiential selfhood” where three major components of selfhood (...) (phenomenal first-person agency, embodiment, and reflection/narration) are related to three Operational Modules (OMs) of the self-referential brain network. These modules can be reliably estimated through operational synchrony analysis of the Electroencephalogram (EEG). Six individuals with PTSD symptoms and twenty-nine sex-, age- and demographic- (race, education, marital status) matched healthy controls underwent resting state EEG signal acquisition with the following estimation of the synchrony strength within every OM. Results: Our results indicate that subjects with PTSD symptoms had significantly stronger EEG operational synchrony within anterior and right posterior OMs as well as significantly weaker EEG operational synchrony within left posterior OM compared to healthy controls. Moreover, increased the functional integrity of the anterior OM was positively associated with hyperactivity symptoms, reduced synchrony of the left posterior OM was associated with greater avoidance, and increased right posterior OM integrity was positively correlated with intrusion and mood symptoms. Conclusion: The results are interpreted in light of the triad model of selfhood and its theoretical and clinical implications (including a new treatment approach) are discussed. (shrink)

Thanks to Barton Palmer and John McMillan for these thoughtful commentaries. We found much to agree with and it is striking how so many of the issues relating to decision-making capacity assessment find resonances outside of an English jurisdiction. California and New Zealand are clearly grappling with a very similar set of issues and the commentaries speak to the international nature of these discussions.We will pick up on some main points the commentaries raise.As Palmer notes, DMC law is vulnerable to (...) the criticism that it does not attend to the authenticity of a decision. In ordinary language, this is the idea that someone is deciding while “not their self” or that it is the “illness speaking.” There is a... (shrink)

There is an apparent epidemic of mental illness. At the end of 2011, untreated mental disorders accounted for 13% of the total global burden of disease, and for 25.3% and 33.5% of all years lived with a disability in low-and middle-income countries, respectively. Depression affects 350 million people globally and is the leading cause of disability. One in five U.S. adults takes psychiatric medication. One study found that by age 32, 50% of people surveyed qualified for an anxiety disorder, more (...) than 40% for a mood disorder, and more than 30% for substance dependence. Another study reported that... (shrink)

Emotions might contribute to our being rational cognitive agents. Anxiety – and more specifically epistemic anxiety – provides an especially interesting case study into the role of emotion for adaptive cognition. In this paper, I aim at clarifying the epistemic contribution of anxiety, and the role that ill-calibrated anxiety might play in maladaptive epistemic activities which can be observed in psychopathology. In particular, I argue that this emotion contributes to our ability to adapt our cognitive efforts to how we represent (...) the practical factors relevant to the task at hand, by sig- naling the need for increased cognitive processing and evidence gathering in high- stakes situations. I hypothesize that dysfunctional or ill-calibrated epistemic anxiety might play an important role in the motivation driving persons with obsessive- compulsive disorder (OCD) to invest high amounts of cognitive resources into the resolution of apparently simple and innocuous questions. As I argue, OCD might be conceived as a case in which epistemic anxiety is inappropriately elicited, represent- ing these as high-stakes questions, and inadequately signaling a need for cognition. In this paper, I thus make use of the concept of (epistemic) anxiety as developed in the philosophy of emotion and in epistemology, to propose an account of the role of anxiety in the pathological doubt that is central to obsessive-compulsive disorder. (shrink)

Although generally supportive of our overall position, both Zachar and Gala and Laughon raise questions about our research design. Herein, we respond to these questions by presenting counterarguments that support the soundness of this design.Subsequent to stating some broad agreement with our central thesis that mental disorder is best viewed as a disability concept and not a behavioral one, Dr. Zachar expresses a number of reservations about our work. We focus on the following discussion on what seem to be the (...) most significant of these.Dr. Zachar states the following : “In 8 of their 12 conditions, the dependent variable is evaluation of problematic behavior and the independent variable is disability... (shrink)

Tamara Browne proposes a provocative idea: She argues that philosophers, sociologists, and bioethicists should act as an independent editorial panel for future editions of the Diagnostic and Statistical Manual of Mental Disorders. Her paper depends on some well-versed claims in philosophy of psychiatry: She argues that psychiatric classifications are inherently value laden and philosophers, sociologists, and ethicists are best placed to discern the values are that embedded within scientific descriptions of mental disorders, and to speculate on the effects of any (...) such classifications on individuals and the populace at large as a result of these classifications.I agree with Browne that the DSM (and... (shrink)

It sometimes seems to us that our judgments about what we ought to believe diverge from what we in fact believe. I may be perfectly aware that I am not particularly risking my life by flying, for instance, and yet, as I tighten my seatbelt in preparation for takeoff, I may nevertheless embrace the seemingly paradoxical thought that I am likely to die in a matter of mere seconds. In moments like this, it can feel to us like we are (...) experiencing a failure of rationality, as we seem to embrace a belief that we ourselves judge to be unreasonable. That is why philosophers have characterized these kinds of cases as akratic believing. Certainly, they leave us with that same funny feeling, that familiar dread that... (shrink)

Over the last years, self-management has become a central value in the practice of mental health care. Patients are positioned as expertclients who are actively involved in the management of their disease. Some of the ideas that are implied in the concept of self-management may raise important and intriguing questions. For instance, in the context of psychiatry impaired agency and altered self-experience are often part of the psychopathological process itself. The capacity to manage oneself may be impeded by the very (...) problem that needs to be managed. Therefore, how should self-management be conceived in... (shrink)

This paper aims to discuss selected issues related to the effect exerted by the financial aspects of psychotherapy on a psychotherapeutic relationship. At the beginning, I consider the effect that remuneration received by the therapist directly from the customer can have on their therapeutic relationship. Then I discuss the issues related to the compensation for psychotherapy services and show the consequences which the criteria of compensating for specific therapeutic methods have for the quality of psychotherapeutic relationships, as well as the (...) influence which the requirement to study the effectiveness of psychotherapy in the natural science paradigm has on psychotherapeutic services. The arguments I put forward lead to the conclusion that the criteria of the compensation for psychotherapeutic services can change the psychotherapeutic relationship into a business relationship and, as a result, the therapist can start to treat the customer instrumentally. (shrink)

In psychiatry there is no sharp boundary between the normal and the pathological. Although clear cases abound, it is often indeterminate whether a particular condition does or does not qualify as a mental disorder. For example, definitions of ‘subthreshold disorders’ and of the ‘prodromal stages’ of diseases are notoriously contentious. -/- Philosophers and linguists call concepts that lack sharp boundaries, and thus admit of borderline cases, ‘vague’. Although blurred boundaries between the normal and the pathological are a recurrent theme in (...) many publications concerned with the classification of mental disorders, systematic approaches that take into account philosophical reflections on vagueness are rare. This book provides interdisciplinary discussions about vagueness in psychiatry by bringing together scholars from psychiatry, psychology, philosophy, history, and law. It draws together various lines of inquiry into the nature of gradations between mental health and disease and discusses the individual and societal consequences of dealing with blurred boundaries in medical practice, forensic psychiatry, and beyond. -/- Part I starts with an overview chapter that helps readers to navigate through the philosophy of vagueness and through the various debates surrounding demarcation problems in the classification and diagnosis of mental illness. Part II encompasses historical and recent philosophical positions on gradualist approaches to health and disease. Part III approaches the vagueness of present psychiatric classification systems, and the debates concerning their revisions by scrutinizing controversial categories, such as posttraumatic stress disorder, and the difficulties of day-to-day diagnostic and therapeutic practice. Part IV finally focuses on social, moral, and legal implications that arise when being mentally ill is a matter of degree. (shrink)

Cognitive Behavioral Therapy has become the dominant form of psychotherapy in North America. The CBT model is theoretically based on the idea that all external and internal stimuli are filtered through meaning-making, consciously accessible cognitive schemas. The goal of CBT is to identify dysfunctional or maladaptive thoughts and beliefs, and replace them with more adaptive cognitive interpretations. While CBT is clearly effective as a treatment, there is good reason to be skeptical that its efficacy is due to the causal mechanisms (...) posited by the CBT model. This paper will argue that the specific cognitive schemas posited by the CBT model likely do not play a direct role in the development or treatment of psychological illness. Cognitive schemas, as identified in CBT interventions, are likely to be the result of patient confabulation and epistemically under-supported practitioner-based identification. CBT interventions appear to impose coherence on patients’ psychological states, rather than identifying and modifying preexistent causally efficacious core beliefs. (shrink)

Ginger Hoffman and Jennifer Hansen’s study of gender dynamics in psychiatric disability memoirs makes several fruitful moves for the study of psychic diversity. Perhaps the most important is that the article encourages analytic philosophers to contribute to understanding how individual mental life is affected by the larger cultural context—which we can think of as the “mind/culture” problem. This is an important move because, for the most part, analytic philosophers have paid more attention to the mind/body problem than they have to (...) the mind/culture problem. Hoffman and Hansen are right that it would be valuable for analytic philosophy to join in the study of this equally complicated conceptual problem.... (shrink)

I thoroughly enjoyed Dr. Freedman’s paper on “Akratic Believing.” Often, philosophy of psychiatry offers insights to clarify psychological and psychiatric concepts. Less frequently, it involves a real dialogue between philosophy and psychological science. Dr. Freedman’s account of what is bothersome, rather than just philosophically wrong-headed, about the concept of epistemic akrasia demonstrates that, at least where anxiety is concerned, the a posteriori world may have a great deal to offer theoretical philosophy. Freedman argues that understanding somatic responses to trauma, or (...) more broadly construed, to anxiety, dissolves the problem of why there seems to be more to the problem of epistemic... (shrink)

Do our diagnostic terms refer? If they do not, what implications does this have for our understanding of the practice of validation in psychiatry? These are the questions raised and addressed in the main part of John Campbell’s contribution to this volume, and the ones we will focus on in our reply. While we are sympathetic to Campbell’s contentions that the Diagnostic and Statistical Manual of Mental Disorders (DSM) style of validation needs reassessment, and that causality should play a more (...) prominent role in nosological revisions, we think his picture of reference and validation is misconceived. In this short comment, we first address Campbell’s question about the reference of our diagnostic terms, before briefly sketching an alternative view of validation. (shrink)

We undergo a traumatic experience, such as a life-threatening accident or a brutal attack. We survive a period of relentless stress, perhaps because we are in a war zone and witness or commit atrocities. Raised by parents who are alcoholic or mentally ill, we endure traumatic experiences on a daily basis. Or, we are ignored, neglected, or treated as playthings by narcissistic parents, who themselves were ignored and neglected, and on and on through generations. To survive these experiences, perhaps we (...) dissociate. This can take various forms. In the extreme form, we remove ourselves, psychically speaking, from the situation, perhaps by adopting the role... (shrink)

In cases where one sense-modality is stimulated by another, we speak of synesthesia, i.e., of a subjective experience of multiple distinct sensations as being quite literally conjoined. The term “synesthesia” is derived indirectly from the Greek words “syn,” meaning “together,” and “aisthesis,” meaning “sensation.” This article focuses on the question of whether synesthesia is in fact a mental disorder or a creative gift. Both the commonsense views that have emerged in recent times, and neurological research, demonstrate that our knowledge of (...) this relatively uncommon phenomenon is slowly but constantly expanding. Proper experimental research conducted with the right sorts of synesthete, and philosophically and scientifically nuanced conceptual studies of synesthesia, can all be helpful when seeking answers to the question posed above, while also confirming general claims about the extent to which our perceptions are really subjective. Most synesthetes see themselves as gifted, and claim that this “conjoining of the senses” enriches the quality of their lives. (shrink)

To consider power as not only the direct physical oppression of others, but as a production of authority through discursive knowledge and a claimed ‘expertise’ of the world, has been one of Foucault’s great legacies to critical work on mental health and illness. As arbiters of the ‘truth’ on what is and what is not mental pathology, I agree with Swerdfager that the privileged knowledge of the mental health professions and the consequential marginalization of other forms of knowledge on distress (...) can be better theorized through an investigation of the power/knowledge nexus. Practically, scholars and researchers can begin to address these... (shrink)

In their 2013 study of traumatic flashback formation, Bourne, Mackay and Holmes raise the question of whether the propensity of a traumatic experience to produce flashbacks is determined by the emotions that are felt at the time of that experience. They suggest that it is not, but the grounds on which they make this suggestion are flawed. Further research is required. That research will need to overcome a significant methodological difficulty — one which is hard to avoid when fMRI data (...) and introspective reports are combined in a single causal inference. (shrink)

This chapter has two aims. The first aim is to compare and contrast three different conceptual-explanatory models for thinking about mental illness with an eye towards identifying the assumptions upon which each model is based, and exploring the model’s advantages and limitations in clinical contexts. Major Depressive Disorder is used as an example to illustrate these points. The second aim is to address the question of what conceptual-theoretical framework for thinking about mental illness is most likely to facilitate the discovery (...) of causes and treatments of mental illness in research contexts. To this end, the National Institute of Mental Health’s Research Domain Criteria (RDoC) Project is briefly considered. (shrink)

Suicidal ideation would often appear to relate to ideas about life’s meaninglessness. In this chapter, I consider the suicidal thoughts of an elderly person in light of the recent philosophical discussion on the meaning of life. I start by distinguishing between two importantly different questions about life’s meaning and explaining how they differ from certain other issues sometimes treated as questions about the meaning of life. Then I address the two questions about life’s meaning in turn, connecting them to the (...) example case. After that, I briefly consider how the elderly person’s committing suicide would appear from the viewpoint of the philosophical debate on life’s meaning. I conclude by summing up how the philosophical discussion on the meaning of life I have referred to might help a person like the one in the example case. (shrink)

This article examines the development of koro’s epistemic status as a paradigm for understanding culture-specific disorders in modern psychiatry. Koro entered the DSM-IV as a culture-bound syndrome in 1994, and it refers to a person’s overpowering belief that his genitalia is retracting and even disappearing. I focus in particular on mental health professionals’ competing views of koro in the 1960s—as an object of psychoanalysis, a Chinese disease, and a condition predisposed by culture. At that critical juncture, transcultural psychiatrists based outside (...) of continental China—namely, Taiwan, Hong Kong, and Singapore—appropriated ideas from traditional Chinese culture to consolidate the clinical diagnosis of koro as culture-bound. This new global meaning of koro was made possible by a cohort of medical experts who encountered the phenomenon and its sufferers in Sinophone communities, but placed their contributions within the broader contours of the global reach of Anglophone psychiatric science. (shrink)

According to human enhancement advocates, it is morally permissible (and sometimes obligatory) to use biomedical means to modulate or select certain biological traits in order to increase people’s welfare, even when there is no pathology to be treated or prevented. Some authors have recently proposed to extend the use of biomedical means to modulate lust, attraction, and attachment. I focus on some conceptual implications of this proposal, particularly with regard to bioconservatives’ understanding of the notions of therapy and enhancement I (...) first explain what makes the proposal of medicalizing love interesting and unique, compared to the other forms of bioenhancement usually advocated. I then discuss how the medicalization of love bears on the more general debate on human enhancement, particularly with regard to the key notion of “normality” that is commonly used to define the therapy–enhancement distinction. This analysis suggests that the medicalization of love, in virtue of its peculiarity, requires bioconservatives to reconsider their way of understanding and applying the notions of “therapy” and “enhancement.” More in particular, I show that, because a non-arbitrary and value-free notion of “therapy” cannot be applied to the case of love, bioconservatives have the burden of either providing some new criterion that could be used for drawing a line between permissible and impermissible medicalization, or demonstrating that under no circumstances—including the cases in which love is already acknowledged to require medical intervention—can love fall within the domain of medicine. (shrink)

The ultimate language of madness is that of reason.In short, under the chaotic and manifest delirium reigns the order of a secret delirium. In this second delirium, which is, in a sense, pure reason, reason delivered of all the external tinsel of dementia, is located the paradoxical truth of madness. And this in a double sense, since we find here both what makes madness true and what makes it truly madness.At the urging of his parents, Mr. A, a college-age young (...) man with a past diagnosis of Asperger’s... (shrink)

In his case report, A Logic in Madness, Aaron Hauptman details the case of Mr. A, an intelligent college student with Asperger’s syndrome, who became severely depressed subsequent to what he perceived as a rejection by what he viewed as “the love of his life.” Dr. Hauptman describes Mr. A as suicidal and as suffering from all the hallmarks of a major depression. At the urging of his family, he presents himself to a psychiatric inpatient unit and agrees to a (...) voluntary hospitalization. However, he refuses pharmacological treatment or electroconvulsive therapy, both of which his clinicians are considering given the severity of his case. Dr. Hauptman describes the young man’s response... (shrink)

Before broaching our main subject, and exploring why, among all disorders of the mind, obsessive-compulsive disorders have a place apart, I would like to start from a dilemma that is well-known to historians interested in mental disorders. According to one approach, a mental illness X is considered as a bona fide or ‘genuine’ illness if, and only if, it originates from a disturbance of the brain. Its neurobiological form is in this case considered as invariant, whatever cultural veneer might give (...) it a different aspect in accord with historical and local settings. The assumption is that this veneer does not, properly speaking, have any deep grounding in reality... (shrink)

My article in this issue of PPP is based on a lengthy book, La Société du malaise, in which I examine the shift from Oedipal neurosis to narcissistic pathologies in France and in the United States, viewing this shift in connection with changes in social ideals regarding autonomy that I summarize as autonomy–aspiration and autonomy–condition. Using the notion of social pathology, I consider sociological/anthropological dimensions of so-called mental health problems by viewing them as individualistic ways of dealing with adversity or (...) misfortune in a form of life permeated with the autonomy–ideal. Changes in ways of acting in society go together with changes in forms of being.. (shrink)