Other Mental Disorders

“Spousal revenge” killers murder their child apparently out of a desire to cause harm to their ex-partner, the child’s other parent. Standard explanations of these killings fail to provide an adequate solution to what I call the problem of spousal revenge filicide. This is the problem of how a killer comes to take their rage at their former partner out on their own child and how that child can be dehumanized to the point of murder. Although the dehumanization of the (...) victim is acknowledged to occur, why it occurs is not well understood. Here, I offer an hypothesis that the killer fails to represent their child as a moral subject with a mind of their own. This is due to a deficit in the killer’s capacity for person perception which is, by hypothesis, pathological. As such, the killer experiences the child as an object, rather than a person, which is of significant emotional value to the other parent. The specificity of this disorder explains why the ex-partner themselves is not targeted, and it explains how the killer is able to understand that killing the child will harm the other parent. (shrink)

Anorexia Nervosa (AN) is an eating disorder characterised by self-starvation. Accounts of AN typically frame the disorder in individualistic terms: e.g., genetic predisposition, perceptual disturbances of body size and shape, experiential bodily disturbances. Without disputing the role these factors may play in developing AN, we instead draw attention to the way disordered eating practices in AN are actively supported by others. Specifically, we consider how Pro-Anorexia (ProAna) websites — which provide support and solidarity, tips, motivational content, a sense of community, (...) and understanding to individuals with AN — help drive and maintain AN practices. We use C. Thi Nguyen’s work on epistemic “echo chambers”, along with Maria Lugones’ work on “worlds” and “ease”, to explore the dynamics of these processes. Adopting this broader temporal and intersubjective perspective, we argue, not only helps to further illuminate the experiential character of AN but also has important clinical and therapeutic significance. (shrink)

This article explores histories of the science of stress and its measurement from the mid 19th century, and brings these into dialogue with critical sociological analysis of emerging responses to work stress in policy and practice. In particular, it shows how the contemporary development of biomedical and consumer devices for stress self-monitoring is based on selectively rediscovering the biological determinants and biomarkers of stress, human functioning in terms of evolutionary ecology, and the physical health impacts of stress. It considers how (...) the placement of the individual body and its environment within particular spatio-temporal configurations renders it subject to experimental investigation through standardized apparatus, electricity, and statistical normalization. Examining key themes and processes such as homeostasis, metricization, datafication, and emotional governance, we conclude that the figure of the ‘body electric’ plays a central limiting role in current technology-supported approaches to managing work stress, and that an historical account can usefully open these to collective scrutiny. (shrink)

Scrupulosity is a form of OCD where patients obsess about morality and sometimes compulsively confess or atone. It involves chronic doubt and anxiety as well as deviant moral judgments. This chapter argues that Scrupulosity is a mental illness and that its distortion of moral judgments undermines, or at least reduces, patients’ moral responsibility. The authors go on to argue that this condition challenges popular deep-self theories of responsibility, which assert that one is only blameworthy or praiseworthy for actions that arise (...) from one’s deep self, from what one truly values. Patients with ego-syntonic Scrupulosity, however, identify with their condition and seem to have cares that reflect their deep selves, yet do not seem fully responsible for their actions or their consequences, such as neglecting the needs of their loved ones. Other theories, particularly reasons-responsiveness theories, better capture the ways in which responsibility in Scrupulosity is reduced. (shrink)

Formal thought disorder (FTD) is a clinical mental condition that is typically diagnosable by the speech productions of patients. However, this has been a vexing condition for the clinical community, as it is not at all easy to determine what “formal” means in the plethora of symptoms exhibited. We present a logic-based model for the syntax–semantics interface in semantic networking that can not only explain, but also diagnose, FTD. Our model is based on description logic (DL), which is well known (...) for its adequacy to model terminological knowledge. More specifically, we show how faulty logical form as defined in DL-based Conception Language (CL) impacts the semantic content of linguistic productions that are characteristic of FTD. We accordingly call this the dyssyntax model. (shrink)

ObjectiveBulimia nervosa and binge eating disorder are eating disorders characterized by recurrent binge eating episodes. Overlap exists between ED diagnostic groups, with BE episodes presenting one clinical feature that occurs transdiagnostically. Neuroimaging of the responses of those with BN and BED to disorder-specific stimuli, such as food, is not extensively investigated. Furthermore, to our knowledge, there have been no previous published studies examining the neural response of individuals currently experiencing binge eating, to low energy foods. Our objective was to examine (...) the neural responses to both low energy and high energy food images in three emotive categories in BN and BED participants.MethodsNineteen females with BN or BED, comprising the binge eating group, and 19 age-matched healthy control ’s completed thorough clinical assessment prior to functional MRI. Neural response to low energy and high energy foods and non-food images was compared between groups using whole-brain exploratory analyses, from which six regions of interest were then selected: frontal, occipital, temporal, and parietal lobes; insula and cingulate.ResultsIn response to low energy food images, the BEG demonstrated differential neural responses to all three low energy foods categories compared to HCs. Correlational analyses found a significant association between frequency of binge episodes and diminished temporal lobe and greater occipital lobe response. In response to high energy food images, compared to HC’s, the BEG demonstrated significantly decreased neural activity in response to all high energy food images. The HC’s had significantly greater neural activity in the limbic system, occipital lobe, temporal lobe, frontal lobe, and limbic system in response to high energy food images.ConclusionResults in the low energy food condition indicate that binge frequency may be related to increased aberrant neural responding. Furthermore, differences were found between groups in all ROI’s except the insula. The neural response seen in the BEG to disgust food images may indicate disengagement with this particular stimuli. In the high energy food condition, results demonstrate that neural activity in BN and BED patients may decrease in response to high energy foods, suggesting disengagement with foods that may be more consistent with those consumed during a binge eating episode. (shrink)

Dissociative experiences have been associated with diachronic disunity. Yet, this work is in its infancy. Dissociative identity disorder is characterized by different identity states reporting their own relatively continuous sense of self. The degree to which patients in dissociative identity states experience diachronic unity has not been empirically explored. This study examined the degree to which patients in dissociative identity states experienced diachronic unity. Participants were DID adults assessed in adult and child identity states, adults with a psychotic illness, adults (...) from the general population, children from the general population and adults imagining themselves as children. They completed the Diachronic Disunity Scale, the Dissociative Experiences Scale, and the Self-Concept Clarity Scale. Diachronic disunity was not limited to psychiatric groups, but evident to some degree in all adult and child samples. The DID adult sample experienced more dissociation and self-confusion than the psychosis and adult comparison groups, but did not differ on the diachronic measure. DID patients in their child identity states and child comparisons showed disunity and were significantly different from child simulators, who showed relatively more unity. Results suggest that DID patients in either adult or child dissociative identity states, like those in other samples, do not universally experience themselves as having a consistent sense of self over time. (shrink)

Many intelligent, capable, and successful individuals believe that their success is due to luck and fear that they will someday be exposed as imposters. A puzzling feature of this phenomenon, commonly referred to as imposter syndrome, is that these same individuals treat evidence in ways that maintain their false beliefs and debilitating fears: they ignore and misattribute evidence of their own abilities, while readily accepting evidence in favour of their inadequacy. I propose a novel account of imposter syndrome as an (...) instance of self-deception, whereby biased evidence treatment is driven by the motivational benefit of negative self-appraisal. This account illuminates a number of interconnected philosophical and scientific puzzles related to the explanation, definition, and value of imposter syndrome. (shrink)

Generalized anxiety disorder can cause significant socioeconomic burden and daily life dysfunction; hence, therapeutic intervention through early detection is important. This study was the final stage of a 3-year anxiety screening tool development project that evaluated the psychometric properties and diagnostic screening utility of the Mental Health Screening Tool for Anxiety Disorders, which measures GAD. A total of 527 Koreans completed online and offline versions of the MHS: A, Beck Anxiety Inventory, Generalized Anxiety Disorder-7, and Penn State Worry Questionnaire. The (...) participants had an average age of 38.6 years and included 340 females. Participants were also administered the Mini-International Neuropsychiatric Interview. Internal consistency, convergent/criterion validity, item characteristics, and test information were assessed based on the item response theory, and a factor analysis and cut-off score analyses were conducted. The MHS: A had good internal consistency and good convergent validity with other anxiety scales. The two versions of the MHS: A were nearly identical. It had a one-factor structure and showed better diagnostic accuracy for GAD detection than the GAD-7 and BAI. The IRT analysis indicated that the MHS: A was most informative as a screening tool for GAD. The MHS: A can serve as a clinically useful screening tool for GAD in Korea. Furthermore, it can be administered both online and offline and can be flexibly used as a brief mental health screener, especially with the current rise in telehealth. (shrink)

In this paper I review how the notion of gender is understood in psychiatry, specifically in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). First, I examine the contraposition between sex and gender, and argue that it is still retained by DSM-5, even though with some caveats. Second, I claim that, even if genderqueer people are not pathologized and gender pluralism is the background assumption, some diagnostic criteria still conceal a residue of gender dualism and (...) essentialism. Third, I consider gender dysphoria, which is characterized by an incongruence between one’s experienced or expressed gender and one’s assigned gender; since this condition pertains to distress and disability, not to the incongruence per se, it does not pathologize transgender people. Still, I contend that it should be removed from DSM-5 for theoretical reasons. (shrink)

Enactive approaches to emotion are rare and to anxiety and anxiety disorder even more. This article aims to show how an enactive paradigm might be helpful in solving some problems in the clinical and scientific understanding of anxiety and anxiety disorder. I begin by pointing at a number of relevant clinical features of anxiety and anxiety disorder and by sketching how and why anxiety theories have difficulties with doing justice to these features. I specifically focus on two themes: a) how (...) to conceptualize anxiety as the expression of a dynamical interaction with the environment instead of as just a reaction to the environment (or to... (shrink)

‘Gender disappointment’ is the feeling of sadness when a parent’s strong desire for a child of a certain sex is not realised. It is frequently mentioned as a reason behind parents’ pursuit of sex selection for social reasons. It also tends to be framed as a mental disorder on a range of platforms including the media, sex selection forums and among parents who have been interviewed about sex selection. Our aim in this paper is to investigate whether ‘gender disappointment’ represents (...) a unique diagnosis. We argue that ‘gender disappointment’ does not account for a unique, distinct category of mental illness, with distinct symptoms or therapy. That said, we recognise that parents’ distress is real and requires psychological treatment. We observe that this distress is rooted in gender essentialism, which can be addressed at both the individual and societal level. (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)

Since its introduction into the Diagnostic and Statistical Manual of Mental Disorders, the diagnostic category of post-traumatic stress disorder has dominated public and legal discourse about the harm of sexual violence against women. There is, however, disagreement among some clinical psychologists and philosophers over whether a PTSD diagnosis further harms the victim. Clinical psychologists claim that focusing on a PTSD diagnosis risks undermining a victim’s agency and subjectivity if therapists neglect the victim’s own voice and experiences. Philosophers who acknowledge PTSD (...) in identifying the harm of sexual violence look to victims’ experience of PTSD symptoms rather than how it is used in clinical practice. They conclude that PTSD symptoms are compatible with agency and subjectivity insofar as they help illuminate what it is to be an agent and a subject. I argue that the latter are too optimistic and the former are too pessimistic. An examination of these conflicting views traces the disagreement to unacknowledged discipline-specific boundaries. I conclude with the very tentative suggestion that moral injury could bridge these boundaries. (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)

In some neuropsychological disorders memory distortions seemingly fill gaps in people’s knowledge about their past, where people’s self-image, history, and prospects are often enhanced. False beliefs about the past compromise both people’s capacity to construct a reliable autobiography and their trustworthiness as communicators. However, such beliefs contribute to people’s sense of competence and self-confidence, increasing psychological wellbeing. Here we consider both psychological benefits and epistemic costs, and argue that distorting the past is likely to also have epistemic benefits that cannot (...) be obtained otherwise, such as enabling people to exchange information, receive feedback, and retain key beliefs about themselves. (shrink)

Selective mutism is a developmental disorder characterized by a child’s inability to speak in certain contexts and/or in the presence of unfamiliar interlocutors. This work proposes a critical discussion of the most recent studies on SM, with respect to clinical and diagnostic features, as well as the etiology and treatment of this disorder. At present, all research work supports the hypothesis that SM is a complex anxiety disorder with multifactorial etiology. The latest edition of the Diagnostic and Statistical Manual of (...) Mental Disorders places SM mutism among “Anxiety Disorders”, and no longer among “Other Childhood, Infant and Adolescent Disorders”. Other important aspects relate to cognitive biases and emotional states at the base of SM, which partly explain the disorder’s persistence and represent an important objective of intervention work. No data in the literature point to a total remission of SM, but good results are achieved with cognitive behavior intervention and multimodal therapy involving a variety of child interaction contexts. (shrink)

The network approach to psychopathology has recently gen-erated enthusiasm in the research community. This is likely due in large part to network methods being promoted with the prom-ise of improving clinical prevention and intervention strategies by explicating the dynamic causal architecture of mental illness1. As a result, studies using network methods have proliferated with the aim of understanding causal interactions between psychiat-ric symptoms through empirical data.

In this article we examine obsessive compulsive disorder. We examine and reject two existing models of this disorder: the Dysfunctional Belief Model and the Inference-Based Approach. Instead, we propose that the main distinctive characteristic of OCD is a hyperactive sub-personal signal of being in error, experienced by the individual as uncertainty about his or her intentional actions. This signalling interacts with the anxiety sensitivities of the individual to trigger conscious checking processes, including speculations about possible harms. We examine the implications (...) of this model for the individual's capacity to control his or her thoughts. (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)

ABSTRACTRumination and worry are two perseverative, negatively valenced thought processes that characterise depressive and anxiety disorders. Despite significant research interest, little is known about the everyday precipitants and consequences of rumination and worry. Using an experience sampling methodology, we examined and compared rumination and worry with respect to their relations to daily events and affective experience. Participants diagnosed with Major Depressive Disorder, Generalized Anxiety Disorder, co-occurring MDD–GAD, or no diagnosis carried an electronic device for one week and reported on rumination, (...) worry, significant events, positive affect, and negative affect. Across the clinical groups, occurrences of everyday events predicted subsequent increases in rumination, but not worry. Further, higher momentary levels of rumination, but not worry, predicted subsequent decreases in PA and increases in NA. Thus, in these clinical groups, rumination was more susceptible to... (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)

I am grateful to Brian Earp, Julian Savulescu, and Kristina Gupta for their thoughtful remarks on my paper. I cannot answer all of their points here, but select what I consider to be the most important. Gupta believes that I commit myself to “a common sense” account of love. This is not so. “Common sense” refers to beliefs, not concepts. Concepts can be used to express true, false, and diametrically opposed beliefs, so are not themselves beliefs; rather, they are the (...) logical precondition for holding beliefs. When I say, “red is a color,” I am not advocating on behalf of common sense, still less making a claim held by any “dominant social group.” Suppose Gupta disagrees and says, “The red-green... (shrink)

In her account of thought insertion, Pedrini follows the prevailing view that it is an error about ‘who is thinking a thought.’ This view is based on a particular characterization of thinking as analogous to physical actions, where an object can be made, possessed, moved about, and put in and out of containers. This picture is well-suited for explaining thought insertion where the speaker talks of having the thoughts of others put into his mind. The question, ‘Who is thinking?’ can (...) then be answered in at least two ways, as the person who has or possesses the thought, or the person who produces it. This leads into discussions about agency and its criteria. This move is understandable as part of a... (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)

From 1965, the Swedish penal law does not require accountability as a condition for criminal responsibility. Instead, severely mentally disordered offenders are sentenced to forensic psychiatric care. The process that led to the present legislation had its origins in a critique of the concept of accountability that was first launched 50 years earlier by the founding father of Swedish forensic psychiatry, Olof Kinberg. The concept severe mental disorder is part of the Criminal Code as well as the Compulsory Mental Act. (...) The medical conditions for being sentenced to forensic psychiatric care are supposed to be the same as those for being admitted to involuntary psychiatric care. What these conditions are is not regulated in any law. For the guidance of the courts and others, there is a collection of examples in the government bill drafting the legislation in question. On the basis of these examples the content of the concept of severe mental disorder is chiselled out. However, the purposes of imposing penal law sanction and admitting someone to psychiatric care are not the same, and therefore the content of the concept severe mental disorder is bound to differ accordingly. Severe mental disorder is a legal concept that masks as a psychiatric one. In its applications in penal law, the court determines its content. But for the forensic psychiatrist it is more natural to interpret the term as a medical one. This creates a tension that has led to several controversies in recent criminal cases in Sweden. The best way to alleviate the situation is to discard the concept of severe mental disorder from criminal law. This will allow for a better separation of the roles of the psychiatrist and the court. (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)

The diagnosis of Fetal Alcohol Spectrum Disorders is embedded in a matrix of biological, social and ethical processes, making it an important topic for crossdisciplinary social and ethical research. This article reviews different branches of research relevant to understanding how FASD is identified and defined and outlines a framework for future social and ethical research in this area. We outline the character of scientific research into FASD, epidemiological discrepancies between reported patterns of maternal alcohol consumption during pregnancy and the incidence (...) of FASD, and the social and ethical considerations that may impact on who is, and is not, diagnosed. We highlight what further research investigating FASD diagnostic processes, as well as the multi-generational impacts of FASD, is needed. Important research priorities are to: 1) enumerate the variety of stakeholders involved in seeking FASD diagnoses; 2) understand the experiences and perspectives of mothers from different backgrounds who have consumed alcohol during pregnancy and their affected children; and 3) collect health histories of maternal alcohol consumption in families to determine the effect of FASD at sub-cultural and cultural levels. (shrink)

In a recent article in this journal, Schaefer et al. argue that it might be possible to enhance autonomy through the use of cognitive enhancements. In this article, I highlight an example that Schaefer et al. do not acknowledge of a way in which we already seem to be using pharmacological agents in a manner that can be understood as enhancing an agent’s autonomy. To make this argument, I begin by following other theorists in the philosophical literature in claiming that (...) impulsivity can serve to undermine an agent’s autonomy. I then explain that we are already able to reduce impulsivity through the use of pharmacological interventions, as is evidenced by the use of Methylphenidate in the treatment of ADHD. (shrink)

Can psychiatry distinguish social deviance from mental disorder? Historical and recent abuses of psychiatry indicate that this is an important question to address. Typically, the deviance/disorder distinction has been made, conceptually, on the basis of dysfunction. Challenges to naturalistic accounts of dysfunction suggest that it is time to adopt an alternative strategy to draw the deviance/disorder distinction. This article adopts and follows through such a strategy, which is to draw the distinction in terms of the origins of distress with the (...) relevant conditions. It is argued that psychiatry's ability to distinguish deviance from disorder rests on the ability to define, identify, and exclude socially constituted forms of distress. These should lie outside the purview of candidacy for mental disorder. In pursuing this argument, the article provides an analysis of the social origins of a form of distress with the personality and sexual disorders, and indicates in what ways it is constituted socially. (shrink)

This paper explores the factors that contribute to the degree of a mood disorder patient’s self- insight, defined here as her understanding of the particular contingencies of her life that are responsive to her personal identity, interpersonal relationships, illness symptoms, and the relationship between these three necessary components of her lived experience. I consider three factors: (i) the Diagnostic Statistical Manual of Mental Disorders (DSM), (ii) the DSM culture, and (iii) the cognitive architecture of the self. I argue that the (...) symptom-based descriptions of mood disorders which eliminate the subjective features of the patient’s illness experience, in conjunction with the features of the DSM-culture and the cognitive biases that guide the patient, contribute to the impoverishment of her self-insight. The resulting impoverished self-insight would prevent her from developing resourceful responses to her interpersonal problems. In analyzing how these factors combine to influence the patient’s self-insight, I distinguish the therapeutic impact of receiving a psychiatric diagnosis, which facilitates patient’s clinical treatment, from its reflective impact, how the diagnosis informs the patient’s reflection on who she is, how her mental disorder is expressed, and how her interpersonal relationships proceed. I substantiate my argument by considering a patient’s memoir of psychopathology. (shrink)

Contemporary diagnostic criteria for anorexia nervosa explicitly refer to affective states of fear and anxiety regarding weight gain, as well as a fixed and very strong attachment to the pursuit of thinness as an overarching personal goal. Yet current treatments for that condition often have a decidedly cognitive orientation and the exact nature of the contribution of affective states and processes to anorexia nervosa remains largely uncharted theoretically. Taking our inspiration from the history of psychiatry, we argue that conceptualizing anorexia (...) nervosa as a passion is a promising way forward in both our understanding and treatment of that condition. Building on the theory of the passions elaborated by Théodule Ribot, the founder of scientific psychology in France, we argue that there is convincing empirical evidence in defense of the empirical hypothesis that anorexia nervosa is a passion in Ribot’s specific, technical sense. We then explore the implications of this finding for current approaches to treatment, including cognitive–behavioral therapy, and clinical and ethical issues associated with treatment refusals. (shrink)

This paper seeks to demonstrate the structural difference in communication of schizophrenia and autism. For a normal adult, spontaneous communication is nothing but the transmission of phantasía (thought) by means of perceptual objects or language. This transmission is first observed in a make-believe play of child. Husserl named this function “perceptual phantasía,” and this function presupposes as its basis the “internalized affection of contact” (which functions empirically in eye contact, body contact, or voice calling me). Regarding autism, because of the (...) innate lack of affection of contact, intersubjective perceptual phantasía does not occur spontaneously. Consequently, autistics do not engage in make-believe play but in stereotyped and solipsistic play. Without the formation of perceptual phantasía, there is no differentiation between phantasía and perception. For this reason, people with Asperger's syndrome consider conversation not an immediate communication of thought but a logical transmission of concepts. Schizophrenia is characterized by a distortion in the internalized affection of contact, resulting in a disturbance of perceptual phantasía, and this later is covered by various symptoms—for example, delusion as a pathological kind of communication of thought. This delusion is based on the pathological internalized affection of contact represented by a terrifying Other. (shrink)

In 1952, the Diagnostic and Statistical Manual of Mental Disorders (DSM) system of creating, validating, studying and employing a diagnostic system in clinical psychiatric practice was introduced. There have been several updates and revisions to this manual and, regardless of its a theoretical framework, it actually does have a framework and presupposition. Essentially the DSM dictates that all psychiatric disorders are syndromes, or a collection of symptoms that commonly occur together and impair psychosocial functioning. These syndromes allow for homogenous groups (...) of patients to be studied and psychotherapies and pharmacotherapies to be developed. This editorial will examine the DSM system with regards to its applicability to central nervous system dysfunction where psychiatric disorders are concerned. Specifically, the brain does not follow categorical, or syndromal, constructs. In fact, the psychiatric patient likely inherits several risk genes that promote abnormal proteins along several neuropathways in the brain. These abnormalities create dysfunctional neurocircuits which create individual psychiatric symptoms, but not a categorical syndrome or diagnosis. The concept that the DSM may be excellent for clinical diagnostic purposes, but less correct in its assumptions for a psychopharmacologist's treatment approaches will be discussed. (shrink)

The catch 22 situation in psychiatry is that for precise diagnostic categories/criteria, we need precise investigative tests, and for precise investigative tests, we need precise diagnostic criteria/categories; and precision in both diagnostics and investigative tests is nonexistent at present. The effort to establish clarity often results in a fresh maze of evidence. In finding the way forward, it is tempting to abandon the scientific method, but that is not possible, since we deal with real human psychopathology, not just concepts to (...) speculate over. Search for clear-cut definitions/diagnostic criteria in psychiatry must be relentless. There is a greater need to be ruthless and blunt in this, rather than being accommodative of diverse opinions. Investigative tests - psychological, serum, CSF, or neuroimaging - are only corroborative at present; they need to become definitive. Medicalisation appears most prominent in psychiatry; so, diagnostic proliferation and fuzziness appear inevitable. And yet, the established diagnostic entities need to forward greater and conclusive precision. Also, the need for clarity and precision must outweigh pandering to and mollifying diverse interests, moreso in the upcoming revision of diagnostic manuals. This is specially because the DSM-5, being an Association manual, may need to accommodate powerful member lobbies; and ICD-11 may similarly need to cater to diverse country lobbies. Finding precise biological correlates of psychiatric phenomena, whether through neuroimaging, molecular neurobiology and/or neurogenomics, is the right way forward. It is in the 1.5-kg structure in the cranium that all secrets of psychiatric conditions lie. Social forces, behavioural modification, psychosocial restructuring, study of intrapsychic processes, and philosophical insights are not to be discounted, but they are supplementary to the primary goal - studying and deciphering those brain processes that result in psychiatric malfunction. Experimental breakthroughs, both in psychiatric aetiology and therapeutics, will come mainly from biology and its adjunct, psychopharmacology; while supplementary and complementary breakthroughs will come from the psychosocial, cognitive and behavioural approaches; the support base will come from phenomenology, epidemiology, nosology and diagnostics; while insights and leads can hopefully come from many fields, especially the psychosocial, the behavioural, the cognitive and the philosophical. Major energies must now be marshalled towards finding biomarkers and deciphering the precise phenotype-genotype-endophenotype axis of psychiatric disorders. Energies also need to be focussed on unravelling those critical processes in the brain that tip the scale towards psychiatric disorders. At how those critical processes are set into motion by forces de novo, in utero, in the genes and their expression, by the environment's psychopathological social forces - stress, peer pressure, poverty, deprivation, alienation, malnutrition, discrimination of various types (caste, gender, race, etc.), mass conflicts (war, terror attacks, etc.), disasters (natural and man-made), religious/ideological fascism - or social institutions like marriage, family, work place, political governance, etc. Ultimately, we must decipher how the brain goes into malfunction when such varied forces impinge on it, which precise cortical areas and neuronal cellular and molecular processes are involved in such malfunction and its manifestation, as also which of these are involved when malfunction ceases and health is restored, and the psychosocial processes and institutions which aid such health restoration, as also those which promote well-being and help in primary prevention. Emphasis on the brain and its intimate neurological and molecular mechanisms will not impinge on, or nullify, importance of the 'mind,' wherein subtle and gross brain functions in the form of behaviour, thought and emotions in all their ramifications will continue to be the focus of psychological, cognitive, sociological, psychopharmacological, behavioural and philosophical research. Progress in brain research must move in tandem with progress in 'mind' research. (shrink)

There is a growing interest among scientists and the lay public alike in using the South American psychedelic brew, ayahuasca, to treat psychiatric disorders like depression and anxiety. Such a practice is controversial due to a style of reasoning within conventional psychiatry that sees psychedelic-induced modified states of consciousness as pathological. This article analyzes the academic literature on ayahuasca's psychological effects to determine how this style of reasoning is shaping formal scientific discourse on ayahuasca's therapeutic potential as a treatment for (...) depression and anxiety. Findings from these publications suggest that different kinds of experiments are differentially affected by this style of reasoning but can nonetheless indicate some potential therapeutic utility of the ayahuasca-induced modified state of consciousness. The article concludes by suggesting ways in which conventional psychiatry's dominant style of reasoning about psychedelic modified states of consciousness could be reconsidered. (shrink)

Young’s paper (2012) offers an interesting and fruitful extension to recent work on Cotard’s syndrome, and in particular, a philosophical investigation of how and why beliefs around death and non-existence frequently co-occur with beliefs around immortality. In this brief response, we discuss a few issues from the paper. Namely, the issue of Cotard delusion being a natural kind, the seeming paradox of death and immortality and its relation to wider culture and literature, and the utility of the concept of misplaced (...) being. (shrink)