Other Mental Disorders

This paper makes an important contribution to the ongoing debate over the validity of the psychological construct, ADHD. While not ruling out the possibility that something of value may lie at the core of this diagnosis, the authors articulate a clear set of problems with the research logic that forms the foundation of the disorder itself, reaching the conclusion that there appears to be insuffi cient, valid scientifi c evidence for the demarcation of a coherent and independent disease entity.

The object of this study was to assess the prevalence and correlates of the DSM-IV diagnosis of hypochondriasis in a primary care setting. A large sample of primary care users was given a structured interview to make diagnoses of mood, anxiety, and somatoform disorders and estimate levels of disability. The prevalence of hypochondriasis was about 3%. Patients with this disorder had higher levels of medically unexplained symptoms and were more impaired in their physical functioning than patients without the disorder. Of (...) the various psychopathologies examined, major depressive syndromes were the most frequent among patients with hypochondriasis. Interestingly, unlike somatization disorder, hypochondriasis was not related to any demographic factor. Hypochondriasis is a relatively rare condition in primary care that is largely separable from somatization disorder but seems closely intertwined with the more severe depressive syndromes. (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)

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)

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)

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 new edition of Mind, Meaning, and Mental Disorder addresses key issues in the philosophy of psychiatry, drawing on both philosophical and scientific theory. The main idea of the book is that causal models of mental disorders have to include meaningful processes as well as any possible lower-level physical causes, and this propsoal is illustrated with detailed discussion of current models of common mental health problems. First published in 1996, this volume played an important role in bridging the gap between (...) philosophy and psychiatry, and introducing those in psychiatry to philosophical ideas somewhat neglected in their field. Completely updated, the new edition of this acclaimed volume draws on the strengths of the first edition, and will be a central text in the burgeoning field of philosophy of psychiatry. (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)

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)

People experiencing alien control report that their thoughts, movements, actions, and emotions have been replaced by those of an "other." The latter is commonly a perceived persecutor of the patient. Here I describe the clinical phenomenology of alien control, mechanistic models that have been used to explain it, problems inherent in these models, the brain deficits and functional abnormalities associated with this symptom, and the means by which disordered agency may be examined in this perplexing condition. Our current state of (...) knowledge implicates potentially reversible dysfunction in certain key brain regions (especially the right parietal cortex), which is temporally related to the presence of symptoms. Alien control is quintessentially a disorder of agency. (shrink)

Simona Giordano (2010) claims that whether or not anorexics should be allowed to die should not primarily depend on their competence, but on the extent of whether the condition can be alleviated. This implies two outcomes. First, that if an anorexic has a reasonable chance of recovery, competent refusal of treatment can be overridden. Second, that if an anorexic has no realistic chance of recovery, patient refusal needs to be upheld—not, exclusively, on the basis of patient’s decision-making competence, but on (...) the basis of their prolonged and unnecessary suffering. Giordano is right, in my view, to suggest that there are good moral grounds to uphold patient wishes to refuse life-saving treatment, when .. (shrink)

In Alan Bennett’s play The History Boys, Irwin, a sixth-form history tutor destined for a media career (based, it is rumored, on that specialist in historical controversy Niall Ferguson) sets out his views on how a difficult change in the law that will affect individual rights should be dealt with. The tactic Irwin advocates is for the Government to insist that the Bill, rather than reducing the liberty of the subject “amplifies it.” The use of paradox, notes Irwin, “works well (...) . . . the loss of liberty is the price we pay for freedom type thing” (Bennett 2004, 3). Thus, in a few sentences, Bennett encapsulates one of the greatest, or, at least, what we in the West have come to think of as one of the greatest, of .. (shrink)

In Feelings of Being, one of the most recent publications in the IPPP series, Matthew Ratcliffe provides a detailed phenomenological investigation of a distinct category of existential feelings in everyday life and psychiatric illness. Ratcliffe´s book is divided into three parts, each dealing with issues of remarkable complexity and scope.

The unified framework for addiction (UFA) formulated by Redish et al. is a tour de force. It uniquely predicts that there should be multiple addiction syndromes and pathways – a diversity that would reflect the complexity of the mammalian brain decision system. Here I explore some of the evolutionary and developmental ramifications of UFA and derive several new avenues for research.

Psychiatry is increasingly dominated by the reductionist claim that mental illness is caused by neurobiological abnormalities such as chemical imbalances in the brain. Critical psychiatry does not believe that this is the whole story and proposes a more ethical foundation for practice. This book describes an original framework for renewing mental health services in alliance with people with mental health problems. It is an advance over the polarization created by the "anti-psychiatry" of the past.

We clarify some points previously made by Andrews, and defend the claim that Davidson's account of belief can be and is challenged by the existence of some people with autism. We argue that both Bouma and Andrews (Philosophical Psychology, 15) blurred the subtle distinctions between the psychological concepts of theory of mind and joint attention and the Davidsonian concepts of interpretation and triangulation. And we accept that appeal to control group studies is not the appropriate place to look for an (...) individual who can speak but who has significant problems with interpretation. In this paper we argue that by turning to the clinical literature we can more readily find such a challenge to Davidson's account. (shrink)

© 2004 by The Johns Hopkins University Press.

We argue that the pivotal role assigned by Northoff to the principle of top-down modulation in catatonia might successfully be applied to other symptoms of schizophrenia, for example, hallucinations. Second, we propose that Northoff's account would benefit from a more comprehensive analysis of the cognitive level of explanation. Finally, contrary to Northoff, we hypothesize that “top-down modulation” might play as important a role as “horizontal modulation” in affective-behavioral alterations.

The recent discussion in scientific psychiatry has paid increasing attention to the role of concepts of the person in psychiatric discourse. What are the uses of concepts of the person, such as self or person, in psychiatric discourse? Does describing these uses clarify the significance of conceptual and empirical elements in conceptions of mental illness? I try to answer these questions in a philosophically informed textual analysis of one representative psychiatric article. I conclude that concepts of the person are used (...) largely interchangeably in their various relevant meanings. The interplay between different uses of the concepts of the person allows us to conceptualize psychopathology and to conceive possibilities of overcoming this vague usage. My results underline the importance of a sensitivity to the ways concepts of the person are used in psychiatry and manifest the embeddedness of the language of psychopathology in everyday "person discourse.". (shrink)

The philosopher, John Searle (1992, 1990), has challenged some of the most basic tenets of cognitive psychology, especially the notion of a “deep unconscious” defined as mental processes that are in principle inaccessible to consciousness. In previous papers I have argued for a broad concept of the unconscious which includes in addition to mental contents accessible to consciousness under appropriate conditions mental processes that can never become conscious under any conditions. The core of my answer to Searle derives from Millikan’s (...) (1984) theory of proper functions which provides a definition of intentionality independent of consciousness. (shrink)

Connectionism—also known as parallel distributed processing, or neural network modeling—offers promise as a framework to unite clinical and cognitive psychology, and as a tool for studying conscious and unconscious mental activity. This paper describes a neural network model of the case study of Lucy R., from Freud and Breuer's Studies on Hysteria. Though very simple in architecture, the network spontaneously displays analogues of repression and hallucination, corresponding to Lucy R.'s symptoms. Salient elements of Lucy's conscious experience are represented in the (...) model by the activations of neuronlike processors in a fully interconnected network, without hidden units. The model learns to associate elements of experience that were associated in Lucy's case history. Some of these configurations of elements were traumatic for Lucy; trauma is modeled in the network by "emphatic learning," learning accomplished at an abnormally high learning rate. The model suggests that changing associations among conscious elements are sufficient to generate the symptoms Freud observed: apparent repression, hallucination, and recovery through therapy. In the case of Lucy R., Freud's theoretical inference regarding active but unconscious thought is not required by his data. Instead, the unconscious can be understood as a set of complex dispositions embodied in connections between elements of conscious experience. (shrink)

This paper attempts to show how certain approaches in Values Based Practice duplicate key moves in liberal political theory.

Immédiates, efficaces et inépuisables comme des sensations, mais indépendantes du dehors et maîtresses de l’espace comme des images, les visions «imaginatives» de Thérèse, pour voisines qu’elles soient de nos visions sensorielles, méritent pourtant une place à part et ne sont ni des hallucinations vulgaires, indiscernables des sensations, ni des hallucinations psychiques. Ce sont les hallucinations thérésiennes. (Pierre Quercy 1930).

A certain kind of externalism—"the view from nowhere"—lies at the heart of evidence-based medicine (EBM). As a consequence, the individual case glides out of focus. However, to judge to what extent external knowledge is applicable to an individual case, the clinician has to rely on some sort of knowledge of the case at hand. The article focuses on the tension between the externalism of EBM and the "internal evidence" one has to presuppose when making clinical judgments.

This work begins by proposing the need for exploring the mode of being of mental disorders. It is a philosophical study in an Aristotelian perspective, with special emphasis on the anthropological–cultural dimension. It is difficult for such an inquiry to be carried out from within psychiatry or clinical psychology, committed as these fields are to their own logic and practical conditions. The issues are, in any case, more ontological than strictly clinical in nature. We therefore turn to Aristotle, and specifically (...) his doctrine of the four “causes,” to flesh out the social and cultural dimensions of mental disorders. In accordance with the present analysis, the material cause of disorders would be found in the contingencies of life; the formal cause would pertain primarily to the way clinical conditions themselves can serve as models of ‘being ill’ in our society; the efficient cause would correspond to the patients themselves, understood as active (albeit less than fully conscious) agents as well as to the pharmaceutical industry and the mass media; the final cause would be found in different adaptive functions served by the disorder. We conclude that the “mode of being” of most (if not all) mental disorders—in particular, their status as mental disorders—can often have more to do with cultural forms than with biological factors. (shrink)