Philosophy of Psychiatry

In this paper, I look into one of the particular ways in which decreased reasons-responsiveness in addiction may come about, by focusing on certain anomalous features of addictive desires. The account I offer centers on two prominent features of these desires: the recalcitrance of standing or long-term dispositional addictive desires to use drugs in the face of contrary considerations, and the recurrent, intrusive nature of episodes of occurrently wanting to use drugs that addicted agents experience. Both the recalcitrance and the (...) recurrency of addictive desires, I submit, contribute to decrease in control in addiction by inclining action-selection processes towards drug-using outcomes in a way that results in an overall less reasons-responsive pattern of behavior. While the presence of desires with these features is not the only way in which decreased reasons-responsiveness may be instantiated, the picture of addictive agency they give rise to helps us get a firmer grip on how control may be diminished in addiction. (shrink)

The diverse essays in this volume speak to the relevance of phenomenological and psychological questioning regarding perceptions of the human. This designation, human, can be used beyond the mere identification of a species to underwrite exclusion, denigration, dehumanization and demonization, and to set up a pervasive opposition in Othering all deemed inhuman, nonhuman, or posthuman. As alerted to by Merleau-Ponty, one crucial key for a deeper understanding of these issues is consideration of the nature and scope of perception. Perception defines (...) the world of the perceiver, and perceptual capacities are constituted in engagement with the world – there is co-determination. Moreover, the distinct phenomenology of perception in the spectatorial mode in contrast to the reciprocal mode, deepens the intersubjective and ethical dimensions of such investigations. -/- Questions motivating the essays include: Can objectification and an inhuman gaze serve positive ends? If so, under what constraints and conditions? How is an inhuman gaze achieved and at what cost? How might the emerging insights of the role of perception into our interdependencies and essential sociality from various domains challenge not only theoretical frameworks, but also the practices and institutions of science, medicine, psychiatry and justice? What can we learn from atypical social cognition, psychopathology and animal cognition? Could distortions within the gazer’s emotional responsiveness and habituated aspects of social interaction play a role in the emergence of an inhuman gaze? -/- Perception and the Inhuman Gaze will interest scholars and advanced students working in phenomenology, philosophy of mind, psychology, psychiatry, sociology and social cognition. -/- Table of Contents -/- Introduction -/- Part I. The Gaze in Classical Phenomenology: Perspectives on Objectification -/- 1. Defending the Objective Gaze as a Self-transcending Capacity of Human Subjects -/- Dermot Moran -/- 2. Two Orders of Bodily Objectification: The Look and the Touch -/- Sara Heinämaa -/- 3. On Eliminativism’s Transient Gaze -/- Timothy Mooney -/- 4. Not wholly human. Reading Maurice Merleau-Ponty with Jacques Lacan. -/- Dorothée Legrand -/- 5. Disclosure and the Gendered Gaze in Simone de Beauvoir's Ethics -/- Christinia Landry -/- Part II. Vision, Perception and Gazes -/- 6. Inside the gaze -/- Shaun Gallagher -/- 7. Perception and its Objects. -/- Maurita Harney -/- 8. Technological Gaze: Understanding How Technologies Transform Perception -/- Richard Lewis -/- 9. The Inhuman Gaze and Perceptual Gestalts: The Making and Unmaking of Others and Worlds -/- Anya Daly -/- Part III. Psychiatry, Psychopathology and Inhuman Gazes -/- 10. Values and Values-based Practice in Psychopathology: Combining Analytic and Phenomenological Approaches -/- G Stanghellini and K.W.M. (Bill) Fulford -/- 11. The Inhuman and Human Gaze in Psychiatry, Psychopathology and Schizophrenia. -/- Matthew Broome -/- 12. Overcoming the Gaze: Psychopathology, Affect, and Narrative. -/- Anna Bortolan -/- 13. From excess to exhaustion : The rise of burnout in a post-modern achievement society. -/- Philippe Wuyts -/- 14. Blackout Rages: The Inhibition of Episodic Memory in Extreme Berserker Episodes -/- John Protevi -/- Part IV. Beyond the Human: Divine, Posthuman and Animal Gazes -/- 15. Wondering at the Inhuman Gaze -/- Sean. D. Kelly -/- 16. What Counts as Human/ Inhuman Right Now? -/- Rosi Braidotti -/- 17. Beyond Human and Animal: Metamorphosis in Merleau-Ponty -/- Dylan Trigg -/- Part V. Sociality and Boundaries of the Human -/- 18. Voice and gaze considered together in ‘languaging’. -/- Fred Cummins -/- 19. Ethics Beyond the Human: Disability and The Inhuman -/- Jonathan Mitchell -/- 20. Social Invisibility and Emotional Blindness -/- James Jardine -/- 21. What are you looking at? Dissonance as a window on the autonomy of participatory sense-making frames. -/- Mark James. (shrink)

This thesis is a philosophical examination of the explanatory roles of diagnoses in psychiatry. In medicine, diagnoses normally serve as causal explanations of patients’ symptoms. Given that psychiatry is a discipline whose practice is shaped by medical traditions, it is often implied that its diagnoses also serve such explanatory functions. This is evident in clinical texts that portray psychiatric diagnoses as referring to diseases that cause symptoms. However, there are problems which cast doubt on whether such portrayals are justified. I (...) address these problems and examine whether psychiatric diagnoses provide explanations of symptoms. The first problem is conceptual. In diagnostic manuals, psychiatric diagnoses are defined by their symptoms. This suggests that invoking them as explanations of the symptoms amounts to circularity. I argue that this can be resolved with an appropriate conceptual framework that captures the complex semantic values of diagnostic terms and their different uses in clinical discourse. I put forward such a framework based on two-dimensional semantics. The second problem is ontological. Empirical research suggests that diagnostic categories in psychiatry do not correspond to invariant causal types, but are associated with variable combinations of diverse causes that interact across biological, psychological, and social levels. Given this heterogeneity, I argue that psychiatric diagnoses fall short of paradigmatic cases of causal explanation, but that some can still provide other sorts of useful causal explanatory information. The original contribution of this thesis is the illumination of the conceptual relations between diagnoses and symptoms. This philosophical work is important, because it can be brought to valuable application in modifying psychiatric practice. (shrink)

Diagnoses are central to the practice of medicine, where they serve a variety of functions for clinicians, patients, and society. They aid communication, explain symptoms, inform predictions, guide therapeutic interventions, legitimize sickness, and authorize access to resources. Insofar as psychiatry is a discipline whose practice is shaped by medical conventions, its diagnoses are sometimes presented as if they serve the same sorts of function as diagnoses in bodily medicine. However, there are philosophical problems that cast doubt on whether the functions (...) of psychiatric diagnoses can legitimately be considered to be equivalent to those of medical diagnoses. The aim of this chapter is to explicate some of these problems, particularly conceptual and epistemological problems pertaining to the roles of diagnoses as explanations. I begin with an overview of the various functions that medical diagnoses normally serve and suggest that many of these functions receive justificatory support from the explanatory roles of the diagnoses. I then present issues regarding the epistemic functions of psychiatric diagnoses and how these issues have featured in the arguments of prominent critics of psychiatry. (shrink)

Winner of the 2020 Essay Competition of the International Social Ontology Society. -/- Ian Hacking uses the looping effect to describe how classificatory practices in the human sciences interact with the classified people. While arguably this interaction renders the affected human kinds unstable and hence different from natural kinds, realists argue that also some prototypical natural kinds are interactive and human kinds in general are stable enough to support explanations and predictions. I defend a more fine-grained realist interpretation of interactive (...) human kinds by arguing for an explanatory domain account of the looping effect. First, I argue that knowledge of the feedback mechanisms that mediate the looping effect can supplement, and help to identify, the applicability domain over which a kind and its property variations are stably explainable. Second, by applying this account to cross-cultural case studies of psychiatric disorders, I distinguish between congruent feedback mechanisms that explain matches between classifications and kinds, and incongruent feedback mecha- nisms that explain mismatches. For example, congruent mechanisms maintain Western auditory experiences in schizophrenia, whereas exporting diagnostic labels inflicts incongruence by influencing local experiences. Knowledge of the mechanisms can strengthen explanatory domains, and thereby facilitate classificatory adjustments and possible interventions on psychiatric disorders. (shrink)

The experiences described in the VIP transcripts are incredibly varied and yet frequently explicitly labelled by participants as "voices." How can we make sense of this? If we reflect carefully on uses of the word "voice", we see that it can express at least two entirely different concepts, which pick out categorically different phenomena. One concept picks out a speech sound (e.g. "This synthesizer has a "voice" setting"). Another concept picks out a specific agent (e.g. "I hear two voices: one (...) is a ten year-old boy…"). This chapter explores how these two concepts are related to one another in the context of voice-hearing. (shrink)

Approaching mental health on a global scale with particular reference to low- and mid-income countries raises issues concerning the disregard of the local context and values and the imposition of values characteristic of the Global North. Seeking a philosophical viewpoint to surmount these problems, the present paper argues for a value-laden framework for psychiatry with the specific incorporation of value pluralism, particularly in relation to the Global South context, while also emphasizing personal values such as the choice of treatment. In (...) sketching out this framework, the paper aims to overcome the clash between universalism and relativism about psychiatric categories by focusing on how overlaps between cultures can contribute to ontology-building. A case study analyzing ethnopsychiatric research in the context of South India will illustrate the proposed view, while also pointing out avenues for further research on the causal efficacy of local shared beliefs about mental disorder. If approaches across different traditions and theoretical frames are shown to work in treating similar ailments, causal connections appear to cut across the different ontologies. Ethnopsychiatry would play a central role in such research, namely in disclosing the variables and mechanisms at work within the local approaches. (shrink)

An estimated 15% of patients seen by neurologists have neurological symptoms, such as paralysis, tremors, dystonia, or seizures, that cannot be medically explained. For a long time, such patients were diagnosed as having conversion disorder and referred to psychiatrists, but for the last two decades or so, neurologists have started to pay more serious attention to this patient group. Instead of maintaining the commonly used label of conversion disorder – which refers to Freud’s idea that traumatic events can be converted (...) into deviant behaviour – these neurologists use the term functional neurological disorder and explain that the problems are due to abnormal central nervous system functioning. The situation that some patients with medically unexplained neurological symptoms are diagnosed with CD and treated by psychiatrists while others are diagnosed with FND and stay under the control of neurologists provides a unique case for analysing how neurological and psychological explanations affect subjectivity. In this article, I compare patient reports from English-language websites from the past 15 years to find out how minds, bodies, brains, and selves act and interact in the accounts of both patient groups. I conclude that the change in label from CD to FND has not only influenced ideas of medically unexplained disorders, but also affected ideas of the self and the body; of self-control and accountability. (shrink)

According to several researchers, core affect lies at the foundation of our affective lives and may be characterized as a consciously accessible state combining arousal and valence. The interaction between these two dimensions is still a matter of debate. In this paper we provide a novel hypothesis concerning their interaction, by arguing that subjective arousal levels modulate the experience of a stimulus’ affective quality. All things being equal, the higher the arousal, the more a given stimulus would be experienced as (...) pleasant. While marshaling some preliminary evidence in favor of this hypothesis, we also show how it might be relevant in reframing our conception of depressive disorders. (shrink)

Epistemic akrasia is the phenomenon of voluntarily believing what you think you should not. Whether epistemic akrasia is possible is a matter of controversy. I argue that at least some people who suffer from obsessive–compulsive disorder are genuinely epistemically akratic. I advance an account of epistemic akrasia that explains the clinical data and provides broader insight into the nature of doxastic attitude‐formation.

Though the divide between reason-based and causal-explanatory approaches in psychiatry and psychopathology is old and deeply rooted, current trends involving multi-factorial explanatory models and evidence-based approaches to interpersonal psychotherapy, show that it has already been implicitly bridged. These trends require a philosophical reconsideration of how reasons can be causes. This paper contributes to that trajectory by arguing that Donald Davidson’s classic paradigm of 1963 is still a valid option.

The pathologization of women’s depression covers over the social and institutional causes of that symptomology. Insofar as patriarchal values continue to devalue and debase women and mothers in ways that colonize psychic space, and depression becomes a cover for what I call ‘social melancholy.’ This is not the melancholy of traditional psychoanalysis, but a form of melancholy that results from oppression, domination, and the colonization of psychic space. Social melancholy differs from both Freud’s notion of melancholy in that it is (...) the result of social factors that constitute the depressed subject as ashamed and lacking agency. Crucial to my analysis is a distinction between shame and guilt missing from traditional psychoanalytic accounts of melancholy and depression. (shrink)

THE TARGET OF ERICA LILLELEHT'S interesting comparison between 19th-century moral treatment and 20th-century psychiatric rehabilitation is contemporary psychiatric rehabilitation. Using Foucault's (1979) Discipline and Punish as her critical foil, she argues that psychiatric rehabilitation is "an approach to madness fraught with paradox." The paradox lies in the fact that the techniques of psychiatric rehabilitation can be practiced in a manner that contradicts its professed humanitarian intentions; notably, liberating the mad from "resource dependency and segregated living." The lesson to be drawn (...) from this paradox is that "our practices, may be shaped and reformulated to serve goals of which we are only dimly aware." The resulting "mindfulness" is supposed to make us more careful and critical of what to count as success and progress in psychiatric treatment. (shrink)

The question of decision-making capacity for informed consent to experimental brain surgery for severely ill anorectic patients is about as dramatic an ethical issue one can imagine. Sabine Muller and her co-authors (2015) should be commended for this extremely timely and original clinical and ethical discussion of decision-making capacity in relation to the issues raised by informed consent to such therapies. In this commentary, I elaborate on the new account of the nature of anorexia nervosa that the authors allude to (...) in order to frame their discussion. This is the hypothesis that anorexia nervosa is a passion: a view with important implications for how we think about decision-making capacity in anorexia nervosa and elsewhere. (shrink)

Moral treatment refers to a psychological approach to treating mental disorder that arose across Europe and North America around the turn of the eighteenth century. It is mostly associated with the French physician Philippe Pinel (1745–1826) and the English Quaker philanthropist William Tuke (1732–1819). Pinel and Tuke each independently developed their own distinct models of the once popular therapy known as moral treatment. Although moral treatment is often considered to have been a successful therapy in its early years, it was (...) eventually replaced by custodial care on a mass scale and became a travesty of its earlier self. (shrink)

Along with Philippe Pinel (1745–1826), Jean‐Étienne Esquirol (1772–1840) is often considered one of the fathers of clinical psychiatry. While his indebtedness to the views of his teacher, Pinel, is indisputable, his own later contributions to the diagnosis and treatment of mental disorder are often considered to be clinically superior and more sophisticated than those of his mentor. Esquirol's contributions to the psychopathology of affectivity are especially important and differ in many important respects from those of Pinel, who also stressed the (...) role of the passions in mental disorder. (shrink)

Philippe Pinel (1745–1826) is often said to be the father of modern clinical psychiatry. He is most famous for being a committed pioneer and advocate of humanitarian methods in the treatment of the mentally ill, and for the development of a mode of psychological therapy known as moral treatment. Pinel also made important contributions to nosology and the diagnosis and treatment of mental disorder, especially the psychopathology of affectivity, stressing the role of the passions in mental disorder. Pinel also conducted (...) what may be considered one of the first large‐scale clinical trials in psychiatry and was also arguably the first to introduce the new statistical methods of the time to that domain. (shrink)

This chapter argues that the conditions under the umbrella “personality disorders” actually constitute two very different kinds of theoretical entities. In particular, several core personality disorders are actually moral, and not medical, conditions. Thus, the categories that are held to represent them are really moral, and not medical, theoretical kinds. The chapter works back from the possibility of treatment to the nature of the kinds that are allegedly treated, revisiting 18th-century ideas of moral treatment along the way. The discussion closes (...) with a reflection on how the ambiguous medical status of personality disorders and their treatment today is reminiscent of the ideological tug of war that pits alienist “mad doctors” like Pinel against their lay counterparts such as Tuke as they battled over who should be in charge of treating the mad. (shrink)

Mental competence, or decision‐making capacity, is an important concept in law, psychiatry, and bioethics. A major problem faced in the development and implementation of standards for assessing mental competence is the issue of objectivity. The problem is that objective standards are hard to formulate and apply. The aim here is to review the limited philosophical literature on the place of value in competence in an attempt to introduce the issues to a wider audience. The thesis that the assessment of competence (...) must incorporate elements of value and rationality is defended, and some tentative suggestions offered about how this might be achieved in a clinical setting. (shrink)

The York Retreat is famous in the histor y of nineteenth-centur y psychiatr y because of its association with moral treatment. Although there exists a substantial historical literature on the evolution of moral treatment at the Retreat, several interpretive problems continue to obscure its unique therapeutic legacy. The nature of moral treatment as practised at the Retreat will be clarified and discussed in a historical perspective. It will be argued that moral treatment at the Retreat was pr imar ily a (...) matter of affective conditioning guided by `benevolent theory'. (shrink)

Purpose of review This review considers the literature on ethical and conceptual issues in eating disorders from the last 18 months. Some reference to earlier work is necessary in order to provide context for the recent findings from research that is ongoing. -/- Recent findings Empirical ethics research on anorexia nervosa includes novel ethical and conceptual findings on the role of authenticity and personal identity in individuals’ reports of their experience, as well as new evidence on the role of affective (...) states and values in decision making at later stages of the illness. Evidence points to the hypothesis that anorexia nervosa may be a distinct affective syndrome that organizes feelings and emotions in accordance with a fixed idea. -/- Summary There has been impressive progress in empirical ethics research on anorexia nervosa, with important implications for ethical and conceptual issues that surround decision-making capacity and our understanding of the illness. (shrink)

Locke is famous for defining madness as an intellectual disorder in the realm of ideas. Numerous commentators take this to be his main and only contribution to the history of psychiatry. However, a detailed exegetical review of all the relevant textual evidence suggests that this intellectualist interpretation of Locke’s account of madness is both misleading and incomplete. Affective states of various sorts play an important role in that account and are in fact primordial in the determination of human conduct generally. (...) Locke’s legacy in this domain must therefore be revised and the intellectualist bias that dominates discussions of his views must be redressed. (shrink)

Philippe Pinel is widely regarded as one of the founders of modern evidence-based psychiatry. Yet, until recently, his most important contributions to psychiatric theory and practice were effectively lost in myth, or lost in translation. It is instructive to review the history of these developments in order to correct any errors or omissions that may stand in the way of an accurate recognition of Pinel’s contributions to psychiatry, while at the same time highlighting some of his achievements that have been (...) hidden by his celebrated mythical status as a pioneering humanitarian reformer. The aim of this article is to motivate further historical study of Pinel’s work, especially his 1809 Medico-Philosophical Treatise on Mental Alienation, which has only recently become available in English translation. (shrink)

Normal convictions are formed in a context of social living and common knowledge. Immediate experience of reality survives only if it can fit into the frame of what is socially valid or can be critically tested. … Each single experience can always be corrected but the total context of experience is something stable and can hardly be corrected at all. The source for incorrigibility therefore is not to be found in any single phenomenon by itself but in the human situation (...) as a whole, which nobody would surrender lightly. If socially accepted reality totters, people become adrift.As Jaspers indicates in this quotation on incorrigibility, delusions may not be regarded as mere disorders of thinking, reasoning or... (shrink)

In 1937, John Dewey delivered a lecture to the College of Physicians in Saint Louis. His clear message was that in the practice of medicine it does not suffice for physicians to treat just the body, or to look to just the body for the mechanism of disease. Emphasizing the relational nature of organism-environment, he argued that the physician must treat the whole patient and must therefore consider the environment of the patient. It makes no sense, he suggested, to provide (...) medicine to address a problem with the patient's lungs and then to send him back into the coal mine. As he put it: "We must observe and understand internal processes and their interactions from the standpoint of their interactions with what is... (shrink)

Towards the end of Tsitsi Dangarembga’s Nervous Conditions, Nyasha is taken to a psychiatrist who dismisses her family’s concerns based on his belief that Africans cannot suffer metal illness. Frantz Fanon explores a similar theme in his 1952 essay, ‘The “North African Syndrome”’. In both cases, the veil of sterility behind which the clinical encounter is often presumed to take place is rent, and the clinician and patient are exposed as coloniser and colonised or ‘white’ and ‘raced’ first. Similarly, the (...) pages that follow provide an account of the situation of the racialised at the outset of a psychiatric consultation with a white clinician in a Western clinical setting. Drawing on Fanon’s ‘The “North African Syndrome”’ I attempt to shed light on the gulf that must be traversed in order for the patient to be intelligible to the clinician. I question the process of bridging that divide, particularly the question of which party bears the bulk of the responsibility for traversing the distance between the two. The challenge presented to clinician, and the extent of the turmoil of the patient in this kind of encounter are thus brought to the fore. I conclude by offering a suggestion of what Fanonian ethics demand of the clinician. (shrink)

Arguing for the theoretical importance of the concept of “subject” or “self” on behalf of the “psychiatric/psycho-pathological thinking” is justified in so far as, as Costa, Bezerra Jr., and Gama say, “this is still an indispensable concept for understanding the conditions for the gestation and functioning of psychological life.” In what sense are these concepts “indispensable?”All the hints suggest them as necessary complements for neurobiological investigations to become useful for clinical employment. So, if we consider that it is possible to (...) approach mental phenomena connecting in some way their two sides to favor clinical use, the neurobiological and the psychological, we might as well suppose that any... (shrink)

The aim of my paper is to review the discussion concerning various difficulties which surround the definition of depression and the methods of diagnosing and treating the disease against the background of the now dominant reductionist paradigm in psychiatry, as well as to answer the question whether a new approach to psychiatric disorders proposed by philosophers of psychiatry working within the phenomenologically inspired embodied and enactive paradigm indeed offers a solution to these difficulties. I present the issues specific to the (...) subject of depression in light of the more general problems related to biological psychiatry that have recently caused much debate. In the second part of the paper, I consider enactive, phenomenological and embodied theories of depression and the possibilities of new methods of treatment. My goal is to assess whether these theories indeed add anything important to the conceptions that are already present in psychiatry. I conclude that even if the embodied philosophy of psychiatry does not solve many of the problems faced by modern psychiatry, it can, nevertheless, provide a useful theoretical basis for future changes. (shrink)

In this paper we discuss the two-system framework, examine its strengths, point out a fundamental weakness concerning the unity of conscious experience, and then propose a new hypothesis that avoids that weakness and other related concerns. According to our strong emergence hypothesis, what emerges are not merely mental properties in specialized, distributed neural areas, but also a new, irreducibly singular entity that functions in a recurrent manner to integrate its mental properties and to rewire its brain. We argue that the (...) former function is suggested, in part, by the effects of anesthetics on sensory integration, and that the latter function is suggested by evidence garnered from the neuroscience of mindfulness, constraint-induced movement therapy for stroke, and neuroimaging data surrounding mental illness. We then discuss how our strong emergence hypothesis relates to the description and treatment of neuropsychiatric disorders. Finally, potential objections are addressed. (shrink)

How comes that two organisms can interact with each other or that we can comprehend what the other experiences? The theories of embodiment, intersubjectivity or empathy have repeatedly taken as their starting point an individualistic assumption (the comprehension of the other comes after the self-comprehension) or a cognitivist one (the affective dimension follows the cognitive process). The thesis of this book is that there are no two isolated entities at the origin which successively interact with each other. There is, rather, (...) an impersonal stratum – the original affectivity (Gefühlsdrang) – which lets the living organisms be constitutively attuned with the expressive dimension of the life from the very beginning. The book aims to rethink the issue of corporality on the basis of a biosemiotics of the interaction between lived body (Leib) and environment (Umwelt). The human emotions reveals themselves as devices that experiment further attunement levels and expose the human being – because of her ex-centricity – to the alienation in various forms of the psychopathological existence. This is an unprecedented perspective that turns to psychopathology to reread against the light the watermark weaving the structure of personal singularity. What emerges is an intermediate territory confining both with philosophy and psychiatry: the psychopathology of ordo amoris. The author advances the project of a new psychopathology of ordo amoris, not only tackling with the 19th-century tradition of psychiatry and phenomenological psychopathology, but also with the contemporary disputes on intersubjectivity in phenomenology and with those on schizophrenia as disruption of aida or as disembodiment process in psychiatry. What results from his project is the first systematic study on the international level showing the relevance of Schelerian concepts of body schema (Leibschema) and order of feeling (ordo amoris) to understand the disruptions of emotional regulation on the psychopathological dimension as well as on the formation process of the singularity. (shrink)

Although enactive approaches to cognition vary in terms of their character and scope, all endorse several core claims. The first is that cognition is tied to action. The second is that cognition is composed of more than just in-the-head processes; cognitive activities are externalized via features of our embodiment and in our ecological dealings with the people and things around us. I appeal to these two enactive claims to consider a view called “direct social perception” : the idea that we (...) can sometimes perceive features of other minds directly in the character of their embodiment and environmental interactions. I argue that if DSP is true, we can probably also perceive certain features of mental disorders as well. I draw upon the developmental psychologist Daniel Stern’s notion of “forms of vitality”—largely overlooked in these debates—to develop this idea, and I use autism as a case study. I argue further that an enactive approach to DSP can clarify some ways we play a regulative role in shaping the temporal and phenomenal character of the disorder in question, and it may therefore have practical significance for both the clinical and therapeutic encounter. (shrink)

In Possibilities of Misidentification, Ashwell contends that the immunity principle developed and defended in my Pathologies of Thought and First Person Authority "doesn't show us anything about introspection or the first person—which should make us wonder whether it really captures that's at stake in discussions of IEM". Ashwell's argument hinges on two claims: IP turns on features that are not unique to introspection, to the first person, or to "subject matter that is thought to have IEM", and IP does not (...) yet capture "the standard claim of IEM for introspective self-attribution". Ashwell thereupon contends that the immunity furnished by IP "might be merely contingent"... (shrink)

In his paper, Young has eloquently put forward a novel account of how and why the phenomenon of thought-insertion seen in patients with schizophrenia does not contradict the immunity principle. He argues that, in TI, the problem lies not in misidentification but in mispredication: the individual with TI does not ascribe the right predicate to the wrong subject, but has misdetected the predicate in the first place. The author points out that an inconsistently formulated immunity principle could risk confusing the (...) two types of errors. The author defines the immunity principle as: Any agent... (shrink)

Martin Heidegger (1889–1976) is one of the most influential philosophers of the twentieth century. His influence, however, extends beyond philosophy. His account of Dasein, or human existence, permeates the human and social sciences, including nursing, psychiatry, psychology, sociology, anthropology, and artificial intelligence. In this chapter, I outline Heidegger’s influence on psychiatry and psychology, focusing especially on his relationships with the Swiss psychiatrists Ludwig Binswanger and Medard Boss. The first section outlines Heidegger’s early life and work, up to and including the (...) publication of Being and Time, in which he develops his famous concept of being-in-the-world. The second section focuses on Heidegger’s initial influence on psychiatry via Binswanger’s founding of Daseinsanalysis, a Heideggerian approach to psychopathology and psychotherapy. The third section turns to Heidegger’s relationship with Boss, including Heidegger’s rejection of Binswanger’s Daseinsanalysis and his lectures at Boss’s home in Zollikon, Switzerland. (shrink)

The biological functions debate is a perennial topic in the philosophy of science. In the first full-length account of the nature and importance of biological functions for many years, Justin Garson presents an innovative new theory, the 'generalized selected effects theory of function', which seamlessly integrates evolutionary and developmental perspectives on biological functions. He develops the implications of the theory for contemporary debates in the philosophy of mind, the philosophy of medicine and psychiatry, the philosophy of biology, and biology itself, (...) addressing issues ranging from the nature of mental representation to our understanding of the function of the human genome. Clear, jargon-free, and engagingly written, with accessible examples and explanatory diagrams to illustrate the discussion, his book will be highly valuable for readers across philosophical and scientific disciplines. (shrink)

In this paper, I propose an existentialist-phenomenological model that conceives of mental illness through the terminology of Heidegger’s Being and Time. In particular, the concepts of existentiality, disturbance and the relation between ‘being-with’ and ‘the one’, will be implemented in order to reconstruct the experience of mental illness. The proposed model understands mental illness as a disturbance of a person’s existentiality. More precisely, mental illness is conceptualized as the disturbance of a person’s existential structure, the process of which leads to (...) a becoming explicit of the otherwise implicit dynamical structure that constitutes a person’s experience. In particular, the existential component of ‘being-with’ comes to play a central role in the disturbance of existentiality, thus, I will claim, that it enables a person’s structure of experience to be ‘open for normativity’. By adopting a pragmatist stance on Heideggerian phenomenology, the suggested model proves compatible with naturalist and normativist theories of mental illness while still offering a phenomenological description of the phenomenon. (shrink)

Schizophrenia is usually described as a fragmentation of subjective experience and the impossibility to engage in meaningful cultural and intersubjective practices. Although the term schizophrenia is less than 100 years old, madness is generally believed to have accompanied mankind through its historical and cultural ontogeny. What does it mean to be “mad”? The failure to adopt social practices or to internalize cultural values of common sense? Despite the vast amount of literature and research, it seems that the study of schizophrenia (...) and of the psychoses is suffering from a generic disintegration. In this introduction, we offer an historical overview of the variety of theories and approaches to schizophrenia. We also provide an overview of how the authors in this volume attempt an integrative account where training, practice, theory and research are considered as parts of a larger whole. This is a varied and pluralistic volume, and it is up to the readers to make use of different chapters according to their own needs. (shrink)

In its first part, the paper explores the challenge of conceptualizing the Thomist theological virtue of hope in Aristotelian terms that are compatible with non-Thomist and even atheist metaphysics as well. I argue that the key concept in this endeavor is friendship—as an Aristotelian virtue, as relational value in Thomist theology, as a recognized value in supportive care and as a kind of ‘personal hope.’ Then, the paper proceeds to examine the possible differences between hope as a virtue and hope (...) as an experience reported by people, terminal patients in particular. With the clinical problem of hope at the end of life in mind, the paper concludes with two meta-ethical questions—about the overridingness of .. (shrink)

Anorectics typically maintain that they perceive their bodies as ‘fat’ and yet also state that they are aware of being ‘too thin.’ In this study, I use phenomenological insights from the work of Merleau-Ponty and Sartre to explore this apparent contradiction. I suggest that the anorectic experiences a pathological corporealization of the body, and show how this bodily experience may be described as ‘feeling fat’ due to cultural influences. In addition, I explore how this anomalous bodily experience may lead to (...) partial feelings of disassociation from visual perceptions of the body, allowing the anorectic to recognize the emaciation of a reflected image of herself without it impacting upon her subjective experience of the body as ‘fat.’. (shrink)

Barilan’s (2012) essay “From Hope in Palliative Care to Hope as a Virtue and a Life Skill” provides a novel way of exploring hope as experienced by people at the end of life. He proposes that hope can be usefully seen as an Aristotelian virtue; something to be “conscientiously chosen” as a “habit of behavior, perceptiveness and mental response, holistically considered” (Barilan 2012, 166). Hope coalesces with other virtues, particularly courage, in the terminally ill, to enable human flourishing even at (...) this time of great uncertainty, loss, and ultimately personal annihilation. The virtue of hope in an individual might manifest itself in various ways, particularly in creativity and caring relationships. .. (shrink)

Autism Spectrum Condition presents a challenge to social and relational accounts of the self, precisely because it is broadly seen as a disorder impacting social relationships. Many influential theories argue that social deficits and impairments of the self are the core problems in ASC. Predictive processing approaches address these based on general purpose neurocognitive mechanisms that are expressed atypically. Here we use the High, Inflexible Precision of Prediction Errors in Autism approach in the context of cultural niche construction to explain (...) atypicalities of the relational self, specifically its minimal, extended, and intersubjective aspects. We contend that the social self in ASC should not be seen as impaired, but rather as an outcome of atypical niche construction. We unpack the scientific, ethical, and practical consequences of this view, and discuss implications for how the challenges that autistic persons face should be approached. (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)

I present and defend the generalized selected effects theory (GSE) of function. According to GSE, the function of a trait consists in the activity that contributed to its bearer’s differential reproduction, or differential retention, within a population. Unlike the traditional selected effects (SE) theory, it does not require that the functional trait helped its bearer reproduce; differential retention is enough. Although the core theory has been presented previously, I go significantly beyond those presentations by providing a new argument for GSE (...) and defending it from a recent objection. I also sketch its implications for teleosemantics and philosophy of medicine. (shrink)