Philosophy of Psychiatry

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)

Pickard’s attempt to undermine the disease view of addiction by arguing that addiction is never a matter of irresistible compulsion fails on two accounts. First, it fallaciously hinges on the construction of a straw figure, a metaphysical postulate that misrepresents the nature and complexity of the real empirical issues at hand. Second, it goes on to frame the issues according to a false dichotomy, an all-or-nothing opposition between irresistible compulsion and its metaphysical counterpart, the philosopher’s free will.

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)

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)

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)

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.

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 (at least partially) 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" (DSP): 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)

This essay presents a new account of thought insertion. Prevailing views in both philosophy and cognitive science tend to characterize the experience of thought insertion as missing or lacking some element, such as a ‘sense of agency’, found in ordinary first-person awareness of one's own thoughts. By contrast, I propose that, rather than lacking something, experiences of thought insertion have an additional feature not present in ordinary conscious experiences of one's own thoughts. More specifically, I claim that the structure of (...) an experience of thought insertion consists of two distinct elements: a state of ordinary first-person awareness and a sense that this state of awareness is highly unusual. In addition to modeling the experience of thought insertion, I also explain how a delusional pattern of thinking could lead someone who has this kind of experience to adopt a belief that some other entity is inserting thoughts into her mind. Finally, I briefly sketch a neurocomputational framework that could be developed to explain the sense that one's state of first-person awareness is highly irregular. (shrink)

This paper examines the fortunes of the controversial use of hypnosis to ‘enhance’ autobiographical memories in postwar America. From the 1950s through the early 1980s, hypnosis became increasingly popular as a means to exhume information thought to be buried within the mind. This practice was encouraged by lay understandings of memory drawn from a material culture full of new recording devices ; and during the years when the practice was becoming most popular and accepted, academic psychologists developed a contrary, reconstructive, (...) account of memory that was put to use in a series of battles meant to put an end to hypnotic recall. But popular commitment to the idea of permanent memory ‘recordings’ sustained the practice and the assumptions about memory and self that were associated with it, and in the face of a culture of academic psychology fully committed to the idea of ‘reconstructive’, malleable memory, a tidal wave of ‘enhanced’ memories swept America in the late 1980s and 1990s, in the so-called ‘memory wars’. These, in turn, provoked academic psychologists to research the claims and counter claims central to the memory wars. The paper will also make an argument about the importance of lay knowledge in the psychological sciences explored in this paper: that popular psychological beliefs played a significant, even formative role in defining the nature of forensic psychological expertise, and also the framing of elite academic psychological research. (shrink)

Notwithstanding recent successes of philosophical counseling, which appear to be leading to its legitimization as a professional practice in America and abroad, many forces concen to condition its emergent structure and function. This paper briefly elucidates some of the influences to which philosophical counseling is subject, that lie beyond its unilateral control. These include its portayal by the media to the public, its scope of practice, its relations with psychology and psychiatry, its foreseeable effects in particular cases, and its perception (...) by analytical philosophy. (shrink)

Gupta effectively probes the methodological and ethical presuppostions of Evidence Based Medicine, and its more contestable application to psychiatry. She concludes with an endorsement of a very modest reformulation of it as one guide to practice among many.

This book offers a broad, systematic philosophical approach to mental disorder. The authors spend the first half of the book presenting their basic philosophical allegiances, and they go on to apply their philosophical approach to mental disorder. As the authors note, psychiatry has been largely neglected by contemporary philosophy of mind, and this book is a laudable attempt to rectify the situation by producing a sustained and clinically well-informed philosophical treatment of mental disorder.

The dominant philosophical conceptions of obsessive-compulsive behavior present its subject as having a deficiency, usually characterized as volitional, due to which she lacks control and choice in acting. Compulsions (mental or physical) tend to be treated in isolation from the obsessive thoughts that give rise to them. I offer a different picture of compulsive action, one that is, I believe, more faithful to clinical reality. The clue to (most) obsessive-compulsive behavior seems to be the way obsessive thoughts, which are grounded (...) in an irrational cognitive style in matters of risk, danger, and responsibility, motivate compulsions through bizarre means–end reasoning. I show that the patient with obsessive-compulsive disorder (OCD) is not weak and passive with regard to the compulsive act; rather, the act is voluntary and regarded by the patient as an instrument of control. I also defend the idea that OCD-related cognitions are either beliefs or mental states with relevantly similar functional roles. (shrink)

In this paper I examine the ways in which our language and terminology predetermine how we approach, investigate and conceptualise mental illness. I address this issue from the standpoint of hermeneutic phenomenology, and my primary object of investigation is the phenomenon referred to as “mania”. Drawing on resources from classical phenomenology, I show how phenomenologists attempt to overcome their latent presuppositions and prejudices in order to approach “the matters themselves”. In other words, phenomenologists are committed to the idea that in (...) our everyday, natural attitude, we take for granted a number of prejudices and presuppositions that predetermine how we conceive of and understand what we experience. In order to properly approach the phenomena themselves, we need to find ways of neutralising our presuppositions and prejudices in order to develop new (and hopefully more accurate) accounts of the phenomena under investigation. One of the most popular examples of such an attempt at neutralisation is what Edmund Husserl calls the epoché, which is the practice of bracketing out or suspending presuppositions. However, later phenomenologists developed alternative approaches. Martin Heidegger, for instance, engaged in etymological analyses to discover latent meanings in our language and terminology. Hans-Georg Gadamer also engaged in historical analyses of how our traditions sediment into latent prejudices. After discussing the various ways in which phenomenologists have attempted to neutralise presuppositions and prejudices prior to engaging in their investigations, I apply some of these principles and methods to the domain of psychopathology, and discuss some of the prejudices inherent in contemporary discussions of the phenomenon of mania. I examine recent attempts to link the phenomenon that we today refer to as “mania” with the ancient Greek concept of “μανία” (mania), and argue that the practice of linking contemporary and historical concepts can be detrimental to attempts at reclassifying disorders. In addition, I consider the implications of the shift in terminology from “manic depressive illness” to “bipolar disorder” – especially how conceiving of mania as one of two “poles” predetermines its description by both clinicians and patients. Finally, I address the implications of the headings under which mania and bipolar disorder are discussed within diagnostic manuals. For example, I discuss the removal of the headings of affective and mood disorders in the DSM-5, and the explicit decision by the authors to place bipolar disorder between depressive disorders and schizophrenia. What I aim to accomplish in this paper is not so much a phenomenological investigation of mania as it is a pre-phenomenological investigation. In other words, I offer a preparatory investigation of the phenomenon (or phenomena) referred to as “mania” in contemporary discourse, with the intention of laying the groundwork for further phenomenological and psychological research. (shrink)