Philosophy of Psychiatry and Psychopathology, Misc

Con il termine psicoterapia è d'uso riferirsi al trattamento del "disagio" mentale attraverso mezzi psichici, ma l'ovvietà "tautologica" della definizione tende a svanire se si affronta un esame più approfondito dei termini "psiche", "mezzi psichici" e "disagio mentale". Una definizione non può in linea generale che assumere un significato ed un valore limitato nel tempo e nello spazio, ma il sostanziale polimorfismo teorico, metodologico, tecnico e linguistico che contraddistingue la psicoterapia ne rende ancora più ardua una chiara ed univoca definizione. (...) Vi è un sostanziale accordo, che però lascia inalterati i problemi sottostanti, su definizioni che sono sulla stessa linea di quelle ad esempio di Wolberg o di Frank. Wolberg(1) parla di: «trattamento, con mezzi psicologici, di problemi di natura psichica, in cui una persona appositamente qualificata stabilisce deliberatamente una relazione professionale con il paziente con lo scopo di rimuovere, di modificare e di attenuare i sintomi esistenti, di mediare modi di comportamento disturbato e di promuovere la crescita e lo sviluppo positivo della personalità». (shrink)

We consider essential the need to integrate the causalistic nomothetic scientific approach with an unavoidable acausal finalistic approach. We come to consider too that it is precisely the psychoanalytic sphere that contributes decisively to this redefinition within the epistemology of science.

Nel quadro di una teorizzazione, derivante da più ambiti, indebolente, non fondazionalistica, dell'approccio alla realtà fenomenica, la nostra attenzione si è soffermata sull'ambito psicologico, nel quale contestiamo una visione statica, atemporale e oggettivistica dell'identità soggettuale, e sosteniamo, tra l'altro, l'imprescindibilità, per la psicoterapia, del rimando alla sintomatologia dei significati esperiti dall'individuo.

In 1913, eccentric French composer Erik Satie wrote a fragmentary, diary-like essay where he depicted a strikingly rigid diet consisting solely of white foods: eggs, sugar, coconuts, rice, cream cheese, fuchsia juice and so on. Satie’s brief essay has later been used as one of many puzzle pieces in attempts to retrospectively diagnose him with autism spectrum disorder. With Satie’s white meal as a starting point, this paper explores colour-based food preferences and selective eating in clinical and non-clinical populations, with (...) a special focus on autism spectrum disorder and avoidant/restrictive food intake disorder. General colour preferences and their causes as well as the impact of colour on taste and food identification are also explored. Selective eating during childhood is immensely common and does not generally lead to disordered eating in the long run, although subgroups may experience rigidity around food of a more enduring nature. Problems related to eating were repeatedly described in Kanner’s original 1943 autism case series and continue to be common in autism. Most studies on eating and sensory sensitivity in autism show that the texture and consistency of the food are the most common factors behind selective eating. In contrast, colour-based food preferences appear to be relatively rare, although numerous anecdotal reports exist. Foods that are white or colourless may be particularly appealing or tolerable for individuals with sensory hypersensitivity, which can occur in autism or ARFID. Ultimately, in the case of Erik Satie, this paper concludes that his description of a strictly white diet should not be read as an autobiographical account but rather as an ironic take on contemporary symbolist literature, with the famously decadent all-black dinner party in French novelist Joris-Karl Huysmans’ À Rebours as an obvious source of inspiration. (shrink)

This paper provides an analysis of Franz Brentano’s thesis that psychology employs a distinctive method, which sets it apart from physiology. The aim of the paper is two-fold: First, I situate Brentano’s thesis (and the broader metaphysical system that underwrites it) within the context of specific debates about the nature and status of psychology, arguing that we regard him as engaging in a form of boundary work. Second, I explore the relevance of Brentano’s considerations to more recent debates about autonomy (...) on the one hand and theoretical and/or methodological integration on the other. I argue that Brentano puts his finger on the idea that an integrated research process presupposes the existence of distinct methods and approaches, and that he highlights the philosophical challenge of accounting for such distinct methods. I suggest that Brentano’s ideas offer unconventional perspectives on current debates, in particular regarding first-person methods and the investigative process in cognitive science. (shrink)

Psychiatry is enormously complex. One of its main difficulties is how to connect the wide diversity of factors that may cause or contribute to the problems at hand, factors ranging from traumatic experiences, dysfunctional neurotransmitters, existential worries, economic deprivation, and social exclusion, to genetic bad luck. Interventions are also diverse, with options including chemical or electrical treatment, therapies aimed at behavior change and those promoting insight. Much is still unknown: what are the causal pathways, which interventions work best for which (...) patients and why?In practice, many mental health care professionals work holistically in a pragmatic and eclectic way. Without using any explicit... (shrink)

Glas's rich article makes several useful points about both anxiety and enactivism, and about how enactivism can help to conceptualize anxiety in a suitably complex way. I agree that we need to characterize anxiety as an embedded, context-sensitive and temporally evolving phenomenon with layered symptoms. As Glas points out, the enactive approach has useful conceptual tools for doing so, because of its incorporation of the theoretical apparatus of dynamical systems theory. I am sympathetic with most of what Glas says about (...) this point, so I shall not dwell on it any further.I want to focus instead on Glas's discussion of self-referentiality, which I found interesting and valuable but also in need of further... (shrink)

In his article, "Delusion, Reality, and Inter-subjectivity," Thomas Fuchs gives an "enactivist" account of how primary delusions in early schizophrenia evolve. First, subjects experience the "loss of familiar, commonsensical meanings"—known as delusional mood. Consecutively they experience new "revelatory significances," in perception as well as in social interaction, with all experiences becoming radically "subjectivized." Out of these "uncanny, spurious and made" experiences delusions develop. Suddenly the formerly uncanny experiences make sense. This new subjective reality, however, is "rigid." Subjects are no longer (...) able to take on different perspectives. The usually present, shared reality we live by is lost.... (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)

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)

How we think about the mind affects how we think about mental disorders: about what they are, how they develop and how we should best treat them. How we think about the mind and its relation to both body and world will typically be implicit though. One commonly assumed 'mind-world topology' regards the mind as internal and the world as external, and gives the mind the task of properly representing the outer world. This leads to a division of labor in (...) which perception provides input from world to mind, cognition processes this input and generates output from mind to world in the form of actions. From such a perspective, psychiatric... (shrink)

De Haan has provided a novel and distinctly enactivist solution to the problem of integrating the physiological, experiential, social and existential. We admire her articulation of her fourth "existential" dimension. Not only does it represent a real attempt to bridge, as she says, enactivism's explanatory gap, it is also a potentially useful construct for conceptualizing the way that self-reflexivity seems to go astray in much psychopathology. We think that pinpointing this phenomenon is something that phenomenological accounts excel at. We have, (...) however, two key reservations about her account, which we outline.To begin with, we are unsure that there is any particular scientific research program that derives from... (shrink)

In "Delusion, Reality, and Intersubjectivity," Thomas Fuchs offers a superb presentation of an enactive/phenomenological approach to schizophrenic delusions—an approach that is clearly superior to the poor-reality-testing formula that has dominated thinking about delusion in psychiatry, psychoanalysis, and cognitive-behavioral theory. As he convincingly argues, two key tendencies go a long way toward accounting for the distinctive features of delusion in schizophrenia: 1) withdrawal from practical, sensori-motoric interaction with the physical environment; and 2) failure to experience reality in intersubjective terms—as a realm (...) of "participatory... (shrink)

Today the concept of 'schizophrenia' is often presented in psychiatric texts as a construct, a construct bringing together a diverse and, allegedly, independently assailable range of signs and symptoms. According to such a diagnostic scheme two patients may both be allowed to count as suffering from schizophrenia despite sharing hardly a single symptom. The validity of the concept has accordingly been contested by psychologists for its apparent lack of unity. In the absence of clear independent evidence of a unitary physiological (...) disease process underlying such diverse phenomena, a natural enough suggestion has been to... (shrink)

In her commentary, Dibitonto helpfully compares my understanding of schizophrenic ego disturbance with that of Blankenburg. His patient Anne described her true schizophrenic difficulty as obtaining in some sense 'before' those experiential disturbances she can articulate. Ordinary conversational modes misleadingly invite her and us to attempt describing her difficulties in terms which presuppose the intactness of, rather than capture the underlying disturbance to, her self-hood. They fail to locate the disturbance deep enough, fail to grasp how it arises 'before' what (...) is readily articulable in the psyche. I believe this is the same 'before' which prompts my own articulation of schizophrenic ego... (shrink)

In the target article, Iain McGilchrist draws upon his work, The Master and his Emissary: The Divided Brain and the Making of the Western World (=ME), to develop the relevance of its central claims to religion. Here and elsewhere McGilchrist contends, contrary to some critics, that his construal of the divided brain hypothesis (=DBH) does not make the fundamental philosophical error which is known as the homunculus fallacy. The critics’ charge is this: McGilchrist’s DBH purports to explain certain psychological features (...) of human persons by providing an explanation that is in fact a pseudo-explanation. It is a pseudo-explanation because the DBH’s explanation of these psychological phenomena merely reintroduces the same psychological phenomena as explanatory factors that belong to the two different hemispheres of the brain. This article addresses whether McGilchrist’s position is in fact innocent of the charge of the homunculus fallacy. It is one thing to recognize the principle of contradiction and aim to avoid contradictions, it is another thing to avoid actually contradicting oneself. I show that McGilchrist consistently violates the homunculus fallacy despite his consistent claims to the contrary. I then argue that it is impossible for McGilchrist to articulate the central thesis of ME, namely, DBH, without violating the homunculus fallacy. Indeed, McGilchrist’s DBH requires that the error identified by the homunculus fallacy is not a fallacy at all, but is a deep insight crucial to understanding the making of the western world. Let us begin with the homunculus fallacy. (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)

The recent publication of DSM-5 highlighted the two opposing views that exist within psychology and psychiatry as to how we deal with mental disorders. This book provides an introduction to the history of psychiatry and clinical psychology, looking at how people have attempted to classify the various problems and disorders they face.

Psychiatry has been subject to major changes in the last 150 years. This book explores the forces that have shaped these changes and how they have impacted on the psychiatric profession in this time. The result is a dynamic discussion about the nature of psychiatric disorders, and a book that is compelling reading.

In this important new book in the IPPP series, a group of leading thinkers in psychiatry, psychology, and philosophy offer alternative perspectives that address both the scientific and clinical aspects of psychiatric validation, emphasizing throughout their philosophical and historical considerations.

Leonard L. Heston, M.D. is a Professor of Psychiatry at The University of Washington and is the Director of The Washington Institute for Mental Illness Training and Research. Dr. Heston writes about "a QUIET revolution [which] has been occurring in psychiatry" . Dr. Heston's "new psychiatry" focuses on the "actual study of the brain as a biologic tissue" and avoids "elaborate theorizing, guru-isms, blaming of mothers for unhappiness, backbiting among contending schools, or [popular and simple] prescriptions for instant mental health. (...) Such topics were a product of prescience..." . Heston wishes to distance himself from traditional Freudianism. Most importantly, according to Heston, his biological and scientific psychiatry portends greater hope for the "nearly one person in five [who] will develop a major psychiatric illness...". (shrink)

This work is a reappraisal of the nature of psychiatric illness and therapeutic approaches to it. It looks at how current classifications and treatment derive from a century-old framework which is now incoherent.

In this dissertation, I use recent theoretical approaches in the human sciences to reconsider fundamental organizing structures of psychiatric knowledge. Chapter 1 outlines how the tropes of "theory" and "a-theory" are used in the human sciences and in psychiatry, critiques psychiatry's a-theoretical approach, and explores the possibilities for a retheorized psychiatry along the lines of work in the human sciences. Chapter 2 and 3 concentrate respectively on two key aspects of "theory"---language and power---and considers their role in shaping and fixing (...) psychiatric knowledge structures. Chapter 4 organizes the theoretical discussion thus far around a sustained reflection on "modernism" and "postmodernism" as relevant to psychiatry. Three themes of psychiatric modernism are outlined and contrasted with three themes of psychiatric postmodernism. I argue in favor of psychiatry, or some branch of psychiatry, shifting toward more postmodern paradigm. ;Chapter 5 is a bridge chapter, which explores other recent theoretical scholarship similar to mine applied in the new genre I call "medical cultural studies." I make this shift to medicine primarily for the practical reason that there has been more work in cultural studies of medicine than there has in cultural studies of psychiatry. The next two chapters start the process of cultural studies of psychiatry. Chapter 6 is devoted to the dramatic rise of pharmaceuticals in psychiatry, and chapter 7 is devoted to the controversial role of DSM---psychiatry's dominant diagnostic manual. The last chapter imagines a possible feminist successor science for psychiatry. After reviewing the main themes of feminist epistemology, I apply their efforts to a "re-formed" psychiatry. In this chapter, I imagine, based on my research but without regard for politically practicalities, how things might be otherwise in psychiatry. Of course, imagination doesn't make it so, but; imagination can guide our efforts toward change. (shrink)

The first official condemnation of political abuse of psychiatry in the USSR to be made by an international psychiatric organization came on August 30, 1977. On that date, the General Assembly, governing body of the World Psychiatric Association (WPA), adopted a resolution of Britain's Royal College of Psychiatrists against "the systematic abuse of psychiatry for political purposes in the USSR." Subsequently passed by a vote of 122 to 66 was a resolution submitted by the American Psychiatric Association, to set up (...) a committee monitoring "The misuse of psychiatric skills, knowledge and facilities for the suppression of dissent wherever it occurs.". (shrink)

This Presidential Address of the Bombay Psychiatry Society covers the state of psychiatry in India in 1997. It posits that with the advent of newer brain imaging technologies in India such as computerised tomography, magnetic resonance imaging, single photon emission computerised tomography and brain electrical activity mapping, an era of evidence-based psychiatry in India has arrived. The Address cautions against the dehumanising potential of excessive reliance on technology. The need for a greater emphasis on psychiatry during undergraduate medical education is (...) discussed along with the need to destigmatise psychiatric disorders. Finally, the need to encourage quality research in psychiatric disorders is stressed. (shrink)

Mumbai, like any other Metro city, has its own share of contentious issues influencing psychiatric management. These could be old ongoing issues like myths about medications, electroconvulsive therapy and counselling, or newer ones like our stand on homosexuality and crime related to psychosocial factors. A range of these issues is considered in this paper along with some possible solutions. Getting due credit and status for psychiatry as a medical branch is also a challenge we need to address.