Philosophy of Psychiatry and Psychopathology, Misc

It has been claimed that cognitive therapists endorse sets of uplifting beliefs BECAUSE the client feels better believing them: not because they lead towards greater verisimilitude, a purported cognitivists’ hallmark of rational choice. Since standard cognitive therapists sometimes ask us to choose sets of beliefs that interpret evidence on the basis of greater individual happiness (all other things being equal), this suggests that the basis of choice goes beyond rationality. I contend that the case against the rationality of cognitive therapy (...) is not made if one allows a broadening of what to count as rational cognitive therapy. The rationality of therapy consists in how well it achieves its goal. My claim is that at least one goal is, or ought to be, greater information value of the client’ dialogues. Among other things, information values encode affect. Understanding reason in this way effectively transforms our understanding of rationality in a way that may be incommensurable with the standard view. If these radically divergent approaches to cognitive therapy are incommensurable, there is no way to discover that we are still talking about the same thing. So, a challenge for this competing view is to say on what basis the term cognitive therapy may be projectable. I identify some constraints on this project and sketch a possible solution. (shrink)

The different approaches of the mind-body problem a fortiori have implications on the foundations of Psychology, Psychopathology and Psychiatry, leading to many clashing theories about the determinants of "normal" human behavior, as well of the mental illnesses. These schools of research on the human mind may on a first approach be divided in two main branches: 1) the neurogenetic ones; 2) the psychogenetic ones. This paper sprang up from a lifelong pondering on its subject by its author, while working as (...) a Clinical Psychiatrist and conducting a Ph D in Philosophy. (shrink)

Brief description of Freud's life and work, emphasising the role of fictive belief and experience (phantasy) in his account of mental disorder.

Philosophers have long been fascinated by the stream of consciousness––thoughts, images, and bits of inner speech that dance across the inner stage. Yet for centuries, such “mind-wandering” was deemed private and thus resistant to empirical investigation. Recent developments in psychology and neuroscience have reinvigorated scientific interest in the stream of thought, leading some researchers to dub this “the era of the wandering mind”. Despite this flurry of progress, scientists have stressed that mind-wandering research requires firmer philosophical foundations. The time is (...) therefore ripe for the philosophy of mind-wandering. Our review begins with a foundational question: what is mind-wandering? We then investigate the significance of mind-wandering for general philosophical topics, namely mental action, introspection, and the norms of thinking and attention. (shrink)

In this comparative study, we examine experiential disruptions of embodiment and affectivity in Moebius Syndrome and schizophrenia. We suggest that using phenomenological resources to explore these experiences may help us better understand what it’s like to live with these conditions, and that such an understanding may have significant therapeutic value. Additionally, we suggest that this sort of phenomenologically-informed comparative analysis can shed light on the importance of embodiment and affectivity for the constitution of a sense of self and interpersonal relatedness (...) in normal conditions. (shrink)

We argue that a phenomenological approach to social space, as well as its relation to embodiment and affectivity, is crucial for understanding how the social world shows up as social in the first place—that is, as affording different forms of sharing, connection, and relatedness. We explore this idea by considering two cases where social space is experientially disrupted: Moebius Syndrome and schizophrenia. We show how this altered sense of social space emerges from subtle disruptions of embodiment and affectivity characteristic of (...) these conditions. These disruptions are instructive, we suggest, in that they highlight the foundational role that body and affect play in organizing social space—the lived context in which we first encounter one another as social agents. (shrink)

In ‘Psychotherapy, Placebos and Informed Consent’, I argued that the minimal standard for informed consent in psychotherapy requires that ‘patients understand that there is currently no consensus about the mechanisms of change in psychotherapy, and that the therapy on offer…is based on disputed theoretical foundations’, and that the dissemination of this information is compatible with the delivery of many theory-specific forms of psychotherapy (including cognitive behavioural therapy [CBT]). I also argued that the minimal requirements for informed consent do not include (...) information about the role of therapeutic common factors in healing (e.g., expectancy effects and therapist effects); practitioners may discuss the common factors with patients, but they are not part of the ‘core set’ of information necessary to obtain informed consent. In a recent reply, Charlotte Blease criticises these two arguments by claiming they are not supported by empirical findings about the therapeutic common factors. Blease’s response is based on serious misunderstandings of both CBT and what the common factor findings actually find. Nevertheless, addressing the reasons for these misunderstandings is instructive and gives us an opportunity to clarify what, exactly, needs to be explained to patients in order to obtain informed consent for psychotherapy. (shrink)

Human behavior is frequently described both in abstract, general terms and in concrete, specific terms. We asked whether these two ways of framing equivalent behaviors shift the inferences people make about the biological and psychological bases of those behaviors. In five experiments, we manipulated whether behaviors are presented concretely (i.e. with reference to a specific person, instantiated in the particular context of that person’s life) or abstractly (i.e. with reference to a category of people or behaviors across generalized contexts). People (...) judged concretely framed behaviors to be less biologically based and, on some dimensions, more psychologically based than the same behaviors framed in the abstract. These findings held true for both mental disorders (Experiments 1 and 2) and everyday behaviors (Experiments 4 and 5) and yielded downstream consequences for the perceived efficacy of disorder treatments (Experiment 3). Implications for science educators, students of science, and members of the lay public are discussed. (shrink)

In this response to "Mild Mania and Well-Being" I propose a different analytic strategy and scrutinize the presented case of mild mania within the framework of a holistic theory of health. I distinguish between the following fundamental questions: (1) is mild mania a disease or illness? (2) does the mild mania of Mr. M. reduce his health significantly? and (3) should Mr. M. be recommended treatment with lithium or not? I answer the first question in the affirmative. I propose some (...) theoretical tools for resolving the second one. A complete resolution of it, however, requires a deeper analysis of Mr. M.'s state of mind and general situation. Finally, I hold that an affirmative answer to the first two questions does not imply an affirmative answer to the third, namely that Mr. M. should be recommended treatment with lithium. Other considerations, in particular ethical ones, should play a r. (shrink)

Crime is a serious social problem, but its causes are not exclusively social. There is growing consensus that explaining and preventing it requires interdisciplinary research efforts. Indeed, the landscape of contemporary criminology includes a variety of theoretical models that incorporate psychological, biological and sociological factors. These multi-disciplinary approaches, however, have yet to radically advance scientific understandings of crime and shed light on how to manage it. In this paper, using conceptual tools on offer in the philosophy of science in combination (...) with theoretical work represented in this special volume of Psychology, Crime and Law, I provide some perspective on why explanatory progress in criminology has remained elusive and evaluate some positive proposals for attaining it. -/- . (shrink)

Despite technological innovations, clinical expertise remains the cornerstone of psychiatry. A clinical expert does not only have general textbook knowledge, but is sensitive to what is demanded for the individual patient in a particular situation. A method that can do justice to the subjective and situation-specific nature of clinical expertise is ethnography. Effective deep brain stimulation for obsessive-compulsive disorder involves an interpretive, evaluative process of optimizing stimulation parameters, which makes it an interesting case to study clinical expertise. The aim of (...) this study is to explore the role of clinical expertise through an ethnography of the particular case of DBS optimization in OCD. In line with the topic of the special issue this article is a part of, we will also use our findings to reflect on ethnography as a method to study complex phenomena like clinical expertise. This ethnography of DBS optimization is based on 18 months of participant observation and nine in-depth interviews with a team of expert clinicians who have been treating over 80 OCD patients since 2005. By repeatedly observing particular situations for an extended period of time, we found that there are recurrent patterns in the ways clinicians interact with patients. These patterns of clinical practice shape the possibilities clinicians have for making sense of DBS-induced changes in patients’ lived experience and behavior. Collective established patterns of clinical practice are dynamic and change under the influence of individual learning experiences in particular situations, opening up new possibilities and challenges. We conclude that patterns of clinical practice and particular situations are mutually constitutive. Ethnography is ideally suited to bring this relation into view thanks to its broad temporal scope and focus on the life-world. Based on our findings, we argue that clinical expertise not only implies skillful engagement with a concrete situation but also with the patterns of clinical practice that shape what is possible in this specific situation. Given this constraining and enabling role of practices, it is important to investigate them in order to find ways to improve diagnostic and therapeutic possibilities. (shrink)

The relationship between traumatic experiences and subsequent distress is not well understood, and little research focuses on the lived experience of psychological trauma. I draw on Louis Sass’s phenomenological taxonomy to address this lacuna. I present his differentiation between relations of phenomenological causality and implication and demonstrate that his taxonomy can be applied to experiences of trauma. Relations of phenomenological causality and implication can be identified in the genesis and constitution of post-traumatic distress. My adaptation of Sass’s taxonomy will furthermore (...) offer an extension and development of his account, applying it to the study of post-traumatic experiences and elaborating it in the process. I shall demonstrate that whether experiences occur synchronically or diachronically is not essential to their categorization in terms of phenomenological implication and causality, respectively. I will show that an alteration in perception or behavior post trauma might temporally succeed the traumatizing event while, at the same time, being implied in the experience of the event. Thereby, I demonstrate how phenomenology may contribute to a detailed understanding of experiences of trauma. Scrutiny of traumatic experiences furthermore promises to contribute to the philosophical discourse on causality, implication, and temporal experience. (shrink)

This is the prologues to a collection of essays on eugenics and psychiatry out in the second half of 2020.

Why do some people enjoy being afraid? A recent study by Andersen et al . found an inverted U-shaped relationship between fear and enjoyment, consistent with the theory that the pursuit of pleasurable fear is a form of play.

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)

The last 20 years have seen the development of a new form of therapy, compassion focused therapy. Although CFT has a growing evidence base, there have been few studies of CFT outside of an Anglo-European cultural context. In this paper, we ask: Might a CFT-based approach be of value for Indigenous Australians? If so, what kind of cultural adaptations might be needed? We report the findings from a pilot study of an arts-based compassion skills training group, in which usual CFT (...) group processes were significantly adapted to meet the needs of Indigenous Australians. At face value, CFT appeared to be a promising approach to enhancing the social and emotional wellbeing of Australia’s Indigenous peoples. However, despite initial consultations with Indigenous health professionals, the first attempts to offer a more conventional group-based CFT to Indigenous clients were largely unsuccessful. Following a review and advice from two Indigenous clients, we combined elements of CFT with visual arts to develop a new approach, “arts-based compassion skills training”. This paper reports an evaluation of this pilot ABCST group. The group had 6 × 4 h sessions of ABCST, facilitated by two psychologists and two artists. There were 10 participants, who attended between 2 and 6 sessions: five were clients, five were health professionals. Between 1 and 3 months later, six of the participants were interviewed. Qualitative analysis of interview data identified that two key processes—creating a positive group atmosphere and channeling compassion skills training through the medium of visual arts—led to four positive outcomes for participants: planting the seeds of new understandings, embodying the skills of compassion, strengthening relationships with others, and evolving a more self-compassionate relationship. We suggest that the preliminary results are sufficiently encouraging to warrant further development of ABCST in Indigenous communities. (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)

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)

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)

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)

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)

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)

In this paper, I examine a kind of delusion in which the patients judge that their occurrent thoughts are false and try to abandon them precisely because they are false, but fail to do so. I call this delusion transparent, since it is transparent to the sufferer that their thought is false. In explaining this phenomenon, I defend a particular two-factor theory of delusion that takes the proper integration of relevant reasoning processes as vital for thought-evaluation. On this proposal, which (...) is a refinement of Gerrans’s account of delusion as unsupervised by decontextualized processing, I can have all my reasoning processes working reliably and thus judge that my delusion is false but, if I cannot use their outputs when revising the thought itself, the delusion will persist. I also sketch how this framework explains some interesting cases of failed belief-revision in the general population in which people judge that ~p but nonetheless continue to believe that p. (shrink)

Mental health research faces a suite of unresolved challenges that have contributed to a stagnation of research efforts and treatment innovation. One such challenge is how to reliably and validly account for the subjective side of patient symptomatology, that is, the patient’s inner experiences or patient phenomenology. Providing a structured, standardised semantics for patient phenomenology would enable future research in novel directions. In this contribution, we aim at initiating a standardized approach to patient phenomenology by sketching a tentative formalisation within (...) the framework of an applied ontology, in the broader context of existing open-source Open Biomedical Ontologies resources such as the Mental Functioning Ontology. We further discuss a number of prevailing challenges and observations bearing on this task. (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)

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)

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)

In this paper, I enquire into the nature of the influence culture has on the experience of trauma. I begin with a brief elaboration of the dominant conceptualisation of post-traumatic experiences: the diagnostic category of PTSD as it can be found in the DSM. Then, I scrutinise the nature and extent to which cultural factors may influence the phenomenology of the experience of certain events as traumatic and subsequent symptoms of post-traumatic stress. It seems that cultural circumstances alter the way (...) in which trauma is experienced; it is not clear whether there is in fact a core pathology of PTSD, as the DSM assumes, or whether the structure of the experience of trauma is too multifaceted to be summarised in one diagnostic category. Finally, I show that phenomenological enquiry promises to identify the structural similarities that would justify the delineation of a distinct diagnostic category. (shrink)

In this paper, I will present and advocate a view about what we are doing when we attribute delusion, namely, say that someone is delusional. It is an “expressivist” view, roughly analogous to expressivism in meta-ethics. Just as meta-ethical expressivism accounts for certain key features of moral discourse, so does this expressivism account for certain key features of delusion attribution. And just as meta-ethical expressivism undermines factualism about moral properties, so does this expressivism, if correct, show that certain attempts to (...) objectively define delusion are misguided. I proceed as follows. I start by examining different attempts at defining delusion, separating broadly psychiatric attempts from epistemic ones. I then present a change of approach, according to which we question whether the term “delusion” is in the business of (merely) describing reality. I then support this proposal, first, by borrowing standard lines of argument from meta-ethics (including ontological reluctance, intrinsic motivation, and deep disagreement) but also, by inference to the best explanation of some the features we see when we try to theorise about delusion (namely that it is hard to define, and that our delusion attributions are elicited by a plurality of norms). (shrink)

The essay by Potter and El-Mallakh proposes "on the ground" consultations in psychiatric ethics as a novel style of bioethics deliberation. The continual dialogue between a moral philosopher and clinician creates the opportunity for informal real-time ethical thinking as cases unfold, instead of formal ethics committee reviews and instead of the artificially simple scenarios found in much bioethics literature. The essay has important practical implications for ethics pedagogy during psychiatric training and in mental health settings more generally. It also has (...) important theoretical implications for the cross-talk between... (shrink)

The question of the subject seems to occupy much of the current psychiatric/psychological landscape. Some theoreticians affirm that the subject or the self is an imaginary fiction, not a substantial entity in whose structure causes of psychological disorders and their respective antidotes are latent. “Subject,” they continue, “is what the vernacular speech says it is, that is, a self-reference marker that indexes human organisms’ sensory/motor singularity.” This marker, however, has nothing in common with a supposed metaphysical ethereal substrate, made up (...) of particles such as will, freedom, autonomy, ineffable consciousness, reason, emotions, desires, beliefs, judgments, aspirations, or interests. Taking such an... (shrink)