Although formal thought disorder (FTD) has been for long a clinical label in the assessment of some psychiatric disorders, in particular of schizophrenia, it remains a source of controversy, mostly because it is hard to say what exactly the “formal” in FTD refers to. We see anomalous processing of terminological knowledge, a core construct of human knowledge in general, behind FTD symptoms and we approach this anomaly from a strictly formal perspective. More specifically, we present here a symbolic (...) computational model of storage in, and activation of, a human semantic network, or semantic memory, whose core element is logical form; this is normalized by description logic (DL), namely by CL, a DL-based language – Conception Language – designed to formalize conceptualization from the viewpoint of individual cognitive agency. In this model, disruptions in the rule-based implementation of the logical form account for the apparently semantic anomalies symptomatic of FTD, which are detected by means of a CL-based algorithmic assessment. (shrink)

Formal thought disorder (FTD) is a clinical mental condition that is typically diagnosable by the speech productions of patients. However, this has been a vexing condition for the clinical community, as it is not at all easy to determine what “formal” means in the plethora of symptoms exhibited. We present a logic-based model for the syntax–semantics interface in semantic networking that can not only explain, but also diagnose, FTD. Our model is based on description logic (DL), which is (...) well known for its adequacy to model terminological knowledge. More specifically, we show how faulty logical form as defined in DL-based Conception Language (CL) impacts the semantic content of linguistic productions that are characteristic of FTD. We accordingly call this the dyssyntax model. (shrink)

L’article s’intéresse à la manière dont Michel Foucault fait usage de la psychanalyse, dont il est un grand lecteur dans les années 1950, essentiellement de Freud. Si elle est parfois enrôlée au sein d’une « fonction-Psy » et ne fait pas l’objet d’un cours spécifique au Collège de France comme la psychiatrie, elle apparaît toutefois comme un problème de longue date, une référence qui persiste tout au long de l’œuvre de Foucault, même si elle est abordée de façon tout à (...) fait pointilliste. En ce sens, elle a un statut à part au sein de cette fonction, parfois contradictoire, assez souvent obscur, tantôt matrice de toutes les institutions disciplinaires, tantôt forme de dépsychiatrisation hors de l’asile. À côté d’un usage « instrumental » asservi à la problématique du savoir-pouvoir pointent des usages tout à fait singuliers. Foucault triture ainsi le concept d’inconscient au point de le rendre tout à fait hétérogène au savoir élaboré par Freud et révisé par Lacan. (shrink)

Background:The belief that we can control our thoughts is not inevitably adaptive, particularly when it fuels mental control activities that have ironic unintended consequences. The conviction that the mind can and should be controlled can prompt people to suppress unwanted thoughts, and so can set the stage for the intrusive return of those very thoughts. An important question is whether or not these beliefs about the control of thoughts can be reduced experimentally. One possibility is that behavioral experiments aimed at (...) revealing the ironic return of suppressed thoughts might create a lesson that could reduce unrealistic beliefs about the control of thoughts. Aims: The present research assessed the influence of the thought suppression demonstration on beliefs about the control of thoughts in a non-clinical sample, and among individuals with obsessive-compulsive disorder (OCD). Method: In Study 1, we assessed the effect of the thought suppression demonstration on beliefs about the control of thoughts among low and high obsessive individuals in the non-clinical population (N= 62). In Study 2, we conducted a similar study with individuals with OCD (N= 29). Results: Results suggest that high obsessive individuals in the non-clinical population are able to learn the futility of suppression through.. (shrink)

According to a popular line of thought, being excluded from interpersonal life is to be exempted from accountability, and vice versa. In ordinary life, this is most often illustrated by the treatment of people with serious psychological disorders. When people are excluded from valuable domains on the basis of their arbitrary characteristics (such as race and sex), they are discriminated against, prevented from receiving the benefits of participation in those domains for morally irrelevant reasons. Exemption from accountability—via exclusion from (...) the interpersonal domain—seems to prevent exempted parties from receiving crucial human goods for morally irrelevant reasons. This chapter discusses two widely deployed ways of trying to ameliorate morally costly disabilities. Both fail to apply viably to various psychopathologies. The solution involves disentangling accountability and interpersonality in a way that also provides insights into our shared human nature. (shrink)

On one influential view, the problems that should attract medical attention involve a disorder, because the goals of medical practice are to prevent and treat disorders. Based on this view, if there are no mental disorders then the status of psychiatry as a medical field is challenged. In this paper, I observe that it is often difficult to establish whether the problems that attract medical attention involve a disorder, and argue that none of the notions of disorder (...) proposed so far offers a successful demarcation criterion between medical and non-medical problems. As an illustration, I consider why delusions are considered pathological and whether they attract medical attention in virtue of being pathological, where ‘pathological’ stands for ‘being caused by a disorder’. Although there are several promising answers to what makes delusions pathological, available accounts of the pathological nature of delusions fail to distinguish delusions from other irrational beliefs that are not typically thought of as pathological; and cannot explain why delusions typically attract medical attention whereas other irrational beliefs do not. (shrink)

Mental disorders are often thought to be harmful dysfunctions. Jerome Wakefield has argued that such dysfunctions should be understood as failures of naturally selected functions. This suggests that evolutionary biology and other Darwinian disciplines hold important information for anyone working on answering the philosophical question, "What is a mental disorder?". In this article, the author argues that Darwinian theory is not only relevant to the understanding of the disrupted functions, but it also sheds light on the disruption itself, (...) as well as on the harm that attends the disruption. The arguments advanced here are partially based on the view that a core feature of Darwinism is that it stresses the environmental relativity of functions and dysfunctions. These arguments show a very close empirical connection between social judgments and dysfunctions, which is of interest for psychiatric theory. Philosophically, they lead to the conclusion that the concept of mental disorder is identical to the concept of mental dysfunction. Consequently, it is both misleading and redundant to conceptualize mental disorders as 'harmful dysfunctions', and not simply as 'mental dysfunctions'. (shrink)

Borderline Personality disorder is a severe personality dysfunction characterized by behavioural features such as impulsivity, identity disturbance, suicidal behaviour, emptiness, and intense and unstable relationships. Approximately 2% of the population are thought to meet the criteria for BPD. The authors of this volume - Anthony Bateman and Peter Fonagy - have developed a psychoanalytically oriented treatment to BPD known as mentalization treatment. With randomised controlled trials having shown this method to be effective, this book presents the first account (...) of mentalization treatment for BPD. The first section gives an overview of BPD, including discussion of nosology, epidemiology, natural history, and psychosocial aetiology. It additionally summarises the present state of our research knowledge about effective psychotherapeutic treatments and use of medication. The second section outlines the authors' theoretical approach and contrasts it with other well known methods, including DBT, CAT, and CBT. In the extensive final section, the authors outline their clinical approach starting with how treatment is organised. A detailed account of the transferable features of the model is provided along with the main strategies and techniques of treatment. Numerous clinical examples are given to illustrate the core techniques and detailed information provided about how to apply aspects of the mentalization based treatment approach in everyday practice. Aimed at mental health professionals, along with counsellors, psychotherapists, and psychoanalysts, the book will be a valuable tool, providing an effective means of treating those suffering from Borderline Personality Disorder. (shrink)

According to a standard picture of agency, a person’s actions always reflect what they most desire, and many theorists extend this model to mental illness. In this chapter, I pin down exactly where this “volitional” view goes wrong. The key is to recognize that human motivational architecture involves a regulatory control structure: we have both spontaneous states (e.g., automatically-elicited thoughts and action tendencies, etc.) as well as regulatory mechanisms that allow us to suppress or modulate these spontaneous states. Our regulatory (...) abilities, however, are bounded. Mental illnesses, I argue, arise precisely where these bounds are reached, thus allowing inappropriate spontaneous states to regularly manifest in thought and action. I conclude that the volitional view of mental illness is wrong: when a person with mental illness reaches the limits of control, what they do often does not reflect what they most prefer. (shrink)

In this paper I aim to provide a characterisation of emotional disorder. I begin by criticising the thought that an agent can be judged to be experiencing an emotional disorder if his emotion causes him some type of harm. This then leads me to develop the claim that emotional disorder relates to sufficiently inappropriate emotion, where (sufficiently) inappropriate emotion relates to emotion that fails to be (sufficiently) responsive to the agent's beliefs and/or desires. Finally, I conclude (...) the paper by suggesting that if an essentially non‐cognitivist conception of emotion is accepted then – on the characterisation of emotional disorder that I defend – there may exist strong grounds for thinking that cognitive therapy will be an inappropriate form of treatment in cases of emotional disorder.1. (shrink)

Plato tries to explain the becoming of the cosmos by referring to the concepts of order and disorder. Scholars have usually focused on the relationship between the cosmos and the demiurge that Plato puts forward to explain the reasonable development. Along these lines, scholarship has examined the providential role played by both the demiurge and the soul of the world. Yet, an interesting prob­lem still remains open: what exactly is the function of disorder? What is the sense of (...) the concept of a perfectly established order if we do not know the manner in which it is achieved, since we have no understand­ing of the conditions that make it possible? Pursuing this line of thought, one may point to a providential role of the disorder given the balance of forces that operates in Plato’s cosmic becoming. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mental Disorder and Intentional OrderRichard Gipps (bio)Bengt Brülde and Filip Radovic inform the reader that they will assume "there is such a thing as a general category of disorder, of which mental and somatic disorders can be regarded as subcategories" (2006, 100). With this assumption in place, they take up a fascinating discussion of what warrants our categorizations of certain disorders as mental as opposed to physical. (...) The answers they then canvass include the possibilities that it is the mentality of the internal causes, or of the symptomatic effects, of these disorders which renders them mental, or that there is no single answer, or that there is no valid distinction to be drawn.In what follows I wish to question the initial assumption, and then offer an understanding of the nature of mentality that I hope will lead to a different way of answering the question, what is mental about mental disorder? It worries me that the views I develop here may share too little by way of common framework assumptions with the views developed in Brülde and Radovic's paper. I hope that this does not render dialogue impossible, or make the thoughts that were inspired by their thoughtful paper appear just too off field to be seriously entertained.The Concept of DisorderBrülde and Radovic assume that "mental disorders" and "physical disorders" are subtypes of a general category of disorder. (In what follows I describe this as the assumption.) They also distinguish between two questions: (1) What is mental about mental disorder? (in what follows I describe this as the question) and (2) What does it take for a condition to be a disorder? This latter question is, they acknowledge, certainly important, but is set aside for the time being.Mental disorder, physical disorder, and we might perhaps also add social disorder, are then subcategories of disorder. They are perhaps not natural kinds, but nevertheless they are subcategories within a general category. With their assumption in place it makes good sense to reject accounts of the mentality of mental disorders that seem to simply presuppose the concepts of mind and body when they address the question.There is of course a trivial sense in which everyone must agree that mental disorders and physical disorders are to be considered subcategories of disorder. There is what could be described as a logical sense of category and subcategory, in which any noun is said to designate a category and any adjectival qualification of it to introduce a subcategory. However, we can also distinguish what I call a "semantic" sense, in which talk of categories and subcategories is more restricted. Here we rely on there being a unitary sense to the putative category if we are to talk meaningfully of subcategories of this single category. [End Page 117]The philosophy of the individuation of senses is not within my expertise, but I am relying on an intuitive notion spelled out by the following. First, that a good dictionary would elaborate these senses by providing different definitions of the putative category rather than a single definition followed by examples. Second, that when we do not have to do with categories in the semantic sense, we would find ourselves more in want of true understanding of what was being said, and not so much in want of mere further knowledge, if we are offered a description that included the noun (disorder) without the qualifier (mental). Third, that we are less likely to be dealing with subcategories within a general semantic category if we easily can turn the adjective–noun pair (e.g., mental disorder) around to provide two nouns in a short phrase (e.g., disorder of the mind), or if there are verbal and adjectival forms of the second noun that can also be used in conjunction with the first noun (e.g., disordered mind).An example serves to make things clearer. Consider a chemist who has a reaction in her laboratory. What is referred to may be an emotional reaction (to her sudden scientific breakthrough), or a chemical reaction. In this case, I suggest, we do not have to do with a semantic category of "reaction," which... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mental Disorder and Moral Responsibility:Disorders of Personhood as Harmful Dysfunctions, With Special Reference to AlcoholismJerome C. Wakefield (bio)Keywordsalcohol dependence, philosophy of psychiatry, mental disorder, harmful dysfunction, psychiatric diagnosis, person, moral responsibilityIn his paper, Ethical Decisions in the Classification of Mental Conditions as Mental Illness, Craig Edwards grapples with a profound problem: why is it that when we classify a mental condition as a mental disorder, that (...) tends to take the condition out of the sphere of moral responsibility or virtuousness of character? For example, it is not uncommon when someone commits suicide and the question is raised as to why he or she did it, that instead of a reason or character trait that would place the act within a moral calculus, one is offered the explanation "she was clinically depressed" or "he was bipolar," and this tends to terminate discussion and make reasons and moral evaluation superfluous. Why does such a comment have that effect?As Edwards notes, this can get complicated as the moral and the disordered interact. Certainly people are sometimes morally responsible for acting on their disordered impulses (as in pedophilia), and they are responsible for putting themselves in the way of disorder, as when someone imbibes in a way likely to lead to alcoholism. But at the normal/disorder divide, there seems to be a consistent lifting of some responsibility, reflecting the application of the sick role. For example, the rough equivalent of our current category of post-traumatic stress disorder (PTSD) was recognized as a disorder in earlier wars ("shell shock," "war neurosis"), but often considered an expression of cowardice; the cowardice was morally evaluable as a failure of virtue (even if, like many personality traits, being a coward is not within the person's direct voluntary control) and led to contempt for those with PTSD, but nonetheless—except in cases thought to be malingering—the PTSD that resulted constituted a disorder for which the individual was [End Page 91] not in the same direct sense blameworthy. This moral shift requires explanation.This topic also has important social ramifications. Relief from responsibility may sound like a good thing, and it is trumpeted by mental health advocates as a reason for supporting the classification of many conditions as disorders. But as Edwards is aware, it is a two-edged sword. Disordered status may allow escape from censure and offer the protections of the sick role, but it also changes the relationship of the agent to his or her own actions and imposes the responsibility of the sick role on the individual to attempt to change ("get better"). The sick role allows for no defense of an idiosyncrasy based on normal variation ("It takes all kinds…") or the individual's eccentric vision or steadfast integrity, for that vision or sense of integrity are now seen as pathological and not morally legitimate. The individual is subjected to endless entreaties to seek help and it is implied that not to do so is irresponsible, so that a decision to embrace one's nature and remain as one is becomes illegitimate. Moreover, the sick role allows for no explanation in terms of the individual's normal defensive response to unjust, deprived, or challenging social or environmental circumstances, thus weakening the motives for social change rather than individual intervention.In sum, there is an inevitable sense in which being placed in the sick role inherently stigmatizes the "sick" condition in virtue of the special moral attitudes extended to the disordered. Cultures can thus easily exploit the sick role and its much-touted relief from responsibility to extend the reach of social control processes. This is one reason why the distinction between disorder and non-disorder is so important, and why it is crucial to identify when non-disordered conditions are mislabeled as disorders—as when, for example, psychiatry gets it wrong about the distinction between normal and disordered sadness (Horwitz and Wakefield, 2007). Such overpathologization can redefine the boundaries of our moral universe on mistaken grounds.Edwards offers two provocative answers—not entirely at ease with each other—to the question of why mental disorders relieve the patient from moral responsibility: (1) mental disorders are... (shrink)

The problems of contemporary states are in large part “affective disorders”; they are failures of states to properly understand and coordinate the emotions of the individuals within and in some instances outside the state. By excluding, imprisoning, and marginalizing members of their societies, states create internal enemies who ultimately enervate their own power and the possibility of peace and freedom within the state. Spinoza’s political theory, based on the notion that the best forms of state are those that coordinate the (...) power and emotions of those within a state, offers us both a diagnosis of and a cure for these affective disorders. In this paper I will outline Spinoza’s notion of the power of the state as a function of the power and coordination of the emotions of its citizens, and show that when the state contracts an affective disorder, such as excessive crime, rebellion, terrorism, etc. the state has failed to properly empower, include and coordinate the passions of the multitude of its citizens and subjects. (shrink)

It is widely agreed that obsessive-compulsive disorder involves irrationality. But where in the complex of states and processes that constitutes OCD should this irrationality be located? A pervasive assumption in both the psychiatric and philosophical literature is that the seat of irrationality is located in the obsessive thoughts characteristic of OCD. Building on a puzzle about insight into OCD (Taylor 2022), we challenge this pervasive assumption, and argue instead that the irrationality of OCD is located in the emotions that (...) are characteristic of OCD, such as anxiety or fear. In particular, we propose to understand the irrationality of OCD as a matter of harboring recalcitrant emotions. We argue that this account not only solves the puzzle about insight, but also makes better sense of how OCD sufferers experience and describe their condition and helps explain some otherwise puzzling features of compulsive behavior. (shrink)

Mental disorders are often thought to be harmful dysfunctions. Jerome Wakefield has argued that such dysfunctions should be understood as failures of naturally selected functions. This suggests, implicitly, that evolutionary biology and other Darwinian disciplines hold important information for anyone working on answering the philosophical question, ‘what is a mental disorder?’. In this article, the author argues that Darwinian theory is not only relevant to the understanding of the disrupted functions, but it also sheds light on the disruption (...) itself, as well as on the harm that attends the disruption. The arguments advanced here are partially based on the view that a core feature of Darwinism is that it stresses the environmental relativity of functions and dysfunctions. These arguments show a very close empirical connection between social judgments and dysfunctions , which is of interest for psychiatric theory. Philosophically, they lead to the conclusion that the concept of mental disorder is identical to the concept of mental dysfunction. Consequently, it is both misleading and redundant to conceptualize mental disorders as ‘harmful dysfunctions’, and not simply as ‘mental dysfunctions’. (shrink)

Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/uws) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial nutrition (...) and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/uws more respondents agreed with treatment withdrawal when they considered that VS/uws patients did not feel pain (77%) as compared to those who thought VS/uws did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments. (shrink)

It is commonly thought that mental disorder is a valid concept only in so far as it is an extension of or continuous with the concept of physical disorder. A valid extension has to meet two criteria: determination and coherence. Essentialists meet these criteria through necessary and sufficient conditions for being a disorder. Two Wittgensteinian alternatives to essentialism are considered and assessed against the two criteria. These are the family resemblance approach and the secondary sense approach. (...) Where the focus is solely on the characteristics or attributes of things, both these approaches seem to fail to meet the criteria for valid extension. However, this focus on attributes is mistaken. The criteria for valid extension are met in the case of family resemblance by the pattern of characteristics associated with a concept, and by the limits of intelligibility of applying a concept. Secondary sense, though it may have some claims to be a good account of the relation between physical and mental disorder, cannot claim to meet the two criteria of valid extension. (shrink)

Apotemnophilia, a disorder that blurs the distinction between neurology and psychiatry, is characterized by the intense and longstanding desire for amputation of a speci¢c limb. Here we present evidence from two individuals suggestive that this condition, long thought to be entirely psychological in origin, actually has a neurological basis. We found heightened skin conductance response..

Mental disorders are often thought to be harmful dysfunctions. Jerome Wakefield has argued that such dysfunctions should be understood as failures of naturally selected functions. This suggests, implicitly, that evolutionary biology and other Darwinian disciplines hold important information for anyone working on answering the philosophical question, 'what is a mental disorder?'. In this article, the author argues that Darwinian theory is not only relevant to the understanding of the disrupted functions, but it also sheds light on the disruption (...) itself, as well as on the harm that attends the disruption. The arguments advanced here are partially based on the view that a core feature of Darwinism is that it stresses the environmental relativity of functions and dysfunctions. These arguments show a very close empirical connection between social judgments and dysfunctions, which is of interest for psychiatric theory. Philosophically, they lead to the conclusion that the concept of mental disorder is identical to the concept of mental dysfunction. Consequently, it is both misleading and redundant to conceptualize mental disorders as 'harmful dysfunctions', and not simply as 'mental dysfunctions'. (shrink)

A few years ago an interesting exhibition took place in Cambridge (and London) under the title ‘N01SE’.2 The title recalls of course the word ‘noise’ but written as ‘N01SE’ it also refers to the binary code (with the two numbers 0 and 1) which is the basic language of calculators - from the simplest to the most sophisticated, (eg. contemporary computers). The title of this exhibition could then be read in two ways. On one side, by playing with the word (...) ‘noise/n01se’, we are presented with the idea that there might be a core of information in any situation of noise, provided that there is a context, an interpretation, a point of view which allows us to identify such information and to decode it. On the other side, we are prompted to reflect critically on the assumptions and goals of the revolutionary field of contemporary digital technologies, whose promise is indeed that of a complete removal of any sort of noise. Is such a promise achievable? At what costs? Should noise, any form of noise, be removed? Is noise inevitably the dark side of any form of information? Is it the opposite of order? Are there contexts in which we can value its presence? Can noise turn into its purported opposite? Attendance at the Cambridge exhibition is what originally prompted some of the thoughts and ideas I explore in this paper. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Vice, Disorder, Conduct, and CulpabilityStephen J. Morse (bio)Keywordsvice, conduct, culpability, mental disorderDr. John sadler’s interesting paper raises an important issue. It defines vice as criminal, wrongful or immoral behavior. He claims that the Diagnostic and Statistical Manual of Mental Disorders (DSM) “confounds the concepts of vice and mental illness” and that this confounding has “important implications... for the relationship between crime, criminality, wrongful conduct, and mental illness.” The (...) paper correctly notes that disorders for which vice is the primary criterion tend to be impoverished diagnostically and are probably less valid than non–vice-related disorders. Dr. Sadler wonders if the subjects of his case studies are “involved in sick behavior, immoral behavior, both, neither, or some other metaphysical kind altogether.” This is an excellent question that this comment will seek to clarify. It will also consider the moral and legal implications of the answer.The domain of immoral, wrongful, and criminal behavior is essentially action. Some moral and religious traditions evaluate the content of an agent’s thoughts, desires, and character, but the dominant view is that vice primarily describes action that is wrongful because it violates the rights of others or it is wrong in itself. The rules of morality and law create value, but their essential task is to guide the action of agents who must live together. Dr. Sadler does not explicitly recognize that the diagnostic criteria that are vice are all actions, and not simply abnormal perceptions, desires, thoughts, or moods. His three case studies of conduct disorder, factitious disorder, and paraphilia confirm this point. Even pedophilia, which can be diagnosed simply on the basis of urges or fantasies that cause marked distress or interpersonal difficulty, would not be considered a vice unless the agent acted on these sexual urges. Those individual actions that meet Dr. Sadler’s criteria for vice I will term “vice actions.”Actions, including vice actions, may be evaluated medically and morally. There is no logical or conceptual reason why the same action cannot be both a sign of mental disorder and wrongful and potentially blameworthy. Actions can be just mad, just bad, or mad and bad. Also, the same action may sometimes be a sign of disorder and sometimes not. No general argument suggesting the contrary is provided. Consequently, there is no confound between the concepts of vice and mental disorder unless vice actions fail to satisfy the generic criteria for being a sign of mental disorder. Dr. Sadler seems to implicitly recognize [End Page 47] this when he asks whether vice–mental disorder relationship criteria are impoverished because there is a lack of consensus about “the minimum requirements for an acceptable set of descriptive criteria for a mental disorder category,” or when he asks “where criminal syndromes... fit into a classification of mental disorders.”No consensual, generic definition of mental disorder exists, and deciding whether actions should be signs of mental disorder is particularly fraught because cultural context and values always play a role in the definition of mental disorder. The other potential signs and symptoms of mental disorder are virtually all phenomena that simply happen to people and are not products of agency. Actions are by definition the product of agency, however, and vice actions affect by definition the rights and interests of others. The latter is true whether or not the agent is “vicious.” Even if an agent who has done wrong is excused, the rights of the victim have been violated.Moral, political, and legal evaluation is largely beside the point for non-action signs and symptoms, but it is always on point for vice actions. This is the primary potential source of the confound between vice and disorder. To claim that a vice action is a sign of disorder because it is vice begs the question and is indeed a confound. Even the presence of a biological marker will not save this claim. All human action presumably has biological markers and one cannot say that a marker is of a disorder without first having an independent definition of disorder that the vice action satisfies.Until a robust theory of mental disorder is provided, we cannot determine whether a vice action is... (shrink)

Autism continues to fascinate researchers because it is both debilitating in its effects and complex in its nature and origins. The prevalent theory is that autism is primarily characterised by difficulties in understanding mental concepts, but the contributors to this book present new and compelling arguments for an alternative theory. Their research points strongly to the idea that autism is primarily a disorder of "executive functions", those involved in the control of action and thought. As such, the book (...) provides a new and controversial perspective on this important question. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:What Makes a Mental Disorder Mental?Jerome C. Wakefield (bio)Keywordsharmful dysfunction, mental disorder, intentionality, mental dysfunction, mental functioning, phenomenality, somatic disorderWhat makes a medical disorder mental rather than (exclusively) somatic or physical? Psychiatry to some extent depends for its existence as a medical specialty on the distinction between mental and somatic disorders, yet the history of this distinction presents a bewildering array of puzzling judgments, radical shifts, (...) and seemingly arbitrary distinctions. The historical observation that putative mental disorders are often reclassified as physical disorders as soon as their physiologic basis is understood further confuses matters. Moreover, recent debates about such classifications often seem to reflect desires to protect professional turf or obtain optimal reimbursement for treatment more than they do the application of a coherent conceptual distinction. No wonder that Brülde and Radovic (2006) disarmingly admit at the outset of their exploration of this question that there is a case to be made that their topic is relatively unimportant or even meaningless intellectually, a rare way to start an inquiry!Could there nonetheless be a cogent conceptual distinction lurking here? Brülde and Radovic usefully invite us to reframe the question, in effect as follows: Suppose we pay attention to professional and lay judgments as evidence but at the same time try to avoid being ensnared by the distortions resulting from turf issues and other pragmatic motives and constraints. Can we then identify some principled distinction in this domain that is worth making and that interestingly corresponds to the distinction generally made between mental disorders and strictly somatic disorders? Brülde and Radovic do not come to any confident or compelling conclusion about this.My answer, based on my harmful dysfunction analysis of disorder (Wakefield, 1992a, 1992b, 1999a, 1999b), is that a mental disorder is a harmful mental dysfunction, where a mental dysfunction is a failure of the capacity of some mental mechanism to perform a function for which it was biologically designed. I argue that, owing to a series of logical missteps, Brülde and Radovic needlessly reject this view. After some preliminary comments and clarifications, I defend the internal dysfunction approach from the objections posed by Brülde and Radovic, and then conclude by elaborating this view in some new ways. Note that Brülde and Radovic critique something they call the "internal cause view" of what makes a disorder mental, and they name others who hold that view. However, my work figures prominently in their discussion, and for expository simplicity, I will presume to simply construe their arguments as aimed at the harmful dysfunction analysis. [End Page 123]Clarifying the QuestionIt is easy to misconstrue the question "What makes a mental disorder mental" as demanding a precise account of the mental, an error to which Brülde and Radovic succumb in their repeated complaints that various writers do not present principled accounts of the mental but rely on lists of prototypical mental states or tentative guidelines to fix the reference of mental. We would need a precise definition of mental if the problem were how to classify cases in which it is ambiguous whether some phenomenon is mental or physical. We might imagine, for example, someone being genuinely puzzled as to whether inability to sleep is failure of a mental function or process. But this sort of puzzle about the boundaries of the mental is not the problem with which Brülde and Radovic are concerned; anyway, ambiguous cases may just be inherently ambiguous. The problem, which a crisp definition of mental will not resolve, is what relation mental states or mechanisms must have to a disorder to make it a mental disorder; must there be mental symptoms, or mental dysfunctions, or either one, and so on? But, even if a precise resolution of the nature of the mental is not needed, some notion of the mental domain is essential in pursuing this discussion. We can pick out the mental ostensively, by pointing to lots of examples (e.g., perception, motivation, emotion, thought, and sensation) much more confidently than we can define it in a principled way. But because Brülde and Radovic find fault in such ostensive reference fixing, let me... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Vice, Mental Disorder, and the Role of Underlying Pathological ProcessesNancy Nyquist Potter (bio) and Peter Zachar (bio)Keywordsresponsibility, virtue theory, cultural norms, psychopathologyThe issues discussed by John Sadler are among the most complicated in the philosophy of psychiatry, if for no other reason than that they highlight an area where disciplinary fault lines between clinical psychiatry/ psychology and philosophy seem most evident. We spent a year writing an article (...) on the relationship between the assessment of personality disorders and moral evaluations, and these fault lines became manifest not only between ourselves, but also when discussing our ideas with members of the various disciplines.Many practicing psychiatrists acknowledge that moral attributions (such as manipulativity) might be made about people with certain disorders (such as borderline personality disorder), but also find the argument that psychiatric diagnoses are moral rather than medical conditions to be a ludicrous bit of antipsychiatry in the Szaszian tradition. Philosophers, on the other hand, are less involved with these diagnostic categories in their day-to-day work and are more willing to be skeptical. Whether they are doing philosophy of psychiatry, moral theory, or sociopolitical philosophy, they are interested in digging a little bit deeper and are not impressed by arguments to the effect that—it’s obvious that these are really disorders. Being “obvious” is not a persuasive philosophical argument.The metaphysical task of determining what belongs in the category of criminality compared with other ways of sorting behavior has parallels in moral philosophy: Why is fraud, or theft, criminalized whereas (most) lying is not? Why is one set of moral norms enforceable, whereas a second set is aspirational? Does the difference involve property, where infractions of property are thought to be more serious wrongs than lying, which is “only” psychological rather than material? Are the “most serious” wrongs the ones we mark as crimes? Why is sodomy still criminalized in some areas but betraying one’s lifelong love is viewed as morally reprehensible but not criminal? Both actions are private, and only one seems to do harm—unfaithfulness—yet that is the one that is not criminalized. The point here is that, regardless of domain, our classification systems need to be justifiable, yet justification is most often mystifying. [End Page 27]The same is true for classifying mental disorders. The class of mental disorders appears to be a somewhat inconsistent collection of heterogeneous conditions and does not form a natural kind (Zachar 2000). At the most, the class of mental disorders names a family of loosely related conditions and the reasons for inclusion can shift from disorder to disorder.If the class of mental disorders does not specify an internally coherent kind akin to gold, deciding on the scope of psychiatric practice becomes an important problem. As Sadler asks, for what reasons do we classify pedophilia with schizophrenia—both as disorders—but omit sadism? This is an important question of disciplinary scope.This question of scope is itself ethically charged because, on the one hand, bringing a condition under the purview of psychiatry offers the possibility for treatment, and at least establishes the goal of improving the lives of people with specific kinds of problems. Making lives better is one of the humanistic justifications for science itself; clearly it is a raison d’être of psychiatry. On the other hand, medicalization sets up the conditions for a certain kind of social control. Hospitalization, educational services, day treatment, and disability payments are all contingent upon psychiatric diagnostic practices. These programs and the institutions that manage them are both socially available and socially prescribed. The diagnosed behaviors can now be considered to be entities, and explanations of them can be developed. New technologies for altering them will also be introduced. Such practices have been associated with dehumanization (Phillips 2009).Two important questions also need to be distinguished. The first is a question for moral philosophy—What degree of responsibility do people with putative mental disorders have for their behaviors? For example, should people with psychotic disorders or personality disorders be held responsible for crimes they commit? If so, under what conditions? Should responsibility for certain behavior be mitigated? If so, under what conditions? Moral philosophy... (shrink)

Just fifteen years ago, the common non-religious consensus was that homosexual acts were immoral. Within one decade, however, this consensus waned. The secular majority no longer held, as they previously did, that such actions are morally bad. What explains this sudden change? One explanation is that many conservatives lacked adequate philosophical tools to explain the foundations of the earlier historical consensus. Another is that modern research has shown that there never existed any solid philosophical grounds for calling such actions immoral (...) in the first place. This book questions the latter narrative; for prior to this book no exhaustive historical treatment of philosophical thought on the moral question of homosexual acts existed. Both liberals and conservatives failed to research adequately the long history of thought on this issue. The current author not only argues that the earlier non-religious philosophical consensus has largely been ignored, but that the proliferation of arguments in favor of acting on homosexual inclinations reveal a strong desire to justify what isn't possible to justify morally. The non-religious arguments of the great philosopher Thomas Aquinas are then examined; they reveal that his reasoning can soundly show that acting on homosexual inclinations is morally wrong, and also that the same argument rightly entails that every untruthful assertive speech act is morally problematic. If conservatives wish to be consistent, they ought to reject lying too. And if liberals expect conservatives to believe that what they preach is true, then they ought to stand with Aquinas and reject all lying as intrinsically evil. (shrink)

A few years ago an interesting exhibition took place in Cambridge under the title ‘N01SE’.2 The title recalls of course the word ‘noise’ but written as ‘N01SE’ it also refers to the binary code which is the basic language of calculators - from the simplest to the most sophisticated,. The title of this exhibition could then be read in two ways. On one side, by playing with the word ‘noise/n01se’, we are presented with the idea that there might be a (...) core of information in any situation of noise, provided that there is a context, an interpretation, a point of view which allows us to identify such information and to decode it. On the other side, we are prompted to reflect critically on the assumptions and goals of the revolutionary field of contemporary digital technologies, whose promise is indeed that of a complete removal of any sort of noise. Is such a promise achievable? At what costs? Should noise, any form of noise, be removed? Is noise inevitably the dark side of any form of information? Is it the opposite of order? Are there contexts in which we can value its presence? Can noise turn into its purported opposite? Attendance at the Cambridge exhibition is what originally prompted some of the thoughts and ideas I explore in this paper. (shrink)

First published in 1977, Emotion, Thought and Therapy is a study of Hume and Spinoza and the relationship of philosophical theories of the emotions to psychological theories of therapy. Jerome Neu argues that the Spinozists are closer to the truth; that is, that thoughts are of greater importance than feelings in the classification and discrimination of emotional states. He then contends that if the Spinozists are closer to the truth, we have the beginning of an argument to show that (...) Freudian or analytic therapies make philosophic sense. Throughout the book, careful attention is paid to modern discussions in philosophy of mind and psychology, and materials from anthropology and other relevant disciplines are considered. At the centre of the discussion is the notion of ‘thought-dependence’. Therapies for psychological disorders are placed along a spectrum in accordance with the role they assign to thoughts. The Spinozist view of the emotions can be seen as at the extreme thought end of a corresponding spectrum of theories of the emotions. The book suggests that this stream may help explain the spectrum of therapeutic theories and the possibilities that exist for psychological development and change. This book will be of interest to students of philosophy, psychology and counselling. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Still Defining Mental Disorder in Terms of Our Goals for Demarcating Mental DisorderJukka Varelius (bio)Keywordsmental disorder, definition, psychological capacity for autonomy, Matthews, SavulescuI thank Eric Matthews and Julian Savulescu for their thought-provoking comments. Unfortunately, I am not here able to discuss all the important points they raise, but must settle for briefly addressing their main criticisms of my view.Reply to MatthewsI believe that some arguments are (...) rationally irresolvable, but do not think that about all philosophical arguments. In terms of moral philosophical argumentation, though not only that, I share the rather common belief that we should proceed by seeking reflective equilibrium between requirements of logic, the best factual knowledge about ourselves and our environment, and our strongly held evaluative intuitions. (This is not to say that there would always be a clear distinction between facts and values.) By such intuitions I refer, for example, to the intuition that it is morally wrong to torture babies for fun. If we are considering whether it is morally permissible to act in a particular way and realize that acting in that way is in the morally relevant respects similar to torturing babies for fun, we conclude that it is not morally permissible to act in that way. That question is solved for persons who accept the moral intuition that it is wrong to torture babies for fun and wish to take facts and logic into account. This method is useful in the context of defining mental disorder, too.Although we have some strongly held intuitions as to what mental disorder is about, such as that person A is a paradigm case of a mentally disordered person, referring to them has not sufficed to solve the controversy concerning the demarcation of mental disorder. Therefore, I want to consider the possibility that referring also to the goals we have for demarcating mental disorder could help us in solving it. At this stage of enquiry at least, I thus believe that the controversy is solvable, but only among persons who share certain points of departure. Accordingly, the "our" in expressions like 'our goals for demarcating mental disorder,' whose reference Matthews enquires about, refer to those who share the intuition that A is a paradigm example of a mentally disordered person, consider the demarcation goals significant, want to take [End Page 67] facts into account, and wish to make logically valid inferences.If one cares about the other things but does not want to consider A's case, one can focus on some other case of a person whose psychological capacity for autonomy is diminished. (Unless, of course, one thinks that no such persons exist and all whom we believe to lack psychological capacity for autonomy are really playacting, malingering, etc.) I, however, now continue with A's case. We have, ex hypothesi, sufficient reason to believe that A lacks not merely relevant information, but also the psychological capacity that understanding it and making use of it in assessing her beliefs and desires presupposes. If someone who knows this about A still insists that A is in perfect mental health and wants, say, to treat her as an object of entertainment in a human zoo, my argument is unlikely to reach him. But who is he to say that we should not care about A's loss of capacity for autonomy and the misfortunes it involves?And of course, also rationally establishing that a person who lacks such capacity is mentally healthy or that the controversy on the nature of mental disorder is not rationally resolvable presupposes that the discussants share some points of departure, including evaluative intuitions. Instead of the intuitions that to be ill is essentially to suffer harm, that behavior governed by one's feelings is always autonomous, and so on, that Matthews refers to, proponents of such views are, however, well advised to resort to less obscure and less controversial intuitions. What, for example, is meant by 'harm'? Is a person who is so overwhelmed by emotions that she is unable to think clearly always autonomous with respect to the actions she performs while in that state? If one takes that all intuitions are useless... (shrink)

In this paper, I investigate in detail one theoretical approach to the symptom of thought insertion. This approach suggests that patients are lead to disown certain thoughts they are subjected to because they lack a sense of active participation in the occurrence of those thoughts. I examine one reading of this claim, according to which the patients’ anomalous experiences arise from a breakdown of cognitive mechanisms tracking the production of occurrent thoughts, before sketching an alternative reading, according to which (...) their experiences have to be explained in terms of a withdrawal, on the part of the patients themselves, from certain forms of active engagement in reasoning. I conclude with a discussion of the relationship between this view and the idea that patients’ reports of thought insertion reflect a situation in which the boundaries between the self and the world have become uncertain. (shrink)

Hume's explanation of our tendency to confuse calm passions with reason due to lack of feeling appears to present a tension with his claim that we cannot be mistaken about our own impressions. I argue that the calm/violent distinction cannot be understood in terms of presence/absence of feeling. Rather, for Hume the presence or absence of disruption and disordering of natural and/or customary modes of thought is the key distinction between the calm and violent passions. This reading provides new (...) explanations of our confusion of calm passions with reason, and the potential for calm passions to prevail over violent. (shrink)

Obsessive-compulsive disorder (OCD) is considered to be one of the more common serious mental disorders, with a prevalence rate of about 1% (Heyman et al. 2006). It is characterized by obsessions, or compulsions, or both. According to the DSM-IV (American Psychiatric Association 1994), obsessions are “recurrent and persistent thoughts, impulses, or images that are experienced at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.” Compulsions, on the other hand, are repetitive behaviors (...) (e.g., hand washing, ordering, checking) or “mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied .. (shrink)

Why do thoughts involving harm and damage trigger guilt in certain individuals and not in others? The significance of this question comes into view when considering the medical and psychological literature on patients with obsessive-compulsive disorder (OCD). Patients with OCD feel guilt in response to having certain recurring, negative thoughts whose content evoke scenarios of harm and damage. This, however—at least in most readings of what those thoughts consist of—is puzzling. The transition from having a thought about being (...) the source of harm popping up in one’s mind to feeling guilty is not straightforward, and it calls for explanation. Indeed, OCD appears to challenge a traditional picture of what guilt is all about... (shrink)

Safe stair negotiation is an everyday task that children with developmental coordination disorder are commonly thought to struggle with. Yet, there is currently a paucity of research supporting these claims. We investigated the visuomotor control strategies underpinning stair negotiation in children with and without DCD by measuring kinematics, gaze behavior and state anxiety as they ascended and descended a staircase. A questionnaire was administered to determine parents' confidence in their child's ability to safely navigate stairs and their child's (...) fall history. Kinematics were measured using three-dimensional motion capture, whilst gaze was measured using mobile eye-tracking equipment. The parents of DCD children reported significantly lower confidence in their child's ability to maintain balance on the stairs and significantly more stair-related falls in the previous year compared to the parents of typically developing children. During both stair ascent and stair descent, the children with DCD took longer to ascend/descend the staircase and displayed greater handrail use, reflecting a more cautious stair negotiation strategy. No differences were observed between groups in their margin of stability, but the DCD children exhibited significantly greater variability in their foot-clearances over the step edge, which may increase the risk of a fall. For stair descent only, the DCD children reported significantly higher levels of state anxiety than the TD children and looked significantly further along the staircase during the initial entry phase, suggesting an anxiety-related response that may bias gaze toward the planning of future stepping actions over the accurate execution of an ongoing step. Taken together, our findings provide the first quantifiable evidence that safe stair negotiation is a significant challenge for children with DCD, and that this challenge is reflected by marked differences in their visuomotor control strategies and state anxiety levels. Whilst it is currently unclear whether these differences are contributing to the frequency of stair-related falls in children with DCD, our findings pave the way for future research to answer these important questions. (shrink)

On January 5, 2019, the Associated Press reported that a woman thought to have been in the vegetative state for over a decade gave birth at a Hacienda HealthCare facility. Until she delivered, the staff at the Phoenix center had not noticed that their patient was pregnant. The patient was also misdiagnosed.Misdiagnosis of patients with disorders of consciousness in institutional settings is more the norm than the exception. Misdiagnosis is also connected to a broad and extremely significant change in (...) the understanding of the vegetative state—a change that the field of bioethics has not yet fully taken into account. In September 2018, the American Academy of Neurology, the American College of Rehabilitation Medicine, and the National Institute on Disability, Independent Living, and Rehabilitation Research issued a comprehensive evidence‐based review on disorders of consciousness and an associated practice guideline on the care of these patients. These landmark publications update the 1994 Multi‐Society Task Force Report on the Vegetative State, which subcategorized the persistent vegetative state as either persistent (once the vegetative state lasted one month) or permanent (once the vegetative state lasted three months after anoxic injury or twelve months after traumatic injury). Noting that 20 percent of patients thought to be permanently unconscious might regain some level of consciousness, the new guideline has eliminated the permanent vegetative state as a diagnostic category, replacing it with the chronic vegetative state. (shrink)

As the title suggests, the book's theme is inspired by, and also stands in contrast to, Hayek's theme and title of his book, Individualism and Economic Order. the chapters are the papers written by James Buchanan after the publication of his Collected Work volumes, with and without co-authorship with Yoon. These chapters reflect the authors' thoughts on politics seen through fiscal policies and the tragedies of the commons and anticommons in collective actions. the pathologies of democratic politics rigorously analyzed in (...) the book prove the relevance of Buchanan's constitutionalism. (shrink)

This article discusses a puzzle arising from the phenomenon of insight in obsessive–compulsive disorder. “Insight” refers to an awareness or understanding of obsessive thoughts as false or irrational. I argue that a natural and plausible way of characterizing insight in OCD conflicts with several different possible explanations of the epistemic attitude underlying insight‐directed obsessive thought. After laying out the puzzle for five proposed explanations of obsessive thought and then discussing several possible ways that the puzzle might be (...) avoided, I close the article by arguing that we can avoid the puzzle by adopting a new positive view of insight‐directed obsessive thought. (shrink)

"Disgust and Its Disorders: Theory, Assessment, and Treatment Implications thoughtfully examines the role of disgust in psychopathology by highlighting important theoretical and methodological developments and discussing recent research on behavioral patterns that can be provoked by disgust. Contributors demonstrate that disgust plays an important role in a wide range of psychopathology, including sexual dysfunction, eating disorders, animal phobias, and obsessive - compulsive disorder. Disgust is shown to be a multidimensional construct that centers on the unifying theme of potential contamination (...) of the body, soul, and broad social order. Editors Bunmi O. Olatunji and Dean McKay thoroughly review the available research on disgust and shed light on how its interpretation will, in turn, facilitate the development of better treatment of disgust-related avoidance."--BOOK JACKET. (shrink)

Various psychopathologies of self-awareness, such as somatoparaphrenia and thought insertion in schizophrenia, might seem to threaten the viability of the higher-order thought (HOT) theory of consciousness since it requires a HOT about one’s own mental state to accompany every conscious state. The HOT theory of consciousness says that what makes a mental state a conscious mental state is that there is a HOT to the effect that “I am in mental state M” (Rosenthal 2005, Gennaro 2012). In a (...) previous publication (Gennaro 2015), I argued that a HOT theorist can adequately respond to this concern with respect to somatoparaphrenia. Somatoparaphrenia is a “depersonalization disorder” which is characterized by the sense of alienation from parts of one’s body. It is a bizarre type of body delusion where one denies ownership of a limb or an entire side of one’s body. My focus in the chapter, however, is on “inserted thoughts” which is a common symptom of schizophrenia, although it will also be useful to contrast it with somatoparaphrenia. Schizophrenia is a mental disorder which most commonly manifests itself through auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking. Thought insertion is the delusion that some thoughts are not “one’s own” in some sense or are somehow being inserted into one’s mind by someone else. Graham and Stephens (2000), for example, have suggested that thought insertion should be understood as alienated self-consciousness or meta-representation. I argue that HOT theory has nothing to fear from this phenomenon either and can consistently explain what happens in this admittedly unusual case. (shrink)

The concept of hysteria is traced from Hippocrates, where it was thought to be caused by a wandering uterus, through Galen and up to Freud. Throughout the history of medicine from the early Greeks up to the end of the nineteenth century, the definition and diagnosis of hysteria had a function similar to that found in the persecution of witchcraft: it sought to eradicate the outbursts of nonconforming and emotionally threatening conduct of women. At the beginning of the twentieth (...) century, however, the category virtually disappears from psychiatric nosologies. (shrink)