In lieu of an abstract, here is a brief excerpt of the content:Schizophrenic Delusions, Embodiment, and the BackgroundGiovanni Stanghellini (bio)Keywordsschizophrenia, delusion, embodiment, common sense, phenomenologyIn their article Delusions, Certainty, and the Background, Rhodes and Gipps (2008) argue for a Background theory of delusions. Their central argument may be summed up as follows:• The formation and maintenance of delusions becomes intelligible once they are seen to reflect a basic disturbance. When studying delusions, the focus should be on providing an adequate framework (...) for understanding, rather than providing empirical hypotheses to be tested.• The basic disturbance in delusions, and insanity in general, is not a deficiency in reasoning or a defect in the content of experience, but rather something more fundamental.• Delusions––this is their central claim––are caused by a failure of the Bedrock of beliefs (Wittgenstein) or the Background (Searle) to adequately inform or constrain the process of belief formation.• Our Bedrock certainties are defined––following Wittgenstein––as ultimately constituted by our ability to act in the world and demonstrate our primary engagement with the world. They are born out of our everyday experience of the world, conveying our direct, pre-reflective, and practical grasp of the world, rather than expressing judgments we make about it.• Similarly, the Background is defined as those abilities and dispositions that are neither representations nor rules, that function before we can make sense of our experiences.• Wittgenstein’s Bedrock and Searle’s Background in great part overlap with Blankenburg’s pre-reflective natural self-evidence and Stanghellini’s common sense, namely, our own unreflecting know-how, a set of nonpropositional skills, capacities, and dispositions that attune us with the world.• Without a fully functioning Background, the distinctions between imaginary and real (mind and world), self and non-self, and cause and coincidence fail to be adequately drawn within experience. Also, grasping the meaning of others’ behaviors and a weakening of contextual influences are entailed by an erosion of Background sensibilities.I feel extremely sympathetic to this account and, as Rhodes and Gipps report, there are remarkable points of overlap between their and my own ideas about the formation of schizophrenic delusions. I would like to add some comments on the main theories on the basic disorders entailed in the pathogenesis of delusions and conclude with some suggestions to integrate the Background theory of delusions. [End Page 311]Syntagmatic Versus Paradigmatic Models of DelusionsLet me raise first an epistemological point: paradigmatic models of delusions––defining what a delusion is in itself and what are its borders with similar phenomena––proved to be unsatisfactory in psychopathology. As Schneider and Huber (1975) put it more that 40 years ago, “[w]hat counts in delusions is not the delusion itself... but snagging the course of the lived experience, rather than its product” (p. 2042). What we do need, to understand what delusions really are, are syntagmatic models how––delusions (in this case, delusions in persons with schizophrenia) are connected to other phenomena within a structure or a process. What we should look for, then, are the phenomena that contribute as motivationally (or causally) necessary vulnerability, that is, the basic disturbance for the development of delusions. This logically implies that we need studying delusions in fieri, or the pathways that lead to delusions themselves. I subscribe to the principle that studying delusion by merely concentrating exclusively on its crystallized forms would be like studying stroke victims to know more about hypertension (Parnas and Sass 2001). This methodological move from crystallized delusions to delusions in-the-making is quintessential to define the subtle, basic, phenomenal invariant core that characterizes a given psychopathological phenomenon and that emerges across the manifold facets of the phenomenon itself and shapes them and keeps them meaningfully interconnected.A syntagmatic model should account for (at least) the following features of schizophrenic delusions:• abnormalities in symbolization (loss of commonsense meaning of a given thing or fact),• formal aspects (e.g., revelation character, experience of centrality), and• specificity of content (e.g., metaphysical tinge).It should also be compatible with those phenomena like self-disorders (loss of sense of ownership and of agency) that are entailed in most schizophrenic symptoms (e.g., verbal–acoustic hallucinations and experiences of alien control). Finally, it should keep meaningfully... (shrink)

Kafka's writings are frequently interpreted as representing the historical period of modernism in which he was writing. Little attention has been paid, however, to the possibility that his writings may reflect neural mechanisms in the processing of self during hypnagogic (i.e., between waking and sleep) states. Kafka suffered from dream-like, hypnagogic hallucinations during a sleep-deprived state while writing. This paper discusses reasons (phenomenological and neurobiological) why the self projects an imaginary double (autoscopy) in its spontaneous hallucinations and how (...) Kafka's writings help to elucidate the underlying cognitive and neural mechanisms. I further discuss how the proposed mechanisms may be relevant to understanding paranoid delusions in schizophrenia. Literature documents and records cognitive and neural processes of self with an intimacy that may be otherwise unavailable to neuroscience. To elucidate this approach, I contrast it with the apparently popularizing view that the symptoms of schizophrenia result from what has been called an operative (i.e., pre-reflective) hyper-reflexivity. The latter approach claims that pre-reflective self-awareness (diminished in schizophrenia) pervades all conscious experience (however, in a manner that remains unverifiable for both phenomenological and experimental methods). This contribution argues the opposite: the. (shrink)

An important source of doubt about our knowledge of the "external world" is the thought that all of our sensory experience could be delusive without our realizing it. Such wholesale questioning of the deliverances of all forms of perception seems to leave no resources for successfully justifying our belief in the existence of an objective world beyond our subjective experiences. I argue that there is there is a fatal flaw in the very expression of philosophical doubt about the "external world." (...) Therefore, no such justification is necessary. The feature of skepticism which I believe renders it vulnerable is the assumption that each of us has a right to be certain of his own existence as a subject of conscious experience even in the face of comprehensive doubt about our empirical beliefs. (shrink)

We propose that typical schizophrenic delusions develop on the background of preexisting anomalies of self-experience. We argue that disorders of the Self represent the experiential core clinical phenomena of schizophrenia, as was already suggested by the founders of the concept of schizophrenia and elaborated in the phenomenological psychiatric tradition. The article provides detailed descriptions of the pre-psychotic or schizotypal anomalies of self-experience, often illustrated through clinical vignettes. We argue that delusional transformation in the evolution of schizophrenic psychosis (...) reflects a global reorganization of consciousness and existential reorientation, both of which radiate from a fundamental alteration of the Self. We critically address the contemporary cognitive approaches to delusion formation, often finding them inconsistent with the clinical features of schizophrenia or implausible from a phenomenological point of view. (shrink)

Patients with delusions of control are abnormally aware of the sensory consequences of their actions and have difficulty with on-line corrections of movement. As a result they do not feel in control of their movements. At the same time they are strongly aware of the action being intentional. This leads them to believe that their actions are being controlled by an external agent. In contrast, the normal mark of the self in action is that we have very little experience (...) of it. Most of the time we are not aware of the sensory consequences of our actions or of the various subtle corrections that we make during the course of goal-directed actions. We know that we are agents and that we are successfully causing the world to change. But as actors we move through the world like shadows glimpsed only occasional from the corner of an eye. (shrink)

The relationship between self- and informant reports of personality using psychometric instruments is constantly the focus of attention for researchers in the field of clinical assessment in psychology. The research shows weak agreement between clinicians and patients’ assessments of personality disorders (PDs). The current study aimed at the convergence of measurement of PDs using the Shedler-Westen Assessment Procedure (SWAP-200), the self-report Character Styles Questionnaire-R (CSQ-R) and Borderline Personality Inventory (BPI). Paper-pencil questionnaires were administered to 102 inpatients (88.2% (...) female, aged 18-64, M = 38.4) in a voivodeship hospital and outpatient health care centre. The SWAP-200 allowed us to gather expert (clinician) personality ratings basing on the intensive contact with patients. Results show that only a few SWAP-200 PD scales showed low positive correlations with corresponding self-reported PD scales from the CSQ-R. With the canonical correlation analysis, we identified two functions (borderline and internalising) that described similarities between the SWAP-200 and CSQ-R. SWAP-200 Obsessive-Compulsive PD correlated negatively with BPI scales. Consistent with previous studies, the self-report and the clinical assessment were only marginally convergent. Furthermore, OCPD stands out from other disorders in that it correlates positively with health indicators and negatively with some of the other personality disorders. The highest agreement was observed in the description of Borderline PD. (shrink)

This is an investigation of Character Education in American public schools in the Chicago area. The research involved interviewing almost 700 children from a wide variety of schools and ages. The children were asked about their views on citizenship, Americanness and identity. They were also asked explicitly what they thought of Character Education. The results indicate that, despite a similar programme of education, teaching attitudes and teaching materials, the most marked difference between the children's responses correlated strongly with (...) the type of school, magnet or non-magnet, they were attending. This indicates that the social and political background, which determines their school, does have an impact on the way that an educational programme is received and understood, at least in the terms of how children articulate their ideas, if not in terms of how these programmes affect their behaviour. (shrink)

Delusions are usually defined as false beliefs about the state of affairs in the public world. Taking this premise as unquestionable, the debate in cognitive science tends to oscillate between the so-called 'rationalist approach'- proposing some breakdown in the central intellective modules embodying human rationality - and the 'empiricist approach' - proposing a primary peripheral deficit , followed by explanatory efforts in the form of delusions. In this article the foundational assumption about delusion is questioned. Especially in the case of (...) schizophrenia, delusions are not epistemic statements about external world but metaphorical reports of altered structure of experiencing . Delusions as epistemic statements or beliefs occur paradigmatically in delusional disorder . These two types of delusions are compared from a primarily phenomenological stance. (shrink)

A person suffering a mental illness or disorder may differ dramatically from his or her previous well self. Family and close friends who knew the person before the onset of illness tend to regard the illness as obscuring their loved one's true self and see the goal of treatment as the restoration of that self. ‘He is not really like this,’ they will say with increasing desperation. Treatment teams and others, who have no acquaintance with the person (...) when well, respond to what they see in front of them and do sometimes make harmful judgments of character based on the person's presentation when ill. (shrink)

David Rosenthal’s higher-order thought theory says that for a mental state to be conscious, it must be accompanied by a higher-order thought about that state. One objection to Rosenthal’s account is that HOTs do not secure what Sydney Shoemaker has called ‘immunity to error through misidentification’. I will argue that Rosenthal’s discussion of dissociative identity order fails to salvage his account from this objection and that his thin immunity principle is in tension with cases of somatoparaphrenia. Rather than showing that (...) self-awareness consists in identification, an examination of the delusions of disownership found in dissociative identity disorder and somatoparaphrenia lends support to IEM and highlights an important distinction between perspectival ownership and personal ownership. (shrink)

The purpose of this article is to show how schizophrenia, understood as a distortion of the most intimate structures of subjectivity, illustrates the nature of subjectivity as such, while at the same time how philosophical considerations may help to understand schizophrenia. More precisely, schizophrenic experiences of self-alienation seem to reflect a congealing or concretization of a form of differentiation or potential alterity implicit in the dynamic nature of subjectivity. In other words, we propose that the structure of subjectivity includes (...) potential divisions and fissures that condition the experiences of radical self-alienation seen in schizophrenia. In order to elucidate how this alterity emerges within the self in schizophrenia and in order to consider its conditions of possibility we examine the disorders of the self as described in phenomenological psychopathology. We especially use the work of the Japanese psychiatrists Mari Nagai, her teacher Bin Kimura, and the French psychiatrist Henry Ey, supplemented with clinical material from our own research. Finally, we shed light on the development of the psychotic symptoms such as hallucinations and delusions, which are understood as the expressions of a radical alterization of the self. (shrink)

Human beings have the unique ability to consciously reflect on the nature of the self. But reflection has its costs. We can ask what the self is, but as David Hume pointed out, the self, once reflected upon, may be nowhere to be found. The favored view is that we are material beings living in the material world. But if so, a host of destabilizing questions surface. If persons are just a sophisticated sort of animal, then what (...) sense is there to the idea that we are free agents who control our own destinies? What makes the life of any animal, even one as sophisticated as Homo sapiens, worth anything? What place is there in a material world for God? And if there is no place for a God, then what hold can morality possibly have on us--why isn't everything allowed? Flanagan's collection of essays takes on these questions and more. He continues the old philosophical project of reconciling a scientific view of ourselves with a view of ourselves as agents of free will and meaning-makers. But to this project he brings the latest insights of neuroscience, cognitive science, and psychiatry, exploring topics such as whether the conscious mind can be explained scientifically, whether dreams are self-expressive or just noise, the moral socialization of children, and the nature of psychological phenomena such as multiple personality disorder and false memory syndrome. What emerges from these explorations is a liberating vision which can make sense of the self, agency, character transformation, and the value and worth of human life. Flanagan concludes that nothing about a scientific view of persons must lead to nihilism. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Underplayed Ethics and the Dilemmas of Psychiatric CareChong Siow Ann and Tamra LysaghtThe practice of psychiatry is fraught with uncertainty. The exact causes and the biological substrates underlying mental disorders remain to be elucidated; even the diagnosis of these disorders is descriptive and not based on an etiological understanding and no biological diagnostic markers have been validated. The manifestation of almost all mental disorders results from a complex interaction (...) of biological and environmental factors which encompasses the patient’s unique life history, experiences and relationship with others and the community. In the face of such uncertainties — at times extending to the types of treatment (psychiatry is generally acknowledged not be an exact science) — it has been argued that adopting a pragmatic approach is necessary.1 Accordingly, this approach necessitates high ethical standards among mental health practitioners.Some mental illnesses are associated with varying degrees and types of cognitive impairments. Others have certain symptoms like auditory hallucinations and delusions that might severely compromise the patients’ autonomy, distort their sense of reality, increase the risk of harm to themselves or others and render them incapable of making informed decisions in their treatment and participation in research.Consequently, there are issues that are particular to the provision of mental healthcare. These include the need for enforced involuntary treatment with the corollary of depriving a patient of his personal liberty even [End Page 173] though it is often justified on the grounds that it is in the patient’s best interests. However, at times, it is the legal and societal obligation of mental health practitioners to protect those who might be harmed from the patient’s action that might seem to be more pressing. In this situation of double agency, lies the tension of providing confidential care for patients and acting as “an agent of the state” where that patient’s confidentiality might be breached and his liberty infringed upon. This situation is further aggravated by the stigma that clings ever so tenaciously to those who suffer from mental disorders and where it is the norm to stereotype them as dangerous and unpredictable.Consideration of a patient’s autonomy is also challenged by characteristics that are unique to the practice of psychiatry. The prescription of certain psychotropic medications can alter how people think and feel, while psychotherapy works towards changing the patient’s views and values. The philosopher, Jennifer Radden, describes this process as “re-forming the patient’s whole self or character … akin to the responsibilities of raising children”.2 The psychotherapeutic relationship is thus particularly personal and intimate because patients are asked to provide information that often reveals their innermost feelings, fears and fantasies. This information is provided on the basis of trust and assurance of confidentiality, and with expectation of being helped.Jeremy Holmes and Gwen Adshead have elaborated on the vulnerability of patients seeking psychotherapy: they might be particularly susceptible to exploitation because their past experiences of being exploited have led to their distress and help seeking — their dependency and the extreme privacy of the therapeutic relationship make any transgression difficult to be uncovered.3 There is a calamitous combination of the “unconscious wish in the patient to be used” with the complicity of an unethical therapist seeking to fulfil his own interests.4As in any other doctor-patient relationship, the relationship between the mental healthcare practitioner and the patient is one of unequal power where the former is ascendant. While that power should be exercised to heal and to relieve suffering, it also gives the practitioner tremendous power “to harm, reject, misunderstand, or exploit patients who struggle with the experience of mental illness, which itself may generate helplessness, despair, distress, and exceptional dependence on the clinician”.5 Given the potential of doing good and harm coupled with the likelihood of being so significant in the life of the patient,6 providing care for those with mental disorders and distress is necessarily ethically exacting — arguably more so than in other medical practice settings. [End Page 174]This precariousness has led to the suggestion that ethics in psychiatry should have a special status and that the more general principles of biomedical ethics are too limited in scope to... (shrink)

English summary: This ambitious volume examines the Foucaults later writings from the 1980s. Foucaults contemporaries were baffled by his new perspective from this period in which he explored the modalities of a relationship with the self and the truth, seeming to blur the image of a Foucault concerned with describing and denouncing the forms of contemporary power. This study brings to light the theoretical and practical aspects of this period, in order to a reinvention of our own actuality. French (...) description: Les recherches menees par Foucault au cours des annees quatre-vingt demeurent, a beaucoup d'egards, indecidables. Doit-on parler, a leur propos, d'un retour aux questions classiques du sujet, de la morale, de la liberte? D'un abandon de la mise en perspective politique? D'un dandysme esthetisant? Les contemporains furent profondement deconcertes par des analyses qui, en se concentrant sur les modalites du rapport a soi et a la verite dans l'Antiquite ou le christianisme primitif, paraissaient brouiller l'image d'un Foucault attache a decrire et denoncer les formes du pouvoir moderne. Le present ouvrage se propose de relever le defi pose par ce dernier moment, aussi fecond que provocateur, de la pensee foucaldienne, d'en degager les enjeux theoriques et pratiques, et de se donner les moyens, a partir d'eux, de reinventer notre actualite. (shrink)

Margaret Atwood’s novels are usually celebrated for their blunt feminism. However, in Moral Disorder—a series of interconnected stories that forms a novel—feminist concerns are replaced with worries about territory and survival. The protagonist is an insider whose sole concern is to survive and to protect her territory. The confrontation between the narrator as the insider and the outsiders does not occur directly but could be inferred by her cruelty toward other characters and her violence against the animals under her care. (...) The present study argues that this cruelty, which abounds in the novel, could be viewed as a substitute for violence against the outsiders. The narrator’s gaze at the Indian boy who entered the protagonist’s territory manifests a garrison mentality. The frequent references to axes in the novel are compared to the use of axes in “Wilderness Tips,” a short story by Atwood in which axes also have a metaphoric significance. The beheading and dismemberment of domestic animals could be the punishment awaiting the intruder. The novel establishes a division between the insider/outsider, here/there, self/other and civilized/barbaric to call for action and awareness about the importance of protecting one’s territory. (shrink)

This chapter offers an overview of the phenomenological approach to delusions, emphasizing what Karl Jaspers called the "true delusions" of schizophrenia. Phenomenological psychopathology focuses on the experience of delusions and the delusional world. Several features of this approach are surveyed, including emphasis on formal qualities of subjective life and questioning of standard assumptions about delusions as erroneous belief. The altered modalities of world-oriented and self-oriented experience that precede and ground delusions in schizophrenia, especially the experiences of revelation that Klaus (...) Conrad termed the outer and inner apophany, are then discussed. The chapter first considers the famous "delusional mood", then the role of ipseity-disturbance. In both cases it is explained how delusions can develop out of these distinctive alterations of perception and feeling. The classic question of the understandability or comprehensibility of schizophrenic delusion, together with the related issues of wish-fulfillment and rationalizing motives are then considered. The chapter addresses the crucial but neglected issue of the felt reality-status of delusions or the delusional world, discussing derealization, "double bookkeeping", and "double exposure". The chapter concludes by discussing delusions typically found in paranoid and affective psychoses, and monothematic delusions found in certain organic conditions. (shrink)

_The Disordered Mind: An Introduction to Philosophy of Mind and Mental Illness, second edition_ examines and explains, from a philosophical standpoint, what mental disorder is: its reality, causes, consequences, and more. It is also an outstanding introduction to philosophy of mind from the perspective of mental disorder. Revised and updated throughout, this _second edition_ includes new discussions of grief and psychopathy, the problems of the psychophysical basis of disorder, the nature of selfhood, and clarification of the relation between rationality and (...) mental disorder. Each chapter explores a central question or problem about mental disorder, including: what is mental disorder and can it be distinguished from neurological disorder? what roles should reference to psychological, cultural, and social factors play in the medical/scientific understanding of mental disorder? what makes mental disorders undesirable? Are they diseases? mental disorder and the mind–body problem is mental disorder a breakdown of rationality? What is a rational mind? addiction, responsibility and compulsion ethical dilemmas posed by mental disorder, including questions of dignity and self-respect. Each topic is clearly explained and placed in a clinical and philosophical context. Mental disorders discussed include clinical depression, dissociative identity disorder, anxiety, religious delusions, and paranoia. Several non-mental neurological disorders that possess psychological symptoms are also examined, including Alzheimer’s disease, Down’s syndrome, and Tourette’s syndrome. Containing chapter summaries and suggestions for further reading at the end of each chapter, _The Disordered Mind, second edition_ is a superb introduction to the philosophy of mental disorder for students of philosophy, psychology, psychiatry, and related mental health professions. (shrink)

Delusional beliefs are typically pathological. Being pathological is clearly distinguished from being false or being irrational. Anna might falsely believe that his husband is having an affair but it might just be a simple mistake. Again, Sam might irrationally believe, without good evidence, that he is smarter than his colleagues, but it might just be a healthy self-deceptive belief. On the other hand, when a patient with brain damage caused by a car accident believes that his father was replaced (...) by an imposter or another patient with schizophrenia believes that “The Organization” painted the shops on a street in red and green to convey a message, these beliefs are not merely false or irrational. They are pathological. What makes delusions pathological? This paper explores the negative features because of which delusional beliefs are pathological. First, I critically examine the proposals according to which delusional beliefs are pathological because of (1) their strangeness, (2) their extreme irrationality, (3) their resistance to folk psychological explanations or (4) impaired responsibility-grounding capacities of people with them. I present some counterexamples as well as theoretical problems for these proposals. Then, I argue, following Wakefield’s harmful dysfunction analysis of disorder, that delusional beliefs are pathological because they involve some sorts of harmful malfunctions. In other words, they have a significant negative impact on wellbeing (=harmful) and, in addition, some psychological mechanisms, directly or indirectly related to them, fail to perform the jobs for which they were selected in the past (=malfunctioning). An objection to the proposal is that delusional beliefs might not involve any malfunctions. For example, they might be playing psychological defence functions properly. Another objection is that a harmful malfunction is not sufficient for something to be pathological. For example, false beliefs might involve some malfunctions according to teleosemantics, a popular naturalist account of mental content, but harmful false beliefs do not have to be pathological. I examine those objections in detail and show that they should be rejected after all. (shrink)

In psychiatry some disorders of cognition are distinguished from instances of normal cognitive functioning and from other disorders in virtue of their surface features rather than in virtue of the underlying mechanisms responsible for their occurrence. Aetiological considerations often cannot play a significant classificatory and diagnostic role, because there is no sufficient knowledge or consensus about the causal history of many psychiatric disorders. Moreover, it is not always possible to uniquely identify a pathological behaviour as the symptom of a certain (...) disorder, as disorders that are likely to differ both in their causal histories and in their overall manifestations may give rise to very similar patterns of behaviour. -/- Consider delusions as an example. It wouldn’t be correct to define delusions as those beliefs people form as a result of a neurobiological deficit and a hypothesis-evaluation deficit (as some versions of the two-factor theory of delusions suggest), because for some delusions no neurobiological deficit may be found, and reasoning biases and motivational factors may be contributors to the formation of the delusion (e.g. McKay et al., 2005). Moreover, it would be a mistake to define delusions as symptoms of schizophrenia alone, because they occur also in other disorders, including dementia, amnesia, and delusional disorders. Thus, aetiological considerations may appear in the description and analysis of delusions, but do not feature prominently in their definition. -/- In this paper I argue that the surface features used as criteria for the classification and diagnosis of disorders of cognition are often epistemic in character. I shall offer two examples: confabulations and delusions are defined as beliefs or narratives that fail to meet standards of accuracy and justification. Although classifications and diagnoses based on features of people’s observable behaviour are necessary at these early stages of neuropsychiatric research, given the variety of conditions in which certain phenomena appear, I shall attempt to show that current epistemic accounts of confabulations and delusions have limitations. Epistemic criteria can guide both research and clinical practice, but fail to provide sufficient conditions for the identification of delusions and confabulations, and fail to demarcate pathological from non-pathological narratives or beliefs. -/- Another limitation of current epistemic accounts – which I shall not address here – is the excessive focus on epistemic faults of confabulations and delusions at the expense of their epistemically neutral or advantageous features (see Bortolotti and Cox, 2009). This may lead to a misconception of delusions and confabulations, and to an oversimplification in the assessment of the needs of people who require clinical treatment for their psychotic symptoms. (shrink)

This dissertation is a defence of agent-regret and an exploration of its role in our lives. I argue that agent-regret shows that an agent takes seriously her status as an agent who impacts the world, but who only has fallible control over it. To accept responsibility for any outcomes, she must accept responsibility for unintended outcomes, too: agent-regret is part of being a human agent. In doing this, I try to defend and develop Williams’s own conception of (...) agent-regret. -/- In the first part, I explore the nature of agent-regret. Agent-regret is distinct from guilt because we can feel agent-regret without being at fault. I argue that several challenges that seek to reduce agent-regret to a form of guilt fail. I further argue that agent-regret takes as its object not only something one has done, but the fact that one did it; I discuss this in terms of what Bernard Williams called taking an “external” view on one’s own action. -/- I suggest that we can best understand the object of agent-regret as one’s responsibility for an outcome. I argue that this form of “responsibility” is conceptually separate from liability or answerability; it concerns whether the outcome can be ascribed to an agent. This is a restricted form of causal responsibility but retains its agential character. I suggest that we can be responsible for outcomes even when we did not intend to bring them about. -/- In the second part, I vindicate the propriety of agent-regret against the ideas that we are not responsible for unintended outcomes or that such responsibility is not important. I set out several challenges to this effect. I argue that we are responsible for unintended outcomes because in order to be responsible as agents at all, we must use fallible abilities. When we exercise these abilities but fail, we are responsible as agents for those unintended outcomes that arise. I then consider the importance of being responsible for particular unintended outcomes and analyse the idea that this affects our identities. I argue that responsibility for an outcome affects a form of identity, but that it does not involve essential features of a person. Instead, our responsibility for outcomes is a contingent feature that nonetheless plays an important role in our interpersonal interactions and self-conceptions. I argue that these reactions are appropriate, because our responsibility for particular outcomes is independently significant—but these reactions also lend this responsibility added significance as part of inescapable human practices. -/- Thus our responsibility for outcomes is important. Its importance means that it can serve as an appropriate object of agent-regret that vindicates the propriety of agent-regret. I end by considering several interesting features of agent-regret, including its expression and “pure” cases, which are cases where an agent feels agent-regret despite not regretting the result of her action. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Collective Regret and Guilt and Heroic Agency:A Pro-Existential ApproachIonut UnteaIntroductory Discussion: Challenging the Supposedly "Rationally Refutable" Character of GuiltStudies in social psychology point out that feelings of guilt are more likely than feelings of regret to occur in an interpersonal context (Wagner et al. 1) marked by "interpersonal harm," or harm done to others (Berndsen et al. 55, 66). In keeping with these studies, in social (...) ontology, regret seems to involve an evaluation of the kind of wrongdoing that is out of someone's control (Konzelmann Ziv 488), while the feeling of guilt implies the self-attribution of blame over something that is connected, even in a loose manner, to a blameworthy action (Gilbert, "Group Wrongs" 65, 66n3).In order to advance the argument of the reasonableness of a person's feeling of guilt if that person is part of a group that has acted wrongfully, Margaret Gilbert distinguishes between feelings of personal guilt and feelings of collective guilt ("Group Wrongs" 76), with the latter still impacting on the individual feelings of guilt. From this point of view, a person may be "personally guiltless," but can still reasonably feel guilt if that person's group behaves in a morally unacceptable way ("Group Wrongs" 66). By distinguishing between personal and collective guilt, Gilbert intends to give an "intelligible" dimension to what she calls Jaspers's "dilemma" ("Collective Guilt" 135, 136). She emphasizes Karl Jaspers's hesitation in categorizing his own feeling of guilt for what his people have done: "There is a way that he 'cannot help feeling' which is 'rationally refutable'" (Gilbert "Collective Guilt" 135; Jaspers 74). As a philosopher, Gilbert argues, Jaspers finds this existential dilemma "extremely problematic" ("Collective Guilt" 135). Nonetheless, Gilbert also concedes that these two types of guilt may be difficult to distinguish in regard to their "phenomenological conditions" at the level of [End Page 59] the "pangs and twinges" experienced by each person, but rather on the basis of the "judgment or thought" involved with that feeling ("Collective Guilt" 135).Gilbert argues that "it is indeed intelligible for group members to feel guilt over the action in question" by virtue of what she calls a "foundational joint commitment," which brings together a number of people to "intend as a body" to carry out certain actions ("Collective Guilt" 136). Although not committed to the goal of showing the intelligibility of the feeling of membership guilt as is Gilbert, I favor the acceptance of a kind of reasonableness of such a feeling, even when it conserves its "rationally refutable" character. This even applies when membership guilt may not so easily be distinguished from personal guilt. Gilbert sees joint commitment as "authority-creating," in the sense that "a person or body" may become "authorized" to apply the collective intention to the concrete settings. This is realized by making decisions for the entire group, thus bringing the collective intention into effect ("Collective Guilt" 136). This joint commitment becomes binding for individual members of the group since once they commit themselves to the group's intention, "they are not in a position unilaterally to change the collective's mind." This does not apply in situations when "they may do so by mutual consent" ("Collective Guilt" 127). What I find concerning about Gilbert's involvement of the argument of the "authority-creating" ("Collective Guilt" 136) joint commitment within the dimension of membership guilt is precisely that it discourages any contestation of the authority that decides the content of the collective intention, unless this is done by "mutual consent" ("Collective Guilt" 127). This makes the members of the collective rather passive, and unwilling to challenge the authority generated through their participation in the joint commitment.This reluctance of the members of a collective body to challenge the authority that gives content to their collective intention can easily be identified in history and in the contemporary landscapes of political authority, especially in countries led continuously for decades by authoritarian leaders. In spite of the oppressive character of their leadership, these are very rarely contested, and then only by sporadic voices who fail to generate a coherent long-term commitment from other group members. In this sense, Gilbert's... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Inappropriate RegretClaire Pouncey (bio)Keywordsanxiety, inappropriate guilt, moral sentiments, supererogation, regretThis delightful and provocative vignette has many interesting clinical facets, and I thank Dr. Bailey for his candid introspection. For me, this essay calls attention to an asymmetry in our culture, in which women tend to feel more comfortable than men in expressing anxieties about our unpredictable and often dangerous world. Women's fears, however, often are dismissed or minimized, revealing (...) an overall social discomfort with expressed anxiety, and a sense that anxiety itself is, somehow, feminine. When I read Dr. Bailey's essay, I am struck that two self-aware men need the metaphors of war and heroism to address their own anxieties.The vignette builds around a soldier, Colin, who presents with guilt about having been deployed to Iraq, but not engaging in combat. Guilt is a moral sentiment, a feeling that one ought to have acted otherwise in a given situation. It is a self-imposed sanction for a moral failure. In mental health care, we use the term ‘inappropriate guilt’ to describe a clinical symptom commonly associated with depression. Clinicians understand inappropriate guilt as a manifestation of the self-criticism and low self-esteem often associated with depressive disorders. In Colin's case, it did fit with a constellation of symptoms that suggested depression. Dr. Bailey's essay explores the psychodynamics of Colin's guilt, and possible responses to it.As I understand the situation, Colin sees himself as having a moral obligation to exceed his contractual obligation to the military. In the terminology of ethics, he imposes upon himself a duty to be supererogatory, that is, a duty to go beyond the call of duty, which some moral philosophers have considered oxymoronic. For Colin to feel guilty about not engaging in combat, he must have understood a moral obligation to participate in combat that goes beyond his obligation to follow orders. It seems to me that soldiers have a nonmoral, contractual obligation to train, deploy, follow orders, and if circumstances so dictate, fight. But if the circumstances do not lead to combat (Nagel might call this good moral luck), it does not seem to me that a soldier has failed either a contractual or a moral obligation by not being sent into battle. Supererogation aside, to my mind, Colin's guilt is inappropriate: he is holding himself to an unreasonable moral standard, according to which he is required not only to do what the military demands, but also to sacrifice or suffer from the experience in some meaningful way.Although the notion of inappropriate guilt fits with the description of Colin's depression, it occurs to me that the word ‘guilt’ may be too strong here. Perhaps what Dr. Bailey is seeing is better characterized as ‘inappropriate regret’ that Colin missed “his last, best chance to be a hero.” ‘Regret’ is the sentiment that one could have (rather than should have) acted otherwise, perhaps to a better eventual end. Dr. Bailey agrees that Colin's guilt is inappropriate, that no one is ever required [End Page 233] to be a hero. But he seems to share, and even encourage, what I am calling Colin's ‘inappropriate regret,’ which suggests that if Colin had engaged in combat, he would not experience feelings of helplessness or insecurity in our uncertain world. What fascinates me is that Dr. Bailey accepts this premise, and even reflects on his own fears about self-protection in his own urban setting.Rather than challenging it, Dr. Bailey clearly shares Colin's concern that he may not be able to respond adequately should a real threat arise. Both therapist and patient seem to want reassurance that they can keep themselves and their families safe when danger strikes. But this is not a matter of achieving or going beyond the call of duty. Rather, it is an expression of familiar and diffuse anxiety that is unrelated to wartime. In the essay, heroism seems to serve as a metaphor, a filter that makes the expression of anxiety more palatable to both the patient and the therapist. I am fascinated that these two sensitive and introspective interlocutors need to filter their anxieties through... (shrink)

Near the end of someone’s life, or when a chapter in their life closes, they may nurse regrets but no longer be able to act to change the situation they regret having caused. This paper asks what is the point of such vain regrets and contrasts them with the typical case where regret is effectual. Regret usually involves both anger at oneself for what one has done and sadness at having done it. Richard Wollheim takes regret (...) to be an attitude of hostility to oneself resulting from a fall in one’s secure sense of self as an ongoing person. His account is considered and rejected as unable to reveal the point of vain regrets. Sartre’s description of the emotions is adapted to the case of regret with its dual affective character. His idea of anger as a substitute for the suppression of another consciousness is used to show how regret involves a rejection of one’s previous way of seeing the world, by contrast with one’s present view. This enables us to see how regret, even when vain, can reinforce, rather than undermine, one’s sense of self and provide a form of self-understanding. (shrink)

The Disordered Mind, Third Edition is a wide-ranging introduction to the philosophy of mental disorder or illness. It examines and explains, from a philosophical standpoint, what mental disorder is: its reality, causes, consequences, compassionate treatment, and more. Revised and updated throughout, the third edition includes enhanced discussions of the distinction between mental health and illness, selfhood and delusions about the self, impairments of basic psychological capacities in mental disorder and the distinct roles that mental causation and neural mechanisms play (...) in mental illness. The book is organized around four questions: What is a mental disorder or illness? What makes mental disorder something bad? What are various mental disorders and what do they tell us about the mind? What is mental health and how may it be restored? Numerous disorders are discussed including: addiction, agoraphobia, delusion, depression, dissociative identity disorder, obsession-compulsion, schizophrenia, and religious scrupulosity, among others. Several neurological disorders are examined. Various problems associated with DSM-5 and with psychiatric diagnosis are explored. Including chapter summaries and suggestions for further reading at the end of each chapter, The Disordered Mind presupposes no special background in philosophy, and as such will be of interest to those in related disciplines such as psychology, psychiatry and mental health, and professions such as nursing and social work. (shrink)

In this paper the question of autonomy in delusional disorders is investigated using a phenomenological approach. I refer to the distinction between freedom of intentional action, and freedom of the will, and develop phenomenological descriptions of lived autonomy, taking into account the distinction between a pre-reflective and a reflective type. Drawing on a case report, I deliver finely-grained phenomenological descriptions of lived autonomy and experienced self-determination when acting on delusions. This analysis seeks to demonstrate that a person with delusions (...) can be described as responsible for her behaviour on a ‘framed’ level (level of freedom of intentional action), even though she is not autonomous on a higher (‘framing’) level (level of freedom of the will), if, and only if, the goods of agency for herself and others are respected. In these cases the person with delusions is very nearly comparable to people in love, who are also not free to choose their convictions, and who could also be rightly held responsible for the behaviour flowing from their convictions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.1 (2004) 65-70 [Access article in PDF] Top-Down and Bottom-Up in Delusion Formation Jakob Hohwy Keywords delusions, top-down, bottom-up, predictive coding Some delusions may arise as responses to unusual experiences (Davies et al. 2001; Maher 1974;). The implication is that delusion formation in some cases involves some kind of bottom-up mechanism—roughly, from perception to belief. Delusion formation may also involve some kind of top-down mechanism. (...) This could be in the shape of a patient's flawed background beliefs, or biases, which somehow modulate perception or ensure delusional interpretations of experience. There is little agreement about what kind of mechanism is primary in delusion formation, or, indeed, what the particular mechanisms and their neural substrates might be.In the evaluation of top-down and bottom-up mechanisms in delusion formation, a number of conceptual questions should be addressed (Davies and Coltheart 2000). For example, if there is an experiential component, why is a hypothesis with a delusional explanation of the unusual experience seen as relevant? Why do the subjects come to believe it tenaciously? How come some unusual experiences do not develop into delusions?A number of empirical findings also need to be taken into account: for example, the damage to the autonomic system in Capgras delusion (Ellis et al. 1997), the decreased ability for fast error correction in schizophrenia (Frith and Done 1989), modulation of activity in parietal cortex in delusions of alien control and other passivity experiences (Blakemore, Oakley, and Frith 2003), and also in schizophrenia, the increased sensitivity to self-produced stimuli, such as tickling oneself (Blakemore et al. 2000) and the sound of one's own voice (Ford et al. 2001).Theory choice can also be guided by philosophical doctrines about, for example, the nature of belief, the constitutive role of rationality, and intersubjectivity and the nature of judgements about the external world. It is natural, however, to let beliefs about philosophical doctrine be secondary to empirical findings and conceptual issues.The distinction between bottom-up and top-down mechanisms is particularly sharp in John Campbell's (2001) account of delusions and in Tim Bayne and Elisabeth Pacherie's (2004) discussion of Campbell. In this discussion, top-down approaches are associated with the general philosophical doctrine of rationalism, and bottom-up approaches with the philosophical doctrine of empiricism. Campbell's account is top-down because he posits delusional framework beliefs that arise directly as a result of brain damage or malfunction, and that work in some top-down fashion on the interpretation of experience. Bayne [End Page 65] and Pacherie convincingly defend empiricism against Campbell's rationalist account. Among their many other objections, they briefly puzzle about how a delusional framework belief (e.g., that one's spouse is an impostor) in a top-down fashion could cause the damage to the autonomic system seen in the Capgras and Cotard delusions (2004, 1). I think this is a very important objection because skin conductance data are part of the evidence for the bottom-up hypothesis concerning the Capgras delusion. We could add to this, for example, that it is mysterious how belief in a top-down fashion could cause people with schizophrenia to be worse at fast error correction than normal controls, to be better at tickling themselves than normal controls, and to have an increased response to the sound of their own voice.On the other hand, although the skin conductance response (SCR) evidence suggests a bottom-up approach to the Capgras delusion, it does not explain the character of the subjective experience that is hypothesized to give rise to the delusional belief: reduced SCR is not part of the experience itself (thanks to Ian Gold for discussion of this). Something more is required to give a full account of the type of experience that gives rise to the delusion. Further, as they stand, most bottom-up accounts are unable to account for why reality testing fails for beliefs based on these experiences.Neither rationalism nor empiricism on their own seem able to address the conceptual questions while paying... (shrink)

This paper explores the possibility of understanding schizophrenic delusion through the role of a primary alteration of subjective experience. Two approaches are contrasted: the first defines schizophrenic delusion as a primary symptom resisting any attempt to understand, whereas the second describes delusion as a secondary symptom, to be understood as a rational reaction of the self. The paper discusses the possibility of applying this second approach to schizophrenic delusion. This leads us to raise the issue of the specificity of (...) psychotic experiences and to wonder whether some accounts of delusion arising in neurological disorders can be generalized into psychotic delusion. A few points are addressed, demanding clarification and the rephrasing of some assumptions implied by the model of a secondary delusion. These points call for an interaction between clinical descriptions, neurocognitive explorations and a philosophical analysis of psychotic subjective experiences. (shrink)

Cheyne and Girard characterize felt presence during sleep paralysis attacks as a pre-hallucinatory expression of a threat-activated vigilance system. While their results may be consistent with this interpretation, they are nonetheless correlational and do not address a parsimonious alternative explanation. This alternative stipulates that FP is a purely spatial, hallucinatory form of a common cognitive phenomenon—social imagery—that is often, but not necessarily, linked with threat and fear and that may induce distress among susceptible individuals. The occurrence of both fearful and (...) non-fearful FPs in a multiplicity of situations other than sleep paralysis attacks supports the notion that FPs are hallucinatory variants of social imagery and that they are not necessarily bound to threat-activated vigilance. Evidence linking FPs with anxiety disorders supports the notion that the distress they evoke may be mediated by a more general affective distress personality factor. To illustrate the predominantly spatial character of FP hallucinations, similarities between FP and phantom limbs are summarized and the possibility that these two phenomena are parallel expressions of a mirror neuron system is considered. (shrink)

In response to criticisms of phenomenology as being a solipsistic approach to psychological research and theory, this paper examines the interplay of both the creative/active and receptive/passive constituents of subjective experience identified in Husserl's exposition of intentional analysis. By delineating the ways in which intentional constitution requires passive as well as active processes, we come to see in the first part of this paper how experience and personal identity are as much formed and informed by the social and historical world (...) as they are created by individual subjects. Once we have established the non-solipsistic nature of phenomenology, we then apply it in the second part of this paper to open a window onto the disorder of self long considered to be integral to schizophrenia. Through an exploration of the constitution of sense of self in the experiences of two people with schizophrenia, we see how cognitive disruptions, auditory hallucinations, and delusional ideation may be related to fundamental peculiarities in a person's experiences of intentionality and his/her resulting sense of agency and identity. In conclusion, we suggest that while phenomenology may not be able to provide a complete account of psychosis, it may be used to shed valuable, descriptive light on subjective aspects that provide a conceptual base for the consideration of other factors. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Background Theory of Delusion and Existential PhenomenologyRichard G. T. Gipps (bio) and John Rhodes (bio)KeywordsPhenomenology, psychological explanation, epistemology, schizophreniaSituating and Clarifying the PaperThe commentaries of Nassir Ghaemi and Giovanni Stanghellini help to sketch out the intellectual landscape of philosophical perspectives in psychiatry, and situate our paper within it. A happy convergence between the analytical philosophy perspective from which we were writing, and the existential–phenomenological paradigm described by both (...) authors, is the result. Stanghellini in particular carefully describes three main theories of existential deformations, tracing delusion formation back to either (i) a disturbance of meaning synthesis conceived as a dysfunction of a Husserlian consciousness, (ii) a disturbance of pre-reflective self-consciousness resulting in a kind of paralyzing hyperreflexivity, and (iii) (Stanghellini’s preferred model) a disturbance of embodiment. This final account views delusion as springing from a failure in the subject’s corporeal and praxical being-in-the-world. As the subject’s practical, pre-reflective grip on the world is loosened, so their minds become unconstrained by that understanding and practical rationality immanent within that grip, and thought, now unconstrained, starts to travel through delusional worlds. Stanghellini accordingly views our model as an example of a disembodiment theory, which allows it to overcome the disadvantages of the first two models, which may both, in their own ways, overvalue the rôle of (disturbances of) reflective consciousness in the formation (and delusional deformation) of everyday understanding.Being situated within a preexisting landscape has both its benefits and its disbenefits, the principle example of the latter being the potential assimilation of anything new to what has already been said. Thus, although we are grateful to our commentators for placing us on the larger historical and conceptual map, it may be helpful to briefly rehearse our motivations for drawing on the philosophical ideas of the Bedrock and Background in our theory of delusion. Our paper was primarily motivated by a concern that current, psychologically mainstream, cognitive models of delusion, although helpfully drawing our attention to common reasoning and perceptual deficits in the person with psychosis, fail to adequately account for what is delusional about delusions. It was, in [End Page 321] particular, to account for the certainty with which the deluded person clings to often quite extraordinary beliefs that we drew on the epistemological notion of the background. And although this epistemological notion fits quite neatly with ontological concerns regarding the embodied and praxical character of human existence, it is the particular epistemic rôle that it played in our theory—to do with the extraratiocinative constraint on judgement provided by the Background—that we wish to stress here.We return to this shortly, but first wish to comment briefly on two specific considerations raised by the commentaries. The first concerns Stanghellini’s claim that, for us, “when studying delusions, the focus should be on providing an adequate framework for understanding, rather than providing empirical hypotheses to be tested” (2008, 311–314). It seems to us, however, that both are equally important. What we wished to stress, however, was that empirical hypothesis testing may be led astray if it is not informed by an adequate framework for understanding. For example, most cognitive psychological experiments on delusions concern themselves with the individual’s ability to make appropriate guesses (e.g., regarding the color of beads in a bag), and their tendency to jump to conclusions; they do not concern themselves with the kinds of extraordinary conviction and certainty met with in delusion. The risk run by empirical researchers of cognitive factors in delusion is that a lack of a prior adequate theorization of delusion makes for accounts that are ultimately only of the formation, not of delusion in particular but rather of false or unusual beliefs more generally. An analytical approach, however, can help to explicate the ways in which the psychiatric concept of delusion fails to be adequately characterized by the quite general ‘external criteria’ of delusion (as Jaspers [1963] called them: falsity, stubbornness, uncommon), and aids in the construction of empirical hypotheses this time constrained by an understanding of the true ‘internal criteria’ of psychotic belief. Such an approach helps to spell out the... (shrink)

“Identity disorders” constitute a large class of psychiatric disturbances that, due to deviant forms of self-modeling, result in dramatic changes in the patients’ phenomenal experience of their own personal identity. The phenomenal experience of selfhood and transtemporal identity can vary along an extremely large number of dimensions: There are simple losses of content. There are also various typologies of phenomenal disintegration as in schizophrenia, in depersonalization disorders and in_ Dissociative Identity Disorder_, sometimes accompanied by multiplications of the phenomenal (...) class='Hi'>self within one and the same physical system. It is important to not only analyze these state-classes in terms of functional deficits or phenomenology alone, but as _self-representational _content as well. For instance, in the second type of cases just mentioned, we confront major redistributions of the phenomenal property of "mineness” in representational space, of what is sometimes also called the “sense of ownership”. Finally, there are at least four different delusions of misidentification. Being a philosopher, I will discuss two particular types of identity disorder _ 2 _ in this contribution - disorders, which are of direct philosophical relevance: A specific form of DM, and the Cotard delusion. Why should philosophers do this? And why should psychiatrists care? (shrink)

The self-disorder model provides a phenomenological framework for understanding how the core symptoms of Schizophrenia Spectrum Disorders (SSDs) are rooted in an instability of minimal selfhood. This instability involves a range of “anomalous experiences”: transformations in an individual’s perceptual field and sense of being an agent of action. The explanatory value of this theoretical model can be summarized in two claims about the role of anomalous experiences in self-disorders: (1) anomalous experiences express a common trait-like disturbance that is (...) characteristic of SSDs, and (2) anomalous experiences contribute to explanations regarding how self-disorders progress into SSDs. While hypotheses consistent with the first claim have been substantiated in several studies, hypotheses consistent with the second claim remain underexamined. We argue that attending to this gap in the literature requires considering which methodological strategies are best suited for investigating if and how anomalous experiences contribute to the development of self-disorders into SSDs and psychotic states. Network modeling is discussed as one such strategy suitable for examining the role of anomalies of lived-world in the maintenance of paranoid delusions in SSDs. (shrink)

The early theology of Karl Barth exhibits a seemingly incongruous emphasis on concepts like “origins” and “memory,” which would seem to suggest a point of contact between God and humanity. Although memory and anticipation are both ambiguous and tend towards self-reference, this article suggests that revelation is mediated through this ambiguity in Barth's theology through the early 1930s. Recollection can legitimately function as the basis of individual and ecclesial anticipation only when it is interpreted through the lens of the (...) character of God. Although this language largely disappears by the Church Dogmatics, this article argues that the early tension between memory and anticipation is gradually eclipsed but remains a crucially neglected foundation to Barth's later thought. (shrink)

My dissertation, “Love, Self-Constitution, and Practical Necessity,” offers an interpretation of love between people. Love is puzzling because it appears to involve essentially both rational and non-rational phenomena. We are accountable to those we love, so love seems to participate in forms of necessity, commitment, and expectation, which are associated with morality. But non-rational attitudes—forms of desire, attraction, and feeling—are also central to love. Consequently, love is not obviously based in rationality or inclination. In contrast to views that attempt (...) to fit love into existing models of practical reasoning, I argue that love participates in a unique form of practical necessity, different from both moral and psychological necessity, yet bearing resemblances to each. Distinctive to this type of practical necessity is a direct appeal to another particular person that cannot be delivered in third-personal terms—that is, a non-moral yet normative type of expectation on another person. This type of expectation is predominant in loving relationships, but can also make better sense of the experiences of humor and beauty, as well as attitudes like forgiveness, gratitude, and agent-regret. I treat Immanuel Kant’s discussion of the experience of beauty in the Critique of Judgment and Christine Korsgaard’s work on self-constitution as fruitful starting points for this account of love. I conclude that our loving relationships enable us to have distinctive personal selves, and provide support for this account of love by offering a complementary theory of grief. In Part One of the dissertation, I focus on two prominent approaches to love characteristic of the sentimentalist and rationalist traditions. I begin with the work of David Hume, which treats desire (understood as something like a simple impulse or craving) as the paradigmatic mental state, and emphasizes our personal and affective dimensions. Hume has the valuable insight that loving someone affects our sense of ourselves. But Hume’s view becomes unsatisfying when he claims that love is essentially enfeebling, implying that to love is to be passive toward and readily overcome by another person. While this indicates Hume’s awareness that love involves being open and receptive to another person, the problem is that love is also a demanding attitude. Hume lacks the conceptual resources to offer a nuanced view of the self, in which we can—with one attitude—be both demanding of and vulnerable to another person. Hume’s model of a desire-based deliberative process has recently been revived in Harry Frankfurt’s discussions on love and rationality. Frankfurt, however, goes beyond Hume’s picture of the self by introducing a notion of “identification,” which he offers to make sense of our apparent ability to commit ourselves decisively to certain projects or people. I argue that active powers like identification and commitment cannot be accommodated within any basically Humean moral psychology. Such abilities, and with them the possibility of love, depend on something closer to a Kantian conception of rational agency. I next focus on the work of Kant, who provides the substantial counterpart to Humean-inspired moral theories, but is not known for his insight into our emotional lives. In the Metaphysics of Morals, Kant divides love into “practical love”—what we experience when we are morally motivated to help someone—and “pathological love”—what we experience when we feel fond of something. But in reality, we experience love neither as a mere preference for another person, nor as something that generates the kind of demands that would be binding on any rational creature. David Velleman attempts to remedy the deficiency of Kant’s dichotomy. Velleman offers a Kantian theory in which he describes love and respect as two ends of a continuum of attitudes that it is morally appropriate to have toward people. Velleman’s view has the peculiar implication that everyone deserves the love of everyone else, and I argue that this is a fatal flaw. Like Kant and Velleman, Korsgaard characterizes personal love as involving the treatment of other people as Kantian ends-in-themselves to a heightened degree. Korsgaard, though, also contends that our individual identities depend upon our personal relationships, and I take this position seriously for the remainder of the dissertation. Ultimately, however, characterizations of loving relations as subsets of moral relations can account for the authority of the demands of love, but not its particularity. The major conclusion of Part One is that any attempt to understand love primarily on a model of practical reasoning with which we are already familiar is doomed to fail. Our experience of love calls for a theory of a unique type of practical necessity. In Part Two I take seriously the possibility that love is simultaneously inescapable (in something like the way morality is supposed to be), and yet ineluctably personal. In love, we experience an engagement with a person as essentially particular, rather than as an instance of a rational agent in general. To make sense of this direct attachment to an individual, I argue that love involves distinctive forms of expectation and disappointment. When those we love let us down, they hurt our feelings, which is not a response to a failed prediction, but nor is it a reaction to a moral insult or offense. According to Peter Strawson and Stephen Darwall, second-personal moral reactive attitudes (such as resentment) always have third-personal analogues (such as indignation). In contrast, I argue that the type of hurt feelings associated with love is a second-personal reactive attitude that does not have a third-personal corollary. I take this as evidence that the expectations involved in love are not objective in the way that the moral is objective. Nor, however, is love a matter of mere preference. On my interpretation, Kant introduces this different type of expectation in the Critique of Judgment. Whereas he characterizes moral judgments as universally communicable, judgments of beauty implicitly involve only second-personal address: I appeal to your direct experience with a particular object. This provides the conceptual space for an account of love according to which it involves a uniquely second-personal form of practical necessity. I contend that the second-personal addresses we make in love are appeals to strengthen the intimacy implicit in the loving relationship, and I identify three interrelated dimensions of that intimacy. First, those we love have the standing to interpret us in a constitutive manner. We fine-tune and make determinate the character of our concerns and interests in part by accepting the interpretations provided by those we love. In that way, the people we love have the normative power to constitute who we are. Second, we share a perspective with those we love in a way that is not reducible to or derivative of our independent perspectives. Loving someone centrally involves the activity of forming concerns together, and we do this in a mode best understood on the model of playing a spontaneous game or improvising music. Finally, being loved enables us to see ourselves as distinctive and special, because the concern those who love us have for us does not track the objective merit of our characteristics. These dimensions of the intimacy that characterizes a loving relationship reveal what it is that we appeal for in love, and how we are hurt when our appeals are rebuffed. In broad terms, this dissertation advocates the recognition of a non-moral yet normative type of expectation, which is predominant in loving relationships. Humor and beauty, too, make more sense when understood in terms of this non-moral yet normative type of expectation, as they involve appeals to others that are more than mere predictions of, but less than rational demands for, a certain kind of response. Introducing this alternative notion of expectation into the discourse of moral philosophy can shed light on other common attitudes that are clearly normative, but defy translation into objective, third-personal terms. Such attitudes include certain experiences of pride and shame, apology and forgiveness, the bestowing of mercy, gratitude, agent-regret, and perhaps a basic sense of trust we have in others. Ultimately, I situate love in respect to grief, which demonstrates my theory’s ability to make sense of related dimensions of our emotional lives. The people we love and grieve over give us a sense of who we are as distinctive, particular individuals, as the three interrelated dimensions of intimacy in loving relationships reveal. Consequently, grief is best understood as a type of practical disorientation—namely, a disorientation that involves the loss of the personal self. I present my account of grief against the type of account that would draw philosophical conclusions about the nature of love and grief from empirical psychological data alone. In particular, these data indicate that we recover quickly from the deaths of loved ones, and Dan Moller draws the philosophical conclusion that those we love fulfill certain roles in our lives and are replaceable. In contrast, I contend that while we should acknowledge the truth of the objective judgment, made in the third-person, that we will likely recover after the deaths of those we love, it does not follow that we must affirm such a claim from the internal perspective of one person who loves another. As a result, the case of love and grief supports a general claim concerning the proper work of moral philosophy, which is that the understanding of ourselves gained through empirical data is not a substitute for the normative conclusions that are revealed through first-personal reflections on our relationships. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.1 (2004) 65-70 [Access article in PDF] Top-Down and Bottom-Up in Delusion Formation Jakob Hohwy Keywords delusions, top-down, bottom-up, predictive coding Some delusions may arise as responses to unusual experiences (Davies et al. 2001; Maher 1974;). The implication is that delusion formation in some cases involves some kind of bottom-up mechanism—roughly, from perception to belief. Delusion formation may also involve some kind of top-down mechanism. (...) This could be in the shape of a patient's flawed background beliefs, or biases, which somehow modulate perception or ensure delusional interpretations of experience. There is little agreement about what kind of mechanism is primary in delusion formation, or, indeed, what the particular mechanisms and their neural substrates might be.In the evaluation of top-down and bottom-up mechanisms in delusion formation, a number of conceptual questions should be addressed (Davies and Coltheart 2000). For example, if there is an experiential component, why is a hypothesis with a delusional explanation of the unusual experience seen as relevant? Why do the subjects come to believe it tenaciously? How come some unusual experiences do not develop into delusions?A number of empirical findings also need to be taken into account: for example, the damage to the autonomic system in Capgras delusion (Ellis et al. 1997), the decreased ability for fast error correction in schizophrenia (Frith and Done 1989), modulation of activity in parietal cortex in delusions of alien control and other passivity experiences (Blakemore, Oakley, and Frith 2003), and also in schizophrenia, the increased sensitivity to self-produced stimuli, such as tickling oneself (Blakemore et al. 2000) and the sound of one's own voice (Ford et al. 2001).Theory choice can also be guided by philosophical doctrines about, for example, the nature of belief, the constitutive role of rationality, and intersubjectivity and the nature of judgements about the external world. It is natural, however, to let beliefs about philosophical doctrine be secondary to empirical findings and conceptual issues.The distinction between bottom-up and top-down mechanisms is particularly sharp in John Campbell's (2001) account of delusions and in Tim Bayne and Elisabeth Pacherie's (2004) discussion of Campbell. In this discussion, top-down approaches are associated with the general philosophical doctrine of rationalism, and bottom-up approaches with the philosophical doctrine of empiricism. Campbell's account is top-down because he posits delusional framework beliefs that arise directly as a result of brain damage or malfunction, and that work in some top-down fashion on the interpretation of experience. Bayne [End Page 65] and Pacherie convincingly defend empiricism against Campbell's rationalist account. Among their many other objections, they briefly puzzle about how a delusional framework belief (e.g., that one's spouse is an impostor) in a top-down fashion could cause the damage to the autonomic system seen in the Capgras and Cotard delusions (2004, 1). I think this is a very important objection because skin conductance data are part of the evidence for the bottom-up hypothesis concerning the Capgras delusion. We could add to this, for example, that it is mysterious how belief in a top-down fashion could cause people with schizophrenia to be worse at fast error correction than normal controls, to be better at tickling themselves than normal controls, and to have an increased response to the sound of their own voice.On the other hand, although the skin conductance response (SCR) evidence suggests a bottom-up approach to the Capgras delusion, it does not explain the character of the subjective experience that is hypothesized to give rise to the delusional belief: reduced SCR is not part of the experience itself (thanks to Ian Gold for discussion of this). Something more is required to give a full account of the type of experience that gives rise to the delusion. Further, as they stand, most bottom-up accounts are unable to account for why reality testing fails for beliefs based on these experiences.Neither rationalism nor empiricism on their own seem able to address the conceptual questions while paying... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.1 (2004) 71-80 [Access article in PDF] Some Reflections on the (Analytic) Philosophical Approach to Delusion Louis A. Sass There are more things in heaven and earth, Horatio, Than are dreamt of in your philosophy." —Hamlet, Act I, Scene 5 The peculiar, often problematic phenome na of psychopathology have been attract ing the attention of analytic philosophers in recent years. The topic of delusion has (...) been a particular draw, with a number of analytic philosophers attempting to use their conceptual tools, usually combined with ideas from cognitive neuroscience, to criticize the traditional understanding and to clarify the nature of this central psychiatric topic. It is useful to have this kind of interdisciplinary dialogue. Indeed, there is good reason to hope that concepts honed in the philosophy of mind and other philosophical subfields will help to sort out our understanding of a phenomenon (or set of phenomena) for which contemporary psychiatric definitions and conceptualizations are clearly inadequate and, in some respects, downright misleading (see Parnas and Sass 2001; Spitzer 1990).1Here, however, I would like to call attention to some weaknesses that, it seems to me, are rather common (I do not say universal) in many analytic philosophical approaches to psychopathology. In my opinion, there is a tendency to formulate issues and arguments in overly polarized, even dichotomous terms, and then to rely too uncritically on these essentialistic formulations in exploring the domain of inquiry. Although this polarizing tendency sometimes has the salutary effect of clarifying conceptual domains, it can, when taken too far, actually hamper our understanding of phenomena that are often fraught with ambiguities and complexities that defy many standard conceptualizations.The relationship between philosophy and psychopathology is obviously a two-way street—we are familiar, for example, with disorders that challenge deep philosophical assumptions about self and mind (e.g., blindsight, split-brain phenomena, perhaps also Dissociative Identity Disorder, and the first rank symptoms of schizophrenia). I am suggesting that, in their work on delusions, philosophers may need to put more emphasis on moving from the natural phenomena [End Page 71] of psychopathology and to the domain of philosophical analysis.I believe that a greater sensitivity to the modes of knowing associated with the phenomenological tradition, and to the forms of conceptual self-critique fostered by Ludwig Wittgenstein, are crucial ingredients for any adequate approach to delusion as well as many other topics in psychopathology. In my opinion, the work of many analytic philosophers interested in psychopathology would be enriched if they spent more time trying to discover and imagine what it might be like to experience certain kinds of abnormal psychiatric conditions, and also speculating about what implications such experiential modalities might have for action and verbal expression. I believe they would also be wise to spend more time questioning, and attempting to transcend, the philosophically derived conceptual distinctions and dichotomies that appear to organize their conceptual universes. Phenomenological imagination and Wittgensteinian critique can show how to move outside the conceptual capsule and into the rich and strange realms of actual experience, both normal and abnormal.So far I have offered only slogans. Let me use the articles by Tim Bayne and Elisabeth Pacherie (2004) and Robert Klee (2004) to flesh out the criticisms I have offered. There is much that is intelligent and much that is worthwhile in both their articles. (For example, I was largely convinced by the criticisms of John Campbell and of Donald Davidson that are central to the articles by Bayne and Pacherie and by Klee, respectively.) Here, however, I will focus only on issues that illustrate the above-mentioned tendencies—tendencies that, in my view, tend to infect even the best writings on the (analytic) philosophy of psychiatry. I will also make some remarks about the works of Campbell and Davidson, the two philosophers criticized in the articles by Bayne and Pacherie and by Klee. Because the article by Eugenie Georgaca (2004) is in a different tradition, I will say only a few words about it at the end. Bayne and Pacherie on the Preservation-Of-meaning... (shrink)

This book brings together insights from the enactivist approach in philosophy of mind and existing work on autonomous agency from both philosophy of action and feminist philosophy. It then utilizes this proposed account of autonomous agency to make sense of the impairments in agency that commonly occur in cases of dissociative identity disorder, mood disorders, and psychopathy. While much of the existing philosophical work on autonomy focuses on threats that come from outside the agent, this book addresses how inner conflict, (...) instability of character, or motivational issues can disrupt agency. In the first half of the book, the author conceptualizes what it means to be self-governing and to exercise autonomous agency. In the second half, she investigates the extent to which agents with various forms of mental disorder are capable of exercising autonomy. In her view, many forms of mental disorder involve disruptions to self-governance, so that agents lack sufficient control over their intentional behavior or are unable to formulate and execute coherent action plans. However, this does not mean that they are utterly incapable of autonomous agency; rather, their ability to exercise this capacity is compromised in important respects. Understanding these agential impairments can help to deepen our understanding of what it means to exercise autonomy, and also devise more effective treatments that restore subjects' agency. Autonomy, Enactivism, and Mental Disorder will be of interest to researchers and advanced students working in philosophy of mind, philosophy of action, philosophy of psychiatry, and feminist philosophy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Peter Lamarque TRUTH AND ART IN IRIS MURDOCH'S THE BLACK PRINCE "Art," writes Bradley Pearson, protagonist and narrator in The Black Prince, "is concerned not just primarily but absolutely with truth." Bradley Pearson is also concerned with truth. And understandably so, as he has just taken the rap, and been imprisoned, for a murder he claims he never committed. There are two rather different concerns here with truth: there (...) is the high-minded concern of the artist and there is the more pragmatic concern of the despised and falsely convicted man writing his "apologia." The careful juxtaposition of these two appeals to truth is a central theme in The Black Prince. The bulk of the novel purports to be a first-person narration of events in the later life of Bradley Pearson. Bradley is a writer who has been waiting patiently and silently for the inspiration, "the dark blaze," to produce a great work of art. This "dark blaze" eventually shows itself as the "black Eros," in a passionate but short-lived love affair with the youngJulian Baffin. Bradley is reflecting on these events from his prison cell, guided by his mentor and fellow prisoner, the "editor" P. Loxias (a witty reference to Apollo, god of truth). He sees his art and his love as stemming "from the same source" (p. 172) and, although sensitive to his shortcomings as an artist, he believes that through a divine inspiration he has attained a kind of Platonic tranquillity in the presence of truth and self-knowledge. However, through the device of "postscripts," purportedly written by other characters, we are presented with another picture of him rather different from his own. His former friends, more down to earth, though variously self-interested, depict him as a pitiful, even contemptible, charlatan lost in fantasy and delusion and a suitable case for psychoanalysis. What, then, is the real Bradley Pearson? Is he the pathetic, fantasy-ridden creature of the "postscripts"? Or is he, as he thinks, the great artist inspired by the gods and by Eros who has seen the revelation of truth? 209 2 1 0 Philosophy and Literature By forcing us to raise these questions about the novel, Iris Murdoch, I suggest, is inviting us to reflect on, and relate, two concerns we might have with truth in works of fiction. The first is with truth internal to the novel, truth-within-fiction, which informs us about the fictional characters and events. In The Black Prince, our attention is focused on unravelling and assessing the "truth" of Bradley's account. The second is with truth proper, as it might be revealed through fiction. This is truth not about the fictional world but about the non-fictional real world. It is often maintained that novels can instruct us in acquiring knowledge of the world. This, I suggest, is the type of truth that Bradley, so grandly and solemnly, and frequently, identifies with art. The nature of such truth is the main topic of this article. II What sense can we make of Bradley's repeated claims to the effect that "good art speaks truth" (p. xi)? One answer, reflecting an obvious feature of literary works, is that propositions about the world are often expressed, explicitly, within a fictional context; they might be uttered by one of the characters or directly by the author. The Black Prince offers many such propositions, some of which, on the nature of art, I shall be considering in detail. Examples are plentiful. Thus, Bradley remarks on marriage: "People who boast of happy marriages are, I submit, usually self-deceivers, if not actually liars. The human soul is not framed for continued proximity..." (p. 64). He meditates on love: "The foreverness of real love is one of the reasons why even unrequited love is a source of joy" (pp. 173-74) and discusses jealousy (p. 207). He also reflects on human consciousness and responsibility (p. 155) and on selfishness and goodness: "The burden of genuine goodness is instinctively appreciated as intolerable, and a desire for it would put out of focus the other and ordinary wishes by which one lives" (p. 149). Such explicit propositions carry us beyond the... (shrink)

What altered states of consciousness—the dissolution of feelings of time and self—can tell us about the mystery of consciousness. During extraordinary moments of consciousness—shock, meditative states and sudden mystical revelations, out-of-body experiences, or drug intoxication—our senses of time and self are altered; we may even feel time and self dissolving. These experiences have long been ignored by mainstream science, or considered crazy fantasies. Recent research, however, has located the neural underpinnings of these altered states of mind. In (...) this book, neuropsychologist Marc Wittmann shows how experiences that disturb or widen our everyday understanding of the self can help solve the mystery of consciousness. Wittmann explains that the relationship between consciousness of time and consciousness of self is close; in extreme circumstances, the experiences of space and self intensify and weaken together. He considers the emergence of the self in waking life and dreams; how our sense of time is distorted by extreme situations ranging from terror to mystical enlightenment; the experience of the moment; and the loss of time and self in such disorders as depression, schizophrenia, and epilepsy. Dostoyevsky reported godly bliss during epileptic seizures; neurologists are now investigating the phenomenon of the epileptic aura. Wittmann describes new studies of psychedelics that show how the brain builds consciousness of self and time, and discusses pilot programs that use hallucinogens to treat severe depression, anxiety, and addiction. If we want to understand our consciousness, our subjectivity, Wittmann argues, we must not be afraid to break new ground. Studying altered states of consciousness leads us directly to the heart of the matter: time and self, the foundations of consciousness. (shrink)

As an alternative to linear and unidimensional perspectives focused mainly on either organic or psychological processes, the enactive approach to life and mind—a branch of 4-E cognitive theories—offers an integrative framework to study mental disorders that encompasses and articulates organic, sensorimotor, and intersubjective dimensions of embodiment. These three domains are deeply entangled in a non-trivial manner. A question remains on how this systemic and multi-dimensional approach may be applied to our understanding of mental disorders and symptomatic behavior. Drawing on Gilbert (...) Simondon’s philosophy of individuation, we provide some enactive conceptual tools to better understand the dynamic, interactive, and multi-dimensional nature of human bodies in mental disorders and psychopathological symptoms. One of such tools cursiva is sense-making, a key notion that captures the relational process of generating meaning by interacting with the sociomaterial environment. The article analyzes five aspects related to sense-making: temporality, adaptivity, the multiplicity of normativities it involves, the fundamental role of tension, and its participatory character. On this basis, we draw certain implications for our understanding of mental disorders and diverse symptoms, and suggest their interpretation in terms of difficulties to transform tensions and perform individuation processes, which result in a reduction of the field of potentialities for self-individuation and sense-making. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.2 (2003) 161-167 [Access article in PDF] Social, Cognitive, and Neural Constraints on Subjectivity and Agency:Implications for Dissociative Identity Disorder Peter Q. Deeley In this commentary, I consider Matthew's argument after making some general observations about dissociative identity disorder (DID). In contrast to Matthew's statement that "cases of DID, although not science fiction, are extraordinary" (p. 148), I believe that there are natural analogs of (...) the disorder that, when considered, make it seem less puzzling and exotic. After discussing these examples, I examine the relations between social, cognitive, and neural processes supporting subjectivity and agency, to identify sources of personal identity in cases of DID that can be used as a basis for assessing Matthew's points against Behnke and Sinnott-Armstrong. I am not proposing a comprehensive theory, but rather identifying what I believe are components of such a theory. I then outline an approach to determining criminal responsibility in DID, drawing on analogies with other psychiatric disorders. Dissociative Identity Disorder DID is a disorder described in DSM-IV, which "is characterised by the presence of two or more distinct identities or personality states that recurrently take control of the individual's behaviour accompanied by an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness" (American Psychiatric Association, p. 519). Recognizing Personal Identity How is personal identity recognized in normal cognition? If we take personhood to involve recognition of continuity of social, psychological, and physical identity for a given individual, then such judgments are routinely made rapidly and automatically as an aspect of what has come to be termed social cognition (Adolphs 2003). There is likely to be considerable redundancy in [End Page 161] the types of information used to make judgments about whether a person is the same as one who was previously encountered, or perhaps heard about—for example, facial features, movement patterns, speech prosody, dress, speech content, gender, ethnicity, social role, among other features, all provide information about individual identity, and hence personhood. When uncertainty exists, it is likely to reflect a loss or alteration of cues that would ordinarily be used in a rapid, automatic, unexamined way (Adolphs 2003). In such extreme cases (for example, severe mental illness or disfigurement), the problem of identification becomes the subject of explicit reasoning (and hence of potential disagreement, because we then engage in post hoc rationalizations to establish criteria for determining personhood, whereas normally we rely on essentially automatic, implicit abilities that work in most circumstances, some of which make little use of linguistic representations and formal reasoning—for example, individual facial identity recognition, which may occur as quickly as 170 ms after stimulus onset [Adolphs 2003]). Nevertheless, examining our judgments and intuitions in cases that force us to explicitly consider whether personal identity is preserved may provide analogies and clues for how we should proceed with DID. Let us consider, then, some natural analogs of DID. Natural Analogs of DID Method Acting I suggest that method acting is an analog of DID (Manderino 1985). Method acting refers to an approach to acting training and performance in which emphasis is placed on intensely imagining and identifying with the mental life of the character being portrayed. Training courses and manuals list many techniques and practices that can be used to facilitate absorption in a role, drawing on different kinds of memory—for example, experiential memories, memories of others, general knowledge (semantic memory), and memories of sensations and feelings, to creative a vivid sense of the subjective experience and actions of the character. Manderino, a method acting teacher, comments: "it is important to investigate the way in which your own mental makeup can improperly influence a character. Insecurities, self-consciousness, shyness or self-doubts can maintain a strong hold, and permitting any of these feelings to enter a performance is to remain the actor and not enter into the mental life of the character. For some, acting allows personal problems to be left behind, and they are thankful for the complete escape that... (shrink)

Localizing the self in the brain has been the goal of consciousness research for centuries. Recently, there has been an increase in attention to the localization of the self. Here we present data from patients suffering from a loss of self in an attempt to understand the neural correlates of consciousness. Focusing on delusional misidentification syndrome , we find that frontal regions, as well as the right hemisphere appear to play a significant role in DMS and DMS (...) related disorders. These data are placed in the context of neuroimaging findings. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Dante's Inferno as Poetic Revelation of Prophetic TruthWilliam FrankeIDante's Inferno demands to be understood as the culmination of a series of visits to the underworld in ancient epic tradition. Dante's most direct precedent is Aeneas's journey to meet his father in Hades, as told by Virgil in Book VI of the Aeneid. Aeneas's voyage is modeled in turn on Odysseus's encounter with shades of Hades in Book XI of (...) the Odyssey. The epic quest in each of these models pivots, in various ways, on a visit to the world of the dead, a discensus ad inferas, as a climactic episode at its center. However, Dante makes this episode the general framework of the whole poem: from beginning to end, Dante's poem represents a voyage through the world beyond the grave. In this respect, Dante's Inferno, and indeed the whole Divine Comedy, is conceived primarily as an expansion of the ancient epic motif of the katabasis or "going down" of the protagonist to the underworld for a revelation of his destiny from beyond the threshold of death. Like Virgil, Dante interprets history prophetically, finding in it the essential pattern of things to come. But this projection now reaches to an eschatological future beyond history altogether—to an uncannily dynamic realization of eternity.The other world that is visited by Dante asserts itself unequivocally as ultimate reality. It is not just some shadowy world of bloodless phantasms like the shades that approach Odysseus, nor is it vacuous and inane, as are Virgil's "houses void and empty realms of Dis" ("domos Ditis vacuas et inania regna," Aeneid VI.269). This "other" world shows up as even more vivid than the world of ordinary sense-perception by virtue of a strikingly realistic, indeed surrealistic imagery. Dante heightens the [End Page 252] mythological topos of the visit to the underworld that he inherited from Virgil and Homer to a level where it represents the true essence of life on this earth transposed into a transcendent dimension. The world of the dead is not just one in a series of episodes befalling the protagonist but rather the final and definitive experience that reveals the true meaning of all possible experiences and thereby the meaning of the world as a whole. This is perhaps implicit and incipient in Homer and Virgil, since the journey to the underworld in each case encloses a revelation that illuminates the meaning of everything else and orients the protagonist's subsequent life in the world up to his death. But Dante's other world is more than the place for a miraculous glimpse into the true meaning of life: it is itself the vera vita, the "true life."Of course, Virgil had interpreted the whole of Roman history through the optics of prophecy, but his prophetic history was directly disclosed only in privileged moments within his poem. Dante's entire poetic narrative transpires in an eschatological dimension of existence; it thereby aspires to reveal beyond the limits of history a full-blown vision of eternity—that is, history as projected into the eternal worlds that it prefigures. While at the level of content Dante expands the theme of a visit to the underworld into an entire poem of epic proportions, more deeply, at the level of genre and in terms of its mode, Dante's whole poem is prophetic in character. History and narrative become in themselves prophetic rather than only forming a background for prophecy and framing it.The descent to the world of the dead—a symbol for the place of revelation of the meaning of life—is a thematic issue that runs as a thread through each of the epic works that have been mentioned so far. But in Dante it becomes the central axis of a poem that emerges in its entirety as religious revelation, and Dante greatly intensifies the self-conscious grasp of this function of poetry. His work represents an unprecedentedly powerful reflection on poetry as revelation in the mode of prophecy, for the customary literary means of poetic expression are now revealed in their intrinsically prophetic potency. From the Aeneid Dante could learn... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Dante's Inferno as Poetic Revelation of Prophetic TruthWilliam FrankeIDante's Inferno demands to be understood as the culmination of a series of visits to the underworld in ancient epic tradition. Dante's most direct precedent is Aeneas's journey to meet his father in Hades, as told by Virgil in Book VI of the Aeneid. Aeneas's voyage is modeled in turn on Odysseus's encounter with shades of Hades in Book XI of (...) the Odyssey. The epic quest in each of these models pivots, in various ways, on a visit to the world of the dead, a discensus ad inferas, as a climactic episode at its center. However, Dante makes this episode the general framework of the whole poem: from beginning to end, Dante's poem represents a voyage through the world beyond the grave. In this respect, Dante's Inferno, and indeed the whole Divine Comedy, is conceived primarily as an expansion of the ancient epic motif of the katabasis or "going down" of the protagonist to the underworld for a revelation of his destiny from beyond the threshold of death. Like Virgil, Dante interprets history prophetically, finding in it the essential pattern of things to come. But this projection now reaches to an eschatological future beyond history altogether—to an uncannily dynamic realization of eternity.The other world that is visited by Dante asserts itself unequivocally as ultimate reality. It is not just some shadowy world of bloodless phantasms like the shades that approach Odysseus, nor is it vacuous and inane, as are Virgil's "houses void and empty realms of Dis" ("domos Ditis vacuas et inania regna," Aeneid VI.269). This "other" world shows up as even more vivid than the world of ordinary sense-perception by virtue of a strikingly realistic, indeed surrealistic imagery. Dante heightens the [End Page 252] mythological topos of the visit to the underworld that he inherited from Virgil and Homer to a level where it represents the true essence of life on this earth transposed into a transcendent dimension. The world of the dead is not just one in a series of episodes befalling the protagonist but rather the final and definitive experience that reveals the true meaning of all possible experiences and thereby the meaning of the world as a whole. This is perhaps implicit and incipient in Homer and Virgil, since the journey to the underworld in each case encloses a revelation that illuminates the meaning of everything else and orients the protagonist's subsequent life in the world up to his death. But Dante's other world is more than the place for a miraculous glimpse into the true meaning of life: it is itself the vera vita, the "true life."Of course, Virgil had interpreted the whole of Roman history through the optics of prophecy, but his prophetic history was directly disclosed only in privileged moments within his poem. Dante's entire poetic narrative transpires in an eschatological dimension of existence; it thereby aspires to reveal beyond the limits of history a full-blown vision of eternity—that is, history as projected into the eternal worlds that it prefigures. While at the level of content Dante expands the theme of a visit to the underworld into an entire poem of epic proportions, more deeply, at the level of genre and in terms of its mode, Dante's whole poem is prophetic in character. History and narrative become in themselves prophetic rather than only forming a background for prophecy and framing it.The descent to the world of the dead—a symbol for the place of revelation of the meaning of life—is a thematic issue that runs as a thread through each of the epic works that have been mentioned so far. But in Dante it becomes the central axis of a poem that emerges in its entirety as religious revelation, and Dante greatly intensifies the self-conscious grasp of this function of poetry. His work represents an unprecedentedly powerful reflection on poetry as revelation in the mode of prophecy, for the customary literary means of poetic expression are now revealed in their intrinsically prophetic potency. From the Aeneid Dante could learn... (shrink)

This paper discusses the findings of qualitative research that examined the accounts of five “mostly recovered” ex-patients who had experienced transition between two or more eating disorder diagnoses. This study found that, in the minds of participants, the different diagnostic labels were associated with various good or bad character traits. This contributed to the belief in a diagnostic hierarchy, whereby individuals diagnosed with anorexia nervosa were viewed as morally better than those diagnosed with bulimia nervosa or binge eating disorder. (...) Consequently, diagnostic crossover from a “better” to a “worse” eating disorder was often experienced as shameful moral failing, and a new diagnosis impacted the individual’s sense of self-identity. These findings are of significance for both ethicists and clinicians; the paper concludes by outlining the relevance and possible clinical implications of shame in diagnostic crossover and suggesting avenues for future research. (shrink)

This collection of essays focuses on the interface between delusions and self-deception. As pathologies of belief, delusions and self-deception raise many of the same challenges for those seeking to understand them. Are delusions and self-deception entirely distinct phenomena, or might some forms of self-deception also qualify as delusional? To what extent might models of self-deception and delusion share common factors? In what ways do affect and motivation enter into normal belief-formation, and how might they be (...) implicated in self-deception and delusion? The essays in this volume tackle these questions from both empirical and conceptual perspectives. Some contributors focus on the general question of how to locate self-deception and delusion within our taxonomy of psychological states. Some contributors ask whether particular delusions - such as the Capgras delusion or anosognosia for hemiplegia - might be explained by appeal to motivational and affective factors. And some contributors provide general models of motivated reasoning, against which theories of pathological belief-formation might be measured. (shrink)

This paper explores the differences between bringing about self-change by way of antidepressants versus psychotherapy from an ethical point of view, taking its starting point in the concept of authenticity. Given that the new antidepressants (SSRIs) are able not only to cure psychiatric disorders but also to bring about changes in the basic temperament structure of the person—changes in self-feeling—does it matter if one brings about such changes of the self by way of antidepressants or by way (...) of psychotherapy? Are antidepressants a less good alternative than psychotherapy because antidepressants are in some way less authentic than psychotherapy? And, if so, what does this mean exactly? In this paper I try to show that the self-change brought about by way of antidepressants challenges basic assumptions of authentic self-change that are deeply ingrained in our Western culture: that changes in self should be brought about by laborious ‘self-work’ in which one explores the deep layers of the self (the unconscious) and comes to realise who one really is and should become. To become oneself has been held to presuppose such a journey. While the assumed importance of self-work appears to be badly founded on closer inspection, the notions of exploring and knowing oneself appear to be more promising in fleshing out an ethical distinction between psychopharmacological and psychotherapeutic practice with the help of the concept of authenticity. Psychotherapy, to a much greater extent than psychopharmacological interventions, involves the whole profile of the self in its attempts to effect a change, not only in the temperament but also in the character of the person in question, and this is important from an ethical point of view. In the article, the concepts of self-change, authenticity, temperament and character are presented and used in order to understand and flesh out the relevant ethical differences between the practice of psychotherapy and the use of antidepressants. Looping, collective effects of psychopharmacological self-change in a cultural context are also considered in this context. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Seeking the Everyday Meaning of Autonomy in Neurologic DisordersGeorge J. Agich (bio)The Socratic aphorism that the unexamined life is not worth living and dictums like "Know thyself" remind us of the centrality of self-understanding in the history of philosophical reflections on autonomy. These traditional concerns with autonomy may seem far removed from the neurologic impairments to which Joel Anderson and Warren Lux draw our attention. Nonetheless, Anderson and (...) Lux have provided an important discussion that links the traditional philosophical commitment to self-knowledge with an account that parses these concepts in the context of neurologic disorders. Theirs is a potentially productive approach for improving our understanding of autonomy, one that Emilio Mordini and I advocated in a paper entitled, "Autonomy and the Ethics of Neurosurgery" (Agich and Mordini 1998, 54). We argued that the focus of bioethics on issues such as informed consent misses the more challenging and potentially fruitful collaboration that neurosurgery and neurology affords for advancing the philosophical understanding of the conditions of autonomy. The challenge is in the integration of concepts used in one context of meaning with other domains of discourse. A good example of the challenges embedded in pursuing this kind of project can be found in Anderson and Lux's discussion of the concept of accurate self-assessment.Anderson and Lux argue that accurate self-assessment is a requirement for one to act autonomously. On first hearing, this phrase sounds unsurprising and consistent with standard approaches that assume a higher degree of awareness of one's capacities. Their characterization, however, derives from their observations of cases involving severe neurologic impairments, which point to more basic processes than the reflective awareness or knowledge that is often assumed. Paradoxically, the language of accurate self-assessment sounds remarkably like an intellectual function. It appears to fall squarely within the traditional philosophical tendency to define autonomy in terms of ego-centered, intellectual functions involving relatively high-level reflective capacities. Despite their terminology, Anderson and Lux stress that their account requires a type of reflexivity that is not the same as self-conscious reflection understood in the highest degree. They stress this in a number of places. For example, they see the neurologic concept of executive function as involving basic feedback mechanisms that are "broadly isomorphic with capacities associated [End Page 295] with autonomy;" these include anticipation, goal seeking, planning, initiation, sequencing, monitoring, error detection, self-correction, as well as initiation of novel responses, a clearly heterogenous set of capacities (Anderson and Lux 2004, 285). These capacities are not capacities of the "mind," but basic neurologic functions of the intact embodied agent who is actively engaged in the world. Thus, these concepts capture or express a practical (or clinical) as opposed to a theoretical understanding of the basic conditions or capacities defining autonomy. Similarly, their talk of "self-assessment" does not need to be understood as explicit or conscious; rather, it typically operates in the background (Anderson and Lux 2004). They term this character of self-assessment "mundane" (Anderson and Lux 2004, 289), which strikes me as exactly the right way to characterize this key feature of autonomy (Agich 1995). Their phenomenological and clinically based insights are quite sound, but the reader struggles with a terminology that seems to run in a different direction. To be sure, they stress that they intend their language of "autonomy" and "accurate self-assessment" to involve ordinary, background, and everyday functions that do not require high levels or significant capacities for reflective self-assessment, but their very insistence underscores the problem inherent in this terminology.Anderson and Lux argue that the capacity for self-assessment has a task-relative dimension that requires a degree of "accuracy." They characterize accuracy in a way that may promote rather than forestall misunderstanding. They state that "an adequate degree of precision" (281) is required in such assessment. For example, in assessing whether one is able to jump a hurdle, they say "one must accurately estimate not only the strength of one's legs but also the height of the hurdle" (Anderson and Lux 2004, 281). They further characterize their account of "accuracy" as involving an epistemological externalism, which might lead some readers to assume... (shrink)