How can we better understand and treat those suffering from schizophrenia and manic-depressive illnesses? This important new book takes us into the world of those suffering from such disorders. Using self descriptions, its emphasis is not on how mental health professionals view sufferers, but on how the patients themselves experience their disorder. A new volume in the International Perspectives in Philosophy and Psychiatry series, this book will be of great interest to all those working with sufferers from such disorders - (...) helping them to better understand their mental lives, and providing important insights into how best to treat them. (shrink)
Emotions and personhood are important notions within the field of mental health care. How they are related is less evident. This book provides a framework for understanding the important and complex relationship between our emotional wellbeing and our sense of self, drawing on psychopathology, philosophy, and phenomenology.
2013 sees the centenary of Jaspers' foundation of psychopathology as a science with the publication of his magnum opus the Allgemeine Psychopathologie (General Psychopathology), Many of the issues concerning methodology and diagnosis are today the subject of much discussion and debate. This volume brings together leading psychiatrists and philosophers to discuss the impact of this volume, its relevance today, and the legacy it left.
In this paper, we consider the nature of two aspects of human emotional experience—moods and affects—in their relation to the concept of the person. We argue for the importance of the concept of the person in an approach to human emotional experience. This paper differentiates between the concepts of minimal self, extended self, and person. Furthermore, it offers a phenomenological proposal to understand the feeling dimension of moods and affects as critical for the differentiation of human emotional experience, and hence (...) an understanding of that experience. By way of conclusion, we opt for a narrative approach to the question of the normative dimension of emotional experience to clarify the intricate relationship between mood and personhood. (shrink)
Persons with borderline personality disorder are often described as affected by extreme emotional fluctuations and by the sudden emergence of uncontrollable and disproportionate emotional reactions. Borderline persons frequently experience their own self as dim and fuzzy, are deprived of a stable sense of identity and unable to be steadily involved in a given life project. We will interpret these typical features as fluctuations between a clearly normative emotion such as anger and the more diffuse and confusing background of bad moods (...) like dysphoria. Our main focus will be on dysphoria. The intentional structure that characterizes much of human emotional experience, we shall argue, is absent in dysphoria. If we imagine emotions as fluxes of intentionality that innervate the body and connect it to the world, dysphoria is empty intentionality, so to speak, devoid of the moderating power of language and representation. Dysphoria exerts a centrifugal force which fragments the borderline person's representations of herself and of others, inducing a painful experience of incoherence and inner emptiness, a feeling of uncertainty and inauthenticity in interpersonal relationships, and an excruciating sense of futility and inanity of life. But it also entails a sense of vitality, although a disorganized, aimless, and explosive one -- a desperate vitality. (shrink)
Nature and Narrative is the launch volume in a new series of books entitled International Perspectives in Philosophy and Psychiatry. The series will aim to build links between the sciences and humanities in psychiatry. Our ability to decipher mental disorders depends to a unique extent on both the sciences and the humanities. Science provides insight into the 'causes' of a problem, enabling us to formulate an 'explanation', and the humanities provide insight into its 'meanings' and helps with our 'understanding'. Psychiatry, (...) if it is to develop as a balanced discipline, must draw on input from both of these spheres. Nature (for causes) and Narrative (for meanings) will help define the series as a whole by touching on a range of issues relevant to this 'border country'. With contributions from an international star-studded cast, representing the field of psychiatry, psychology and philosophy, this volume will set the scene for this new interdisciplinary field. This will be of interest to all those with practical experience of mental health issues, whether as providers or as users/consumers of services, as well as to philosophers, social scientists, and bioethicists. (shrink)
A significant cluster of complaints of persons affected by schizophrenia, for example, their feeling ephemeral, lacking core identity, being affected by a diminished sense of existing as a self-present subject, point to the disruptions of structural aspects of the core self. These and similar disturbances aggregate significantly and selectively in the schizophrenia spectrum disorders, occur and are detectable in adolescents at risk of future schizophrenic disorder, and have a tendency to persist. All this led to the proposal that the generative (...) disorder in schizophrenia is a disorder of the self. The phenomenological notion of the self serves to investigate the fact that we live.. (shrink)
Awareness of illness in schizophrenia reflects complex storied understanding of the impact of the disorder upon one’s life. Individuals may be aware of their illness in different ways and this may be related to their functioning. A total of 76 adults with schizophrenia were assessed for their awareness of illness, neurocognition, social cognition, and social function concurrently and social function was also assessed at three later time points. A cluster analysis revealed 3 groups: generally full awareness, generally limited awareness, and (...) superficial awareness. Comparisons between these profiles revealed the superficial group had poorer executive function, emotion recognition ability, and capacity for social relationships than the full awareness group, yet had better verbal memory and more social contacts than the limited awareness group. These results suggest assessing the narrative qualities of awareness of illness may reveal unique links with cognition and function, and this may have implications for interventions. (shrink)
Three revolutions in psychiatry characterised the closing decade of the twentieth century: 1) in the neurosciences, 2) in patient-centred models of service delivery, and 3) in the emergence of a rapidly expanding new cross-disciplinary field of philosophy and psychiatry. Starting with a case history, the paper illustrates the impact of this third revolution - the new philosophy of psychiatry - on day-to-day clinical practice through training programmes and policy developments in what has become known as values-based practice. Derived from philosophical (...) value theory and phenomenology, values-based practice is a partner to evidence-based practice in supporting clinical decision-making in the highly complex environment of mental health care. The paper concludes by setting values-based practice in context with other potentially practical important areas of the new philosophy of psychiatry arguing that all three revolutions need to be brought together if psychiatry is to meet the challenges of the twenty-first century. (shrink)
We are glad to acknowledge the wide spectrum of topics posited by our commentators and at the same time the recognition of the thematic issue of our project: that the mentally ill is still a person, and that this humane dimension of his existence must be brought to the fore in psychopathological studies and kept always in the fore in the therapeutic process.We are also glad to have encountered appreciation for the fact that long gone is the time when the (...) clinician could have afforded to be the plenipotentiary in the therapeutic relationship, and that a more equal geometry of relations with the patient is not only useful but probably necessary for therapeutic success, intended as a "success [that] also involves... (shrink)
To provide a qualitative analysis of abnormal temporal experiences of persons affected by feeding and eating disorders. This is a naturalistic explorative study on a group of 27 patients affected by FED interviewed over a two-year period in a clinical/psychotherapeutic setting. Clinical files were analysed by means of Consensual Qualitative Research. Twenty-one out of twenty-seven patients affected by FED reported at least one ATE. The main categories identified are 1) Irruption of disturbing bodily experiences ; 2) Anxiety for the passing (...) of time ; 3) Ritualization/Digitalization of time. ATE are a relevant feature of the life-world inhabited by people with FED and may represent an important link between abnormal bodily experiences and disorders of personal identity in these patients. The sample number is small but our preliminary findings justify testing a larger number of patients. (shrink)
I develop here one of the many topics raised by Sass, Parnas, and Zahavi, namely the role of phenomenology in clarifying issues not amenable to standard empirical methods. The authors of this scholarly paper mainly tackle this issue from the angle of psychopathological research in schizophrenia. I would like to build on their argument, having in mind one dimension of clinical phenomenology that has not been approached in their paper: the issue of care, that is the use of the method (...) implemented by clinical phenomenology in the therapeutic setting.I first briefly outline some methodological principles of clinical phenomenology in the context of psychopathological research that may be implemented in the context of .. (shrink)
The field of psychiatry has long struggled with developing models of practice; most underemphasize the interpersonal aspects of clinical practice. This essay is unique in putting intersubjectivity front and centre. It is an attempt to provide a clinical method to re-establish the fragile dialogue of the soul with oneself and with others.
This essay is unique in putting intersubjectivity front and center. It is an attempt to provide a clinical method to re-establish the fragile dialogue of the soul with oneself and with others. Throughout, the book builds on the assumption that to be human means to be in dialogue. It uses dialogue as a unitary concept to address three essential issues for clinical practice: 'What is a human being?', 'What is mental pathology'?, and 'What is care?'. To be human - it (...) is argued - means to be in dialogue with oneself and with other persons. Thus, mental pathology is the interruption of this dialogue - of the person with the alterity that inhabits them, and with the alterity incarnated in other persons. Therefore, therapy is a dialogue with a method whose aim is to re-enact one's interrupted dialogue with alterity. Lost in Dialogue provides a method to approximate the Other, to understand its experiences, actions, and in general, understand the world in which it lives. (shrink)
The psychiatric interview plays a critical role in clinical assessment and therapy. Problems with assessment reliability and validity that were apparent in nosological and diagnostic discrepancies plagued the field of psychiatry historically. Technical approaches including structured interviews were developed to address these problems. Although these approaches decreased diagnostic variance, they focused narrowly on eliciting signs and symptoms conforming to previously agreed diagnostic categories, necessarily restricting the range and richness of experiences and narratives that are elicited. This restriction inhibits the utility (...) of assessment in furthering the interpersonal rapport and exploration that is essential to the task of therapy. The author reviews critiques of technical approaches to psychiatric assessment and highlights critical, often unexamined, epistemological assumptions and questions. In light of these critiques, he proposes a phenomenological approach to psychiatric assessment focused on narratives that situate particular experiences in the broader life context. In this approach the assessor functions as a participant observer, relying on the same empathic skills that inform effective therapy. It is argued that without over turning the advances in assessment reliability gained through technical approaches to the psychiatric interview, a phenomenological approach can illuminate, enrich, and broaden psychiatric assessment, increasing its effectiveness in psychopathological understanding and in therapy. (shrink)