Delusions play a fundamental role in the history of psychology, philosophy and culture, dividing not only the mad from the sane but reason from unreason. Yet the very nature and extent of delusions are poorly understood. What are delusions? How do they differ from everyday errors or mistaken beliefs? Are they scientific categories? In this superb, panoramic investigation of delusion Jennifer Radden explores these questions and more, unravelling a fascinating story that ranges from Descartes’s demon to famous first-hand accounts of (...) delusion, such as Daniel Schreber’s Memoirs of My Nervous Illness. Radden places delusion in both a clinical and cultural context and explores a fascinating range of themes: delusions as both individually and collectively held, including the phenomenon of folies á deux ; spiritual and religious delusions, in particular what distinguishes normal religious belief from delusions with religious themes; how we assess those suffering from delusion from a moral standpoint; and how we are to interpret violent actions when they are the result of delusional thinking. As well as more common delusions, such as those of grandeur, she also discusses some of the most interesting and perplexing forms of clinical delusion, such as Cotard and Capgras. (shrink)
IntroductionThose in mental health-related consumer movements have made clear their demands for humane treatment and basic civil rights, an end to stigma and discrimination, and a chance to participate in their own recovery. But theorizing about the politics of recognition, 'recognition rights' and epistemic justice, suggests that they also have a stake in the broad cultural meanings associated with conceptions of mental health and illness.ResultsFirst person accounts of psychiatric diagnosis and mental health care (shown here to represent 'counter stories' to (...) the powerful 'master narrative' of biomedical psychiatry), offer indications about how experiences of mental disorder might be reframed and redefined as part of efforts to acknowledge and honor recognition rights and epistemic justice. However, the task of cultural semantics is one for the entire culture, not merely consumers. These new meanings must be negotiated. When they are not the result of negotiation, group-wrought definitions risk imposing a revision no less constraining than the mis-recognizing one it aims to replace. Contested realities make this a challenging task when it comes to cultural meanings about mental disorder. Examples from mental illness memoirs about two contested realities related to psychosis are examined here: the meaninglessness of symptoms, and the role of insight into illness. They show the magnitude of the challenge involved - for consumers, practitioners, and the general public - in the reconstruction of these new meanings and realities.ConclusionTo honor recognition rights and epistemic justice acknowledgement must be made of the heterogeneity of the effects of, and of responses to, psychiatric diagnosis and care, and the extent of the challenge of the reconstructive cultural semantics involved. (shrink)
In Moody Minds Distempered philosopher Jennifer Radden assembles several decades of her research on melancholy and depression. The chapters are ordered into three categories: those about intellectual and medical history of melancholy and depression; those that emphasize aspects of the moral, psychological and medical features of these concepts; and finally, those that explore the sad and apprehensive mood states long associated with melancholy and depressive subjectivity. A newly written introduction maps the conceptual landscape, and draws out the analytic and thematic (...) interconnections between the chapters. Radden emphasizes and develops several new themes: the implications, theoretical phenomenological and moral, of recognizing melancholy and depressive states as mood states; questions of method, as they affect how we understand and characterize claims about melancholy and depression; and the persistence and force of cultural tropes linking such states to brilliance, creativity, and sagacity. Insights from literature and the history of medicine, psychology, and psychiatry are woven together with those from the more recent disciplines of feminist theory and cultural studies. This is interdisciplinary writing at its best-part analytic philosophy, and part history of ideas. (shrink)
Psychiatric ethics as professional and biomedical ethics -- The distinctiveness of the psychiatric setting -- Psychiatric ethics as virtue ethics -- Elements of a gender-sensitive ethics for psychiatry -- Some virtues for psychiatrists -- Character and social role -- Case studies in psychiatric virtues.
This discussion is about the moods characteristic of depressive and manic states. Moods are distinguished from the emotions they often accompany, and the relationship between these less and more cognitive, and seemingly less and more intentional, states is provided preliminary clarification. Epistemic deficiencies identified here, when combined with differences of quality and quantity in the moods and motivations that beset the depression and mania sufferer, seem likely to hinder self-knowledge and self-integration. These deficiencies, it is argued, may help explain why (...) the extreme moods found in states of depression and mania contribute to our inclination to regard these conditions as disorder. (shrink)
Although employed throughout health-related rhetoric and research today, prevention it is an ambiguous and complicated category when applied to mental and behavioral health. It is analyzed here, along with four ethical issues arising when public health preventative methods and goals involve mental health: age of intervention; resource priorities between prevention and treatment; substantive issues in preventive pedagogies and trade-offs framed by differences of approach. Illustrations include some of the most widespread and ambitious recent preventive models: those aiming to avert subsequent (...) mood disorders of depression and anxiety; those that would curb self-harming behavior, and efforts to anticipate and avoid or delay psychosis. To suppose that public mental health can be entirely modeled on other public health programs is mistaken. Instead, it must proceed with awareness of the particular features typifying many mental disorders. These include features of the disorders themselves; the preliminary nature of scientific knowledge about them; the contested applicability of traditional disease models to them; the dearth of established research data available about preventive interventions currently in place or proposed; and the effects of stigma and discrimination on any such interventions. (shrink)
Jennifer Radden finds, within Robert Burton's religious and humoral explanations in his Anatomy of Melancholy, a remarkably coherent account of normal and abnormal psychology with echoes in modern day clinical psychology.
Spanning 24 centuries, this anthology collects over thirty selections of important Western writing about melancholy and its related conditions by philosophers, doctors, religious and literary figures, and modern psychologists. Truly interdisciplinary, it is the first such anthology. As it traces Western attitudes, it reveals a conversation across centuries and continents as the authors interpret, respond, and build on each other's work. Editor Jennifer Radden provides an extensive, in-depth introduction that draws links and parallels between the selections, and reveals the ambiguous (...) relationship between these historical accounts of melancholy and today's psychiatric views on depression. This important new collection is also beautifully illustrated with depictions of melancholy from Western fine art. (shrink)
This is a comprehensive resource of original essays by leading thinkers exploring the newly emerging inter-disciplinary field of the philosophy of psychiatry. The contributors aim to define this exciting field and to highlight the philosophical assumptions and issues that underlie psychiatric theory and practice, the category of mental disorder, and rationales for its social, clinical and legal treatment. As a branch of medicine and a healing practice, psychiatry relies on presuppositions that are deeply and unavoidably philosophical. Conceptions of rationality, personhood (...) and autonomy frame our understanding and treatment of mental disorder. Philosophical questions of evidence, reality, truth, science, and values give meaning to each of the social institutions and practices concerned with mental health care. The psyche, the mind and its relation to the body, subjectivity and consciousness, personal identity and character, thought, will, memory, and emotions are equally the stuff of traditional philosophical inquiry and of the psychiatric enterprise. A new research field--the philosophy of psychiatry--began to form during the last two decades of the twentieth century. Prompted by a growing recognition that philosophical ideas underlie many aspects of clinical practice, psychiatric theorizing and research, mental health policy, and the economics and politics of mental health care, academic philosophers, practitioners, and philosophically trained psychiatrists have begun a series of vital, cross-disciplinary exchanges. This volume provides a sampling of the research yield of those exchanges. Leading thinkers in this area, including clinicians, philosophers, psychologists, and interdisciplinary teams, provide original discussions that are not only expository and critical, but also a reflection of their authors' distinctive and often powerful and imaginative viewpoints and theories. All the discussions break new theoretical ground. As befits such an interdisciplinary effort, they are methodologically eclectic, and varied and divergent in their assumptions and conclusions; together, they comprise a significant new exploration, definition, and mapping of the philosophical aspects of psychiatric theory and practice. (shrink)
In this chapter we outline ethical issues raised by the application of public health approaches to the field of mental health. We first set out some of the basics of public health ethics that are particularly relevant to mental health, with special attention to the ongoing debate over the traditional presumption of non-infringement, increased recognition of the social determinants of health, and the concept of prevention. Then we turn to the moral particularities of mental health, focusing on questions concerning coercion (...) and treatment pressure, personal identity and sociocultural factors (including stigma), and unresolved conceptual and methodological issues in psychiatry that complicate its extension into the domain of public health. (shrink)
In this paper, I explore the implications of adopting one model of self rather than another in respect to one particular feature of our mental life. The need to explain synchronic unity in normal subjectivity, and also to explain the apparent and puzzling absence of synchronic unity in certain symptoms of severe mental disorder, I show, becomes more pressing with one particular model. But in the process of developing that explanation we learn something about subjectivity and perhaps also something about (...) brain functioning. (shrink)
Richard Mullen and Grant Gillett (2014) decry the oversimplifications that accompany ‘doxastic’ analyses of delusion analogizing them to belief states; particularly, they object to the recent elevation to the status of paradigmatic the ordinary beliefs often understood, in Bayesian terms, as probabilistic estimates of empirical facts. Such an approach ignores the significance of the delusion for the individual, they emphasize, neglecting the delusional person’s conceptions of self and identity in relation to the world. In support of their plea for a (...) broader, more nuanced, and more clinically and existentially sensitive understanding of delusion, Mullen and Gillett enumerate drawbacks to the doxastic view not .. (shrink)
Psychiatry has a habit of ignoring its past, which is understandable but, in some instances, a mistake. It is my contention that some of the lacunae about mood disorder in today's psychiatric understanding and treatment may be illuminated by the medical lore captured in Burton's Anatomy of Melancholy (1621). The implications of the present analysis for network based accounts of depression seem to encourage a reconsideration of therapeutic and remedial principles based on those found in Burton's work.
In this introduction to the edited volume we briefly describe some of the current challenges faced by public mental health initiatives, at both the national and global level. We also include several general remarks on interdisciplinary methodology in public mental health ethics, followed by short descriptions of the chapters included in the volume.
My aim here is to clarify the practice of honoring and validating the relational model of self which plays an important role in feminist therapy. This practice rests on a tangle of psychological claims, moral and political values, and mental health norms which require analysis. Also, severe pathology affects the relative "relationality" of the self. By understanding it we can better understand the senses of autonomy compatible with and even required for a desired relationality.
This paper explores the two-factor theoretical model currently widely used to provide an explanatory analysis of the delusions that regularly accompany neurological disease or damage. The model hypothesizes a combination of an experiential factor – a strange or untoward experience – and a cognitive factor, such as an impairment of reasoning. The two-factor model has been devised for monothematic delusions that are usually manifested in a single, implausible idea. These have to be distinguished from the more elaborated, polythematic delusions that (...) are found in psychiatry. Psychiatric delusions exceed neurological ones in frequency and, often, semantic complexity. This text offers a preliminary clarification of underlying assumptions about the breadth, terminology and presuppositions of two-factor theorizing, exploring its potential application to psychiatric delusions. (shrink)
Data indicate the ubiquity and rapid increase of depression wherever war, want and social upheaval are found. The goal of this paper is to clarify such claims and draw conceptual distinctions separating the depressive states that are pathological from those that are normal and normative responses to misfortune. I do so by appeal to early modern writing on melancholy by Robert Burton, where the inchoate and boundless nature of melancholy symptoms are emphasized; universal suffering is separated from the disease states (...) known as melancholy or melancholia, and normal temperamental variation is placed in contrast to such disease states. In Burton's time these distinctions and characterizations could be secured by the anchoring tenets of humoral theory. Without such anchoring, and in light of the findings and assumptions of today's biological diagnostic psychiatry, we must re-visit each of them. My goals here are to show the need for analytic foundations when claims are made about depression such as those cited above, and to draw attention to some contemporary attempts that may help provide those foundations, particularly, attempts to define disorder or disease. With adjustments, one of these (Cooper 2002) is shown to take us some way toward that goal. (shrink)
My response to the preceding essays begins with some preliminaries about my terminology, approach, and conception of rationality as a regulative ideal. I then comment on the Murphy's discussion about normal religious belief and religious delusions, and on causal assumptions challenged by Langdon's folies à deux. Responding to Gerrans's imagination-based account of delusion and Hohwy's discussion of illusions, I next try to envision what both doxastic and imagination-based approaches might have overlooked by asking whether there can be delusional feelings. Final (...) comments address the place of phenomenology within Coltheart's two-factor theorizing. (shrink)
Because other cultures classify mental disorders very differently from ours, it behooves us to inquire into the philosophical and cultural sources of our own guiding nosological categories. This paper is a philosophical exploration into the historical and theoretical bases of the late nineteenth-century, Kraepelinian division between disorders of mood or affect, and schizophrenia, in which our present day nosological categories are rooted. By tracing the early nosologists’ divisions into eighteenth-century and Kantian faculty psychology, and following the fate of faculty psychology (...) through the nineteenth century, we discover genealogical elements of our taxonomy likely to affect clinical diagnosis and understanding. (shrink)