Several fields contributing to psychiatric advances, such as psychology, biology, and the humanities, have not yet met to produce a cohesive and integrated picture of human function and dysfunction, strength and vulnerability, etc., despite advances in their own areas. The failure may have its roots in a disagreement on what we mean by the human person and his or her relationship with the world, for which the incommensurate language of these disciplines may be partly to blame. Turns taken by western (...) philosophy over the past 400 years may help to explain this. Language is such an important tool for psychiatrists, that examination of it may afford an insight into the reasons for divisions in the field. This paper aims to examine and compare psychologies (and hence psychiatries) derived from modern western philosophy, with similar concepts in other cultures, through the study of developments in terminology, in terms of the simplest facts about what it means to be human. Terminology used in mental health in western cultures is examined, with particular consideration of the term “self” as it has come to be used in a technical sense. Analogous terms from non-English speaking European languages, and some non-western cultures are studied. Western philosophy and psychology have evolved a meaning for the term “self” which is quite different from equivalent terms in non-western cultures. It is a moot point whether or not the development in western psychiatry of what are now technical terms to describe normal human experience has become needlessly obscure and ambiguous. It is not evident that this “new” language represents a genuine advance in understanding; it distances mental health professionals from those who are not familiar with it; and it makes transcultural dialogue difficult. (shrink)

The aim of this paper is to highlight the rationale behind the use of data from neuroscience, particularly neuroimaging, in psychiatric legal expert procedures and their interference with the mind-brain problem.The critical argument is that the employment of mental health evaluation of the defendants and/or witnesses as collected with clinical assessment methods in court proceedings should not be considered irrespective to the data from neuroscience. Essentially, neuroscience methods belong to the domain of nomothetic (natural explanatory) knowledge, whereas clinical evaluation methods (...) in psychiatry belong to the domain of intra- and inter-subjective narratives. There exists an explanatory gap between those two groups of disciplines which concerns the ability to translate and integrate data across diverse methodological and terminological systems. Furthermore, it depends largely on the implicit positions in the mind-brain debate and the brain-to-behavior connections, which reflect on the professional and legal reasoning in terms of prioritizing certain solutions or approaches over another in the expert judgements. There are described those tacit positions adopted in the mind-brain debate by different traditions in psychiatry, with special emphasis on reductive and non-reductive forms of physicalism.In conclusion, a cognitive pluralist stance is adopted which sets priority for the supervenience theory of mind. (shrink)

Toward a definition of mental disorder -- From normality to mental health -- Physical diseases and mental disorders : should they be differentiated? -- Conceptual cacophony in psychiatry.

The aim of Language for those who have Nothing is to think psychiatry through the writings of Mikhail Bakhtin. Using the concepts of Dialogism and Polyphony, the Carnival and the Chronotope, a novel means of navigating the clinical landscape is developed. Bakhtin offers language as a social phenomenon and one that is fully embodied. Utterances are shown to be alive and enfleshed and their meanings realised in the context of given social dimensions. The organisation of this book corresponds with (...) carnival practices of taking the high down to the low before replenishing its meaning anew. Thus early discussions of official language and the chronotope become exposed to descending levels of analysis and emphasis. Patients and practitioners are shown to occupy an entirely different spatio-temporal topography. These chronotopes have powerful borders and it is necessary to use the Carnival powers of cunning and deception in order to enter and to leave them. The book provides an overview of practitioners who have attempted such transgression and the author records his own unnerving experience as a pseudopatient. By exploring the context of psychiatry's unofficial voices: its terminology, jokes, parodies, and everyday narratives, the clinical landscape is shown to rely heavily on unofficial dialogues in order to safeguard an official identity. (shrink)

(1) It remains to be seen if in the field of Psychiatry just as in that of Psychology the verbal output of a subject can be submitted to verification. Many statements of a highly emotional character being merely symptoms of certain dispositions have no direct communicative sense at all.(2) It being one of the characteristics of the mentally ill to loose contact and exchange of ideas with other people, the question naturally suggests itself if this symptom may be at (...) the bottom of the phenomenon of these persons taking refuge in logical and ideological terminologies, their talk being a kind of verbal autism. (shrink)

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 formonothematicdelusions that are usually manifested in a single, implausible idea. These have to be distinguished from the more elaborated,polythematicdelusions that are found in (...) class='Hi'>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)

Research suggests that people tend to overweight arguments accompanied by neuroscientific terminology, which is dubbed as the seductive allure of neuroscience explanations (SANE) in the literature. Such an effect might be of particular significance when it comes to physicians and mental health professionals (MHP), given that it has the potential to cause significant bias in their understanding as well as their treatment approaches toward psychiatric symptoms. In this study, we aimed to test the SANE effect among Turkish medical students, (...) and assess its uniqueness by comparing it with a discipline that still maintains an important role in contemporary psychiatric training in Turkey: psychoanalysis. 109 medical students with a basic level of knowledge of psychiatry and clinical neuroscience were asked to rate the credibility of explanations of differing quality (good vs. circular) for psychological phenomena, followed by three types of information: none, neuroscientific (SNI) or psychoanalytical (SPI). Our findings showed that SNI significantly increased the judged quality of explanations for both conditions with the effect being more prominent for circular explanations. On the other hand, SPI had no effect on good explanations but enhanced the judged quality of circular explanations in a level comparable to that of SNI. For the first time, the SANE effect was replicated among medical students and provided preliminary data in favor of a similar effect for psychoanalytically oriented information. (shrink)

While classifications of mental disorders have existed for over one hundred years, it still remains unspecified what terms such as 'mental disorder', 'disease' and 'illness' might actually denote. While ontologies have been called in aid to address this shortfall since the GALEN project of the early 1990s, most attempts thus far have sought to provide a formal description of the structure of some pre-existing terminology or classification, rather than of the corresponding structures and processes on the side of the (...) patient. We here present a view of mental disease that is based on ontological realism and which follows the principles embodied in Basic Formal Ontology and in the application of BFO in the Ontology of General Medical Science. We analyzed statements about what counts as a mental disease provided in the research agenda for the DSM-V, and in Pies' model. The results were used to assess whether the representational units of BFO and OGMS were adequate as foundations for a formal representation of the entities in reality that these statements attempt to describe. We then analyzed the representational units specific to mental disease and provided corresponding definitions. Our key contributions lie in the identification of confusions and conflations in the existing terminology of mental disease and in providing what we believe is a framework for the sort of clear and unambiguous reference to entities on the side of the patient that is needed in order to avoid these confusions in the future. (shrink)

Diagnostic terms in psychiatry like ‘schizophrenia’ and ‘bipolar disorder’ are deeply contested in the professional community, by mental health activists and the public. In this paper, we provide a theoretical framework for considering diagnostic terms as ordinary linguistic expressions and illustrate this approach by a corpus linguistic analysis of ‘schizophrenia.’ Our aim is to show how a focus on language itself can inform current and future debates about psychiatric terminology and provide new insights on relevant processes concerning their (...) actual usage and change over time. We hope that this contributes to enhancing mutual understanding between different discourse spheres and stakeholders. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Spiritual Experience and PsychopathologyMike Jackson and K. W. M. Fulford (bio)AbstractA recent study of the relationship between spiritual experience and psychopathology (reported in detail elsewhere) suggested that psychotic phenomena could occur in the context of spiritual experiences rather than mental illness. In the present paper, this finding is illustrated with three detailed case histories. Its implications are then explored for psychopathology, for psychiatric classification, and for our understanding of (...) the concept of mental illness. It is argued that pathological and spiritual psychotic phenomena cannot be distinguished by 1) form and content alone (as in traditional psychopathology), 2) by their relationship either with other symptoms or with pathological causes (as in psychiatric classification), or 3) by reference to the descriptive criteria of mental illness implied by the “medical” model. The distinction is shown to depend, rather, on the way in which psychotic phenomena themselves are embedded in the values and beliefs of the person concerned. This in turn is shown to have implications for diagnosis (it shows the need for clinicians to attend to the values and beliefs of individual patients), for treatment (it points to a cognitive problem-solving model), and for research in psychopathology (especially as related to the emerging sciences of dynamic brain imaging and cognitive neuroscience).Keywordsfirst rank symptoms, schizophrenia, delusion, hallucination, thought disorder, religious experience, mystical experienceIntroductionThis paper explores some of the conceptual and practical implications of the finding that phenomena which in a medical context would probably be diagnosed as psychotic symptoms, may occur in the context of non-pathological, and indeed essentially benign, spiritual experiences.The existence of non-pathological psychotic experiences of this kind (we will call them “psychotic phenomena” as distinct from “psychotic symptoms”—see also Endnote 1, terminology) was a key finding in a study carried out by one of us (MJ) at the Alister Hardy Research Centre (AHRC) in Oxford. Details are given elsewhere both of the overall empirical findings of the study, including the relationship between spiritual experience and personality variables, and of a hypothetical cognitive problem-solving model of these phenomena (Jackson 1991, and forthcoming a and b). In the present paper, 1) the background to the study is described briefly in relation to earlier work on the possible links between spiritual experience and psychopathology; 2) some of the psychotic phenomena identified are illustrated with three detailed case histories; 3) the significance of these phenomena is reviewed for our understanding respectively of psychopathology, of diagnostic syndromes, and of the concept of mental illness; and 4) some of the practical implications of the study for clinical work and research in psychiatry are indicated.BackgroundIt has long been recognized that there are similarities between spiritual and psychotic experiences. [End Page 41] William James (1902), for example, argued that “in delusional insanity, paranoia as they sometimes call it, we may have a kind of diabolical mysticism, a sort of religious mysticism turned upside down” (426). Other commentators have noted a wide variety of phenomena, such as time distortion, synesthesias, loss of self-object boundaries and the transition from a state of conflict and anxiety to one of sudden “understanding,” all of which are reported in both spiritual and psychotic experiences (Buckley 1981; Watson 1982; Wapnick 1969; and Wootton and Allen 1983).Yet the similarities notwithstanding, the distinction between these two kinds of experience can be crucially important. Spiritual experiences, whether welcome or unwelcome, and whether or not they are psychotic in form, have nothing (directly) to do with medicine (Fulford 1996a). It would be quite wrong, then, to “treat” spiritual psychotic experiences with neuroleptic drugs, just as it is quite wrong to “treat” political dissidents as though they were ill (Fulford, Smirnoff and Snow, 1993). Pathological psychotic experiences, on the other hand, or psychotic symptoms, are by definition a proper object of medical treatment, sometimes even against the wishes of the person concerned. Hence it would be both negligent and, as Wing (1978) put it, morally “repellent,” to leave untreated someone who is genuinely ill (244).Given how much turns on the distinction between spiritual experience and psychopathology, it is perhaps not surprising that scholarly discussion of the relationship between them has at times... (shrink)

The term 'therapeutic misconception' (TM) was introduced in 1982 to conceptualize how some psychiatry trial participants perceived and interpreted their involvement in research. TM has since been identified in many settings and is a major component in research ethics discussions. A qualitative study included a subgroup of interviews with five parents (two couples, one mother) who declined to enrol their baby in a neonatal trial. Analysis suggested the possibility of a counterpart to TM which, given the original terminology, (...) we term the 'injurious misconception' (IM). While TM is closely linked to the elision of care and research, and involves an over-stated sense of benefit and protection, IM may be a product of a particularly keen and discomforting sense of distinctions between care and research and a correspondingly over-stated sense of risk and threat. (shrink)

For years a debate has raged within the various literatures of philosophy, psychiatry, and psychology over whether, and to what degree, the concepts that characterize psychopathology are social constructions that reflect cultural values. While the majority position among philosophers has been normativist, i.e., that the conception of a mental disorder is value-laden, a vocal and cogent minority have argued that psychopathology results from malfunctions that can be described by terminology that is objective and scientific. Scientists and clinicians have (...) tended to endorse the objectivist position, with some notable exceptions. (shrink)

Psychopathy fascinates. Modernist writers construct out of it an image of alienated individualism pursuing the moment, killing they know not why, exploiting in passing, troubled, if troubled at all, not by guilt, but by perplexity (Camus 1989; Gide 1995; Mailer 1957; Musil 1996). Psychiatrists and psychologists—even those who should know better—are drawn by it to take off into philosophical speculation about morality, evil, and the beast in man (Mullen 1992; Simon 1996). Philosophers succumb to the temptation of attempting to ground (...) speculation in the supposed facticity of psychopathy. -/- Psychopathy is a cultural construct with roots going back to the eighteenth century, but which only came to full flower over the last fifty years (Hare 1998; Lewis 1974). The currently fashionable constructions of psychopathy find wide acceptance among clinicians and academics. The problem is, however, whether the concept has connections that have been established to the behavior, psychopathology, or the structure and function of brain worthy of according even a modest level of scientific status. There is little point in basing an argument on some supposed scientific gold standard if what glitters is iron pyrites (fools' gold). -/- Neil Levy's opening paragraph contains the statement "Yet in other respects they seem quite irrational; so much so that the term moral insanity has sometimes been applied to them" (p. 129). This both asserts that there is a category "them," namely the psychopaths, and connects them to "moral insanity." Moral insanity entered the language of psychiatry when Pritchard chose to use the term to translate Pinel's category of mania sans deliré (Pritchard 1836). Pinel was attempting to conceptualize a range of disorders that bordered on insanity in the sense of severe disturbances of affect, judgment, and behavior, but that were not accompanied by hallucinations or delusions (Pinel 1798/1964). In today's terminology, the cases he described would probably fall into diagnostic groups, including major depression, bipolar disorder, epilepsy, and a range of personality disorders. A number of his more striking case histories involved antisocial and even murderous behavior, which probably reflected Pinel's role in assessing offenders for the criminal courts of Paris. Pritchard's use of the English word "moral" reflected an appeal first to its use at the time to designate something which was like or similar, but not identical (a usage the OED labels "vulgar"), and second moral in the sense of ethical, conforming to virtuous behavior. Anglophones seized on the latter meaning, although Pinel emphasized the former. Forty years later, Henry Maudsley, the most widely read psychiatrist of his generation, could assert that moral insanity was as real as Colour blindness, some people being Colour blind and some moral blind (Maudsley 1879). Moral insanity became connected variously to phrenology with its own bump over the underlying moral cortex, with the twisted genetics of degeneration, with atavistic theories of criminality, and with a range of disorders of brain from epilepsy to frontal lobe damage (Combed 1853; Ellis 1890; Pick 1989). Although it is anachronistic to use the terms "psychopathy" and "moral insanity" together, it is clear they occupied a similar social and psychiatric space, albeit in different era. This should caution against too ready acceptance of psychopathy which may turn out to be as empty and dangerous a conceptualization as moral insanity. Why dangerous? Dangerous to those labeled, because the morally insane and the moral imbeciles were placed in preventive detention in asylums and prisons, and even sterilized in some jurisdictions. Dangerous to society, because it gave a spurious scientific justification for viewing crime not as reflecting the social evils of deprivation, ignorance, and inequality but as the ravages of the born criminals. -/- Psychopaths are not, as Levy asserts, "(causally) responsible for … more than fifty percent of violent crime" (p. 129). A proportion of violent offenders, which varies widely between observers, are labeled psychopaths. This is often on the basis of Hare's psychopathy checklist, which is a subjective, albeit through training aspiring to be reproducible, and to some extent self-sustaining, evaluation system (Hare 1980, 2003). Part of the checklist gathers data on prior antisocial behavior; part constrains the examiner to subjectively estimate such matters as glibness and callousness, part requires judgments about whether the... (shrink)

This essay results from a common interest in the history of emotions shared by an academic with appointments in philosophy and psychiatry (Charland) and a literary historian (White). Where our interests converge is in the early modern concept of 'the passions,' as explanatory of what we now call mental illness. The task we have set ourselves is to see how this might: (a) be exemplified in a 'case study' of the dramatic revelation of Leontes's jealousy in the first half (...) of William Shakespeare's The Winter's Tale, and his 'cure' which takes sixteen years. Both events have troubled literary critics as implausible, lacking in realistic motivation, and clumsy as narrative devices, but can be explained in terms of theories of the passions ; and (b) open up a greater, modern understanding of irrational, pathological states, their onset and termination, by using as an explanatory model the early modern understanding of passions as revived and refined in the nineteenth century by Théodule Ribot. Janus-like, this chapter faces into the past and the future (our present) via a play written in 1610 that is still performed to receptive audiences today. We hope to show that the theory can illuminate a playtext, and that the play can revivify the theory, and to contend that historical analysis can shed light on modern clinical problems. The particular historical distinction which lies at the heart of our approach derives from early modern terminology offered by Thomas Wright in his book, The Passions of the Minde in Generall (first published in 1601; corrected, enlarged and augmented in 1604), and presented in more modern fashion in the nineteenth century by Théodule Ribot, in his La Psycholgie des sentiments * We dedicate this essay to Philippa Maddern, whose inspiration has generated so much inter-disciplinary research in the history of emotions and has brought so many like-minded scholars into fertile contact—in our cases, linking Western Ontario and Western Australia. (shrink)

For years a debate has raged within the various literatures of philosophy, psychiatry, and psychology over whether, and to what degree, the concepts that characterize psychopathology are social constructions that reflect cultural values. While the majority position among philosophers has been normativist, i.e., that the conception of a mental disorder is value-laden, a vocal and cogent minority have argued that psychopathology results from malfunctions that can be described by terminology that is objective and scientific. Scientists and clinicians have (...) tended to endorse the objectivist position, with some notable exceptions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Autonomy, Well-Being, Disease, and DisabilityJulian Savulescu (bio)Keywordsautonomy, well-being, mental disorder, psychiatric disease, disability, welfare, body integrity identity disorderVarelius seeks to redefine what constitutes mental disorder or mental illness. (I use these terms interchangeably.) "According to this account, 'a person is mentally disordered when her psychological capacity for autonomy is diminished as compared with that of a typical member of our species of her age-group" (Varelius 2009). This is a (...) stimulating and important paper. Varelius describes fruitfully the relationship between mental illness and autonomy, specifically the ways in which mental disorder can undermine autonomy. This is valuable in understanding the impact of mental illness on the lives of people who suffer from it, which is a serious issue in practical ethics. But is it what constitutes mental disorder or illness? There are logical, conceptual reasons why we should not redefine mental illness in this way.Incomplete Account of Mental DisorderThere are a family of related concepts: disease, injury, disorder, illness, disability. There are old and entrenched disputes about how we should define these concepts. Varelius' paper is a contribution to the definition of mental disorder and illness.The primary classificatory category that defines medical practice is that of health and disease. Disease, broadly construed, involves the presence of pathology. Pathology can result from processes primarily or predominantly internal to the organism, such as genetic disease (although external factors affect their expression), or from processes primarily or predominantly external to the organism, such as injuries.The concepts of disorder and illness relate to the concept of disease. Disorder could be defined in terms of the functional effect of pathology. Illness could be defined in terms of the experiential impact of disease.1 How these terms are precisely defined and related need not concern us at the present. What matters is that the primary category is disease.Psychiatry has evolved in its use of terminology. What used to be called psychiatric diseases are now often called mental disorders. I now claim, for the purposes of illustration of the argument (though it does not require this claim), that the dominant category is disease. Indeed, what are called mental disorders appear in the International Classification of Diseases.Disease can be divided into the mental and physical. I believe that the mental will one day be [End Page 59] shown to be shown to be entirely a subset of the physical. That is, that brain pathology will be a cause, if not the only cause, of mental disease. But others may believe the sets of mental and physical disease are intersecting but not coextensive.What matters is that mental disease is a subcategory of the more general category of disease. It must have the same definitional features as "disease" plus some extra ones specific to the "mental," or mind. (The same points apply if you use "disorder" as the dominant category rather than "disease.")One problem for Varelius is this: how does this autonomy account of "mental disease" relate to an account of "physical disease," and "disease" in general? If mental disease is defined in terms of its impact on the psychological capacities necessary for autonomy, how is "disease" in general, or physical disease, to be defined? One obvious response is to define these related concepts in a similar way:Disease: "a person is diseased when her capacity for autonomy is diminished as compared to that of a typical member of our species of her age-group." Physical disease: "a person is physically disordered when her physical capacity for autonomy is diminished as compared to that of a typical member of our species of her age-group."This interpretation is suggested by the following passage from Varelius:As contrasted with the actual condition of being autonomous, as a capacity of an individual autonomy means that a person has the psychological and bodily abilities that being autonomous... requires.(2009)It would be radical to define disease in general in terms of capacity for autonomy. There is no doubt that disease affects our autonomy, and that is morally significant, but these seem clearly separable concepts. Varelius could respond that he is not defining mental disease but rather the mental component... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Spiritual Experience and Psychopathology”Roland Littlewood (bio)Keywordsreligion, innovation, psychosis, culture, diagnosisThis is an ambiguous though clinically valuable paper. Jackson and Fulford suggest that the distinction between their two categories, spiritual experience and mental illness, is conventional, yet their emphasis on issues of correct practice from the medical perspective threatens to return both into distinct ontological categories, albeit with a shared phenomenology. I do not understand why any single (...) instance must either be pathological or spiritual, except through clinical and clerical demands for clarity and order.Mental illness and spirituality are not two distinct natural phenomena “out there,” existing independently of human volition. They are both social—cultural if one prefers—ascriptions. Neither has some substantive core whose elucidation through psychophysiological, phenomenological or ultrahuman procedures could enable us to define its essence and thus differentiate it from the other. Neither experience is a self-evident datum. Both are easily susceptible to critiques, either that they do not exist as natural categories, or else that they should more properly be described as something else—as the workings out of social exclusion in the case of mental illness, as cosmological understanding or mass hysteria in the case of spirituality. Neither, I would suggest, can be specified by physiology or ultrahuman interventions respectively, but rather through shared cultural meanings which in turn are experientially validated by the biosocial phenomena themselves. It is not that we need to exclude the possibility of concurrences in brain states, but rather that these cannot specify the meaning and experience of the phenomena.Note that I emphasize “experienced through cultural meanings,” not “influenced by” culture: I do not accept that psychophysiology can have any existence independent of the social world through which it occurs. The psychiatrists’ form/content distinction, an optimistic proxy for nature/culture (Birnbaum 1923; Schneider 1928) may remain a convenient heuristic device, but it has a curious, perhaps doubtful, intellectual history (see the Endnote following).Cross-cultural comparisons argue that local idioms which we might approximate to current Western notions of mental illness and religion are quite varied. And the validity of particular instances of both “spiritual experience” and “psychopathology” may be contested in any society. While the social consequences of a pattern may determine the approbation accorded to a pattern such that patterns recalling chronic schizophrenia [End Page 67] are regarded as a deficit (and here I agree with James [1902] and the two authors), they are not necessarily aligned to categories of physical illness, but may be seen as a spiritual failure or obstruction. Unsuccessful or inappropriate shamanic practice among Amerindian and circumpolar societies is the classic instance (Eliade 1964). Within Western societies, demonic possession may be read by doctors as mental illness. (It is just as much a “spiritual experience”: why introduce the religionist’s distinctions between different types of ultrahuman agency? Compare Maslow on “peak” experiences. The terms “spiritual” and “religious world view” are naturalized idioms of late Christianity rather than cross-culturally valid terms [Tambiah 1990].) But also the converse (Koch 1972). And this depends on our professional interests. Clearly, psychiatrists prefer to perceive the world in a psychopathological idiom, while religious enthusiasts and clergy may favor divine intercession or demonic possession; and a Christian psychiatry not surprisingly may claim to act as arbiter (Sims 1991). Any specific instance may be perceived differently by individuals in accordance with their interests and affiliations.The paper’s terminology—“spiritual psychotic experience,” “genuine spiritual experience”—is confusing in that it does imply realist, not conventional claims (cf. Endnote 1, Jackson and Fulford). It is not necessary. A less laden idiom—such as “statistically or normatively unusual brain states and their experiential correlates” (Littlewood 1993, 257)—may be just too unwieldy for repetition, but I would propose that at this level of detail we need rather four categories depending or not on concordance with (i) something close to psychiatry’s recognition of a major mental illness, and (ii) something like an anthropological notion of religious or spiritual experience (cf. Littlewood 1991):[Table 1]PsychosisReligious ExperiencePresentAbsentPresentABAbsentCDSo Jackson and Fulford’s three cases fall into group “A” if the PSE was scored... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 8.4 (2001) 327-329 [Access article in PDF] Husserlian Comments on Blankenburg's "Psychopathology of Common Sense" Osborne P. Wiggins, Michael Alan Schwartz, and Jean Naudin In this essay, Wolfgang Blankenburg sketches his influential view that some of the disturbances of schizophrenia in particular can be interpreted as a pathology of common sense. We think it important at the outset, however, to avoid possible misunderstandings of (...) Blankenburg's point. It is perhaps unfortunate that this point is expressed by use of the phrase, "common sense." As Blankenburg's own essay shows, even among the learned, "common sense" has no definite or univocal meaning. Therefore, it is entirely possible to find many people who, under some conception of "common sense," appear to lack common sense and yet should not be deemed schizophrenic. Consequently, it is probably best to avoid the ambiguous phrase "common sense" altogether and seek to comprehend Blankenburg's point in other terms. That is precisely what we shall attempt here. We do endorse Blankenburg's view. Moreover, we shall pursue his suggestions that a Husserlian phenomenology of our experience of the life-world may provide the basis for developing the kind of psychopathology he seeks. Our ultimate aim, however, is for this phrase "common sense" to vanish into the Husserlian phenomenology we offer, so that all the other meanings of common sense will not threaten Blankenburg's position with misunderstandings.Our comments must remain a mere sketch. Since, however, Husserl's phenomenology is not well known, we shall have to devote some time to outlining those features of it that we deem relevant here.For Husserl, every mental process is an awareness of something. In his terminology, it is "intentional." No mental process occurs in isolation, however. It rather occurs within a concatenation of many other mental processes. Some of these co-occurring mental processes intend the same object; they intend other aspects of the object. For example, a woman may be aware of the color of a dress she is considering wearing. Hence, one process in her mental life is (visually) aware of the brown color. But another process in her mental life may be intending it as a "party dress." And yet another process in her mental life may be (tactually) intending the texture of the cloth. Because all of these mental processes (and many others) intend the same object, namely, the dress, Husserl says that they are synthesized with one another. "Synthesis," then, connotes a multiplicity of mental processes united with one another through intending the same object.Now Husserl believed that it is because the many processes occurring in our mental lives [End Page 327] synthetically intend the many objects we encounter that we experience ourselves as inhabiting a world of objects. If these syntheses failed to occur, we would not experience the world or ourselves as parts of this world. These syntheses make it possible for us to experience objects and events as related to one another in the manifold spatial, causal, temporal, social, political, religious, and other relationships that we do in fact experience. Husserl thus contends that our mental lives "constitute" the world for us. Mental life can accordingly be viewed as "world-constituting." Mental life is thus the condition for the possibility of there being a world of objects for us, to modify Kant's phrase. Husserl thought his notion of world-constituting consciousness sufficiently similar to Kant's for him to appropriate the latter philosopher's concept of "transcendental." Husserl also then spoke of "transcendental consciousness" and the study of this consciousness as "transcendental philosophy."Husserl made many distinctions among kinds of mental processes and their correlative objects. We shall here explicate only one such distinction. Mental processes must be distinguished as those that are actively generated by an ego and those that are not produced by an ego. The latter kind of mental process occurs automatically or, as Husserl writes, "passively." Husserl calls the first kind of mental process "active." Having mentioned him, however, we should also briefly characterize the "ego... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.4 (2002) 313-316 [Access article in PDF] Normativity and Pathology Mike Gane Keywords: positivism, sociology, pathology, normativity. THE STRENGTH OF VICTORIA MARGREE'S contribution to the examination of the thematic of pathology and its Nietzschean/Canguilhemian variation is that it reveals the challenging complexity of this theme. My comments on this contribution are developed from an interest in the ways that the concern with pathology was (...) part of the initial program of the social sciences, particularly sociology, as it was inaugurated by Auguste Comte and Emile Durkheim in its formative period. Margree touches on the importance of social analysis at the end of her paper; my comments work to some extent in the opposite direction—from the social to the psychological. My concerns lead me to contest a number of her epistemological positions, particularly those concerning the notion of positivism and "objective" analysis.For the first positivist philosophers, positivism was primarily a method; in fact it embraced the set of methods developed by the sciences to obtain the highest degree of objectivity. It was explicitly opposed to methodological reductionism, arguing that each science had specific methods applicable to its own domain. Canguilhem was certainly against methodological reductionism (Renard 1996, 127), but Margree's conception of positivism in psychology as biological reductionism is quite a different and is a later-derived variation of positivism. As such perhaps it should not be conflated with early notions of pathology. Sociological positivism as developed in Durkheim's methodology, although different in many aspects from that of Comte, retained the idea that scientific objectivity was to be the result of epistemological procedures, not what might be called ontological reduction to a physical level of the object. Durkheim tries to clarify the rules governing the analysis of abnormal forms and to define social dysfunction and teratology. The general field of abnormal forms or pathology in the analysis of social life fell into decline after Durkheim and was abandoned in favor of the study of social deviance. The very idea of a study of social pathology itself was critiqued by Szasz and Foucault in particular as a new form of power, which came into existence at the end of the eighteenth century as an essential component of the disciplinary society. Foucault was himself clearly indebted to Canguilhem, and he made this evident on several occasions, such as his lectures at the Collège de France Les Anormaux given in 1974 and 1975 (Foucault 1999). Thus, although the field of pathology and abnormal forms continues in psychology it has been abandoned in sociology, leaving only traces (such as the concept of anomie) in the works of some thinkers such as Baudrillard, whose usage may be ironic more than an attempt to revive the terrain. Could it be that Canguilhem and Foucault [End Page 313] have then more or less swept the field clear of such scientism, even though the reconceptualization in terms of normativity suggested by Canguilhem has not been widely taken on? Indeed there may be important differences between the conceptualization of Canguilhem and Foucault (after all, as Margree points out, Canguilhem can be read as attempting to invert the relation between normativity and normative, not to withdraw from the terrain altogether). Foucault seems to approach a position elaborated in sociology earlier by Max Weber in his rejection of the attempt to use the field of pathology as a way of evading moral choices. Canguilhem discusses responsibility in "Thérapeutique, expérimentation, responsibilité" (1983, 391), noting the importance of professionalization and legal controls on professional practice.The fundamental issues posed by the project of social science continue to be haunted by the same set of problems as established in analysis of pathological phenomena, whether it be conceived in terms of order and disorder (chaos), social breakdown, radical evil, "failed states," even deviation or noncompliance with "correct" forms of language or behavior (harassment, racism, child abuse) and so on, or pathology (perversion, dysfunction, disease, illness, abnormalities). The question in part is: is there anything lost by replacing pathology with more political, religious, moral, and legal terminologies? From Foucault's point... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 8.4 (2001) 343-346 [Access article in PDF] Kimura Bin on Schizophrenia James Phillips With "Cogito and I: A Bio-Logical Approach," Kimura has continued his research into the core disturbance in schizophrenia. In his work, he has combined an original phenomenological approach with some fundamental concepts taken from his native Japanese and Zen culture. As in the work of others in the tradition of phenomenological (...) psychiatry, he has focused on a basic disturbance that underlies the positive symptoms found in schizophrenic conditions. In what follows, I will attempt to relate this current effort to some of his previous work on schizophrenia. I will conclude this commentary with some remarks on what I find problematic in the treatment of Heidegger.In "Cogito and I," Kimura plunges us directly into the core ego disturbance of schizophrenic patients by quoting two patients who, each in his own words, describe a pathological split between what we may call a "subjective" and an "objective" I or self. The latter is the self that acts and is recognizable by others (and by the patient) as the agent acting in the world. The former, the subjective self, is the non-objectified sense of self or self-awareness that accompanies all our actions. The two must be integrated, and it is a failure of this integration that is at the basis of the schizophrenic's ego disturbance.We can gain further clarification of this central notion in Kimura's treatment of schizophrenia through reference to some of his other discussions of the topic. In "Reflection and Self in the Schizophrenic" (Kimura 1992b), he invokes Husserlian terminology to discuss the same polarity within the self. 1 In this study, he distinguishes "simultaneous reflection" (the subjective self) from "secondary reflection" (the objective self). In the latter, the self is a noematic object of reflection; it is the image of myself after the act, the I that has done something and can now be captured in reflection. While "Cogito and I" describes the schizophrenic split as between the noematic self and the noetic self of simultaneous reflection, "Reflection and Self in the Schizophrenic" locates the split further back within the noetic self. Kimura distinguishes in the noetic self an observing I from the I that is moving toward action, both prior to the noematic self of secondary reflection. "One could say that a subjective self here accompanies an other self no less subjective and observes it constantly 'from behind'. There is no objective, noematic self involved here; a sole noetic self splits into two simultaneous 'moments' which occupy alternitively the places of seeing and seen, and which nonetheless remain subjective-noetic" (Kimura 1992b, 118). Pélicier emphasizes this Husserlian analysis in his exposition of Kimura Bin's phenomenological treatment of schizophrenia: The Self is never grasped as an object, but rather experienced in a noetic mode. On the other hand, the representation (l'image), as an object of consciousness, and in a certain manner all representations (images), as objects of consciousness, are of the noematic [End Page 343] order in Husserl's sense. Kimura insists then on the difference between this auto-perception (jikaku) in the noetic register and its content, which, itself, is noematic. Starting from this analysis, Kimura poses to himself the question of the nature of schizophrenia.... (Pélicier 1984, 32) In still another treatment of the theme, "Pathology of the Immediate" (Kimura 1992c), Kimura Bin focuses on the role of language in the structure of the self. The circuit of simultaneous and secondary reflection described above is played out in the pre-linguistic and linguistic dimensions of the self. Simultaneous reflection is immediate and fugitive in a manner that escapes articulation but at the same time, very readily flows into a secondary reflection that exists only as a mediated, articulated, noematic self. As Kimura puts it, "As for the I, which seems apparently the most immediately given, this also, when it becomes conscious of itself as 'I,' is constituted equally as an experience mediated by a negative differentiation that inserts itself between the 'I' that is in the process of becoming... (shrink)

In this paper, I propose an existentialist-phenomenological model that conceives of mental illness through the terminology of Heidegger’s Being and Time. In particular, the concepts of existentiality, disturbance and the relation between ‘being-with’ and ‘the one’, will be implemented in order to reconstruct the experience of mental illness. The proposed model understands mental illness as a disturbance of a person’s existentiality. More precisely, mental illness is conceptualized as the disturbance of a person’s existential structure, the process of which leads (...) to a becoming explicit of the otherwise implicit dynamical structure that constitutes a person’s experience. In particular, the existential component of ‘being-with’ comes to play a central role in the disturbance of existentiality, thus, I will claim, that it enables a person’s structure of experience to be ‘open for normativity’. By adopting a pragmatist stance on Heideggerian phenomenology, the suggested model proves compatible with naturalist and normativist theories of mental illness while still offering a phenomenological description of the phenomenon. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 8.4 (2001) 337-338 [Access article in PDF] On Kimura's Écrits de psychopathologie phénomenologique John Cutting This book is a French translation of six articles that the Japanese psychiatrist, Kimura Bin, wrote in the 1970s and 1980s. There is the usual long introduction in such books by the translator. There is also the mandatory explanation of the whole matter as a postface by philosopher Henry (...) Maldiney as if the meaning of anything these days has to be in the form of a sandwich.The first article by Kimura Bin deals with the meaning of certain Japanese words pertaining to self and inter-subjectivity. The critical Japanese word is aida, which means something like interpersonal bonding and is that primordial state of the human being that founds both everyday sociality and the individual self, the latter both in its external and internal composition and orientation: "From time immemorial, the Japanese understood interpersonal social existence, the being between, life in the aida of itself and of others, as the essential trait of an individual human. The interpersonal aida is in some sense the quintessence of known individuality." Schizophrenia, for Kimura, stems from a disturbance in this aida at the most fundamental level, and all its manifestations follow from this.The second article is entitled "Time and Anxiety (Angoisse)." This sets out his major psychopathological thesis—judging from these six articles—which is that schizophrenia and depressive illness differ fundamentally in their temporality. In schizophrenia the subject is geared toward the future: "Subjects with a schizophrenic tendency give sufficient proof in their daily life of a marked inclination to imagine future possibilities or ideas whose feasibility is impossible or implausible." In depressive illness there is a preoccupation with the past: "The lived time of the melancholic type of person has a preponderance towards the past, or, more precisely, towards lived being up to the present."The third article, entitled "Schizophrenic Temporality," amplifies this thesis and introduces his terminology for these, respectively, as the Latin terms, ante festum and post festum. The French translation gives the meaning of the latter as "apres la fête" and "trop tard"—after the holiday, too late. (I shall deal with the potpourri of languages involved below.) This article is the most elaborate, and in it Kimura attempts to derive the core characteristics of the two nosological entities from these two underlying anomalous temporalities.The fourth article is about borderline states, a nosological entity that I have no sympathy for, and I shall not discuss it.The fifth article is entitled "Reflection and Self in Schizophrenia." Again, it concerns a fundamental difference between the mode of reflection in schizophrenia and that in depressive illness, but I cannot say, despite numerous readings, [End Page 337] that I understand it. The reason for this may be my poor French, an inadequate translation, or a confused formulation in the first place, or all three. The gist of it seems to be that in schizophrenia the "other" is a "stranger" projected by the thinking self, whereas in depressive illness the "other" is a "familiar" inhabitant of the sociality adherent to this condition.The sixth article, "Pathology of Immediateness," is an attempt to seek philosophical, theoretical, psychopathological, and even nosological and biological backing for what Kimura has set out earlier, particularly in the third article. Hegel, Lacan, Bergson, Heidegger, Derrida, and Husserl are brought in as philosophical support. Blankenburg and Binswanger provide psychopathological backing. A third prong is the nosological tradition, prevalent in Germany and Japan in the twentieth century, of promoting the concept of an atypical or third type of psychosis with a biological resemblance to epileptic psychosis. All this is then brought together and complicated by a discussion of language and 'mediation' to support the notion that there is a third psychopathological principle—in addition to the ante festum pertaining to schizophrenia and the post festum pertaining to depressive illness—which is that of an intra festum: a preoccupation with the now, characteristic of atypical psychoses with an epileptic basis.These articles tax one's linguistic and conceptual repertoire to the... (shrink)

Reading the vast panorama of the history of Western medicine in general and psychiatry in particular sheds an interesting light not only on social constructions and representations but also on the perception of the Other by the medical institution. Colonial medicine in its struggle - praiseworthy, moreover - against epidemics, presents an interesting case here. We read in the Colonial Medical Archives at Berlin, that a certain Dr Roesener was sent to Kamerun (Cameroon), a German protectorate, to take charge (...) of the eradication of malaria, hookworm (anchylostoma), filariosa and sleeping sickness. But he also found himself faced with mental illnesses and, in his report of October 1909, reported the case of a sick man of the Dwala tribe claiming to be a friend of the Kaiser and presenting all the symptoms of mental illness. A problem of nosography arose - stemming from the cultural perception of an illness and above all of the Other: did this Dwala merit being mad? To understand the meaning of this question, we must return to the German anthropology of the last century, which made a clear distinction between ‘natural people’ (Naturmenschen) and those that were civilized, who were part of Kultur. Moreover, in this report Roesener used the word Naturmenschen to signify the Dwala. In this perspective, as the doctor notes, mental illness was, in the medical teaching of that time, a disturbance of the mind, a malaise of civilization. The prerequisite for being mentally ill was being implicitly part of a civilization. Mental illness was, moreover, translated in German by Geisteskrankheit, in other words, literally, illness of the mind. Now, the ‘natural person’ (the Dwala) has no civilization and in consequence cannot be sick in his mind. And yet he presented all the symptoms which made him a classic mental patient. Could one apply the nosography proper to illnesses stemming from civilization to ‘natural peoples’? Without resolving the problem which his terminological usage posed, Roesener insistently demanded that Berlin send the logistical means to Cameroon to build a lunatic asylum (Irrenhaus). To the problem of mental fragility that was posed came the answer of incarceration in a society that knew nothing of confinement of its ‘mental patients’, the latter often not being considered as inferior. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Phenomenology of Superstition or a Phenomenological Superstition?Elena Ibáñez-Guerra (bio)KeywordsBehaviorism, constructionism, intentionality, operant behaviorWhen the editors of Philosophy, Psychiatry, & Psychology asked me to make some brief comments on two articles for the special issue edited by Pérez-Álvarez and Sass, I was delighted to accept, thinking that the task would be a straightforward one, and that I could easily meet the agreed deadline. But nothing could be further (...) from the truth. The articles were of such density and their content of such profundity that it took months of interpretation and study, and of bringing my own knowledge up to date, before I was in a position to understand the concepts, adjust my beliefs, and make some comments. I could certainly have delivered some kind of eulogy about the brilliance of their content; I might have countered with my own article. However, what seemed most coherent to me was to meet their arguments head on and deal with what I consider to be their principal weaknesses, leaving the bouquets for the end.The articles set out, as I understand them and within the clinical context, to relate phenomenology, in its most traditional form, with the most current form of Skinnerian behaviorism, situating themselves in a contextualism that is, at the same time, close to and removed from the most radical type of social constructionism.But let us begin by looking more closely at “Phenomenology and Behaviorism.” It is novel for me, though Professor Pérez-Álvarez had already proposed it several years ago (Pérez-Álvarez 1992), to view operant behavior as intentionality, or at least as involving final causality according to the Aristotelian classification. It is a surprising contention, not least because, as I recall, Skinner lived in a time and a context (historical reason) in which the basic goal of psychology was to convert itself into a natural science, comparable in all respects to physics, which it took as a model, focusing therefore on efficient causality (also according to Aristotle’s terminology), so that behavior was considered as the immediate consequence of a stimulus, and the stimulus–response association became the cornerstone of the discipline. It is true that the operant behavior concept refers to the functional relationship between behavior and reinforcement, but it is no less true that Skinner’s definition of reinforcement is totally empirical—“all that which increases or decreases the probability”—meaning that reinforcement can be considered neither as a motive nor as a reason for behavior, unless it be in the eyes of the observer. [End Page 251]Furthermore, even though Yela (1987) refers to Ortega y Gasset’s formula “I am myself and my circumstances” as a Skinnerian approach, the truth is that Yela himself argues that it is precisely the self that constitutes personality, such that I have a personality because I am me, and not vice versa, as Skinner would appear to argue. In this regard, Ortega’s celebrated formula has generally been interpreted, from the most personalist perspectives, as “the circumstances are myself”—to highlight the denial of the psychological subject by radical behaviorism (Mischel’s [1968] criticism of the concept of personality is relevant here). On top of this, Skinner’s rejection of all that was not directly observable, or at least, that could not be operationalized, calls into question the admissibility of anything called final cause or intentionality of behavior. In his philosophy, all the indications are that contingencies are what determine behavior; and that there would be no room for a structural causality, as Althusser would argue, or of a reciprocal determinism, in Bandura’s terms, or even of an interaction between subject and environment, as modern interactionists would maintain. “I am myself and my circumstances” seems in Skinner to become “the circumstances are me”, and indeed, the reinforcement history – which in the article in question is considered as something akin to the Sartrian idea of “life project” – is for Skinner nothing more than a continuous association of events. In my view, Ortega’s perspectivism would perhaps be closer to the sociology of the American action theorists, Merton, Parsons, etc., than to Skinnerian behaviorism, since “action”—as the action theorists... (shrink)

In this thesis I develop an account of how processes of social understanding are implicated in experiences of mental disorder, critiquing the lack of examination of this phenomena along the way. First, I demonstrate how disorder concepts, as developed and deployed by psychiatric institutions, have the effect of shaping the cognition of individuals with psychopathology through setting expectations. Such expectation-setting can be harmful in some cases, I argue, and can perpetuate epistemic injustices. Having developed this view, I criticise enactive accounts (...) of mental disorder for failing to consider how such terms like ‘dysfunction’ are open to interpretation and can come embedded with normative expectations. Enactive accounts consequently run the risk of perpetuating injustices in their account of the sociality of mental disorder. Similar concerns arise when we consider the attachment of enactivism to the medical model, I argue. But by adapting enactivism to consider other experiences of disorder, such as those described as ‘madness’, enactive psychiatry may genuinely provide ethical groundwork for a better conception of disordered experience. Then, I consider a further concern with a distinctly medicalised conception of mental disorder from the perspective of self-illness ambiguity, arguing that self-illness ambiguities appear to form a special class of ambiguities due to their proximity to disorder concepts which mark them as appropriate targets for therapeutic treatment. However, I argue further that we should be critical of the idea that self-illness ambiguities necessitate disambiguation, as, in cases where self and illness are demarcated, individuals may still experience distress because simply having a mental disorder can be socially alienating. The medicalised focus in self-illness ambiguity, and the explicit need from the medical perspective to disambiguate it, might then exacerbate the distress someone experiences in mental disorder. Moreover, drawing on Mad Studies, I suggest that one might not need a coherent self-narrative to live well. Because of this, one may not need to adopt a medicalised view of the self in the case of selfillness ambiguity. In order to support this analysis, I provide a phenomenological account of language and argue that the very thoughts implicated in mental disorder shape the individual’s perception of the world due to the way that language foregrounds particular aspects of our world. This demands a critical examination of the language adopted and used by both clinicians and disordered individuals. I thus conclude with some thoughts on how to approach research and developing understanding of mental disorder given that we, as people, are always implicated in this process and therefore socialisation of some kind will always be taking place. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Lumps and Bumps”Katherine Arens (bio)“Lumps and Bumps” offers a fresh look at nosological classifications in terms of their genesis in eighteenth-century philosophy by acknowledging the proximity of philosophy to the sciences of the mind in the eighteenth and nineteenth centuries, especially in Germany. Today, strict borders are drawn between these fields by mainstream practitioners, but work like Radden’s makes a strong case for acknowledging not only multiculturalism, (...) but also the historicity of science. As such, it is exemplary interdisciplinary work tracing a set of concepts (here, a taxonomy of mental illness) back to its sources. Yet Radden tacitly raises other questions significant for the interrelationships between psychology/psychiatry and philosophy in the nineteenth and twentieth centuries.First, Radden quite rightly points to the fact that taxonomies defining mental illness will differ across cultures (e.g., that Scottish and German “faculty psychologies” differed). Yet her question can be inverted to ask a historical question: how can taxonomies of mental illness be used to interrogate the very construct of “the European Enlightenment” itself (in a sense, offering a variant on Michel Foucault’s Birth of a Clinic). This question is significant, since the “Enlightenment” has an internationalist contour in the history of philosophy that it may well not have had in medicine.In what way, for example, can Hume and Locke be considered more direct references for Kant than his philosophical nemesis, Johann Gottfried Herder, or physiologists La Mettrie (French) and Albrecht von Haller (Swiss)? Today, these two questions seem to lie on opposite sides of acknowledged disciplinary boundaries, across discourses of the various sciences, and they are not generally asked by intellectual historians, since they lie in different cultural traditions. Yet the German Idealist tradition that came out of the Enlightenment in the generation between Wolf and Kant had different boundaries between philosophy and the natural sciences than did its English equivalent. In this sense, then, Radden has made an argument that could be used to indicate how far the British empiricists actually influenced Kant, as an index of how science crosses both disciplinary and national boundaries.Second, Radden’s work raises a methodological issue for interdisciplinary work on the emergence of psychology: how one can trace the rapid mutation of critical terminology within the evolution of a single discipline across time. Even if some differentiation between affect and cognition was in place from the time of Kant all the way through to the DSM, for instance, the historical and cultural behavioral phenomena to which that distinction refers need to be specified in each context in which they occur, in different [End Page 15] times and places. Psychology between Kant and Kraepelin exemplifies this “interdisciplinarity” of an evolving field. Was psychology to be institutionalized as part of philosophy departments, or of physiology, or of education? The research in these three fields was carried out in almost identical terms in the early nineteenth century, but what that research means needs to be further historicized.For example, “reason” and “passion” occur as reference concepts in Goethe’s Sorrows of Young Werther, just as they do in Rousseau’s Nouvelle Heloise and Confessions, and in Richardson’s Pamela. Yet the behaviors that are identified as “passionate” differ across cultures, and so need to be defined today in ways that acknowledge chains of influence as they existed at that time, not as reconstructed for other purposes.The third issue raised by Radden’s study and needing further study is the question of power politics in science. Each use of terms has its own strategic importance, and every act of classification is potentially political. When classification schema are exported, imported, rejected, or upheld, the practitioner/professional not only makes a scientific statement, but a social one as well, by adhering to a set of professional organizations, institutions, and other power configurations in which the schema appear. In the case of Kant’s taxonomy of mind, one might ask what the significance was when he added “will” to the reason/passion dichotomy that pervaded his sources. What has he gained or lost by using these terms in the context of faculty psychology?Similarly, what is the cultural significance of that third... (shrink)

Psychiatry widely assumes an internalist biomedical model of mental illness. I argue that many of psychiatry’s diagnostic categories involve an implicit commitment to constitutive externalism about mental illness. Some of these categories are socially externalist in nature.

The need for a model -- Currently available models in psychiatry -- Introduction to enactivism -- Body and mind - and world -- The existential dimension and its role in psychiatry -- Enriched enactivism : existential sense-making, values, and socio-cultural worlds -- Enactive psychiatry : psychiatric disorders are disorders of sense-making -- An enactive approach to causes, diagnosis and treatment of psychiatric disorders.

Externalist theories hold that a comprehensive understanding of mental disorder cannot be achieved unless we attend to factors that lie outside of the head: neural explanations alone will not fully capture the complex dependencies that exist between an individual’s psychiatric condition and her social, cultural, and material environment. Here, we firstly offer a taxonomy of ways in which the externalist viewpoint can be understood, and unpack its commitments concerning the nature and physical realization of mental disorder. Secondly, we apply a (...) strongly externalist approach to the case of Autistic Spectrum Disorder, and argue that this condition can be illuminated by appeal to the hypothesis of extended cognition. We conclude by briefly considering the significance this strongly externalist approach may have for psychiatric practice and pedagogy. (shrink)

La savoir pyschiatrique et la pensée philosophique entretiennent des relations étroites d'intercritique et d'éclairage réciproque. La dynamique de ces échanges est sans cesse relancée par la croissance des connaissances sur les maladies mentales, l'organisation du cerveau et par les mutations de la société. La sémiologie, les interprétations psychopathologiques, la thérapeutique entraînent le praticien au seuil des cercles de la métaphysique de la connaissance et de l'intersubjectivité. Le savoir de la psychiatrie incite à reformuler certaines interrogations philosophiques essentielles. Il permet d'esquisser (...) les tracés des nouvelles frontières des " topiques " du psychisme humain et des diverses représentations et théories de l'Esprit. (shrink)

Essential Philosophy of Psychiatry is a concise introduction to the growing field of philosophy of psychiatry. Divided into three main aspects of psychiatric clinical judgement, values, meanings and facts, it examines the key debates about mental health care, and the philosophical ideas and tools needed to assess those debates, in six chapters. In addition to outlining the state of play, Essential Philosophy of Psychiatry presents a coherent and unified approach across the different debates, characterized by a rejection (...) of reductionism and an emphasis on the ineliminability of uncodified skilled judgement. The first part, Values, outlines the debate about whether diagnosis of mental illness is essentially value-laden and argues that the prospects for reducing illness or disease to plainly factual matters are poor. It also explains the important role of skilled contextual judgement, rather than a principles-based deduction, in ethical judgement. The second part, Meanings, examines the central role of understanding and a shared first person perspective, both against attempts to reduce meaning to basic information-processing mechanisms and to explain away the difficulties of understanding psychopathology in recent models of delusion. The third part, Facts, shows the importance of uncodified clinical judgements, both in assessing the validity of psychiatric taxonomy and in the application of Evidence Based Medicine. Despite advances in the codifaction of practice and operationalism of diagnosis, an element of judgement remains in the assessment both of what, at one level, is good evidence for diagnosis and treatment and what, at a higher level, is good evidence for the validity of classification overall. (shrink)

The dominance of the medical-model in American psychiatry over the last 30 years has resulted in the subsequent decline of the “talking cure”. In this paper, we identify a number of problems associated with medicalized psychiatry, focusing primarily on how it conceptualizes the self as a de-contextualized set of symptoms. Drawing on the tradition of hermeneutic phenomenology, we argue that medicalized psychiatry invariably overlooks the fact that our identities, and the meanings and values that matter to us, (...) are created and constituted by our dialogical relations with others. While acknowledging the importance of medical and pharmaceutical interventions, we suggest that it is only by means of the dialogical interplay of the talking cure that the client can both recognize unhealthy and self-defeating ways of being and be opened up to the possibility of new meanings and self-interpretations. (shrink)

"Psychiatry and Philosophy of Science" explores conceptual issues in psychiatry from the perspective of analytic philosophy of science. Through an examination of those features of psychiatry that distinguish it from other sciences - for example, its contested subject matter, its particular modes of explanation, its multiple different theoretical frameworks, and its research links with big business - Rachel Cooper explores some of the many conceptual, metaphysical and epistemological issues that arise in psychiatry. She shows how these (...) pose interesting challenges for the philosopher of science while also showing how ideas from the philosophy of science can help to solve conceptual problems within psychiatry. Cooper's discussion ranges over such topics as the nature of mental illnesses, the treatment decisions and diagnostic categories of psychiatry, the case-history as a form of explanation, how psychiatry might be value-laden, the claim that psychiatry is a multi-paradigm science, the distortion of psychiatric research by pharmaceutical industries, as well as engaging with the fundamental question whether the mind is reducible to something at the physical level. "Psychiatry and Philosophy of Science" demonstrates that cross-disciplinary contact between philosophy of science and psychiatry can be immensely productive for both subjects and it will be required reading for mental health professionals and philosophers alike. (shrink)

"Psychiatry and Philosophy of Science" explores conceptual issues in psychiatry from the perspective of analytic philosophy of science. Through an examination of those features of psychiatry that distinguish it from other sciences - for example, its contested subject matter, its particular modes of explanation, its multiple different theoretical frameworks, and its research links with big business - Rachel Cooper explores some of the many conceptual, metaphysical and epistemological issues that arise in psychiatry. She shows how these (...) pose interesting challenges for the philosopher of science while also showing how ideas from the philosophy of science can help to solve conceptual problems within psychiatry. Cooper's discussion ranges over such topics as the nature of mental illnesses, the treatment decisions and diagnostic categories of psychiatry, the case-history as a form of explanation, how psychiatry might be value-laden, the claim that psychiatry is a multi-paradigm science, the distortion of psychiatric research by pharmaceutical industries, as well as engaging with the fundamental question whether the mind is reducible to something at the physical level. "Psychiatry and Philosophy of Science" demonstrates that cross-disciplinary contact between philosophy of science and psychiatry can be immensely productive for both subjects and it will be required reading for mental health professionals and philosophers alike. (shrink)

Common mental health disorders are rising globally, creating a strain on public healthcare systems. This has led to a renewed interest in the role that digital technologies may have for improving mental health outcomes. One result of this interest is the development and use of artificial intelligence for assessing, diagnosing, and treating mental health issues, which we refer to as ‘digital psychiatry’. This article focuses on the increasing use of digital psychiatry outside of clinical settings, in the following (...) sectors: education, employment, financial services, social media, and the digital well-being industry. We analyse the ethical risks of deploying digital psychiatry in these sectors, emphasising key problems and opportunities for public health, and offer recommendations for protecting and promoting public health and well-being in information societies. (shrink)

Jonathan Y. Tsou examines and defends positions on central issues in philosophy of psychiatry. The positions defended assume a naturalistic and realist perspective and are framed against skeptical perspectives on biological psychiatry. Issues addressed include the reality of mental disorders; mechanistic and disease explanations of abnormal behavior; definitions of mental disorder; natural and artificial kinds in psychiatry; biological essentialism and the projectability of psychiatric categories; looping effects and the stability of mental disorders; psychiatric classification; and the validity (...) of the DSM's diagnostic categories. The main argument defended by Tsou is that genuine mental disorders are biological kinds with harmful effects. This argument opposes the dogma that mental disorders are necessarily diseases that result from biological dysfunction. Tsou contends that the broader ideal of biological kinds offers a more promising and empirically ascertainable naturalistic standard for assessing the reality of mental disorders and the validity of psychiatric categories. (shrink)

In the management of biomedical data, vocabularies such as ontologies and terminologies (O/Ts) are used for (i) domain knowledge representation and (ii) interoperability. The knowledge representation role supports the automated reasoning on, and analysis of, data annotated with O/Ts. At an interoperability level, the use of a communal vocabulary standard for a particular domain is essential for large data repositories and information management systems to communicate consistently with one other. Consequently, the interoperability benefit of selecting a particular O/T as a (...) standard for data exchange purposes is often seen by the end-user as a function of the number of applications using that vocabulary (and, by extension, the size of the user base). Furthermore, the adoption of an O/T as an interoperability standard requires confidence in its stability and guaranteed continuity as a resource. (shrink)

In _ Psychiatry in the Scientific Image, _Dominic Murphy looks at psychiatry from the viewpoint of analytic philosophy of science, considering three issues: how we should conceive of, classify, and explain mental illness. If someone is said to have a mental illness, what about it is mental? What makes it an illness? How might we explain and classify it? A system of psychiatric classification settles these questions by distinguishing the mental illnesses and showing how they stand in relation (...) to one another. This book explores the philosophical issues raised by the project of explaining and classifying mental illness. Murphy argues that the current literature on mental illness -- exemplified by the Diagnostic and Statistical Manual of Mental Disorders -- is an impediment to research; it lacks a coherent concept of the mental and a satisfactory account of disorder, and yields too much authority to commonsense thought about the mind. He argues that the explanation of mental illness should meet the standards of good explanatory practice in the cognitive neurosciences, and that the classification of mental disorders should group symptoms into conditions based on the causal structure of the normal mind. (shrink)

The three essays reprinted in this book were first published in 1963 as individual chapters of a psychiatric treatise entitled Psychiatrie der Gegen wart (Psychiatry of the Present Day). The editors, W. H. GRUHLE (Bonn), R. JUNG (Freiburg/Br. ), W. MAYER-GROSS (Birmingham, England), M. MUL LER (Bern, Switzerland), had not planned an encyclopedic presentation; they did not intend to present a "handbook" which would be as complete as possible in details and bibliographic reference. Their intention was to "raze the (...) walls" separating Continental and Anglo-Saxon psychiatries and to offer a synopsis of developments in psychiatry during the last decades on an international basis. The editors requested, therefore, cooperation of scholars from many foreign countries, large and small, on both sides of the Atlantic. A section entitled "Borderlands of Psychiatry", in which MARGARET MEAD (New York) discusses the relation of "Psychiatry and Ethnology", HANS HEIMAN (Bern), the relation of "Religion und Psychiatrie", and ROBERT VOLMER (Paris), "Art et Psychiatrie", is a good illustration of the trilingual character of the whole work. Two of the editors, GRUHLE and MAYER-GROSS, died before the publi cation had been completed. In a kind of posthumous eulogy, Professor JUNG and Professor MULLER praised the initiative and accomplishments of MAYER-GROSS, "who during the last five years of his life had given a great deal of his time to this work. He had set his mind on a synthesis of German and Anglo-Saxon psychiatry. (shrink)

Psychiatry is increasingly dominated by the reductionist claim that mental illness is caused by neurobiological abnormalities such as chemical imbalances in the brain. Critical psychiatry does not believe that this is the whole story and proposes a more ethical foundation for practice. This book describes an original framework for renewing mental health services in alliance with people with mental health problems. It is an advance over the polarization created by the "anti-psychiatry" of the past.

Advance Praise: "A distillation of the wisdom accumulated over a lifetime by one of our leading thinkers in psychiatry. . . .It should interest. . .anyone who has thought seriously about the brain, the mind and the meaning of illness." --Albert J. Stunkard, M.D., Professor of Psychiatry, University of Pennsylvania.

Neuroscience has long had an impact on the field of psychiatry, and over the last two decades, with the advent of cognitive neuroscience and functional neuroimaging, that influence has been most pronounced. However, many question whether psychopathology can be understood by relying on neuroscience alone, and highlight some of the perceived limits to the way in which neuroscience informs psychiatry. -/- Psychiatry as Cognitive Neuroscience is a philosophical analysis of the role of neuroscience in the study of (...) psychopathology. The book examines numerous cognitive neuroscientific methods, such as neuroimaging and the use of neuropsychological models, in the context of a variety of psychiatric disorders, including depression, schizophrenia, dependence syndrome, and personality disorders. -/- Psychiatry as Cognitive Neuroscience includes chapters on the nature of psychiatry as a science; the compatibility of the accounts of mental illness derived from neuroscience, information-processing, and folk psychology; the nature of mental illness; the impact of methods such as fMRI, neuropsychology, and neurochemistry, on psychiatry; the relationship between phenomenological accounts of mental illness and those provided by naturalistic explanations; the status of delusions and the continuity between delusions and ordinary beliefs; the interplay between clinical and empirical findings in psychopathology and issues in moral psychology and ethics. -/- With contributions from world class experts in philosophy and cognitive science, this book will be essential reading for those who have an interest in the importance and the limitations of cognitive neuroscience as an aid to understanding mental illness. (shrink)

These are the basic foundations of liberatory psychiatry.

The introduction of the Diagnostic and statistical manual of mental disorders in May 2013 is being hailed as the biggest event in psychiatry in the last 10 years. In this paper I examine three important issues that arise from the new manual: Expanding nosology: Psychiatry has again broadened its nosology to include human experiences not previously under its purview . Consequence-based ethical concerns about this expansion are addressed, along with conceptual concerns about a confusion of “construct validity” and (...) “conceptual validity” and a failure to distinguish between “disorder” and “non disordered conditions for which we help people.” The role of claims about societal impact in changes in nosology: Several changes in the DSM-5 involved claims about societal impact in their rationales. This is due in part to a new online open comment period during DSM development. Examples include advancement of science, greater access to treatment, greater public awareness of condition, loss of identify or harm to those with removed disorders, stigmatization, offensiveness, etc. I identify and evaluate four importantly distinct ways in which claims about societal impact might operate in DSM development. Categorisation nosology to spectrum nosology: The move to “degrees of severity” of mental disorders, a major change for DSM-5, raises concerns about conceptual clarity and uniformity concerning what it means to have a severe form of a disorder, and ethical concerns about communication. (shrink)

The catch 22 situation in psychiatry is that for precise diagnostic categories/criteria, we need precise investigative tests, and for precise investigative tests, we need precise diagnostic criteria/categories; and precision in both diagnostics and investigative tests is nonexistent at present. The effort to establish clarity often results in a fresh maze of evidence. In finding the way forward, it is tempting to abandon the scientific method, but that is not possible, since we deal with real human psychopathology, not just concepts (...) to speculate over. Search for clear-cut definitions/diagnostic criteria in psychiatry must be relentless. There is a greater need to be ruthless and blunt in this, rather than being accommodative of diverse opinions. Investigative tests - psychological, serum, CSF, or neuroimaging - are only corroborative at present; they need to become definitive. Medicalisation appears most prominent in psychiatry; so, diagnostic proliferation and fuzziness appear inevitable. And yet, the established diagnostic entities need to forward greater and conclusive precision. Also, the need for clarity and precision must outweigh pandering to and mollifying diverse interests, moreso in the upcoming revision of diagnostic manuals. This is specially because the DSM-5, being an Association manual, may need to accommodate powerful member lobbies; and ICD-11 may similarly need to cater to diverse country lobbies. Finding precise biological correlates of psychiatric phenomena, whether through neuroimaging, molecular neurobiology and/or neurogenomics, is the right way forward. It is in the 1.5-kg structure in the cranium that all secrets of psychiatric conditions lie. Social forces, behavioural modification, psychosocial restructuring, study of intrapsychic processes, and philosophical insights are not to be discounted, but they are supplementary to the primary goal - studying and deciphering those brain processes that result in psychiatric malfunction. Experimental breakthroughs, both in psychiatric aetiology and therapeutics, will come mainly from biology and its adjunct, psychopharmacology; while supplementary and complementary breakthroughs will come from the psychosocial, cognitive and behavioural approaches; the support base will come from phenomenology, epidemiology, nosology and diagnostics; while insights and leads can hopefully come from many fields, especially the psychosocial, the behavioural, the cognitive and the philosophical. Major energies must now be marshalled towards finding biomarkers and deciphering the precise phenotype-genotype-endophenotype axis of psychiatric disorders. Energies also need to be focussed on unravelling those critical processes in the brain that tip the scale towards psychiatric disorders. At how those critical processes are set into motion by forces de novo, in utero, in the genes and their expression, by the environment's psychopathological social forces - stress, peer pressure, poverty, deprivation, alienation, malnutrition, discrimination of various types (caste, gender, race, etc.), mass conflicts (war, terror attacks, etc.), disasters (natural and man-made), religious/ideological fascism - or social institutions like marriage, family, work place, political governance, etc. Ultimately, we must decipher how the brain goes into malfunction when such varied forces impinge on it, which precise cortical areas and neuronal cellular and molecular processes are involved in such malfunction and its manifestation, as also which of these are involved when malfunction ceases and health is restored, and the psychosocial processes and institutions which aid such health restoration, as also those which promote well-being and help in primary prevention. Emphasis on the brain and its intimate neurological and molecular mechanisms will not impinge on, or nullify, importance of the 'mind,' wherein subtle and gross brain functions in the form of behaviour, thought and emotions in all their ramifications will continue to be the focus of psychological, cognitive, sociological, psychopharmacological, behavioural and philosophical research. Progress in brain research must move in tandem with progress in 'mind' research. (shrink)