Psychopathology

Sertraline is one of the most commonly prescribed antidepressants. Major depressive disorder (MDD) is characterized by spontaneous thoughts that are laden with negative affect-a "malignant sadness". Prior neuroimaging studies have identified abnormal resting-state functional connectivity (rsFC) in the spontaneous brain networks of MDD patients. But how antidepressant medication acts to relieve the experience of depression as well as adjust its associated spontaneous networks and mood-regulation circuits remains an open question. In this study, we recruited 22 drug-naïve MDD patients along with (...) 35 normal controls and investigated whether the functional integrity of cortical networks associated with spontaneous thoughts is modulated by sertraline treatment. We attempted to predict post-treatment effects based upon what we observed in the pre-treatment rsFC of drug-naïve MDD patients. In the result, we demonstrated that (1) after the sertraline treatment, the medial temporal lobe of default network (DNMTL) and mood regulation pathway-the fronto-parietal control network (FPCN), the thalamus, and the salience network (SN)-were restored to normal connectivity, relative to the pre-treatment condition; however, the altered connections of FPCN-core DN (DNCORE), FPCN-SN, and intra-FPCN among MDD patients remained impaired; (2) thalamo-prefrontal connectivity provides moderate predictive power (r2 = 0.63) for the effectiveness of sertraline treatment. In summary, our findings contribute to a body of evidence that suggests salubrious effects of sertraline treatment primarily involve the FPCN-thalamus-SN pathway. The pre-treatment rsFC in this pathway could serve as a predictor of sertraline treatment outcome. (shrink)

The main message of Neuroethics is that neuroscience forces us to reconceptualize human agency as marvelously diverse and flexible. Free will can arise from unconscious brain processes. Individuals with mental disorders, including addiction and psychopathy, exhibit more agency than is often recognized. Brain interventions should be embraced with cautious optimism. Our moral intuitions, which arise from entangled reason and emotion, can generally be trusted. Nevertheless, we can and should safely enhance our brain chemistry, partly because motivated reasoning crops up in (...) everyday life and in the practice of neuroscience itself. Despite serious limitations, brain science can be useful in the courtroom and marketplace. Recognizing all this nuance leaves little room for anxious alarmism or overhype and urges an emphasis on neurodiversity. The result is a highly opinionated tour of neuroethics as an exciting field full of implications for philosophy, science, medicine, law, and public policy. (shrink)

Thomas Szasz famously argued that mental illness is a myth. Less famously, Szasz argued that since mental illness is a myth, so too is psychotherapy. Szasz’ claim that mental illness is a myth has been much discussed, but much less attention has been paid to his claim that psychotherapy is a myth. In the first part of this essay, I critically examine Szasz’ discussion of psychotherapy in order to uncover the strongest version of his case for thinking that it is (...) a myth. As we’ll see, this involves an understanding of psychotherapeutic interventions as treatments of psychopathological problems. In the rest of this essay, I turn to this directly and argue that psychotherapy has an important non-pathocentric dimension. I argue that we fail to appreciate the nature and variety of psychotherapy if we concentrate only on its pathocentric dimensions. Though I use Szasz as a stalking horse, the substantive topic is the nature of psychotherapy. This enquiry falls into the philosophy of psychotherapy as distinct from the philosophy of psychiatry and the philosophy of psychoanalysis. (shrink)

According to a common philosophical intuition, the deep nature of things is hidden from us, and the world as we know it through perception and science is somehow shallow and lacking in reality. For all we knwo, the intuition goes, we could be living in a cave facing shadows, in a dream or even in a computer simulation, This “intuition of unreality” clashes with a strong, but perhaps more naive, intuition to the effect that the world as we know it (...) seems perfectly real. Shadows, dreams, or informational structures appear too unreal to be identical to the world as we know it! This clash between the two intuitions forms the basis of the "problem of reality." At the turn of the nineteenth century psychiatrists encountered patients they referred to as “metaphysician doubters” who constantly questioned the reality of the world. This essay draws on the study of these patients to reject, and indeed diagnose, the intuition of unreality and recent metaphysical doctrines drawing on it, such as structuralism, digitalism, and virtual realism. (shrink)

Background: Rumination, a tendency to focus on negative self-related thoughts, is a central symptom of depression. Studying the self-related aspect of such symptoms is challenging because of the need to distinguish self effects from the emotional content of task stimuli. This study employed an emotionally neutral self-related paradigm to investigate possible altered self-processing in depression and its link to rumination. Methods: People with major depressive disorder (n = 25) and controls (n = 25) underwent task-based electro-encephalogram recording. We studied late (...) event-related potentials, along with low-frequency oscillatory power. We compared electroencephalogram metrics between groups and correlated them with depressive symptoms and reported rumination. Results: Participants with major depressive disorder displayed a difference in late positive potentials across frontocentral electrodes between self-related and non-self-related conditions. We found no such difference in controls. The magnitude of this difference was positively correlated with depressive symptoms and reported rumination. Participants with major depressive disorder also had elevated theta oscillation power at central electrodes in self-related conditions, a finding that we did not see in controls. Limitations: Patients with major depressive disorder were medicated at the time of the study. The group studied was primarily female, so the observed effects may have been sex-specific. Conclusion: Rumination appears to be linked to altered self-related processing in depression, independent of stimuli-related emotional confounds. This connection between self-related processing and depression may point to a self disorder as a core component of depression. (shrink)

إن للعب دور أساس في تنمية مختلف جوانب شخصيات الأطفال، الحسية الحركية والعقلية والوجدانية واللغوية والاجتماعية ... فهو يؤهلهم لاكتساب القدرة على احترام النظام وقوانين الجماعة، كما يدفعهم إلى تبني قيم التعاون والتضامن وضبط النفس والصبر واحترام الآخر...ولقد تعددت التفسيرات التي أعطيت للعب الأطفال بتعدد النظريات والمدارس السيكولوجية التي اهتمت بهذه الممارسة. لذا سنحاول تقديم مقاربة مركزة لهذا الموضوع عبر الإجابة على الأسئلة التالية: ما الذي نقصده باللعب؟ وكيف يسهم اللعب في تنمية جوانب الشخصية عند الطفل؟ وما هي أهم النظريات (...) السيكولوجية التي اهتمت بتفسير اللعب؟ وما علاقة اللعب بالتعلم؟ اللعب هو نشاط جسمي وعقلي ونفسي تلقائي لا يصدر تحت أي إكراه أو ضغط خارجي¹، وهو يعتبر وسيلة أساسية لتنشئة الأطفال وإدماجهم في محيطهم الاجتماعي. فعبر اللعب يستضمر الطفل القوانين والمعايير المتحكمة في إقامة علاقات اجتماعية متوازنة وسليمة مع الآخرين. إن هذه الممارسة تعتبر «وسيلة للتنشئة و إدماج الطفل في بيئته، فاللعب يجعل الطفل فردا مشاركا في الجماعة، ويطور فهمه للغة وللنظام الاجتماعي، كما يمكنه من إدماج مفهوم المعيار بإدراكه أن العلاقة مع الآخرين تحكمها معايير و يجعله مساهما فعالا في سيرورة تعلمه»². إن مدرسة علم النفس التقليدية لم تعر أي اهتمام باللعب ولم تعطه أي قيمة، فبالنسبة لها يعتبر تسلية فقط وتزجية للوقت. حيث يرى أصحاب هذه المدرسة، كما يؤكد ذلك بياجيه³، أن اللعب خال من المعنى التربوي. كما أن البحث في موضوع اللعب من طرف المربين التقلديين لم ينل ما يستحقه من العناية والاهتمام. (shrink)

In this chapter, we explain how Karl Jaspers’ concept of empathy can be expanded by drawing upon the tradition of philosophical phenomenology. In the first section, we offer an account of Jaspers' concepts of empathy and incomprehensibility as he develops them in General Psychopathology and “The Phenomenological Approach in Psychopathology.” In the second section, we survey the recent literature on overcoming Jaspers' notion of incomprehensibility and expanding his concept of empathy. In the third section, we outline the levels of investigation (...) at which phenomenological inquiries into psychopathology may proceed. These levels of human existence are, in descending order of depth, (1) phenomenal experiences, (2) interpretive frameworks, (3) modes of existence, and (4) existentials. In the fourth and final section, we argue that to fully empathically comprehend patients with schizophrenia and other mental disorders, the possibility of alterations at all four levels of existence must be acknowledged. (shrink)

Embodiment and mindfulness interventions provide a range of benefits for individuals living with trauma yet a lack of clarity surrounds their integration in group work practice. This article provides a framework for the integration of embodiment and mindfulness interventions in group settings for trauma. While such interventions can be utilised in primary trauma processing and open process group psychotherapy, this article provides particular guidance for the more general integration of these tools in structured format resourcing groups. Attention is given to (...) the value and features of a phasic, staged integration of these interventions for specialised trauma-oriented group work. This article details how mindfulness and embodiment interventions support participants to cultivate the capacity to counter experiential avoidance and reorient attention towards the present moment, consequently increasing bodily and affective self-awareness. This serves to reduce patterns of reactivity, thereby supporting symptom stabilisation, improved reflective and mentalising ability, and cultivation of the self- and co-regulatory capacities necessary for trauma-processing group work. These interventions also possess supportive implications for the facilitator’s wellbeing, the formation and cohesiveness of the group, and, crucially, the norming process, both implicit and explicit. Attention is given also to safety considerations, including contraindications of mindfulness practices with certain trauma presentations, and the necessary screening requirements and exclusion criteria in the formation of a trauma-oriented group. (shrink)

This paper clarifies Merleau-Ponty’s original account of “higher-order” cognition as fundamentally embodied and enacted. Merleau-Ponty’s philosophy inspired theories that deemphasize overlaps between conceptual knowledge and motor intentionality or, on the contrary, focus exclusively on abstract thought. In contrast, this paper explores the link between Merleau-Ponty’s account of motor intentionality and his interpretations of our capacity to understand and interact productively with cultural symbolic systems. I develop my interpretation based on Merleau-Ponty’s analysis of two neuropathological modifications of motor intentionality, the case (...) of the brain-injured war veteran Schneider, and a neurological disorder known as Gerstmann’s syndrome. Building on my analysis of Schneider’s sensorimotor compensatory performances in relation to his limitations in the domains of algebra, geometry, and language usage, I demonstrate a strong continuity between the sense of embodiment and enaction at all these levels. Based on Merleau-Ponty’s interpretations, I argue that “higher-order” cognition is impaired in Schneider insofar as his injury limits his sensorimotor capacity to dynamically produce comparatively more complex differentiations of any given phenomenal structure. I then show how Merleau-Ponty develops and specifies his interpretation of Schneider’s intellectual difficulties in relation to the ambiguous role of the body, and in particular the hand, in Gerstmann’s syndrome. I explain how Merleau-Ponty defends the idea that sensorimotor and quasi-representational cognition are mutually irreducible, while maintaining that symbol-based cognition is a fundamentally enactive and embodied process. (shrink)

In contemporary philosophy of mind and psychiatry, schizophrenic thought insertion is often used as a validating or invalidating counterexample in various theories about how we experience ourselves. Recent work has taken cases of thought insertion to provide an invalidating counterexample to the Humean denial of self-experience, arguing that deficiencies of agency in thought insertion suggest that we normally experience ourselves as the agent of our thoughts. In this paper, I argue that appealing to a breakdown in the sense of agency (...) to explain thought insertion is problematic, and that rather than following the prevailing binary approach which holds that certain features of consciousness go missing while others remain wholly intact, a better explanation involves construing thought insertion as a disturbing or disrupting of the subjectivity (for-me-ness) of experience. The result is that experiencing ourselves as the subject of our thoughts is where future research should be directed, given the robust persistence of this form of self-experience across psychopathological and non-psychopathological cases alike. (shrink)

Delusions have traditionally been considered the hallmark of mental illness, and their conception, diagnosis and treatment raise many of the fundamental conceptual and practical questions of psychopathology. One of these fundamental questions is whether delusions are understandable. In this paper, we propose to consider the question of understandability of delusions from a philosophy of language perspective. For this purpose, we frame the question of how delusions can be understood as a question about the meaning of delusional utterances. Accordingly, we ask: (...) “what meaning(s) can delusional utterances possibly have?”. We argue that in the current literature, there is a standard approach to the meaning of delusional utterances, namely the descriptive account which assumes that a delusional utterance “p” means that p is the case. Drawing on Speech Act Theory, we argue that solely relying on the descriptive account disregards essential ways of how linguistic meaning is constituted. Further, we show that Speech Act Theory can prove a helpful addition to the theoretical and clinical “toolbox” used for attempting to understand delusional utterances. This, we believe, may address some of the theoretical and clinical shortcomings of using only the currently predominant descriptive account. (shrink)

Le controversie nosologiche in psichiatria siano orientate da ragioni sia epistemiche che non epistemiche, da questioni di evidenza ma anche di etica e sociologia della scienza, data la presenza di vari programmi di ricerca, di metodologie e anche di agenti differenti che si focalizzano sul problema del disturbo mentale. I due casi qui brevemente considerati, quello della Disposofobia e quello del Disturbo di personalità narcisistica mostrano, assieme al ruolo dell’evidenza empirica, da un lato il peso delle ragioni etiche dei gruppi (...) di pazienti e di quelle culturali della società allargata, dall’altro le dinamiche del consenso tra esperti. Che i disturbi mentali siano o non siano generi naturali, la loro classificazione è un processo razionale complesso che comprende norme e deviazioni dalle norme di diverso tipo. (shrink)

Introduction: The experience of disconnection is common in first-person accounts of grief. One way in which this feeling of estrangement can manifest is through the splintering apart of the time of the mourner and the time of the world. Supplementing and extending Thomas Fuchs' influential idea of temporal desynchronization, my aim in this article is to give an account of the heterogeneous ways in which grief can disturb time. -/- Method: I organize these manifold experiences of temporal disruption according to (...) a method of "depth analysis": a phenomenological interpretation of temporal desynchronization that tracks the increasing disconnect between the mourner and the world as it manifests in time. In so doing, I draw on a wide range of descriptive first-person responses to the question "Has your experience of time changed in any way?" - included as part of an online questionnaire on the emotional experience of grief conducted recently with colleagues at the University of York. I then stratify these according to a mild, moderate, and profound level of disruption. -/- Results: Before setting out the results of this analysis, I give a background account of Fuchs' interpretation of temporal desynchronization in phenomenological psychopathology more generally and in grief specifically. In my results, I then supplement and extend his interpretation by setting out my phenomenological depth analysis of the increasing disconnect between the time of the mourner and the time of the world, as demonstrated by the questionnaire data. As I argue, such a fine-grained account is an important step in understanding the way time can shape the meaning and significance of different grief experiences. Following this, in my discussion, I demonstrate how a depth approach might be helpful in differentiating between temporal disturbances in a range of affective disorders and give an illustrative comparison of grief and depression. -/- Conclusion: In conclusion, I reflect briefly on what grief might reveal about the depth and complexity of temporal experience itself. In so doing, I consider how the radical disruptions to time in grief might transform the mourner's experience of time irreversibly but in a way that enables a renewed connection to both their deceased loved one and the world from which they have become estranged. (shrink)

This paper deals with a classical issue that remains at the core of the contemporary philosophical debate: the fact that the meaning of life is interlaced—in both negative and positive ways, with respect to morality—with happiness. On some historical conceptions, individual happiness must be sacrificed for the moral (universal, objective) good of a life, where the good fundamentally coincides with the meaning of life. On other approaches, happiness and flourishing (where flourishing is understood in terms of life’s meaningfulness) consist in (...) good action and a good life. On still other views, happiness, while equated with the meaning of life, is reduced to mere pleasure, to a sensorial state that can be influenced by outside forces. In the current literature, the prevailing interpretations of this question are largely deontological, eudaimonic or hedonic in character. Moving from the Schelerian theory of the stratification of the emotional life, and emphasizing the affective side of this broadly ethical question, this paper intends to examine this issue through the lens of phenomenology. From this perspective, the connection between happiness and the meaning not only of life but also of existence can be understood in light of what appears to underlie both phenomena: the entire existence of the individual, which is revealed most clearly in an act of personal love. Since this paper considers the condition humaine in all its complexity, that is to say, even in its fragility and vulnerability, within this framework I will also consider possible abnormal manifestations of happiness. Following Rümke’s clinical observations of pathological frameworks in which the feeling of happiness manifests itself, this paper shows how the deepest feeling of happiness, understood as a Schelerian personality feeling, can remain untouched by pathology. In his classic (but largely unappreciated) enquiry into the happiness syndrome, Rümke engages in a fruitful dialogue with Scheler, whose theory of the stratification of emotional life plays a crucial role in the former’s study of the phenomenology and the clinical aspects of happiness. Not only is Rümke’s Zur Phänomenologie und Klinik des Glücksgefühls an excellent example of applied phenomenology, but it also confirms the results of Scheler’s research on affective life. (shrink)

Max Scheler’s Formalism – and other of his essays on the philosophy of psychology, such as The Idols of Self-Knowledge and Ressentiment – continues to be in dialogue with contemporary philosophers of mind, psychiatrists and neuroscientists. Moving essentially from Formalism and essays from the same period, this paper provides an outline of a genuine Schelerian philosophy of psychopathology, investigating the close connection between “identity” and “freedom”. Not only did Scheler contribute to phenomenological psychology, but he also took an original approach (...) to psychopathology. From this point of view, it is possible to shed further light on his fruitful cooperation with Kurt Schneider and to understand so-called ‘emotional blindness’ from a new perspective. Within this framework, what emerges is the crucial role, in the formation of certain affective disorders, of the modification of pulsions and tendencies. Insofar as it allows for the development of a Schelerian model of delusion and (self)-deception, this approach also has implications for the debate on delusion in the context of contemporary philosophy of psychiatry. (shrink)

Introduction to The Oxford Handbook of Phenomenological Psychopathology.

In this chapter, I introduce phenomenology and phenomenological psychopathology by clarifying the kind of implicit experiences that phenomenologists are concerned with. In section one, I introduce the phenomenological concept of pre-reflective experience, focusing especially on its relation to the concept of implicit experience. In section two, I introduce the structure of pre-reflective self-consciousness, which has been studied extensively by both classical phenomenologists and contemporary phenomenological psychopathologists. In section three, I show how phenomenological psychopathologists rely on an account of pre-reflective self-consciousness (...) to better understand the experience of schizophrenia and I outline some of the methodological challenges that arise in this field of research. This introduction should facilitate critical engagement and collaboration between phenomenologists and researchers working across a variety of disciplines, including psychology, psychiatry, the cognitive sciences, and analytic philosophy of mind. (shrink)

Naturalistic accounts of mental disorder aim to identify an objective basis for attributions of mental disorder. This goal is important for demarcating genuine mental disorders from artificial or socially constructed disorders. The articulation of a demarcation criterion provides a means for assuring that attributions of 'mental disorder' are not merely pathologizing different forms of social deviance. The most influential naturalistic and hybrid definitions of mental disorder identify biological dysfunction as the objective basis of mental disorders: genuine mental...

When interacting with other people, we assume that they have their reasons for what they do and believe, and experience recognizable feelings and emotions. When people act from weakness of will or are otherwise irrational, what they do can still be comprehensible to us, since we know what it is like to fall for temptation and act against one’s better judgment. Still, when someone’s experiences, feelings and way of thinking is vastly different from our own, understanding them becomes increasingly difficult. (...) Delusions and psychosis are often seen as marking the end of intelligibility. In this paper, I argue first for the importance of seeing other people as intelligible as long as this is at all possible. Second, I argue, based on both previous literature and my own lived experience, that more psychotic phenomena than previously thought can be rendered at least somewhat intelligible. Besides bizarre experiences like illusions, hallucinations and intense feelings of significance, I also explain what it is like to lose one’s bedrock, and how this loss impacts which beliefs one has reason to reject. Finally, I give an inside account of some disturbances of reason, and show that there are important similarities between certain psychotic reasoning problems and common non-pathological phenomena. (shrink)

English abstract: On last day of the year 1999, Russia has entered another era of despotism, that of Vladimir Putin. During his reign, the Putin‘s clan has undermined and infiltrated the mass media, the parliament and the judicial system. Deliberate violation of basic citizen‘s rights, compulsory acquisition of property, government-funded racket, misuse of mass media to scarify and to disinform the peoples belong to the diabolic methods of self-constituted disposers. All this lawlessness has led to exorbitant corruption, mass poverty, economic (...) stagnation, and escalation of crimes. The actual manuscript investigates the roots of Putinism putting the person of Vladimir Putin in the focus of investigation. -/- Russian abstract: В 1999 году, в последний день столетия и тысячелетия, Россия вступила в новую эру деспотизма, эру Владимира Путина. В продолжение его правления, клан Путина коррумпировал и инфильтрировал средства массовой информации, парламент, правовую систему. Умышленное нарушение основных гражданских прав, конфискация собственности, государственный рэкет, злоупотребление средств массовой информации с целью запугивания и дезинформации населения стали дьявольскими методами самоназванных правителей. Всё это привело к безмерной продажности, массовой бедности, экономической стагнации и взрыву преступности. Данный манускрипт исследует корни Путинизма, помещая личность Владимира Путина в центр исследования. (shrink)

The experiences described in the VIP transcripts are incredibly varied and yet frequently explicitly labelled by participants as "voices." How can we make sense of this? If we reflect carefully on uses of the word "voice", we see that it can express at least two entirely different concepts, which pick out categorically different phenomena. One concept picks out a speech sound (e.g. "This synthesizer has a "voice" setting"). Another concept picks out a specific agent (e.g. "I hear two voices: one (...) is a ten year-old boy…"). This chapter explores how these two concepts are related to one another in the context of voice-hearing. (shrink)

Despite increasing interest in the work of Tetsuro Watsuji, his discussion of intentionality remains underexplored. I here develop an interpretation and application of his view. First, I unpack Watsuji’s arguments for the inherently social character of intentionality, consider how they connect with his more general discussion of embodiment and betweenness, and then situate his view alongside phenomenologists like Husserl, Heidegger, and Merleau-Ponty. Next, I argue that Watsuji’s characterization of the social character of intentionality is relevant to current discussions in phenomenological (...) psychopathology. I consider how it can help illuminate the character and structure of some anomalous experiences in schizophrenia. I argue further that this application can enrich existing attempts to connect Watsuji and psychopathology, such as those found in the work of the psychiatrist Bin Kimura. (shrink)

Con il termine psicoterapia è d'uso riferirsi al trattamento del "disagio" mentale attraverso mezzi psichici, ma l'ovvietà "tautologica" della definizione tende a svanire se si affronta un esame più approfondito dei termini "psiche", "mezzi psichici" e "disagio mentale". Una definizione non può in linea generale che assumere un significato ed un valore limitato nel tempo e nello spazio, ma il sostanziale polimorfismo teorico, metodologico, tecnico e linguistico che contraddistingue la psicoterapia ne rende ancora più ardua una chiara ed univoca definizione. (...) Vi è un sostanziale accordo, che però lascia inalterati i problemi sottostanti, su definizioni che sono sulla stessa linea di quelle ad esempio di Wolberg o di Frank. Wolberg(1) parla di: «trattamento, con mezzi psicologici, di problemi di natura psichica, in cui una persona appositamente qualificata stabilisce deliberatamente una relazione professionale con il paziente con lo scopo di rimuovere, di modificare e di attenuare i sintomi esistenti, di mediare modi di comportamento disturbato e di promuovere la crescita e lo sviluppo positivo della personalità». (shrink)

Objective: Alterations in psychomotor dimension cut across different psychiatric disorders, such as schizophrenia (SCZ) and bipolar disorder (BD). This preliminary study aimed to investigate the organization of intrinsic brain activity in the subcortical-cortical sensorimotor system in SCZ (and BD) as characterized according to psychomotor dimension. -/- Method: In this resting-state functional magnetic resonance imaging (fMRI) study, functional connectivity (FC) between thalamus and sensorimotor network (SMN), along with FC from substantia nigra (SN) and raphe nuclei (RN) to basal ganglia (BG) and (...) thalamic regions, were investigated by using an a-priori-driven and dimensional approach. This was done in two datasets: SCZ patients showing inhibited psychomotricity (n = 18) vs. controls (n = 19); SCZ patients showing excited psychomotricity (n = 20) vs. controls (n = 108). Data from a third dataset of BD in inhibited depressive or manic phases (reflecting inhibited or excited psychomotricity) were used as control. -/- Results: SCZ patients suffering from psychomotor inhibition showed decreased thalamus-SMN FC toward around-zero values paralleled by a concomitant reduction of SN-BG/thalamus FC and RN-BG/thalamus FC (as BD patients in inhibited depression). By contrast, SCZ patients suffering from psychomotor excitation exhibited increased thalamus-SMN FC toward positive values paralleled by a concomitant reduction of RN-BG/thalamus FC (as BD patients in mania). -/- Conclusions: These findings suggest that patients exhibiting low or high levels of psychomotor activity show distinct patterns of thalamus-SMN coupling, which could be traced to specific deficit in SN- or RN-related connectivity. Notably, this was independent from the diagnosis of SCZ or BD, supporting an RDoC-like dimensional approach to psychomotricity. (shrink)

This paper is a loose commentary on Marcinów’s book (2017). The commentary is focused on the objects of psychopathological investigations and the role of psychology / psychiatry tension in the process of singling out, tracking, and describing them. As a consequence, there are limitations of collaborative and integrative efforts between psychologists and psychiatrists where questions of psychopathology are concerned.

This paper argues in favor of two related theses. First, due to a fundamental, biologically grounded world-openness, human culture is a biological imperative. As both biology and culture evolve historically, cultures rise and fall and the diversity of the human species develops. Second, in this historical process of rise and fall, abnormality plays a crucial role. From the perspective of a broader context traditionally addressed by speculative philosophies of history, the so-called mental disorders may be seen as entailing particular functional (...) advantages, and thus have a great impact on the course of human history. Nowadays, however, we live under a threat of cultural uniformity. While the diversity of the human species is cherished at the political level, it is being slowly eradicated through medical means. This paradox is a dangerous feature of contemporary globalized society that can lead to highly problematic consequences. (shrink)

“On the Subject Matter of Phenomenological Psychopathology” provides a framework for the phenomenological study of mental disorders. The framework relies on a distinction between (ontological) existentials and (ontic) modes. Existentials are the categorial structures of human existence, such as intentionality, temporality, selfhood, and affective situatedness. Modes are the particular, concrete phenomena that belong to these categorial structures, with each existential having its own set of modes. In the first section, we articulate this distinction by drawing primarily on the work of (...) Martin Heidegger—especially his study of the ontological structure of affective situatedness (Befindlichkeit) and its particular, ontic modes, which he calls moods (Stimmungen). In the second section, we draw on a study of grief to demonstrate how this framework can be used when conducting phenomenological interviews and analyses. In the concluding section, we explain how this framework can be guide phenomenological studies across a broad range of existential structures. (shrink)

Reports of patients with schizophrenia show a fragmented and anomalous subjective experience. This pathological subjective experience, we suggest, can be related to the fact that disembodiment inhibits the possibility of intersubjective experience, and more importantly of common sense. In this paper, we ask how to investigate the anomalous experience both from qualitative and quantitative viewpoints. To our knowledge, few studies have focused on a clinical combination of both first- phenomenological assessment and third-person biological methods, especially for Schizophrenia, or ASD therapeutics (...) and diagnosis. We will thus attempt to bring forward a second-person scientific design, accounting for both the first-person subjective experiential aspects, and respective third-person neurobiological correlates of embodied aesthetics in anomalous experience. From this proposal, we further explore the consequences to clinical and research practice. (shrink)

Schizophrenia is usually described as a fragmentation of subjective experience and the impossibility to engage in meaningful cultural and intersubjective practices. Although the term schizophrenia is less than 100 years old, madness is generally believed to have accompanied mankind through its historical and cultural ontogeny. What does it mean to be “mad”? The failure to adopt social practices or to internalize cultural values of common sense? Despite the vast amount of literature and research, it seems that the study of schizophrenia (...) and of the psychoses is suffering from a generic disintegration. In this introduction, we offer an historical overview of the variety of theories and approaches to schizophrenia. We also provide an overview of how the authors in this volume attempt an integrative account where training, practice, theory and research are considered as parts of a larger whole. This is a varied and pluralistic volume, and it is up to the readers to make use of different chapters according to their own needs. (shrink)

Patients suffering from the Cotard syndrome can deny being alive, having guts, thinking or even existing. They can also complain that the world or time have ceased to exist. In this article, I argue that even though the leading neurocognitive accounts have difficulties meeting that task, we should, and we can, make sense of these bizarre delusions. To that effect, I draw on the close connection between the Cotard syndrome and a more common condition known as depersonalisation. Even though they (...) are not delusional, depersonalised patients seem to have experiences that are quite similar to those of Cotard patients. I argue that these experiences are essentially characterised by a lack of subjective character and of two other structural features of experience, which I call ‘the present character’ and ‘the actual character’. Cotard's nihilistic delusions simply consist in taking these anomalous experiences at face value. (shrink)

In this paper I examine the ways in which our language and terminology predetermine how we approach, investigate and conceptualise mental illness. I address this issue from the standpoint of hermeneutic phenomenology, and my primary object of investigation is the phenomenon referred to as “mania”. Drawing on resources from classical phenomenology, I show how phenomenologists attempt to overcome their latent presuppositions and prejudices in order to approach “the matters themselves”. In other words, phenomenologists are committed to the idea that in (...) our everyday, natural attitude, we take for granted a number of prejudices and presuppositions that predetermine how we conceive of and understand what we experience. In order to properly approach the phenomena themselves, we need to find ways of neutralising our presuppositions and prejudices in order to develop new (and hopefully more accurate) accounts of the phenomena under investigation. One of the most popular examples of such an attempt at neutralisation is what Edmund Husserl calls the epoché, which is the practice of bracketing out or suspending presuppositions. However, later phenomenologists developed alternative approaches. Martin Heidegger, for instance, engaged in etymological analyses to discover latent meanings in our language and terminology. Hans-Georg Gadamer also engaged in historical analyses of how our traditions sediment into latent prejudices. After discussing the various ways in which phenomenologists have attempted to neutralise presuppositions and prejudices prior to engaging in their investigations, I apply some of these principles and methods to the domain of psychopathology, and discuss some of the prejudices inherent in contemporary discussions of the phenomenon of mania. I examine recent attempts to link the phenomenon that we today refer to as “mania” with the ancient Greek concept of “μανία” (mania), and argue that the practice of linking contemporary and historical concepts can be detrimental to attempts at reclassifying disorders. In addition, I consider the implications of the shift in terminology from “manic depressive illness” to “bipolar disorder” – especially how conceiving of mania as one of two “poles” predetermines its description by both clinicians and patients. Finally, I address the implications of the headings under which mania and bipolar disorder are discussed within diagnostic manuals. For example, I discuss the removal of the headings of affective and mood disorders in the DSM-5, and the explicit decision by the authors to place bipolar disorder between depressive disorders and schizophrenia. What I aim to accomplish in this paper is not so much a phenomenological investigation of mania as it is a pre-phenomenological investigation. In other words, I offer a preparatory investigation of the phenomenon (or phenomena) referred to as “mania” in contemporary discourse, with the intention of laying the groundwork for further phenomenological and psychological research. (shrink)

A number of concerns have been raised about the possible future use of pharmaceuticals designed to enhance cognitive, affective, and motivational processes, particularly where the aim is to produce morally better decisions or behavior. In this article, we draw attention to what is arguably a more worrying possibility: that pharmaceuticals currently in widespread therapeutic use are already having unintended effects on these processes, and thus on moral decision making and morally significant behavior. We review current evidence on the moral effects (...) of three widely used drugs or drug types: propranolol, selective serotonin reuptake inhibitors, and drugs that effect oxytocin physiology. This evidence suggests that the alterations to moral decision making and behavior caused by these agents may have important and difficult-to-evaluate consequences, at least at the population level. We argue that the moral effects of these and other widely used pharmaceuticals warrant further empirical research and ethical analysis. (shrink)

Phänomenologie intendiert allgemein eine Beschreibung und intersubjektiv nachvollziehbare Analyse der in einer konkreten Situation sich erschließenden Phänomene des menschlichen Bewußtseins. Klinische Phänomenologie hat darüber hinaus die therapeutische Situation zu berücksichtigen. Im Folgenden wird die These vertreten, daß die psychische Verfassung eines Menschen niemals allein aufgrund einer rein phänomenologischen Analyse auf alle praktisch und therapeutisch relevanten Konsequenzen hin ergründet werden kann. Das kann insbesondere dann nicht der Fall sein, wenn sich solche Konsequenzen aus einem außerhalb der konkreten Situation gewonnenen, empirisch verallgemeinerbaren (...) psychopathologischen Wissen ergeben. Die Integration wird am ehesten dadurch ermöglicht, dass in einer vorausgehenden Analyse der therapeutischen Situation unterschiedliche "Sinnebenen" beachtet werden. Mit einem solchen klinisch-phänomenologischen Ansatz ist die reine Phänomenologie der Bewußtseinsphänomene überschritten, jedoch ergibt sich eben dadurch die Möglichkeit, die jeder praxisbezogenen Wissenschaft inhärenten "Aporien der praktischen Vernunft" darzulegen. Ohne eine solche vorausgehende Analyse der therapeutischen Situation bleibt die Gefahr einer subjektivitischen oder auch objektivistischen Vereinseitigung der Positionen bestehen, wie wir sie aus der jüngeren Psychiatriegeschichte kennen. Um eine Urteils-, Entscheidungs- und Handlungskompetenz im Bereich der klinischen Psychiatrie zu gewährleisten, bedarf es zusätzlich ethischer Maßstäbe und Kriterien, die sich auf der Grundlage eines von dogmatischen Vorstellungen freien Menschenbildes begründen lassen. (shrink)

This paper discusses the representation and explanation of relationships between phenomena that are important in psychiatric contexts. After a general discussion of complexity in the philosophy of science, I distinguish zooming-out approaches from zooming-in approaches. Zooming-out has to do with seeing complex mental illnesses as abstract models for the purposes of both explanation and reduction. Zooming-in involves breaking complex mental illnesses into simple components and trying to explain those components independently in terms of specific causes. Connections between existing practice and (...) zooming-out are drawn, and zooming-in is criticised. (shrink)

No two individuals with the autism diagnosis are ever the same—yet many practitioners and parents can recognize signs of ASD very rapidly with the naked eye. What, then, is this phenotype of autism that shows itself across such distinct clinical presentations and heterogeneous developments? The “signs” seem notoriously slippery and resistant to the behavioral threshold categories that make up current assessment tools. Part of the problem is that cognitive and behavioral “abilities” typically are theorized as high-level disembodied and modular functions—that (...) are assessed discretely (impaired, normal, enhanced) to define a spectral syndrome. Even as biology reminds us that organic developing bodies are not made up of independent switches, we remain often seduced by the simplicity of mechanistic and cognitive models. Developmental disorders such as autism have accordingly been theorized as due to different modular dysfunctions—typically of cortical origin, i.e., failures of “theory of mind” (Baron-Cohen et al., 1985), of the “mirror neuron system” (Ramachandran and Oberman, 2006), of “weak central coherence” (Happe and Frith, 2006) or of the balance of “empathizing” and “systemizing” (Baron-Cohen, 2009), just to list a few. -/- The broad array of autonomic (Ming et al., 2005; Cheshire, 2012) and sensorimotor (Damasio and Maurer, 1978; Maurer and Damasio, 1982; Donnellan and Leary, 1995; Leary and Hill, 1996; Donnellan and Leary, 2012; Donnellan et al., 2012) differences experienced and reported by people with autism have by such theories typically been sidelined as “co-morbidities,” possibly sharing genetic causes, but rendered as incidental and decisively behaviorally irrelevant symptoms—surely disconnected from cognition. But what if the development of cortically based mental processes and autonomous control relies on the complexities and proper function of the peripheral nervous systems? Through such an “embodied” lens the heterogeneous symptoms of autism invites new interpretations. We propose here that many behavioral-level findings can be re-defined as downstream effects of how developing nervous systems attempt to cope and adapt to the challenges of having various noisy, unpredictable, and unreliable peripheral inputs. (shrink)

Karl Jaspers was the first major author who emphasized empathy as the proper method of the phenomenological approach to human psychopathology (“static understanding”). He divided mental symptoms into subjective and objective ones, stressing the crucial importance of the former. Subjective symptoms are mainly those expressing patients’ emotions as well as those experienced by them and verbally communicated during the diagnostic interview. Whereas the expressive symptoms can be grasped immediately by clinicians, the understanding of the experienced ones is mediated by patients’ (...) verbal communications as re-experienced or actualized in clinicians’ own consciousness. Thus, jaspersian empathic understanding is mediated by two distinct processes: the first is a direct and automatic one, whereas the second is an effortful process of “feeling oneself into other’s condition” or of “immersing oneself in other people’s self-description” which has to be learned by systematic and rigorous training. Both processes provide the core of what Jaspers called “static understanding”. This paper aims to show that Jaspers’ static understanding prefigures two main types of empathy emerging from contemporary scientific research in neuroscience and social psychology, namely “automatic emotional empathy” and “cognitive empathy”. (shrink)

Pseudohallucinations have remained a contentious phenomenon in clinical psychopathology. Here following a review of the history and current conceptualisation on pesudohallucinations, they have been critically reviewed with regards to their defining characteristics especially their quality, location and patient’s insight into them. It is argued that the insight and location criterion are not able to distinguish pseudohallucinations from hallucinations. The quality of the perception is a better guide in this distinction.

The ability of a group of adults with high functioning autism (HFA) or Asperger Syndrome (AS) to distinguish moral, conventional and disgust transgressions was investigated using a set of six transgression scenarios, each of which was followed by questions about permissibility, seriousness, authority contingency and justification. The results showed that although individuals with HFA or AS (HFA/AS) were able to distinguish affect-backed norms from conventional affect-neutral norms along the dimensions of permissibility, seriousness and authority-dependence, they failed to distinguish moral and (...) disgust transgressions along the seriousness dimension and were unable to provide appropriate welfare-based moral justifications. Moreover, they judged conventional and disgust transgressions to be more serious than did the comparison group, and the correlation analysis revealed that the seriousness rating was related to their ToM impairment. We concluded that difficulties providing appropriate moral justifications and evaluating the seriousness of transgressions in individuals with HFA/AS may be explained by an impaired cognitive appraisal system that, while responsive to rule violations, fails to use relevant information about the agent’s intentions and the affective impact of the action outcome in conscious moral reasoning. (shrink)

(This version was submitted to Behavioral and Brain Science. A revised version was published by Biological Theory) Estimates of autism’s incidence increased 5-10 fold in ten years, an increase which cannot be genetic. Though many mutations are associated with autism, no mutation seems directly to cause autism. We need to find the direct cause. Complexity science provides a new paradigm - confirmed in biology by extensive hard data. Both the body and the personality are complex dynamic systems which spontaneously self-organize (...) from simple dynamic systems. Autism may therefore be caused by the failure of a simple dynamic system. We know that infants who cannot track their mother’s face often become autistic, that eye-contact initiates intersubjectivity which is blocked in autism, and that the infant-mother pair seems designed to promote eye-contact, as does the eye’s appearance. This author earlier proposed that failure of eye-contact might directly cause autism and that early non-maternal childcare, including television/video, would therefore be statistically linked to autism. Waldman et al. (2008; 2006) recently proved that autism is strongly linked to precipitation (indoor activity) and to the introduction of cable. The most plausible explanation? Early exposure to television/video is linked to autism. Furthermore a normal developmental cascade (blocked in autism) has been deciphered: (a) Infant-mother eye-contact triggers increased maternal attention. (b) Early maternal attention permanently increases not only baseline vasopressin but also that oxytocin release which is triggered by subsequent maternal attention. (c) Vasopressin and oxytocin promote face recognition, gazing-at-the-eyes, emotion recognition, and social bonding. The eye-contact hypothesis suggests a clinical study addressing prevention: recruit prospective parents who agree to curtail television/video/computer/wi-fi in their families; measure autism’s incidence in their children. (shrink)

The past twenty years have seen an increase in the importance of the body in psychology, neuroscience, and philosophy of mind. This 'embodied' trend challenges the orthodox view in cognitive science in several ways: it downplays the traditional 'mind-as-computer' approach and emphasizes the role of interactions between the brain, body, and environment. In this article, I review recent work in the area of embodied cognitive science and explore the approaches each takes to the ideas of consciousness, computation and representation. Finally, (...) I look at the current relationship between orthodox cognitive science and the study of mental disorder, and consider the implications that the embodied trend could have for issues in psychopathology. (shrink)

An attempt to answer four unsettled questions about the Stoic definition of passions. (I am no longer working on this paper, but have incorporated some of its thoughts into subsequent work.).

[This download contains the Table of Contents and Chapter 1.] This first book-length study of confabulation breaks ground in both philosophy and cognitive science.

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

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

The DSM‐5 highlights two essential psychological features of anorexia nervosa (AN): recalcitrant fear of gaining weight and body image disturbance. Prominent accounts grant false beliefs about body weight and shape a central role in the explanation of AN behavior. In this article, we propose a stronger emphasis on recalcitrant fear. We show that such fear can explain AN behavior without the intermediary of a false belief, and thus without the associated explanatory burdens and conceptual difficulties. We illustrate how shifting the (...) emphasis from false belief to recalcitrant fear can supplement a number of different non‐doxastic models of AN. (shrink)

Body checking, characterized by the repeated visual or physical inspection of particular parts of one’s own body (e.g. thighs, waist, or upper arms) is one of the most prominent behaviors associated with eating disorders, particularly Anorexia Nervosa (AN). In this paper, we explore the explanatory potential of the Recalcitrant Fear Model of AN (RFM) in relation to body checking. We argue that RFM, when combined with certain plausible auxiliary hypotheses about the cognitive and epistemic roles of emotions, is able to (...) explain key characteristics of body checking, including how body checking behavior becomes habitual and compulsive. (shrink)