Mental Illness

Anxiety is a main contributor to human psychological sufferings. Its evolutionary sources are generally related to alert signals for coping with adverse or unexpected situations [Steiner, 2002] or to hunter-gatherer emotions mismatched with today environments [Horwitz & Wakefield, 2012]. We propose here another evolutionary perspective that links human anxiety to an evolutionary nature of self-consciousness. That approach introduces new relations between mental health and human mind. The proposed evolutionary scenario starts with the performance of primate identification with conspecifics [de Waal (...) 1998, 2008]. It is assumed that the evolution of that identification brought our ancestors to represent themselves as entities existing in the environment, like conspecifics were represented as existing in the environment. We consider that this process has implemented in the mind of our ancestors some first elements of self-consciousness [Menant 2014a]. But the same process has also produced new sufferings coming from identification with suffering or endangered conspecifics. In addition, the emerging performance of self-focus brought in the new feeling of being a suffering entity. We consider that all these new sufferings have created in the mind of our primate ancestors a huge anxiety increase, unbearable if not limited. Among the options available to limit that anxiety increase we focus on two of them that may have taken place. The first was a withdrawal from the process. Some primates may have simply rejected the evolution of identification (and with it self-consciousness). This may have led them to an ecological niche resulting in our today great apes. The second option was about limiting the causes of sufferings and taking advantage of possible resulting evolutionary benefits. This may have been achieved by developing performances like imitation, communication, simulation, synergy and ToM. Added to a positive feedback on identification these performances may have initiated an evolutionary engine that has accelerated the evolution toward human self-consciousness. That option is characterized by an early build up of anxiety limitation processes in an evolutionary nature of our human self-consciousness. This option corresponds to a human specificity and introduces anxiety management and self-consciousness as sharing a same evolutionary story. The build up of these anxiety management processes is now buried in the evolutiony story of our human mind. But these processes are still present in our minds at an unconscious level and participate to many of our human mental states and behaviors. Such positioning of anxiety management as part of the nature of human mind is new and makes available entry points for new understandings of human emotion, motivations and mental disorders. The proposed evolutionary scenario has been introduced in philosophy of mind [Menant 2011, 2014a, b] but it has not been so far explicitly part of primatology nor of psychology/psychiatry/ethics. We present here a drawing of the scenario with highlights on corresponding key points. More work is needed on these new evolutionary links between human mind and anxiety management. References: de Waal, F B.M. (1998). No imitation without identification. Behavioral and Brain Sciences (1998) 21:89. http://cogweb.ucla.edu/Abstracts/deWaal_98.html de Waal, F B.M. (2008). Putting the Altruism Back into Altruism: The Evolution of Empathy. Annu. Rev. Psychol. 2008, 59. http://www.life.umd.edu/faculty/wilkinson/BIOL608W/deWaalAnnRevPsych2008.pdf Horwitz, A. V. and Wakefield, J. C. (2012). All We Have to Fear: Psychiatry’s Transformation of Natural Anxieties into Mental Disorders. Oxford Univ. Press. 2012. Menant, C. (2011). Computation on Information, Meaning and Representations. An Evolutionary Approach. https://philpapers.org/rec/MENCOI Menant, C. (2014a). Proposal for an evolutionary approach to self-consciousness. https://philpapers.org/rec/MENPFA-3 Menant, C. (2014b). Consciousness of oneself as object and as subject. Proposal for an evolutionary approach. https://philpapers.org/rec/MENCOO Steiner, T. (2002). The biology of fear- and anxiety-related behaviors. Dialogues Clin Neurosci. 2002 Sep; 4(3): 231–249. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181681/. (shrink)

Representing oneself as an existing entity and having intense fear of the unknown are human specificities. Self-consciousness and anxiety states are characteristics of our human minds. We propose that these two characteristics share a common evolutionary history during which they acted in synergy for the build-up of our human minds. We present that perspective by using an evolutionary scenario for self-consciousness in which anxiety management plays a key role. Such evolutionary background can introduce new relations between philosophy of mind and (...) psychology. The proposed evolutionary scenario starts at the Pan-Homo split time (about 6my ago) when our pre-human ancestors were able to manage representations while also being able to partly identify with their conspecifics. These identifications allowed our ancestors to merge the representations they had of parts of themselves with the corresponding representations they had of their conspecifics. The scenario proposes that such merger has led our ancestors to progressively build up a representation of their own entity as existing in the environment, like conspecifics were represented as existing. This evolutionary process is considered in the scenario as the source of an ancestral form of self-consciousness. The same process has also produced identifications with suffering or endangered conspecifics which have created in the minds of our ancestors some new anxieties coming in addition to the animal ones. The resulting psychological sufferings had to be limited for evolution to continue. The tools developed to that end by our ancestors (caring, collaboration, communication, ToM, ...) have also procured significant evolutionary benefits with positive feedbacks on identifications. Overall, the evolutionary scenario proposes that the combination of the anxiety management processes with the evolution toward self-consciousness has created an evolutionary engine that has accelerated the coming up of our human self-consciousness. As a result, our today human minds contain important anxieties interwoven with an evolutionary nature of self-consciousness. Such perspective brings to consider that many of our mental states may be unconsciously guided by these evolutionary sourced anxieties (which are still to be clearly understood). Corresponding anxiety management processes are then key contributors to our human feelings and motivations, and to our interpersonal relationship. For instance, the role of Pascalian type diversions can be understood as keeping consciousness away from psychological sufferings produced by too anxious mental states. Also, part of our human sexuality developed during human evolution can be considered as a multidimensional escape and refuge from anxiety. This also brings to look at our psychological well-being and to our mental health as much more related to anxiety management than assumed so far. Dis-functioning of anxiety management processes can then be source of mental disorders and illnesses. On that subject the evolutionary scenario proposes that avoidances of too anxious mental states can lead to evil behaviors. These subjects need more developments. Possible continuations are introduced. (shrink)

There are numerous studies suggesting a substantial link between psychotic hallucinatory states and some forms of disordered imaginings. We have to figure out (1) what characteristic makes imagining, not other mental states, prone to induce hallucination, and (2) what underlies the (phenomenological/conceptual) transition from imagining X to the hallucinatory experience of X? In this paper, I will try to provide answers to these questions, in order to shed light on the nature of the so-called “misidentified” or “disordered” imaginative experience. To (...) achieve this, I emphasize the phenomenological aspects of hallucination and imagination. (shrink)

The different approaches of the mind-body problem a fortiori have implications on the foundations of Psychology, Psychopathology and Psychiatry, leading to many clashing theories about the determinants of "normal" human behavior, as well of the mental illnesses. These schools of research on the human mind may on a first approach be divided in two main branches: 1) the neurogenetic ones; 2) the psychogenetic ones. This paper sprang up from a lifelong pondering on its subject by its author, while working as (...) a Clinical Psychiatrist and conducting a Ph D in Philosophy. (shrink)

According to the traditional Western concept of freedom, the ability to exercise free will depends on the availability of options and the possibility to consciously decide which one to choose. Since neuroscientific research increasingly shows the limits of what we in fact consciously control, it seems that our belief in free will and hence in personal autonomy is in trouble. -/- A closer look at the phenomenology of Obsessive-Compulsive Disorder (OCD) gives us reason to doubt the traditional concept of freedom (...) in terms of conscious control. Patients suffering from OCD experience themselves as unfree. The question is whether their lack of freedom is due to a lack of will power. Do they have too little conscious control over their thoughts and actions? Or could it be the opposite: are they exerting too much conscious control over their thoughts and actions? -/- In this chapter, we will argue that OCD patients testify to the general condition that exercising an increased conscious control over actions can in fact diminish the sense of agency rather than increase the experience of freedom. The experiences of these patients show that the traditional conception of freedom in terms of ‘free will’ has major shortcomings. There is an alternative, however, to be found in the work of Hannah Arendt. She advocates a conception of freedom as freedom in action. Combined with phenomenological insights on action, Arendt’s account of freedom helps us to get a more adequate understanding of the role of deliberation in the experience of freedom. We argue that the experience of freedom depends on the right balance between deliberate control and unreflective actions. (shrink)

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)

In this article, I explore Seth Farber’s critique, in The Spiritual Gift of Madness, that the leaders of the Mad Pride movement are failing to realize his vision of the mad as spiritual vanguard of sociopolitical transformation. First, I show how, contra Farber’s polemic, several postmodern theorists are well suited for this leadership (especially the Argentinian post-Marxist philosopher Ernesto Laclau). I reinterpret the first book by the Icarus Project, Navigating the Space between Brilliance and Madness, by reimagining its central metaphor (...) of Icarus. And I conclude with four strategies for higher functioning mad folks to transform our penitentiary world. (shrink)

Brief description of Freud's life and work, emphasising the role of fictive belief and experience (phantasy) in his account of mental disorder.

Philosophers have long been fascinated by the stream of consciousness––thoughts, images, and bits of inner speech that dance across the inner stage. Yet for centuries, such “mind-wandering” was deemed private and thus resistant to empirical investigation. Recent developments in psychology and neuroscience have reinvigorated scientific interest in the stream of thought, leading some researchers to dub this “the era of the wandering mind”. Despite this flurry of progress, scientists have stressed that mind-wandering research requires firmer philosophical foundations. The time is (...) therefore ripe for the philosophy of mind-wandering. Our review begins with a foundational question: what is mind-wandering? We then investigate the significance of mind-wandering for general philosophical topics, namely mental action, introspection, and the norms of thinking and attention. (shrink)

Under the current Mental Health Act of England and Wales, it is lawful to perform deep brain stimulation in the absence of consent and independent approval. We argue against the Care Quality Commission's preferred strategy of addressing this problematic issue, and offer recommendations for deep brain stimulation-specific provisions in a revised Mental Health Act.

Some recent considerations of religion and psychiatry have drawn a distinction between pathological and spiritual/mystical experiences of mental phenomena typically regarded as within the realm of psychiatry (e.g. depression, hearing voices, seeing visions/hallucinations). Such a distinction has clinical implications, particularly in relation to whether some religious people who suffer from depression, hear voices, or see visions should be biomedically treated. Approaching this question from a theological and philosophical perspective, I draw a distinction between (what I call) ‘spiritual health’ (SH) and (...) ‘potentially transformative’ (PT) theologies, arguing that a PT model is therapeutically and philosophically more sound than a SH one. I then apply this to the clinical debate in critical dialogue with Dein and Durà-Vilà’s 2009 article, ‘The Dark Night of the Soul: spiritual distress and psychiatric implications’. My primary focus is on depression, though the discussion is also relevant to debates about psychosis and schizophrenia. (shrink)

A recent paper in this journal argues that some cases of schizophrenia should be seen as cases of demon possession and treated by faith healers. A reply, also published in this journal, responds by raising concerns about the intellectual credibility and potentially harmful practical implications of demon possession beliefs. My paper contributes to the discussion, arguing that a critique of demon possession beliefs in the context of schizophrenia is needed, but suggesting an alternative basis for it. It also reflects on (...) important differences between demonic and other forms of spirit possession, and considers the implications of this for mental health care providers. (shrink)

The purpose of this chapter is to describe what we see as several important new directions for philosophy of medicine. This recent work (i) takes existing discussions in important and promising new directions, (ii) identifies areas that have not received sufficient and deserved attention to date, and/or (iii) brings together philosophy of medicine with other areas of philosophy (including bioethics, philosophy of psychiatry, and social epistemology). To this end, the next part focuses on what we call the “epistemological turn” in (...) recent work in the philosophy of medicine; the third part addresses new developments in medical research that raise interesting questions for philosophy of medicine; the fourth part is a discussion of philosophical issues within the practice of diagnosis; the fifth part focuses on the recent developments in psychiatric classification and scientific and ethical issues therein, and the final part focuses on the objectivity of medical research. (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)

Crime is a serious social problem, but its causes are not exclusively social. There is growing consensus that explaining and preventing it requires interdisciplinary research efforts. Indeed, the landscape of contemporary criminology includes a variety of theoretical models that incorporate psychological, biological and sociological factors. These multi-disciplinary approaches, however, have yet to radically advance scientific understandings of crime and shed light on how to manage it. In this paper, using conceptual tools on offer in the philosophy of science in combination (...) with theoretical work represented in this special volume of Psychology, Crime and Law, I provide some perspective on why explanatory progress in criminology has remained elusive and evaluate some positive proposals for attaining it. -/- . (shrink)

Our main objective is to locate and analyze some philosophical issues about the concept of mental illness and the manner it is used, especially in contemporary psychiatry. It is even difficult to find a standard meaning in the main psychiatric textbooks; and, when there is some exposition of the concept, it is sparse, uncritical and vague. As an immediate consequence of these issues, practical guidelines and protocols for the clinic arise, which become almost “automatic”, unreflective behaviors, practices translated as health (...) interventions and public mental health policies. An example is the problem of overdiagnosis, in which the use of medical technology (categories, drugs, clinical exams, etc.) has generated more harm and risks to the subject's health than benefits. Exposing these issues from a philosophical perspective can eventually contribute to the field of mental health. For this work, the main manuals and textbooks of psychiatry were selected to analyze how they deal with the concept of mental illness or disorder, in addition to locating the present discussion in authors from both philosophy and the psychiatric field and how they contribute to its clarification. (shrink)

Delusional mood is a well-recognized psychological state, often present in the prodromal stage of schizophrenia. Various phenomenological psychopathologists have proposed that delusional mood may not only precede but also contribute to the later formation of schizophrenic delusion. Hence, understanding experiential abnormalities involved with the delusional mood have been considered central for the understanding of schizophrenic delusion. Ranging from traditional and contemporary phenomenological and neurobiological accounts, it has been often mentioned that the peculiar affective saliency of the world experience may underpin (...) the emergence of delusional mood. In this paper, I employ Edmund Husserl’s account of affection and affective syntheses to clarify the nature of such an experience and illuminate how this experiential abnormality contributes to the emergence of the delusional mood. I conclude by relating the phenomenological account I advance here with a neurobiological account of aberrant salience hypothesis and chart out a possible way toward mutual enlightenment for both approaches. (shrink)

In this paper we propose that our understanding of pathocentric epistemic injustices can be enriched if they are theorised in terms of predicaments. These are the wider socially scaffolded structures of epistemic challenges, dangers, needs, and threats experienced by ill persons due to their particular emplacement within material, social, and epistemic structures. In previous work we have described certain aspects of these predicaments - pathocentric epistemic injustices, pathophobia, and so on. We argue that thinking predicamentally helps us integrate the various (...) social, epistemic, and practical obstacles experienced by ill persons and also unify the many concepts available for theorising them (microaggessions, epistemic injustices, and so on). (shrink)

Many intelligent, capable, and successful individuals believe that their success is due to luck and fear that they will someday be exposed as imposters. A puzzling feature of this phenomenon, commonly referred to as imposter syndrome, is that these same individuals treat evidence in ways that maintain their false beliefs and debilitating fears: they ignore and misattribute evidence of their own abilities, while readily accepting evidence in favour of their inadequacy. I propose a novel account of imposter syndrome as an (...) instance of self-deception, whereby biased evidence treatment is driven by the motivational benefit of negative self-appraisal. This account illuminates a number of interconnected philosophical and scientific puzzles related to the explanation, definition, and value of imposter syndrome. (shrink)

In the present review we focus on what we take to be some remaining issues with the Behaviour Change Intervention Ontology (BCIO). We are in full agreement with the authors’ endorsement of the principles of best practice for ontology development In particular, we agree that an ontology should be “logically consistent and having a clear structures [sic], preferably a well-organised hierarchical structure,” and that “Maximising the new ontology’s interoperability with existing ontologies by reusing entities from existing ontologies where appropriate” is (...) critically important (Wright et al., 2020, p. 17). Our remaining concerns with BCIO relate directly to these two principles. First, we identify a number of issues with some of the classifications and definitions in BCIO that seem to be in tension with the just-mentioned principle . Second, we note some reservations about the reuse of certain classes in BCIO, namely from the Gazetteer (GAZ), the Ontology of Medically Related Social Entities (OMRSE), and the Information Artifact Ontology (IAO). While the latter principle of “reuse” is important, it is also important not to let the reuse of existing classes (or their corresponding definitions) compromise the logical integrity or the realist nature of one’s ontology. (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...

What is it to be mentally healthy? In the ongoing movement to promote mental health, to reduce stigma, and to establish parity between mental and physical health, there is a clear enthusiasm about this concept and a recognition of its value in human life. However, it is often unclear what mental health means in all these efforts and whether there is a single concept underlying them. Sometimes, the initiatives for the sake of mental health are aimed just at reducing mental (...) illness, thus implicitly identifying mental health with the absence of diagnosable psychiatric disease. More ambitiously, there are high-profile proposals to adopt a positive definition, identifying mental health with psychic or even overall well-being. We argue against both: a definition of mental health as mere absence of mental illness is too thin, too undemanding, and too closely linked to psychiatric value judgments, while the definition in terms of well-being is too demanding and potentially oppressive. As a compromise, we sketch out a middle position. On this view, mental health is a primary good, that is, the psychological preconditions of pursuing any conception of the good life, including well-being, without being identical to well-being. (shrink)

In this article, I argue that phenomenological psychopathologists, despite their critical attitude toward mainstream psychiatry, still hold problematic prejudices about the nature of psychiatric conditions as illness or disorder. I suggest that phenomenological psychopathologists turn to resources in the neurodiversity and mad pride movements to critically reflect upon these prejudices and appreciate the methodological problems that they pose.

The professional application of ethics often lacks the necessary conceptual tools to construct adequate theoretical foundations that can be used for practical enterprise. This book focuses on an anthropological approach to mental illness, describing how schizophrenia can distort one's experience of empathy and of the presence in the world through pathological indifference. It describes factual and phenomenological perspectives on a case of schizophrenia, based on the method of Eugène Minkowski.

Post-Traumatic Stress Disorder is a mental health condition in which the experience of a traumatic event causes a series of psychiatric and behavioral symptoms such as hypervigilance, insomnia, irritability, aggression, constricted affect, and self-destructive behavior. This paper investigates two case studies to argue that the experience of PTSD is not restricted to humans alone; we have good epistemic reason to hold that some animals can experience genuine PTSD, given our current and best clinical understanding of the disorder in humans. I (...) will use this evidence to argue for two claims. First, because the causal structure of PTSD plausibly requires reference to a traumatic conscious experience in order to explain subsequent behaviors, the fact that animals can have PTSD provides new evidence for animal consciousness. Second, the discovery of PTSD in animals puts pressure on accounts which hold that animal behavior can be fully explained without reference to subjective experience. (shrink)

Recently there has been a trend of moving towards biological and neurocognitive based classifications of mental disorders that is motivated by a dissatisfaction with the syndrome-based classifications of mental disorders. The Research Domain Criteria (indicated with the acronym RDoC) represents a bold and systematic attempt to foster this advancement. However, RDoC faces theoretical and conceptual issues that need to be addressed. Some of these difficulties emerge when we reflect on the plausible reading of the slogan “mental disorders are brain disorders”, (...) that according to proponents of RDoC constitutes one of its main presuppositions. Some authors think that endorsing this idea commits RDoC to a form of biological reductionism. We offer empirical and theoretical considerations for concluding that the slogan above should not be read as a reductionist thesis. We argue, instead, that the slogan has a pragmatic function whose aim is to direct research in psychopathology. We show how this function might be captured in the framework of a Carnapian explication as a methodological tool for conceptual engineering. Thus, we argue that a charitable interpretation of the aims of the proponents of RDoC should be understood as an attempt at providing an explication of the concept of mental disorder in terms of brain disorder whose main goal is to provide a more precise and fruitful notion that is expected to have a beneficial impact on classification, research, and treatment of psychiatric conditions. (shrink)

A family of recent externalist approaches in philosophy of mind argues that our psychological capacities are synchronically and diachronically “scaffolded” by external resources. I consider how these “scaffolded” approaches might inform debates in phenomenological psychopathology. I first introduce the idea of “affective scaffolding” and make some taxonomic distinctions. Next, I use schizophrenia as a case study to argue—along with others in phenomenological psychopathology—that schizophrenia is fundamentally a self-disturbance. However, I offer a subtle reconfiguration of these approaches. I argue that schizophrenia (...) is not simply a disruption of ipseity or minimal self-consciousness but rather a disruption of the scaffolded self, established and regulated via its ongoing engagement with the world and others. I conclude by considering how this scaffolded framework indicates the need to consider new forms of intervention and treatment. (shrink)

Confabulation is typically understood to be dysfunctional. But this understanding neglects the phenomenon’s potential benefits. In fact, we think that the benefits of non-clinical confabulation provide a better foundation for a general account of confabulation. In this paper, we start from these benefits to develop a social teleological account of confabulation. Central to our account is the idea that confabulation manifests a kind of willful ignorance. By understanding confabulation in this way, we can provide principled explanations for the difference between (...) clinical and non-clinical cases of confabulation and the extent to which confabulation is rational. (shrink)

Donald Capps (2009: 145) suggested the hypothesis that “the Nash equilibrium is descriptive of the normal brain, whereas the game theory formulated by John van Neumann, which Nash’s theory challenges, is descriptive of the schizophrenic brain”. The paper offers arguments in its favor. They are from psychiatry, game theory, set theory, philosophy and theology. The Nash equilibrium corresponds to wholeness, stable emergent properties as well as to representing actual infinity on a material, limited and finite organ as a human brain.

Approaching mental health on a global scale with particular reference to low- and mid-income countries raises issues concerning the disregard of the local context and values and the imposition of values characteristic of the Global North. Seeking a philosophical viewpoint to surmount these problems, the present paper argues for a value-laden framework for psychiatry with the specific incorporation of value pluralism, particularly in relation to the Global South context, while also emphasizing personal values such as the choice of treatment. In (...) sketching out this framework, the paper aims to overcome the clash between universalism and relativism about psychiatric categories by focusing on how overlaps between cultures can contribute to ontology-building. A case study analyzing ethnopsychiatric research in the context of South India will illustrate the proposed view, while also pointing out avenues for further research on the causal efficacy of local shared beliefs about mental disorder. If approaches across different traditions and theoretical frames are shown to work in treating similar ailments, causal connections appear to cut across the different ontologies. Ethnopsychiatry would play a central role in such research, namely in disclosing the variables and mechanisms at work within the local approaches. (shrink)

Kant’s conception of mental illness is unlikely to satisfy contemporary readers. His classifications of mental illness are often fluid and ambiguous, and he seems to attribute to human beings at least some responsibility for preventing mental illness. In spite of these apparent disadvantages, I argue that Kant’s account of mental illness can be illuminating to his views about the normative dimensions of human cognition. In contrast to current understandings of mental illness, Kant’s account is what I refer to as “non-pathological.” (...) That is, most mental illnesses are for Kant continuous with normally functioning cognition. Someone with a healthy reason can easily fall into mental illness and someone with mental illness can (perhaps not as easily) re-establish healthy reason. By accepting a non-pathological definition of mental illness, it follows for Kant that humans have more agency and responsibility regarding their mental health than current views allow, which explains why several of his writings aim to prescribe a “diet of the mind” (2:271). Contrary to popular readings of Kant as a champion of reason’s power, Kant’s conception of mental illness shows that he recognizes how fragile human reason can be. (shrink)

ABSTRACT -/- In this dissertation I make a case for how mental health care, specifically disordered eating, is in need of an adjunctive field of discourse, that being theories on philosophy of consciousness, cosmology, and the new epistemology of science based on physics. Without psychological inquiry and education on new theories about consciousness and new perspectives on the nature of reality, mental health treatment is incomplete and outdated. I bring these topics to the eating disorder field in three ways: by (...) choosing the scientific and philosophical discourse to be added into treatment; by translating the complex and abstract topics into psychologically relevant, lay public coursework; and, finally, through the creation of actual processes that help bring the material into direct experience. The science and philosophy discourse topics that will transform disordered eating are presented through lecture, inquiry for consideration, and discussion options. Consciousness, cosmology, and the new epistemology of science based on physics is simplified with examples of how it can be implemented within individual sessions, group sessions, or workshops for disordered eating treatment and with application to other mental health problems. The psychological application of the material is further enhanced through my description of a variety of experiential processes, from writing assignments and guided visualizations to storytelling, rituals, encounters in nature, and embodiment activities. I have created the lectures, inquiry, and experiential processes within a dynamic body of work, named the Emergence Courses, that have been introduced to professionals treating disordered eating and to clients for use. (shrink)

This is the prologue to a collection of essays on eugenics and psychiatry.

In this chapter, I provide an overview of phenomenological approaches to psychiatric classification. My aim is to encourage and facilitate philosophical debate over the best ways to classify psychiatric disorders. First, I articulate phenomenological critiques of the dominant approach to classification and diagnosis—i.e., the operational approach employed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-10). Second, I describe the type or typification approach to psychiatric classification, which I distinguish into three different (...) versions: ideal types, essential types, and prototypes. I argue that despite their occasional conflation in the contemporary literature, there are important distinctions among these approaches. Third, I outline a new phenomenological-dimensional approach. I show how this approach, which starts from basic dimensions of human existence, allows us to investigate the full range of psychopathological conditions without accepting the validity of current diagnostic categories. (shrink)

Advocates of physician-assisted suicide often argue that, although the provision of PAS is morally permissible for persons with terminal, somatic illnesses, it is impermissible for patients suffering from psychiatric conditions. This claim is justified on the basis that psychiatric illnesses have certain morally relevant characteristics and/or implications that distinguish them from their somatic counterparts. In this paper, I address three arguments of this sort. First, that psychiatric conditions compromise a person’s decision-making capacity. Second, that we cannot have sufficient certainty that (...) a person’s psychiatric condition is untreatable. Third, that the institutionalisation of PAS for mental illnesses presents morally unacceptable risks. I argue that, if we accept that PAS is permissible for patients with somatic conditions, then none of these three arguments are strong enough to demonstrate that the exclusion of psychiatric patients from access to PAS is justifiable. (shrink)

Psychotherapy is effective. Since the 1970’s, meta-analyses, and meta-analyses of meta-analyses, have consistently shown a significant effect size for psychotherapeutic interventions when compared to no treatment or placebo treatments. This effectiveness is normally taken as a sign of the scientific legitimization of clinical psychotherapy. A significant problem, however, is that most psychotherapies appear to be equally effective. This poses a problem for specific psychotherapies: they may work, but likely not for the reasons that ground their theoretical explanations for their effectiveness. (...) A prominent explanation for the findings of common efficacy in psychotherapy is to postulate that all successful therapies work by altering maladaptive meanings and providing patients with new, more adaptive meanings. This paper argues that the ‘meaning view’ of psychological change is likely mistaken; psychological problems are not normally problems of meaning nor are they directly ameliorated by changes in meaning. This paper then outlines a skill-based explanation for the findings of the common efficacy of psychotherapy. (shrink)

Deutsche Krankheit: eine Diagnosestellung mit Rückblick und Ausblick auf Krankheitsverlauf.

Introduction to The Oxford Handbook of Phenomenological Psychopathology.

The article discusses the actual problem of social support for people with mental health problems, which has an important place in the study field of social psychology and social work.The article also deals with the definition of the concept of “mental health”, the problem of introducing the term “mental health problems” as a way to avoid stigmatization, and the spread of a humanistic attitude to persons with a psychiatric diagnosis. It also discussed modern theoretical approaches that offer an understanding of (...) the contribution of biological, social, and psychological factors into the cause of mental health problems. -/- The problem of mental illness is common to all countries of the world, as WHO data evidenced the number of people with mental disorders among the world’s population, ranging from 4–5 %. According to researchers P. Voloshin and N. Maruta, the spread of mental and behavioral disorders in Ukraine is characterized by a slow increase of about 2.9 % in every 10 years. Researchers argue that in subsequent years, according to the prognostic data, there will be an increase in these indicators. The issue of providing social support to people with PDS in Ukrainian society is very relevant, which is complicated by their social isolation in the process of recovery after the treatment. The results of scientific research in the context of different cultures and relatively diverse life events (hospitalization, mental illness, unemployment, old age) generally confirm the positive results of using social support to promote mental and physical health. Instead, there are no studies in Ukrainian science related to the phenomenon of social support of people with mental health problems. -/- It is important to define the concepts of “mental health” and “mental health problems” in the process of studying the features of social support for people with mental health problems. The term “mental health” combines the medical and psychological fields of science and practice, but modern psychology offers a comprehensive approach to assessing the psychological health of a person, the psychological norm, its limits, taking into account the criteria of mental health. The description of the mental health given by the Psychological Dictionary points out the components of awareness and the sense of continuity, continuity and identity of their physical and mental “I”; sense of continuity and identity of experiences in similar situations; critical to yourself and your mental activity and its results; the adequacy of psychic reactions of force and frequency of environmental influences; the ability to manage their behavior in accordance with social norms; planning personal activities and implementing them; changing the way of behavior depending on the changing circumstances of life. -/- The concept of “mental health problem” was taken as a term that denotes all the symptoms classified in ICD-10 and DSM-IV, which are recommended by experts to clients for appropriate treatment and care. Scientists and mental health practitioners point out that mental health problems can affect the way an individual thinks, feels, and behaves; affects self-service, fulfills professional duties, social, family roles, and household behavior, which is usually deeply affected by the quality of life of the individual. Numerous results of the research show that there are specific psychological and personality factors apart from the biological causes of mental disorders (genetic factors that contribute to the imbalance of chemicals in the brain) that make people vulnerable to occurrences of the mental health problems. -/- Several modern theoretical approaches offer an understanding of the contribution of biological, social, and psychological factors to the induction of mental health problems: the traditional medical model, the rehabilitation model, the interface model, the social model, and the biopsychosocial approach. Only biopsychosocial and social models are consistent with the definition of WHO disability and emphasize the impact social aspects of mental health and the quality of life of people with mental health problems. -/- Individuals with PPP, as a social community, have specific needs that differentiate them from other members of society, one of which is the need for constant socio-psychological support. So, the contribution of psychology and social work to the quality of life of people with mental disorder lies in the application of professional approaches and methods based on the biopsychosocial (social) model, which emphasize the need for socio-psychological support. An example of such a technique is the model of modern social work practice “people-in-environment”, which serves as a guiding principle of social work and emphasizes the importance of understanding the persons with disorder and their behavior in the light of the multiple context of the social environment in which these persons live and act. Specialists of social work and psychology make interventions at three levels: individual, at the family level, and at the community level, by means of intensifying the support of the environment within the cognitive-behavioral and other approaches, which contribute to the process of reintegrating people with mental health problems into community. (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)

Does having a mental disorder, in general, affect whether someone is morally responsible for an action? Many people seem to think so, holding that mental disorders nearly always mitigate responsibility. Against this Naïve view, we argue for a Nuanced account. The problem is not just that different theories of responsibility yield different verdicts about particular cases. Even when all reasonable theories agree about what's relevant to responsibility, the ways mental illness can affect behavior are so varied that a more nuanced (...) approach is needed. (shrink)

Self-disorders in depression and schizophrenia have been the focus of much recent work in phenomenological psychopathology. But little has been said about the role the material environment plays in shaping the affective character of these disorders. In this paper, we argue that enjoying reliable (i.e., trustworthy) access to the things and spaces around us — the constituents of our material environment — is crucial for our ability to stabilize and regulate our affective life on a day-today basis. These things and (...) spaces often play an ineliminable role in shaping what we feel and how we feel it; when we interact with them, they contribute ongoing feedback that " scaffolds " the character and temporal development of our affective experiences. However, in some psychopathological conditions, the ability to access to these things and spaces becomes disturbed. Individuals not only lose certain forms of access to the practical significance of the built environment but also to its ​ regulative​ significance, too — and the stability and organization of their affective life is compromised. In developing this view, we discuss core concepts like " affordance spaces " , " scaffolding " , and " incorporation ". We apply these concepts to two case studies, severe depression and schizophrenia, and we show why these cases support our main claim. We conclude by briefly considering implications of this view for developing intervention and treatment strategies. (shrink)

This article draws upon the civic republican tradition to offer new conceptual resources for the normative assessment of mental capacity law. The republican conception of liberty as non-domination is used to identify ways in which such laws generate arbitrary power that can underpin relationships of servility and insecurity. It also shows how non-domination provides a basis for critiquing legal tests of decision-making that rely upon ‘diagnostic’ rather than ‘functional’ criteria. In response, two main civic republican strategies are recommended for securing (...) freedom in the context of the legal regulation of psychological disability: self-authorisation techniques and participatory shaping of power. The result is a series of proposals for the reform of decisional capacity law, including a transition towards purely functional assessment of decisional capacity, surer legal footing for advanced care planning, and greater control over the design and administration of decision-making capacity laws by those with psychological disabilities. (shrink)