Other Mental Disorders

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)

It’s a common assumption in psychiatry and psychotherapy that mental health conditions are marked out by some form of epistemic irrationality. With respect to obsessive-compulsive disorder (OCD), the mainstream view is that OCD causes irrational beliefs. Recently, however, this ‘doxastic view’ has been criticized from a theoretical and empirical perspective. Instead a more promising ‘zetetic view’ has been proposed which locates the epistemic irrationality of OCD not in irrational beliefs, but in the senseless inquiries it prompts. Yet, in this paper (...) I present a special class of cases—sexual obsessive-compulsive disorder (S-OCD)—which cannot be explained by existing doxastic and zetetic accounts of the epistemic irrationality of OCD. In addition, some people with S-OCD appear to be adhering too well to a plausible set of norms for inquiry. Their suffering seems to be partially caused by an excess of rationality, and not a lack thereof. They seem, if anything, too rational. This shows firstly that it’s unlikely that there is one form of epistemic irrationality common to all persons living with OCD. Secondly, it should lead us to rethink the epistemic categories we use in classifying mental health conditions such as OCD. (shrink)

Formal thought disorder (FTD) is a clinical mental condition that is typically diagnosable by the speech productions of patients. However, this has been a vexing condition for the clinical community, as it is not at all easy to determine what “formal” means in the plethora of symptoms exhibited. We present a logic-based model for the syntax–semantics interface in semantic networking that can not only explain, but also diagnose, FTD. Our model is based on description logic (DL), which is well known (...) for its adequacy to model terminological knowledge. More specifically, we show how faulty logical form as defined in DL-based Conception Language (CL) impacts the semantic content of linguistic productions that are characteristic of FTD. We accordingly call this the dyssyntax model. (shrink)

In this opinion piece we propose the investigation of psychedelic-assisted psychotherapy for the treatment of body dysmorphic disorder (BDD). BDD is a psychiatric disorder characterised by appearance-based preoccupations and accompanying compulsions. While safe and effective treatments for BDD exist, non-response and relapse rates remain high. Therefore, there is a need to investigate promising new treatment options for this highly debilitating condition. Preliminary evidence suggests safety, feasibility, and potential efficacy of psychedelic treatments in disorders that share similar psychopathological mechanisms with BDD. (...) Drawing on this evidence, as well as on relevant qualitative reports and theoretical proposals, we argue that it would be worthwhile to conduct a phase 2a study aimed at assessing the safety and feasibility of psychedelic-assisted psychotherapy in BDD. We also offer some suggestions for how future research ought to proceed. (shrink)

The notion of harm is frequently used in the discussion of the nature of mental disorder. Harm also plays important roles in the prominent diagnostic manuals such as DSM and ICD. Recently, however, Cristina Amoretti and Elisabetta Lalumera have questioned the idea that harm should be a necessary constituent of mental disorders. They argue that the notion of harm is underspecified and potentially leads to false negatives in diagnosing mental disorders. Given that harm plays significant roles in medical diagnosis and (...) treatment indicates that we should be reluctant to remove it as a criterion for deciding whether some condition is a mental disorder. Instead, we argue that harm should be understood in the prudential sense and harm in this sense provides a way of responding to worries raised by Amoretti and Lalumera, while staying true to the conception of harm that is relevant for psychiatric practice. (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)

Anorexia Nervosa (AN) is an eating disorder characterised by self-starvation. Accounts of AN typically frame the disorder in individualistic terms: e.g., genetic predisposition, perceptual disturbances of body size and shape, experiential bodily disturbances. Without disputing the role these factors may play in developing AN, we instead draw attention to the way disordered eating practices in AN are actively supported by others. Specifically, we consider how Pro-Anorexia (ProAna) websites—which provide support and solidarity, tips, motivational content, a sense of community, and understanding (...) to individuals with AN—help drive and maintain AN practices. We use C. Thi Nguyen’s work on epistemic “echo chambers”, along with Maria Lugones’ work on “worlds” and “ease”, to explore the dynamics of these processes. Adopting this broader temporal and intersubjective perspective, we argue, not only helps to further illuminate the experiential character of AN but also has important clinical and therapeutic significance. (shrink)

In this paper I review how the notion of gender is understood in psychiatry, specifically in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). First, I examine the contraposition between sex and gender, and argue that it is still retained by DSM-5, even though with some caveats. Second, I claim that, even if genderqueer people are not pathologized and gender pluralism is the background assumption, some diagnostic criteria still conceal a residue of gender dualism and (...) essentialism. Third, I consider gender dysphoria, which is characterized by an incongruence between one’s experienced or expressed gender and one’s assigned gender; since this condition pertains to distress and disability, not to the incongruence per se, it does not pathologize transgender people. Still, I contend that it should be removed from DSM-5 for theoretical reasons. (shrink)

In this article we examine obsessive compulsive disorder (OCD). We examine and reject two existing models of this disorder: the Dysfunctional Belief Model and the Inference‐Based Approach. Instead, we propose that the main distinctive characteristic of OCD is a hyperactive sub‐personal signal of being in error, experienced by the individual as uncertainty about his or her intentional actions (including mental actions). This signalling interacts with the anxiety sensitivities of the individual to trigger conscious checking processes, including speculations about possible harms. (...) We examine the implications of this model for the individual's capacity to control his or her thoughts. (shrink)

From 1965, the Swedish penal law does not require accountability as a condition for criminal responsibility. Instead, severely mentally disordered offenders are sentenced to forensic psychiatric care. The process that led to the present legislation had its origins in a critique of the concept of accountability that was first launched 50 years earlier by the founding father of Swedish forensic psychiatry, Olof Kinberg. The concept severe mental disorder is part of the Criminal Code as well as the Compulsory Mental Act. (...) The medical conditions for being sentenced to forensic psychiatric care are supposed to be the same as those for being admitted to involuntary psychiatric care. What these conditions are is not regulated in any law. For the guidance of the courts and others, there is a collection of examples in the government bill drafting the legislation in question. On the basis of these examples the content of the concept of severe mental disorder is chiselled out. However, the purposes of imposing penal law sanction and admitting someone to psychiatric care are not the same, and therefore the content of the concept severe mental disorder is bound to differ accordingly. Severe mental disorder is a legal concept that masks as a psychiatric one. In its applications in penal law, the court determines its content. But for the forensic psychiatrist it is more natural to interpret the term as a medical one. This creates a tension that has led to several controversies in recent criminal cases in Sweden. The best way to alleviate the situation is to discard the concept of severe mental disorder from criminal law. This will allow for a better separation of the roles of the psychiatrist and the court. (shrink)

Holism in interwar Germany provides an excellent example for social and political in- fluences on scientific developments. Deeply impressed by the ubiquitous invocation of a cultural crisis, biologists, physicians, and psychologists presented holistic accounts as an alternative to the “mechanistic worldview” of the nineteenth century. Although the ideological background of these accounts is often blatantly obvious, many holistic scientists did not content themselves with a general opposition to a mechanistic worldview but aimed at a rational foundation of their holistic projects. (...) This article will discuss the work of Kurt Goldstein, who is known for both his groundbreaking contributions to neuropsychology and his holistic philosophy of human nature. By focusing on Goldstein’s neurolinguistic research, I want to reconstruct the empirical foundations of his holistic program without ignoring its cultural background. In this sense, Goldstein’s work provides a case study for the formation of a scientific theory through the complex interplay between specific empirical evidences and the general cultural developments of the Weimar Republic. (shrink)

Reply to Ronald de Sousa and Douglas W. Heinrichs.

This paper explores how the diagnosis of mental disorder may affect the diagnosed subject’s self-concept by supplying an account that emphasizes the influence of autobiographical and social narratives on self-understanding. It focuses primarily on the diagnoses made according to the criteria provided by the Diagnostic Statistical Manual of Mental Disorders (DSM), and suggests that the DSM diagnosis may function as a source of narrative that affects the subject’s self-concept. Engaging in this analysis by appealing to autobiographies and memoirs written by (...) people diagnosed with mental disorder, the paper concludes that a DSM diagnosis is a double-edged sword for self- concept. On the one hand, it sets the subject’s experience in an established classificatory system which can facilitate self-understanding by providing insight into subject’s condition and guiding her personal growth, as well as treatment and recovery. In this sense, the DSM diagnosis may have positive repercussions on self-development. On the other hand, however, given the DSM’s symptom-based approach and its adoption of the Biomedical Disease model, a diagnosis may force the subject to make sense of her condition divorced from other elements in her life that may be affecting her mental- health. It may lead her frame her experience only as an irreversible imbalance. This form of self-understanding may set limits on the subject’s hopes of recovery and may create impediments to her flourishing. (shrink)

The essay aims to analyse the gradual historical process of the partial overlap, replacement and expansion of the theoretical paradigm of depression with respect to that of melancholy. The first part is devoted to analysing some of the central features of the multivalent thematizations of melancholy drawn up during modernity, also with relation to the spirit of capitalism (in its Weberian acceptation). This is followed by an overview of the birth of the modern category of depression, and the process that (...) during the twentieth century led to its transformation into a theoretical and nosological paradigm which in the end replaced that of melancholy. The second part is the attempt to draw up a Zeitdiagnose: the aim is to assess the ‘depressive’ psychosocial impact exercised by particular socio-economic mechanisms and cultural trends, with particular reference to what has been defined as the ‘new spirit of capitalism’, as well as the new forms of individualism and their paradoxical dynamics. In conclusion, I will form a bridge between the history of the two aforesaid paradigms and the contemporary psychosocial dynamics correlated to the phenomenon today interpreted as a ‘depression epidemic’. Der Aufsatz zielt darauf, der Prozess der historischen Überlagerung, Substitution und Verbreitung des theoretischen Paradigmas der Depression gegenüber jenem der Melancholie darzustellen. Im ersten Teil wird versucht, einige der einschneidenden Eigenschaften der Thematisierungen der Melancholie in der Frühen Neuzeit anzugeben, auch im Verhältnis zum Geist des Kapitalismus. Nachdem eine Skizze der Entstehung der moderne Kategorie der Depression, geht es darum, den Verlauf nachzuzeichnen, der im 20. Jahrhundert zu ihrer Transformation in ein weitläufiges theoretisches Paradigma geführt hat, das schließlich jenes der Melancholie ersetzt hat. Der zweite Teil stellt den Versuch dar, eine Zeitdiagnose umzureißen: An dieser Stelle ist die psychosoziale Bedeutung bestimmter sozioökonomischer und kultureller Mechanismen zu untersuchen, unter besonderem Hinweis auf das, was als »der neue Geist des Kapitalismus« bezeichnet worden ist, sowie auf neue Formen des Individualismus und ihre paradoxen Dynamiken. Abschließend wird eine Brücke geschlagen, zwischen der Geschichte der beiden bezeichneten Paradigmen und der zeitgenössischen psychosozialen Dynamiken, die mit dem als »depressive Epidemie« interpretierten Phänomen verbunden sind. (shrink)

In their work Gilio et al. investigate the mechanisms involved in the regulation of excitability of the cortex in epileptic subjects, and in particular their epileptogenic threshold.

Epileptogenesis involves an increase in excitatory synaptic strength in the brain in a manner similar to synaptic potentiation. In the present study we investigated the mechanisms of short-term synaptic potentiation in patients with focal epilepsy by using 5 Hz repetitive transcranial magnetic stimulation (rTMS), a non invasive neurophysiological technique able to investigate the mechanisms of synaptic plasticity in humans. Ten patients with focal idiopathic cortical epilepsy were studied. 5 Hz-rTMS (10 stimuli-trains, 120% of motor threshold, RMT) was delivered over the (...) first dorsal interosseus (FDI) motor area of both (affected and unaffected) hemispheres. Changes in the motor evoked potential (MEP) size in the FDI muscle during the trains and the RMT were measured and compared between the hemispheres. 5 Hz-rTMS was also delivered in a group of healthy subjects over both hemispheres. 5 Hz-rTMS in patients elicited a reduced MEP facilitation compared to normal subjects. The reduced MEP amplitude was more evident in the affected hemisphere than in the unaffected hemisphere. RMT in the affected hemisphere was higher than in the unaffected hemisphere and in healthy subjects. Our findings showing a decreased response to 5 Hz-rTMS over the affected hemisphere, differently from the expected results suggest a reduced cortical excitability in epileptic patients. We hypothesize an altered balance between excitatory and inhibitory circuits in epileptic patients under chronic therapy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.3 (2005) 257-259 [Access article in PDF] Atrocity, Banality, Self-Deception Adam Morton Keywords evil, self-deception, banality, atrocity, motivation When talking about evil we must make a fundamental choice about how we are to use the term. We may use it as half of the contrast "good versus evil," in which case it covers everything that is not good. That includes moral incompetence, lack of imagination, (...) willingness to follow orders, overreactions, and a host of other reasons why people who do not have personalities that we would call evil do things that are wrong, often very wrong. Call this the weak reading of evil: evil as wrongdoing. Or we may use it with the meaning suggested by "evil person," "really evil act," "the evil lurking in all of us," and other such idioms. If we do this, we focus on a particular class of actions, and the motives and people that produce them, that arouse a particular moral revulsion in us. Call this the strong reading of evil: evil as atrocity (for more on this contrast see Morton [2004] and Card [2002]).Kubarych, following Peck, thinks of evil in the strong way. Most of the time at any rate: Some of the philosophers, such as Kant, that he draws on are thinking of evil in the weak way, and some of his quotations are from the German, where good/bad/evil distinctions are not drawn in the same way as in English. He explores a general explanation of evil that seems to be targeted at the psychology of extremely abhorrent actions. But, I argue, his account is in danger of collapse in either of two directions. Depending on how we interpret Kubarych's account, it could turn out that it describes all wrongdoing as evil, or, making some different choices, it could turn out that there are no really evil people.The strong reading of evil is definitely the most interesting and potentially fruitful. After all, we have no shortage of satisfying explanations of why people lie to get out of unwelcome appointments, steal to support their children or their drug habits, or defraud investors to become rich. But we do feel deeply puzzled by those who commit torture, serial murder, or genocide. We ask of these people not so much "Why did he do it?" as "How could he do it?" We feel the need of a philosophical or psychological theory that can give us even a slight handle of these people and their deeds. There are two risks associated with the project of explaining atrocity, though. The first is the risk of accepting unsatisfactory accounts, just because they purport to explain what we desperately want to understand. The second is the risk of supposing that there is a single explanation when the causes of the phenomenon are in fact too varied. On other topics these two risks have often combined to make people believe what seem to us now to be evident falsehoods. Humans have often for example wanted to know the causes of disease, and as a result have accepted blanket explanations, in terms of [End Page 257] evil spirits or lack of faith, that seem ludicrous to us now that we have a better grasp of the variety of factors that can cause our bodies to misfunction. So before asking naively "Why and how can people do these awful things?" we should ask "Is there a deeper causal unity here, beyond the fact that we react to these acts with horror?"My suspicion is that there is not much unity, that it is asking too much to want a common profile to the psychology of serial killers, or of proponents of genocide, let alone a profile that applies across these and other categories. What we can do, I believe, is describe our concept of evil in such a way that we can leave some parameters to be filled in by a large variety of objective psychological factors. Even this runs the risk that the really relevant factors cannot be forced into the role that the philosophical account requires. In... (shrink)