Philosophy of Psychiatry and Psychopathology

This paper examines the relations between stubbornness and weakness of will, adopting Holton’s definition of weakness of will as an over-readiness to revise one’s resolutions. It posits that both stubbornness and weakness of will are responses to pessimism – the negative perception of a task or its outcome. Contrary to naive judgement, stubbornness is not merely the opposite of weakness; rather, it serves as a preventive behaviour stemming from a fear of weakness of will. Weakness of will and stubbornness can (...) be viewed as two facets of the same phenomenon, both influenced by pessimism. The paper explores the implications of this unified account, particularly at the therapeutic level, suggesting that enhancing self and other trust could reduce both weak and stubborn behaviours. (shrink)

There are a number of conflicting accounts of thought insertion, the delusion that the thoughts of another are inserted into one’s own mind. These accounts share the common assumption of _realism_: that the subject of thought insertion has a thought corresponding to the description of her thought insertion episode. I challenge the assumption by arguing for an anti-realist treatment of first-person reports of thought insertion. I then offer an alternative account, _simulationism_, according to which sufferers merely simulate having a thought (...) inserted into their heads. By rejecting realism, the paper undermines a widespread explanatory framework that unites otherwise competing cognitive models of thought insertion. (shrink)

In addressing the question of what mental health is we might proceed as if there is a single phenomenon – mental health – denoted by a single overarching concept. The task, then, is to provide an informative analysis of this concept which applies to all and only instances of mental health, and which illuminates what it is to be mentally healthy. In contrast, mental health pluralism is the idea that there are multiple mental health phenomena denoted by multiple concepts of (...) mental health. Analysis and illumination of mental health may still be possible, but there isn’t a single phenomenon or concept to be analysed in addressing the question of what mental health is. The question of pluralism has been overlooked in the philosophy of mental health. The discussion to follow is an attempt to get us to take mental health pluralism seriously. To that end, in this essay I have three primary goals: (1) to give a precise account of what mental health pluralism is, (2) to show that the question of pluralism should not be neglected in debate about what mental health is, and (3) to argue for mental health pluralism. I also draw out some implications of this discussion for philosophy, science, and psychotherapy. (shrink)

This paper advances a theory of disease as domino dysfunction. It is often argued that diseases are biological dysfunctions. However, a theory of disease as biological dysfunction is complicated by some plausible cases of dysfunction, which seem clearly non-pathological. I argue that pathological conditions are not just dysfunctions but domino dysfunctions, and that domino dysfunctions can be distinguished on principled biological grounds from non-pathological dysfunctions. I then show how this theory can make sense of the problem cases; they are not (...) diseases because they are not domino dysfunctions. (shrink)

Any progress in shaping up an externalist psychiatry, so previous discussion suggested, must begin from questions about the ontology of social causation. So far, research and theory have adhered to a naturalistic approach to the social causes of illness, concentrating mostly on the ‘social determinants of mental health’ (inequality, discrimination, housing insecurity, etc.). The paper starts with an assessment of ‘social determinants’ through the lens of epidemiology and critical psychiatry. It illustrates existing practical and political approaches that fight these constraints (...) and it highlights their therapeutic value. It argues, though, that a focus on social determinants is not sufficient for fully realizing externalism because a great portion of sociogenic illness remains causally indeterminate. Alongside political action, externalism requires a social etiology that is established by virtue of the meaning that it holds for patients, rather than by virtue of its capacity to identify objective social causes of illness. This entails abandoning naturalism about social causation and embracing constructivism. The paper shows that this methodological shift is less contradictory and more effective than it is commonly imagined. Drawing from further anthropological evidence, it concludes that only by lending support to projects that balance a focus on constraints with social construction will psychiatry be truly externalist. At stake is a prospect of effective treatment for sociogenic illness for the countless in struggle. (shrink)

Response to commentaries on the three-paper set 'Outline for an externalist psychiatry'.

The biopsychosocial (BPS) model in psychiatry has come under fire for being too vague to be of any practical use in the clinic. For many, its central flaw consists in lack of scientific validity and philosophical coherence: the model never specified how biological, psychological and social factors causally integrate with one another. Recently, advances in the cognitive sciences have made great strides towards meeting this very ‘integration challenge.’ The paper begins by illustrating how enactivist and predictive processing frameworks propose converging (...) accounts of biopsychosocial integration that are far superior to those of previous theories. It argues, however, that the main problem of implementing the BPS model has less to do with integration than with the lack of a social etiology. Psychiatric practice leans heavily towards ‘bio’ and ‘psycho’ approaches, without an equally developed set of explanatory and therapeutic resources for dealing with the ‘social’ dimension of illness. This leaves psychiatry essentially internalist in orientation. As illustrated most poignantly by conditions such as functional neurological disorders, internalism comes with the risks of stigma and the curtailment of therapeutic possibilities. The paper argues that the answer to the failings of the BPS model lies in combining the integration challenge with the development of an ‘externalist psychiatry,’ which casts both causes and treatment of psychiatric illness onto the social environment. The following two papers explore the conditions that might make this idea a reality. (shrink)

Philosophical speculation about how psychiatric externalism might function in practice has yet to fully consider the multitude of externalist psychiatric systems that exist beyond the bounds of modern psychiatry. Believing that anthropology can inform philosophical debate on the matter, the paper illustrates one such case. The discussion is based on 19 months of first-hand ethnographic fieldwork among Akha, a group of swidden farmers living in highland Laos and neighboring borderlands. First, the paper describes the Akha set of medicinal, ritual, and (...) shamanic practices, analyzing issues of stigma and medical pluralism within it. Second, it makes the case that the Akha realize a functioning biopsychosocial system which comes with a well-developed set of resources for treating the social dimension of illness. Externalism among the Akha re-frames psychiatric illness as a ‘problem in living,’ which becomes manageable as such. The paper claims that, in so doing, the Akha system succeeds in many of the areas where modern internalist psychiatry falls short, and that it does so because Akha society is structured in such a way so that its practitioners can shift the social environment around the patient. As a takeaway for philosophers, it suggests that the development of an externalist psychiatry must begin from questioning the accepted ontology of the social causes of psychiatric illness. (shrink)

Die Theory of Mind (ToM) ist eine au fwendige, zu sammengesetzte Leistung, die auf mehreren kognitiven Voraussetzungen aufbaut. Sie wird in Laborsituationen mit anspruchsvollen Paradigmen untersucht. Diesen Ansprüchen sind ältere Menschen aus u nterschiedlichen Gründen oft nicht mehr gewachsen. Schreiten altersassoziierte Probleme wie Herz-Kreislauf-Krankheiten, Seh- und Hörstörungen fort oder entwickeln sich besondere Hirnerkrankungen wie vaskuläre und neurodegenerative Demenzen (zum Beispiel eine frontotemporale Lobärdegeneration), so fällt es zu nehmend schwer, passende Antworten auf schwierige soziale Fragen finden. Überdies muss ToM regelmässig trainiert (...) werden, u nd d es wird oft durch die »soziale Entsorgung« im Rentenalter vereitelt; dafür wird die altersassoziierte Egozentrizität (AAE) gefördert. (shrink)

This article aims to contribute to cognitive therapy of polythematic delusions by proposing a preliminary step to the implementation of traditional cognitive therapy, based on the construction of alternative hypotheses to delusions and testing of the latter. This additional step resides in the construction in the patient of the necessary skills to use the general experimentalist method of knowledge acquisition. Such an approach is based on the contrast between the logico-theoretical and the experimentalist turn of mind. Some elements such as (...) to allow any such construction in the patient are then described and analyzed. (shrink)

Schizophrenia is often associated with other physical and mental problems. Generalized anxiety disorder is notably one of the comorbid disorders which is often linked to schizophrenia. The association of polythematic delusions and of ideas resulting from generalized anxiety disorder complicates the exercise of the corresponding cognitive therapy, for the resulting ideas are most often inextricably intertwined. In what follows, we endeavour to propose a methodology for the differential treatment of polythematic delusions inherent to schizophrenia when combined with ideas originating from (...) generalized anxiety disorder. We propose, with regard to the corresponding content of delusions, an analysis which allows under certain conditions, to separate the content associated with polythematic delusions and the one that relates to generalized anxiety disorder, in order to facilitate the exercise of the corresponding cognitive therapy. (shrink)

In a previous paper (Compléments pour une théorie des distorsions cognitives, Journal de Thérapie Comportementale et Cognitive, 2007), we did present some elements aimed at contributing to a general theory of cognitive distortions. Based on the reference class, the duality and the system of taxa, these elements led to distinguish between the general cognitive distortions (dichotomous reasoning, disqualification of one pole, minimization, maximization) and the specific cognitive distortions (disqualifying the positive, selective abstraction, catastrophism). By also distinguishing between three levels of (...) reasoning – the instantiation stage, the interpretation stage and the generalization stage – we did also define two other cognitive distortions: over-generalization and mislabeling (Théorie des distorsions cognitives : la sur-généralisation et l'étiquetage, Journal de Thérapie Comportementale et Cognitive, 2009). We currently extend this model to another classical cognitive distortion: personalization. (shrink)

In a previous paper (Compléments pour une théorie des distorsions cognitives, Journal de Thérapie Comportementale et Cognitive, 2007), we did present some elements aimed at contributing to a general theory of cognitive distortions. The latter elements, based on the reference class, the duality and the system of taxa, are applied here to generalised anxiety disorder. This allows to describe, on the one hand, the specific distortions related to generalised anxiety disorder, consistently with recent work emphasising the role played by uncertain (...) situations with regard to future events. On the second hand, these elements allow to define one type of structured reasoning, of inductive nature, which contributes to the formation and maintenance of anxious ideas. (shrink)

Withdrawal involves emotional pain that motivates much addictive behavior. In this paper, I argue that the emotional pain of withdrawal compels much addictive behavior. Researchers have noticed this possibility but it is widely underappreciated. Among philosophers, only Hanna Pickard has discussed emotional compulsion in addiction, and the emotional aspect of withdrawal has been almost completely neglected. Accounts of emotional compulsion in the philosophical literature (from Tappolet, Elster, and Furrow) probably do not capture how the distress of withdrawal compels, so I (...) propose a more suitable account of “pathodoxastic” compulsion in addiction. On this account, the emotional pain of withdrawal compels when it undermines the ability to believe that one can continue to endure it, and therefore the ability to intend abstinence. (shrink)

The mental health crisis and loneliness epidemic have sparked a growing interest in leveraging artificial intelligence (AI) and chatbots as a potential solution. This report examines the benefits and risks of incorporating chatbots in mental health treatment. AI is used for mental health diagnosis and treatment decision-making and to train therapists on virtual patients. Chatbots are employed as always-available intermediaries with therapists, flagging symptoms for human intervention. But chatbots are also sold as stand-alone virtual therapists or as friends and lovers. (...) There is evidence that these uses of AI and chatbots can provide better quality service, improve accessibility, and lower costs. The systems can reduce the stigma and shame of sharing their problems and leverage a mass of biometric and behavioral data to supplement self-reports. As the systems' intelligence rapidly improves, they will need to be rigorously tested for the accuracy and precision of their diagnoses and the quality of their interactions with patients. As chatbots become indistinguishable from humans and leverage their superhuman capacity to detect affect and draw on knowledge of a patient’s life, patients will be drawn to attribute personality to and relationship with the chatbot. Consequently, it will be essential to study what the “therapeutic alliance” with an actual human counselor provides and the risks of patients attributing such a relationship to a one-sided or “parasocial” relationship. (shrink)

Psychological and philosophical studies have extended J. J. Gibson’s notion of affordances. Affordances are possibilities for bodily action presented to us by the objects of our perception. Recent work has argued that we should extend the actions afforded by perception to mental action. I argue that we can extend the notion of affordance itself. What I call ‘Introspective Affordances’ are possibilities for mental action presented to us by introspectively accessible states. While there are some prima facie worries concerning the non-perceptual (...) nature of introspection, I will argue that our internal mental lives share enough commonalities with experiences in our environment to warrant this extension. I will demonstrate the value of introspective affordances by showing how they allow us to explain an underexplored aspect of thought insertion. (shrink)

This paper argues that proper functions are proximal functions. In other words, it rejects the notion that there are distal biological functions – strictly speaking, distal functions are not functions at all, but simply beneficial effects normally associated with a trait performing its function. Once we rule out distal functions, two further positions become available: dysfunctions are simply failures of proper function, and pathological conditions are dysfunctions. Although elegant and seemingly intuitive, this simple view has had surprisingly little uptake in (...) the literature. Indeed, our position departs from that of almost every theorist who has engaged with the issue at any depth. We start by presenting three arguments for the position that proper functions are proximal: one from the specificity of functions, one from their relation to intervention, and one from their relation to pathology. We then consider two case studies evidencing the trouble that accepting distal functions causes for philosophical reflection on the nature of pathological conditions. Finally, we anticipate and respond to three objections: that there can be failure of function without dysfunction; that our account is unacceptably revisionary in respect of normal function-talk; and that our thesis over-generalises from a narrow set of cases. (shrink)

Psychiatric research is in crisis because of repeated failures to discover new drugs for mental disorders. Lack of measurement validity could partly account for these failures. If researchers do not actually measure the effects of drugs on the disorders they aim to investigate, one should expect suboptimal treatment outcomes. I argue that this is the case, focusing on depression, and fear & anxiety disorders. In doing so, I show how psychiatric research illustrates a more general phenomenon that I call “validity (...) drift.” A validity drift occurs when, in the course of developing new measurement procedures, researchers end up studying something different from what they originally aimed to study. I analyze the different ways in which scientists attempt to validate procedures for measuring mental disorders for the purpose of testing drugs in animal models. I show how those validation efforts might fail, thereby leading to validity drifts. Overall, this analysis highlights the complex interplay between the development of new measurement procedures, their calibration, and scientific theories of the target phenomena. (shrink)

Research in the philosophy of addiction commonly explores how agency is impacted in addiction by focusing on moments of apparent loss of control over addictive behavior and seeking to explain how such moments result from the effects of psychoactive substance use on cognition and volition. Recently, Glackin et al. (2021) have suggested that agency in addiction can be helpfully analyzed using the concept of affordances. They argue that addicted agents experience addiction-related affordances, such as action possibilities relating to drugs, drug (...) paraphernalia, and drug-related activities, as aberrantly salient motivations for action. Building on this approach, we present a novel two-tiered affordance model of addiction. In doing so, we suggest that what is significant about the addicted person’s world is not simply what affordances are experienced as salient, but also the way in which the addicted person’s world is shaped by a dominant concern. It is not only that addiction-related affordances become more prominent as addiction progresses but that one’s plurality of concerns become monopolized by and funneled through addiction. Our model endorses Glackin et al.’s idea that addiction-related affordances become aberrantly salient, while proposing why they become and remain so. This way of viewing agency in addiction also brings to light important implications for recovery and treatment. For, if an addicted person adopts a new, even “socially approved”, dominant concern, there is a risk that the shape of addiction is preserved, even though the content changes, leaving an individual at the risk of addiction substitution or relapse. (shrink)

Contemplative scholarship has recently reoriented attention towards the neuroscientific study of the soteriological ambition of Buddhist practice, 'awakening'. This article evaluates the project of seeking neural correlates for awakening. Key definitional and operational issues are identified demonstrating that: the nature of awakening is highly contested both within and across Buddhist traditions; the meaning of awakening is both context- and concept-dependent; and awakening may be non-conceptual and ineffable. It is demonstrated that operationalized secular conceptions of awakening, divorced from soteriological and cultural (...) factors, have little relationship to traditional Buddhist construct(s) of awakening. This article identifies methodological issues for secular conceptions of awakening concerning introspection and neuroimaging yet demonstrates also the value of recent advancements in empirical first-person phenomenology for attenuating introspective bias. Overall, it is contended that significant problems arise when decontextualizing awakening and placing it within a scientific naturalistic framework. Careful attention to the definitional, operational, and methodological neuroscientific obstacles identified herein is required in the responsible approach to the investigation of awakening states. (shrink)

Critical notice of Puddifoot, Katherine. 2021. How Stereotypes Deceive Us. NY: OUP.--------- -/- Kathy Puddifoot makes a compelling and enlightening case for a striking pair of claims: 1) false stereotypes sometimes steer us to the truth, while 2) true stereotypes often lead us into error. This is a wonderful book, a seamless integration of epistemology with ethics, of philosophy with social science, and of “mainstream” or “Western analytic” approaches with marginalized and underappreciated contributions from critical social traditions, especially black feminism. (...) The integrations are so seamless, in fact, as to give the reader the impression that Puddifoot is simply picking up conversations already underway. Instead, she has done a tremendous service in bringing representatives from wide-ranging, often-siloed disciplines into dialogue. Another virtue of Puddifoot’s book is how thoroughly it maps out the actual and possible views and logical spaces revolving around each topic she addresses. How Stereotypes Deceive Us could therefore be used to introduce budding epistemologists to the field, as it offers clear and careful explanations of leading approaches to a range of topics, including virtue epistemology, theory of mind, and more. (shrink)

A common but overlooked form of explanation in psychiatry is what I label ‘empathetic explanation’. Empathetic explanations invoke empathetic variables, which, in addition to providing an explanation of the target phenomenon, also afford an empathetic understanding of it. Focusing on the case of auditory verbal hallucination (AVH), I argue that empathetic explanation fails to provide an adequate account of the phenomenon, perniciously shapes empirical research, and confuses empathetic understanding with scientific understanding. I close by providing a general condition on the (...) legitimate application of empathetic explanation. (shrink)

Commentary of Justin Garson, "Madness and idiocy: Reframing a basic problem of philosophy of psychiatry." Philosophy, Psychiatry, & Psychology.

Commentary on Pablo Hubacher Haerle’s paper “Is OCD Epistemically Irrational?”. I argue for expanding our assessment of rationality in OCD by considering a wider range of epistemic parameters and how they fit together.

Abstract:In this paper, I distinguish four ways in which aspects or features of mental illness may be said to be functional. I contend that discussion of teleological perspectives on mental illness has unfortunately tended to conflate these senses. The latter two senses have played important practical roles both in predicting and explaining patterns of behavior, cognition, and affective response, atnd relatedly, in developing successful interventions. I further argue that functional talk in this context is neither inconsistent with viewing some disorders (...) as dysfunctional in one of several senses, nor inappropriately adaptationist, provided we keep these senses of function distinct, and are precise about which is in play in a given context. (shrink)

Dysmenorrhea, or menstrual pain, is regularly suffered by 45 to 95% of menstruating women. Despite its prevalence, and despite the philosophical importance of pain as a general phenomenon, dysmenorrhea has been all but completely overlooked in contemporary analytic philosophy of mind. This paper aims at rectifying this situation. We single out three properties of what is often considered the paradigmatic case of painful experience, what we call injury-centered pains, and argue that dysmenorrhea does not have any of them, and hence (...) that it does not neatly conform to the injury-centered model of pain. This calls into question the centrality of the injury-centered model, and suggests novel research avenues within theoretical debates on affectivity. (shrink)

Most mental health research largely ignores or minimises gender and age differences in depression. In ‘Don't mind the gap: Why do we not care about the gender gap in mental health?’, Patalay and Demkowicz identify a dearth of research on the causal factors of depression in young women. They attribute this to an over-reliance on biological accounts of gender differences in depression. Patalay and Demkowicz conclude that a person-centred approach that meaningfully engages with the reports of young women with depression (...) is more likely to expose the social drivers of depression that impact this group. This commentary focuses on Patalay and Demkowicz's call to examine the patient's lived experience. We argue that there is an urgent need to reflect upon the methodologies involved in examining lived experience and how they can be best utilised. Ultimately, we advocate for an approach known as ‘phenomenological psychopathology’, through a phenomenological investigation of depression in young women, we can go some way towards closing the gender gap. (shrink)

Traumatic experiences do not merely impact on the individual’s body and psyche, they alter the way we experience others, our interpersonal relationships, and how we make sense of the world. In my dissertation, I integrate work in phenomenology, psychopathology, philosophy of mind, philosophy of psychiatry, and trauma studies, and draw on trauma testimonies ob- tained in an online questionnaire. I engage analytically with the question of what constitutes a trauma, whether psychological trauma is necessarily pathological, and what the causal and (...) im- plicatory relations between traumatising and post-traumatic experiences are. Informed by these preliminary elaborations, I focus on the intersubjective dimension of trauma, drawing on a qualitative study I conducted in 2020. I show that empathic abilities may be altered but are not necessarily diminished through traumatising experiences; I suggest a framework for under- standing feelings of alienation in the aftermath of trauma; and I demonstrate how feelings of belonging may be re-established. My dissertation is exemplary of how phenomenological frameworks can contribute to a better understanding of psychological trauma and that engaging with trauma can, in turn, inform and enrich philosophical thinking. (shrink)

The notion of belief appears frequently in cognitive science. Yet it has resisted definition of the sort that could clarify inquiry. How then might a cognitive science of belief proceed? Here we propose a form of pluralism about believing. According to this view, there are importantly different ways to "believe" an idea. These distinct psychological kinds occur within a multi-dimensional property space, with different property clusters within that space constituting distinct varieties of believing. We propose that discovering such property clusters (...) is empirically tractable, and that this approach can help sidestep merely verbal disputes about what constitutes “belief.”. (shrink)

Recent trends in psychiatry involve a transition from categorical to dimensional frameworks, in which the boundary between health and pathology is understood as a difference in degree rather than as a difference in kind. A major tenet of dimensional approaches is that no qualitative distinction can be made between health and pathology. As a consequence, these approaches tend to characterize such a threshold as pragmatic or conventional in nature. However, dimensional approaches to psychopathology raise several epistemological and ontological issues. First, (...) we review major sources of evidence usually recruited in support of the dimensional trend (focusing on clinical observation and biological data), and we show that these are connected to different conceptualizations of how dimensional traits extend across health and pathology. Second, we criticize two unquestioned assumptions that stand at the core of the dimensional trend: a) that there is continuity from health to pathology at the symptomatic level; b) that such continuity reflects an underlying continuity in the genetic liability for pathological conditions. Third, we argue against the idea of a conventional threshold by showing that such a view implies a linear relationship between the genotype and the phenotype. Fourth, drawing on epigenetics and developmental biology, we offer a characterization of mental disorders as stable and dynamic constellations of multi-level variables that differ qualitatively from ‘healthy states’. We conclude by showing that our account has several theoretical advantages over both categorical and dimensional approaches. Notably, it provides crucial insights into psychological development over time and individual differences, with major implications in terms of intervention and clinical decision-making. (shrink)

Se presenta una visión de la epistemología como lógica del pensar y se la lleva a una elaboración de la práctica clínica como una lógica del padecimiento psíquico. Esto basado en los planteamientos de Deleuze y Guattari. Para ello se toma como punto de partida la noción de los movimientos aberrantes que, leyendo la obra de Deleuze, elaboró David Lapoujade entendiéndolos como movimientos que se producen en la relación entre distintos términos heterogéneos, pero manteniendo su heterogeneidad. Esto es vinculado con (...) la invitación que hace el mismo Lapoujade a entender la obra deleuzeana como el desarrollo de lógicas irracionales, intentando pensar desde ahí una lógica de la locura y del padecimiento mental con base en, a su vez, una lógica de las obras literarias de Proust y Kafka, tal como las leen los mismos Deleuze y Guattari. En relación con ello destacamos, por un lado, cierta lógica de conjuntos abiertos y no totalizables que estos últimos autores encuentran en la obra de Proust y, por otro lado, una lógica de la contigüidad que encuentran en la obra de Kafka. Al mismo tiempo, se establecen puntos en común entre estas dos lecturas a propósito de lo esquizoide como algo que excede a la significación del discurso, así como a la normatividad de la conducta. Asimismo, en distintos puntos del escrito se extraerán las implicaciones que estos modos de pensar tienen para una práctica clínica en relación con modos de existencia subjetivos que se escapan a lo que está establecido en el campo social. De esa manera, ponemos en conjunción una aproximación epistemológica con una política. (shrink)

A lo largo de la tradición psicopatológica, incluso de la pre-fenomenológica, se encuentra la categorización del delirio como creencia. Jaspers asumió ese uso y lo fundó fenomenológico-existencialmente, definiendo su carácter de convicción. El concepto de creencia ha tenido un largo recorrido dentro de la historia del pensamiento, aunque recientemente se ha intensificado el debate acerca de la visión doxástica del delirio. En virtud de lo ya mencionado, en el presente artículo presentamos un análisis conceptual de la creencia, con el objetivo (...) de identificar de manera precisa los aspectos esenciales que permiten al delirio definirse según ella. De esta manera, se discutirán algunas de las principales incursiones realizadas en el concepto desde la antigüedad periplatónica hasta José Ortega y Gasset, remarcando en cada pensador las directrices esenciales de su aproximación a la creencia. A su vez, introducir al filósofo español al debate psicopatológico permitirá incluir en la discusión dos aspectos importantes que creemos pueden ser fructíferos para la discusión filosófica sobre el delirio: la diferencia entre ideas y creencias, y la vitalidad de estas últimas. Finalmente, hacemos referencia al actual debate pro- y antidoxástico, haciendo hincapié en la necesidad de considerar la amplitud del concepto de creencia en su genealogía histórica. Con base en ello estaríamos en condición de acercarnos a la visión doxástica moderada que han defendido autoras como Lisa Bortolotti. (shrink)

En el presente artículo realizamos un análisis del estatus ontológico de la noción de psicopatología que se deriva de cuatro aproximaciones metodológicas a su estudio, a saber: aproximación psiquiátrica, fenomenológico-existencial, constructivista-histórica y antipsiquiátrica. Por medio de una metodología de revisión bibliográfica sistematizada y siguiendo el marco de trabajo metaframework ReSiste-CHS (Revisiones Sistematizadas en Ciencias Humanas y Sociales), sostendremos que dicha noción presenta divergencias en al menos tres puntos: (i) la relevancia de la sintomatología como característica, (ii) la existencia o inexistencia (...) del sufrimiento psíquico y (iii) la relevancia de los factores sociales en su configuración. En el apartado introductorio abordaremos las consideraciones históricas generales relacionadas con el estudio de los trastornos mentales. En el segundo apartado nos referiremos a la metodología empleada para la realización del artículo. En el tercer apartado expondremos los rasgos fundamentales de las cuatro metodologías de estudio mencionadas anteriormente, dividiendo la descripción en los siguientes puntos: orientación, etiología, clasificación, diagnóstico y tratamiento. En el cuarto apartado contrastaremos los conceptos de psicopatología que pueden ser extraídos de ellas. A modo de conclusión, propondremos una sistematización de las condiciones mínimas que debe cumplir una noción de psicopatología que sea fructífera desde un punto de vista teórico y práctico. Estas condiciones incluyen un posicionamiento crítico ante los extremos reduccionista y relativista, la consideración del sufrimiento psíquico como rasgo constitutivo y núcleo fundamental de este género de experiencia, así como una dimensión ética relacionada con su abordaje. Por último, mostraremos algunas limitaciones y futuras directrices que se derivan del trabajo realizado. (shrink)

This paper offers an overview of the philosophical work on epistemic injustices as it relates to psychiatry. After describing the development of epistemic injustice studies, we survey the existing literature on its application to psychiatry. We describe how the concept of epistemic injustice has been taken up into a range of debates in philosophy of psychiatry, including the nature of psychiatric conditions, psychiatric practices and research, and ameliorative projects. The final section of the paper indicates future directions for philosophical research (...) of epistemic injustices and psychiatry, concerning neurocognitive disorders, identity prejudices in psychiatric illness, concepts of epistemic privilege in psychiatry, and the prospects for combining phenomenological psychopathology and epistemic justice. We argue that much remains to be done in the conceptualization of these epistemic injustices and suggest that this future work should be multidisciplinary in character and sensitive to the phenomenology of psychiatric conditions. (shrink)

This paper asks when a natural disease kind is truly 'reactive' and when it is merely associated with a corresponding social kind. I begin with a permissive account of real kinds and their structure, distinguishing natural kinds, indifferent kinds and reactive kinds as varieties of real kind characterised by super-explanatory properties. I then situate disease kinds within this framework, arguing that many disease kinds prima facie are both natural and reactive. I proceed to distinguish ‘simple dependence’, ‘secondary dependence’ and ‘essential (...) dependence’ between a natural kind and its classification, and argue that a natural kind is only really reactive, in an important sense, under conditions of essential dependence. On this basis, I offer a principled hypothesis for why psychiatric kinds tend to be more metaphysically unstable than paradigm somatic disease kinds. (shrink)

Temporal experience and its radical alteration in schizophrenia have been one of the central objects of investigation in phenomenological psychopathology. Various phenomenologically oriented researchers have argued that the change in the mode of temporal experience present in schizophrenia can foreground its psychotic symptoms of delusion. This paper aims to further the development of such a phenomenological investigation by highlighting a much-neglected aspect of schizophrenic temporal experience, i.e., its non-emotional affective characteristic. In this paper, it denotes the type of an experience (...) wherein an afflicted individual experiences a pervasive pull or attraction coming from the past, present, and future. By employing Husserl’s account of affection, I argue that such an affectively prominent temporal experience is not yet another abnormality that happens to be present in schizophrenia. Instead, it is indicative of the core disturbance that underpins the schizophrenic temporal mode of experience. I identify such a disturbance as ‘affective modification dysfunction’ and employ it as a core concept with which I synthesize and organise heterogeneous components of schizophrenic temporal experience in their conceptual unity. For the sake of clear description, I organise those components into the following categories: 1.) Time Stop 2.) Ante-festum 3.) Déjà vu/vécu and 4.) Time Fragmentation. I conclude by demonstrating how approaching schizophrenic temporal experience from its affective dimension can further help us better understand its pre-psychotic phase known to precipitate schizophrenic primary delusion, i.e., delusional mood. (shrink)

In this paper, we explore the conceptual problems arising when using network analysis in person- centered care (PCC) in psychiatry. Personalized network models are potentially helpful tools for PCC, but we argue that using them in psychiatric practice raises boundary problems, i.e., problems in demarcating what should and should not be included in the model, which may limit their ability to provide clinically-relevant knowledge. Models can have explanatory and representational boundaries, among others. We argue that we can make more explicit (...) what kind of questions personalized network models can address in PCC, given their representational and explanatory boundaries, using perspectival reasoning. (shrink)

Martin Luther King Jr. claimed that “the salvation of the world lies in the hands of the maladjusted”. I elaborate on King’s claim by focusing on the way in which we treat and understand ‘maladjustment’ that is responsive to severe trauma (e.g. PTSD that is a result of military combat or rape). Mental healthcare and our social attitudes about mental illness and disorder will prevent us from recognizing real injustice that symptoms of mental illness can be appropriately responding to, unless (...) we recognize that many emotional states (and not just beliefs!) that constitute those symptoms are warranted by the circumstances they are responsive to. I argue that there is a failure to distinguish between PTSD symptoms that are warranted emotional responses to trauma and those that are not. This results in us focusing our attention on “fixing” the agent internally, but not on fixing the world. It is only by centering questions of warrant that we will be able to understand and expose the relationship between agents’ internal mental states and their oppression. But we also need to ask when someone’s emotional response is unwarranted by their experience (as in the case of someone who develops PTSD after a non-traumatic event). If we fail to do this—as, I claim, both our mental healthcare and the broader social world fail to do—we treat warranted and unwarranted emotions as on a par. This undermines the epistemic judgment of the agent who has warranted PTSD symptoms, resulting in her failing to trust her evaluation of whether her emotional response to her own trauma is warranted by that trauma, and thus failing to recognize her own oppression. (shrink)

In a rather long piece which an exhibition catalog has called „catholic propaganda”(Busch & Maisak, 2013, p. 342), Guido Görres reflected on madness and art, using Kaulbach’s iconic 1835 drawing of asylum inmates (Das Narrenhaus) as pretext. Görres wrote of “this hospital of the human spirit (…), this charnel ground of the living, who like specters roam, wearing on their foreheads the faded and almost illegible traces of their former names.”1(1836, p. 9). Overdramatic prose, but unlikely to strike one as (...) unprecedented. If anything, it has long been customary to exhibit a mix of fascination and revulsion when discussing the institutions which in the past two centuries at the same time sheltered and shattered those deemed mentally ill. (shrink)

Why was Raymond Tallis’s book Not Saussure largely ignored by literary critics? Here I present one response to this question: he does not offer a novel alternative system for literary interpretation. And I consider whether the situation is any different in other fields, introducing a rival to Simon Baron-Cohen’s empathizing-systematizing theory of gender differences when doing so.

Recently, psychologists have developed indirect measurement procedures to predict suicidal behavior. A prominent example is the Death/Suicide Implicit Association Test (DS-IAT). In this paper, I argue that there is something special about the DS-IAT which distinguishes it from different IAT measures. I argue that the DS-IAT does not measure weak or strong associations between the implicit self-concept and the abstract concept of death. In contrast, assuming a goal-system approach, I suggest that sorting death-related to self-related words takes effort because death-related (...) words trigger avoidance-impulses, which suicide ideation weakens. The DS-IAT taps into weakened automatic responses from the self-preservation system. Additionally, the suggested cognitive structure, illuminated with the selfish-goal theory, explains predictable suicidal behavior. (shrink)

According to Simon Baron-Cohen, having a male brain disposes a person to be more systematic than empathetic, whereas having a female brain disposes a person to be more empathetic than systematic. However, one can be a male human being with a female brain or a female human being with a male brain. Autistics have an extreme version of the male brain, says Baron-Cohen. In this paper, I present an “a priori” argument against the very idea of an extreme female brain.

This is a commentary on Humpston, C. S. (2022). “Isolated by Oneself: Ontologically Impossible Experiences in Schizophrenia.” Philosophy, Psychiatry, & Psychology 29(1), 5–15. It is published with an additional commentary by H. Green and Humpston’s response.

Human behavior and thought often exhibit a familiar pattern of within group similarity and between group difference. Many of these patterns are attributed to cultural differences. For much of the history of its investigation into behavior and thought, however, cognitive science has been disproportionately focused on uncovering and explaining the more universal features of human minds—or the universal features of minds in general. -/- This entry charts out the ways in which this has changed over recent decades. It sketches the (...) motivation behind the cultural turn in cognitive science, and situates some of its central findings with respect to the questions that animate it and the debates that it has inspired. Woven throughout the entry are examples of how the cognitive science of culture, and especially its elevated concern with different forms of diversity and variation, continues to influence and be influenced by philosophers. -/- One cluster of philosophical work falls within the traditional subject matter of philosophy of science, in this case of the cognitive and social sciences. Philosophers have analyzed and assessed the methods and evidence central to the scientific study of cognition and culture, and have offered conceptual scrutiny, clarification, and synthesis. Research in a second vein sees philosophers themselves contributing more directly to cognitive scientific projects, (co)constructing theories, helping build computational models, even gathering empirical data. A third kind of work is naturalistic philosophy or philosophy of nature, wherein philosophers seek to use results from the cognitive science of culture to inform or transform debates over long-standing philosophical questions, including questions about the nature of philosophy and philosophical methodology itself. (shrink)

While some form of loss of control is often assumed to be a common feature of the diverse manifestations of addiction, it is far from clear how loss of control should be understood. In this paper, I put forward a concept of decrease in control in addiction that aims to fill this gap and thus provide a general framework for thinking about addictive behavior. The development of this account involves two main steps. First, I present a view of degrees of (...) control as the degree to which an agent would be responsive to potential or counterfactual sufficient reasons to do otherwise. Second, I sketch an account of the relevant control-undermining factors in addiction that is consonant with my proposed view of degrees of control. Being a high-level functional property, reasons-responsiveness is particularly well suited to frame an account of control-undermining factors that is doubly pluralistic: it encompasses the contribution of factors both internal and external to the agent, and it is consistent with various proposals as to the precise nature of the anomaly taking place in the psychology of addiction. (shrink)