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

Words we use to characterize mental states matter; they affect, for better or worse, the individual whose mental states are in question. For example, referring to a child whose behavior seems a bit...

The question “What is the relationship between the self and mental disorder?” is especially important for mental health professionals interested in understanding and treating patients, as most mental disorders are intimately tied to self‐related concerns, such as loss of self‐esteem and self‐control, or diminished agency and autonomy. Philosophy, along with the cognitive and behavioral sciences, offers a wealth of conceptual and empirical resources to answer this question, as the concepts of the self and psychopathology have occupied a central place in (...) these fields since their inception. Interestingly, and unfortunately, however, scientific psychiatry, in its approach to mental disorder as primarily a cluster of signs and symptoms has been slow in acknowledging the advances in conceptualizing and investigating mental disorders in relation to the self. The article addresses this problem and offers solutions for better cross‐fertilization between empirical and philosophical inquiry into the self and psychiatric research on mental disorders. The first part evaluates what empirically informed philosophical inquiry and philosophically informed empirical inquiry offer to the examination of the relationship between the self and mental disorders. The second part argues that scientific psychiatry has missed opportunities to find effective treatments for mental disorders because of its insularity from debates in naturalistic philosophy and cognitive and behavioral sciences. Psychiatry has much to gain from the conceptual, scientific, and clinical resourcefulness of philosophy's collaboration with the cognitive and behavioral sciences. (shrink)

Various traditions in mental health care, such as phenomenological, and existential and cognitive-behavioral psychotherapy, implicitly or explicitly acknowledge that a disruption of the self, or the person, or the agent is among the common denominators of different mental disorders. They often emphasize the importance of understanding patients as reasonsresponsive, in their full mental health relevant complexity, if their mental disorder is to be treated successfully. The centrality of the concept of the self is not mirrored in the mainstream scientific approaches (...) in psychiatry however; the self has rarely been considered as the object of scientific research, the empirical investigation of which might yield successful explanations of and interventions in mental disorders. Thus, even though self-related phenomena are clinically relevant in so far as they give important information about a mental disorder to the clinician and help the development of effective interventions, they are not considered among the scientifically relevant properties of mental disorders. Leaving the self-related phenomena out of the scientific research on mental disorders can be attributed to the presupposition that the self is not empirically tractable and its use will hinder psychiatry’s goal to be scientific. In this paper, taking issue with this, I argue the self is empirically tractable, and its use as a target of research will not hinder psychiatry’s scientific commitments. (shrink)

In this short article I will review Galen Strawson’s most recent book, “Things That Bother Me: Death, Freedom, The Self, etc.“ As it is impossible to do justice to the full collection in a review,...

In a compelling and provocative paper, ‘Solving the Self-Illness Ambiguity: The Case for Construction Over Discovery,’ Sofia M.I. Jeppsson distinguishes two ways of addressing the self-illness ambiguty problem. The first is the Realist Solution, which postulates a pre-existing border between the self and the illness and frames the goal of treatment in psychiatry as helping the patient ‘discover’ this boundary. Addressing the shortcomings of the Realist Solution, both in terms of its feasibility and possible outcomes, Jeppsson proposes and defends the (...) Constructivist Solution, according to which the patient, through self-reflection and deliberation with others, including the clinicians, decides, which parts of her experiences they identify with themselves and which parts they attribute to their illness. This paper critically evaluates Jeppson’s arguments and addresses some of the shortcomings of Jeppsson’s positive argument, i.e. the Constructivist Solution. (shrink)

The concept of a “validator” as a unit of evidence for the validity of a psychiatric category has been important for more than fifty years. Validator evidence is aggregated by expert committees (for the Diagnostic and Statistical Manual of Mental Disorders (DSM), these are referred to as “workgroups”), which use the results to make nosological decisions. Through an examination of the recent history of psychiatric research, this paper argues that it is time to reassess this traditional practice. It concludes with (...) specific suggestions for going forward. (shrink)

Psychiatric patients sometimes ask where to draw the line between who they are – their selves – and their mental illness. This problem is referred to as the self-illness ambiguity in the literature; it has been argued that solving said ambiguity is a crucial part of psychiatric treatment. I distinguish a Realist Solution from a Constructivist one. The former requires finding a supposedly pre-existing border, in the psychiatric patient’s mental life, between that which belongs to the self and that which (...) belongs to the mental illness. I argue that no such border exists, and that attempts to find it might even render the felt ambiguity worse. Instead, any solution must be constructivist; the patient (and others) should deliberate and discuss what to identify with or not. I further argue that psychiatric patients need not see their mental illness as wholly distinct from themselves to avoid ‘identifying with their diagnoses' in a problematic way. Finally, we can excuse problematic behaviour by mentally ill people – in fact, we can do so in a more nuanced and constructive way – while rejecting the view that the mental illness is wholly distinct from the patient’s self. (shrink)

The thesis that mental states extend beyond the skull, otherwise known as the extended mind thesis, has attracted considerable philosophical attention and support. It has also been accused of lacking practical import. At the same time, the field of psychiatry has remained largely unacquainted with ExM, tending to rely instead upon what ExM proponents would consider to be outdated models of the mind. ExM and psychiatry, therefore, have much to offer one another, but the connection between the two has remained (...) largely unexplored. Here, I consider what implications ExM may have for psychiatry and, in so doing, reveal how psychiatry may lend practical import to ExM. First, I detail the possibility of the extension of one mental state relevant to psychiatry. I augment this example by surveying other possibilities for extension in the context of psychiatric diagnoses. I then consider ways in which such extensions might alter psychiatric diagnosis and treatment. Overall, I argue that recognition of the truth of ExM could alter the diagnostic status of certain individuals by correcting both false positives and false negatives, re-conceptualize certain aspects of treatment, help us re-envision psychiatric research, and potentially increase empathy towards those individuals considered to be mentally disordered or mentally different. (shrink)

In the 2000s, several psychiatrists cited the lack of relational disorders in the DSM-IV as one of the two most glaring gaps in psychiatric nosology, and campaigned for their inclusion in the DSM-5. This campaign failed, however, presumably in part due to serious “ontological concerns” haunting such disorders. Here, I offer a path to quell such ontological concerns, adding to previous conceptual work by Jerome Wakefield and Christian Perring. Specifically, I adduce reasons to think that collective disorders are compatible with (...) key metaphysical commitments of contemporary scientific psychiatry, and argue that if one accepts the existence of mental disorders in individuals as medical, then one has good reasons to accept the existence of collective disorders as medical. First, I outline how collective disorders are reconcilable with both the harmful dysfunction model of disorder and a denial of mind-body dualism. I then identify some potential weaknesses in the main pre-existing example of a collective disorder, offering my own examples as supplements. These examples’ medical plausibility is bolstered by: work in philosophy of biology on the generalized selected effects theory of function, and work in analytic philosophy of mind on collective mentality. Finally, after offering preliminary responses to the objection that the recognition of collective disorders may lead to an overpathologization of everyday life, I spell out ways in which this recognition may have empowering effects for some would-be patients; for example, by providing substance to the notion of a “sane response to an insane world.”. (shrink)

In the 2000s, several psychiatrists cited the lack of relational disorders (what I call “collective disorders”—disorders of groups rather than individuals) in the DSM-IV as one of the two most glaring gaps in psychiatric nosology, and campaigned for their inclusion in the DSM-5. This campaign failed, however, presumably in part due to serious “ontological concerns” haunting such disorders. Here, I offer a path to quell such ontological concerns, adding to previous conceptual work by Jerome Wakefield and Christian Perring. Specifically, I (...) adduce reasons to think that collective disorders are compatible with key metaphysical commitments of contemporary scientific psychiatry, and argue that if one accepts the existence of mental disorders in individuals as medical, then one has good reasons to accept the existence of collective disorders as medical. First, I outline how collective disorders are reconcilable with both the harmful dysfunction model of disorder and a denial of mind-body dualism. I then identify some potential weaknesses in the main pre-existing example of a collective disorder, offering my own examples as supplements. These examples’ medical plausibility is bolstered by: (1) work in philosophy of biology on the generalized selected effects theory of function (largely from Justin Garson), and (2) work in analytic philosophy of mind on collective mentality (largely from Bryce Huebner). Finally, after offering preliminary responses to the objection that the recognition of collective disorders may lead to an overpathologization of everyday life, I spell out ways in which this recognition may have empowering effects for some would-be patients; for example, by providing substance to the notion of a “sane response to an insane world.”. (shrink)

As a text in use by mental health practitioners, policy makers, and ordinary individuals, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) categorizes a variety of mental, psychological, and emotional experiences on a wide spectrum of disorders. Many common experiences are described there as symptoms, chiefly for the purposes of identifying, diagnosing, and treating disorders. “Disorientations” are not (yet) categorized as a stand-alone disorder in the DSM, but involve a cluster of experiences that border on and overlap with experiences (...) already categorized as symptoms of other disorders. Where experiences of disorientation appear in the DSM, they are, for the most part, still understood as.. (shrink)

This paper uses a non-ideal theory approach advocated for by Alison Jaggar to show that practices involved with the medicalization of serious mental disorders can subject people who have these disorders to a cycle of vulnerability that keeps them trapped within systems of injustice. When medicalization locates mental disorders solely as problems of individual biology, without regard to social factors, and when it treats mental disorders as personal defects, it perpetuates injustice in several ways: by enabling biased diagnoses through stereotyping, (...) by exploiting and coercing people who are seen as insufficiently competent, and by perpetuating idealized conceptions of choice and control that do not take into account people’s real limitations and the social context of health. Through practices of diagnosis, treatment, and recovery, medicalization can perpetuate injustices toward people who have serious mental disorders. (shrink)

Narratives structure and inform how we understand our experiences and identity, especially in instances of suffering. Suffering in mental disorder (e.g. bipolar disorder) is often uniquely distressing as it impacts capacities central to our ability to make sense of ourselves and the world—and the role of narratives in explaining and addressing these effects is well-known. For many with a mental disorder, spiritual/religious narratives shape how they understand and experience it. For most, this is because they are spiritual and/or religious. For (...) others, spiritual/religious narratives still often influence secular approaches to mental disorder, more than approaches to other disabilities (e.g. intellectual, physical) or causes of suffering (e.g. physical disease). Such narratives are often harmful, especially insofar as they ‘over-spiritualize’ mental disorder; and undercut ‘spiritual meaning-making’. Here I address the impact of spiritual/religious narratives that helpfully avoid over-spiritualizing mental disorder while enabling spiritual meaning-making about it. First, I address the role of narratives in meaning-making more generally; then, I present results from my recent empirical study testing the impact of such narratives on participants’ meaning-making about their mental disorder. I conclude by addressing implications and potential worries. (shrink)

The article provides a conceptualization of self(-illness) ambiguity and investigates to what extent self(-illness) ambiguity is ‘special’. First, we draw on empirical findings to argue that self-ambiguity is a ubiquitous phenomenon. We suggest that these findings are best explained by a multidimensional account, according to which selves consist of various dimensions that mutually affect each other. On such an account, any change to any particular self-aspect may change other self-aspects and thereby alter the overall structural pattern of self-aspects, potentially leading (...) to self-ambiguity. Second, we propose that self-ambiguity comes in degrees and should be understood as a spectrum (as opposed to there being qualitative differences among instances of self-ambiguity). Third, we argue that complexity is the most useful dimension to organize cases of self-ambiguity, with mundane instances of self-ambiguity on the one end and self-illness ambiguity on the other end of the spectrum. Fourth, we address the promises and perils of narrativity with regard to self-ambiguity. Finally, we link our deflationary account of self(-illness) ambiguity to pattern theories of self. (shrink)

The article provides a conceptualization of self(-illness) ambiguity and investigates to what extent self(-illness) ambiguity is ‘special’. First, we draw on empirical findings to argue that self-ambiguity is a ubiquitous phenomenon. We suggest that these findings are best explained by a multidimensional account, according to which selves consist of various dimensions that mutually affect each other. On such an account, any change to any particular self-aspect may change other self-aspects and thereby alter the overall structural pattern of self-aspects, potentially leading (...) to self-ambiguity. Second, we propose that self-ambiguity comes in degrees and should be understood as a spectrum (as opposed to there being qualitative differences among instances of self-ambiguity). Third, we argue that complexity is the most useful dimension to organize cases of self-ambiguity, with mundane instances of self-ambiguity on the one end and self-illness ambiguity on the other end of the spectrum. Fourth, we address the promises and perils of narrativity with regard to self-ambiguity. Finally, we link our deflationary account of self(-illness) ambiguity to pattern theories of self. (shrink)

The significance of critical phenomenology for psychiatric praxis has yet to be expounded. In this paper, I argue that the adoption of a critical phenomenological stance can remedy localised instances of hermeneutical injustice, which may arise in the encounter between clinicians and patients with psychosis. In this context, what is communicated is often deemed to lack meaning or to be difficult to understand. While a degree of un-shareability is inherent to subjective life, I argue that issues of unintelligibility can be (...) addressed by shifting from individualistic conceptions of understanding to an interactionist view. This takes into account the contextual, historical and relational background within which meaning is co-constituted. I conclude by providing a corrective for hermeneutical injustice, which entails a specific attentiveness towards the person’s subjectivity, a careful sensitivity to contingent meaning-generating structures, and a degree of hermeneutical flexibility as an attitude of openness towards alternative horizons of possibility. (shrink)

There is a strong presumption that mental disorder injures a person's autonomy, understood as a set of capacities and as an ideal condition of agency which is worth striving for. However, recent multidimensional approaches to autonomy have revealed a greater diversity in ways of being autonomous than has previously been appreciated. This presumption, then, risks wrongly dismissing variant, neuro-atypical sorts of autonomy as non-autonomy. This is both an epistemic error, which impairs our understanding of autonomy as a phenomenon, and a (...) moral error, which withholds recognition and respect that autonomous agents are due. I argue that careful attention to the different 'shapes' of agent's autonomy reveals that there are indeed distinctive kinds of neuro-atypical autonomy that are widely mistaken for non-autonomy. This project argues for two propositions. First, that there is a kind of autonomy, with a distinctive shape and texture, available to bipolar agents. This is a variant sort of autonomy, but not a defective or deficient sort. It is the ideal of autonomy that it is worth bipolar agents striving for, given the range and intensity of experiences that they will have to confront. Whilst bipolar autonomy will look unlike more neurotypical kinds of autonomy, it continues to be owed recognition. The second proposition is that we should understand the ideal of autonomy to be both pluralist and highly context sensitive. Given the range of starting points from which agents will strive to an ideal of autonomy, there will be some variation in the ideals worth striving for. The variation in ideals will reflect the existential realities they are local to. Theory of autonomy must be adapted to recognise bipolar, and other neuro-atypical, kinds of autonomy, and to reflect this wider pluralism. These propositions will be argued for with careful attention to the experiences and agency of people living with bipolar, or related, disorders. Understanding the ways that manic or depressive episodes, and the shifts between them, alter and apply pressure to our agency will inform an account of the distinctively bipolar autonomy that can be built on top of it. (shrink)

Psychiatric patients sometimes ask where to draw the line between who they are – their selves – and their mental illness. This problem is referred to as the self-illness ambiguity in the literature; it has been argued that solving said ambiguity is a crucial part of psychiatric treatment. I distinguish a Realist Solution from a Constructivist one. The former requires finding a supposedly pre-existing border, in the psychiatric patient’s mental life, between that which belongs to the self and that which (...) belongs to the mental illness. I argue that no such border exists, and that attempts to find it might even render the felt ambiguity worse. Instead, any solution must be constructivist; the patient (and others) should deliberate and discuss what to identify with or not. I further argue that psychiatric patients need not see their mental illness as wholly distinct from themselves to avoid ‘identifying with their diagnoses' in a problematic way. Finally, we can excuse problematic behaviour by mentally ill people – in fact, we can do so in a more nuanced and constructive way – while rejecting the view that the mental illness is wholly distinct from the patient’s self. (shrink)

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)

, Looping Effects, the Self, Psychopathology.

Philosophers and psychologists have advanced a plethora of explanations of the self in relation to narratives, positing varying degrees of connection between them. For some, narratives created by a subject about herself shape her self-constitution (Flanagan 1991; Fivush 1994). For others, they help the subject to participate in social cognition (Hutto 2008). Some represent narratives as merely one basis of personal identity and consider them cognitive tools used by the subject to construct self-concepts (Neisser 1997; Tekin 2011); others render narratives (...) the basis for self-constitution (Dennett 1992; MacIntyre 1981; Schechtman 1996). Some require that the subject create her ‘whole life narrative’ unifying her .. (shrink)