The distinction between explanation and understanding was foundational to Jaspers’ ‘phenomenological’ approach to psychiatry. It makes sense that those now calling for a phenomenological approach to psychiatry would look to Jaspers for inspiration, and that in doing so, they would take up this distinction. However, I argue that it is and was a mistake to use the distinction in work on psychiatry: adhering to the distinction now would undermine, rather than support, the goals of those advocating a phenomenological approach to (...) psychiatry; furthermore, if the distinction had been adhered to, then contemporary psychiatry and its patients would be worse off. (shrink)

This thesis is a philosophical examination of the explanatory roles of diagnoses in psychiatry. In medicine, diagnoses normally serve as causal explanations of patients’ symptoms. Given that psychiatry is a discipline whose practice is shaped by medical traditions, it is often implied that its diagnoses also serve such explanatory functions. This is evident in clinical texts that portray psychiatric diagnoses as referring to diseases that cause symptoms. However, there are problems which cast doubt on whether such portrayals are justified. I (...) address these problems and examine whether psychiatric diagnoses provide explanations of symptoms. The first problem is conceptual. In diagnostic manuals, psychiatric diagnoses are defined by their symptoms. This suggests that invoking them as explanations of the symptoms amounts to circularity. I argue that this can be resolved with an appropriate conceptual framework that captures the complex semantic values of diagnostic terms and their different uses in clinical discourse. I put forward such a framework based on two-dimensional semantics. The second problem is ontological. Empirical research suggests that diagnostic categories in psychiatry do not correspond to invariant causal types, but are associated with variable combinations of diverse causes that interact across biological, psychological, and social levels. Given this heterogeneity, I argue that psychiatric diagnoses fall short of paradigmatic cases of causal explanation, but that some can still provide other sorts of useful causal explanatory information. The original contribution of this thesis is the illumination of the conceptual relations between diagnoses and symptoms. This philosophical work is important, because it can be brought to valuable application in modifying psychiatric practice. (shrink)

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

In this paper we focus on the psychiatric approach of Open Dialogue and seek to explain why the intersubjective process of dialogue, one of OD’s core clinical principles, is effective in schizophrenia treatment. We address this question from an interdisciplinary viewpoint, by linking the OD approach with a theoretical account of the self as endorsed by enactive cognitive science. The paper is structured as follows: first, we introduce the OD approach and focus in particular on the principles that are characteristic (...) of the dialogical therapeutic attitude. Second, we clarify our stance on the concept of schizophrenia by relying on insights from phenomenological psychiatry. Third, we introduce an enactive perspective on mental disorders, which elaborates on phenomenological psychiatry and conceives of the self as a self-organizing system, brought forth through interactional processes. Based on this enactive approach, we draw clinical implications for schizophrenia. In the fourth and final part, we propose conceptual bridges between the OD and the enactive approach by bringing to attention the intersubjective nature of the human self and the inherent vulnerability entailed in both the self’s maintenance and in the practice of dialogue. We then propose that the dialogical stance adopted by OD is effective in supporting the recovery of a balanced sense of self precisely because it provides an intersubjective space in which clients can safely experience and maintain the basic structures underlying the socially constituted self. Since our analysis touches upon fundamental structures of the therapeutic relationship, we hope that it will also be useful to inform general psychiatric practice and help advancing a more integrative understanding of psychotherapy for schizophrenia. (shrink)

After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...) practical reason or their stunted emotions that are at fault. The evidence supports both explanations. I conclude with an overview of the debate concerning whether they are morally or legally responsible for their actions. (shrink)

Clinical delusions have traditionally been characterized as beliefs in psychiatry. However, philosophers have recently engaged with the empirical literature and produced a number of objections to the so-called doxastic status of delusion, stemming mainly from the mismatch between the functional role of delusions and that expected of beliefs. In response to this, an appeal to dispositionalism about the nature of belief has been proposed to vindicate the doxastic status of delusion. In this paper, I first present the objections to attributing (...) beliefs to delusional patients and the application of dispositionalism in the attempt to vindicate doxasticism. I then assess this application and some responses to the objections to the doxastic characterization. Finally, I offer some conclusions about the limits of folk-psychological concepts in the characterization and explanation of complex psychological phenomena such as delusions. (shrink)

In this chapter, our focus is the role played by notions of rationality in the diagnosis of mental disorders, and in the practice of overriding patient autonomy in psychiatry. We describe and evaluate different hypotheses concerning the relationship between rationality and diagnosis, raising questions about what features underpin psychiatric categories. These questions reinforce widely held concerns about the use of diagnosis as a justification for overriding autonomy, which have motivated a shift to mental incapacity as an alternative justification. However, this (...) approach too has recently been criticized from a mental disability rights perspective. Our analysis of the relationship between mental capacity and rationality is used to illuminate these concerns, and to investigate further the relationship between rationality and psychiatric diagnosis. (shrink)

Premenstrual dysphoric disorder was recently moved to a full category in the DSM-5 . It also appears set for inclusion as a separate disorder in the ICD-11 . This paper argues that PMDD should not be listed in the DSM or the ICD at all, adding to the call to recognise PMDD as a socially constructed disorder. I first present the argument that PMDD pathologises understandable anger/distress and that to do so is potentially dangerous. I then present evidence that PMDD (...) is a culture-bound phenomenon, not a universal one. I also argue that even if medication produces a desired effect, there are biological correlates with premenstrual anger/distress, such anger/distress seems to occur monthly, and women are more likely than men to be diagnosed with affective disorders, none of these factors substantiates that premenstrual anger/distress is caused by a mental disorder. I argue that to assume they do is to ignore the now accepted role that one’s environment and psychology play in illness development, as well as arguments concerning the social construction of mental illness. In doing so, I do not claim that there are no women who experience premenstrual distress or that their distress is not a lived experience. My point is that such distress can be recognised and considered significant without being pathologised and that it is unethical to describe premenstrual anger/distress as a mental disorder. Further, if the credibility of women’s suffering is subject to doubt without a clinical diagnosis, then the way to address this problem is to change societal attitudes towards women’s suffering, not to label women as mentally ill. The paper concludes with some broader implications for women and society of the change in status of PMDD in the DSM-5 as well as a sketch of critical policy suggestions to address these implications. (shrink)

This paper discusses ethical issues related to social work practice in the area of mental health. It does so via the use of a case study taken from my practice whilst I was on placement. Ethical issues are explored within a practice context that is becoming increasingly proceduralised and risk averse, and where protectionist responses contribute to undermining the rights of service users to self-determination. The paper explores the relationship between utilitarian and Kantian ethical theory and ethical decision-making as well (...) as commenting on the usefulness of an anti-oppressive ethical perspective. (shrink)

The voices and visions experienced by Emanuel Swedenborg remain a topic of much debate. The present article offers a reconsideration of these experiences in relation to changes in psychiatric practice. First, the phenomenology of Swedenborg's experiences is reviewed through an examination of his writings. The varying conceptualizations of these experiences by Swedenborg and his contemporaries, and by psychiatrists of later generations, are examined. We show how attempts by 19th- and 20th-century psychiatrists to explain Swedenborg's condition as the result of either (...) schizophrenia or epilepsy are unable to account for his experiences. We then demonstrate that the re-emergence of the 19th-century concept of `hallucinations in the sane' offers an alternative way to understand Swedenborg's experiences outside typical discourses of mental illness. Finally we argue that Swedenborg's experiences should be understood as exemplifying phenomena which we term `hallucinations without mental disorder', and investigate how conceiving of Swedenborg in this way can inform future research into the experience and clinical significance of hallucinations. (shrink)

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

Extant philosophical accounts of schizophrenic alien thought neglect three clinically signifi cant features of the phenomenon. First, not only thoughts, but also impulses and feelings, are experienced as alien. Second, only a select array of thoughts, impulses, and feelings are experienced as alien. Th ird, empathy with experiences of alienation is possible. I provide an account of disownership that does justice to these features by drawing on recent work on delusions and selfknowledge. Th e key idea is that disownership occurs (...) when there is a failure of rational control over one’s mind. Th is produces a clash between the deliverances of introspection and practical enquiry as ways of knowing one’s mind. Th is explanation places disownership on a continuum with more common aspects of our psychological life, such as addiction, akrasia, obsessional thinking, and immoral, selfi sh or shameful thoughts. I conclude by addressing objections, and exploring the relevance of my account to questions in the philosophy of psychiatry concerning the validity of our current taxonomy of symptoms, and the nature of psychiatric classifi cation.. (shrink)

Abstract: The notion that philosophy can be practised as a kind of therapy has become a focus of debate. This article explores how philosophy can be practised literally as a kind of therapy, in two very different ways: as philosophical therapy that addresses “real-life problems” (e.g., Sextus Empiricus) and as therapeutic philosophy that meets a need for therapy which arises in and from philosophical reflection (e.g., Wittgenstein). With the help of concepts adapted from cognitive and clinical psychology, and from cognitive (...) linguistics, the article shows that both philosophical projects address important and literally therapeutic tasks and explains how they can do so with genuinely philosophical argument and analysis. This brings into view new applications for philosophy, a need for therapy in core areas of the subject, and the outline of a new approach to meet what will be shown to be a central need. (shrink)

Philosophy of psychiatry has boomed in the last few years. We are now seeing a growing literature on the nature of psychiatric explanation, including work that makes contact with longstanding disputes in the philosophy of science as well as more specific work on mental disorders. This paper looks at some recent work on both representing and explaining mental illness. An emerging picture sees explanation of mental disorder as first constructing causal-statistical networks that represent disease pathways as they unfold in time, (...) and then choosing strategies for causal explanation. The epistemic problems in psychiatry are huge, and they arise from the extreme variety in the causes and trajectories of mental disorders across patients. Existing concepts of levels of explanation and mechanism may seem like an obvious epistemic armoury, but they may not fit psychiatry very well, and philosophical theories of psychiatric explanation stress different ways of trying to understand robust patterns amid the individual variation. (shrink)

I offer an account of thought insertion based on a certain model of self-knowledge. I propose that subjects with thought insertion do not experience being committed to some of their own beliefs. A hypothesis about self-knowledge explains why. According to it, we form beliefs about our own beliefs on the basis of our evidence for them. First, I will argue that this hypothesis explains the fact that we feel committed to those beliefs which we are aware of. Then, I will (...) point to one feature of schizophrenia that suggests that subjects with thought insertion may not be able to know their own beliefs in that way. (shrink)

Psychiatry is increasingly dominated by the reductionist claim that mental illness is caused by neurobiological abnormalities such as chemical imbalances in the brain. Critical psychiatry does not believe that this is the whole story and proposes a more ethical foundation for practice. This book describes an original framework for renewing mental health services in alliance with people with mental health problems. It is an advance over the polarization created by the "anti-psychiatry" of the past.

Autistic-spectrum conditions and psychotic-spectrum conditions (mainly schizophrenia, bipolar disorder, and major depression) represent two major suites of disorders of human cognition, affect, and behavior that involve altered development and function of the social brain. We describe evidence that a large set of phenotypic traits exhibit diametrically opposite phenotypes in autistic-spectrum versus psychotic-spectrum conditions, with a focus on schizophrenia. This suite of traits is inter-correlated, in that autism involves a general pattern of constrained overgrowth, whereas schizophrenia involves undergrowth. These disorders also (...) exhibit diametric patterns for traits related to social brain development, including aspects of gaze, agency, social cognition, local versus global processing, language, and behavior. Social cognition is thus underdeveloped in autistic-spectrum conditions and hyper-developed on the psychotic spectrum.;>We propose and evaluate a novel hypothesis that may help to explain these diametric phenotypes: that the development of these two sets of conditions is mediated in part by alterations of genomic imprinting. Evidence regarding the genetic, physiological, neurological, and psychological underpinnings of psychotic-spectrum conditions supports the hypothesis that the etiologies of these conditions involve biases towards increased relative effects from imprinted genes with maternal expression, which engender a general pattern of undergrowth. By contrast, autistic-spectrum conditions appear to involve increased relative bias towards effects of paternally expressed genes, which mediate overgrowth. This hypothesis provides a simple yet comprehensive theory, grounded in evolutionary biology and genetics, for understanding the causes and phenotypes of autistic-spectrum and psychotic-spectrum conditions. (shrink)

The present article proposes a logical account of delusions, which are regarded as conclusions resulting from fallacious arguments. This leads to distinguish between primary, secondary, ..., n-ary types of delusional arguments. Examples of delusional arguments leading to delusion of reference, delusion of influence, thought-broadcasting delusion and delusion of grandeur are described and then analyzed. This suggests finally a way susceptible of improving the efficiency of cognitive therapy for delusions.

Clinically significant delusion is a symptom of a number of mental illnesses. We rely on what a person says and how she behaves in order to identify if she has this symptom and it is clear from the literature that delusions are heterogeneous and extremely difficult to define. People with active delusions were interviewed to explore what it is like to develop and experience delusion. The transcribed interview data was analysed to identify themes and narrative trajectories that help to explain (...) the phenomenon. Results showed that delusions can sometimes provide pragmatic benefits and that the genesis of some delusions can be characterised in terms of the enactivist notion of affective framing. Affective framing is a term that captures the background emotions that enable know-how in terms of goal directed action and cognition. If a person’s affective frame alters the world is no longer understood and know-how is lost. The way in which a person relates to her environment can be highly anomalous thus requiring her to find an extraordinary explanation. I argue that delusions arise as a result of a breakdown in affective framing and offer a conceptualisation of delusion supported by empirical findings. (shrink)

This dissertation seeks to examine the validity of the justification commonly offered for a coercive (1) psychiatric intervention, namely that the intervention was in the ‘best interests’ of the subject and/or that the subject posed a danger to others. As a first step,it was decided to analyse justifications based on ‘best interests’ [the ‘Stage 1’ argument] separately from those based on dangerousness [the ‘Stage 2’ argument]. Justifications based on both were the focus of the ‘Stage 3’ argument. Legal and philosophical (...) analyses of coercive psychiatric interventions generally regard such interventions as embodying a benign paternalism occasioning slight, if any, ethical concern. Whilst there are some dissenting voices even at the very heart of academic and professional psychiatry, the majority of psychiatrists also appear to share such views. The aim of this dissertation is to show that such a perspective is mistaken and that such interventions raise philosophical and ethical questions of the profoundest importance.(2) The philosophical well-spring of the Stage 1 dissertation argument lay in an observation made by Philippa Foot (3) that the “… right to be let free from unwanted interference” is one of the most fundamental and distinctive rights of persons, a right which takes precedence over any “… action we would dearly like to take for his sake.” This – in conjunction with the recognition that some coercive psychiatric interventions are of a gravity as to result in the personhood of the subject being severely damaged if not destroyed – suggested that the concept of personhood play a central role in the formulation of the dissertation argument. For ease of analysis it was presumed that the term ‘person’ could be defined by a set of necessary and sufficient conditions of which ‘minimum levels of rationality’ and ‘ability to communicate’ were the only conditions relevant to the formulation of justifications for coercive psychiatric interventions. This presumption was explicated into a number of postulates which enabled the construction of a rigorous foundation on which to develop the dissertation argument. This argument then sought to determine whether psychiatric assessments of irrationality were accurate and reliable. In furtherance of this analysis it was necessary to examine the reliability of psychiatric determinations in other areas of claimed expertise namely diagnosis, treatment and assessment of dangerousness. This ‘crossing of the disciplinary threshold’ brought to light the dearth of studies on psychiatric misdiagnosis and iatrogenic harm. A variant of the Precautionary Principle was developed to enable the extent of such harms to be estimated. The not insignificant levels of psychiatric misdiagnosis and iatrogenic harm and erroneous assessments of dangerousness which were thus found are of considerable relevance to any ethical analysis of the justification for coercive psychiatric intervention and serve to undermine simple paternalistic justifications. --- (1)The term ‘coercive’ (rather than ‘non-consensual’) is used to indicate an intervention carried out against the explicit and contemporaneous objections of the subject (2)Not least because the number of individuals detained in Irish psychiatric hospitals is of a comparable order of magnitude to the number detained in Irish prisons subsequent to a criminal conviction (3)See Foot (1977), p.102. (shrink)

Currently, psychopathy and related terms such as antisocial personality disorder are popular yet problematic constructs within forensic psychology and other disciplines. Psychopathy is traced typically to the works of Pinel and Prichard in the early 19th century, and it has even been linked to biblical passages, although there appears to be little or no support for the latter claim. The first use of the term psychopathy in German psychiatry of the mid-19th century referred only to psychological disturbance in general, or (...) ‘personality diseases’, although German psychiatrists such as Kraepelin did propose more specific definitions of the term related to social deviance. Our modern understanding of psychopathy as a psychiatric disorder of an undetermined genetic origin involving antisocial elements and a lack of feeling or concern for others owes much to the clinical work and writings of Cleckley. Antisocial personality disorder appears similarly to derive from the work of psychiatric nosologists like Kraepelin and Schneider, while sociopathy is due more to the work of Partridge in the 1920s and 1930s. (shrink)

Background Delusions are a significant feature of mental illnesses and can occur in many clinical conditions (Maher, 2001) yet the standard clinical definition (American Psychiatric Association. DSM-5 Task Force, 2013) is highly contentious. Much of the literature holds elements such as bizarreness of content and incorrigibility of belief as defining factors of delusion. However, on closer inspection, delusions are not so easy to pin down. The difficulty in defining delusion is not a new one as “…we are all capable of (...) having convictions and it is a universal human characteristic to hold on to our own mistaken judgements.” (Jaspers, 1963, p.63). Objective I intend to highlight some of the difficulties associated with the definition of delusion and perhaps clarify the phenomenology. Methodology I examine some of the philosophical, psychological and psychiatric literature with regard to the definition of delusion. I also consider my experience of my own mental activity and experiences from my therapeutic work. Results/Conclusion I identify that delusions are a heterogeneous group and that there may be more than one ‘class’ of delusion. I also show that delusions are multi-dimensional with characteristics on a continuum with normal beliefs and that further research is needed to clarify the phenomenology. (shrink)

b is collection focuses on conceptual issues that arise within the theoretical dimension of psychiatry. In particular, the invited contributions centre on the nature of psychiatric classification and explanation by addressing important methodological issues. Two strategies are exemplified here. Either the authors directly contribute to foundational issues in psychiatry concerning the nature of psychiatric classification and explanation; or they provide a conceptual analysis that can play a role in developing adequate theories of specific psychiatric disorders.

Existing reports of Anomalous/Paranormal Experiences (APE) by nurses in the hospital/Health centers settings. The aim of this research project is carry out of descriptive analysis and quantitative/qualitative study of near-death and out of body experience, sense of "presence", an apparition, floating lights, luminescence, or unexplained object movements, hearing strange noises, voices or dialogues, crying or moaning, seeing energy fields, lights or "electric shock" around an inpatient have had an extrasensory experience, malfunction of equipment or medical intrumental in certain patients, and/or (...) spiritual/paranormal form of intervention. The structure of the nursing study closely follow concurrent research taking place with three of 8 hospitals. The main aim are to determine the extent of occurrence of certain types of APEs in hospitals and their relationship to job stress and psychological absorption, to assess the frequency of certain unusual APEs in hospital, to assess the level of psychological absorption of people experiencing these perceptions, and to compare experiences nurses without experience in their degree of job stress and absorption. The recruited sample (up to December 20th.) consisted of 39 nurses (Experiencers) who reported paranormal experiences in hospitals and 61 nurses as control group (Non-experiencers). All of them filled four instruments: The Anomalous/Paranormal Experiences in Nurse & Health Workers (which measures frequency of paranormal/anomalous experiencies), the Maslach Burnout Inventory which leading measure of burnout, the Hallucinations Experiences Questionnaire, and Tellegen Absorption Scale and an open, non-structured interview based on questions of the first instrument. Non parametric statistics was used to test the hypotheses, and the analysis were transformed into a zs (one-tailed). The results showed that nurses reporting these experiences tended to experience greater job stress is not confirmed, however, nurses who reported a combination of perceptual experiences and psychological absorption (high level), tended to score higher work stress compared to those who do not report such experiences. Nurses reporting these experiences tended to report greater psychological absorption, and also tended to report greater proneness to hallucinate. The best predictor was psychological absorption in nurses with APE experiences [β = 0.33, df = 3, p = 0.005; R2 = 0.12] compared to the group nurses no-experiencers. (shrink)

Mental disorder (earlier entitled “illness” or “disease”) is ascribed to deviations from normal thoughts, reasoning, feelings, attitudes, and actions that are considered socially or personally dysfunctional and apt for treatment. Schizophrenia, depression, and bipolar disorder are core examples. The concept of mental disorder plays a role in many domains, including medicine, social sciences such as psychology and anthropology, and the humanities, including literature and philosophy. Philosophical discussions are the primary focus of the present entry, which differs from the entry on (...) Philosophy of Psychiatry in noting several different approaches—not only those of the philosophy of science and mind, but also those arising from phenomenology and social theory. -/- Mental disorder is a widely contested concept and there are longstanding debates on whether disorders are biological or social in nature. Even uncontroversial disorders, such as those listed above, were not always regarded as disorders in the past (Porter 2002). Moreover, the status of mental disorder has frequently indicated ethical, as much as other deficiency (Irwin 2013). Such reminders direct our attention to contemporary medical psychiatry’s sometimes uncompromisingly neurobiological, and avowedly value-free “medical model”, with its incumbent analogies and assumptions, and to the general question of how the taxa of psychiatric classifications are to be viewed as objects of natural science. This model has received intensive philosophical scrutiny, including arguments that deny these conditions are deficiencies at all. Along with issues arising from cognitive psychology and the neurosciences, such foundational matters make up much of the following entry. Because of their focus on issues central to the philosophy of mind and ethics (e.g., the mind-body problem, moral responsibility, agency and identity), analyses of mental disorder have extensive implications for those fields. As clinical phenomena, they also reflect an inescapable, everyday, social reality, giving theoretical inquiries additionally urgent practical, moral, and legal implications. (shrink)

What is the status of the dichotomy proposed and the nosological validity of the contrasting pathologies described in the target article? How plausibly can dysregulated imprinting explain the array of features described, compared with other genetic models? We believe that considering alternative models is more likely to lead in the long term to the correct classification and explanation of the component behaviours.

IntroductionThose in mental health-related consumer movements have made clear their demands for humane treatment and basic civil rights, an end to stigma and discrimination, and a chance to participate in their own recovery. But theorizing about the politics of recognition, 'recognition rights' and epistemic justice, suggests that they also have a stake in the broad cultural meanings associated with conceptions of mental health and illness.ResultsFirst person accounts of psychiatric diagnosis and mental health care (shown here to represent 'counter stories' to (...) the powerful 'master narrative' of biomedical psychiatry), offer indications about how experiences of mental disorder might be reframed and redefined as part of efforts to acknowledge and honor recognition rights and epistemic justice. However, the task of cultural semantics is one for the entire culture, not merely consumers. These new meanings must be negotiated. When they are not the result of negotiation, group-wrought definitions risk imposing a revision no less constraining than the mis-recognizing one it aims to replace. Contested realities make this a challenging task when it comes to cultural meanings about mental disorder. Examples from mental illness memoirs about two contested realities related to psychosis are examined here: the meaninglessness of symptoms, and the role of insight into illness. They show the magnitude of the challenge involved - for consumers, practitioners, and the general public - in the reconstruction of these new meanings and realities.ConclusionTo honor recognition rights and epistemic justice acknowledgement must be made of the heterogeneity of the effects of, and of responses to, psychiatric diagnosis and care, and the extent of the challenge of the reconstructive cultural semantics involved. (shrink)

In this paper we defend the doxastic conception of delusions against the metacognitive account developed by Greg Currie and collaborators. According to the metacognitive model, delusions are imaginings that are misidentified by their subjects as beliefs: the Capgras patient, for instance, does not believe that his wife has been replaced by a robot, instead, he merely imagines that she has, and mistakes this imagining for a belief. We argue that the metacognitive account is untenable, and that the traditional conception of (...) delusions as beliefs should be retained. (shrink)

Recent debates concerning the abolition of the schizophrenia label in psychiatry have focused upon problems with the scientific status of the concept. In this article, I argue that rather than attacking schizophrenia for its lack of scientific validity, we should focus on the conceptual history of this label. I reconstruct a specific tradition when exploring the conceptual history of schizophrenia. This is the concern with the question of the sense of life itself, conducted through the confrontation with schizophrenia as a (...) form of life that does not live, or as Robert Jay Lifton termed it ‘lifeless life’ (1979: 222—39). I conclude by arguing that the contemporary attempt to deconstruct or abolish the schizophrenia concept involves a fundamental shift in concern. The attempt both to normalize psychotic experiences, and to conceive them purely in terms of cognitive processes that can be mapped onto brain function, results in a fundamental move away from the attempt to understand the experience of madness. (shrink)

Viewing the brain as an organ of approximate Bayesian inference can help us understand how it represents the self. We suggest that inferred representations of the self have a normative function: to predict and optimise the likely outcomes of social interactions. Technically, we cast this predict-and-optimise as maximising the chance of favourable outcomes through active inference. Here the utility of outcomes can be conceptualised as prior beliefs about final states. Actions based on interpersonal representations can therefore be understood as minimising (...) surprise – under the prior belief that one will end up in states with high utility. Interpersonal representations thus serve to render interactions more predictable, while the affective valence of interpersonal inference renders self-perception evaluative. Distortions of self-representation contribute to major psychiatric disorders such as depression, personality disorder and paranoia. The approach we review may therefore operationalise the study of interpersonal representations in pathological states. (shrink)

Projection does not reliably serve cognition; it all too often contributes to failures of knowledge. Our projecting not only imaginatively misrepresents the world by attributing a feature of ourself to it. In doing so it can misrepresent us as lacking that feature. It is an act of the imagination which re-locates unwanted attributes into a motivated misrepresentation which distorts our grasp of reality and of ourselves. The imaginative act itself is not consciously intended so that we take the resulting picture (...) at face value, despite the distortion. Without a strong reason to question this misperception the projection remains undetected and the misrepresentation affects our relations to others. Projection serving motivated self-deception thus evades correction. Realistic self-knowledge becomes possible through psychoanalysis when the patient's projections are received by the analyst as communications impinging on her capacity for sympathy. I show how the psychology of sympathy we find in Hume and Smith provides a philosophical frame of reference for understanding this interaction between sympathy and projection. I bring sympathy together with contemporary Kleinian psychoanalytic theory to explain how psychoanalytic interpretation engages with this interaction to reduce the effects of projection and enable a self-knowledge grounded in the subject's own experience of herself. (shrink)

Creating a space for recovery‐focused psychiatric nursing care Within contemporary mental health‐care, power relationships are regularly played out between psychiatric nurses and service users. These power relationships are often imperceptible to the practicing nurse. For instance, in times of distress, service users often turn to or/and ‘construct’ discourses, beliefs and knowledge that are at odds with those which psychiatric nurses rely on to inform them of the mental status of the service user. The psychiatric nurse is in the position to (...) impose knowledge onto service users, usually in concurrence with ‘traditional or bio‐psychiatry’, without realizing or failing to acknowledge that the service user may have an alternative explanation of his/her mental health problems/experiences. In this paper, practice examples, based on the experiences of the four authors (from within and outside of services), are used to illustrate this ‘hidden’ power relationship. The authors use Foucault's ideas about: (i) government; (ii) the knowledge/power nexus and resistance; (iii) and his analytic tool of genealogy to help unravel this paradox within psychiatric nursing practice. The authors also use the emerging discourse of recovery as an alternative (and challenge) to ‘traditional bio‐psychiatry’ and consider the implications for psychiatric nursing practice. (shrink)

In recent years both philosophers and scientists have asked whether or not our current kinds of mental disorder—e.g., schizophrenia, depression, bipolar disorder—are natural kinds; and, moreover, whether or not the search for natural kinds of mental disorder is a realistic desideratum for psychiatry. In this dissertation I clarify the sense in which a kind can be said to be “natural” or “real” and argue that, despite a few notable exceptions, kinds of mental disorder cannot be considered natural kinds. Furthermore, I (...) contend that psychopathological phenomena do not cluster together into kinds in the way that paradigmatic natural kinds (e.g., chemical kinds and species) do; and, in light of this fact, I conclude that the normative ideal of natural classification—i.e. classifying real or natural kinds—is not appropriate as a general strategy for psychiatry. In the conclusion to this dissertation I propose an alternative way forward. Rather than assuming a priori that psychopathological phenomena cluster together into kinds, a more tractable and theoretically promising approach would be to first explain how particular kinds of experiences and behaviours—e.g, hallucinations, delusions, disorganized thinking, mania, low mood, etc.—are produced. (shrink)

This paper explores and develops a theological perspective on taking and receiving medication. It argues that the task of prescribing and administering psychopharmaceutical drugs is a thoroughly theological enterprise and should be looked at and practiced accordingly. The paper presents a theological anthropology that opens up space for rethinking the role of medication not only in relation to therapeutic intervention, but in relation to the chief end of human beings: to glorify God and live with God forever. Drawing on theology (...) and the narratives of people living with mental health challenges, the paper seeks to facilitate a movement from neurons to souls: a movement that realigns the goals of prescribing and opens up space to rethink the nature of “symptoms” and the ultimate intentions of the psychopharmacological enterprise. (shrink)

Background The convergence of neuroscience, genomics, and data science holds promise to unveil the neurobiology of psychosis and to produce new ways of preventing, diagnosing, and treating psychotic illness. Yet, moral challenges arise in neurobiological research and in the clinical translation of research findings. This article investigates the views of relevant actors in mental health on the moral challenges of accessing neurobiological information in the context of psychosis. Methods Semi-structured individual interviews with two groups: researchers employed in the National Health (...) Service (NHS) or a university in England (n = 14), and mental health professionals employed in NHS mental health services (n = 14). This article compares results in the two groups (total n = 28). Results This article presents findings around three conceptual areas: (1) research ethics as mostly unproblematic, (2) psychosis, neurobiological information, and mental health care, and (3) identity, relationships, and the future. These areas are drawn from the themes and topics that emerged in the interviews across the two groups of participants. Researchers and health professionals provided similar accounts of the moral challenges of accessing—which includes acquisition, communication, and use of—neurobiological information in the context of psychosis. Acquiring neurobiological information was perceived as mostly unproblematic, provided ethical safeguards are put in place. Conversely, participants argued that substantive moral challenges arise from how neurobiological information is delivered—that is, communicated and used—in research and in clinical care. Neurobiological information was seen as a powerful tool in the process through which individuals define their identity and establish personal and clinical goals. The pervasiveness of this narrative tool may influence researchers and health professionals’ perception of ethical principles and moral obligations. Conclusions This study suggests that the moral challenges that arise from accessing neurobiological information in the context of psychosis go beyond traditional research and clinical ethics concerns. Reflecting on how accessing neurobiological information can influence individual self-narratives will be vital to ensure the ethical translation of neuroscience and genomics into mental health. Trial registration The study did not involve a health care intervention on human participants. It was retrospectively registered on 11 July 2018, registration number: researchregistry4255. (shrink)

Artykuł prezentuje krytyczny szkic historyczny i charakterystykę biomedycznego modelu psychopatologii, koncentrując się na drugiej połowie XX w. Wskazuje i opisuje także kluczowe problemy związane z jego dominacją we współczesnej praktyce klinicznej i badawczej. Problemy te dotyczą, m. in., trafności i rzetelności diagnoz psychiatrycznych, metodologii badań, skuteczności leczenia, czy też wpływów koncernów farmaceutycznych na działalność naukową i terapeutyczną. Poważne konceptualne problemy całego modelu stawiają pod znakiem zapytania fundamenty współczesnej psychiatrii oraz opartą na nich wiedzę. Nie udało się stworzyć przekonujących biologicznych wyjaśnień (...) zaburzeń psychicznych ani zidentyfikować mechanizmów odpowiadających za ich powstawanie. Uzasadnione wątpliwości istnieją także w odniesieniu do najczęściej przepisywanych współcześnie leków: przeciwpsychotycznych i antydepresyjnych – pomimo ich coraz szerszego stosowania, przybywa ludzi przewlekle chorych. Rodzi to poważne dylematy etyczne i uzasadnione pytania o nadmierną medykalizację kwestii wiązanych ze zdrowiem psychicznym. Konieczna wydaje się reforma dominującego modelu i wzrost nakładów na badania i praktykę uwzględniającą czynniki psychologiczne, społeczne i kulturowe. (shrink)

Human genetics research appears to be approaching a period of re-examination due to the decades-long failure of molecular genetic research to uncover the genes presumed to underlie psychiatric disorders, psychological traits, and some common medical conditions. As currently dominant theories of genetic causation come more into question, we will see a renewed interest in reassessing the potential roles of genes and environment in these areas. To illustrate the potentially harmful and diversionary impact of emphasizing genetics over the environment, the author (...) tells a story in the form of a parable. In this parable, the citizens of a medium-size city are confronted with the task of dealing with a group of arsonists who are systematically burning down several houses each week. The Mayor argues that the best way to prevent arson is to analyze the types of wood used to build the city’s houses, with an accompanying lack of interest in arresting the arsonists. Her opponents argue that regardless of the type of wood used, the city and its citizens should prevent arson attacks by focusing attention on identifying and arresting the arsonists. The Mayor’s position prevails, and the arson attacks continue for years to come at the same time as researchers continue to study and analyze the wood used to construct the houses. Informed readers will recognize the analogous ideas, research strategies, interest groups, publications, and historical controversies related to “nature–nurture” issues, which encompass every aspect of the parable. (shrink)