This paper is a loose commentary on Marcinów’s book (2017). The commentary is focused on the objects of psychopathological investigations and the role of psychology / psychiatry tension in the process of singling out, tracking, and describing them. As a consequence, there are limitations of collaborative and integrative efforts between psychologists and psychiatrists where questions of psychopathology are concerned.

ABSTRACTTime-consciousness has long been a focus of research in phenomenology and phenomenological psychology. We advance and extend this tradition of research by focusing on the character of temporal experience under conditions of mania. Symptom scales and diagnostic criteria for mania are peppered with temporally inflected language: increased rate of speech, racing thoughts, flight-of-ideas, hyperactivity. But what is the underlying structure of temporal experience in manic episodes? We tackle this question using a strategically hybrid approach. We recover and reconstruct three hypotheses (...) regarding manic temporality that were advanced and modeled by two pioneers of clinical phenomenology: Eugène Minkowski and Ludwig Binswanger. We then test, critique, and refine these hypotheses using heterophenomenological methods in an interview-based study of persons with a history of bipolar and a current diagnosis of acute mania. Our conclusions support a central hypothesis due to Minkowski... (shrink)

The scientific concepts of mental imagery and hallucinations are each used independently of the other in experiments; uses that simultaneously evoke and obscure their historical connections. To highlight one of these connections, I will begin by sketching episodes from the largely separate developmental trajectories of each concept. Considering these historical sketches side-by-side, I will argue that the independent uses of these concepts each inherited a shared set of interdependent associations. In doing so, I seek to illustrate the value of examining (...) historical connections between mental imagery and hallucinations for studying the current uses of these two concepts in neuroimaging experiments. (shrink)

Clinical delusions are widely characterized as being pathological beliefs in both the clinical literature and in common sense. Recently, a philosophical debate has emerged between defenders of the commonsense position (doxasticists) and their opponents, who have the burden of pointing toward alternative characterizations (anti-doxasticists). In this chapter, I argue that both doxasticism and anti- doxasticism fail to characterize the functional role of delusions while at the same time being unable to play a role in the explanation of these phenomena. I (...) also argue that though a more nuanced view of belief in which mental states are more or less belief-like instills a healthy skepticism towards the precision of folk-psychological concepts, such a stance fails to be of use in building a theory of delusion that will be able to bridge different levels of explanation, such as the phenomenology and neurobiology of delusion. Thus, I advocate moving past the question ‘Are delusions beliefs?’ and their description as propositional attitudes toward the description of the processes that generate delusion, with a view toward explaining, rather than explaining away, the personal-level aspects of the phenomenon that have been made inscrutable by investing in doxastic terminology. (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)

Although delusion is one of the central concepts of psychopathology, it stills eludes precise conceptualization. In this paper, I present certain basic issues concerning the classification and definition of delusion, as well as its ontological status. By examining these issues, I aim to shed light on the ambiguity of the clinical term ‘delusion’ and its extension, as well as provide clues as to why philosophers are increasingly joining the ranks of psychiatrists, psychologists, and neuroscientists in the effort to come to (...) a comprehensive understanding of delusion. (shrink)

Basic self-awareness is the kind of self-awareness reflected in our standard use of the first-person. Patients suffering from severe forms of depersonalization often feel reluctant to use the first-person and can even, in delusional cases, avoid it altogether, systematically referring to themselves in the third-person. Even though it has been neglected since then, depersonalization has been extensively studied, more than a century ago, and used as probe for understanding the nature and the causal mechanisms of basic self-awareness. In this paper, (...) I argue that depersonalized patients indeed have an impaired basic self-awareness, and that their study allows us both to favor one specific theory of basic self-awareness and to understand what is wrong with its rivals. According to the favored theory, which I call Cartesian, we are basically self-aware in virtue of being acquainted with ourselves through introspection. (shrink)

This paper addresses philosophical issues concerning whether mental disorders are natural kinds and how the DSM should classify mental disorders. I argue that some mental disorders (e.g., schizophrenia, depression) are natural kinds in the sense that they are natural classes constituted by a set of stable biological mechanisms. I subsequently argue that a theoretical and causal approach to classification would provide a superior method for classifying natural kinds than the purely descriptive approach adopted by the DSM since DSM-III. My argument (...) suggests that the DSM should classify natural kinds in order to provide predictively useful (i.e., projectable) diagnostic categories and that a causal approach to classification would provide a more promising method for formulating valid diagnostic categories. (shrink)

During the late 20th century numerical rating scales became central to the diagnosis of dementia and helped transform attitudes about its causes and prevalence. Concentrating largely on the development and use of the Blessed Dementia Scale, I argue that rating scales served professional ends during the 1960s and 1970s. They helped old age psychiatrists establish jurisdiction over conditions such as dementia and present their field as a vital component of the welfare state, where they argued that ‘reliable modes of diagnosis’ (...) were vital to the allocation of resources. I show how these arguments appealed to politicians, funding bodies and patient groups, who agreed that dementia was a distinct disease and claimed research on its causes and prevention should be designated ‘top priority’. But I also show that worries about the replacement of clinical acumen with technical and depersonalized methods, which could conceivably be applied by anyone, led psychiatrists to stress that rating scales had their limits and could be used only by trained experts. (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)

In this research I present a study on the origin of alienism in the 19th century in the work of Phillipe Pinel in context. The purpose of the paper is to show how the French physician proposes alienism inspired by the anthropological ideas of his time. After the introduction, a brief historical overview of the anthropology of modernity is given to place Pinel's work in context. This is followed by a survey of Pinel's anthropological ideas, which are in a sense (...) coincident with his period. Finally, it is presented how Pinel proposes his famous alienism, situated between the understanding and the affected life, as well as the way of curing his patients as a consequence of his anthropological approach. (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)

One of the most remarkable implications of psychological medicine in the transition from the 18th to the 19th century was the advent of a new way of looking at the human being and new tools for analysing not only behaviour and individual experience, but also historical events, collective behavioural patterns or complex cultural achievements. Unsurprisingly, the deployment of this gaze could not advance without there being a series of disputes and controversies about its reach and the limits to its indiscriminate (...) application. Focusing on the figure of French alienist Alexandre Brierre de Boismont and on the controversial cases of hallucinations and suicide, this article addresses the conflicts generated by the use of certain emblematic concepts and categories present in French psychological medicine throughout the central decades of the 19th-century, as well as the essentially ambivalent relationship of the psychopathological point of view with the criticism of a culture that was made responsible, then, as now, for a great number of psychological disorders and illnesses. (shrink)

The contemporary epistemic status of mental health disciplines does not allow the cross validation of mental disorders among various genetic markers, biochemical pathway or mechanisms, and clinical assessments in neuroscience explanations. We attempt to provide a meta-empirical analysis of the contemporary status of the cross-disciplinary issues existing between neuro-biology and psychopathology. Our case studies take as an established medical mode an example cross validation between biological sciences and clinical cardiology in the case of myocardial infarction. This is then contrasted with (...) the incoherence between neuroscience and psychiatry in the case of bipolar disorders. We examine some methodological problems arising from the neuro-imaging studies, specifically the experimental paradigm introduced by the team of Wayne Drevets. Several theoretical objections are raised: temporal discordance, state independence, and queries about the reliability and specificity, and failure of convergent validity of the inter-disciplinary attempt. Both modern neuroscience and clinical psychology taken as separate fields have failed to reveal the explanatory mechanisms underlying mental disorders. The data acquired inside the mono-disciplinary matrices of neurobiology and psychopathology are deeply insufficient concerning their validity, reliability, and utility. Further, there haven’t been developed any effective trans-disciplinary connections between them. It raises the requirement for development of explanatory significant multi-disciplinary “meta-language” in psychiatry (Berrios, 2006, 2008). We attempt to provide a novel conceptual model for an integrative dialogue between psychiatry and neuroscience that actually includes criteria for cross-validation of the common used psychiatric categories and the different assessment methods. The major goal of our proactive program is the foundation of complementary “bridging” connections of neuroscience and psychopathology which may stabilize the cognitive meta-structure of the mental health knowledge. This entails bringing into synergy the disparate discourses of clinical psychology and neuroscience. One possible model accomplishment of this goal would be the synergistic (or at least compatible) integration of the knowledge under trans-disciplinary convergent cross-validation of the commonly used methods and notions. (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)

Delusion is one of the most intriguing psychopathological phenomena and its conceptualization remains the subject of genuine debate. Claims that it is ill-defined, however, are typically grounded on essentialist expectations that a given definition should capture the core of every instance acknowledged as delusion in the clinical setting.

The present thesis surveys different philosophical approaches to the nature of delusions: specifically, their ontology. However, since none of the various theories of the nature of delusions succeeds, I argue that there must be something problematic about the form of the analyses commonly offered. My general conclusion is that one cannot characterize delusions without taking away what it is distinctive about them.

Although physicians have attempted for centuries to uncover the biological differences between men and women with regard to mental illness, they continue to face the challenges of untangling biological factors from social and cultural ones. This article uses examples from history to illustrate three common problems in trying to establish biological differences: identifying factors as sex-based when they are really gender-based; overlooking changes in masculine and feminine roles over time; and placing too great an emphasis on hormones. By using the (...) benefit of hindsight to identify problems from the past, we can think more critically about these issues in the present and the future. (shrink)

This article explores two very different forms in which immoral conduct was problematized over the course of the 19th century. It does this by contrasting the sexual purity politics of the Vice Society and the medicalization of morality as `moral insanity'. Early in the century the Vice Society promoted coercive legislation with the aim of `suppressing vice'. From mid-century, moral insanity theories sought to grapple with vice by disaggregating `moral' from other forms of insanity. These two movements had quite distinct (...) and incompatible lines of development; and they never overtly engaged with each other. The article makes its key argument by demonstrating the way in which such dissimilar trajectories came together towards the end of the century in the `moral hygiene' movement, mobilizing discourses of `degeneration' (and `feeblemindedness') with projects promoting sexual purity. (shrink)

This paper focuses on one of the original moments of the development of the “phenomenological” current of psychiatry, namely, the psychopathological research of Ludwig Binswanger. By means of the clinical and conceptual problem of schizophrenia as it was conceived and developed at the beginning of the twentieth century, I will try to outline and analyze Binswanger’s perspective from a both historical and epistemological point of view. Binswanger’s own way means of approaching and conceiving schizophrenia within the scientific, medical, and psychiatric (...) context of that time will lead us to grasp the epistemological stakes at the origins of his project of reforming psychiatry by means of phenomenology. I will finally attempt to upgrade and update Binswanger’s project in light of the current reappraisal of phenomenology within the ongoing debate on psychopathology engaged by studies in the field of science and philosophy of mind. (shrink)

Locke is famous for defining madness as an intellectual disorder in the realm of ideas. Numerous commentators take this to be his main and only contribution to the history of psychiatry. However, a detailed exegetical review of all the relevant textual evidence suggests that this intellectualist interpretation of Locke’s account of madness is both misleading and incomplete. Affective states of various sorts play an important role in that account and are in fact primordial in the determination of human conduct generally. (...) Locke’s legacy in this domain must therefore be revised and the intellectualist bias that dominates discussions of his views must be redressed. (shrink)

The diagnosis of psychopathic personality disorder has salience for forensic clinical practice. It influences decisions regarding risk, treatability and sentencing, indeed, in certain jurisdictions it serves as an aggravating factor that increases the likelihood of a capital sentence. The concatenation of symptom that is associated with modern conceptions of the disorder can be discerned in early writings, including the book of Psalms. Despite its forensic clinical importance and historical pedigree the concept remains elusive and controverted. In this paper I describe (...) an attempt to map the concept of psychopathic personality disorder—the Comprehensive Assessment of Psychopathic Personality (CAPP). I outline the processes used to create the concept map; I summarise evidence in support of the content validity of the map and describe different operations designed to operationalise the construct. It is only when conceptual clarity is achieved that valid operations and measures can be created. I end with a plea for more carefully considered application of statistical methods; applications that better fit the theoretical questions being posed. (shrink)

Les délires sont des composantes cruciales de nombreux troubles psychiques, surtout la schizophrénie. Que sont les délires? Selon l’opinion courante, il s’agit d’un type de croyance, plus précisément, une croyance pathologique. Malheureusement, l’opinion courante ne correspond pas rigoureusement, dans tous les cas, à la pratique clinique, où l’expression « délire » est souvent appliquée à des états qui ne sont pas des croyances. Nous examinons les raisons pour lesquelles des états qui ne sont pas des croyances peuvent être considérés comme (...) des délires. Nous soutenons que les délires sont des structures complexes d’attitudes d’ordre supérieur et inférieur. Ils constituent un type spécifique de défaillance de la connaissance et de la gestion de soi. Nous fournirons une description du type en question. Notre point de vue implique sur le plan conceptuel que les croyances ne sont pas essentielles aux délires.Delusions are critical components in a number of mental disorders, schizophrenia formost. What are they? The standard view is that they are a type of belief — a pathological belief. Unfortunately, the standard view does not consistently correspond to clinical practice, where the term « delusion » often applies to non-beliefs. We review the case for saying that non-beliefs can count as delusions. We argue that delusions are complexes of higher and lower order attitudes. They constitute a distinctive type of failure of self-knowledge and self-management. We describe the relevant type. One of the conceptual implications of our view is that beliefs need not be central to delusions. (shrink)

Relationalism claims that the phenomenal character of perception is constituted by the obtaining of a non-representational psychological relation to mind-independent objects. Although relationalism provides what seems to be the most straightforward and intuitive account of how experience strikes us introspectively, it is very often believed that the argument from hallucination shows that the view is untenable. The aim of this thesis is to defend relationalism against the argument from hallucination. The argument claims that the phenomenal character of hallucination and perception (...) deserves the same account, and that relationalism cannot be true for hallucinations, therefore relationalism must be rejected. This argument relies on the Indiscriminability Principle, the claim that two experiences that are introspectively indiscriminable from each other have the same phenomenal character. Before assessing the plausibility of this principle, I first consider and dismiss versions of the argument which wouldn’t depend on IND. Although widely accepted, no satisfactory support for IND has been presented yet. In this thesis I argue that defending IND requires that we understand the notion of ‘indiscriminability’ employed in IND in an impersonal sense. I then identify what underwrites IND: the intuition that, in virtue of its superficiality, the nature of a phenomenal character must be accessible through introspection, together with the claim that it is not possible to deny IND without denying the superficiality of phenomenal characters too. I argue that the relationalist can deny IND while preserving the superficiality of phenomenal characters. This can be done by adopting a negative view of hallucination and an account of introspection whereby the phenomenal character doesn’t exist independently of one’s introspective awareness of it and where having introspective access to our experience depends on our perceptual access to the world. (shrink)

Emotion Review, Volume 14, Issue 1, Page 3-14, January 2022. Advocates for the psychological construction of emotion view themselves as articulating a non-essentialist alternative to basic emotion theory's essentialist notion of affect programs. Psychological constructionists have also argued that holding essentialist assumptions about emotions engenders misconceptions about the psychological constructionist viewpoint. If so, it is important to understand what psychological constructionists mean by “essentialism” and “non-essentialism.” To advance the debate, I take a deeper dive into non-essentialism, comparing the non-essentialist views (...) of the early empiricists with those of the psychological constructionists, focusing on the theories of James Russell and Lisa Barrett. Using Lakatos’ notion of scientific research programs, I also describe how Russell's and Barrett's views have evolved into different and potentially competing research programs under the psychological constructionist banner. (shrink)

Louis Charland's ‘Technological reason and the regulation of emotion’ focuses on a specific area, that of the emotions, in which he sees a problematic dominance of the technical attitude. He argues that our technologically oriented psychiatry has taken an instrumentalist approach to regulation of emotion that severely limits and distorts the role of emotion in psychiatric practice. A prominent example is the exclusion of moral judgments and values, emotion-laden aspects of experience, from psychotherapy because they do not fit the technical (...) model. To illustrate his point, Charland both contrasts the modern notion of emotion with the traditional notion of passion, and our contemporary practice of technically regulated emotion with the ‘moral treatment’ of the nineteenth century. (shrink)

Both in research on Auditory Verbal Hallucinations (AVHs) and in their clinical assessment, it is common to distinguish between voices that are experienced as ‘inner’ (or ‘internal’, ‘inside the head’, ‘inside the mind’,...) and voices that are experienced as ‘outer’ (‘external’, ‘outside the head’, ‘outside the mind’,...). This inner/outer-contrast is treated not only as an important phenomenological variable of AVHs, it is also often seen as having diagnostic value. In this article, we argue that the distinction between ‘inner’ and ‘outer’ (...) voices is ambiguous between different readings, and that lack of disambiguation in this regard has led to flaws in assessment tools, diagnostic debates and empirical studies. Such flaws, we argue furthermore, are often linked to misreadings of inner/outer-terminology in relevant 19th and early twentieth century work on AVHs, in particular, in connection with Kandinsky’s and Jaspers’s distinction between hallucinations and pseudo-hallucinations. (shrink)

The subject of this paper is the problematisation of depression in today’s mental health care. It is based on a study of the professional discussion on depression in Finland from the mid-1980s to the 1990s. The ways in which Finnish mental health experts define the object of depression treatment bring out an ambivalence that stems from the discrepancy between two parallel but incongruent notions of what depression is: the psychopharmacological and the psychotherapeutic. The analysis of the discussion demonstrates how clinical (...) and practical rationales of today’s mental health care are formed in the space between the two poles. Two tendencies of these rationales are also pointed out: first, the DSM paradigm of depressive illness inclines to become problematic and to dissolve in the actual practices. Second, they insinuate emphasis on antidepressant medication and overall neuropsychiatric approach in the treatment of depressive disorders, although in an ambivalent way. (shrink)

Existing accounts of the early history of Alzheimer’s disease have focused on Alois Alzheimer’s (1864–1915) publications of two ‘peculiar cases’ of middle-aged patients who showed symptoms associated with senile dementia, and Emil Kraepelin’s (1856–1926) discussion of these and a few other cases under the newly introduced name of ‘Alzheimer’s disease’ in his Textbook of Psychiatry. This article questions the underpinnings of these accounts that rely mainly on publications and describe ‘presenility’ as a defining characteristic of the disease. Drawing on archival (...) research in the Munich psychiatric clinic, in which Alzheimer and Kraepelin practised, this article looks at the use of the category as a diagnostic label in practice. It argues that the first cases only got their exemplary status as key referents of Alzheimer’s disease in later readings of the original publications. In the 1900s, the published cases rather functioned as material to think about the limits of the category of senile dementia. The examination of paper technologies in the Munich psychiatric clinic reveals that the use of the clinical diagnosis of Alzheimer’s disease was not limited to patients of a certain age and did not exclude ‘senile’ cases. Moreover, the archival records reflect that many diagnoses of Alzheimer’s disease were noted in the medical records as suspicions rather than conclusions. Against this background, the article argues that in theory and practice, Alzheimer’s disease was not treated as a well-defined disease entity in the Munich clinic, but as an exploratory category for the clinical and histopathological investigation of varieties of organic brain diseases. (shrink)

This article investigates “impaired insight,” a controversial psychiatric category describing a mad person unable to know his or her madness. Like “moral insanity” and other concepts before it, impaired insight offers a way to link the disparate logics of human responsibility in psychiatry and the law. I attribute its development to changes wrought by deinstitutionalization, the rise of antipsychotic medication, and patient incarceration in penal settings. In a system that aims to govern psychiatric patients through their freedom, the logic of (...) impaired insight introduces a wrinkle: can a person make an informed choice to refuse treatment if madness itself impairs awareness of illness? Drawing on tools from the sociology of science, I trace the process by which researchers recast psychodynamic “denial” as a neurological and therefore non-volitional “impairment” in the 1990s. I then show how social movement actors mobilized the materialized form in the legal and policy fields in the 2000s, bringing insight science to bear upon the very questions of custodial management and patient rights that gave birth to it. At stake is this dilemma: how can societies that simultaneously privilege individual responsibility and somatic accounts of behavior govern those at the border of legal capacity, and with what justification? (shrink)