The modern editions of the Diagnostic and Statistical Manual of Mental Disorders, beginning with DSM-III in 1980, emerged in response to notable challenges to psychiatry’s practices and ways of knowing in the early 1970s. Because these challenges threatened psychiatry’s scientific self-understanding and moral authority, they exemplify what Alasdair MacIntyre has termed “epistemological crisis.” As a response to crisis, the modern DSM has been a stunning political achievement, providing the central diagnostic constructs around which psychiatric research, practice, and reimbursement has been (...) organized for four decades. Indeed, the DSM’s authority survives in the face of ongoing trenchant scientific and philosophical critique. But if psychiatry is to be healthy, it must be epistemologically humble, reckoning honestly with the limits of the DSM before a future epistemological crisis destabilizes it entirely. (shrink)

In light of the recent calls for integrating phenomenology and psychiatry, I will address the problem of heterogeneity in major depressive disorder (MDD) using the phenomenological account of depression put forth by Fernandez (Fernandez, 2014). I will first go over the distinction between two of the major specifiers of major depressive disorder, namely melancholic and atypical depression. Then, I review the account of depression developed by Fernandez, which considers some of the people diagnosed with MDD to have an erosion of (...) the capacity for the category of moods as opposed to a particular kind of mood. I will apply this conception to the diagnostic and statistical manual criteria for melancholic and atypical depression, and consider how reactive and unreactive depressed moods can be clarified using this conception. I argue that we can help our understanding of MDD by viewing melancholic depression as primarily characterized by structural erosion of the person’s situatedness (observed as a lack of mood reactivity) and atypical depression as a state in which the capacity for moods in general has not been eroded (hence, the retention of mood reactivity), with the psychopathology rooted only in the content of experience (the moods themselves). I discuss how this conception related to other phenomenological accounts of depression and why it can be useful in making sense of some clinical observations between the two specifiers, namely the differences in illness severity and symptoms of depersonalization and derealization, before concluding the work by considering its relationship with the operationalized approach of the DSM. (shrink)

Anorexia Nervosa (AN) is widely considered to be a bodily disorder accompanied by unrealistic perceptions about one’s own body. Some researchers thus have wondered whether deficits in interoception, a conscious or non-conscious sense of one’s own body, could be a primary cause of AN. In this paper, we make the case that rather than interoception being a primary cause, deficits in interoception may occur as by-products of emotions that arise upstream in the pathogenesis of AN and interact with feelings of (...) a loss of self-control. We consider interoception, emotion, and self-control as a dynamical triad involved in the explanation of AN, with emotions as the central aspect of their interactions. We begin with a critical analysis of recent empirical literature on AN and differentiate three types of interoceptive processes. We then consider the role of self-control in AN. We go on to evaluate recent empirical and philosophical work on the role of emotions in AN and assess their importance in both interoception and self-control dynamics. We develop a testable integrative model that we believe best captures how self-control, emotional and interoceptive processes causally interact in the pathogenesis of AN. In this model, AN behaviors are not caused by interoceptive abnormalities, but rather interact with changes in emotional regulation and feelings of loss of self-control, subsequently leading to interoceptive deficits downstream. To capture a later stage in the pathogenesis of AN, we show how AN behaviors are maintained as a result of feedback among components in the model. We briefly explain future plans to further complement the model using a semi-structured interview to probe patient perspectives in AN. To develop a more valid understanding of AN, this model will have to be integrated into pluralistic approaches that include patient perspectives. (shrink)

The practice of self-diagnosing, amplified by the spread of psychiatric knowledge through social media, has grown rapidly. Yet, the motivations behind this trend, and, critically, its psychological repercussions remain poorly understood. Self-ascribing a psychiatric label always occurs within a broader narrative context, with narratives serving as essential interpretive tools for understanding oneself and others.In this paper, we identify four principal motivators for people pursuing self-diagnosis, pertaining to 1. waiting time and cost of mental health resources, 2. recognition, 3. identity formation, (...) and 4. destigmatization. We compare these motivators against the backdrops of psychiatric narratives, including DSM-based (operationalism), bio-medical, and Neurodiversity narratives, to evaluate the psychological implications of self-ascriptions. We show that while self-ascription aligns with many motivations, it also carries the risk of essentialism across all analyzed narratives, which can over-simplify and sometimes misrepresent people’s attempts to find meaning through psychiatric labels. Essentialism makes narratives less comprehensive, responsive, and resourceful.We contend that self-ascriptions are not inherently problematic; instead, they show the need for greater focus and understanding in psychiatric practices and the importance of incorporating people’s experiences and perspectives in clinical settings. However, both the narratives and the social climate from which they emerge may need adjustments to make self-ascriptions meaningful, comprehensive, and resourceful tools. (shrink)