Recently, there have been calls to develop a more contextual approach to phenomenological psychopathology—an approach that attends to the socio-cultural as well as personal and biographical factors that shape experiences of mental illness. In this Perspective article, we argue that to develop this contextual approach, phenomenological psychopathology should adopt a new paradigm case. For decades, schizophrenia has served as the paradigmatic example of a condition that can be better understood through phenomenological investigation. And recent calls for a contextual approach continue (...) to use schizophrenia as their primary example. We argue, in contrast, that substance misuse provides a better paradigm case around which to develop a contextually sensitive phenomenological psychopathology. After providing a brief vignette and analysis of a case of substance misuse, we explain why this kind of condition requires considerable sensitivity and attention to context, better motivating the incorporation and development of new contextually sensitive approaches. (shrink)

Currently, anomalous lived temporality is not included in the main diagnostic criteria or standard symptom checklists. In this article, we present the Transdiagnostic Assessment of Temporal Experience, a structured interview that can be used by researchers and clinicians without a comprehensive phenomenological background to explore abnormal time experiences in persons with abnormal mental conditions regardless of their diagnosis. When extensive data gathered by this scale are available, it will be possible to delineate well-defined anomalous lived temporality profiles for each psychopathological (...) disorder. This instrument may also prove useful for clinicians by providing a more refined assessment of relevant psychopathological symptoms and an in-depth understanding of the patient’s abnormal behaviour as related to specific types of time experience. In the first part of the article, we provide a brief overview of the phenomenological concept of temporality, including pre-phenomenal and phenomenal time, synthesis, conation and synchronization, and of abnormal time experiences in persons affected by psychopathological conditions. In the following part, we describe the basic structure of the interview that comprises seven categories corresponding to the abnormal features of lived temporality: anomalies of synchrony, of time structure, of implicit time flow, of explicit time flow, and anomalous experiences of the past, the present and the future. The paper also includes a section on administration and scoring of the TATE scale, the complete interview and a Likert table for quantifying the frequency, intensity and interference with daily life of the phenomena explored. (shrink)

Individuals suffering from depression consistently report experiencing a lack of connectedness with others. David Karp (2017, 73), in his memoir and study of depression, has gone so far to describe depression as “an illness of isolation, a disease of disconnectedness”. It has become common, in phenomenological circles, to attribute this social impairment to the depressed individual experiencing their body as corporealized, acting as a barrier between them and the world around them (Fuchs 2005, 2016). In this paper, I offer an (...) alternative view of the experience of social disconnectedness in depression, suggesting that rather than necessarily experiencing their body as object-like, the depressed individual’s bodily is saturated with experiences of lethargy, tiredness, heaviness, sadness, hopelessness and so on, to the exclusion of being able to bodily connect to others. I suggest that depression does not involve a complete social impairment but a specific impairment of affective forms of interpersonal experience. (shrink)

The aim of my paper is to review the discussion concerning various difficulties which surround the definition of depression and the methods of diagnosing and treating the disease against the background of the now dominant reductionist paradigm in psychiatry, as well as to answer the question whether a new approach to psychiatric disorders proposed by philosophers of psychiatry working within the phenomenologically inspired embodied and enactive paradigm indeed offers a solution to these difficulties. I present the issues specific to the (...) subject of depression in light of the more general problems related to biological psychiatry that have recently caused much debate. In the second part of the paper, I consider enactive, phenomenological and embodied theories of depression and the possibilities of new methods of treatment. My goal is to assess whether these theories indeed add anything important to the conceptions that are already present in psychiatry. I conclude that even if the embodied philosophy of psychiatry does not solve many of the problems faced by modern psychiatry, it can, nevertheless, provide a useful theoretical basis for future changes. (shrink)

Self-disorders in depression and schizophrenia have been the focus of much recent work in phenomenological psychopathology. But little has been said about the role the material environment plays in shaping the affective character of these disorders. In this paper, we argue that enjoying reliable (i.e., trustworthy) access to the things and spaces around us — the constituents of our material environment — is crucial for our ability to stabilize and regulate our affective life on a day-today basis. These things and (...) spaces often play an ineliminable role in shaping what we feel and how we feel it; when we interact with them, they contribute ongoing feedback that " scaffolds " the character and temporal development of our affective experiences. However, in some psychopathological conditions, the ability to access to these things and spaces becomes disturbed. Individuals not only lose certain forms of access to the practical significance of the built environment but also to its ​ regulative​ significance, too — and the stability and organization of their affective life is compromised. In developing this view, we discuss core concepts like " affordance spaces " , " scaffolding " , and " incorporation ". We apply these concepts to two case studies, severe depression and schizophrenia, and we show why these cases support our main claim. We conclude by briefly considering implications of this view for developing intervention and treatment strategies. (shrink)

A family of recent externalist approaches in philosophy of mind argues that our psychological capacities are synchronically and diachronically “scaffolded” by external resources. I consider how these “scaffolded” approaches might inform debates in phenomenological psychopathology. I first introduce the idea of “affective scaffolding” and make some taxonomic distinctions. Next, I use schizophrenia as a case study to argue—along with others in phenomenological psychopathology—that schizophrenia is fundamentally a self-disturbance. However, I offer a subtle reconfiguration of these approaches. I argue that schizophrenia (...) is not simply a disruption of ipseity or minimal self-consciousness but rather a disruption of the scaffolded self, established and regulated via its ongoing engagement with the world and others. I conclude by considering how this scaffolded framework indicates the need to consider new forms of intervention and treatment. (shrink)

In this paper, I propose an existentialist-phenomenological model that conceives of mental illness through the terminology of Heidegger’s Being and Time. In particular, the concepts of existentiality, disturbance and the relation between ‘being-with’ and ‘the one’, will be implemented in order to reconstruct the experience of mental illness. The proposed model understands mental illness as a disturbance of a person’s existentiality. More precisely, mental illness is conceptualized as the disturbance of a person’s existential structure, the process of which leads to (...) a becoming explicit of the otherwise implicit dynamical structure that constitutes a person’s experience. In particular, the existential component of ‘being-with’ comes to play a central role in the disturbance of existentiality, thus, I will claim, that it enables a person’s structure of experience to be ‘open for normativity’. By adopting a pragmatist stance on Heideggerian phenomenology, the suggested model proves compatible with naturalist and normativist theories of mental illness while still offering a phenomenological description of the phenomenon. (shrink)

I discuss Watsuji’s characterization of aidagara or “betweenness”. First, I develop a phenomenological reading of aidagara. I argue that the notion can help illuminate aspects of our embodied subjectivity and its interrelation with the world and others. Along the way, I also indicate how the notion can be fruitfully supplemented by different sources of empirical research. Second, I put aidagara to work in the context of psychopathology. I show how disruptions of aidagara in schizophrenia not only affirm the foundational role (...) it plays in organizing our experience of self and world in everyday life. Additionally, I suggest the notion can, in this context of application, potentially enhance our understanding of and empathy for those living with schizophrenic disorders. (shrink)

This paper takes a new look at an old question: what is the human self? It offers a proposal for theorizing the self from an enactive perspective as an autonomous system that is constituted through interpersonal relations. It addresses a prevalent issue in the philosophy of cognitive science: the body-social problem. Embodied and social approaches to cognitive identity are in mutual tension. On the one hand, embodied cognitive science risks a new form of methodological individualism, implying a dichotomy not between (...) the outside world of objects and the brain-bound individual but rather between body-bound individuals and the outside social world. On the other hand, approaches that emphasize the constitutive relevance of social interaction processes for cognitive identity run the risk of losing the individual in the interaction dynamics and of downplaying the role of embodiment. This paper adopts a middle way and outlines an enactive approach to individuation that is neither individualistic nor disembodied but integrates both approaches. Elaborating on Jonas’ notion of needful freedom it outlines an enactive proposal to understanding the self as co-generated in interactions and relations with others. I argue that the human self is a social existence that is organized in terms of a back and forth between social distinction and participation processes. On this view, the body, rather than being identical with the social self, becomes its mediator. (shrink)

Name der Zeitschrift: Cognitive Linguistics Jahrgang: 27 Heft: 4 Seiten: 559-572.

In this comparative study, we examine experiential disruptions of embodiment and affectivity in Moebius Syndrome and schizophrenia. We suggest that using phenomenological resources to explore these experiences may help us better understand what it’s like to live with these conditions, and that such an understanding may have significant therapeutic value. Additionally, we suggest that this sort of phenomenologically-informed comparative analysis can shed light on the importance of embodiment and affectivity for the constitution of a sense of self and interpersonal relatedness (...) in normal conditions. (shrink)

In this paper, I examine recent phenomenological research on both depressive and manic episodes, with the intention of showing how phenomenologically oriented studies can help us overcome the apparently paradoxical nature of mixed states. First, I argue that some of the symptoms included in the diagnostic criteria for depressive and manic episodes in the DSM-5 are not actually essential features of these episodes. Second, I reconsider the category of major depressive disorder (MDD) from the perspective of phenomenological psychopathology, arguing that (...) severe depressive episodes should not be characterized by any particular moods (such as sadness, hopelessness, or guilt), and should instead be characterized by a diminished capacity for finding ourselves situated in and attuned to the world at all. In other words, the affective dimension of depression should be characterized as a change in the way we have moods, not as a change from one kind of mood to another. Third, I turn to mania, arguing that manic episodes, taken as the opposite of depressive episodes, should be characterized not by any particular moods (such as euphoria, grandiosity, or even irritability), but should instead be characterized by an enhanced or heightened capacity for finding ourselves situated in and attuned to the world. In other words, the affective dimension of mania, like the affective dimension of depression, should be understood as a change in the way we have moods, not as a change from one kind of mood to another. Fourth, I return to the phenomenon of mixed states and argue that the affective dimension of depression and mania, when conceived along the phenomenological lines I set forth in the previous sections, dissolves the paradox of mixed states by showing that the essential characteristics of depression and mania cannot and do not coincide. Many cases of mixed states are diagnosed because moods that we take to be essential features of either depression or mania arise within the context of what is considered to be the opposite kind of episode (e.g. dysphoria, typically associated with depression, often arises in what is otherwise considered a manic state). However, if we conceive of the affective dimension of depression as a decrease in the degree to which one is situated in and attune to the world through moods, and the affective dimension of mania as an increase in the degree to which one is situated in and attuned to the world through moods, then the particular mood one finds oneself in is simply irrelevant to the diagnosis of either depression or mania. As a result, the manifestation of any particular moods in what otherwise seems to be a pure manic or depressive episode does not constitute a mixed state. (shrink)

Despite the recent proliferation of scientific, clinical, and narrative accounts of auditory verbal hallucinations, the phenomenology of voice hearing remains opaque and undertheorized. In this article, we outline an interdisciplinary approach to understanding hallucinatory experiences which seeks to demonstrate the value of the humanities and social sciences to advancing knowledge in clinical research and practice. We argue that an interdisciplinary approach to the phenomenology of AVH utilizes rigorous and context-appropriate methodologies to analyze a wider range of first-person accounts of AVH (...) at 3 contextual levels: cultural, social, and historical; experiential; and biographical. We go on to show that there are significant potential benefits for voice hearers, clinicians, and researchers. These include informing the development and refinement of subtypes of hallucinations within and across diagnostic categories; “front-loading” research in cognitive neuroscience; and suggesting new possibilities for therapeutic intervention. In conclusion, we argue that an interdisciplinary approach to the phenomenology of AVH can nourish the ethical core of scientific enquiry by challenging its interpretive paradigms, and offer voice hearers richer, potentially more empowering ways to make sense of their experiences. (shrink)

I argue that we find the articulation of a problem concerning bodily agency in the early works of the Merleau-Ponty which he explicates as analogous to what he explicitly calls the problem of perception. The problem of perception is the problem of seeing how we can have the object given in person through it perspectival appearances. The problem concerning bodily agency is the problem of seeing how our bodily movements can be the direct manifestation of a person’s intentions in the (...) world. In both cases what, according to Merleau-Ponty, obscures a recognition of the phenomenon in question is a conception of our bodily capacities, i.e. our sensibility and our motility, which reduces these to the workings of mechanisms that are blind to meaning. I argue that both the problem concerning perception and the problem concerning bodily agency can be properly called transcendental. The problem of perception is transcendental because it concerns the very intelligibility of appearances and judgements with empirical content. The problem of bodily agency is transcendental in the sense that it concerns the very intelligibility of our bodily capacity to carry out intentions and by implication the intelligibility of our intentions as such. (shrink)

In this paper I offer an alternative phenomenological account of depression as consisting of a degradation of the degree to which one is situated in and attuned to the world. This account contrasts with recent accounts of depression offered by Matthew Ratcliffe and others. Ratcliffe develops an account in which depression is understood in terms of deep moods, or existential feelings, such as guilt or hopelessness. Such moods are capable of limiting the kinds of significance and meaning that one can (...) come across in the world. I argue that Ratcliffe’s account is unnecessarily constrained, making sense of the experience of depression by appealing only to changes in the mode of human existence. Drawing on Merleau-Ponty’s critique of traditional transcendental phenomenology, I show that many cases of severe psychiatric disorders are best understood as changes in the very structure of human existence, rather than changes in the mode of human existence. Working in this vein, I argue that we can make better sense of many first-person reports of the experience of depression by appealing to a loss or degradation of the degree to which one is situated in and attuned to the world, rather than attempting to make sense of depression as a particular mode of being situated and attuned. Finally, I argue that drawing distinctions between disorders of structure and mode will allow us to improve upon the currently heterogeneous categories of disorder offered in the DSM-5. (shrink)

This paper addresses the phenomenology of bodily feeling in depersonalization disorder. We argue that not all bodily feelings are intentional states that have the body or part of it as their object. We distinguish three broad categories of bodily feeling: noematic feeling, noetic feeling, and existential feeling. Then we show how an appreciation of the differences between them can contribute to an understanding of the depersonalization experience.

We report on an interview-based study of decision-making capacity in two classes of patients suffering from depression. Developing a method of second-person hermeneutic phenomenology, we articulate the distinctive combination of temporal agility and temporal inability characteristic of the experience of severely depressed patients. We argue that a cluster of decision-specific temporal abilities is a critical element of decision-making capacity, and we show that loss of these abilities is a risk factor distinguishing severely depressed patients from mildly/moderately depressed patients. We explore (...) the legal and clinical consequences of this result. (shrink)

This paper explores the question concerning the relationship between basic and higher layers of experience and self-experience. The latter distinction implicitly presupposes the idea of a univocal foundation. After explaining the formal ontological law of foundation, an attempt is made to clarify how the idea of foundation may be suitable to understand the relationship among moments, or layers, of self-experience. To this aim, the phenomenological descriptions of self- and world-experience in dementia and schizophrenia are compared. The comparison between these two, (...) in many ways radically different, pathologies allows us to highlight both the potentialities and the limits of resorting to the foundational relationship for the description of lived experience. Taking the challenges coming from the description of dementia and schizophrenia into serious consideration, the meaning of the “stratified” account of self-experience will be eventually reassessed, and a way to complement the idea of foundation among layers will be proposed. (shrink)

In this paper, we draw on developmental findings to provide a nuanced understanding of background emotions, particularly those in depression. We demonstrate how they reflect our basic proximity (feeling of interpersonal connectedness) to others and defend both a phenomenological and a functional claim. First, we substantiate a conjecture by Fonagy & Target (International Journal of Psychoanalysis 88(4):917–937, 2007) that an important phenomenological aspect of depression is the experiential recreation of the infantile loss of proximity to significant others. Second, we argue (...) that proximity has a particular cognitive function that allows individuals to morph into a cohesive dyadic system able to carry out distributed emotion regulation. We show that elevated levels of psychological suffering connected to depressive background emotions may be explained not only in terms of a psychological loss, but also as the felt inability to enter into dyadic regulatory relations with others—an experiential constraint that decreases the individual’s ability to adapt to demanding situations. (shrink)

The paper first introduces the concept of implicit and explicit temporality, referring to time as pre-reflectively lived vs. consciously experienced. Implicit time is based on the constitutive synthesis of inner time consciousness on the one hand, and on the conative–affective dynamics of life on the other hand. Explicit time results from an interruption or negation of implicit time and unfolds itself in the dimensions of present, past and future. It is further shown that temporality, embodiment and intersubjectivity are closely connected: (...) While implicit temporality is characterised by tacit bodily functioning and by synchronisation with others, explicit temporality arises with states of desynchronisation, that is, of a retardation or acceleration of inner time in relation to external or social processes. These states often bring the body to awareness as an obstacle as well. On this basis, schizophrenia and melancholic depression are investigated as paradigm cases for a psychopathology of temporality. Major symptoms of schizophrenia such as thought disorder, thought insertion, hallucinations or passivity experiences may be regarded as manifesting a disturbance of the constitutive synthesis of time consciousness, closely connected with a weakening of the underlying pre-reflective self-awareness or ipseity. This results in a fragmentation of the intentional arc, a loss of self-coherence and the appearance of major self-disturbances. Depression, on the other hand, is mostly triggered by a desynchronisation from the social environment and further develops into an inhibition of the conative–affective dynamics of life. As will be shown, both mental illnesses bear witness of the close connection of temporality, embodiment and intersubjectivity. (shrink)

While there is a great diversity of treatments of other minds and inter-subjectivity within both analytic and continental philosophy, this article specifies some of the core structural differences between these treatments. Although there is no canonical account of the problem of other minds that can be baldly stated and that is exhaustive of both traditions, the problem(s) of other minds can be loosely defined in family resemblances terms. It seems to have: (1) an epistemological dimension (How do we know that (...) others exist? Can we justifiably claim to know that they do?); (2) an ontological dimension that incorporates issues having to do with personal identity (What is the structure of our world such that inter-subjectivity is possible? What are the fundamental aspects of our relations to others? How do they impact upon our self-identity?); and (3) A conceptual dimension in that it depends on one's answer to the question what is a mind (How does the mind – or the concept of 'mind'– relate to the brain, the body and the world?). While these three issues are co-imbricated, I will claim that analytic engagements with the problem of other minds focus on (1), whereas continental philosophers focus far more on (2). In addition, this article will also point to various other downstream consequences of this, including the preoccupation with embodiment and forms of expressivism that feature heavily in various forms of continental philosophy, and which generally aim to ground our relations with others in a pre-reflective manner of inhabiting the world that is said to be the condition of reflection and knowledge. (shrink)

The concept of bodily doubt has been proposed as a model for describing the experience of illness. According to this model, bodily doubt determines any experience of illness, whether somatic or mental. However, the phenomenology of mental disorders presents a series of experiential disturbances beyond doubt at the bodily level. The hypothesis to be investigated in this article concerns the formulation of an adequate concept of doubt from the point of view of these disorders. Often, psychiatric patients experience their condition (...) of suffering primarily in terms of a doubt about the totality of their experiences, and not just in relation to the bodily aspect. On the other hand, cognitive, affective and behavioural elements also play a fundamental role in determining mental disorders. In order to identify the peculiarities of the notion of doubt in this context, this paper sets out to reconstruct and analyze the phenomenological literature on somatic and mental illness, as well as non-reductionist approaches to cognition (4EA) and its disorders. (shrink)

1. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), anxiety and phobias are common in schizophrenia, and anxiety is often part of the dysphoric mood (A...

In this paper, I will provide a phenomenological analysis of somatic obsessions at times present in obsessive–compulsive disorder. I will compare two different types of bodily obsessions, which have a different neurological-physiological underpinning: anguishing awareness of one’s own heartbeat and of one’s own breathing. In addition, I will contrast these two with how one experiences one’s own liver. I will use the concepts "tactility obsessions” and "motility obsessions”, which I have coined for the purpose of this comparison. In other words, (...) these are obsessions concerning the felt sense of one’s autonomous organs and obsessions concerning one’s ability to voluntarily move. Ultimately, I claim that the core lived experience in somatic obsessive–compulsive disorder should not only be understood as having to do with intruding and "distorted thoughts” concerning bodily processes, but could also be understood as having to do with a felt sense of our organs interrupting and intruding our daily lives. (shrink)

This paper will philosophically extend Julian Leff’s Avatar therapy paradigm (AT) for voice-like hallucinations that was initially proposed for treatment-resistant Schizophrenia patients into the realm of gesture-enhanced embodied cognition and Virtual Reality (VR), entitled g+TA (gesture-enhanced Avatar Therapy). I propose an philosophy of technology approach of embodied rhetorics of triadic kinetic “actions” in the sense of Charles Sanders Peirce that transforms the voice hallucination incorporated by an avatar- and that can confront acousmatic voice-like hallucinations with a method of gesture synchronization (...) and dyssynchronization and gestural refusal of interaction that the player with the Avatar can resist in full embodiment. This paper therefore introduces a gesture-enhanced, extended version of Cybertherapy with Avatars that tackle multimodal bodily experience of voice-like hallucinations beyond mere visual or auditory stimulation. This is put forward theoretically in a 4E-cognition approach that expands Avatar Therapy with gestures into VR. (shrink)

There has recently been a resurgence of philosophical and scientific interest in the foundations of self-consciousness, with particular focus on its altered, anomalous forms. This paper looks at the altered forms of self-awareness in Depersonalization Disorder (DPD), a condition in which people feel detached from their self, their body and the world (Derealisation). Building upon the phenomenological distinction between reflective and pre-reflective self-consciousness, we argue that DPD may alter thetransparencyof basic embodied forms of pre-reflective self-consciousness, as well as the capacity (...) to flexibly modulate and switch between the reflective and pre-reflective facets of self-awareness. Empirical evidence will be invoked in support of the idea that impaired processing of bodily signals is characteristic of the condition. We provide first-hand subjective reports describing the experience of self-detachment or fracture between an observing and an observed self. This split is compared with similar self-detachment phenomena reported in certain Buddhist-derived meditative practices. We suggest that these alterations and changes may reveal the underlying and tacit transparency that characterises the embodied and basic pre-reflective forms of self-consciousness, in the same way that a crack in a transparent glass may indicate the presence of an unnoticed window. (shrink)

According to constitution views of persons, we are constituted by spatially coinciding human animals. Constitution views face an ‘overpopulation’ puzzle: if the animal has my brain, there is another thinker where I am. An influential solution to this problem distinguishes between derivative and non‐derivative property possession: persons non‐derivatively have their personal properties, while inheriting others from their constituters. I will show that this solution raises a new problem, by constructing a puzzle with the absurd result that we instantiate certain properties (...) incompatibly. In setting up the puzzle, I demonstrate the relevance of the bodily awareness and self‐awareness literatures to overpopulation puzzles. (shrink)

This paper utilizes the enactivist notion of ‘sense-making’ to discuss the nature of depression and examine some implications for treatment. As I understand it, sensemaking is fully embodied, fundamentally affective, and thoroughly embedded in a social environment. I begin by presenting an enactivist conceptualization of affective intentionality and describing how this general mode of intentional directedness to the world is disrupted in cases of major depressive disorder. Next, I utilize this enactivist framework to unpack the notion of ‘temporal desituatedness,’ and (...) maintain that the characteristic symptoms of depression result from a disruption to the future-directed structure of affective intentionality. This can be conceptualized as a loss of “online intelligence” and a shrinking of the field of affordances. Then, I argue that two of the standard modes of treatments for depression, medication and cognitive behavioral therapy, are not fully sufficient means of restoring online intelligence, and that these limitations stem partly from the approaches’ implicit commitment to a brain-bound, overly cognitivist view of the mind. I recommend expressive arts interventions such as dance-movement therapy and music therapy as important supplementary treatment methods that deserve further consideration. Insofar as they revitalize subjects’ bodies and emotions, cultivate an openness to the future, and promote self-insight and social synchrony, these treatment modes not only reflect key insights of enactivism, but also offer great potential for lasting healing. (shrink)

In this contribution, I refer to a discussion between Jürgen Habermas and Robert Brandom on the latter’s normative pragmatics as advanced in Making it Explicit. Parting with Habermas, I intend to show that though both normative pragmatics and formal pragmatics postulate similar discursive ideals, the former, as compared with the latter, is not a particularly well-calibrated critical tool. I argue that whereas Brandom focuses on making conceptual norms explicit, and takes mutual recognition among participants to a linguistic practice for granted, (...) Habermas proposes a universal frame of reference, which delineates what should be taken as a paradigm case of perception and action, and thus a normative standard according to which all kinds of human endeavors can be judged. Thus construed, the formal frame of reference points to possible perceptual distortions along any of the three dimensions: the subjective, social, and objective worlds. (shrink)

The structure of human embodiment is fundamentally characterized by a polarity or ambiguity between Leib and Körper, the subjective body and the objectified body, or between being-body and having-a-body. This ambiguity, emphasized, above all, by Helmuth Plessner and Maurice Merleau-Ponty, is also of crucial significance for psychopathology. Insofar as mental illnesses disturb or interrupt the unhindered conduct of one’s life, they also exacerbate the tension within embodiment that holds between being-body and having-a-body. In mental illnesses, there is a failure of (...) tacit mediations upon which one’s bodily being-toward-the-world is based. Instead of serving as a medium of relating to the world, the body makes .. (shrink)

This paper has three interdependent aims. The first is to make Reichenbach’s views on induction and probabilities clearer, especially as they pertain to his pragmatic justification of induction. The second aim is to show how his view of pragmatic justification arises out of his commitment to extensional empiricism and moots the possibility of a non-pragmatic justification of induction. Finally, and most importantly, a formal decision-theoretic account of Reichenbach’s pragmatic justification is offered in terms both of the minimax principle and the (...) dominance principle. (shrink)

Fredrik Svenaeus has applied Heidegger’s concept of ‘being-in-the-world’ to health and illness. Health, Svenaeus contends, is a state of ‘homelike being-in-the-world’ characterised by being ‘balanced’ and ‘in-tune’ with the world. Illness, on the other hand, is a state of ‘unhomelike being-in-the-world’ characterised by being ‘off-balance’ and alienated from our own bodies. This paper applies the phenomenological concepts presented by Svenaeus to cases from a study of depression. In doing so, we show that while they can certainly enrich our understanding of (...) depression, they can also reveal a clash between some societal definitions of illness and the individual’s definition. Phenomenological analysis may thus cause us to question what we mean, or think should be meant, by the terms ‘health’ and ‘illness’. (shrink)

Recent editions of diagnostic manuals in psychiatry have focused on providing quick and efficient operationalized criteria. Notwithstanding the genuine value of these classifications, many psychiatrists have argued that the operationalization approach does not sufficiently accommodate the rich and complex domain of patients’ experiences that is crucial for clinical reasoning in psychiatry. How can we increase the role of phenomenology in the process of diagnostic reasoning in psychiatry? I argue that this could be done by adopting a clinical staging approach in (...) diagnostic reasoning in psychiatry. The approach has the resources to include the progressive nature of patients’ experiences to a much greater degree than is currently practiced. It can address the recent plea for increasing the role of phenomenology in psychiatric diagnosis by offering a model for clinical reasoning that goes beyond the operationalized, static criteria of diagnostic manuals, without depriving us of their benefits. (shrink)

The DSM characterizes major depressive disorder partly in temporal terms: the depressive mood must last for at least two weeks, and also must impact the subject "most of the day, nearly every day." However, from the standpoint of phenomenological psychopathology, the long-lasting quality of the condition hardly captures the distinctiveness of depression. While the DSM refers to objective time as measured by clocks and calendars, what is especially striking about depression is the distortions to lived time that it involves. But (...) is there any relation between a) these disruptions to temporal experience and b) the tendency for depressive symptoms to persist and endure? To explore the connection between lived time and objective time, I investigate the embodied and enactive nature of intentionality among subjects suffering from depression. What I call 'affective framing' is a spontaneous, pre-reflective way of filtering information that involves bodily attunement and allows subjects to focus their attention on what they feel is important. I will argue that affective framing ordinarily has a forward-looking temporal structure and a "teleological direction" that is rooted in our embodiment. However, depression involves a distortion in future-directed intentionality, so that a subject becomes temporally desituated and cut off from the future. This contributes to many of the characteristic features of depression, including apparent lack of motivation, inability to imagine future possibilities, alterations in lived time, and a sense that one is "stuck." To gain a better understanding of this disruption to the futuredirected structure of affective framing in cases of depression, I look to concepts from complex dynamic systems theory and the notion of 'habit.' My proposed account aims to shed light on how a disruption to future-directedness impacts bodily attunement and reinforces depression as a long-term condition. (shrink)

In this paper I explore the various meanings of embodiment from a patient’s perspective. Resorting to phenomenology of health and medicine, I take the idea of ‘lived experience’ as starting point. On the basis of an analysis of phenomenology’s call for bracketing the natural attitude and its reduction to the transcendental, I will explain, however, that in medical phenomenological literature ‘lived experience’ is commonly one-sidedly interpreted. In my paper, I clarify in what way the idea of ‘lived experience’ should be (...) revisited and, subsequently, what this reconsideration means for phenomenological research on embodiment in health and medicine. The insight that the body is a condition of possibility for world-disclosing yet, at the same time, itself conditioned by this world forces us to not only zoom in on the body’s subject-side, but also on its object-side. I argue that in order to render account for this double body ontology, phenomenology should include empirical sociological analyses as well. I thus argue in favor of the idea of a socio-phenomenology. Drawing on material from my own research project on embodied self-experiences after breast surgery, I show how this approach can be fruitful in interpreting the impact of disfigurements on a person’s embodied agency, or a person’s ‘I can’. (shrink)

This paper integrates personal narratives with the methods of phenomenology in order to draw some general conclusions about ‘what it means’ and ‘what it feels like’ to be depressed. The analysis has three parts. First, it explores the ways in which depression disrupts everyday experiences of spatial orientation and motility. This disruption makes it difficult for the person to move and perform basic functional tasks, resulting in a collapse or contraction of the life-world. Second, it illustrates how depression creates a (...) situational atmosphere of emotional indifference that reduces the person’s ability to qualitatively distinguish what matters in his or her life because nothing stands out as significant or important anymore. In this regard, depression is distinct from other feelings because it is not directed towards particular objects or situations but to the world as a whole. Finally, the paper examines how depression diminishes the possibility for ‘self-creation’ or ‘self-making’. Restricted by the illness, depression becomes something of a destiny, preventing the person from being open and free to access a range of alternative self-interpretations, identities, and possible ways of being-in-the-world. (shrink)

In this paper, we use a phenomenological approach to compare the unusual ways in which language can be experienced by individuals with schizophrenia or severe mood disorders, specifically mania and melancholia. Our discussion follows a tripartite/dialectical format: first we describe traditionally observed distinctions ; then we consider some apparent similarities in the experience of language in these conditions. Finally, we explore more subtle, qualitative differences. These involve: 1, interpersonal orientation, 2, forms of attention and context-relevance, 3, underlying mutations of experience, (...) and 4, meta-attitudes toward language. Such distinctions appear to reflect significant differences in underlying forms of subjectivity; they are broadly consistent with work in phenomenological psychopathology on other aspects of experience, including body, self, and social world. An understanding of such distinctions may assist with difficult cases of differential diagnosis, while also contributing to a better understanding of suffering persons and of psychological factors underlying their disorders. (shrink)

Among the characteristic features of depression is a diminishment in or lack of action and motivation. In this paper, I consider a dominant philosophical account which purports to explain this lack of action or motivation. This approach comes in different versions but a common theme is, I argue, an over reliance on psychologistic assumptions about action–explanation and the nature of motivation. As a corrective I consider an alternative view that gives a prominent place to the body in motivation. Central to (...) the experience of depression are changes to how a person is motivated to act and, also as central, are changes to bodily feelings and capacities. I argue that broadly characterizing motivation in terms of bodily capacities can, in particular, provide a more compelling account of depressive motivational pathology. (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)

Guided by a phenomenological perspective, this paper aims to account for the existence of a corporeal consciousness—something that clinicians should take into account, not merely in the case of physical pathologies but especially in the case of mental disorders. Firstly, I will highlight three cases: schizophrenia, depression, and autism spectrum disorder. Then, I will show how these cases correspond to three different kinds of bodily existence: disembodiment (in the case of schizophrenia), chrematization (in melancholic depression), and dyssynchrony (in the autism (...) spectrum disorder). Finally, I will argue for the importance of an “expressive common environment” between the patient and the clinician, who are two distinct, embodied conscious subjects resonating with one another. In this view, the primary goal of the therapeutic process seems to develop a shared understanding of the patient’s life-world, which finds its main expression through the disrupted body. (shrink)

In recent years, the societal and personal impacts of pain, and the fact that we still lack an effective method of treatment, has motivated researchers from diverse disciplines to try to think in new ways about pain and its management. In this paper, we aim to develop an enactive approach to pain and the transition to chronicity. Two aspects are central to this project. First, the paper conceptualizes differences between acute and chronic pain, as well as the dynamic process of (...) pain chronification, in terms of changes in the field of affordances. This is, in terms of the possibilities for action perceived by subjects in pain. As such, we aim to do justice to the lived experience of patients as well as the dynamic role of behavioral learning, neural reorganization, and socio-cultural practices in the generation and maintenance of pain. Second, we aim to show in which manners such an enactive approach may contribute to a comprehensive understanding of pain that avoids conceptual and methodological issues of reductionist and fragmented approaches. It proves particularly beneficial as a heuristic in pain therapy addressing the heterogenous yet dynamically intertwined aspects that may contribute to pain and its chronification. (shrink)

Major depression is a prevalent mental disorder that leads to persistent negative mood and tremendous suffering in affected individuals. However, the biological realization of this disorder and associated symptom clusters remain poorly understood. Recently, phenomenological accounts of major depressive disorder and contributions to the emerging predictive processing account have provided valuable insights into the phenomenological and neuro-functional components that lead to manifestations of major depressive episodes. The purpose of this paper is to weave together these different strands of research to (...) develop a predictive processing account of major depressive disorder. In doing so, I will relate personal-level descriptions of associated phenomenal experiences to a sub-personal-level predictive processing account of the functional realization of major depression. I will argue that pervasive symptoms of the disorder, which include a diminished sense of agency, fatigue, social withdrawal, and rumination, are integrated by existential feelings of loss and impossibility. These phenomenal experiences, I will argue, are associated with dysfunctional processes of prediction error minimization, which are characterized by an overall decrease of the causal contributions of active inference and by distorted precision estimates. The emerging account promises to contribute to a better understanding of the complex processes that give rise to depressive experiences. (shrink)

Despite its complex experiential structure, the phenomenon of grief following bereavement has not been a major topic of phenomenological research. The paper investigates its basic structures, elaborating as its core characteristic a conflict between a presentifying and a ‘de-presentifying’ intention: In grief, the subject experiences a fundamental ambiguity between presence and absence of the deceased, between the present and the past, indeed between two worlds he lives in. This phenomenological structure will be analyzed under several aspects: regarding bodily experience, as (...) disruption of a shared intercorporeality; as a loss of the shared world and shared habitualities, leaving the bereaved person with ubiquitous indications of absence and with a contraction of their own self; regarding temporality, as a separation of two strands of time, namely a still ongoing past and an alienated present which become more and more desynchronized; finally, as an “as-if presence” of the deceased which the bereaved continue to feel and sometimes to perceive, leading to a cognitive-affective conflict between two experienced realities. The transforming process of grief is then analyzed as a gradual adjustment to the loss, finally enabling a re-integration of the conflicting realities. This is achieved through an incorporation and identification with the deceased on the one hand, and through various forms of representation on the other hand, in particular by recollection and symbolization. (shrink)