In recent years, autopoietic enactivism has been used to address persistent conceptual problems in psychiatry, such as the problem of demarcating disorder, that other models thus far have failed to overcome. There appear to be three main enactive accounts of psychopathology with subtle, although not incompatible, differences: Maiesecharacterizes disorder as distinct disruptions in autonomy and agency; Nielsen characterizes disorder as behaviors that relevantly conflict with the functional norms of an individual; De Haan emphasizes patterns of disordered sense-making, that are transformed (...) through the existential dimension. Given that these accounts are intended to provide not only an ontologically richer account of psychopathology but also reduce the stigma experienced by individuals with mental disorders by accounting for lived experience, a critical analysis of these approaches is needed. I will provide a problematization of enactive accounts of mental disorder, showing that this particular framework does not, as it stands, necessarily reduce the harm and suffering experienced by individuals with mental disorder because of its ontological openness; enactivism leaves much to be interpreted and applied by the clinician (or patient) such that practical and ethical problems in its use arise. (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)

This paper argues that existing accounts of shame are incomplete in so far as they don’t take account of the problem of shame. This is the problem concerning the possibility of a primary experience...

This article examines the phenomenology of body shame in the context of the clinical encounter, using the television program ‘Embarrassing Bodies’ as illustrative. I will expand on the insights of Aaron Lazare’s 1987 article ‘Shame and Humiliation in the Medical Encounter’ where it is argued that patients often see their diseases and ailments as defects, inadequacies or personal shortcomings and that visits to doctors and medical professionals involve potentially humiliating physical and psychological exposure. I will start by outlining a phenomenology (...) of shame in order to understand more clearly the effect shame about the body can have in terms of one’s personal experience and, furthermore, one’s interpersonal dynamics. I will then examine shame in the clinical encounter, linking body shame to the cultural stigma attached to illness, dysfunction and bodily frailty. I will furthermore explore how shame can be exacerbated or even incited by physicians through judgment and as a result of the power imbalance inherent to the physician-patient dynamic, compounded by the contemporary tendency to moralise about ‘lifestyle’ illnesses. Lastly, I will provide some reflections for how health care workers might approach patient shame in clinical practice. (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)

The aim of this article is to explore bodily changes following weight loss surgery. Our empirical material is based on individual interviews with 22 Norwegian women. To further analyze their experiences, we build primarily on the phenomenologist Drew Leder`s distinction between bodily dis-appearance and dys-appearance. Additionally, our analysis is inspired by Simone de Beauvoir, Merleau-Ponty and Julia Kristeva. Although these scholars have not directed their attention to obesity operations, they occupy a prime framework for shedding light on different dimensions of (...) bodily change. In doing so, we were able to identify two main themes: The felt “inner” body versus the visible “surface” body and the “old” body versus the “new” body. In different, though interconnected ways, these main themes encompass tensions between changes the women experienced as contributing to a more “normal” and active life, feeling more accepted, and changes that generated ambivalence. In particular, their skin became increasingly problematic because it did not “shrink” like the rest of the body. On the contrary, it became looser and looser. Moreover, badsmelling folds of skin that wobbled, sweated and chafed at the smallest movement, aprons of fat hanging in front of their stomachs, batwing arms, thick flabby thighs and sagging breasts were described as a huge contrast to the positive response they received to their changed body shape when they were out and about with their clothes on. At the same time, they expressed ambivalence with regards to removing the excess skin by means of plastic surgery. Through their own and other women`s experiences they learned removing the excess skin by means of surgery could be a double-edged sword. By illuminating the experiences of the ones undergoing such changes our article offers new insight in a scholarly debate predominated by medical research documenting the positive outcomes of weight loss surgery. (shrink)

Given the residual homonegativity in evidence throughout our diverse communities, and given the large numbers of gay people who remain “in the closet”, it is critical that we seek to understand in greater depth the complexities of the coming-out process with a view to dispelling some of the confusion relating to sexual identity. Internalised homophobia is more widespread than generally acknowledged, and it manifests in a variety of ways, including the sociological phenomenon of gay men remaining closeted until well into (...) middle age. This article applies a hermeneutic phenomenological lens to examine the process of realisation, where an individual gradually becomes aware of his sexual orientation, and eventually acknowledges to himself that he is gay. This process can take decades. For this research project, twelve participants (gay men who have come out after the age of 40) from Aotearoa New Zealand willingly shared intensely personal accounts of their lived experiences. The findings indicate that individuals experience clarity about same-sex attraction in strikingly different ways. This study helps us to understand the difficulties faced by men who have lived the majority of their lives as “straight”, then in middle age find themselves having to negotiate the tortuous terrain between heterosexuality and a new gay identity. (shrink)

This essay explores the unique temporal experience in anxiety. Drawing on first-person accounts as well as examples from literature, I attempt to show how anxiety not only disrupts our physiological and cognitive timing but also disturbs the embodied rhythms of everyday social life. The primary goal, however, is to articulate the extent to which human existence itself is a temporally structured event and to identity the ways that anxiety disrupts this structure. Using Martin Heidegger’s account of human existence as a (...) point of departure, I show how the mood of anxiety has the power to alter our self-interpretations by closing down or constricting our experience of the future. I argue that a constricted future impedes our ability ‘to be’ because it closes off the range of projective meanings that we would ordinarily draw on to create or fashion our identities. (shrink)

This essay explores the unique temporal experience in anxiety. Drawing on first-person accounts as well as examples from literature, I attempt to show how anxiety not only disrupts our physiological and cognitive timing but also disturbs the embodied rhythms of everyday social life. The primary goal, however, is to articulate the extent to which human existence itself is a temporally structured event and to identity the ways that anxiety disrupts this structure. Using Martin Heidegger’s account of human existence as a (...) point of departure, I show how the mood of anxiety has the power to alter our self-interpretations by closing down or constricting our experience of the future. I argue that a constricted future impedes our ability ‘to be’ because it closes off the range of projective meanings that we would ordinarily draw on to create or fashion our identities. (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)

It is generally maintained that emotions consist of intentional states and /or bodily feelings. This paper offers a phenomenological analysis of guilt in severe depression, in order to illustrate how such conceptions fail to adequately accommodate a way in which some emotional experiences are said to be deeper than others. Many emotions are intentional states. However, I propose that the deepest emotions are not intentional but pre-intentional, meaning that they determine which kinds of intentional state are possible. I go on (...) to suggest that pre-intentional emotions are at the same time feelings. In so doing, I reject the distinction that is often made between bodily feelings and the world-oriented aspects of emotion. (shrink)

Obstetric violence—violence in the labor room—has been described in terms not only of violence in general but specifically of gender violence. We offer a philosophical analysis of obstetric violence, focused on the central role of gendered shame for construing and perpetuating such violence. Gendered shame in labor derives both from the reifying gaze that transforms women's laboring bodies into dirty, overly sexual, and “not‐feminine‐enough” dysfunctional bodies and from a structural tendency to relate to laboring women mainly as mothers‐to‐be, from whom (...) “good motherhood” is demanded. We show that women who desire a humane birth are thus easily made to feel ashamed of wanting to be respected and cared for as subjects, rather than caring exclusively for the baby's well‐being as a good altruistic mother supposedly should. We explore how obstetric violence is perpetuated and expanded through shaming mechanisms that paralyze women, rendering them passive and barely able to face and fight against this violence. Gendered shame has a crucial role in returning women to “femininity” and construing them as “fit mothers.” To stand against gendered shame, to resist it, on the other hand, is to clearly challenge obstetric violence and its oppressive power. (shrink)

After 50 years of being profoundly deaf, Patricia finds her world ‘transformed’—literally and metaphorically—when she receives a cochlear implant. Her sense of self and the taken-for-granted, comfortable world she knew before surgery disappear and she is thrown into an alien, surreal existence full of hyper-noise. Entry into this new world of sounds proves a mixed blessing as Pat struggles to come to terms with her changing relationships, not only with others but also with herself. On good days, she is exhilarated (...) by all her sensory gains and her feeling of being more connected with and to the world. On bad days she is distracted and overwhelmed by the intrusive noise and she is forcibly confronted with the painful reality of her own disability. The challenge she confronts is not simply the cognitive-perceptual one of learning to discriminate between sounds. Pat must also re-orientate herself and learn to cope with her transformed self and world. She must undertake a journey to come to terms with her past, present and future being. Pat shared her story with me and together we undertook collaborative existential phenomenological research, co-creating a narrative of her journey over the year and a half following her implant. This paper presents this narrative followed by an existential analysis of Pat’s disrupted, changing lifeworld. (shrink)

This paper discusses the findings of qualitative research that examined the accounts of five “mostly recovered” ex-patients who had experienced transition between two or more eating disorder diagnoses. This study found that, in the minds of participants, the different diagnostic labels were associated with various good or bad character traits. This contributed to the belief in a diagnostic hierarchy, whereby individuals diagnosed with anorexia nervosa were viewed as morally better than those diagnosed with bulimia nervosa or binge eating disorder. Consequently, (...) diagnostic crossover from a “better” to a “worse” eating disorder was often experienced as shameful moral failing, and a new diagnosis impacted the individual’s sense of self-identity. These findings are of significance for both ethicists and clinicians; the paper concludes by outlining the relevance and possible clinical implications of shame in diagnostic crossover and suggesting avenues for future research. (shrink)

ABSTRACT Current attempts to understand unusually high rates of psychiatric illness in complex, chronic illnesses can be guilty of operating within an explanatory framework whereby there are two options. Either (a) that the psychiatric predicaments are secondary to the bodily condition, and (b) that they are primary. In this paper, I draw upon philosophical work on affect, contemporary empirical work, and qualitative first-person patient data to illustrate a much messier reality. I argue that affective experience is generally more complex in (...) such conditions, and that a variety of pre- and post-morbid causal factors dynamically interact such that the resultant psychiatric predicaments do not permit to classification as strictly primary or secondary to the bodily condition. Affective scaffolding, in my view, provides an apt theoretical framework for capturing this nuance. (shrink)

In this paper, I develop a phenomenological account of social anxiety disorder (SAD) as a disturbance of lived time through an analysis of first-person accounts informed by Minkowski’s notion of disordered temporality. The core psychopathology of the patient, I argue, is a constricted sense of relational time. Instead of the ordinary sense of a taken-for-granted shared future, the patient experiences time as running a predetermined course toward their social death. This manifests itself in a relational life lived as if it (...) might end at any moment or has already done so. Patients describe the end of their current relationships as self-evident and struggle against it by attempting to evade its immediate occurrence and to postpone it into the less eminent future. At times, patients succumb to passivity and self-blame, revelatory of a sense of an entirely lacking relational future. This phenomenological conceptualization provides an alternative to the predominant cognitive-behavioral (CBT) account of SAD. The CBT approach conceptualizes the core disorder as a set of dysfunctional beliefs about other people’s opinion of the patient. The phenomenological account elucidates a part of the subjective background on which these beliefs come to make sense to the patient. Further, with its concept of social death, the phenomenological account captures the existential contexts, which makes the intensity of the patient’s fear of rejection comprehensible. This way of understanding the patient and their psychopathology has important implications for diagnostic and psychotherapeutic practice. (shrink)

Cognitive theory (CT) is currently the most widely acknowledged framework used to describe the psychological processes in affective disorders like depression. The purpose of this paper is to assess the philosophical assumptions upon which CT rests. It is argued that CT must be revised due to significant flaws in many of these philosophical assumptions. The paper contains suggestions as to how these problems could be overcome in a manner that would secure philosophical accuracy, while also providing an account that is (...) better suited to explaining some of the cognitive, emotional, and bodily manifestations of affective disorders. (shrink)

During the pandemic of Covid-19, internet-based communication became for many the primary, or only, means of interaction with others, and it has been argued that this had a host of negative effects on emotional and mental health. However, some people with a lived experience of mental ill-health also perceived improvements to their wellbeing during the period in which social activities were moved online. In this paper, I explore the possibility that some of these improvements are due to the partial “disembodiment” (...) of emotions facilitated by internet-mediated interaction. In particular, I consider the phenomenology of social anxiety and how it may be impacted upon by encountering others primarily through the medium of internet-enabled technology. I will start by reconstructing a phenomenological account of social anxiety to which disruptions of bodily experience are central. I will then move to consider how the experiential dynamics that are particularly prominent in social anxiety can be weakened when communicating with others via video calls, instant messages, and social media more broadly. I will suggest that this is the case due to the diminished visibility of the body online, and the higher degree of control and agency over one’s experience that can be exercised in this context. Finally, I will argue that the weakening of social anxiety through internet-mediated contact exemplifies some of the processes which are key to emotion regulation more widely, thus suggesting that communication and interaction online could have a positive effect on a wider range of affective disturbances. (shrink)