Drawing on Latin treatises, letters, and autobiographical writings, this article outlines the changes in the—thoroughly somatic—learned medical understanding of the emotions (or “affectus/passiones...

The frequent occurrence of comorbidity has brought about an extensive theoretical debate in psychiatry. Why are the rates of psychiatric comorbidity so high and what are their implications for the ontological and epistemological status of comorbid psychiatric diseases? Current explanations focus either on classification choices or on causal ties between disorders. Based on empirical and philosophical arguments, we propose a conventionalist interpretation of psychiatric comorbidity instead. We argue that a conventionalist approach fits well with research and clinical practice and resolves (...) two problems for psychiatric diseases: experimenter’s regress and arbitrariness. (shrink)

Fechner's conception of psychophysics included both “outer psychophysics” the relation between stimulus intensity and the response reflecting sensation strength, and “inner psychophysics” the relation between neurelectric responses and sensation strength. In his own time outer psychophysics focussed on the form of the psychophysical law, with Fechner espousing a logarithmic law, Delboeuf a variant of the logarithmic law incorporating a resting level of neural activity, and Plateau a power law. One of the issues on which the dispute was focussed concerned the (...) appearance of contrasts if the overall illumination was increased or decreased; another issue was the question of whether a sensation of a “just noticeable difference” established for one value of a sensory dimension appeared the same for a value elsewhere on the dimension. The development of “inner psychophysics” led through the works of Delboeuf, Solomons, Jastrow, and Thurstone to modern signal detection theory. A third line of research, devoted to the question of what was meant by the “measurement” of sensation strength, stemmed from the criticism of Fechner's work by von Kries (1882) and others. Although a valid body of science could be built up without the intervening variable called “sensation strength,” such a science might be a cumbersome representation of reality. When an optical contrast is set up, and its overall illumination is increased or decreased, subjective contrasts involving medium levels of lightness vary little as illumination varies (as a power law based on sensation ratios or a logarithmic law based on sensation differences predict), but subjective contrasts involving extreme levels of lightness might be subject to the effects of other variables. (shrink)

This dissertation in Theory of Practical Knowledge contends that depression is a disorder of the self. Using the existential-phenomenology of Maurice Merleau-Ponty, I argue that if we want to disclose the basic structure of depressed experience, then we must likewise disclose how selfexperience is inseparable from depressed experience. However, even though depression is a contemporary psychiatric category of illness, it is nevertheless a historically and heterogenous concept. To make sense of depression in the context of contemporary psychiatric practice, I show (...) that depression has historically been characterized by two broad models of causation; that is, a phenomenon that is causally explained by either a biological dysfunction or a psychological conflict. But this stark characterization is not limited just to history; by conducting qualitative interviews with psychiatric professionals, I illustrate how this causal dichotomy remains prevalent in contemporary psychiatric practice. On one hand, the clinicians report dissatisfaction with the depression diagnostic criteria (i.e. it is impersonal or vague), while on the other hand, the clinicians also recognize that a depression diagnosis is useful insofar as a diagnosis facilitates access to various resources associated with psychiatric care. Consequently, clinicians have developed a coping strategy that is witnessed in their empathetic desire to distance patients from their depression diagnosis, which led to statements such as, “you are not the problem, the problem is depression.” One consequence of this approach is that depression is artificially cleaved from the person who experiences depression, which subsequently means that depression is viewed to be something independent of oneself. Because I argue that depression and the self are mutually implicated, it is crucial to disseminate some of the most influential contemporary models of selfhood. I show that the brainbound, situated, psychological, and narrative model of self, all have respective strengths and weaknesses. But I also go beyond these models and characterize selfhood as a developmental phenomenon that is expressed as an embodied-style. This style reflects the way in which we establish perceptual contact with the otherness, without which there could be no self-experience. (shrink)

Pictures in historical chapters of textbooks convey information about the values and assumptions of the authors’professions and the larger culture. We scrutinized 15 recent abnormal psychology textbooks for reproductions of art created before 1900. Thirteen works appeared in three or more textbooks. Overall, these pictures support a “Whiggish” account of history that celebrates the present and gives a distorted, incomplete rendering of the past. The 13 pictures tended to depict the mentally ill as an underclass who are released from their (...) literal and metaphorical shackles by men who are “ahead of their time” in their struggles against prevailing ignorance. The pictures also emphasized the difference of the mentally ill by presenting a catalogue of stereotypic visual elements attributed to insanity throughout Western history. We argue for the inclusion in textbooks of “history for the sake of the past” as a way of genuinely engaging different ideologies and thereby stimulating interest in our own implicit values and biases. (shrink)

ArgumentThis paper considers how certain ideas elaborated by the Montpellier vitalists influenced the rise of French alienism, and how those ideas framed the changing view of passions during the eighteenth century. Various kinds of evidence attest that the passions progressively became the focus of medical attention, rather than a theme specific to moralists and philosophers. Vitalism conceived of organisms as animal economies understandable through the transformations of the various modes of their sensibility. This allowed some physicians to define a kind (...) of anthropological program, which viewed human beings as a whole, with no distinction betweenle physiqueandle moral. The passions in this context became a specific alteration of the animal economy. Such an anthropological program was the framework within which Pinel understood the various classes of madness as disease – those troubles being general disturbances of the animal economy, which presupposed a knowledge of the latter, to be addressed and cured. In this view, and departing from the vitalist writers with regard to the specificity of mental illness as such, Pinel proposed another conception of the relations between passions and madness, and elaborated a general view of their status in etiology and therapeutics; those views were taken up and systematized by Esquirol, who finally defined a new kind of continuity between passion and madness, demonstrated by the idea that some kinds of madness that he called “monomania” had as a principle a “ruling passion” that the alienist, this novel medical specialist, had to unveil and address. (shrink)

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)

The ArgumentMedicine is only a cultural system of its own. It also performs specific roles in the broader culture of society at large. This article examines the role of medical arguments in the critique of“enthusiasm” on the eve of the Enlightenment. The enthusiasts, who claimed to prophesy and to have direct divine inspiration, were increasingly see in the seventeenth century as melancholics. With the decline of humoral medicine, however, the account of melancholic disturbances – including enthusiasm – that was offered (...) tended to be chemical, mechanistic, and clearly corpuscular. Protestant ministers, in adopting such an account of enthusiasm, also adopted a strict distinction between the realm of the mind (to which true prophecy belonged) and that of the body (in which they located the phenomena of enthusiasm). Such a distinctions served in turn to demarcate more specifically the limits between the clerical and medical professions. Yet in relegating the treatment of enthusiasts to the physicians, rather than seeing the enthusiasts as heretics, the ministers stood in danger of relying too much on a secular profession and secular arguments, thus paving the way to a more general secularization of the ideological basis of the social order. (shrink)

Humoralism, the view that the human body is composed of a limited number of elementary fluids, is one of the most characteristic aspects of ancient medicine. The psychological dimension of humoral theory in the ancient world has thus far received a relatively small amount of scholarly attention. Medical psychology in the ancient world can only be correctly understood by relating it to psychological thought in other fields, such as ethics and rhetoric. The concept that ties these various domains together is (...) character (êthos), which involves a view of human beings focused on clearly distinguishable psychological types that can be recognized on the basis of external signs. Psychological ideas based on humoral theory remained influential well into the early modern period. Yet, in 17th-century medicine and philosophy, humoral physiology and psychology started to lose ground to other theoretical perspectives on the mind and its relation to the body. This decline of humoralist medical psychology can be related to a broader reorientation of psychological thought in which the traditional concept of character lost its central position. Instead of the focus on types and stable character traits, a perspective emerged that was primarily concerned with individuality and transient passions. (shrink)

Is mental illness an object of knowledge? The history of psychiatry teaches us to doubt it, by emphasizing the infinitely variable and fluctuating character of psychiatric entities. Mental illness is not simply ‘out there’, waiting to be described and theorized by psychiatrists; it interacts with psychiatric theories, clinical entities waxing and waning in accordance with diagnostic fashions, institutional practices and methods of treatment. This should be a warning to psychiatrists and therapists: their intervention is part of the ‘etiological equation’ of (...) the syndromes that they claim to observe from the outside. But this should also be a warning to historians of psychiatry, who can no longer be content with writing the history of ready-made syndromes and psychiatric theories. They must, if they want to remain faithful to their improbable ‘object’, study the complex interactions from which those syndromes and those theories emerge, somewhere between the doctors, the patients and the society that surrounds them. In short, they must study the making of psychiatric history, and understand that they participate in it. (shrink)