Understood in their historical context, current debates about psychiatric classification, prompted by the publication of the DSM-5, open up new opportunities for improved translational research in psychiatry. In this paper, we draw lessons for translational research from three time slices of 20th century psychiatry. From the first time slice, 1913 and the publication of Jaspers’ General Psychopathology, the lesson is that translational research in psychiatry requires a pluralistic approach encompassing equally the sciences of mind (including the social sciences) and of (...) brain. From the second time slice, 1953 and a conference in New York from which our present symptom-based classifications are derived, the lesson is that, while reliability remains the basis of psychiatry as an observational science, validity too is essential to effective translation. From the third time slice, 1997 and a conference on psychiatric classification in Dallas that brought together patients and carers with researchers and clinicians, the lesson is that we need to build further on collaborative models of research combining expertise-by-training with expertise-by-experience. This is important if we are to meet the specific challenges to translation presented by the complexity of the concept of mental disorder, particularly as reflected in the diversity of desired treatment outcomes. Taken together, these three lessons – a pluralistic approach, reliability and validity, and closer collaboration – provide an emerging framework for more effective translation of research into practice in 21st century psychiatry. (shrink)

Recently, many philosophers and psychologists have claimed that the explanation that grounds both passivity phenomena in the cognitive domain and passivity phenomena that occur with respect to overt actions is, along broad lines, the same. Furthermore, they claim that the best account we have of such phenomena in both scenarios is the “comparator” account. However, there are reasons to doubt whether the comparator model can be exported from the realm of overt actions to the cognitive domain in general. There is (...) a lingering worry concerning such explanations of thought insertion: the "What is compared to what?" problem. Here I examine two ways to tackle this problem. First: thought insertion consists of the misattribution of strings of inner speech which are not attenuated (thought insertion is thus another name for auditory verbal hallucinations). Second: thought insertion is misattributed inner speech which exhibits the same phenomenological characteristics as normal inner speech. After explaining the types of problem that each of these potential solutions faces, I conclude with a set of open questions that the comparator theorist has to tackle. (shrink)

This chapter identifies and explores a series of challenges raised by the clinical concept of delusion for theories which conceive autonomy as an agency rather than a status concept. The first challenge is to address the autonomy-impairing nature of delusions consistently with their role as grounds for full legal and ethical excuse, on the one hand, and psychopathological significance as key symptoms of psychoses, on the other. The second challenge is to take into account the full logical range of delusions, (...) which may take the form of true or false factual beliefs, positive or negative evaluations, as well as the paradoxical delusion of mental illness. The third and final challenge is to make room for non-pathological or, autonomy-preserving delusions and to offer a credible way of distinguishing between these and pathological or, autonomy-impairing delusions. By setting out these challenges, we are able to, firstly, distinguish between two separate conceptions of objectivity that may be at work in existing accounts of delusions and, secondly, to put a spotlight on an elusive yet inescapable notion of agential success that underlies our thinking about autonomy as well as mental disorder. (shrink)

In this Introduction, I situate the underlying project “Autonomy and Mental Disorder” with reference to current debates on autonomy in moral and political philosophy, and the philosophy of action. I then offer an overview of the individual contributions. More specifically, I begin by identifying three points of convergence in the debates at issue, stating that autonomy is: 1) a fundamentally liberal concept; 2) an agency concept and; 3) incompatible with (severe) mental disorder. Next, I explore, in the context of decisional (...) capacity assessments, the difficulties to reconcile 1) and 2) with 3) which they at the same time seem to imply. Having clarified the centrality of a cogent notion of mental disorder for addressing these difficulties, I comment on three promising lines of inquiry about the nature and scope of autonomy that emerge from the following chapters. (shrink)

At a time when different groups in society are achieving notable gains in respect and rights, activists in mental health and proponents of mad positive approaches, such as Mad Pride, are coming up against considerable challenges. A particular issue is the commonly held view that madness is inherently disabling and cannot form the grounds for identity or culture. This paper responds to the challenge by developing two bulwarks against the tendency to assume too readily the view that madness is inherently (...) disabling: the first arises from the normative nature of disability judgements, and the second from the implications of political activism in terms of being a social subject. In the process of arguing for these two bulwarks, the paper explores the basic structure of the social model of disability in the context of debates on naturalism and normativism; the applicability of the social model to madness; and the difference between physical and mental disabilities in terms of the unintelligibility often attributed to the latter. (shrink)

How shall we distinguish religious delusion from sane religious belief? Making this determination is not usually found to be difficult in clinical practice – but what shall be our theoretical rationale? Attempts to answer this question often try to provide differentiating principles by which the religious “sheep” may be separated from the delusional “goats.” As we shall see, none of these attempts work. We may, however, ask whether the assumption underlying the search for a differentiating principle – that religious beliefs (...) and religious delusions can usefully be considered species of a common genus – is a good one. In this paper, we outline an alternative, “disjunctive,” understanding of religious belief and religious delusion. By reminding ourselves both of what is central to any delusion and of what distinguishes bona fide religious claims from their pretenders, we show how to resolve our reflective puzzlement about religious delusion without recourse to differentiating principles. (shrink)

In this article I make links between melancholia, creativity and communion with God at a personal level, referencing John’s gospel, ‘God’s house has many rooms’ and ‘The Mansions’, a text written by Theresa of Avila where the ‘mansion’ is an analogy for the space in which God’s omniscient love is realized. My paintings were formed from the day-to-day lived experience of ‘psycheache’ and are a graphic representation of a non-explainable reality. I see in these paintings a transcendent reality for they (...) are the markings I made to express a state-of-being that could not be articulated. During this episode of Depression I painted dark interiors with rambling corridors, flights of steps and doorways leading into rooms empty of people. (shrink)

Studies in the psychology and phenomenology of religious experience have long acknowledged similarities with various forms of psychopathology. Consequently, it has been important for religious practitioners and mental health professionals to establish criteria by which religious, spiritual, or mystical experiences can be differentiated from psychopathological experiences. Many previous attempts at differential diagnosis have been based on limited textual accounts of mystical experience or on outdated theoretical studies of mysticism. In contrast, this study presents qualitative data from contemporary Buddhist meditation practitioners (...) and teachers to identify salient features that can be used to guide differential diagnosis. The use of certain existing criteria is complicated by Buddhist worldviews that some difficult or distressing experiences may be expected as a part of progress on the contemplative path. This paper argues that it is important to expand the framework for assessment in both scholarly and clinical contexts to include not only criteria for determining normative fit with religious experience or with psychopathology, but also for determining need for intervention, whether religious or clinical. Qualitative data from Buddhist communities shows that there is a wider range of experiences that are evaluated as potentially warranting intervention than has previously been discussed. Decision making around these experiences often takes into account contextual factors when determining appraisals or need for intervention. This is in line with person-centered approaches in mental health care that emphasize the importance of considering the interpersonal and cultural dynamics that inevitably constitute the context in which experiences are evaluated and rendered meaningful. (shrink)

Abstract—The issue of the mental state of mediums, and whether experiences considered mediumistic are symptoms of mental disorders, has long been subject to debate. Recent empirical studies may help to shed light on these controversies. As there are only a few studies on the mental health of mediums, findings regarding hallucination and dissociation in non-clinical populations are presented and discussed. Recent studies have not found an association between mediumship and mental disorders. Mediumistic experiences often occur in healthy and well-adjusted subjects. (...) The occurrence of psychotic and/or dissociative experiences alone are not enough for a diagnosis of a mental disorder. It is essential to take into consideration the sociocultural context and the impact of these experiences on a patient’s life. In some cases, the emergence of mediumship may appear in the context of physical and mental symptoms, which poses a challenge for differential diagnosis. Further research is still necessary in order to discover enough elements to make a definitive differential diagnosis between mediumship and mental disorders. Keywords: mediumship—mental health—mental disorders—differential diagnosis. (shrink)

Personal autonomy is often lauded as a key value in contemporary Western bioethics. Though the claim that there is an important relationship between autonomy and rationality is often treated as uncontroversial in this sphere, there is also considerable disagreement about how we should cash out the relationship. In particular, it is unclear whether a rationalist view of autonomy can be compatible with legal judgments that enshrine a patient's right to refuse medical treatment, regardless of whether the reasons underpinning the choice (...) are known and rational, or indeed whether they even exist. Jonathan Pugh brings recent philosophical work on the nature of rationality to bear on the question of how we should understand personal autonomy in contemporary bioethics. In doing so, he develops a new framework for thinking about the concept of autonomy, one that is grounded in an understanding of the different roles that rational beliefs and rational desires have to play in it. Pugh's account allows for a deeper understanding of d the relationship between our freedom to act and our capacity to decide autonomously. His rationalist perspective is contrasted with other prominent accounts of autonomy in bioethics, and the revisionary implications it has for practical questions in biomedicine are also outlined. (shrink)

What would you think if someone told you they heard voices when no one was there, or could sense the presence of the dead? In some historical periods and in some societies today these experiences are made sense of positively in religious or spiritual terms, but in modern western societies they tend to be regarded as symptomatic of mental illnesses such as schizophrenia. I argue that interpreting these experiences in terms of illness can negatively affect them, turning them into something (...) pathological when they needn't necessarily be so. I also discuss wider issues regarding illness, medicine, authority, interpretation and meaning.Export citation. (shrink)

This thesis presents a study of transcendent experiences — experiences of connection with something greater than oneself — focusing on what they are, how artefacts support them, and how design can contribute to that support. People often find such experiences transformative, and artefacts do support them — but the literature rarely addresses designing artefact support for TXs. This thesis provides a step toward filling that gap. The first phase of research involved the conduct and analysis of 24 interviews with adults (...) of diverse spiritual perspectives, using constructivist Grounded Theory methods informed by relevant literature and by studies performed earlier in the PhD programme. Analysis found that TXs proceed in three phases — creating the context, living the experience, integrating the experience — and that artefacts support two phases and people desire enhancements to all three. This TX framework supports and extends experience structures from the literature: it recognises the top-level categories as phases in a cycle where integration may alter future contexts, and it extends the structure of TX by incorporating the relationships of artefacts and of enhancement desires to the phases of these experiences. This extended structure constitutes a grounded theory of transcendent user experience. The second phase involved the design and conduct of three “Transcendhance” game workshops for enhancing transcendence, which incorporated themes from the grounded theory and aimed to elicit design ideas in an atmosphere of imagination, fun, and play. Participants sketched 69 speculative ideas for techno-spiritual artefacts, and analysis mapped them to TX phases and identified possible extensions inspired by relevant research. The great majority of ideas mapped to the phase Creating the Context, with very few mapping to Living the Experience, which suggests that context may be easier than lived experience to understand and address directly. This point is especially important for experiences such as TX that are tricky to define, impossible to arrange or anticipate, and thus unsuitable for straight-forward “classic” user experience methods. The final phase involved the elaboration of workshop ideas to explore the extension of design fiction for TUX. Analysis related design fiction to the TX phases and suggested features that affect design ideas’ potential for TUX design fiction. This phase ended with the proposal and analysis of three new forms of design fiction — extended imaginary abstracts, comparative imaginary abstracts, and design poetry — using workshop ideas to illustrate the forms, their construction and use, and their benefits to TUX design. Transcendhance workshops and TUX design fictions approach techno-spiritual design peripherally, “sneaking up” on lived experience by addressing context and enabling the consideration of ineffable experience through storytelling, metaphors, and oblique imagery. This thesis combines the grounded theory of transcendent user experience with the Transcendhance workshop process and new forms of design fiction, presenting peripheral design as a promising strategy for facilitating design to enhance transcendent experience. (shrink)

After briefly reviewing some of the empirical and philosophical literature suggesting that there may be an adaptive role for delusion formation, we discuss the results of a recent study consisting of in-depth interviews with people experiencing delusions. We analyse three such cases in terms of the circumstances preceding the development of the delusion; the effects of the development of the delusion on the person’s situation; and the potential protective nature of the delusional belief as seen from the first-person perspective. We (...) argue that the development of the delusional belief can play a short-term protective function and we reflect on the implications that this might have for our understanding of psychotic symptoms, for the stigma associated with mental health issues, and for treatment options. (shrink)

The neurological and psychological traits that regulate our thought and behavior fall along a spectrum that extends from the normal to the pathological, from traits that enable us to perform mental and physical functions to traits that interfere with these functions. Yet many people have a constellation of both normal and pathological mental traits. Some even have traits associated with exceptional intellectual or artistic ability despite being diagnosed as having a neurological or psychiatric disorder. These cases raise medical, ethical and (...) legal questions about which conditions should be diagnosed as mental disorders or pathologies, and whether it is always in one’s best interests to be treated for these conditions. (shrink)

Values-Based Medicine (VBM) is the theory and practice of clinical decision-making for situations in which legitimately different values are in play. VBM is thus to values what Evidence-Based Medicine (EBM) is to facts. The theoretical basis of VBM is a branch of analytic philosophy called philosophical value theory. As a set of practical tools, VBM has been developed to meet the challenges of value diversity as they arise particularly in psychiatry. These challenges are illustrated in this paper by a case (...) study of the differential diagnosis between delusion and religious experience. In a traditional model of scientific medicine, such challenges would be expected to become less pressing with advances in medical science. Philosophical value theory suggests, to the contrary, that scientific progress, through opening up an ever-wider range of choices, will increasingly bring the full range and diversity of human values into play not just in psychiatry but in all areas of medicine. The future, then, for medicine, is an integrated model in which VBM and EBM are equal partners in a genuinelyhuman discipline. (shrink)

This is a comprehensive resource of original essays by leading thinkers exploring the newly emerging inter-disciplinary field of the philosophy of psychiatry. The contributors aim to define this exciting field and to highlight the philosophical assumptions and issues that underlie psychiatric theory and practice, the category of mental disorder, and rationales for its social, clinical and legal treatment. As a branch of medicine and a healing practice, psychiatry relies on presuppositions that are deeply and unavoidably philosophical. Conceptions of rationality, personhood (...) and autonomy frame our understanding and treatment of mental disorder. Philosophical questions of evidence, reality, truth, science, and values give meaning to each of the social institutions and practices concerned with mental health care. The psyche, the mind and its relation to the body, subjectivity and consciousness, personal identity and character, thought, will, memory, and emotions are equally the stuff of traditional philosophical inquiry and of the psychiatric enterprise. A new research field--the philosophy of psychiatry--began to form during the last two decades of the twentieth century. Prompted by a growing recognition that philosophical ideas underlie many aspects of clinical practice, psychiatric theorizing and research, mental health policy, and the economics and politics of mental health care, academic philosophers, practitioners, and philosophically trained psychiatrists have begun a series of vital, cross-disciplinary exchanges. This volume provides a sampling of the research yield of those exchanges. Leading thinkers in this area, including clinicians, philosophers, psychologists, and interdisciplinary teams, provide original discussions that are not only expository and critical, but also a reflection of their authors' distinctive and often powerful and imaginative viewpoints and theories. All the discussions break new theoretical ground. As befits such an interdisciplinary effort, they are methodologically eclectic, and varied and divergent in their assumptions and conclusions; together, they comprise a significant new exploration, definition, and mapping of the philosophical aspects of psychiatric theory and practice. (shrink)

Delusions are often portrayed as paradigmatic instances of incomprehensibility and meaninglessness. Here we investigate the relationship between delusions and meaning from a philosophical perspective, integrating arguments and evidence from cognitive psychology and phenomenological psychopathology. We review some of the empirical and philosophical literature relevant to two claims about delusions and meaning: delusions are meaningful, despite being described as irrational and implausible beliefs; some delusions can also enhance the sense that one’s life is meaningful, supporting agency and creativity in some circumstances. (...) Delusions are not incomprehensible representations of reality. Rather, they can help make sense of one’s unusual experiences and in some circumstances even support one’s endeavours, albeit temporarily and imperfectly. Acknowledging that delusions have meaning and can also give meaning to people’s lives has implications for our understanding of psychotic symptoms and for addressing the stigma associated with psychiatric conditions. (shrink)

On one influential view, the problems that should attract medical attention involve a disorder, because the goals of medical practice are to prevent and treat disorders. Based on this view, if there are no mental disorders then the status of psychiatry as a medical field is challenged. In this paper, I observe that it is often difficult to establish whether the problems that attract medical attention involve a disorder, and argue that none of the notions of disorder proposed so far (...) offers a successful demarcation criterion between medical and non-medical problems. As an illustration, I consider why delusions are considered pathological and whether they attract medical attention in virtue of being pathological, where ‘pathological’ stands for ‘being caused by a disorder’. Although there are several promising answers to what makes delusions pathological, available accounts of the pathological nature of delusions fail to distinguish delusions from other irrational beliefs that are not typically thought of as pathological; and cannot explain why delusions typically attract medical attention whereas other irrational beliefs do not. (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)

“Neurodiversity” is associated with the struggle for the civil rights of all those diagnosed with neurological or neurodevelopmental disorders. Two basic approaches in the struggle for what might be described as “neuro-equality” are taken up in the literature: There is a challenge to current nosology that pathologizes all of the phenotypes associated with neurological or neurodevelopmental disorders ); there is a challenge to those extant social institutions that either expressly or inadvertently model a social hierarchy where the interests or needs (...) of individuals are ranked relative to what is regarded as properly functioning cognitive capacities. In this paper, we explore some of the reasons justifying which make it an important tool for achieving greater neuro-equality, while still recognizing its limitations for achieving this goal. Particularly, we explore how an appeal to functionality and neurological diversity can support a re-seeing of at least certain forms of ASD. (shrink)

How to draw the line between depression-as-disorder and non-pathological depressive symptoms continues to be a contested issue in psychiatry. Relatively few philosophers have waded into this debate, but the tools of philosophical analysis are quite relevant to it. In this paper, I defend a particular answer to this question, the Contextual approach.On this view, depression is a disorder if and only if it is a disproportionate response to a justifying cause or else is unconnected to any justifying cause. I present (...) four objections to this approach and then defend it from them. Along the way, I explain why it matters whether we get this question right. (shrink)

Clinically significant delusion is a symptom of a number of mental illnesses. We rely on what a person says and how she behaves in order to identify if she has this symptom and it is clear from the literature that delusions are heterogeneous and extremely difficult to define. People with active delusions were interviewed to explore what it is like to develop and experience delusion. The transcribed interview data was analysed to identify themes and narrative trajectories that help to explain (...) the phenomenon. Results showed that delusions can sometimes provide pragmatic benefits and that the genesis of some delusions can be characterised in terms of the enactivist notion of affective framing. Affective framing is a term that captures the background emotions that enable know-how in terms of goal directed action and cognition. If a person’s affective frame alters the world is no longer understood and know-how is lost. The way in which a person relates to her environment can be highly anomalous thus requiring her to find an extraordinary explanation. I argue that delusions arise as a result of a breakdown in affective framing and offer a conceptualisation of delusion supported by empirical findings. (shrink)

_ Source: _Volume 39, Issue 2, pp 139 - 164 The aim of the present study is to explore the significance of religiousness for patients suffering from first-episode psychosis. Our study is a thematic analysis. The study illustrates how the patients understood their hallucinations as mystical experiences. Even so, many of the patients describe their religiousness to be helpful in coping with their disorder, giving meaning to life as well as a relationship to a sacred figure. However, their religiousness often (...) contained religious omnipotent delusions, and built on hallucinations, displayed an unsecure relationship to the sacred figure. From a psychiatric point of view, the misinterpretation of hallucinations as mystical experiences may reinforce their delusional system and cause an obstacle to recovery. This misinterpretation may also cause problems for patients’ religious coping. Our findings underline the importance of taking patients’ religiousness into account in psychotherapy. (shrink)

In this article I ask whether elaborated and systematized delusions emerging in the context of schizophrenia have the potential for epistemic innocence. Cognitions are epistemically innocent if they have significant epistemic benefits that could not be attained otherwise. In particular, I propose that a cognition is epistemically innocent if it delivers some significant epistemic benefit to a given agent at a given time, and if alternative cognitions delivering the same epistemic benefit are unavailable to that agent at that time. Elaborated (...) and systematized delusions in schizophrenia are typically false and exemplify failures of rationality and self-knowledge. Empirical studies suggest that they may have psychological benefits by relieving anxiety and enhancing meaningfulness. Moreover, these delusions have been considered as adaptive in virtue of the fact that they enable automated learning to resume after a significant disruption caused by incorrect prediction-error signalling. I argue that such psychological benefits and adaptive features also have positive epistemic consequences. More precisely, delusions can be a means to restoring epistemic functionality in agents who are overwhelmed by hypersalient experiences in the prodromal stage of psychosis. The analysis leads to a more complex view of the epistemic status of delusions than is found in the contemporary philosophical literature and has some implications for clinical practice. 1 Introduction2 Types of Delusions3 What Is Wrong with Elaborated and Systematized Delusions?4 Finding Life Meaningful5 Learning Resumed6 Epistemic Innocence7 Epistemic Benefit8 No Alternatives9 Conclusions and Implications. (shrink)

Central to the identity of modern medical specialities, including psychiatry, is the notion of hypostatic abstraction: doctors treat conditions or disorders, which are conceived of as “things” that people “have.” Mad activism rejects this notion and hence challenges psychiatry’s identity as a medical specialty. This article elaborates the challenge of Mad activism and develops the hypostatic abstraction as applied to medicine. For psychiatry to maintain its identity as a medical speciality while accommodating the challenge of Mad activism, it must develop (...) an additional conception of the clinical encounter. Toward elaborating this conception, this article raises two basic framing questions: For what kind of understanding of the situation should the clinical encounter aim? What is the therapeutic aim of the encounter as a whole? It proposes that the concepts of “secondary insight” (as the aim of understanding) and of “identity-making” (as a therapeutic aim) can allow the clinical encounter to proceed in a way that accommodates the challenge of Mad activism. (shrink)

This study applied a body of knowledge derived from the common core thesis of mysticism to investigate the hypothesis that similarities in belief significantly contribute to the appearance of overlap between mystical and positive dimension schizotypal phenomena. Data from 211 university students who completed Hood's Mysticism Scale and Eckblad and Chapman's Magical Ideation Scale were submitted to correlational analyses. Contrary to the hypothesis, results indicated that positive schizotypy correlates more strongly with the experiential dimensions of mysticism than with the interpretive (...) dimension of mysticism. These correlation differences suggest criteria for distinguishing mystical and schizotypal experiences and identify specific points of overlap. Suggestions for future research into this relationship, and implications for schizotypy research, are noted. (shrink)

The standard approach to the core phenomenology of thought insertion characterizes it in terms of a normal sense of thought ownership coupled with an abnormal sense of thought agency. Recently, Fernández (2010) has argued that there are crucial problems with this approach and has proposed instead that what goes wrong fundamentally in such a phenomenology is a sense of thought commitment, characterized in terms of thought endorsement. In this paper, we argue that even though Fernández raises new issues that enrich (...) the topic, his proposal cannot rival the version of the standard approach we shall defend. (shrink)

This paper is positioned within broader scholarly debates about ritual‐religious and psychological elements underlying the phenomenon of altered states of mind in Egyptian Muslim contexts. This research examines the intricate relationships between ritual, consciousness, and the unseen/unknowable world reflected in the imagination and practices of urban and rural communities belonging administratively to the city of Tanta in Egypt. This comparative study proposes that the image of the embodied invisible Other, in both benevolent and malevolent forms, impacts the state of consciousness (...) of persons participating in two different rituals, thezikr(remembrance of God) and thezār(the exorcism of spirits). This inquiry concentrates on the transformation of the states of people's consciousness, namely themajzūb(those mystically attracted to God) and themalbūs(those possessed by spirits), through embodied engagement with the invisible Other that is made visible through participation in the ritual performances of thezikrand/or thezār. Rituals performed by Egyptians, particularly those who experience altered states of consciousness, display both a psychic (emotional) experience and an encounter with the invisible Other that may be depicted as divine or otherwise non‐divine. Each case of thezikrritual andzārcult relates to its participants' perception of reality. (shrink)

In this paper we ask whether the two-factor theory of delusions is compatible with two claims, that delusions are pathological and that delusions are adaptive. We concentrate on two recent and influential models of the two-factor theory: the one proposed by Max Coltheart, Peter Menzies and John Sutton (2010) and the one developed by Ryan McKay (2012). The models converge on the nature of Factor 1 but diverge about the nature of Factor 2. The differences between the two models are (...) reflected in different accounts of the pathological and adaptive nature of delusions. We will explore such differences, considering naturalist and normativist accounts of the pathological and focusing on judgements of adaptiveness that are informed by the shear-pin hypothesis (McKay and Dennett 2009). After reaching our conclusions about the two models, we draw more general implications for the status of delusions within two-factor theories. Are there good grounds to claim that delusions are pathological? Are delusions ever adaptive? Can delusions be at the same time pathological and adaptive? (shrink)

My aim in this paper is to consider the question ‘Why is belief in God not a delusion?’. In the first half of the paper, I distinguish two kinds of religious belief: institutional and personal religious belief. I then review how cognitive science accounts for cultural processes in the acquisition and transmission of institutional religious beliefs. In the second half of the paper, I present the clinical definition of delusion and underline the fact that it exempts cultural beliefs from clinical (...) diagnosis. Finally, I review cognitive models of the intuitive attribution of mental disorders and how they support cultural exemption. Through the comparison of the models of cultural acquisition of religious beliefs and of cultural exemption in the attribution of delusion I intend to make it clear that we can provide an answer to our motivating question: even though some institutional religious beliefs may seem as strange as the most florid delusions, humans can readily recognize that they are not the product of mental dysfunction due to the fact that their acquisition and transmission is embedded within a cultural context. (shrink)

The ‘multicultural clinical interaction’ presents itself as a dilemma for the mental health practitioner. Literature describes two problematic areas where this issues emerges - how to make an adequate distinction between religious rituals and the rituals that may be symptomatic of ‘obsessive compulsive disorder’ (OCD), and how to differentiate ‘normative’ religious or spiritual beliefs, behaviours, and experiences from ‘psychotic’ illnesses. When it comes to understanding service user’s ‘idioms of distress’, beliefs about how culture influences behaviour can create considerable confusion and (...) ‘normative uncertainty’ for mental health practitioners. In the absence of clear diagnostic and assessment criteria on distinguishing between ‘culture’ and ‘psychopathology’, practitioners have had to rely on their own intuition and seek out possible ‘strategies’ or ‘procedures’ from a contradictory and cross-disciplinary evidence base. Decontextualisation of service users’ experiences may result in the pathologisation of culturally ‘normative’ phenomenon, ‘category fallacy’ errors, and poor health care experiences and outcomes for service users. This paper situates this dilemma within a wider debate that has concerned both the biomedical and social sciences, namely, the unresolved question of ‘normality’ or ‘abnormality’. Indeed, issues that arise from dilemmas surrounding the question of ‘culture’ or ‘psychopathology’ are intimately tied to wider cultural ideas about what is considered ‘normal’. The disciplines of psychiatry, psychology, and medical anthropology have struggled to establish workable criteria against which to judge behaviour as ‘normal’, ‘abnormal’, or ‘pathological’. Three models for understanding mental ‘abnormality’ are evident in ‘transcultural psychiatry’ (what is now commonly known as ‘cultural psychiatry’), and these models have corresponded closely to the interpretive models used by anthropologists attempting to make sense of the apparent diversity of human societies. The three models of ‘absolutism’, ‘universalism’ and ‘cultural relativism’ have not only important consequences for the nature and conduct of research enquiry, but also have implications for how the dilemma of ‘culture’ or ‘psychopathology’ is attended to in clinical practice. (shrink)