This paper offers an overview of the philosophical work on epistemic injustices as it relates to psychiatry. After describing the development of epistemic injustice studies, we survey the existing literature on its application to psychiatry. We describe how the concept of epistemic injustice has been taken up into a range of debates in philosophy of psychiatry, including the nature of psychiatric conditions, psychiatric practices and research, and ameliorative projects. The final section of the paper indicates future directions for philosophical research (...) of epistemic injustices and psychiatry, concerning neurocognitive disorders, identity prejudices in psychiatric illness, concepts of epistemic privilege in psychiatry, and the prospects for combining phenomenological psychopathology and epistemic justice. We argue that much remains to be done in the conceptualization of these epistemic injustices and suggest that this future work should be multidisciplinary in character and sensitive to the phenomenology of psychiatric conditions. (shrink)

Psychedelic-assisted Psychotherapy combines the use of psychedelic compounds, such as psilocybin, with psychotherapy. PAP has shown some promise as a novel treatment for Major Depressive Disorder, and empirical research suggests that its efficacy turns on the altered states induced by psychedelic compounds. In this paper we draw on the literature of phenomenology to explain the therapeutic potential of psychedelic experiences. Svenaeus characterises mental illness as a form of suffering that entails three distinct but related experiences of alienation or “unhomelike being-in-the-world”: (...) illness suffering, which relates to embodiment; existential suffering, which relates to self-narratives, and political suffering, which relates to social relationships. Ratcliffe further characterises the experience of MDD in phenomenological terms as a loss of pre-intentional possibility that manifests as excessive noematic feeling in the experience of embodiment, restrictive narratives in the construction of self, and disconnectedness in experience of the social world. We contend that PAP ameliorates the suffering associated with MDD by inducing and consolidating a state of broadened pre-intentional possibility—one that entails sudden, profound and enduring changes in embodiment, self-narratives, and social experience. We argue further that this phenomenological account is consistent with a bio-psycho-social model of mental health and illness, and we frame it as an argument supporting the plausibility of recent claims about treatment success. This helps to justify ongoing future empirical research in this setting. (shrink)

Empathy is a topic of continuous debate in the nursing literature. Many argue that empathy is indispensable to effective nursing practice. Yet others argue that nurses should rather rely on sympathy, compassion, or consolation. However, a more troubling disagreement underlies these debates: There’s no consensus on how to define empathy. This lack of consensus is the primary obstacle to a constructive debate over the role and import of empathy in nursing practice. The solution to this problem seems obvious: Nurses need (...) to reach a consensus on the meaning and definition of empathy. But this is easier said than done. Concept analyses, for instance, reveal a profound ambiguity and heterogeneity of the concept of empathy across the nursing literature. Since the term “empathy” is used to refer to a range of perceptual, cognitive, emotional, and behavioral phenomena, the presence of a conceptual ambiguity and heterogeneity is hardly surprising. Our proposal is simple. To move forward, we need to return to the basics. We should develop the concept from the ground up. That is, we should begin by identifying and describing the most fundamental form of empathic experience. Once we identify the most fundamental form of empathy, we will be able to distinguish among the more derivative experiences and behaviors that are addressed by the same name and, ideally, determine the place of these phenomena in the field of nursing. The aim of this article is, consequently, to lay the groundwork for a more coherent concept of empathy and thereby for a more fruitful debate over the role of empathy in nursing. In Part 1, we outline the history of the concept of empathy within nursing, explain why nurses are sometimes warry of adapting concepts from other disciplines, and argue that nurses should distinguish between adapting concepts from applied disciplines and from more theoretical disciplines. In Part 2, we show that the distinction between emotional and cognitive empathy—borrowed from theoretical psychology—has been a major factor in nurses’ negative attitudes toward emotional empathy. We argue, however, that both concepts fail to capture the most fundamental form of empathy. In Part 3, we draw on and present some of the seminal studies of empathy that can be found in the work of phenomenological philosophers including Max Scheler, Edmund Husserl, and Edith Stein. In Part 4, we outline how their understanding of empathy may facilitate current debates about empathy’s role in nursing. (shrink)

O presente artigo tem como objetivo produzir um estudo sobre a empatia a partir da perspectiva fenomenológica. Para tanto, será feita uma distinção entre os vários sentidos e usos da palavra “empatia” na contemporaneidade. Logo após, serão analisadas as várias teorias e modelos explicativos da empatia a partir da investigação de “como” a consciência humana acessa o mundo externo. Dentre os modelos explicativos explorados, destacam-se o modelo Theory – Theory, o Simulation Theory, o Integrated Theory, o Graded Empathy Hypothesis e (...) o Reintegrated Theory. Feito isso, será explorada, mais detidamente, a proposta fenomenológica para a questão da empatia. Por fim, se buscará, à luz da perspectiva fenomenológica, avançar na reflexão sobre a empatia a partir de três ideias: a de ressonância, a de afetação e a de interimplicação, buscando desenvolver os primeiros passos para uma interintencionalidade imanente. Como limites e possibilidades, pode-se notar que é preciso explorar mais os processos de modalização da empatia no processo de constituição do ego, principalmente da vida pré-egótica. (shrink)

Whereas empathy is most often looked upon as a virtue and essential skill in contemporary health care, the relationship to sympathy is more complicated. Empathic approaches that lead to emotional arousal on the part of the health care professional and strong feelings for the individual patient run the risk of becoming unprofessional in nature and having the effect of so-called compassion fatigue or burnout. In this paper I want to show that approaches to empathy in health care that attempt to (...) solve these problems by cutting empathy loose from sympathy—from empathic concern—are mistaken. Instead, I argue, a certain kind of sympathy, which I call professional concern, is a necessary ingredient in good health care. Feeling oneself into the experiences and situation of the patient cannot be pursued without caring for the patient in question if the empathy is going to be successful. Sympathy is not only a thing that empathy makes possible and more or less spontaneously provides a way for but is something that we find at work in connection to empathy itself. In the paper I try to show how empathy is a particular form of emotion in which I feel with, about, and for the other person in developing an interpretation of his predicament. The with and for aspects of the empathy process are typically infused by a sympathy for the person one is empathizing with. Sympathy can be modulated into other ways of feeling with and for the person in the empathy process, but these sympathy-replacement feelings nevertheless always display some form of motivating concern for the target. Such an understanding of empathy is of particular importance for health care and other professions dealing with suffering clients. (shrink)

This article is an introduction to a thematic section on the phenomenology of empathy in medicine, attempting to provide an expose of the field. It also provides introductions to the individual articles of the thematic section.

Critics who are concerned over the epistemological status of psychiatric diagnoses often describe them as being constructed. In contrast, those critics usually see symptoms as relatively epistemologically unproblematic. In this paper I show that symptoms are also constructed. To do this I draw upon the demarcation between data and phenomena. I relate this distinction to psychiatry by portraying behaviour of individuals as data and symptoms as phenomena. I then draw upon philosophers who consider phenomena to be constructed to argue that (...) symptoms are also constructed. Rather than being ready made in the world I show how symptoms are constructs we apply to the world. I highlight this with a historical example and describe methodological constraints on symptom construction. I show the epistemic problems with psychiatric diagnoses are also applicable to symptoms. Following this, I suggest that critics of psychiatric diagnoses should extend their criticism to symptoms or, if they still believe symptoms are relatively epistemologically unproblematic, should rethink their concerns over psychiatric diagnoses. (shrink)

Psychedelics have shown promise as a treatment for depression. Although there is some debate, a popular view is that psychedelics produce their benefits in an experience-dependent manner. This is the view that a depressed person gets better, inter alia, because of the experience she has had on psychedelics. Among the various questions that treatment for depression with psychedelics raise, one of the most important is: By what mechanism do these drugs reduce symptoms? If the experience-dependent view is correct, the answer, (...) at least on the personal level of explanation, lies in the phenomenology. In this paper, borrowing mainly from Ratcliffe’s account of depression, I offer such an answer. I argue that psychedelic experiences involve a surge of existential feelings, which can revise the depressed person’s diminished sense of possibility and restore their ability to be affected by the world. I explain how this occurs via a change in the sense of reality linked to the subjective effects of psychedelics. This, I suggest, is the personal level mechanism or process behind psychedelic-assisted psychotherapy for depression. (shrink)

Recent studies have revealed a drop in the ability of physicians to empathize with their patients. It is argued that empathy training needs to be provided to both medical students and physicians in order to improve patient care. While it may be true that empathy would lead to better patient care, it is important that the right theory of empathy is being encouraged. This paper examines and critiques the prominent explanation of empathy being used in medicine. Focusing on the component (...) of empathy that allows us to understand others, it is argued that this understanding is accomplished through a simulation. However, simulation theory is not the best explanation of empathy for medicine, since it involves a limited perspective in which to understand the patient. In response to the limitations and objections to simulation theory, interaction theory is presented as a promising alternative. This theory explains the physicians understanding of patients from diverse backgrounds as an ability to learn and apply narratives. By explaining how we understand others, without limiting our ability to understand various others, interaction theory is more likely than simulation theory to provide better patient care, and therefore is a better theory of empathy for the medical field. (shrink)

ABSTRACTThis paper brings together a phenomenological and vulnerability-theoretic approach to dementia. The paper challenges the view that subjects with dementia can simply be understood in terms of diminished cognitive capacities or that they have lost all vestiges of personhood or the capacity for meaningful interaction. Instead, drawing on vulnerability theory and the phenomenological work of Kristin Zeiler and Lisa Käll, an alternative view of persons with dementia is offered that is based on intersubjective and intercorporeal relations and accomplishments. A vulnerability (...) approach to dementia is developed that not only provides the basis for empathetic responses to illnesses such as dementia but also points to the intersubjective constitution of subjects more generally. The argument developed is that the notion of vulnerability designates a form of openness to others and that such openness is a precondition for empathy. (shrink)

This dissertation contributes to the philosophy of empathy and biomedical ethics by drawing on phenomenological approaches to empathy, intersubjectivity, and affectivity in order to contest the primacy of the intersubjective aspect of empathy at the cost of its affective aspect. Both aspects need to be explained in order for empathy to be accurately understood in philosophical works, as well as practically useful for patient care in biomedical ethics. In the first chapter, I examine the current state of clinical empathy in (...) medicine including professional opinions about empathy, the dominant definition being employed, and the problems that arise from this definition. By trying to define empathy in a way that is useful to the current presuppositions in medicine, clinical empathy aligns with simulation theory, which has three problems: the discrepancy between the way empathy is defined and the way it is explained, the lack of diversity that this theory of empathy allows in our understanding of others, and the lack of affective understanding and affective engagement involved in the patient-physician interaction. These three problems are used to derive three questions that are important for any theory of empathy: (1) What is the phenomenon being explained? (2) What is the intersubjective context of empathy? (3) What is the affective dimension of empathy? The best theory of clinical empathy can be formulated by answering these three questions as they relate to phenomenological theories, which are more attuned to overcoming presuppositions. Chapters two and three each examine a different phenomenological approach to empathy from opposite extremes in their theories of intersubjectivity. Husserl and Stein begin from an isolated, transcendental subject that needs empathy to bridge the gap between itself and others, while Scheler begins from a primary intersubjectivity in which self and other are undifferentiated, making empathy a largely unnecessary skill. Despite their strongly opposed positions, and the acknowledgement that their theories of intersubjectivity necessitate their theories of empathy, I argue that both fail to understand the affective dimension of empathy. Husserl and Stein leave no room in empathy for it to be an affect, while Scheler prioritizes affects that reunite subjects, but leaves empathy itself as a non-affective skill. Chapter four explains Gallagher’s interaction theory as a more moderate approach to the relation between empathy and intersubjectivity. He draws on the insights of the other two theories, but conceives of empathy as a multi-leveled phenomenon that allows for an understanding of others. While this theory does aid in addressing the intersubjective context of empathy in a way that best solves the first two problems with clinical empathy, interaction theory still fails to fully address the affectivity of empathy, maintaining empathy as a largely cognitive ability. Gallagher does acknowledge the affective core of empathy, but he does not explain the way in which it is affective. In response to this problem, I explain Anya Daly’s application of Merleau-Ponty’s theory of reversibility to affectivity as a possible solution to the problematic gap in Gallagher’s theory. Chapter five focuses on theories of clinical empathy in order to address the neglected affective aspects of empathy, and respond to the problem of detached concern. The problems caused by detached concern are explained, as well as why the theories discussed in the middle chapters are still unable to solve them. This is done in two parts. In the first part, I explain the basis of this issue in the cognitive/feeling divide, as explained in the philosophy of emotion. Then, I give a brief overview of the phenomenology of affectivity to be used as a guide to the affectivity of empathy. In the second part, I examine three theories of clinical empathy that attempt to solve the problem of detached concern, noting their strengths and weaknesses based on their similarities to phenomenological approaches to empathy and affectivity. (shrink)

The present thesis surveys different philosophical approaches to the nature of delusions: specifically, their ontology. However, since none of the various theories of the nature of delusions succeeds, I argue that there must be something problematic about the form of the analyses commonly offered. My general conclusion is that one cannot characterize delusions without taking away what it is distinctive about them.

The aim of this paper is to mount a philosophical challenge to the currently highly visible research and discourse on empathy. The notion of empathetic perspective-shifting—a conceptually demanding, high-level construal of empathy in humans that arguably captures the core meaning of the term—is criticized from the standpoint of a philosophy of normatively accountable agency. Empathy in this demanding sense fails to achieve a true understanding of the other and instead risks to impose the empathizer’s self-constitutive agency upon the person empathized (...) with. Attempts to ‘simulate’ human agency, or attempts to emulate its cognitive or emotional basis, will likely distort their target phenomena in profound ways. Thus, agency turns out to be empathy’s blind spot. Elements of an alternative understanding of interpersonal relatedness are also discussed, focusing on aspects of ‘interaction theory’. These might do some of the work that high-level constructs of empathy had been supposed to do without running into similar conceptual difficulties. (shrink)

Patients’ experience of symptoms does not follow the body–mind divide that characterizes the classification of disease in the health care system. Therefore, understanding patients in their entirety rather than in parts demands a different theoretical approach. Attempts have been made to formulate such approaches but many of these, such as the biopsychosocial model, are still basically dualistic or methodologically reductionist. In primary care, patients often present with diffuse symptoms, making primary care the ideal environment for understanding patients’ undifferentiated symptoms and (...) disease patterns which could readily fit both bodily and mental categories. In this article we discuss theoretical models that have attempted to overcome this challenge: The psychosomatic approach could be called holistic in the sense of taking an anti-dualistic stance. Primary care theorists have formulated integrative views but these have not gained a foothold in primary care medicine. McWhinney introduced a new metaphor, ‘the body–mind’, and Rudebeck advocated cultivating ‘bodily empathy’. These views have much in common with both phenomenological thinking and mentalization, a psychological concept for understanding others. In the process of understanding patients there is a need for the physician to enter an intersubjectivity that aims at understanding the patient’s experiences and sensations without initially jumping to diagnostic conclusions or into a division into mental and physical phenomena. Mentalization theory could form the basis of an approach to a more comprehensive understanding of patients. The success of such an approach is, however, dependent upon structural and organizational conditions that do not counteract it. (shrink)