Body dissatisfaction has long been considered an integral component of and driving force behind anorexia nervosa. In this paper, I characterise body dissatisfaction in terms of problematic beliefs about body size and the value of thinness. I suggest two methods for understanding these beliefs. Regarding body size beliefs, I suggest focusing on certain forms of misleading phenomenal evidence that sufferers of anorexia nervosa are exposed to. Regarding beliefs about the value of thinness, I suggest focusing on the benefits of such (...) beliefs. (shrink)

In this paper, we argue that there are reasons to believe that an implicit bias for normalcy influences what are considered medically necessary treatments in psychiatry. First, we outline two prima facie reasons to suspect that this is the case. A bias for ‘the normal’ is already documented in disability studies; it is reasonable to suspect that it affects psychiatry too, since psychiatric patients, like disabled people, are often perceived as ‘weird’ by others. Secondly, psychiatry's explicitly endorsed values of well-being (...) and function are hard to measure directly, which is why we see simpler box-ticking conceptions of recovery used in large research studies. This need not be problematic, but might lead to researchers and clinicians focusing too much on treatments that promote easy-to-measure proxies for recovery, instead of what actually matters to psychiatric patients themselves. Next, we provide examples of treatments and treatment decisions within two areas – self-injury and psychosis – which are hard to explain unless we assume that an implicit and harmful normalcy bias is at work. We conclude with some suggestions for clinicians and future research. (shrink)

Delusions have traditionally been considered the hallmark of mental illness, and their conception, diagnosis and treatment raise many of the fundamental conceptual and practical questions of psychopathology. One of these fundamental questions is whether delusions are understandable. In this paper, we propose to consider the question of understandability of delusions from a philosophy of language perspective. For this purpose, we frame the question of how delusions can be understood as a question about the meaning of delusional utterances. Accordingly, we ask: (...) “what meaning(s) can delusional utterances possibly have?”. We argue that in the current literature, there is a standard approach to the meaning of delusional utterances, namely the descriptive account which assumes that a delusional utterance “p” means that p is the case. Drawing on Speech Act Theory, we argue that solely relying on the descriptive account disregards essential ways of how linguistic meaning is constituted. Further, we show that Speech Act Theory can prove a helpful addition to the theoretical and clinical “toolbox” used for attempting to understand delusional utterances. This, we believe, may address some of the theoretical and clinical shortcomings of using only the currently predominant descriptive account. (shrink)

Wouter Kusters argues that madness has much to offer philosophy, as does philosophy to madness. In this paper, i support both claims by drawing on a mad phenomenon which I label Radical Psychotic Doubt, or RPD. First, although skepticism is a minority position in epistemology, it has been claimed that anti-skeptical arguments remain unsatisfying. I argue that this complaint can be clarified and strengthened by showing that anti-skeptical arguments are irrelevant to RPD sufferers. Second, there's a debate about whether so-called (...) hinge commitments are beliefs or not. I argue that RPD can be used to strengthen the case that they are. Moreover, if hinges are beliefs, some madpeople are more epistemically rational than some sane philosophers. Third, drawing on my own mad experiences, I challenge evidentialism by presenting a better candidate for a truly forced cchoice about what to believe than William James' traditional religious example. I further show that in certain psychiatric contexts, evidentialism has more radical implications than Jamesian pragmatism, which comes out as more conservative. Finally, I discuss how philosophical theories like pragmatism and Pyrrhonism can provide inspiration for new and much-needed coping strategies for RPD sufferers. (shrink)

Psychiatric patients sometimes ask where to draw the line between who they are – their selves – and their mental illness. This problem is referred to as the self-illness ambiguity in the literature; it has been argued that solving said ambiguity is a crucial part of psychiatric treatment. I distinguish a Realist Solution from a Constructivist one. The former requires finding a supposedly pre-existing border, in the psychiatric patient’s mental life, between that which belongs to the self and that which (...) belongs to the mental illness. I argue that no such border exists, and that attempts to find it might even render the felt ambiguity worse. Instead, any solution must be constructivist; the patient (and others) should deliberate and discuss what to identify with or not. I further argue that psychiatric patients need not see their mental illness as wholly distinct from themselves to avoid ‘identifying with their diagnoses' in a problematic way. Finally, we can excuse problematic behaviour by mentally ill people – in fact, we can do so in a more nuanced and constructive way – while rejecting the view that the mental illness is wholly distinct from the patient’s self. (shrink)

This thesis develops a novel framework for explaining delusions. In Chapter 1, I introduce the two fundamental challenges posed by delusions: the evidence challenge lies in explaining the flagrant ways delusions flout evidence; and the specificity challenge lies in explaining the fact that patients’ delusions are often about a few specific themes, and patients rarely have a wide range of delusional or odd beliefs. In Chapter 2, I discuss the strengths and weaknesses of current theories of delusions, which typically appeal (...) to one or both of two factors: anomalous experience and reasoning abnormality. I argue that anomalous experience can help explain the specificity of delusions, but has difficulties in addressing the evidence challenge; reasoning abnormality can help address the evidence challenge, but has difficulties in explaining the specificity of delusions. This suggests that there may be an important factor that has not been captured by current theories of delusions. To search for this missing factor, in Chapter 3, I turn to normal believing. Inspired by the literature on Cartesian clarity and phenomenal dogmatism, I develop a dual-force framework of believing, according to which beliefs can be understood as the results of the interaction between the justificatory force and causal force of evidence and the justificatory force and causal force of clear experience, in which something clearly seems to be so to the subject. This framework suggests that the missing factor may be the clear experience with its distinctive phenomenal clarity that compels assent. In Chapter 4, I return to delusions, and argue that the dualforce framework can help us to get a better grip on some personal descriptions of delusions; make progress in addressing the evidence and specificity challenges of delusions; and shed new light on the underpinnings of delusions. In the end, I conclude with some remaining questions for future study. (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)

Body dissatisfaction has long been considered an integral component of and driving force behind anorexia nervosa. In this paper, I characterise body dissatisfaction in terms of problematic beliefs about body size and the value of thinness. I suggest two methods for understanding these beliefs. Regarding body size beliefs, I suggest focusing on certain forms of misleading phenomenal evidence that sufferers of anorexia nervosa are exposed to. Regarding beliefs about the value of thinness, I suggest focusing on the benefits of such (...) beliefs. (shrink)

The conceptual pair of own-world (ídios kósmos) and common world (koinós kósmos) constitutes an archaic pair, originally introduced by Heraclitus. More than two millennia after its introduction, Binswanger picked up this conceptual pair in the attempt to understand existence and mental disorder. Ever since, this conceptual pair has been part of the conceptualization of schizophrenia in phenomenological psychopathology. However, the concepts of ídios kósmos and koinós kósmos have seldomly been elaborated and expanded upon, and certain unclarities rest within the literature. (...) This paper resolves some of these unclarities and contributes to a theory of anthropological proportions, which furthers our understanding of ídios kósmos and koinós kósmos. The paper begins with an exploration of the theoretical underpinnings of this conceptual pair, i.e., it discusses the concept of world, what is understood by common world, and what it means to live in an own-world. This theoretical exploration segues into an in-depth analysis of the alterations of experiential life in schizophrenia, which can be illuminated via this conceptual pair. It is further argued that this conceptual pair contributes to an understanding of the puzzling phenomenon of double bookkeeping. Finally, the paper concludes in a discussion of clinical implications of this conceptual pair, stressing the importance of a mindfulness of the alterations to the ídios kósmos and koinós kósmos in schizophrenia. (shrink)

Stanford Encyclopedia Entry on Delusions.

1. Built upon systems of nosology that claimed to be “atheoretical,” modern psychiatry largely relies on descriptive psychopathological models based on the assumption that psychotic symptoms (such...

In his account of phenomenological psychopathology, Karl Jaspers advocates for the central role of subjective experience, something which he maintains cannot be accessed through intellectual effort, but through “empathic understanding” alone. In contradistinction to Jaspers’ account, I propose that phenomenology, as a process of inquiry and investigation, is fundamentally epistemological. Accordingly, I offer an intellectual virtue characterization of phenomenological psychopathology, using open-mindedness to illustrate the close conceptual links between the phenomenological endeavor and the intellectual virtues. By introducing the intellectual virtue (...) lexicon into the phenomenological psychopathology discourse, I then offer three preliminary recommendations for the training and education of phenomenological clinicians. Centering the educational recommendations on the psychiatric interview, I suggest that good questioning, listening, and reflecting necessarily require cultivation for intellectually virtuous phenomenological inquiry. (shrink)