When interacting with other people, we assume that they have their reasons for what they do and believe, and experience recognizable feelings and emotions. When people act from weakness of will or are otherwise irrational, what they do can still be comprehensible to us, since we know what it is like to fall for temptation and act against one’s better judgment. Still, when someone’s experiences, feelings and way of thinking is vastly different from our own, understanding them becomes increasingly difficult. (...) Delusions and psychosis are often seen as marking the end of intelligibility. In this paper, I argue first for the importance of seeing other people as intelligible as long as this is at all possible. Second, I argue, based on both previous literature and my own lived experience, that more psychotic phenomena than previously thought can be rendered at least somewhat intelligible. Besides bizarre experiences like illusions, hallucinations and intense feelings of significance, I also explain what it is like to lose one’s bedrock, and how this loss impacts which beliefs one has reason to reject. Finally, I give an inside account of some disturbances of reason, and show that there are important similarities between certain psychotic reasoning problems and common non-pathological phenomena. (shrink)

Understanding the mental life of persons with psychosis/schizophrenia has been the crucial challenge of psychiatry since its origins, both for scientific models as well as for every therapeutic encounter between persons with and without psychosis/schizophrenia. Nonetheless, a preliminary understanding is always the first step of phenomenological as well as other qualitative research methods addressing persons with psychotic experiences in their life-world. In contrast to Rashed's assertions, in order to achieve such understanding, phenomenological psychopathologists need not necessarily adopt the transcendental-phenomenological attitude, (...) which, however, is often required if performing phenomenological philosophy. Additionally, in the course of these scientific endeavors, differences between persons with psychosis/schizophrenia and so-called normal people seem to have a methodological function and value driving the scientist in her enterprise. Yet, these differences do not extend to ethical dimensions, and therefore, do not by any means touch ethical equality. (shrink)

Abstract This paper proposes that adopting a ?phenomenological stance? enables a distinctive kind of empathy, which is required in order to understand forms of experience that occur in psychiatric illness and elsewhere. For the most part, we interpret other people's experiences against the backdrop of a shared world. Hence our attempts to appreciate interpersonal differences do not call into question a deeper level of commonality. A phenomenological stance involves suspending our habitual acceptance of that world. It thus allows us to (...) contemplate the possibility of structurally different ways of ?finding oneself in the world?. Such a stance, I suggest, can be incorporated into an empathetic appreciation of others' experiences, amounting to what we might call ?radical empathy? (shrink)

This paper explores how the diagnosis of mental disorder may affect the diagnosed subject’s self-concept by supplying an account that emphasizes the influence of autobiographical and social narratives on self-understanding. It focuses primarily on the diagnoses made according to the criteria provided by the Diagnostic Statistical Manual of Mental Disorders (DSM), and suggests that the DSM diagnosis may function as a source of narrative that affects the subject’s self-concept. Engaging in this analysis by appealing to autobiographies and memoirs written by (...) people diagnosed with mental disorder, the paper concludes that a DSM diagnosis is a double-edged sword for self- concept. On the one hand, it sets the subject’s experience in an established classificatory system which can facilitate self-understanding by providing insight into subject’s condition and guiding her personal growth, as well as treatment and recovery. In this sense, the DSM diagnosis may have positive repercussions on self-development. On the other hand, however, given the DSM’s symptom-based approach and its adoption of the Biomedical Disease model, a diagnosis may force the subject to make sense of her condition divorced from other elements in her life that may be affecting her mental- health. It may lead her frame her experience only as an irreversible imbalance. This form of self-understanding may set limits on the subject’s hopes of recovery and may create impediments to her flourishing. (shrink)

Miranda Fricker claims that a “gap” in collective hermeneutical resources with respect to the social experiences of marginalized groups prevents members of those groups from understanding their own experiences (Fricker 2007). I argue that because Fricker misdescribes dominant hermeneutical resources as collective, she fails to locate the ethically bad epistemic practices that maintain gaps in dominant hermeneutical resources even while alternative interpretations are in fact offered by non-dominant discourses. Fricker's analysis of hermeneutical injustice does not account for the possibility that (...) marginalized groups can be silenced relative to dominant discourses without being prevented from understanding or expressing their own social experiences. I suggest that a gap in dominant hermeneutical resources is ambiguous between two kinds of unknowing: hermeneutical injustice suffered by members of marginalized groups, and epistemically and ethically blameworthy ignorance perpetrated by members of dominant groups. (shrink)

This article examines the supposedly incomprehensibility of schizophrenic delusions. According to the contemporary classificatory systems (DSM-IV-TR and ICD-10), some delusions typically found in schizophrenia are considered bizarre and incomprehensible. The aim of this article is to discuss the notion of understanding that deems these delusions incomprehensible and to see if it is possible to comprehend these delusions if we apply another notion of understanding. First, I discuss the contemporary schizophrenia definitions and their inherent problems, and I argue that the notion (...) of incomprehensibility in these definitions rests heavily on Jaspers’ notions of understanding and empathy. Secondly, I discuss two Wittgensteinian attempts to comprehend bizarre delusions: (a) Campbell’s proposal to conceive delusions as framework propositions and (b) Sass’s suggestion to interpret delusions in the light of solipsism. Finally, I discuss the phenomenological conception of schizophrenia, which conceives delusion formation as resulting from alterations of the structure of experiencing and from underlying self-disorders. I argue that although a psychological understanding that seeks to grasp meaning in terms of motivations, desires, and other more straightforward psychological connections between mental states is impossible in schizophrenia, we can in fact have a philosophical understanding of the schizophrenic world and of the emergence of delusions typically found in schizophrenia. (shrink)

What is the meaning of critique for critical phenomenology? Building on Gayle Salamon’s engagement with this question in the inaugural issue of Puncta: A Journal for Critical Phenomenology (2018), I will propose a six-fold account of critique as: 1) the art of asking questions, moved by crisis; 2) a transcendental inquiry into the conditions of possibility for meaningful experience; 3) a quasi-transcendental, historically-grounded study of particular lifeworlds; 4) a (situated and interested) analysis of power; 5) the problematization of basic concepts (...) and methods; and 6) a praxis of freedom that seeks not only to interpret the meaning of lived experience, but also to change the conditions under which horizons of possibility for meaning, action, and relationship are wrongfully limited or foreclosed. While the first two dimensions of critique are alive and well in classical phenomenology, the others help to articulate what is distinctive about critical phenomenology. (shrink)

Epistemic injustice is a kind of injustice that arises when one’s capacity as an epistemic subject is wrongfully denied. In recent years it has been argued that psychiatric patients are often harmed in their capacity as knowers and suffer from various forms of epistemic injustice that they encounter in psychiatric services. Acknowledging that epistemic injustice is a multifaceted problem in psychiatry calls for an adequate response. In this paper I argue that, given that psychiatric patients deserve epistemic respect and have (...) a certain epistemic privilege, healthcare professionals have a pro tanto epistemic duty to attend to and/or solicit reports of patients’ first-person experiences in order to prevent epistemic losses. I discuss the nature and scope of this epistemic duty and point to one interesting consequence. In order to prevent epistemic losses, healthcare professionals may need to provide some patients with resources and tools for expressing their experiences and first-person knowledge, such as those that have been developed within the phenomenological approach. I discuss the risk of secondary testimonial and hermeneutical injustice that the practice of relying on such external tools might pose and survey some ways to mitigate it. (shrink)

McCabe & Healey argue that in patient‐psychiatrist interaction, the more the participants engage in repair, i.e., trying to fix potential misunderstandings, the better the outcomes of the interaction, as measured by treatment adherence and the quality of the Dr – patient relationship. This holds both for self‐repair, when psychiatrists fix their own utterances, as well as other‐repair, where patients try to fix the understanding displayed by the psychiatrist.

The centenary of Karl Jaspers' General Psychopathology was recognised in 2013 with the publication of a volume of essays dedicated to his work. Leading phenomenological-psychopathologists and philosophers of psychiatry examined Jaspers notion of empathic understanding and his declaration that certain schizophrenic phenomena are ‘un-understandable’. The consensus reached by the authors was that Jaspers operated with a narrow conception of phenomenology and empathy and that schizophrenic phenomena can be understood through what they variously called second-order and radical empathy. This article offers (...) a critical examination of the second-order empathic stance along phenomenological and ethical lines. It asks: Is second-order empathy possible? Is the second-order empathic stance an ethically acceptable attitude towards persons diagnosed with schizophrenia? I argue that second-order empathy is an incoherent method that cannot be realised. Further, the attitude promoted by this method is ethically problematic insofar as the emphasis placed on radical otherness disinvests persons diagnosed with schizophrenia from a fair chance to participate in the public construction of their identity and, hence, to redress traditional symbolic injustices. (shrink)

Hans-Georg Gadamer is often criticized for his account of the fusions of horizons as the ideal resolution of dialogue. I argue that in fact it is an excellent account of the successful resolution of dialogue, but only in light of a proper understanding of what Gadamer means by 'horizon' and how then horizons are fused. I do this by showing how Gadamer is drawing on the technical sense of 'horizon' found in Edmund Husserl's and Martin Heidegger's phenomenologies. In the process (...) I show why a prominent criticism of Gadamer's account of the fusion of horizons, a criticism presented most forcefully by E. D. Hirsch, is mistaken. (shrink)

A good therapeutic relationship in mental health services is a predictor of positive clinical outcomes for people who seek help for distressing experiences, such as voice hearing and paranoia. One factor that may affect the quality of the therapeutic relationship and raises further ethical issues is the impact of the clinical encounter on users’ sense of self, and in particular on their sense of agency. In the paper, we discuss some of the reasons why the sense of epistemic agency may (...) be especially fragile in young people with unusual experiences and beliefs. We argue that it is important to identify and avoid behaviours that can undermine young people’s contributions as epistemic agents in the clinical encounter. (shrink)

Many individuals who have mental disorders often report negative experiences of a distinctively epistemic sort, such as not being listened to, not being taken seriously, or not being considered credible because of their psychiatric conditions. In an attempt to articulate and interpret these reports we present Fricker’s concepts of epistemic injustice (Fricker, 2007, p. 1) and then focus on testimonial injustice and hermeneutic injustice as it applies to individuals with mental disorders. The clinical impact of these concepts on quality of (...) care is discussed. Within the clinical domain, we contrast epistemic injustice with epistemic privilege and authority. We then argue that testimonial and hermeneutic injustices also affect individuals with mental disorders not only when communicating with their caregivers but also in the social context as they attempt to reintegrate into the general society and assume responsibilities as productive citizens. Following the trend of the movement of mental health care to the community, the testimonies of people with mental disorders should not be restricted to issues involving their own personal mental states. (shrink)

Epistemic injustice is a harm done to a person in their capacity as an epistemic subject by undermining her capacity to engage in epistemic practices such as giving knowledge to others or making sense of one’s experiences. It has been argued that those who suffer from medical conditions are more vulnerable to epistemic injustice than the healthy. This paper claims that people with mental disorders are even more vulnerable to epistemic injustice than those with somatic illnesses. Two kinds of contributory (...) factors for epistemic injustice in psychiatric patients are outlined: global and specific. Some suggestions are made to counteract the effects of these contributory factors, for instance we suggest that physicians should participate in groups where the subjective experience of patients is explored, and learn to become more aware of their own unconscious prejudices towards psychiatric patients. (shrink)

Miranda Fricker identifies a wrong she calls ‘hermeneutical injustice’. A culture’s hermeneutical resources are the shared meanings its members use to understand their experience, and communicate this understanding to others. Cultures tend to be composed of different social groups that are organised hierarchically. As a consequence of these uneven power relations, the culture’s shared meanings often reflect the lives of its more powerful members, and fail to properly capture the experiences of the less powerful. This may result in members of (...) less powerful groups being harmed. Such disadvantage constitutes, for Fricker, hermeneutical injustice. In this paper, I discuss a problem for Fricker, which arises when we consider what is required to remedy a hermeneutical wrong. Fricker characterizes hermeneutical injustice as involving a lack of concepts, on the part of the disadvantaged group, to capture some important aspect of their experience. But what has not been properly appreciated in the literature to date, is that it is really competing views of the world that are at stake. Moreover, Fricker’s account seemingly implies that the disadvantaged group’s understanding of the world should be treated as authoritative, and taken up by the wider culture. The worry is that in some cases, the disadvantaged group’s view of the world is not one that we think should be accepted. Having presented this problem, I will then show that it bears some similarities to another debate: the dispute over feminist critiques of alien cultural practices. I will then argue that lessons drawn from the latter can help overcome the problem of authority in Fricker’s case. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.2 (2003) 125-132 [Access article in PDF] Incomprehensibility and Understanding:On the Interpretation of Severe Mental Illness Louis A. Sass Keywords hermeneutics, psychopathology, paradox, Wittgenstein, solipsism, delusion, principle of charity, phenomenological psychopathology. I would like to begin by thanking Rupert Read for the care he has put into reading my work, and into thinking through its implications in the context of the "new-Wittgensteinian" interpretation of the (...) thought of Ludwig Wittgenstein. This interpretation derives from an influential reading of this philosopher's early book, the Tractatus Logico-Philosophicus (1961), that is not explicitly discussed in Read's article, yet that lies behind much of his argument. Read does allude to this reading of the Tractatus when he refers to the concept of "logically alien thought" (see Conant [1992]), and by citing, in his endnotes, the Diamond, Conant, and Cerbone articles that appear in Crary and Read's edited collection, The New Wittgenstein (2000). In an earlier paper that also addresses my work, "On approaching schizophrenia through Wittgenstein," Read (2001) explicitly discusses the relevance of the new-Wittgensteinian interpretation of the Tractatus.According to this new-Wittgensteinian interpretation of the Tractatus, Wittgenstein took absolutely seriously his own realization (explicitly stated at the end of the Tractatus) that his book was internally self-contradictory, and he therefore realized that all or nearly all the sentences of the Tractatus must be totally devoid of any meaning or semantic reference. According to this austere view, the vast bulk of the Tractatus only pretends to be making meaningful statements about the nature of logic and semantics; its real purpose is to give the reader the illusion of meaning, and this it does in order to lead the reader to the eventual realization that there can in fact be no meaningful statements or thoughts at the level of self-referential abstraction at which the Tractatus pretends to be operating. Further, when Wittgenstein (1961) writes (in the famous last line of the book), "Whereof one cannot speak, thereof one must be silent" (p. 189), this statement should, supposedly, not be taken as any kind of mystical pointing toward some ineffable realm or truth, but, rather, as an austere recognition that there just are no ineffable truths—that, so to speak, there just is no mystical there there. [End Page 125]Rupert Read sees an analogy between, on the one hand, the (supposedly mistaken) readers of Wittgenstein's Tractatus who think that Wittgenstein is exploiting self-contradiction to allude to some higher, ineffable truth (i.e., something that can be pointed at even if it cannot be said), and, on the other hand, my own elucidation of Schreber's contradictions (see especially Chapter 2 of Paradoxes of Delusion [1994]) to argue that Schreber can be said to be having particular kinds of experiences, which I refer to as solipsistic or quasi-solipsistic in nature. Just as Wittgenstein's self-contradictions can (supposedly) point nowhere other than to their own failure to mean, so Schreber's self-contradictory and other nonstandard statements cannot (according to Read) be used to illuminate in any meaningful way the form of experience that supposedly lies behind them—as I, for example, have tried to do by offering a phenomenological account of Schreber and schizophrenia. Patients like Schreber and Renée cannot really be understood, just as we cannot really understand logically alien thought—which, in fact, is not really thought at all; in both cases, there is only the illusion of meaning, only the mirage of an alternative mode of thinking or of living. This, at least, is Read's new-Wittgensteinian claim.Few readers of Philosophy, Psychiatry, & Psychology will, I suspect, be familiar with these discussions centering on Wittgenstein's Tractatus, which were introduced largely by the philosophers Cora Diamond and James Conant (see Crary and Read [2000]). (I myself have found their writings fascinating and inspiring in many ways, despite my ultimate disagreement on fundamental issues.) 1 Most readers of Philosophy, Psychiatry, & Psychology will have no way of assessing the validity of this austere reading of the Tractatus... (shrink)