Part I The Imperative Mood 'Virtue, then, is a disposition governing our choices '. ARISTOTLE, Eth. Nic. 36 Prescriptive Language. ...

In this book, one of the world's preeminent philosophers takes issue with an idea that has found an all-too-prominent place in popular culture and philosophical ...

In lieu of an abstract, here is a brief excerpt of the content:Spiritual Experience and PsychopathologyMike Jackson and K. W. M. Fulford (bio)AbstractA recent study of the relationship between spiritual experience and psychopathology (reported in detail elsewhere) suggested that psychotic phenomena could occur in the context of spiritual experiences rather than mental illness. In the present paper, this finding is illustrated with three detailed case histories. Its implications are then explored for psychopathology, for psychiatric classification, and for our understanding of (...) the concept of mental illness. It is argued that pathological and spiritual psychotic phenomena cannot be distinguished by 1) form and content alone (as in traditional psychopathology), 2) by their relationship either with other symptoms or with pathological causes (as in psychiatric classification), or 3) by reference to the descriptive criteria of mental illness implied by the “medical” model. The distinction is shown to depend, rather, on the way in which psychotic phenomena themselves are embedded in the values and beliefs of the person concerned. This in turn is shown to have implications for diagnosis (it shows the need for clinicians to attend to the values and beliefs of individual patients), for treatment (it points to a cognitive problem-solving model), and for research in psychopathology (especially as related to the emerging sciences of dynamic brain imaging and cognitive neuroscience).Keywordsfirst rank symptoms, schizophrenia, delusion, hallucination, thought disorder, religious experience, mystical experienceIntroductionThis paper explores some of the conceptual and practical implications of the finding that phenomena which in a medical context would probably be diagnosed as psychotic symptoms, may occur in the context of non-pathological, and indeed essentially benign, spiritual experiences.The existence of non-pathological psychotic experiences of this kind (we will call them “psychotic phenomena” as distinct from “psychotic symptoms”—see also Endnote 1, terminology) was a key finding in a study carried out by one of us (MJ) at the Alister Hardy Research Centre (AHRC) in Oxford. Details are given elsewhere both of the overall empirical findings of the study, including the relationship between spiritual experience and personality variables, and of a hypothetical cognitive problem-solving model of these phenomena (Jackson 1991, and forthcoming a and b). In the present paper, 1) the background to the study is described briefly in relation to earlier work on the possible links between spiritual experience and psychopathology; 2) some of the psychotic phenomena identified are illustrated with three detailed case histories; 3) the significance of these phenomena is reviewed for our understanding respectively of psychopathology, of diagnostic syndromes, and of the concept of mental illness; and 4) some of the practical implications of the study for clinical work and research in psychiatry are indicated.BackgroundIt has long been recognized that there are similarities between spiritual and psychotic experiences. [End Page 41] William James (1902), for example, argued that “in delusional insanity, paranoia as they sometimes call it, we may have a kind of diabolical mysticism, a sort of religious mysticism turned upside down” (426). Other commentators have noted a wide variety of phenomena, such as time distortion, synesthesias, loss of self-object boundaries and the transition from a state of conflict and anxiety to one of sudden “understanding,” all of which are reported in both spiritual and psychotic experiences (Buckley 1981; Watson 1982; Wapnick 1969; and Wootton and Allen 1983).Yet the similarities notwithstanding, the distinction between these two kinds of experience can be crucially important. Spiritual experiences, whether welcome or unwelcome, and whether or not they are psychotic in form, have nothing (directly) to do with medicine (Fulford 1996a). It would be quite wrong, then, to “treat” spiritual psychotic experiences with neuroleptic drugs, just as it is quite wrong to “treat” political dissidents as though they were ill (Fulford, Smirnoff and Snow, 1993). Pathological psychotic experiences, on the other hand, or psychotic symptoms, are by definition a proper object of medical treatment, sometimes even against the wishes of the person concerned. Hence it would be both negligent and, as Wing (1978) put it, morally “repellent,” to leave untreated someone who is genuinely ill (244).Given how much turns on the distinction between spiritual experience and psychopathology, it is perhaps not surprising that scholarly discussion of the relationship between them has at times... (shrink)

In this unique study Fulford combines the disciplines of rigorous philosophy with an intimate knowledge of psychopathology to overturn traditional hegemonies. The patient replaces the doctor at the heart of medicine. Moral theory and the logic of evaluation replace epistemology as the focus of philosophical enquiry. Ever controversial, mental illness is at the interface of philosophy and medicine. Mad or bad? Dissident or diseased? Dr Fulford shows that it is possible to achieve new insights into these traditional dilemmas, insights at (...) once practically relevant and philosophically significant. (shrink)

Nature and Narrative is the launch volume in a new series of books entitled International Perspectives in Philosophy and Psychiatry. Nature(representing interest in the causes of a problem) and Narrative (for understanding its meanings) will introduce the field and the series, by touching on a range of issue relevant to this interdisciplinary 'border country'.

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Spiritual Experience and Psychopathology”Andrew Sims (bio)In examining this interesting paper, we need first of all to understand what the authors are doing. They are not taking the conceptual vehicles of “spiritual experience” (SE) and “psychotic phenomena” (PP) for a gentle outing, but exposing both of them to the hardest road test they can devise. From 1,000 accounts of “spiritual experiences” that were already so dramatic that those (...) involved were prepared to describe them, the authors selected three which most successfully blurred the boundaries between SE and PP. So we are not exploring whether these concepts have general practical validity, but whether their mutual frontiers are discrete or overlapping. The authors’ task is legitimate, but it needs to be recognized for what it is.Unusual spiritual experiences are interpreted by the authors as psychotic symptoms, and the definitions of the Present State Examination (PSE) descriptions are cited to justify this. However, we have known for a long time that using instruments for purposes for which they were not designed can produce unexpected results; it is rather like washing socks in a dishwasher and being surprised that it does little good to the socks. The PSE was devised for categorizing and quantifying existing psychiatric disorders in epidemiological studies. The further one gets from this, its true purpose, the less satisfactory it becomes as an instrument. A better way of evaluating symptomatology in an individual case is a skilled and painstaking interview by a well-trained descriptive psychopathologist. One can only conclude from the authors’ use of the PSE in distinguishing SE from PP, that the instrument itself is not capable of doing this, which is not really very surprising. One can form no views on the concepts of SE and PP themselves, except that in some circumstances they may be difficult to tell apart.It would be easy to dispute whether Simon’s beliefs were delusions. Believers from many religious backgrounds “know” that God gives them thoughts or ideas, and it requires detailed psychopathological examination, and not the application of a questionnaire, to distinguish this from the much more concrete experience as described in PSE of “inserted thoughts.”Rating scales, be they assessments of the quality of teaching in primary schools or quantification of established psychotic symptoms, are necessarily only a pale reflection and an over-simplification of the skilled work that professionals undertake. To imply that because a score could be given on the PSE to an otherwise healthy woman who describes the frequent experience of hearing God’s voice, denies the validity of her experience, but also affronts the professional skills of a trained psychopathologist. When psychiatrists, or even [End Page 79] untrained research workers, use the PSE they are presumably doing so as part of an epidemiological research study, and the validity of their individual result is evened out by results from a number of other subjects. If a psychiatrist is trying to decide whether Sara had “true” hallucinations, he or she will carry out a psychopathological interview in which the criteria for establishing true hallucinations are much more sophisticated than is possible in a questionnaire, and the interview will be individualized. Sara’s significant statement, “but God doesn’t take your free will away,” immediately distinguishes her diagnosis from schizophrenia. It was good that Sara’s priest did not need detailed knowledge of psychopathology to come to a common-sense evaluation of her experience.It was with some feelings of disappointment that I realized that when the authors use the word “psychotic” they merely mean that a tick could be placed in an appropriate box for the PSE. If one were to carry out an investigation of serum electrolytes on a fit athlete on completion of a marathon, one would get bizarre and probably abnormal results. For a quantified investigation to be meaningful, one must always take account of the context.When I read these three cases as a psychopathologist, I find no convincing psychotic phenomena, and the three human beings were undoubtedly not psychotic at the time of expression of their religious experiences. The word psychosis is not helpful in psychopathology: if one looks more specifically in these cases for the phenomena... (shrink)