Medicalization was the theme of the 29th European Conference on Philosophy of Medicine and Health Care that included a panel session on the DSM and mental health. Philosophical critiques of the medical model in psychiatry suffer from endemic assumptions that fail to acknowledge the real world challenges of psychiatric nosology. The descriptive model of classification of the DSM 3-5 serves a valid purpose in the absence of known etiologies for the majority of psychiatric conditions. However, a consequence of the “atheoretical” (...) approach of the DSM is rampant epistemological confusion, a shortcoming that can be ameliorated by importing perspectives from the work of Jaspers and McHugh. Finally, contemporary psychiatry’s over-reliance on neuroscience and pharmacotherapy has led to a reductionist agenda that is antagonistic to the inherently pluralistic nature of psychiatry. As a result, the field has suffered a loss of knowledge that may be difficult to recover. (shrink)

First published in 1980. Routledge is an imprint of Taylor & Francis, an informa company.

The main concepts of the free energy (FE) neuroscience developed by Karl Friston and colleagues parallel those of Freud's Project for a Scientific Psychology. In Hobson et al. ( 2014 ) these include an innate virtual reality generator that produces the fictive prior beliefs that Freud described as the primary process. This enables Friston's account to encompass a unified treatment—a complexity theory—of the role of virtual reality in both dreaming and mental disorder. In both accounts the brain operates to minimize (...) FE aroused by sensory impingements—including interoceptive impingements that report compliance with biological imperatives—and constructs a representation/model of the causes of impingement that enables this minimization. In Friston's account (variational) FE equals complexity minus accuracy, and is minimized by increasing accuracy and decreasing complexity. Roughly the brain (or model) increases accuracy together with complexity in waking. This is mediated by consciousness-creating active inference—by which it explains sensory impingements in terms of perceptual experiences of their causes. In sleep it reduces complexity by processes that include both synaptic pruning and consciousness/virtual reality/dreaming in REM. The consciousness-creating active inference that effects complexity-reduction in REM dreaming must operate on FE-arousing data distinct from sensory impingement. The most relevant source is remembered arousals of emotion, both recent and remote, as processed in SWS and REM on “active systems” accounts of memory consolidation/reconsolidation. Freud describes these remembered arousals as condensed in the dreamwork for use in the conscious contents of dreams, and similar condensation can be seen in symptoms. Complexity partly reflects emotional conflict and trauma. This indicates that dreams and symptoms are both produced to reduce complexity in the form of potentially adverse (traumatic or conflicting) arousals of amygdala-related emotions. Mental disorder is thus caused by computational complexity together with mechanisms like synaptic pruning that have evolved for complexity-reduction; and important features of disorder can be understood in these terms. Details of the consilience among Freudian, systems consolidation, and complexity-reduction accounts appear clearly in the analysis of a single fragment of a dream, indicating also how complexity reduction proceeds by a process resembling Bayesian model selection. (shrink)

In the past decades, reductionism has dominated both research directions and funding policies in clinical psychology and psychiatry. The intense search for the biological basis of mental disorders, however, has not resulted in conclusive reductionist explanations of psychopathology. Recently, network models have been proposed as an alternative framework for the analysis of mental disorders, in which mental disorders arise from the causal interplay between symptoms. In this target article, we show that this conceptualization can help explain why reductionist approaches in (...) psychiatry and clinical psychology are on the wrong track. First, symptom networks preclude the identification of a common cause of symptomatology with a neurobiological condition; in symptom networks, there is no such common cause. Second, symptom network relations depend on the content of mental states and, as such, feature intentionality. Third, the strength of network relations is highly likely to depend partially on cultural and historical contexts as well as external mechanisms in the environment. Taken together, these properties suggest that, if mental disorders are indeed networks of causally related symptoms, reductionist accounts cannot achieve the level of success associated with reductionist disease models in modern medicine. As an alternative strategy, we propose to interpret network structures in terms of D. C. Dennett's (1987) notion ofreal patterns, and suggest that, instead of being reducible to a biological basis, mental disorders feature biological and psychological factors that are deeply intertwined in feedback loops. This suggests that neither psychological nor biological levels can claim causal or explanatory priority, and that a holistic research strategy is necessary for progress in the study of mental disorders. (shrink)

An analysis of the history and social role of mobile phones today is followed by a proposal of a philosophical theory of objects, which is meant to be complementary to Searle's 'collective intentionality', that places writing at the basis of social reality.

This article examines the revision of the Diagnostic and Statistical Manual of Mental Disorders and its claim of incorporating a “greater cultural sensitivity.” The analysis reveals that the manual conveys mixed messages as it explicitly addresses the critique of being ethnocentric and having a static notion of culture yet continues in a similar fashion when culture is applied in diagnostic criteria. The analysis also relates to current trends in psychiatric nosology that emphasize neurobiology and decontextualize distress and points to how (...) the DSM-5 risks serving as an ethnic dividing line in psychiatry by making sociocultural context relevant only for some patients. (shrink)

This paper outlines the process of verbal communication of emotion as this occurs through the phases of the referential process, including arousal of an emotion schema; detailed and specific descriptions of images and episodes that are exemplars of emotion schemas; and reflection and reorganization, which may include emotion labels and other types of categorical terms. The concepts of emotion schemas and the referential process are defined in the theoretical framework of multiple code theory which includes subsymbolic sensory, visceral and motoric (...) processes, symbolic images and words. Emotion schemas are defined as clusters of representations of events incorporating similar bodily, sensory and motoric processes activated in relation to different people in different contexts. Through the referential process subsymbolic components of a schema that have been activated in a speaker or writer and that may be connected only partially to words may be evoked in a listener or reader. The concept of the emotion schemas is examined in relation to current work in emotion theory and neuroscience. The unique effects of detailed descriptions of episodes in conveying complex aspects of emotional experience are discussed, as recognized by writers, and as demonstrated in empirical research. Computerized measures of the phases of the referential process are presented, focusing particularly on the central measure, the Weighted Referential Activity Dictionary which identifies points of narrative and imagery. The operation of the function words that dominate the WRAD are examined in relation to the structure of narrative expression underlying the verbal representation of emotion schemas. (shrink)

If one formulates Helmholtz's ideas about perception in terms of modern-day theories one arrives at a model of perceptual inference and learning that can explain a remarkable range of neurobiological facts. Using constructs from statistical physics it can be shown that the problems of inferring what cause our sensory inputs and learning causal regularities in the sensorium can be resolved using exactly the same principles. Furthermore, inference and learning can proceed in a biologically plausible fashion. The ensuing scheme rests on (...) Empirical Bayes and hierarchical models of how sensory information is generated. The use of hierarchical models enables the brain to construct prior expectations in a dynamic and context-sensitive fashion. This scheme provides a principled way to understand many aspects of the brain's organisation and responses. In this paper, we suggest that these perceptual processes are just one emergent property of systems that conform to a free-energy principle. The free-energy considered here represents a bound on the surprise inherent in any exchange with the environment, under expectations encoded by its state or configuration. A system can minimise free-energy by changing its configuration to change the way it samples the environment, or to change its expectations. These changes correspond to action and perception, respectively, and lead to an adaptive exchange with the environment that is characteristic of biological systems. This treatment implies that the system's state and structure encode an implicit and probabilistic model of the environment. We will look at models entailed by the brain and how minimisation of free-energy can explain its dynamics and structure. (shrink)

Freud's core interest in the psyche was the dynamic unconscious: that part of the psyche which is unconscious due to conflict (Freud, 1923/1961 ). Over the course of his career, Freud variously described conflict as an opposition to the discharge of activation (Freud, 1950 ), opposition to psychic activity due to the release of unpleasure (Freud, 1990/1991 ), opposition between the primary principle and the reality principle (Freud, 1911/1963 ), structural conflict between id, ego, and superego (Freud, 1923/1961 ), and (...) ambivalence (Freud, 1912/1963 ). Besides this difficulty of the shifting description of conflict, an underlying question remained the specific shared terrain in which emotions, thoughts, intentions or wishes could come into conflict with one another (the neuronal homolog of conflict), and most especially how they may exist as quantities in opposition within that terrain. Friston's free-energy principle (FEP henceforth) connected to the work of Friston (Friston et al., 2006 ; Friston, 2010 ) has provided the potential for a powerful unifying theory in psychology, neuroscience, and related fields that has been shown to have tremendous consilience with psychoanalytic concepts (Hopkins, 2012 ). Hopkins ( 2016 ), drawing on a formulation by Hobson et al. ( 2014 ), suggests that conflict may be potentially quantifiable as free energy from a FEP perspective. More recently, work by Friston et al. ( 2017a ) has framed the selection of action as a gradient descent of expected free energy under different policies of action. From this perspective, the article describes how conflict could potentially be formalized as a situation where opposing action policies have similar expected free energy, for example between actions driven by competing basic prototype emotion systems as described by Panksepp ( 1998 ). This conflict state may be avoided in the future through updating the relative precision of a particular set of prior beliefs about outcomes: this has the result of tending to favor one of the policies of action over others in future instances, a situation analogous to defense. Through acting as a constraint on the further development of the person, the defensive operation can become entrenched, and resistant to alteration. The implications that this formalization has for psychoanalysis is explored. (shrink)

From Billy Graham and Ronald Regan to Newt Gingrich and William Bennett, God is a Conservative provides an important look at the role of religion in conservative politics in modern America. Kenneth J. Heineman reveals the profoundly religious nature of contemporary conservatism, offering an intriguing look at the social history of moral politics over the last three decades, and the still tremulous aftershocks of the New Deal. With a new Preface that examines the Bush presidency, including a provocative analysis of (...) his re-election, and the rising influence of the Conservative Right, God is a Conservative is essential reading for understanding today's American political landscape. (shrink)

Neurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

Psychiatric researchers typically assume that the modelling of psychiatric symptoms is not influenced by psychiatric categories; symptoms are modelled and then grouped into a psychiatric category. I highlight this primarily through analysing research domain criteria. RDoC’s importance makes it worth scrutinizing, and this assessment also serves as a case study with relevance for other areas of psychiatry. RDoC takes inadequacies of existing psychiatric categories as holding back causal investigation. Consequently, RDoC aims to circumnavigate existing psychiatric categories by directly investigating the (...) causal basis of symptoms. The unique methodological approach of RDoC exploits the supposed lack of influence of psychiatric categories on symptom modelling, taking psychiatric symptoms as the same regardless of which psychiatric category is employed or if no psychiatric category is employed. But this supposition is not always true. I will show how psychiatric categories can influence symptom modelling, whereby identical behaviours can be considered as different symptoms based on an individual’s psychiatric diagnosis. If the modelling of symptoms is influenced by psychiatric categories, then psychiatric categories will still play a role, a situation which RDoC researchers explicitly aim to avoid. I discuss four ways RDoC could address this issue. This issue also has important implications for factor analysis, cluster analysis, modifying psychiatric categories, and symptom based approaches. (shrink)

Mit dem Anfang der 1990er Jahre für kommerzielle Zwecke entwickelten World Wide Web hat die Nutzung digitaler Kommunikationsmedien rasant zugenommen; deren Einsatz ist zu einem Massenphänomen geworden. Das hat erhebliche Auswirkungen auf das Gesundheitswesen, die Psychotherapie und nicht zuletzt auch die Psychoanalyse. Neben der grundsätzlichen Frage nach dem gesellschaftlichen Umgang mit Gesundheits- bzw. Krankheitsdaten, dem Persönlichkeitsrecht der Bürger sowie dem Datenschutz bei der Nutzung digitaler Medien stellen sich auch grundlegende ethische Fragen in der Psychotherapie und in der Psychoanalyse. Unabdingbar für (...) die implizite Ethik der Psychoanalyse bzw. der psychoanalytisch begründeten Verfahren ist der geschützte therapeutische Raum, dessen Vorhandensein (nach innen und außen) überhaupt erst ermöglicht, vor- und unbewusstes Material zu untersuchen. Auch wenn die digitale therapeutische Kommunikation geeignet ist, bei Analytiker und Analysand das Phantasma der Omnipräsenz zu befördern, greift die radikale Ablehnung ihres Einsatzes zu kurz. Umgekehrt muss man sich der Frage stellen, ob und wie das, was Psychoanalyse ausmacht, im »Bereich des Virtuellen« bzw. mit den Mitteln digitaler Kommunikationsmedien möglich ist. (shrink)

If one formulates Helmholtz’s ideas about perception in terms of modern-day theories one arrives at a model of perceptual inference and learning that can explain a remarkable range of neurobiological facts. Using constructs from statistical physics it can be shown that the problems of inferring what cause our sensory inputs and learning causal regularities in the sensorium can be resolved using exactly the same principles. Furthermore, inference and learning can proceed in a biologically plausible fashion. The ensuing scheme rests on (...) Empirical Bayes and hierarchical models of how sensory information is generated. The use of hierarchical models enables the brain to construct prior expectations in a dynamic and context-sensitive fashion. This scheme provides a principled way to understand many aspects of the brain’s organisation and responses. In this paper, we suggest that these perceptual processes are just one emergent property of systems that conform to a free-energy principle. The free-energy considered here represents a bound on the surprise inherent in any exchange with the environment, under expectations encoded by its state or configuration. A system can minimise free-energy by changing its configuration to change the way it samples the environment, or to change its expectations. These changes correspond to action and perception, respectively, and lead to an adaptive exchange with the environment that is characteristic of biological systems. This treatment implies that the system’s state and structure encode an implicit and probabilistic model of the environment. We will look at models entailed by the brain and how minimisation of free-energy can explain its dynamics and structure. (shrink)