ABSTRACTTime-consciousness has long been a focus of research in phenomenology and phenomenological psychology. We advance and extend this tradition of research by focusing on the character of temporal experience under conditions of mania. Symptom scales and diagnostic criteria for mania are peppered with temporally inflected language: increased rate of speech, racing thoughts, flight-of-ideas, hyperactivity. But what is the underlying structure of temporal experience in manic episodes? We tackle this question using a strategically hybrid approach. We recover and reconstruct three hypotheses (...) regarding manic temporality that were advanced and modeled by two pioneers of clinical phenomenology: Eugène Minkowski and Ludwig Binswanger. We then test, critique, and refine these hypotheses using heterophenomenological methods in an interview-based study of persons with a history of bipolar and a current diagnosis of acute mania. Our conclusions support a central hypothesis due to Minkowski... (shrink)

This paper argues that Plato recognized that Socrates’ rational, reflective love, learned from the wise Diotima, is the only means of achieving secure, self-sufficient happiness and so the only way to avoid tragedy in human life.

Objective Manic and depressive phases of bipolar disorder (BD) show opposite psychomotor symptoms. Neuronally, these may depend on altered relationships between sensorimotor network (SMN) and subcortical structures. The study aimed to investigate the functional relationships of SMN with substantia nigra (SN) and raphe nuclei (RN) via subcortical-cortical loops, and their alteration in bipolar mania and depression, as characterized by psychomotor excitation and inhibition. -/- Method In this resting-state functional magnetic resonance imaging (fMRI) study on healthy (n = 67) and BD (...) patients (n = 100), (1) functional connectivity (FC) between thalamus and SMN was calculated and correlated with FC from SN or RN to basal ganglia (BG)/thalamus in healthy; (2) using an a-priori-driven approach, thalamus-SMN FC, SN-BG/thalamus FC, and RN-BG/thalamus FC were compared between healthy and BD, focusing on manic (n = 34) and inhibited depressed (n = 21) patients. -/- Results (1) In healthy, the thalamus-SMN FC showed a quadratic correlation with SN-BG/thalamus FC and a linear negative correlation with RN-BG/thalamus FC. Accordingly, the SN-related FC appears to enable the thalamus-SMN coupling, while the RN-related FC affects it favoring anti-correlation. (2) In BD, mania showed an increase in thalamus-SMN FC toward positive values (ie, thalamus-SMN abnormal coupling) paralleled by reduction of RN-BG/thalamus FC. By contrast, inhibited depression showed a decrease in thalamus-SMN FC toward around-zero values (ie, thalamus-SMN disconnection) paralleled by reduction of SN-BG/thalamus FC (and RN-BG/thalamus FC). The results were replicated in independent HC and BD datasets. -/- Conclusions These findings suggest an abnormal relationship of SMN with neurotransmitters-related areas via subcortical-cortical loops in mania and inhibited depression, finally resulting in psychomotor alterations. (shrink)

Temporality and Spatiality have been extensively addressed in philosophy, and their disturbances have been extensively studied in psychopathology (e.g. Wyllie 2005). Mental health patients: (1) describe pathological experiences of Time and Space (Gallagher and Varela 2003); (2) show disturbed timing (Tysk 1984); (3) experience psychopathological phenomena that could be the cause of changes in temporality and spatiality. These topics will be discussed in the case of mood disorders, in particular euphoric and dysphoric mania episodes. Any phenomenological study in mood disorders (...) is delicate as affective disorders are in themselves phenomenologically diverse, because they have obscure meaning, multitude of criteria and inconsistent reference norms. Also, psychoanalytical, colloquial and cognitive psychologies keep instilling comprehensive and epistemological structures onto both mood and time/space notions. Nevertheless, bridging philosophical phenomenology and epistemology on time and temporality with mood psychopathology and taxonomy constitutes an on-going project. Theories by Heidegger, Husserl and Merleau-Ponty as well as by Minkowsky, Binswanger, Fuchs, Parnas, and Sass could help to describe this relation deepened into many other Twentieth-Century philosophical papers. A similar account of space and spatiality will be brought about. We will reason about the concept that they provide evidence to address current conceptualization of “bipolar” disorder and the hierarchical grouping of dysphoric and euphoria mania. (shrink)

Objective: Inflammation is one of several etiopathological mechanisms contributing to bipolar disorder. Neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) are relatively cheap hematological parameters recommended to measure the level of inflammation. In this study, the NLR, MLR, and PLR values of the same patients during manic and euthymic periods were compared to a healthy control group. -/- Methods: This retrospective study was conducted on inpatients with bipolar disorder manic episodes at the University Faculty of Medicine psychiatry clinic. (...) Ninety-nine patients with manic episodes of bipolar disorder and age and gender-matched 101 volunteers without prior psychiatric illness were included in the study. Neutrophil, lymphocyte, monocyte, and platelet counts during the disease period were recorded, and NLR, MLR, and PLR values were calculated from these values. Similar hematological parameters of the same patients in the euthymic period after discharge were compared. -/- Results: Patients with manic episodes were shown to have significantly higher neutrophil, platelet, NLR, MLR, and PLR levels than the control group (p<0.001). Monocyte count was significantly lower in manic episode patients compared to controls (p<0.001). Neutrophil and monocyte counts were significantly lower during the euthymic period compared to the control group, while NLR, MLR, and PLR levels were higher (p<0.001). -/- Conclusions: The fact that NLR, MLR, and PLR are higher in BD patients compared to the healthy control group in both manic and euthymic periods indicates that they can be used as trait biomarkers. (shrink)

Josh is a typical 27-year-old in a career that he enjoys and a successful marriage. Josh begins to exhibit the symptoms of a manic episode. He is soon diagnosed with bipolar disorder. While non-manic, Josh’s preferences are typical. While manic, his preferences change dramatically. He quits his job, cheats on his partner, and squanders his savings. These are behaviors that Josh, when non-manic (euthymic), would never agree to. When Josh returns to a euthymic state, he regrets these decisions. Should those (...) close to Josh have prevented him from making these decisions, or does his competence to decide persist despite his acute mania? In this paper, I examine the connections be-tween bipolar disorder and consent. I defend the view that many (although far from all) individuals with bipolar disorder are competent to consent to a wide variety of things when they are in a manic state. This means that mania should not be presumed to undermine competence in clinical settings. -/- I have several goals in this paper. I want to bring philosophy to bear on the connection between consent and bipolar disorder. Additionally, I intend this paper to contribute to the general debate about the conditions of informed consent. Bipolar disorder presents novel challenges to existing conceptions of competence to consent which require stable core of values for an agent to be competent. For example, Buchanan and Brock endorse such a view. In showing that shifting values do not undermine the competence of a person experiencing acute mania, I show that the aforementioned views of competence are false. Overall, this paper makes substantive contributions to the debate about competence to consent and presents the first sustained philosophical treatment of consent among people with bipolar disorder. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:diacritics 35.1 (2005) 8-21MuseSearchJournalsThis JournalContents[Access article in PDF]Klossowski's Reading of Nietzsche Impulses, Phantasms, Simulacra, StereotypesDaniel W. SmithIn his writings on Nietzsche, Pierre Klossowski makes use of various concepts—such as intensities, phantasms, simulacra and stereotypes, resemblance and dissemblance, gregariousness and singularity—that have no place in Nietzsche's own oeuvre. These concepts are Klossowski's own creations, his own contributions to thought. Although Klossowski consistently refused to characterize himself as a philosopher ("Je (...) suis une 'maniaque,'" he once said, "Un point, c'est tout!"),1 his work in its entirety was marked by an extraordinary conceptual creation. From this point of view, his Nietzsche and the Vicious Circle can be read as a work in philosophy—at least in the idiosyncratic sense given to this term by Gilles Deleuze, who defined philosophy as the creation or invention of concepts [Deleuze and Guattari 2]. No doubt, Klossowski remains an almost unclassifiable figure—philosopher, novelist, essayist, translator, artist—and attempting to analyze his work through the prism of philosophy may seem to be a reductive approach that belies the complexity of his exceptional oeuvre. Reading Klossowski as a conceptual innovator, however, at least has the advantage of allowing us to chart a consistent trajectory through his difficult and often labyrinthine text, without denying its other dimensions (affective, perceptive, literary, and so on). In what follows, then, I would like to examine three of Klossowski's most characteristic and important concepts—impulses and their intensities, phantasms, and simulacra and their stereotypes—as well as the precise interrelations he establishes among them. Taken together, these three concepts describe what Klossowski terms the tripartite economy of soul, which constitutes the implicit model through which he interprets Nietzsche's thought.1Impulses as Fluctuating IntensitiesKlossowski describes his books on both Nietzsche and Sade as "essays devoted not to ideologies but to the physiognomies of problematic thinkers who differ greatly from each other" ["Postface" 137, emphasis added]. This emphasis on the "physiognomy" of thinkers reflects Nietzsche's insistence on taking the body rather than the mind as a guide for philosophy since the body is a more accessible phenomenon, less surrounded by myth and superstition. "The body and physiology as the starting point," Nietzsche wrote. "Why?... The phenomenon of the body is the richer, clearer, more tangible [End Page 8] phenomenon.... Belief in the body is more fundamental than belief in the soul" [WP §§492, 489, 491]. Klossowski himself, however, when writing of the intensive status of the impulses, frequently makes use of the term "soul" (âme), owing in part, no doubt, to his interest in the theological literature of the mystics, such as Meister Eckhardt and Teresa of Avila. For the mystics, the depth of the soul is something irreducible and uncreated: it eludes the exercise of the created intellect, and can only be grasped negatively.2 Nonetheless, if one can find a similar apophaticism (or "negative theology") in Klossowski, it is related exclusively to the immanent and chaotic movements of the soul's intensive affects, and not to the transcendence of God. What is incommunicable in the soul (or body) are its "impulses"—their fluctuations of intensity, their rises and falls, their manic elations and depressive descents, which are in constant variation.Nietzsche himself had recourse to a highly varied vocabulary to describe what Klossowski summarizes in the term "impulse": "drive" (Triebe), "desire" (Begierden), "instinct" (Instinke), "power" (Mächte), "force" (Kräfte), "impulse" (Reize, Impulse), "passion" (Leidenschaften), "feeling" (Gefülen), "affect" (Affekte), "pathos" (Pathos), and so on.3 Klossowski frequently employs the musical term tonalité to describe these states of the soul's fluctuating intensities—their diverse tones, timbres, and changing amplitudes—which can take on various forms ("aggressiveness, tolerance, intimidation, anguish, the need for solitude, the forgetting of oneself" [NVC 6]). At bottom, what these impulses express are what Klossowski calls the "obstinate singularity" of the human soul, which is by nature noncommunicable; they constitute "the unexchangeable depth" (le fond inéchangeable) or "the unintelligible depth" (le fond unintelligible) of the soul. What makes every individual... (shrink)

In this paper, I examine recent phenomenological research on both depressive and manic episodes, with the intention of showing how phenomenologically oriented studies can help us overcome the apparently paradoxical nature of mixed states. First, I argue that some of the symptoms included in the diagnostic criteria for depressive and manic episodes in the DSM-5 are not actually essential features of these episodes. Second, I reconsider the category of major depressive disorder (MDD) from the perspective of phenomenological psychopathology, arguing that (...) severe depressive episodes should not be characterized by any particular moods (such as sadness, hopelessness, or guilt), and should instead be characterized by a diminished capacity for finding ourselves situated in and attuned to the world at all. In other words, the affective dimension of depression should be characterized as a change in the way we have moods, not as a change from one kind of mood to another. Third, I turn to mania, arguing that manic episodes, taken as the opposite of depressive episodes, should be characterized not by any particular moods (such as euphoria, grandiosity, or even irritability), but should instead be characterized by an enhanced or heightened capacity for finding ourselves situated in and attuned to the world. In other words, the affective dimension of mania, like the affective dimension of depression, should be understood as a change in the way we have moods, not as a change from one kind of mood to another. Fourth, I return to the phenomenon of mixed states and argue that the affective dimension of depression and mania, when conceived along the phenomenological lines I set forth in the previous sections, dissolves the paradox of mixed states by showing that the essential characteristics of depression and mania cannot and do not coincide. Many cases of mixed states are diagnosed because moods that we take to be essential features of either depression or mania arise within the context of what is considered to be the opposite kind of episode (e.g. dysphoria, typically associated with depression, often arises in what is otherwise considered a manic state). However, if we conceive of the affective dimension of depression as a decrease in the degree to which one is situated in and attune to the world through moods, and the affective dimension of mania as an increase in the degree to which one is situated in and attuned to the world through moods, then the particular mood one finds oneself in is simply irrelevant to the diagnosis of either depression or mania. As a result, the manifestation of any particular moods in what otherwise seems to be a pure manic or depressive episode does not constitute a mixed state. (shrink)

(For English, scroll down) „Kreativität“ ist ein sehr junger Begriff und ein sehr altes Phänomen. Sie gilt als unaufklärbares Rätsel, als eine Art „Black Box“ des Denkens. Dem kollektiven Bewußtsein zufolge ist sie etwas Rares, Flüchtiges, strapaziös zu erzielen und nur wenige Glückliche begünstigend. Das vorliegende Buch präsentiert eine logische Grundidee zur Entstehung von schöpferisch Neuem – Elemente aus Logik, Symbotheorie, Informations-, Kommunikations- und Medientheorie verbindend. Diese „Formel“ wird an philosophischen Stationen von der Antike bis zur Gegenwart erprobt und weiterentwickelt, (...) darunter Theorien von Platon, Aristoteles, Leibniz, Baumgarten, Kant, Wittgenstein, Nelson Goodman und Gregory Bateson. Kreativität zeigt sich als ein Transformationsphänomen, welches das Denken auf eine andere logische Ebene führt, kategoriale Grenzen transformiert und Anschlußformen öffnet. Im Ergebnis ist sie nichts per Definition Abwesendes, erreichbar nur über den Umweg von unverfügbarer Gunst, weltabgewandter Passion oder verborgenen Tricks. Kreativität ist vielmehr omnipräsent, schöpferische Energien sind nur mit großem Aufwand zu unterdrücken, und die Frage, wie man sie erreicht, wird zur Frage, wie man ihr eine optimale Basis bereitet, ohne sie wesentlich zu behindern. Creativity" is a young term and an old phenomenon. It is considered an unexplainable enigma, a kind of "black box" of thought. According to the default view, it is something rare, fleeting, hard to achieve and favoring only a lucky few. The present book presents a logical formula for the emergence of creative newness - combining elements from logic, theories of symbolization, information-theory, communication- and media theories. This structural idea is tested and further developed by confronting it with select philosophical theories regarding the production of ‘newness’ from antiquity to the present, including theories by Plato, Aristotle, Leibniz, Baumgarten, Kant, Wittgenstein, Nelson Goodman and Gregory Bateson. As a result, creativity shows up as a transformation phenomenon, including different logical levels, thereby transforming categorical boundaries. As a result, it is not something mostly absent, attainable only through of luck, manic passion, or hidden tricks. Creativity is rather omnipresent, creative energies can only be suppressed with great effort, and the question of how to achieve it becomes the question of how to prepare an optimal basis without significantly hindering it. (shrink)

Time is an essential feature in bipolar disorder (BP). Manic and depressed BP patients perceive the speed of time as either too fast or too slow. The present article combines theoretical and empirical approaches to integrate phenomenological, psychological, and neuroscientific accounts of abnormal time perception in BP. Phenomenology distinguishes between perception of inner time, ie, self-time, and outer time, ie, world-time, that desynchronize or dissociate from each other in BP: inner time speed is abnormally slow (as in depression) or fast (...) (as in mania) and, by taking on the role as default-mode function, impacts and modulates the perception of outer time speed in an opposite way, ie, as too fast in depression and too slow in mania. Complementing, psychological investigation show opposite results in time perception, ie, time estimation and reproduction, in manic and depressed BP. Neuronally, time speed can be indexed by neuronal variability, ie, SD. Our own empirical data show opposite changes in manic and depressed BP (and major depressive disorder [MDD]) with abnormal SD balance, ie, SD ratio, between somatomotor and sensory networks that can be associated with inner and outer time. Taken together, our combined theoretical-empirical approach demonstrates that desynchronization or dissociation between inner and outer time in BP can be traced to opposite neuronal variability patterns in somatomotor and sensory networks. This opens the door for individualized therapeutic “normalization” of neuronal variability pattern in somatomotor and sensory networks by stimulation with TMS and/or tDCS. (shrink)

In this paper I examine the ways in which our language and terminology predetermine how we approach, investigate and conceptualise mental illness. I address this issue from the standpoint of hermeneutic phenomenology, and my primary object of investigation is the phenomenon referred to as “mania”. Drawing on resources from classical phenomenology, I show how phenomenologists attempt to overcome their latent presuppositions and prejudices in order to approach “the matters themselves”. In other words, phenomenologists are committed to the idea that in (...) our everyday, natural attitude, we take for granted a number of prejudices and presuppositions that predetermine how we conceive of and understand what we experience. In order to properly approach the phenomena themselves, we need to find ways of neutralising our presuppositions and prejudices in order to develop new (and hopefully more accurate) accounts of the phenomena under investigation. One of the most popular examples of such an attempt at neutralisation is what Edmund Husserl calls the epoché, which is the practice of bracketing out or suspending presuppositions. However, later phenomenologists developed alternative approaches. Martin Heidegger, for instance, engaged in etymological analyses to discover latent meanings in our language and terminology. Hans-Georg Gadamer also engaged in historical analyses of how our traditions sediment into latent prejudices. After discussing the various ways in which phenomenologists have attempted to neutralise presuppositions and prejudices prior to engaging in their investigations, I apply some of these principles and methods to the domain of psychopathology, and discuss some of the prejudices inherent in contemporary discussions of the phenomenon of mania. I examine recent attempts to link the phenomenon that we today refer to as “mania” with the ancient Greek concept of “μανία” (mania), and argue that the practice of linking contemporary and historical concepts can be detrimental to attempts at reclassifying disorders. In addition, I consider the implications of the shift in terminology from “manic depressive illness” to “bipolar disorder” – especially how conceiving of mania as one of two “poles” predetermines its description by both clinicians and patients. Finally, I address the implications of the headings under which mania and bipolar disorder are discussed within diagnostic manuals. For example, I discuss the removal of the headings of affective and mood disorders in the DSM-5, and the explicit decision by the authors to place bipolar disorder between depressive disorders and schizophrenia. What I aim to accomplish in this paper is not so much a phenomenological investigation of mania as it is a pre-phenomenological investigation. In other words, I offer a preparatory investigation of the phenomenon (or phenomena) referred to as “mania” in contemporary discourse, with the intention of laying the groundwork for further phenomenological and psychological research. (shrink)