As a contribution to a wider discussion on moral discernment in theological anthropology, this paper seeks to answer the question “What is the impact of mental illness on an individual’s ability to make moral decisions?” Written from a clinical psychiatric perspective, it considers recent contributions from psychology, neuropsychology and imaging technology. It notes that the popular conception that mental illness necessarily robs an individual of moral responsibility is largely unfounded. Most people who suffer from mental (...) health problems do not lose the capacity to make moral decisions, and mental illness on its own rarely explains anti-social or criminal behaviour. Moreover, the assumptions of some scientists, that recent developments in neuropsychology and brain imaging suggest biological determinism, must be treated with caution. (shrink)

Hegel reads the poet Novalis as an expression of terminal irony, a pathological case of Gemüt, where the conscious mind is alienated from reality and turns its negativity inwards on the contents of its own natural soul. The condition of self-feeling, presented in Hegel’s “Anthropology”, is a self-consumption that manifests itself somatically in the physical disease (consumption) from which Novalis dies. The poet’s literary production represents a pathological fixation that impedes the dynamic organicity of Hegelian Science. As such, Novalis’s (...) class='Hi'>mental illness and death constitute an expression of romantic irony and an ongoing threat to Hegel’s philosophy. (shrink)

This chapter has two aims. The first aim is to compare and contrast three different conceptual-explanatory models for thinking about mental illness with an eye towards identifying the assumptions upon which each model is based, and exploring the model’s advantages and limitations in clinical contexts. Major Depressive Disorder is used as an example to illustrate these points. The second aim is to address the question of what conceptual-theoretical framework for thinking about mental illness is most likely (...) to facilitate the discovery of causes and treatments of mental illness in research contexts. To this end, the National Institute of Mental Health’s Research Domain Criteria (RDoC) Project is briefly considered. (shrink)

This article argues in favor of modifying the medical model of severe psychiatric disturbances that underlies calling them "mental illness." The key reason for this proposal is that numerous specialists other than physicians as well as non-specialists contribute to the process of assisting a person recover from what the author suggests might better be called "extraordinary functional disability." There is little uniformity in existing definitions under state laws, but all involve three types of intervention: civil commitment; civil determination (...) of legal competency; and standing to be subject to criminal law. Physicians typically make relevant determinations in each of these areas; but non-physicians are the principal care-givers once a determination has been made. (shrink)

Prof. Cohen and I answer six questions: (1) Why do we lock people up? (2) How can involuntary civil commitment be reconciled with people's constitutional right to liberty? (3) Why don't we treat homicide as a public health threat? (4) What is the difference between legal and medical approaches to mental illness? (5) Why is mental illness required for involuntary commitment? (6) Where are we in our efforts to understand the causes of mental illness?

This paper offers a philosophical analysis of mental illness as a concept and attempts to provide an understanding of what contributes to the instability of this concept. Mental illness is argued to be susceptible to looping effects, which means that the behaviours of those diagnosed is affected by their classification. This idea of looping is a contributor to mental illness being an unstable category as it affects the behaviours of those classified and the classifications (...) themselves. Specific mental disorders such as anxiety and depression are particularly vulnerable to looping effects due to their value-laden and subjective diagnostic criteria, argued by many anti-psychiatrists such as Rosenhan, Foucault and Szasz. These looping effects are more relevant than ever, with the increased awareness of mental illnesses on social media, overgeneralized information surrounding the symptoms of disorder, the glamorisation and self-assessments which inspire self-diagnosis. Whilst mental illness should not be abandoned as a concept, ‘mental illness’ has deviated from the proper use of ‘mental disorder’ due to overdiagnosis and looping effects and this conceptual instability is a bad thing due to the long-term consequences of over-prescribing antidepressants, preventing access to treatment, political and social implications and a looping trap: which is the idea that an individual cannot escape from their classification once identified. This paper gives a conceptual analysis of ‘mental illness’ and argues that looping effects are mainly responsible for its instability and in order to avoid the negative consequences of such an instability, we should be aware of these effects and attempt to find a basic framework which presents a clear understanding of what we mean by ‘abnormal’ or ‘disordered’ behaviours. (shrink)

Our philosophical understanding of mental illness is being shaped by neuroscience. However, it has the paradoxical effect of igniting two radically opposed groups of philosophical views. On one side, skepticism and denialism assume that, lacking clear biological mechanisms and etiologies for most mental illnesses, we should infer they are constructions best explained by means of social factors. This is strongly associated with medical nihilism: it considers psychiatry more harmful than benign. On the other side of the divide, (...) naturalism and reductionism are on the look for failures in the biological functioning of the organism whenever a genuine mental illness occurs. Psychiatry as currently practiced, accordingly, exhibits the gaps of an ongoing research programme; a yet to be completed neuroscience would link mental illnesses with identifiable biological mechanisms. Both sides of this divide claim to be fostered by scientific discoveries and advances in neuroscience, when taken at face value. Against this background, we argue instead for a modest view. To that end, we draw attention to some nuances in the scientific realism debate. While contending that neuroscientific theories and models aim to provide true representations of their target systems, and can justifiably claim to have attained some, we argue that our confidence should not be placed beforehand in specific features of these scientific representations. Hence, it would be unwarranted to extract morals for psychiatry from posits (or their absence) in neuroscientific explanations of mental illnesses. To illustrate our position, we examine some recent discoveries in neuroscience concerning bipolar disorder. We conclude by linking our topic to a broader issue in the philosophy of medicine: insofar as psychiatry is a biomedical specialty, its classifications of health and disease are guided by pragmatic concerns, as well as by scientific discoveries. (shrink)

Our main objective is to locate and analyze some philosophical issues about the concept of mental illness and the manner it is used, especially in contemporary psychiatry. It is even difficult to find a standard meaning in the main psychiatric textbooks; and, when there is some exposition of the concept, it is sparse, uncritical and vague. As an immediate consequence of these issues, practical guidelines and protocols for the clinic arise, which become almost “automatic”, unreflective behaviors, practices translated (...) as health interventions and public mental health policies. An example is the problem of overdiagnosis, in which the use of medical technology (categories, drugs, clinical exams, etc.) has generated more harm and risks to the subject's health than benefits. Exposing these issues from a philosophical perspective can eventually contribute to the field of mental health. For this work, the main manuals and textbooks of psychiatry were selected to analyze how they deal with the concept of mental illness or disorder, in addition to locating the present discussion in authors from both philosophy and the psychiatric field and how they contribute to its clarification. (shrink)

Many worry about the over-medicalisation of mental illness, and some even argue that we should abandon the term mental illness altogether. Yet, this is a commonly used term in popular discourse, in policy making, and in research. In this paper I argue that if we distinguish between disease, illness, and sickness (where illness refers to the first-personal, subjective experience of the sufferer), then the concept of mental illness is a useful way of (...) understanding a type of human experience, inasmuch as the term is (i) apt or accurate, (ii) a useful hermeneutical resource for interpreting and communicating experience, and (iii) can be a good way for at least some of us to establish a liveable personal identity within our culture. (shrink)

The Philosophy of Psychiatry is a unique area of research because the nature of the subject matter leads to quite distinct methodological issues. Naturalism, Interpretation, and Mental Disorder is an original new work focusing on the challenges we face when trying to interpret and understand mental illness. The book integrates a hermeneutical perspective, and shows how such an approach can reveal important facts about historical sources in psychiatry and the nature of dialogue in the therapeutic encounter. In (...) addition, the book demonstrates how such an approach can be valuable for understanding the concept of mental disorder itself. Naturalism, Interpretation, and Mental Disorder brings fresh thinking to the philosophy of psychiatry, and will be of interest to students and scholars in the fields of Mental Health and Philosophy. (shrink)

This paper discusses the representation and explanation of relationships between phenomena that are important in psychiatric contexts. After a general discussion of complexity in the philosophy of science, I distinguish zooming-out approaches from zooming-in approaches. Zooming-out has to do with seeing complex mental illnesses as abstract models for the purposes of both explanation and reduction. Zooming-in involves breaking complex mental illnesses into simple components and trying to explain those components independently in terms of specific causes. Connections between existing (...) practice and zooming-out are drawn, and zooming-in is criticised. (shrink)

This paper aims to show how the legacy of socialism with a human face represents a far more serious obstacle for the postsocialist transition than the heritage of rigid socialism. This is because an amalgamation of the perception of the autochthonous character of socialism accompanied by the perception of its soft, human face, creates an anti-capitalist mentality (Ludwig von Mises) that leaves an enormous impact on the long-term understandings of the concepts of individual, society, state, and reforms. This sort of (...) mentality is deeply entrenched in Serbia, where a full-scale process of “debolshevization” has never been initiated. The continuity with socialist legacy is apparent in key segments of the ill-fated transition: political, institutional, economic, symbolical, and no less moral. (shrink)

What is it to be mentally healthy? In the ongoing movement to promote mental health, to reduce stigma, and to establish parity between mental and physical health, there is a clear enthusiasm about this concept and a recognition of its value in human life. However, it is often unclear what mental health means in all these efforts and whether there is a single concept underlying them. Sometimes, the initiatives for the sake of mental health are aimed (...) just at reducing mental illness, thus implicitly identifying mental health with the absence of diagnosable psychiatric disease. More ambitiously, there are high-profile proposals to adopt a positive definition, identifying mental health with psychic or even overall well-being. We argue against both: a definition of mental health as mere absence of mental illness is too thin, too undemanding, and too closely linked to psychiatric value judgments, while the definition in terms of well-being is too demanding and potentially oppressive. As a compromise, we sketch out a middle position. On this view, mental health is a primary good, that is, the psychological preconditions of pursuing any conception of the good life, including well-being, without being identical to well-being. (shrink)

Rather than eliminate the terms "mental health and illness" because of the grave moral consequences of psychiatric labeling, conservative definitions are proposed and defended. Mental health is rational autonomy, and mental illness is the sustained loss of such. Key terms are explained, advantages are explored, and alternative concepts are criticized. The value and descriptive components of all such definitions are consciously acknowledged. Where rational autonomy is intact, mental hospitals and psychotherapists should not think of (...) themselves as treating an illness. Instead, they are functioning as applied axiologists, moral educators, spiritual mentors, etc. They deal with what Szasz has called "personal, social, and ethical problems in living." But mental illness is real. (shrink)

Since 1900, debates about the justification of punishment have also been debates about the cause of crime. In the early twentieth century, the rehabilitative ideal of punishment viewed mental illness and dysfunction in individuals as the cause of crime. Starting in the 1970s, retributivism identified the immorality of human agents as the source of crime, which dovetailed well with the “tough-on-crime” political milieu of the 1980s and 1990s that produced mass incarceration. After surveying these historical trends, Wirts argues (...) for a social critical view that crime is best understood as a product of an unjust society, not faulty human beings. This view should take the lessons learned by the critiques of rehabilitation, however, and resist the tendency to reduce human beings to recipients of social services. (shrink)

The tendency to draw mind-brain dichotomies and evaluate mental disorders dualistically arises in both laypeople and mental health professionals, leads to biased judgments, and contributes to mental health stigmatization. This paper offers a theory identifying an underlying source of these evaluations in social practice. According to this theory, dualistic evaluations are rooted in two mechanisms by which we represent and evaluate the beliefs of others in folk psychology and theory of mind: the doxastic conception of mental (...) disorders and doxastic voluntarism. Tracing these origins contributes to our understanding of mental state representation in cognitive science and philosophy of psychiatry, the concept of belief in philosophy of mind, and may help improve patient experience and treatment in light of social stigmatization and bias toward mental illness. (shrink)

Do psychological traits predict philosophical views? We administered the PhilPapers Survey, created by David Bourget and David Chalmers, which consists of 30 views on central philosophical topics (e.g., epistemology, ethics, metaphysics, philosophy of mind, and philosophy of language) to a sample of professional philosophers (N = 314). We extended the PhilPapers survey to measure a number of psychological traits, such as personality, numeracy, well-being, lifestyle, and life experiences. We also included non-technical ‘translations’ of these views for eventual use in other (...) populations. We found limited to no support for the notion that personality or demographics predict philosophical views. We did, however, find that some psychological traits were predictive of philosophical views, even after strict correction for multiple comparisons. Findings include: higher interest in numeracy predicted physicalism, naturalism, and consequentialism; lower levels of well-being and higher levels of mental illness predicted hard determinism; using substances such as psychedelics and marijuana predicted non-realist and subjectivist views of morality and aesthetics; having had a transformative or self-transcendent experience predicted theism and idealism. We discuss whether or not these empirical results have philosophical implications, while noting that 68% of our sample of professional philosophers indicated that such findings would indeed have philosophical value. (shrink)

The use of neuroscientific evidence in criminal trials has been steadily increasing. Despite progress made in recent decades in understanding the mechanisms of psychological and behavioral functioning, neuroscience is still in an early stage of development and its potential for influencing legal decision-making is highly contentious. Scholars disagree about whether or how neuroscientific evidence might impact prescriptions of criminal culpability, particularly in instances in which evidence of an accused’s history of mental illness or brain abnormality is offered to (...) support a plea of not criminally responsible. In the context of these debates, philosophers and legal scholars have identified numerous problems with admitting neuroscientific evidence in legal contexts. To date, however, less has been said about the challenges of evaluating the evidence upon which integrative mechanistic explanations that bring together evidence from different areas of neuroscience are based. As we explain, current criteria for evaluating such evidence to determine its admissibility in legal contexts are inadequate. Appealing to literature in the philosophy of scientific experimentation and theoretical work in the social, cognitive and behavioral sciences, we lay the groundwork for reforming these criteria and identify some of the implications of modifying them. (shrink)

I offer a preliminary examination on the importance of narrative for helping to overcome the issue of stigma surrounding mental illness, specifically schizophrenia. I maintain that engaging with first-person accounts of schizophrenia allows caregivers, and the broader general public, to better understand the phenomenological lived experiences of persons living with this mental health challenge and to better understand the experience of dealing with stigma. In doing so, I maintain that both caregivers and the public can begin developing (...) more accepting views of schizophrenia and begin to support those who need it the most. (shrink)

Predictive processing theorists have claimed PTSD and depression are maladaptive and epistemically distorting because they entail undesirably wide gaps between top-down models and bottom-up information inflows. Without denying this is sometimes so, the “maladaptive” label carries questionable normative assumptions. For instance, trauma survivors facing significant risk of subsequent attacks may overestimate threats to circumvent further trauma, “bringing forth” concretely safer personal spaces, to use enactive terminology, ensuring the desired gap between predicted worries and outcomes. The violation of predictive processing can (...) go in the opposite direction too, as when depression coincides with energy-depletion, and hence objectively strenuous situations in which things look farther away because they are (accurately anticipated to be) harder to reach. These examples partly encapsulate what predictive processing theorists call “active inference,” yet with differences. In the first case, actions fruitfully obviate predictions rather than fulfilling them. In the second, mental models do not dysregulate bodily processes, making coping harder. Instead, problems (e.g., personal obstacles, gastric illness) deplete energy, eliciting a depressive and adaptive slow-down. Some predictive proponents apply correspondence criteria when alleging mismatches between internal models and the world, while incongruously asserting that the brain did not evolve to see things veridically, but to execute actions. An alternative is to adopt pluralistic, pragmatic epistemologies suited to the complexity of mind. The upshot is that mental outlooks can depart from the norm without epistemically being distorted and that mismatches between anticipatory worries and outcomes, when they actually exist, can be a measure of adaptive and epistemic success. (shrink)

Abstract:In this paper, I distinguish four ways in which aspects or features of mental illness may be said to be functional. I contend that discussion of teleological perspectives on mental illness has unfortunately tended to conflate these senses. The latter two senses have played important practical roles both in predicting and explaining patterns of behavior, cognition, and affective response, atnd relatedly, in developing successful interventions. I further argue that functional talk in this context is neither inconsistent (...) with viewing some disorders as dysfunctional in one of several senses, nor inappropriately adaptationist, provided we keep these senses of function distinct, and are precise about which is in play in a given context. (shrink)

Medical assistance in dying, which includes voluntary euthanasia and assisted suicide, is legally permissible in a number of jurisdictions, including the Netherlands, Belgium, Switzerland and Canada. Although medical assistance in dying is most commonly provided for suffering associated with terminal somatic illness, some jurisdictions have also offered it for severe and irremediable psychiatric illness. Meanwhile, recent work in the philosophy of psychiatry has led to a renewed understanding of psychiatric illness that emphasises the role of the relation (...) between the person and the external environment in the constitution of mental disorder. In this paper, I argue that this externalist approach to mental disorder highlights an ethical challenge to the practice of medical assistance in dying for psychiatric illness. At the level of the clinical assessment, externalism draws attention to potential social and environmental interventions that might have otherwise been overlooked by the standard approach to mental disorder, which may confound the judgement that there is no further reasonable alternative that could alleviate the person’s suffering. At the level of the wider society, externalism underscores how social prejudices and structural barriers that contribute to psychiatric illness constrain the affordances available to people and result in them seeking medical assistance in dying when they otherwise might not have had under better social conditions. (shrink)

In the Netherlands and Belgium, it is lawful for voluntary euthanasia to be offered on the grounds of psychiatric suffering. A recent case that has sparked much debate is that of Aurelia Brouwers, who was helped to die in the Netherlands on account of her suffering from borderline personality disorder. It is sometimes claimed that whether or not a mentally ill person’s wish to die is valid hinges on whether or not that wish is a symptom of the person’s (...) class='Hi'>mental disorder. This article addresses the philosophical problems raised by this claim, with a specific focus on the diagnosis of borderline personality disorder. After considering descriptivist and causal conceptualizations of mental disorder, I argue that the current approach to borderline personality disorder in psychiatry precludes the possibility of dissociating the wish to die from the disorder. I then examine the implications of this analysis for the question of whether or not the request for voluntary euthanasia in the case of borderline personality disorder can be considered valid. Ultimately, I conclude that the inability to dissociate the wish to die from the disorder does not invalidate the wish in the case of borderline personality disorder. (shrink)

Immanuel Kant (1724-1804) had not been a close friend of Johann Daniel Metzger (1739-1805), the most productive professor at the Medical Faculty of Königsberg and specialist for social and forensic medicine. Kant felt, that many somatic diseases needed philosophical support, while severe mental illness should exclusively and safely be treated with the veterinary procedures of medicine as all rational, sensible interventions were in vain. According to Kant, Metzger's outstanding domain, forensic issues, could only be resolved by philosophy. Metzger (...) used his anonymous obituary on Kant to set several things straight. (shrink)

If we already had a periodic table of mental illness in hand, there would be less need for a book of this type. Although some psychiatrists do think of themselves as chemists, the analogy is without warrant. Not only does psychiatry lack an analogue of the periodic table, its principal tool -- the Diagnostic and Statistical Manual of Mental Disorders (DSM) -- is a contentious document. Even subsequent to the publication of DSM-III in 1980, which was intended (...) to serve as an operational guideline for clinical practice, it and its heirs (DSM-V was published in 2013) have often fueled rather than quelled controversy. Although beginning with that third major revision of DSM a concerted effort has been made to ensure greater consistency in diagnoses, psychiatry remains beset by concerns that it is insufficiently scientific, unduly influenced by the pharmaceutical industry, indecisive as to whether it should focus on the mind or the brain, incapable of distinguishing among types of diseases, inclined to expand illness criteria without adequate justification, overly reliant on subjective judgments, wont to conflate clinical and ethical judgments, and engaged in indiscriminate use of psychoactive drugs. These worries concerning its scientific and ethical status are among the reasons that psychiatry attracts the attention of philosophers. (shrink)

For Philippe Pinel, the concept of melancholy is one of the key methods for understanding not only a specific mental illness but also the new map of mental alienation. However, as Hegel shows in his work, the madness is not only a moment of growth in the history of the mind, but also a pattern of scientific intellect that builds a new science of the mind that is a science of humanity. It is the melancholy, however, with (...) its complex and rich history, which represents the testbed of the nascent psychiatry: the epistemological crisis caused by the inquiry into the nature of melancholy started, which with Pinel, will force both medicine and philosophy to build anew the moral science, only recently born with Pinel and Esquirol. This new foundation will be possible only by meditating on the history of the conception of melancholy and its relation to the antique and modern philosophical and scientific thought. (shrink)

The history of psychiatry does not inspire confidence, even among psychiatrists, and there has always been a cottage industry in medicine and psychology that wrestles with various conceptual problems around mental illness. It’s arguable that philosophers of science have not paid enough attention to this literature. Even if you aren’t interested in psychiatry, you might profit from the debates in psychometrics on the measurement of mental constructs, or look at the arguments over causation, reduction, and explanation that (...) psychiatrists fight out among themselves, increasingly with some philosophical input. Kenneth Kendler is a major contributor to this literature as theorist, experimentalist, and (via his role in the DSM) institution-builder and gatekeeper. He stands out too for his willingness to engage and learn from philosophy; and also to teach, for many of us can vouch to learning a lot about psychiatry from Kendler’s willingness to collaborate with philosophers and integrate the two communities. So it is a great pleasure to have a selection of Kendler’s papers assembled in one place. The essays in this volume cover a variety of conceptual issues in psychiatry, together with some historical material looking at the recent development of biomedical psychiatry. The most notable historical piece is the chapter on the origins of the Fechner criteria for validation of diagnoses, which had an enormous impact on the development of biological psychiatry in the 1970s. This collection covers many issues, and we won’t try to discuss everything, instead opting for one or two main issues that we think philosophers of science will be especially interested in. But there is something here for almost everyone in philosophy of science, and we urge them to look at this volume even if psychiatry is not on their normal reading list. (shrink)

In this thesis I develop an account of how processes of social understanding are implicated in experiences of mental disorder, critiquing the lack of examination of this phenomena along the way. First, I demonstrate how disorder concepts, as developed and deployed by psychiatric institutions, have the effect of shaping the cognition of individuals with psychopathology through setting expectations. Such expectation-setting can be harmful in some cases, I argue, and can perpetuate epistemic injustices. Having developed this view, I criticise enactive (...) accounts of mental disorder for failing to consider how such terms like ‘dysfunction’ are open to interpretation and can come embedded with normative expectations. Enactive accounts consequently run the risk of perpetuating injustices in their account of the sociality of mental disorder. Similar concerns arise when we consider the attachment of enactivism to the medical model, I argue. But by adapting enactivism to consider other experiences of disorder, such as those described as ‘madness’, enactive psychiatry may genuinely provide ethical groundwork for a better conception of disordered experience. Then, I consider a further concern with a distinctly medicalised conception of mental disorder from the perspective of self-illness ambiguity, arguing that self-illness ambiguities appear to form a special class of ambiguities due to their proximity to disorder concepts which mark them as appropriate targets for therapeutic treatment. However, I argue further that we should be critical of the idea that self-illness ambiguities necessitate disambiguation, as, in cases where self and illness are demarcated, individuals may still experience distress because simply having a mental disorder can be socially alienating. The medicalised focus in self-illness ambiguity, and the explicit need from the medical perspective to disambiguate it, might then exacerbate the distress someone experiences in mental disorder. Moreover, drawing on Mad Studies, I suggest that one might not need a coherent self-narrative to live well. Because of this, one may not need to adopt a medicalised view of the self in the case of selfillness ambiguity. In order to support this analysis, I provide a phenomenological account of language and argue that the very thoughts implicated in mental disorder shape the individual’s perception of the world due to the way that language foregrounds particular aspects of our world. This demands a critical examination of the language adopted and used by both clinicians and disordered individuals. I thus conclude with some thoughts on how to approach research and developing understanding of mental disorder given that we, as people, are always implicated in this process and therefore socialisation of some kind will always be taking place. (shrink)

One might be inclined to assume, given the mouse donning its cover, that the behavior of interest in Nicole Nelson's book Model Behavior (2018) is that of organisms like mice that are widely used as “stand-ins” for investigating the causes of human behavior. Instead, Nelson's ethnographic study focuses on the strategies adopted by a community of rodent behavioral researchers to identify and respond to epistemic challenges they face in using mice as models to understand the causes of disordered human behaviors (...) associated with mental illness. Although Nelson never explicitly describes the knowledge production activities in which her behavioral geneticist research subjects engage as “exemplary”, the question of whether or not these activities constitute “model behavior(s)”—generalizable norms for engaging in scientific research—is one of the many thought-provoking questions raised by her book. As a philosopher of science interested in this question, I take it up here. (shrink)

In “The myth of mental illness” Thomas Szasz challenges the idea that mental illnesses are diseases in the biomedical sense. In his view they are more similar to a foreign language and for this reason they cannot be treated by means of biomedical therapies. The present article explores the semiotic implications of Szasz’s view of the hysterical symptoms as an iconic language. Following Reichenbach, Szasz distinguishes three classes of signs: indexical, iconic and symbolic. The somatic language of (...) the hysteric person would be an iconic protolanguage which is more primordial than the objective language. Nevertheless, it retains all the basic functions of the language: to transmit information, to induce mood, and to promote action. Five different but intertwined reasons for the use of such an iconic form of communication are discussed. In conclusion, the hysterical symptom speaks its proper language and our ethical commitment is primarily to empathically listen to it. (shrink)

The High Court continues to exercise its inherent jurisdiction to make declarations about interventions into the lives of situationally vulnerable adults with mental capacity. In light of protective responses of health care providers and the courts to decision-making situations involving capacitous vulnerable adults, this paper has two aims. The first is diagnostic. The second is normative. The first aim is to identify the harms to a capacitous vulnerable adult’s autonomy that arise on the basis of the characterisation of situational (...) vulnerability and autonomy as fundamentally opposed concepts or the failure to adequately acknowledge the conceptual relationship between them at common law. The second part of this aim is to draw upon developments in analytic feminist philosophy to illustrate how standard approaches to autonomy are ill-equipped to capture the autonomy issues of capacitous vulnerable adults when their decisions regarding care and treatment are at stake. The second (normative) aim is to develop an account of self-authorised, intersubjective autonomy on the basis of analytic feminist insights into the relational practices of recognition. This account not only attempts to capture the autonomy of capacitous vulnerable adults and account for the necessary harms to their autonomy that arise from standard common law responses to their situational vulnerability, it is also predicated on the distinctions between mental capacity, the satisfaction of conditions for informed consent and the exercise of autonomy, meaning that it is better placed to fulfil the primary aim of the inherent jurisdiction – to facilitate the autonomy of vulnerable adults with capacity. (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)

Scientists, philosophers, and even the lay public commonly accept that schizophrenia stems from a biological or internal ‘dysfunction.’ However, this assessment is typically accompanied neither by well-defined criteria for determining that something is dysfunctional nor empirical evidence that schizophrenia satisfies those criteria. In the following, a concept of biological function is developed and applied to a neurobiological model of schizophrenia. It concludes that current evidence does not warrant the claim that schizophrenia stems from a biological dysfunction, and, in fact, that (...) unusual neural structures associated with schizophrenia may have functional or adaptive significance. The fact that current evidence is ambivalent between these two possibilities (dysfunction versus adaptive function) implies that schizophrenia researchers should be much more cautious in using the ‘dysfunction’ label than they currently are. This has implications for both psychiatric treatment as well as public perception of mental disorders. (shrink)

The main message of Neuroethics is that neuroscience forces us to reconceptualize human agency as marvelously diverse and flexible. Free will can arise from unconscious brain processes. Individuals with mental disorders, including addiction and psychopathy, exhibit more agency than is often recognized. Brain interventions should be embraced with cautious optimism. Our moral intuitions, which arise from entangled reason and emotion, can generally be trusted. Nevertheless, we can and should safely enhance our brain chemistry, partly because motivated reasoning crops up (...) in everyday life and in the practice of neuroscience itself. Despite serious limitations, brain science can be useful in the courtroom and marketplace. Recognizing all this nuance leaves little room for anxious alarmism or overhype and urges an emphasis on neurodiversity. The result is a highly opinionated tour of neuroethics as an exciting field full of implications for philosophy, science, medicine, law, and public policy. (shrink)

From our perspective, we believe that it is necessary to abandon the idea that all those who suffer from SI or SA are mentally ill, which causes them to be stigmatized and subjected to psychiatric treatment, when what they need is a different vision of life as well as adaptive strategies to employ a new philosophy. Public policies should consider implementing programs that reinforce cognitive flexibility in addition to character strengths.

Thomas Szasz famously argued that mental illness is a myth. Less famously, Szasz argued that since mental illness is a myth, so too is psychotherapy. Szasz’ claim that mental illness is a myth has been much discussed, but much less attention has been paid to his claim that psychotherapy is a myth. In the first part of this essay, I critically examine Szasz’ discussion of psychotherapy in order to uncover the strongest version of his (...) case for thinking that it is a myth. As we’ll see, this involves an understanding of psychotherapeutic interventions as treatments of psychopathological problems. In the rest of this essay, I turn to this directly and argue that psychotherapy has an important non-pathocentric dimension. I argue that we fail to appreciate the nature and variety of psychotherapy if we concentrate only on its pathocentric dimensions. Though I use Szasz as a stalking horse, the substantive topic is the nature of psychotherapy. This enquiry falls into the philosophy of psychotherapy as distinct from the philosophy of psychiatry and the philosophy of psychoanalysis. (shrink)

Exemption from blameworthiness is often bound to implicit or explicit claims of diminished agency, or even non-agency. This poses a dilemma in navigating moral relationships affected by mental illness. While it is crucial for assessments of responsibility to be responsive to the significance of mental illness, must this responsiveness come at a cost to symmetrical moral relations? In this paper we argue, contra recent critiques, that Strawsonian accounts of responsibility are able to navigate this dilemma, and (...) can accommodate significant exculpation on the basis of mental illness while maintaining symmetrical relations. We understand this to be part of the larger recognition that while we have certain fundamental entitlements within our moral relationships, it is also possible to be over-entitled, and to expect too much of others. Our account draws, in particular, on the moral significance of difficulty. Difficulty is inherently scalar, and in drawing on this explanatory framework we explicate a theory of both excuse and exemption by degree. We argue for a significant realm of excuse on the basis of mental illness that is fully compatible with symmetrical relations. However, we also acknowledge the limits of this accommodation on Strawsonian grounds, and argue that these limits are justified and appropriate. (shrink)

Challenges to psychiatric stigma fall between a rock and a hard place. Decreasing one prejudice may inadvertently increase another. Emphasising similarities between mental illness and ‘ordinary’ experience to escape the fear-related prejudices associated with the imagined ‘otherness’ of persons with mental illness risks conclusions that mental illness indicates moral weakness and the loss of any benefits of a medical model. An emphasis on illness and difference from normal experience risks a response of fear (...) of the alien. Thus, a ‘likeness-based’ and ‘unlikeness-based’ conception of psychiatric stigma can lead to prejudices stemming from paradoxically opposing assumptions about mental illness. This may create a troubling impasse for anti-stigma campaigns. (shrink)

In their work Gilio et al. investigate the mechanisms involved in the regulation of excitability of the cortex in epileptic subjects, and in particular their epileptogenic threshold.

Does having a mental disorder, in general, affect whether someone is morally responsible for an action? Many people seem to think so, holding that mental disorders nearly always mitigate responsibility. Against this Naïve view, we argue for a Nuanced account. The problem is not just that different theories of responsibility yield different verdicts about particular cases. Even when all reasonable theories agree about what's relevant to responsibility, the ways mental illness can affect behavior are so varied (...) that a more nuanced approach is needed. (shrink)

Social ontology focuses on questions about the reality of human categories. The typical examples are gender and race. Common questions about them are: Do they exist? What is their nature? Do they exist in the best possible way? Meanwhile, the philosophy of psychiatry has been discussing the reality of psychopathology, what is the best way to classify mental disorders, and whether it is possible to define them without normative vocabulary. I think there is something not only strange but inadequate (...) about these discussions being held apart. Particularly, I hold that by being held separately these discussions are philosophically incomplete. In this paper, I argue that these debates are parallel in crucial aspects, but more importantly that they can benefit from each other if they start a dialogue. I suggest some paths we can take to start fruitful discussions and offer examples of the kind of outcomes we can expect. However, my main contribution is to sketch a common framework to map current discussions, make comparisons between them, and, more importantly, guide new research. (shrink)

In this paper, I first examine the classification of mental derangements contained in Kant’s "Anthropology from a Pragmatic Point of View", in order to highlight the role played by imagination in their pathogenesis. Later, on the basis of this examination, I reflect on the origins of critical philosophy, which can be seen as an attempt to construct a control device for the imagination structured as a systematic, organic space.

“But surely if it's not irrational, it can’t be OCD!” my friend exclaimed, when I told them about the paper Carolina Flores and Brent Kious provided their excellent comments for. In all fairness, my friend is not working in philosophy, or psychiatry, or in psychology. Still, I take their sentiment to be expressive of a widely held view: if you have a certain mental illness, then you must be irrational. Conversely, rationality guarantees mental health; the sane life (...) is the rational life. -/- In my paper, I attempted to complicate this picture. My main line of thought was that if the sane life is the rational life, we do not have a good conception of rationality yet. For, our best theories of rationality fail to capture what is going wrong in some cases of obsessive-compulsive disorder (OCD). Addressing the criticisms raised by my commentators will allow me to clear up some misunderstandings and sketch avenues for further work. (shrink)

Ian Hacking (born in 1936, Vancouver, British Columbia) is most well-known for his work in the philosophy of the natural and social sciences, but his contributions to philosophy are broad, spanning many areas and traditions. In his detailed case studies of the development of probabilistic and statistical reasoning, Hacking pioneered the naturalistic approach in the philosophy of science. Hacking’s research on social constructionism, transient mental illnesses, and the looping effect of the human kinds make use of historical materials to (...) shed light on how developments in the social, medical, and behavioural sciences have shaped our contemporary conceptions of identity and agency. Hacking’s other contributions to philosophy include his work on the philosophy of mathematics (Hacking, 2014), philosophy of statistics, philosophy of logic, inductive logic (Hacking, 1965, 1979, 2001) and natural kinds (Hacking, 1991, 2007a). (shrink)

The different approaches of the mind-body problem a fortiori have implications on the foundations of Psychology, Psychopathology and Psychiatry, leading to many clashing theories about the determinants of "normal" human behavior, as well of the mental illnesses. These schools of research on the human mind may on a first approach be divided in two main branches: 1) the neurogenetic ones; 2) the psychogenetic ones. This paper sprang up from a lifelong pondering on its subject by its author, while working (...) as a Clinical Psychiatrist and conducting a Ph D in Philosophy. (shrink)

Digital phenotyping will potentially enable earlier detection and prediction of mental illness by monitoring human interaction with and through digital devices. Notwithstanding its promises, it is certain that a person’s digital phenotype will at times be at odds with their first-person testimony of their psychological states. In this paper, we argue that there are features of digital phenotyping in the context of psychiatry which have the potential to exacerbate the tendency to dismiss patients’ testimony and treatment preferences, which (...) can be instances of epistemic injustice. We first explain what epistemic injustice is, and why it is argued to be an extensive problem in health and disability settings. We then explain why epistemic injustice is more likely to apply with even greater force in psychiatric contexts, and especially where digital phenotyping may be involved. Finally, we offer some tentative suggestions of how epistemic injustice can be minimised in digital psychiatry. (shrink)

The causes and underlying natures of common mental disorders are, for the most part, quite mysterious. Our best taxonomies acknowledge this poverty of causal knowledge about minds, brains, society, and whatever else, to instead classify psychopathology based on clusters of detectable signs and symptoms: what it is to be, say, depressed, is simply to exhibit the minimum number of typical features for the right amount of time. Nothing in this approach references what causes and maintains a characteristic set of (...) symptoms, and so by conceptualizing disorders as syndromes psychiatry stands in stark contrast to somatic medicine, its close cousin, and other successful sciences that classify... (shrink)

This paper surveys some philosophical issues with the language surrounding mental illness, but is especially focused on pejoratives relating to mental illness. I argue that though 'crazy' and similar mental illness-based epithets (MI-epithets) are not best understood as slurs, they do function to isolate, exclude, and marginalize members of the targeted group in ways similar to the harmfulness of slurs more generally. While they do not generally express the hate/contempt characteristic of weaponized uses of (...) slurs, MI-epithets perpetuate epistemic injustice by portraying sufferers of mental illness as deserving minimal credibility. After outlining the ways in which these epithets can cause harm, I examine available legal and social remedies, and suggest that the best path going forward is to pursue a reclamation project rather than aiming to censure the use of MI-epithets. (shrink)

In this paper, I discuss the question whether objective criteria could be provided for judging something to be a mental illness. I consider the two most prominent objectivist or naturalistic accounts of mental illness, evolutionary and bio-statistical account, which offer such a criterion by relying on the notion of biological function. According to such suggestions, illness is a condition in which there is dysfunciton in some feature of an organism. In this context, I consider different (...) accounts for ascribing functions in biologyand their relationship with the suggested accounts of illnesses. Special focus is placed on the objections according to which the ascription of functions, as envisaged in naturalistic accounts of illness, is incompatible with actual medical and psychiatric practice. I conclude that these objections are legitimate insofar we want to an account of illness that preserves the current practice of ascribing illness. However, the question remains, could a theory that tries to capture the actual medical practice be value-neutral, since our ordinary conception of illness is permeated with value judgments that indirectly enter into medical practice. In that respect, it seems that the requirement for pure objectivity is too strong and thus, it is not reasonable to expect that naturalistic accounts can satisfy it. (shrink)