In the film classic Blade Runner, the story explores the notion of personal identity through that of carefully crafted androids. Can an android have a personality; can androids be persons? The title of the original story by Philip K. Dick is Do Androids Dream of Electric Sheep? The story suggests that our sense of being a person depends on our having memories that connect us with our childhood. In the movie, the androids are only a couple of years old, (...) but have adult bodies. To complete them as persons they are given simulated memories of childhood. Some psychiatrists have decided that even humans dream only of electric sheep. I explore how Popper’s world 3 can help to defend a notion of personhood that can be used to criticize the thesis that persons are simply complex physical processes and that all their serious life-problems can be conceptualised as a form of physical illness. (shrink)

Cognitive neuroscientists frequently talk about the brain representing the world. Some philosophers claim that this is a confusion. This paper argues that there is no confusion, and outlines one thing that might mean, using the notion of a model derived from the philosophy of science. This description is then extended to make apply to propositional attitude attributions. A number of problems about propositional attitude attributions can be solved or dissolved by treating propositional attitudes as models.

According to what I call ‘the asymmetry thesis’, persons, though they are the direct bearers of the properties expressed by mental predicates, are not the direct bearers of properties such as those expressed by ‘weighs 135 pounds’ or ‘has crossed legs’. A number of different views about persons entail the asymmetry thesis. I first argue that the asymmetry thesis entails an error theory about our discourse involving person‐referring terms. I then argue that it is further threatened by (...) consideration of the grounds we have for self‐ascribing mental and physical predicates. (shrink)

This chapter begins by sketching an account of morally responsible agency and the general conditions under which it may fail. We discuss how far individuals with psychiatric diagnoses may be exempt from morally responsible agency in the way that infants are, with examples drawn from a sample of diagnoses intended to make dierent issues salient. We further discuss a recent proposal that clinicians may hold patients responsible without blaming them for their acts. We also consider cognitively impaired subjects in (...) the light of related issues in moral and political theory, asking whether they have been unjustly excluded from liberal conceptions of political community due to their presumed lack of agency. (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)

In some situations, we attribute intentional mental states to a person despite their inability to articulate the contents in question: these are implicit mental states. Attributions of implicit mental states raise certain philosophical challenges related to rationality, concept possession, and privileged access. In the philosophical literature, there are two distinct strategies for addressing these challenges, depending on whether the content attributions are personal-level or subpersonal-level. This paper explores the difference between personal-level and subpersonal-level approaches to implicit (...) mental state attribution and investigates the relationship between the two approaches. It concludes by highlighting the methodological and metaphilosophical commitments which can result in different perspectives on the relative priority of personal-level and subpersonal-level theories. (shrink)

In this article I aim to make progress towards the philosophical goal of ascertaining what, if anything, all mental illnesses have in common, attempting to unify a large sub-set of them that have a relational or interpersonal dimension. One major claim is that, if we want a promising theory of mental illness, we must go beyond the dominant western accounts of mental illness/health, which focus on traits intrinsic to a person such as pain/pleasure, lethargy/liveliness, fragmentation/integration, (...) and falsehood/authenticity. A second major claim is that the relational facets of mental illness are plausibly understood theoretically in terms of a person’s inability to identify with others or to exhibit solidarity with them, relational values that are salient in the African philosophical tradition. I show that these two extrinsic properties well explain several intuitive instances of mental illness, including, amongst several others, being abusive, psychopathic, narcissistic, histrionic, paranoid, and phobic. (shrink)

Personal recovery entails the idea of learning to live a good life in the face of mental illness. It takes place in a continuous dynamic between change and acceptance and involves the existential dimension in the broadest sense. With cognitive self-regulation and empowerment as central elements, however, current models of recovery mostly have an individual focus instead of a relational one. Furthermore, there seems to be an emphasis on the component of change. Little attention is payed to the (...) role and integration of dealing with loss in personal recovery. In this paper, the role of loss in mental illness will be elaborated from an existential perspective. This will be done by relating existential changes to possibly disruptive experiences of loss in wider experience. With the help of several perspectives on dealing with loss it will be argued this can be integrated in processes of recovery. Then, it will be elaborated how reexperiencing a state of being surrounded, or being included, being held is a necessary part of recovery. The result consists of a refinement of the view on personal recovery. The aim of this paper is therefore twofold: (1) to arrive at a better understanding of what existential loss and loss in wider experience in the context of psychopathology entails, and (2) to further develop perspectives on recovery in mental health care. (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)

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)

Kant’s conception of mental illness is unlikely to satisfy contemporary readers. His classifications of mental illness are often fluid and ambiguous, and he seems to attribute to human beings at least some responsibility for preventing mental illness. In spite of these apparent disadvantages, I argue that Kant’s account of mental illness can be illuminating to his views about the normative dimensions of human cognition. In contrast to current understandings of mental (...) class='Hi'>illness, Kant’s account is what I refer to as “non-pathological.” That is, most mental illnesses are for Kant continuous with normally functioning cognition. Someone with a healthy reason can easily fall into mental illness and someone with mental illness can (perhaps not as easily) re-establish healthy reason. By accepting a non-pathological definition of mental illness, it follows for Kant that humans have more agency and responsibility regarding their mental health than current views allow, which explains why several of his writings aim to prescribe a “diet of the mind” (2:271). Contrary to popular readings of Kant as a champion of reason’s power, Kant’s conception of mental illness shows that he recognizes how fragile human reason can be. (shrink)

The article discusses the actual problem of social support for people with mental health problems, which has an important place in the study field of social psychology and social work.The article also deals with the definition of the concept of “mental health”, the problem of introducing the term “mental health problems” as a way to avoid stigmatization, and the spread of a humanistic attitude to persons with a psychiatric diagnosis. It also discussed modern theoretical approaches that (...) offer an understanding of the contribution of biological, social, and psychological factors into the cause of mental health problems. -/- The problem of mental illness is common to all countries of the world, as WHO data evidenced the number of people with mental disorders among the world’s population, ranging from 4–5 %. According to researchers P. Voloshin and N. Maruta, the spread of mental and behavioral disorders in Ukraine is characterized by a slow increase of about 2.9 % in every 10 years. Researchers argue that in subsequent years, according to the prognostic data, there will be an increase in these indicators. The issue of providing social support to people with PDS in Ukrainian society is very relevant, which is complicated by their social isolation in the process of recovery after the treatment. The results of scientific research in the context of different cultures and relatively diverse life events (hospitalization, mental illness, unemployment, old age) generally confirm the positive results of using social support to promote mental and physical health. Instead, there are no studies in Ukrainian science related to the phenomenon of social support of people with mental health problems. -/- It is important to define the concepts of “mental health” and “mental health problems” in the process of studying the features of social support for people with mental health problems. The term “mental health” combines the medical and psychological fields of science and practice, but modern psychology offers a comprehensive approach to assessing the psychological health of a person, the psychological norm, its limits, taking into account the criteria of mental health. The description of the mental health given by the Psychological Dictionary points out the components of awareness and the sense of continuity, continuity and identity of their physical and mental “I”; sense of continuity and identity of experiences in similar situations; critical to yourself and your mental activity and its results; the adequacy of psychic reactions of force and frequency of environmental influences; the ability to manage their behavior in accordance with social norms; planning personal activities and implementing them; changing the way of behavior depending on the changing circumstances of life. -/- The concept of “mental health problem” was taken as a term that denotes all the symptoms classified in ICD-10 and DSM-IV, which are recommended by experts to clients for appropriate treatment and care. Scientists and mental health practitioners point out that mental health problems can affect the way an individual thinks, feels, and behaves; affects self-service, fulfills professional duties, social, family roles, and household behavior, which is usually deeply affected by the quality of life of the individual. Numerous results of the research show that there are specific psychological and personality factors apart from the biological causes of mental disorders (genetic factors that contribute to the imbalance of chemicals in the brain) that make people vulnerable to occurrences of the mental health problems. -/- Several modern theoretical approaches offer an understanding of the contribution of biological, social, and psychological factors to the induction of mental health problems: the traditional medical model, the rehabilitation model, the interface model, the social model, and the biopsychosocial approach. Only biopsychosocial and social models are consistent with the definition of WHO disability and emphasize the impact social aspects of mental health and the quality of life of people with mental health problems. -/- Individuals with PPP, as a social community, have specific needs that differentiate them from other members of society, one of which is the need for constant socio-psychological support. So, the contribution of psychology and social work to the quality of life of people with mental disorder lies in the application of professional approaches and methods based on the biopsychosocial (social) model, which emphasize the need for socio-psychological support. An example of such a technique is the model of modern social work practice “people-in-environment”, which serves as a guiding principle of social work and emphasizes the importance of understanding the persons with disorder and their behavior in the light of the multiple context of the social environment in which these persons live and act. Specialists of social work and psychology make interventions at three levels: individual, at the family level, and at the community level, by means of intensifying the support of the environment within the cognitive-behavioral and other approaches, which contribute to the process of reintegrating people with mental health problems into community. (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)

I argue for two propositions. First, contrary to the common wisdom, we may justly punish individuals who are not morally responsible for their crimes. Psychopaths – individuals who lack the capacity to feel sympathy – help to prove this point. Scholars are increasingly arguing that psychopaths are not morally responsible for their behavior because they suffer from a neurological disorder that makes it impossible for them to understand, and therefore be motivated by, moral reasons. These same scholars then (...) infer from this conclusion that they must also lack criminal responsibility and therefore that our continuing to punish psychopaths for their crimes is unjust. My response is that this inference is entirely fallacious. -/- Criminal responsibility turns out to be quite distinct from moral responsibility. The two kinds of responsibility require very different conditions to be satisfied. In particular, criminal responsibility, unlike moral responsibility, does not require an agent be able to grasp and follow moral reasons; it requires only that the individual be able to grasp and follow criminal laws. Once this point is recognized, it becomes much easier to accept my thesis: while the subset of psychopaths who commit crimes are not morally responsible for their criminal behavior because they cannot understand moral reasons, they are still criminally responsible because they can understand what the consequences will be if they get caught. For this reason, even though I concede that psychopaths are not morally responsible for the crimes that they commit, our practice of punishing them for these crimes is still just. -/- Second, I argue that psychopathy is a mental illness and should be recognized as such. One reason that it should be recognized as a mental illness is simply because it is; it satisfies the main criteria for inclusion in the DSM-IV, the “bible” of mental disorders. The other reason is more practical than conceptual. It starts with two facts: the U.S. Supreme Court has decided that the preventive detention of any individual who is not a criminal suspect is not constitutional unless the individual is not only dangerous but also mentally ill; and psychopathy is not currently considered to be a mental illness. So, as things now stand, we cannot preventively commit dangerous psychopaths – that is, psychopaths who have clearly indicated that they will be committing serious crimes. Instead, we must wait for them to commit the crimes before we can lock them up. Unfortunately, this incarceration always comes too late for the victims. It would therefore be better if we could lock them up before they actually inflict any harm. Once again, then, I propose that the legal and psychological communities classify psychopathy as a mental illness. (shrink)

1. The restless mind[1] Like us, early modern philosophers, both natural and moral, didn’t always understand the springs of their own actions. They didn’t want to feel everything they felt, and couldn’t trace the sources of all their thoughts and imaginings. Events from past experience come to mind again unwilled: abstract thought is interrupted by fantastical images, like the ‘winged horses, fiery dragons, and monstrous giants’ by which Hume exemplified ‘the liberty of the imagination’[2]. Then, as now, a (...) failure to keep a train of thought on track could be blamed for both personal and social ills, for wasted lives and erratic policies. The ongoing struggle to distinguish the deliverances of reason from what Hume called ‘the loose and indolent reveries of a castle-builder’ (1739/ 1978, p.624) thus required scrutiny of daydream and fancy as much as belief and knowledge (see also Tierney- Hynes 2007 on the ‘castle-builder’). The mind’s tendencies to float and to roam were of great interest to early modern philosophers as well as to others concerned with medicine, mental health, morals, education, and taste. This paper sketches one local line of thinking and theorizing about ‘mind-wandering’ and its bodily causes in British philosophy over the first decades of the 18th century, as a small exemplar of a form of cognitive history intended to illuminate independent historical and contemporary concerns about our understanding of mental life. The dual aim is to see problems in our historical material that we might otherwise miss, and to use history to explore phenomena more or less marginalized by modern psychology[3]. (shrink)

This dissertation examines the theory of perceptual cognition laid out by the 7th century Buddhist scholar, Dharmakīrti, in his magnum opus, the Pramāṇavārttika. Like most theories of perception, both ancient and modern, the sensory cognition of ordinary objects is a topic of primary concern. Unlike other theorists, however, Dharmakīrti advances a technical definition of “perception” as a cognition which is both nonconceptual and non-erroneous. Dharmakīrti’s definition of perception is thereby deliberately inclusive of three additional types of “perceptual” cognition, in addition (...) to veridical sensory awareness: the nonconceptual mental apprehension of an immediately-preceding cognition (“mental perception”), the vivid appearance of soteriologically efficacious objects of contemplative practice (“yogic perception”), and the sheer unmediated presence of the contents of cognition—whatever these might be—to the cognizing mind (“reflexive awareness”). Through the logical examination of what it means to be aware of an object, Dharmakīrti demonstrates that the awareness of an object is just the awareness of a phenomenal form or cognitive image produced by that object. Pursuing this analysis further, however, Dharmakīrti argues that the very notion of an object of cognition that exists “externally” or outside the mind is incoherent. Additionally, Dharmakīrti maintains that the phenomenological structure of subject and object—that is, the “first-personal” sense of one’s own cognitions as pertaining to oneself (“for-me-ness”), together with the inseparably concomitant sense that the objects of cognition exist “out there” in an extramental world—is strictly a form of cognitive error. Therefore, because ordinary sensory cognition is inherently structured by this subject-object duality, ordinary sensory cognition must in the final analysis be understood as erroneous. According to Dharmakīrti, in other words, ultimately only the nondual “luminosity” of reflexive awareness is genuinely perceptual, because only reflexive awareness is undistorted by nature. In this way, Dharmakīrti’s epistemology provides a theoretical foundation for the advanced nondual contemplative practices of Indian and Tibetan Buddhism, particularly Mahāmudrā and rDzogs chen. (shrink)

I argue that the feeling that one is the owner of his or her mental states is not an intrinsic property of those states. Rather, it consists in a contingent relation between consciousness and its intentional objects. As such, there are (a variety of) circumstances, varying in their interpretive clarity, in which this relation can come undone. When this happens, the content of consciousness still is apprehended, but the feeling that the content “belongs to me” no longer is (...) secured. I discuss the implications of a mechanism enabling personal ownership for understanding a variety of clinical syndromes as well normal mental function. (shrink)

In recent metaphysics, the questions of whether fictional entities exist, what their nature is, and how to explain truths of statements such as “Sherlock Holmes lives at 221B Baker Street” and “Holmes was created by Arthur Conan Doyle” have been subject to much debate. The main aim of my thesis is to wrestle with key proponents of the abstractionist view that fictional entities are abstract objects that exist (van Inwagen 1977, 2018, Thomasson 1999 and Salmon 1998) as well as (...) Walton’s (1990) pretense view, which denies the existence of such entities. In the process, I propose modifications to these views to deal with problems they face and show how the modifications better account for the philosophical data. -/- Key abstractionists (van Inwagen 1977, Thomasson 1999) make a strict distinction between discourse within fiction, in which statements about literary characters cannot be literally true, and discourse about fiction, as it occurs in literary criticism, where statements about fictional characters can be literally true. Fictional objects are postulated to account for the truth of the latter. This runs into trouble because statements thought to be literally true are not literal. (Yagisawa 2001, Friend 2002) I provide a uniform analysis to account for the truth of statements involving fictional characters by appealing to a presupposition involving a metaphor in both contexts. The presupposition is that there is an x such that x is fictional; x is likened to a real person; and x is and ought to be treated/counted as a real person for all relevant intents and purposes. -/- More generally, I adopt Everett and Schroeder’s (2015) realist view that fictional characters are ideas constituted by mental representations. This, to me, better accounts for how fictional characters are created within the world’s causal nexus (unlike non-spatiotemporal entities in abstractionism), among other things. One key challenge they face is to explain how ideas can possess properties such as being a detective. I present a fine-grained version of their view, according to which the mental representations constituting fictional entities encode mind-dependent properties. Moreover, I explain how reference to such representations is possible, using Bencivenga’s (1983) Neo-Kantian view of reference and Karttunen’s (1976) view on discourse referents. Finally, I suggest that the identity of fictional characters is interest-relative. The constant, and sometimes radical, change of properties that, fictional characters can undergo is taken to be a consequence of the fact that unified mental representations are bundles of simpler mental representations. As change occurs, simpler representations are replaced by others. -/- A key theme that runs through the thesis is that neither fictionality nor pretense is relevant to the semantics of fictional sentences—a claim bolstered by Matravers’ (2014) arguments. Whether or not my account works, this claim, as well as the new philosophical data I bring up, are some of the challenges I pose to the heart of established views. (shrink)

Advocates of physician-assisted suicide often argue that, although the provision of PAS is morally permissible for persons with terminal, somatic illnesses, it is impermissible for patients suffering from psychiatric conditions. This claim is justified on the basis that psychiatric illnesses have certain morally relevant characteristics and/or implications that distinguish them from their somatic counterparts. In this paper, I address three arguments of this sort. First, that psychiatric conditions compromise a person’s decision-making capacity. Second, that we cannot have sufficient (...) certainty that a person’s psychiatric condition is untreatable. Third, that the institutionalisation of PAS for mental illnesses presents morally unacceptable risks. I argue that, if we accept that PAS is permissible for patients with somatic conditions, then none of these three arguments are strong enough to demonstrate that the exclusion of psychiatric patients from access to PAS is justifiable. (shrink)

Judgments of blame for others are typically sensitive to what an agent knows and desires. However, when people act negligently, they do not know what they are doing and do not desire the outcomes of their negligence. How, then, do people attribute blame for negligent wrongdoing? We propose that people attribute blame for negligent wrongdoing based on perceived mental control, or the degree to which an agent guides their thoughts and attention over time. To acquire information about (...) others’ mental control, people self-project their own perceived mental control to anchor third-personal judgments about mental control and concomitant responsibility for negligent wrongdoing. In four experiments (N = 841), we tested whether perceptions of mental control drive third-personal judgments of blame for negligent wrongdoing. Study 1 showed that the ease with which people can counterfactually imagine an individual being non-negligent mediated the relationship between judgments of control and blame. Studies 2a and 2b indicated that perceived mental control has a strong effect on judgments of blame for negligent wrongdoing and that first-personal judgments of mental control are moderately correlated with third-personal judgments of blame for negligent wrongdoing. Finally, we used an autobiographical memory manipulation in Study 3 to make personal episodes of forgetfulness salient. Participants for whom past personal episodes of forgetfulness were made salient judged negligent wrongdoers less harshly compared to a control group for whom past episodes of negligence were not salient. Collectively, these findings suggest that first-personal judgments of mental control drive third-personal judgments of blame for negligent wrongdoing and indicate a novel role for counterfactual thinking in the attribution of responsibility. (shrink)

Phenomenology has been adapted for use in qualitative health research, where it’s often used as a method for conducting interviews and analyzing interview data. But how can phenomenologists study subjects who cannot accurately reflect upon or report their own experiences, for instance, because of a psychiatric or neurological disorder? For conditions like these, qualitative researchers may gain more insight by conducting observational studies in lieu of, or in conjunction with, interviews. In this article, we introduce a phenomenological approach to (...) conducting this kind of observational research. The approach relies on conceptual grounding to focus a study on specific aspects of the participants’ experiences. Moreover, the approach maintains the openness to novel discoveries that qualitative research requires while also providing a structured framework for data collection and analysis. To illustrate its practical application, we use examples of hemispatial neglect—a neurologic disorder in which patients characteristically lack awareness of their own illness and bodily capacities. However, the approach that we describe can be applied more broadly to the study of complex illness experiences and other experiential alterations. (shrink)

Background. The literature on Theory of Mind (ToM) in antisocial samples is limited despite evidence that the neural substrates of theory of mind task involve the same circuits implicated in the pathogenesis of antisocial behaviour. Method. Eighty-nine male DSM-IV Antisocial Personality Disordered subjects (ASPDs) and 20 controls (matched for age and IQ) completed a battery of ToM tasks. The ASPD group was categorized into psychopathic and non-psychopathic groups based on a cut-off score of 18 on the Psychopathy Checklist: Screening Version. (...) Results. There were no significant group (control v. psychopath v. non-psychopathic ASPD) dif- ferences on basic tests of ToM but both psychopathic and non-psychopathic ASPDs performed worse on subtle tests of mentalizing ability (faux pas tasks). ASPDs can detect and understand faux pas, but show an indifference to the impact of faux pas. On the face/eye task non-psychopathic ASPDs showed impairments in the recognition of basic emotions compared with controls and psychopathic ASPDs. For complex emotions, no significant group differences were detected largely due to task difficulty. Conclusions. The deficits in mentalizing ability in ASPD are subtle. For the majority of criminals with ASPD and psychopathy ToM abilities are relatively intact and may have an adaptive function in maintaining a criminal lifestyle. Our findings suggest the key deficits appear to relate more to their lack of concern about the impact on potential victims than the inability to take a victim perspective. The findings tentatively also suggest that ASPDs with neurotic features may be more impaired in mentalizing ability than their low anxious psychopathic counterparts. (shrink)

Psychiatric patients sometimes ask where to draw the line between who they are – their selves – and their mental illness. This problem is referred to as the self-illness ambiguity in the literature; it has been argued that solving said ambiguity is a crucial part of psychiatric treatment. I distinguish a Realist Solution from a Constructivist one. The former requires finding a supposedly pre-existing border, in the psychiatric patient’s mental life, between that which belongs (...) to the self and that which belongs to the mental illness. I argue that no such border exists, and that attempts to find it might even render the felt ambiguity worse. Instead, any solution must be constructivist; the patient (and others) should deliberate and discuss what to identify with or not. I further argue that psychiatric patients need not see their mental illness as wholly distinct from themselves to avoid ‘identifying with their diagnoses' in a problematic way. Finally, we can excuse problematic behaviour by mentally ill people – in fact, we can do so in a more nuanced and constructive way – while rejecting the view that the mental illness is wholly distinct from the patient’s self. (shrink)

Contra the dominant readings, Hieronymi—refusing to sideline concerns of metaphysics for the impasse of normativity—argues that the core of Strawson's argument in "Freedom and Resentment" rests on an implicit and overlooked metaphysics of morals grounded in social naturalism, focusing her discussion on Strawson's conception of objective attitudes. The objective attitude deals with exemption, rather than excuse. This distinction is critical to Strawson's picture of responsibility: In addition to our personal reactive attitudes are their impersonal or vicarious analogues. There are (...) two such cases: first, cases where we suspend or modify reactive attitudes due to error about the quality of the will. In these cases of excuse, we might include an actor who we learn was innocently ignorant, or whose behavior was an accident, and so we see that he or she really meant no harm. Consequently, we exculpate the injury in question. In cases of excuse, we are mistaken about the quality of the actor's will and, thus, our reactive attitude changes, but the moral demands stay. However, one might view other people as equipped with mental attributes and as people about whom one is disposed not to indulge in with those reactive attitudes of resentment, approbation, and so on; this involves viewing others objectively. We encounter these scenarios in the case of small children, people suffering from dementia, or those with forms of other serious mental illness. This second category involves exemption: Rather than reacting with the corresponding reactive attitudes, we view those actors—who lack the capacities required to fit into the usual system tolerably well—objectively, thereby exempting them from the usual demands of ordinary interpersonal relating. (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)

As the science and technology of the brain and mind develop, so do the ways in which brains and minds may be surveilled and manipulated. Some cognitive libertarians worry that these developments undermine cognitive liberty, or “freedom of thought.” I argue that protecting an individual’s cognitive liberty undermines others’ ability to use their own cognitive liberty. Given that the threatening devices and processes are not relevantly different from ordinary and frequent intrusions upon one’s brain and mind, strong protections of (...) cognitive liberty may proscribe neurotechnological intrusions, but also ordinary intrusions. Thus, the cognitive libertarian position “hog-ties” others’ use of their own liberties. This problem for the cognitive libertarian is the same problem that ordinary libertarianism faces in protecting individual rights to property and person. But the libertarian strategies for resolving the problem don’t work for the cognitive libertarian. I conclude that the right to mental privacy is weaker than what cognitive libertarians want it to be. (shrink)

This article analyses the phenomenon of epistemic injustice within contemporary healthcare. We begin by detailing the persistent complaints patients make about their testimonial frustration and hermeneutical marginalization, and the negative impact this has on their care. We offer an epistemic analysis of this problem using Miranda Fricker's account of epistemic injustice. We detail two types of epistemic injustice, testimonial and hermeneutical, and identify the negative stereotypes and structural features of modern healthcare practices that generate them. We claim that (...) these stereotypes and structural features render ill persons especially vulnerable to these two types of epistemic injustice. We end by proposing five avenues for further work on epistemic injustice in healthcare. (shrink)

For many employees, ‘work’ is no longer something performed while sitting at a computer in an office. Employees in a growing number of industries are expected to carry mobile devices and be available for work-related interactions even when beyond the workplace and outside of normal business hours. In this article it is argued that a future step will increasingly be to move work-related information and communication technology (ICT) inside the human body through the use of neuroprosthetics, to create employees who (...) are always ‘online’ and connected to their workplace’s digital ecosystems. At present, neural implants are used primarily to restore abilities lost through injury or illness, however their use for augmentative purposes is expected to grow, resulting in populations of human beings who possess technologically altered capacities for perception, memory, imagination, and the manipulation of physical environments and virtual cyberspace. Such workers may exchange thoughts and share knowledge within posthuman cybernetic networks that are inaccessible to unaugmented human beings. Scholars note that despite their potential benefits, such neuroprosthetic devices may create numerous problems for their users, including a sense of alienation, the threat of computer viruses and hacking, financial burdens, and legal questions surrounding ownership of intellectual property produced while using such implants. Moreover, different populations of human beings may eventually come to occupy irreconcilable digital ecosystems as some persons embrace neuroprosthetic technology, others feel coerced into augmenting their brains to compete within the economy, others might reject such technology, and still others will simply be unable to afford it. In this text we propose a model for analyzing how particular neuroprosthetic devices will either facilitate human beings’ participation in new forms of socioeconomic interaction and digital workplace ecosystems – or undermine their mental and physical health, privacy, autonomy, and authenticity. We then show how such a model can be used to create device ontologies and typologies that help us classify and understand different kinds of advanced neuroprosthetic devices according to the impact that they will have on individual human beings. (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.

Advocates of the Person-Centered Healthcare (PCH) approach say that PCH is a response to a failure of caring for patients as persons. Nevertheless, there are many human subjects falling to fulfill the requirements of a traditional philosophical definition of personhood. Hence, if we take, PCH seriously, a greater clarification of the key terminology of PCH is urgently needed. It seems necessary, for instance, that the concept of the person should be extended in order to include those individuals with insipient (...) or immature levels of consciousness, as well as those who are severely and permanently mentally handicapped. In this article, we will depart from some well-known philosophical concepts of what it means to be a person and try to offer a broader and more inclusive meaning. We suggest that persons are human beings with a socially recognized biography, which implies to recognize as persons individuals with necessities, but also with narratives about their interests and claims, expressed sometimes by other people related to them. This is particularly the case of individuals that suffer from severe disorders of consciousness. For those, is not only care that matters; respect matters too. Caregivers should therefore not only sympathetically care for the well-being of these people; they should also be concerned to respect their interests and claims by interpreting them empathetically, in the light of their biographical story. Our conclusion is that, in order to be coherent, PCH must consider individuals with severe disorders of consciousness as persons and we think that our revised concept of personhood fits with this requirement. (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)

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)

We present experimental evidence that an interpretation was accurate. Current wisdom notwithstanding, we could interpret from the text alone because its information is redundant: repetition provides internal checks. Knowing neither dreamer nor their associations we made falsifiable predictions that we tested by subsequently gathering information about the dreamer. Predictions were supported. Results were repeated with seven additional dreams. Each dream was tightly crafted, used humor, drama or hyperbole to penetrate the dreamer’s defenses, and furthered the emergence of personality. Our (...) experiment compliments fMRI and statistics because it studies a whole text as a unique narrative: one iteration identified healing steps during therapy; another confirmed the psychological meaning of a myth. Our experiment might generate a body of objective knowledge about interpretation and make interpretation itself more accurate. In the US 20% live with mental illness. Our experiment supports talk therapy against pressure from the drug and insurance industries. (shrink)

Nancy Jecker and Andrew Ko (2017) wish to present an account of personal identity which captures what matters to the patient and places the patient at the center of medical decisions. They focus particularly on medical interventions in the brain that can cause drastic changes in personality; under what circumstances should we say the patient has 'survived' these changes? More specifically, how can we best understand the notion of survival in a way that captures what is of concern to the (...) patient? This goal is laudable, however, their chosen account of narrative identity is ill-suited to this task for one reason in particular; it does not give sufficient guidance in predicting which medical decisions are likely to be experienced as disruptive to identity. (shrink)

The Two Selves takes the position that the self is not a "thing" easily reduced to an object of scientific analysis. Rather, the self consists in a multiplicity of aspects, some of which have a neuro-cognitive basis (and thus are amenable to scientific inquiry) while other aspects are best construed as first-person subjectivity, lacking material instantiation. As a consequence of their potential immateriality, the subjective aspect of self cannot be taken as an object and therefore is not easily amenable (...) to treatment by current scientific methods. -/- Klein argues that to fully appreciate the self, its two aspects must be acknowledged, since it is only in virtue of their interaction that the self of everyday experience becomes a phenomenological reality. However, given their different metaphysical commitments (i.e., material and immaterial aspects of reality), a number of issues must be addressed. These include, but are not limited to, the possibility of interaction between metaphysically distinct aspects of reality, questions of causal closure under the physical, the principle of energy conservation. -/- After addressing these concerns, Klein presents evidence based on self-reports from case studies of individuals who suffer from a chronic or temporary loss of their sense of personal ownership of their mental states. Drawing on this evidence, he argues that personal ownership may be the factor that closes the metaphysical gap between the material and immaterial selves, linking these two disparate aspects of reality, thereby enabling us to experience a unified sense of self despite its underlying multiplicity. -/- . (shrink)

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)

Traditional ways of characterizing humans and persons are vague and simplistic. For example, persons are often defined as having free will and responsibility – but what actual powers underlie these vague metaphysical abstractions? Traditional answers like "rationality" and "creativity" are still vague, and also simplistic. Similar traits appear as defining traits of humans, yet we’re far too complex to be distinguished from other species in such simple and tight ways. But there may be a looser hallmark of humans (...) that just serves to best distinguish our complex package of traits from those of other species. It will be argued that while humans and persons differ, the underlying hallmark of both is their innately powerful, symbolically organized minds and societies. This seems to capture what is most distinctive about humans without the vagueness or oversimplification above. It explains how creativity, rationality, etc. arose in stages from precursors, and what is distinctive about their human forms. It also helps clarify what underlies the free will and responsibility of persons. It might also say interesting things about persons that may have evolved elsewhere, for example, that we have similar mentalities and evolutions, and that we are capable of mutual understanding. Finally, it might help weigh our evolutionary importance. (shrink)

Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, (...) decision-making capacity, and human rights. Methods This study used qualitative data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision-making in bipolar disorder. Quantitative analysis of a closed question about self-binding directives had already demonstrated endorsement amongst a very high proportion of participants with bipolar disorder who completed the survey. We conducted thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was co-produced within a multi-disciplinary team, with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methodologies associated with all these areas of expertise were used in the analysis of these reasons and to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Findings Between Oct 23 and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 (154 men; 400 women; 11 transgender or other) providing free text answers to the open question. A large majority of respondents endorsed self-binding directives, nearly all describing a determinate shift to types of distorted thinking and decision-making when unwell as their key justification. Responses indicating ambivalence were dominated by logistical concerns about the drafting and implementation of self-binding directives, while those who rejected self-binding directives also cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. Interpretation This study is, to our knowledge, the first large study of reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health advance decision-making practice and policy and may help to address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. Funding The Wellcome Trust . (shrink)

According to a standard picture of agency, a person’s actions always reflect what they most desire, and many theorists extend this model to mental illness. In this chapter, I pin down exactly where this “volitional” view goes wrong. The key is to recognize that human motivational architecture involves a regulatory control structure: we have both spontaneous states (e.g., automatically-elicited thoughts and action tendencies, etc.) as well as regulatory mechanisms that allow us to suppress or modulate these spontaneous states. (...) Our regulatory abilities, however, are bounded. Mental illnesses, I argue, arise precisely where these bounds are reached, thus allowing inappropriate spontaneous states to regularly manifest in thought and action. I conclude that the volitional view of mental illness is wrong: when a person with mental illness reaches the limits of control, what they do often does not reflect what they most prefer. (shrink)

This paper develops a mechanistic account of basic mental agency by identifying similarities between two of its major exemplars: endogenous attention and imagination. Five key similarities are identified: i) that both capacities are driven by currently prioritised goals that are either person-level or apt to become person-level. ii) that both deliver their outputs to the working memory iii) that both range across all and only conceptual contents; iv) that both proceed under the guidance of norms and/or habits; and (...) v) that both directly activate rather than inhibit content. These five features are consolidated by proposing that basic mental agency is essentially the power to call for conceptual content and hold it within our working memories. (shrink)

The illness immersion condition prevents patients from enjoying everything worth living life for. In any case, according to Frank, this condition could represent one of the most insightful experiences towards understanding the meaning of life. Using the metaphor of phoenix taken from May, Frank identified four kinds of embodiments through which the phoenix can reveal itself in a patient after an illness immersion experience: the phoenix that could ever be and the phoenix that might have been; the recurrent (...) and cumulative phoenix and the reluctant phoenix. Based on these considerations, a qualitative study was conducted in order to give voice to the different phoenix embodiments focusing on several autobiographies of patients afflicted with severe or terminal illness. The analysis highlights several similarities that the different phoenixes shared ; however, a deep difference emerged in their worldview which proves able to lead them towards different epiphanies. These evidences reveal that every sick person should be understood, stimulated and accompanied throughout his lived experience of illness by an expressly designed and dedicated care. (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?

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)

So far, the value dimension underlying affectivity disorders has remained out of focus in phenomenological psychopathology. As early as at the beginning of the 20th century, however, German phenomenologist Max Scheler examined in depth the relationship between affectivity and value dimension through the concept of valueception (Wertnehmung). In this sense, a recent noteworthy contribution has been provided by John Cutting, who has drawn attention to the importance of Scheler’s analyses for psychiatry. In this work I take into consideration only two (...) aspects of Cutting’s proposal: 1) the relationship between the impairments of valueception and the perception of certain value classes; and 2) the interpretation of Scheler’s phenomenological reduction and its juxtaposition with the modus vivendi of schizophrenia. According to Cutting, in the modus vivendi of schizophrenia the valueception impairment entails putting vital values in brackets and focusing on personal values, with a process that recalls Scheler’s phenomenological reduction. Regarding the first aspect, I share Cutting’s starting point, but then shift the focus on how important the valueception is for the intersubjective dimension. In particular, I maintain that rather than compromising the perception of vital values, valueception impairments in the modus vivendi of schizophrenia interfere with the intersubjective dimension and are interwoven with a process of disembodiment. My thesis is that the modus vivendi of schizophrenia involves a disturbance of the intersubjective dimension that arises from the level of valueception and that determines the person’s self-referential closure. With regard to the second point, by analyzing Scheler’s phenomenological reduction, I sustain that its main objective is to increase both the interaction with otherness and the openness to the world (Weltoffenheit). As a consequence, the modus vivendi of schizophrenia, in my opinion, is not comparable, as Cutting claims, with Scheler’s phenomenological reduction, but goes in a different direction. (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)

Recently, there have been calls to develop a more contextual approach to phenomenological psychopathology—an approach that attends to the socio-cultural as well as personal and biographical factors that shape experiences of mental illness. In this Perspective article, we argue that to develop this contextual approach, phenomenological psychopathology should adopt a new paradigm case. For decades, schizophrenia has served as the paradigmatic example of a condition that can be better understood through phenomenological investigation. And recent calls for a contextual (...) approach continue to use schizophrenia as their primary example. We argue, in contrast, that substance misuse provides a better paradigm case around which to develop a contextually sensitive phenomenological psychopathology. After providing a brief vignette and analysis of a case of substance misuse, we explain why this kind of condition requires considerable sensitivity and attention to context, better motivating the incorporation and development of new contextually sensitive approaches. (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)

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)

Spatial models dominated memory research throughout much of the 20th century, but in recent decades, the concept of memory as a form of mental time travel (MTT) to the past has gained prominence. Initially introduced as a metaphor, the MTT perspective shifted the focus from internal memory processes to the subjective conscious experience of remembering. Despite its significant impact on empirical and theoretical memory research, there has been limited discussion regarding the meaning and adequacy of the MTT metaphor in (...) accounting for memory. While previous work has addressed the general limitations of the MTT metaphor in explaining memory (Trakas, 2022), the objective of this article is more focused and modest: to gain a better understanding of what constitutes MTT to the past. To achieve this objective, a detailed analysis of the characteristics of MTT to the past is presented through a comparison with time travel (TT) to the past. Although acknowledging that TT does not refer to an existing physical phenomenon, it is an older concept extensively discussed in the philosophical literature and provides commonly accepted grounds, particularly within orthodox theories of time, that can offer insights into the nature of MTT. Six specific characteristics serve as points of comparison: (1) a destination distinct from the present, (2) the distinction between subjective time and objective time, (3) the subjective experience of the time traveler, (4) their differentiation from the past self, (5) the existence of the past, and (6) its unchangeability. Through this research, a detailed exploration of the phenomenal and metaphysical aspects of MTT to the past is undertaken, shedding light on the distinct features that mental time travel to the past acquires when it occurs within the realm of the mind rather than as a physical phenomenon. By examining these characteristics, a deeper understanding of the nature of mental time travel is achieved, offering insights into how it operates in relation to memory and the past. (shrink)