In this volume, leading philosophers of psychiatry examine psychiatric classification systems, including the Diagnostic and Statistical Manual of Mental Disorders, asking whether current systems are sufficient for effective diagnosis, treatment, and research. Doing so, they take up the question of whether mental disorders are natural kinds, grounded in something in the outside world. Psychiatric categories based on natural kinds should group phenomena in such a way that they are subject to the same type of causal explanations and respond similarly to (...) the same type of causal interventions. When these categories do not evince such groupings, there is reason to revise existing classifications. The contributors all question current psychiatric classifications systems and the assumptions on which they are based. They differ, however, as to why and to what extent the categories are inadequate and how to address the problem. Topics discussed include taxometric methods for identifying natural kinds, the error and bias inherent in DSM categories, and the complexities involved in classifying such specific mental disorders as "oppositional defiance disorder" and pathological gambling. -/- Contributors George Graham, Nick Haslam, Allan Horwitz, Harold Kincaid, Dominic Murphy, Jeffrey Poland, Nancy Nyquist Potter, Don Ross, Dan Stein, Jacqueline Sullivan, Serife Tekin, Peter Zachar. (shrink)

According to a common philosophical intuition, the deep nature of things is hidden from us, and the world as we know it through perception and science is somehow shallow and lacking in reality. For all we knwo, the intuition goes, we could be living in a cave facing shadows, in a dream or even in a computer simulation, This “intuition of unreality” clashes with a strong, but perhaps more naive, intuition to the effect that the world as we know (...) it seems perfectly real. Shadows, dreams, or informational structures appear too unreal to be identical to the world as we know it! This clash between the two intuitions forms the basis of the "problem of reality." At the turn of the nineteenth century psychiatrists encountered patients they referred to as “metaphysician doubters” who constantly questioned the reality of the world. This essay draws on the study of these patients to reject, and indeed diagnose, the intuition of unreality and recent metaphysical doctrines drawing on it, such as structuralism, digitalism, and virtual realism. (shrink)

In this chapter, I provide an overview of phenomenological approaches to psychiatric classification. My aim is to encourage and facilitate philosophical debate over the best ways to classify psychiatric disorders. First, I articulate phenomenological critiques of the dominant approach to classification and diagnosis—i.e., the operational approach employed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-10). Second, I describe the type or typification approach to psychiatric classification, which I distinguish into three (...) different versions: ideal types, essential types, and prototypes. I argue that despite their occasional conflation in the contemporary literature, there are important distinctions among these approaches. Third, I outline a new phenomenological-dimensional approach. I show how this approach, which starts from basic dimensions of human existence, allows us to investigate the full range of psychopathological conditions without accepting the validity of current diagnostic categories. (shrink)

Affordances are action-possibilities, ways of relating to and acting on things in our world. They help us understand how these things mean what they do and how we have bodily access to our world more generally. But what happens when this access is ruptured or impeded? I consider this question in the context of psychopathology and reports that describe this experience. I argue that thinking about the bodily consequences of losing access to everyday affordances can help us better understand (...) these reports. An affordance-based approach to psychopathology can illuminate some of the causes, as well as the experiential character and consequences, of affective disorders and diminished spatial agency in self-world disturbances. It also highlights some under-explored ethical and political dimensions of these issues that need further attention. (shrink)

In Disturbed Consciousness, philosophers and other scholars examine various psychopathologies in light of specific philosophical theories of consciousness. The contributing authors—some of them discussing or defending their own theoretical work—consider not only how a theory of consciousness can account for a specific psychopathological condition but also how the characteristics of a psychopathology might challenge such a theory. Thus one essay defends the higher-order thought (HOT) theory of consciousness against the charge that it cannot account for somatoparaphrenia (a delusion (...) in which one denies ownership of a limb). Another essay argues that various attempts to explain away such anomalies within subjective theories of consciousness fail. -/- Other essays consider such topics as the application of a model of unified consciousness to cases of brain bisection and dissociative identity disorder; prefrontal and parietal underconnectivity in autism and other psychopathologies; self-deception and the self-model theory of subjectivity; schizophrenia and the vehicle theory of consciousness; and a shift in emphasis away from an internal (or brainbound) approach to psychopathology to an interactive one. Each essay offers a distinctive perspective from the intersection of philosophy, consciousness research, and psychiatry. -/- Contributors Alexandre Billon, Andrew Brook, Paula Droege, Rocco J. Gennaro, Philip Gerrans, William Hirstein, Jakob Hohwy, Uriah Kriegel, Timothy Lane, Thomas Metzinger, Erik Myin, Inez Myin-Germeys, Myrto Mylopoulos, Gerard O’Brien, Jon Opie, J. Kevin O’Regan, Iuliia Pliushch, Robert Van Gulick . (shrink)

There is a long tradition of employing a phenomenological approach to gain greater insight into the unique experience of psychiatric illness. Researchers in this field have shed light upon a distur...

Max Scheler’s Formalism – and other of his essays on the philosophy of psychology, such as The Idols of Self-Knowledge and Ressentiment – continues to be in dialogue with contemporary philosophers of mind, psychiatrists and neuroscientists. Moving essentially from Formalism and essays from the same period, this paper provides an outline of a genuine Schelerian philosophy of psychopathology, investigating the close connection between “identity” and “freedom”. Not only did Scheler contribute to phenomenological psychology, but he also took an original (...) approach to psychopathology. From this point of view, it is possible to shed further light on his fruitful cooperation with Kurt Schneider and to understand so-called ‘emotional blindness’ from a new perspective. Within this framework, what emerges is the crucial role, in the formation of certain affective disorders, of the modification of pulsions and tendencies. Insofar as it allows for the development of a Schelerian model of delusion and (self)-deception, this approach also has implications for the debate on delusion in the context of contemporary philosophy of psychiatry. (shrink)

“Classic”, serotonergic psychedelic drugs such as LSD and psilocybin are the objects of renewed attention in science and psychiatry. A recent spate of research has produced evidence that psychedelics might be safe and effective adjuncts to the treatment of mood and addictive disorders, agents of positive psychological change in healthy subjects, and valuable tools for studying the neural mechanisms of perception and cognition. This chapter surveys three philosophical debates that have arisen in response to this “renaissance” of psychedelic research. (...) The first concerns the mechanisms of psychedelic-assisted psychotherapy (“psychedelic therapy”): How, exactly, does psychedelic administration in controlled conditions cause lasting psychological benefits? The second concerns the implications of psychedelic research for the philosophy of mind: Does psychedelic evidence show that there can be conscious mental states lacking all forms of self-consciousness? The third concerns the epistemic status of the psychedelic state: Is it possible that certain kinds of knowledge, or other epistemic benefits, could be gained by undergoing a psychedelic experience? (shrink)

This paper deals with a classical issue that remains at the core of the contemporary philosophical debate: the fact that the meaning of life is interlaced—in both negative and positive ways, with respect to morality—with happiness. On some historical conceptions, individual happiness must be sacrificed for the moral (universal, objective) good of a life, where the good fundamentally coincides with the meaning of life. On other approaches, happiness and flourishing (where flourishing is understood in terms of life’s meaningfulness) consist (...) in good action and a good life. On still other views, happiness, while equated with the meaning of life, is reduced to mere pleasure, to a sensorial state that can be influenced by outside forces. In the current literature, the prevailing interpretations of this question are largely deontological, eudaimonic or hedonic in character. Moving from the Schelerian theory of the stratification of the emotional life, and emphasizing the affective side of this broadly ethical question, this paper intends to examine this issue through the lens of phenomenology. From this perspective, the connection between happiness and the meaning not only of life but also of existence can be understood in light of what appears to underlie both phenomena: the entire existence of the individual, which is revealed most clearly in an act of personal love. Since this paper considers the condition humaine in all its complexity, that is to say, even in its fragility and vulnerability, within this framework I will also consider possible abnormal manifestations of happiness. Following Rümke’s clinical observations of pathological frameworks in which the feeling of happiness manifests itself, this paper shows how the deepest feeling of happiness, understood as a Schelerian personality feeling, can remain untouched by pathology. In his classic (but largely unappreciated) enquiry into the happiness syndrome, Rümke engages in a fruitful dialogue with Scheler, whose theory of the stratification of emotional life plays a crucial role in the former’s study of the phenomenology and the clinical aspects of happiness. Not only is Rümke’s Zur Phänomenologie und Klinik des Glücksgefühls an excellent example of applied phenomenology, but it also confirms the results of Scheler’s research on affective life. (shrink)

Philosophical lessons come in many different shapes and sizes. Some lessons are big, some are small. Some lessons go deep and have a big impact, some are shallow and have almost none. Some lessons are not really philosophical at all or would not really be lessons for an audience of academic philosophers. I mention these truisms not to disparage this informative book on 'moral OCD' (moral obsessive-compulsive disorder, or 'Scrupulosity') but rather to emphasize how difficult it can be (...) to discern the book's intended audience, given its interdisciplinary aims and structure. That question is never explicitly addressed (it is admittedly a slim book, slimmer than it appears), but the question has consequences for how to think about the book's ultimate value, and for whom. The book might attract two groups in particular: philosophers working on the nature of responsibility (the subject of the book's longest chapter) and psychiatric researchers or mental health professionals interested in moral philosophy and the philosophy of mental illness. I will return to what moral philosophers can learn from moral OCD, but there will be spoilers. (shrink)

Several authors have recently suggested that classic psychedelics might be safe and effective agents of moral enhancement. This raises the question: can we learn anything interesting about the nature of moral experience from a close examination of transformative psychedelic experiences? The interdisciplinary enterprise of philosophical psychopathology attempts to learn about the structure and function of the “ordinary” mind by studying the radically altered mind. By analogy, in this chapter we argue that we can gain knowledge about the everyday (...) moral life by studying extraordinary experiences of altered moral cognition and experience. We focus on a specific class of cases: experiences of forgiveness induced by psychedelics. We argue that close attention to such experiences reveals the importance of thought/emotion coherence and dissonance in the moral life and vindicates some heterodox ideas about moral phenomenology and psychology. (shrink)

According to the cognitive model of psychopathology, maladaptive beliefs about oneself, others, and the world are the main factors contributing to the development and persistence of various forms of mental suffering. Therefore, the key therapeutic process of Cognitive Behavioral Therapy (CBT)—a therapeutic approach rooted in the cognitive model—is cognitive restructuring, i.e., a process of revision of such maladaptive beliefs. In this paper, I examine the philosophical assumptions underlying CBT and offer theoretical reasons to think that the effectiveness of (...) belief revision in psychotherapy is very limited. This is the case, I argue, because the cognitive model wrongly assumes that our body of beliefs is unified, while it is in fact fragmented. (shrink)

In this chapter, we explain how Karl Jaspers’ concept of empathy can be expanded by drawing upon the tradition of philosophical phenomenology. In the first section, we offer an account of Jaspers' concepts of empathy and incomprehensibility as he develops them in General Psychopathology and “The Phenomenological Approach in Psychopathology.” In the second section, we survey the recent literature on overcoming Jaspers' notion of incomprehensibility and expanding his concept of empathy. In the third section, we outline the (...) levels of investigation at which phenomenological inquiries into psychopathology may proceed. These levels of human existence are, in descending order of depth, (1) phenomenal experiences, (2) interpretive frameworks, (3) modes of existence, and (4) existentials. In the fourth and final section, we argue that to fully empathically comprehend patients with schizophrenia and other mental disorders, the possibility of alterations at all four levels of existence must be acknowledged. (shrink)

The methodological differences of understanding, versus explaining, have been at the centre of a century-long methodenstreit debate (and disagreement) among philosophers and scientists. Karl Jaspers managed to import this discussion to the realm of psychiatry and psychopathology in a significant, but unresolved, manner. Side-tracked by the advent of various changes in psychiatry during the 20th century, phenomenology and philosophy of psychiatry have made a comeback in the last decades and, since then, developed new contributions to this subject. Quite similarly, (...) the study of time experience, standing on the shoulders of notorious philosophers, has too witnessed a similar renaissance, with groundbreaking developments across several conditions, including depression. The present essay is essentially exploratory, but during its development, after addressing the concepts of the methodenstreit debate, and tackling both meaningful and causal connections behind time dysperception in depression, I argue that understanding, at least in this context and at present time, is not entirely reducible to causal explanations, for some things are only gained in understanding, such as the feeling of being understood and the implications it carries for a therapeutic relationship and the treatment plan. (shrink)

In § 6 of his General Psychopathology (1st edition 1913) Jaspers distinguished between drives, wants and volitions as three different and irreducible kinds of motivational phenomena which are involved in human decision making and which may lead to successful actions. He has characterized the qualitative differences between volitions in comparison with basic vital drives and emotional wants such as being (a.) intentional, (b.) content-specific and (b.) directed towards concrete objects and actions as goals. Furthermore, Jaspers has presented and discussed (...) three kinds of pathological problems about motivation and willing. (1.) The first kind is impulsive action or impulsive behaviour, as e.g. in psychoses or personality disorders, which he compares with instinctive action which are both without any previous hesitation, deliberation and reflection of any presumable consequences, but still very different with respect to their motivational content. (2.) The second kind of pathological problems about motivation and willing are the inhibitions of the will and Jaspers is discussing two major kinds of them: (a.) the energetic or motivational inhibition of the will which is an inability of willing due to the mere lack of any drives and motives, as in the case of any severe and pathological depression; (b.) the cognitive inhibition of the will which is due to the pathological inability to be aware of and understand properly the complexity and difficulty of real life situations in order to solve some given tasks by appropriate decision making, as e.g. in some cases of schizophrenia. (3.) The third kind is a pathological weakness of the will which is extraordinary and not familiar to normal human adults. This pathological kind of weakness of the will consist in the complete causal ineffectiveness of the subjectively felt impulse of willing which is not leading to any inward and outward observable action, such as e.g. as a movement of the limbs or some verbal utterance. This pathological weakness of the will is a complete ineffectiveness of the volitional impulse and therefore different from what philosophers discuss under the heading of weakness of the will which presuppose some evaluation of the intended resp. realized action as ethically, morally or religiously right or wrong. Finally, there are three kinds of normal or non-pathological weakness of the will, as discussed by philosophers: (A.) ethical weakness of the will as in Aristotle’s disagreement about akrasia with the Platonic Socrates; (B) moral weakness of the will as in Kant’s analysis of the absence or failure of any specific moral reasoning by pure practical reason as opposed to mere strategic and pragmatic reason or as the occurrence of a self-deceptive “dialectics of the exception“; (C.) religious weakness of the will as in Pauls personal insight about the incoherence between his high spiritual aspirations and his factual ethical achievements. (shrink)

Although delusion is one of the central concepts of psychopathology, it stills eludes precise conceptualization. In this paper, I present certain basic issues concerning the classification and definition of delusion, as well as its ontological status. By examining these issues, I aim to shed light on the ambiguity of the clinical term ‘delusion’ and its extension, as well as provide clues as to why philosophers are increasingly joining the ranks of psychiatrists, psychologists, and neuroscientists in the effort to come (...) to a comprehensive understanding of delusion. (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)

Psychedelic-Assisted Psychotherapy is being investigated as a treatment for a range of psychiatric illnesses. Current research suggests that the kinds of subjective experiences induced by psychedelic compounds play key roles in producing therapeutic outcomes. To date, most knowledge of therapeutic psychedelic experiences are derived from psychometric assessments with scales such as the Mystical Experience Questionnaire. While these approaches are insightful, more nuanced and detailed descriptions of psychedelic-induced changes to subjective experience are required. Drawing on recent advancements in qualitative methods arising (...) from the interdisciplinary field of phenomenological psychopathology, we propose a systematic and comprehensive investigation into how Psychedelic-Assisted Psychotherapy alters subjective experience. This research program aims to characterise the nature of therapeutic psychedelic experiences by drawing on concepts from philosophical phenomenology. Such characterisations should, moreover, contribute to our understanding of the mechanisms of psychedelic therapy, the role of integration therapy, and related philosophical debates. (shrink)

When political philosopher Hannah Arendt introduced the concept of ‘banality of evil’ she did so in reference to the actions of Germans who appropriated the doctrines of National Socialism “thoughtlessly” and without obvious intentions to do evil. But, Arendt’s description of this phenomenon entails that such banality can be found even in a democracy such as the USA. The relation of law and morality must therefore be unambiguous to defend the rule of law against the rule of men. However, a (...) legal philosophy other than positivism is essential to safeguard the Republic against the overreach of executive power. And, where the psychopathology of Donald Trump is at the core of America’s electoral discontent in 2020, as mental health professionals have argued, there is all the more reason to take Arendt’s counsel especially seriously today. It is in this context that it is argued here that the American public must beware Trump’s inducement of America’s banality of evil. (shrink)

How do philosophers and psychologists receive paradigmatic cases from pathology? More specifically, how are some essential features of ‘normal’ cognitive, affective or perceptual functions derived from these pathological cases? In this paper, I argue that Maurice Merleau-Ponty offers a fecund answer to this question by putting forth a logic of supplementation in pathology that distinguishes the coping behavior of the organic world in contrast to an inorganic one. Supplementation, instead of substitution, marks the world of the living, particularly in its (...) higher forms, as it denotes a persistence through impairment governed by an organic norm. A prominent example of this appears in his reading of the patient Schneider case, a classic example from Goldstein and Gelb’s Gestalt psychology. While earlier commentators were interested in underlying whether or not Merleau-Ponty used this example to denote the persistence of a key function or the disruption of another, what has been missed, on my view, is a far more consequential point about pathologies and how they structure our relation to our world. -/- . (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)

The phenomenology of agency has, until recently, been rather neglected, overlooked by both philosophers of action and philosophers of consciousness alike. Thankfully, all that has changed, and of late there has been an explosion of interest in what it is like to be an agent. 1 This burgeoning field crosses the traditional boundaries between disciplines: philosophers of psychopathology are speculating about the role that unusual experiences of agency might play in accounting for disorders of thought and action; cognitive scientists (...) are developing models of how the phenomenology of agency is generated; and philosophers of mind are drawing connections between the phenomenology of agency and the nature of introspection, phenomenal character, and agency itself. My aim in this paper is not to provide an exhaustive survey of this recent literature, but to provide a.. (shrink)

I draw on neurobiological evidence to defend the rationalist thesis that moral judgments are essentially dependent on reasoning, not emotions (conceived as distinct from inference). The neuroscience reveals that moral cognition arises from domain-general capacities in the brain for inferring, in particular, the consequences of an agent’s action, the agent’s intent, and the rules or norms relevant to the context. Although these capacities entangle inference and affect, blurring the reason/emotion dichotomy doesn’t preferentially support sentimentalism. The argument requires careful consideration of (...) the empirical evidence (from neuroimaging to psychopathology) and philosophical analysis of the commitments of rationalism versus sentimentalism in ethics. (shrink)

This paper introduces a novel conceptualisation of mental imagery; namely, that is grease for the mind’s gears (MGT). MGT is not just a metaphor. Rather, it describes an important and overlooked higher-order function of mental imagery: that it aids various mental faculties discharge their characteristic functional roles. MGT is motivated by reflection on converging evidence from clinical, experimental and social psychology and solves at least two neglected conceptual puzzles about mental imagery. The first puzzle concerns imagery’s architectural promiscuity; that is, (...) its ability to assist diverse mental faculties and perform many different functions when doing so. The second puzzle concerns how to square imagery’s architectural promiscuity with its psychopathological relevance; that is, its being a maintaining cause, and possibly even a partial constituent, of several psychological disorders, including post-traumatic stress disorder, bipolar disorder and major depressive disorder. Mental imagery helps and harms human psychology to extreme degrees and this is something that calls for elucidation. MGT says that instead of facing perplexing heterogeneities here, we instead face a significant unity. On this score, MGT is argued to be superior to the currently dominant conception of imagery in the philosophical literature; namely, as a perception-like state of mind. (shrink)

Psychologists often characterize the infant’s attachment to her primary caregiver as love. Philosophical accounts of love, however, tend to speak against this possibility. Love is typically thought to require sophisticated cognitive capacities that infants do not possess. Nevertheless, there are important similarities between the infant-primary caregiver bond and mature love, and the former is commonly thought to play an important role in one’s capacity for the latter. In this work, I examine the relationship between the infant-primary caregiver bond and (...) love. I argue that while these very early attachments do not represent genuine love, a fuller understanding of them can inform extant philosophical views of love. (shrink)

This paper offers an overview of the philosophical work on epistemic injustices as it relates to psychiatry. After describing the development of epistemic injustice studies, we survey the existing literature on its application to psychiatry. We describe how the concept of epistemic injustice has been taken up into a range of debates in philosophy of psychiatry, including the nature of psychiatric conditions, psychiatric practices and research, and ameliorative projects. The final section of the paper indicates future directions for (...) class='Hi'>philosophical research of epistemic injustices and psychiatry, concerning neurocognitive disorders, identity prejudices in psychiatric illness, concepts of epistemic privilege in psychiatry, and the prospects for combining phenomenological psychopathology and epistemic justice. We argue that much remains to be done in the conceptualization of these epistemic injustices and suggest that this future work should be multidisciplinary in character and sensitive to the phenomenology of psychiatric conditions. (shrink)

Philosophers and psychologists have advanced a plethora of explanations of the self in relation to narratives, positing varying degrees of connection between them. For some, narratives created by a subject about herself shape her self-constitution (Flanagan 1991; Fivush 1994). For others, they help the subject to participate in social cognition (Hutto 2008). Some represent narratives as merely one basis of personal identity and consider them cognitive tools used by the subject to construct self-concepts (Neisser 1997; Tekin 2011); others render narratives (...) the basis for self-constitution (Dennett 1992; MacIntyre 1981; Schechtman 1996). Some require that the subject create her ‘whole life narrative’ unifying her .. (shrink)

In psychiatry, pharmacological research has played a crucial role in the formulation, revision, and refinement of neurobiological theories of psychopathology. Besides being utilized as potential treatments for various mental disorders, pharmacological drugs play an important epistemic role as experimental instruments that help scientists uncover the neurobiological underpinnings of mental disorders (Tsou, 2012). Interventions with psychiatric patients using pharmacological drugs provide researchers with information about the neurobiological causes of mental disorders that cannot be obtained in other ways. This important source (...) of evidence for the biological causes of mental disorder is often overlooked in philosophical analyses of psychiatry, especially in skeptical analyses that debase the biological aspects of psychopathology (e.g., Szasz, 1960; Scheff, 1963; Laing, 1967). In discussing pharmacological interventions as a form of evidence for the physical basis of mental disorders, this paper aims to clarify the nature, reliability, and limitations of this evidence. In addition, it illustrates the central role that pharmacological findings in applied clinical contexts play in the acquisition of neurobiological knowledge in research contexts. (shrink)

For millennia self has been conjectured to be necessary for consciousness. But scant empirical evidence has been adduced to support this hypothesis. Inconsistent explications of “self” and failure to design apt experiments have impeded progress. Advocates of phenomenological psychiatry, however, have helped explicate “self,” and employed it to explain some psychopathological symptoms. In those studies, “self” is understood in a minimalist sense, sheer “for-me-ness.” Unfortunately, explication of the “minimal self” (MS) has relied on conceptual analysis, and applications to psychopathology (...) have been hermeneutic, allowing for many degrees of interpretive latitude. The result is that MS’s current scientific status is analogous to that of the “atom,” at the time when “atom” was just beginning to undergo transformation from a philosophical to a scientific concept. Fortunately, there is now an opportunity to promote a similar transformation for “MS.” Discovery of the brain’s Default Mode Network (DMN) opened the door to neuroimaging investigations of self. Taking the DMN and other forms of intrinsic activity as a starting point, an empirical foothold can be established, one that spurs experimental research and that enables extension of research into multiple phenomena. New experimental protocols that posit “MS” can help explain phenomena hitherto not thought to be related to self, thereby hastening development of a mature science of self. In particular, targeting phenomena wherein consciousness is lost and recovered, as in some cases of Unresponsive Wakefulness Syndrome (UWS), allow for design of neuroimaging probes that enable detection of MS during non-conscious states. These probes, as well as other experimental protocols applied to NREM Sleep, General Anesthesia (GA), and the waking state, provide some evidence to suggest that not only can self and consciousness dissociate, MS might be a necessary precondition for conscious experience. Finally, these findings have implications for the science of consciousness: it has been suggested that “levels of consciousness” (LoC) is not a legitimate concept for the science of consciousness. But because we have the conceptual and methodological tools with which to refine investigations of MS, we have the means to identify a possible foundation—a bifurcation point—for consciousness, as well as the means by which to measure degrees of distance from that foundation. These neuroimaging investigations of MS position us to better assess whether LoC has a role to play in a mature science of consciousness. (shrink)

Illusionism is the view that conscious experience is some sort of introspective illusion. According to illusionism, there is no conscious experience, but it merely seems like there is conscious experience. This would suggest that much phenomenological enquiry, including work on phenomenological psychopathology, rests on a mistake. Some philosophers have argued that illusionism is obviously false, because seeming is itself an experiential state, and so necessarily presupposes the reality of conscious experience. In response, the illusionist could suggest that the relevant (...) sort of seeming here is not an experiential state, but is a cognitive state, such as a judgement or a belief, which is fully amenable to a physical or functionalist analysis. Herein, I argue that this response is unsuccessful and fails to undermine the reality of conscious experience. Nonetheless, the response does raise the problem of how a judgement or belief about the character of a conscious experience, even if it is true, can be justified if the conscious experience has no causal role in the formation of the judgement or belief. This is not a new problem, but is a reiteration of an old problem that is known in the philosophy of mind literature as the paradox of phenomenal judgement. I consider how the paradox of phenomenal judgement can be resolved and how the judgement or belief about conscious experience can be justified with appeal to the notion of acquaintance. (shrink)

The psychiatric diagnostic system, as exemplified by the DSM, is a pseudo-scientific framework for diagnosing sick Cartesian isolated minds. As such, it completely overlooks the exquisite context sensitivity and radical context dependence of human emotional life and of all forms of emotional disturbance. In Descartes’s vision, the mind is a “thinking thing,” ontologically decontextualized, fundamentally separated from its world. Heidegger’s existential phenomenology mended this Cartesian subject-object split, unveiling our Being as always already contextualized, a Being-in-the-world. Here I offer a critique (...) of studies in “phenomenological psychopathology” that presuppose the validity of the psychiatric diagnostic system and leave it unchallenged. In this vein, I contend that all emotional disturbances are constituted in an indissoluble context of human interrelatedness. Specifically, I claim that all emotional disturbances, including those objectified by the DSM, take form in relational contexts of severe emotional trauma. There are no psychiatric entities, only devastating contexts. Additionally, I show that Heidegger’s analyses of Angst, world-collapse, uncanniness, and thrownness into Being-toward-death provide extraordinary philosophical tools for grasping the existential significance of such contexts of emotional trauma. Applying Heidegger’s concept of authenticity, I suggest that emotional health entails an ease of passage—i.e., an absence of dissociation—between the world of trauma and the world of everydayness. (shrink)

The aim of this collection is to show how work in the analytic philosophical tradition can shed light on the nature, value, and experience of anxiety. Contrary to widespread assumptions, anxiety is not best understood as a mental disorder, or an intrinsically debilitating state, but rather as an often valuable affective state which heightens our sensitivity to potential threats and challenges. As the contributions in this volume demonstrate, learning about anxiety can be relevant for debates, not only in the (...) philosophy of emotion, but also in epistemology, value theory, and the philosophy of psychopathology. In this introductory article, we also show that there is still much to discover about the relevance that anxiety may have for moral action, self-understanding, and mental health. (shrink)

Shaun Gallagher has actively looked into the possibility that psychopathologies involving “thought insertion” might supply a counterexample to the Cartesian principle according to which one can always recognize one’s own thoughts as one’s own. Animated by a general distrust of a priori demonstrations, Gallagher is convinced that pitting clinical cases against philosophical arguments is a worthwhile endeavor. There is no doubt that, if true, a falsification of the immunity to error through misidentification would entail drastic revisions in how we (...) conceive the boundary between self and other. However, I argue that (1) the idea of unearthing an exception to the Cartesian thesis is, on further reflection, not a realistic prospect and that (2) this casts doubt on the attempt to conjoin first-person phenomenology and third-person cognitive science in the service of philosophical debates. (shrink)

Though the divide between reason-based and causal-explanatory approaches in psychiatry and psychopathology is old and deeply rooted, current trends involving multi-factorial explanatory models and evidence-based approaches to interpersonal psychotherapy, show that it has already been implicitly bridged. These trends require a philosophical reconsideration of how reasons can be causes. This paper contributes to that trajectory by arguing that Donald Davidson’s classic paradigm of 1963 is still a valid option.

Martin Heidegger (1889–1976) is one of the most influential philosophers of the twentieth century. His influence, however, extends beyond philosophy. His account of Dasein, or human existence, permeates the human and social sciences, including nursing, psychiatry, psychology, sociology, anthropology, and artificial intelligence. In this chapter, I outline Heidegger’s influence on psychiatry and psychology, focusing especially on his relationships with the Swiss psychiatrists Ludwig Binswanger and Medard Boss. The first section outlines Heidegger’s early life and work, up to and including the (...) publication of Being and Time, in which he develops his famous concept of being-in-the-world. The second section focuses on Heidegger’s initial influence on psychiatry via Binswanger’s founding of Daseinsanalysis, a Heideggerian approach to psychopathology and psychotherapy. The third section turns to Heidegger’s relationship with Boss, including Heidegger’s rejection of Binswanger’s Daseinsanalysis and his lectures at Boss’s home in Zollikon, Switzerland. (shrink)

In this article I develop two arguments, taking Max Scheler’s phenomenology as a starting point. The first one is that emotions are not private and internal states of consciousness, but what makes us come into contact with the expressive dimension of reality, by orienting our placement in the world and our interaction with others. The second thesis is that some emotions have an “anthropogenetic” nature that is at the roots of the ontology of a person and of social ontology: it (...) is through practices of “sharing” certain emotions that the humanity has been born and that the various forms of social realities are established. In accordance with one of María Zambrano’s phrases, I propose to trace these anthropogenetic emotions back to the «hambre de nacer del todo» («hunger for being fully born») of a being that never stops being born again. (shrink)

Traumatic experiences do not merely impact on the individual’s body and psyche, they alter the way we experience others, our interpersonal relationships, and how we make sense of the world. In my dissertation, I integrate work in phenomenology, psychopathology, philosophy of mind, philosophy of psychiatry, and trauma studies, and draw on trauma testimonies ob- tained in an online questionnaire. I engage analytically with the question of what constitutes a trauma, whether psychological trauma is necessarily pathological, and what the causal (...) and im- plicatory relations between traumatising and post-traumatic experiences are. Informed by these preliminary elaborations, I focus on the intersubjective dimension of trauma, drawing on a qualitative study I conducted in 2020. I show that empathic abilities may be altered but are not necessarily diminished through traumatising experiences; I suggest a framework for under- standing feelings of alienation in the aftermath of trauma; and I demonstrate how feelings of belonging may be re-established. My dissertation is exemplary of how phenomenological frameworks can contribute to a better understanding of psychological trauma and that engaging with trauma can, in turn, inform and enrich philosophical thinking. (shrink)

The antipsychiatrists in the 1960's, specifically Thomas Szasz, have claimed that mental illness does not exist. This argument was based on a specific definition of physical disease that, Szasz argued, could not be applied to mental illness. Thus, by problematizing mental illness, the spotlight had turned to physical disease. Since then, philosophers of medicine have proposed definitions applying both to pathophysiological and psychopathological conditions. This paper analyzes prominent naturalist definitions which aim to provide value-free accounts of pathological conditions, as well (...) as normative accounts that propose value-laden accounts. The approaches surveyed differ not only in terms of value, but also in terms of their perspective. This perspective concerns whether the concept of health, illness or disease/disorder is emphasized. The emphasis on health or illness is holistic as it looks at the human being as a whole, while focus on disease or disorder is analytic as it considers part functions. I will here argue in favor of holism and will propose a definition of mental health based on Sartre's existential psychoanalysis of Gustave Flaubert. (shrink)

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

The professor of psychopathology Simon Baron-Cohen is well-known for his thesis that males are on average better at systematizing than empathizing and females are on average better at empathizing than systematizing. In this paper, I note an ambiguity in how he defines systematizing.

Affordances are action-possibilities, ways of relating to and acting on our world. A theory of affordances helps us understand how we have bodily access to our world and what it means to enjoy such access. But what happens to bodies when this access is somehow ruptured or impeded? This question is relevant to psychopathology. People with psychiatric disorders often describe feeling as though they’ve lost access to affordances that others take for granted. Focusing on schizophrenia, depression, and autistic spectrum (...) disorder, I argue that thinking about the bodily consequences of losing access to everyday affordances can help us better understand these reports. An affordance-based approach to psychopathology can illuminate some of the causes, as well as the experiential character and content, of affective disorders in psychopathology. It can also draw our attention to some under-explored ethical and political dimensions of these issues needing further consideration. (shrink)

In this chapter, I introduce phenomenology and phenomenological psychopathology by clarifying the kind of implicit experiences that phenomenologists are concerned with. In section one, I introduce the phenomenological concept of pre-reflective experience, focusing especially on its relation to the concept of implicit experience. In section two, I introduce the structure of pre-reflective self-consciousness, which has been studied extensively by both classical phenomenologists and contemporary phenomenological psychopathologists. In section three, I show how phenomenological psychopathologists rely on an account of pre-reflective (...) self-consciousness to better understand the experience of schizophrenia and I outline some of the methodological challenges that arise in this field of research. This introduction should facilitate critical engagement and collaboration between phenomenologists and researchers working across a variety of disciplines, including psychology, psychiatry, the cognitive sciences, and analytic philosophy of mind. (shrink)

Addicts are often portrayed as compelled by their addiction and thus as a paradigm of unfree action and mitigated blame. This chapter argues that our best scientific theories of addiction reveal that, psychologically, addicts are not categorically different from non-addicts. There is no pairing of contemporary accounts of addiction and of prominent theories of moral responsibility that can justify our intuitions about the mitigation of addicts but not non-addicts. Two conclusions are advanced. First, we should either treat addicts as we (...) normally treat non-addicts (as fully culpable) or embrace the skeptical conclusion that everyone is less responsible than we thought—perhaps not responsible at all. Second, we should be doubtful that theorizing about responsibility will be advanced by focusing on particular kinds of psychopathologies. (shrink)

Prior research has demonstrated that antisocial behavior, substance-use disorders, and personality dimensions of aggression and impulsivity are indicators of a highly heritable underlying dimension of risk, labeled externalizing. Other work has shown that individual trait constructs within this psychopathology spectrum are associated with reduced self-monitoring, as reflected by amplitude of the error-related negativity (ERN) brain response. In this study of undergraduate subjects, reduced ERN amplitude was associated with higher scores on a self-report measure of the broad externalizing construct that (...) links these various indicators. In addition, the ERN was associated with a response-locked increase in anterior theta (4–7 Hz) oscillation; like the ERN, this theta response to errors was reduced among high-externalizing individuals. These findings suggest that neurobiologically based deficits in endogenous action monitoring may underlie generalized risk for an array of impulse-control problems. (shrink)

According to the traditional Western concept of freedom, the ability to exercise free will depends on the availability of options and the possibility to consciously decide which one to choose. Since neuroscientific research increasingly shows the limits of what we in fact consciously control, it seems that our belief in free will and hence in personal autonomy is in trouble. -/- A closer look at the phenomenology of Obsessive-Compulsive Disorder (OCD) gives us reason to doubt the traditional concept of freedom (...) in terms of conscious control. Patients suffering from OCD experience themselves as unfree. The question is whether their lack of freedom is due to a lack of will power. Do they have too little conscious control over their thoughts and actions? Or could it be the opposite: are they exerting too much conscious control over their thoughts and actions? -/- In this chapter, we will argue that OCD patients testify to the general condition that exercising an increased conscious control over actions can in fact diminish the sense of agency rather than increase the experience of freedom. The experiences of these patients show that the traditional conception of freedom in terms of ‘free will’ has major shortcomings. There is an alternative, however, to be found in the work of Hannah Arendt. She advocates a conception of freedom as freedom in action. Combined with phenomenological insights on action, Arendt’s account of freedom helps us to get a more adequate understanding of the role of deliberation in the experience of freedom. We argue that the experience of freedom depends on the right balance between deliberate control and unreflective actions. (shrink)

Self-disorders in depression and schizophrenia have been the focus of much recent work in phenomenological psychopathology. But little has been said about the role the material environment plays in shaping the affective character of these disorders. In this paper, we argue that enjoying reliable (i.e., trustworthy) access to the things and spaces around us — the constituents of our material environment — is crucial for our ability to stabilize and regulate our affective life on a day-today basis. These things (...) and spaces often play an ineliminable role in shaping what we feel and how we feel it; when we interact with them, they contribute ongoing feedback that " scaffolds " the character and temporal development of our affective experiences. However, in some psychopathological conditions, the ability to access to these things and spaces becomes disturbed. Individuals not only lose certain forms of access to the practical significance of the built environment but also to its ​ regulative​ significance, too — and the stability and organization of their affective life is compromised. In developing this view, we discuss core concepts like " affordance spaces " , " scaffolding " , and " incorporation ". We apply these concepts to two case studies, severe depression and schizophrenia, and we show why these cases support our main claim. We conclude by briefly considering implications of this view for developing intervention and treatment strategies. (shrink)

An attempt to answer four unsettled questions about the Stoic definition of passions. (I am no longer working on this paper, but have incorporated some of its thoughts into subsequent work.).

Realists about mental disorder have been hasty about dismissing social explanations of how mental disorder is constituted. However, many social ontologies are realist ontologies. In order to create a meaningful distinction between realism and social metaphysics about mental disorder, I propose that realism about mental disorder is best understood as Individual Trait Realism (ITR) about them. For ITR, mental disorders exist in virtue of traits. I defend the view that ITR is compatible with social metaphysics, arguing that, in asking whether (...) constituents in the social sphere figure the metaphysics of psychopathology, we are asking questions on three different strata of explanation: the strata of demarcation, instantiation, and individual traits. Distinguishing between these strata allows for nuanced realism that need not reject the social constitution of mental disorder. (shrink)

According to what we will call subjectivity theories of consciousness, there is a constitutive connection between phenomenal consciousness and subjectivity: there is something it is like for a subject to have mental state M only if M is characterized by a certain mine-ness or for-me-ness. Such theories appear to face certain psychopathological counterexamples: patients appear to report conscious experiences that lack this subjective element. A subsidiary goal of this chapter is to articulate with greater precision both subjectivity theories and the (...) psychopathological challenge they face. The chapter’s central goal is to present two new approaches to defending subjectivity theories in the face of this challenge. What distinguishes these two approaches is that they go to great lengths to interpret patients’ reports at face value – greater length, at any rate, than more widespread approaches in the extant literature. (shrink)

Despite increasing interest in the work of Tetsuro Watsuji, his discussion of intentionality remains underexplored. I here develop an interpretation and application of his view. First, I unpack Watsuji’s arguments for the inherently social character of intentionality, consider how they connect with his more general discussion of embodiment and betweenness, and then situate his view alongside phenomenologists like Husserl, Heidegger, and Merleau-Ponty. Next, I argue that Watsuji’s characterization of the social character of intentionality is relevant to current discussions in phenomenological (...) psychopathology. I consider how it can help illuminate the character and structure of some anomalous experiences in schizophrenia. I argue further that this application can enrich existing attempts to connect Watsuji and psychopathology, such as those found in the work of the psychiatrist Bin Kimura. (shrink)