This paper explores how the diagnosis of mental disorder may affect the diagnosed subject’s self-concept by supplying an account that emphasizes the influence of autobiographical and social narratives on self-understanding. It focuses primarily on the diagnoses made according to the criteria provided by the Diagnostic Statistical Manual of Mental Disorders (DSM), and suggests that the DSM diagnosis may function as a source of narrative that affects the subject’s self-concept. Engaging in this analysis by appealing to autobiographies (...) and memoirs written by people diagnosed with mental disorder, the paper concludes that a DSM diagnosis is a double-edged sword for self- concept. On the one hand, it sets the subject’s experience in an established classificatory system which can facilitate self-understanding by providing insight into subject’s condition and guiding her personal growth, as well as treatment and recovery. In this sense, the DSM diagnosis may have positive repercussions on self-development. On the other hand, however, given the DSM’s symptom-based approach and its adoption of the Biomedical Disease model, a diagnosis may force the subject to make sense of her condition divorced from other elements in her life that may be affecting her mental- health. It may lead her frame her experience only as an irreversible imbalance. This form of self-understanding may set limits on the subject’s hopes of recovery and may create impediments to her flourishing. (shrink)

Many who suffer from eating disorders claim that they see themselves as “fat”. Despite decades of research into the phenomenon, behavioural evidence has failed to confirm that eating disorders involve visual misperception of own-body size. I illustrate the importance of this phenomenon for our understanding of perceptual processing, outline the challenges involved in experimentally confirming it, and provide solutions to those challenges.

This article describes a case of a teenager with early complex trauma due to chronic domestic violence. Cannabis use triggered auditory hallucinations, after which the teenager was diagnosed with an acute schizophrenia-like psychotic disorder. Antipsychotic medication did not fully resolve symptoms. Eventually the teenager chose to self-medicate with LSD in order to resolve a suicidal condition. The teenager carried out six unsupervised LSD sessions, followed by an extended period of almost daily use of inhaled low-dose DMT. Psychotic symptoms (...) were mostly resolved after approximately one year. Subsequent cannabis use caused a transient relapse. -/- While his psychosis may have been due to cannabis use in the presence of a genetic predisposition, LSD and DMT did not promote psychotic symptoms in this case, and resolved the suicidal condition in one session. Additional high-dose LSD sessions and low-dose DMT sessions appeared to resolve the symptoms related to the early complex trauma. Alternatively, if psychosis is understood as a massive defense system resulting from early complex trauma, and if his psychotic symptoms were partially due to such trauma, psychedelics appeared to transcend this defense system, providing access to traumatic memories in order to allow for an integrative treatment effect. -/- Information was acquired from medical record excerpts provided by the patient, a semi-structured retrospective video interview, and follow-up interviews a year later. The present case suggests a need for further studies on the relationship between psychedelics and psychotic disorders, the feasibility of supervised vs unsupervised settings for various situations, and alternative therapeutic models for utilizing the hyperaware-hypersensitive state induced by psychedelics. With regard to self-treatment, a harm reduction approach should be adopted. Low-risk psycholytic self-treatment protocols could be developed for future use in public health care systems. (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)

Impairment of self-control is often said to be a defining feature of addiction. Yet many addicts display what appears to be a considerable amount of control over their drug-oriented actions. Not only are their actions clearly intentional and frequently carried out in a conscious and deliberate manner, there is evidence that many addicts are responsive to a wide range of ordinary incentives and counter-incentives. Moreover, addicts have a wide variety of reasons for using drugs, reasons which often seem to (...) go a long way towards explaining their drug-oriented behavior. Many use drugs, for example, to cope with stressful or traumatic experiences. In this article I argue that some standard philosophical explanations of addicts’ impairment of self-control are inadequate, and propose an alternative. (shrink)

A family of recent externalist approaches in philosophy of mind argues that our psychological capacities are synchronically and diachronically “scaffolded” by external resources. I consider how these “scaffolded” approaches might inform debates in phenomenological psychopathology. I first introduce the idea of “affective scaffolding” and make some taxonomic distinctions. Next, I use schizophrenia as a case study to argue—along with others in phenomenological psychopathology—that schizophrenia is fundamentally a self-disturbance. However, I offer a subtle reconfiguration of these approaches. I argue that (...) schizophrenia is not simply a disruption of ipseity or minimal self-consciousness but rather a disruption of the scaffolded self, established and regulated via its ongoing engagement with the world and others. I conclude by considering how this scaffolded framework indicates the need to consider new forms of intervention and treatment. (shrink)

People suffering from Obsessive-Compulsive Disorder (OCD) do things they do not want to do, and/or they think things they do not want to think. In about 10 percent of OCD patients, none of the available treatment options is effective. A small group of these patients is currently being treated with deep brain stimulation (DBS). Deep brain stimulation involves the implantation of electrodes in the brain. These electrodes give a continuous electrical pulse to the brain area in which they are (...) implanted. It turns out that patients may experience profound changes as a result of DBS treatment. It is not just the symptoms that change; patients rather seem to experience a different way of being in the world. These global effects are insufficiently captured by traditional psychiatric scales, which mainly consist of behavioural measures of the severity of the symptoms. In this article we aim to capture the changes in the patients’ phenomenology and make sense of the broad range of changes they report. For that we introduce an enactive, affordance-based model that fleshes out the dynamic interactions between person and world in four aspects. The first aspect is the patients’ experience of the world. We propose to specify the patients’ world in terms of a field of affordances, with the three dimensions of broadness of scope (‘width’ of the field), temporal horizon (‘depth’), and relevance of the perceived affordances (‘height’). The second aspect is the person-side of the interaction, that is, the patients’ self-experience, notably their moods and feelings. Thirdly, we point to the different characteristics of the way in which patients relate to the world. And lastly, the existential stance refers to the stance that patients take towards the changes they experience: the second-order evaluative relation to their interactions and themselves. With our model we intend to specify the notion of being in the world in order to do justice to the phenomenological effects of DBS treatment. (shrink)

I argue that Plato believes that the soul must be both the principle of motion and the subject of cognition because it moves things specifically by means of its thoughts. I begin by arguing that the soul moves things by means of such acts as examination and deliberation, and that this view is developed in response to Anaxagoras. I then argue that every kind of soul enjoys a kind of cognition, with even plant souls having a form of Aristotelian discrimination (...) (krisis), and that there is therefore no completely unintelligent, evil soul in the cosmos that can explain disorderly motions; as a result, the soul is not the principle of all motion but only motion in the cosmos after it has been ordered by the Demiurge. (shrink)

The Disabilities Act of 1990 and the Developmental Disabilities Assistance and Bill of Rights Act of 2000 of United States in act to prevent social exclusion of people with intellectual and developmental disabilities (IDDs) and to cut back on unneeded expenditures to society. However, despite the protective legislation, the rights of adults with neurodevelopmental disorders have not yet been fully realised. There are several obstacles to overcome the neurological development related health care services, including health care usage, educational and career (...) pathways, family and social lives, self-fulfilment, and quality of life. There are significant gaps in the transition process that affect the health care systems. Lack of transition and transfer planning, neurodevelopmental disorder health care pathway services have lack of experience, education, and expertise which result the inadequate growth of the health care quality and create communication gap in between service providers and service users. The aim of this short communication is to mention and clarify the ethical concerns of neurodevelopmental service evaluation. (shrink)

In this paper, I am generally concerned with certain mental disorders and the doxastic attitudes that sometimes characterize them. According to recent Anglo-American philosophical studies on this topic, the latter involve beliefs that have somehow “gone wrong”: strange or irrational beliefs and cases of “motivated irrationality”. I aim to focus on pathological and deceptive phenomena such as delusion and self-deception. From a phenomenological perspective, these can also be investigated with regard to their experiential content. Adopting this approach, and starting (...) in particular with the eidetic connection between the living body and its own environment, I will examine disorders of the ecological self. Psychiatric delusion, which is at the core of this examination, is a symptom of a great number of mental disorders, such as Capgras disorder, Cotard disorder and schizophrenia. Integrating dominant (propositional) models of delusion which reduce this pathological phenomenon to a certain kind of belief, I propose an eco-phenomenological understanding of its contours. From this perspective, delusion reveals itself primarily as an illusory experience: a delusional value-perception. In particular, I offer a Schelerian-based description of a peculiar case of delusion: Capgras delusion. People who suffer from Capgras delusion claim that an otherwise familiar individual has been replaced by an impostor. I consider, although in its negative variations, the contextual (rather than internalist) character of this type of delusion. (shrink)

Various psychopathologies of self-awareness, such as somatoparaphrenia and thought insertion in schizophrenia, might seem to threaten the viability of the higher-order thought (HOT) theory of consciousness since it requires a HOT about one’s own mental state to accompany every conscious state. The HOT theory of consciousness says that what makes a mental state a conscious mental state is that there is a HOT to the effect that “I am in mental state M.” I have argued in previous work that (...) a HOT theorist can adequately respond to this concern with respect to somatoparaphrenia and thought insertion. There is also Cotard syndrome which is a rare neuropsychiatric disorder in which people hold the delusional belief that they are dead, do not exist, or have lost their blood or internal organs. In this paper, I argue that HOT theory has nothing to fear from it either and can consistently account for what happens in such unusual cases. I analyze Cotard syndrome in light of my previous discussion of somatoparaphrenia and thought insertion, and argue that HOT theory can provide a somewhat analogous account without the worry of inconsistency. It is crucial to recognize that there are multiple “self-concepts” and levels of HOTs which can help to provide a more nuanced explanation. With regard to the connection between consciousness and self-consciousness, it is proposed that Cotard patients are indeed capable of having some “I-thoughts” about their bodies and mental states. (shrink)

A striking feature of post-modernism is its distrust of the subject. If the modern period, beginning with Descartes, sought in the subject a source of certainty, an Archimedian point from which all else could be derived, post- modernism has taken the opposite tack. Rather than taking the self as a foundation, it has seen it as founded, as dependent on the accidents which situate consciousness in the world. The same holds for the unity of the subject. Modernity, in its (...) search for a single foundation, held the subject to be an indissoluble unity. Post-modernism’s position, by contrast, is announced by Nietzsche: “The assumption of one single subject is perhaps unnecessary; perhaps it is just as permissible to assume a multiplicity of subjects, whose interaction and struggle is the basis of our thought and our consciousness in general? ...My hypotheses: The subject as multiplicity.” Given this, there is a natural correspondence between the success of post- modernism and the current interest in multiple personality disorder. In the latter, we actually have the experience of a “multiplicity of subjects” in their interaction and struggle. The subject stands there before us “as multiplicity.” It gives us a concrete case, one which raises some of the pressing questions associated with the post-modern denial of the subject. Confronting it, we ask: how real are the personalities composing the multiplicity of this disordered self? What, in fact, does this multiplicity tell us about the self? about its genesis and status? What does it reveal about “our thought and consciousness in general”? I plan, in the short compass of this paper, to sketch some answers to these questions. §1. A brief description of MPD. The American Psychiatric Association gives two criteria for (MPD) multiple personality disorder. First, and most obviously, there is “the existence within the person of two or more distinct personalities or personality states (each with its own relatively enduring pattern. (shrink)

The paper presents basic Gestalt psychological concepts of ego and self. They differ from other concepts in the way that they do not comprehend ego and self as fixed entities or as central controlling instances of the psyche, but as one specific organized unit in a psychological field in dynamic interrelation with the other organized units—the environment units—of this field. On this theme, well-known representatives of Gestalt theory have presented some general and special theories since the early days (...) of this approach that could partly be substantiated experimentally. They illuminate the relationship between ego and world in everyday life as well as in the case of mental disorders. Not only the spatial extension of the phenomenal ego is subject to situational changes, but also its place in the world, its functional fitting in this world, its internal differentiation, its permeability to the environment, and much more. The German Gestalt psychologist Wolfgang Metzger emphasizes the significant functional role that this dynamic plasticity of the phenomenal world and its continuously changing segregation of ego and environment have for human life by designating the phenomenal world as a “Central Steering Mechanism.” In this article, ego and self as part of this field in their interrelation with the total psychological field will be illuminated from the perspective of the thinking of the Gestalt psychologists Max Wertheimer, Kurt Koffka, Wolfgang Köhler, Kurt Lewin, Wolfgang Metzger, Mary Henle, Edwin Rausch, and Giuseppe Galli. (shrink)

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

Body dysmorphic disorder (BDD) poses a significant challenge to an individual’s mental well-being. The obsessive preoccupation with perceived defects in one’s appearance affects individuals’ daily functioning and can result in serious risks, including suicidal ideation and self-surgery. While treatments such as cognitive behavioural therapy and serotonin reuptake inhibitors can provide relief, they do not achieve complete remission. It has been suggested that therapy should not only interrupt the harmful behaviour, but should also address their sense of self, (...) and that after addressing their internalised values, individuals with BDD will be able to incorporate their perceived defect in a manner similar to how individuals with real deformities often do. Phenomenology of psychopathology analyses subjectivity in cases of pathology, and analyses of BDD show that the perceived defect has become a locus of shame. This implies that individuals with BDD have permanently incorporated the gaze of the Other and constantly experience their body as a body-for-others. This paper further explores the sense of self in individuals with BDD through Jenny Slatman’s interpretation of bodily integrity: bodily integrity as a never-ending process of identification. By comparing the experiences of individuals with BDD to those with real deformities and to those who have undergone cosmetic surgery, I will show that re-identification does not occur in individuals with BDD. This suggests that their bodily integrity is fundamentally disturbed and that addressing their internalised values alone will probably not be sufficient for the disorder to go into remission. (shrink)

Psychopathic individuals are characterized by impaired affective processing, impulsivity, sensation-seeking, poor planning skills and heightened aggressiveness with poor self-regulation. Based on brain self-regulation studies using neurofeedback of Slow Cortical Potentials (SCPs) in disorders associated with a dysregulation of cortical activity thresholds and evidence of deficient cortical functioning in psychopathy, a neurobiological approach seems to be promising in the treatment of psychopathy. The results of our intensive brain regulation intervention demonstrate, that psychopathic offenders are able to gain control of (...) their brain excitability over fronto-central brain areas. After SCP self-regulation training, we observed reduced aggression, impulsivity and behavioral approach tendencies, as well as improvements in behavioral-inhibition and increased cortical sensitivity for error-processing. This study demonstrates improvements on the neurophysiological, behavioral and subjective level in severe psychopathic offenders after SCP-neurofeedback training and could constitute a novel neurobiologically-based treatment for a seemingly change-resistant group of criminal psychopaths. (shrink)

This paper explores the possibility of AI-based addendum therapy for borderline personality disorder, its potential advantages and limitations. Identity disturbance in this condition is strongly connected to self-narratives, which manifest excessive incoherence, causal gaps, dysfunctional beliefs, and diminished self-attributions of agency. Different types of therapy aim at boosting self-knowledge through self-narratives in BPD. The suggestion of this paper is that human-to-human therapy could be complemented by AI assistance holding out the promise of making patients' (...) class='Hi'>self-narratives more coherent through improving the accuracy of their self-assessments, reflection on their emotions, and understanding their relationships with others. Theoretical and pragmatic arguments are presented in favour of this idea, and certain technical solutions are suggested to implement it. (shrink)

Autoethnographic accounts of mental illness (MI) are sparse in academic scholarship, despite generating valuable insights into how MI can be experienced and coped with in real-life contexts. First-person accounts from men are especially lacking, possibly linked to historic trend for masculine stoicism stifling male MI discussions. Some scholarships explore video-gaming as a positive, escapist aid benefiting individuals experiencing major depressive disorder (MDD). However, no research exists presenting in-depth perspectives on possible positive effects, self-identified and articulated by actors engaging (...) with gaming to cope with MDD. This research adopts a novel qualitative perspective, representing an in-depth autoethnographic examination of my experiences playing the personal computer game DeusEx, during a period of my life where I was under treatment for MDD. My positions as both a psychologist specializing in research prioritizing feminist theory as applied to understand men, masculinities, and mental health, and someone themselves recurrently treated for MDD over longer than 22 years, construct a unique dual-positionality perspective. Explicit discussions of my MDD experiences and my experiences concerning the value of video-gaming as a positive, escapist aid during MDD are presented, alongside personal deconstructions of the lasting influences of hegemonic masculinity upon men speaking up about MI. Arguments are presented for future scholars utilizing autoethnographic methods to generate realist perspectives, normalizing mental health discussions, particularly the sharing of underrepresented male experiences. Implications for future scholarship, building upon learnings generated by this research, are developed and put forward. (shrink)

Background: Rumination, a tendency to focus on negative self-related thoughts, is a central symptom of depression. Studying the self-related aspect of such symptoms is challenging because of the need to distinguish self effects from the emotional content of task stimuli. This study employed an emotionally neutral self-related paradigm to investigate possible altered self-processing in depression and its link to rumination. Methods: People with major depressive disorder (n = 25) and controls (n = 25) underwent (...) task-based electro-encephalogram recording. We studied late event-related potentials, along with low-frequency oscillatory power. We compared electroencephalogram metrics between groups and correlated them with depressive symptoms and reported rumination. Results: Participants with major depressive disorder displayed a difference in late positive potentials across frontocentral electrodes between self-related and non-self-related conditions. We found no such difference in controls. The magnitude of this difference was positively correlated with depressive symptoms and reported rumination. Participants with major depressive disorder also had elevated theta oscillation power at central electrodes in self-related conditions, a finding that we did not see in controls. Limitations: Patients with major depressive disorder were medicated at the time of the study. The group studied was primarily female, so the observed effects may have been sex-specific. Conclusion: Rumination appears to be linked to altered self-related processing in depression, independent of stimuli-related emotional confounds. This connection between self-related processing and depression may point to a self disorder as a core component of depression. (shrink)

This chapter conceptually analyzes the post-traumatic stress injuries called moral injury, moral fatigue or exhaustion, and broken spirit. It then identifies two puzzles. First, soldiers sometimes sustain moral injury even from doing right actions. Second, they experience moral exhaustion from making decisions even where the morally right choice is so obvious that it shouldn’t be stressful to make it; and even where rightness of decision is so murky that no decision could be morally faulted. The injuries result of mistaken moral (...) self-evaluation. Methods of preventing and treating these injuries are defended, including training in self-forgiveness, moral off-loading of actions and decisions to persons and devices less likely to feel inappropriate guilt, and the use of drugs to prevent such guilt. The foregoing has been about moral injury erroneously resulting from the non-violation of a correct moral code. But the chapter then introduces the concept of moral pseudo-injury—felt moral injury that has in reality resulted from violation of a false moral code, so that no one has really been morally injured. This can be used as a method in warfighting. And since the injuries it produces are illusory, this would be morally superior to physical violence. For it causes less injury to its victims, and should cause less guilt in those who must inflict it. Historical precedents are considered. Finally, our enemies often use moral pseudo-injury against us, in the form of terrorist violence against civilians. Terrorism causes comparatively few harms, yet we mistakenly see it as more morally horrific than conventional combat that causes much worse loss of life among armed forces members. Here we need the nuancing and clarifying power of philosophy to restore a sense of proportion, thence to prevent or therapize the moral pseudo-injury we may experience from these sorts of attacks. (This is a pre-penultimate version of the published version, available from OUP at the external link, which contains minor variances. The paper was earlier known as "PTSD Weaponized: A Theory of Moral Injury"; that now superseded version is archived under "past conferences" on the Center for Ethics and the Rule of Law website.). (shrink)

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

Autism Spectrum Condition presents a challenge to social and relational accounts of the self, precisely because it is broadly seen as a disorder impacting social relationships. Many influential theories argue that social deficits and impairments of the self are the core problems in ASC. Predictive processing approaches address these based on general purpose neurocognitive mechanisms that are expressed atypically. Here we use the High, Inflexible Precision of Prediction Errors in Autism approach in the context of cultural niche (...) construction to explain atypicalities of the relational self, specifically its minimal, extended, and intersubjective aspects. We contend that the social self in ASC should not be seen as impaired, but rather as an outcome of atypical niche construction. We unpack the scientific, ethical, and practical consequences of this view, and discuss implications for how the challenges that autistic persons face should be approached. (shrink)

Two main approaches can be discerned in the literature on agentive self-awareness: a top-down approach, according to which agentive self-awareness is fundamentally holistic in nature and involves the operations of a central-systems narrator, and a bottom-up approach that sees agentive self-awareness as produced by lowlevel processes grounded in the very machinery responsible for motor production and control. Neither approach is entirely satisfactory if taken in isolation; however, the question of whether their combination would yield a full account (...) of agentive self-awareness remains very much open. In this paper, I contrast two disorders affecting the control of voluntary action: the anarchic hand syndrome and utilization behavior. Although in both conditions patients fail to inhibit actions that are elicited by objects in the environment but inappropriate with respect to the wider context, these actions are experienced in radically different ways by the two groups of patients. I discuss how top-down and bottom-up processes involved in the generation of agentive self-awareness would have to be related in order to account for these differences. (shrink)

Understanding the autonomic nervous system and homeostatic changes associated with emotions remains a major challenge for neuroscientists and a fundamental prerequisite to treat anxiety, stress, and emotional disorders. Based on recent publications, the inter-relationship between respiration and emotions and the influence of respiration on autonomic changes, and subsequent widespread membrane potential changes resulting from changes in homeostasis are discussed. We hypothesize that reversing homeostatic alterations with meditation and breathing techniques rather than targeting neurotransmitters with medication may be a superior method (...) to address the whole body changes that occur in stress, anxiety, and depression. Detrimental effects of stress, negative emotions, and sympathetic dominance of the autonomic nervous system have been shown to be counteracted by different forms of meditation, relaxation, and breathing techniques. We propose that these breathing techniques could be used as firstline and supplemental treatments for stress, anxiety, depression, and some emotional disorders. (shrink)

Importance: Patients with remitted major depressive disorder (MDD) were previously found to display abnormal functional magnetic resonance imaging connectivity (fMRI) between the right superior anterior temporal lobe (RSATL) and the subgenual cingulate cortex and adjacent septal region (SCSR) when experiencing self-blaming emotions relative to emotions related to blaming others (eg, "indignation or anger toward others"). This finding provided the first neural signature of biases toward overgeneralized self-blaming emotions (eg, "feeling guilty for everything"), known to have a key (...) role in cognitive vulnerability to MDD. It is unknown whether this neural signature predicts risk of recurrence, a crucial step in establishing its potential as a prognostic biomarker, which is urgently needed for stratification into pathophysiologically more homogeneous subgroups and for novel treatments. -/- Objective: To use fMRI in remitted MDD at baseline to test the hypothesis that RSATL-SCSR connectivity for self-blaming relative to other-blaming emotions predicts subsequent recurrence of depressive episodes. -/- Design, setting, and participants: A prospective cohort study from June 16, 2011, to October 10, 2014, in a clinical research facility completed by 75 psychotropic medication-free patients with remitted MDD and no relevant comorbidity. In total, 31 remained in stable remission, and 25 developed a recurring episode over the 14 months of clinical follow-up and were included in the primary analysis. Thirty-nine control participants with no personal or family history of MDD were recruited for further comparison. -/- Main outcomes and measures: Between-group difference (recurring vs stable MDD) in RSATL connectivity, with an a priori SCSR region of interest for self-blaming vs other-blaming emotions. -/- Results: We corroborated our hypothesis that during the experience of self-blaming vs other-blaming emotions, RSATL-SCSR connectivity predicted risk of subsequent recurrence. The recurring MDD group showed higher connectivity than the stable MDD group (familywise error-corrected P < .05 over the a priori SCSR region of interest) and the control group. In addition, the recurring MDD group also exhibited RSATL hyperconnectivity with the right ventral putamen and claustrum and the temporoparietal junction. Together, these regions predicted recurrence with 75% accuracy. -/- Conclusions and relevance: To our knowledge, this study is the first to provide a robust demonstration of an fMRI signature of recurrence risk in remitted MDD. Additional studies are needed for its further optimization and validation as a prognostic biomarker. (shrink)

Orthorexia is a condition in which the subject becomes obsessed with identifying and maintaining the ideal diet, rigidly avoiding foods perceived as unhealthy or harmful. In this paper, I examine widespread cultural factors that provide particularly fertile ground for the development of orthorexia, drawing out social and historical connections between religion and orthorexia (which literally means “righteous eating”), and also addressing how ambiguities in the concept of “health” make it particularly prone to take on quasi-religious significance. I argue that what (...) makes this sort of disordered eating destructive to both men and women is ultimately a common urge to transcend rather than to embrace the realities of embodiment. In sum, I believe that orthorexia is best understood as a manifestation of age-old anxieties about human nitude and mortality—anxieties which current dominant sociocultural forces prime us to experi- ence and express in unhealthy attitudes toward healthy eating. (shrink)

This article examines the Buddhist idea of anātman, ‘no- self ’ and pudgala, ‘the person’ in relation to the notion of ‘self ’ emerging from contemporary cognitive science. The Buddhist no-self doctrine is enriched by the cognitive scientist’s understanding of the multiple facets of selfhood, or structures of experience, and the causative action of a functional self in the world. A proper understanding of the Buddhist concepts of anātman and pudgala proves critical to mindfulness-based therapeutic interventions: (...) this is as the ‘person’, as constituted by various structures of selfhood, including—the ecological, interpersonal, extended, private, narrative, relational and conceptual selves—which may be disrupted by traumatic events which disorder one’s experience of time, defence, relationality, memory, resource and agency. In the absence of this understanding, the no-self doctrine might encourage a sort of bypass, in which traumatic facets of selfhood are overlooked in the quest for spiritual liberation. With a proper understanding of the function served by the Buddhist concepts of no-self and ‘person’, psychotherapeutic work may be situated as a necessary ‘preliminary practice’ for meditative exploration of deeper transpersonal domains and soteriological goals. (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)

Many philosophers and psychologists have sought to explain experiences of auditory verbal hallucinations and “inserted thoughts” in schizophrenia in terms of a failure on the part of patients to appropriately monitor their own inner speech. These self-monitoring accounts have recently been challenged by some who argue that AVHs are better explained in terms of the spontaneous activation of auditory-verbal representations. This paper defends two kinds of self-monitoring approach against the spontaneous activation account. The defense requires first making some (...) important clarifications concerning what is at issue in the dispute between the two forms of theory. A popular but problematic self-monitoring theory is then contrasted with two more plausible conceptions of what the relevant self-monitoring deficits involve. The first appeals to deficits in the neural mechanisms that normally filter or attenuate sensory signals that are the result of one’s own actions. The second, less familiar, form of self-monitoring approach draws an important analogy between Wernicke’s aphasia and AVHs in schizophrenia. This style of self-monitoring theory pursues possible connections among AVHs, inserted thoughts, and the disorganized speech characteristic formal thought disorder. (shrink)

The experience of embodiment is a central theme in phenomenological philosophy and has recently received increasing attention also within psychological science. In the present paper we argue (1) that the experience of embodiment represents a fundamental synthesis of having a body (the body as an object) and being a body (the body as felt “from within”); (2) that this synthesis is basic to an individual’s experience of self-identity; (3) that each individual, as an existential task, has to develop their (...) specific version of the embodiment synthesis; (4) that these syntheses can be more or less harmonious or disharmonious, and that disharmonious syntheses are associated with psychological distress and psychopathology. Different phenomenological accounts of possible variants of disharmonious embodiment, as found in the literature on eating disorders, are discussed and compared. Finally, some research implications and clinical implications are discussed. (shrink)

Our experiences with the external world are possible mainly through vision, hearing, taste, touch, and smell providing us a sense of reality. How the brain is able to seamlessly integrate stimuli from our external and internal world into our sense of reality has yet to be adequately explained in the literature. We have previously proposed a three-dimensional unified model of consciousness that partly explains the dynamic mechanism. Here we further expand our model and include illustrations to provide a better conception (...) of the ill-defined space within the self, providing insight into a unified mind-body concept. In this article, we propose that our senses “super-impose” on an existing dynamic space within us after a slight, imperceptible delay. The existing space includes the entire intrapersonal space and can also be called the “the body’s internal 3D default space”. We provide examples from meditation experiences to help explain how the sense of ‘self’ can be experienced through meditation practice associated with underlying physiological processes that take place through cardio-respiratory synchronization and coherence that is developed among areas of the brain. Meditation practice can help keep the body in a parasympathetic dominant state during meditation, allowing an experience of inner ‘self’. Understanding this physical and functional space could help unlock the mysteries of the function of memory and cognition, allowing clinicians to better recognize and treat disorders of the mind by recommending proven techniques to reduce stress as an adjunct to medication treatment. (shrink)

Representing oneself as an existing entity and having intense fear of the unknown are human specificities. Self-consciousness and anxiety states are characteristics of our human minds. We propose that these two characteristics share a common evolutionary history during which they acted in synergy for the build-up of our human minds. We present that perspective by using an evolutionary scenario for self-consciousness in which anxiety management plays a key role. Such evolutionary background can introduce new relations between philosophy of (...) mind and psychology. The proposed evolutionary scenario starts at the Pan-Homo split time (about 6my ago) when our pre-human ancestors were able to manage representations while also being able to partly identify with their conspecifics. These identifications allowed our ancestors to merge the representations they had of parts of themselves with the corresponding representations they had of their conspecifics. The scenario proposes that such merger has led our ancestors to progressively build up a representation of their own entity as existing in the environment, like conspecifics were represented as existing. This evolutionary process is considered in the scenario as the source of an ancestral form of self-consciousness. The same process has also produced identifications with suffering or endangered conspecifics which have created in the minds of our ancestors some new anxieties coming in addition to the animal ones. The resulting psychological sufferings had to be limited for evolution to continue. The tools developed to that end by our ancestors (caring, collaboration, communication, ToM, ...) have also procured significant evolutionary benefits with positive feedbacks on identifications. Overall, the evolutionary scenario proposes that the combination of the anxiety management processes with the evolution toward self-consciousness has created an evolutionary engine that has accelerated the coming up of our human self-consciousness. As a result, our today human minds contain important anxieties interwoven with an evolutionary nature of self-consciousness. Such perspective brings to consider that many of our mental states may be unconsciously guided by these evolutionary sourced anxieties (which are still to be clearly understood). Corresponding anxiety management processes are then key contributors to our human feelings and motivations, and to our interpersonal relationship. For instance, the role of Pascalian type diversions can be understood as keeping consciousness away from psychological sufferings produced by too anxious mental states. Also, part of our human sexuality developed during human evolution can be considered as a multidimensional escape and refuge from anxiety. This also brings to look at our psychological well-being and to our mental health as much more related to anxiety management than assumed so far. Dis-functioning of anxiety management processes can then be source of mental disorders and illnesses. On that subject the evolutionary scenario proposes that avoidances of too anxious mental states can lead to evil behaviors. These subjects need more developments. Possible continuations are introduced. (shrink)

Anxiety is a main contributor to human psychological sufferings. Its evolutionary sources are generally related to alert signals for coping with adverse or unexpected situations [Steiner, 2002] or to hunter-gatherer emotions mismatched with today environments [Horwitz & Wakefield, 2012]. We propose here another evolutionary perspective that links human anxiety to an evolutionary nature of self-consciousness. That approach introduces new relations between mental health and human mind. The proposed evolutionary scenario starts with the performance of primate identification with conspecifics [de (...) Waal 1998, 2008]. It is assumed that the evolution of that identification brought our ancestors to represent themselves as entities existing in the environment, like conspecifics were represented as existing in the environment. We consider that this process has implemented in the mind of our ancestors some first elements of self-consciousness [Menant 2014a]. But the same process has also produced new sufferings coming from identification with suffering or endangered conspecifics. In addition, the emerging performance of self-focus brought in the new feeling of being a suffering entity. We consider that all these new sufferings have created in the mind of our primate ancestors a huge anxiety increase, unbearable if not limited. Among the options available to limit that anxiety increase we focus on two of them that may have taken place. The first was a withdrawal from the process. Some primates may have simply rejected the evolution of identification (and with it self-consciousness). This may have led them to an ecological niche resulting in our today great apes. The second option was about limiting the causes of sufferings and taking advantage of possible resulting evolutionary benefits. This may have been achieved by developing performances like imitation, communication, simulation, synergy and ToM. Added to a positive feedback on identification these performances may have initiated an evolutionary engine that has accelerated the evolution toward human self-consciousness. That option is characterized by an early build up of anxiety limitation processes in an evolutionary nature of our human self-consciousness. This option corresponds to a human specificity and introduces anxiety management and self-consciousness as sharing a same evolutionary story. The build up of these anxiety management processes is now buried in the evolutiony story of our human mind. But these processes are still present in our minds at an unconscious level and participate to many of our human mental states and behaviors. Such positioning of anxiety management as part of the nature of human mind is new and makes available entry points for new understandings of human emotion, motivations and mental disorders. The proposed evolutionary scenario has been introduced in philosophy of mind [Menant 2011, 2014a, b] but it has not been so far explicitly part of primatology nor of psychology/psychiatry/ethics. We present here a drawing of the scenario with highlights on corresponding key points. More work is needed on these new evolutionary links between human mind and anxiety management. References: de Waal, F B.M. (1998). No imitation without identification. Behavioral and Brain Sciences (1998) 21:89. http://cogweb.ucla.edu/Abstracts/deWaal_98.html de Waal, F B.M. (2008). Putting the Altruism Back into Altruism: The Evolution of Empathy. Annu. Rev. Psychol. 2008, 59. http://www.life.umd.edu/faculty/wilkinson/BIOL608W/deWaalAnnRevPsych2008.pdf Horwitz, A. V. and Wakefield, J. C. (2012). All We Have to Fear: Psychiatry’s Transformation of Natural Anxieties into Mental Disorders. Oxford Univ. Press. 2012. Menant, C. (2011). Computation on Information, Meaning and Representations. An Evolutionary Approach. https://philpapers.org/rec/MENCOI Menant, C. (2014a). Proposal for an evolutionary approach to self-consciousness. https://philpapers.org/rec/MENPFA-3 Menant, C. (2014b). Consciousness of oneself as object and as subject. Proposal for an evolutionary approach. https://philpapers.org/rec/MENCOO Steiner, T. (2002). The biology of fear- and anxiety-related behaviors. Dialogues Clin Neurosci. 2002 Sep; 4(3): 231–249. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181681/. (shrink)

For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD (...) and efforts to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being 'protected' through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician-patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research. (shrink)

This paper contributes to the debate in the philosophy of psychiatry regarding the relation between thought insertion in schizophrenia and the sense of selfhood. Some scholars have suggested that thought insertion presents a case where the sense of selfhood is lacking. Other scholars have disputed this by proposing that a form of minimal selfhood is a necessary feature of consciousness that is still present in thought insertion, albeit in a disturbed manner. Herein, I argue that the notion of minimal selfhood (...) that is used by these scholars is ambiguous between two meanings. The first is an ontological notion concerning the first-person individuation of consciousness. The second is a phenomenological notion concerning how a conscious experience is experienced as being given to the first-person subject. I argue that the former ontological notion is indeed a necessary feature of conscious experience, but the latter phenomenological notion is only a contingent feature. Therefore, even if it is possible that thought insertion presents a case where the feeling of first-person givenness is lacking or disturbed, the first-person individuation of consciousness remains present and undisturbed. As well as further clarifying the connection between consciousness and selfhood, this philosophical analysis reveals the extent to which schizophrenia can and cannot be said to comprise a disorder of selfhood. (shrink)

Commentary on: Olaf Blanke, Thomas Metzinger, Full-body illusions and minimal phenomenal selfhood, Trends in Cognitive Sciences, Volume 13, Issue 1, January 2009, Pages 7-13, ISSN 1364-6613, DOI: 10.1016/j.tics.2008.10.003.

This compilation focuses on success stories—cases of courage, innovation, and the application of knowledge and power in overcoming illness and suffering. It features thirteen ethnographic case studies that describe how people were able to alleviate or overcome serious issues including alcoholism, severe anxiety and depression, suicidal behavior, and psychotic disorders caused by ignorance, neglect, violence, war, and sexual abuse. It is a tribute to the possibility of healing.

In this paper, I investigate in detail one theoretical approach to the symptom of thought insertion. This approach suggests that patients are lead to disown certain thoughts they are subjected to because they lack a sense of active participation in the occurrence of those thoughts. I examine one reading of this claim, according to which the patients’ anomalous experiences arise from a breakdown of cognitive mechanisms tracking the production of occurrent thoughts, before sketching an alternative reading, according to which their (...) experiences have to be explained in terms of a withdrawal, on the part of the patients themselves, from certain forms of active engagement in reasoning. I conclude with a discussion of the relationship between this view and the idea that patients’ reports of thought insertion reflect a situation in which the boundaries between the self and the world have become uncertain. (shrink)

It’s a common assumption in psychiatry and psychotherapy that mental health conditions are marked out by some form of epistemic irrationality. With respect to obsessive-compulsive disorder (OCD), the mainstream view is that OCD causes irrational beliefs. Recently, however, this ‘doxastic view’ has been criticized from a theoretical and empirical perspective. Instead a more promising ‘zetetic view’ has been proposed which locates the epistemic irrationality of OCD not in irrational beliefs, but in the senseless inquiries it prompts. Yet, in this (...) paper I present a special class of cases—sexual obsessive-compulsive disorder (S-OCD)—which cannot be explained by existing doxastic and zetetic accounts of the epistemic irrationality of OCD. In addition, some people with S-OCD appear to be adhering too well to a plausible set of norms for inquiry. Their suffering seems to be partially caused by an excess of rationality, and not a lack thereof. They seem, if anything, too rational. This shows firstly that it’s unlikely that there is one form of epistemic irrationality common to all persons living with OCD. Secondly, it should lead us to rethink the epistemic categories we use in classifying mental health conditions such as OCD. (shrink)

Most mental disorders affect only a small segment of the population. On the reasonable assumption that minds or brains are prone to occasional malfunction, these disorders do not seem to pose distinctive explanatory problems. Depression, however, because it is so prevalent and costly, poses a conundrum that some try to explain by characterizing it as an adaptation—a trait that exists because it performed fitness-enhancing functions in ancestral populations. Heretofore, proposed evolutionary explanations of depression did not focus on thought processes; instead, (...) they emphasized that it facilitates navigation of adverse social circumstances or promotes immune response to infectious agents. According to a new hypothesis, the “analytical rumination hypothesis” (ARH), however, depression’s crucial adaptive trait is rumination—negative, intrusive thought. ARH holds that, (i) social dilemmas trigger depressed mood; (ii) depressed mood induces changes in body systems that facilitate ruminative analysis aimed at solving dilemmas; and, (iii) depressive rumination is a fitness-enhancing trait that was selected for in evolutionary time. Jointly, (i)~(iii) imply that we should not think of rumination as a disorder; instead, it is a trade-off, an eminently rational one. In the same way that fever solves a problem—coordination of the immune system in response to infection—so too does depressive rumination solve a problem, a social dilemma, albeit at the cost of inducing anhedonia and other maladies. But they argue that the cost is worthwhile, something that should be endured “until the problem is solved.” First, we argue that there are two distinct types of rumination, brooding and pondering; the former is associated with a disposition for depression, not the latter. But only the latter has the problem-solving capabilities that ARH requires. Second, recent brain imaging studies of depression reveal resting state hypoactivity in lateral regions and hyperactivity in paralimbic regions; this asymmetric pattern correlates with heightened levels of brooding, self-focused rumination. In other words, on the personal level, patients are trapped within self, isolated from the external world and suffused with negative affect; on the subpersonal level, this pattern is reflected by an asymmetric pattern of lateral vs. paralimbic resting state activity. Third, we proceed to conjecture that rational responses (e.g., pondering) to social dilemmas are those that strike a balance between internal and external considerations in the process of belief formation. Fourth, because the asymmetric resting state activity blocks those who suffer with depression from accessing and processing potentially positive stimuli from the external world, the capacity for rational, analytic response—hence, problem-solving—is constrained. Fifth, it follows that, although there might be conditions for which suffering should be endured rather than pharmacologically alleviated, depression is not one of those. Indeed, in view of the effects of the asymmetric resting state pattern, it is unlikely that depressive rumination would have been useful even for ancestral populations. (shrink)

A large part of the controversy surrounding the publication of DSM-5 stems from the possibility of replacing the purely descriptive approach to classification favored by the DSM since 1980. This paper examines the question of how mental disorders should be classified, focusing on the issue of whether the DSM should adopt a purely descriptive or theoretical approach. I argue that the DSM should replace its purely descriptive approach with a theoretical approach that integrates causal information into the DSM’s descriptive diagnostic (...) categories. The paper proceeds in three sections. In the first section, I examine the goals (viz., guiding treatment, facilitating research, and improving communication) associated with the DSM’s purely descriptive approach. In the second section, I suggest that the DSM’s purely descriptive approach is best suited for improving communication among mental health professionals; however, theoretical approaches would be superior for purposes of treatment and research. In the third section, I outline steps required to move the DSM towards a hybrid system of classification that can accommodate the benefits of descriptive and theoretical approaches, and I discuss how the DSM’s descriptive categories could be revised to incorporate theoretical information regarding the causes of disorders. I argue that the DSM should reconceive of its goals more narrowly such that it functions primarily as an epistemic hub that mediates among various contexts of use in which definitions of mental disorders appear. My analysis emphasizes the importance of pluralism as a methodological means for avoiding theoretical dogmatism and ensuring that the DSM is a reflexive and self-correcting manual. (shrink)

Somatoparaphrenia is a pathology of self characterized by the sense of alienaton from parts of one’s body. It is usually construed as a kind of delusional disorder caused by extensive right hemisphere lesions. Lesions in the temporoparietal junction are common in somatoparaphrenia but deep cortical regions (for example, the posterior insula) and subcortical regions (for example, the basal ganglia) are also sometimes implicated (Valler and Ronschi 2009). Patients are often described as feeling that a limb belongs to another (...) person and thus attribute ownership of the limb and bodily sensation to someone else. There is also some question as to whether or not the higher-order thought (HOT) theory of consciousness can plausibly account for the depersonalization psychopathology of somatoparaphrenia (Liang and Lane 2009, Rosenthal 2010, Lane and Liang 2010). Liang and Lane argue that it cannot. The HOT theory of consciousness says that what makes a mental state a conscious mental state is that it is the target of a HOT to the effect that “I am in mental state M” (Rosenthal 2005, Gennaro 2012). When the HOT is itself is unconscious, the conscious state is still outer-directed. When the HOT is conscious, we have introspection and so the conscious thought is directed at the mental state. In section I, I briefly review the previous exchange between Lane and Liang and David Rosenthal. In section II, I further explore somatoparaphrenia and the nature of delusion while offering a number of additional replies to Lane and Liang. In section III, I examine the central notions of “mental state ownership” and “self-concepts” in an effort to account especially for the depersonalization aspect of somatoparaphrenia against the background of HOT theory. In section IV, I argue that to the extent that somatoparaphrenia casts doubt on the notion that some thoughts are “immune to error through misidentification” (IEM), the most fundamental aspect of IEM is still consistent with HOT theory. Overall, I argue that HOT theory is left unscathed by the pheneomenon of somatoparaphrenia and can even help to explain what happens in these cases. (shrink)

Background: Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home. Depression affects an estimated one in 15 adults (6.7%) in any (...) given year. And one in six people (16.6%) will experience depression at some time in their life. Depression can strike at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime. Objectives: The main goal of this expert system is to get the appropriate diagnosis of disease and the correct treatment and give the appropriate method of treatment through several tips that concern the disease and how to treat it and we will see it through the application on the expert system. Methods: in this paper the design of the proposed Expert System which was produced to help Psychologist in diagnosing depression disease through its symptoms such as: a loss of energy, a change in appetite, sleeping more or less, anxiety, reduced concentration, indecisiveness, restlessness, feelings of worthlessness, guilt or hopelessness and thoughts of self-harm or suicide. The proposed expert system presents an overview about depression disease is given, the cause of diseases is outlined and the treatment of disease whenever possible is given out. SL5 Object Expert System language was used for designing and implementing the proposed expert system. Results: The proposed depression disease diagnosis expert system was evaluated by psychologist students and they were satisfied with its performance. Conclusions: The Proposed expert system is very useful for psychologist, patients with depression and newly graduated psychologist. (shrink)

Since its publication, the Psychopathic Personality Inventory and its revision (Lilien- feld & Andrews, 1996; Lilienfeld & Widows, 2005) have become increasingly popular such that it is now among the most frequently used self-report inventories for the assessment of psychopathy. The current meta-analysis examined the relations between the two PPI factors (factor 1: Fearless Dominance; factor 2: Self-Centered Impulsivity), as well as their relations with other validated measures of psychopathy, internalizing and externalizing forms of psychopathology, general personality traits, (...) and antisocial personality disorder symptoms. Across 61 samples reported in 49 publications, we found support for the convergent and criterion validity of both PPI factor 2 and the PPI total score. Much weaker validation was found for PPI factor 1, which manifested limited convergent validity and a pattern of correlations with central criterion variables that was inconsistent with many conceptualizations of psychopathy. (shrink)

Just as sadness is not always a symptom of mood disorder, irrational beliefs are not always symptoms of illness. Pathological irrational beliefs are distinguished from non-pathological ones by considering whether their existence is best explained by assuming some underlying dysfunctions. The features from which to infer the pathological nature of irrational beliefs are: un-understandability of their progression; uniqueness; coexistence with other psycho-physiological disturbances and/or concurrent decreased levels of functioning; bizarreness of content; preceding organic diseases known to be associated with (...) irrational beliefs; treatment response to medical intervention, etc. Severe irrationality is sometimes caused by normal human motivation rather than by mental or physical dysfunction. Pure forms of self-deception may satisfy the diagnostic criteria of delusional disorder, but there may be no evidence that suggests that they are caused by illness. Although those with pathological delusions do not recognize their delusions as symptomatic of illness, differentiating pathological beliefs from normal irrational beliefs is vitally important: If a belief is pathological, psychiatrists must seriously consider treating the patient against her will. If it is not pathological, conversely, involuntary treatments are prohibited because they offend her basic autonomy. (shrink)

(Runner-up, Royal Institute of Philosophy 2020 Philosophy Essay Prize) Technological developments have led to the digitization of certain sectors of the economy, and this has many authors looking ahead to the prospects of a post-work society. While it is valuable to theorize about this possibility, it is also important to take note of the present state of work. For better or worse, it is what we are currently stuck with, and as the COVID-19 pandemic has ensured, much of that work (...) is now taking place online. Though a ‘return to normalcy’ is on the horizon, part of that normalcy involves online work, which is itself a significant change in the lives of many workers. Here I develop an account of work on which work is teleologically structured. This gives the result that working is something we can fail at doing, even when we try, and we can also be unsure of whether we’ve succeeded or failed. The shift of certain work from in-person to online modes generates a persistent uncertainty for workers in affected professions. Because our ability to work is something we typically value, this uncertainty has significant negative consequences for a worker’s self-conception. Indeed, it is analogous to disorders of agency and generates a kind of alienation. (shrink)

Case reports about patients undergoing Deep Brain Stimulation (DBS) for various motor and psychiatric disorders - including Parkinson’s Disease, Obsessive Compulsive Disorder, and Treatment Resistant Depression - have sparked a vast literature in neuroethics. Questions about whether and how DBS changes the self have been at the fore. The present chapter brings these neuroethical debates into conversation with recent research in moral psychology. We begin in Section 1 by reviewing the recent clinical literature on DBS. In Section 2, (...) we consider whether DBS poses a threat to personal identity. In Section 3 we argue for engagement with recent empirical work examining judgements of when identity changes. We conclude in Section 4 by highlighting a range of ethical issues raised by DBS, including various cross-cultural considerations. (shrink)

Currently, documentation on the effects of psychedelics on psychosis appears scarce. In the present case, a higher-dose LSD experience during acute paranoid psychosis before the initiation of antipsychotics induced feelings of love, which resolved the majority of the symptoms of the paranoid psychosis in one session, leading the person to reconnect with his family and seek treatment in a psychiatric hospital. The session did not resolve schizoaffective disorder, however. More than a decade later, while using the antipsychotic aripiprazole, concurrent (...) self-administration of ketamine induced psychedelic effects that appeared to allow for practicing 'grounding' of psychotic thoughts. Immediately afterwards, daily self-administration of psycholytic doses of LSD for four weeks caused a mood-enhancing effect that enabled the patient to successfully discontinue aripiprazole without the return of psychotic symptoms. No psychotic or other noticeable symptoms could be observed during two interviews conducted in the two months following the discontinuation of the antipsychotic. -/- The mechanisms of action remain unexplored, and their possible generalizability to other cases remains unclear, but the observations may serve as a basis for further research. It may, for example, be that chronic use of LSD induces a tolerance to its psychedelic effects but not to its anti-inflammatory or other possibly unknown effects, which may be related to the observed mood-enhancing effect. A preclinical study from 1971 appeared consistent with the claimed effect. -/- In the present case, paranoia, i.e., the hypersensitivity to potential threats, was partly due to childhood trauma, partly intentionally induced by military training, and partly accentuated by war experiences. It could not be 'turned off'. Fear related to the uncertainty of survival formed the core of psychosis; without the fear, psychosis would likely not have existed. Paranoid psychosis presented itself as a biased estimation of probabilities of possible adverse outcomes, as a mismatch between the past and the present. (shrink)

(This version was submitted to Behavioral and Brain Science. A revised version was published by Biological Theory) Estimates of autism’s incidence increased 5-10 fold in ten years, an increase which cannot be genetic. Though many mutations are associated with autism, no mutation seems directly to cause autism. We need to find the direct cause. Complexity science provides a new paradigm - confirmed in biology by extensive hard data. Both the body and the personality are complex dynamic systems which spontaneously (...) class='Hi'>self-organize from simple dynamic systems. Autism may therefore be caused by the failure of a simple dynamic system. We know that infants who cannot track their mother’s face often become autistic, that eye-contact initiates intersubjectivity which is blocked in autism, and that the infant-mother pair seems designed to promote eye-contact, as does the eye’s appearance. This author earlier proposed that failure of eye-contact might directly cause autism and that early non-maternal childcare, including television/video, would therefore be statistically linked to autism. Waldman et al. (2008; 2006) recently proved that autism is strongly linked to precipitation (indoor activity) and to the introduction of cable. The most plausible explanation? Early exposure to television/video is linked to autism. Furthermore a normal developmental cascade (blocked in autism) has been deciphered: (a) Infant-mother eye-contact triggers increased maternal attention. (b) Early maternal attention permanently increases not only baseline vasopressin but also that oxytocin release which is triggered by subsequent maternal attention. (c) Vasopressin and oxytocin promote face recognition, gazing-at-the-eyes, emotion recognition, and social bonding. The eye-contact hypothesis suggests a clinical study addressing prevention: recruit prospective parents who agree to curtail television/video/computer/wi-fi in their families; measure autism’s incidence in their children. (shrink)