Data indicate the ubiquity and rapid increase of depression wherever war, want and social upheaval are found. The goal of this paper is to clarify such claims and draw conceptual distinctions separating the depressive states that are pathological from those that are normal and normative responses to misfortune. I do so by appeal to early modern writing on melancholy by Robert Burton, where the inchoate and boundless nature of melancholy symptoms are emphasized; universal suffering is separated from the disease states (...) known as melancholy or melancholia, and normal temperamental variation is placed in contrast to such disease states. In Burton's time these distinctions and characterizations could be secured by the anchoring tenets of humoral theory. Without such anchoring, and in light of the findings and assumptions of today's biological diagnostic psychiatry, we must re-visit each of them. My goals here are to show the need for analytic foundations when claims are made about depression such as those cited above, and to draw attention to some contemporary attempts that may help provide those foundations, particularly, attempts to define disorder or disease. With adjustments, one of these (Cooper 2002) is shown to take us some way toward that goal. (shrink)

IntroductionThose in mental health-related consumer movements have made clear their demands for humane treatment and basic civil rights, an end to stigma and discrimination, and a chance to participate in their own recovery. But theorizing about the politics of recognition, 'recognition rights' and epistemic justice, suggests that they also have a stake in the broad cultural meanings associated with conceptions of mental health and illness.ResultsFirst person accounts of psychiatric diagnosis and mental health care (shown here to represent 'counter stories' to (...) the powerful 'master narrative' of biomedical psychiatry), offer indications about how experiences of mental disorder might be reframed and redefined as part of efforts to acknowledge and honor recognition rights and epistemic justice. However, the task of cultural semantics is one for the entire culture, not merely consumers. These new meanings must be negotiated. When they are not the result of negotiation, group-wrought definitions risk imposing a revision no less constraining than the mis-recognizing one it aims to replace. Contested realities make this a challenging task when it comes to cultural meanings about mental disorder. Examples from mental illness memoirs about two contested realities related to psychosis are examined here: the meaninglessness of symptoms, and the role of insight into illness. They show the magnitude of the challenge involved - for consumers, practitioners, and the general public - in the reconstruction of these new meanings and realities.ConclusionTo honor recognition rights and epistemic justice acknowledgement must be made of the heterogeneity of the effects of, and of responses to, psychiatric diagnosis and care, and the extent of the challenge of the reconstructive cultural semantics involved. (shrink)

Delusions play a fundamental role in the history of psychology, philosophy and culture, dividing not only the mad from the sane but reason from unreason. Yet the very nature and extent of delusions are poorly understood. What are delusions? How do they differ from everyday errors or mistaken beliefs? Are they scientific categories? In this superb, panoramic investigation of delusion Jennifer Radden explores these questions and more, unravelling a fascinating story that ranges from Descartes’s demon to famous first-hand (...) accounts of delusion, such as Daniel Schreber’s Memoirs of My Nervous Illness. Radden places delusion in both a clinical and cultural context and explores a fascinating range of themes: delusions as both individually and collectively held, including the phenomenon of folies á deux ; spiritual and religious delusions, in particular what distinguishes normal religious belief from delusions with religious themes; how we assess those suffering from delusion from a moral standpoint; and how we are to interpret violent actions when they are the result of delusional thinking. As well as more common delusions, such as those of grandeur, she also discusses some of the most interesting and perplexing forms of clinical delusion, such as Cotard and Capgras. (shrink)

The theoretical implications of equating the melancholic states of past eras with today's depression are explored. These include the presuppositions of the descriptive psychiatry so influential in twentieth century classification, which attempts to identify and describe mental disorders without reference to underlying causes. It also includes claims made about different forms of masked, and non-Western depression, and the new "drug cartography" assigning psychiatric categories based on psychopharmacological effect. An evaluation of the relative merits of descriptivist and causal ontologies, together with (...) an assessment of the similarities and differences between melancholia and depression, suggest the conclusion that these two conditions are misleadingly equated. (shrink)

This book addresses these and a cluster of other questions about changes in the self through time and about the moral attitudes we adopt in the face of these...

In this introduction to the edited volume, we briefly describe some of the current challenges faced by public mental health initiatives, at both the national and global level. We also include several general remarks on interdisciplinary methodology in public mental health ethics, followed by short descriptions of the chapters included in the volume.

In lieu of an abstract, here is a brief excerpt of the content:Insightlessness, the Deflationary TurnJennifer Radden (bio)Keywordsinsightlessness, deflationary turn, Harry Stack Sullivan, open placebos, space of reasonsMarga Reimer argues that treatment compliance in patients who are without any, or complete, insight into psychotic symptoms may be neither particularly abnormal nor entirely unreasonable. In broad sympathy with these conclusions, I wish only to add a couple of ancillary observations and some historical context.Reimer's discussion can be placed alongside other research (...) on aspects of psychosis putting forward what have been called "deflationary" accounts, accounts that depict psychotic symptoms as differing from normal states, traits, and responses in degree rather than kind. Such accounts have been offered about auditory hallucinations or "hearing voices" (Leudar and Thomas 2000; Romme and Escher 1989; Smith 2007), about delusional thinking (Bentall 2003; Bentall et al. 1989; Bracken and Thomas 2005; Hamilton 2007; Kinderman and Bentall 2007), and spiritual experiences (Jackson 1997; Jackson and Fulford 1997); in the introduction of the notion of "benign psychosis" (Jackson 2007), and even in recognition that insight is a complex, dimensional attribute (Amador and David 1998). Harkening back to the middle years of the twentieth century, and associated with Adolph Meyer's influence in the United States, as well as the influence of psychodynamic (and psychoanalytic) ideas, this deflationary turn challenges the neo-Kraepelinian presuppositions of our contemporary biomedical psychiatry. Rather than sharply separating psychotic states and symptoms from normal experience, the deflationary approach emphasizes the continuities and similarities linking them.Reimer proceeds in two separate steps. To the extent that treatment compliance among patients suffering psychotic states occurs in the absence of any or full insight, it is shown, this seems not dissimilar from other more ordinary cases where treatment compliant behavior occurs either without—or without regard for—a recognition that one is ill. (The term insightlessness is here used to indicate the absence of full and complete insight. This recognizes the dimensional and complex nature of insight, which has been shown to involve a range of beliefs over one's disorder, those about its presence, about the need for treatment, and about the social consequences of suffering it.)Had her discussion stopped here, Reimer would have completed the first "deflationary" step. By showing that this sort of insightless treatment compliance also occurs in the absence of mental disorder, she encourages us to see psychotic patients' lack of insight into their disorder as at least akin to more benign and commonplace responses. In doing so, she would have shifted something of the burden of proof within discussions of insight. Those insisting insightlessness is an irresoluble obstacle to positive treatment outcomes would [End Page 81] now be required to explain why this should be so. And those denying the analogy between the insightless compliance of the psychotic patient and more everyday cases such as those Reimer describes, might be called upon to show why these cases were disanalogous.Reimer does not leave matters there. She goes on to establish that none of the instances of insightless treatment compliance that she discusses can be judged to be entirely unreasonable. Treatment compliance without full insight is not only quite normal, it may not even be particularly irrational. As she explains, the patients in each case anticipate benefits from the treatment, even though such benefits are not understood in terms suggestive of pathology. Unfailingly, they conform to a general human tendency: [T]o act in accordance with what we perceive, rightly or wrongly, to be in our best interests.Reimer locates the error in more traditional thinking about lack of insight at the immodest assumption that there is but a single way to accurately characterize the patient's condition—medically. This view, which she attributes to contemporary psychiatry, she finds mistaken—and mistaken, I agree it is. Rather than one, there seem likely to be several accurate ways to frame things. And although the medical framing will best fit the interests and purposes of clinicians, other framings may better suit the interests of their patients.When the possibility of alternative, non-medical perspectives is granted, and our goal is to assess insightless compliance vis à vis rationality norms, a number of considerations gain salience. The insightless patient, Reimer shows, may... (shrink)

In Moody Minds Distempered philosopher Jennifer Radden assembles several decades of her research on melancholy and depression. The chapters are ordered into three categories: those about intellectual and medical history of melancholy and depression; those that emphasize aspects of the moral, psychological and medical features of these concepts; and finally, those that explore the sad and apprehensive mood states long associated with melancholy and depressive subjectivity. A newly written introduction maps the conceptual landscape, and draws out the analytic (...) and thematic interconnections between the chapters. Radden emphasizes and develops several new themes: the implications, theoretical phenomenological and moral, of recognizing melancholy and depressive states as mood states; questions of method, as they affect how we understand and characterize claims about melancholy and depression; and the persistence and force of cultural tropes linking such states to brilliance, creativity, and sagacity. Insights from literature and the history of medicine, psychology, and psychiatry are woven together with those from the more recent disciplines of feminist theory and cultural studies. This is interdisciplinary writing at its best-part analytic philosophy, and part history of ideas. (shrink)

Spanning 24 centuries, this anthology collects over thirty selections of important Western writing about melancholy and its related conditions by philosophers, doctors, religious and literary figures, and modern psychologists. Truly interdisciplinary, it is the first such anthology. As it traces Western attitudes, it reveals a conversation across centuries and continents as the authors interpret, respond, and build on each other's work. Editor Jennifer Radden provides an extensive, in-depth introduction that draws links and parallels between the selections, and reveals (...) the ambiguous relationship between these historical accounts of melancholy and today's psychiatric views on depression. This important new collection is also beautifully illustrated with depictions of melancholy from Western fine art. (shrink)

This is a comprehensive resource of original essays by leading thinkers exploring the newly emerging inter-disciplinary field of the philosophy of psychiatry. The contributors aim to define this exciting field and to highlight the philosophical assumptions and issues that underlie psychiatric theory and practice, the category of mental disorder, and rationales for its social, clinical and legal treatment. As a branch of medicine and a healing practice, psychiatry relies on presuppositions that are deeply and unavoidably philosophical. Conceptions of rationality, personhood (...) and autonomy frame our understanding and treatment of mental disorder. Philosophical questions of evidence, reality, truth, science, and values give meaning to each of the social institutions and practices concerned with mental health care. The psyche, the mind and its relation to the body, subjectivity and consciousness, personal identity and character, thought, will, memory, and emotions are equally the stuff of traditional philosophical inquiry and of the psychiatric enterprise. A new research field--the philosophy of psychiatry--began to form during the last two decades of the twentieth century. Prompted by a growing recognition that philosophical ideas underlie many aspects of clinical practice, psychiatric theorizing and research, mental health policy, and the economics and politics of mental health care, academic philosophers, practitioners, and philosophically trained psychiatrists have begun a series of vital, cross-disciplinary exchanges. This volume provides a sampling of the research yield of those exchanges. Leading thinkers in this area, including clinicians, philosophers, psychologists, and interdisciplinary teams, provide original discussions that are not only expository and critical, but also a reflection of their authors' distinctive and often powerful and imaginative viewpoints and theories. All the discussions break new theoretical ground. As befits such an interdisciplinary effort, they are methodologically eclectic, and varied and divergent in their assumptions and conclusions; together, they comprise a significant new exploration, definition, and mapping of the philosophical aspects of psychiatric theory and practice. (shrink)

My aim here is to clarify the practice of honoring and validating the relational model of self which plays an important role in feminist therapy. This practice rests on a tangle of psychological claims, moral and political values, and mental health norms which require analysis. Also, severe pathology affects the relative "relationality" of the self. By understanding it we can better understand the senses of autonomy compatible with and even required for a desired relationality.

Psychiatric ethics as professional and biomedical ethics -- The distinctiveness of the psychiatric setting -- Psychiatric ethics as virtue ethics -- Elements of a gender-sensitive ethics for psychiatry -- Some virtues for psychiatrists -- Character and social role -- Case studies in psychiatric virtues.

Psychiatric ethics spans several overlapping domains, including the guidelines for ethical research in psychiatry, the professional ethics required in the practice of psychiatry, and a broader set of moral and ethical problems and dilemmas distinctive to, or at least magnified by, the mental health care setting. Reviewed here are selected issues arising in the last two domains, some seemingly inevitable components of mental disorder and its cultural history and others resultant from recent changes and discoveries. Even as science explains and (...) demystifies mental disorder, it is concluded, new ethical problems will continue to arise in psychiatry and certain recalcitrant problems will likely persist. (shrink)

This discussion is about the moods characteristic of depressive and manic states. Moods are distinguished from the emotions they often accompany, and the relationship between these less and more cognitive, and seemingly less and more intentional, states is provided preliminary clarification. Epistemic deficiencies identified here, when combined with differences of quality and quantity in the moods and motivations that beset the depression and mania sufferer, seem likely to hinder self-knowledge and self-integration. These deficiencies, it is argued, may help explain why (...) the extreme moods found in states of depression and mania contribute to our inclination to regard these conditions as disorder. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 63-66 [Access article in PDF] The Pragmatics of Psychiatry and the Psychiatry of Cross-Cultural Suffering Jennifer Radden I AM IN SUBSTANTIAL AGREEMENT with many of the conclusions David Brendel draws in his thoughtful discussion. Misleading language aside, I particularly applaud his use of my plea for ontological descriptivism to support clinical practice, which respects, as he puts it, the subjectively "melancholic" (...) person living behind the objectively "depressed" clinical presentation.Brendel offers two main critiques of my discussion about the relationship between today's depression and melancholia of past eras. First, he asserts that I neglect the relevance of causal reasoning in my preference for a descriptivist over a causal ontology. Second, arguing that pragmatic considerations ought to be, as he says, front and center when philosophers and psychiatrists "grapple with the complexities of psychiatric explanation," (Brendel 2003, 54) he questions what he sees as my too ready dismissal of pragmatism in this discussion. Allegiance to pragmatism seems to me to sit strangely with support for a causal ontology, as I shall try to demonstrate. But first let me comment on these two sides of Brendel's commentary.The case of Van Gogh's alleged melancholia is particularly well chosen because there has been continuing debate about Van Gogh's condition, including scholarly work attributing it to an inherited metabolic disorder (Arnold 1992). Brendel's suggestion that a causal ontology might allow us to use historical evidence to throw light on the relation between depression and melancholia is an interesting and fruitful one that I had overlooked. Brendel also holds hope for drug cartography as a means of determining the causes of mental disorders. I admit to the initial plausibility of the approach to classification employed by drug cartography, of course. Diagnostic maps must be evaluated according to their effectiveness for the purposes they serve, and cannot—or should not—be seen as mere descriptions of natural phenomena. And maps based on psychopharmacological effects will serve one of the most important purposes we can have in relation to mental disorders: their successful treatment. Nonetheless, as I indicated in my essay, there are conceptual limitations to drug cartography. That several different syndromes respond to the same drug is suggestive, but it does not tell us anything definitive about structural similarities or differences between those different disorders. Nor, from the fact that a condition is alleviated by drugs, does it follow that a particular brain state was the initiating cause of that condition.My dismissal of a pragmatic approach in the foregoing discussion may have been overly hasty. [End Page 63] But in trying to make good this omission, I find myself struck by the complexity of the task. There appear to be at least five different places where a pragmatic response might be called for: (1) in deciding what to say about the relationship between depression and melancholia; (2) in determining the structure of any given psychiatric classification; (3) in choosing between what I have called descriptivist and causal ontologies; (4) in electing a course or method of treatment in the clinical context; and (5) in evaluating psychiatric explanations.With regard to (1), I have sketched in a note one pragmatic consideration in favor of equating melancholia and depression: by so doing, we might reinvest depressive states with some of the glamorous associations from the past and so diminish the stigma and provide some compensation and consolation for the suffering attaching to depression. Pragmatic reasoning may be perfectly appropriate here. I beg to point out that pragmatic considerations let me neglect it.With regard to (2), I recognize that psychiatric classifications are not so much identifications of natural kinds as responses to our various purposes; indeed, this point is offered as one drawback of adopting a causal analysis, because there is little reason to expect our purposes, which are a product of culture, to correspond to natural arrangements, which are not.With regard to (3), if there were overriding pragmatic considerations that favored accepting one or the other of these ontologies, then perhaps this would be... (shrink)

Although employed throughout health-related rhetoric and research today, prevention it is an ambiguous and complicated category when applied to mental and behavioral health. It is analyzed here, along with four ethical issues arising when public health preventative methods and goals involve mental health: age of intervention; resource priorities between prevention and treatment; substantive issues in preventive pedagogies and trade-offs framed by differences of approach. Illustrations include some of the most widespread and ambitious recent preventive models: those aiming to avert subsequent (...) mood disorders of depression and anxiety; those that would curb self-harming behavior, and efforts to anticipate and avoid or delay psychosis. To suppose that public mental health can be entirely modeled on other public health programs is mistaken. Instead, it must proceed with awareness of the particular features typifying many mental disorders. These include features of the disorders themselves; the preliminary nature of scientific knowledge about them; the contested applicability of traditional disease models to them; the dearth of established research data available about preventive interventions currently in place or proposed; and the effects of stigma and discrimination on any such interventions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Psychopathy, Other-Regarding Moral Beliefs, and Responsibility”Jennifer Radden (bio)Fields’s line of reasoning may be summarized, though to do so is to lose much that is nice, and important, in the details. He begins by distinguishing the kind of disorder we are dealing with. Psychopathy is a personality disorder: an unchanging, trait-based condition, not a mental disease or illness. Then he asks why we might judge the (...) presence of psychopathy to vitiate moral and legal responsibility, and answers that psychopathy must reflect some kind of disability. It has been hypothesized (by Duff) that this disability concerns moral understanding, but Fields offers an alternative account. Rather than lacking moral understanding, he argues, the psychopath is disabled in that he cannot form other-regarding moral beliefs. A very convincing argument is then made to persuade us that such a disability would—or should—constitute an excuse.Much of this reasoning is unassailable, and Fields’s careful and systematic approach is impressive. Yet I am left with a lingering concern. He has not convinced me that the psychopath is incapable of forming instead of merely disinclined to form the required sort of moral beliefs. And rather than furthering or supporting his incapacity explanation, Cleckley’s example of Milt undermines it.Maybe the example of Milt’s callousness is the place to start, although whether this is as strong an example as Fields and Cleckley seem to think of psychopathy, is questionable. It is a rather underdescribed example, certainly. We are told that this is the unvarying pattern of Milt’s behavior. Indeed, it has to be to fit the clinical definition of psychopathy as a trait-based character disorder rather than a short-lived “out of character” response. And yet Milt has reached driving age and his mother is still naive enough to expect he’ll pick her up! We need to know more. If mother hasn’t grasped Milt’s dispositional traits yet, why not? Perhaps these traits are not so unvarying and entrenched after all. Or mother is colluding, or denying? Perhaps the understanding between mother and son contained meanings not apparent in the bald clinical description provided by Cleckley. There may be more to this story than meets the eye.So I’m not sure that the example successfully illustrates the clinical definition of psychopathy. But let’s say it does. If we accept the story as we are told it, there remains a gap in the reasoning. That Milt lacks the capacity to form such (other regarding) beliefs, and to harbor guilt feelings as Fields asserts, would explain his irresponsible [End Page 287] behavior—why he “so easily gives way to whims, even though he knows that to do so is to leave his mother... stranded”(p. 33).An incapacity to form other-regarding beliefs may explain this behavior, true. But so equally might being someone given to whims. After all Milt might just have the personality trait, also long established and unchanging, that he gives in to whims more often than most. This is what people sometimes mean when they attribute impulsiveness. And impulsiveness is not only a rather common trait; as it happens it is also one associated with this particular disorder (among others).Fields recognizes the type of explanation which refers to the presence of an unthought out impulse to act, a whim explanation. But he fails to give this kind of explanation its due, using it only selectively and arbitrarily. If, as Field establishes, it is more coherent to think that Milt’s initial offer to his mother was a matter of whim—rather than evidence of the other-regarding belief that one ought to concern oneself with the welfare of one’s parents—then there is no reason to suppose that his failure to follow through and pick her up was not also a whim. This second whim represents an equally satisfactory (simple, plausible, explanatory, not ad hoc ) explanation: Milt might have come to pick up his mum but he whimfully chose not to.And this is a separate and distinct explanation from the one Fields proposes in terms of incapacity. A whim is not (immediate) evidence of incapacity... (shrink)

In this paper, I explore the implications of adopting one model of self rather than another in respect to one particular feature of our mental life. The need to explain synchronic unity in normal subjectivity, and also to explain the apparent and puzzling absence of synchronic unity in certain symptoms of severe mental disorder, I show, becomes more pressing with one particular model. But in the process of developing that explanation we learn something about subjectivity and perhaps also something about (...) brain functioning. (shrink)

My thanks to Professors Hawkins and Szmukler for their thoughtful commentaries; I am particularly glad to see these scholars' valuable expertise directed toward what raises pressing issues not only for psychiatry but for contemporary society.Prof. Hawkins reasons that the use of forced feeding with some anorexia is justified, while emphasizing that this will occur rarely. She and I are in agreement that a mere handful of cases may be affected by our debate, since anecdotal evidence from clinical settings as well (...) as the studies Hawkins cites suggest that forced feeding will often be contraindicated. Still, the matter can equally well be cast hypothetically, as I implied in my earlier discussion. If forced feeding... (shrink)

Because other cultures classify mental disorders very differently from ours, it behooves us to inquire into the philosophical and cultural sources of our own guiding nosological categories. This paper is a philosophical exploration into the historical and theoretical bases of the late nineteenth-century, Kraepelinian division between disorders of mood or affect, and schizophrenia, in which our present day nosological categories are rooted. By tracing the early nosologists’ divisions into eighteenth-century and Kantian faculty psychology, and following the fate of faculty psychology (...) through the nineteenth century, we discover genealogical elements of our taxonomy likely to affect clinical diagnosis and understanding. (shrink)

Jennifer Radden finds, within Robert Burton's religious and humoral explanations in his Anatomy of Melancholy, a remarkably coherent account of normal and abnormal psychology with echoes in modern day clinical psychology.

This paper explores the two-factor theoretical model currently widely used to provide an explanatory analysis of the delusions that regularly accompany neurological disease or damage. The model hypothesizes a combination of an experiential factor – a strange or untoward experience – and a cognitive factor, such as an impairment of reasoning. The two-factor model has been devised formonothematicdelusions that are usually manifested in a single, implausible idea. These have to be distinguished from the more elaborated,polythematicdelusions that are found in psychiatry. (...) Psychiatric delusions exceed neurological ones in frequency and, often, semantic complexity. This text offers a preliminary clarification of underlying assumptions about the breadth, terminology and presuppositions of two-factor theorizing, exploring its potential application to psychiatric delusions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Diagnostic WannabesJennifer Radden, PhD (bio)Saunders explores challenges for the clinician faced with self-styled sufferers from attention deficit hyperactivity disorder, post-traumatic stress disorder, bipolar disorder, autism spectrum disorder (ASD), and fibromyalgia. The diagnostic system was not meant to be used as “a scaffold for identity,” she points out. Yet wannabe patients now step into the clinic wielding self-proclaimed diagnoses as social identities. Saunders explains the context where such phenomena (...) arise, and offers guidelines for clinicians addressing this new reality. To do so, she enlists Rashed’s innovative normative approach to the so-called boundary problem of assigning, and providing justification for, the contested line between normal and disordered. The boundary problem itself seems to rise to prominence during our current era of increasingly dimensional thinking, it is worth noting, with psychiatric diagnoses taken to refer to points on a continuum, rather than to discrete categorical disease entities.On the likely sources of these ‘diagnostic’ social identities, as well as reasons why certain diagnoses attach to them more commonly than others, Saunders points to social trends (including what she asserts to be a “post-stigma” cultural environment), the failure of efforts to identify neurobiological markers for psychiatric disorder, the ubiquity of social media, the algorithms themselves, and the hyperconnected existence of contemporary times. Such narratives also offer the comforts of a sense of belonging and explanations for perceived inadequacies, she rightly observes.Despite today’s virtual and other inducements, the problem introduced here is not an entirely new one. The first part of the seventeenth century in Europe saw an apparent “epidemic” of what was known as “melancholy,” a condition associated with the spleen, whose symptoms loosely resembled those of today’s depression and anxiety. Much of this suffering was undeniably real, but much was a fashionable, identity-conferring pose. “Every distemper of the body now is complicated with spleen,” the poet John Donne ironically observes in a letter dated 1622, “and when we were young men we scarce ever heard of the spleen. In our declinations now, every accident is accompanied with heavy clouds of melancholy”1 (Gosse, 2019). By then, the Melancholic Man (or homo melancholicus), with his surfeit of spleen, was an unmistakable character type—or social identity, as we would now say. Recognized and saluted in centuries-long literary and illustrative traditions, the type was an anchoring element of the humoral medicine which, despite the gradual emergence of more empirical science, had endured since Galenic times.Melancholy’s closest descendants, affective depressive and anxiety disorders, are today less evident among the troubling identities Saunders discusses—somewhat preempted, she points out, by more cognitively-based diagnoses such as ASD. [End Page 279] This is itself an ironic reminder of the vagaries of cultural attitudes, cautioning us to remember the broader context where these particular social identities are selected for emulation and adoption.The lure of the melancholy man’s2 social identity is well understood: already normalized, within the humoral system in which excess black bile afflicted roughly one in four people, it had been valorized for centuries—arguably by Aristotelian writing (in the dubious ‘Problems’), during the Renaissance by Ficino, and Shakespeare—even by Freud in his 1916 ‘Mourning and Melancholia.’ Through most of Western history, the positive attributes and benefits of the dark moods of melancholy have needed no further explaining or justifying. They glow with glamorous associations.Applying Rashed’s conditions for appropriately acknowledging and recognizing the fit of a person’s chosen social identity, Saunders‘ guidance for clinicians clarifies boundary matters. And it illustrates how to understand, regulate and communicate the appropriate norms in ways that can dissuade those whose personal growth and mental health are not served by claiming such identities.With at least some of the popular social identities Saunders describes, I think we can helpfully continue the comparison with the homo melancholicus. For the ‘neurodiversity’ rhetoric of our own times contains forces promoting both the normalization and the valorization of syndromes such as ASD. Pointing to analogies with differences of gender, ethnicity and culture, neurodiversity theorizing argues for a respect for, and appreciation of, difference. Mental or cognitive variations are equally natural and valuable, it is... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.4 (2003) 357-359 [Access article in PDF] Learning From Disunity Jennifer Radden In describing his four cases, Lloyd Wells (2003) throws out a challenge. He asks his readers to recognize similarities between their own more ordinary self-identity and the discontinuous narrative and seeming absence of a steady authorial subject resulting from disorders such as depression, schizophrenia, and Multiple Personality Disorder (MPD). In light (...) of these cases, he implies, the unity of the self we have unreflectively assumed until now to be universal requires reconsideration. Psychopathology seems to force a sharpening, clarification, and closer conceptualization of our philosophical theories of self-identity.While acknowledging that philosophical categories and theories of narrative identity can help us to assess the ravages wrought by mental disorder, James Phillips (2003) is also respectful of the contribution of psychopathology to theorizing about identity: he ends his thoughtful discussion of Wells' cases by looking not at how philosophy can enlighten us about psychopathology but at how cases such as these can illuminate philosophical categories. Speculating on the tragic absence of narrative identity in schizophrenia and advanced Alzheimer's disease, Phillips concludes that, as he puts it, psychopathology "reconfigures the contours of our notion of narrative identity and requires a looser, minimized, nonsubstantial notion of the narrative self" and argues for a self that "transcends the limits and loss of narrative identity" (2003, 326).I also support the approach, shared by Wells and Phillips, that allows psychopathology to clarify and illuminate philosophical concepts and categories. Here, in a handful of footnotes to their insights, I want to point out ways that cases from psychopathology reveal distinguishable elements or aspects of self-identity often confused because, in the normal case, they form an unquestioned and apparently indissoluble unity. One of these is the difference between synchronic and diachronic subjective unity. Another is the difference between the elements of authorship and temporality in conceptions of narrative identity. And last is the difference between what I shall call constitutional identity and self-identity. Synchronic and Diachronic Identity The difference between synchronic and diachronic identity, elements so seamlessly blurred in more ordinary subjectivity, is nicely illustrated by Wells' cases. Mary's dissociative states leave her with interruptions in her diachronic identity: the memory of her experiences is fragmented and incoherent. Yet at any given moment, her synchronic unity is unimpaired. She recognizes and can describe the oneness of her experiences and their boundaries; she is aware which are her experiences and which are not. For all her scatteredness and dissociation, as Phillips puts it in describing Mary's case: "there is a strong and [End Page 357] articulate narrator... the fact remains that this I is there" (2003, 318).In contrast, the shy and self-conscious adolescent Edward seems to suffer not from diachronic but from synchronic disunity. (And if anything, as Melvin Woody [2003] points out, Edward's "narrative" seems to fuel the comparisons which so distress him about his uncomfortable and distressing subjective experiences.) Edward struggles to "delineate what's inside my mind and what's outside it... " When he thinks about what he sees as a firm boundary around the self in others which is not well demarcated in his own case, he remarks "... I completely lose any sense of myself" (p. 330).Thought insertion or "made" feelings in psychosis provide similar instances of such fracturing of their sufferer's synchronic identity (it is perhaps such experiences that Edward alludes to here; Wells' quotations are too sparse for us to tell). Just as Edward complains of losing any sense of himself, so other sufferers from these alarming conditions complain of losing a sense of the self's boundaries, of possession and mind control, and of being the unwelcome host to alien thoughts, feelings, and intentions.In normal experience diachronic and synchronic unity—my oneness across time and at a time—form a seamless whole. These cases, where one or the other is compromised, vividly remind us that these two forms of unity must be distinguished. Narrative Identity Phillips (2003) explicates an analysis of narrative identity which comprises entwined but distinguishable features: a narrating... (shrink)

A professor of philosophy at Western University in Ontario, with joint appointments in Philosophy and the School of Health Studies, Louis Charland unexpectedly passed away on May 9, 2021. In addition to Western, he taught at the Universities of Toronto, McGill, and Concordia. He had visiting appointments at Institute for Advanced Study at Princeton, the Australian Research Council Centre of Excellence for the History of Emotion in Perth, and the Max Planck Institute for Human Development in Berlin. Beyond his teaching (...) and research, he also undertook consulting work for several hospitals and governmental and social service agencies.Louis was the son of a diplomat and was raised as a citizen of the world, with Paris... (shrink)

Richard Mullen and Grant Gillett (2014) decry the oversimplifications that accompany ‘doxastic’ analyses of delusion analogizing them to belief states; particularly, they object to the recent elevation to the status of paradigmatic the ordinary beliefs often understood, in Bayesian terms, as probabilistic estimates of empirical facts. Such an approach ignores the significance of the delusion for the individual, they emphasize, neglecting the delusional person’s conceptions of self and identity in relation to the world. In support of their plea for a (...) broader, more nuanced, and more clinically and existentially sensitive understanding of delusion, Mullen and Gillett enumerate drawbacks to the doxastic view not .. (shrink)

In this paper I shall first expose a weakness shared by several philosophical discussions of self-deception: I shall show that these discussions have failed to give it a complete analysis. The apparent phenomenon of self-deception is all too familiar, and yet its adequate characterization in general terms is wanting. More exactly, I shall argue that to understand self-deception statically, as these accounts have done, has been—and must be—to fail to give a characterization of it as a state of mind, sufficient (...) to distinguish it from other mental states not born of self-deception. (shrink)

Feelings associated with grief are regularly described as painful, but in what respect are they to be understood as pain? The acute pain of easily located tissue damage has long been the paradigm of pain in scientific and philosophical analysis, a dominance serving to obscure features the pain of grief might share not only with chronic pain but with some depressive suffering. Two examples of such commonalities are explored (ways pain feelings are experienced as in and of the body; and (...) are often recessed to the background of consciousness). These features are introduced to illustrate how a preliminary search for additional pain paradigms might proceed, and in so doing to offer some support for the proposal that pain endured as part of grieving may be real pain, not merely 'pain'. (shrink)

Author's reply to comments on J. RADDEN, Imagined and delusional pain, Forum Imagining pain, in: «Rivista internazionale di Filosofia e Psicologia», vol. XII, n. 2, 2021, pp. 151-206.

In lieu of an abstract, here is a brief excerpt of the content:Sigewiza’s CureJennifer H. Radden (bio)Keywordsbiopsychosocial model, Hildegard of Bingen, associationist presuppositions, causation, power of suggestionSuzanne Phillips and Monique Boivin provide us with a sympathetic and compelling account of how the various elements of Hildegard’s sophisticated amalgam of ritual, magic, religion, dietary and other medical remedies, caring, and community, formed a seamless cure for Sigewiza’s affliction. Whether Hildgard’s approach reflects an early instance of the biopsychosocial “model” is a (...) separate claim, and may be challenged. But that her ministrations somehow effected a cure in this case seems—if not without a doubt, then very likely.Descriptions of Sigewiza’s condition, with its “clumping together of blackness and steam” caused by a “constellation of humors,” echo those of other medieval writers speaking of the humoral disorder of melancholia—at that time an encompassing category for a range of symptoms and syndromes that would today be assigned as different mental disorders. In these descriptions a variety of explanations for mental illness are quite typically introduced, including biological, social, supernatural, dietary and astrological ones. Phillips and Boivin take care to point out that Hildegard was not offering her remedies as alternatives, but rather proposing them as at work jointly and in a range of causal directions, exhibiting mutual influence, and feedback loops. As these authors say, multiple explanations “were often held simultaneously... in reference to a specific case” (Phillips and Boivin 2007, XX). And the factors that might cause the system to move out of balance are many: food, emotions, the soul, the mind, actions, and spiritual forces. So although deeds may cause bodily changes and their psychological accompaniments, “problems in the diet might affect the humors which would then have psychological effects, which demons might... use as opportunities to cause further trouble in the spirit, mind, and body” (Phillips and Boivin 2007, 365).What first struck me about Hildegard’s description of these many distinct causes interacting in complex ways is its compatibility with the multi-causal accounts of depression (and other mental disorder) frequently proffered in our own time. Daily habits (e.g., diet, sleep and exercise regimes), genetic predispositions, including biological states of fragility, external events, experiences of loss, social roles, and cultural beliefs—not to mention spontaneous recovery, and placebo effects—are all regularly implicated in the onset and course of conditions such as depression.Still, the similarity to these modern causal accounts may be somewhat misleading and we must beware of overstating it. In favoring and pressing on Hildegard’s holistic understanding, moreover, Phillips and Boivin perhaps insufficiently emphasize significant dissimilarities between Hildegard’s and our contemporary accounts.It is the interaction between the various elements making up Sigewiza’s cure that is most noteworthy [End Page 373] in this account, as Phillips and Boivin recognize. Yet that relationship itself seems in some ways surprisingly problematic: difficult for us to make sense of, and profoundly unmodern. Granted, we think we see the way these approaches probably influenced how Sigewiza felt and responded; but it is not so clear how Hildegard saw things. Like a lot of thinking in medieval times, Hildegard’s account provides us with glimpses of an understanding of the world that today looks prescientific and in that respect, almost precausal. (So, to the extent that the biopsychosocial model is understood as a causal one, the case of Sigewiza may exemplify it only inexactly.)It is not merely the range and type of causes, including supernatural and astrological ones, in accounts such as Hildegard’s that distinguish it from today’s analyses. It is also the reliance of such accounts on what seems to be a different metaphysics, one of associations or qualities.Associationist presuppositions can be found in accounts of health and illness from before, during, and long after, Hildegard’s time. Three examples of this pervasive, but puzzling thinking serve to illustrate. The melancholiac’s perceived swarthiness and darkened skin color—regularly noted from the time of the Greek physicians and an established part of the medieval iconography in images of melancholy—were not, or not primarily, thought to be a causal result of the darkness of his bile, as one might suppose. Instead, this coloring seems... (shrink)

My response to the preceding essays begins with some preliminaries about my terminology, approach, and conception of rationality as a regulative ideal. I then comment on the Murphy's discussion about normal religious belief and religious delusions, and on causal assumptions challenged by Langdon's folies à deux. Responding to Gerrans's imagination-based account of delusion and Hohwy's discussion of illusions, I next try to envision what both doxastic and imagination-based approaches might have overlooked by asking whether there can be delusional feelings. Final (...) comments address the place of phenomenology within Coltheart's two-factor theorizing. (shrink)

: Extreme pain and suffering are associated with depression as well as tissue damage. The impossibility of imagining any feelings of pain and suffering intersect with two matters: the kind of imagining involved, and the nature of delusions. These two correspond to the sequence of the following discussion, in which it is contended first that feelings of pain and suffering resist being imagined in a certain, key way, and second that, given a certain analysis of delusional thought, this precludes the (...) possibility of delusional affections while allowing delusions about affections. Keywords: Pain; Imagination; Delusion; Affection; Feelings Dolore immaginato e dolore illusorio Riassunto: Dolore estremo e sofferenza sono solitamente associati a depressione e danni tissutali. L’impossibilità di immaginare il provare dolore e sofferenza dipende da due fattori: il tipo di immaginazione coinvolta e la natura dell’illusione. Questi due fattori saranno trattati in parallelo nell’analisi che qui si propone, in cui si discuterà in primo luogo come il provare dolore e sofferenza oppongano resistenza all’essere immaginati in un certo modo e in secondo luogo come, secondo una certa analisi del pensiero illusorio, questo preclude la possibilità di affezioni illusorie mentre consente illusioni circa le affezioni. Parole chiave: Dolore; Immaginazione; Illusioni; Affezione; Sensazioni. (shrink)