Mental Disorders

It is a mistake to think that any philosophical contribution to the study of psychopathology is otiose. I identify three non-exhaustive roles that philosophy can and does occupy in the study of mental disorder, which I call the agenda-setting role, the synthetic role, and the regulative role. The three roles are illustrated via consideration of the importance of Jaspers’ notion of understanding and its application to specific examples of mental disorder, including delusions of reference, Capgras delusion and other monothematic delusions, (...) and clinical depression. Together the three roles assign to philosophy of psychopathology the task of determining how to situate the varieties of mental disorder within the system of interpretive and evaluative concepts that partially make up the dynamic but indispensable manifest image. (shrink)

Wie jedes Krankenhaus hat Charité ihre Geschichte, die mit dem Erlaß des preußischen Königs Friedrich I. vom 14. November 1709 zur Gründung von Lazareth-Häusern anfing, um der Ausbreitung der Pest entgegenzuwirken, wozu es allerdings in Berlin nie gekommen ist. Am 9. Januar 1727 verfügte König Friedrich Wilhelm I. die Umwandlung des vor dem Spandowischen Tor errichteten Lazareth in ein Hospital und nannte es „das Haus die Charité“ nach dem Vorbild von Hôpital de la Charité in Paris. -/- Das Wort und (...) der Begriff Charité ist wesentlich älter als das Krankenhaus. Das Französische charité ist äquivalent dem Englischen charity und dem Deutschen Barmherzigkeit, während ihre Ursprünge im Griechischen zu finden sind: χάρις bedeutet Gnade, Gunst, χαριτόω Gnade oder Gunst zeigen oder empfangen, favorisieren oder favorisiert werden, gnädig oder begnadet sein. Das Krankenhaus ist ein Ort der Gnade, welche den Kranken und Bedürftigen zusteht aufgrund allgemeiner Verpflichtung, seinen Nächsten so zu lieben wie sich selbst. Die Gunst und die Gnade zu erweisen heißt auch, sich zu erbarmen und mitleidig sein, eigenes Herz für fremdes Leid zu offnen. -/- Seit ihrer Gründung weichte Charité von diesem Grundgedanke mehrmals ab, was bisher in ihrer Geschichtsschreibung mehr oder weniger wahrheitsgetreu festgehalten wurde. Dieser Tradition des Festhaltens und der Wiedergabe der Wahrheit bin ich verpflichtet, weil offizielle Geschichtsschreibung erneut beginnt, von der Realität abzuweichen und die Tatsachen zu leugnen, die sowohl unzweifelhaft sind als auch unzweifelhaft würdig sind, erzählt zu werden, weil es dabei um die Frage des Auftrags der Charité geht. -/- Charité wurde gegründet, um das Unheil abzuwenden, dennoch war ihre Geschichte keine Heilsgeschichte, wie ich bereits feststellte. Das Unheil setzte sich im 21. Jahrhundert fort, was ich zu unterbinden suche. Einziges Heilmittel dagegen ist die Wahrheit, daran besteht kein Zweifel, und der Weg, um die Wahrheit zu erkennen, ist die Barmherzigkeit. (shrink)

In this paper, I draw on phenomenological analyses of religious voice-hearing and related experiences to elucidate the role of phenomenology in discerning benign from pathological religious experience. First, I present phenomenological discontinuities between cases of benign and pathological voice-hearing by drawing on a study of first-person accounts of voice-hearers within the Pentecostal movement which evinces that voice-hearing is not inherently pathological. Second, I introduce the epidemiological continuity of psychotic-like phenomena by drawing on a study of the contextual and responsive differences (...) between clinical and non-clinical voice-hearers which point to the contexts wherein voice-hearing does not lead to pathology. Third, I present a successful case where the meaning of the anomalous experiences is validated and normalized by drawing on studies of mediumistic experience which illuminate its therapeutic benefits. Finally, I argue that failing to take the voice-hearer’s lived experience into account in the diagnostic moment can result in the pathologization of benign experiences. (shrink)

Meaning-making plays a central role in how we deal with experiences of suffering, including those due to mental disorder. And for many, religious beliefs, experiences, and practices (hereafter, religious engagement) play a central role in informing this meaning-making. However, a crucial facet of the relationship between experiences of mental disorder and religious engagement remains underexplored—namely the potentially positive effects of mental disorder on religious engagement (e.g. experiences of bipolar disorder increasing sense of God’s presence). In what follows, I will present (...) empirical findings from two recent studies of mine which shed light on the extent to which participants experienced these positive effects, specific components of these effects, and how they fit into their understanding of their mental disorder and its relationship to their religious identity. In doing so, I will draw on and expand Tasia Scrutton’s Potentially Transformative view (2015a, 2015b, 2020) according to which mental disorders may provide opportunities for spiritual growth. My empirical results align with and help deepen an account according to which mental disorders are potentially spiritually transformative by providing further insight into such instances: specifically, which symptoms and internal and external factors are often involved, as well as which religious beliefs, experiences, and/or practices are often affected. After presenting these results and articulating their relevance for a potentially transformative view of mental disorder, I will then address some potential objections to the theoretical account as well as some limitations of the empirical work, before sketching possible promising directions for future research. (shrink)

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

Le controversie nosologiche in psichiatria siano orientate da ragioni sia epistemiche che non epistemiche, da questioni di evidenza ma anche di etica e sociologia della scienza, data la presenza di vari programmi di ricerca, di metodologie e anche di agenti differenti che si focalizzano sul problema del disturbo mentale. I due casi qui brevemente considerati, quello della Disposofobia e quello del Disturbo di personalità narcisistica mostrano, assieme al ruolo dell’evidenza empirica, da un lato il peso delle ragioni etiche dei gruppi (...) di pazienti e di quelle culturali della società allargata, dall’altro le dinamiche del consenso tra esperti. Che i disturbi mentali siano o non siano generi naturali, la loro classificazione è un processo razionale complesso che comprende norme e deviazioni dalle norme di diverso tipo. (shrink)

La pandemia mundial del coronavirus ha supuesto una de las mayores conmociones de nuestra historia reciente y, como tal, parece obligarnos a repensar nuestros modos de organización y formas de vida e, incluso, como se propone aquí, a plantearnos cómo podríamos habitar el colapso. En este escenario incierto y desconocido, la filosofía, con sus múltiples enfoques y subdisciplinas, se presenta como un lugar privilegiado para analizar las vertiginosas transformaciones que han dado lugar a esta “nueva normalidad”. El presente monográfico aglutina (...) una serie de contribuciones realizadas por distintos investigadores e investigadoras de la Universidad de Oviedo, que han tratado de abordar la crisis sanitaria global desde diversas perspectivas filosóficas y humanísticas. Entre los temas que se estudian en estas páginas, figuran los relativos a la gestión de la pandemia y la comunicación científica sobre la misma, las relaciones entre pobreza, salud mental y suicidio o el alcance de la revalorización del mundo rural. También se utilizan las herramientas del análisis biopolítico para examinar la gestión de los cuerpos durante la pandemia a partir de tres ejes distintos: el tratamiento de los enfermos, los nuevos dispositivos de control y la gestión de la pandemia en las instituciones de encierro. Además, varios de los capítulos se ocupan explícitamente de un tema inherente a la mayoría de las reflexiones que componen este volumen: a saber, el de la necesidad de un cuestionamiento profundo de la sociedad occidental contemporánea y la insostenibilidad de su forma de vida. (shrink)

This paper provides a historical analysis of a shift in the way animal models of mental disorders were conceptualized: the shift from the mid-twentieth-century view, adopted by some, that animal models model syndromes classified in manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM), to the later widespread view that animal models model component parts of psychiatric syndromes. I argue that in the middle of the twentieth century the attempt to maximize the face validity of animal models (...) sometimes led to the pursuit of the ideal of an animal model that represented a behaviorally defined psychiatric syndrome as described in manuals such as the DSM. I show how developments within psychiatric genetics and related criticism of the DSM in the 1990s and 2000s led to the rejection of this ideal and how researchers in the first decade of the twenty-first century came to believe that animal models of mental disorders should model component parts of mental disorders, adopting a so-called endophenotype approach. (shrink)

In this article, we consider how certain types of contemporary biosocial psychiatric research conceptualise and explicate biology-social relations. We compare the historic biopsychosocial model to recent examples of social defeat research on schizophrenia and cultural neuroscience work on affective disorders. This comparison reveals how the contemporary turn towards the ‘biosocial’ within psychiatric research relies upon ideas of the psychological as an interface. This is problematic because psychological notions of ‘experience’ are used as the central mechanics of biosocial processes, but lack (...) any meaningful engagement with considerable debates within psychology and cognitive science about what the mind, and indeed the psychological, actually is, its relationship to social life, and how we should study it. The psychological interface is therefore vital to these biosocial hypotheses but is remarkably underdeveloped in comparison to its biological and sociological components. We argue that biosocial psychiatric research could gain a great deal from engaging with contemporary theorisations of experience and being more critical of vague appeals to psychological phenomena. (shrink)

This paper offers a philosophical analysis of the connection between mental disorder and suicide risk. In contemporary psychiatry, it is commonly suggested that this connection is a causal connection that has been established through empirical discovery. Herein, I examine the extent to which this claim can be sustained. I argue that the connection between mental disorder and increased suicide risk is not wholly causal but is partly conceptual. This in part relates to the way suicidality is built into the definitions (...) of some psychiatric diagnoses. It also relates to the broader normative assumption that suicidal behavior is by definition mentally disordered behavior. The above has significant epistemological implications, which I explore. I propose that the claim that suicide is connected with mental disorder cannot be justified solely by appealing to empirical evidence but also warrants a justification on conceptual and normative grounds. (shrink)

The addiction literature is fraught with conceptual confusions, stalled debates, and an unfortunate lack of clear and careful attempts to delineate the phenomenon of addiction in a way that might lead to consensus. My dissertation has two overarching aims, one metaphysical and one practical. -/- The first aim is to defend an account of addiction as the systematic disposition to fail to control one’s desires to engage in certain types of behaviors. I defend the inclusion of desires and impaired control (...) in the definition, and I flesh out the notion of systematicity central to my dispositionalist framework. I engage the so-called ‘disease vs. choice’ debate, criticizing its presupposition that we are dealing here with a dichotomy and arguing that the movement towards a middle ground is the right track to take. I explain how the dispositionalist account can capture this middle ground and how it serves to expand upon existing views, in particular by filling in the metaphysical details. -/- The second aim is to show how the account I defend can help to unify the extant views and disciplinary perspectives in the literature. Both the dispositionalist aspect of my framework and the methodology adopted (applied ontology and systematic metaphysics) can move the literature towards both substantive and methodological unification. This will help to clear up conceptual confusions, resolve (or sometimes dissolve) apparently intractable disputes, situate different research perspectives with respect to each other, facilitate interdisciplinary dialogue, and help to frame important questions about addiction. Finally, I offer the beginnings of an ontology of addiction, which will provide a terminologically well-structured guide to the addiction literature in a way that will facilitate more effective and efficient communication and data management across disciplines. (shrink)

This book explores how the human mind works through the lens of psychological disorders, challenging many existing theoretical constructs, especially in the fields of psychology, psychiatry and philosophy of mind. Drawing on the expertise of leading academics, the book discusses how psychopathology can be used to inform our understanding of the human mind. The book argues that studying mental disorders can deepen the understanding of psychological mechanisms such as reasoning, emotions, and beliefs alongside fundamental philosophical questions, including the nature of (...) the self, the universal aspects of morality, and the role of rationality and normativity in human nature. By crossing different domains, this book offers a fresh perspective on the human mind based on the dialogue between philosophy, cognitive science and clinical psychology. Mental disorders discussed include schizophrenia, anxiety disorders, major depression, obsessive-compulsive disorder, post-traumatic stress disorder and paranoia. This book caters to the increasing interest in interdisciplinary approach to solving some of the problems in psychopathology. Since this book treats psychological engagement with empirically informed philosophy of mind, this book is essential reading for students and researchers of cognitive psychology, clinical psychology, and philosophy, as well as being of interest to clinicians and psychiatrists. (shrink)

Over the last decades, childhood maltreatment has emerged as a major risk factor for the development and maintenance of transdiagnostic psychopathology. Notably, higher prevalence rates of maltreatment have been found for nearly all mental disorders, with particularly high numbers for post-traumatic stress disorder, depression, borderline personality disorder and anxiety disorders. Furthermore, childhood maltreatment has been associated with an earlier onset of mental disorders, a more severe and chronic course of disease as well as reduced rates of psychological treatment benefit. However, (...) the pathways that underlie this relationship are still unknown. It has been shown that various factors, for example biological alterations, play a role in the relationship between childhood maltreatment and mental disorders. Research investigating the influence of psychological factors, such as emotional reactivity and emotional regulation, attachment or post-traumatic stress symptoms is rare. These investigations are highly relevant in order to identify potential targets for psychological interventions. First approaches in this line of research examine specific transdiagnostic treatments for early traumatization, such as Imagery Rescripting. However, as childhood maltreatment is suspected to be associated with a broad array of mental disorders, it might not be explained by a single underlying mechanism. Instead, multiple pathways are probable to mediate the relationship between childhood maltreatment and transdiagnostic psychopathology. Therefore, the major aim of this thesis is to make a first step in filling this research gap by investigating the underlying psychological mechanisms between childhood maltreatment and psychopathology in clinical studies. Studies I and II were conducted with a clinical sample of patients with obsessive compulsive disorder. Preliminary research, though limited by small sample sizes and inconsistent findings, showed that childhood maltreatment might play a role in OCD. In order to replicate and expand on these findings we aimed to examine the association of childhood maltreatment and OCD more closely. Study I primarily examined the subtypes of childhood maltreatment influencing OCD and additionally the impact of childhood maltreatment on the success of psychological OCD treatment. We found three main results: First, increased prevalence rates of childhood maltreatment among our OCD patient sample in comparison to a general German population sample. Second, childhood maltreatment severity was related to greater OCD symptom severity, with the most robust relationship for the maltreatment subtype of emotional abuse. Third, individuals with higher levels of childhood maltreatment reported greater OCD symptoms at pre-treatment, post-treatment, and 6 months after their inpatient stay, compared to patients without maltreatment experiences. However, in contradiction of our hypothesis, childhood maltreatment did not influenced treatment benefit. Based on the findings, study II aimed to examine the underlying mechanisms of the detected association between childhood maltreatment and OCD symptoms. Potential mediating factors were chosen based on the following criteria: evidence for association with childhood maltreatment, evidence for association with OCD, and existing plausible theoretical explanation for this mediator as an underlying mechanism. Therefore, we predicted that, emotion regulation difficulties, rumination, an insecure attachment style, dissociation, and post-traumatic stress symptoms are potential mediators between the association of childhood maltreatment and OCD symptom severity. In line with our hypotheses, these factors all mediated the relationship between childhood maltreatment and OCD symptom severity. However, regarding insecure attachment styles, the subtype of avoidant attachment was not linked to either childhood maltreatment or OCD symptom severity, suggesting that in OCD an anxious attachment is more prominent. Study III investigated the specific role of emotional reactivity as an underlying mechanism between childhood maltreatment and major depression in a clinical sample of patients with major depression. Whereas in the literature for major depression the findings regarding heightened emotional reactivity are inconsistent, childhood maltreatment was widely associated with increased emotional reactivity. We therefore hypothesized that the severity of childhood maltreatment is related to higher emotional reactivity among depressive patients. Hence, self-reported and physiological emotional reactivity was measured while presenting audio recordings with neutral, negative and individualized childhood trauma-related scripts. In line with our hypothesis, depressive patients with higher levels of childhood maltreatment reported heightened emotional reactivity to the childhood trauma-related script and the negative script compared to the neutral script. In particular, they rated the negative script as more aversive and distressing. Additionally, they showed more re-experiencing and dissociation experiences in response to the negative script. Equally, the trauma-related script was perceived as more aversive and distressing. Furthermore, it resulted in greater levels of arousal and showed more avoidance as an emotional regulation strategy. In contrast to our hypothesis, no effect of childhood maltreatment on physiological responsiveness emerged. Overall, there is a growing body of literature showing that childhood maltreatment is a transdiagnostic risk factor for various mental disorders. However, few researchers have addressed the question of how this early vulnerability to psychopathology develops and persists. This thesis aimed to expand on current knowledge of the underlying pathways of the relationship between childhood maltreatment and psychopathology in two different mental disorders. The study findings presented in this thesis provide first evidence that heightened emotional reactivity and difficulties in emotion regulation, together with rumination might play a role. Moreover, post-traumatic stress symptoms, even those deemed subclinical, such as hyperarousal, avoidance and dissociative symptoms might be mediating factors between childhood maltreatment and transdiagnostic psychopathology. Since we found indications that re-experience might also play a role in mediating this relationship, future work will concentrate on exploring this factor in more detail. Additionally, further work is needed to investigate the cause of high divergence between self-report emotional reactivity and psychophysiological reactivity. From a methodological perspective, problems in assessing childhood maltreatment retrospectively with the childhood trauma questionnaire will be discussed. Moreover, implications for a theoretical transdiagnostic model and methodological approaches, as well as directions for future research on the underlying pathways of childhood maltreatment and psychopathology are outlined. (shrink)

Sufferers of eating disorders often hold false beliefs about their own body size. Such beliefs appear to violate norms of epistemic rationality, being neither grounded by nor responsive to appropriate forms of evidence. Contrary to appearances, I defend the rationality of these beliefs. I argue that they are in fact grounded in and reinforced by appropriate evidence, emanating from proprioceptive misperception of bodily boundaries. This argument has far-reaching implications for the explanation and treatment of eating disorders, as well as debates (...) over the relationship between rationality and human psychology. (shrink)

Introduction to The Oxford Handbook of Phenomenological Psychopathology.

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

The Heythrop Journal, Volume 63, Issue 2, Page 315-316, March 2022.

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

Sufferers of body integrity identity disorder (BIID) experience a severe, non-delusional mismatch between their physical body and their internalised bodily image. For some, healthy limb amputation is the only alleviation for their significant suffering. Those who achieved an amputation, either self-inflicted or via surgery, often describe the procedure as resulting in relief. However, in England, surgeons who provide ‘elective amputations’ could face prosecution for causing grievous bodily harm (GBH) under section 18 of the Offences Against the Persons Act 1861. Whether (...) such a therapeutic intervention should be classified as GBH depends on the presence of harm, as, without harm, it is hard to argue that GBH has occurred. However, there is no agreed-upon definition of what constitutes harm. Such a definitional absence then begs the question, what is harm? It is this question which this article addresses, using the provision of healthy limb amputation in cases of BIID as an example. Drawing on metaphysics, this article will seek to clarify three separate contemporary models of harm: the counter-temporal, the counterfactual, and the non-comparative. Each model will be applied to the scenario of a surgeon carrying out a BIID-induced, therapeutic, healthy limb amputation, and in each, how harm may, or may not, be understood to have been caused will be explored. It concludes that an unexamined conception of harm is ill-equipped for employment in suspected cases of GBH when it is unclear whether harm has been caused and that a better-informed understanding of harm is required in cases where there is potential disagreement, be that in instances of BIID or a myriad of other borderline scenarios. (shrink)

Since its advent in the 20th century, informed consent has become a cornerstone of ethical healthcare, and obtaining it a core obligation in medical contexts. In my dissertation, I aim to examine the theoretical underpinnings of informed consent and identify what values it is taken to protect. I will suggest that the fundamental motivation behind informed consent rests in something I’ll call bodily self-sovereignty, which I argue involves a coupling of two groups of values: autonomy and non-domination on the one (...) hand, and self-ownership and personal integrity on the other. I will then go on to consider two 'case studies' I take to shed light on what is at stake in securing informed consent - consent in psychiatrically ill populations, and consent to interventions that involve the modification of the genetic germline. (shrink)

Naturalistic accounts of mental disorder aim to identify an objective basis for attributions of mental disorder. This goal is important for demarcating genuine mental disorders from artificial or socially constructed disorders. The articulation of a demarcation criterion provides a means for assuring that attributions of 'mental disorder' are not merely pathologizing different forms of social deviance. The most influential naturalistic and hybrid definitions of mental disorder identify biological dysfunction as the objective basis of mental disorders: genuine mental...

“The addict” is a well-known figure in philosophy, but analytical attempts to define “addictive disorder” are rare. According to extant views, the “hallmark” of addiction lies in an individual’s inability or impaired ability to control the behavior the individual is addicted to doing. But how exactly are we to understand the relevant concept of (in)ability (or impaired ability) in the first place? Furthermore, what else is necessary for an individual to have an addictive disorder? I argue for a definition of (...) “addictive disorder” in terms of desire, tolerance and withdrawal, inability, and harm. The main focus of this paper is on the concept of ability. The view I propose integrates insights from the literature on abilities and develops them further as they are relevant to addiction. The resulting view offers a more differentiated perspective on questions about what individuals with an addictive disorder can and cannot do. (shrink)

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders included the Social Communication Disorder as a new mental disorder characterized by deficits in pragmatic abilities. Although the introduction of SPCD in the psychiatry nosography depended on a variety of reasons—including bridging a nosological gap in the macro-category of Communication Disorders—in the last few years researchers have identified major issues in such revision. For instance, the symptomatology of SPCD is notably close to that of Autism Spectrum Disorder. This (...) opens up the possibility that individuals with very similar symptoms can be diagnosed differently and receive different clinical treatments and social support. The aim of this paper is to review recent debates on SPCD, particularly as regards its independence from ASD. In the first part, we outline the major aspects of the DSM-5 nosological revision involving ASD and SPCD. In the second part, we focus on the validity and reliability of SPCD. First, we analyze literature on three potential validators of SPCD, i.e., etiology, response to treatment, and measurability. Then, we turn to reliability issues connected with the introduction of the grandfather clause and the use of the concepts of spectrum and threshold in the definition of ASD. In the conclusion, we evaluate whether SPCD could play any role in contemporary psychiatry other than that of an independent mental disorder and discuss the role that non-epistemic factors could play in the delineation of the future psychiatry nosography. (shrink)

In this paper, I argue for a new way to understand the integration of facts and values in the concept of mental disorder that has the potential to avoid the flaws of previous hybrid approaches. I import conceptual tools from the account of procedural objectivity defended by Helen Longino to resolve the controversy over the definition of mental disorder. My argument is threefold: I first sketch the history of the debate opposing objectivists and constructivists and focus on the criticisms that (...) led to the emergence of the debate. Second, I offer a reconstruction of the “Natural Function Approach” argument to make explicit an unsound assumption underlying this approach. The reconstruction will allow me to show that the NFO’s argument depends on the ideal of value-free science that I will criticize. Then I propose an alternative ideal for psychiatry: social objectivity. I argue that the concept of mental health should be seen as “socially objective” rather than value-free, moving the debate towards the social procedures by which the definition is produced rather than the normative and factual content of its definition. (shrink)

This paper aims at considering the conceptual status of feeding and eating disorders (FEDs). Now that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has changed the classification and some relevant criteria of FEDs, it is particularly relevant to evaluate their psychiatric framework and their status as mental disorders. I focus my efforts on address- ing only one specific question: Do FEDs fit the DSM-5 general definition of mental disorder? In DSM-5 a mental disorder is defined as a syndrome (...) that reflects a dysfunction and is usually associated with significant distress or disability. More importantly, there is an explicit statement saying that all mental disorders listed in the manual must meet the requirements highlighted by the general definition. Thus, I evaluate whether or not FEDs are really meant to reflect a dysfunction and are usually associated with significant distress or disability. (shrink)

This paper aims at considering the conceptual status of feeding and eating disorders. Now that the Diagnostic and Statistical Manual of Mental Disorders has changed the classification and some relevant criteria of FEDs, it is particularly relevant to evaluate their psychiatric framework and their status as mental disorders. I focus my efforts on addressing only one specific question: Do FEDs fit the DSM-5 general definition of mental disorder? In DSM-5 a mental disorder is defined as a syndrome that reflects a (...) dysfunction and is usually associated with significant distress or disability. More importantly, there is an explicit statement saying that all mental disorders listed in the manual must meet the requirements highlighted by the general definition. Thus, I evaluate whether or not FEDs are really meant to reflect a dysfunction and are usually associated with significant distress or disability. (shrink)

In this paper I put forward a view of the drug-related desires experienced by addicted agents ―‘addictive desires’, for short. On my account, the most remarkable feature of these desires is not that they ‘push’ the agent with a force she cannot oppose, but that they constitute an unusually stubborn source of motivation. Addictive desires are unordinary, in part, in that they are a persistent source of influence over decision-making processes that is not easily undermined by factors that normally have (...) the ability of undermining desires, with the result that addicted individuals experience episodes of occurrently wanting to use drugs that recur with tremendous frequency. Both these features ―their unusually high degrees of recalcitrance and recurrence― contribute to a decrease in reasons-responsiveness when it comes to matters related with drug use. While the difference with ordinary, non-addictive desires in both these regards is a matter of degree, it comes down to a highly significant difference nonetheless. (shrink)

Willpower has ramifications for autonomy and mental time-travel. Autonomy presupposes mature powers of volition and the capacity to anticipate future events and consequences of one's actions. Ainslie's study is useful to clarify basic autonomy in addiction and dementia. Furthermore, we show how our study on coping with stress can be applied to suppression and resolve.

The Caraka Saṃhitā, the first classical Indian medical compendium, covers a wide variety of pharmacological and therapeutic treatment, while also sketching out a philosophical anthropology of the human subject who is the patient of the physicians for whom this text was composed. In this article, I outline some of the relevant aspects of this anthropology – in particular, its understanding of ‘mind’ and other elements that constitute the subject – before exploring two ways in which it approaches ‘psychiatric’ disorder: one (...) as ‘mental illness’, the other as ‘madness’. I focus on two aspects of this approach. One concerns the moral relationship between the virtuous and the well life, or the moral and the medical dimensions of a patient’s subjectivity. The other is about the phenomenological relationship between the patient and the ecology within which the patient’s disturbance occurs. The aetiology of and responses to such disturbances helps us think more carefully about the very contours of subjectivity, about who we are and how we should understand ourselves. I locate this interpretation within a larger programme on the interpretation of the whole human being, which I have elsewhere called ‘ecological phenomenology’. (shrink)

Borsboom and colleagues have recently proposed a “network theory” of psychiatric disorders that conceptualizes psychiatric disorders as relatively stable networks of causally interacting symptoms. They have also claimed that the network theory should include non-symptom variables such as environmental factors. How are environmental factors incorporated in the network theory, and what kind of explanations of psychiatric disorders can such an “extended” network theory provide? The aim of this article is to critically examine what explanatory strategies the network theory that includes (...) both symptoms and environmental factors can accommodate. We first analyze how proponents of the network theory conceptualize the relations between symptoms and between symptoms and environmental factors. Their claims suggest that the network theory could provide insight into the causal mechanisms underlying psychiatric disorders. We assess these claims in light of network analysis, Woodward’s interventionist theory, and mechanistic explanation, and show that they can only be satisfied with additional assumptions and requirements. Then, we examine their claim that network characteristics may explain the dynamics of psychiatric disorders by means of a topological explanatory strategy. We argue that the network theory could accommodate topological explanations of symptom networks, but we also point out that this poses some difficulties. Finally, we suggest that a multilayer network account of psychiatric disorders might allow for the integration of symptoms and non-symptom factors related to psychiatric disorders and could accommodate both causal/mechanistic and topological explanations. (shrink)

Background: Post-traumatic stress disorder is a prevalent, debilitating, and costly psychiatric disorder. Evidenced-based psychotherapies, including Cognitive Processing Therapy, are effective in treating PTSD, although a fair proportion of individuals show limited benefit from such treatments. CPT requires cognitive demands such as encoding, recalling, and implementing new information, resulting in behavioral change that may improve PTSD symptoms. Individuals with PTSD show worse cognitive functioning than those without PTSD, particularly in acquisition of verbal memory. Therefore, memory dysfunction may limit treatment gains in (...) CPT in some individuals with PTSD. Methods and Analysis: Here, we present a protocol describing the Cognition and PsychoTherapy in PTSD study, a prospective, observational study examining how cognitive functioning affects treatment response in CPT for PTSD. The study aims to recruit 105 outpatient veterans with PTSD between the ages of 18 and 70 years. Prior to beginning 12 sessions of CPT, Veteran participants will have standardized assessments of mood and functioning and complete a comprehensive neurocognitive battery assessing episodic learning, attention and speed of processing, language ability, executive control, and emotional functioning. This study aims to fill gaps in the current literature by: examining the specificity of memory effects on treatment response; exploring how baseline cognitive functioning impacts functional outcomes; and examining potential mechanisms, such as memory for treatment content, that might explain the effects of baseline memory functioning on PTSD symptom trajectory. Discussion: If successful, this research could identify clinically relevant neurocognitive mechanisms that may impact PTSD psychotherapy and guide the development of individualized treatments for PTSD. (shrink)

The Research Domani Criteria framework (RdoC) encourages research on specific impairments present across traditional nosological categories and suggests a list of biological and behavioral measures for assessing them. After a description of RdoC, in this article we focus on impairments of the ability of understanding others, specifically in Theory of Mind and empathy. We illustrate recent evidence on brain anomalies correlating with these deficits in Schizophrenia, Addiction Disorders and Mood Disorders populations. In the last section, we zoom out and consider (...) this kind of research vis-à-vis the objection of being reductionistic that is, in favoring mechanistic accounts of mental disorders. We argue that metaphysical reductionism and explanatory reductionism are not conceptually entailed by the RdoC framework. (shrink)

The Diagnostic and Statistical Manual of Mental Disorders is the guidebook for psychiatric practice in medicine. In the fifth edition, published in 2013, the American Psychiatric Association significantly revised the section on gender identity disorder, which it renamed gender dysphoria. In previous editions, the conviction that one’s sex did not match one’s gender was treated as a mental disorder in need of psychiatric treatment. In DSM-5, the remedy for that same conviction was changed to hormonal and surgical procedures to give (...) the patient the appearance of the opposite sex. A complete reversal of this sort is surprising, as it implies that all previous guidance on this question was in error. The change is even more perplexing given that little evidence shows that hormonal or surgical interventions actually improve the psychological health of the sufferer. (shrink)

An estimated 15% of patients seen by neurologists have neurological symptoms, such as paralysis, tremors, dystonia, or seizures, that cannot be medically explained. For a long time, such patients were diagnosed as having conversion disorder and referred to psychiatrists, but for the last two decades or so, neurologists have started to pay more serious attention to this patient group. Instead of maintaining the commonly used label of conversion disorder – which refers to Freud’s idea that traumatic events can be converted (...) into deviant behaviour – these neurologists use the term functional neurological disorder and explain that the problems are due to abnormal central nervous system functioning. The situation that some patients with medically unexplained neurological symptoms are diagnosed with CD and treated by psychiatrists while others are diagnosed with FND and stay under the control of neurologists provides a unique case for analysing how neurological and psychological explanations affect subjectivity. In this article, I compare patient reports from English-language websites from the past 15 years to find out how minds, bodies, brains, and selves act and interact in the accounts of both patient groups. I conclude that the change in label from CD to FND has not only influenced ideas of medically unexplained disorders, but also affected ideas of the self and the body; of self-control and accountability. (shrink)

Our concept of disorder is changing. This causes problems for projects of descriptive conceptual analysis. Conceptual change means that a criterion that was necessary for a condition to be a disorder at one time may cease to be necessary a relatively short time later. Nevertheless, some conceptually based claims will be fairly robust. In particular, the claim that no adequate account of disorder can appeal only to biological facts can be maintained for the foreseeable future. This is because our current (...) concept of disorder continues to be laden with ethical and political values in multiple ways. (shrink)

Psychiatry has witnessed a new wave of approaches to clinical phenotyping and the study of psychopathology, including the National Institute of Mental Health’s Research Domain Criteria, clinical staging, network approaches, the Hierarchical Taxonomy of Psychopathology, and the general psychopathology factor, as well as a revival of interest in phenomenological psychopathology. The question naturally emerges as to what the relationship between these new approaches is – are they mutually exclusive, competing approaches, or can they be integrated in some way and used (...) to enrich each other? In this opinion piece, we propose a possible integration between clinical staging and phenomenological psychopathology. Domains identified in phenomenological psychopathology, such as selfhood, embodiment, affectivity, etc., can be overlaid on clinical stages in order to enrich and deepen the phenotypes captured in clinical staging (‘high resolution’ clinical phenotypes). This approach may be useful both ideographically and nomothetically, in that it could complement diagnosis, enrich clinical formulation, and inform treatment of individual patients, as well as help guide aetiological, prediction, and treatment research. The overlaying of phenomenological domains on clinical stages may require that these domains are reformulated in dimensional rather than categorial terms. This integrative project requires assessment tools, some of which are already available, that are sensitive and thorough enough to pick up on the range of relevant psychopathology. The proposed approach offers opportunities for mutual enrichment: clinical staging may be enriched by introducing greater depth to phenotypes; phenomenological psychopathology may be enriched by introducing stages of severity and disorder progression to phenomenological analysis. (shrink)

In Patricia Churchland's 2006 essay on free will, she cites the case of a middle-aged man who, without any prior history of misbehavior, suddenly became obsessed with child pornography and started to molest his 8-year-old stepdaughter. He was subsequently discovered to have a brain tumor affecting the frontal lobes, and when it is successfully treated his aberrant behavior stopped.Thomas Szasz is famous for his denunciation of the concept of mental illness, and his critique is partly responsible for instigating an enduring (...) philosophical discourse about the nature of mental disorder. Szasz's key insight was the recognition that we find it important to distinguish between situations that are characterized by... (shrink)

This book defends the much-disputed view that emotions are what Hume referred to as ‘original existences’: feeling states that have no intentional or representational properties of their own. In doing so, the book serves as a valuable counterbalance to the now mainstream view that emotions are representational mental states. Beginning with a defence of a feeling theory of emotion, Whiting opens up a whole new way of thinking about the role and centrality of emotion in our lives, showing how emotion (...) is key to a proper understanding of human motivation and the self. Whiting establishes that emotions as types of bodily feelings serve as the categorical bases for our behavioural dispositions, including those associated with moral thought, virtue, and vice. The book concludes by advancing the idea that emotions make up our intrinsic nature - the characterisation of what we are like in and of ourselves, when considered apart from how we are disposed to behave. The conclusion additionally draws out the implications of the claims made throughout the book in relation to our understanding of mental illness and the treatment of emotional disorders. (shrink)

Abstract—The issue of the mental state of mediums, and whether experiences considered mediumistic are symptoms of mental disorders, has long been subject to debate. Recent empirical studies may help to shed light on these controversies. As there are only a few studies on the mental health of mediums, findings regarding hallucination and dissociation in non-clinical populations are presented and discussed. Recent studies have not found an association between mediumship and mental disorders. Mediumistic experiences often occur in healthy and well-adjusted subjects. (...) The occurrence of psychotic and/or dissociative experiences alone are not enough for a diagnosis of a mental disorder. It is essential to take into consideration the sociocultural context and the impact of these experiences on a patient’s life. In some cases, the emergence of mediumship may appear in the context of physical and mental symptoms, which poses a challenge for differential diagnosis. Further research is still necessary in order to discover enough elements to make a definitive differential diagnosis between mediumship and mental disorders. Keywords: mediumship—mental health—mental disorders—differential diagnosis. (shrink)

Practical and evidence-based, this unique book is the first comprehensive text focused on person-centered approaches to people with serious mental illness such as schizophrenia and bipolar disorder. It reflects a range of views and findings regarding assessment, treatment, rehabilitation, self-help, policy-making, education and research. It is highly recommended for all healthcare professionals, students, researchers and educators involved in general practice, psychiatry, nursing, social work, clinical psychology and therapy. Healthcare service providers, and policy makers and shapers, will find the book's wide-ranging, (...) multi-professional approach enlightening. 'Serious Mental Illness reflects a continued distancing from the outmoded and unsubstantiated belief that people with severe mental illnesses could not recover, and that they would respond positively only to goals and treatment plans chosen, designed and implemented by providers in order to prevent their further deterioration. Anyone with an interest in the concept of person-centered approaches will discover new ideas in this book. Indeed, anyone with an interest in person-centered approaches has to read this book. Not only is it the first such book on person-centered approaches, but it will serve as the gold standard in this topic area for years to come.' William A Anthony, in the Foreword. (shrink)

Purpose of review This review considers the literature on ethical and conceptual issues in eating disorders from the last 18 months. Some reference to earlier work is necessary in order to provide context for the recent findings from research that is ongoing. -/- Recent findings Empirical ethics research on anorexia nervosa includes novel ethical and conceptual findings on the role of authenticity and personal identity in individuals’ reports of their experience, as well as new evidence on the role of affective (...) states and values in decision making at later stages of the illness. Evidence points to the hypothesis that anorexia nervosa may be a distinct affective syndrome that organizes feelings and emotions in accordance with a fixed idea. -/- Summary There has been impressive progress in empirical ethics research on anorexia nervosa, with important implications for ethical and conceptual issues that surround decision-making capacity and our understanding of the illness. (shrink)

Realism about mental disorders is a perennial area of dispute, but the controversy burns especially intensely for Attention Deficit Hyperactivity Disorder. In this dissertation, I clarify what is at issue in these debates, surveying how realists have typically argued for mental disorder realism: the definitional debate about health and illness. I argue that the realist need not be committed to the terms of the definitional debate and recommend that a better approach is to show that mental disorders are natural kinds. (...) While there are many accounts of kind-hood on offer, I adopt Richard Boyd’s homeostatic property cluster theory of kinds, which I interpret through the philosophy of neuroscience literature on mechanisms. In sum, I conclude that if ADHD is a natural kind – and thus real – then individuals diagnosed with the disorder should be sufficiently similar with respect to an underlying cognitive neurobiological mechanism. To determine whether ADHD individuals are similar in this way, I consider the question through Russell Barkley’s Executive Function Model of ADHD. Relying primarily on the cognitive neurobiological research, I argue that there is now reasonable evidence to conclude that the DSM classification of ADHD corresponds not to a single natural kind, but several. Thus, ADHD is thus real. (shrink)

Mental disorders are often thought to be harmful dysfunctions. Jerome Wakefield has argued that such dysfunctions should be understood as failures of naturally selected functions. This suggests that evolutionary biology and other Darwinian disciplines hold important information for anyone working on answering the philosophical question, "What is a mental disorder?". In this article, the author argues that Darwinian theory is not only relevant to the understanding of the disrupted functions, but it also sheds light on the disruption itself, as well (...) as on the harm that attends the disruption. The arguments advanced here are partially based on the view that a core feature of Darwinism is that it stresses the environmental relativity of functions and dysfunctions. These arguments show a very close empirical connection between social judgments and dysfunctions, which is of interest for psychiatric theory. Philosophically, they lead to the conclusion that the concept of mental disorder is identical to the concept of mental dysfunction. Consequently, it is both misleading and redundant to conceptualize mental disorders as 'harmful dysfunctions', and not simply as 'mental dysfunctions'. (shrink)

In psychiatry's transformation from an asylum-based to a community-oriented profession, false positive diagnoses became a major challenge to the validity of the diagnostic system. The shift to descriptive, symptom-based operationalized diagnostic criteria of DSM-III further exacerbated this difficulty because of the contextually based nature of the distinction between normal distress and mental disorder. Through selected examples, the degree of success with which DSM-III and DSM-IV have attended to the challenge of avoiding false positive diagnoses is examined. Conceptual analysis of selected (...) criteria sets, with a focus on counterexamples to the claim that DSM criteria imply disorder, is performed. Psychiatry has so far failed to systematically confront the problem of false positives. Flaws in criteria, which can be recognized even by lay people, remain unaddressed, despite the fact that the issue is purely conceptual and is not sensitive to any new research information. (shrink)

The introduction of the Diagnostic and Statistical Manual of Mental Disorders in May 2013 is being hailed as the biggest event in psychiatry in the last 10 years. In this paper I examine three important issues that arise from the new manual: Expanding nosology: Psychiatry has again broadened its nosology to include human experiences not previously under its purview. Consequence-based ethical concerns about this expansion are addressed, along with conceptual concerns about a confusion of "construct validity" and "conceptual validity" and (...) a failure to distinguish between "disorder" and "nondisordered conditions for which we help people." The role of claims about societal impact in changes in nosology: Several changes in the DSM-5 involved claims about societal impact in their rationales. This is due in part to a new online open comment period during DSM development. Examples include advancement of science, greater access to treatment, greater public awareness of condition, loss of identify or harm to those with removed disorders, stigmatization, offensiveness, etc. I identify and evaluate four importantly distinct ways in which claims about societal impact might operate in DSM development. Categorisation nosology to spectrum nosology: The move to "degrees of severity" of mental disorders, a major change for DSM-5, raises concerns about conceptual clarity and uniformity concerning what it means to have a severe form of a disorder, and ethical concerns about communication. (shrink)

Philosophy of psychiatry is a philosophical discipline focused on fundamental theoretical and conceptual issues in contemporary psychiatry. One of such issues is the so-called demarcation problem, which can be understood as the question about the difference between mental illness and psychological functioning which is normal, or healthy. After a brief account of the standard criteria for such differentiation the dominant naturalistic understanding of psychiatry as well as the notion of mental illness proper to the latter are subjected to scrutiny. Then, (...) in turn, critical currents are investigated with their concept of psychiatry as a discipline of humanistic and normative character. Some of these currents, such as the antipsychiatry of Szasz, are of historical importance today. Still, however, many threads are discussed, especially in the context of the notion of mental disorder developed by the American Psychiatric Association. One may expect that such discussions will be fruitfully carried on, especially in those cases when particular disorders are philosophically investigated. (shrink)