Philosophy of Psychiatry and Psychopathology

Abstract:Since Homeric times, psychotherapy has been an essential part of the medical act. Initially, the word of physicians had a magical character. Plato rationalizes this in many of his dialogues. In "Charmides," he dives deeper into this matter and proposes to apply it to every disease. Analysing this dialogue has fundamental consequences for psychotherapy: 1) Remedy and epodé (charm) must be applied in every doctor–patient relationship. 2) The body can only be healed if the soul is cured first by a (...) charm. Patients must "offer" their souls to the physician, which implies the need for confidence and the unavoidable asymmetry which characterize doctor–patient relationships. 3) The openness of the patient's soul to the physician and the physician's "beautiful speech" to the patient will enable the latter to reach the state of sophrosyne (temperance), the condition of the possibility of true health. In the discussion of the meaning of sophrosyne, Socrates questions every one of the disciples' propositions and concludes that the only thing one can be sure of is that sophrosyne is a way of searching for virtue (areté). Later, in Theaetetus, Plato adds another element: temperance is a homoiosis theó, that is, the assimilation of patient with God. With this, Plato seals the ethical character of psychotherapy forever. (shrink)

First, I would like to thank Dr. Phillips for his generous words about the potential interest of my work. He speaks about the fact that it is "insightful" and thought-provoking ("it offers us much to think about"). In his comment Dr. Phillips reviews the main moments of the evolution of treatment by words in the Greek world and he focuses on Plato's Dialogue Charmides, whose analysis is the center of my article. He even quotes some parts of the dialogue, which (...) I mention too, although in a different translation. He rightfully underlines the moment in which Socrates tells Charmides: "And the soul... my dear friend, is cured by means of certain charms, and these charms consist of beautiful words. It is a result of... Read More. (shrink)

Abstract:This article brings together considerations from philosophical work on standpoint epistemology, feminist philosophy of science, and epistemic injustice to examine a particular problem facing contemporary psychiatry: the conflict between the conceptual resources of psychiatric medicine and alternative conceptualizations like those of the neurodiversity movement and psychiatric abolitionism. I argue that resistance to fully considering such alternative conceptualizations in processes such as the revision of the Diagnostic and Statistical Manual of Mental Disorders emerges in part from a particular form of epistemic (...) injustice (hermeneutical ignorance) leveled against a particular social group (which I call the "psychopathologized"). Further, insofar as the objectivity which psychiatry should aspire to is a kind of "social objectivity" which requires incorporation of various normative perspectives, this particular form of epistemic injustice threatens to undermine its scientific objectivity. Although many questions regarding implementation remain, this implies that psychiatry must grapple substantively with radical reconceptualizations of its domain if it is to achieve legitimate scientific objectivity. (shrink)

Dr. Otto Doerr-Zegers's article is so interesting and insightful that I have nothing critical to say about it. On the other hand, in finding Greek, mainly Platonic, origins for psychotherapy, he offers us much to think about. In this brief commentary I will attempt to draw out some of the implications of his analysis for contemporary psychotherapy.Doerr-Zegers's analysis begins with a reflection on Socrates' Maieutics, Socrates' invoking the midwife metaphor to convey his use of dialectics to bring forth the ignorance (...) of his interlocutor. Dörr recognizes that Maieutics is a kind of psychotherapy in that, like psychotherapy, it involves a "treatment by the word." He takes this verbal dimension of the treatment back... Read More. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Recognizing Wounds and Giving Uptake The Undoing of Dominant Collective MemoriesEmily Walsh*, PhD (bio)I want to begin this response by thanking Dr. Kirmayer and Dr. Potter for taking the time to craft insightful and intellectually stimulating responses to my article. Both commentaries enabled me to clarify the complexity of the question of how best to commence the undoing of dominant collective memories (DCMs) in psychiatry. In this response, I (...) will clarify what I intend to capture by the term DCMs, tackle two problems identified with my account, and end by remarking on the solutions proposed by the authors, defending that a hybrid combination of both positions leaves us with the most robust solution to the problems created by DCMs.I briefly outline in the article that DCMs are singular and exclusionary collective memories underpinned by colonialism. Potter expresses concern about being left with uncertainty regarding what sorts of DCMs serve to deny the violence faced by the colonized given this definition. This concern is important as it shows that there is some conceptual confusion about how to distinguish ordinary collective memories from DCMs, which I propose ought to be rejected. Addressing this concern would also be useful for the reason Potter makes; to help better motivate why change is required in psychiatry regarding DCMs. In response to Potter's definitional concern, I will now posit a thicker explanation of DCMs, which outlines how they are distinct from ordinary collective memories on three grounds.DCMs are unique from other kinds of collective memory insofar as they deny that there could be various perspectives of the same event. This denial occurs in multiple ways, such as silencing, scapegoating, attacking, and undermining others' perspectives, painting certain actors as all good and others as all bad. Therein lies the danger of DCMs as I have defended that people are neither wholly good nor wholly bad, but they are at the mercy of their social situation. Good examples of cases of the kind of DCMs I have in mind are how colonial nations defend their reasons for engaging in colonialism and failing to acknowledge sectors of history entirely (such as failing to recognize horror crimes against certain social and ethnic minorities). Such a failure to integrate both positive and negative parts of a nation's history is not [End Page 249] present in all contexts. For instance, Germany has integrated teaching about the horrors endured during Nazi Germany into their historical narrative of the past to avoid reproducing similar atrocities in the future. Places like the UK and Canada are slower to follow suit and admit that there are horrors present in the nation's past too.DCMs are also unique in legitimizing and reproducing negative and positive stereotypes, ideals, and cultural myths. Such stereotypes tend to be harmful such as "I expect X group always to steal," but they can also be positive "I expect X to be the most intelligent person I've ever met." As Fanon instructed us (Fanon 1964, 1967), these stereotypes are entrenched in the content of DCMs. Similarly, they are reproduced with the intent of controlling specific populations of persons. If, after all, I have 'evidence' that you are a thief by 'nature,' I will seek to protect my belongings from you. The problem is that the 'evidence' is not evidence—it is a form of DCM. The evidence fails to see processes of racialization and colonialism and thereby, advertently or inadvertently, reproduces them.As reiterated by Kirmayer in his commentary, DCMs are not primarily concerned about individual and discrete events, but they aim to produce narratives of events. According to Kirmayer, these narratives are imbued with explanations and rationalizations that drive the plot forward in time. My primary concern in the article was to show that DCMs can work to move the plot backward in time as a means of controlling specific populations—back to a time the world does not recognize as a time but forces racialized persons to keep perpetually enduring the aftereffects of (Al-Saji, 2013, 2021). Thus, there are deep contradictions in DCMs which are not present in all collective memories. On the one hand, DCMs deny the violence inflicted on the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Decolonizing MemoryLaurence J. Kirmayer*, MD (bio)In this far-reaching essay, Emily Walsh explores the significance of memory for coming to grips with the enduring legacy of colonialism in psychiatry. She argues that "for reasons of self-preservation, racialized individuals should reject collective memories underwritten by colonialism." Psychiatry can enable this process or collude with the structures of domination to silence and disable those who bear the brunt of the colonialist history (...) of violence and its current global incarnations. In this brief commentary, I want to underscore the importance of Walsh's argument, link it to contemporary work in cognitive and social science on the dynamics of memory, and point to some resources for implementing these insights in health services and clinical practice.Memory as Psychological Process, Social Practice and Cultural InstitutionMemory is not simply an individual psychological process of accessing images, stories, and knowledge of the past, but a reconstructive process of building a narrative (Kirmayer, 1996). This narrative is profoundly shaped by available templates, metaphors and models that are provided by the tacit, normative and official histories of society (Hirst, Yamashiro & Coman, 2018). But memory is also shaped by cultural affordances that guide attention and by narrative practices, which depend on other people (Ramstead, Veissière, & Kirmayer, 2017). In effect, remembering is not a matter of reaching down into one's memory archive or sedimented experience, but an embodied and enactive process of thinking with and through others (Laanes & Meretoja, 2021; Veissière, Constant, Ramstead, Friston, & Kirmayer, 2020). Memory then depends on community and on a shared understanding of history and of possible futures through which one can anchor and elaborate one's individual story.A direct consequence is that disconnecting a person from others, disembedding them from their social milieu, will lead to disruptions in memory and in the continuity of self. When the environment is toxic, this severance may sometimes be (partly) beneficial—but it always comes at a cost. Figuring out those costs, making them explicit, and ensuring that those whose history is being suppressed or overwritten by others have a chance to reclaim and write their own, is an ethical and pragmatic imperative.The denial of vital memories (recent or remote, personal or collective) causes fractures in the self that may disorganize the individual, install false consciousness, and cement the exclusionary and disvalued position of colonized, racialized, and [End Page 243] marginalized subjects. This process is not only—or even primarily—about memory. It is part of the structure of everyday life, inscribed in institutions and practices where colonial histories, racism, and economic exploitation are deeply entangled. Representations of the past are part of the way we construe the present and anticipate the future—but not every interpretive frame is a memory; there are structures in and of the moment that condition how we think about ourselves in health and illness and these too convey interests and biases disguised as "just the way things are."Fanon's Politics of Postcolonial Memory and IdentityWalsh offers a reading of aspects of Fanon's philosophy to reveal the workings of colonialism in and through memory. She is concerned with specific subsets of collective memories that are affectively charged and related to the identity of a group (Wertsch & Roediger, 2008). These memories are collective not simply they are shared by or distributed among the members of a group but because they define or constitute the collective itself.History is written largely by the powerful who create dominant or 'master' narratives that serve their own projects of legitimation and self-mystification (Trouillot, 2015; Lindqvist, 2021). But the creation of dominant narratives is not solely the province of those in power. There are many kinds of self-serving collective memory (Baumeister & Hastings, 2013)—from those related to the creation of nation states, which may ignore not only colonized peoples, but all ethnicities, religions or linguistic groups subordinated to the ideals of the dominant group (Anderson, 2006; Gunew, 2013; van Alphen & Carretero, 2015), to other forms of collective identity, even to those created by liberatory movements. These are maintained by institutionalization, ceremonial repetition and reenactment... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Memory and the Instituting Social ImaginaryNancy Nyquist Potter*, PhD (bio)Emily Walsh's Article on the way that colonialism is perpetuated in psychiatry through dominant collective memory is simultaneously exciting and challenging, and merits active engagement toward making changes (Walsh, 2022). This presents a challenge to clinicians to address entrenched, often subconscious, ways of being with and helping racialized people with historical memories and current experiences.Such changes are necessary in that (...) dominant collective memory is contributory to mental illness, as Walsh writes. It also contributes to what Walsh calls a traumatic loop, whichinvolves feeling unwell due to racist abuse or the effects racialization has on the psyche, then being unable to voice these concerns to the practitioners who desire to help you. Not having the opportunity to voice these concerns can make patients feel as though these memories are not important, thereby invalidating their own negative experiences of racialization.(Walsh, 2022, p. 232)For these reasons, it is crucial that psychiatrists fully understand the harm they can do by reproducing dominant collective memories and work to change this in themselves and in the institutional systems in which they see patients/service users.I focus on one question briefly and then turn to the heart of active engagement.The question concerns what the content of dominant collective memory is and how it might play out in a particular interaction in psychiatry. This is important for clinicians who want to learn what sorts of changes need to be made in order not to continue to enact colonialism and to avoid doing harm. Walsh does a fine job setting out forms of memory and how Fanon (and she) suggest that clinicians can assist patients toward liberation from dominant collective memory. Yet I am left with uncertainty about what sorts of dominant memory serve to deny the violence in the colonized. A bit of filling out on this idea would help the motivated to move toward change.A pressing question is how to facilitate such changes. Both the limitations and the possibilities of the social imaginary can help us understand why change is so difficult and yet how it nevertheless is possible and, in fact, necessary. The social imaginary, as Code explains it, "refers to implicit but effective systems" of values, meanings, interpretations of reality, norms for living, what counts as knowing and who can be knowers, that are found in a social-political order in ways that shape our sense of self, our ways of relating to others, our responsibilities, and a sense of place (Code, 2008, pp. 31–32). The instituted social imaginary, then, tells us what sorts of persons we should be and [End Page 241] how we should see and treat others. It shapes memories and limits which memories—and whose memories—get acknowledged and which ones and whose memories are erased or ignored. It is difficult to see for what it is because it is implicit and assumed to be fixed and natural. However, this is the instituted social imaginary, where the content of the imaginary is taken as given and is naturalized. It trades in stereotypes of Black and Indigenous and other people of color as well as stereotypes of queers, people living with disabilities, the homeless, and others. It is harmful in that it perpetuates those stereotypes, controls patients/ service users, negates their own personal and community identities, and erases episodic memory. It is difficult to change because it is entrenched and often not questioned. Nevertheless, the instituted social imaginary is not totalizing. There is hope, and energy, and excitement to be found in active engagement with an instituting social imaginary. Here, we find people and communities working to critique the given, the naturalized, and even ourselves: "Imaginatively initiated counterpossibilities interrogate the social structure to destabilize its pretensions to naturalness and wholeness, to initiate a new making" (Code, 2008, pp. 34–35). In the final section, I begin to fill out these moves in relation to Walsh's work on memory and psychiatry.Clinicians are trained to be good listeners, and many of them already practice good listening skills in interacting with their patients/service users. However, many patients' experiences... (shrink)

Abstract:This article defends the idea that colonialism still has a grasp on a valuable tool in the construction of our reality: memory. Developments in cognitive neuroscience and interdisciplinary memory studies propose that memory is far more creative and tied to one's imaginal capacities than we used to believe, suggesting that remembering is not simply a reproductive process, but a complex reconstructive process. Drawing on the psychiatric works of Frantz Fanon, in Alienation & Freedom; Black Skin, White Masks; and Wretched of (...) the Earth, this article seeks to illustrate the ways in which colonialism continues to be involved in this reconstructive memory process. Colonialism has affected both episodic memories, the kind we have as individuals regarding our own past, and collective memories, the intersubjective shared narratives we possess in our societies. I argue that dominant collective memories ought to be rejected as a means of self-preservation for racialized individuals because these memories do not do justice to the violence of colonialism. Nevertheless, rejection of dominant collective memories comes at a significant personal cost in our societies, as it creates a traumatic loop for racialized individuals. I propose that psychiatry itself plays an instrumental role in the alienation experienced by racialized individuals because psychiatry has not yet appreciated the ways in which colonialism continues to have a hold on memory. Piecing together a theory of remembering in Fanon's texts, this article suggests that this cycle of alienation can be broken, if psychiatrists incorporate Fanon's insights regarding memory into their practice. (shrink)

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

This paper asks when a natural disease kind is truly 'reactive' and when it is merely associated with a corresponding social kind. I begin with a permissive account of real kinds and their structure, distinguishing natural kinds, indifferent kinds and reactive kinds as varieties of real kind characterised by super-explanatory properties. I then situate disease kinds within this framework, arguing that many disease kinds prima facie are both natural and reactive. I proceed to distinguish ‘simple dependence’, ‘secondary dependence’ and ‘essential (...) dependence’ between a natural kind and its classification, and argue that a natural kind is only really reactive, in an important sense, under conditions of essential dependence. On this basis, I offer a principled hypothesis for why psychiatric kinds tend to be more metaphysically unstable than paradigm somatic disease kinds. (shrink)

In painting portraits, artists used to subtly place objects which reflected the biography or ambitions of the subject, but it is only more recently that objects which were part of the everyday life of institutionalized individuals became themselves part of the narratives offered by historians and other scholars of psychiatry. Excavating these remains – and finding ways to listen to them – is part of telling a fuller story of the people who lived for many years in mental institutions, and (...) indirectly of madness as both part of medical science, and a figment of our culture. (shrink)

Abstract:Since the birth of autism as a psychiatric category, autistic individuals have been described as preoccupied with the world of objects and detached from the world of subjects, thus marking a distinction between the “social” and the “non-social” still prevalent in autism research and diagnostic criteria. The aim of this article is to question this distinction by examining the role of things in autistic forms of social interaction. Drawing on qualitative data from an ongoing qualitative and phenomenological study on social (...) interaction among youth with autism, I argue that material things enjoy a sustaining and facilitating role in autistic social interaction for two reasons: First, by being sensible things open to tactile, auditory, and visual engagement, and second, by being things that incorporate normative practices. This relation between the material and the social in which the latter is mediated by the former, is beneficial to individuals with autism because it exploits a particular relation to materiality to consolidate a shaky attunement to the social world. I propose a materially mediated mode of interaction guided by the approaches to perception, embodiment, and materiality developed by Maurice Merleau-Ponty and James Gibson. This account puts pressure on the phenomenological emphasis on the face-to-face encounter and brings intersubjectivity into view as a many-faceted phenomenon realizable not only through interbodily dynamics but also through the material landscapes situating social encounters. (shrink)

Tilmes concludes his interesting and informative piece with the sentence that “analysis of psychiatric vagueness merits further consideration.” I agree with this point, as well as with his earlier assertion that how one understands psychiatric vagueness may implicate the diagnostic model that one adopts, and the research that one pursues. Fortunately, there has been recent attention to vagueness in psychiatry, addressing both degree-vagueness and combinatorial vagueness.Vagueness in psychiatry is related to a range of nosological debates, including about the...

In “semantic vagueness in Psychiatric Nosology,” Nicholas Tilmes offers a conditional claim for further consideration. The conditional is that “if psychiatric vagueness exists, there is reason to think that some cases of it are at least partially semantic.” From this, some conclusions worth investigating follow. In this brief commentary I will set out a question Tilmes introduces by, like him, drawing on a paper by Miriam Schoenfield, which also examines vagueness as semantic, epistemic or ontic though she draws a contrasting (...) conclusion for her subject matter: moral judgment. Highlighting a supposed contrast between semantic and ontic vagueness will also highlight an issue for... (shrink)

Ithank the commenters for their insightful remarks, from which I have learned much. In my article, I sought to explain psychiatric vagueness, which arises in borderline cases where there is no fact of the matter as to whether a diagnosis rightly can be said to apply.1 I argued “if psychiatric vagueness exists, then some of it is at least partially semantic”. A semantic account holds that vague utterances express different propositions since small gaps in how linguistic communities apply terms modify (...) their referents, making their precise extension indeterminate.2 On my view, this best accommodates intuitions about the nature of conditions and explains historical changes in the application of... (shrink)

Both woody and Wharne provided insightful commentary on my view that survivors of trauma have a duty to repair any impaired natural powers caused by symptoms of trauma by seeking empirically informed treatment. While Woody agrees with the main aspects of my view, they disagree with the motivation for seeking treatment. Woody argues that the “helplessness” caused by symptoms of post-traumatic stress disorder should motivate survivors to pursue treatment. I disagree with this characterization and will discuss my concerns in the (...) first part of this reply.Wharne contends that the symptoms of PTSD should be characterized as understandable responses to trauma rather than deviations from normal experience. We should... (shrink)

Abstract:Many discussions in the philosophy of psychiatry hinge on, among other things, the concepts of disorders, the role of underlying mechanisms, and the merits of various diagnostic models. Yet, some such disputes rest on assumptions about vagueness in the sense of susceptibility to the Sorites paradox as opposed to mere uncertainty in clinical practice. Studying borderline cases of psychiatric conditions—those where it is indeterminate whether applying a diagnosis is appropriate—may shed light on broader debates about the nature and boundaries of (...) these conditions. In this article, I will argue that if psychiatric vagueness exists, then some instances of it stem at least partially from how we describe the world instead of the state of the world or what we know about it. In other words, vagueness in psychiatric terms and concepts is at least in part semantic and neither solely epistemic nor solely ontic. On this view, slight differences in how various linguistic communities apply diagnostic terms modify their referents, making their precise extension indeterminate. This implies that we can sometimes answer questions about diagnosis by settling disagreements about language, which may provide traction in debates about the philosophy of nosology and help inform psychiatric practice. (shrink)

Professor katie harster has considered the phenomenon of psychological trauma, bringing philosophical understandings into play. She provides an informed account of observed “symptoms,” and associated treatments. I comment as a counseling psychologist, although I do not specialize in the evidence-based treatments that she describes. Usually, in my work with clients, we are trying to make sense of what has happened, with a concern for what might happen in the future. I am grateful therefore to colleagues who have the expertise that (...) I lack. I recall a discussion with one of these colleagues, who suggested that, “If a house is on fire, your priority should be to put out the flames and you can worry about how it caught... (shrink)

Abstract:Most mental health conditions, though appropriate targets of treatment, do not generate a moral obligation to seek treatment. Trauma, in contrast, is caused (at least in part) by an external event that can happen at any point in the individual’s life. Survivors often experience diverse and enduring symptoms that adversely affect their cognitive, social, emotional, and physical functioning (American Psychiatric Association, 2013). These global impairments diminish an individual’s ability to respond appropriately to morally relevant reasons and stimuli. Fortunately, symptoms of (...) trauma respond well to treatment (Bradley, Greene, Russ, Dutra, & Westen, 2005). The external etiology and effectiveness of treatment allows us examine the moral duties of someone with impaired moral faculties due to trauma within a Kantian framework. The symptoms of trauma interfere with their ability to cultivate what Kant calls “natural powers” of spirit, soul, and body (DoV 6:444–6:445). Kant’s discussion of the natural powers implies that we must possess a baseline level of functioning in these areas in order to fulfill our moral duties (DoV 6:444–446). By Kant’s own reasoning it seems that individuals who experience impairments in any of the three powers are morally obligated to cultivate these capacities. Using Johnson’s (2011) discussion of Kant’s duties to self and careful analysis of available treatments for trauma, I argue that individuals who experience symptoms of trauma and suffer from impairments in Kantian natural powers have an imperfect duty to themselves to repair these powers through empirically informed trauma treatment. (shrink)

One must freely admit that there is here a sort of circle from which, so it seems, there is no way of escape. In order the order of efficient causes, we assume that we are free so that we may think of ourselves as subject to moral laws in the order of ends. And we think of ourselves as subject to these laws because we have attributed to ourselves freedom of the will. Freedom and self-legislation of the will are both (...) autonomy and are hence reciprocal concepts.Post-traumatic stress disorder stems from an overwhelming experience of complete helplessness. The traumatized victim has utterly lost all sense of agency. He or she may well dissociate from that helpless, passive self and become... (shrink)

Autism is a highly heterogeneous phenomenon. Not only is it difficult to understand the various and diverse aspects of autism, their relation to each other is also complex and still poorly understood. In my article, “Material encounters. A phenomenological account of social interaction in autism,” I have addressed this heterogeneity by presenting an understanding of how social features of autism relate to behavioral features. Straddling this divide between the social and the non-social that still pervades much thinking in philosophy, psychiatry, (...) and psychology is crucial for understanding the diverse experiences of autistic persons and... (shrink)

Is autism a condition internal to the person that causes problems in social interaction? Or should we conceive of autism primarily at the level of interaction, as a “two-way” phenomenon that develops in the relation between the person with autism and her social-material environment? Over the last decade or so, this issue has increasingly gained interest, not only in academia, but also in the field of mental health care and in the wider public domain.Much is at stake here. Framing autism (...) as an internal deficit or rather as an interaction phenomenon has far-reaching implications for scientific research and clinical practice. It steers the focus of autism research by determining the kind of... (shrink)

Research on autistic spectrum disorder commonly describes autistic individuals as displaying: i) a preoccupation with the world of objects and ii) a withdrawal or detachment from the world of subjects. In her insightful and persuasive article, Sofie Boldsen argues that we should not fall into the trap of viewing the world of objects and the world of subjects in isolation from one another. Drawing from her qualitative and phenomenological study on social interaction in ASD, Boldsen urges us to recognize how (...) interacting with material objects can scaffold, facilitate, and regulate different forms of social connectedness in ASD. In doing so, the distinction between the “social” and “non-social” dimensions of ASD... (shrink)

This article presents the findings of a study about the history of aversion therapy as a treatment technique in the English mental health system to convert lesbians and bisexual women into heterosexual women. We explored published psychiatric and psychological literature, as well as lesbian, gay, and bisexual archives and anthologies. We identified 10 examples of young women receiving aversion therapy in England in the 1960s and 1970s. We situate our discussion within the context of post-war British and transnational medical history. (...) As a contribution to a significantly under-researched area, this article adds to a broader transnational history of the psychological treatment of marginalised sexualities and genders. As a consequence, it also contributes to LGBTQIA+ history, the history of medicine, and psychiatric survivor history. We also reflect on the ethical implications of the research for current mental health practice. (shrink)

Temporal experience and its radical alteration in schizophrenia have been one of the central objects of investigation in phenomenological psychopathology. Various phenomenologically oriented researchers have argued that the change in the mode of temporal experience present in schizophrenia can foreground its psychotic symptoms of delusion. This paper aims to further the development of such a phenomenological investigation by highlighting a much-neglected aspect of schizophrenic temporal experience, i.e., its non-emotional affective characteristic. In this paper, it denotes the type of an experience (...) wherein an afflicted individual experiences a pervasive pull or attraction coming from the past, present, and future. By employing Husserl’s account of affection, I argue that such an affectively prominent temporal experience is not yet another abnormality that happens to be present in schizophrenia. Instead, it is indicative of the core disturbance that underpins the schizophrenic temporal mode of experience. I identify such a disturbance as ‘affective modification dysfunction’ and employ it as a core concept with which I synthesize and organise heterogeneous components of schizophrenic temporal experience in their conceptual unity. For the sake of clear description, I organise those components into the following categories: 1.) Time Stop 2.) Ante-festum 3.) Déjà vu/vécu and 4.) Time Fragmentation. I conclude by demonstrating how approaching schizophrenic temporal experience from its affective dimension can further help us better understand its pre-psychotic phase known to precipitate schizophrenic primary delusion, i.e., delusional mood. (shrink)

In this paper, we explore the conceptual problems arising when using network analysis in person- centered care (PCC) in psychiatry. Personalized network models are potentially helpful tools for PCC, but we argue that using them in psychiatric practice raises boundary problems, i.e., problems in demarcating what should and should not be included in the model, which may limit their ability to provide clinically-relevant knowledge. Models can have explanatory and representational boundaries, among others. We argue that we can make more explicit (...) what kind of questions personalized network models can address in PCC, given their representational and explanatory boundaries, using perspectival reasoning. (shrink)

Scott Waterman's reflection on his experience with chronic pain and alternative treatments raises a fundamental question in medical epistemology: How can we know that an intervention will help people who are suffering?Waterman's details his trial of an alternative therapy with a dubious pathophysiological rationale. Despite the lack of research demonstrating its efficacy, and a lack of therapeutic benefit for him in particular, he acknowledges its benefit to others who were more attitudinally predisposed to it. This leads him to conclude that (...) one's personal beliefs and explanatory hypotheses play a role in the healing process. From this he concludes that data from clinical studies conducted according to... (shrink)

When we sit down to write an article that we plan to submit for publication, it is usually because we have completed some piece of empirical or conceptual work that has led us to conclusions we wish to share with our scholarly communities. In this instance, though, my essay under discussion was itself the means by which I sought to draw some conclusions about my recent experiences. Contrary to my initial plans—and my custom—I began writing without a clear idea of (...) where I would wind up. The commentaries, taken as a whole, affirm that my ambivalence about the topic at hand—fully revealed to me while formulating the article—came through, albeit in different ways to different commentators. And... (shrink)

Waterman's clinical anecdote highlights several important concepts related to aging, as his own journey with chronic pain leads him to explore an "unconventional" craniosacral therapy. He draws important connections between epistemic humility and wisdom, and he touches on related topics of cognitive neuroscience and ageism. In particular, his comment that, "Perhaps one hallmark of successful aging is when the growth of wisdom outpaces the depletion of mental plasticity" is ripe for further discussion.Waterman asks the question of whether epistemic humility results (...) from wisdom. While I surmise that the answer is yes, these concepts present interesting questions related to the nature of wisdom in the context of... (shrink)

Ethics, including medical ethics, has historically paid insufficient attention to epistemic rights and wrongs. This neglect fails to recognize the ways ethics and epistemology are intertwined. In the past fifteen years or so, there has been an interest in epistemic issues in medical practices, relationships with patients, and what is called epistemic injustice. Miranda Fricker identifies a kind of epistemic wrong as an injustice and a harm because it diminishes the speaker's capacity of a knower and treats her as uncredible (...) on the basis of prejudice due to their social identity as a member of a group. Scott Waterman inquires into the status of a rejection of unscientific methodologies... (shrink)

When a person in pain seeks medical attention, but his doctors cannot help him, a quest begins for alternative treatment, with its attendant imperative to identify the difference between genuine solace and snake oil. This is the task undertaken by Scott Waterman, and the situation faced by millions of people in chronic pain for whom conventional medicine proves ineffective, and who likewise then embark on a desperate search for comfort.Alternative treatments sit on a spectrum of empirical plausibility, from some like (...) hypnosis or mindfulness with demonstrable mechanisms of action in the brain and nervous system to others like Reiki and craniosacral therapy that purport to channel mysterious energy fields beyond the... (shrink)

It might seem too obvious to start with this quotation:O day and night, but this is wondrous strange!And therefore as a stranger give it welcome.There are more things in heaven and earth, Horatio,Than are dreamt of in your philosophy.But then, I think it is obviously correct, as Professor Waterman suggests, that "There are more things in heaven and earth" than simply the application of the scientific method to medical practice. Perhaps there are two quick comments to make about the quotation. (...) First, in Shakespeare's time, "philosophy" would have included science; second, Shakespeare apparently contemplated using "our" rather than "your." So Hamlet is speaking to us, not just to Horatio, and he's speaking about our... (shrink)

I would like to thank Scott Waterman for sharing what must have been very challenging personal circumstances. Waterman's reflections touched upon many complex issues. For my part, I would like to explore how Waterman's experience underscores the importance of epistemic humility regarding the limits of scientific knowledge and our sense of the meaning of scientific knowledge while still recognizing the significance and power of scientific knowledge. The first epistemic challenge presented by Scott Waterman's experience of "patienthood" that demonstrates the limits (...) of scientific knowledge is the ability to know pain. Of course, we have all known pain, but such firstperson knowledge would not qualify as scientific... (shrink)

Ratnayake's interesting paper challenges two claims, that cognitive distortions in depression involve epistemic issues; and that cognitive behavioral therapy can rectify those epistemic issues. We are going to discuss both claims here and offer some reasons not to underestimate the epistemic relevance of CBT. First, there may be epistemic issues underlying cognitive distortions in depression that CBT can effectively address, including blind acceptance of negative automatic thoughts and insensitivity to evidence. But, even if CBT were primarily in the business of (...) enhancing utility as opposed to validity, this would have significant, though indirect, epistemic benefits.All human agents, whether they have a... (shrink)

Psychotherapy is entrusted with the ingrate mission to fight an enigmatic and demanding scourge of humanity—mental illnesses—with all its emotional suffering and personal distress, let alone their behavioral, physiological, interpersonal and societal consequences–and if this would not be enough a challenge, psychotherapists are left alone to their own devices, which is nothing more than words and wisdom. Thus, the feat to achieve clinically relevant sustainable changes and reductions in face of these demands and possibilities can hardly be overrated.It might be (...) reasoned that this is made possible by the constant evolvement and refinement of psychological models and methods, which underlie, stimulate and steer... (shrink)

It is a truth universally known but not oft discussed that a journal article is often a fragment of a larger series of thoughts, or a longer piece of work. In entering into dialogue with Gaab and Bamboulis and Bortolotti, I will briefly describe the context of this paper, in the hopes that it will clarify my commitments and wider thinking on this area.This paper isolates one thread of my doctoral dissertation evaluating what I take to be two central theoretical (...) claims of CBT: first, that mental illness is related to patterns of thought with epistemic issues and secondly, that CBT works through rectifying these epistemic issues. In the broader work I argue that over time, because psychotherapy has... (shrink)

Justin Garson has recently advanced a Generalised Selected Effects Theory of biological proper function. According to Garson, his theory spells trouble for the Dysfunction Account of Disorder. This paper argues that Garson’s critique of the Dysfunction Account from the Generalised Theory fails, and that we should reject the Generalised Theory outright. I first show that the Generalised Theory does not, as Garson asserts, imply that neurally selected disorders are not dysfunctional. Rather, it implies that they are both functional and dysfunctional. (...) I argue on this basis that the Generalised Theory yields conflicting functional norms, and we that should reject it outright on these grounds. (shrink)

Having a body is one of those unquestionable certainties of which we could not really understand the negation: the latter would not be a legitimate doubt in our linguistic, and therefore the epistemic game. In facts, according to Wittgenstein, contravening certain cornerstones of our language game implies that the used combination of words is being excluded from the game, withdrawn from circulation. The idea of this paper is that what a mental illness is, prima facie, comes from here. Seriously questioning (...) whether someone else controls my actions or my thoughts or whether I am actually dead, then, are not just doubts: such believes are constitutively excluded from our way of seeing the world and characterized as illnesses, anomalies; otherwise, it would the complete destruction of the linguistic game we inhabit and therefore of the world as we know it, because we would not know on which bases something could be said truthfully or falsely if we do not even know that “this one is my hand”. Therefore, even if mental illnesses objectify themselves in correlative physiological dysfunctions, this comes only after the external recognition of some symptoms, and to recognize the external symptoms of an illness we have to treat them as such; hereby is suggested that we do treat something this way when it threatens the "ungrounded grounds" of our being-in-the-world. (shrink)

Martin Luther King Jr. claimed that “the salvation of the world lies in the hands of the maladjusted”. I elaborate on King’s claim by focusing on the way in which we treat and understand ‘maladjustment’ that is responsive to severe trauma (e.g. PTSD that is a result of military combat or rape). Mental healthcare and our social attitudes about mental illness and disorder will prevent us from recognizing real injustice that symptoms of mental illness can be appropriately responding to, unless (...) we recognize that many emotional states (and not just beliefs!) that constitute those symptoms are warranted by the circumstances they are responsive to. I argue that there is a failure to distinguish between PTSD symptoms that are warranted emotional responses to trauma and those that are not. This results in us focusing our attention on “fixing” the agent internally, but not on fixing the world. It is only by centering questions of warrant that we will be able to understand and expose the relationship between agents’ internal mental states and their oppression. But we also need to ask when someone’s emotional response is unwarranted by their experience (as in the case of someone who develops PTSD after a non-traumatic event). If we fail to do this—as, I claim, both our mental healthcare and the broader social world fail to do—we treat warranted and unwarranted emotions as on a par. This undermines the epistemic judgment of the agent who has warranted PTSD symptoms, resulting in her failing to trust her evaluation of whether her emotional response to her own trauma is warranted by that trauma, and thus failing to recognize her own oppression. (shrink)

In a rather long piece which an exhibition catalog has called „catholic propaganda”(Busch & Maisak, 2013, p. 342), Guido Görres reflected on madness and art, using Kaulbach’s iconic 1835 drawing of asylum inmates (Das Narrenhaus) as pretext. Görres wrote of “this hospital of the human spirit (…), this charnel ground of the living, who like specters roam, wearing on their foreheads the faded and almost illegible traces of their former names.”1(1836, p. 9). Overdramatic prose, but unlikely to strike one as (...) unprecedented. If anything, it has long been customary to exhibit a mix of fascination and revulsion when discussing the institutions which in the past two centuries at the same time sheltered and shattered those deemed mentally ill. (shrink)

Why was Raymond Tallis’s book Not Saussure largely ignored by literary critics? Here I present one response to this question: he does not offer a novel alternative system for literary interpretation. And I consider whether the situation is any different in other fields, introducing a rival to Simon Baron-Cohen’s empathizing-systematizing theory of gender differences when doing so.

The search for the “furniture of the mind” has acquired added impetus with the rise of new technologies to study the brain and identify its main structures and processes. Philosophers and scientists are increasingly concerned to understand the ways in which psychological functions relate to brain structures. Meanwhile, the taxonomic practices of cognitive scientists are coming under increased scrutiny, as researchers ask which of them identify the real kinds of cognition and which are mere vestiges of folk psychology. Muhammad Ali (...) Khalidi presents a naturalistic account of “real kinds” to validate some central taxonomic categories in the cognitive domain, including concepts, episodic memory, innateness, domain specificity, and cognitive bias. He argues that cognitive kinds are often individuated relationally, with reference to the environment and etiology of the thinking subject, whereas neural kinds tend to be individuated intrinsically, resulting in crosscutting relationships among cognitive and neural categories. (shrink)

Recently, psychologists have developed indirect measurement procedures to predict suicidal behavior. A prominent example is the Death/Suicide Implicit Association Test (DS-IAT). In this paper, I argue that there is something special about the DS-IAT which distinguishes it from different IAT measures. I argue that the DS-IAT does not measure weak or strong associations between the implicit self-concept and the abstract concept of death. In contrast, assuming a goal-system approach, I suggest that sorting death-related to self-related words takes effort because death-related (...) words trigger avoidance-impulses, which suicide ideation weakens. The DS-IAT taps into weakened automatic responses from the self-preservation system. Additionally, the suggested cognitive structure, illuminated with the selfish-goal theory, explains predictable suicidal behavior. (shrink)

According to Simon Baron-Cohen, having a male brain disposes a person to be more systematic than empathetic, whereas having a female brain disposes a person to be more empathetic than systematic. However, one can be a male human being with a female brain or a female human being with a male brain. Autistics have an extreme version of the male brain, says Baron-Cohen. In this paper, I present an “a priori” argument against the very idea of an extreme female brain.