Philosophy of Psychiatry and Psychopathology

Human behavior and thought often exhibit a familiar pattern of within group similarity and between group difference. Many of these patterns are attributed to cultural differences. For much of the history of its investigation into behavior and thought, however, cognitive science has been disproportionately focused on uncovering and explaining the more universal features of human minds—or the universal features of minds in general. -/- This entry charts out the ways in which this has changed over the past decades. It sketches (...) the motivation behind the cultural turn in cognitive science, and situates some of its central findings with respect to the questions that animate it and the debates that it has inspired. Woven throughout the entry are examples of how the cognitive science of culture, and especially its elevated concern with different forms of diversity and variation, continues to influence and be influenced by philosophers. -/- One cluster of philosophical work falls within the traditional subject matter of philosophy of science, in this case of the cognitive and social sciences. Philosophers have analyzed and assessed the methods and evidence central to the scientific study of cognition and culture, and have offered conceptual scrutiny, clarification, and synthesis. Research in a second vein sees philosophers themselves contributing more directly to cognitive scientific projects, (co)constructing theories, helping build computational models, even gathering empirical data. A third kind of work is naturalistic philosophy or philosophy of nature, wherein philosophers seek to use results from the cognitive science of culture to inform or transform debates over long-standing philosophical questions, including questions about the nature of philosophy and philosophical methodology itself. (shrink)

While some form of loss of control is often assumed to be a common feature of the diverse manifestations of addiction, it is far from clear how loss of control should be understood. In this paper, I put forward a concept of decrease in control in addiction that aims to fill this gap and thus provide a general framework for thinking about addictive behavior. The development of this account involves two main steps. First, I present a view of degrees of (...) control as the degree to which an agent would be responsive to potential or counterfactual sufficient reasons to do otherwise. Second, I sketch an account of the relevant control-undermining factors in addiction that is consonant with my proposed view of degrees of control. Being a high-level functional property, reasons-responsiveness is particularly well suited to frame an account of control-undermining factors that is doubly pluralistic: it encompasses the contribution of factors both internal and external to the agent, and it is consistent with various proposals as to the precise nature of the anomaly taking place in the psychology of addiction. (shrink)

Medical kinds often have an interesting metaphysical structure: they constitute natural kinds but are in part explained or impacted upon by our practices of classification. This prompts the question: when is a natural disease kind truly reactive in response to our practice of classification, and when is it merely associated with or intersecting with a social kind? This paper proposes an answer. I begin with a permissive account of ‘real’ kinds and their structure, distinguishing natural kinds, indifferent kinds and reactive (...) kinds as varieties of real kinds characterised by super-explanatory properties. I proceed to situate disease kinds within this framework, arguing that many disease kinds prima facie satisfy the conditions for being natural as well as reactive. I distinguish ‘simple dependence’, ‘secondary dependence’ and ‘essential dependence’, and argue that a disease kind is only truly reactive under conditions of essential dependence. Finally, I offer a principled hypothesis indicating that neuropsychiatric kinds truly are more ‘on the move’ than paradigm biomedical kinds. (shrink)

Readers, please welcome the new Philosophy, Psychiatry, & Psychology editorial team of Senior Editors and our Managing Editor. We are grateful to keep our veteran Senior Editors Tim Thornton, Nancy Potter, Mona Gupta, and Werdie van Staden. However, we are equally grateful to have our new cohort of Senior editors, Awais Aftab, Anna Bergqvist, Derek Strijbos, and Michael Wong, revitalize our efforts. Many of you already know our efficient and capable Managing Editor, Sébastien Arviset, who has been with us for (...) several years now. This new influx of talent and energy we hope will invigorate the Journal and keep our editorial operations smooth and efficient. In alphabetical order, our editors can tell you a little... (shrink)

First, I want to thank PPP for the privilege of having my work read and commented on by esteemed colleagues. In this response, I briefly review some of the key issues that they have raised. These issues include 1) the usefulness of a definition of mental disorder for North American psychiatry, 2) the absence of a concrete criterion to address the demarcation problem, 3) the place and role of values in such a demarcation, and 4) the worries of over-inclusiveness, problematic (...) values and imposition of values.The first question that needs to be clarified is raised by Waterman's commentary : Is it really necessary to define mental disorder and mental health? Here I feel I should clarify a background assumption of... (shrink)

Psychiatry's relation to the rest of medicine is ambivalent. Its legitimacy as a specialty is often conceived as being closely linked to its fidelity to the fundamental paradigms of medicine, especially the centrality of diagnosis and the association of diagnosis with treatment indications. However, as Gagné-Julien notes, a major impetus behind the quest for a solution to the demarcation problem in psychiatry is "growing concerns regarding over-medicalization". Although it could appear that these two considerations point in opposite directions, both arguably (...) would be served by what Gagné-Julien labels "a satisfying definition" of mental disorder. Such a... (shrink)

In "On the Concept of 'Psychiatric Disorder,'" Miriam Solomon strives to resolve the tension between thinking of bereavement as a normal reaction to loss, and recognizing that its most extreme forms look very much like major depressive episodes and benefit from psychiatric treatment. To do this, she introduces the idea that a condition can be both normal and a mental disorder, or in other words, that some mental disorders are normal. Although I very much like the idea that some mental (...) are predictable responses to stressors, I have trouble making sense of the argument Solomon provides. I am going to focus on two reasons why.First, the concept of psychological injury is not new and does not do the work Solomon needs... (shrink)

About ten years ago, I participated in a consensus process on migraine nomenclature. Participants used a modified Delphi technique to explore their views about what migraine is. Candidate concepts included an illness, disease, syndrome, condition, disorder, or susceptibility. Initially, there was a wide range of views about which concept best fits our concept of migraine. Migraine—in common with many psychiatric disorders—is poorly understood by neuroscience. On scientific grounds, participants thought that "susceptibility" and "syndrome" describes our current knowledge well. However, participants (...) were concerned that terms like "susceptibility" and "syndrome" could lead to migraine not... (shrink)

Miriam solomon resuscitates a famous proposal of George Engel's to classify normal grief as a medical disorder. She has two main arguments justifying such a reclassification, one based on Engel's "wound analogy" and another a "Humpty Dumpty"-type argument that 'disorder' is a technical term that we can redefine any way we please. I consider them in turn.Solomon says: "I suggest that we allow a concept of "psychological injury" that is analogous to the concept of physical injury." Of course, we already (...) have a whole chapter of the Diagnostic and Statistical Manual of Mental Disorders devoted to psychological injuries in the form of "trauma- and stressor-related disorders" (this is where the new... (shrink)

Should madness be recognized as grounds for identity? Should society recognize and validate madness as diversity, be it psychological, behavioral, or emotional? To answer these questions, we might turn to medical consensus about which mental, behavioral, or emotional states count as mental illness. Unfortunately, the criteria for determining which mental health phenomena fall within the boundary of mental illness remain open to debate, creating what is known as "the boundary problem." Common approaches to resolving the boundary problem include naturalism, a (...) position that aims to answer the problem by positing a scientific concept of disorder based on value-free judgments about species-typical functioning. In An... (shrink)

Political activity on the basis of a shared identity has been with us for several decades. Race, sexual orientation, gender, and myriad other categories form the center-of-gravity around which social groups demand recognition of the validity and value of their self-understandings. How should social and political institutions respond to these demands? In contemporary social and political philosophy much of the weight of answering this question has fallen on developing a theory of recognition. That theory would then perform several functions: It (...) could provide an explanation as to the emergence and subsequent contestation of shared social norms; it could offer an account of the motivation that drives people to... (shrink)

The boundary problem on defining the conceptual scope and limits of a mental disorder may be tackled at either side of the boundary. On one side, philosophers and philosophically minded clinicians tried clarifying the concept of mental disorder and its related concepts of mental illness and dysfunction in their use and definition. On the other side, Mohammed Rashed's article gives a substantive and refreshing account of this neglected side in terms of social recognition. Thereby the boundary is clarified from the (...) outside through the limits set by the epistemic status of identity claims and the diachronic and synchronic unity of the self-conceptions that make up a person's identity.Stimulated by and building... (shrink)

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

Friends, family, and the Association of the Advancement of Philosophy and Psychiatry community mourn the death of Osborne "Ozzie" Wiggins this past May 18. In many ways, his story contributes a large portion to the founding of the AAPP, this journal, and the philosophy/psychiatry community worldwide.I met Professor Wiggins as a sophomore at Southern Methodist University in Dallas in 1974. I was a student in his twentieth-century humanities class. I didn't know at the time that he was in his early (...) years as an academic, having recently obtained his PhD in philosophy from the New School for Social Research in New York. Moreover, I hadn't yet encountered a teacher who was so audacious as to tell his students on... (shrink)

In this paper, my goal is to use an epistemic injustice framework to extend an existing normative analysis of over-medicalization to psychiatry and thus draw attention to overlooked injustices. Kaczmarek has developed a promising bioethical and pragmatic approach to over-medicalization, which consists of four guiding questions covering issues related to the harms and benefits of medicalization. In a nutshell, if we answer “yes” to all proposed questions, then it is a case of over-medicalization. Building on an epistemic injustice framework, I (...) will argue that Kaczmarek’s proposal lacks guidance concerning the procedures through which we are to answer the four questions, and I will import the conceptual resources of epistemic injustice to guide our thinking on these issues. This will lead me to defend more inclusive decision-making procedures regarding medicalization in the DSM. Kaczmarek’s account complemented with an epistemic injustice framework can help us achieve better forms of medicalization. I will then use a contested case of medicalization, the creation of Premenstrual Dysphoric Disorder in the DSM-5 to illustrate how the epistemic injustice framework can help to shed light on these issues and to show its relevance to distinguish good and bad forms of medicalization. (shrink)

What position on dualism does medicine require? Our understanding of that ques- tion has been dictated by holism, as defined by the biopsychosocial model, since the late twentieth century. Unfortunately, holism was characterized at the start with con- fused definitions of ‘dualism’ and ‘reductionism’, and that problem has led to a deep, unrecognized conceptual split in the medical professions. Some insist that holism is a nonreductionist approach that aligns with some form of dualism, while others insist it’s a reductionist view (...) that sets out to eradicate dualism. It’s important to consider each version. Nonreductive holism is philosophically consistent and clinically unprob- lematic. Reductive holism, however, is conceptually incoherent—yet it is the basis for the common idea that the boundary between medical and mental health disorders must be vague. When we trace that idea through to its implementation in medical practice, we find evidence that it compromises the safety of patient care in the large portion of cases where clinicians grapple with diagnosis at the boundary between psychiatry and medicine. Having established that medicine must embrace some form of nonreduc- tionism, I argue that Chalmers’ naturalistic dualism is a stronger prima facie candidate than the nonreductive alternatives. Regardless of which form of nonreductionism we prefer, some philosophical corrections are needed to give medicine a safe and coherent foundation. (shrink)

Debates on dualism continue to plague psychiatry. I suggest that these debates are based on false dichotomies. According to metaphysical physicalism, reality is ultimately physical. Although this view excludes the idea of entities distinct from physical reality, it does not compel us to favour neural over psychological interventions. According to methodological dualism, both physical and mental interventions on the world can be deemed effective, and both perspectives can therefore be thought to be equally ‘real’.

A brief critical notice of Dan J Stein's new book _Problems of Living: Perspectives from Philosophy, Psychiatry, and Cognitive-Affective Science_.

Debates concerning whether Attention Deficit/Hyperactivity Disorder mitigates responsibility often involve recourse to its genetic and neurodevelopmental etiology. For such arguments, individuals with ADHD have diminished self-control, and hence do not fully satisfy the control condition for responsibility, when there is a genetic or neurodevelopmental etiology for this diminished capacity. In this article, I argue that the role of genetic and neurobiological explanations has been overstated in evaluations of responsibility. While ADHD has genetic and neurobiological causes, rather than embrace the essentialistic (...) notion that it directly diminishes self-control and, therefore, responsibility, we ought to think of ADHD as constraining only some self-control practices. In particular, situational self-control strategies remain feasible for people with ADHD. However, not all individuals have access to these strategies. I suggest a way to evaluate responsibility in terms of situational rather than agential pleas, which tracks whether the individual had access to self-control behaviors. While I restrict my discussion to ADHD, the access-based approach is also relevant for assessments of responsibility for other cases where self-control failures are at stake. (shrink)

The aim of this paper is to provide a novel analysis of anorexia nervosa (AN) in the context of the sense of agency literature. I first show that two accounts of anorexia nervosa that we ought to take seriously— i.e., the first personal reports of those who have experienced it firsthand as well as the research that seeks to explain anorexic behavior from an empirical perspective— appear to be thoroughly in tension with one another in their descriptions of anorexic actions. (...) Rather than proceeding at this point by way of disregarding anorexic testimony as meaningless or insincere, I instead offer a positive account of the sense of agency in anorexia nervosa that renders these two depictions compatible. The resultant picture of anorexic behavior is one that accommodates current empirical findings while also providing valuable insight into how it is that anorexics can sincerely report feeling fully in control over their food restriction. (shrink)

How is conceptual foreignness received within an existing territory? I am grateful to my respondents for receiving my invocation of foreignness from phenomenological psychopathology not as a question of culture or nationality but rather, in terms of philosophical distance. As I ask in the article: how do we measure philosophical distance? Rather than complete agreement, or assimilation, or estrangement, perhaps distance is best calibrated through the small events of thought–understandings, misunderstandings, and clarifications, that punctuate even the most thoughtful and hospitable (...) reception, as I have been fortunate to receive from our respondents. In my brief response, I will focus on some of these smaller events... (shrink)

Schizophrenia involves significant disturbances to inter-subjective experience, the complex nature of which have become an increasingly important area for research in the philosophy of psychiatry. In “Schizophrenia as a Problem of Other Minds,”, Brighupati Singh offers a thought-provoking contribution to this trajectory by engaging Stanley Cavell’s idea of skepticism: the recognition that ordinary life is inherently fragile, and that the affective attunement between self and other is something that can be undone. Through detailed ethnographic and literary studies, primarily undertaken in (...) the Department of Psychiatry at the All India Institute of Medical Sciences in Delhi, Singh demonstrates how patients with... (shrink)

Over the past years, the intersubjective dimension of psychotic disorders, including schizophrenia, has gained increasing phenomenological attention. Psychopathologists and philosophers have developed ideas on how the social aspects of psychotic symptoms and experiences could be understood, in particular in their relation to the ipseity disturbance model, namely the idea that schizophrenia is essentially a disorder of the minimal self. Although the exact characteristics of the ipseity disorder hypothesis can differ from author to author, emphasizing certain phenomenological aspects like temporality or (...) embodiment... (shrink)

In his interesting comments on my article, Mohammed Abouelleil Rashed distinguishes between different senses in which one can try to render psychosis “intelligible.” One might try to explain what the psychotic worldview looks like from the inside and what it is like to go through this kind of experience, or present an intelligible theory about psychosis. Philosophers of psychiatry have, of course, mostly been preoccupied with the latter project, and, according to Rashed, so am I, despite my stated intention to (...) do the former.To some extent, I believe this is fair criticism. All philosophers whose interests touch on phenomenology are likely prone to over-intellectualizing their experiences, and I might likewise be... (shrink)

The challenge of understanding psychotic phenomena is one of the enduring problems in the philosophy of psychiatry. The first to formulate the problem in its philosophical dimension was Karl Jaspers in General Psycho-pathology. Jasper’s solution was rather pessimistic, for he argued that we cannot extend empathic understanding to certain phenomena, such as primary delusions. His work was followed by a long period of philosophical silence on the issue, and it was only three decades ago that philosophy began to engage once (...) again with the problem of understanding. Today there is a rich literature that explores this problem: from philosophy of language to European phenomenology, and from theories... (shrink)

In her wonderfully rich and insightful article, Sofia Jeppsson argues that, although a person with psychosis may seem to be strange and unintelligible to us, we nevertheless have duties of intelligibility toward them. And she draws upon her own experience to show that psychotic experiences and reasoning are more intelligible than we might have thought.In this brief commentary, I focus on why the assumption of hypothetical intelligibility is a duty of respect owed to those experiencing psychosis. In everyday human interaction (...) we expend significant resources on interpreting other people, largely to be able to predict and explain their behavior and to adjust our own behavior and expectations accordingly in our... (shrink)

I am grateful to the authors for their comments, and for the opportunity to respond. To clarify my approach, I sought to discuss the centrality of ‘set and setting’ at descriptive and normative levels in the Psychedelic Renaissance by focusing on the language of containment prevalent during my ethnographic research. Inspired by the study of material culture, I took up certain questions that can be asked of any container—how they are constructed and maintained, how leaks and overflows are dealt with, (...) the work done by their boundaries, and relationship of these containers to their contents. There are undoubtedly more questions but these are the ones I found fruitful to think with. My goal was to explore how the... (shrink)

Tehseen noorani’s article “Containment Matters: Set and Setting in Contemporary Psychedelic Psychiatry” presents a comprehensive, deeply researched ethnographic perspective on current research practices in psychedelic-assisted therapy. This is rapidly evolving terrain scientifically, clinically, legally, and socially. Noorani’s on-the-ground observations from within the Johns Hopkins research program are fascinating and timely given the numerous challenges faced in investigating and developing this emerging mode of psychiatric treatment as well as the complex history psychedelics represent. The level of detail afforded by Noorani’s embedded (...) work between 2015 and 2019 in characterizing the complexities of this... (shrink)

Psychedelics require cross-cultural, interdisciplinary study, and we were happy to see a contribution from the field of medical anthropology. Such a study holds the promise of characterizing the ways in which psychedelics are situated in contemporary societies, both within and beyond research and clinical contexts. Here, we offer some friendly criticism of the target article by Noorani while also highlighting various points of agreement and looking ahead to future research in this field.Noorani’s article is structured around an organizing theme of (...) “containment.” The term is not formally defined, but functions more as a poetic metaphor, allowing the author to explore various ways in which psychedelics... (shrink)

First, i would like to thank Drs. Gipps and de Haan for taking the time to formulate their commentaries; it is an honor to hear your perspectives on my work. Gipps presents a series of questions concerning my perspective, and seems interested in my view of rationality-based concepts. De Haan questions some of the similarities I see between our views and highlights several aspects of my perspective that she disagrees with. Both go beyond the current target article and engage with (...) my wider perspective. There is much that could be discussed further but I will keep my responses structured and brief.Gipps’s commentary is structured as a series of questions. I have structured my response around those same questions.My... (shrink)

The relevance and potential value of insights from enactivism for the field of psychiatry have been recognized for some time now. Recently, two overarching frameworks have been proposed, one by Nielsen, and one by me.1 As mentioned by Nielsen, we developed our approaches largely in parallel: I was not aware of Nielsen’s work, and he only became aware of my work in the last phase of his PhD. Nielsen compares our approaches and concludes that our frameworks are ‘largely compatible, do (...) different work to one another, and are best understood as complimentary’. I think, however, that the differences between our... (shrink)

Despite a recent surge in publications on Tourette Syndrome, we still lack substantial insight into first-personal aspects of “what it is like” to live with this condition. This is despite the fact that developments in phenomenological psychiatry have demonstrated the scientific and clinical importance of understanding subjective experience in a range of other neuropsychiatric conditions. We argue that it is time for Tourette Syndrome research to tap into the sophisticated frameworks developed in the philosophical tradition of phenomenology for describing experience (...) in a way that integrates discrete symptoms into an overarching experiential framework concerning the self, the body, and its modes of experience. Following a historical introduction that contextualises the pertinence of phenomenology to psychopathology, we distinguish this approach from the existing, psychologically oriented studies on TS that are also qualitative. We then outline gaps and opportunities for future research, including the sorts of questions that might be utilised in phenomenological interviews and why they are of potential benefit to research programs in philosophy, psychology, and neuroscience. In conclusion we address some of the broader implications for phenomenology of the body and philosophy of action. (shrink)

First-person reports of Major Depressive Disorder reveal that when an individual becomes depressed a profound change or ‘shift’ to one’s conscious experience occurs. The depressed person reports that something fundamental to their experience has been disturbed or shifted; a change associated with the common but elusive claim that when depressed one finds oneself in a ‘different world’ detached from reality and other people. Existing attempts to utilise these phenomenological observations in a psychiatric context are challenged by the fact that this (...) experiential ‘shift’ characteristic of depression appears mysterious and resists analysis in scientific terms. This paper offers a way out of this predicament. The hypothesis proposed is that when an individual becomes depressed, the individual departs from a state of ordinary wakeful consciousness and enters a distinctive global state of consciousness akin to dreaming and the psychedelic state. After unpacking and motivating this hypothesis in the context of research in consciousness science, I outline two of its important implications for the neurobiology of depression and psychedelic psychiatry. The upshot is a promising and conceptually well-motivated hypothesis about depression which is apt for empirical uptake and development. (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)

A concern for evidence can be viewed as a fundamental aspect of human existence. The biological structure of our bodies evolved during over thousands of years in which survival was predicated on a capacity to interpret small signs, such as crushed grass, smells, and sounds as evidence of the whereabouts of prey. The emergence of modern science and medicine was built on the ability to learn about what counted as evidence for what, and to observe it reliably. Evidence is information (...) that matters. Drinking a glass of water because one feels thirsty is not evidence, unless there is a suspicion of an underlying condition for which water intake is a symptom. Appraisal of evidence is a complex task. It relies on the... (shrink)

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

In a searching analysis, Radden elucidates key problems in justifying coercive treatment in anorexia nervosa despite a common intuition that it should have a place. Indeed, AN, perhaps more than any other condition, challenges the validity of a test purporting to provide a justification. Our generally accepted model for involuntary treatment is based on impaired decision-making capacity and "best interests." A treatment refusal by a person with "capacity" is to be respected, regardless of the consequences. (I exclude here the criteria (...) under conventional mental health law—a diagnosis of a "mental disorder" coupled with a risk of harm to self or to others—because they discriminate against people with a... (shrink)

With its focus on evidence, psychology has grown into a mature, professional, and scientifically supported practice over the last decades. In general, psychotherapy and psychological counselling have shown to be more efficacious than waiting it out and a staggering 350 specific treatments have been scientifically supported as effective. Although, evidencebased treatments seem to work equally well, not all people benefit from evidence-based treatments, and it often remains unclear why. This raised the field-wide concern of what works for whom and sparked (...) a wealth of research on specific ingredients, common factors, process factors, and intra- and... (shrink)

Cleckley's Mask of Sanity is indeed a brilliant and seminal work, but to read it is to recognize that the condition delineated in its pages differs importantly from the psychopathy most of us have in mind today, and certainly from the psychopathy Hare had in mind when he devised Psychopathy Checklist-Revised in "an attempt to develop a new research scale for the assessment of psychopathy in prison populations."1 Cleckley's psychopaths stay out of prison as a rule, instead passing into and (...) out of psychiatric hospitals in what Cleckley depicts as an absurd, unending cycle. Such crimes as they commit are almost never crimes of violence, and they appear to Cleckley, and the reader, not so much as threats to society as... (shrink)

Clinical research is difficult. It confronts massive heterogeneity in its participants, who are real people bumping around the world in complex ways. Clinical research in psychology is doubly difficult, since it tries systematically to study conditions that are inherently difficult to systematize. In their thoughtful and closely argued article, Truijens et al. emphasize these difficulties, and describe a novel challenge to psychotherapy research: that the support for many evidence-based therapies is weaker than previously recognized because it relies on patient-reported outcome (...) measures that often yield invalid results. Despite the initial plausibility of their position, however, their... (shrink)

Psychopathy is among the more widely discussed personality disorders. Psychopathy is intriguing for many reasons, one of which is that many of the most famous and heinous villains, real or imagined, are psychopathic. Understanding how a person could be so evil is clearly a very important, fundamental social concern. Yet, there remains no consensus as to even an authoritative description of the disorder. It is our impression, perhaps incorrectly, that Justman is arguing for a central importance of lack of guilt.We (...) begin by noting that it is only the rare person who has all of the features of a respective personality disorder (Widiger &... (shrink)