Philosophy of Psychiatry and Psychopathology

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.

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)

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)

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.

Christian miller invites further clarification about the relationship between accountability and autonomy. Whereas embracing accountability to others for one’s responsibilities in those relationships emphasizes relationality, autonomy accents the individual’s own capacities to exhibit agency in enacting one’s decisions. Accordingly, we theorize that relational capacities for empathic concern and perspective-taking are especially important in the virtue of accountability. The capacity for self-regulation may serve both one’s autonomous pursuits and accountability for carrying out one’s responsibilities...

Peteet, witvliet, and Evans have done a great service in bringing to our attention the importance of accountability in all aspects of psychiatric care, in assessments of accountability in our patients’ lives—its role in treatment planning and engagement, and identifying it as a goal of treatment itself. In their paper, the authors distinguish the virtue of accountability from merely being accountable to another person by emphasizing one’s embrace of being accountable to others as a motivated disposition that furthers human flourishing. (...) They identify it as a sub-virtue of justice, defined as giving to others what is their due, and delineate two fundamental aspects of accountability that are in keeping with... (shrink)

John peteet, charlotte witvliet, and c. stephen evans are to be commended for drawing our attention to the relatively neglected virtue of accountability, and for making the case that it is an important virtue to cultivate in general and specifically within the context of psychiatry. I find little to object to in their discussion, and so my comments here will be more of an invitation for them to address in greater detail two important issues: the relationship between accountability and autonomy, (...) and the role of motivation in the virtue of accountability.According to Peteet et al., a person with the virtue of accountable is someone who “embraces being accountable”. The virtue is said to... (shrink)

Ivery much appreciated the thoughtful response to my Datafied brains and digital twins: lessons from industry, caution for psychiatry provided by Douglas W. Heinrichs. I am encouraged that we differ merely in emphasis among the issues upon which we share a wider understanding.In his response, Assessing the Dangers of the Next Reductionist Fantasy, Heinrichs elaborates upon an underemphasized dimension in my Digital Twin article. Heinrichs approaches this dimension through “a semantic understanding of scientific theorizing.” According to this understanding, all science (...) is fundamentally concerned with model making, and testing of models whose efficacy is evaluated on an adaptable basis relating to factors including... (shrink)

In this thought-provoking article, a number of very valid and serious ethical concerns are raised about the potential application of research in neuro-circuitry to future treatment devices in clinical psychiatry. Rainey elaborates the basis for his concerns within the framework of a hypothetico-deductive notion of science,, and in his characterization.) From this perspective, the critical source of problems derives from an interposed step C in which “techniques are applied to extract relevant signals from the complicated raw signal.” The resulting characteristics (...) of brain recordings can be taken to be “deduced by algorithms, though they are themselves inductive engines through and through”... (shrink)

This is a commentary on Humpston, C. S. (2022). “Isolated by Oneself: Ontologically Impossible Experiences in Schizophrenia.” Philosophy, Psychiatry, & Psychology 29(1), 5–15. It is published with an additional commentary by H. Green and Humpston’s response.

Philosophers have hitherto only interpreted the world in various ways; the point is to change it.Karl marx’s distinction between interpreting the world and changing it points by extension to the state of contemporary philosophy and psychiatry. The 1990s resurgence of interdisciplinary work in this area was driven equally by phenomenological scholarship and by initiatives in analytic philosophy. The former reflected the focus in phenomenology on ‘what it is like’ to experience a given mental symptom with the aim of reconstructing the (...) life-worlds of people experiencing mental disorders, while the latter reflected directly or indirectly the influence of J. L. Austin and others from... (shrink)

In the field of clinical practice, there does not seem to be too much contention about what schizophrenia is, at least from a high level. After all, there are various diagnostic systems and guidelines, all of which point toward schizophrenia as a psychotic syndrome which likely forms a continuum with other psychotic disorders. It may sound obvious that, according to the current definitions, the major commonality between schizophrenia and all other psychoses is psychotic symptoms; more precisely, delusions and hallucinations. Any (...) description, or ‘phenomenology’ as most clinicians view it, can be found in these diagnostic manuals. However, is there anything at all that sets schizophrenia apart from the other... (shrink)

This book focuses on two important, interlinked themes in psychiatry, i.e., the relation between self (or: person), context and psychopathology; and the intrinsic value-ladenness of psychiatry as a practice. -/- Written against the background of scientistic tendencies in today’s psychiatry, it is argued in Part I that psychiatry needs a clinical conception of psychopathology alongside more traditional scientific conceptions; that this clinical conception of psychopathology must be based on a fundamental rethinking of the interaction between illness manifestations, contextual influences and (...) the patient as person, such that psychopathology is conceived as the product of this interaction rather than as the outward manifestation of a broken mechanism within the patient. -/- In Part II, it is shown that self- and context-related factors have a large impact on who one is as a professional. I argue that an analysis is needed of the normative aspects of the relations that sustain and frame professional role-fulfilment. This analysis culminates into a so-called normative practice model (NPM) which distinguishes between qualifying, conditioning and foundational principles (or: rules, norms). The normative practice model helps to locate and resist scientistic defenses of the legitimacy of psychiatry and to replace them by a positive account that provides clinicians (and scientists) the conceptual tools they need to justify what they do in broader contexts. The main thrust of the argument is to show that psychiatry needs a value-sensitive account of its legitimacy, in which other normative dimensions are recognized than those that sustain the expert role. Psychiatrists should in other words not defend the legitimacy of their profession by referring to the expert role solely but provide a broader account in which justice is done to the broader social, legal, and economic contexts of professional activity. The analysis of this inherent normativity begins within clinical practice, it extends to the concept of disease as well as to wider domains of psychiatric care and the sociology of professions, and, finally, amounts into an analysis of the value-ladenness of interactions between healthcare institutions, the government, professional organizations and patient groups. (shrink)

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)

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 to 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 may be are more metaphysically unstable 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)

This is a preprint draft. Please cite published version (DOI: 10.1111/mila.12385). 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)

My response to Rashed's critique of my account as theorizing instead of showing what it is like.

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)