At a time when different groups in society are achieving notable gains in respect and rights, activists in mental health and proponents of mad positive approaches, such as Mad Pride, are coming up against considerable challenges. A particular issue is the commonly held view that madness is inherently disabling and cannot form the grounds for identity or culture. This paper responds to the challenge by developing two bulwarks against the tendency to assume too readily the view that madness is inherently (...) disabling: the first arises from the normative nature of disability judgements, and the second from the implications of political activism in terms of being a social subject. In the process of arguing for these two bulwarks, the paper explores the basic structure of the social model of disability in the context of debates on naturalism and normativism; the applicability of the social model to madness; and the difference between physical and mental disabilities in terms of the unintelligibility often attributed to the latter. (shrink)

Delusions are deeply evidence-resistant. Patients with delusions are unmoved by evidence that is in direct conflict with the delusion, often responding to such evidence by offering obvious, and strange, confabulations. As a consequence, the standard view is that delusions are not evidence-responsive. This claim has been used as a key argumentative wedge in debates on the nature of delusions. Some have taken delusions to be beliefs and argued that this implies that belief is not constitutively evidence-responsive. Others hold fixed the (...) evidenceresponsiveness of belief and take this to show that delusions cannot be beliefs. Against this common assumption, I appeal to a large range of empirical evidence to argue that delusions are evidence-responsive in the sense that subjects have the capacity to respond to evidence on their delusion in rationally permissible ways. The extreme evidence-resistance of delusions is a consequence of powerful masking factors on these capacities, such as strange perceptual experiences, motivational factors, and cognitive biases. This view makes room for holding both that belief is constitutively evidence-responsive and that delusions are beliefs, and it has important implications for the study and treatment of delusions. (shrink)

En este artículo se plantea una discusión con el enfoque doxástico de los delirios. A pesar de que esta línea de análisis ha hecho importantes aportes a la comprensión del fenómeno, tiene dificultades importantes a la hora de aportar un marco explicativo completo de los delirios, porque deja por fuera el aspecto total de la experiencia y sigue basándose implícitamente en la idea de que podemos estudiar de manera separada e independiente los aspectos físicos, cognitivos y experienciales de un fenómeno (...) tan complejo. El artículo propone que, más allá de la decisión acerca de si se debe considerar a los delirios como creencias irracionales o no, o de si se puede concebirlos como creencias en absoluto, es necesario tener en cuenta la drástica transformación del mundo entero de la experiencia que se da en el sujeto delirante, tal como lo plantea la fenomenología. (shrink)

Contemporary perspectives on delusions offer valuable neuropsychiatric, psychoanalytic, and philosophical explanations of the formation and persistence of delusional phenomena. However, two problems arise. Firstly, these different perspectives offer us an explanation “from the outside”. They pay little attention to the actual personal experiences, and implicitly assume their incomprehensibility. This implicates a questionable validity. Secondly, these perspectives fail to account for two complex phenomena that are inherent to certain delusions, namely double book-keeping and the primary delusional experience. The purpose of this (...) article is to address both problems, by offering an understanding “from the inside”. Our phenomenological approach is a form of “radical empathy”, and crosses the Jaspersian limits of understanding. It compares delusional experiences with variations of reality experience in everyday life, and makes use of the structure of imagination. Six factors influencing the experience of reality are discussed and illustrated by clinical and non-clinical examples. These factors are: continuity, materiality and resistance, multiplicity of sensations and perceptions, intensity, the sense of authorship, and the complex role of intersubjectivity. I suggest that experiences of hypo- and hyperreality are not restricted to pathology, but have their place in everyday life as well. Delusional phenomena can be better understood by investigating the interplay of these six factors. With this framework, the two complex phenomena consequently prove to be better understandable to us. Our approach remains within the phenomenal experience and might thereby contribute to the validity of psychopathology. (shrink)

In this paper, we use a phenomenological approach to compare the unusual ways in which language can be experienced by individuals with schizophrenia or severe mood disorders, specifically mania and melancholia. Our discussion follows a tripartite/dialectical format: first we describe traditionally observed distinctions ; then we consider some apparent similarities in the experience of language in these conditions. Finally, we explore more subtle, qualitative differences. These involve: 1, interpersonal orientation, 2, forms of attention and context-relevance, 3, underlying mutations of experience, (...) and 4, meta-attitudes toward language. Such distinctions appear to reflect significant differences in underlying forms of subjectivity; they are broadly consistent with work in phenomenological psychopathology on other aspects of experience, including body, self, and social world. An understanding of such distinctions may assist with difficult cases of differential diagnosis, while also contributing to a better understanding of suffering persons and of psychological factors underlying their disorders. (shrink)

Delusions are often portrayed as paradigmatic instances of incomprehensibility and meaninglessness. Here we investigate the relationship between delusions and meaning from a philosophical perspective, integrating arguments and evidence from cognitive psychology and phenomenological psychopathology. We review some of the empirical and philosophical literature relevant to two claims about delusions and meaning: delusions are meaningful, despite being described as irrational and implausible beliefs; some delusions can also enhance the sense that one’s life is meaningful, supporting agency and creativity in some circumstances. (...) Delusions are not incomprehensible representations of reality. Rather, they can help make sense of one’s unusual experiences and in some circumstances even support one’s endeavours, albeit temporarily and imperfectly. Acknowledging that delusions have meaning and can also give meaning to people’s lives has implications for our understanding of psychotic symptoms and for addressing the stigma associated with psychiatric conditions. (shrink)

This current study is a pilot project designed to clarify changes in the lived world among people with diagnoses within the schizophrenia spectrum. The Examination of Anomalous World Experience was used to interview ten participants with schizophrenia spectrum disorders and a comparison group of three participants with major depressive disorder. Interviews were analyzed using the descriptive phenomenological method. This analysis revealed two complementary forms of experience unique toszparticipants: Destabilization, the experience that reality and the intersubjective world are less comprehensible, less (...) stable, and generally less real; and Subjectivization, the dominance of one’s internal, subjective experiences in the perception or interpretation of the lived world. Persons with depressive disorders, by contrast, did not experience disruptions of the reality or independence of the world or any significant disruptions of appearance or meaning. These results are consistent with contemporary and classic phenomenological views on anomalous world experience in schizophrenia. (shrink)

According to several researchers, core affect lies at the foundation of our affective lives and may be characterized as a consciously accessible state combining arousal (activated-deactivated) and valence (pleasure-displeasure). The interaction between these two dimensions is still a matter of debate. In this paper we provide a novel hypothesis concerning their interaction, by arguing that subjective arousal levels modulate the experience of a stimulus’ affective quality. All things being equal, the higher the arousal, the more a given stimulus would be (...) experienced as pleasant (or unpleasant). While marshaling some preliminary evidence in favor of this hypothesis, we also show how it might be relevant in reframing our conception of depressive disorders (i.e., major and bipolar depression). (shrink)

By examining first-person descriptions of thought insertion I show that thought insertion is a complex and heterogeneous phenomenon. People experiencing this phenomenon have huge difficulty explaining what it is like due to the bizarre nature of the experience. Through careful analysis of first-person descriptions I identify some of the characteristics of thought insertion. I then briefly examine some of the philosophical literature regarding agency, ownership and thought insertion and conclude that the standard account of the basic characteristics of thought insertion (...) is inadequate when we consider the phenomenon as it is experienced. First person descriptions suggest that thought insertion is characterised by a lack of personal ownership and not simply by a loss of agency or authorship. This is an important factor that should inform research and therapeutic intervention. We cannot hope to arrive at appropriate therapeutic intervention or identify underlying neuronal mechanisms for the experience if we cannot say what the experience actually is. I further suggest that more analysis of first-person description is required for an improved account of the phenomenology of thought insertion. (shrink)

The distinction of „understanding“ and „explaining“, formulated by Karl Jaspers in his „General Psychopathology“, has had a lasting effect on psychiatry. As a result, phenomenological, hermeneutic, or psychodynamic approaches have often been accorded only descriptive or epiphenomenal status, while the actual causes of mental illness have been sought in neurobiologically or genetically based explanations. In contrast, this paper defends the explanatory role of understanding and phenomenological approaches. To this end, two levels of explanation are distinguished and shown to be equally (...) justified in principle, namely, motivational explanation at the macro-level and physical explanation at the micro-level. The actual causal role of motivational, i.e., understandable connections is then demonstrated by means of a conception of circular causality, which includes downward causality. Finally, the explanatory role of phenomenological analyses is also shown in psychotic disorders that refuse motivational understanding, using the example of schizophrenic delusion. (shrink)