Abstract

In lieu of an abstract, here is a brief excerpt of the content:Subjective Knowledge, Mental Disorders, and MedsHow to Parse the EquationMark D. Rego (bio)Keywordspsychopathology, antidepressants, suicidality, subjective experience, pre-reflectiveA few weeks, ago I was walking down the hall to my office when I spotted my brother-in-law coming the other way. This was odd on two accounts. First, he lives in Kentucky (I am in Connecticut) and second, he is at least a foot taller than the man in my hallway. Nonetheless, I struggled to figure out why he was there. The resemblance was so striking it took me a minute or two to convince myself it was not him. Even after such convincing, the feeling that it was him remained.Later, I imagined that had I just returned from a crack cocaine den I would have been hypervigilant, if not paranoid, and consequently would be certain that my brother-in-law had arrived unannounced. Furthermore, I would probably assume that he was up to no good.How did I retain a strong feeling of recognition, the feeling that maybe it was really him, when I already concluded otherwise? And why, were I on crack cocaine, would the obvious facts be useless in rendering a decision about the identity of the man in the hall? Last, why would the post-cocaine man in the hall become a nefarious brother-in-law rather than a benign one?If I just computed some symbols to figure this out, wouldn't the feeling have gone away? If I activated a brother-in-law neural network, how did I come to acquire an evil brother-in-law neural network? And why wouldn't that go away either?In his article in this issue of Philosophy, Psychiatry, & Psychology, Hadreas looks at questions like these through the prism of before and after effects of people treated with selective serotonin reuptake inhibitors (SSRIs). Hadreas investigates the implications of a straightforward recomputation of self-awareness when treated with these medicines and finds such approaches unsatisfying and incomplete in their explanatory power. (My example looks at a type of awareness, but not specifically self-awareness, as does Hadreas. Furthermore, my paradigm asks about computational conclusions using language more common in psychiatric literature, whereas Hadreas uses standard philosophical terms. Although not isomorphic, I believe the interchange of the two remains true to the issues Hadreas is addressing). [End Page 57]In my example, there is clearly something else going on than the incorrect arrangement of symbols or the misfiring of nodes in a network that influences how I feel and what I think. Neither reason nor empiricism seem to serve me well here. Hadreas utilizes Husserl to begin to unpeel the layers of self-awareness and self-states that intermix to form the shifts and contradictions which are so common in psychiatric treatment (and in common experience as I describe).This is a welcome reckoning; the psychiatric literature is overflowing with unquestioned premises about the neuropsychiatric correlates of reason and empirical approaches (described more as computation and neural networks in the literature—again, not strictly analogous, but the same criticisms apply) Hadreas is critical of. Unfortunately, Hadreas has navigated through a sea of highly questionable assumptions about the psychopharmacology of depression to illustrate his points. This is due in large part to the common practice of consulting literary narratives and critics rather than one of immersion in the literature as a whole and the daily life of patients and active clinicians. He arrived at his destination despite this, because many of these details did not affect his particular analysis. However, to look forward to a continuation of this work and clarify some important issues I devote most of my commentary to these issues. The points I raise are more extensively discussed in a previous edition of this journal (Rego 2005).Affect to Reason ShiftLet's begin with the idea that SSRIs work by dampening emotions. An extension of this idea is that they dampen negative emotions and strengthen positive ones like assertiveness, confidence, and optimism. An even further development in this direction is that, by dampening strong emotions, cognitive enhancement takes place with SSRI treatment. A summary observation then is that SSRIs facilitate...