Spirit possession is a common phenomenon around the world in which a non-corporeal agent is involved with a human host. This manifests in a range of maladies or in displacement of the host's agency and identity. Prompted by engagement with the phenomenon in Egypt, this paper draws connections between spirit possession, and the concepts of personhood and intentionality. It employs these concepts to articulate spirit possession, while also developing the intentional stance as formulated by Daniel Dennett. It argues for an (...) understanding of spirit possession as the spirit stance: an intentional strategy that aims at predicting and explaining behaviour by ascribing to an agent beliefs and desires, but is only deployed once the mental states and activity of the subject fail specific normative distinctions. Applied to behaviours which are generally taken to signal mental disorder, the spirit stance preserves a peculiar form of intentionality where behaviour would otherwise be explained as a consequence of a malfunctioning physical mechanism. Centuries before the modern disciplines of psychoanalysis and phenomenological-psychopathology endeavoured to restore meaning to 'madness', the social institution of spirit possession had been preserving the intentionality of socially deviant behaviour. (shrink)

The effects of mental disorder are apparent and pervasive, in suffering, loss of freedom and life opportunities, negative impacts on education, work satisfaction and productivity, complications in law, institutions of healthcare, and more. With a new edition of the 'bible' of psychiatric diagnosis - the DSM - under developmental, it is timely to take a step back and re-evalutate exactly how we diagnose and define mental disorder. This new book by Derek Bolton tackles the problems involved in the definition and (...) boundaries of mental disorder. It addresses two main questions regarding mental illness. Firstly, what is the basis of the standards or norms by which we judge that a person has a mental disorder - that the person's mind is not working as it should, that their mental functioning is abnormal? Controversies about these questions have been dominated by the contrast between norms that are medical, scientific or natural, on the one hand, and social norms on the other. The norms that define mental disorder seem to belong to psychiatry, to be medical and scientific, but are they really social norms, hijacked and disguised by the medical profession? Secondly, what is the validity of the distinction between mental disorder and order, between abnormal and normal mental functioning? To what extent, notwithstanding appearances, does mental disorder involve meaningful reactions and problem-solving? These responses may be to normal problems of living, or to not so normal problems - to severe psycho-social challenges. Is there after all order in mental disorder? With the closing of asylums and the appearance of care in the community, mental disorder is now in our midst. While attempts have been made to define clearly a concept of mental disorder that is truly medical as opposed to social, there is increasing evidence that such a distinction is unviable - there is no clear line between what is normal in the population and what is abnormal. 'What is Mental Disorder?' reviews these various crucial developments and their profound impact for the concept and its boundaries in a provocative and timely book. (shrink)

Psychiatric ethics as professional and biomedical ethics -- The distinctiveness of the psychiatric setting -- Psychiatric ethics as virtue ethics -- Elements of a gender-sensitive ethics for psychiatry -- Some virtues for psychiatrists -- Character and social role -- Case studies in psychiatric virtues.

Cultural congruence is the idea that to the extent a belief or experience is culturally shared it is not to feature in a diagnostic judgement, irrespective of its resemblance to psychiatric pathology. This rests on the argument that since deviation from norms is central to diagnosis, and since what counts as deviation is relative to context, assessing the degree of fit between mental states and cultural norms is crucial. Various problems beset the cultural congruence construct including impoverished definitions of culture (...) as religious, national or ethnic group and of congruence as validation by that group. This article attempts to address these shortcomings to arrive at a cogent construct. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.4 (2003) 357-359 [Access article in PDF] Learning From Disunity Jennifer Radden In describing his four cases, Lloyd Wells (2003) throws out a challenge. He asks his readers to recognize similarities between their own more ordinary self-identity and the discontinuous narrative and seeming absence of a steady authorial subject resulting from disorders such as depression, schizophrenia, and Multiple Personality Disorder (MPD). In light of these (...) cases, he implies, the unity of the self we have unreflectively assumed until now to be universal requires reconsideration. Psychopathology seems to force a sharpening, clarification, and closer conceptualization of our philosophical theories of self-identity.While acknowledging that philosophical categories and theories of narrative identity can help us to assess the ravages wrought by mental disorder, James Phillips (2003) is also respectful of the contribution of psychopathology to theorizing about identity: he ends his thoughtful discussion of Wells' cases by looking not at how philosophy can enlighten us about psychopathology but at how cases such as these can illuminate philosophical categories. Speculating on the tragic absence of narrative identity in schizophrenia and advanced Alzheimer's disease, Phillips concludes that, as he puts it, psychopathology "reconfigures the contours of our notion of narrative identity and requires a looser, minimized, nonsubstantial notion of the narrative self" and argues for a self that "transcends the limits and loss of narrative identity" (2003, 326).I also support the approach, shared by Wells and Phillips, that allows psychopathology to clarify and illuminate philosophical concepts and categories. Here, in a handful of footnotes to their insights, I want to point out ways that cases from psychopathology reveal distinguishable elements or aspects of self-identity often confused because, in the normal case, they form an unquestioned and apparently indissoluble unity. One of these is the difference between synchronic and diachronic subjective unity. Another is the difference between the elements of authorship and temporality in conceptions of narrative identity. And last is the difference between what I shall call constitutional identity and self-identity. Synchronic and Diachronic Identity The difference between synchronic and diachronic identity, elements so seamlessly blurred in more ordinary subjectivity, is nicely illustrated by Wells' cases. Mary's dissociative states leave her with interruptions in her diachronic identity: the memory of her experiences is fragmented and incoherent. Yet at any given moment, her synchronic unity is unimpaired. She recognizes and can describe the oneness of her experiences and their boundaries; she is aware which are her experiences and which are not. For all her scatteredness and dissociation, as Phillips puts it in describing Mary's case: "there is a strong and [End Page 357] articulate narrator... the fact remains that this I is there" (2003, 318).In contrast, the shy and self-conscious adolescent Edward seems to suffer not from diachronic but from synchronic disunity. (And if anything, as Melvin Woody [2003] points out, Edward's "narrative" seems to fuel the comparisons which so distress him about his uncomfortable and distressing subjective experiences.) Edward struggles to "delineate what's inside my mind and what's outside it... " When he thinks about what he sees as a firm boundary around the self in others which is not well demarcated in his own case, he remarks "... I completely lose any sense of myself" (p. 330).Thought insertion or "made" feelings in psychosis provide similar instances of such fracturing of their sufferer's synchronic identity (it is perhaps such experiences that Edward alludes to here; Wells' quotations are too sparse for us to tell). Just as Edward complains of losing any sense of himself, so other sufferers from these alarming conditions complain of losing a sense of the self's boundaries, of possession and mind control, and of being the unwelcome host to alien thoughts, feelings, and intentions.In normal experience diachronic and synchronic unity—my oneness across time and at a time—form a seamless whole. These cases, where one or the other is compromised, vividly remind us that these two forms of unity must be distinguished. Narrative Identity Phillips (2003) explicates an analysis of narrative identity which comprises entwined but distinguishable features: a narrating... (shrink)

This book addresses these and a cluster of other questions about changes in the self through time and about the moral attitudes we adopt in the face of these...

Patients with psychosis often have poor insight into their illness. Poor insight into illness is, at least among patients with psychosis, a good predictor of treatment non-adherence. This is no mystery, for as Xavier Amador asks, "Who would want to take medicine for an illness they did not believe they had?" What is curious is that some patients with psychosis do adhere to treatment despite a lack of insight. Why do these patients adhere to treatment, given that they do not (...) believe they are ill to begin with? In this paper, I attempt to answer this question. I do so by first considering cases of non-psychotic patients who adhere to treatment despite a lack of insight. I point out that these sorts of cases are commonplace, and attempt to explain why they arise. The explanation is given in terms of anticipated treatment benefits. However, these benefits are not conceptualized by the patient in terms of pathology. The patient does not, in other words, think of such benefits in terms of illness, symptoms, treatment, and so forth. I then argue that the proposed explanation can be extended to account for why psychotic patients without insight sometimes adhere to treatment. I conclude by drawing out some of the practical implications of the proposed view. I first argue, on practical as well as ethical grounds, that improving insight for purposes of treatment adherence is misguided. I then suggest that such adherence might be increased simply by explaining treatment benefits in language that does not presuppose that the patient is, in any sense, "ill," "diseased," "sick," "unwell," and so on. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Spiritual Experience and PsychopathologyMike Jackson and K. W. M. Fulford (bio)AbstractA recent study of the relationship between spiritual experience and psychopathology (reported in detail elsewhere) suggested that psychotic phenomena could occur in the context of spiritual experiences rather than mental illness. In the present paper, this finding is illustrated with three detailed case histories. Its implications are then explored for psychopathology, for psychiatric classification, and for our understanding of (...) the concept of mental illness. It is argued that pathological and spiritual psychotic phenomena cannot be distinguished by 1) form and content alone (as in traditional psychopathology), 2) by their relationship either with other symptoms or with pathological causes (as in psychiatric classification), or 3) by reference to the descriptive criteria of mental illness implied by the “medical” model. The distinction is shown to depend, rather, on the way in which psychotic phenomena themselves are embedded in the values and beliefs of the person concerned. This in turn is shown to have implications for diagnosis (it shows the need for clinicians to attend to the values and beliefs of individual patients), for treatment (it points to a cognitive problem-solving model), and for research in psychopathology (especially as related to the emerging sciences of dynamic brain imaging and cognitive neuroscience).Keywordsfirst rank symptoms, schizophrenia, delusion, hallucination, thought disorder, religious experience, mystical experienceIntroductionThis paper explores some of the conceptual and practical implications of the finding that phenomena which in a medical context would probably be diagnosed as psychotic symptoms, may occur in the context of non-pathological, and indeed essentially benign, spiritual experiences.The existence of non-pathological psychotic experiences of this kind (we will call them “psychotic phenomena” as distinct from “psychotic symptoms”—see also Endnote 1, terminology) was a key finding in a study carried out by one of us (MJ) at the Alister Hardy Research Centre (AHRC) in Oxford. Details are given elsewhere both of the overall empirical findings of the study, including the relationship between spiritual experience and personality variables, and of a hypothetical cognitive problem-solving model of these phenomena (Jackson 1991, and forthcoming a and b). In the present paper, 1) the background to the study is described briefly in relation to earlier work on the possible links between spiritual experience and psychopathology; 2) some of the psychotic phenomena identified are illustrated with three detailed case histories; 3) the significance of these phenomena is reviewed for our understanding respectively of psychopathology, of diagnostic syndromes, and of the concept of mental illness; and 4) some of the practical implications of the study for clinical work and research in psychiatry are indicated.BackgroundIt has long been recognized that there are similarities between spiritual and psychotic experiences. [End Page 41] William James (1902), for example, argued that “in delusional insanity, paranoia as they sometimes call it, we may have a kind of diabolical mysticism, a sort of religious mysticism turned upside down” (426). Other commentators have noted a wide variety of phenomena, such as time distortion, synesthesias, loss of self-object boundaries and the transition from a state of conflict and anxiety to one of sudden “understanding,” all of which are reported in both spiritual and psychotic experiences (Buckley 1981; Watson 1982; Wapnick 1969; and Wootton and Allen 1983).Yet the similarities notwithstanding, the distinction between these two kinds of experience can be crucially important. Spiritual experiences, whether welcome or unwelcome, and whether or not they are psychotic in form, have nothing (directly) to do with medicine (Fulford 1996a). It would be quite wrong, then, to “treat” spiritual psychotic experiences with neuroleptic drugs, just as it is quite wrong to “treat” political dissidents as though they were ill (Fulford, Smirnoff and Snow, 1993). Pathological psychotic experiences, on the other hand, or psychotic symptoms, are by definition a proper object of medical treatment, sometimes even against the wishes of the person concerned. Hence it would be both negligent and, as Wing (1978) put it, morally “repellent,” to leave untreated someone who is genuinely ill (244).Given how much turns on the distinction between spiritual experience and psychopathology, it is perhaps not surprising that scholarly discussion of the relationship between them has at times... (shrink)

In this paper, I offer one moral reason to eschew antidepressant medication in favor of cognitive therapy, all other things being equal: taking antidepressants can be a form of self-objectification. This means that, by taking antidepressants, one treats oneself, in some sense and some cases, like a mere object. I contend that, morally, this amounts to a specific form of devaluing oneself. I argue this as follows. First, I offer a detailed definition of “objectification” and argue for the possibility of (...) self-objectification on this definition. I then explain why this form of self-objectification is morally problematic. (Morally problematic does not mean morally impermissible. It means, instead, that there is a moral reason opposing the activity in question). After, I describe how taking antidepressants can count as self-objectifying. Finally, I defend my thesis against a key objection offered by Levy. Thus, assuming that antidepressants and cognitive therapy are equally efficacious, and that all other things are equal, the self-objectifying character of antidepressants is a compelling reason to regard cognitive therapy as a first-choice treatment for depression. (shrink)

A pluralistic view of psychiatric classification is defended, according to which psychiatric categories take a variety of structural forms. An ordered taxonomy of these forms—non-kinds, practical kinds, fuzzy kinds, discrete kinds, and natural kinds—is presented and exemplified. It is argued that psychiatric categories cannot all be understood as pragmatically grounded, and at least some reflect naturally occurring discontinuities without thereby representing natural kinds. Even if essentialist accounts of mental disorders are generally mistaken, they are not implied whenever a psychiatric category (...) that is not pragmatically grounded is posited. (shrink)

This article argues humans should not be defined strictly at their physical boundaries with clear distinctions between anatomical bodies, mental states, and the rest of the world. Rather, diverse mental states, which are often diagnosed as “mental illness,” take shape within greater environmental forces and flows, including those that are constructed online. Drawing from a multi-sited ethnography of The Icarus Project, a radical mental health community, the author situates online narratives written by two of its members within posthuman emotional ecologies (...) in which the exchange of ideas online affects mental states in a profound way. These narratives can be seen as a new type of psychiatric resistance based in new technologies, one that “uncivilizes” mental illness by searching for alternative frameworks and metaphors to understand lived experiences with mental distress. This ethnographic perspective differs significantly from traditional bio-psychiatric models and interventions and can offer both patients and mental healthcare providers with an alternative language to frame mental health. (shrink)

Over the past 12 years, I’ve had the good fortune of collaborating with others to create a project which challenges and complicates the dominant biopsychiatric model of mental illness. The Icarus Project, founded in 2002, not only critiqued the terms and practices central to the biopsychiatric model, it also inspired a new language and a new community for people struggling with mental health issues in the 21st century. The Icarus Project believes that humans are meaning makers, that meaning is created (...) through developing intrapersonal and interpersonal narratives, and that these narratives are important sites of creativity, struggle, and growth. The Icarus counter narrative and the community it fostered has been invaluable for people around the world dealing with psychic diversity—particularly for people alienated by mainstream approaches. But, despite the numbers of people who have been inspired by this approach, the historical background of the Icarus Project is hard to find. It exists primarily in oral history, newspaper articles, unpublished or self-published Icarus documents, and in internet discussion forums. As the co-founder of the Icarus Project, I use this article to make my understanding of that history and its key documents more widely available. (shrink)

The question "What is mental illness?" raises many issues in many contexts, personal, social, legal, and scientific. This chapter reviews mental health problems as they appear to the person with the problems, and to family and friends-before the person attends the clinic and is given a diagnosis-a time in which whether there really is a problem, as opposed to life's normal troubles and variations, is undecided, as also the nature of the problem, if such it be, and the related matter (...) what kind of expert advice should be sought. Once at the clinic, a diagnosis may be given-using criteria well-worked-out in the diagnostic manuals. The chapter discusses the conceptualizations of mental disorder in the diagnostic manuals, their rationale, and what can and cannot be reasonably expected of them. There are more position statements than definitions, and while they signal many dilemmas, they do not resolve them. Attempts to do so in the surrounding literature on the concept of mental illness are reviewed in the chapter, with conclusions favoring the features emphasized in the diagnostic manuals: distress and impairment. Finally the chapter considers how far the science may help draw boundaries around mental illness. (shrink)

Embodied Selves and Divided Minds examines how research in embodied cognition and enactivism can contribute to our understanding of the nature of self-consciousness, the metaphysics of personal identity, and the disruptions to self-awareness that occur in case of psychopathology. The book reveals how a critical dialogue between Philosophy and Psychiatry can lead to a better understanding of important issues surrounding self-consciousness, personal identity, and psychopathology.

Can psychiatry distinguish social deviance from mental disorder? Historical and recent abuses of psychiatry indicate that this is an important question to address. Typically, the deviance/disorder distinction has been made, conceptually, on the basis of dysfunction. Challenges to naturalistic accounts of dysfunction suggest that it is time to adopt an alternative strategy to draw the deviance/disorder distinction. This article adopts and follows through such a strategy, which is to draw the distinction in terms of the origins of distress with the (...) relevant conditions. It is argued that psychiatry's ability to distinguish deviance from disorder rests on the ability to define, identify, and exclude socially constituted forms of distress. These should lie outside the purview of candidacy for mental disorder. In pursuing this argument, the article provides an analysis of the social origins of a form of distress with the personality and sexual disorders, and indicates in what ways it is constituted socially. (shrink)

The enlarging domain of psychiatric intervention is frequently associated with the undue medicalization of unusual experiences. In such a climate, it becomes of utmost importance to carefully choose appropriate candidates for the psychiatric gaze. This suggests a need to draw a distinction between religious experiences (with psychotic form) and pathological psychotic experiences. As Jackson and Fulford (1997) maintain, “spiritual experiences, whether welcome or unwelcome, and whether or not they are psychotic in form, have nothing (directly) to do with medicine. It (...) would be quite wrong, then, to “treat” spiritual psychotic experiences with neuroleptic drugs, just as it is quite wrong to “treat” political .. (shrink)