“On the Subject Matter of Phenomenological Psychopathology” provides a framework for the phenomenological study of mental disorders. The framework relies on a distinction between (ontological) existentials and (ontic) modes. Existentials are the categorial structures of human existence, such as intentionality, temporality, selfhood, and affective situatedness. Modes are the particular, concrete phenomena that belong to these categorial structures, with each existential having its own set of modes. In the first section, we articulate this distinction by drawing primarily on the work of (...) Martin Heidegger—especially his study of the ontological structure of affective situatedness (Befindlichkeit) and its particular, ontic modes, which he calls moods (Stimmungen). In the second section, we draw on a study of grief to demonstrate how this framework can be used when conducting phenomenological interviews and analyses. In the concluding section, we explain how this framework can be guide phenomenological studies across a broad range of existential structures. (shrink)

According to what we will call subjectivity theories of consciousness, there is a constitutive connection between phenomenal consciousness and subjectivity: there is something it is like for a subject to have mental state M only if M is characterized by a certain mine-ness or for-me-ness. Such theories appear to face certain psychopathological counterexamples: patients appear to report conscious experiences that lack this subjective element. A subsidiary goal of this chapter is to articulate with greater precision both subjectivity theories and (...) the psychopathological challenge they face. The chapter’s central goal is to present two new approaches to defending subjectivity theories in the face of this challenge. What distinguishes these two approaches is that they go to great lengths to interpret patients’ reports at face value – greater length, at any rate, than more widespread approaches in the extant literature. (shrink)

The question of the subject seems to occupy much of the current psychiatric/psychological landscape. Some theoreticians affirm that the subject or the self is an imaginary fiction, not a substantial entity in whose structure causes of psychological disorders and their respective antidotes are latent. “Subject,” they continue, “is what the vernacular speech says it is, that is, a self-reference marker that indexes human organisms’ sensory/motor singularity.” This marker, however, has nothing in common with a supposed metaphysical ethereal substrate, made up (...) of particles such as will, freedom, autonomy, ineffable consciousness, reason, emotions, desires, beliefs, judgments, aspirations, or interests. Taking such an... (shrink)

Recently, there have been calls to develop a more contextual approach to phenomenological psychopathology—an approach that attends to the socio-cultural as well as personal and biographical factors that shape experiences of mental illness. In this Perspective article, we argue that to develop this contextual approach, phenomenological psychopathology should adopt a new paradigm case. For decades, schizophrenia has served as the paradigmatic example of a condition that can be better understood through phenomenological investigation. And recent calls for a contextual approach continue (...) to use schizophrenia as their primary example. We argue, in contrast, that substance misuse provides a better paradigm case around which to develop a contextually sensitive phenomenological psychopathology. After providing a brief vignette and analysis of a case of substance misuse, we explain why this kind of condition requires considerable sensitivity and attention to context, better motivating the incorporation and development of new contextually sensitive approaches. (shrink)

Many methodologies for systematic study of lived experience have been proposed in recent decades. These methods are typically calibrated in terms of the depth and complexity of data collection, and whether they consider reports on pre-reflective experience admissible. Even though it has been shown that lived experience occurs at different timescales (elementary, integrative, narrative), contemporary methods tend to focus on momentary experience. We trace the focus on momentary experience to the current cultural milieu and attitudes in the history of psychology. (...) We point out the need for studying temporally extended experiences in the field of psychopathology. We propose that lived experiences at different timescales are nested within each other and that this principle can be used to organize data collected with qualitative methods for the study of experience. We suggest that temporally extended experiences occur at the narrative level of description (i.e. they consist of experiential reports and sense-making). (shrink)

In this volume, leading philosophers of psychiatry examine psychiatric classification systems, including the Diagnostic and Statistical Manual of Mental Disorders, asking whether current systems are sufficient for effective diagnosis, treatment, and research. Doing so, they take up the question of whether mental disorders are natural kinds, grounded in something in the outside world. Psychiatric categories based on natural kinds should group phenomena in such a way that they are subject to the same type of causal explanations and respond similarly to (...) the same type of causal interventions. When these categories do not evince such groupings, there is reason to revise existing classifications. The contributors all question current psychiatric classifications systems and the assumptions on which they are based. They differ, however, as to why and to what extent the categories are inadequate and how to address the problem. Topics discussed include taxometric methods for identifying natural kinds, the error and bias inherent in DSM categories, and the complexities involved in classifying such specific mental disorders as "oppositional defiance disorder" and pathological gambling. -/- Contributors George Graham, Nick Haslam, Allan Horwitz, Harold Kincaid, Dominic Murphy, Jeffrey Poland, Nancy Nyquist Potter, Don Ross, Dan Stein, Jacqueline Sullivan, Serife Tekin, Peter Zachar. (shrink)

The phenomenological approach to schizophrenia has undergone something of a renaissance in Anglophone psychiatry in recent years. There has been a proliferation of works that focus on the nature of subjectivity in schizophrenia and related disorders, and that take inspiration from the work of such German and French philosophers as Husserl, Heidegger, and Merleau-Ponty, and such classical psychiatrists as Minkowski, Blankenburg, and Binswanger (Rulf 2003; Sass 2001a, 2001b). This trend includes predominantly theoretical articles, which typically incorporate clinical material as well (...) as reviews of empirical and experimental findings in psychopathology. Some very recent examples (since 2000) are studies of .. (shrink)

The purpose of this article is to show how schizophrenia, understood as a distortion of the most intimate structures of subjectivity, illustrates the nature of subjectivity as such, while at the same time how philosophical considerations may help to understand schizophrenia. More precisely, schizophrenic experiences of self-alienation seem to reflect a congealing or concretization of a form of differentiation or potential alterity implicit in the dynamic nature of subjectivity. In other words, we propose that the structure of subjectivity includes potential (...) divisions and fissures that condition the experiences of radical self-alienation seen in schizophrenia. In order to elucidate how this alterity emerges within the self in schizophrenia and in order to consider its conditions of possibility we examine the disorders of the self as described in phenomenological psychopathology. We especially use the work of the Japanese psychiatrists Mari Nagai, her teacher Bin Kimura, and the French psychiatrist Henry Ey, supplemented with clinical material from our own research. Finally, we shed light on the development of the psychotic symptoms such as hallucinations and delusions, which are understood as the expressions of a radical alterization of the self. (shrink)

When philosophers want an example of a person who lacks the ability to do otherwise, they turn to psychopathology. Addicts, agoraphobics, kleptomaniacs, neurotics, obsessives, and even psychopathic serial murderers, are all purportedly subject to irresistible desires that compel the person to act: no alternative possibility is supposed to exist. I argue that this conception of psychopathology is false and offer an empirically and clinically informed understanding of disorders of agency which preserves the ability to do otherwise. First, I appeal to (...) standard clinical treatment for disorders of agency and argue that it undermines this conception of psychopathology. Second, I offer a detailed discussion of addiction, where our knowledge of the neurobiological mechanisms underpinning the disorder is relatively advanced. I argue that neurobiology notwithstanding, addiction is not a form of compulsion and I explain how addiction can impair behavioural control without extinguishing it. Third, I step back from addiction, and briefly sketch what the philosophical landscape more generally looks like without psychopathological compulsion: we lose our standard purported real-world example of psychologically determined action. I conclude by reflecting on the centrality of choice and free will to our concept of action, and their potency within clinical treatment for disorders of agency. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy's Role in Psychopathology Back to Jaspers and an Appeal to Grow PracticalThe author reports no conflicts of interest.In "Philosophy's role in theorizing psychopathology," Gibson presents a defense of the continued relevance of philosophy to psychopathology, and a non-exhaustive framework for the role of philosophy in this domain (Gibson, 2024). I find it hard to disagree that psychopathology is soaked in philosophy from its origins, and that to try (...) and dry it out would be both unwise and impossible.In this commentary, I go back to Karl Jaspers' account of the role of philosophy in his General Psychopathology. In doing so, I do not find that Gibson adds anything new, but instead gives us a well-illustrated reminder that philosophy "is operative within every living science" (Jaspers, 1997, p. 770).Situated Psychopathological TheorizingGibson addresses a broad 'we' who might be engaged with psychopathological theorizing. This seems to encompass three main settings, from which examples are drawn.1. Everyday and regulative social practices (ordinary and legal setting).2. Empirically driven disciplines which work with psychopathological constructs (academic setting).3. Psychiatry and psychotherapy (clinical setting).In my view, it is a mistake not to map the terrain where psychopathological theorizing is situated. In each setting psychopathological theorizing has its own set of aims and constraints. In the ordinary setting, the aim might be to know whether to blame a loved one for their action. In the legal setting it might be to decide whether treatment or punishment is appropriate. In the clinical setting, the aim is usually a therapeutic assessment, and moral stance taking is often best kept at bay. In the academic setting, we might want to ensure our concepts are reliable and valid, opening them up to investigation using objective scientific methods. [End Page 13]Beyond what can be said in the most general terms, the role of philosophy will look different in these different situations.Understanding Is Not (Just) a Philosophical ToolUnderstanding is a mode of knowing that is concerned with the particular, rather than the general, and accessed inter-relationally, relying on tacit knowledge and empathetic imagination. Gibson introduces the concept as an elementary form of social intuition, used in ordinary life to make sense of social relations and other people's behaviors and reactions. I agree with Gibson, drawing on Strawson, that Understanding is a mode of knowledge that involves the subject of enquiry as a participant (Strawson, 1982). There is a moral imperative to take this stance, which drives us to value the expansion of what we are able to understand of other people's mental states. This at least partly motivates the agenda when we theorize about psychopathology.At times throughout his argument, Gibson seems to be arguing for the role of Understanding in psychopathological theorizing, in place of his explicit aim of arguing for the role of philosophy. However it is not at all clear that this replacement can be made. Accepting the picture drawn, Understanding is not any more the expertise or domain of the philosopher than the author, police officer, or sociologist. We are surely not meant to take Understanding as a uniquely philosophical tool, but rather a mode of knowing available to all social agents, integral to social reasoning in ordinary life and in the human studies.What philosophy can distinctively do is point to and defend the existence of forms of intersubjective and tacit knowledge within human studies such as psychopathology. For Jaspers, Understanding can be a scientific tool, albeit one that reminds us that knowledge in psychopathology is not all of one kind. One role for philosophy therefore is to help us to "distinguish the different modes of knowing," so that we might "order knowledge into a comprehensive whole" (Jaspers, 1997, p. 769). This is akin to the 'synthetic' role that Gibson proposes.Philosophy and ScienceJaspers defines scientific knowledge broadly as knowledge with "general validity, convincing insights (which can be proved), clarity of method, and the possibility for a meaningful discussion" (Jaspers, 1997, p. 768).We do not get such a definition from Gibson, but in the sections of... (shrink)

Prior research has demonstrated that antisocial behavior, substance-use disorders, and personality dimensions of aggression and impulsivity are indicators of a highly heritable underlying dimension of risk, labeled externalizing. Other work has shown that individual trait constructs within this psychopathology spectrum are associated with reduced self-monitoring, as reflected by amplitude of the error-related negativity (ERN) brain response. In this study of undergraduate subjects, reduced ERN amplitude was associated with higher scores on a self-report measure of the broad externalizing construct that (...) links these various indicators. In addition, the ERN was associated with a response-locked increase in anterior theta (4–7 Hz) oscillation; like the ERN, this theta response to errors was reduced among high-externalizing individuals. These findings suggest that neurobiologically based deficits in endogenous action monitoring may underlie generalized risk for an array of impulse-control problems. (shrink)

It is well established by psychopathological research that disorders of self-experience are among the main features of schizophrenic prodromes in a pathogenetic sense. Disorders of the phenomenal self, as "lack of ipseity" (the vanishing of the feeling of being embedded in oneself and of distinctiveness between the self and the outer world) and "hyper-reflexivity" (the monitoring of one's own life entailing the tendency to objectify parts of one's own self in an outer space) are considered key phenomena of schizophrenic (...) vulnerability. In this paper, I argue that the analyses of the disorders of phenomenal self catch only some dimensions of schizophrenic vulnerability, since they mainly focus on the pathological changes in subjective experience of an isolated self and disregard the fact that the self is not purely personal. Because our existence is fundamentally tied to a social existence, the feeling of one's own self and the sense of "reality" of an experience are products of intersubjectivity and not only a private process based on introspection or reflexivity in which one is engaged in an idiosyncratic way. Building on, and extending, contributions of the phenomenological tradition, I attempt to demonstrate that intuitive attunement is the basic prerequisite for establishing one's sense of "reality" (feeling familiarly related to one's environment) and for establishing one's sense of "ipseity" (the sense of existing as a subject of awareness). In the last part of the paper, I show the importance of the concepts "lack of attunement" and "antagonomia" (the rejection of conventional knowledge and intuitive attunement, experienced as dangerous sources of loss of individuality) to establish a comprehensive theory of schizophrenic vulnerability. I finally discuss the implications of this view for empirical research and clinical management of schizophrenic vulnerability. (shrink)

Many prisoners in solitary confinement experience adverse psychological and physical effects such as anxiety, paranoia, insomnia, headaches, hallucinations and other perceptual distortions. Psychiatrists call this SHU syndrome, named after the Security Housing Units [SHU] of supermax prisons. While psychiatric accounts of the effects of supermax confinement are important, especially in a legal context, they are insufficient to account for the phenomenological and even ontological harm of solitary confinement. This paper offers a phenomenological analysis of the lived experience of space in (...) supermax confinement by drawing on Merleau-Ponty’s account of intercorporeal depth. I argue that the prolonged deprivation of concrete experiences of spatial depth in a shared world is a form of violence against the relational structure of embodied (inter)subjectivity, and that it threatens to undermine the prisoner’s capacity for a meaningful relation to the world, to others, and even to herself. Nevertheless, some prisoners have developed strategies for resisting this psychopathology of space. (shrink)

The structure of human embodiment is fundamentally characterized by a polarity or ambiguity between Leib and Körper, the subjective body and the objectified body, or between being-body and having-a-body. This ambiguity, emphasized, above all, by Helmuth Plessner and Maurice Merleau-Ponty, is also of crucial significance for psychopathology. Insofar as mental illnesses disturb or interrupt the unhindered conduct of one’s life, they also exacerbate the tension within embodiment that holds between being-body and having-a-body. In mental illnesses, there is a failure of (...) tacit mediations upon which one’s bodily being-toward-the-world is based. Instead of serving as a medium of relating to the world, the body makes .. (shrink)

The boundary between spiritual experience and mental disorder remains unclear and should invite collaboration between psychiatry and other disciplines, including theology. Jackson and Fulford (1997), using the tools of analytic philosophy, have proposed a model allowing principled differentiation between spiritual experience and psychotic symptoms based on the personal values of the subject, a cognitive problem-solving model. Spiritual experience is described as positively evaluated psychotic experience, which enables the subject to do more than he or she normally does. In the present (...) paper, it is claimed that values and actions cannot alone always discriminate between religious experience and psychopathology. With reference to three case studies, drawn from the practice of one of us, it is argued that spirituality is not all about experience and that it cannot be understood without reference to the subject's personal history and spiritual tradition, however implicit or fragmented. This approach would allow an account of ordinary religious experience in those who have suffered ego disablement during mental illness. Drawing primarily on the Christian tradition, we argue that the use of theological criteria may allow levels of discrimination between spiritual experience and mental disorder not allowed for by philosophical psychopathology. (shrink)

This chapter is about susceptibility to one type of division within our selves that can occur within self‐conscious experience and is present in certain mental disorders. This is the separation between experiencing oneself as subject and as agent. The chapter considers some disorders of self‐consciousness and examines the role that this particular division may play in those disorders. Companion to consciousness studies is not completed without attention to the philosophical psychopathology of self‐consciousness. The chapter also examines the case of verbal (...) auditory hallucinations. Investigators often say that hallucinations involve “loss of ego boundaries” or “internal/external confusion”. The chapter presents a case of alienated self‐consciousness, and explores the phenomenon of thought insertion. According to the standard or traditional account of thought insertion, the patient is aware of her own thoughts, but denies that they are hers and attributes them to someone else. So, thought insertion certainly seems to constitute alienated awareness of one's own thoughts. (shrink)

French thought no longer enjoys the kind of prominence in the Anglophone world that it did in most of the last half of the twentieth century, a time when Sartre and Camus, then Lévi-Strauss, Foucault, and Derrida exercised a decisive influence on innovative work in literary and cultural theory, the human and social sciences, and on social thought more generally. It would be a mistake, however, to exaggerate the degree to which this represents either a decline in the actual influence (...) of twentieth century French thinkers or an enervation of contemporary theorizing in France. Derridean deconstruction and Foucauldian power/knowledge analyses have, for.. (shrink)

Some psychopathologic experiences have as one of their structural aspects the experience of restructured temporality. The general argument is that one of the universal microstructures of experience, namely, lived time offers a particular perspective relevant to certain psychopathologic experiences. Lived time is connected with the experience of the embodied human subject as being driven and directed towards the world in terms of bodily potentiality and capability. The dialectical relationship between the embodied human subject and the world results in a sense (...) of lived time (personal time), a lived time that is intimately synchronized with the time of others (intersubjective time). Some experiences of acute suffering, and in particular acute melancholic suffering, can dramatically alter the temporal microstructure of experience to the extent that personal lived time becomes disordered. Normally, past and future withdraw on their own according with their nature of "not being." The future is characterized as openness to change and movement. The absence of this openness is the closing of the future; without this openness, the future appears static and deterministic. When the future is experienced as static, then one longer has the possibility of "things getting better," nor does one have any possibility of relinquishing or escaping from the past because a static future does not allow openness to change and movement. In short, both past and future become static. With the presence of melancholic suffering and the absence of temporal movement, a sense of hopelessness may arise in the individual because suffering without temporal movement becomes, from the sufferer's perspective, eternal suffering. (shrink)

This article examines the role of time as a methodological tool and pathological focus of clinical psychiatry and psychology in the first half of the 20th century. Contextualizing ‘psychopathologies of time’ developed by practitioners in Europe and North America with reference to the temporal theories implicit in Freudian psychoanalysis and Henri Bergson’s philosophy of durée, it illuminates how depression, schizophrenia, and other mental disorders such as obsessive-compulsive behaviours and aphasia were understood to be symptomatic of an altered or disturbed ‘time-sense’. (...) Drawing upon a model of temporal synthesis whereby in healthy individuals, a subjective temporal sense ( Ichzeit, durée, or personal lifetime) was perceived and understood in relation to objective time frameworks ( Weltzeit, clock-time, or quantitative time models like historical chronology), clinicians argued that mentally ill patients were unable to synthesize Ichzeit and Weltzeit, using variations in this disturbance to define specific pathological conditions. (shrink)

Intersubjectivity impairment has been considered the main pathogenic nucleus of schizophrenia. Enriching this concept with references to Scheler’s phenomenology, our hypothesis is that schizophrenic subjects are affected by a deeper impairment: the inability to resonate with unipathic affectivity. Fragmentation of the Leibschema, valueception impairment, and the lack of vital impulse are, in our hypothesis, the original alterations of the schizophrenic bodily experience from which all relational impairments originate. Our proposal is, therefore, to enhance a psychotherapy that does not only (...) focus on the verbal level, but endeavors to touch the patient’s Leib, focusing on emotional sharing and on the development of a sense of cohesion of one’s body as the starting point for accessing intersubjectivity. (shrink)

Since psychiatry remains a descriptive discipline, it is essential for its practitioners to understand how the language of psychiatry came to be formed. This important book, written by a psychiatrist-historian, traces the genesis of the descriptive categories of psychopathology and examines their interaction with the psychological and philosophical context within which they arose. The author explores particularly the language and ideas that have characterised descriptive psychopathology from the mid-nineteenth century to the present day. He presents a masterful survey of the (...) history of the main psychiatric symptoms, from the metaphysics of classical antiquity to the operational criteria of today. Tracing the evolution of concepts such as memory, consciousness, will and personality, and of symptoms ranging from catalepsy and aboulia to anxiety and self-harm, this book provides fascinating insights into the subjective nature of mental illness, and into the ideas of British, Continental and American authorities who sought to clarify and define it. (shrink)

The article deals with relational aspects of mental disorders. The author takes into account the influence of mental illness on intersubjectivity and interpersonal relations in three aspects: “attitude to the illness,” that is, changes in the functioning of the subject and difficulties in dealing with the experience of mental illness; “dialogical relationship” in the form of difficulties in maintaining social cognition and entering into relationships with others; “social consensus,” that is, difficulties in adapting to the social world and a common (...) sense deficit. The analysis is made with reference to phenomenological research in contemporary philosophy of psychiatry. The result of this study is a reconstruction of a “different existence,” in other words, presentation of the transformation of the life-world and the specific way of inhabiting the world of a person in a mental crisis. Symptoms and experience of the illness are presented in the light of human possibilities of transformation. The analysis emphasizes the role of patients’ subjectivity and their efforts to find the meaning of a painful situation. The study of subjective aspects of disorders aims to reveal their consequences for understanding how to deal with mental crisis and to understand the positive aspects of the recovery process. (shrink)

The relevance of a purely descriptive phenomenology to psychiatry is overshadowed by naturalistic approaches that are both explanatory and predictive. A naturalized transcendental phenomenology, however, carries with it the possibility of explaining and predicting not only the nature of normal subjective experience but also the origin of phenomenological psychopathology in a manner acceptable by scientific standards. A purely mathematical naturalized phenomenology remains in the phenomenological sphere, does not rely on neuroscientific data in its development, is consistent with the Husserlian view (...) of man as free and capable of using reason to influence behavior and focusses on temporality in its definition of normal subjective experience and phenomenological psychopathology. Because what is being naturalized is subjective experience and not any part of the physical world, the project it is not meant to replace the natural science’s understanding of psychopathology but to provide a complementary view that is acceptable by scientific standards. (shrink)

In Disturbed Consciousness, philosophers and other scholars examine various psychopathologies in light of specific philosophical theories of consciousness. The contributing authors—some of them discussing or defending their own theoretical work—consider not only how a theory of consciousness can account for a specific psychopathological condition but also how the characteristics of a psychopathology might challenge such a theory. Thus one essay defends the higher-order thought (HOT) theory of consciousness against the charge that it cannot account for somatoparaphrenia (a delusion in (...) which one denies ownership of a limb). Another essay argues that various attempts to explain away such anomalies within subjective theories of consciousness fail. Other essays consider such topics as the application of a model of unified consciousness to cases of brain bisection and dissociative identity disorder; prefrontal and parietal underconnectivity in autism and other psychopathologies; self-deception and the self-model theory of subjectivity; schizophrenia and the vehicle theory of consciousness; and a shift in emphasis away from an internal (or brainbound) approach to psychopathology to an interactive one. Each essay offers a distinctive perspective from the intersection of philosophy, consciousness research, and psychiatry. (shrink)

In Disturbed Consciousness, philosophers and other scholars examine various psychopathologies in light of specific philosophical theories of consciousness. The contributing authors—some of them discussing or defending their own theoretical work—consider not only how a theory of consciousness can account for a specific psychopathological condition but also how the characteristics of a psychopathology might challenge such a theory. Thus one essay defends the higher-order thought (HOT) theory of consciousness against the charge that it cannot account for somatoparaphrenia (a delusion in (...) which one denies ownership of a limb). Another essay argues that various attempts to explain away such anomalies within subjective theories of consciousness fail. -/- Other essays consider such topics as the application of a model of unified consciousness to cases of brain bisection and dissociative identity disorder; prefrontal and parietal underconnectivity in autism and other psychopathologies; self-deception and the self-model theory of subjectivity; schizophrenia and the vehicle theory of consciousness; and a shift in emphasis away from an internal (or brainbound) approach to psychopathology to an interactive one. Each essay offers a distinctive perspective from the intersection of philosophy, consciousness research, and psychiatry. -/- Contributors Alexandre Billon, Andrew Brook, Paula Droege, Rocco J. Gennaro, Philip Gerrans, William Hirstein, Jakob Hohwy, Uriah Kriegel, Timothy Lane, Thomas Metzinger, Erik Myin, Inez Myin-Germeys, Myrto Mylopoulos, Gerard O’Brien, Jon Opie, J. Kevin O’Regan, Iuliia Pliushch, Robert Van Gulick . (shrink)

Traditionally, phenomenological theories of schizophrenia have emphasized disturbances in self-experience, with relatively little acknowledgement of the surrounding world. However, epidemiological research consistently demonstrates a strong relationship between traumatic and stressful life events and the development of schizophrenia, suggesting that encounters in the world are highly relevant for many people diagnosed with this disorder. This paper reviews foundational texts in phenomenology and phenomenological psychopathology on the nature of subjectivity and its disturbances, finding support for broadening contemporary phenomenological models of schizophrenia to (...) incorporate world events and their subjective meaning as essential aspects of this disorder. This contextual approach to phenomenology emphasizes the relationship between self and world, one that is especially unstable, unclear, and untrustworthy in schizophrenia. Both epidemiological and phenomenological research can benefit from this approach: in epidemiology, researchers might consider the ways that various risk factors are experienced by persons vulnerable to schizophrenia, while phenomenologists are encouraged to inquire about the environmental and social context in which altered experiences occur and incorporate these considerations into their explanatory models. (shrink)

The article covers Erwin W. Straus’ views on the problem of time and temporal experience in the context of psychopathology. Beside Straus’ published scholarship, including his papers dealing exclusively with the subject of time, the sources utilized in this essay comprise several of Straus’ unpublished manuscripts on temporality, with the primary focus on the 1952 manuscript Temporal Horizons, which is discussed in greater detail and subsequently published for the first time in this journal. In the first part of the article, (...) the author introduces what he considers to be the central tension of the whole of Straus’ work on the issue of time, namely, the tension stemming from a dualistic account of time with its personal and impersonal dimensions. Interpretative developments of this tension are followed covering Straus’ early German works and his late American scholarship. The author presents Straus’ way of overcoming the dualistic account of time and his arguments in favour of what is termed here the “unified view of time”. Of critical importance for the unified view is Straus’ concept of “today”, which is extensively commented upon. In the second part of the article, the author focuses on the psychopathological consequences of the unified view as seen by Straus. A clear-cut boundary between a normal and a psychotic experience of time is supposed to lie in breaking the bond between the personal and the impersonal orders of time, leading to a fundamental estrangement. This view, it is claimed, is already present in a nutshell in Straus’ earliest work, and is elaborated upon later. In conclusion, both the merits and the weaknesses of Straus’ account of temporality are presented. A major advantage is that Straus abstains from a dualistic conception of time and reappraises the often-devalued clock time. A fundamental drawback is that Straus does not venture to explore the pathological varieties of temporal experience and fails to specify the acknowledged differences between, on the one hand, psychotic elements in depressive disorders, and, on the other hand, such elements in schizophrenic disturbances. (shrink)

2013 sees the centenary of Jaspers' foundation of psychopathology as a science with the publication of his magnum opus the Allgemeine Psychopathologie (General Psychopathology), Many of the issues concerning methodology and diagnosis are today the subject of much discussion and debate. This volume brings together leading psychiatrists and philosophers to discuss the impact of this volume, its relevance today, and the legacy it left.

Alterations in consciousness are among the most common transdiagnostic psychopathological symptoms. Therefore clinical practice would benefit from a clear conceptual framework that guides the recognition, comprehension, and treatment of consciousness disorders. However, contemporary psychopathology lacks such a framework. We describe how pathology of consciousness is currently being addressed in clinical psychology and psychiatry so far, and how the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and International Classification of Diseases, Tenth Edition (ICD-10) refer to this subject. (...) A brief review of the literature on consciousness is then given. After describing psychological perspectives on consciousness and discussing theoretical issues involved in exploring consciousness, we offer a practical clinical working definition of consciousness and we illustrate its connections with a variety of diagnoses. Making use of Jean-Paul Sartre’s distinctions among: states, functions, qualities, and structure, provide a conceptual framework to understand consciousness, to refine diagnostics and to guide the development of therapeutic possibilities in clinical practice. (shrink)

Schizophrenia is a mental disorder that calls the mineness of one's own sensations, thoughts and actions into question and threatens the person with a loss of self. In order to understand this illness in its essence, an approach based on phenomenological psychopathology is therefore indispensable. Conversely, disorders of the self in schizophrenia should be of crucial interest for any philosophy of subjectivity in order to test its concepts of self-awareness, personhood and intersubjectivity by reference to empirical phenomena.Contemporary neurobiological concepts of (...) schizophrenia predominantly emphasize the importance of impaired integration of somatosensory inputs into stable central-nervous representations... (shrink)

The mechanisms by which delusion and anxiety affect the tendency to make hasty decisions (Jumping-to-Conclusions bias) remain unclear. This paper proposes a Bayesian computational model that explores the assignment of evidence weights as a potential explanation of the Jumping-to-Conclusions bias using the Beads Task. We also investigate the Beads Task as a repeated measure by varying the key aspects of the paradigm. The Bayesian model estimations from two online studies showed that higher delusional ideation promoted reduced belief updating but the (...) impact of general and social anxiety on evidence weighting was inconsistent. The altered evidence weighting as a result of a psychopathological trait appeared insufficient in contributing to the Jumping-to-Conclusions bias. Variations in Beads Task aspects significantly affected subjective certainty at the point of decisions but not the number of draws to decisions. Repetitions of the Beads Task are feasible if one assesses the Jumping-to-Conclusions bias using number of draws to decisions. (shrink)

Emerging action perspectives on psychopathology depict individuals as actively shaping those environmental conditions that then impact on their risk for psychopathology, resilience in the face of it, and successful recovery from it. This view, although having important implications for research and clinical practice, has yet to be articulated in terms of its underlying philosophical framework. To begin to address this challenge, we situate action theory in the context of the writings of Deleuze and Guattari, who, in their seemingly anti-psychiatric series (...) entitled Capitalism and Schizophrenia, argue for the central role of human agency as a fundamentally active force in determining subjective life. Within this context, they propose an alternative approach to the current deficit focus of much psychopathology research, replacing the notion of deficit with a fundamentally productive notion of desire (what they call “desiring-production”). After our exposition of this philosophical perspective on human agency, implications of this approach for action-informed research and clinical practice are discussed. (shrink)

I discuss Watsuji’s characterization of aidagara or “betweenness”. First, I develop a phenomenological reading of aidagara. I argue that the notion can help illuminate aspects of our embodied subjectivity and its interrelation with the world and others. Along the way, I also indicate how the notion can be fruitfully supplemented by different sources of empirical research. Second, I put aidagara to work in the context of psychopathology. I show how disruptions of aidagara in schizophrenia not only affirm the foundational role (...) it plays in organizing our experience of self and world in everyday life. Additionally, I suggest the notion can, in this context of application, potentially enhance our understanding of and empathy for those living with schizophrenic disorders. (shrink)

Delusion is one of the most intriguing psychopathological phenomena and its conceptualization remains the subject of genuine debate. Claims that it is ill-defined, however, are typically grounded on essentialist expectations that a given definition should capture the core of every instance acknowledged as delusion in the clinical setting.

In his classic essay “The phenomenological approach to psychopathology”, Karl Jaspers defended the irreducible reality of the “subjective” mental symptoms and stressed the pivotal role of empathy in their diagnostic assessment. However, Jaspers’ account of the epistemological role of empathy in psychopathological diagnosis was far from clear: whereas at several places Jaspers claimed that empathy provides a direct access to patients’ abnormal mental experiences, at other places he stressed that it did so only indirectly, through a whole battery of (...) their observable clinical indicators. The aim of this paper is to reassess Jaspers’ account of the epistemological role of empathy in psychopathological diagnosis. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Spiritual Experience and Psychopathology”Andrew Sims (bio)In examining this interesting paper, we need first of all to understand what the authors are doing. They are not taking the conceptual vehicles of “spiritual experience” (SE) and “psychotic phenomena” (PP) for a gentle outing, but exposing both of them to the hardest road test they can devise. From 1,000 accounts of “spiritual experiences” that were already so dramatic that those (...) involved were prepared to describe them, the authors selected three which most successfully blurred the boundaries between SE and PP. So we are not exploring whether these concepts have general practical validity, but whether their mutual frontiers are discrete or overlapping. The authors’ task is legitimate, but it needs to be recognized for what it is.Unusual spiritual experiences are interpreted by the authors as psychotic symptoms, and the definitions of the Present State Examination (PSE) descriptions are cited to justify this. However, we have known for a long time that using instruments for purposes for which they were not designed can produce unexpected results; it is rather like washing socks in a dishwasher and being surprised that it does little good to the socks. The PSE was devised for categorizing and quantifying existing psychiatric disorders in epidemiological studies. The further one gets from this, its true purpose, the less satisfactory it becomes as an instrument. A better way of evaluating symptomatology in an individual case is a skilled and painstaking interview by a well-trained descriptive psychopathologist. One can only conclude from the authors’ use of the PSE in distinguishing SE from PP, that the instrument itself is not capable of doing this, which is not really very surprising. One can form no views on the concepts of SE and PP themselves, except that in some circumstances they may be difficult to tell apart.It would be easy to dispute whether Simon’s beliefs were delusions. Believers from many religious backgrounds “know” that God gives them thoughts or ideas, and it requires detailed psychopathological examination, and not the application of a questionnaire, to distinguish this from the much more concrete experience as described in PSE of “inserted thoughts.”Rating scales, be they assessments of the quality of teaching in primary schools or quantification of established psychotic symptoms, are necessarily only a pale reflection and an over-simplification of the skilled work that professionals undertake. To imply that because a score could be given on the PSE to an otherwise healthy woman who describes the frequent experience of hearing God’s voice, denies the validity of her experience, but also affronts the professional skills of a trained psychopathologist. When psychiatrists, or even [End Page 79] untrained research workers, use the PSE they are presumably doing so as part of an epidemiological research study, and the validity of their individual result is evened out by results from a number of other subjects. If a psychiatrist is trying to decide whether Sara had “true” hallucinations, he or she will carry out a psychopathological interview in which the criteria for establishing true hallucinations are much more sophisticated than is possible in a questionnaire, and the interview will be individualized. Sara’s significant statement, “but God doesn’t take your free will away,” immediately distinguishes her diagnosis from schizophrenia. It was good that Sara’s priest did not need detailed knowledge of psychopathology to come to a common-sense evaluation of her experience.It was with some feelings of disappointment that I realized that when the authors use the word “psychotic” they merely mean that a tick could be placed in an appropriate box for the PSE. If one were to carry out an investigation of serum electrolytes on a fit athlete on completion of a marathon, one would get bizarre and probably abnormal results. For a quantified investigation to be meaningful, one must always take account of the context.When I read these three cases as a psychopathologist, I find no convincing psychotic phenomena, and the three human beings were undoubtedly not psychotic at the time of expression of their religious experiences. The word psychosis is not helpful in psychopathology: if one looks more specifically in these cases for the phenomena... (shrink)

Emerging action perspectives on psychopathology depict individuals as actively shaping those environmental conditions that then impact on their risk for psychopathology, resilience in the face of it, and successful recovery from it. This view, although having important implications for research and clinical practice, has yet to be articulated in terms of its underlying philosophical framework. To begin to address this challenge, we situate action theory in the context of the writings of Deleuze and Guattari, who, in their seemingly anti-psychiatric series (...) entitled Capitalism and Schizophrenia, argue for the central role of human agency as a fundamentally active force in determining subjective life. Within this context, they propose an alternative approach to the current deficit focus of much psychopathology research, replacing the notion of deficit with a fundamentally productive notion of desire (what they call “desiring-production”). After our exposition of this philosophical perspective on human agency, implications of this approach for action-informed research and clinical practice are discussed. (shrink)

There are many important methodological decisions that need to be made when examining emotional reactivity in psychopathology. In the present study, we examined the effects of two such decisions in an investigation of emotional reactivity in depression: (1) which (if any) comparison condition to employ; and (2) how to define change. Depressed (N = 69) and control (N = 37) participants viewed emotion-inducing film clips while subjective and facial responses were measured. Emotional reactivity was defined using no comparison condition (i.e., (...) raw scores), baseline comparison condition (i.e., no stimulus presented), and neutral comparison condition (i.e., neutral stimulus presented). Change in emotional reactivity was assessed using four analytic approaches: difference scores, percentage change, residualised change, and ANCOVA. Results differed among the three comparison conditions and among several of the analytic approaches. Overall, our investigation suggests that choosing a comparison condition and the definition of change can significantly influence the presence of group differences in emotional reactivity. Recommendations for studies of emotional reactivity in psychopathology are discussed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Spiritual Experience and Psychopathology”Anthony Storr (bio)Many psychiatrists, including myself, are deeply dissatisfied with current psychiatric taxonomy. Grossly abnormal people like multiple murderers are often deemed sane in law, because they do not happen to exhibit the symptoms of recognized mental illnesses like schizophrenia or manic-depressive psychosis. In contrast, some of those who do exhibit such symptoms, and who therefore risk being labeled psychotic, cannot be considered to (...) be “ill,” and are in fact mentally robust. There is considerable overlap between experiences which psychiatrists call psychotic, and experiences which are generally called spiritual by those who have them.In order to illustrate this overlap, the authors quote three cases of people describing a variety of delusions and hallucinations which would certainly prompt the diagnosis of psychosis—usually some variety of schizophrenia—were it not for the fact that all three claimed that their experiences had been of considerable benefit to them.It is noteworthy that, in each case, the psychotic/spiritual experiences followed a period of stress. The first subject was threatened by legal action; the second had surmounted an episode of depression, but was questioning whether she could continue her career in business; the third was unemployed, in debt, and suspected that he had multiple sclerosis. The first subject developed both grandiose and religious delusions; but the revelations which he claimed were a sign of God’s special grace toward him enabled him to win his law case and set up a charitable institution. The second heard the voice of Jesus summoning her to work for him. She became convinced that she was specially gifted in various parapsychological fields, and became a religious counselor. As the authors point out, “Her experiences, if delusional and hallucinatory, were overwhelmingly positive in their content and fruits.” The third subject also experienced hallucinatory voices which were intensely reassuring, gave him new insight into the nature of reality, and guided his further progress. As a result, he believed that he had such support that “nothing in this world can worry me.” In each case, the psychotic experience proved to be a solution to the subject’s problem, rather than a breakdown ending in admission to a mental hospital. This raises a variety of intellectual problems.The authors suggest that psychotic phenomena may be good or bad, and label the good phenomena “spiritual” and the bad phenomena “pathological.” According to this point of view, psychotic experience need not be considered pathological, especially if consideration is given to the structure of values and beliefs professed by the individual concerned. [End Page 83]I am not happy with this distinction. I entirely agree that psychotic experience may be a solution to a subject’s problems; but whether it is considered spiritual or pathological depends partly upon the nature of the experience, and even more upon the social setting in which it occurs. A grandiose delusion that one is especially selected and addressed by God may cure the depression of someone who has so far considered himself a nonentity if it is accepted by others. In my study of gurus, Feet of Clay (1996), I make the point that a guru seeks disciples because they reinforce his delusions and may, in some instances, keep him out of hospital. Of the three cases described in this paper, the first told “various friends and ministers about them.” The second confided in her priest and was told that her experiences were authentic within their shared Christian belief system. The third did not apparently share his hallucinatory experience with friends; but, when he responded to the invitation to write to the Alister Hardy Research Centre, wrote, “It is fascinating to find I’m not on my own in this. I have naturally queried my own sanity, and generally don’t discuss it....”Medical diagnosis and psychiatric diagnosis are not strictly comparable. If I as a doctor find that X is suffering from diabetes, I can treat X as an isolated entity displaying symptoms and signs of a well-known disease. I cannot do this when X is displaying “psychotic” symptoms; for whether or not those symptoms are regarded as pathological depends upon the social setting in which they... (shrink)

Mental health research faces a suite of unresolved challenges that have contributed to a stagnation of research efforts and treatment innovation. One such challenge is how to reliably and validly account for the subjective side of patient symptomatology, that is, the patient’s inner experiences or patient phenomenology. Providing a structured, standardised semantics for patient phenomenology would enable future research in novel directions. In this contribution, we aim at initiating a standardized approach to patient phenomenology by sketching a tentative formalisation within (...) the framework of an applied ontology, in the broader context of existing open-source Open Biomedical Ontologies resources such as the Mental Functioning Ontology. We further discuss a number of prevailing challenges and observations bearing on this task. (shrink)

Psychiatry as a discipline oscillates between the language of emotions and that of biology; ranging from the immersion into the subjective experience of another person to the objective approach of biomedical science. The tension between these different approaches may seem irreconcilable and confusing to some. This was not the case for Karl Jaspers who pioneered a systematic reflection on the concepts underlying psychiatric theory and practice. In this essay, we engage with Jaspers' thinking and create a dialogue with contemporary psychiatric (...) research and philosophy of mind. Jaspers' conception of erklären and verstehen and his position on research in the neuroscience of mental disorders is brought together with the thought of Thomas Nagel and John Searle. We argue for the compatibility of Jaspers' ideas with Nagel's and Searle's views on the mind/body problem. Furthermore, we look at current trends in biological research in psychiatry through the lens of Jaspers' General Psychopathology, from there we derive suggestions and insights for psychiatric theory and practice. (shrink)

As capitalist society remains incapable of addressing climate breakdown, one measure is waiting in the wings: solar geoengineering. No other technology can cut global temperatures immediately. It would alleviate the symptoms of the crisis, not its causes. But might it be combined with radical emissions cuts? This essay, the final instalment of two, subjects geoengineering to a materialist psychoanalysis and argues that it represents a fantasy of repression, setting itself up for a dreadful return of the repressed.

This essay is a response to proposals to integrate patient-subjective or idiographic data into future versions of nosologies such as the DSM and the ICD. It argues that a nosology is not a suitable vehicle for disseminating psychopathological-phenomenological research results throughout the field. Drawing on the work of Ludwig Binswanger, it examines, on the basis of four postulates, how he applies the Husserlian concept of intentionality in psychiatry and thus arrives at a psychopathological phenomenology. For each individual postulate, (...) we then look in depth at the implications for the current debate around DSM. The conclusion we come to is that, both because of the objective of phenomenological research and because of the complexity of the kind of information involved in findings based on that research, it is impossible to integrate these findings into a nosology without deviating from either them or the nosology itself. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.3 (2005) 209-214 [Access article in PDF] Body-Subjects Martin Wyllie Keywords embodied subjectivity, dialectical relationships, body-subject A complete description of melancholic ex-perience and the experience of suffering can only be given by considering the human being as an embodied subject (body-subject) that is already and always situated in the world (body-subject-in-the-world). A full understanding of the body-subject eliminates the mutual exclusivity of certain conceptual (...) categories. There is no need to preserve the dichotomies of subject/object, inner/outer, mind and body within the field of psychopathology because body and mind and world may be reconciled through the concept of the body-subject. The concept of the body-subject provides a means of evolving a common language that could unify many descriptive levels of explanation into a single integrative descriptive framework.Each of the four excellent commentaries moves the debate forward and I attempt to do the same by engaging in some of the issues raised. Without doubt there is more to lived time than outlined within my paper. For example, the useful "implicit/explicit" distinction of temporality (Fuchs 2005) and "cognitive temporal experience" (Kupke 2005) are important for any developing description of lived time. Kupke identifies that the processes and structures in relation to lived time, intersubjective time (subject–other) and cognitive temporal experience (subject–object) as articulated, in my paper, remain ambiguous. This short reply attempts to clarify some of this ambiguity by placing the concept of lived time within a wider "body-subject-in-the-world" framework (Wyllie 2003). This "body-subject-in-the-world" framework attempts to integrate the universal structures of embodiment, lived time, lived space, and intersubjectivity into a unified description of human experience. Concentrating on some of the problems with this framework, I attempt to clarify some of the ambiguity and show how this slowly developing framework can be of benefit in describing psychopathologic phenomena.One problem in articulating any developing conceptual framework, particularly within the domain of philosophical phenomenology, is attempting to find language that is neutral and does not carry with it a large theoretical payload. This "view from nowhere" approach is, however, doomed to failure as one has to inevitably build on and appropriate meanings, concepts and terms that are already given. Broome (2005) clearly demonstrates the importance of scientific models and outlines how scientific explanatory models are necessary and complementary companions to phenomenological models of melancholia. Matthews (2005) argues that "causal relationships" and causal terms are more appropriate to a scientific understand of melancholia and that the use of reductive subject/object, cause/effect language may be inappropriate because I attempt to holistically understand the phenomena of melancholia. Nonetheless, such a holistic approach ultimately includes the language of the molecular (scientific), the subjective [End Page 209] (intentional), and the communal (intersubjective). There flows from Matthews's point the rational for attempting to evolve a common language that could unify descriptive "phenomenological" and prescriptive "scientific" levels of "explanation" into a common integrated explanatory framework. This, however, is no easy task because one has in developing an inclusive description of melancholia to liberate both the "objective" and "subjective" without losing the force of either polarity. For this to occur something in addition to causal relationships needs to be considered when attempting to describe melancholia. A small part of this "something in addition" may be supplied by considering dialectical relationships.The concept of a causal relationship, as opposed to a dialectical relationship, attempts to understand processes in an atomistic fashion and this may be a wholly inadequate way of characterizing the phenomenology of melancholia or, for that matter, human experience. For example, the objects of my immediate experience only constitute a small minority of that which I can experience in that moment, and this is because I can have the experience of absent objects, impossible objects, future objects, past objects, and ideal objects. The directedness of my experience at those moments toward these objects is not brought about because I am causally influenced by the spatial world proximity of the objects in question. It maybe argued my relation to these... (shrink)

HARDIN PK. Nursing Inquiry 2003; 10: 209–217 Shape-shifting discourses of anorexia nervosa: reconstituting psychopathologyThis article explores how the circuitous relationship between individuals, the media, and discursive systems replicate and reinforce the act of self-starvation in young women. Using a feminist poststructuralist methodology, the focus of this article is on how discourses and institutional practices operate to position young women who take up the subject position of wanting to be diagnosed as anorexic. Utilizing data from online accounts and individual interviews, I (...) attend to the ways in which young women are institutionally positioned as ‘anorexics’ and the effects that those positions have on their behaviors, in addition to reinforcing institutional practices that construct anorexia nervosa. Questions addressed through this inquiry are: How do institutional practices create and continue to constitute ‘anorexia nervosa’? How do discourses operate to position young women such that they are either included and/or excluded into the category of ‘anorexia nervosa’? What are the effects and consequences that emanate from these positionings? (shrink)