An estimated 15% of patients seen by neurologists have neurological symptoms, such as paralysis, tremors, dystonia, or seizures, that cannot be medically explained. For a long time, such patients were diagnosed as having conversion disorder and referred to psychiatrists, but for the last two decades or so, neurologists have started to pay more serious attention to this patient group. Instead of maintaining the commonly used label of conversion disorder – which refers to Freud’s idea that traumatic events can (...) be converted into deviant behaviour – these neurologists use the term functional neurological disorder and explain that the problems are due to abnormal central nervous system functioning. The situation that some patients with medically unexplained neurological symptoms are diagnosed with CD and treated by psychiatrists while others are diagnosed with FND and stay under the control of neurologists provides a unique case for analysing how neurological and psychological explanations affect subjectivity. In this article, I compare patient reports from English-language websites from the past 15 years to find out how minds, bodies, brains, and selves act and interact in the accounts of both patient groups. I conclude that the change in label from CD to FND has not only influenced ideas of medically unexplained disorders, but also affected ideas of the self and the body; of self-control and accountability. (shrink)

The Hospital for Rehabilitation, Stavern, in Norway has treated patients with physical symptoms with no organic cause, so called conversion disorder patients, for over a decade. For four years research on the treatment has been carried out. Patients with conversion disorder seem not to fit in traditional somatic hospitals because their patienthood depends upon psychiatric diagnosis. Ironically, they appear not to belong in psychiatric hospitals because of their physical symptoms. The treatment offered these patients at hospitals for rehabilitation (...) is adapted physical activity consisting of behaviour elements such as positive reinforcement of normal function and lack of positive reinforcement at dysfunction. The pedagogical approach is seen as crucial in the successful rehabilitation of the patients. The disorder and treatment can be understood by using theories about the ecstatic body, radical behaviourism and phenomenology. When patients have problems in behaviour concerning both body and mind, it would be natural to employ both in the road to recovery. This article describes the various treatments and discusses them from phenomenological, ethical and philosophical perspectives. (shrink)

It was [Maria] Edgeworth’s deeply personal motive in writing Harrington that made possible the special self-reflexive quality that informs her novel. In the act of reviewing her role as a reader and a writer of anti-Semitic portraits, she was able to recognize a tradition of discourse she had at once inherited and perpetuated. And only by recognizing such a tradition was she able both to subvert it in Harrington and to articulate for future writers the way to move beyond it. (...) In short, she boldly turned her personal self-examination into a cultural critique: she diagnosed a disorder in “the imaginations of the good people of England,”4 and in so doing she issued a challenge and founded a new tradition. In Harrington Edgeworth inquires into the trials that the English imagination must undergo if it is to exorcise the powerful figure of Shylock, and thereby issues a challenge taken up in subsequent novels : the tradition I am designating “the novel of Jewish Identity” attempts to articulate, investigate, and subvert The Merchant of Venice’s function as the English master text for representing “the Jew.” Maria Edgeworth, Harrington, vol. 9 of Tales and Novels , p. 148; hereafter cited by page number. Michael Ragussis, professor of English at Georgetown University, is the author of The Subterfuge of Art: Language and the Romantic Tradition and Acts of Naming: The Family Plot in Fiction . He is currently working on a book-length study entitled “Figures of Conversion: Jewish Identity and British Fiction.”. (shrink)

Factitious disorder is the deliberate simulation of illness for the purpose of seeking the sick role. It is a 20th-century diagnosis, though the grounds for its introduction are uncertain. While previous authors have considered the social changes contributing to growth in the disorder, this article looks at some of the pressures on doctors that may have created the diagnostic need for a disorder between hysteria and malingering. The recent history of those disorders suggests that malingering would no (...) longer be acceptable when applied to the potentially larger numbers involved in workers’ compensation or in mass conscription. Equally, the absolution given to hysteria on the basis of the Freudian subconscious would survive only as long as that model retained credibility. Growing egalitarianism and changing doctor—patient relationships in the 20th century would no longer tolerate a sharp division between culpable malingering and exculpated hysteria, which may previously have been made on grounds of class or gender. They would contribute to the need for a mediating diagnosis, such as factitious disorder. (shrink)

Functional Neurological Symptom Disorder or Conversion Disorder, is a fairly common diagnosis among mental health patients in Pakistan. Despite its prevalence there's a dearth of research on the phenomenon, particularly on the experience of FNSD. The study was conducted with the aim to ascertain the lived experiences of individuals with Functional Neurological Symptom Disorder around stressful situations in their families in Pakistan. For this purpose, a total sample of 10 participants were recruited from the psychiatry department of (...) a tertiary care hospital in Lahore, Pakistan. Semi-structured interviews were conducted and analyzed through Interpretative Phenomenological Analysis. The two main themes revealed in the analyses were quarrels and unexpressed emotions. The sub-themes of quarrels included quarrels with family members, quarrels within family, parental/marital discord, and quarrels with extended family members. The subthemes for unexpressed emotions were hurt, anger, sadness, and jealousy. In conclusion, this study revealed that in Pakistan, stressors related to family serve as significant contributing factors in the development of FNSD. (shrink)

This chapter argues that the conditions under the umbrella “personality disorders” actually constitute two very different kinds of theoretical entities. In particular, several core personality disorders are actually moral, and not medical, conditions. Thus, the categories that are held to represent them are really moral, and not medical, theoretical kinds. The chapter works back from the possibility of treatment to the nature of the kinds that are allegedly treated, revisiting 18th-century ideas of moral treatment along the way. The discussion closes (...) with a reflection on how the ambiguous medical status of personality disorders and their treatment today is reminiscent of the ideological tug of war that pits alienist “mad doctors” like Pinel against their lay counterparts such as Tuke as they battled over who should be in charge of treating the mad. (shrink)

The American Psychological Association's (APA's) as well as other professional organizations' (e.g., American Psychiatric Association) removal of homosexuality as a mental disorder represented a paradigmatic shift in thinking about exual orientation. Since then, APA (2000) disseminated guidelines for working with lesbian, gay, and bisexual (LGB) clients, and a variety of scholars and researchers alike have advocated affirmative therapeutic interventions with LGB individuals. Despite these efforts, the controversy over treating individuals with LGB orientations using nonaffirmative techniques continues. In this discussion, (...) the limited evidence regarding the efficacy and effects of conversion therapy is surveyed, particularly in the context of empirically supported treatment criteria summarized by Division 12 (clinical psychology) of the APA. Authors then consider the resulting ethical considerations in performing conversion therapy and propose alternative uses of affirmative therapy on the basis of ethical standards defined by APA. Finally, options for treating LGB individuals who are coming to terms with their sexual orientations are discussed. (shrink)

Background: There is a growing interest in using cognitive behavioural therapy with people who have Asperger Syndrome and comorbid mental health problems. Aims: To examine whether modified group CBT for clinically significant anxiety in an AS population is feasible and likely to be efficacious. Method: Using a randomised assessor-blind trial, 52 individuals with AS were randomised into a treatment arm or a waiting-list control arm. After 24 weeks, those in the waiting-list control arm received treatment, while those initially randomised to (...) treatment were followed-up for 24 weeks. Results: The conversion rate for this trial was high, while attrition was 13%. After 24 weeks, there was no significant difference between those randomised to the treatment arm compared to those randomised to the waiting-list control arm on the primary outcome measure, the Hamilton Rating Scale for Anxiety. Conclusions: Trials of psychological therapies with this population are feasible. Larger definitive trials are now needed. Declaration of Interest: None Trial Registration: ISRCTN 30265294, UKCRN 8370. (shrink)

Tissue plasminogen activator (tPA) is administered to patients with suspected ischemic stroke to improve blood flow to the brain In rare cases, patients present with complaints of stroke symptoms that appear to be non-organic due to malingering, factitious disorder, or conversion disorder (psychogenic stroke mimics). Deciding whether or not to administer tPA to these patients can be challenging. The risk of hemorrhage after administration of tPA is low, but not zero. The ethical principles of beneficence and nonmaleficence need (...) to be weighed carefully in these situations. We present two cases of patients with suspected psychogenic stroke mimics to illustrate the ethical challenges faced in identifying and managing psychogenic stroke mimics. Further research is needed to demonstrate effective treatment strategies for patients with acute stroke symptoms of psychogenic etiology. (shrink)

The psychopathological analysis of hysteria is a victim of narrow conceptualizations. Among these is the inscription of hysteria in the feminine sphere, about body and sexuality, which incentivized conceptual reductionism. Hysteria has been mainly considered a gendered pathology, almost exclusively female, and it has been associated with cultural and/or religious features over time rather than treated as a psychopathological world. Further, hysteria has been dominated by conceptual inaccuracies and indecision, not only in terms of clinical features but also in terms (...) of its definition. For this reason, it seems necessary to “undress” hysteria from this feminization, sexualization, and corporealization with which it has been abundantly clothed over the years. “Undressing” hysteria will make possible a reconfiguring and deconstructing of the explanatory-causal model of Charcot and Freud. However, if we take out this cultural heritage, the stigma accompanying this diagnosis, and the weight of the enormous historical tradition that hysteria carries, the world of hysteria continues to constitute a domain full of complexity and nosographic challenges. Hysteria has been considered a sum of psychological behaviors and states illustrated by drama, mystery, or falsity. The difficulty in understanding the multiple somatic manifestations which characterize this clinical condition created several controversies and much confusion. In the current nosography, the personological component of hysteria has been separated from its symptomatic manifestation, in the Histrionic Personality Disorder and Conversion Disorder categories, respectively. This segmentation by descriptive nosography does contribute to a unitary understanding of the phenomenon and, consequently, of daily clinical practice. Clinical complexity can be grasped and deciphered only if the symptom is inscribed in the patient’s lifeworld and his/her subjective life history. Clinical practice is thus thought of in terms of a structural aggregation of a homogeneous set of phenomena, together constituting a specific way of being in the world. The starting point of this article is the evident modalities characterizing this life-world, taking care not to confuse the point of origin with the point of expression. (shrink)

In this review, we provide an overview of the dynamic changes within the microbiota and its metabolites that are implicated in establishing and maintaining gastrointestinal homeostasis during various stages of microbial colonization. The gradual conversion of the gut microbiota toward a mutualistic microbial community involves replacement of pioneer gut colonizers with bacterial taxa that are characteristic for the adult gut. An important microbial signature of homeostasis in the adult gut is the prevalence and activity of a diverse spectrum of bacterial (...) species that produce beneficial metabolites through metabolic interactions between microbial groups. Deciphering these microbial signatures and their metabolites that govern short and long‐term equilibrium, as well as imbalances in host‐microbial relationships, may provide novel diagnostic tools and/or therapeutic targets for specific disorders associated with intestinal dysbiosis and loss of homeostasis. (shrink)

St. Thomas Aquinas treats penance as both a sacrament and a virtue. In either form, penance’s principal human act is contrition—a willed sorrow for one’s sins and an intention to avoid future sins. A look at Aquinas’s understanding of penitential contrition reveals a complex interplay of the different objects of love, the gift of fear, and finally friendship with God. This article offers an analysis of Aquinas’s accounts of penance and contrition with respect to these key elements. I argue that (...) contrition performs a fundamental role in countering, restoring, and safeguarding a proper ordering of love and attainment of the ultimate good of union with God. In short, contrition is the act that directly counters the interior disorder wrought by sin and provides an ongoing counter to the threat of additional disorder. Sin’s disorder is the aversion to God and conversion to self, while contrition involves the aversion to self and a conversion to God. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 63.2 (2002) 239-259 [Access article in PDF] Original Sin and the Problem of Knowledge in Early Modern Europe Peter Harrison It is not the philosophy received from Adam that teaches these things; it is that received from the serpent; for since Original Sin, the mind of man is quite pagan. It is this philosophy that, together with the errors of the senses, made (...) men adore the sun, and that today is still the universal cause of the disorder of men's minds and the corruption of men's hearts. Nicolas Malebranche 1In his Éloge du Pere Malebranche, delivered to the Parisian Academy of Sciences on 22 April 1716, Bernard Fontenelle recounted the story of Nicolas Malebranche's somewhat controversial conversion to Cartesianism. When friends and colleagues had taken him to task over his new-found commitment to the doctrines of Descartes, Malebranche responded with this question: "Did Adam have the perfect science?" It was agreed that this was the common view. Malebranche responded that he, too, aspired to the perfect science, and that his quest for this knowledge could not be satisfied by following the historical or critical pursuits of his colleagues, but by adopting the procedures set out by Descartes. 2 For Malebranche, the Cartesian method offered a means of overcoming the limitations of the fallen intellectual faculties of Adam's seventeenth-century descendents, and thus of restoring the fabled encyclopedic knowledge of the first man. [End Page 239]Aspirations to recover the science of Adam provided a common motivation for a number of early-modern philosophical projects. Earlier in the seventeenth century Francis Bacon had famously observed in his Novum Organum (1620) that the human dominion over nature which Adam had lost at the Fall could be restored in some measure by the sciences: "For man by the fall fell at the same time from this state of innocency and from his dominion over creation." The moral losses of the human race were to be restored in some measure by "religion and faith"; Adam's lost knowledge, and the dominion which it made possible, by "arts and sciences." 3 Bacon's vision of a reconstructed knowledge of nature during the period which he regarded (somewhat prematurely) as "the last times" clearly played an important role in legitimizing the goals and methods of the new natural philosophy. Indeed the program of the Royal Society of London from its inception in 1660 explicitly relied upon a Baconian rhetoric of the restoration of that human knowledge and dominion over nature which Adam had once enjoyed.While historians such as Charles Webster have alluded to the ways in which the myth of an original perfect philosophy motivated projects for the advancement of learning in a rather general way, little attention has been paid to the manner in which early-modern views of the nature of the original fall from knowledge directly informed the methods of the new sciences, determined the scope of their enquiry, and provided ammunition for use against traditional learning. 4 Moreover, most commentators, following Webster's lead, have restricted their attention to Francis Bacon, and to the Baconian aspirations of subsequent reformers of knowledge in seventeenth-century England. In this paper I shall suggest that the biblical narrative of the Fall played a far more direct role in the development of early modern knowledge—both in England and on the Continent—than has often been assumed, and that competing strategies for the advancement of knowledge in the seventeenth century were closely related to different assessments of the Fall and of its impact upon the human mind. While confirmation of this claim would require a more comprehensive study than space here permits, this paper will set out a number of preliminary considerations which establish the plausibility of such a thesis, showing how the biblical narrative of the Fall directly informed the epistemological projects of the seventeenth century, and prompted various rationalist and empiricist solutions. [End Page 240] The Mind of Adam There was an almost universal consensus in the sixteenth... (shrink)

The two commentators have examined and illuminated different aspects of the analysis of delusions that we have offered. Their discussions both raise points that clarify that analysis in helpful ways. Richard Bentall (2014) makes the telling point that distinguishing the mental phenomena that count as delusions is not always straightforward and that, at the margins, there is a perennial problem with patterns of thought that seem to fall outside the realm of shared meanings that most of us derive from our (...) experiences. The problem is evident in certain marginal conditions that come to psychiatric attention, like conversion reactions, body dysmorphic disorder, anorexia, and the many obsessions or strained .. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Spiritual Experience and Psychopathology”Francis G. Lu (bio), David Lukoff (bio), and Robert P. Turner (bio)Jackson and Fulford have written an impor-tant paper which addresses an area of increasing interest in the United States—the relationship between religious/spiritual experiences and psychopathology. Using primarily the Present State Examination as the diagnostic framework, the authors describe in rich clinical detail three patients where certain phenomena lead to a possible diagnosis of (...) schizophrenia. However, the patients’ outcomes were uniformly positive—how can this be? The authors argue persuasively for the importance of a contextual assessment “in which psychotic phenomena themselves are embedded in the values and beliefs of the person concerned.” In this commentary, we will first present innovations in the DSM-IV relevant to cultural and religious/spiritual issues, which complement the authors’ conclusions, and then comment upon the paper from this perspective.In the DSM-IV Introduction (1994), a section entitled “Ethnic and Cultural Considerations” provides a rationale for innovations in DSM-IV that better enables its use with culturally diverse individuals: “A clinician who is unfamiliar with the nuances of an individual’s cultural frame of references may incorrectly judge as psychopathology those normal variations in behavior, belief, or experience that are particular to the individual’s culture. For example, certain religious practices or beliefs (e.g., hearing or seeing a deceased relative during bereavement) may be misdiagnosed as manifestations of a Psychotic Disorder” (xxiv). In the introduction, three types of information are cited: 1) sections entitled “Age, Gender and Cultural Considerations” in the text of ninety diagnostic categories discuss clinical variations due to these factors; 2) an Outline for Cultural Formulation designed to assist the clinician in systematically evaluating and reporting the impact of the individual’s cultural context; and 3) a Glossary of Culture-Bound Syndromes. These innovations, based on recommendations of the NIMH Workgroup on Culture, Diagnosis and Care to the Task Force on DSM-IV, are described in extensive detail in an important recent book (Mezzich, Kleinman, Fabrega, and Parron 1996).As an example of the importance of the Age, Gender, and Cultural Consideration section relevant to religious and spiritual experiences, consider the section in the text describing schizophrenia, where the following appears: “Clinicians assessing the symptoms of Schizophrenia in socioeconomic or cultural situations that are different from their own must take cultural differences into account. Ideas that may appear to be delusional in one culture (e.g., sorcery and witchcraft) may be commonly held in another. In some cultures, visual or auditory hallucinations with a [End Page 75] religious content may be a normal part of religious experience (e.g., seeing the Virgin Mary or hearing God’s voice)” (281). Secondly, in the analogous section of the text describing Brief Psychotic Disorder, the following appears: “It is important to distinguish symptoms of Brief Psychotic Disorder from culturally sanctioned response patterns. For example, in some religious ceremonies, an individual may report hearing voices, but these do not generally persist and are not perceived as abnormal by most members of the person’s community” (303).The Outline for Cultural Formulation provides the clinician a concise tool to specify the following information concerning the cultural context that is relevant to clinical care: cultural identity of the individual, cultural explanations of the individual’s illness, cultural factors related to psychosocial environment and levels of functioning, cultural elements of the relationship between the individual and the clinician, and overall cultural assessment for diagnosis and care. Religion is explicitly mentioned in the third section so as to encourage the assessment of “the role of religion... in providing emotional, instrumental, and information support” (1994, 844). This outline for cultural formulation is more fully explicated in a recent chapter by Lu, Lim, and Mezzich (1995).A major innovation in DSM-IV relevant to this topic is the new diagnostic category entitled Religious or Spiritual Problem defined as follows: “This category can be used when the focus of clinical attention is a religious or spiritual problem. Examples include distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith, or questioning of spiritual values that may not necessarily be related to an organized... (shrink)

Hysteria has disappeared from contemporary culture only insofar as it has been subjected to a repression through the popular diagnosis of 'borderline personality disorder'. In _Hysteria_ the distinguished psychoanalyst Christopher Bollas offers an original and illuminating theory of hysteria that weaves its well-known features - repressed sexual ideas; indifference to conversion; over-identification with the other - into the hysteric form. Through a rereading of Freud, Bollas argues that sexuality in itself is traumatic to all children, as it 'destroys' the (...) relation to the mother, transfiguring her from 'mamma', the infant's caregiver, to 'mother', the child's and father's sex object. For the hysteric this recognition is endlessly traumatic and the hysterical personality forms itself into an organised opposition to this knowledge. True to his earlier writings, Bollas' vision is thought provoking and mind expanding. _Hysteria_ brings new perspectives to long-standing ideas, making enlightening reading for students and professionals involved in psychoanalysis and psychotherapy alike, as well as the lay reader who takes an interest in the formation of personality in western culture. (shrink)

One way of viewing the organizing structure of the Confessions is to see it as an engagement with various texts at different phases of St. Augustine’s life. In the early books of the Confessions, Augustine describes the disordered state that made him unable to read any text (sacred or profane) properly. Yet following his conversion his entire orientation— not only to texts but also to reality as a whole—changes. This essay attempts to trace the winding paths that lead up to (...) Augustine’s conversion through his various encounters with texts (and individuals) and to examine his struggles both intellectual and spiritual along the way. In the final section, I bring Augustine into conversation with Hans-Georg Gadamer in order to highlight a number of hermeneutical continuities shared by premoderns and postmoderns. After comparing premodern and modern hermeneutical orientations, I conclude that Augustine’s approach to Scripture contrasts sharply with a (strict) modern grammatico-historical biblical methodology, whereas premodern hermeneutics share a number of continuities with Gadamerian and postmodern emphases. Lastly, in light of Gadamer’s famous statement, ‘all of life is hermeneutics’, I suggest that perhaps we could read Augustine’s life as affirming this claim. By taking a close look at Augustine’s story, I will attempt to show how pre-judgments, interpretative traditions and a dynamic/analogical rather than a static/univocal understanding of text (and reality) decisively affected his spiritual and intellectual vision—observations Gadamer would no doubt heartily affirm. (shrink)

Segal proposed transquantum commutation relations with two transquantum constants ħ′, ħ″ besides Planck's quantum constant ħ and with a variable i. The Heisenberg quantum algebra is a contraction—in a more general sense than that of Inönü and Wigner—of the Segal transquantum algebra. The usual constant i arises as a vacuum order-parameter in the quantum limit ħ′,ħ″→0. One physical consequence is a discrete spectrum for canonical variables and space-time coordinates. Another is an interconversion of time and energy accompanying space-time meltdown ( (...) class='Hi'>disorder), with a fundamental conversion factor of some kilograms of energy per second. (shrink)

Mucchielli clearly and systematically reviews the history of theories of psychosomatic medicine, criticizing the dominant modern ideas such as "conversion," "régression," and "inadaptation." The failure to eliminate dualisms has been chiefly the failure to discern distinct levels of existence and the complex relations between them: to assert a difference between the organic level and the conscious level need not lead us into an impass of dualism. Mucchielli shows that not all psychosomatic disorders are psycogenetic, but that there are organic illnesses (...) with definite organic etiology. He uses Descartes as a model for style and organization, and revives the relatively ignored Descartes of "the third idea of medicine" and "the union of soul and body," showing how and why Descartes himself did not develop an adequate medical theory of psychosomatic illness. The critical discussions of Dunbar, Alexander, Freud, Pavlov, Boss and others are sharp and convincing.—C. D. (shrink)

Knowing, either by the light of natural reason or by the light of Christian revelation, that homosexuality is a disordered condition is not sufficient for its being ethically permissible to direct self-identified homosexual persons toward just any treatment that aims to modify sexual orientation. For example, such an undertaking would be morally impermissible in cases where the available “treatments” are known to be both futile and potentially damaging to persons undertaking them. I, therefore, introduce this edition of Christian Bioethics by (...) reflecting on (a) the position of homosexuality in our current psychiatric nosology, (b) problems with drawing causal inferences from the outcomes of psychotherapy studies, and (c) the advantages and disadvantages of appealing to traditional categories of sexual orientation in this discussion, all with an eye toward more deeply elucidating core ethical concerns involving the intentional psychotherapeutic modification of sexual orientation. (shrink)

Technologies for deriving human neurons in vitro have transformed our ability to study cellular and molecular components of human neurotransmission. Three groups, including our own, have recently published methods for efficiently generating human serotonergic neurons in vitro. Remarkably, serotonergic neurons derived from each method robustly produce serotonin, express raphe genes, are electrically active, and respond to selective serotonin reuptake inhibitors in vitro. Two of the methods utilize transdifferentiation technology by overexpressing key serotonergic transcription factors. The third and most recent method (...) involves differentiating induced pluripotent stem cells (iPSCs) to serotonergic neurons using developmental patterning cues. In this mini‐review, we briefly describe the developmental programs governing serotonergic specification in vivo and how they have been harnessed to achieve serotonergic differentiation in vitro. We discuss the distinct and overlapping features of the recently published methodologies and their value in the context of in vitro disease modeling.Also see the video abstract here. (shrink)

This chapter examines naturalistic accounts of mental disorder: accounts that define disorder as biological dysfunction. There are three such accounts: an eliminativist account ; a forward-looking or goal-contribution account and a backward-looking or evolutionary account. I argue first, and contra Szasz, that biological functions can be attributed at a mental level. But our mental architecture might simultaneously support many different ways of attributing function claims, which might undermine a strong naturalism about mental disorder. Second, I argue that (...) Boorse's forward-looking account of disorder as dysfunction is not value-free. Third, I argue that Wakefield's backward-looking account does not accurately map onto our disorder judgments or medical purposes. I conclude that whilst Boorse's forward-looking account of disorder as dysfunction tracks medical usage better than Wakefield's evolutionary account, a truly value-free account of mental disorder cannot be sustained. (shrink)

In this paper, I address the question whether mental disorders should be understood to be brain disorders and what conditions need to be met for a disorder to be rightly described as a brain disorder. I defend the view that mental disorders are autonomous and that a condition can be a mental disorder without at the same time being a brain disorder. I then show the consequences of this view. The most important of these is that (...) brain differences underlying mental disorders derive their status as disordered from the fact that they realize mental dysfunction and are therefore non-autonomous or dependent on the level of the mental. I defend this view of brain disorders against the objection that only conditions whose pathological character can be identified independently of the mental level of description count as brain disorders. The understanding of brain disorders I propose requires a certain amount of conceptual revision and is at odds with approaches which take the notion of brain disorder to be fundamental or look to neuroscience to provide us with a purely physiological understanding of mental illness. It also entails a pluralistic understanding of psychiatric illness, according to which a condition can be both a mental disorder and a brain disorder. (shrink)

In _Sentient Flesh _R. A. Judy takes up freedman Tom Windham’s 1937 remark “we should have our liberty 'cause... us is human flesh" as a point of departure for an extended meditation on questions of the human, epistemology, and the historical ways in which the black being is understood. Drawing on numerous fields, from literary theory and musicology, to political theory and phenomenology, as well as Greek and Arabic philosophy, Judy engages literary texts and performative practices such as music and (...) dance that express knowledge and conceptions of humanity appositional to those grounding modern racialized capitalism. Operating as critiques of Western humanism, these practices and modes of being-in-the-world—which he theorizes as “thinking in disorder,” or “poiēsis in black”—foreground the irreducible concomitance of flesh, thinking, and personhood. As Judy demonstrates, recognizing this concomitance is central to finding a way past the destructive force of ontology that still holds us in thrall. Erudite and capacious, _Sentient Flesh _offers a major intervention in the black study of life. (shrink)

As far back as we know, there have been individuals incapacitated by memories that have filled them with sadness and remorse, fright and horror, or a sense of irreparable loss. Only recently, however, have people tormented with such recollections been diagnosed as suffering from "post-traumatic stress disorder." Here Allan Young traces this malady, particularly as it is suffered by Vietnam veterans, to its beginnings in the emergence of ideas about the unconscious mind and to earlier manifestations of traumatic memory (...) like shell shock or traumatic hysteria. In Young's view, PTSD is not a timeless or universal phenomenon newly discovered. Rather, it is a "harmony of illusions," a cultural product gradually put together by the practices, technologies, and narratives with which it is diagnosed, studied, and treated and by the various interests, institutions, and moral arguments mobilizing these efforts. This book is part history and part ethnography, and it includes a detailed account of everyday life in the treatment of Vietnam veterans with PTSD. To illustrate his points, Young presents a number of fascinating transcripts of the group therapy and diagnostic sessions that he observed firsthand over a period of two years. Through his comments and the transcripts themselves, the reader becomes familiar with the individual hospital personnel and clients and their struggle to make sense of life after a tragic war. One observes that everyone on the unit is heavily invested in the PTSD diagnosis: boundaries between therapist and patient are as unclear as were the distinctions between victim and victimizer in the jungles of Southeast Asia. (shrink)

The National Institute of Mental Health (Bethesda, MD) reports that approximately 5.2 million Americans experience post-traumatic stress disorder (PTSD) each year. PTSD can be severely debilitating and diminish quality of life for patients and those who care for them. Studies have indicated that propranolol, a beta-blocker, reduces consolidation of emotional memory. When administered immediately after a psychic trauma, it is efficacious as a prophylactic for PTSD. Use of such memory-altering drugs raises important ethical concerns, including some futuristic dystopias put (...) forth by the President's Council on Bioethics. We think that adequate informed consent should facilitate ethical research using propranolol and, if it proves efficacious, routine treatment. Clinical evidence from studies should certainly continue to evaluate realistic concerns about possible ill effects of diminishing memory. If memory-attenuating drugs prove effective, we believe that the most immediate social concern is the over-medicalization of bad memories, and its subsequent exploitation by the pharmaceutical industry. (shrink)

This article argues in support of the proposition that “A Personality Disorder May Nullify Responsibility for a Criminal Act.” Building upon research in categorical and dimensional controversies in diagnosis, neurocognitive science and the behavioral genetics of mental disorders, and difficulties in differential diagnosis and co-morbidity with personality disorders, this article holds that a per se rule barring personality diagnosis as a basis for a defense of legal insanity is scientifically and conceptually indefensible. Rather, focus should be upon the severity (...) and impact in specific cases of any legally relevant functional deficits arising from a mental disorder (including personality disorders). Failure to do so risks potentially misleading “battles of the experts” about a defendant's diagnosis in criminal responsibility defenses and improper usurpation of the role of the legal finder of fact as mental health expert witnesses are inserted as gatekeepers indefensibly based upon diagnosis. Implications for practice and public policy are considered, including a “modest proposal” for post-trial management of defendants found not guilty by reason of insanity on the basis of functional deficits arising from personality disorder. (shrink)

Aphantasia is a condition characterised by a deficit of mental imagery. Since several psychopathologies are partially maintained by mental imagery, it may be illuminating to consider the condition against the background of psychological disorder. After outlining current findings and hypotheses regarding aphantasia and psychopathology, this paper suggests that some support for defining aphantasia as a lack of voluntary imagery may be found here. The paper then outlines potentially fruitful directions for future research into aphantasia in general and its relation (...) to psychopathology in particular, including rethinking use of the SUIS to measure involuntary imagery, whether aphantasia offers protection against addiction, and whether hyperphantasia is a potential risk factor for maladaptive daydreaming, among others. (shrink)

Due to several socio-political factors, to many psychiatrists only a strictly objective definition of mental disorder, free of value components, seems really acceptable. In this paper, I will explore a variant of such an objectivist approach to defining metal disorder, natural function objectivism. Proponents of this approach make recourse to the notion of natural function in order to reach a value-free definition of mental disorder. The exploration of Christopher Boorse's 'biostatistical' account of natural function (1) will be (...) followed an investigation of the 'hybrid naturalism' approach to natural functions by Jerome Wakefield (2). In the third part, I will explore two proposals that call into question the whole attempt to define mental disorder (3). I will conclude that while 'natural function objectivism' accounts fail to provide the backdrop for a reliable definition of mental disorder, there is no compelling reason to conclude that a definition cannot be achieved. (shrink)

Body integrity identity disorder (BIID), previously called apotemnophilia, is an extremely rare condition where sufferers desire the amputation of a healthy limb because of distress associated with its presence. This paper reviews the medical and philosophical literature on BIID. It proposes an evidenced based and ethically informed approach to its management. Amputation of a healthy limb is an ethically defensible treatment option in BIID and should be offered in some circumstances, but only after clarification of the diagnosis and consideration (...) of other treatment options. (shrink)

This paper outlines a multidimensional conception of Multiple Personality Disorder (MPD) that differs from the 'orthodox' conception in terms of the content of its commitment to the reality of the self. Unlike the orthodox conception it recognizes that selves are fuzzy entities. By appreciating the possibility that selves are fuzzy entities, it is possible to rebut a form of fictionalism about the self which appeals to clinical data from MPD. Realism about self can be preserved in the face of (...) multiple personalities. (shrink)

Jerome Wakefield has argued that a disorder is a harmful dysfunction. This paper develops how Wakefield should construe harmful in his harmful dysfunction analysis. Recently, Neil Feit has argued that classic puzzles involved in analyzing harm render Wakefield’s HDA better off without harm as a necessary condition. Whether or not one conceives of harm as comparative or non-comparative, the concern is that the HDA forces people to classify as mere dysfunction what they know to be a disorder. For (...) instance, one can conceive of cases where simultaneous disorders prevent each other from being, in any traditional sense, actually harmful; in such cases, according to the HDA, neither would be a disorder. I argue that the sense of harm that Wakefield should employ in the HDA is dispositional, similar to the sense of harm used when describing a vile of poison: “Be careful! That’s poison. It’s harmful.” I call this harm in the damage sense. Using this sense of harm enables the HDA to avoid Feit’s arguments, and thus it should be preferred to other senses when analyzing harmful dysfunction. (shrink)

This article examines the unique disadvantages experienced by Black people and other people of color with substance use disorder in health care, and argues that an intersectional approach to enforcing disability rights laws offer an opportunity to ameliorate some of the harms of oppression to this population.

Naturalistic accounts of mental disorder aim to identify an objective basis for attributions of mental disorder. This goal is important for demarcating genuine mental disorders from artificial or socially constructed disorders. The articulation of a demarcation criterion provides a means for assuring that attributions of 'mental disorder' are not merely pathologizing different forms of social deviance. The most influential naturalistic and hybrid definitions of mental disorder identify biological dysfunction as the objective basis of mental disorders: genuine (...) mental... (shrink)

Externalist theories hold that a comprehensive understanding of mental disorder cannot be achieved unless we attend to factors that lie outside of the head: neural explanations alone will not fully capture the complex dependencies that exist between an individual’s psychiatric condition and her social, cultural, and material environment. Here, we firstly offer a taxonomy of ways in which the externalist viewpoint can be understood, and unpack its commitments concerning the nature and physical realization of mental disorder. Secondly, we (...) apply a strongly externalist approach to the case of Autistic Spectrum Disorder, and argue that this condition can be illuminated by appeal to the hypothesis of extended cognition. We conclude by briefly considering the significance this strongly externalist approach may have for psychiatric practice and pedagogy. (shrink)

Lewis’ neurodevelopmental model provides a plausible alternative to the brain disease model of addiction that is a dominant perspective in the USA. We disagree with Lewis’ claim that the BDMA is unchallenged within the addiction field but we agree that it provides unduly pessimistic prospects of recovery. We question the strength of evidence for the BDMA provided by animal models and human neuroimaging studies. We endorse Lewis’ framing of addiction as a developmental process underpinned by reversible forms of neuroplasticity. His (...) view is consistent with epidemiological evidence of addicted individuals ‘maturing out’ and recovering from addiction. We do however hold some reservations about Lewis’ model. We do not think that his analysis of the neurobiological evidence is clearly different from that of the BDMA or that his neurodevelopmental model provides a more rigorous interpretation of the evidence than the BDMA. We believe that our understanding of the neurobiology of drug use is too immature to warrant the major role given to it in the BDMA. Our social research finds very mixed support for the BDMA among addicted people and health professionals in Australia. Lewis’ account of addiction requires similar empirical evaluation of its real-world implications. (shrink)

The paper by Bergnar and Bunford in this edition of Philosophy, Psychiatry, & Psychology is a sophisticated examination of a central question that has lacked consensus in the philosophy of psychiatry, namely, what is “the key aspect of the meaning of this fundamental term, mental disorder”? To settle this question, the authors use an empirical approach by surveying graduate students in clinical psychology. In this way, they attempt to invoke the Wittgensteinian method of determining the meaning of a term (...) by seeing how it is used. The empirical results, the authors argue, serve as strong evidence in support of the position that the term ‘mental disorder’ designates disability... (shrink)

Early-Onset Schizophrenia (EOS) and Attention Deficit-Hyperactivity Disorder (ADHD) are early- onset neurodevelopmental disorders associated with cognitive deficits. The current study represents the first attempt to compare these groups on a comprehensive cognitive test battery in a longitudinal design over 25 years in order to enhance our knowledge of particular patterns resulting from the interaction between normal maturational processes and different illness processes of these disorders. In the baseline study, 19 adolescents with schizophrenia were compared to 20 adolescents with ADHD (...) and 30 healthy controls (HC), all between 12 and 18 years of age. After 13 years (T2) and after 25 years (T3) they were re-evaluated with the cognitive test battery. A cognitive Composite Score was used in a linear mixed model. The EOS group had a significant cognitive stagnation or deterioration from T1 to T2 compared to HC. However, the EOS group had the most positive change from T2 to T3, supporting a stable level of cognitive performance over the 25 year span. The ADHD group improved or had similar development as the HC group from T1 to T2. They continued to improve significantly compared to the HC group from T2 to T3. Individuals in the EOS group performed more impaired on the cognitive composite score compared to the HC group and the ADHD group at all three time points. Results might indicate a neurodevelopmental pathway of EOS with subnormal cognitive development specific in adolescence. In comparison, the ADHD group had a more consistent cognitive maturation supporting a maturational delay hypothesis of ADHD. (shrink)

The current study explores the role of individual and environmental determinants on students’ fear of crime. Based on a large-scale survey among students of a Belgian university (n = 1,463), the relationship between perceived social and physical disorder and the three dimensions of fear of crime (perceived risk of victimization, feelings of anxiety, avoidance behaviour) is examined. Support was found for a relationship between perceived social and physical disorder and perceived risk of victimization. Moreover, a relationship was found (...) between students’ perception of social disorder and anxiety and students’ perception of physical disorder and avoidance behaviour. Based on the results, this study suggests that preventing or reducing visible signs of disorder on campus should inevitably be included in the university’s security policy. This research offers universities more insight in the determinants of students’ fear of crime and potential measures to increase their (perception of) safety. (shrink)

I stipulate and motivate the overlooked problem of demarcating radical skeptics (perceptual and moral) from mentally disordered persons, given that both deny that they know ordinary Moorean propositions (e.g., that they have hands or that killing for fun is morally wrong). Call this ‘the demarcation problem’. In response to the demarcation problem, I develop a novel way to demarcate between mentally disordered persons and radical skeptics in an extensionally adequate way that saves the appearance that radical skeptics are not mentally (...) disordered persons (at least not typically). Finally, I examine how a Moorean, non-skeptical epistemologist would compare radical skeptics with the mentally disordered in terms of what Plantinga calls internal and external rationality. Perhaps surprisingly, by Moorean lights, the mentally disordered fare better than the radical skeptic in terms of (internal) rationality. The upshot is that for Mooreans skeptical philosophy is more of an epistemic evil than mental disorder. (shrink)

In recent decades, attempts to explain autism have been frustrated by the heterogeneous nature of its behavioral symptoms and the underlying genetic, neural, and cognitive mechanisms that produce them. This has led some to propose eliminating the category altogether. The eliminativist inference relies on a conception of psychiatric categories as kinds defined by their underlying mechanistic structure. I review the evidence for eliminativism and propose an alternative model of the family of autisms. On this account, autism is a network category (...) defined by a set of idealized exemplars linked by multiple levels of theoretically significant properties. I argue that this network model better captures the empirical phenomena, the historical growth of the category, and the ways the category has been shaped by social norms and interests. Finally, I defend a realist interpretation of network categories against the challenge from eliminativists. (shrink)