Through a series of essays contributed by clinicians, medical historians, and prominent moral philosophers, Cognitive Disability and Its Challenge to Moral ...

For the last thirty years, cognitive scientists have attempted to describe the cognitive architecture of typically developing human beings, using, among other sources of evidence, the dissociations that result from developmental psychopathologies such as autism spectrum disorders, Williams syndrome, and Down syndrome. Thus, in his recent defense of the massive modularity hypothesis, Steven Pinker insists on the importance of such dissociations to identify the components of the typical cognitive architecture (2005, 4; my emphasis): This kind of faculty psychology has (...) numerous advantages (...). It is supported by the existence of neurological and genetic disorders that target these faculties unevenly, such as a difficulty in recognizing faces (and facelike shapes) but not other objects, or a difficulty in reasoning about minds but not about objects or pictures. Similarly, Simon Baron-Cohen writes (1998, 335; my emphasis; see also Temple, 1997): I suggest that the study of mental retardation would profit from the application of the framework of cognitive neuropsychology (…). In cognitive neuropsychology, one key question running through the investigator’s mind is “Is this process or mechanism intact or impaired in this person?” When cognitive neuropsychology is done well, a patient’s cognitive system is examined with specific reference to a model of the normal cognitive system. And, not infrequently, evidence from the patient’s cognitive deficits leads to a revision of the model of the normal system. However, in recent years, the use of developmental psychopathologies to identify the components of the typical cognitive architecture has come under heavy fire. In a series of influential articles, neuropsychologist Annette Karmiloff-Smith has argued that findings about the pattern of impairments and preserved capacities in people with developmental psychopathologies say nothing about the cognitive architecture of.. (shrink)

Emotions might contribute to our being rational cognitive agents. Anxiety – and more specifically epistemic anxiety – provides an especially interesting case study into the role of emotion for adaptive cognition. In this paper, I aim at clarifying the epistemic contribution of anxiety, and the role that ill-calibrated anxiety might play in maladaptive epistemic activities which can be observed in psychopathology. In particular, I argue that this emotion contributes to our ability to adapt our cognitive efforts to how we (...) represent the practical factors relevant to the task at hand, by sig- naling the need for increased cognitive processing and evidence gathering in high- stakes situations. I hypothesize that dysfunctional or ill-calibrated epistemic anxiety might play an important role in the motivation driving persons with obsessive- compulsive disorder (OCD) to invest high amounts of cognitive resources into the resolution of apparently simple and innocuous questions. As I argue, OCD might be conceived as a case in which epistemic anxiety is inappropriately elicited, represent- ing these as high-stakes questions, and inadequately signaling a need for cognition. In this paper, I thus make use of the concept of (epistemic) anxiety as developed in the philosophy of emotion and in epistemology, to propose an account of the role of anxiety in the pathological doubt that is central to obsessive-compulsive disorder. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.2 (2003) 161-167 [Access article in PDF] Social, Cognitive, and Neural Constraints on Subjectivity and Agency:Implications for Dissociative Identity Disorder Peter Q. Deeley In this commentary, I consider Matthew's argument after making some general observations about dissociative identity disorder (DID). In contrast to Matthew's statement that "cases of DID, although not science fiction, are extraordinary" (p. 148), I believe that there are natural analogs of (...) the disorder that, when considered, make it seem less puzzling and exotic. After discussing these examples, I examine the relations between social, cognitive, and neural processes supporting subjectivity and agency, to identify sources of personal identity in cases of DID that can be used as a basis for assessing Matthew's points against Behnke and Sinnott-Armstrong. I am not proposing a comprehensive theory, but rather identifying what I believe are components of such a theory. I then outline an approach to determining criminal responsibility in DID, drawing on analogies with other psychiatric disorders. Dissociative Identity Disorder DID is a disorder described in DSM-IV, which "is characterised by the presence of two or more distinct identities or personality states that recurrently take control of the individual's behaviour accompanied by an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness" (American Psychiatric Association, p. 519). Recognizing Personal Identity How is personal identity recognized in normal cognition? If we take personhood to involve recognition of continuity of social, psychological, and physical identity for a given individual, then such judgments are routinely made rapidly and automatically as an aspect of what has come to be termed social cognition (Adolphs 2003). There is likely to be considerable redundancy in [End Page 161] the types of information used to make judgments about whether a person is the same as one who was previously encountered, or perhaps heard about—for example, facial features, movement patterns, speech prosody, dress, speech content, gender, ethnicity, social role, among other features, all provide information about individual identity, and hence personhood. When uncertainty exists, it is likely to reflect a loss or alteration of cues that would ordinarily be used in a rapid, automatic, unexamined way (Adolphs 2003). In such extreme cases (for example, severe mental illness or disfigurement), the problem of identification becomes the subject of explicit reasoning (and hence of potential disagreement, because we then engage in post hoc rationalizations to establish criteria for determining personhood, whereas normally we rely on essentially automatic, implicit abilities that work in most circumstances, some of which make little use of linguistic representations and formal reasoning—for example, individual facial identity recognition, which may occur as quickly as 170 ms after stimulus onset [Adolphs 2003]). Nevertheless, examining our judgments and intuitions in cases that force us to explicitly consider whether personal identity is preserved may provide analogies and clues for how we should proceed with DID. Let us consider, then, some natural analogs of DID. Natural Analogs of DID Method Acting I suggest that method acting is an analog of DID (Manderino 1985). Method acting refers to an approach to acting training and performance in which emphasis is placed on intensely imagining and identifying with the mental life of the character being portrayed. Training courses and manuals list many techniques and practices that can be used to facilitate absorption in a role, drawing on different kinds of memory—for example, experiential memories, memories of others, general knowledge (semantic memory), and memories of sensations and feelings, to creative a vivid sense of the subjective experience and actions of the character. Manderino, a method acting teacher, comments: "it is important to investigate the way in which your own mental makeup can improperly influence a character. Insecurities, self-consciousness, shyness or self-doubts can maintain a strong hold, and permitting any of these feelings to enter a performance is to remain the actor and not enter into the mental life of the character. For some, acting allows personal problems to be left behind, and they are thankful for the complete escape that... (shrink)

The study of the cognitive substrates of pragmatic disorders is a relatively recent development in clinical pragmatics. This development has been ushered in by calls from researchers and clinicians on two fronts. First, it has been urged that the field of pragmatics should undergo a cognitive turn, such that a cognitive examination of pragmatic concepts is afforded equal significance to societal, philosophical and linguistic approaches to the discipline. Second, clinicians have increasingly acknowledged that it is not possible to assess (...) and treat clients with pragmatic disorders in isolation from cognitive concerns. The chapter begins with an examination of the various cognitive processes that play a role in a standard communicative exchange. From this examination the two main components of any cognitive treatment of pragmatic disorders—executive functions and theory of mind—are established. The findings of clinical studies of clients with pragmatic disorders are discussed. These studies suggest an association between cognitive processes such as theory of mind on the one hand and a range of pragmatic impairments on the other hand. Conversational data from clients with pragmatic disorders are used to illustrate these cognitive-based pragmatic impairments. Finally, three theoretical frameworks with the potential to explain the cognitive basis of pragmatic disorders are examined. (shrink)

Meaning-making plays a central role in how we deal with experiences of suffering, including those due to mental disorder. And for many, religious beliefs, experiences, and practices (hereafter, religious engagement) play a central role in informing this meaning-making. However, a crucial facet of the relationship between experiences of mental disorder and religious engagement remains underexplored—namely the potentially positive effects of mental disorder on religious engagement (e.g. experiences of bipolar disorder increasing sense of God’s presence). In what follows, I will present (...) empirical findings from two recent studies of mine which shed light on the extent to which participants experienced these positive effects, specific components of these effects, and how they fit into their understanding of their mental disorder and its relationship to their religious identity. In doing so, I will draw on and expand Tasia Scrutton’s Potentially Transformative view (2015a, 2015b, 2020) according to which mental disorders may provide opportunities for spiritual growth. My empirical results align with and help deepen an account according to which mental disorders are potentially spiritually transformative by providing further insight into such instances: specifically, which symptoms and internal and external factors are often involved, as well as which religious beliefs, experiences, and/or practices are often affected. After presenting these results and articulating their relevance for a potentially transformative view of mental disorder, I will then address some potential objections to the theoretical account as well as some limitations of the empirical work, before sketching possible promising directions for future research. (shrink)

In cases where one sense-modality is stimulated by another, we speak of synesthesia, i.e., of a subjective experience of multiple distinct sensations as being quite literally conjoined. The term “synesthesia” is derived indirectly from the Greek words “syn,” meaning “together,” and “aisthesis,” meaning “sensation.” This article focuses on the question of whether synesthesia is in fact a mental disorder or a creative gift. Both the commonsense views that have emerged in recent times, and neurological research, demonstrate that our knowledge of (...) this relatively uncommon phenomenon is slowly but constantly expanding. Proper experimental research conducted with the right sorts of synesthete, and philosophically and scientifically nuanced conceptual studies of synesthesia, can all be helpful when seeking answers to the question posed above, while also confirming general claims about the extent to which our perceptions are reallysubjective. Most synesthetes see themselves as gifted, and claim that this “conjoining of the senses” enriches the quality of their lives. (shrink)

Glas's article is one of several in an interesting special issue focused on applying concepts from enactivism to psychiatry; his focuses on anxiety in particular. Given ongoing developments in work on enactivism, and ongoing debates about how to progress psychiatry, this application is timely. Here, I make three general points about the application of enactivism to psychiatry; I exemplify these with occasional comments on social anxiety disorder.First, as de Haan notes in her introduction, the term enactivism encompasses a number of (...) authors and ideas. Wilson and Foglia note that enactivism falls within a broader literature on "embodied cognition." This literature is partly conceptual, but also relies on... (shrink)

Drawing on the latest work in cognitive neuroscience, a philosopher proposes that delusions are narrative models that accommodate anomalous experiences.

In this paper, I propose an existentialist-phenomenological model that conceives of mental illness through the terminology of Heidegger’s Being and Time. In particular, the concepts of existentiality, disturbance and the relation between ‘being-with’ and ‘the one’, will be implemented in order to reconstruct the experience of mental illness. The proposed model understands mental illness as a disturbance of a person’s existentiality. More precisely, mental illness is conceptualized as the disturbance of a person’s existential structure, the process of which leads to (...) a becoming explicit of the otherwise implicit dynamical structure that constitutes a person’s experience. In particular, the existential component of ‘being-with’ comes to play a central role in the disturbance of existentiality, thus, I will claim, that it enables a person’s structure of experience to be ‘open for normativity’. By adopting a pragmatist stance on Heideggerian phenomenology, the suggested model proves compatible with naturalist and normativist theories of mental illness while still offering a phenomenological description of the phenomenon. (shrink)

This review aimed at exploring the psychosocial disorders of Nigeria as a nation, its effect on the citizens and the remedy. Psychosocial disorder is a mental illness induced by life experiences, stress, as well as maladaptive cognitive and behavioural processes. The prevalence of these disorders include depression, schizophrenia, anxiety disorders, substance use disorder, personality disorder and autism spectrum disorders have rapidly increase over the past years in Nigeria with its negative impact on the socioeconomic status, psychological (...) well-being; peaceful coexistence and mental health of the entire society. These have precipitated some social anomalies such as bribery and corruption, antisocial behaviour, religious fanaticism, terrorism and so on. The study therefore recommends the need for government to implement effective mental health interventions program that would facilitate easy access to mental healthcare services in Nigeria. There is also an urgent need to improve the mental health awareness of Nigerians through education and public mental health campaign. (shrink)

The Phenomenological Mind is the first book to properly introduce fundamental questions about the mind from the perspective of phenomenology. Key questions and topics covered include: What is phenomenology? naturalizing phenomenology and the empirical cognitive sciences phenomenology and consciousness consciousness and self-consciousness, including perception and action time and consciousness, including William James intentionality the embodied mind action knowledge of other minds situated and extended minds phenomenology and personal identity Interesting and important examples are used throughout, including phantom limb syndrome, blindsight (...) and self-disorders in schizophrenia, making The Phenomenological Mind an ideal introduction to key concepts in phenomenology, cognitive science and philosophy of mind. (shrink)

This book contains essential contributions to enrich and broaden the application field of pragmatics. It provides an example of how the fruitful reflections and refined conceptual distinctions born in the philosophical field can find a practical application in addressing social, cognitive, clinical, and psychological problems. Its chapters address, from different points of view, the relationship between pragmatic linguistics and philosophy, and outline the possible application of pragmatic theories to different domains. Developed during the third Pragmasophia international conference, whose name is (...) derived from the Greek terms πρᾶγμα (action, fact) and σοφία (knowledge, science), the book aligns itself with its aim to study human actions and activities and how they take shape through language. But ‘Pragma’ and ‘Sophia’ also signal another purpose: highlighting the importance of creating links between empirical investigations on language use, and more traditional philosophical approaches. In this reading, ‘Pragma’ represents the experimental goal devoted to analysing and interpreting language facts. In contrast, the term ‘Sophia’ recalls the original vocation of past philosophers to pursue an ideal of ‘pure knowledge’, disconnected from any practical-economic interest. While maintaining the conference's original purpose of encouraging productive comparisons between different approaches, the book consists of two sections: first, on philosophical approaches, recalls more theoretical aspects (closer to the term ‘Sophia’); the second, ‘Inferential and Cognitive Pragmatics,’ addresses more practical issues affecting domains such as Greek literature, pragmatic disorders, dictionary entries, and speech analysis. The reader, whether in linguists, philosophy or psychology, obtains a complete overview of the most advanced current research lines, both theoretical and empirical, and thus contributes to broadening the scope of pragmatics. (shrink)

The question “What is the relationship between the self and mental disorder?” is especially important for mental health professionals interested in understanding and treating patients, as most mental disorders are intimately tied to self‐related concerns, such as loss of self‐esteem and self‐control, or diminished agency and autonomy. Philosophy, along with the cognitive and behavioral sciences, offers a wealth of conceptual and empirical resources to answer this question, as the concepts of the self and psychopathology have occupied a central place (...) in these fields since their inception. Interestingly, and unfortunately, however, scientific psychiatry, in its approach to mental disorder as primarily a cluster of signs and symptoms has been slow in acknowledging the advances in conceptualizing and investigating mental disorders in relation to the self. The article addresses this problem and offers solutions for better cross‐fertilization between empirical and philosophical inquiry into the self and psychiatric research on mental disorders. The first part evaluates what empirically informed philosophical inquiry and philosophically informed empirical inquiry offer to the examination of the relationship between the self and mental disorders. The second part argues that scientific psychiatry has missed opportunities to find effective treatments for mental disorders because of its insularity from debates in naturalistic philosophy and cognitive and behavioral sciences. Psychiatry has much to gain from the conceptual, scientific, and clinical resourcefulness of philosophy's collaboration with the cognitive and behavioral sciences. (shrink)

Cognitive neuropsychiatry attempts to understand psychiatric disorders as disturbances to the normal function of human cognitive organisation, and it attempts to link this functional framework to relevant brain structures and their pathology. This recent scientific discipline is the natural extension of cognitive neuroscience into the domain of psychiatry. We present two examples of recent research in cognitive neuropsychiatry: delusions of control in schizophrenia, and affective disorders. The examples demonstrate how the cognitive approach is a fruitful and necessary supplement (...) to the otherwise successful biological psychiatry paradigm, which tend to bypass the cognitive level. Philosophy concerns some of the core concepts involved in psychiatric illness, particularly concerning rationality, thought and action, reality testing, and the self. We present concrete examples that illustrate how philosophical conceptual tools can be particularly important for the construction and interpretation of the cognitive models relevant to the understanding of psychiatric illness. We conclude that cognitive neuropsychiatry is a fruitful and necessary supplement to biological psychiatry. Furthermore, cognitive neuropsychiatry itself may benefit significantly from employing philosophical conceptual tools in the interpretation and construction of its cognitive models. The cognitive and philosophical approaches may thus be further steps towards a scientific psychopathology. (shrink)

A flood of new multidisciplinary work on the causes of depersonalization disorder provides a new way to think about the feeling that experiences “belong” to the self. In this paper I argue that this feeling, baptized “mineness” or “subjective presence” : 565–573, 2013) emerges from a multilevel interaction between emotional, affective and cognitive processing. The “self” to which experience is attributed is a predictive model made by the mind to explain the modulation of affect as the organism progresses through the (...) world. When the world no longer produces predicted affect the organism needs to explain this unpredicted absence of feeling. It is important to this account that cognition and perception are otherwise intact. Consequently the mind’s representation of the world and its emotionally salient properties are unchanged, leading the mind to predict a characteristic affective response. When that prediction is not fulfilled the organisms feels as if she is no longer present in experience. This is reported at the as feeling of depersonalization. (shrink)

Major depression is a prevalent mental disorder that leads to persistent negative mood and tremendous suffering in affected individuals. However, the biological realization of this disorder and associated symptom clusters remain poorly understood. Recently, phenomenological accounts of major depressive disorder and contributions to the emerging predictive processing account have provided valuable insights into the phenomenological and neuro-functional components that lead to manifestations of major depressive episodes. The purpose of this paper is to weave together these different strands of research to (...) develop a predictive processing account of major depressive disorder. In doing so, I will relate personal-level descriptions of associated phenomenal experiences to a sub-personal-level predictive processing account of the functional realization of major depression. I will argue that pervasive symptoms of the disorder, which include a diminished sense of agency, fatigue, social withdrawal, and rumination, are integrated by existential feelings of loss and impossibility. These phenomenal experiences, I will argue, are associated with dysfunctional processes of prediction error minimization, which are characterized by an overall decrease of the causal contributions of active inference and by distorted precision estimates. The emerging account promises to contribute to a better understanding of the complex processes that give rise to depressive experiences. (shrink)

The paper discusses two recent approaches to schizophrenia, a phenomenological and a neuroscientific approach, illustrating how new directions in philosophy and cognitive science can elaborate accounts of psychopathologies of the self. It is argued that the notion of the minimal and bodily self underlying these approaches is still limited since it downplays the relevance of social interactions and relations for the formation of a coherent sense of self. These approaches also illustrate that we still lack an account of how 1st (...) and 3rd person observations can fruitfully go together in an embodied account of disorders of the self. Two concepts from enactive cognitive science are introduced, the notions of autonomy and sense-making. Based on these, a new proposal for an enactive approach to psychopathologies of the self is outlined that integrates 1st and 3rd person perspectives, while strongly emphasising the role of social interactions in the formation of self. It is shown how the enactive framework might serve as a basis for an alternative understanding of disorders of the self such as schizophrenia, as a particular form of socially constituted self-organisation. (shrink)

The Self and its Disorders develops a philosophical and interdisciplinary approach to the formulation of an “integrative” perspective in psychiatry. In contrast to some integrative approaches that focus on narrow brain-based conceptions, or strictly on symptomology, this book takes its bearings from embodied and enactive conceptions of human experience and builds on a perspective that understands self as a self-pattern—a pattern of processes that include bodily, experiential, affective, cognitive-psychological, reflective, narrative, intersubjective, ecological, and normative factors. It provides a philosophical (...) analysis of the notion of self-pattern, framed in terms of dynamical organization. It then draws on phenomenological, developmental, clinical, and experimental evidence to propose a method for studying the effects of psychopathologies on the self-pattern, and includes discussions of network theory, predictive processing models, and the role of narrative. This book explores the hypothesis that psychiatric disorders are self-disorders, and includes specific discussions of schizophrenia, anxiety disorders, depression, borderline personality disorder, obsessive compulsive disorder and autism spectrum disorder, as well as traumatic effects of torture and solitary confinement. Other topics include diagnostic classification, symptom overlap, and transdiagnostic complexity. Several chapters explore a variety of philosophical issues that relate to therapeutic approaches, including deep brain stimulation, meditation-based interventions, and the use of artificial intelligence and virtual reality. (shrink)

It has been suggested that language disorders can serve as real windows onto language evolution. We examine this claim in this paper. We see ourselves forced to qualify three central assumptions of the the ‘disorders-as-windows’ hypothesis. After discussing the main outcome of decades of research on the linguistic ontogeny of pathological populations, we argue that language disorders should be construed as conditions for which canalization has failed to cope fully with developmental perturbations. We conclude that a robust (...) link exists between developmental disturbances and evolutionary history that allows language disorders to be used as real windows onto the evolution of the neuronal substrate of language, and emphasize that our conclusion is more compatible with views of language evolution as the result of reorganizational changes as opposed to radically novel emergences. (shrink)

The DSM-IV-TR (American Psychiatric Association 1994, 689) defines personality disorder (PD) as: An enduring pattern of experience and behavior that deviates markedly from the expectations of an individual’s culture. This pattern is manifested in two (or more) of the following areas: 1 Cognition (i.e., ways of perceiving and interpreting self, other people, and events); 2 Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response); 3 Interpersonal functioning; and 4 Impulse control. B The enduring ..

Several enactive-phenomenological perspectives have pointed to affectivity as a central aspect of mental disorders. Indeed, from an enactive perspective, sense-making is an inherently affective process. A question remains on the role of different forms of affective experiences (i.e., existential feelings, atmospheres, moods, and emotions) in sense-making and, consequently, in mental disorders. This work elaborates on the enactive perspective on mental disorders by attending to the primordial role of affectivity in the self-individuation process. Inspired by Husserl’s genetic methodology (...) and Simondonian philosophy of individuation, sense-making is described as the process of progressive concretization and structuration of the self-world structures that support the intentionality of conscious experiences. Accordingly, affectivity is described as the force that anticipates a partial self-world coherence in sense-making. Structurally different types of affective experiences are integrated into the genetic picture and, on this basis, a reinterpretation and classification of certain mental disorders, such as schizophrenia, depression, and the anxiety spectrum, is provided. In this way, this work contributes to a phenomenologically informed enactive account of mental disorders as disorders of affectivity. (shrink)

In this chapter I investigate the kinds of changes that psychiatric kinds undergo when they become explanatory targets of areas of sciences that are not “mature” and are in the early stages of discovering mechanisms. The two areas of science that are the targets of my analysis are cognitive neuroscience and cognitive neurobiology.

This article explores the idea that there is a spectrum of individuals who feel compelled to dwell in the past, either due to psychological or social conditions. I analyze both conditions respectively by critically examining two cases: post-traumatic stress disorder and racialized oppression. I propose that individuals with PTSD can feel psychologically compelled to dwell in the past in a dually negative sense: the individual lives in the past but also broods on it, causing them to feel “stuck” in the (...) past. This kind of “dwelling” can cause individuals to suffer disruptions to their sense of self and intersubjectivity. After exploring the psychological case of dwelling in the past, I explore the social sense in which individuals can dwell in the past due to oppressive social structures by examining the case of racialized oppression. The case of racialization is philosophically stimulating because of its intersubjective dimensions—it subverts the idea that dwelling in the past is simply a psychological phenomenon by capturing that others can help or hinder us with maintaining a sense of self and future-directed intentionality. By putting the phenomenological work of Al-Saji into conversation with recent phenomenological research on incarceration, I propose that racialization can be similarly disruptive to one’s sense of self and intersubjectivity. The proposed account is suggestive that traumatic and oppressive experiences may amplify and compound each other in ways not yet well elucidated in the literature. If this account is taken to be persuasive, it is indicative that both psychological and social conditions mediate one’s temporality and well-being. (shrink)

We present results from a single case study based on semi-structured interviews with a student (a boy in school year 3) diagnosed with autism spectrum disorder and his school staff after participating in a short and small-scale intervention carried out in a socio-economically disadvantaged Swedish elementary school in 2019. The student participated in a seven week long intervention with a total of 12 philosophical dialogues (ranging from 45 to 60 minutes). Two facilitators, both with years of facilitation experience and teacher (...) degree and at least BA in philosophy, facilitated the majority of the dialogues and mainly followed a ”routine” procedure. The student was interviewed in direct connection to the end of the intervention about his experiences from the dialogues and his perceptions about whether and how the dialogues had influenced him. The student’s two teachers, who had participated in the dialogues as participants, were interviewed as a pair, also in direct connection to the end of the intervention, while the school principal was interviewed two years after the study. These staff interviews concerned the staff’s experiences of the influence of the dialogues on the students within the intervention as well as transfer effects to other contexts in school. The data from the study include detailed elaborations from a student perspective of different effects on the student’s communicative and cognitive development, which are in several respects supported also by staff reports. The results show that the student was able, interested, and willing to participate in philosophical dialogues, and our data point to several positive outcomes for the student in the communicative and cognitive domains. (shrink)

Cognitive theory (CT) is currently the most widely acknowledged framework used to describe the psychological processes in affective disorders like depression. The purpose of this paper is to assess the philosophical assumptions upon which CT rests. It is argued that CT must be revised due to significant flaws in many of these philosophical assumptions. The paper contains suggestions as to how these problems could be overcome in a manner that would secure philosophical accuracy, while also providing an account that (...) is better suited to explaining some of the cognitive, emotional, and bodily manifestations of affective disorders. (shrink)

The dominant philosophical conceptions of obsessive-compulsive behavior present its subject as having a deficiency, usually characterized as volitional, due to which she lacks control and choice in acting. Compulsions (mental or physical) tend to be treated in isolation from the obsessive thoughts that give rise to them. I offer a different picture of compulsive action, one that is, I believe, more faithful to clinical reality. The clue to (most) obsessive-compulsive behavior seems to be the way obsessive thoughts, which are grounded (...) in an irrational cognitive style in matters of risk, danger, and responsibility, motivate compulsions through bizarre means–end reasoning. I show that the patient with obsessive-compulsive disorder (OCD) is not weak and passive with regard to the compulsive act; rather, the act is voluntary and regarded by the patient as an instrument of control. I also defend the idea that OCD-related cognitions are either beliefs or mental states with relevantly similar functional roles. (shrink)

Cognitive scientists have a variety of approaches to studying cognition: experimental psychology, computer science, robotics, neuroscience, educational psychology, philosophy of mind, and psycholinguistics, to name but a few. In addition, they also differ in their approaches to cognition - some of them consider that the mind works basically like a computer, involving programs composed of abstract, amodal, and arbitrary symbols. Others claim that cognition is embodied - that is, symbols must be grounded on perceptual, motoric, and emotional (...) experience. The existence of such different approaches has consequences when dealing with practical issues such as understanding brain disorders, designing artificial intelligence programs and robots, improving psychotherapy, or designing instructional programs. The symbolist and embodiment camps seldom engage in any kind of debate to clarify their differences. This book is the first attempt to do so. It brings together a team of outstanding scientists, adopting symbolist and embodied viewpoints, in an attempt to understand how the mind works and the nature of linguistic meaning. As well as being interdisciplinary, all authors have made an attempt to find solutions to substantial issues beyond specific vocabularies and techniques. (shrink)

Shared Musical Lives makes the case for the epistemological and ethical significance of musical experience. Music can be a source of self-knowledge and self-expression, and hence reveal important dimensions of the self to others. This knowledge - of both self and of others - has a moral force as well. Shared musical experience can transform and establish new modes of being with others, cultivate virtues, and expand the moral imagination. The term sonification (which means translating data into non-verbal audible tones) (...) provides an organizing principle for the arguments in the book.Transposing the concept into a philosophical key, this book explores two forms of sonification: first, the process by which musical experience reveals dimensions of the self and relationships with others; and second, philosophical sonification, or the critical examination of philosophical concepts,arguments, and theories in view of what musical experience reveals. These two kinds of sonification are discussed specifically in the context of disability. In this book, author Licia Carlson brings the musical lives of people with cognitive and intellectual disabilities into the foreground in order to challenge and broaden existing conceptions of disability and music and provide new ways of thinking about the philosophies of music and disability. (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)

A typical device in film is to have a character narrating what is going on, but this narration is not always a reliable guide to the events. According to Maier, distortions may be caused by the narrator’s intent, naivety, use of drugs, and/or cognitive disorder/illness. What is common to these various causes, he argues, is the presence of a point of view, which appears in a movie as shots. While this perspective-based account of unreliability covers most cases, I unpack its (...) methodological consequences and gesture at a possibility that Maier’s analysis overlooks. A narration, I suggest, can be unreliable simply because it is ill-timed with the events shown on screen. In such a case, the distortion is not due to any character’s point of view; rather, it comes from the film medium’s ability to divorce what is seen and what is heard. As a consequence of this mismatch, it is possible to have a reliable narrator but an unreliable narration. Since voice and context of utterance usually match in ordinary speech, I conclude that philosophy of language may be ill-suited to properly understand this particular phenomenon. (shrink)

This paper clarifies Merleau-Ponty’s original account of “higher-order” cognition as fundamentally embodied and enacted. Merleau-Ponty’s philosophy inspired theories that deemphasize overlaps between conceptual knowledge and motor intentionality or, on the contrary, focus exclusively on abstract thought. In contrast, this paper explores the link between Merleau-Ponty’s account of motor intentionality and his interpretations of our capacity to understand and interact productively with cultural symbolic systems. I develop my interpretation based on Merleau-Ponty’s analysis of two neuropathological modifications of motor intentionality, the (...) case of the brain-injured war veteran Schneider, and a neurological disorder known as Gerstmann’s syndrome. Building on my analysis of Schneider’s sensorimotor compensatory performances in relation to his limitations in the domains of algebra, geometry, and language usage, I demonstrate a strong continuity between the sense of embodiment and enaction at all these levels. Based on Merleau-Ponty’s interpretations, I argue that “higher-order” cognition is impaired in Schneider insofar as his injury limits his sensorimotor capacity to dynamically produce comparatively more complex differentiations of any given phenomenal structure. I then show how Merleau-Ponty develops and specifies his interpretation of Schneider’s intellectual difficulties in relation to the ambiguous role of the body, and in particular the hand, in Gerstmann’s syndrome. I explain how Merleau-Ponty defends the idea that sensorimotor and quasi-representational cognition are mutually irreducible, while maintaining that symbol-based cognition is a fundamentally enactive and embodied process. (shrink)

Borderline personality disorder (BPD) is characterized by severe disturbances in a subject’s sense of identity. Persons with BPD suffer from recurrent feelings of emptiness, a lack of self-feeling, and painful incoherence, especially regarding their own desires, how they see and feel about others, their life goals, or the roles to which they commit themselves. Over the past decade or so, clinical psychologists, psychotherapists, and psychiatrists have turned to philosophical conceptions of selfhood to better understand the borderline-specific ruptures in the sense (...) of identity, which are frequently associated with severe affective instability and turbulence in interpersonal relationships. Fuchs (2007) has suggested that these disturbances in self-experience can best be described and explained by using notions—widely discussed in philosophy and psychology—ofnarrativityandnarrative identity. On such a narrative view, key features of BPD present significant modifications of proto-narrative structures and inhibit the development of a narrative identity, resulting in a disturbed sense of identity. Although the role of narrativity in BPD has been acknowledged by many researchers, some have voiced dissatisfaction with what they take to be limitations of a narrativistic understanding of the disorders of identity characterizing BPD, and have proposed alternative, allegedly non-narrativistic, accounts. In this paper, we critically examine an example of the latter, viz. Gold and Kyratsous’ (2017) account ofthe person as an intrapersonal team reasoner. We defend a narrativistic understanding of BPD identity disorder against their objections. To this end, we propose a broader, and more finely-differentiated, concept of narrativity. On this account, four aspects of narrativity are distinguished, the disordering of which can affect those with BPD. As it turns out, our account implies that even Gold and Kyratsous—in order to ground their approach—must either make use of these aspects or propose an as-yet unarticulated alternative. This casts doubt upon whether their approach is non-narrativistic after all. (shrink)

The past twenty years have seen an increase in the importance of the body in psychology, neuroscience, and philosophy of mind. This 'embodied' trend challenges the orthodox view in cognitive science in several ways: it downplays the traditional 'mind-as-computer' approach and emphasizes the role of interactions between the brain, body, and environment. In this article, I review recent work in the area of embodied cognitive science and explore the approaches each takes to the ideas of consciousness, computation and representation. Finally, (...) I look at the current relationship between orthodox cognitive science and the study of mental disorder, and consider the implications that the embodied trend could have for issues in psychopathology. (shrink)

The tendency to draw mind-brain dichotomies and evaluate mental disorders dualistically arises in both laypeople and mental health professionals, leads to biased judgments, and contributes to mental health stigmatization. This paper offers a theory identifying an underlying source of these evaluations in social practice. According to this theory, dualistic evaluations are rooted in two mechanisms by which we represent and evaluate the beliefs of others in folk psychology and theory of mind: the doxastic conception of mental disorders and (...) doxastic voluntarism. Tracing these origins contributes to our understanding of mental state representation in cognitive science and philosophy of psychiatry, the concept of belief in philosophy of mind, and may help improve patient experience and treatment in light of social stigmatization and bias toward mental illness. (shrink)

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

This book brings together insights from the enactivist approach in philosophy of mind and existing work on autonomous agency from both philosophy of action and feminist philosophy. It then utilizes this proposed account of autonomous agency to make sense of the impairments in agency that commonly occur in cases of dissociative identity disorder, mood disorders, and psychopathy. While much of the existing philosophical work on autonomy focuses on threats that come from outside the agent, this book addresses how inner (...) conflict, instability of character, or motivational issues can disrupt agency. In the first half of the book, the author conceptualizes what it means to be self-governing and to exercise autonomous agency. In the second half, she investigates the extent to which agents with various forms of mental disorder are capable of exercising autonomy. In her view, many forms of mental disorder involve disruptions to self-governance, so that agents lack sufficient control over their intentional behavior or are unable to formulate and execute coherent action plans. However, this does not mean that they are utterly incapable of autonomous agency; rather, their ability to exercise this capacity is compromised in important respects. Understanding these agential impairments can help to deepen our understanding of what it means to exercise autonomy, and also devise more effective treatments that restore subjects' agency. Autonomy, Enactivism, and Mental Disorder will be of interest to researchers and advanced students working in philosophy of mind, philosophy of action, philosophy of psychiatry, and feminist philosophy. (shrink)

This paper brings to bear empirical evidence from a sample of undergraduate students to show that perfectionism can be a fundamental cognition behind the essential symptoms of some anxiety and mood disorders, notably Generalized Anxiety Disorder and Major Depression; and it suggests that this popular “philosophy of life” may helpfully be used in diagnosing these disorders.

Does DBS change a patient’s personality? This is one of the central questions in the debate on the ethics of treatment with Deep Brain Stimulation (DBS). At the moment, however, this important debate is hampered by the fact that there is relatively little data available concerning what patients actually experience following DBS treatment. There are a few qualitative studies with patients with Parkinson’s disease and Primary Dystonia and some case reports, but there has been no qualitative study yet with patients (...) suffering from psychiatric disorders. In this paper, we present the experiences of 18 patients with Obsessive-Compulsive Disorder (OCD) who are undergoing treatment with DBS. We will also discuss the inherent difficulties of how to define and assess changes in personality, in particular for patients with psychiatric disorders. We end with a discussion of the data and how these shed new light on the conceptual debate about how to define personality. (shrink)

Narratives structure and inform how we understand our experiences and identity, especially in instances of suffering. Suffering in mental disorder (e.g. bipolar disorder) is often uniquely distressing as it impacts capacities central to our ability to make sense of ourselves and the world—and the role of narratives in explaining and addressing these effects is well-known. For many with a mental disorder, spiritual/religious narratives shape how they understand and experience it. For most, this is because they are spiritual and/or religious. For (...) others, spiritual/religious narratives still often influence secular approaches to mental disorder, more than approaches to other disabilities (e.g. intellectual, physical) or causes of suffering (e.g. physical disease). Such narratives are often harmful, especially insofar as they ‘over-spiritualize’ mental disorder; and undercut ‘spiritual meaning-making’. Here I address the impact of spiritual/religious narratives that helpfully avoid over-spiritualizing mental disorder while enabling spiritual meaning-making about it. First, I address the role of narratives in meaning-making more generally; then, I present results from my recent empirical study testing the impact of such narratives on participants’ meaning-making about their mental disorder. I conclude by addressing implications and potential worries. (shrink)

Contemporary psychiatry is becoming more biologically oriented in the attempt to elicit a biological rationale of mental diseases. Although mental disorders comprise mostly functional abnormalities, there is a substantial overlap between neurology and psychiatry in addressing cognitive disturbances. In schizophrenia, the presence of cognitive impairment prior to the onset of psychosis and early after its manifestation suggests that some neurocognitive abnormalities precede the onset of psychosis and may represent a trait marker. These cognitive alterations may arise from functional disconnectivity, (...) as no significant brain damage has been found. In this review we aim to revise A.R. Luria’s systematic approach used in the neuropsychological evaluation of cognitive functions, which was primarily applied in patients with neurological disorders and in the cognitive evaluation in schizophrenia and other related disorders. As proposed by Luria, cognitive processes, associated with higher cortical functions, may represent functional systems that are not localized in narrow, circumscribed areas of the brain, but occur among groups of concertedly working brain structures, each of which makes its own particular contribution to the organization of the functional system. Current developments in neuroscience provide evidence of functional connectivity in the brain. Therefore, Luria’s approach may serve as a frame of reference for the analysis and interpretation of cognitive functions in general and their abnormalities in schizophrenia in particular. Having said that, modern technology, as well as experimental evidence, may help us to understand the brain better and lead us towards creating a new classification of cognitive functions. In schizophrenia research, multidisciplinary approaches must be utilized to address specific cognitive alterations. The relationships among the components of cognitive functions derived from the functional connectivity of the brain may provide an insight into cognitive machinery. (shrink)

Autism spectrum disorder (ASD) is a psychopathological condition characterized by persistent deficits in social interaction and communication, and restricted, repetitive patterns of behavior and interests. To build an ecological-enactive account of autism, I propose we should endorse the affordance-based approach of the skilled intentionality framework (SIF). In SIF, embodied cognition is understood as skilled engagement with affordances in the sociomaterial environment of the ecological niche by which an individual tends toward the optimal grip. The human econiche offers a whole (...) landscape of affordances, and situated individuals respond to a field of relevant affordances. An important part of SIF is an ecological-enactive interpretation of the free energy principle and predictive processing. Predictive processing accounts indicate that in ASD too much precision is assigned to prediction errors. Autistic persons depend heavily on current sensory information and less on prior beliefs and cannot attune to stable regularities. To reduce uncertainty, they over-rely on routines, strict habits, and a familiar environment—a predictable ecological niche they construct. I argue that skilled intentionality gives us the framework from which to analyze the autistic field of affordances. Autistic patterns of affordance-related bodily states of action readiness are only sensitive to very specific solicitations in the environment and achieve optimal grip in well-known situations. Autism is to be understood as a disorder of bodily normativity. Taking this approach helps us figure out what neurotypical people can do to attune their environment in order to scaffold the needs of autistic individuals by redesigning the landscape of affordances. (shrink)

Worrying is the central feature of generalized anxiety disorder . Many people worry from time to time, but in GAD the worrying is prolonged and difficult to control. Worrying is a specific way of coping with perceived threats and feared situations. Meanwhile, it is not considered to be a helpful coping strategy, and the phenomenological account developed in this paper aims to show why. It builds on several phenomenological notions and in particular on Michael Wheeler's application of these notions to (...) artificial intelligence and the cognitive sciences. Wheeler emphasizes the value of 'online intelligence' as contrasted to 'offline intelligence'. I discuss and apply these concepts with respect to worrying as it occurs in GAD, suggesting that GAD patients overrate the value of detached contemplation , while underrating their embodied-embedded adaptive skills . I argue that this phenomenological account does not only help explaining why worrying is used as a coping strategy, but also why cognitive behavioral therapy is successful in treating GAD. (shrink)

Modern cognitive and clinical psychology offer insight into how people deal with natural disasters. In my methodological paper, I make a strong case for incorporating experimental findings and theoretical concepts of modern psychology into environmental historical disaster research. I show how psychological factors may influence the production and interpretation of historical sources with respect to perceptions of and responses to disasters. While previous psychological approaches to history mostly involve psychoanalysis, I focus on empirical psychology. Specifically, I review a number of (...) well documented heuristics, biases, and memory modulations as described by cognitive psychology. Moreover, I argue that including investigations on disaster related mental disorders would complement the environmental historical research of natural disasters. My approach highlights a strong potential for interdisciplinary collaborations among environmental historians and psychologists. (shrink)

Autism Spectrum Disorders have been defined as a group of developmental conditions that affect the capacity to interact with the physical and social environment, among others. A core feature of autism is the presence of restricted and repetitive behaviors that vary in complexity, form, and frequency throughout life history. These core features have traditionally been defined as impairments that interfere with communication competence. From an embodied approach, however, these actions could be seen as characteristic ways of interacting with the (...) world. In this sense, we take an enactive and embodied approach to cognition in which we conceive cognitive agents as sensorimotor systems whose perception-action occurs in terms of affordances. This framework provides an integrative view of autism considering affectivity, perception, action, exploration, and interaction within a complex and dynamic dimension. Following this, we propose different applications based on embodied, intercultural, and feminist epistemologies, to understand and participate with autistic and cognitively diverse populations. The change in theoretical and methodological paradigms within embodied cognitive science towards autism and other cognitive diversities and how they engage with the world can lead to more comprehensive, integrative, and bioethical approaches. (shrink)