The article is the text of a lecture given at the Faculty of the Humanities, March 2001. It argues that one implication of recent advances in the sciences of life may be that the binary opposition of the normal and the pathological is put into question. Canguilheim’s distinction between vital and social norms is challenged and superseded by a Foucauldian genealogical approach to programs for the government of individuals, and the norms of life that emerged in the nineteenth (...) and twentieth centuries are argued to be fundamentally social. Viewing genetics, biopsychiatry, and the commercialisation of drug development and biomedicine, the author argues that the logic of normalisation is loosing its hold, and being replaced by strategies for the continuous molecular management of variation, the modulation of susceptibilities, and the capitalisation of life itself. (shrink)

In this paper it is suggested that Canguilhem's examination of the history of the distinction between the normal and the pathological contains material of relevance to current debates about the nature of medicine, in particular concerning the status of quantitative indicators as indicators of the need for medical intervention. His arguments against the equation of health with normality are presented, together with his own suggested definition of health and the implications of this definition for physiology and medicine.

Can psychiatry be read from an anthropological point of view? What is normal? What is pathological? Social order and pathos in question on this essay.

Just as sadness is not always a symptom of mood disorder, irrational beliefs are not always symptoms of illness. Pathological irrational beliefs are distinguished from non-pathological ones by considering whether their existence is best explained by assuming some underlying dysfunctions. The features from which to infer the pathological nature of irrational beliefs are: un-understandability of their progression; uniqueness; coexistence with other psycho-physiological disturbances and/or concurrent decreased levels of functioning; bizarreness of content; preceding organic diseases known to be associated with irrational (...) beliefs; treatment response to medical intervention, etc. Severe irrationality is sometimes caused by normal human motivation rather than by mental or physical dysfunction. Pure forms of self-deception may satisfy the diagnostic criteria of delusional disorder, but there may be no evidence that suggests that they are caused by illness. Although those with pathological delusions do not recognize their delusions as symptomatic of illness, differentiating pathological beliefs from normal irrational beliefs is vitally important: If a belief is pathological, psychiatrists must seriously consider treating the patient against her will. If it is not pathological, conversely, involuntary treatments are prohibited because they offend her basic autonomy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.4 (2002) 387-394 [Access article in PDF] Psychosis Good and Bad:Values-Based Practice and the Distinction Between Pathological and Nonpathological Forms of Psychotic Experience Mike C. Jackson and K. W. M. Fulford IN TWO PAPERS in this issue of Philosophy, Psychiatry, and Psychology, Marek Marzanski and Mark Bratton (2002) and Caroline Brett (2002) develop important critiques, from the perspectives respectively of Christian theology and (...) Eastern philosophy, of our 1997 analysis of the distinction between pathological and nonpathological forms of psychotic experience (Jackson and Fulford 1997).In this response, we briefly summarize the main points from our 1997 analysis; we consider, separately, the important although very different challenges to that analysis from the perspectives of our two critics; and we briefly indicate the main lines of recent developments in policy, practice, and research in mental health as they relate to this important area of human experience. The Jackson and Fulford (1997) Analysis In our 1997 paper, we presented three case studies from a larger series (Jackson 1991, 1997, 2001) selected with the express aim of bringing into focus the conceptual difficulties that arise at the borderline between psychotic illness and what we called benign spiritual experience. On the basis of these case studies we argued thatspiritual experiences, which are essentially benign, can involve explicitly psychotic phenomenology; traditional psychiatric diagnostic methods, which focus on the form and content of beliefs and experiences, are not capable of distinguishing between pathological and nonpathological forms of such psychotic experiences; [End Page 387]evaluation of such experiences (and claims about "illness" and health more generally) necessarily involves value judgments as well as judgments about matters of fact (specifically, the "facts" of traditional descriptive psychopathology); and more specifically, the distinction between pathological and nonpathological phenomena concerns the way in which they are embedded in the structure of the values and beliefs by which the actions of the subjects concerned are defined: "In the case of pathological psychotic phenomena," we argued, "there is a radical failure of action.... In the case of spiritual psychotic phenomena, action is radically enhanced" (Jackson and Fulford 1997, 55).We then proposed a cognitive problem-solving model of psychotic experiences. This model suggests that such experiences can be a normal and adaptive psychological response to existential crises, such as loss of meaning or purpose in life, coming to terms with death or bereavement, and so on (Batson and Ventis 1982; Jackson, 1991, 1997, 2001). The model is consistent with a subsequent position paper published by the British Psychological Society arguing the case for a psychological formulation of psychotic experiences and cognitive-behavioural methods in their management (2000).In the case of nonpathological psychotic experience, the psychotic elements of the experience promote a paradigm shift in the individual's underlying assumptions, which effectively resolves their impasse and allows them to move forward. This is normally a self-limiting process, in that when the individual is able to utilize their insight, it acts to resolve the stress which triggered it. In pathological psychosis, this process fails for various possible reasons, which were not explored in any depth in that paper (but see Jackson 2001 for a more detailed discussion). The Challenge From Marzanski and Bratton Marek Marzanski and Mark Bratton reexamine the questions raised by our cases from a Christian theological perspective (Marzanski and Bratton 2002). They suggest a theologically based definition of spiritual experience according to which the criteria for "genuine" experience concerns its context within the development of the individual's religious faith. In Bratton and Marzanski's account, these criteria are based on a Christian value system.They present three cases of their own, which, in contrast to the three cases in our 1997 paper, vividly illustrate how phenomena that may be valued negatively from a medical perspective (i.e., as defined by us in terms of their consequences for action), may, at one and the same time, be valued positively from a religious perspective (i.e., in terms of their consequences for the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Ideal of Shared Decision Making Between Physicians and PatientsDan W. Brock (bio)IntroductionShared treatment decision making, with its division of labor between physician and patient, is a common ideal in medical ethics for the physician-patient relationship.1 Most simply put, the physician's role is to use his or her training, knowledge, and experience to provide the patient with facts about the diagnosis and about the prognoses without treatment (...) and with alternative treatments. The patient's role in this division of labor is to provide the values—his or her own conception of the good—with which to evaluate these alternatives, and to select the one that is best for himself or herself. As a rough guide to practice, this is a reasonable conception; most of the time it is likely to produce sound treatment decisions. However, as an ideal it is too simplistic, and is subject to several challenges that I will explore in this paper.Some challenges relate to the physician's role. This facts/values division of labor seems to assume that the physician can and should provide the facts about treatment alternatives in a value-neutral form. But some have questioned whether the sciences on which medicine is based are, or can be, value free. Moreover, the concepts of health and disease, and of the normal and pathological, are held by many to be value laden. And even if it is possible for physicians to provide only value-neutral facts to the patient, should the physicians' role be restricted in this way?Other challenges that I will present in the paper are to the patient's role [End Page 28] as provider of the values for the evaluation of the different treatment alternatives. One defense of this role is based on the claim that physicians are not in a position to know reliably what is in a patient's best interests (Buchanan, forthcoming). I believe at least as influential—even if often not explicitly stated—is an extreme subjectivism about values that assumes that the patient's own ultimate values, which define his or her own conception of the good, are incorrigible. By incorrigible, I mean they cannot be mistaken. In the standard case in which treatment is pursued for the patient's benefit, this extreme subjectivism is thought to support the patient's values guiding treatment decision making and treatment. I will explore this incorrigibility claim and will argue that on each of the main philosophical conceptions of the good for persons it is indefensible and should not be the basis for shared treatment decision making.Underlying this view of the physician-patient division of labor are assumptions and beliefs about the nature and relation of facts and values, and science and ethics, that are largely the legacy of a logical positivism that has long since been rejected by most philosophers. It is time that these unstable foundations for our normative ideal of the physician-patient relation were finally removed and replaced with more defensible underpinnings.Two Models of the Physician-Patient RelationshipPositivists insisted on a relatively sharp distinction between descriptive or empirical claims and science, on the one hand, and evaluative claims and ethics, on the other.2 Descriptive statements and the claims of science were to be true or false according to whether they in fact correctly described and explained the world. By remaining properly descriptive or empirical, science could, at least in principle, be entirely value neutral or value free.In its more extreme versions, positivism held that ethical judgments lacked cognitive content, but were instead expressions of emotions or attitudes, and as such could be neither true nor false, correct or mistaken. Because no evaluative statements were held to be logically entailed by any descriptive or empirical statements, moral reasoning was thought to be properly understood not as reasoning but as attempts at nonrational persuasion.3 Many drew from this an extreme subjectivism in ethics along the lines of what I have called above the incorrigibility thesis—there is no meaningful sense in which an individual's ultimate values defining his or her own conception of the good life could be mistaken, false, or unfounded.These... (shrink)

Traditionally, debates between psychiatrists and anti-psychiatrists have centered around the appropriateness of positivist models of psychological disorder. According to positivism, the cause of unusual or distressing mental states is to be found in biological abnormalities. This paper suggests that anti-psychiatry often challenges positivism by opposing accounts of social causation to those of physical, biological disease without first questioning the adequacy of positivist accounts of physical illness itself. Using the work of philosopher of medicine, Georges Canguilhem, I wish to elaborate (...) a non-positivist account of physical disease, which can then be applied to debates in mental health to redefine the terms within which the role of biological abnormalities can be thought. Applying Canguilhem's definition of pathology, the paper argues for a conception of mental illness in which the scientific identification of biological abnormalities is useful, but not in itself sufficient. Finally, these arguments are related to recent work involving cognitive therapy approaches to voice hearing and schizophrenia. (shrink)

Ancient sceptics, unlike their modern counterparts, claim to live their scepticism. Nowadays scepticism, whether epistemological, moral, or of any other variety, is seen as a purely theoretical position, with no direct bearing on the actual living of one’s life; this is because philosophical theories and everyday attitudes are taken to be in some way “insulated” from one another. Serious questions may be raised about the character of this alleged “insulation,” but these are not my present concern; the fact is that (...) no such split between “the philosophical” and “the ordinary” was entertained in the ancient world. It follows that the viability of scepticism as a way of life is a crucial issue for ancient sceptics. It is no accident that one of the most enduring objections to ancient scepticism is to the effect that the sceptical attitude—that is, the posture of universal suspension of judgement—is incompatible with any kind of normal human action; this was known in antiquity as the charge of apraxia, “inaction.” The sceptics for their part, were just as persistent in arguing that suspension of judgement had no such damaging consequences. In as much as the assessment of actual or imaginable types of human life is the province of ethics, I take this debate between ancient sceptics and their detractors to be, in a broad sense, an ethical debate. (shrink)

There is little debate regarding the acceptability of providing medical care to restore physical or mental health that has deteriorated below what is considered typical due to disease or disorder (i.e., providing “treatment”—for example, administering psychostimulant medication to sustain attention in the case of attention deficit disorder). When asked whether a healthy individual may undergo the same intervention for the purpose of enhancing their capacities (i.e., “enhancement”—for example, use of a psychostimulant as a “study drug”), people often express greater hesitation. (...) Building on prior research in moral philosophy and cognitive science, in this work, we ask why people draw a moral distinction between treatment and enhancement. In two experiments, we provide evidence that the accessibility of health-related interventions determines their perceived descriptive or statistical normality (Experiment 1), and that gains in descriptive normality for such interventions weaken the moral distinction between treatment and enhancement (Experiment 2). In short, our findings suggest that the tendency to draw a moral distinction between treatment and enhancement is driven, in part, by assumptions about descriptive abnormality; and raise the possibility that normalizing novel biomedical interventions by promoting access could undermine people’s selective opposition toward enhancement, rendering it morally comparable to treatment. (shrink)

This essay discusses Wittgenstein’s suggestion that we may speak of a distinction between a word’s primary and secondary senses. Instead of seeing the distinction merely as an example of a puzzling language use, many commentators have attempted to work out the distinction in terms of a supplement to a general theory of sense that they presume Wittgenstein developed in his later writings. I don’t think it is fair to ascribe such systematic aspirations to Wittgenstein.Indeed, Wittgenstein speaks (...) explicitly of the distinction only at two junctures in his work; this suggests that the distinction in itself was not of great import to Wittgenstein. In my view, it is essential to see how the example resonates with other ideas and problems in his writings, for example, his discussions of rule-following in part one of the Investigations. By my lights, this has not been fully recognized in the standard literature. In discussing the distinction, I will argue for the importance of paying attention to a broader context than what is normally considered. (shrink)

This essay discusses Wittgenstein’s suggestion that we may speak of a distinction between a word’s primary and secondary senses. Instead of seeing the distinction merely as an example of a puzzling language use, many commentators have attempted to work out the distinction in terms of a supplement to a general theory of sense that they presume Wittgenstein developed in his later writings. I don’t think it is fair to ascribe such systematic aspirations to Wittgenstein.Indeed, Wittgenstein speaks (...) explicitly of the distinction only at two junctures in his work; this suggests that the distinction in itself was not of great import to Wittgenstein. In my view, it is essential to see how the example resonates with other ideas and problems in his writings, for example, his discussions of rule-following in part one of the Investigations. By my lights, this has not been fully recognized in the standard literature. In discussing the distinction, I will argue for the importance of paying attention to a broader context than what is normally considered. (shrink)

This article raises the question of ‘normality’ today and the fracturing of health ideals along new lines of enablement and function. In particular the study asks if ‘functional’ and ‘dysfunctional’ are displacing ‘normal’ and ‘pathological’ as master biopolitical binarisms, and if so, what distinctions can be drawn between them. The discourse of ‘function’ and ‘dysfunction’ is certainly ubiquitous in two areas of research and practice: gerontology and sexology. In the former case ‘functional health’ is linked to successful aging (...) represented by technical tests around activities of daily living (ADLs) and risk-assessment profiles. In the latter case, sexual function and dysfunction have become all-encompassing markers of heterosexual competence, now largely detached from reproductive imperatives, but refashioned as integral to responsible and successful self-management. Presenting examples from both cases, the article concludes that functionality, circulating under the signs of ‘normal’, ‘natural’ and ‘healthy’, furnishes economic, technological, educational, professional, pharmacological and policy fields with a rich intellectual, practical and regulatory resource. (shrink)

ABSTRACT Axel Honneth deploys the categories of normal and pathological to explain contemporary society in organic terms. This article concerns itself with how these medical references function in Honneth's work to explain the social world, and what their political implications are. For Honneth, social normality is a normative resource, even if it is only accessible through the study of pathology. Socially accepted norms are taken to reflect legitimate principles, with the early Honneth taking pathology as an individual (...) psychic suffering that results from injustice, and the later Honneth taking pathology as an overextension of the logic of one social sphere into the terrain of another. The implications of Honneth's organic account of society are explored through the lens of a competing “French” account of the norm offered by Canguilhem and Foucault. These French thinkers view socially accepted norms not as reflecting legitimate principles, but as standardizing processes of normalization that stifle normativities that do not conform. It is suggested that Honneth's account of normativity must be articulated with Canguilhem's and Foucault's account of normalization. That said, through the course of the analysis, several unexpected continuities are discovered between these two different traditions. (shrink)

Ideologies, worldviews, or simply personal theories, often acquire a distorted and pathological character, and become a factor of alienation rather than an epistemic resource and an aid for personal existence. This paper attempts to better define the limits and characteristics of this experience, which we call distorted intellectual beliefs, or general conceptual beliefs (GB), while trying to highlight both its sometimes dramatic background and its personal and social consequences, which are no less potentially deleterious. We believe that such experiences should (...) not be confused tout court with a broader and more complex phenomenon, such as extremism and politico-religious radicalism, but are a specific typology of that broader and multifaceted fact that is self-deception. We hypothesize that the self-deception implicit in experiences of intellectual distortion produces a cognitive dissonance of which the subject is normally, though with varying intensity, aware (or may become aware through honest introspection). The phenomenon occurs in two extreme forms: one is normal (sporadic), the other is exceptional (systematic). The passage from one to the other is a complex process of escalation and de-escalation, on which multiple external and internal variables act. In its ascending path, it essentially coincides with a process of psychological polarization and cognitive "de-pluralization", while its descending phase marks a return to reality and a "re-pluralization", where the subject returns to being what he basically is, namely, an active and tireless meaning seeker. In the central part of the chapter, similarities and differences between processes of deradicalization and phenomena of religious deconversion are analyzed, with reference, among others, to the case of the Austro-Hungarian writer Arthur Koestler. -/- An abridged version of this text has been delivered for the Workshop "Explaining Extreme Belief and Extreme Behavior", September 15-16, 2022, Vrije Universiteit Amsterdam. I am grateful to David Konstan (NYU) for reading and commenting on a first version of this chapter and to Rik Peels (VUA) for his comments and questions during the Workshop. I would also like to thank my bachelor's and master's students at UDG, who discussed these topics at length with during semester 2022-B. (shrink)

Ideologies, worldviews, or simply personal theories, often acquire a distorted and pathological character, and become a factor of alienation rather than an epistemic resource and an aid for personal existence. This paper attempts to better define the limits and characteristics of this experience, which we call distorted intellectual beliefs, or general conceptual beliefs (GB), while trying to highlight both its sometimes dramatic background and its personal and social consequences, which are no less potentially deleterious. We believe that such experiences should (...) not be confused tout court with a broader and more complex phenomenon, such as extremism and politico-religious radicalism, but are a specific typology of that broader and multifaceted fact that is self-deception. We hypothesize that the self-deception implicit in experiences of intellectual distortion produces a cognitive dissonance of which the subject is normally, though with varying intensity, aware (or may become aware through honest introspection). The phenomenon occurs in two forms: one is normal (sporadic), the other is exceptional (systematic). The passage from one to the other is a complex process of escalation and de-escalation, on which multiple external and internal variables act. In its ascending path, it essentially coincides with a process of psychological polarization and cognitive "de-pluralization", while its descending phase marks a return to reality and a "re-pluralization", where the subject returns to being what he basically is, namely, an active and tireless meaning seeker. In the central part of the chapter, similarities and differences between processes of deradicalization and phenomena of religious deconversion are analyzed, with reference, among others, to the case of the Austro-Hungarian writer Arthur Koestler. -/- An abridged version of this text has been delivered for the Workshop "Explaining Extreme Belief and Extreme Behavior", September 15-16, 2022, Vrije Universiteit Amsterdam. I am grateful to David Konstan (NYU) for reading and commenting on a first version of this chapter and to Rik Peels (VUA) for his comments and questions during the Workshop. I would also like to thank my bachelor's and master's students at UDG, who discussed these topics at length with during semester 2022-B. (shrink)

According to human enhancement advocates, it is morally permissible (and sometimes obligatory) to use biomedical means to modulate or select certain biological traits in order to increase people’s welfare, even when there is no pathology to be treated or prevented. Some authors have recently proposed to extend the use of biomedical means to modulate lust, attraction, and attachment. I focus on some conceptual implications of this proposal, particularly with regard to bioconservatives’ understanding of the notions of therapy and enhancement (...) I first explain what makes the proposal of medicalizing love interesting and unique, compared to the other forms of bioenhancement usually advocated. I then discuss how the medicalization of love bears on the more general debate on human enhancement, particularly with regard to the key notion of “normality” that is commonly used to define the therapy–enhancement distinction. This analysis suggests that the medicalization of love, in virtue of its peculiarity, requires bioconservatives to reconsider their way of understanding and applying the notions of “therapy” and “enhancement.” More in particular, I show that, because a non-arbitrary and value-free notion of “therapy” cannot be applied to the case of love, bioconservatives have the burden of either providing some new criterion that could be used for drawing a line between permissible and impermissible medicalization, or demonstrating that under no circumstances—including the cases in which love is already acknowledged to require medical intervention—can love fall within the domain of medicine. (shrink)

This article considers whether a morally relevant distinction can be drawn between wild and domesticated animals. The term “wildness” can be used in several different ways, only one of which (constitutive wildness, meaning an animal that has not been domesticated by being bred in particular ways) is generally paired and contrasted with“domesticated.” Domesticated animals are normally deliberately bred and confined. One of the article's arguments concerns human initiatives that establish relations with animals and thereby change what is owed (...) to these animals. The main relations of interest in ethics are the vulnerability and dependence in animals that are created when humans establish certain relations with them on farms, in zoos, in laboratories, and the like. Domestication is a pervasive way in which humans make animals vulnerable, and thereby duties of animal care and protection arise in a persistent way. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.4 (2002) 343-347 [Access article in PDF] Mysticism and Psychosis:Descriptions and Distinctions Michael McGhee IT IS REFRESHING to read a paper that manages at once to be interdisciplinary and intercultural in its range of reference, and that also confronts a difficult and controversial question about how we are to assess the similarities and differences between psychotic and mystical experiences. Many psychiatrists have been skeptical (...) about whether there are any genuine differences, and not, mostly, because they thought that psychotics were in reality mystics. But mystical is pretty vague, as is spiritual, and that does not bode well for the enterprise of making comparisons, unless we can tie these latter terms down with some precision. How vague psychosis is I must leave others to judge, but one of the conclusions I have drawn from reading this paper is that the crucial questions turn not on agreed definitions, but on agreed judgments about what are to count as the examples or cases that fall under the definitions. I have some doubts about Caroline Brett's approach to these questions, in the first half hesitant doubts, in the second part less so. Her leading claim appears first in the Introduction:... spiritual or mystical experiences are those states in which the form of experience is altered from normal consciousness, resulting in a new understanding of the basic nature of reality, life, and the individual. Psychotic experiences are those states that also flow from alterations of the form of experience, but result in a pathological interaction between the individual and the world. Therefore, according to these definitions, phenomena occurring in a spiritual context may be identical to those traditionally viewed as symptoms of psychosis, but cannot be seen as psychotic in themselves. (Brett 2002, 322) What I was struck by in reading this passage was not so much the claim that "phenomena occurring in a spiritual context may be identical to those traditionally viewed as symptoms of psychosis, but cannot be seen as psychotic in themselves." What struck me was its implication: that psychotic experiences cannot be seen as psychotic in themselves, either. In other words, the claim is that there is a neutral core of common experience shared by psychotic and mystic alike. I do not know how controversial this is in the psychiatric literature that deals with delusion and hallucination, but I should like to explore the claim a little in what follows. Brett expands on it near the end of her paper: The pathology that differentiates the psychotic from the benign mystical state lies not in the content of beliefs, or even in the broad form of experience, but in a few interrelated commonsense factors. It consists of an inability to return to the ontological framework of consensus reality; in psychological isolation, and inability [End Page 343] to accommodate to the subjectivity of others; in a focus of interest in the mental realm and loss of practical concerns that leads to paucity of action and neglect of self-care. (Brett 2002, 336) This pushes the pathology away from the experience that might have been thought to constitute the psychosis. I wonder whether there are problems with this. The fact, if it is one, that both mystic and psychotic alike undergo "an altered state" clearly does not imply that there is a (common) altered state that they both undergo, so what are the grounds for the claim that the core or central experience is the same? What kind of experiences are claimed to be common? How are we to conceive delusion on this scenario?What makes psychotic experiences psychotic on the present pushed back view seems to be that they "result in a pathological interaction between individual and world" (my italics), which thus exonerates the experience itself of pathology, pushing it back to one possible set of consequences for someone who reacts badly to the experiential phenomena (e.g., their inability to return from it). It seems to suggest that someone can be comfortable or well adapted to their voices and visions (and surely there are such people around, for whom the boundaries... (shrink)

Taking care of a hyperactive child at school gives 2 meanings to the word ‘care’: worrying about a vulnerable person and health care with the recognition of his behaviour disorder, the unruly pupil becomes a disabled pupil. But how does an undisciplined pupil become a psychiatric case? How do you recognise a hyperactive child at school, that is, from a medical point of view, a child with ADD/ADHD (Attention Deficient Disorder with or without Hyperactivity)? Teachers contribute to the medical diagnosis (...) by filling in behavioural tests. Then, in order to be taken care of, the child will need to have his hyperactivity recognised as a disability. To help the teacher, the doctor will give them advice on how to teach the child. Nevertheless, this desirable partnership raises difficulties. Between a paramedical support teacher and an educationalist doctor isn’t there a risk of witnessing a dilution of roles? The lifting of doctor-patient confidentiality called for by some teachers is emblematic of this confusion. Canguilhem’s distinction between normal and pathological will guide our reflection on the medical care of the hyperactive child at school. This case arouses an ethical issue about the medicalisation of our society. (shrink)

The case of Félida X and her ‘doubled personality’ served in the last quarter of the 19th century as a proving ground for a distinctively French form of psychology that bore the stamp of physiology, including the comparative term normal state. Debates around Félida’s case provided the occasion for reflection about how that term and its opposites could take their places in the emerging discursive field of psychopathology. This article centres its analysis on Eugène Azam’s 1876–77 study of Félida, and (...) the ways his framing of the case was adopted or critiqued by subsequent researchers. Azam initially deployed the label normal state in a routine manner, in contrast to his use of condition seconde to designate Félida’s other state; this pairing served, I argue, to anchor the scientific legitimacy of Félida’s extraordinary psychological manifestations. Unpacking the conceptual associations of Azam’s use of normal state, we find it marked as qualitatively distinct, temporally fixed, and most of all individualized; this without becoming normative. It was only through responses to and criticism of Azam’s study that there emerged a more generalized sense of normality against which pathological (hysteric) subjects’ comportment could be contrasted. Félida’s case itself constitutes a highly individualized reconfiguration of the concept of a normal state, while the subsequent framing of doubled mental states provides a valuable vantage point from which to consider the articulations between the language of emerging French psychology and its evolving subjects of enquiry. (shrink)

Despite the effort on DSM-5 and ICD-11, few appear satisfied with these classification systems. We suggest that the core reason for dissatisfaction is expecting too much from them; they do not provide discrete categories that map to specific causes of disease, they describe clinical syndromes intended to guide treatment choices. Here we review work on anxiety and anxiety disorders to argue that while clinicians draw a pragmatic distinction between normal and abnormal emotions based on considerations such as severity (...) and duration, understanding the evolutionary origins and utility of the emotions, including the adaptive value of adverse emotions, is key for formulating comprehensive assessments of an individual patient’s symptoms and for providing a conceptual foundation for pharmacotherapy, psychotherapy, and public health. (shrink)

The ‘multicultural clinical interaction’ presents itself as a dilemma for the mental health practitioner. Literature describes two problematic areas where this issues emerges - how to make an adequate distinction between religious rituals and the rituals that may be symptomatic of ‘obsessive compulsive disorder’ (OCD), and how to differentiate ‘normative’ religious or spiritual beliefs, behaviours, and experiences from ‘psychotic’ illnesses. When it comes to understanding service user’s ‘idioms of distress’, beliefs about how culture influences behaviour can create considerable (...) confusion and ‘normative uncertainty’ for mental health practitioners. In the absence of clear diagnostic and assessment criteria on distinguishing between ‘culture’ and ‘psychopathology’, practitioners have had to rely on their own intuition and seek out possible ‘strategies’ or ‘procedures’ from a contradictory and cross-disciplinary evidence base. Decontextualisation of service users’ experiences may result in the pathologisation of culturally ‘normative’ phenomenon, ‘category fallacy’ errors, and poor health care experiences and outcomes for service users. This paper situates this dilemma within a wider debate that has concerned both the biomedical and social sciences, namely, the unresolved question of ‘normality’ or ‘abnormality’. Indeed, issues that arise from dilemmas surrounding the question of ‘culture’ or ‘psychopathology’ are intimately tied to wider cultural ideas about what is considered ‘normal’. The disciplines of psychiatry, psychology, and medical anthropology have struggled to establish workable criteria against which to judge behaviour as ‘normal’, ‘abnormal’, or ‘pathological’. Three models for understanding mental ‘abnormality’ are evident in ‘transcultural psychiatry’ (what is now commonly known as ‘cultural psychiatry’), and these models have corresponded closely to the interpretive models used by anthropologists attempting to make sense of the apparent diversity of human societies. The three models of ‘absolutism’, ‘universalism’ and ‘cultural relativism’ have not only important consequences for the nature and conduct of research enquiry, but also have implications for how the dilemma of ‘culture’ or ‘psychopathology’ is attended to in clinical practice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mental Disorder and Moral Responsibility:Disorders of Personhood as Harmful Dysfunctions, With Special Reference to AlcoholismJerome C. Wakefield (bio)Keywordsalcohol dependence, philosophy of psychiatry, mental disorder, harmful dysfunction, psychiatric diagnosis, person, moral responsibilityIn his paper, Ethical Decisions in the Classification of Mental Conditions as Mental Illness, Craig Edwards grapples with a profound problem: why is it that when we classify a mental condition as a mental disorder, that tends to take (...) the condition out of the sphere of moral responsibility or virtuousness of character? For example, it is not uncommon when someone commits suicide and the question is raised as to why he or she did it, that instead of a reason or character trait that would place the act within a moral calculus, one is offered the explanation "she was clinically depressed" or "he was bipolar," and this tends to terminate discussion and make reasons and moral evaluation superfluous. Why does such a comment have that effect?As Edwards notes, this can get complicated as the moral and the disordered interact. Certainly people are sometimes morally responsible for acting on their disordered impulses (as in pedophilia), and they are responsible for putting themselves in the way of disorder, as when someone imbibes in a way likely to lead to alcoholism. But at the normal/disorder divide, there seems to be a consistent lifting of some responsibility, reflecting the application of the sick role. For example, the rough equivalent of our current category of post-traumatic stress disorder (PTSD) was recognized as a disorder in earlier wars ("shell shock," "war neurosis"), but often considered an expression of cowardice; the cowardice was morally evaluable as a failure of virtue (even if, like many personality traits, being a coward is not within the person's direct voluntary control) and led to contempt for those with PTSD, but nonetheless—except in cases thought to be malingering—the PTSD that resulted constituted a disorder for which the individual was [End Page 91] not in the same direct sense blameworthy. This moral shift requires explanation.This topic also has important social ramifications. Relief from responsibility may sound like a good thing, and it is trumpeted by mental health advocates as a reason for supporting the classification of many conditions as disorders. But as Edwards is aware, it is a two-edged sword. Disordered status may allow escape from censure and offer the protections of the sick role, but it also changes the relationship of the agent to his or her own actions and imposes the responsibility of the sick role on the individual to attempt to change ("get better"). The sick role allows for no defense of an idiosyncrasy based on normal variation ("It takes all kinds…") or the individual's eccentric vision or steadfast integrity, for that vision or sense of integrity are now seen as pathological and not morally legitimate. The individual is subjected to endless entreaties to seek help and it is implied that not to do so is irresponsible, so that a decision to embrace one's nature and remain as one is becomes illegitimate. Moreover, the sick role allows for no explanation in terms of the individual's normal defensive response to unjust, deprived, or challenging social or environmental circumstances, thus weakening the motives for social change rather than individual intervention.In sum, there is an inevitable sense in which being placed in the sick role inherently stigmatizes the "sick" condition in virtue of the special moral attitudes extended to the disordered. Cultures can thus easily exploit the sick role and its much-touted relief from responsibility to extend the reach of social control processes. This is one reason why the distinction between disorder and non-disorder is so important, and why it is crucial to identify when non-disordered conditions are mislabeled as disorders—as when, for example, psychiatry gets it wrong about the distinction between normal and disordered sadness (Horwitz and Wakefield, 2007). Such overpathologization can redefine the boundaries of our moral universe on mistaken grounds.Edwards offers two provocative answers—not entirely at ease with each other—to the question of why mental disorders relieve the patient from moral responsibility: (1) mental disorders are... (shrink)

Pathological Internet use will have a serious impact on normal individual study and work and has become one of the most important factors hindering the growth and development of contemporary college students. The purpose of this study was to examine the mechanisms of loneliness and depression in the relationship between the Big Five personality traits and pathological Internet use. A total of 1,179 college students were studied using the Chinese version of the Big Five Personality Scale, Loneliness Scale, Depression (...) Scale, and Pathological Internet Use Scale. The results showed that loneliness partially mediated the relationship between extraversion and PIU and completely mediated the relationship between agreeableness and PIU and neuroticism and PIU. Depression completely mediated the relationship between agreeableness and PIU, neuroticism completely mediated the relationship with PIU, and sense of responsibility partially mediated the relationship with PIU. This study revealed the relationship between different personality traits and PIU and the mediating role of loneliness and depression, suggesting that we should carry out targeted interventions on PIU for college students with different personality traits. (shrink)

Amyloid β peptide (βA4) accumulates as plaques in the brains of individuals with Alzheimer's disease and Down's syndrome, and may contribute to the cognitive decline that is a feature of these diseases. βA4 is a normal product of cell metabolism, derived from the amyloid precursor protein (APP), but the biological functions of these molecules are not fully known. A hypothetical, descriptive model of the biological interrelationships between βA4 and APP is presented. APPS, the soluble form of APP, which is (...) released at the neuronal surface, and βA4 are envisaged as physiological ligands which have reciprocal paracrine effects on neuronal growth and neurite extension. Differential expression of these factors, manifest as changes in the APPS:βA4 ratio, may therefore have growth‐promoting or growth‐inhibiting effects on neurons. These effects may be mediated through separate cell‐surface interactions but common intracellular effector systems, such as calcium and protein kinase C. In turn, the intracellular events may control the relative production of each ligand from APP through negative feedback loops. Disturbances of these control mechanisms may permit pathological overproduction, and hence accumulation, of βA4. Such a model may also have therapeutic implications. (shrink)

A common theme in the contemporary medical model of psychiatry is that pathophysiological processes are centrally involved in the explanation, evaluation, and treatment of mental illnesses. Implied in this perspective is that clinical descriptors of these pathophysiological processes are sufficient to distinguish underlying etiologies. Psychiatric classification requires differentiation between what counts as normality (i.e.- order), and what counts as abnormality (i.e.- disorder). The distinction(s) between normality and pathology entail assumptions that are often deeply presupposed, (...) manifesting themselves in statements about what mental disorders are. (shrink)

In the interpretation of Kant’s transcendental idealism, a textual stalemate between two camps has evolved: two-world interpretations regard things in themselves and appearances as two numerically distinct entities, whereas two-aspect interpretations take this distinction as one between two aspects of the same thing. I try to develop an account which can overcome this dispute. On the one hand, things in themselves are numerically distinct from appearances, but on the other hand, things in themselves can be regarded as (...) they exist in themselves and as they appear. This reveals a mutual entailment of both accounts. Finally, I suggest that this approach most naturally leads to a kind of ‘phenomenalism’, but of a sort not normally attributed to Kant. (shrink)

The treatment-enhancement distinction draws a line between services or interventions meant to prevent or cure conditions that we view as diseases or disabilities and interventions that improve a condition that we view as a normal function or feature of members of our species. The line drawn here is widely appealed to in medical practice and medical insurance contexts, as well as in our everyday thinking about the medical services we do and should assist people in obtaining.

How may a society, in a morally defensible way, confront a past of injustice and suffering, and seek to break the spell of violence and disregard for human life? I begin by demonstrating the relevance of this question to the South African Truth and Reconciliation Commission, and I draw attention to André du Toit's long- standing interest in ways in which truth commissions may function to consolidate political change. In the second section of the article, I argue that truth commissions (...) should be regarded as a defensible moral compromise between the values of justice and social unity, and I criticize claims that truth commissions promote transitional justice, when that is understood as a distinctive conception of justice that emerges in circum stances of regime transition. In the third section, I criticize the claim that truth commissions are not a moral compromise at all but embody a superior, restorative conception of justice. I conclude by showing why retribution is required by criminal justice, and why truth commissions must be seen, not as an end in themselves, but as institutions whose function is to emphasize the importance of the rule of law, normal criminal justice, and legal recognition. (shrink)

An ageing population and increased life expectancy are a characteristic of the Western world. Nevertheless, as Roger Fontaine writes, “although we should be glad about this fact, it should also be stressed that old age reveals profound discrepancies between individuals. In fact, we should not speak of ‘old age’ but ‘old ages’. Specialists make a distinction between normal old age, successful old age, and pathological old age.”Catherine Guchet points out that, at the end of the twentieth century, (...) two images of old age coexist, utilitarian in conception: that of ‘flamboyant’ old age and that of ‘dependent’ old age. The latter is associated with a loss of autonomy and dignity, especially for subjects affected by senile dementia, described as ‘unconscious’. We shall focus on these more problematic forms of old age. (shrink)

Norman Daniels argues that health is important for justice because it affects the distribution of opportunities. He claims that a just society should guarantee fair opportunities by promoting and restoring the “normal functioning” of its citizens, that is, their health. The scope of citizens' mutual obligations with respect to health is defined by a reasonable agreement that, according to Daniels, should be based on the distinction between normal functioning and pathology drawn by the biomedical sciences. This paper (...) deals with the question whether it is legitimate to ascribe the responsibility of defining this important moral boundary to the biomedical sciences, which Daniels regards as value neutral. Daniels appeals to Christopher Boorse's sophisticated bio-statistical theory (BST) to show the plausibility of a value-neutral distinction between normal functioning and pathology. Here I argue that a careful analysis of the concept of normal functioning, such as the one offered by the recent critique by Elselijn Kingma, shows that it depends from evaluative assumptions. This, I argue, implies that Daniels's theory must give up its naturalistic commitments. In the conclusion, the paper offers a detailed discussion and an objection to one of Daniels's arguments in favor of a moderate form of normativism that remains too close to Boorse's naturalism. (shrink)

Bedwetting has confounded the presumed boundaries of the human body, existing in a fluid space, between the normal and pathological. Its treatment has demanded the application of a wide array of different technologies, each based on a distinct conception of the relationship between the body and personality, human organs and personal conduct. In tracing the social history of bedwetting and its regulation, this article examines the ontological assumptions underpinning the treatment of bedwetting and how they have changed over (...) the past two centuries. Through the analysis of medical journals, newspaper articles and magazine advertisements, different topologies are identified which redefine the boundaries of the human body and its capacities. From 16th-century naturalism, in which the human body is subordinated to a cosmic totality, to the circumscribed space of 19th-century paediatrics and the expansive circuits of behavioural psychology and modern psychoanalysis, the body has become multiplied, differently enacted through the application of diverse technologies. It will be shown how coordinating the messy and divergent conceptions of the human body has posed an endemic problem for the human sciences, and how the enduring tension between object enactment and subject constitution is an expression of modern ‘baroque’ subjectivity. (shrink)

The history of mental illnesses is as old as human history. Mental disorders are affected by changing social and cultural factors during the historical process, and have been conceptually restructured and their definitions and classifications have been changed. The evolution of obssessive-compulsive disorders with roots as old as human history into modern concepts took place in the 19th century. The first scientific views on the spiritual origin of OCD belong to S. Freud. Freud observed that mental causes in OCD are (...) different from other mental disorders, and he examined obsession as a separate and specific disorder. Over time, it has been understood that OCD is a very common disorder. The American Psychiatric Association (APA) has classified OCD under an independent title in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by removing it from the category of anxiety disorders. OCD is a mental disorder caused by mental actions such as obsessive thoughts (obsessions) and / or repetitive and compulsive behaviors (compulsion). The patient is often aware that such thoughts and behaviors are irrational and absurd. For this reason, he tries to get away obsessive thoughts that he finds contrary to his beliefs, opinions, moral values and logic from his mind. However, as he tries, obsessive thoughts become more and more frequent and create a great anxiety in the person. This time, the patient resorts to compulsions to alleviate the anxiety he feels or to get rid of it completely. As his compulsions repeat, his anxiety increases and he goes into a vicious circle. There are many symptom subgroups of OCD that seriously worsen the quality of life of the individual. One of these, and even the most overwhelming, is religious obsessions. It has been thought that there has been a relationship between religion and OCD for a long time in the psychology literature, and some remarkable studies have been conducted to clarify this relationship. Although there are many research findings showing that religion is an indispensable element in the protection of the mental health integrity of the individual, some forms of religious understanding and some experiences gained as a result of religious experiences may affect the concerns about OCD. This stage of religiosity is closely related to some sub-symptom groups of OCD. The explanations of the founder of the psychoanalytic method, Freud psychoanalytic method, and his followers made a great contribution to the understanding of OCD. However, since the psychoanalytic method exhibits a theoretically reductionist approach to religion, it is possible that the individual's devotion to religion is initially evaluated as a pathology or at least an important obstacle to insight. Today, cognitive behavioral psychotherapies are considered the most effective psychological treatment method for OCD, but their success rates in the treatment of religious OCD are low. Since religious OCD concerns often involve spiritual issues rather than concrete repeatable situations, behavioral methods can be quite difficult to apply in the treatment of religious OCD. Therefore, traditional psychotherapy approaches, even if they are not openly against religions, are insufficient to relieve the suffering in the lives of individuals with religious obsessions, as they generally neglect the religious dimension. Due to the vacuum that arises from restricting spiritual treatments to secular approaches, religious patients are threatened by the illegal practices of people who abuse religious feelings. Clinically, religious obsessions are more worrying and overwhelming. Therefore, their treatment is more difficult than others. Selective approaches that use different scientific disciplines together in the treatment of OCD and can stretch around religious beliefs and values can create more effective treatment models. Thus, the success rate in the treatment of religious OCD can be carried to higher levels thanks to the appropriate cooperation of the disciplines of medicine, psychology and theology. There is a rich religious cultural heritage that can support this collaboration in terms of theological disciplines. As an example, Abū Zayd al-Balkhī (d. 322/934), in his Maṣāliḥ al-abdān wa-l-anfus, probably made a clear distinction between neuroses and psychosis and classified neurotic disorders for the first time about ten centuries before Freud. In this study, the importance of approaching to religious obsessions as both a psychological disorder and a theological problem is emphasized. For this reason, cooperation of psychiatric and psychological approaches with spiritual counseling and guidance is recommended in the treatment of religious OCD. The difficulty in distinguishing whether the symptoms seen in a religious person are normal, natural religious thoughts and behaviors of religious life or abnormal appearances in the religious guise necessitates this interdisciplinary cooperation. (shrink)

Traditionally, autoimmune disease has been considered to be a case of false recognition; the immune system mistakenly identifies 'self' tissues as foreign, attacking them thus causing damage and malady. Accordingly, the history of autoimmunity is usually told as part ot the history of immunology, that is, of theories and experiments relating to the ability of the immune system to discriminate between self and nonself. This paper challenges this view, claiming that the emergence of the notion of autoimmunity in the (...) 1950s must be considered as part of a long develolpment in thought about pathology throughout the twentieth century, namely the conceptualisaiton of disease as a reactive and self-destructive process. During the first part of the twentieth century this notion became one of the cornerstones of pathology and was increasingly employed for the explanation of the non-infections, slow-burning diseases. Thus, the category of chronic disease had been defined anew, now encompassing all those diseases characterised by a persistent inflammatory process. Inflammation, in turn, was conceived as double-eged physiological mechanism, which was usually the direct mediator of damage, of the essence of disease. The paper also shows how this kind of analysis could emable a unified historical discussion of autoimmunity and allergy, hitherto considered to have distinct conceptual origins. (shrink)

How may a society, in a morally defensible way, confront a past of injustice and suffering, and seek to break the spell of violence and disregard for human life? I begin by demonstrating the relevance of this question to the South African Truth and Reconciliation Commission, and I draw attention to André du Toit’s longstanding interest in ways in which truth commissions may function to consolidate political change. In the second section of the article, I argue that truth commissions should (...) be regarded as a defensible moral compromise between the values of justice and social unity, and I criticize claims that truth commissions promote transitional justice, when that is understood as a distinctive conception of justice that emerges in circumstances of regime transition. In the third section, I criticize the claim that truth commissions are not a moral compromise at all but embody a superior, restorative conception of justice. I conclude by showing why retribution is required by criminal justice, and why truth commissions must be seen, not as an end in them selves, but as institutions whose function is to emphasize the importance of the rule of law, normal criminal justice, and legal recognition. (shrink)

The topic of disease mechanisms is of clinical importance, as our understanding of such mechanisms plays an important role in how we approach devising treatments for disease. In this paper, I critique an argument made by Mauro Nervi, in which he asserts that pathology is often better viewed in the context of distinct theoretical mechanisms. I use this critique as a starting point to argue that viewing pathology as a broken-normal, malfunctioning mechanism is more therapeutically practical and more (...) relevant to clinical drug design, than creating a theoretical separation of pathology from physiology. (shrink)

The meaning of niche and competitive ability have long been surrounded by controversy. The reason for this stems from the obscure relationship that exists between these terms. This extends from the views of Darwin through Eltonian tradition to current views in which the meaning of competitive ability is implicitly infused into the paradigm of niche. Distinct operational definitions for niche and competitive ability are therefore established with special reference to plants. It is proposed that potential niche refer explicitly to (...) a theoretical hyperspace of places where a species would leave descendents if all biotic interactions were precluded, and that competitive ability refer to the relative capacity to leave descendents in a particular place in the face of restrictions imposed by competitive interaction. This leads to a qualitative comprehensive theory for coexistence which may be extended to any type of biotic interaction. Niche and competitive ability are both determined by the biological attributes of a species and may be independently adjusted in a population by natural selection in contexts of competition. Species coexistence in nature may therefore be a consequence of alternative evolutionary mechanisms which may operate to various degrees in concert: (1) natural selection leading to niche differentiation; (2) an ongoing process of reciprocal selection (coevolution) which maintains an approximate balance in relative competitive abilities for contested resources. (shrink)

ObjectiveAre people with a characteristically large physiological sway rendered particularly unstable when standing on a moving surface? Is postural sway in standing individuals idiosyncratic? In this study, we examine postural sway in individuals standing normally, and when subtle continuous sinusoidal disturbances are applied to their support platform. We calculate consistency between conditions to verify if sway can be considered characteristic of each individual. We also correlate two different aspects of participants’ responses to disturbance; their sway velocity and their regulation (...) of body orientation.MethodsNineteen healthy adults (age 29.2 ± 3.2 years) stood freely on footplates coaxially aligned with their ankles and attached to a motorized platform. They had their eyes closed, and hips and knees locked with a light wooden board attached to their body. Participants either stood quietly on a fixed platform or on a slowly tilting platform (0.1 Hz sinusoid; 0.2 and 0.4 deg). Postural sway size was separated into two entities: (1) the spontaneous sway velocity component (natural random relatively rapid postural adjustments, RMS body angular velocity) and (2) the evoked tilt gain component (much slower 0.1 Hz synchronous tilt induced by the movement of the platform, measured as peak-to-peak (p-p) gain, ratio of body angle to applied footplate rotation).ResultsThere was no correlation between the velocity of an individual’s sway and their evoked tilt gain (r= 0.34,p= 0.15 andr= 0.30,p= 0.22). However, when considered separately, each of the two measurements showed fair to good absolute agreement within conditions. Spontaneous sway velocity consistently increased as participants were subjected to increasing disturbance. Participants who swayed more (or less) did so across all conditions [ICC(3,k)= 0.95]. Evoked tilt gain also showed consistency between conditions [ICC(3,k)= 0.79], but decreased from least to most disturbed conditions.ConclusionThe two measurements remain consistent between conditions. Consistency between conditions of two very distinct unrelated measurements reflects the idiosyncratic nature of postural sway. However, sway velocity and tilt gain are not related, which supports the idea that the short-term regulation of stability and the longer-term regulation of orientation are controlled by different processes. (shrink)

RésuméPlusieurs pensent qu'on devrait comprendre la personne qui fait le mal plutôt que la condamner. Le present article suggère que les écrits de Sartre seraient en désaccord avec une telle approche. Lorsqu'on combat le mal, selon ce qu'indiquent ces écrits, il n'y a aucun besoin, si l'on sait qu'une personne fait le mal, d'essayer de la comprendre. La distinction de Sartre entre comprendre une personne et savoir quelque chose est présentée en détail, à partir surtout de ses écrits de (...) fiction et de sa biographie de Gustave Flaubert. En exploitant cette distinction, on arrive à la conclusion qu'il est superflu d'essayer de comprendre la personne quifait le mal. Lorsque nous savons qu'une personne fait le mal, nous devons la combattre, directement et avec force. (shrink)

The impact of our desires and preferences upon our ordinary, everyday beliefs is well-documented [Gilovich, T. . How we know what isn’t so: The fallibility of human reason in everyday life. New York: The Free Press.]. The influence of such motivational factors on delusions, which are instances of pathological misbelief, has tended however to be neglected by certain prevailing models of delusion formation and maintenance. This paper explores a distinction between two general classes of theoretical explanation for delusions; (...) the motivational and the deficit. Motivational approaches view delusions as extreme instances of self-deception; as defensive attempts to relieve pain and distress. Deficit approaches, in contrast, view delusions as the consequence of defects in the normal functioning of belief mechanisms, underpinned by neuroanatomical or neurophysiological abnormalities. It is argued that although there are good reasons to be sceptical of motivational theories , recent experiments confirm that motives are important causal forces where delusions are concerned. It is therefore concluded that the most comprehensive account of delusions will involve a theoretical unification of both motivational and deficit approaches. (shrink)

Dream-enacting behaviors are behavioral expressions of forceful dream images often occurring during sleep-to-wakefulness transitions. We propose that DEBs reflect brain activity underlying social cognition, in particular, motor-affective resonance generated by the mirror neuron system. We developed a Mirror Behavior Questionnaire to assess some dimensions of mirror behaviors and investigated relationships between MBQ scores and DEBs in a large of university undergraduate cohort. MBQ scores were normally distributed and described by a four-factor structure . DEB scores correlated positively with MBQ (...) total and factor scores even with social desirability, somnambulism and somniloquy controlled. Emotion-specific DEB items correlated with corresponding emotion-specific MBQ items, especially crying and smiling. Results provide preliminary evidence for cross-state relationships between propensities for dream-enacting and mirror behaviors—especially behaviors involving motor-affective resonance—and our suggestion that motor-affective resonance mediates dream-enactment imagery during sleep and emotional empathy during waking. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Eating Disorders and Mimetic Desire René Girard Stanford University Among younger women, eating disorders are reaching epidemic proportions. The most widespread and spectacular at this moment is the most recently identified, the so-called bulimia nervosa, characterized by binge eating followed by "purging," sometimes through laxatives or diuretics, more often through self-induced vomiting. Some researchers claim that, in American colleges, at least one third of the female student population is (...) involved to some degree. (Since nine out of ten sufferers are women I will use feminine pronouns in this paper but some undergraduates at Stanford tell me that the epidemic is spreading to male students.) G.M.F. Russell, the first researcher who focused on the specific aspects ofmodern bulimia, is usually presented as the discoverer of a new illness. The title ofhis 1979 publication contradicts this view: "Bulimia Nervosa: An Ominous Variant ofAnorexiaNervosa." And, indeed, all the symptoms he describes had been mentioned before in connection with anorexia (see Bruch). The insurance companies and the medical profession like only welldefined illnesses, and so does the public. We all try to distance ourselves from pathological contamination by giving it a name. Eating disorders are often discussed as ifthey were new varieties ofmeasles or oftyphoid fever. Why distrust the distinction between two illnesses with symptoms as radically opposed as those of anorexia and bulimia? Because we live in a world where eating too much and not eating enough are opposite but inseparable ways ofcoping with the slenderness imperative that dominates 2 René Girard our collective imaginations. Most of us oscillate all our lives between attenuated forms ofthese two pathologies. The man in the street understands perfectly a truth that most specialists prefer not to confront. Our eating disorders are caused by our compulsive desire to lose weight. Most books on the subject acknowledge the universal calorie phobia but somewhat absent-mindedly, as if it could not be the major cause ofa serious illness. How could a fundamentally healthy desire become the cause ofpathological behavior, even ofdeath? Many people would be healthier, no doubt, ifthey ate less. In view of this fact, it is not illogical to suppose that, in anorexia, there must be some motivation other than this healthy desire, some unconscious drive, no doubt, that generates abnormal behavior. By turning anorexia and bulimia into two separate pathologies, the classificators make it easier for us to lose sight of their common basis. The bankruptcy of modern theories The search for hidden motivations is the alpha and omega, ofcourse, of our modern culture. Our number one principle is that no human phenomenon is really what it seems to be. A satisfactory interpretation must rely on one of the hermeneutics of suspicion that have become popular in the nineteenth and twentieth century, or on several ofthese, on a cocktail of soupçon: psychoanalysis, Marxism, feminism, etc. We automatically assume that social phenomena have little if anything to do with what is obvious in them, in this case the rejection offood. In anorexia, psychoanalysts usually diagnose "a refusal of normal sexuality," due to the patient's excessive desire "to please her father," etc. These explanations are still invoked in books being written right now but the voice is growing fainter. Around this sort of thing the smell of mustiness is overpowering. Even in Lacan's own land, the old arrogance is gone. Early in my life, I had an opportunity to observe that the eating practices ofyoung women have nothing to do with a desire to please their fathers. Just before World War II, a pretty cousin of mine was dieting furiously and her father, my uncle, was storming about helplessly, trying to get her to eat more. Fathers, as a rule, are not pleased to see their daughters starve themselves. This particular father was also a physician, at a time when the medical profession had not yet caught the disease it was already trying to cure. Eating Disorders andMimetic Desire3 This uncle was our family doctor and, as such, had great prestige in my eyes, at least until that day. I had not yet read Freud but my later skepticism regarding his conception offatherhood may well originate in this incident. I immediately... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Eating Disorders and Mimetic Desire René Girard Stanford University Among younger women, eating disorders are reaching epidemic proportions. The most widespread and spectacular at this moment is the most recently identified, the so-called bulimia nervosa, characterized by binge eating followed by "purging," sometimes through laxatives or diuretics, more often through self-induced vomiting. Some researchers claim that, in American colleges, at least one third of the female student population is (...) involved to some degree. (Since nine out of ten sufferers are women I will use feminine pronouns in this paper but some undergraduates at Stanford tell me that the epidemic is spreading to male students.) G.M.F. Russell, the first researcher who focused on the specific aspects ofmodern bulimia, is usually presented as the discoverer of a new illness. The title ofhis 1979 publication contradicts this view: "Bulimia Nervosa: An Ominous Variant ofAnorexiaNervosa." And, indeed, all the symptoms he describes had been mentioned before in connection with anorexia (see Bruch). The insurance companies and the medical profession like only welldefined illnesses, and so does the public. We all try to distance ourselves from pathological contamination by giving it a name. Eating disorders are often discussed as ifthey were new varieties ofmeasles or oftyphoid fever. Why distrust the distinction between two illnesses with symptoms as radically opposed as those of anorexia and bulimia? Because we live in a world where eating too much and not eating enough are opposite but inseparable ways ofcoping with the slenderness imperative that dominates 2 René Girard our collective imaginations. Most of us oscillate all our lives between attenuated forms ofthese two pathologies. The man in the street understands perfectly a truth that most specialists prefer not to confront. Our eating disorders are caused by our compulsive desire to lose weight. Most books on the subject acknowledge the universal calorie phobia but somewhat absent-mindedly, as if it could not be the major cause ofa serious illness. How could a fundamentally healthy desire become the cause ofpathological behavior, even ofdeath? Many people would be healthier, no doubt, ifthey ate less. In view of this fact, it is not illogical to suppose that, in anorexia, there must be some motivation other than this healthy desire, some unconscious drive, no doubt, that generates abnormal behavior. By turning anorexia and bulimia into two separate pathologies, the classificators make it easier for us to lose sight of their common basis. The bankruptcy of modern theories The search for hidden motivations is the alpha and omega, ofcourse, of our modern culture. Our number one principle is that no human phenomenon is really what it seems to be. A satisfactory interpretation must rely on one of the hermeneutics of suspicion that have become popular in the nineteenth and twentieth century, or on several ofthese, on a cocktail of soupçon: psychoanalysis, Marxism, feminism, etc. We automatically assume that social phenomena have little if anything to do with what is obvious in them, in this case the rejection offood. In anorexia, psychoanalysts usually diagnose "a refusal of normal sexuality," due to the patient's excessive desire "to please her father," etc. These explanations are still invoked in books being written right now but the voice is growing fainter. Around this sort of thing the smell of mustiness is overpowering. Even in Lacan's own land, the old arrogance is gone. Early in my life, I had an opportunity to observe that the eating practices ofyoung women have nothing to do with a desire to please their fathers. Just before World War II, a pretty cousin of mine was dieting furiously and her father, my uncle, was storming about helplessly, trying to get her to eat more. Fathers, as a rule, are not pleased to see their daughters starve themselves. This particular father was also a physician, at a time when the medical profession had not yet caught the disease it was already trying to cure. Eating Disorders andMimetic Desire3 This uncle was our family doctor and, as such, had great prestige in my eyes, at least until that day. I had not yet read Freud but my later skepticism regarding his conception offatherhood may well originate in this incident. I immediately... (shrink)

Adaptive evolution is usually assumed to be directed by selective processes, development by instructive processes; evolution involves random genetic changes, development involves induced epigenetic changes. However, these distinctions are no longer unequivocal. Selection of genetic changes is a normal part of development in some organisms, and through the epigenetic system external factors can induce selectable heritable variations. Incorporating the effects of instructive processes into evolutionary thinking alters ideas about the way environmental changes lead to evolutionary change, and about the interplay (...) between genetic and epigenetic systems. (shrink)

Inspired by the genetic phenomenology of Maurice Merleau-Ponty and the historical epistemology of Georges Canguilhem, this paper defends a theory of normativity grounded in pathos rather than logos. Proceeding from the double assumption that accounts of the origins of normativity circulated in antiquity and modernity are unsatisfactory, and the determinacy of norms remains a central problem not only for moral theory but also for epistemology, political theory, and even medicine, the author contends that the realm of lived experience can help (...) us furnish determinate though often pre-thetic norms that can underwrite or justify “non-moral normative distinctions,” such as the distinction between the just and the unjust in political theory and the distinction between the normal and the pathological in medicine. With the aid of comparative and hermeneutic analysis, the author establishes that Merleau-Ponty’s Phenomenology of Perception shares with Canguilhem’s The Normal and the Pathological a similar understanding of the norming and normative character of subjective experience and, moreover, that in these works one can find a “pathic” theory of norms that can give us, as the author puts it, “a new foundation for the very possibility of critique” in our post-Enlightenment moment. (shrink)

In this article, I argue that many women lack the epistemic resources that would allow them to recognise the practice of vaginal examinations during childbirth as violent or as unnecessary and potentially declinable. I address vaginal examinations during childbirth as a special case of obstetric violence, in which women frequently lack the epistemic resources necessary to recognise the practice as violent not only because of the inherent difficulty of recognising violence that happens in an ‘essentially benevolent’ setting such as the (...) medical one, but also, and mainly, due to the pervasive sexual reification of women under patriarchy and the pervasive shame to which women are subjected. My argument is that the practice of vaginal examinations is indeed experienced – bodily apprehended – as violent by many women, but that full epistemic recognition of this violence is frequently obstructed because the experience perfectly coincides with the normal phenomenological situation of women within patriarchy and thus cannot really be framed as violent. A phenomenological analysis presenting the embodied experience of women under patriarchy as always already essentially tied to sexual availability and commodification, and to shame, will explain this epistemological impairment. A phenomenological take on Judith Butler’s distinction between ‘recognition’ and ‘apprehension’ informs my analysis: I deploy it to provide a richer, more nuanced response to the question of why vaginal examinations are not fully recognised and expressed as violent – even when they are, frequently, apprehended as such. Furthermore, Butler’s ideas about the epistemic ‘framings’ through which we make sense of different kinds of lives (grievable versus ungrievable) will help me to explain how the patriarchal sexual reification of women in fact already frames sexual violence as not-violence – which ultimately also prevents labouring women (and obstetrics staff) from recognising vaginal examinations during labour as violence. (shrink)

Inspired by the genetic phenomenology of Maurice Merleau-Ponty and the historical epistemology of Georges Canguilhem, this paper defends a theory of normativity grounded in pathos rather than logos. Proceeding from the double assumption that accounts of the origins of normativity circulated in antiquity and modernity are unsatisfactory, and the determinacy of norms remains a central problem not only for moral theory but also for epistemology, political theory, and even medicine, the author contends that the realm of lived experience can help (...) us furnish determinate though often pre-thetic norms that can underwrite or justify “non-moral normative distinctions,” such as the distinction between the just and the unjust in political theory and the distinction between the normal and the pathological in medicine. With the aid of comparative and hermeneutic analysis, the author establishes that Merleau-Ponty’s Phenomenology of Perception shares with Canguilhem’s The Normal and the Pathological a similar understanding of the norming and normative character of subjective experience and, moreover, that in these works one can find a “pathic” theory of norms that can give us, as the author puts it, “a new foundation for the very possibility of critique” in our post-Enlightenment moment. (shrink)