This study seeks to understand the subjective experience or lived world typical of patients with Parkinson’s disease. It uses qualitative methodology, grounded in a hermeneutic-phenomenological perspective, to consider lived experience in a small sample of 7 individuals. The analysis identified four themes that appear to be characteristic of the experience of PD: A) Denial, B) Emotion and symptom expression, C) Volitional and spontaneous action, and D) Alteration of temporal perspective. Concepts from existential-phenomenological philosophy were used to reflect upon these themes (...) to achieve a synthetic account of the subjective experience of PD. The findings of the study are compared to other findings in the phenomenological literature, and suggestions for further research are posed. (shrink)

It is generally understood that Hegel’s influence in the United States was more or less restricted to the field of speculative philosophy. The philosophical importance of the St. Louis movement and The Journal of Speculative Philosophy is well known, just as Hegelian relationships to the New England Transcendentalists. Loyd D. Easton’s pioneering book Hegel’s First American Followers, described the independent Hegelian discussion in mid-nineteenth century Ohio. John B. Stallo and August Willich demonstrated clearly that under totally different cultural, social (...) and political preconditions than in Europe, controversial Hegelian concepts of state and society could yet be developed. Until now, however, it has not been noted that in the 1850’s there was, for a short time, a small, but significant expression of Hegelianism in the Texas Hill Country southwest of Austin, at Sisterdale, Comal County. Only some historians in the field of early Texas history have noticed that among the “lateinische Bauern” who emigrated in 1849/50 to Texas there was the Hegelian Ernst Kapp, a well-known author in the field of environmentology [Erdkunde], who settled in Sisterdale in 1849. (shrink)

Long-term potentiation (LTP) is operationally defined as a long-lasting increase in synaptic efficacy following high-frequency stimulation of afferent fibers. Since the first full description of the phenomenon in 1973, exploration of the mechanisms underlying LTP induction has been one of the most active areas of research in neuroscience. Of principal interest to those who study LTP, particularly in the mammalian hippocampus, is its presumed role in the establishment of stable memories, a role consistent with descriptions of memory formation. Other characteristics (...) of LTP, including its rapid induction, persistence, and correlation with natural brain rhythms, provide circumstantial support for this connection to memory storage. Nonetheless, there is little empirical evidence that directly links LTP to the storage of memories. In this target article we review a range of cellular and behavioral characteristics of LTP and evaluate whether they are consistent with the purported role of hippocampal LTP in memory formation. We suggest that much of the present focus on LTP reflects a preconception that LTP is a learning mechanism, although the empirical evidence often suggests that LTP is unsuitable for such a role. As an alternative to serving as a memory storage device, we propose that LTP may serve as a neural equivalent to an arousal or attention device in the brain. Accordingly, LTP may increase in a nonspecific way the effective salience of discrete external stimuli and may thereby facilitate the induction of memories at distant synapses. Other hypotheses regarding the functional utility of this intensely studied mechanism are conceivable; the intent of this target article is not to promote a single hypothesis but rather to stimulate discussion about the neural mechanisms underlying memory storage and to appraise whether LTP can be considered a viable candidate for such a mechanism. (shrink)

The neurophysiological phenomenon of LTP (long term potentiation) is considered by many to represent an adequate mechanism for acquiring or storing memories in the mammalian brain. In our target article, we reviewed the various arguments put forth in support of the LTP/memory hypothesis. We concluded that these arguments were inconsistent with the purported data base and proposed an alternative interpretation that we suggested was at least as compatible with the available data as the more widely held view. In doing so, (...) we attempted to illustrate that the inadequacy of present experimental designs did not permit us to distinguish between equally viable hypotheses. In the four years since we wrote the first draft of our target article, hundreds of additional studies on LTP have been published and their results have been incorporated into current theories about memory. A diverse group of commentators responded to our target article with their own theories of how memories might be stored in the brain, some of which rely on LTP. Some commentators doubted whether memories can be stored through modifications of synaptic strength. Some assert that it will never be possible to understand the neural mechanisms of memory; still others remain hopeful that we will accomplish some semblance of a resolution, provided we appreciate LTP's role in a subset of seemingly amorphous memory systems. In summary, although it is commonly written that “LTP is a memory storage device,” the divergence of views among the commentators suggests, at least as strongly as our target article, that such conviction is unwarranted and fails to acknowledge both the lack of consensus regarding the role of LTP in memory and the complexity of the phenomenon of memory itself. (shrink)

Long-term potentiation (LTP) is a long-lasting increase in synaptic efficacy that many consider the best candidate currently available for a neural mechanism of memory formation and/or storage in the mammalian brain. In our target article, LTP: What's learning got to do with it?, we concluded that there was insufficient data to warrant such a conclusion. In their commentaries, Jeffery and Zhadin raise a number of important issues that we did not raise, both for and against the hypothesis. Although we agree (...) with a number of these issues, we maintain that there remains insufficient evidence that LTP is a memory mechanism. (shrink)

This article presents an introductory overview of the interpretations of schizophrenia offered by three phenomenological psychiatrists: Eugene Minkowski (1885-1972), Wolfgang Blankenburg (b. 1928), and Kimura Bin (b. 1931). Minkowski views schizophrenia as characterized by a diminished sense of dynamic and vital connection to the world ("loss of vital contact"), often accompanied by a hypertrophy of intellectual and static tendencies ("morbid rationalism," "morbid geometrism"). Blankenburg emphasizes the patient's loss of the normal sense of obviousness or "natural self-evidence"—a loss of the usual (...) common-sense background that enables normal persons to cope easily with the social and practical world. Kimura focuses on certain distortions of self-experience: a distinctive splitting of the subjective self, alienated awareness of one's own ongoing consciousness, and profound uncertainty about the "I-ness" of the self. In addition to a summary, this article offers a comparison and critique of these three approaches. The three approaches are also considered in light of a more recent, phenomenological formulation of schizophrenia as a disorder of self-experience (an ipseity disturbance) involving hyperreflexivity and diminished self-affection (i.e., heightened awareness of aspects of experience that would normally remain tacit or presupposed and decline in the feeling of existing as a subject of awareness). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.1 (2004) 71-80 [Access article in PDF] Some Reflections on the (Analytic) Philosophical Approach to Delusion Louis A. Sass There are more things in heaven and earth, Horatio, Than are dreamt of in your philosophy." —Hamlet, Act I, Scene 5 The peculiar, often problematic phenome na of psychopathology have been attract ing the attention of analytic philosophers in recent years. The topic of (...) delusion has been a particular draw, with a number of analytic philosophers attempting to use their conceptual tools, usually combined with ideas from cognitive neuroscience, to criticize the traditional understanding and to clarify the nature of this central psychiatric topic. It is useful to have this kind of interdisciplinary dialogue. Indeed, there is good reason to hope that concepts honed in the philosophy of mind and other philosophical subfields will help to sort out our understanding of a phenomenon (or set of phenomena) for which contemporary psychiatric definitions and conceptualizations are clearly inadequate and, in some respects, downright misleading (see Parnas and Sass 2001; Spitzer 1990).1Here, however, I would like to call attention to some weaknesses that, it seems to me, are rather common (I do not say universal) in many analytic philosophical approaches to psychopathology. In my opinion, there is a tendency to formulate issues and arguments in overly polarized, even dichotomous terms, and then to rely too uncritically on these essentialistic formulations in exploring the domain of inquiry. Although this polarizing tendency sometimes has the salutary effect of clarifying conceptual domains, it can, when taken too far, actually hamper our understanding of phenomena that are often fraught with ambiguities and complexities that defy many standard conceptualizations.The relationship between philosophy and psychopathology is obviously a two-way street—we are familiar, for example, with disorders that challenge deep philosophical assumptions about self and mind (e.g., blindsight, split-brain phenomena, perhaps also Dissociative Identity Disorder, and the first rank symptoms of schizophrenia). I am suggesting that, in their work on delusions, philosophers may need to put more emphasis on moving from the natural phenomena [End Page 71] of psychopathology and to the domain of philosophical analysis.I believe that a greater sensitivity to the modes of knowing associated with the phenomenological tradition, and to the forms of conceptual self-critique fostered by Ludwig Wittgenstein, are crucial ingredients for any adequate approach to delusion as well as many other topics in psychopathology. In my opinion, the work of many analytic philosophers interested in psychopathology would be enriched if they spent more time trying to discover and imagine what it might be like to experience certain kinds of abnormal psychiatric conditions, and also speculating about what implications such experiential modalities might have for action and verbal expression. I believe they would also be wise to spend more time questioning, and attempting to transcend, the philosophically derived conceptual distinctions and dichotomies that appear to organize their conceptual universes. Phenomenological imagination and Wittgensteinian critique can show how to move outside the conceptual capsule and into the rich and strange realms of actual experience, both normal and abnormal.So far I have offered only slogans. Let me use the articles by Tim Bayne and Elisabeth Pacherie (2004) and Robert Klee (2004) to flesh out the criticisms I have offered. There is much that is intelligent and much that is worthwhile in both their articles. (For example, I was largely convinced by the criticisms of John Campbell and of Donald Davidson that are central to the articles by Bayne and Pacherie and by Klee, respectively.) Here, however, I will focus only on issues that illustrate the above-mentioned tendencies—tendencies that, in my view, tend to infect even the best writings on the (analytic) philosophy of psychiatry. I will also make some remarks about the works of Campbell and Davidson, the two philosophers criticized in the articles by Bayne and Pacherie and by Klee. Because the article by Eugenie Georgaca (2004) is in a different tradition, I will say only a few words about it at the end. Bayne and Pacherie on the Preservation-Of-meaning... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.2 (2003) 125-132 [Access article in PDF] Incomprehensibility and Understanding:On the Interpretation of Severe Mental Illness Louis A. Sass Keywords hermeneutics, psychopathology, paradox, Wittgenstein, solipsism, delusion, principle of charity, phenomenological psychopathology. I would like to begin by thanking Rupert Read for the care he has put into reading my work, and into thinking through its implications in the context of the "new-Wittgensteinian" interpretation (...) of the thought of Ludwig Wittgenstein. This interpretation derives from an influential reading of this philosopher's early book, the Tractatus Logico-Philosophicus (1961), that is not explicitly discussed in Read's article, yet that lies behind much of his argument. Read does allude to this reading of the Tractatus when he refers to the concept of "logically alien thought" (see Conant [1992]), and by citing, in his endnotes, the Diamond, Conant, and Cerbone articles that appear in Crary and Read's edited collection, The New Wittgenstein (2000). In an earlier paper that also addresses my work, "On approaching schizophrenia through Wittgenstein," Read (2001) explicitly discusses the relevance of the new-Wittgensteinian interpretation of the Tractatus.According to this new-Wittgensteinian interpretation of the Tractatus, Wittgenstein took absolutely seriously his own realization (explicitly stated at the end of the Tractatus) that his book was internally self-contradictory, and he therefore realized that all or nearly all the sentences of the Tractatus must be totally devoid of any meaning or semantic reference. According to this austere view, the vast bulk of the Tractatus only pretends to be making meaningful statements about the nature of logic and semantics; its real purpose is to give the reader the illusion of meaning, and this it does in order to lead the reader to the eventual realization that there can in fact be no meaningful statements or thoughts at the level of self-referential abstraction at which the Tractatus pretends to be operating. Further, when Wittgenstein (1961) writes (in the famous last line of the book), "Whereof one cannot speak, thereof one must be silent" (p. 189), this statement should, supposedly, not be taken as any kind of mystical pointing toward some ineffable realm or truth, but, rather, as an austere recognition that there just are no ineffable truths—that, so to speak, there just is no mystical there there. [End Page 125]Rupert Read sees an analogy between, on the one hand, the (supposedly mistaken) readers of Wittgenstein's Tractatus who think that Wittgenstein is exploiting self-contradiction to allude to some higher, ineffable truth (i.e., something that can be pointed at even if it cannot be said), and, on the other hand, my own elucidation of Schreber's contradictions (see especially Chapter 2 of Paradoxes of Delusion [1994]) to argue that Schreber can be said to be having particular kinds of experiences, which I refer to as solipsistic or quasi-solipsistic in nature. Just as Wittgenstein's self-contradictions can (supposedly) point nowhere other than to their own failure to mean, so Schreber's self-contradictory and other nonstandard statements cannot (according to Read) be used to illuminate in any meaningful way the form of experience that supposedly lies behind them—as I, for example, have tried to do by offering a phenomenological account of Schreber and schizophrenia. Patients like Schreber and Renée cannot really be understood, just as we cannot really understand logically alien thought—which, in fact, is not really thought at all; in both cases, there is only the illusion of meaning, only the mirage of an alternative mode of thinking or of living. This, at least, is Read's new-Wittgensteinian claim.Few readers of Philosophy, Psychiatry, & Psychology will, I suspect, be familiar with these discussions centering on Wittgenstein's Tractatus, which were introduced largely by the philosophers Cora Diamond and James Conant (see Crary and Read [2000]). (I myself have found their writings fascinating and inspiring in many ways, despite my ultimate disagreement on fundamental issues.) 1 Most readers of Philosophy, Psychiatry, & Psychology will have no way of assessing the validity of this austere reading of the Tractatus... (shrink)

Madness and Modernism provides a phenomenological study of schizophrenic disorders, criticizing some standard conceptions of these disorders. Sass argues that many aspects of this group of disorders can actually involve more sophisticated (albeit dysfunctional) forms of mind and experience.

In recent years, there has been much focus on the apparent heterogeneity of schizophrenic symptoms. By contrast, this article proposes a unifying account emphasizing basic abnormalities of consciousness that underlie and also antecede a disparate assortment of signs and symptoms. Schizophrenia, we argue, is fundamentally a self-disorder or ipseity disturbance that is characterized by complementary distortions of the act of awareness: hyperreflexivity and diminished self-affection. Hyperreflexivity refers to forms of exaggerated self-consciousness in which aspects of oneself are experienced as akin (...) to external objects. Diminished self-affection or self-presence refers to a weakened sense of existing as a vital and self-coinciding source of awareness and action. This article integrates recent psychiatric research and European phenomenological psychiatry with some current work in cognitive science and phenomenological philosophy. After introducing the phenomenological approach along with a theoretical account of normal consciousness and self-awareness, we turn to a variety of schizophrenic syndromes. We examine positive, then negative, and finally disorganization symptoms—attempting in each case to illuminate shared distortions of consciousness and the sense of self. We conclude by discussing the possible relevance of this approach for identifying early schizophrenic symptoms. (shrink)

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

We propose that typical schizophrenic delusions develop on the background of preexisting anomalies of self-experience. We argue that disorders of the Self represent the experiential core clinical phenomena of schizophrenia, as was already suggested by the founders of the concept of schizophrenia and elaborated in the phenomenological psychiatric tradition. The article provides detailed descriptions of the pre-psychotic or schizotypal anomalies of self-experience, often illustrated through clinical vignettes. We argue that delusional transformation in the evolution of schizophrenic psychosis reflects a global (...) reorganization of consciousness and existential reorientation, both of which radiate from a fundamental alteration of the Self. We critically address the contemporary cognitive approaches to delusion formation, often finding them inconsistent with the clinical features of schizophrenia or implausible from a phenomenological point of view. (shrink)

Various forms of anomalous self-experience can be seen as central to schizophrenia and other psychiatric disorders. We examined similarities and differences between anomalous self-experiences common in schizophrenia-spectrum disorders, as listed in the EASE , and those described in published accounts of severe depersonalization. Our aims were to consider anomalous self-experience in schizophrenia in a comparative context, to refine and enlarge upon existing descriptions of experiential disturbances in depersonalization, and to explore hypotheses concerning a possible core process in schizophrenia . Numerous (...) affinities between depersonalization and schizophrenia-spectrum experience were found: these demonstrate that rather pure forms of diminished self-affection can involve many experiences that resemble those of schizophrenia. Important discrepancies also emerged, suggesting that more automatic or deficiency-like factors—probably involving self/world or self/other confusion and erosion of first-person perspective—are more distinctive of schizophrenia-spectrum disorders. (shrink)

This article examines the structure of self-consciousness in people with schizophrenia. The findings indicate that our self-experience is not neutral with respect to the metaphysical status of the self and that it is important to attend carefully to the experience of the subject in order to understand schizophrenia. The results also suggest that the variable disruptions in the sense of self-presence, first-person perspective, and the phenomenality of experience in schizophrenics directly affect the minimal self and it may also have implications (...) for the narrative self. (shrink)

This paper offers a comparative study of abnormalities in the experience of space, time, and general atmosphere in three psychiatric conditions: schizophrenia, melancholia, and mania. It is a companion piece to our previous article entitled 'Varieties of Self- Experience'; here we focus on experiences of the world rather than of the self. As before, we are especially interested in similarities but also in some subtle distinctions in the forms of subjectivity associated with these three conditions. As before, we survey phenomenologicallyoriented (...) clinical and theoretical accounts as well as patient reports. Experiences involving forms of alienation from the practical and social world and a sense of uncanniness seem to be common in both schizophrenia and affective disorders. But despite some significant similarities, changes in schizophrenic subjectivity appear to be more pervasive and profound, involving experiences of fragmentation, meaninglessess, and ineffable strangeness that are rare or absent in the affective disorders. (shrink)

The life of Saint Teresa of Jesus, the most famous mystic of sixteenth-century Spain, was characterized by recurrent visions and states of ecstasy. In this paper, we examine social components related to Teresa’s personal crises and the historical conditions of her times, factors that must be taken into account to understand these unusual forms of experience and behavior. Many of these factors (e.g., increasing individualism and reflexivity) are precursors of the condition of modern times. Indeed, certain parallels can be observed (...) between Saint Teresa and certain present-day psychopathological disorders. The analogy should not, however, be carried too far. Religion played a particularly crucial role in Teresa’s cultural context; as a result, it would be misleading to view her mystical experiences as resulting from a mental disorder. (shrink)

In this response to Wiggins and Schwartz, Ratcliffe, and Stanghellini, we first wish to express our gratitude to Philosophy, Psychiatry, and Psychology for providing us the space to clarify our views and to overcome certain misunderstandings. Ratcliffe notes that our critique is "harsh," whereas Wiggins and Schwartz lament the fact that the debate "has taken the form of sometimes acid formulations and rejoinders . . . that lack the tone of mutual appreciation" (2011, 31). We deplore the fact that this (...) exchange was at all necessary, and we share Wiggins and Schwartz's concerns. However, we need to recall here and emphasize that our article originated as a response. It originated as a response to an article that was .. (shrink)

This paper provides a critical survey of some subtle and often overlooked disturbances of self-experience that can occur in schizophrenia, melancholia, and mania. The goal is to better understand both similarities and differences between these conditions. We present classical and contemporary studies, mostly from the phenomenological tradition, and illustrate these with patient reports. Experiential changes in five domains of selfhood are considered: Cognition, Self-Awareness, Bodily Experiences, Demarcation/Transitivism, and Existential Reorientation. We discuss: I. major differences involving self-experience between schizophrenia and affective (...) disorders; II. experiences in which these conditions nevertheless resemble each other; III. suggestions on how these experiences may still differ on a more subtle, phenomenological plane. While affective patients may undergo significant changes in self-experience, their underlying sense of basic or minimal selfhood remains intact. In schizophrenia, basic self is disturbed, and this may help to account for many characteristic disturbances of this disorder. (shrink)

Phenomenological psychiatry has suffered from a failure to translate its insights into terms specific enough to be applied to psychiatric diagnosis or to be used in contemporary research programs. This difficulty can be understood in light of the well-known tradeoff between reliability and validity. We argue, however, that with sufficient ingenuity, phenomenological concepts can be adapted and applied in a research context. Elsewhere, we have described a phenomenologically oriented conception of schizophrenia as a self- or ipseity-disorder with two main facets: (...) decline in the sense of existing as a subject of awareness (diminished self-affection) and heightened awareness of aspects of experience that would normally remain tacit or presupposed (hyperreflexivity). This approach is consistent with Minkowski, Blankenburg, and Kimura and offers one possible synthesis of their views. Here we describe two areas of empirical research that are congruent with, or actually inspired by, a phenomenological approach emphasizing such disorders of consciousness and self-experience: (1) Phenomenologically oriented, interview studies show that, whereas negative-symptom patients generally deny any diminishment of affect and thinking, they do describe qualitative alterations of experience suggestive of hyperreflexivity and diminished self-affection. (2) Another line of research suggests that the early detection of schizophrenic symptoms may be enhanced by adopting a phenomenological approach. (shrink)

Schizophrenia involves profound but enigmatic disturbances of affective or emotional life. The affective responses as well as expression of many patients in the schizophrenia spectrum can seem odd, incongruent, inadequate, or otherwise off-the-mark. Such patients are, in fact, often described in rather contradictory terms: as being prone both to exaggerated and to diminished levels of emotional or affective response. According to Ernst Kretschmer, they actually tend to have both kinds of experience at the same time. This paper attempts to explain (...) what might be termed this 'Kretschmerian paradox'. Some relevant concepts and vocabulary for affect and emotion are discussed . The need for a phenomenological approach focusing on subjective experience is suggested. Three modes of abnormal experience in schizophrenia are investigated in light of their implications for affect or emotion: alienation of the lived body ; fragmented perception and loss of affordances ; and preoccupation with a quasi-delusional world created by the self. (shrink)

This paper offers a phenomenological or hermeneutic reading—employing Heidegger's notion of the 'ontological difference'—of certain central aspects of schizophrenic experience. The main focus is on signs and symptoms that have traditionally been taken to indicate either 'poor reality-testing' or else 'poverty of content of speech' (defined in the Diagnostic and Statistical Manual of Mental Disorders III-R as: “speech that is adequate in amount but conveys little information because of vagueness, empty repetitions, or use of stereotyped or obscure phrases"). I argue (...) that, at least in some cases, the tendency to attribute these signs of illness to the schizophrenic patient results from a failure to recognize that such patients—as part of a quasi-solipsistic orientation and alienation from more normal, pragmatic concerns—may be grappling with issues of what Heidegger would call an ontological rather than an ontic type, issues concerned not with entities but with Being (i.e. not with objects in the world but with the overall status of the world itself). An application of the Heideggerian concept of the ontological difference has the potential to alter one's sense of the lived-worlds of such patients, of what they may be attempting to communicate, and of why communication with them so often breaks down. (shrink)

Here we consider interpersonal experience in schizophrenia, melancholia, and mania. Our goal is to improve understanding of similarities and differences in how other people can be experienced in these disorders, through a review of first-person accounts and case examples and of contemporary and classic literature on the phenomenology of these disorders. We adopt a tripartite/dialectical structure: first we explore main differences as traditionally described; next we consider how the disorders may resemble each other; finally we discuss more subtle but perhaps (...) foundational ways in which the phenomenology of these disorders may nonetheless be differentiated. These involve disruptions of common sense and conventionality, abnormalities of empathy, distinct forms of paranoia and the sense of personal centrality, and altered perceptions of intentionality, deadness, and artificiality. We end by considering some neurocognitive research relevant to these abnormal forms of subjectivity, including work on theory of mind, experience of human movement, and perception of faces. (shrink)

This paper uses certain of Michel Foucault's ideas concerning modern consciousness (from The Order of Things) to illuminate a central paradox of the schizophrenic condition: a strange oscillation, or even coexistence, between two opposite experiences of the self: between the loss or fragmentation of self and its apotheosis in moments of solipsistic grandeur. Many schizophrenic patients lose their sense of integrated and active intentionality; even their most intimate thoughts and inclinations may be experienced as emanating from, or under the control (...) of, some external being or mysterious foreign soul (‘I feel it is not me who is thinking’; ‘I have been programmed’). Yet the same patients may also experience the self as preeminent, all-powerful or all-knowing (‘My thoughts can influence things’; ‘This event happens because I think it'). Here one may feel confronted with the very paradigm of irrationality: profound contradictions suggesting regression to primitive ‘primary-process’ thinking or utter collapse of the higher faculties of mind. I argue, however, that these dualities so basic to schizophrenia can best be understood very differently: as consequences of a kind of alienation and hyper-self-consciousness (‘hyper- reflexivity') that is closely analogous to what occurs in the post-Kantian era of Western intellectual history. The parallel dualities of modern thought have been most extensively discussed by Foucault, who describes paradoxes, tensions and other dilemmas central to what he calls the modern ‘episteme'; these result from what Foucault sees as the modern human being's introverted and ultimately self-deceiving preoccupation with, and overvaluing of, the phenomenon of his own consciousness. Parallels between these contradictions and those characteristic of several withdrawn schizophrenic individuals are described and analysed. The paper concludes with an Afterword in which some possible neurobiological underpinnings of these schizophrenic experiences are discussed. (shrink)

The integration of artificial intelligence into bioethics education represents a new pedagogical approach that addresses complex moral issues in healthcare. The use of AI-driven platforms like ChatGPT in bioethics education can enhance critical thinking and decision-making skills among students by providing a diverse range of perspectives and solutions. To assess the ability of ChatGPT-4 to understand and resolve ethical dilemmas using validated clinical case vignettes, thereby determining its suitability as a teaching aid in bioethics. Ten clinical scenarios, each with inherent (...) ethical issues, were presented to ChatGPT-4. These scenarios were expert-validated to ensure relevance and complexity. ChatGPT's responses were evaluated by two blinded external raters to eliminate bias. The assessment criteria included identification of bioethical principles, recognition of stakeholders and their outcomes, and comprehension of ethical and legal frameworks. Additionally, the quality of responses was scored on a scale of 1–10. ChatGPT showed proficiency in identifying the pertinent bioethical principles and stakeholders involved in the ethical dilemmas presented. It achieved an overall score of 84.5%, with high marks for its analytical capabilities in complex scenarios. However, the study identified areas for improvement, particularly in proposing comprehensive solutions and alternative actions. ChatGPT demonstrates potential as an effective tool for bioethics education, capable of guiding learners through the resolution of ethical issues in clinical practice. However, to fully integrate ChatGPT into bioethics education, it requires enhancements in delivering detailed, actionable guidance in ethical decision-making. Future development should focus on refining ChatGPT’s ability to offer nuanced solutions aligned with patient values and clinician needs. (shrink)

This paper considers contradictory features of emotional or affective experience and expression in schizophrenia in light of the “Kretschmerian paradox”—the fact that schizophrenia-spectrum patients can simultaneously experience both exaggerated and diminished levels of affective response. An attempt is made to explain the paradox and explore its implications. Recent research on emotion in schizophrenia is reviewed, including subjective reports, psychophysiological measures of arousal or activation, and behavioural measures, focusing on flat-affect and negative-symptom patients. After discussing relevant concepts and vocabulary of emotion (...) (“affect”, “emotion”, “mood”, “feelings”, the “passions”), the need for a phenomenological approach focusing on subjective experience is proposed. Four modes of nonparanoid experience in schizophrenia are discussed: Bodily Alienation, Disengagement, Unworlding, and Subjectivisation. Each mode involves withdrawal from functional contexts—temporal, practical, and interpersonal—normally associated with emotional reactivity and expression; each may be accompanied by forms of non-emotional affectivity no less intense than the emotions they replace. Possible relationships between psychophysiological measures, expressive behaviour, and subjective emotional or affective response are considered. (shrink)

This current study is a pilot project designed to clarify changes in the lived world among people with diagnoses within the schizophrenia spectrum. The Examination of Anomalous World Experience was used to interview ten participants with schizophrenia spectrum disorders and a comparison group of three participants with major depressive disorder. Interviews were analyzed using the descriptive phenomenological method. This analysis revealed two complementary forms of experience unique toszparticipants: Destabilization, the experience that reality and the intersubjective world are less comprehensible, less (...) stable, and generally less real; and Subjectivization, the dominance of one’s internal, subjective experiences in the perception or interpretation of the lived world. Persons with depressive disorders, by contrast, did not experience disruptions of the reality or independence of the world or any significant disruptions of appearance or meaning. These results are consistent with contemporary and classic phenomenological views on anomalous world experience in schizophrenia. (shrink)