The traditional view that having a personality disorder, unlike other mental disorders, is not usually reason enough to consider a person incompetent to make healthcare decisions is challenged. The example of a case in which a woman was treated for a physical disorder without her consent illustrates that personality disorder can render a person incompetent to refuse essential treatment, particularly because it can affect the doctor–patient relationship within which consent is given.

Delusions, a key feature of psychosis, are usually thought of as a type of belief, as in the definition of the American Psychiatric Association: A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person’s culture or subculture (e.g. it is not an article of religious (...) faith). This characterization is often criticized, but other definitions typically comprise similar elements. For some, delusions are only loosely considered as beliefs (Jaspers 1963; Moor and Tucker .. (shrink)

This paper explores the comparative dynamics of self-mutilation among young, contemporary, female self-cutters, and the holy stigmatics of the Middle Ages. It addresses the types of personalities that engage in self-mutilation and how some manipulate their self-inflicted pain into a method for healing and empowerment. The similarities between teenage cutters and female stigmatics are striking in their mutual psychoanalytical need for self-alteration as a means of escaping their own disassociative identities; and offers evidence of how their mutual bricolage of pain, (...) imagining, languaging, and subsequent self-mutilation often provide a transformation from bodies under siege to a resemblance of health and transformation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.3 (2003) 265-266 [Access article in PDF] Definition Is Limited and Values Inescapable Richard Mullen THIS IS A welcome paper that lays bare some of the presumptions of those who seek to determine the status of psychiatric disorder. At different times debate on the subject reflects stigma, prejudice, needs for coherent categorization, and occasionally just antipsychiatric resentment. As Pickering hints, much philosophical argument may be (...) selected to support a position already chosen.The article illustrates that the likeness argument is insufficient to demonstrate that mental disorders are or are not disorders in any other more profound sense. Similarly perhaps, if a debate were conducted about whether or not a bony fracture, hypertension, obesity, or bacterial infection were real illnesses, the likeness argument might be unfruitful. This is perhaps unsurprising; notions of health and illness, mental or physical, are largely abstractions. In psychiatry, so-called symptoms are themselves abstract classifications of incompletely articulated mental phenomena far more diverse than the definitions and criteria to be found in a diagnostic manual.Argument by analogy is always limited. If my car has a flat tire, the car will be dysfunctional or disordered. Its loss of performance will be the symptoms of the flat tire, which is the lesion. It is a problem quickly diagnosed and treated. If convenient, I suppose my car could have been said to be ill, but this would not lead to any particular insights into the nature of cars, mechanics, health, or anything else.A variety of concepts can be contained within terms such as illness,disease, and disorder. They include the clinicopathological approach (the disease is the organic lesion), the disease is deviance approach, disease as distress, and approaches that consider disease—particularly mental disorder—as largely socially constructed. None may resolve the questions that Pickering raises, but recognizing that our terms are not always precise or used consistently is part of formulating the problem more clearly. For the most part clinical psychiatry (and the rest of medicine) has no difficulty in properly identifying most of our patients as disordered or ill. The fact that there are some borderline instances, difficult to classify either way, does not invalidate the classification.Consideration of whether or not the features of a disorder can in themselves determine whether or not a person is disordered is timely for two reasons. As stigma about (some) psychiatric disorder lessens, and opportunities for complaint and compensation expand, an era of self-definition as mentally disordered has arrived. How are mental health practitioners to respond to someone whose mental distress appears not to be clinically significant, but who demands access to the sick role? Also of current concern for clinical psychiatry is widespread pressure to define as disordered those persons whose antisocial behavior brings them into conflict with society. Professional recognition that definitions of mental disorder are inadequate, or rather incomplete, [End Page 265] may be valid. Worryingly, there are others who are willing to define it for us.Both major international systems of classification of mental disorder offer definitions of mental disorder that turn on what is to be meant by clinical significance or clinically recognizable. In the current Diagnostic and Statistical Manual, mental disorder implies "clinically significant impairment or distress," and criteria for specific disorders mostly including a comment about "clinically significant distress or impairment in social, occupational, or other important areas of functioning" (APA 2000, 8). In the International Classification of Disease, disorder is used to imply "existence of a clinically recognizable set of symptoms or behavior associated in most cases with distress and with interference with personal function" (WHO 1992, 5). It seems that no definition of mental disorder is adequate for all purposes. Seeking to improve existing definitions by further defining the terms used quickly becomes an exercise in pedantry, far removed from practical utility.Pickering mentions as an example the "symptom" of delusions. Available definitions are widely recognized as incomplete or otherwise unsatisfactory (David 1999). This leads to debate about what the individual elements within the definition precisely mean. However in practice delusions are identified with remarkably high reliability (WHO 1973... (shrink)

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

Competitive state anxiety is an integral feature of sports performance but despite its pervasiveness, there is still much debate concerning the measurement of the construct. Adopting a network approach that conceptualizes symptoms of a construct as paired associations, we proposed re-examining competitive state anxiety as a system of interacting components in a dataset of 485 competitive athletes from the United Kingdom. Following a process of data reduction, we estimated a network structure for 15 items from the modified Three Factor Anxiety (...) Inventory using the graphical LASSO algorithm. We then examined network connectivity using node predictability. Exploratory graph analysis was used to detect communities in the network and bridge expected influence calculated to estimate the influence of items from one community to items in other communities. The resultant network produced a range of node predictability values. Community detection analysis derived three communities that corresponded with previous research and several nodes were identified that bridged these communities. We conclude that network analysis is a useful tool to explore the competitive state anxiety response and we discuss how the results of our analysis might inform the assessment of the construct and how this assessment might inform interventions. (shrink)

Psychopathology has two styles. On the one hand, a tradition of phenomenological inquiry, associated in particular with the work of Karl Jaspers, that may be considered as the continental way of approaching psychopathology. On the other hand, an empirical approach more associated with the English-speaking world, which emphasizes the need for objectivity of measurement, and is as close as psychiatry gets to dustbowl empiricism. Stanghellini’s book, Disembodied Spirits and Deanimated Bodies (2004), is undoubtedly in the first tradition. It is part (...) of the growing International Perspectives in Philosophy and Psychiatry series, the success of which suggests some recognition that much of importance in .. (shrink)