This contribution considers the potential of critical realism to illuminate the nature of crises, crisis management, and crisis lessons. After reviewing key aspects of critical realism in general, the analysis notes the challenge of developing critical realism in particular by identifying appropriate entry-points and standpoints for the analysis of specific explananda. It then provides a general critical realist account of the nature of crises in the social world and of learning in, about, and from crisis. A key concept here is (...) symptomatology — the exploration of the contingently necessary relation between actual symptoms and underlying causal mechanisms. This is related in turn to the crucial distinction between scientifically adequate explanations of crisis and conjuncturally ‘correct’ readings of the potential for transformative action in the face of crisis. This has important bearings on the emancipatory contribution of critical realism in the context of a continuing critique of ideology and domination. The article then provides particular critical realist accounts of the abstract possibility of crisis in the capitalist mode of production and its concrete actualization in the complex, overdetermined cases of the North Atlantic Financial Crisis and the Eurozone Crisis. It ends with some general remarks on the potential of crisis as an entry-point into the analysis of the contradictory nature of social structures. (shrink)

In taking up Deleuze's differential diagnosis by observing Masoch's literary practice and extracting his libidinal principles of imperatives, contracts, fetishism and rituals, I demonstrate Deleuzian libidinal symptomatology as a specific semiotics in the service of schizoanalysis. I shall argue that in Masoch the schizoanalytic curettage of the unconscious is executed as schizoid waiting where the fleeting outer symptoms of pain–pleasure reveal the masochist's desired inner splitting of the senses.Several critical-clinical inroads to the schizoanalytic project can be envisaged. Initially, Masoch's (...) visionary concept of sexualised world history is supported by his strategic move to the law of the oral mother, yet then extended by Deleuze's concept of (inter)maternal symbolic which speculates on the fantasised rebirth of a sexless or hermaphroditic man. Finally, the parodic enactment of eros and thanatos functions as technique of dialectical disguise within the masochist's scheme of practising libidinal liberation.Masochism considered as a state of bodily experimentation which turns the oedipal law upside down, emerges as a distinct literary genre in Deleuzian aesthetics. (shrink)

‘À quoi sert la littérature?’, Deleuze opens his book on Leopold von Sacher-Masoch with a question that this paper will pose again, trying to propose an answer to it, and to put to test the methodological approach that can be obtained from that answer: what are the uses of literature and, more specifically, how could the philosopher use literature, what could be done with it? To this end, this paper will focus on Deleuze’s symptomatological conception of literature. The second part (...) of the paper will be dedicated to the reading of two novels, 1984 by George Orwell and The Circle by Dave Eggers. The novels will be put in in a relation of resonation with two concepts sketched in Deleuze’s Post-scriptum sur les sociétés de contrôle: Foucauldian disciplinary societies and control societies. These novels will be considered as signaletic material, symptomatologies of two conditions of society, from which this paper proposes to extract two types of signs: Signs of Order and Signs of Suggestion. These signs will be made react with the concepts of Foucault and Deleuze, in order to see if they can produce the ground for a therapeutic. The paper will therefore combine literary symptomatologies and philosophical aetiology, in the attempt to make them react together, Foucault and Orwell, Eggers and Deleuze, to extract and describe signs from the literary material considered that may be brought to the fore only after the consideration of the causes of the most important symptoms of discipline and control. (shrink)

Personality disorder symptomatology (PD-Sx) can result in personal distress and impaired interpersonal functioning, even in the absence of a clinical diagnosis, and is frequently comorbid with psychiatric disorders such as substance use, mood, and anxiety disorders; however, they often remain untreated, and are not taken into account in clinical studies. To investigate brain morphological correlates of PD-Sx, we measured subcortical volume and shape, and cortical thickness/surface area, based on structural magnetic resonance images. We investigated 37 subjects who reported PD-Sx (...) exceeding DSM-IV Axis-II screening thresholds, and 35 age, sex, and smoking status-matched control subjects. Subjects reporting PD-Sx were then grouped into symptom-based clusters: N = 20 into Cluster B (reporting Antisocial, Borderline, Histrionic, or Narcissistic PD-Sx) and N = 28 into Cluster C (reporting Obsessive–Compulsive, Avoidant, or Dependent PD-Sx); N = 11 subjects reported PD-Sx from both clusters, and none reported Cluster A (Paranoid, Schizoid, or Schizotypal) PD-Sx. Compared to control, Cluster C PD-Sx was associated with greater striatal surface area localized to the caudate tail, smaller ventral striatum volumes, and greater cortical thickness in right prefrontal cortex. Both Cluster B and C PD-Sx groups also showed trends toward greater posterior caudate volumes and orbitofrontal surface area anomalies, but these findings did not survive correction for multiple comparisons. The results point to morphological abnormalities that could contribute to Cluster C PD-Sx. In addition, the observations parallel those in substance use disorders, pointing to the importance of considering PD-Sx when interpreting findings in often-comorbid psychiatric disorders. (shrink)

It has been asserted that the socio-emotional challenges associated with autism spectrum disorder may be explained, in part, by the higher rates of alexithymia in individuals with autism. Alexithymia refers to difficulties in identifying one’s own emotional states and describing those states to others. Thus, one goal of the present study was to examine levels of alexithymia in relation to ASD symptomatology and trait emotion intelligence. Trait EI is a multifaceted concept that captures emotional competencies and behavioral dispositions A (...) second goal was to assess whether alexithymia, ASD symptomatology and trait EI served as significant predictors of adjustment to college, including academic, social, and personal-emotional adjustment. In addition to keeping with the spectrum nature of autism, our research strategy allowed us to capture those students who may not have received a formal diagnosis of ASD but report symptoms that can be indicative of ASD. This includes women, who are less likely to receive a diagnosis of ASD even when ASD symptomatology is present. The results of the study showed that students reporting higher levels of ASD symptomatology also reported significantly higher levels of alexithymia and lower trait emotional intelligence than those with less or no symptomatology. Alexithymia was also negatively related to trait EI, and both alexithymia and ASD symptomatology were found to be significant predictors of trait EI. However, only trait EI was a significant predictor of adjustment to college and only for social adjustment. These findings suggest that support programs that develop trait EI skills may improve the college experience for students with ASD, regardless of alexithymia or ASD symptomatology. (shrink)

It is important for a field to occasionally take stock of where it is, which Annemarie Köhne has done with her exploration of different frames of thought on psychopathology currently in play. As an advocate for thinking of psychiatric constructs as practical kinds that are often calibrated to serve different, even competing purposes, I am in agreement with her concerns about relying on a one-size-fits-all model. Between her and I there are slight differences of emphasis with respect to essentialism and (...) the role and scope of symptom-based descriptive psychopathology. In what follows I explicate these differences.Köhne competently elucidates how a categorical, disease-based model of disorder... (shrink)

The paper aims to describe the stakes of a Nietzschean influence on Deleuze's reflections on the transcendental and conversely to highlight the Deleuzian operation of politicising Nietzsche by ‘minorising’ him. In order to further understand such a complex relationship of becoming between Deleuze and Nietzsche, the first objective of the paper is to focus on active and reactive forces, which seem to be the core of this very relation. Thus, the paper suggests that micropolitics has its conditions of possibility in (...) the Nietzschean corpus and, in particular, in the symptomatology of decadence, resentment and nihilism. In this sense, now the title of the paper reveals its meaning: the whole Deleuzian operation could be summarised as the passage from the criticism and questioning of an image of Nietzsche ‘forbidden to minors’, typical of the interpretations of the first half of the twentieth century, to a becoming-minor of these very same Nietzschean concepts. It is precisely through such a becoming-minor that Nietzsche's diagnosis and concepts are translated in a political and emancipatory key, in order to give power to minorities. (shrink)

BackgroundMediation analysis is important to test the theoretical framework underpinning an intervention. We therefore aimed to investigate if the healthy body image intervention’s effect on eating disorder symptomatology and use of muscle building supplements was mediated by the change in risk and protective factors for ED development and muscle building supplement use.MethodsThis study used data from the HBI intervention: a cluster randomized controlled universal intervention aiming to promote positive body image and embodiment and reduce the risk for ED development (...) including 30 schools in Norway. A total of 1,713 participants were included in the analyses. Conditional latent growth curve analyses were performed to test for indirect effects on ED symptomatology and weekly frequency of protein and creatine supplement use measured at the 12-month follow-up via change in the proposed mediators.ResultsIn girls, the reduction in ED symptomatology was mediated by positive changes in protective factors and reductions in risk factor scores. Comparable changes in protective and risk factors among boys played no mediating role.ConclusionInterventions aiming to reduce the risk of ED development in girls may benefit from aiming to enhance self-esteem and body image flexibility and reduce perceived media pressure and thin appearance internalization. Future studies should investigate the casual relationship between muscle building supplement use and risk and protective factors for ED development in both girls and boys. (shrink)

There has recently been a plethora of attempts to understand the key differences that separate the analytic and continental traditions of philosophy, often involving either painstaking descriptions of the divergent argumentative techniques and methodologies that concern them, or comparatively examining in detail the work of certain major theorists in both traditions (e.g. Rawls and Derrida, Lewis and Deleuze). While partly drawing on these two approaches, in this particular essay I instead propose a rather more speculative way of teasing out the (...) differences between them, interpreting them through the lens of Gilles Deleuze’s non-oppositional typology of sadism and masochism, as it is expressed in Difference and Repetition and ‘Coldness and Cruelty’. (shrink)

The work of Michel Foucault and Gilles Deleuze frequently gave rise to a practice of philosophy as a form of critical problematization. Critical problematization both resonates between their thought and is also generative for contemporary philosophy in their wake. To examine critical problematization in each, a shared theme of inquiry provides a useful focal point. Foucault and Deleuze each deployed critical problematization in the context of studies of sexuality, a site of excited contestation that remains as crucial for us today (...) as it was for them four decades ago. Foucault’s well-known History of Sexuality, Volume 1 and Deleuze’s little-discussed text Coldness and Cruelty thus provide us with exemplary instances of the critical problematization of sexuality. An examination of these two texts, and their broader resonance, illuminates the potential of Foucauldian genealogy and Deleuzian symptomatology as methods for critical problematization today. It is argued that they provide compelling alternatives to modern critical moods that would want to interpret sexuality through a series of oppositions. (shrink)

Hoarding disorder is a psychiatric condition characterized by difficulty discarding items and accumulation of clutter. Although studies have established the negative impact of HD and compulsive hoarding behavior, fewer have examined the impact on quality of life of hoarding behavior independent of obsessive–compulsive disorder. Moreover, specific aspects of QoL such as success in work/academics or satisfaction with interpersonal relationships have not been well-investigated. In this study, we examined, in a sample of 2100 adult participants obtained from Amazon Mechanical Turk, the (...) relationships between hoarding, OCD, and depression symptomatology and four QoL domains derived from a factor analysis of the Quality of Life Inventory. We performed linear regressions to examine associations between psychiatric symptomatology and QoL domains and then conducted mediation analyses to investigate the role of depressive symptomatology in the identified relationships. We found that while hoarding and obsessive–compulsive symptoms were both negatively associated with QoL, they were associated with different domains [hoarding was significantly associated, and was less strongly associated with success or enrichment. Mediation analyses confirmed the role of depression as a complete mediator of hoarding’s effect on total, environment, and family QoL, and as a partial mediator of hoarding’s effect on success and enrichment QoL. Further examination of the relationship between hoarding symptoms and QoL in those with mild, moderate, and severe depression indicated that in those with more severe depression, hoarding was associated with improved QoL, indicating a possible buffering or compensatory effect. The findings suggest a differential impact of hoarding and obsessive–compulsive symptoms on QoL and emphasize the importance of considering co-morbid depressive symptoms in designing more targeted interventions. Future studies should continue to investigate these complex relationships, given the high co-morbidity of hoarding and depression. (shrink)

Introduction: Adolescence is the most critical life period for the development of eating disorder symptomatology. Although problems in identity functioning and emotion dysregulation have been proven important risk and maintaining factors of ED symptomatology, they have never been integrated in a longitudinal study.Methods: The present study is part of the Longitudinal Identity research in Adolescence -study and aimed to uncover the temporal interplay between identity functioning, cognitive emotion regulation, and ED symptomatology in adolescence. A total of 2,162 (...) community adolescents participated at three measurement points with 1-year intervals. They reported on identity functioning, cognitive emotion regulation, and ED symptomatology.Results: Cross-lagged paths could be fixed for boys and girls and showed bidirectional associations between both dimensions of identity functioning and both rumination and catastrophizing over time. Similarly, these maladaptive cognitive emotion regulation strategies were bidirectionally related to ED symptomatology over time. Finally, indirect pathways pointed to bidirectional associations between both dimensions of identity functioning and bulimia symptoms through rumination and catastrophizing. Only unidirectional associations emerged for drive for thinness and almost no cross-lagged associations were found with positive reappraisal.Conclusion: The present study demonstrates that identity confusion may contribute to the development of ED symptomatology in adolescence through cognitive emotion dysregulation. It also reveals that these ED symptoms hamper identity development through emotion dysregulation. These results stress the importance of targeting both identity functioning and cognitive emotion regulation in the prevention and intervention of ED symptoms. (shrink)

This paper seeks to circumscribe the concepts, sources, and limits of Nietzsche’s early ethical thought through a reconstruction of his ethical "symptomatology." In the 1870s, Nietzsche stressed that the Greeks understood the true nature of the political phenomenon, and that this could correct fundamental errors that were responsible for the illness of German culture. His definition of the Greek ethos radically challenges modern democratic politics through a reassertion of aristocratic, heroic, and agonistic values. But because Nietzsche did not systematically (...) describe his early ethics, a reconstruction is necessary. His metaphor of the philosopher as a “physician of culture” is a guide for this reconstruction. Using concepts of wellness and illness, Nietzsche identified different symptoms and possible remedies, and hoped to cure German culture through a therapeutic transvaluation of modernity. To reconstruct this symptomatology I turn to The Greek State, Homer’s Contest, and The Birth of Tragedy. First, I define the notions of “agon” and “eris” that are central to his reading of Greek ethics. I then describe four ethical symptoms and their remedies. I conclude with interpretative hypotheses that address issues that were left unanswered by Nietzsche. This symptomatology shows that his reading of Greek ethics functions as a radical—albeit fragmentary—normative critique of his time, and of our democratic age. (shrink)

Background: The coronavirus disease 2019 has been rapidly transmitted worldwide, which contributed to various psychological problems among the general population in China. The purpose of this study is to investigate the prevalence and associated factors of depressive symptoms among Chinese adults.Methods: A cross-sectional study of Chinese adults was conducted during 17–29 February 2020. Symptoms of depression were assessed using the Center for Epidemiologic Studies Depression scale.Results: A total of 3,399 respondents were included in the analysis. It was observed that 14.2% (...) of the participants were screened positive for depressive symptoms. In a multivariate logistic regression analysis, older age, smoking, self-rated health, having greater support scores, knowledge about the main symptom of COVID-19, and staying in Wuhan within 3 months before the outbreak of epidemic were associated with depressive symptoms.Conclusion: A considerable proportion of the general population in China had depressive symptoms during the COVID-19 epidemic. Routine screening and targeted interventions for depression are needed among high-risk depressed individuals during the COVID-19 epidemic. (shrink)

Previous work employing graph theory and nonlinear analysis has found increased spatial and temporal disorder, respectively, of functional brain connectivity in schizophrenia. We present a new method combining graph theory and nonlinear techniques that measures the temporal disorder of functional brain connections. Multichannel electroencephalographic data were windowed and functional networks were reconstructed using the minimum spanning trees of correlation matrices. Using a method based on Shannon entropy, we found elevated connection entropy in gamma activity of patients with schizophrenia; however, gamma (...) connection entropy remained elevated in patients with schizophrenia even after a reduction in symptoms due to treatment with antipsychotics. Our results are consistent with several possibilities: aberrant functional connectivity is epiphenomenal to schizophrenia, aberrant functional connectivity is a central feature but antipsychotics reduce symptoms by an independent mechanism, or connection entropy is not an appropriately sensitive measure of brain abnormalities in schizophrenia. (shrink)

The present study aims to explore whether the symptoms associated with fibromyalgia are contextually influenced by the area of residence. Furthermore, it is analyzed whether the effect of the acceptance of the disease on the emotional, cognitive and physical symptoms is moderated by the patients’ place of residence. Using a cross-sectional design, a total of 234 women with fibromyalgia were surveyed, of which 55.13% resided in rural areas and 44.87% in urban areas. Self-reported questionnaires were used to assess pain severity, (...) anxiety and depression, functional limitation, physical and mental fatigue and acceptance of the disease. The results show significant differences in acceptance, pain, and physical and mental fatigue between patients from rural and urban areas. The rural area patients presented higher levels of acceptance and pain and lesser levels of physical and mental fatigue compared to the urban area. The moderation analysis add that, only in patients from the rural area, the variables of physical symptoms were significantly and negatively associated with acceptance. This study addresses for the first time the role of the place of residence in suffering from fibromyalgia, suggesting that the rural or urban environment plays a relevant role in the severity and/or management of symptoms in fibromyalgia women. Limitations and practical implications are also discussed. (shrink)

Mental health research faces a suite of unresolved challenges that have contributed to a stagnation of research efforts and treatment innovation. One such challenge is how to reliably and validly account for the subjective side of patient symptomatology, that is, the patient’s inner experiences or patient phenomenology. Providing a structured, standardised semantics for patient phenomenology would enable future research in novel directions. In this contribution, we aim at initiating a standardized approach to patient phenomenology by sketching a tentative formalisation (...) within the framework of an applied ontology, in the broader context of existing open-source Open Biomedical Ontologies resources such as the Mental Functioning Ontology. We further discuss a number of prevailing challenges and observations bearing on this task. (shrink)

This article analyses some of the governmental issues at stake in contemporary institutional politics in its confrontation with the challenges of digitalisation. Through notions such as algorithmic governmentality (Rouvroy and Berns), platformisation (Bratton, Stiegler), extractivism, and the affect theory (Massumi), and following a symptomatologic method, we will try to establish and discuss some key points that could be useful in order to update certain concepts regarding micro- and biopolitics (Deleuze and Guattari, Foucault), the public sphere, and the management of social (...) and individual bodies. Finally, we will try to understand how the manipulation of affects via the staging of possible catastrophic futures (Parisi) is used as a powerful neurosensory weapon, with performative effects for governing and modelling behaviours. If contemporary capitalism is capable of abstracting and extracting affects, of accumulating them and of creating value through this, which policies should we apply in this situation of uncertainty and of the manipulation of affectivity? Is there any place left for public institutions, or is the market the sole political actor left? (shrink)

Much of the characteristic symptomatology of schizophrenia can be understood as resulting from a pervasive sense of disembodiment. The body is experienced as an external machine that needs to be controlled with explicit intentional commands, which in turn leads to severe difficulties in interacting with the world in a fluid and intuitive manner. In consequence, there is a characteristic dissociality: Others become problems to be solved by intellectual effort and no longer present opportunities for spontaneous interpersonal alignment. This dissociality (...) goes hand in hand with a progressive loss of the socially extended mind, which normally affords opportunities for co-regulation of cognitive and affective processes. However, at times people with schizophrenia report that they are confronted by the opposite of this dissociality, namely an unusual fluidity of the self-other boundary as expressed in experiences of ambiguous body boundaries, intrusions, and even merging with others. Here the person has not lost access to the socially extended mind but has instead become lost in it, possibly due to a weakened sense of self. We argue that this neglected aspect of schizophrenic social dysfunction can be usefully approached via the concept of genuine intersubjectivity: We normally participate in a shared experience with another person by implicitly co-regulating how our interaction unfolds. This co-regulation integrates our respective experience’s dynamical bases into one interpersonal process and gives the interaction an ambiguous second-person character. The upshot is that reports of abnormal self-other fluidity are not indicative of hallucinations without any basis in reality, but of a heightened sensitivity and vulnerability to processes of interpersonal alignment and mutual incorporation that form the normal basis of social life. We conclude by discussing implications of this view for both the science of consciousness as well as approaches to intervention and therapy. (shrink)

Detailed studies of people who have experienced the Capgras delusion (the delusion that certain other people, usually close relatives, have been replaced by impostors) have led to advances in constructing an account which can deal with the basic symptomatology, testing alternative possibilities, generating and testing non‐trivial predictions, and broadening the scope of the basic account to encompass other delusions. This paper outlines these developments. It uses them to explore implications for understanding the formation and maintenance of beliefs, and to (...) discuss basic principles of what has come to be known as cognitive neuropsychiatry. (shrink)

Arthur Caplan has argued that the presumptive naturalness, universality, and inevitability of aging are no obstacles to conceptualizing aging as a disease since those traits are themselves merely contingent. Moreover, aging lends itself to discussion in terms of diagnostic symptomatology and etiology. Is aging therefore a disease? I argue that aging need not be shown to be unnatural or a disease in order to make it the subject of biomedical interest. I suggest that rather than ask "Is aging a (...) disease?", the better point of philosophical departure would be to ask "Is aging objectionable such that its prevention and cure ought to be sought?". In this way, the moral issues at stake emerge more clearly. Chief among these issues are the potential results of curing aging and the implications for the prospect of meaningful human life without the de facto limitations that aging (and perhaps death) put upon it. A convincing argument that aging should be cured, therefore, would need to show that human significance warrants and possibly seeks such a cure and that the social costs of curing aging are morally acceptable. Keywords: aging, disease, cure, immortality CiteULike Connotea Del.icio.us What's this? (shrink)

Disorders of consciousness and the self are at the forefront of schizophrenia symptomatology. Patients are impaired in feeling themselves as the authors of their thoughts and actions. In addition, their flow of consciousness is disrupted, and thought fragmentation has been suggested to be involved in the patients’ difficulties in feeling as being one unique, unchanging self across time. Both impairments are related to self disorders, and both have been investigated at the experimental level. Here we review evidence that both (...) mechanisms of motor control and the temporal structure of signal processing are impaired in schizophrenia patients. Based on this review, we propose that the sequencing of action and perception plays a key role in the patients’ impairments. Furthermore, the millisecond time scale of the disorders, as well as the impaired sequencing, highlights the cooperation between brain networks including the cerebellum, as proposed by Andreasen (1999). We examine this possibility in the light of recent knowledge on the anatomical and physiological properties of the cerebellum, its role in timing, and its involvement in known physiological impairments in patients with schizophrenia, e.g., resting states and brain dynamics. A disruption in communication between networks involving the cerebellum, related to known impairments in dopamine, glutamate and GABA transmission, may help to better explain why patients experience reduced attunement with the external world and possibly with themselves. (shrink)

Autism spectrum disorders (ASD) are thought to result in part from altered cortical excitatory-inhibitory balance; this pathophysiology may impact the generation of oscillations on EEG. We investigated premotor-parietal cortical physiology associated with praxis, which has strong theoretical and empirical associations with ASD symptomatology. 25 children with high-functioning ASD (HFA) and 33 controls performed a praxis task involving the pantomiming of tool use, while EEG was recorded. We assessed task-related modulation of signal power in alpha and beta frequency bands. Compared (...) with controls, subjects with HFA showed 27% less left central (motor/premotor) beta (18-22 Hz) event-related desynchronization (ERD) (p = 0.030), as well as 24% less left parietal alpha (7-13 Hz) ERD (p = 0.046). Within the HFA group, blunting of central ERD attenuation was associated with impairments in clinical measures of praxis imitation (r = -0.4; p = 0.04) and increased autism severity (r = 0.48; p = 0.016). The modulation of central beta activity is associated, among other things, with motor imagery, which may be necessary for imitation. Impaired imitation has been associated with core features of ASD. Altered modulation of oscillatory activity may be mechanistically involved in those aspects of motor network function that relate to the core symptoms of ASD. (shrink)

Dissociative symptoms have been related to higher rapid eye movement sleep density, a sleep phase during which hyperassociativity may occur. This may enhance artistic creativity during the day. To test this hypothesis, we conducted a creative photo contest to explore the relation between dissociation, sleep, and creativity. During the contest, participants (N = 72) took one photo per day for five consecutive days, based on specific daily themes (consisting of single words) and the instruction to take as creative a photo (...) as possible each day. Furthermore, they completed daily measures of state dissociation and a short sleep diary. The photos and their captions were ranked by two professional photographers and two clinical psychologists based on creativity, originality, bizarreness, and quality. We expected that dissociative people would rank higher in the contest compared with low-dissociative participants, and that the most original photos would be taken on days when the participants scored highest on acute dissociation. We found that acute dissociation predicted a higher ranking on creativity. Poorer sleep quality and fewer hours of sleep predicted more bizarreness in the photos and captions. None of the trait measures could predict creativity. In sum, acute dissociation related to enhanced creativity. These findings contribute to our understanding of dissociative symptomatology. (shrink)

Ugar and Malele write that generic machine learning (ML) technologies for mental health diagnosis would be challenging to implement in sub-Saharan Africa due to cultural specificities in how those conditions are diagnosed. For example, they say that in South Africa, the appearance of ‘schizophrenia’ might be understood as a type of spiritual possession, rather than a mental disorder caused by a brain dysfunction. Hence, a generic ML system is likely to ‘misdiagnose’ persons whose symptomatology matches that of schizophrenia in (...) the South African context. The authors thus claim that ‘a generic or universal design cannot be effective given the heterogeneity of value judgements in defining what mental health disorders are in different contexts’.1 Should we take this to mean that ML systems ‘should not be designed with a generalised perception of mental disorders,’1 as the authors suggest? On the contrary, my view is that generic ML can be useful, with the caveat that issues of cultural sensitivity may engender translational challenges in various national and cultural contexts. Yet, if it can be demonstrated that a generic ML system can reliably and accurately pick up on shared symptomatologies across cultures despite what any individual or community might believe about their actual causes, this aspect is surely the function and value of diagnostic ML which we should take to matter. Cultural gaps in aetiological understandings of mental health conditions make it all the more important to advance generic ML as a calibrating diagnostic tool. In this commentary, therefore, I will endeavour to make a case for generic ML in mental healthcare. ### Aetiological (mis)understanding across cultures The fundamental complexity to which Ugar and Malele direct our attention is the fact that mental health conditions are attributed to variable causal explanations, rather than a …. (shrink)

Deep brain stimulation (DBS) to different sites allows interfering with dysfunctional network function implicated in major depression. Because a prominent clinical feature of depression is anhedonia--the inability to experience pleasure from previously pleasurable activities--and because there is clear evidence of dysfunctions of the reward system in depression, DBS to the nucleus accumbens might offer a new possibility to target depressive symptomatology in otherwise treatment-resistant depression. Three patients suffering from extremely resistant forms of depression, who did not respond to pharmacotherapy, (...) psychotherapy, and electroconvulsive therapy, were implanted with bilateral DBS electrodes in the nucleus accumbens. Stimulation parameters were modified in a double-blind manner, and clinical ratings were assessed at each modification. Additionally, brain metabolism was assessed 1 week before and 1 week after stimulation onset. Clinical ratings improved in all three patients when the stimulator was on, and worsened in all three patients when the stimulator was turned off. Effects were observable immediately, and no side effects occurred in any of the patients. Using FDG-PET, significant changes in brain metabolism as a function of the stimulation in fronto-striatal networks were observed. No unwanted effects of DBS other than those directly related to the surgical procedure (eg pain at sites of implantation) were observed. Dysfunctions of the reward system--in which the nucleus accumbens is a key structure--are implicated in the neurobiology of major depression and might be responsible for impaired reward processing, as evidenced by the symptom of anhedonia. These preliminary findings suggest that DBS to the nucleus accumbens might be a hypothesis-guided approach for refractory major depression. (shrink)

In the past decades, reductionism has dominated both research directions and funding policies in clinical psychology and psychiatry. The intense search for the biological basis of mental disorders, however, has not resulted in conclusive reductionist explanations of psychopathology. Recently, network models have been proposed as an alternative framework for the analysis of mental disorders, in which mental disorders arise from the causal interplay between symptoms. In this target article, we show that this conceptualization can help explain why reductionist approaches in (...) psychiatry and clinical psychology are on the wrong track. First, symptom networks preclude the identification of a common cause of symptomatology with a neurobiological condition; in symptom networks, there is no such common cause. Second, symptom network relations depend on the content of mental states and, as such, feature intentionality. Third, the strength of network relations is highly likely to depend partially on cultural and historical contexts as well as external mechanisms in the environment. Taken together, these properties suggest that, if mental disorders are indeed networks of causally related symptoms, reductionist accounts cannot achieve the level of success associated with reductionist disease models in modern medicine. As an alternative strategy, we propose to interpret network structures in terms of D. C. Dennett's (1987) notion ofreal patterns, and suggest that, instead of being reducible to a biological basis, mental disorders feature biological and psychological factors that are deeply intertwined in feedback loops. This suggests that neither psychological nor biological levels can claim causal or explanatory priority, and that a holistic research strategy is necessary for progress in the study of mental disorders. (shrink)

Dreaming in patients with schizophrenia was and is of particular interest to researchers and clinicians due to the phenomenological similarities between the dreaming state and schizophrenic daytime symptomatology such as bizarre thoughts or hallucinations. Extensive literature reviews have shown that dream studies in the field of psychopathology often do not fulfill common scientific criteria. The present paper focuses on the methodological issues like sampling methods, the dream collection method, and dream content analysis that are crucial with regard to the (...) validity of the findings. It is also suggested that the so-called dimensional approach (linking severity of daytime symptoms directly to specific dream characteristics) will be very helpful for identifying which psychopathological symptoms of schizophrenia are most closely linked to dream content. (shrink)