Clinicians in their everyday practice of psychiatry face permanently the following epistemological and methodological problem: currently available psychiatric knowledge, like all types of scientific and technological knowledge, is general—at least in certain respects—in sharp contrast with the obvious particularities and even idiosyncrasies of each real individual mental patient they meet in the clinical encounter. This problem is admittedly the source of a permanent tension in the practice and above all in the philosophy of psychiatry. In the practice of (...) psychiatry, conscientious clinicians always try to find a necessarily pragmatic solution to this problem, mainly with the means of their psychiatric knowledge .. (shrink)

Enactive approaches to psychiatry have recently argued for an understanding of psychiatric conditions based within relational interactions between individuals and their environments. A central motivation for these enactive approaches is the goal of social integration: the integration of a naturalistic approach to psychiatric conditions with their broader sociocultural dimensions. One possible issue, however, is whether appeals to the autonomy and authenticity of relationally constituted enactive individuals can provide a means of adjudicating between harmful and beneficial social constraints upon individual (...) behaviour. This paper seeks to provide enactive approaches to psychiatry with a possible means of evaluating normative influences of social contexts beyond direct interactions with relationally constituted individuals. Some of the most significant influences of the sociocultural dimension of psychiatric conditions consist not in direct interaction with individuals, but in setting the terms for interactions and interactants alike. Insofar as some social influences precede and predefine dyadic relations between individuals and their social context, these cannot be accounted for as features of interactions, but must be assessed as independent structures of the sociocultural dimension. I will provide one potential means for enactive models to assess social norms using Canguilhem’s distinction between health and pathology. I will argue that Canguilhem’s conceptualization of health in terms of adaptive normative structure provides a potential tool for social integration which strongly complements enactive approaches to psychiatry. (shrink)

This paper argues that in the case of mental illnesses whose somatic bases are not known or do not exist, a promising route to understand mental illness is to see it as the lack of a patient’s engagement with some moral values that are necessary for a good human life. The paper explains how the first-person perspective, which is constitutive for mental illnesses, makes it impossible to provide an adequate, third-person explanation of the pathological. Because of its irreducible first-personal nature, (...) mental illness must be understood in terms of a moral harm to the patient, and so an integration of ethics and psychiatry is required. This view is further illustrated with A. Kępiński’s idea of psychiatry as therapy with moral values. (shrink)

The decision to involuntary hospitalize a patient underlines an inherent contradiction in psychiatry between the need for care and the lack of consent to care. The growing importance of respect for...

The potential of psychiatry as an integrative science has been impeded by an internal schism that derives from the duality of mental and physical. Organic unity theory is proposed as a conceptual framework that brings together the terms of the mind-body duality in one coherent perspective. Organic unity theory is braided of three strands: identity, which describes the relationship between mentally described events and corresponding physically described events; continuity, which describes the linguistic-conceptual system that contains both mental and (...) physical terms; and dialectic, which describes the relationship between the empirical way of knowing that is associated with the physical domain of the linguistic-conceptual system and the hermeneutic way of knowing that is associated with the mental domain. Each strand represents an integrative formulation that resolves an aspect of mental-physical dualism into an underlying unity. After the theory is presented, its implications for psychiatry are briefly considered. (shrink)

The potential of psychiatry as an integrative science has been impeded by an internal schism that derives from the duality of mental and physical. Organic unity theory is proposed as a conceptual framework that brings together the terms of the mind-body duality in one coherent perspective. Organic unity theory is braided of three strands: identity, which describes the relationship between mentally described events and corresponding physically described events; continuity, which describes the linguistic-conceptual system that contains both mental and (...) physical terms; and dialectic, which describes the relationship between the empirical way of knowing that is associated with the physical domain of the linguistic-conceptual system and the hermeneutic way of knowing that is associated with the mental domain. Each strand represents an integrative formulation that resolves an aspect of mental-physical dualism into an underlying unity. After the theory is presented, its implications for psychiatry are briefly considered. (shrink)

There have been renewed calls to use phenomenology in psychiatry to improve knowledge about causation, diagnostics, and treatment of mental health conditions. A phenomenological approach aims to elucidate the subjective experiences of mental health, which its advocates claim have been largely neglected by current diagnostic frameworks in psychiatry (eg, DSM-5). The consequence of neglecting rich phenomenological information is a comparatively more constrained approach to theory development, empirical research, and care programmes. Although calls for more phenomenology in psychiatry (...) have been met with enthusiasm, there is still relatively little information on how to practically facilitate this integration. In this Personal View, we argue that phenomenological approaches need a shared semantic framework to drive their innovative potential, thus enabling consistent data capture, exchange, and interoperability with current mental health data and informatics approaches (eg, the Research Domain Criteria project). We show how an applied ontology of phenomenological psychopathology offers a suitable method to address these challenges. (shrink)

Psychiatry has witnessed a new wave of approaches to clinical phenotyping and the study of psychopathology, including the National Institute of Mental Health’s Research Domain Criteria, clinical staging, network approaches, the Hierarchical Taxonomy of Psychopathology, and the general psychopathology factor, as well as a revival of interest in phenomenological psychopathology. The question naturally emerges as to what the relationship between these new approaches is – are they mutually exclusive, competing approaches, or can they be integrated in some way and (...) used to enrich each other? In this opinion piece, we propose a possible integration between clinical staging and phenomenological psychopathology. Domains identified in phenomenological psychopathology, such as selfhood, embodiment, affectivity, etc., can be overlaid on clinical stages in order to enrich and deepen the phenotypes captured in clinical staging (‘high resolution’ clinical phenotypes). This approach may be useful both ideographically and nomothetically, in that it could complement diagnosis, enrich clinical formulation, and inform treatment of individual patients, as well as help guide aetiological, prediction, and treatment research. The overlaying of phenomenological domains on clinical stages may require that these domains are reformulated in dimensional rather than categorial terms. This integrative project requires assessment tools, some of which are already available, that are sensitive and thorough enough to pick up on the range of relevant psychopathology. The proposed approach offers opportunities for mutual enrichment: clinical staging may be enriched by introducing greater depth to phenotypes; phenomenological psychopathology may be enriched by introducing stages of severity and disorder progression to phenomenological analysis. (shrink)

In a recent Editorial, Kious et al. (2023) put forward the claim that psychiatrists should resist calls to integrate concerns about epistemic injustice into their practice as this concept not only fails to add significantly to the current professional standards but would also lead to deleterious clinical outcomes. We believe their claim is mistaken, as it arises from several misconceptions about both the nature of epistemic injustice, and its clinical relevance. First, epistemic justice is conflated with what the authors term (...) ‘a quest for social justice’ that could ‘sideline principles of good clinical reasoning’ (Kious at al 2023: 4). Second, the claim about the impracticality and/or counterproductivity of epistemic injustice as a critical tool within psychiatric practice reflects a series of misconceptions about the normative framework from which this concept derives, so the standards they evaluate it against are ill-chosen. Pace Kious at al., fostering epistemic justice in any area of knowledge and inquiry could not – unwittingly or otherwise – inhibit the consideration of relevant evidence, restrict sound argument or facilitate the casual treatment of testimonies at face value. Third and final, this claim obfuscates some immediate ways in which a focus on epistemic justice as an integral goal will strengthen psychiatric practice according to its own internal standards. (shrink)

Mental health professionals can help patients understand exceptional and paranormal experiences, integrate them into day-to-day life, and cope with confusion and anxiety that sometimes accompany them. However, a broader clinical perspective and specialized training in clinical parapsychology is needed. In the first part of the paper I argue that psychiatry as currently practiced is limited because it embraces a strictly materialist paradigm, emphasizes treatment over prevention, and relies principally on pharmaceuticals that are often ineffective and/or unsafe. A paradigm shift (...) in psychiatry is taking place that will soon lead to novel concepts of energy and innovations in therapeutic approaches. In the second part of the paper I review the ongoing debate over consciousness, implications of novel understandings of energy for psychiatry, and research findings in physics, neuroscience and parapsychology that are contributing to a postmaterialist paradigm in psychiatry. I comment on an important problem in the philosophy of science called Hempel’s dilemma and argue that future scientific theories of consciousness will probably encounter similar conceptual limits to those faced by current theories. Following Beauregard, Trent and Schwartz (2018) I argue that different categories of theories may be needed to adequately explain the variety of human experiences and I propose an integral paradigm that acknowledges the validity of both conventional scientific explanations and postmaterialist theories of consciousness. Finally, I discuss implications of postmaterialism for research, education and training in psychiatry. (shrink)

The traditional separation of philosophy, psychiatry, and neuroscience into distinct academic disciplines has led to several discrete approaches to the mind. In an in-depth discussion of major theories from all of these, and related, disciplines, the author progressively reveals fundamental links between these previously unconnected approaches to human thought and experience. The result is a single, unified theory, perhaps the first to integrate all these fields of thought.

Psychiatry has come up as one of the most dynamic branches of medicine in recent years. There are a lot of controversies regarding concepts, nosology, definitions and treatments in psychiatry, all of which are presently under a strict scanner. Differences are so many that even the meaning of psychiatry varies amongst individual psychiatrists. For us, it is an art to practice psychiatry and give the patient what he needs. Still, it should be practiced with great caution (...) and utmost sincerity towards the patient, based on scientific knowledge and not to be guided by individual conceptions alone. Ethics in psychiatry forms an integral part of its basic concept and meaning, and a tight balance should be maintained between professional advancement and patient benefit. In recent years, the scope of psychiatry has enlarged considerably, with wide ranging influences from Sociology, Anthropology and Philosophy on the one hand, and Neurology and Medicine on the other. (shrink)

The integration of digital phenotyping in psychiatry promises unprecedented insights into mental health, particularly in college settings where mental well-being is a growing concern. The COVID-19...

A large part of the controversy surrounding the publication of DSM-5 stems from the possibility of replacing the purely descriptive approach to classification favored by the DSM since 1980. This paper examines the question of how mental disorders should be classified, focusing on the issue of whether the DSM should adopt a purely descriptive or theoretical approach. I argue that the DSM should replace its purely descriptive approach with a theoretical approach that integrates causal information into the DSM’s descriptive diagnostic (...) categories. The paper proceeds in three sections. In the first section, I examine the goals (viz., guiding treatment, facilitating research, and improving communication) associated with the DSM’s purely descriptive approach. In the second section, I suggest that the DSM’s purely descriptive approach is best suited for improving communication among mental health professionals; however, theoretical approaches would be superior for purposes of treatment and research. In the third section, I outline steps required to move the DSM towards a hybrid system of classification that can accommodate the benefits of descriptive and theoretical approaches, and I discuss how the DSM’s descriptive categories could be revised to incorporate theoretical information regarding the causes of disorders. I argue that the DSM should reconceive of its goals more narrowly such that it functions primarily as an epistemic hub that mediates among various contexts of use in which definitions of mental disorders appear. My analysis emphasizes the importance of pluralism as a methodological means for avoiding theoretical dogmatism and ensuring that the DSM is a reflexive and self-correcting manual. (shrink)

Medicalization in contemporary psychopharmacology is increasingly dominated by commercial interests that threaten the scientific and ethical integrity of psychiatry. At the same time, the proliferation of new social media has altered the manner in which the social groups and institutions that have stakes in medicalization interact. Consumers are at once more powerful than ever before, but also more vulnerable. The upshot of all these developments is that medicalization is no longer simply the professed enemy of anti-psychiatry and its (...) supporters. It is now also an enemy of psychiatry. Once a welcome ally of psychiatry, medicalization appears to have turned into a fearsome enemy. (shrink)

In this paper, I explain why evolutionary psychiatry is not where the next revolution in psychiatry will come from. I will proceed as follows. Firstly, I will review some of the problems commonly attributed to current nosologies, more specifically to the DSM. One of these problems is the lack of a clear and consensual definition of mental disorder; I will then examine specific attempts to spell out such a definition that use the evolutionary framework. One definition that deserves (...) particular attention, is one put forward by Jerome Wakefield. Despite my sympathy for his position, I must indicate a few reasons why I think his attempt might not be able to resolve the problems related to current nosologies. I suggest that it might be wiser for an evolutionary psychiatrist to adopt the more integrative framework of “treatable conditions”. As it is thought that an evolutionary approach can contribute to transforming the way we look at mental disorders, I will provide the reader with a brief sketch of the basic tenets of evolutionary psychology. The picture of the architecture of the human mind that emerges from evolutionary psychology is thought by some to be the crucial backdrop to identifying specific mental disorders and distinguishing them from normal conditions. I will also provide two examples of how evolutionary thinking is supposed to change our thinking about some disorders. Using the case of depression, I will then show what kind of problems evolutionary explanations of particular psychopathologies encounter. In conclusion, I will evaluate where evolutionary thinking leaves us in regard to what I identify as the main problems of our current nosologies. I’ll then argue that the prospects of evolutionary psychiatry are not good. (shrink)

In this book Hundert proposes a new, unified view of the mind, one that integrates the insights of philosophers, psychologists, and neuroscientists. Through a detailed discussion of major theories from these and related disciplines, he gradually reveals links between what were previously unconnected approaches to human thought and experience.

This book examines core issues related to legal insanity, integrating perspectives from psychiatry, law, and ethics. Various criteria for insanity are analyzed and recommendations for forensic psychiatric and legal practice are offered. Many legal systems have an insanity defense, in one form or another. Still, it remains unclear exactly when and why mental disorders affect a person’s moral or criminal responsibility. Questions addressed in this book include: Why should insanity be a component of our legal system? What should be (...) the criteria for an insanity defense? What would be the reasons for abolishing it? Who should bear the burden of proof? Furthermore, the book discusses the impact neurosciences may have on psychiatric and psychological evaluations of defendants as well as on legal decisions about insanity. (shrink)

For three decades Jeremy Holmes has been a leading figure in psychodynamic psychiatry in the UK and across the world. He has played a central role in promoting the ideas of John Bowlby and in developing the clinical applications - psychiatric and psychotherapeutic - of Attachment Theory in working with adults. Drawing on both psychoanalytic and attachment ideas, Holmes has been able to encompass a truly biopsychosocialperspective. As a psychotherapist Holmes brings together psychodynamic, systemic and cognitive models, alert to (...) vital differences, but also keenly sensitive to overlaps and parallels. This volume of selected papers brings together the astonishing range of Holmes' interests and contributions. The various sections in the book cover: An extended interview - covering Holmes' career and philosophy as a psychodynamic psychiatrist 'Juvenilia' - sibling relationships, the psychology of nuclear weapons, and the psychodynamics of surgical intervention. Psychodynamic psychiatry: Integrative and Attachment-Informed A psychotherapy section inwhich he develops his model of psychotherapeutic change 'Heroes' - biographical pieces about the major influences including, John Bowlby, Michael Balint, David Malan, Jonathan Pedder and Charles Rycroft. 'Ephemera' - brief pieces covering such topics as frequency of psychodynamic sessions and fees. Attachments: Psychiatry, Psychotherapy, Psychoanalysis - The Selected Works of Jeremy Holmeswill be essential and illuminating reading for practitioners and students of psychiatry and psychotherapy in all its guises. (shrink)

In a recent article, Henri Wijsbek discusses the 1991 Chabot “psychiatric euthanasia” case in the Netherlands, and argues that Chabot was justified in helping his patient to die. Dutch legislation at the time permitted physician assisted suicide when the patient’s condition is severe, hopeless, and unbearable. The Dutch Supreme Court agreed with Chabot that the patient met these criteria because of her justified depression, even though she was somatically healthy. Wijsbek argues that in this case, the patient’s integrity had been (...) undermined by recent events, and that this is the basis for taking her request seriously; it was unreasonable to expect that she could start again. In this paper, I do not challenge the Dutch euthanasia criteria in the case of somatic illness, but I argue that both Chabot and Wijsbek are wrong because we can never be sufficiently confident in cases of severe exogenous depression to assist the patient in her irreversible act. This is partly because of the essential difference between somatic and mental illness, and because of the possibility of therapy and other help. In addition, I argue that Wijsbek’s concept of integrity cannot do the work that he expects of it. Finally, I consider a 2011 position paper from the Royal Dutch Medical Association on euthanasia, and the implications it might have for Chabot-style cases in the future. (shrink)

The aim of this paper is to highlight the rationale behind the use of data from neuroscience, particularly neuroimaging, in psychiatric legal expert procedures and their interference with the mind-brain problem.The critical argument is that the employment of mental health evaluation of the defendants and/or witnesses as collected with clinical assessment methods in court proceedings should not be considered irrespective to the data from neuroscience. Essentially, neuroscience methods belong to the domain of nomothetic (natural explanatory) knowledge, whereas clinical evaluation methods (...) in psychiatry belong to the domain of intra- and inter-subjective narratives. There exists an explanatory gap between those two groups of disciplines which concerns the ability to translate and integrate data across diverse methodological and terminological systems. Furthermore, it depends largely on the implicit positions in the mind-brain debate and the brain-to-behavior connections, which reflect on the professional and legal reasoning in terms of prioritizing certain solutions or approaches over another in the expert judgements. There are described those tacit positions adopted in the mind-brain debate by different traditions in psychiatry, with special emphasis on reductive and non-reductive forms of physicalism.In conclusion, a cognitive pluralist stance is adopted which sets priority for the supervenience theory of mind. (shrink)

Biological psychiatry has been dominated by a psychopharmacologically-driven neurotransmitter dysfunction paradigm. The objective of this paper is to explore a reductionist assumption underlying this paradigm, and to suggest an improvement on it. The methods used are conceptual analysis with a comparative approach, particularly using illustrations from the history of both biological psychiatry and molecular biology. The results are that complete reduction to physicochemical explanations is not fruitful, at least in the initial stages of research in the medical and (...) life sciences, and that an appropriate (non-reducible) integrative principle - addressing a property of the whole system under study - is required for each domain of research. This is illustrated in Pauling's use of a topological integrative principle for the discovery of the functioning of proteins and in Watson and Crick's use of the notion of a genetic code as an integrative principle for the discovery of the structure of genes. The neurotransmitter dysfunction paradigm addresses single molecules and their neural pathways, yet their interactions within the CNS as a whole seem most pertinent to mental disorders such as schizophrenia. The lack within biological psychiatry of an integrative principle addressing a property of the CNS as a whole may be responsible for the empirical failure of orthomolecular psychiatry, as well as for the central role that serendipity has played in the study of mental disorders, which is dominated by the neurotransmitter paradigm. The conclusion is that research in biological psychiatry may benefit from using, at least initially, some integrative principle(s) addressing a property of the CNS as a whole, such as connectionism or a hierarchical notion. (shrink)

This book proposes a new, unified view of the mind which integrates the insights of philosophers, psychologists, and neuroscientists. Through a detailed discussion of major theories from all these, and related disciplines, the author gradually reveals fundamental links between these previously unconnected approaches to human thought and experience. The author has studied medicine, philosophy, mathematics and history, and is currently a practising psychiatrist and a teacher at the Harvard Medical School. He discusses diverse fields of thought with depth and clarity, (...) and his unique perspective should stimulate a re-evaluation of our traditional approaches to the mind. (shrink)

Psychiatry is rapidly changing. The authors review the history of psychiatry in the United States, its gradual integration into medicine and society, and the dialectic between its “biologic” and “mentalist” outlooks. After describing the current state of the profession and its knowledge base, they discuss the likely future of the field: psychiatry's projected mode of practice and economics; its future as a science for understanding human behavior; its expected boundaries with other treatment disciplines; its anticipated relationship with (...) academia and with the community at large; and internal issues for the profession. Unprecedented internal and external pressures on the field are likely to require important reconceptualizations of psychiatry both by its members and by the rest of the American public. (shrink)

Hallucination lies at an intriguing border between psychiatry and philosophy. Although Behrendt & Young (B&Y) tie their proposal to Kantian transcendental idealism, other philosophical positions are equally consistent. Cognition is underconstrained by reality not only in hallucination but also in autism and dreaming. Sensory underconstraint is insufficient to encompass schizophrenia. There is also a breakdown in integrative capacity on the cognitive side. From a wider clinical perspective than schizophrenia, there can be underconstraint or overconstraint in sensory and cognitive (...) functionalities. (shrink)

Delusions are currently characterised as false beliefs produced by incorrect inference about external reality (DSM IV). This inferential conception has proved hard to link to explanations pitched at the level of neurobiology and neuroanatomy. This paper provides that link via a neurocomputational theory, based on evolutionary considerations, of the role of the prefrontal cortex in regulating offline cognition. When pathologically neuromodulated the prefrontal cortex produces hypersalient experiences which monopolise offline cognition. The result is characteristic psychotic experiences and patterns of thought. (...) This bottom-up account uses neural network theory to integrate recent theories of the role of dopamine in delusion with the insights of inferential accounts. It also provides a general model for evolutionary psychiatry which avoids theoretical problems imported from evolutionary psychology. (shrink)

The uniqueness of Psychiatry as a medical speciality lies in the fact that aside from tackling what it considers as illnesses, it has perchance to comment on and tackle many issues of social relevance as well. Whether this is advisable or not is another matter; but such a process is inevitable due to the inherent nature of the branch and the problems it deals with. Moreover this is at the root of the polarization of psychiatry into opposing psychosocial (...) and biological schools. This gets reflected in their visualization of scope, in definitions and in methodology as well. Whilst healthy criticism of one against the other school is necessary, there should be caution against hasty application of one's frame of reference to an approach that does not intend to follow, or conform to, one's methodology. This should be done within the referential framework of the school critically evaluated, with due consideration for its methods and concepts. Similarly, as at present, there is no evidence to prove one or the other of these approaches as better, aside from personal choice. We can say so even if there is a strong paradigm shift towards the biological at present. A renaissance of scientific psychoanalysis coupled with a perceptive neurobiology which can translate those insights into testable hypotheses holds the greatest promise for psychiatry in the future. This suggests the need for unification of diverse appearing approaches to get a more comprehensive and enlightened worldview. It requires a highly integrative capacity. Just as a physicist thinks simultaneously in terms of particles and waves, a psychiatrist must think of motives, emotions and desires in the same breath as neurobiology, genetics and psychopharmacology. However, the integration must be attempted without destroying the internal cohesiveness of the individual schools. This will give a fair chance for polarization in which a single proper approach in psychiatry could emerge, which may be a conglomerate of diverse appearing approaches of today, or one which supersedes the rest. A synthesis of cognitive psychology and neuroscience offers the greatest promise at present. (shrink)

The contemporary epistemic status of mental health disciplines does not allow the cross validation of mental disorders among various genetic markers, biochemical pathway or mechanisms, and clinical assessments in neuroscience explanations. We attempt to provide a meta-empirical analysis of the contemporary status of the cross-disciplinary issues existing between neuro-biology and psychopathology. Our case studies take as an established medical mode an example cross validation between biological sciences and clinical cardiology in the case of myocardial infarction. This is then contrasted with (...) the incoherence between neuroscience and psychiatry in the case of bipolar disorders. We examine some methodological problems arising from the neuro-imaging studies, specifically the experimental paradigm introduced by the team of Wayne Drevets. Several theoretical objections are raised: temporal discordance, state independence, and queries about the reliability and specificity, and failure of convergent validity of the inter-disciplinary attempt. Both modern neuroscience and clinical psychology taken as separate fields have failed to reveal the explanatory mechanisms underlying mental disorders. The data acquired inside the mono-disciplinary matrices of neurobiology and psychopathology are deeply insufficient concerning their validity, reliability, and utility. Further, there haven’t been developed any effective trans-disciplinary connections between them. It raises the requirement for development of explanatory significant multi-disciplinary “meta-language” in psychiatry (Berrios, 2006, 2008). We attempt to provide a novel conceptual model for an integrative dialogue between psychiatry and neuroscience that actually includes criteria for cross-validation of the common used psychiatric categories and the different assessment methods. The major goal of our proactive program is the foundation of complementary “bridging” connections of neuroscience and psychopathology which may stabilize the cognitive meta-structure of the mental health knowledge. This entails bringing into synergy the disparate discourses of clinical psychology and neuroscience. One possible model accomplishment of this goal would be the synergistic (or at least compatible) integration of the knowledge under trans-disciplinary convergent cross-validation of the commonly used methods and notions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hermeneutics, Neuroscience and PsychiatryMichael T. H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM (bio)Hermeneutic practice in mental health has been a theme in Philosophy, Psychiatry, & Psychology (PPP) since its very beginnings. In this essay I argue that hermeneutics, the theory and practice of interpretation, promotes therapeutic interaction between mental health professionals, patients and their family.Why does this patient present in such a way at this (...) particular point in time? The distressing symptoms are there. The changes in behavior are obvious. Impairments of functions are hurting. A mental illness clearly runs in the family. There were early losses of loved ones, physical abuse at home, bullying by peers and self-medication with drugs and alcohol. Three in four adults with a mental illness first experienced that before they turned 24. The brain goes through major reorganization during adolescence and early adulthood. If synaptic pruning went wrong, psychoses emerged. When stresses activated the hypothalamic–pituitary–adrenal axis the elevated cortisol level impacted the size and function of the hippocampus and amygdala in the genetically vulnerable; anxiety, depression, bipolar, and personality disorders developed. The patient needs a voice/language to describe all these experiences and events and the psychiatrist needs a discourse to make sense of them.Eisenberg laments the swings between "brainlessness" and "mindlessness" in psychiatry. Engel argues for a "biopsychosocial" discourse. The major challenge for psychiatry is how to organize clinical information of different nature (categories, dimensions, narratives; i.e., objective vs. subjective, personal vs. interpersonal) into a coherent and comprehensible account for us all. Mental illnesses are not only neuropsychiatric spectrum disorders but also dysfunctions of social relationship and environmental/ecological adaptation. Psychiatry as a clinical neuroscience per se lacks the semantics to address the rich interactions between the physical, psychological, social, cultural, and spiritual in the illness experience of our patients. Explanation in the diagnostic formulation (objective scientific discourse on cause and effect) and understanding in the patient narrative (subjective ordinary everyday discourse on significance and meaning) are irreducible to each other (Wong, 2018). They instead interact with one another to achieve an integrative formulation, not through merging different discourses into a single assertion/monologue but via the dialectic/dialogue of "explaining more in order to understand better," as Ricoeur puts it, and between "the whole and the parts," as Schleiermacher highlights.This "therapeutic hermeneutic circle" of "explanation vs understanding" and "the whole vs the parts" includes symptoms behavior function and life events. It correlates between bio-psychosociocultural-spiritual dimensions/perspectives and does not reduce them to any particular/single [End Page 13] stance. The whole integrates the parts and the parts enrich the whole. It explains but does not explain away. It understands through an articulation of meaning and significance. This discourse is a multilayered (bio-psycho-social-cultural-spiritual) personal narrative that formulates diagnosis and care in a correlative (linking different voices/discourses) and non-reductive (no particular voice/discourse is prejudiced against) manner that is comprehensible to us all (Wong, 2021).PPP will be an excellent forum for discussing clinical hermeneutics in the future. In this digital era of social media and virtual reality, hermeneutics has the never-ending task to tackle the unprecedented challenges to meaning illness and health posed by polarizing discourses.Michael T. H. Wong Michael T.H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM, is Hon Clinical Professor, Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, HKSAR, China. Michael is Chair, Section of Philosophy & Humanities in Psychiatry, World Psychiatric Association. He is an Organizational Partner & International Lead with The Collaborating Centre for Values-Based Practice in Health and Social Care, St Catherine's College Oxford. He is Advisor to the Chinese Health Foundation of Australia.ReferencesWong M. T. H. (2018). Ricoeur and the third discourse of the person: From philosophy and neuroscience to psychiatry and theology. London: Lexington Books. Google ScholarWong, M. T. H. (2021). Values, meanings, hermeneutics and mental health. In Stoyanov, D., Fulford, K. M. W. F., Stanghellini, G., Van Staden, W., & Wong, M. TH. (Eds.), International perspectives in values-based mental health practice: Case studies and commentaries (pp. 341–349... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:100 HISTORY OF PHILOSOPHY porary philosophers, mesmerized by neurology, does not even appear to exist: that our casual, mechanical view of nature, when extended beyond the workings of gears and pulleys and the collision of billiard balls to become a general conception of how things happen, is a metaphysical prejudice. In sum, this is a valuable addition to the thought of Wittgenstein, and an important work of philosophy in (...) its own right. A. R. LoucH ~laremon$ Graduate ~ehool Final Integration in the Adult Personality. By A. Reza Arasteh. (Leiden: E. J. BriU, 1965. Pp. 404.) This amazing work bears the subtitle ".4 Measure ]or Health, Social Change, and Leaderahip." But though many readers might consider such a design a formidable task, the book actually accomplishes infinitely more. It offers a completely novel approach to depth psy= chology and psychiatry, incorporating these disciplines into the broader context of an original monolithic philosophy of our time. It also shows a unique and quite unexpected way of how to overcome the "departmentalization of sciences" which has resulted in "fragmented theories of man." Thus it provides something many of us have been looking for rather desperately: a holistic psychology and philosophy, directed toward human life in its entirety and, by its own nature, encompassing a great healing force. Dr. A. Reza Arasteh has obtained this fortunate result by amalgamating Western concepts with oriental ideas and, therefore, for the first time has eliminated from our thinking another cleavage which threatened to invalidate our psycho-philosophical findings. For, in the jet and space age where there is actually one world, what use could a Western psychiatrist make of his psychodynamic training when called upon to treat a person from the Near or Far East with a completely different frame of reference based on an apparently distinct culture and tradition? Arasteh, an Iranian now with the George Washington University's Department of Psy= chiatry, has done something quite unusual for a Persian scholar and psychologist brought up in Islamic cultural tradition: he has devoted many years of thorough research to our Western neuropsychiatric, psychological and philosophical heritage and compared and confronted it with his home=grown Near-Eastern and Far-Eastern wisdom, doctrines, and scientific methods. This confrontation performed by a searcher who has delved equally deep into the basic sources of Western and Eastern culture has given Arasteh the golden opportunity to explore the weaknesses and strengths of both approaches to life and more: the insight that if both cultures were to adopt the positive findings of their seemingly opposite doctrines and drop their own negative ones, they could overcome the shortcomings barring the road to full in= tegration and personal maturity. In other words: a pooling of the best philosophical and psychological discoveries of the East and West would help to bring about a monolithic, yet diversified approach to the problems of life and man which was lost after the Middle Ages. It would help to overcome and use for his best the anxiety of modern man who is fumbling in uncertainties while desperately longing for meaningfulness. According to Arasteh, the West has reached the end of its tether because of an overemphasis on intellectual solutions and endeavors which even in their most brilliant forms fall short of any substantial activity of life. It is a fallacy to believe, as Freud and long before him Socrates did, that a purely intellectual understanding of problematic or even neurotic behavior will lead any man to overcome and eliminate these failures. The intellect never has the power to change a personality and bring about what the Iranian psychologist calls a total "rebirth." Oriental attitudes toward life, on the other hand, are too much focused on inner feelings and socio-psychological directedness, thereby neglecting the independent action of the intelhgent individual. Religion and family, in some countries even connected with ancestor worship, have been and sometimes still are at the foreground of oriental thought. BOOK REVIEWS 101 Yet, in the basic chapter of h/s work, titled, "Principles of Psyehocultural Analysis: A Technique for Developing Fully Integrated Individuals," Arasteh stresses a very important point all too frequently overlooked in our era of specialization: "Regardless of language, culture and temporal... (shrink)

Explanations in psychiatry often integrate various factors relevant to psychopathology. Identifying genuine causes among them is theoretically and clinically important, but epistemically challenging. Woodward’s interventionism appears to provide a promising tool to achieve this. However, Woodward’s interventionism is too demanding to be applied to psychiatry. I thus introduce difference-making interventionism, which detects relevance in general rather than causation, to make interventionist reasoning viable in clinical practice. DMI mirrors the empirical reality of psychiatry even more closely than interventionism, (...) but it needs to be supplied with additional heuristics to disambiguate between causes and other difference-makers. To achieve this, I suggest employing heuristics based on multiple experiments, temporal order and scientific domain. (shrink)

Explanatory models in psychiatry reflect what clinicians deem valuable in rendering people's behavior intelligible and thus help guide treatment choices for mental illnesses. This article outlines some key scientific and ethical principles of clinical explanation in twenty-first century psychiatry. Recent work in philosophy of science, clinical psychiatry, and psychiatric ethics are critically reviewed in order to elucidate conceptual underpinnings of contemporary explanatory models. Many explanatory models in psychiatry are reductionistic or eclectic. The former restrict options for (...) diagnostic and therapeutic paradigm choice, while the latter lack a well-defined theoretical basis. These two methodological approaches stand in a dialectical relation to one another insofar as clinicians often move from one approach to its antithesis, ultimately seeking a synthesis of the two approaches that satisfies clinical needs. Pragmatic considerations can help to transcend the reductionism/eclecticism dialectic. In the absence of a completed science of mental disorders, psychiatrists must tolerate ambiguity and uncertainty as they strive to integrate diverse explanatory concepts in a rigorous and evidence-based fashion. A pragmatic explanatory model in clinical psychiatry must focus on favorable treatment outcomes for patients by respecting the pluralistic, participatory, and provisional nature of psychiatric explanation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.1 (2002) 93-96 [Access article in PDF] Phenomenological Methods in Psychiatry:A Necessary First Step M. Gupta and L. Rex Kay Keywords: behavior, empathy, human science, methodology, natural science, phenomenology. WE ARE GRATEFUL to the journal for prviding the opportunity for exchange and discussion of some of the themes raised in our paper, "The impact of phenomenology on North American psychiatric assessment" and we (...) are pleased to be able to reply to the two excellent commentaries by McMillan and Morley. Both McMillan and Morley question the prospect of employing phenomenology and its methods in psychiatric assessment, and in psychiatric practice more generally. McMillan questions the utility of such a step, and Morley is pessimistic about its feasibility. We shall address each author's concerns in turn.Initially, let us restate the aims of our paper to contextualize our arguments and those made in the commentaries. First, we sought an understanding of what is meant by North American psychiatrists, working within the DSM framework, when they refer to the phenomenological approach to psychiatric assessment. To elucidate this meaning, we compared the contemporary North American usage to a small number of definitions of phenomenology, particularly those definitions that were, and are now, applied to clinical psychiatric work. Contrary to McMillan's suggestion, we did not intend to state definitively what should or should not count as phenomenological, but rather to compare North American psychiatric assessment to what typically has counted as phenomenological. Second, we sought to examine phenomenology's influence on North American psychiatric practice, particularly psychotherapy.Morley argues that such influences usually exemplify the inappropriate appending of phenomenology to psychiatric practice rather than true integration of different paradigms. Although we do not disagree with this general contention, we will argue that the deployment of phenomenological methods in psychiatric assessment is a necessary first step toward the kind of integration he proposes.McMillan makes two related but unintegrated points. First, he argues that objective, behavioral data are phenomenological, according to his broad definition of the term. Second, he proposes that, if the behavioral and the phenomenological are different, we are better off staying with the behavioral when it comes to psychiatric nosology. Let us consider these two points in succession.McMillan seeks to broaden Jasper's definition of phenomenology to include objective observations [End Page 93] as phenomenological. To this end, he distinguishes methods from aims. He summarizes Jasper's definition of phenomenology as "an empirical method for investigating 'individual psychic experience (p 55)" and claims that this is a statement of aim or objectives. He then urges us to "consider the merits of different phenomenological methodologies in terms of their success in achieving this objective" whether or not they utilize "all the methods" of phenomenology. This is much like saying that if we treat waving one's hand as a method for greeting someone, we are then free to treat the objective of the wave as one of greeting someone, and then say that anything that serves as a greeting is, by definition, a "wave." Whatever else McMillan's objective observations are, he has not convinced us that they are phenomenological, anymore than we are likely to convince you that a kiss on the lips is really just a wave.Nonetheless, it is worthwhile seeing what McMillan does with this argument. He tells us that we can "read the first-person experience from behavior in a fairly accurate and informative way." He uses the example of a father gazing at his young child and notes that it is not unreasonable to infer that he is experiencing loving and nurturing feelings. It is, indeed, not unreasonable to draw such an inference. But it is far more reasonable to infer that the father is experiencing a cacophony of feelings, including, but not limited to, love, concern, anxiety, pride, envy, hope, and sadness (Stern 1995, 18-58). If we are able to distinguish which of these feelings is dominant at any given moment—which we are—and if we are also able to track subtle shifts in such feelings... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.1 (2002) 87-90 [Access article in PDF] Phenomenological and Biological Psychiatry:Complementary or Mutual? James Morley Keywords: phenomenology, psychiatry, psychoanalysis, ontology. We feel that even if all possible scientific questions be answered the problems of life have still not been touched at all. (Witgenstein, Tractatus, 6.52) IF ONE WAS TO PERFORM a thought experiment by imagining a scientifically explained universe, how would this (...) explained universe resolve my issues of value and meaning? Would it help me to live a better life? In one sentence, Witgenstein expressed exactly the issues dividing, and defining, the phenomenological and biophysical approaches to psychiatry. (Natural) scientific questions are concerned with relations of physical causality while phenomenology is aimed at the problems of life, i.e., the elucidation of lived personal meanings.Clarifying the relation between phenomenology and the general psychiatric literature is clearly a significant undertaking. At this juncture in the history of psychiatry where the biophysical model is so dominant, the authors' efforts are especially welcome, as I wholeheartedly appreciate, and thank the authors for this endeavor. I only wish to explicate a few issues latent within the article and perhaps add a few supportive points. Explicitly or implicitly, the need for phenomenology in psychiatry is long enduring and will always persist (Ellenberger 1981, 1993). The integration of phenomenology with general psychiatric practice would certainly serve the needs of patients and society generally. But, in the present state of affairs where the biological model is so preeminent, a full accounting of the dramatic divergences between the two approaches is necessary if there is to be authentic dialogue between them.Essentially, I want to stress that phenomenology and natural science medicine are genuinely distinct paradigms for construing reality and organizing knowledge. As distinct scientific paradigms, each one is holistically self-contained. Like soap bubbles, if pushed together too forcefully one or the other may burst. In this case, it is more likely that the smaller, less prevalent paradigm would burst by becoming absorbed into the more dominant paradigm. I believe that this is precisely the risk when phenomenology is introduced to conventional psychiatry as "complementary." Whereas one could hardly object to any application of empathy and understanding toward the experiences of patients, it would be tragic if the [End Page 87] full philosophical power of phenomenology were to be overlooked in favor of its mere utility as a preliminary stage of diagnosis and assessment, a framework for bedside manners, or worst of all, an appendage to neuroscience or pharmacology. This would not be phenomenology but the very symptomatology that the authors have has so clearly distinguished from true phenomenology.This equation of phenomenology with symptomatology is exactly the misunderstanding that the authors so effectively address. However, I would hesitate to join the authors' optimism in regard to phenomenology's potential complementary role to conventional psychiatric practice. Furthermore, in the process of paradigm mix, certain constituents of each paradigm may be taken out of context and the strength of each paradigm thus diluted. For example, the very power of the experimental method is its reduction of phenomena to measurable variables that can be altered in order to discern causality. Unmeasurable variables detract form the rigor of this entire approach. Then on the other hand, phenomenological empathy is only possible within a standpoint that is severed from the causal thinking of experimental science. This is the holistic perceptual shift that cannot be accomplished when one only appends phenomenological insights to an otherwise materialist approach to psychiatry. Thus, it is not at all clear how one can be both phenomenological and nonphenomenologically natural scientific. Instead of positioning phenomenology as a potential complimentary component of natural-science psychiatry, both world views need to be examined, on their own terms, in a framework of mutuality.Empathy or the understanding of other peoples subjective experience is indeed an essential component of the application of phenomenology to clinical assessment and especially therapeutic treatment. But, to limit phenomenology to this theme alone may not honor the profoundly radical character of this paradigm. As the authors point out, phenomenology asks the practitioner to... (shrink)

The Inherent inseparability of psychopathology and phenomenology is generally a known fact, established and popularised by Karl Jaspers in Allgemeine Psychopathologie. In the following paper, I will show the development of interdisciplinary methodology initiated by Jaspers, and discuss it by combining M. Merleau Ponty`s theory of embodiment, R. D. Laing`s existential-phenomenological approach, and T. Fuchs` concept of brain resonance and integral causality with the hermeneutical thoughts of Paul Ricœur regarding the notion of selfhood. The main thesis proposes that fusion of (...) hermeneutics and phenomenology with psychiatry can play a significant methodological role in the approach to diagnosis and treatment of the psychotic disorders spectre, especially regarding the most complex yet inaccurately defined and evaluated mental disorder – schizophrenia. Due to the fundamental interpretative capacity of both disciplines regarding the understanding of the displacement (translocation) of subject, disembodiment, delusions and consciousness, I am considering them as a prerequisite for the effective expansion of psychiatric practice. (shrink)

The uniqueness of Psychiatry as a medical speciality lies in the fact that aside from tackling what it considers as illnesses, it has perchance to comment on and tackle many issues of social relevance as well. Whether this is advisable or not is another matter; but such a process is inevitable due to the inherent nature of the branch and the problems it deals with. Moreover this is at the root of the polarization of psychiatry into opposing psychosocial (...) and biological schools. This gets reflected in their visualization of scope, in definitions and in methodology as well. Whilst healthy criticism of one against the other school is necessary, there should be caution against hasty application of one's frame of reference to an approach that does not intend to follow, or conform to, one's methodology. This should be done within the referential framework of the school critically evaluated, with due consideration for its methods and concepts. Similarly, as at present, there is no evidence to prove one or the other of these approaches as better, aside from personal choice. We can say so even if there is a strong paradigm shift towards the biological at present. A renaissance of scientific psychoanalysis coupled with a perceptive neurobiology which can translate those insights into testable hypotheses holds the greatest promise for psychiatry in the future. This suggests the need for unification of diverse appearing approaches to get a more comprehensive and enlightened worldview. It requires a highly integrative capacity. Just as a physicist thinks simultaneously in terms of particles and waves, a psychiatrist must think of motives, emotions and desires in the same breath as neurobiology, genetics and psychopharmacology. However, the integration must be attempted without destroying the internal cohesiveness of the individual schools. This will give a fair chance for polarization in which a single proper approach in psychiatry could emerge, which may be a conglomerate of diverse appearing approaches of today, or one which supersedes the rest. A synthesis of cognitive psychology and neuroscience offers the greatest promise at present. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Integrating the Parts of the Biopsychosocial ModelMichael A. Westerman (bio)Keywordsbiopsychosocial approach, pragmatism, participatory framework, functionalist accounts, mind-body-behavior integrationEngel’s (1977, 1980) call for replacing the biomedical model with his biopsychosocial approach pointed in the right direction. Bradley Lewis recognizes this, but argues that Engel’s framework does not provide us with everything we need to develop the biopsychosocial approach. Lewis attempts to add what is missing by reinterpreting Engel as a (...) pragmatist. As I see it, he is on the right track. We need to add something more to Engel’s position, and Lewis’s reinterpretation is an intriguing attempt to respond to this need. Nevertheless, I believe Lewis’s article only takes us so far. Something is still missing. In what follows, I identify what is missing, make suggestions about additional steps we can take to remedy the situation, and raise the possibility that pragmatism can be helpful in this venture in ways that Lewis does not consider.It should come as no surprise that it will take a lot to accomplish Engel’s objectives, because those goals are extremely ambitious. For one thing, Engel offered his biopsychosocial model as an alternative framework for all of medicine, not just psychiatry. Furthermore, he believed that it was not enough to augment the technological focus of the biomedical model by simply tacking onto it more humane concern with the patient as a person and more attention to the patient–physician relationship (although he certainly advocated changes along those lines). Engel maintained that psychosocial factors play an intrinsic role in the etiology of disease, its assessment, and treatment. He based his biopsychosocial model on general systems theory because he believed that it provides a framework for dealing with disease in a way that reflects this view.This is where Lewis enters the arena. He endorses Engel’s goal of developing a biopsychosocial approach to medicine and psychiatry, but he takes issue with Engel’s belief that we can reach this goal by following along the lines of general systems theory. Indeed, he claims that Engel’s biopsychosocial model was “doomed from the start” because of this idea. At a later point, I will turn to Lewis’s arguments against employing a systems theory framework. I first consider what Lewis proposes we bring to the biopsychosocial endeavor in its place.Lewis argues that pragmatism can get us where we want to go and that it makes sense to reinterpret Engel as a pragmatist because there [End Page 321] are a number of noteworthy similarities between pragmatism and Engel’s work. First, Lewis points out that both Engel and the pragmatists believed that inquiry should start with real problems, that is, with something that is not working. Another similarity is that, like the pragmatists, Engel believed that it is important to be aware of the impact theories and philosophical perspectives have on the ways we deal with problems, even though their influence may not be readily apparent. The third similarity Lewis points to is that even though Engel at times justifies beliefs by taking recourse to idealized notions about “The Method” of science (which, Lewis notes, parallels Peirce’s own early idealization of science), Engel ends up holding the pragmatists’ view that the justification of beliefs rests on their usefulness. Finally, Lewis argues that Engel and the pragmatists (in particular, Dewey) have similar views of nature, or the world, in that they believe nature can be characterized by a hierarchy of “levels” (Engel) or “plateaus” (Dewey).What do we gain from lewis’s reinterpretation?There is a lot to recommend this new reading of Engel. I agree with Lewis that Engel did not provide us with all the tools we need for developing his biopsychosocial approach. I also think that Lewis is right when he asserts that, in particular, we have to place Engel’s ideas about the biopsychosocial model in the context of a richer philosophical perspective. In addition, Lewis has identified a number of interesting similarities between Engel’s work and pragmatism. Hence, there is a basis for reinterpreting him as a pragmatist—and, in my opinion, this brings in a philosophical perspective that does indeed... (shrink)

Murphy (2006) criticizes psychiatric nosology from the perspective of the philosophy of science, arguing that the model of pathology as encapsulated in the Diagnostic and Statistical Manual of Mental Disorders reflects a folk conception of the mental, and of malfunctioning, that is inadequately integrated with cognitive and behavioral neuroscience. The present paper supports this view through a case study of research on pathological gambling. It argues that recent modeling based on fMRI studies and behavioral genetics suggests a stipulative, non-seamless reduction (...) of pathological gambling to a specific disorder of the mesolimbic dopamine system. This argument is agnostic as between prior philosophical commitments to realism or empiricism. (shrink)

In this contribution, I comment on Raffaella Campaner’s defense of explanatory pluralism in psychiatry (in this volume). In her paper, Campaner focuses primarily on explanatory pluralism in contrast to explanatory reductionism. Furthermore, she distinguishes between pluralists who consider pluralism to be a temporary state on the one hand and pluralists who consider it to be a persisting state on the other hand. I suggest that it would be helpful to distinguish more than those two versions of pluralism – different (...) understandings of explanatory pluralism both within philosophy of science and psychiatry – namely moderate/temporary pluralism, anything goes pluralism, isolationist pluralism, integrative pluralism and interactive pluralism. Next, I discuss the pros and cons of these different understandings of explanatory pluralism. Finally, I raise the question of how to implement or operationalize explanatory pluralism in scientific practice; how to structure the “genuine dialogue” or shape “the pluralistic attitude” Campaner is referring to. As tentative answers, I explore a question-based framework for explanatory pluralism as well as social-epistemological procedures for interaction among competing approaches and explanations. (shrink)

_The first part called the Preamble tackles: (a) the issues of silence and speech, and life and disease; (b) whether we need to know some or all of the truth, and how are exact science and philosophical reason related; (c) the phenomenon of Why, How, and What; (d) how are mind and brain related; (e) what is robust eclecticism, empirical/scientific enquiry, replicability/refutability, and the role of diagnosis and medical model in psychiatry; (f) bioethics and the four principles of beneficence, (...) non-malfeasance, autonomy, and justice; (g) the four concepts of disease, illness, sickness, and disorder; how confusion is confounded by these concepts but clarity is imperative if we want to make sense out of them; and how psychiatry is an interim medical discipline. The second part called The Issues deals with: (a) the concepts of nature and nurture; the biological and the psychosocial; and psychiatric disease and brain pathophysiology; (b) biology, Freud and the reinvention of psychiatry; (c) critics of psychiatry, mind-body problem and paradigm shifts in psychiatry; (d) the biological, the psychoanalytic, the psychosocial and the cognitive; (e) the issues of clarity, reductionism, and integration; (f) what are the fool-proof criteria, which are false leads, and what is the need for questioning assumptions in psychiatry. The third part is called Psychiatric Disorder, Psychiatric Ethics, and Psychiatry Connected Disciplines. It includes topics like (a) psychiatric disorder, mental health, and mental phenomena; (b) issues in psychiatric ethics; (c) social psychiatry, liaison psychiatry, psychosomatic medicine, forensic psychiatry, and neuropsychiatry. The fourth part is called Antipsychiatry, Blunting Creativity, etc. It includes topics like (a) antipsychiatry revisited; (b) basic arguments of antipsychiatry, Szasz, etc.; (c) psychiatric classification and value judgment; (d) conformity, labeling, and blunting creativity. The fifth part is called The Role of Philosophy, Religion, and Spirituality in Psychiatry. It includes topics like (a) relevance of philosophy to psychiatry; (b) psychiatry, religion, spirituality, and culture; (c) ancient Indian concepts and contemporary psychiatry; (d) Indian holism and Western reductionism; (e) science, humanism, and the nomothetic-idiographic orientation. The last part, called Final Goal, talks of the need for a grand unified theory. The whole discussion is put in the form of refutable points._. (shrink)

The incorporation of neural-based technologies into psychiatry offers novel means to use neural data in patient assessment and clinical diagnosis. However, an over-optimistic technologisation of neuroscientifically-informed psychiatry risks the conflation of technological and psychological norms. Neurotechnologies promise fast, efficient, broad psychiatric insights not readily available through conventional observation of patients. Recording and processing brain signals provides information from ‘beneath the skull’ that can be interpreted as an account of neural processing and that can provide a basis to evaluate (...) general behaviour and functioning. But it ought not to be forgotten that the use of such technologies is part of a human practice of neuroscience informed psychiatry. This paper notes some challenges in the integration of neural technologies into psychiatry and suggests vigilance particularly in respect to normative challenges. In this way, psychiatry can avoid a drift toward reductive technological approaches, while nonetheless benefitting from promising advances in neuroscience and technology. (shrink)

Clinical fields of the “sciences of the mind” (psychotherapy, psychiatry, etc.) lack integrative conceptual frameworks that have explanatory power. Mainly descriptive-classificatory taxonomies like DSM dominate the field. New taxonomies such as Research Domain Criteria (RDoC) aim to collect scientific knowledge regarding “systems” for “processes” of the brain. These terms have a supradisciplinary” meaning if they are considered in context of Systems Science. This field emerges as a platform of theories like general systems theory, catastrophe theory, synergetics, chaos theory, (...) etc. It provides a lot of abstract concepts, constructs, methods and models. We assume that these tools also enable theoretical integration in the diversified field of clinical practice in the sciences of the mind. Additionally, systems thinking in clinical psychology improves conceptual links to currently network-oriented neurobiology. However, clear definitions of systemic terms are necessary to emerge from their mainly metaphorical use. Here we revise mainly terms like “structure”, “process” and “dynamics” as they are used already in psychology, psychoanalysis, psychopathology and psychiatry in an ill-defined way. For instance, affective-cognitive structures like “life space” or “object representations” can be seen as products of mental processing. These structures, in turn, modulate dynamics of mental processes. Additionally, we suggest a coupled network concept of emotions and motivations as the main subsystem that modulates mental dynamics that results in a qualitative systemic model of the mind. Finally, we assume that a revisited systemic approach could improve interdisciplinary understanding of the mental. ystem for mental dynamics. In this context, we assume that a revisited systemic approach could improve interdisciplinary understanding of the mental. (shrink)

The medical specialty of psychiatry should possess a basic science in which pathologies are considered deviations from normal brain physiology. Historically, psychoanalytic pathogenesis was considered separately from brain physiology. It was not scientific because observations could not be refuted. Countering this, Eli Robins's legacy stemmed partly from his having been damaged by a psychoanalyst. It eschewed pathogenesis. Attempting to integrate psychiatry with medicine more generally, Robins and colleagues refocused on empiricism, although they acknowledged the brain's centrality. Here I (...) hold that the term biology used in the context of psychiatry should broadly encompass social facets of organismal function. The term sociophysiology may best describe the central basic science of psychiatry because it alludes to brain functions used for the person's social realm. Disruptions of such functions result in deviant behaviors and unpleasant feelings which psychiatrists diagnose and treat. Future study encompassing top-down and bottom-up research should include genome-neural-behavioral analyses. (shrink)

The medical specialty of psychiatry should possess a basic science in which pathologies are considered deviations from normal brain physiology. Historically, psychoanalytic pathogenesis was considered separately from brain physiology. It was not scientific because observations could not be refuted. Countering this, Eli Robins's legacy stemmed partly from his having been damaged by a psychoanalyst. It eschewed pathogenesis. Attempting to integrate psychiatry with medicine more generally, Robins and colleagues refocused on empiricism, although they acknowledged the brain's centrality. Here I (...) hold that the term biology used in the context of psychiatry should broadly encompass social facets of organismal function. The term “sociophysiology” may best describe the central basic science of psychiatry because it alludes to brain functions used for the person's social realm. Disruptions of such functions result in deviant behaviors and unpleasant feelings which psychiatrists diagnose and treat. Future study encompassing top-down and bottom-up research should include genome-neural-behavioral analyses. (shrink)

In the last few years, avatars have been increasingly used in treating persistent persecutory auditory verbal hallucinations. The digital representation (an avatar) of persecutory hallucinations is voiced by the therapist and engages the patient in a dialogue, progressively conceding its power and, hence, reducing the stress experienced by the patient. Such attempts at integrating digital representations and cognitive behavior therapy raise a range of philosophical questions, which this chapter tackles along two trajectories. From an epistemological standpoint, we inquire what notion (...) of mental disorder can underlie the use of avatar therapy, and how our understanding of psychiatric diseases can be affected by the implementation of such a therapy. Relatedly, from an ethical standpoint, we reflect on some of the controversial issues posed by such therapeutic strategies. Discussing selected epistemological and ethical aspects stemming from the latest relevant literature both in philosophy and in psychiatry, the chapter aims to provide a tentative evaluation of trade-offs between the promises of and the limits to this therapeutic option. (shrink)

This paper aims to explore the validity of phenomenology in the psychiatric setting. The phenomenological method - as a mode of research, a method of engagement between self and other, and a framework for approaching what it means to know - has found a legitimate home in therapeutic practice. Over the last century, phenomenology, as a philosophical endeavour and research method, has influenced a wide range of disciplines, including psychiatry. Phenomenology has enabled an enrichment of such practice through deepening (...) the way in which we can come to know the experiences of the other. This knowing-of-the-other is explored here within the context of psychiatric and clinica assessment. The question asked is: How best can we come to know those we work with? What method of engagement can be used to most completely come to understand and narrate the experiences of the individual, and how can this be applied in the context of an assessment aimed at psychiatric or psychological intervention? Elements of phenomenological praxis are presented as definitive of the most integral way of approaching the human subject. Husserlian and Heideggerian notions are explicated and related to phenomenological conceptions of intersubjectivity, in an effort to describe a phenomenology that can be used effectively within the psychiatric setting. Indo-Pacific Journal of Phenomenology , Volume 7, Edition 1 May 2007. (shrink)

Health disparities in primary care remain a continual challenge for both practitioners and patients alike. Integrating mental health services into routine patient care has been one approach to address such issues, including access to care, stigma of health-care providers, and facilitating underserved patients’ needs. This article addresses examples of training programs that have included mental health learners and licensed providers into family medicine residency training clinics. Descriptions of these models at two Midwestern Family Medicine residency clinics in the United States (...) are highlighted. Examples of cross-training both medical residents and mental health students are described, detailing specific areas where this integration improves mental health and medical outcomes in patients. Challenges to effective integration are discussed, including larger system buy-in, medical providers’ knowledge of mental health treatment, and the skills for clinical providers to possess in order to present mental health options to patients. Patients who traditionally experience multiple barriers to mental health treatment now have increased access to comprehensive care. As a result of more primary care clinics ascribing to an integrated care model of practice, providers may benefit from not only increased coordination of patient services but also utilizing behavioral health professionals to address health barriers in patients’ lives. (shrink)