The Psychosis of Race offers a unique and detailed account of the psychoanalytic significance of race, and the ongoing impact of racism in contemporary society. Moving beyond the well-trodden assertion that race is a social construction, and working against demands that simply call for more representational equality, The Psychosis of Race explores how the delusions, anxieties, and paranoia that frame our race relations can afford new insights into how we see, think, and understand race's pervasive appeal. With examples (...) drawn from politics and popular culture--such as Candyman, Get Out, and the music of Kendrick Lamar--critical attention is given to introducing as well as explicating on several key concepts from Lacanian psychoanalysis and the study of psychosis, including foreclosure, phallus, the Name-of-the-Father, sinthome, and the objet petit a. By elaborating a cultural mode to psychosis and its understanding, an original and critical exposition of the effects of racialization, as well as our ability to discern the very limits of our capacity to think through, or even beyond, the idea of race, is provided. The Psychosis of Race speaks to an emerging area in the study of psychoanalysis and race, and will appeal to scholars and academics across the fields of psychology, sociology, cultural studies, media studies, and the arts and humanities. (shrink)

When interacting with other people, we assume that they have their reasons for what they do and believe, and experience recognizable feelings and emotions. When people act from weakness of will or are otherwise irrational, what they do can still be comprehensible to us, since we know what it is like to fall for temptation and act against one’s better judgment. Still, when someone’s experiences, feelings and way of thinking is vastly different from our own, understanding them becomes increasingly difficult. (...) Delusions and psychosis are often seen as marking the end of intelligibility. In this paper, I argue first for the importance of seeing other people as intelligible as long as this is at all possible. Second, I argue, based on both previous literature and my own lived experience, that more psychotic phenomena than previously thought can be rendered at least somewhat intelligible. Besides bizarre experiences like illusions, hallucinations and intense feelings of significance, I also explain what it is like to lose one’s bedrock, and how this loss impacts which beliefs one has reason to reject. Finally, I give an inside account of some disturbances of reason, and show that there are important similarities between certain psychotic reasoning problems and common non-pathological phenomena. (shrink)

Autistic-spectrum conditions and psychotic-spectrum conditions (mainly schizophrenia, bipolar disorder, and major depression) represent two major suites of disorders of human cognition, affect, and behavior that involve altered development and function of the social brain. We describe evidence that a large set of phenotypic traits exhibit diametrically opposite phenotypes in autistic-spectrum versus psychotic-spectrum conditions, with a focus on schizophrenia. This suite of traits is inter-correlated, in that autism involves a general pattern of constrained overgrowth, whereas schizophrenia involves undergrowth. These disorders also (...) exhibit diametric patterns for traits related to social brain development, including aspects of gaze, agency, social cognition, local versus global processing, language, and behavior. Social cognition is thus underdeveloped in autistic-spectrum conditions and hyper-developed on the psychotic spectrum.;>We propose and evaluate a novel hypothesis that may help to explain these diametric phenotypes: that the development of these two sets of conditions is mediated in part by alterations of genomic imprinting. Evidence regarding the genetic, physiological, neurological, and psychological underpinnings of psychotic-spectrum conditions supports the hypothesis that the etiologies of these conditions involve biases towards increased relative effects from imprinted genes with maternal expression, which engender a general pattern of undergrowth. By contrast, autistic-spectrum conditions appear to involve increased relative bias towards effects of paternally expressed genes, which mediate overgrowth. This hypothesis provides a simple yet comprehensive theory, grounded in evolutionary biology and genetics, for understanding the causes and phenotypes of autistic-spectrum and psychotic-spectrum conditions. (shrink)

Psychotic and prodromal states are characterized by distortions of intersubjectivity, and a number of psychopathologists see in the concrete I-You frame of the clinical encounter the manifestation of such impairment. Rümke has coined the term of ‘praecox-feeling’, designated to describe a feeling of unease emanating in the interviewer that reflects the detachment of the patient and the failure of an ‘affective exchange.’ While the reliability of the praecox-feeling as a diagnostic tool has since been established, the explanation and theoretical framing (...) of the phenomena is still lacking. By drawing on enactivist approaches to social cognition, the paper will attempt to provide such an explanation. This is relevant, since such an explanation could contribute to a more precise understanding of the phenomena in question and possibly add to our knowledge regarding the link between experiential vulnerability to psychosis and disturbed I-Thou intersubjectivity. (shrink)

In the target article, Crespi & Badcock (C&B) propose a novel hypothesis based on observations that a large set of phenotypic traits exhibit diametrically opposite phenotypes in autism-spectrum versus psychotic-spectrum conditions. They propose that development of these conditions is mediated in part by alterations in This hypothesis is based on the model of the Prader-Willi and Angelman syndromes. The authors have produced a masterful discussion of the differences between psychosis and autism. Of course, another article could be written on (...) the similarities. (shrink)

The study of the neuroscience and genomics of mental illness are increasingly intertwined. This is mostly due to the translation of medical technologies into psychiatry and to technological convergence. This article focuses on psychosis. I argue that the convergence of neuroscience and genomics in the context of psychosis is morally problematic, and that ethics scholarship should go beyond the identification of a number of ethical, legal, and social issues. My argument is composed of two strands. First, I argue (...) that we should respond to technological convergence by developing an integrated, patient-centred approach focused on the assessment of individual vulnerabilities. Responding to technological convergence requires that we integrate insights from several areas of ethics, translate bioethical principles into the mental health context, and proactively try to anticipate future ethical concerns. Second, I argue that a nuanced understanding of the concept of vulnerability might help us to accomplish this task. I borrow Florencia Luna’s notion of ‘layers of vulnerability’ to show how potential harms or wrongs to individuals who experience psychosis can be conceptualised as stemming from different sources, or layers, of vulnerability. I argue that a layered notion of vulnerability might serve as a common ground to achieve the ethical integration needed to ensure that biomedical innovation can truly benefit, and not harm, individuals who suffer from psychosis. (shrink)

Delusions and hallucinations present a challenge to traditional epistemology by allowing two people’s experiences of the world to be vastly different to each other. Traditional objective realism assumes that there is a mind-independent objective world of which people gain knowledge through experience. However, each person only has direct access to his or her own subjective experience of the world, and so neither can be certain that his or her experience represents an objective world more accurately than the other’s. This essay (...) proposes an intersubjective account of psychosis, which avoids this sceptical attack on objective certainty by considering reality not at the level of an objective mindindependent world, but at the level of peoples’ shared experiences. This intersubjective hypothesis is developed further, with reference to Husserl’s concept of multiple lifeworlds, into a relativistic account. The implication on the social role of psychiatry is also explored. (shrink)

I shall draw on my experience of being an ICU patient to make some practical, ethical, and philosophical points about the care of the critically ill. The recurring theme in this paper is ICU psychosis. I suggest that discharged patients ought to be educated about it; I discuss the obstacles in the way of accurately measuring it; I argue that we must rethink autonomy in light of it; and I suggest that the self disintegrates in the face of it.

This article explores the evolution of a major longitudinal ‘high risk for schizophrenia’ research programme, started over 50 years ago, which has been largely ignored in recent debates over ‘psychosis risk’ and early intervention. Studying mainly the offspring of individuals with schizophrenia, high-risk investigators aimed to identify a range of precursors of schizophrenia in the hope that the findings would eventually facilitate effective primary prevention. Specifically, the article examines the origins and impact of the pioneering Copenhagen High-Risk Project and (...) thus provides an important contribution to the sparse historical literature on schizophrenia research, including the study of milder conditions and at-risk states in the borderlands of psychosis. (shrink)

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

With regard to social-cognitive deficits in autism and psychosis, Crespi & Badcock's (C&B's) theory does not incorporate the developmental context of the disorders. We propose that there is significant overlap in social-cognitive impairments, but that the exact manifestation of social-cognitive deficits is highly dependent on the dynamics of cognitive development and hence different in autism as compared to psychosis.

The philosophy of Thomas Kuhn proposes that scientific progress involves periods of crisis and revolution in which previous paradigms are discarded and replaced. Revolutions in how mental health problems are conceptualised have had a substantial impact on the work of mental health nurses. However, despite numerous revolutions within the field of mental health, the biological paradigm has remained largely dominant within western healthcare, especially in orientating the understanding and treatment of psychosis. This paper utilises concepts drawn from the philosophy (...) of Thomas Kuhn to explore the impact of what Kuhn terms ‘anomalies’ within the dominant biological paradigm: the anomaly of the meaningful utterance, the anomaly of complex aetiology and taxonomy and the anomaly of pharmacological inefficacy in recovery. The paper argues that the biological paradigm for understanding psychosis is in crisis and explores the implications for mental health nursing. (shrink)

The insight a patient shares into their own psychosis is fundamental to their condition - it goes to the heart of what we understand 'madness' to be. Can a person be expected to accept treatment for a condition that they deny they have? Can a person be held responsible for their actions if those actions are inspired by their own unique perceptions and beliefs - beliefs that no-one else shares? The topic of insight in schizophrenia and related disorders has (...) become a major focus of research in psychiatry and psychology. It has important clinical implications in terms of outcome, treatment adherence, competence, and forensic issues. In order to study 'insight' a broad perspective is required. This involves applying knowledge from the cognitive and brain sciences, as well as from philosophy and the social sciences. Insight and Psychosis comprises a series of in-depth, well-referenced, scholarly overviews from each of these perspectives with a strong empirical foundation - including in some cases the presentation of new data and meta-analysis of the published literature. These are integrated and synthesised by the editors, both acknowledged experts in the field. The scope is truly international and spans theoretical perspectives, clinical practice, and consumer views. The book will act as a source for students and researchers interested in pursuing any number of questions and controversies around lack of insight and awareness, and will guide clinical psychologists and psychiatrists who seek a broader view of the many facets of insight that might arise during their day-to-day work. (shrink)

Research focused on the prodromal period prior to the onset of psychosis is essential for the further development of strategies for early detection, early intervention, and disease pre-emption. Such efforts necessarily require the enrollment of individuals who are at risk of psychosis but have not yet developed a psychotic illness into research and treatment protocols. This work is becoming increasingly internationalized, which warrants special consideration of cultural differences in conceptualization of mental illness and international differences in health care (...) practices and rights regarding research participation. The process of identifying and requesting informed consent from individuals at elevated risk for psychosis requires thoughtful communication about illness risk and often involves the participation of family members. Empirical studies of risk reasoning and decisional capacity in young people and individuals with psychosis suggest that most individuals who are at-risk for psychosis can adequately provide informed consent; however ongoing improvements to tools and procedures are important to ensure that this work proceeds with maximal consideration of relevant ethical issues. This review provides a discussion of these issues in the context of international research efforts. (shrink)

The positive functions of psychosis are examined. It is concluded that psychosis might have following positive and compensating functions: satisfaction of urgent needs that otherwise would remain unsatisfied; avoidance of and coping with unbearable reality, harmful influences and stress, and/or trauma; realization of urgent but otherwise unattainable goal settings; and upgrading of social-emotional and cognitive incapacities into more adequate social-emotional and cognitive awareness and functioning. The therapeutic implications of these findings are also discussed.

In this ground breaking and controversial work Richard Bentall shatters the myths that surround madness. He shows there is no reassuring dividing line between mental health and mental illness.

This is an exploratory paper of the ethical implications for genomic research and mental illness with specific reference to Singapore. Singapore has a unique context due to its social and political systems, and although it is a relatively small country, its population is religiously and culturally diverse. The issues that we identify here, therefore, will offer new perspectives and will also shed light on the existing literature on psychiatric genomics in society. We contextualise issues such as risk and stigma in (...) the identification and diagnosis of psychosis in the way they relate to Singaporean society, and use a current study as a case example. Genomic research has the potential to change significantly he practice of clinical medicine if, as expected, fast and inexpensive sequencing becomes a reality. It will likely also change how society thinks and acts in respect to multi-factorial diseases, conditions, traits, and syndromes that have a genetic component. Genomic research already raises a number of ethical concerns relating to the privacy of individuals, including the disclosure of research results and incidental findings, surreptitious tests, third party access to data, and the re-emergence of genetic determinism. These issues are potentially exacerbated when genomics - the study of whole genomes to understand complex illness and behavioural traits - is applied to psychiatric research, because of the stigma that is often attached to mental illness. In this paper, we discuss some of the issues that have arisen in the context of a study in Singapore that is currently investigating the genomics and biomarkers of psychosis. We argue that although a genomic study rarely creates data that is directly useful to the participant, it can have incidental benefits to the individual who is identified during the study as being at high risk of developing psychosis and its related states. Understanding these potential benefits requires us to examine the implications that this type of research may have on public understandings of genomic data and risk. (shrink)

Some limitations of ‘category work’ in the history of psychiatry are illustrated via the example of attempts within US alienism and psychiatry since 1889 to identify psychosis and its prodromes. A slowly evolving acceptance of the need for specifiable biological disease concepts, distinct diagnostic categories and defined boundaries of the ‘before and after’ of psychosis among some elite physicians challenged widespread vernacular methods of diagnosis expressed as intuition, feelings or scent as well as local practices of creating novel (...) placeholder terms ‘as needed’ or using question marks to express liminality or confusion. When ‘error of diagnosis’ emerged as a concern circa 1909, the professional transformation of this ‘scientific self of subjectivity’ of the psychiatrist into a ‘scientific self of objectivity’ eventually resulted in the turn to numerical judgments based on rating scales for psychotic symptoms. However, rating scales do not ‘count’ anything at all and exist as instruments of liminality between subjective clinical opinion and the affection of objectivity that quantification symbolizes. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.1 (2004) 35-41 [Access article in PDF] The Rationality of Psychosis and Understanding the Deluded Matthew R. Broome Campbell's important and influential paper (Campbell 2001) has framed the debate that Bayne and Pacherie (2004) most explicitly, and Klee (2004) and Georgaca (2004) more implicitly, engage in. Campbell has offered two broad ways of thinking about explanations of delusions—the empirical and the rational. He offers (...) some criticism of the former and an endorsement of the latter. Campbell uses examples from clinical psychopathology to illustrate his argument and Bayne and Pacherie in turn employ these. Campbell discusses the eponymously named delusions of Capgras and Cotard—the former a subtype of delusional misidentification and the latter a delusion whose content is colored predominantly with nihilistic and possibly hypochondriacal themes. Campbell, Bayne and Pacherie, and Klee discuss the empirical data in relation to such delusions and as an aid to discussing the empirical model more generally. It does seem a little unfortunate that these delusions, which are less than typical, become the focus of Campbell's paper, and Bayne and Pacherie's criticism of his work. Delusions are remarkably heterogeneous; this indeed may be part of the reason why there is so much difficulty in reaching a definition as Klee discusses, and occur in a wide variety of mental and neurological illnesses. The most common delusions are those of persecution and reference (World Health Organization [WHO] 1973) and typically occur in schizophrenia. By contrast, delusional misidentification occurs most commonly in patients with dementia, delirium, and focal cognitive impairment, but can occur in other functional psychoses such as an affective or schizophrenic psychosis. The most common form of delusional misidentification is not that of either the exotic Capgras or Fregoli syndromes but delusional misidentification for place; thus, although Bayne and Pacherie's arguments against Campbell may still hold, delusional misidentification tends to occur in the context of a patient believing that they are at home or on holiday rather than in hospital and may not necessarily involve close family members or other intimate relationships. Similarly, Cotard's syndrome tends to occur in the context of a severe depressive illness with mood-congruent psychotic symptoms, typically in an elderly individual. It does not have to have the content that the deluded is dead, but can include beliefs, for example, that the world no longer exists or that their internal organs are not present. Thus, a patient with either Capgras' or Cotard's syndrome is likely to differ from patients with delusions of persecution. They would [End Page 35] have different diagnoses, probably be older, and have a greater likelihood of structural abnormalities of the brain on imaging and consequent neuropsychological dysfunction. That is not to say that patients with schizophrenia have normal cerebral anatomy and neuropsychology, but rather that the Capgras' and Cotard's patients are likely to have neurological quality to their presentation that is clinically relevant, rather than what commonly the case in schizophrenia and the other functional psychoses, where the neurological abnormalities are only currently important at the level of academic research. Empirical Models of Delusion Formation Different delusions may not have that much in common, nor may the patients who believe in them. This in turn relates to the empirical paradigm that both Campbell and Bayne and Pacherie discuss. It is true that current research, and indeed the clinical practice of cognitive behavioral therapy for psychosis, is indebted to the work of Maher and it is within his legacy which we work. This, however, is not to say that we think his initial formulation was correct. Maher's (1988, 1992) work focused attempts in explaining delusions—both to support and refute his thesis that delusions are the consequence of normal cognitive mechanisms seeking to explain an anomalous sensory experience. Such a view initially led to work demonstrating delusions in the absence of anomalous perceptions, the presence of reasoning biases in the deluded population, and the possibility that abnormal sensory experience may be consequent upon biased cognitive processes (Garety and Freeman 1999). More recent work has demonstrated the prevalence of... (shrink)

_ Source: _Volume 39, Issue 2, pp 139 - 164 The aim of the present study is to explore the significance of religiousness for patients suffering from first-episode psychosis. Our study is a thematic analysis. The study illustrates how the patients understood their hallucinations as mystical experiences. Even so, many of the patients describe their religiousness to be helpful in coping with their disorder, giving meaning to life as well as a relationship to a sacred figure. However, their religiousness (...) often contained religious omnipotent delusions, and built on hallucinations, displayed an unsecure relationship to the sacred figure. From a psychiatric point of view, the misinterpretation of hallucinations as mystical experiences may reinforce their delusional system and cause an obstacle to recovery. This misinterpretation may also cause problems for patients’ religious coping. Our findings underline the importance of taking patients’ religiousness into account in psychotherapy. (shrink)

A fictitious dialogue in which an answer is given to the question: Why are the rates of psychosis and psychopathy in the United States so high?

The question that drives this paper is: How does time function in psychosis? Given the altered or inhibited relation to speech in psychosis, I think that it is worth working out a notion of temporal or, to borrow Bessel van der Kolk’s term, “rhythmical. .. .interactions” (Listening to Trauma, 2014) with the afflicted persons. Using Freud’s analysis of non-linear psychic time, I construct a theoretical model of temporal modifications in psychosis. I then use this model, along with (...) Lacan’s writings on psychosis, to show the temporality peculiar to psychotic breakdowns. Aligning the theoretical analyses with the individual testimonies, I draw on patient accounts of psychotic time-perception recited by Davoine and Gaudillière and by Minkowski. (shrink)

This study in the philosophy of psychiatrydeals with the concept `psychosis'. Methodologicallyit follows Wittgenstein's proposal to `dissolve'philosophical problems by studying the actual use ofthe relevant concepts. Philosophical problemsconcerning both identification of psychosis and themeaning of this concept are pointed out. The logicaldependencies between `psychosis' and `understanding'and between `understanding' and the concept ofperson are demonstrated. Studying theinterdependence of these concepts in the light ofthe actual uses of `madness' shows how the use of`psychosis' implies a radical loss of (...) understanding.The status and legitimacy of `psychosis' as a psychiatric concept is then demonstrated. (shrink)

Over the last decade or so, several researchers have considered the predictive processing framework (PPF) to be a useful perspective from which to shed some much-needed light on the mechanisms behind psychosis. Most approaches to psychosis within PPF come down to the idea of the “atypical” brain generating inaccurate hypotheses that the “typical” brain does not generate, either due to a systematic top-down processing bias or more general precision weighting breakdown. Strong at explaining common individual symptoms of (...) class='Hi'>psychosis, such approaches face some issues when we look at a more general clinical picture. In this paper, we propose an update on the current accounts of psychosis based on the realization that a neurotypical brain constantly generates non-actual, de-coupled, counterfactual hypotheses as part of healthy cognition. We suggest that what is going on in psychosis, at least in some cases, is not so much a generation of erroneous hypotheses, but rather an inability to correctly use the counterfactual ones. This updated view casts “accurate” cognition as more fragile and delicate, but also closes the gap between psychosis and typical cognition. (shrink)

In this introduction we present the orthodox account of auditory verbal hallucinations, a number of worries for this account, and some potential responses open to its proponents. With some problems still remaining, we then introduce the problems presented by the phenomenon of thought insertion, in particular the question of how different it is supposed to be from AVHs. We then mention two ways in which theorists have adopted different approaches to voices and thoughts in psychosis, and then present the (...) motivation and composition of this special issue. (shrink)

Diverse evidence from genomics, epidemiology, neurophysiology, psychology, and evolutionary biology converges on simple general mechanisms, based on negative secondary effects of strong selection, for how mental disorders such as psychosis have evolved and how they are sustained. (Published Online November 9 2006).

Over the past years, the intersubjective dimension of psychotic disorders, including schizophrenia, has gained increasing phenomenological attention. Psychopathologists and philosophers have developed ideas on how the social aspects of psychotic symptoms and experiences could be understood, in particular in their relation to the ipseity disturbance model, namely the idea that schizophrenia is essentially a disorder of the minimal self. Although the exact characteristics of the ipseity disorder hypothesis can differ from author to author, emphasizing certain phenomenological aspects like temporality or (...) embodiment... (shrink)

The purpose of this article is to problematize the theme of the individual psychoemotional health of a modern person and indicate an alternative interpretation of affect. This problem is investigated not from the point of view of the individual's autonomy, but from a trans-individual perspective, in which modern depression is associated not with the problems of an individual suffering subject, but with the sociocultural situation that produces this subject. The recursiveness of the individual and society ultimately has a structural-semiotic character, (...) mediated by representation. It is suggested that it is the affect that can serve to open up alternative ways in understanding subjective life and building new cultural practices. (shrink)

We argue that autism and psychosis spectrum disorders cannot be conceptualized as polar extremes of mentalizing ability. We raise two main objections: (1) the autistic-psychotic continuum, as conceptualized by the authors, excludes defining features of schizophrenia spectrum: negative symptoms, which correlate more strongly with mentalizing impairments; and (2) little evidence exists for a relationship between mentalizing ability and positive symptoms.

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

This is an exploratory paper of the ethical implications for genomic research and mental illness with specific reference to Singapore. Singapore has a unique context due to its social and political systems, and although it is a relatively small country, its population is religiously and culturally diverse. The issues that we identify here, therefore, will offer new perspectives and will also shed light on the existing literature on psychiatric genomics in society. We contextualise issues such as risk and stigma in (...) the identification and diagnosis of psychosis in the way they relate to Singaporean society, and use a current study as a case example. (shrink)

Background: The aim of this study was to investigate associations between demographic and clinical variables and duration of untreated psychosis (DUP) in a sample of cases of psychosis across an adult early intervention in psychosis service and a child and adolescent community team. Method: Cross-sectional baseline data for cases of psychosis across the two teams on the caseload at a given time point were collected, including age of onset, gender, ethnicity, referral route, and DUP. Results: The (...) median DUP across the entire sample was 91 days, while those patients with initial treatment for psychosis from the child and adolescent team had a median DUP of 69 days. Using multiple linear regression, there were two variables that showed a significant association with DUP: referral route (p < .001), and age of onset, with earlier age of onset associated with shorter DUP (p = .015). Conclusion: These findings are discussed in relation to possible explanatory factors, with particular focus on service-level variables and pathways to care. It is suggested that the involvement of child and adolescent teams is vital to the work of early intervention in psychosis services. (shrink)

Some psychoanalytic truths are identified and some of their practical corollaries are identified.

In lieu of an abstract, here is a brief excerpt of the content:Recovering One's Self from PsychosisA Philosophical AnalysisThe author reports no conflicts of interest.Rosanna Wannberg (2024) has given us a dense but helpful introduction to certain philosophical questions raised by the fact that many patients recovering from psychotic illnesses describe their recovery in terms of gaining or regaining a 'sense of self' and a 'sense of agency,' which often involves acceptance of the 'fact' of being mentally ill, for example, (...) of 'having schizophrenia.' She raises two important questions: How should we understand what is going on in these accounts? and What are the implications of these reports for our understanding of what it is to have a 'sense of self' or a 'sense of agency'—of 'subjectivity' generally—which might have, both, clinical and nonclinical implications?What does it mean to have a self or a sense of having one, agency or a sense of having it? One might think these are the possession or experience of something 'inner' such as feelings of confidence or assurance, perhaps having a kind of inner structure or a set of deeply held ideas which give us coherence, motivate us and justify our actions, and which we can know by 'looking inward,' in an introspective act which provides direct, privileged acquaintance.Yet Wittgenstein called this a dangerously misleading 'picture' which 'held us captive,' and needed always to be 'gotten rid of' (Wittgenstein, 1958). One way of seeing the problem is to consider that no inner 'object,' no thing inside us, can be, or give us a sense of having, a self or agency, because no mere thing (whether an experience of confidence, or having an inner structure) can have any meaning or provide any explanation. A thing (like a word on a page) is just a thing—inert, dead— and must be interpreted, that is used, before it can play a role in our 'forms of life' (Wittgenstein, 1958) including explaining our sense of self or agency.Semantic externalists (Burge, 1979; Putnam, 1975), have argued that even what is internal to our minds—like thoughts—have contents which are determined by experiences in the 'outside' world in which we have lived and learned: if our experiences in the world, they have shown, were different, then so, also, would be the contents of our thoughts. It has even been argued that internal mental experiences which appear to be purely phenomenological (such as an image or a thought-token, so-called narrow content) can only [End Page 67] be identified and thought about using concepts having references in the external world: there is, so it is claimed, no narrow content (Yli-Vakkuri and Hawthorne, 2018); or, if there is, it is of no explanatory use in psychology (Fodor, 1994).If this is the philosophical background from which Wannberg confronts first-person accounts of recovery from psychosis which include (re)gaining a sense of self or agency, and if this philosophy is right, what becomes of the accounts? How are they to be understood?To meet this challenge, Wannberg invokes an alternative account of self-possession and firstperson authority provided by Richard Moran (2001). Moran's position is that we find or possess ourselves when we find or hold beliefs about the world which we do not merely believe but endorse or avow, where to endorse or avow a belief about the world is to find and endorse reasons in the world, which support that belief. Thus, I can avow that it's raining if I can look outside and see that it is raining. This Moran calls the transparency condition. Endorsing or avowing both a belief and the external reasons for it gives the self what Moran refers to as authenticity and which also might be said to provide cohesion, consistency and intelligibility—plausibly, a 'sense of self.'The transparency condition also applies to beliefs that justify actions. We act intentionally when we can give good reasons for what we do (Anscombe, 1957; Moran, 2001) and we can give good reasons for what we do when we can identify facts in the world that support those reasons. Thus, the transparency condition can explain both a sense of self and a sense... (shrink)