Wouter Kusters argues that madness has much to offer philosophy, as does philosophy to madness. In this paper, i support both claims by drawing on a mad phenomenon which I label Radical Psychotic Doubt, or RPD. First, although skepticism is a minority position in epistemology, it has been claimed that anti-skeptical arguments remain unsatisfying. I argue that this complaint can be clarified and strengthened by showing that anti-skeptical arguments are irrelevant to RPD sufferers. Second, there's a debate about whether (...) so-called hinge commitments are beliefs or not. I argue that RPD can be used to strengthen the case that they are. Moreover, if hinges are beliefs, some madpeople are more epistemically rational than some sane philosophers. Third, drawing on my own mad experiences, I challenge evidentialism by presenting a better candidate for a truly forced cchoice about what to believe than William James' traditional religious example. I further show that in certain psychiatric contexts, evidentialism has more radical implications than Jamesian pragmatism, which comes out as more conservative. Finally, I discuss how philosophical theories like pragmatism and Pyrrhonism can provide inspiration for new and much-needed coping strategies for RPD sufferers. (shrink)

Previous analyses of descriptively defined psychotic phenomena have concluded that they can occur in benign spiritual experiences as well as pathological states. Attempts to forge a distinction between psychotic experiences in spiritual and pathological contexts on the basis of the form or content of the experience (broadly described) can be disproved by counterexample; distinguishing on the basis of negative or positive consequences of the phenomena for the individual can be seen to beg the question. In the present paper, (...) it is argued that examining the fundamental conceptual organization of psychotic and mystical mental states not only elucidates the observed similarities between them, but can highlight the differences, and the processes by which negatively evaluated pathological features can be seen to emerge. Oriental philosophical systems such as Tibetan and Zen Buddhism, and Tantric Hinduism, provide conceptualizations of mystical states of mind, from which a model can be drawn, while the epistemologies of these systems provide an illuminating metaphysical perspective on both psychotic and mystical experiences. It is concluded that mystical and psychotic experiences can be distinguished not only by emotional and behavioral consequences, but by real differences in the states themselves; certain features, such as loss of subject/object boundaries and loss of the relative dimensional structure of perception, are common to both processes. (shrink)

I attempt to describe and defend an alternative definition of insanity. I claim that my definition follows from an adequate general understanding of legal excuse and that it describes correctly the question that jurors in the recent Andrea Yates case and others like it ought to be faced with. My essay has three parts. In the first, I briefly criticize M'Naghten- and Durham-inspired insanity statutes. In the second, I sketch and defend a general understanding of legal excuse and try to (...) show how an adequate insanity statute follows from it. Finally, in the third section, I describe and defend a rough version of the statute itself. In the course of doing so, I try to explain why I believe that statute is superior to the American Law Institute's various model insanity statutes. (shrink)

Understanding the psychodynamics of madness is essential to the therapy of most patients, including those who are not diagnosed as mad in the literal sense. This volume draws on Freud, Jung, recent object relation and self psychologies, and, particularly, the work of Winnicott, Bion and Elkin. It describes and critiques the basic ideas on the dynamics of psychoses and provides a framework for interpretation.

This study comes from a series of research carried out in some Italian Psychiatric Hospitals. Specifically, the investigation concerns emotional, cognitive and linguistic aspects of psychotic forms of expression. So, we will discuss psychotic expressive language by analysis of an exemplary case report: i.e. commenting on the iconographic and textual productions by a subject in several decades of psychopathological experiences. In this paper, we examine some psychotic expressive codes, and the emotional mode characterizing them. These psychotic (...) expressive codes are linguistic, communicative, referential and they are of importance for artistic creativity. But we especially try to highlight the role of emotional, liberating, cathartic and compensatory functions that the “language of madness” enables patients to express. More in general, we try to regard their specific relational mode, and their being or being-at-world. Keywords: Psychotic languages. Fantastic or imagination delusion. Artistic creativity. Emotive expressive forms. (shrink)

Immunological mechanisms and therapy approaches in psychotic syndromes were recently supported by the discovery of autoantibody-associated limbic and non-limbic encephalitis. However, how clinical diagnostic procedures in psychiatry should be adapted to these new insights is still unclear. In this study, we analyzed the cerebrospinal fluid (CSF) and neuroimmunological alterations and their association with cerebral MRI (cMRI) and electroencephalographic (EEG) findings. From 2006 until 2013, we acquired 180 CSF samples from psychotic patients. Between 2006 and 2009, CSF examinations were (...) only performed in cases in which organic brain disease was suspected. Since then, this procedure has been integrated into our routine diagnostic workup. CSF basic diagnostics were supplemented by measuring antineuronal antibodies against intracellular synaptic antigens, antibodies against intracellular onconeural antigens, antibodies against neuronal cell surface antigens and thyroid antibodies. In addition, cMRIs and EEGs were conducted. We found white cell counts elevated in 3.4% of the cases, albumin quotient elevated in 21.8%, and protein concentration elevated in 42.2%. Evidence of intrathecal immunoglobulin synthesis was found in 7.2% of the cases. Antibodies measured against neuronal cell surface antigens were positive in 3.2%. Reactivity on antibodies against intracellular onconeural antigens were detected in 3.5%. Serum thyroid antibodies were elevated in 24.7%. Abnormalities were found in 39.5% of cMRIs and in 34.3% of EEGs. The main finding of our study was the high prevalence of CSF and autoantibody abnormalities in 54.4% of psychotic patients. In combination with cMRIs and EEGs, 75.6% showed abnormal findings. Our results are discussed with regard to the concept of immunological encephalopathy. Future studies should analyze the efficacy of immunomodulatory therapies. (shrink)

This article tells the story of an anthropologist and a research subject who encountered each other in the middle of the 20th century on an island in the southwestern Pacific. In the midst of an intensive spate of evidence gathering for his dissertation, anthropologist Melford Spiro noted that one of his would-be interlocutors, a man named Tarev – notable for failing all of his psychological tests – still managed to contribute a different form of evidence: if his views could not (...) be amalgamated in numbers via test scores, they could still be rendered as a case. Tarev’s personality study, ‘A Psychotic in the South Seas’, counted as one of many cases contributing to a broad, worldwide effort to explore the meaning of suffering – specifically psychological illnesses – in non-Western cultures. This article examines Tarev’s rejected test-response ‘data’ and the ways in which his answers did not fit the epistemological and geopolitical frameworks that provoked them. The encounter between anthropologist and interlocutor, today, allows an investigation into how mid-20th-century scholars amassed ambitious data sets meant to revolutionize the sciences that dealt with human beings as psycho-social entities. What sorts of data made it into their archives and what sorts did not? How was the data of happiness, sadness and other fleeting emotional states collected from whole islands newly under US naval occupation? (shrink)

_The Borderline Psychotic Child_ reviews the history and evolution of the borderline diagnosis for children, both in the USA and the UK, bringing the reader up to date with current clinical opinion on the subject. Using a range of clinical case studies, the book attempts to harmonise US and UK views on borderline diagnosis in the light of new developments in theory at The Menninger Clinic, The Anna Freud Centre and The Tavistock Clinic. Providing an introduction to the borderline (...) concept, and a systematic overview of current theoretical thinking and clinical practices from leading practitioners in the field, _The Borderline Psychotic Child_ will make informative reading both for professionals and students in the field of child analysis. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“No One Is Psychotic in My Presence”S. Nassir Ghaemi (bio)Keywordsexistentialism, Semrad, delusions, psychosis, empathy, HavensWe are all prone to make wrong judgments about others (and ourselves) based on inaccurate (or insufficient) information. I recently had this experience with a relative, who cited a number of behaviors as reasons for him to make a rather harsh judgment about my internal mental states. Before hearing his rationale—and despite my belief (...) that he was wrong—I had to reserve some doubt that I might, unconsciously, have those disagreeable habits that my kind relative ascribed to me. But after I heard his explanation, the only possibility that seemed to fit was psychosis (in him, not me); because I was rather certain that he did not have a psychotic illness, I had to conclude that he had beliefs that served his own purposes in some way, although they were simply wrong.We all do this, all the time (perhaps this is the source of the wisdom behind a peasant woman’s admonition to Maxim Gorky: “Remember, above all, do not judge: that is the Devil’s work” [Gorky 1949]).But we do not all have delusions, at least in the sense that delusions are supposed to mark out psychiatric illnesses. Rhodes and Gipps (2008) make this point in their critique of cognitive theories of delusion: “One (‘rationalist’) line of research has explored to what extent people with psychotic delusions may have a malfunction in their reasoning processes (Garety and Hemsley 1994). Another (‘empiricist’) approach has it that delusions are a product of normal reasoning processes running on data provided by abnormal perceptual experiences (Maher 1988, 1999).” Both approaches identify abnormal kinds of reasoning in persons with psychosis, most of which are shared with the normal population (like my relative). But: “the question needs to be asked as to why, in many cases, clear counter-evidence has no effect in correcting the delusional belief. Confirmation bias after all itself only explains why people may not look for disconfirming evidence (Wason 1968), and does not explain why people may fail to believe it when they happen upon or are presented with it” (Rhodes and Gipps 2008, 306).This gets to the distinction between non-bizarre and bizarre delusions (a distinction that the authors do not make in their paper): Non-bizarre delusions seem completely explainable on cognitive grounds—they are not incredibly irrational (my relative’s perspective is logically plausible), yet they are just wrong (it is empirically false, I think). (Another example: I could plausibly believe that the FBI has me—a Shiite Muslim Middle Eastern male who hails from the Axis of Evil—under surveillance; it would simply be false, or not). On the other hand, the authors’ examples of delusions are both bizarre and wrong at first glance, not because they are illogical (in their conceptual associations), but simply because they just seem wrong without [End Page 315] much need to explain why (unlike my relative’s theories): “What, then, needs accounting for is why deluded persons do not themselves recognize the following: the unlikeliness of their belief, the insufficiency of the grounds they provide, the unlikeliness of their premises when they provide them (as well as their conclusions), the greater likelihood that the evidence they adduce was (for example) hallucinated rather than perceived, and so on” (Rhodes and Gipps 2008, 297).The authors turn first to Ludwig Wittgenstein, then John Searle—the former for the notion that we have “Bedrock certainties” that are founded on having served us in acting in the world (these beliefs do not require rational or empirical justification), the latter for the notion of a Background “defined as those abilities and dispositions which themselves are neither representations nor rules, yet that we need to hypothesize as functioning before we can make sense of everyday perception, thinking and language” (Searle 1995, 129). Go mow the lawn, we say, presuming that scissors will not be used:The capacity to discern what counts as the relevant context is itself a Background capacity that cannot, on pains of an infinite regress of an infinity of disambiguations, be understood as consisting in further propositional knowledge. The cultural ‘common sense... (shrink)

This essay examines Slavoj Žižek’s radical pedagogy by drawing on his concepts of parallax and his gloss on objet petit a.

This essay examines Slavoj Žižek’s radical pedagogy by drawing on his concepts of parallax and his gloss on objet petit a.

Bizarre delusions are not specific to schizophrenia and can be found in other psychotic disorders. However, to date, there are no studies investigating socio-demographic and clinical characteristics associated with BizD across the psychosis spectrum. In this study 819 subjects with a diagnosis of SZ, schizoaffective disorder and bipolar I disorder were included. Patients with history of BizD and with no BizD were compared with respect to socidemographic and clinical variables, and predictors of BizD were explored. Patients with BizD were (...) less educated, less likely to be married, had higher Positive and Negative Syndrome Scale negative scores and lower Young Mania Rating Scale scores. Younger age, SZ and SZA diagnoses, higher PANSS positive scores, presence of reference delusions, tactile and olfactory hallucinations were predictors. Our results indicate that BizD are associated with higher illness severity, lower functionality and specific set of symptoms. (shrink)

Current research suggests that stressful life experiences and situations create a substantive effect in the development of the initial manifestations of psychotic disorders and may influence temporo-limbic epileptic-like activity manifesting as cognitive and affective seizure-like symptoms in non-epileptic conditions. The current study assessed trauma history, hair cortisol levels, epileptic-like manifestations and other psychopathological symptoms in 56 drug naive adult young women experiencing their initial occurrence of psychosis. Hair cortisol levels among patients experiencing their initial episode of psychosis, were significantly (...) correlated with stress symptoms measured by Trauma Symptom Checklist-40, and complex partial seizure-like symptoms measured by the Complex Partial Seizure-Like Symptoms Inventory and LSCL-33. Hair cortisol levels were not found to be significantly correlated with symptoms of anxiety and depression measured by Beck depression Inventory and Zung Anxiety Scale. These findings suggest a significant relationship between epileptic-like symptoms and stress responses demonstrated by patients in their first psychotic episode. These findings may suggest the potential for research to explore usefulness of anticonvulsant treatment in patients who do not respond to usual psychotropic medication. (shrink)

Is there ever any reason for a doctor to lie to a patient? In this paper, we critically review the literature on lying to patients and challenge the common notion that while lying is unacceptable, a related entity--'benevolent deception' is defensible. Further, we outline a rare circumstance when treating psychotic patients where lying to the patient is justified. This circumstance is illustrated by a clinical vignette.

A number of studies have demonstrated pragmatic language difficulties in people with Schizophrenia Spectrum and Other Psychotic Disorders. However, research about how people with schizophrenia spectrum and other psychotic disorders understand scalar implicatures is surprisingly rare, since SIs have generated much of the most recent literature. Scalar implicatures are pragmatic inferences, based on linguistic expressions like some, must, or, which are part of a scale of informativeness. Logically, the less informative expressions imply the more informative ones, but pragmatically (...) people usually infer that the presence of a less informative term implies that the more informative term was not applicable. In one of the few existing studies with people with schizophrenia spectrum and other psychotic disorders, Wampers et al. observed that in general, people with schizophrenia spectrum and other psychotic disorders were less likely to derive SIs than controls. The current study has three main aims. First, we want to replicate the original finding with the scalar terms some-all. Second, we want to investigate how these patients deal with different scalar terms, that is, we want to investigate if scalar diversity is also observed in this clinical group. Third, we investigate the role of working memory, often seen as another important mechanism to enable inferring SIs. Twenty-one individuals with a psychotic disorder and 21 matched controls answered 54 under-informative statements, in which seven different pairs of scalar terms were used. In addition, working memory capacity was measured. Patients with schizophrenia spectrum and other psychotic disorders did not make more logical interpretations when processing quantifiers, disconfirming Wampers et al.. However, certain scalar scales elicited more pragmatic interpretations than others, which is in line with the scalar diversity hypothesis. Additionally, we observed only partial evidence for the role of working memory. Only for the scalar scale and-or, a significant effect of working memory was observed. The implications of these results for patients with schizophrenia spectrum and other psychotic disorders are discussed, but also the role of working memory for pragmatic inferences, as well as the place of SIs in experimental pragmatics. (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)

A short autobiographical piece on madness and philosophy that I wrote for the Schizophrenia Bulletin's First Person Account section.

Disorders of the self figure prominently in psychotic experiences. Subjects de­scribe that “alien” thoughts are inserted in their mind by foreign powers, can sometimes hear their thoughts aloud or describe complex voices interacting with each other. Such experiences can be conceptualized in the framework of a Philosophical Anthropology, which suggests that human experience is characterized by centric and excentric positionality: subjects experience their environment centered around their enlived body and at the same time can reflect upon their place in (...) a shared lifeworld from an excentric point of view. Pre-reflective self awareness has been suggested to ensure that subjects can identify their own thoughts or actions as belonging to themselves, even when they reflect upon them from an excentric point of view. This pre-reflective self awareness appears to be impaired during psychotic experiences, when subjects no longer identify thoughts in their own stream of consciousness as belonging to themselves and instead attribute them to an outside agent. Among several potential causes, it is suggested that such impairments can be due to discrimi­natory or traumatic experiences, which affect the enlived (centric) position of a person and make her feel encircled and deeply threatened by aversive powers. As a consequence, the afflicted individual may fundamentally distance herself from her current centric position in a hostile environment, at the price of experiencing her own thoughts or actions as alien. Philosophical Anthropology may thus help to explain how social exclusion, discrimination and traumatization can promote psychotic experiences and why social support is of primary importance for any treatment of psychosis. (shrink)

This article addresses the issue of properly assenting children with psychotic disorders to participate in clinical research. Due to the protective concerns with such a vulnerable population, additional precautions are necessary to ensure that youth with psychotic disorders assent to research with an appropriate level of understanding regarding study procedures. Current literature suggests that positive/negative symptoms and minor cognitive deficits do not interfere with the ability to comprehend study-related information for adults with psychosis if the study information is (...) presented through an educative process. Similarly, youth benefit from repeated presentation of procedures and periodic assessment of their comprehension. An integrated educative process is proposed that emphasizes the importance of an interactive consent through repetition and participant/investigator feedback. (shrink)

Psychotic-like experiences are a phenomenon that occurs in the general population experiencing delusional thoughts and hallucinations without being in a clinical condition. PLEs involve erroneous attributions of inner cognitive events to the external environment and the presence of intrusive thoughts influenced by dysfunctional beliefs; for these reasons, the role played by metacognition has been largely studied. This study investigates PLEs in a non-clinical population and discriminating factors involved in this kind of experience, among which metacognition, as well as psychopathological (...) features, seems to have a crucial role. The aim of this study was to extend the knowledge about the relationship between metacognition, psychopathology, and PLEs, orienting the focus on metacognitive functioning. The sample consisted of 207 Italian participants voluntarily recruited online, who gave consent to participate in the study. The average age of the sample was 32.69 years. Subjects affected by psychosis, neurological disease, and drug addiction were excluded from the analyses. The following scales were used to investigate PLEs: Peters et al. Delusions Inventory, Launay-Slade Hallucinations Scale-Extended Revised, Prodromal Questionnaire-Brief, and Revised Hallucination Scale. To assess general psychopathological features, the Behavior and Symptom Identification Scale was administrated. The Metacognition Self-Assessment Scale was chosen to evaluate metacognitive functioning. From hierarchical regression analyses, it emerged that the presence of anxiety, depression, and impulsive/addictive symptoms constitute a remarkable vulnerability factor for PLEs, in line with previous evidence regarding the relationship between general psychopathology and PLEs. Metacognition negatively predicts PLEs, and its presence does not affect the significance of psychopathological variables, suggesting that metacognitive abilities seem to play a protective role for the occurrence of PLEs among non-clinical individuals, and such ability operates as an independent predictor along with other variables. These results are explained by the role of metacognitive functions, which allow individuals to operate many mental processes such as interpreting sensorial events as real or illusory, understanding behaviors, thoughts, and drives of others, and questioning the subjective interpretation of facts. (shrink)

Six individuals with experience of psychosis were interviewed about their psychotic experiences. The material was analyzed using the empirical phenomenological psychological method. The results consist of a whole meaning structure, a gestalt, entailing the following characteristics: The feeling of estrangement in relationship to the world; the dissolution of time; the loss of intuitive social knowledge; the alienation of oneself, and finally; the loss of intentionality/loss of agency. In brief, the results show that an altered perception of the self and (...) the world was an essential part of the psychotic experience where subjects described themselves as changed; something was sensed as being wrong as psychosis is perceptible but hard to communicate. The normal life-world experience was altered and reality seemed strange. Time perception seemed to be changed as temporality appeared dissolved and the experience of time was focused on the current moment excluding the future. The subjects described loss of intentionality, they were no longer agents in their actions but partly steered by others and they could feel as if their experiences were not theirs. The patients also describe problems regarding their ability to socialize and communicate with others. They seem to lose their intuitive social capacity and were prone to suspiciousness. (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)

Skinner has made significant contributions to the science of the behavior of organisms, including human ones, especially through his emphasis on observable behavior. He has correctly placed psychology among the biological sciences. My disagreement with his position stems from his apparent belief that a knowledge of the pertinent neurophysiology is not necessary (though perhaps desirable) to an explanation of the behavior of an organism. I believe this is a significant conceptual shortcoming, and that correcting it will bring psychology into a (...) more consistent position with the biological sciences in general. CiteULike Connotea Del.icio.us What's this? (shrink)

A groundbreaking, deeply personal, magnum opus on madness and philosophy from a psychotic patient turned philosopher.