Mental Illness

Representing oneself as an existing entity and having intense fear of the unknown are human specificities. Self-consciousness and anxiety states are characteristics of our human minds. We propose that these two characteristics share a common evolutionary history during which they acted in synergy for the build-up of our human minds. We present that perspective by using an evolutionary scenario for self-consciousness in which anxiety management plays a key role. Such evolutionary background can introduce new relations between philosophy of mind and (...) psychology. The proposed evolutionary scenario starts at the Pan-Homo split time (about 6my ago) when our pre-human ancestors were able to manage representations while also being able to partly identify with their conspecifics. These identifications allowed our ancestors to merge the representations they had of parts of themselves with the corresponding representations they had of their conspecifics. The scenario proposes that such merger has led our ancestors to progressively build up a representation of their own entity as existing in the environment, like conspecifics were represented as existing. This evolutionary process is considered in the scenario as the source of an ancestral form of self-consciousness. The same process has also produced identifications with suffering or endangered conspecifics which have created in the minds of our ancestors some new anxieties coming in addition to the animal ones. The resulting psychological sufferings had to be limited for evolution to continue. The tools developed to that end by our ancestors (caring, collaboration, communication, ToM, ...) have also procured significant evolutionary benefits with positive feedbacks on identifications. Overall, the evolutionary scenario proposes that the combination of the anxiety management processes with the evolution toward self-consciousness has created an evolutionary engine that has accelerated the coming up of our human self-consciousness. As a result, our today human minds contain important anxieties interwoven with an evolutionary nature of self-consciousness. Such perspective brings to consider that many of our mental states may be unconsciously guided by these evolutionary sourced anxieties (which are still to be clearly understood). Corresponding anxiety management processes are then key contributors to our human feelings and motivations, and to our interpersonal relationship. For instance, the role of Pascalian type diversions can be understood as keeping consciousness away from psychological sufferings produced by too anxious mental states. Also, part of our human sexuality developed during human evolution can be considered as a multidimensional escape and refuge from anxiety. This also brings to look at our psychological well-being and to our mental health as much more related to anxiety management than assumed so far. Dis-functioning of anxiety management processes can then be source of mental disorders and illnesses. On that subject the evolutionary scenario proposes that avoidances of too anxious mental states can lead to evil behaviors. These subjects need more developments. Possible continuations are introduced. (shrink)

Anxiety is a main contributor to human psychological sufferings. Its evolutionary sources are generally related to alert signals for coping with adverse or unexpected situations [Steiner, 2002] or to hunter-gatherer emotions mismatched with today environments [Horwitz & Wakefield, 2012]. We propose here another evolutionary perspective that links human anxiety to an evolutionary nature of self-consciousness. That approach introduces new relations between mental health and human mind. The proposed evolutionary scenario starts with the performance of primate identification with conspecifics [de Waal (...) 1998, 2008]. It is assumed that the evolution of that identification brought our ancestors to represent themselves as entities existing in the environment, like conspecifics were represented as existing in the environment. We consider that this process has implemented in the mind of our ancestors some first elements of self-consciousness [Menant 2014a]. But the same process has also produced new sufferings coming from identification with suffering or endangered conspecifics. In addition, the emerging performance of self-focus brought in the new feeling of being a suffering entity. We consider that all these new sufferings have created in the mind of our primate ancestors a huge anxiety increase, unbearable if not limited. Among the options available to limit that anxiety increase we focus on two of them that may have taken place. The first was a withdrawal from the process. Some primates may have simply rejected the evolution of identification (and with it self-consciousness). This may have led them to an ecological niche resulting in our today great apes. The second option was about limiting the causes of sufferings and taking advantage of possible resulting evolutionary benefits. This may have been achieved by developing performances like imitation, communication, simulation, synergy and ToM. Added to a positive feedback on identification these performances may have initiated an evolutionary engine that has accelerated the evolution toward human self-consciousness. That option is characterized by an early build up of anxiety limitation processes in an evolutionary nature of our human self-consciousness. This option corresponds to a human specificity and introduces anxiety management and self-consciousness as sharing a same evolutionary story. The build up of these anxiety management processes is now buried in the evolutiony story of our human mind. But these processes are still present in our minds at an unconscious level and participate to many of our human mental states and behaviors. Such positioning of anxiety management as part of the nature of human mind is new and makes available entry points for new understandings of human emotion, motivations and mental disorders. The proposed evolutionary scenario has been introduced in philosophy of mind [Menant 2011, 2014a, b] but it has not been so far explicitly part of primatology nor of psychology/psychiatry/ethics. We present here a drawing of the scenario with highlights on corresponding key points. More work is needed on these new evolutionary links between human mind and anxiety management. References: de Waal, F B.M. (1998). No imitation without identification. Behavioral and Brain Sciences (1998) 21:89. http://cogweb.ucla.edu/Abstracts/deWaal_98.html de Waal, F B.M. (2008). Putting the Altruism Back into Altruism: The Evolution of Empathy. Annu. Rev. Psychol. 2008, 59. http://www.life.umd.edu/faculty/wilkinson/BIOL608W/deWaalAnnRevPsych2008.pdf Horwitz, A. V. and Wakefield, J. C. (2012). All We Have to Fear: Psychiatry’s Transformation of Natural Anxieties into Mental Disorders. Oxford Univ. Press. 2012. Menant, C. (2011). Computation on Information, Meaning and Representations. An Evolutionary Approach. https://philpapers.org/rec/MENCOI Menant, C. (2014a). Proposal for an evolutionary approach to self-consciousness. https://philpapers.org/rec/MENPFA-3 Menant, C. (2014b). Consciousness of oneself as object and as subject. Proposal for an evolutionary approach. https://philpapers.org/rec/MENCOO Steiner, T. (2002). The biology of fear- and anxiety-related behaviors. Dialogues Clin Neurosci. 2002 Sep; 4(3): 231–249. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181681/. (shrink)

There are numerous studies suggesting a substantial link between psychotic hallucinatory states and some forms of disordered imaginings. We have to figure out (1) what characteristic makes imagining, not other mental states, prone to induce hallucination, and (2) what underlies the (phenomenological/conceptual) transition from imagining X to the hallucinatory experience of X? In this paper, I will try to provide answers to these questions, in order to shed light on the nature of the so-called “misidentified” or “disordered” imaginative experience. To (...) achieve this, I emphasize the phenomenological aspects of hallucination and imagination. (shrink)

Hegel reads the poet Novalis as an expression of terminal irony, a pathological case of Gemüt, where the conscious mind is alienated from reality and turns its negativity inwards on the contents of its own natural soul. The condition of self-feeling, presented in Hegel’s “Anthropology”, is a self-consumption that manifests itself somatically in the physical disease (consumption) from which Novalis dies. The poet’s literary production represents a pathological fixation that impedes the dynamic organicity of Hegelian Science. As such, Novalis’s mental (...) illness and death constitute an expression of romantic irony and an ongoing threat to Hegel’s philosophy. (shrink)

The different approaches of the mind-body problem a fortiori have implications on the foundations of Psychology, Psychopathology and Psychiatry, leading to many clashing theories about the determinants of "normal" human behavior, as well of the mental illnesses. These schools of research on the human mind may on a first approach be divided in two main branches: 1) the neurogenetic ones; 2) the psychogenetic ones. This paper sprang up from a lifelong pondering on its subject by its author, while working as (...) a Clinical Psychiatrist and conducting a Ph D in Philosophy. (shrink)

Police killings of individuals with mental illness have prompted calls for greater funding of mental health services to shift responsibilities away from the police. Such investments can reduce police interactions with vulnerable populations but are unlikely to eliminate them entirely, particularly in cases where individuals with mental illness have a weapon or are otherwise dangerous. It remains a pressing question, then, how police should respond to these and other vulnerable aggressors with diminished culpability (VADCs). This article considers and ultimately rejects (...) three potential approaches from the ethics of defensive force literature. It looks to improve on them by developing what I call the fusion account, which explains how vulnerability and diminished culpability fit together to provide moral grounds for extra protections from deadly force. The article’s final sections explore the policy implications of the fusion account for police administrators, officers, and the law. (shrink)

Philosophy has always been concerned with mental health and mental disorder, and many prominent historical figures have held views that have drawn attention to these issues. In recent years, however, there has been a surge of interest in philosophical issues surrounding psychiatry. As a result, the philosophy of psychiatry has emerged as a distinct, well-established field of inquiry.

According to the traditional Western concept of freedom, the ability to exercise free will depends on the availability of options and the possibility to consciously decide which one to choose. Since neuroscientific research increasingly shows the limits of what we in fact consciously control, it seems that our belief in free will and hence in personal autonomy is in trouble. -/- A closer look at the phenomenology of Obsessive-Compulsive Disorder (OCD) gives us reason to doubt the traditional concept of freedom (...) in terms of conscious control. Patients suffering from OCD experience themselves as unfree. The question is whether their lack of freedom is due to a lack of will power. Do they have too little conscious control over their thoughts and actions? Or could it be the opposite: are they exerting too much conscious control over their thoughts and actions? -/- In this chapter, we will argue that OCD patients testify to the general condition that exercising an increased conscious control over actions can in fact diminish the sense of agency rather than increase the experience of freedom. The experiences of these patients show that the traditional conception of freedom in terms of ‘free will’ has major shortcomings. There is an alternative, however, to be found in the work of Hannah Arendt. She advocates a conception of freedom as freedom in action. Combined with phenomenological insights on action, Arendt’s account of freedom helps us to get a more adequate understanding of the role of deliberation in the experience of freedom. We argue that the experience of freedom depends on the right balance between deliberate control and unreflective actions. (shrink)

In this chapter, we explain how Karl Jaspers’ concept of empathy can be expanded by drawing upon the tradition of philosophical phenomenology. In the first section, we offer an account of Jaspers' concepts of empathy and incomprehensibility as he develops them in General Psychopathology and “The Phenomenological Approach in Psychopathology.” In the second section, we survey the recent literature on overcoming Jaspers' notion of incomprehensibility and expanding his concept of empathy. In the third section, we outline the levels of investigation (...) at which phenomenological inquiries into psychopathology may proceed. These levels of human existence are, in descending order of depth, (1) phenomenal experiences, (2) interpretive frameworks, (3) modes of existence, and (4) existentials. In the fourth and final section, we argue that to fully empathically comprehend patients with schizophrenia and other mental disorders, the possibility of alterations at all four levels of existence must be acknowledged. (shrink)

Thomas Szasz famously argued that mental illness is a myth. Less famously, Szasz argued that since mental illness is a myth, so too is psychotherapy. Szasz’ claim that mental illness is a myth has been much discussed, but much less attention has been paid to his claim that psychotherapy is a myth. In the first part of this essay, I critically examine Szasz’ discussion of psychotherapy in order to uncover the strongest version of his case for thinking that it is (...) a myth. As we’ll see, this involves an understanding of psychotherapeutic interventions as treatments of psychopathological problems. In the rest of this essay, I turn to this directly and argue that psychotherapy has an important non-pathocentric dimension. I argue that we fail to appreciate the nature and variety of psychotherapy if we concentrate only on its pathocentric dimensions. Though I use Szasz as a stalking horse, the substantive topic is the nature of psychotherapy. This enquiry falls into the philosophy of psychotherapy as distinct from the philosophy of psychiatry and the philosophy of psychoanalysis. (shrink)

Anorexia nervosa involves seemingly irrational beliefs about body size and the value of thinness. Historically, researchers and clinicians have avoided referring to such beliefs as delusions, instead opting for the label ‘overvalued ideas’. I discuss the relationship between the beliefs associated with anorexia nervosa and the distinction between delusions and overvalued ideas, as it is conceived in both European and American psychiatric traditions. In doing so, I question the benefit of applying the concepts of delusion and overvalued idea to anorexia (...) nervosa and raise some issues with contemporary use of the Brown Assessment of Beliefs scale for assessing the level of delusionality associated with the disorder. (shrink)

The dominant approach to assessing decision-making capacity in medicine focuses on determining the extent to which individuals possess certain core cognitive abilities. Critics have argued that this model delivers the wrong verdict in certain cases where patient values that are the product of mental disorder or disordered affective states undermine decision-making without undermining cognition. I argue for a re-conceptualization of what it is to possess the capacity to make medical treatment decisions. It is, I argue, the ability to track one’s (...) own personal interests at least as well as most people can. Using this idea, I demonstrate that it is possible to craft a solution for the problem cases—one that neither alters existing criteria in dangerous ways (e.g. does not open the door to various kinds of abuse) nor violates widely accepted ethical constraints on decision-making assessment. (shrink)

Brief description of Freud's life and work, emphasising the role of fictive belief and experience (phantasy) in his account of mental disorder.

Philosophers have long been fascinated by the stream of consciousness––thoughts, images, and bits of inner speech that dance across the inner stage. Yet for centuries, such “mind-wandering” was deemed private and thus resistant to empirical investigation. Recent developments in psychology and neuroscience have reinvigorated scientific interest in the stream of thought, leading some researchers to dub this “the era of the wandering mind”. Despite this flurry of progress, scientists have stressed that mind-wandering research requires firmer philosophical foundations. The time is (...) therefore ripe for the philosophy of mind-wandering. Our review begins with a foundational question: what is mind-wandering? We then investigate the significance of mind-wandering for general philosophical topics, namely mental action, introspection, and the norms of thinking and attention. (shrink)

Affordances are action-possibilities, ways of relating to and acting on things in our world. They help us understand how these things mean what they do and how we have bodily access to our world more generally. But what happens when this access is ruptured or impeded? I consider this question in the context of psychopathology and reports that describe this experience. I argue that thinking about the bodily consequences of losing access to everyday affordances can help us better understand these (...) reports. An affordance-based approach to psychopathology can illuminate some of the causes, as well as the experiential character and consequences, of affective disorders and diminished spatial agency in self-world disturbances. It also highlights some under-explored ethical and political dimensions of these issues that need further attention. (shrink)

The cognitive science of belief is a burgeoning field, with insights ranging from detailing the fundamental structure of the mind, to explaining the spread of fake news. Here we highlight how new insights into belief acquisition, storage, and change can transform our understanding of psychiatric disorders. Although we focus on monothematic delusions, the conclusions apply more broadly. -/- .

Under the current Mental Health Act of England and Wales, it is lawful to perform deep brain stimulation in the absence of consent and independent approval. We argue against the Care Quality Commission's preferred strategy of addressing this problematic issue, and offer recommendations for deep brain stimulation-specific provisions in a revised Mental Health Act.

A recent paper in this journal argues that some cases of schizophrenia should be seen as cases of demon possession and treated by faith healers. A reply, also published in this journal, responds by raising concerns about the intellectual credibility and potentially harmful practical implications of demon possession beliefs. My paper contributes to the discussion, arguing that a critique of demon possession beliefs in the context of schizophrenia is needed, but suggesting an alternative basis for it. It also reflects on (...) important differences between demonic and other forms of spirit possession, and considers the implications of this for mental health care providers. (shrink)

Some recent considerations of religion and psychiatry have drawn a distinction between pathological and spiritual/mystical experiences of mental phenomena typically regarded as within the realm of psychiatry (e.g. depression, hearing voices, seeing visions/hallucinations). Such a distinction has clinical implications, particularly in relation to whether some religious people who suffer from depression, hear voices, or see visions should be biomedically treated. Approaching this question from a theological and philosophical perspective, I draw a distinction between (what I call) ‘spiritual health’ (SH) and (...) ‘potentially transformative’ (PT) theologies, arguing that a PT model is therapeutically and philosophically more sound than a SH one. I then apply this to the clinical debate in critical dialogue with Dein and Durà-Vilà’s 2009 article, ‘The Dark Night of the Soul: spiritual distress and psychiatric implications’. My primary focus is on depression, though the discussion is also relevant to debates about psychosis and schizophrenia. (shrink)

The purpose of this chapter is to describe what we see as several important new directions for philosophy of medicine. This recent work (i) takes existing discussions in important and promising new directions, (ii) identifies areas that have not received sufficient and deserved attention to date, and/or (iii) brings together philosophy of medicine with other areas of philosophy (including bioethics, philosophy of psychiatry, and social epistemology). To this end, the next part focuses on what we call the “epistemological turn” in (...) recent work in the philosophy of medicine; the third part addresses new developments in medical research that raise interesting questions for philosophy of medicine; the fourth part is a discussion of philosophical issues within the practice of diagnosis; the fifth part focuses on the recent developments in psychiatric classification and scientific and ethical issues therein, and the final part focuses on the objectivity of medical research. (shrink)

Crime is a serious social problem, but its causes are not exclusively social. There is growing consensus that explaining and preventing it requires interdisciplinary research efforts. Indeed, the landscape of contemporary criminology includes a variety of theoretical models that incorporate psychological, biological and sociological factors. These multi-disciplinary approaches, however, have yet to radically advance scientific understandings of crime and shed light on how to manage it. In this paper, using conceptual tools on offer in the philosophy of science in combination (...) with theoretical work represented in this special volume of Psychology, Crime and Law, I provide some perspective on why explanatory progress in criminology has remained elusive and evaluate some positive proposals for attaining it. -/- . (shrink)

Debates about the genuine disease status of controversial diseases rely on intuitions about a range of factors. Adopting tools from experimental philosophy, this paper explores some of the factors that influence judgments about whether low sexual desire should be considered a disease and whether it should be medically treated. Drawing in part on some assumptions underpinning a divide in the literature between viewing low sexual desire as a genuine disease and seeing it as improperly medicalized, we investigate whether health and (...) disease judgments are affected by factors such as an individual’s gender, the cause of the low desire, whether the desire is high or low, and both personal and societal valuations of the condition. Our main findings indicate that (a) the cause of a condition influences whether it is judged a disorder, (b) how the individual values the condition influences whether the condition is seen as a proper target of medical intervention, and (c) perceived dysfunction influences judgments regarding health, disorder classification, medicalization, and medical intervention. Our findings help further illuminate the intricate interplay of factors that influence judgments about health and disease in controversial conditions. (shrink)

This paper argues that the crucial feature of the drug-related desires experienced by addicted agents is not that they ‘push’ the agent with a force she cannot oppose, but that they are not easily undermined by things that normally have the ability to undermine desires —in other words, that they are extraordinarily recalcitrant. As a result, the disposition to experience these desires is very persistent over the long-term, manifesting itself in particular episodes of wanting to use drugs that recur with (...) great frequency. Both the persistence and the recurrence of these desires, it is argued, contribute to a diminished ability to respond to relevant reasons that speak against drug use. (shrink)

It is widely agreed that obsessive-compulsive disorder involves irrationality. But where in the complex of states and processes that constitutes OCD should this irrationality be located? A pervasive assumption in both the psychiatric and philosophical literature is that the seat of irrationality is located in the obsessive thoughts characteristic of OCD. Building on a puzzle about insight into OCD (Taylor 2022), we challenge this pervasive assumption, and argue instead that the irrationality of OCD is located in the emotions that are (...) characteristic of OCD, such as anxiety or fear. In particular, we propose to understand the irrationality of OCD as a matter of harboring recalcitrant emotions. We argue that this account not only solves the puzzle about insight, but also makes better sense of how OCD sufferers experience and describe their condition and helps explain some otherwise puzzling features of compulsive behavior. (shrink)

In this chapter, I introduce phenomenology and phenomenological psychopathology by clarifying the kind of implicit experiences that phenomenologists are concerned with. In section one, I introduce the phenomenological concept of pre-reflective experience, focusing especially on its relation to the concept of implicit experience. In section two, I introduce the structure of pre-reflective self-consciousness, which has been studied extensively by both classical phenomenologists and contemporary phenomenological psychopathologists. In section three, I show how phenomenological psychopathologists rely on an account of pre-reflective self-consciousness (...) to better understand the experience of schizophrenia and I outline some of the methodological challenges that arise in this field of research. This introduction should facilitate critical engagement and collaboration between phenomenologists and researchers working across a variety of disciplines, including psychology, psychiatry, the cognitive sciences, and analytic philosophy of mind. (shrink)

This contribution focuses on what type of question “Are mental disorders brain disorders?” is and what task Anneli Jefferson performs in her book with the same title. I distinguish between conceptual engineering and conceptual choice, the former involving the individuation of an adequate concept for a specific goal, and the latter involving the normative problem of whether we should employ the concept at hand. I contend that Anneli Jefferson’s book is a work of conceptual engineering, which is valuable in and (...) of itself, but that this is insufficient to answer an equally essential version of the question, “Are mental disorders brain disorders?”, namely, whether we should adopt the newly engineered concept or not, considering a broader range of goals for mental health research and practice. (shrink)

Are psychiatric disorders natural kinds? This question has received a lot of attention within present-day philosophy of psychiatry, where many authors debate the ontology and nature of mental disorders. Similarly, historians of psychiatry, dating back to Foucault, have debated whether psychiatric researchers conceived of mental disorders as natural kinds or not. However, historians of psychiatry have paid little to no attention to the influence of (a) theories within logic, and (b) theories within metaphysics on psychiatric accounts of proper method, and (...) on accounts of the nature and classification of mental disorders. Historically, however, logic and metaphysics have extensively shaped methods and interpretations of classifications in the natural sciences. This paper corrects this lacuna in the history of psychiatry, and demonstrates that theories within logic and metaphysics, articulated by Christian Wolff (1679-1754), have significantly shaped the conception of medical method and (psychiatric) nosology of the influential nosologist Boissier De Sauvages (1706-1767). After treating Sauvages, I discuss the method of the influential nosologist William Cullen (1710-1790), and demonstrate the continuity between the classificatory methods of Sauvages and Cullen. I show that both Sauvages and Cullen were essentialists concerning medical diseases in general and psychiatric disorders in particular, contributing to the history of conceptions of the ontology and nature of mental disorders. (shrink)

The DSM‐5 highlights two essential psychological features of anorexia nervosa (AN): recalcitrant fear of gaining weight and body image disturbance. Prominent accounts grant false beliefs about body weight and shape a central role in the explanation of AN behavior. In this article, we propose a stronger emphasis on recalcitrant fear. We show that such fear can explain AN behavior without the intermediary of a false belief, and thus without the associated explanatory burdens and conceptual difficulties. We illustrate how shifting the (...) emphasis from false belief to recalcitrant fear can supplement a number of different non‐doxastic models of AN. (shrink)

Despite the huge and constant progress in the molecular and cellular neuroscience fields, our capability to understand brain alterations and treat mental illness is still limited. Therefore, a paradigm shift able to overcome such limitation is warranted. Behavior and the associated mental states are the interface between the central nervous system and the living environment. Since, in any system, the interface is a key regulator of system organization, behavior is proposed here as a unique and privileged level of control and (...) orchestration of brain structure and activity. This view has relevant scientific and clinical implications. First, the study of behavior represents a singular starting point for the investigation of neural activity in an integrated and comprehensive fashion. Second, behavioral changes, accomplished through psychotherapy or environmental interventions, are expected to have the highest impact to specifically reorganize the complexity of the human mind and thus achieve a solid and long-lasting improvement in mental health. (shrink)

Aphantasia is a condition characterised by a deficit of mental imagery. Since several psychopathologies are partially maintained by mental imagery, it may be illuminating to consider the condition against the background of psychological disorder. After outlining current findings and hypotheses regarding aphantasia and psychopathology, this paper suggests that some support for defining aphantasia as a lack of voluntary imagery may be found here. The paper then outlines potentially fruitful directions for future research into aphantasia in general and its relation to (...) psychopathology in particular, including rethinking use of the SUIS to measure involuntary imagery, whether aphantasia offers protection against addiction, and whether hyperphantasia is a potential risk factor for maladaptive daydreaming, among others. (shrink)

In this article, I explore Seth Farber’s critique in _The Spiritual Gift of Madness_ that the leaders of the Mad Pride movement are failing to realize his vision of the mad as spiritual vanguard of sociopolitical transformation. First, I show how, contra Farber’s polemic, several postmodern theorists are well suited for this leadership (especially the Argentinian post-Marxist philosopher Ernesto Laclau). Second, I reinterpret the first book by the Icarus Project, _Navigating the Space between Brilliance and Madness_, by reimagining its central (...) metaphor of Icarus in the context of late capitalism as a prison world. Finally, I conclude with four strategies derived therefrom for higher functioning mad leaders to transform our penitentiary world. (shrink)

Does a diagnosis of brain dysfunction matter for ascriptions of moral responsibility? This chapter argues that, while knowledge of brain pathology can inform judgments of moral responsibility, its evidential value is currently limited for a number of practical and theoretical reasons. These include the problem of establishing causation from correlational data, drawing inferences about individuals from group data, and the reliance of the interpretation of brain findings on well-established psychological findings. Brain disorders sometimes matter for moral responsibility, however, because they (...) change an individual’s moral psychology in a way that is beyond their control. While control over psychological changes is not an excusing factor, brain disorders can mitigate moral responsibility because they confront individuals with new psychological deficits or urges for which their previous moral education and existing external and internal moral resources have not prepared them. (shrink)

Our philosophical understanding of mental illness is being shaped by neuroscience. However, it has the paradoxical effect of igniting two radically opposed groups of philosophical views. On one side, skepticism and denialism assume that, lacking clear biological mechanisms and etiologies for most mental illnesses, we should infer they are constructions best explained by means of social factors. This is strongly associated with medical nihilism: it considers psychiatry more harmful than benign. On the other side of the divide, naturalism and reductionism (...) are on the look for failures in the biological functioning of the organism whenever a genuine mental illness occurs. Psychiatry as currently practiced, accordingly, exhibits the gaps of an ongoing research programme; a yet to be completed neuroscience would link mental illnesses with identifiable biological mechanisms. Both sides of this divide claim to be fostered by scientific discoveries and advances in neuroscience, when taken at face value. Against this background, we argue instead for a modest view. To that end, we draw attention to some nuances in the scientific realism debate. While contending that neuroscientific theories and models aim to provide true representations of their target systems, and can justifiably claim to have attained some, we argue that our confidence should not be placed beforehand in specific features of these scientific representations. Hence, it would be unwarranted to extract morals for psychiatry from posits (or their absence) in neuroscientific explanations of mental illnesses. To illustrate our position, we examine some recent discoveries in neuroscience concerning bipolar disorder. We conclude by linking our topic to a broader issue in the philosophy of medicine: insofar as psychiatry is a biomedical specialty, its classifications of health and disease are guided by pragmatic concerns, as well as by scientific discoveries. (shrink)

The notion of harm is frequently used in the discussion of the nature of mental disorder. Harm also plays important roles in the prominent diagnostic manuals such as DSM and ICD. Recently, however, Cristina Amoretti and Elisabetta Lalumera have questioned the idea that harm should be a necessary constituent of mental disorders. They argue that the notion of harm is underspecified and potentially leads to false negatives in diagnosing mental disorders. Given that harm plays significant roles in medical diagnosis and (...) treatment indicates that we should be reluctant to remove it as a criterion for deciding whether some condition is a mental disorder. Instead, we argue that harm should be understood in the prudential sense and harm in this sense provides a way of responding to worries raised by Amoretti and Lalumera, while staying true to the conception of harm that is relevant for psychiatric practice. (shrink)

Our main objective is to locate and analyze some philosophical issues about the concept of mental illness and the manner it is used, especially in contemporary psychiatry. It is even difficult to find a standard meaning in the main psychiatric textbooks; and, when there is some exposition of the concept, it is sparse, uncritical and vague. As an immediate consequence of these issues, practical guidelines and protocols for the clinic arise, which become almost “automatic”, unreflective behaviors, practices translated as health (...) interventions and public mental health policies. An example is the problem of overdiagnosis, in which the use of medical technology (categories, drugs, clinical exams, etc.) has generated more harm and risks to the subject's health than benefits. Exposing these issues from a philosophical perspective can eventually contribute to the field of mental health. For this work, the main manuals and textbooks of psychiatry were selected to analyze how they deal with the concept of mental illness or disorder, in addition to locating the present discussion in authors from both philosophy and the psychiatric field and how they contribute to its clarification. (shrink)

This chapter begins by sketching an account of morally responsible agency and the general conditions under which it may fail. We discuss how far individuals with psychiatric diagnoses may be exempt from morally responsible agency in the way that infants are, with examples drawn from a sample of diagnoses intended to make dierent issues salient. We further discuss a recent proposal that clinicians may hold patients responsible without blaming them for their acts. We also consider cognitively impaired subjects in the (...) light of related issues in moral and political theory, asking whether they have been unjustly excluded from liberal conceptions of political community due to their presumed lack of agency. (shrink)

Social ontology focuses on questions about the reality of human categories. The typical examples are gender and race. Common questions about them are: Do they exist? What is their nature? Do they exist in the best possible way? Meanwhile, the philosophy of psychiatry has been discussing the reality of psychopathology, what is the best way to classify mental disorders, and whether it is possible to define them without normative vocabulary. I think there is something not only strange but inadequate about (...) these discussions being held apart. Particularly, I hold that by being held separately these discussions are philosophically incomplete. In this paper, I argue that these debates are parallel in crucial aspects, but more importantly that they can benefit from each other if they start a dialogue. I suggest some paths we can take to start fruitful discussions and offer examples of the kind of outcomes we can expect. However, my main contribution is to sketch a common framework to map current discussions, make comparisons between them, and, more importantly, guide new research. (shrink)

Delusional mood is a well-recognized psychological state, often present in the prodromal stage of schizophrenia. Various phenomenological psychopathologists have proposed that delusional mood may not only precede but also contribute to the later formation of schizophrenic delusion. Hence, understanding experiential abnormalities involved with the delusional mood have been considered central for the understanding of schizophrenic delusion. Ranging from traditional and contemporary phenomenological and neurobiological accounts, it has been often mentioned that the peculiar affective saliency of the world experience may underpin (...) the emergence of delusional mood. In this paper, I employ Edmund Husserl’s account of affection and affective syntheses to clarify the nature of such an experience and illuminate how this experiential abnormality contributes to the emergence of the delusional mood. I conclude by relating the phenomenological account I advance here with a neurobiological account of aberrant salience hypothesis and chart out a possible way toward mutual enlightenment for both approaches. (shrink)

The fifth text-revised iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) defines paraphilia as “any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners”. Paraphilic disorders specifically denote a paraphilia that is “currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others”. A diagnosis of paraphilic disorder either demands the personal (...) distress and/or impairment of function that is caused by the atypical sexual urges and fantasies to be present, or the status of non-consent of the other person that these sexual fantasies and urges are directed towards when acted upon by the patient. This paper discusses how consent not only becomes the standard for permissible and legal sexual activity with other persons, but also, when the diagnostic criteria are taken at face-value, for sexual pathology in the DSM-5-TR when the patient acts on their sexual urges. After a close investigation of various possible interpretations of the element of non-consensuality in the diagnostic criteria for paraphilic disorders, this paper concludes that the DSM-5-TR does not offer a clarifying explanation on how mental health professionals should under-stand its approach to diagnosing paraphilic disorders, leaving us with an ambiguous, unclear and unsettled conceptualisation of what it would mean to fulfil its diagnostic criteria. (shrink)

In this paper we propose that our understanding of pathocentric epistemic injustices can be enriched if they are theorised in terms of predicaments. These are the wider socially scaffolded structures of epistemic challenges, dangers, needs, and threats experienced by ill persons due to their particular emplacement within material, social, and epistemic structures. In previous work we have described certain aspects of these predicaments - pathocentric epistemic injustices, pathophobia, and so on. We argue that thinking predicamentally helps us integrate the various (...) social, epistemic, and practical obstacles experienced by ill persons and also unify the many concepts available for theorising them (microaggessions, epistemic injustices, and so on). (shrink)

This contribution retraces the most significant moments of a debate that has seen researchers from different disciplinary areas reflect on schizophrenia, in particular on the symptom of thought insertion, with the conceptual tools of Kant’s theoretical philosophy. In the course of this report, some problematic aspects of the interpretations of the "Critique of Pure Reason" promoted in the aforementioned debate are highlighted. The last part of the contribution presents some considerations on the relationship between critical philosophy and madness.

Many intelligent, capable, and successful individuals believe that their success is due to luck and fear that they will someday be exposed as imposters. A puzzling feature of this phenomenon, commonly referred to as imposter syndrome, is that these same individuals treat evidence in ways that maintain their false beliefs and debilitating fears: they ignore and misattribute evidence of their own abilities, while readily accepting evidence in favour of their inadequacy. I propose a novel account of imposter syndrome as an (...) instance of self-deception, whereby biased evidence treatment is driven by the motivational benefit of negative self-appraisal. This account illuminates a number of interconnected philosophical and scientific puzzles related to the explanation, definition, and value of imposter syndrome. (shrink)

As moral injury is a still-emerging concept within the area of military mental health, prevalence estimates for moral injury and its precursor, potentially morally injurious events (PMIEs), remain unknown for many of the world’s militaries. The present study sought to estimate the prevalence of PMIEs in the Canadian Armed Forces (CAF), using data collected from CAF personnel deployed to Afghanistan, via logistic regressions controlling for relevant sociodemographic, military, and deployment characteristics. Analyses revealed that over 65% of CAF members reported exposure (...) to at least one event that would be considered a PMIE. The most commonly PMIEs individuals reported included seeing ill or injured women and children they were unable to help (48.4%), being unable to distinguish between combatants and non-combatants (43.6%), and finding themselves in a threatening situation where they were unable to respond due to the rules of engagement under which they were required to operate (35.4%). These findings provide support for both the presence of exposure to PMIEs in CAF members and the need for formal longitudinal data collection regarding PMIE exposure and moral injury development. (shrink)

Background: Rumination, a tendency to focus on negative self-related thoughts, is a central symptom of depression. Studying the self-related aspect of such symptoms is challenging because of the need to distinguish self effects from the emotional content of task stimuli. This study employed an emotionally neutral self-related paradigm to investigate possible altered self-processing in depression and its link to rumination. Methods: People with major depressive disorder (n = 25) and controls (n = 25) underwent task-based electro-encephalogram recording. We studied late (...) event-related potentials, along with low-frequency oscillatory power. We compared electroencephalogram metrics between groups and correlated them with depressive symptoms and reported rumination. Results: Participants with major depressive disorder displayed a difference in late positive potentials across frontocentral electrodes between self-related and non-self-related conditions. We found no such difference in controls. The magnitude of this difference was positively correlated with depressive symptoms and reported rumination. Participants with major depressive disorder also had elevated theta oscillation power at central electrodes in self-related conditions, a finding that we did not see in controls. Limitations: Patients with major depressive disorder were medicated at the time of the study. The group studied was primarily female, so the observed effects may have been sex-specific. Conclusion: Rumination appears to be linked to altered self-related processing in depression, independent of stimuli-related emotional confounds. This connection between self-related processing and depression may point to a self disorder as a core component of depression. (shrink)

In the present review we focus on what we take to be some remaining issues with the Behaviour Change Intervention Ontology (BCIO). We are in full agreement with the authors’ endorsement of the principles of best practice for ontology development In particular, we agree that an ontology should be “logically consistent and having a clear structures [sic], preferably a well-organised hierarchical structure,” and that “Maximising the new ontology’s interoperability with existing ontologies by reusing entities from existing ontologies where appropriate” is (...) critically important (Wright et al., 2020, p. 17). Our remaining concerns with BCIO relate directly to these two principles. First, we identify a number of issues with some of the classifications and definitions in BCIO that seem to be in tension with the just-mentioned principle . Second, we note some reservations about the reuse of certain classes in BCIO, namely from the Gazetteer (GAZ), the Ontology of Medically Related Social Entities (OMRSE), and the Information Artifact Ontology (IAO). While the latter principle of “reuse” is important, it is also important not to let the reuse of existing classes (or their corresponding definitions) compromise the logical integrity or the realist nature of one’s ontology. (shrink)

Sertraline is one of the most commonly prescribed antidepressants. Major depressive disorder (MDD) is characterized by spontaneous thoughts that are laden with negative affect-a "malignant sadness". Prior neuroimaging studies have identified abnormal resting-state functional connectivity (rsFC) in the spontaneous brain networks of MDD patients. But how antidepressant medication acts to relieve the experience of depression as well as adjust its associated spontaneous networks and mood-regulation circuits remains an open question. In this study, we recruited 22 drug-naïve MDD patients along with (...) 35 normal controls and investigated whether the functional integrity of cortical networks associated with spontaneous thoughts is modulated by sertraline treatment. We attempted to predict post-treatment effects based upon what we observed in the pre-treatment rsFC of drug-naïve MDD patients. In the result, we demonstrated that (1) after the sertraline treatment, the medial temporal lobe of default network (DNMTL) and mood regulation pathway-the fronto-parietal control network (FPCN), the thalamus, and the salience network (SN)-were restored to normal connectivity, relative to the pre-treatment condition; however, the altered connections of FPCN-core DN (DNCORE), FPCN-SN, and intra-FPCN among MDD patients remained impaired; (2) thalamo-prefrontal connectivity provides moderate predictive power (r2 = 0.63) for the effectiveness of sertraline treatment. In summary, our findings contribute to a body of evidence that suggests salubrious effects of sertraline treatment primarily involve the FPCN-thalamus-SN pathway. The pre-treatment rsFC in this pathway could serve as a predictor of sertraline treatment outcome. (shrink)

Kant’s conception of mental illness is unlikely to satisfy contemporary readers. His classifications of mental illness are often fluid and ambiguous, and he seems to attribute to human beings at least some responsibility for preventing mental illness. In spite of these apparent disadvantages, I argue that Kant’s account of mental illness can be illuminating to his views about the normative dimensions of human cognition. In contrast to current understandings of mental illness, Kant’s account is what I refer to as “non-pathological.” (...) That is, most mental illnesses are for Kant continuous with normally functioning cognition. Someone with a healthy reason can easily fall into mental illness and someone with mental illness can (perhaps not as easily) re-establish healthy reason. By accepting a non-pathological definition of mental illness, it follows for Kant that humans have more agency and responsibility regarding their mental health than current views allow, which explains why several of his writings aim to prescribe a “diet of the mind” (2:271). Contrary to popular readings of Kant as a champion of reason’s power, Kant’s conception of mental illness shows that he recognizes how fragile human reason can be. (shrink)