The need for a model -- Currently available models in psychiatry -- Introduction to enactivism -- Body and mind - and world -- The existential dimension and its role in psychiatry -- Enriched enactivism : existential sense-making, values, and socio-cultural worlds -- Enactive psychiatry : psychiatric disorders are disorders of sense-making -- An enactive approach to causes, diagnosis and treatment of psychiatric disorders.

Martin Heidegger has been one of the most influential but also criticized philosophers of the XX century. With Being and Time (1927) he sets apart his existential analytic from psychology as well as from anthropology and from the other human sciences that deny the ontological foundation, overcoming the Cartesian dualism in search of the ontological unit of an articulated multiplicity, as human being is. Heidegger’s Dasein Analytic defines the fundamental structures of Dasein such as being-in-the-world, a unitary structure that discloses (...) the worldhood of the world; the modes of being (Seinsweisen), such as fear (Furcht) and anxiety (Angst); and the relationship between existence and time. In his existential analytic, anxiety is one of the fundamental moods (Grundbefindlichkeit) and it plays a pivotal role in the relationship of Dasein with time and world. The paper firstly focuses on the modes of being, underling the importance of anxiety for the constitution of human being; secondly, it is shown the relationship between anxiety and world, and anxiety and time: rejecting both the Aristotelian description of time, as a sequence of moments that informs our common understanding of time, and the Augustine’s mental account of inner time, Heidegger considers temporality under a transcendental point of view. Temporality is ek-static, it is a process through which human being comes toward and back to itself, letting itself encounter the world and the entities. The transcendental interpretation of time provided by Heidegger may give its important contribution in psychopathology. (shrink)

Background: Psychedelics are known for their powerful mental effects due to the activation of 5HT-2A receptors in the brain. During the 1950s and 1960s, research was conducted on these molecules until their criminalization. However, their clinical investigation as therapeutic tools for psychiatric disorders has revived the deontological ethics surrounding this subject. Questions arise as research on their therapeutic outcome becomes a reality. We aim to explore deontological ethics to understand the implications of psychedelics for the clinician, patient, and society. Results: (...) A total of 42 articles were considered for this review. Methods: A methodological search of psychedelic studies from 2017 to 2022 was conducted in PubMed, Scopus, EBSCOhost, and ScienceDirect to address the deontological ethics of clinical psychedelic use. Conclusion: Psychedelics need to be culturally contextualized, epistemic harm minimized and represented to ensure informed consent. Open data and commissions are needed to ensure safe and equal distribution. (shrink)

In this stunning reappraisal of the celebrated case of Daniel Paul Schreber, Lothane takes the reader on a richly documented tour of all the ingredients that made Schreber's illness a unique psychiatric event. Building outward from a close examination of Schreber's troubled relationship to his two psychiatrists, Flechsig and Weber, Lothane elaborates the personal, familial, and cultural contexts of Schreber's illness. Incorporating extensive new archival and bibliographic research, and providing extensive accounts of the personalities and theories of Schreber's two psychiatrists, (...) Paul Flechsig and Guido Weber, Zvi Lothane offers a stunning reappraisal of the Schreber case that overturns virtually all previous opinion. Lothane examines both the man and his milieu in a way that allows the reader fresh access not only to the tragedy of Schreber's illness but also to his heroic, if doomed, attempts to come to terms with his condition through writing. In the process, he persuasively demonstrates that important issues of both psychiatric diagnosis and psychoanalytic interpretation have heretofore been compromised by a failure to pay sufficient attention to Schreber's interpersonal, cultural, and historical contexts. (shrink)

Psychiatry widely assumes an internalist biomedical model of mental illness. I argue that many of psychiatry’s diagnostic categories involve an implicit commitment to constitutive externalism about mental illness. Some of these categories are socially externalist in nature.

In recent years, phenomenologically informed philosophers, psychologists and psychiatrists have attempted to import philosophical notions associated with the self into the empirical study of pathological experience. In particular, so-called ipseity disturbances have been put forward as generative of symptoms of schizophrenia, and several attempts have been made to operationalize and measure kinds and degrees of ipseity disturbances in schizophrenia. However, we find that this work faces challenges caused by the fact that the notion of ipseity is used ambiguously, both in (...) the philosophical and in the empirical discussion, and the methods employed to operationalize ipseity often portray a rather different understanding of the notion from that found in the literature that is cited as providing the philosophical foundation for the studies in question. In particular, according to the definitions found in the philosophical literature, while being phenomenologically available, the self is not represented in ipseity. However, when it comes to the empirical study of ipseity and its disturbances, the object of investigation is often a kind of explicit self-representation. As a result, it is unclear whether different researchers are really talking about the same thing. Future progress in this area will require more careful conceptual distinctions; the present article aims to contribute to this task. (shrink)

There is an apparent epidemic of mental illness. At the end of 2011, untreated mental disorders accounted for 13% of the total global burden of disease, and for 25.3% and 33.5% of all years lived with a disability in low-and middle-income countries, respectively. Depression affects 350 million people globally and is the leading cause of disability. One in five U.S. adults takes psychiatric medication. One study found that by age 32, 50% of people surveyed qualified for an anxiety disorder, more (...) than 40% for a mood disorder, and more than 30% for substance dependence. Another study reported that... (shrink)

"Psychiatry and Philosophy of Science" explores conceptual issues in psychiatry from the perspective of analytic philosophy of science. Through an examination of those features of psychiatry that distinguish it from other sciences - for example, its contested subject matter, its particular modes of explanation, its multiple different theoretical frameworks, and its research links with big business - Rachel Cooper explores some of the many conceptual, metaphysical and epistemological issues that arise in psychiatry. She shows how these (...) pose interesting challenges for the philosopher of science while also showing how ideas from the philosophy of science can help to solve conceptual problems within psychiatry. Cooper's discussion ranges over such topics as the nature of mental illnesses, the treatment decisions and diagnostic categories of psychiatry, the case-history as a form of explanation, how psychiatry might be value-laden, the claim that psychiatry is a multi-paradigm science, the distortion of psychiatric research by pharmaceutical industries, as well as engaging with the fundamental question whether the mind is reducible to something at the physical level. "Psychiatry and Philosophy of Science" demonstrates that cross-disciplinary contact between philosophy of science and psychiatry can be immensely productive for both subjects and it will be required reading for mental health professionals and philosophers alike. (shrink)

This article seeks to understand the origins of the Soviet concept of ‘sluggish schizophrenia’, a diagnostic category that was used to imprison political dissidents in the post-WWII era. It focuses on the 1920s and 1930s, a period when Soviet psychiatrists attempted to find ways to diagnose schizophrenia at its earliest stages. The new Soviet state supported these efforts, funding new institutions where clinicians encountered types of patients they had not previously studied. Conceptual disagreements arose about what symptoms could be used (...) to diagnose schizophrenia, and how it could be differentiated from other ‘borderline’ mental disorders such as neurosis and psychopathy. Several research groups used their findings to propose new clinical concepts, including ‘mild schizophrenia’ and sluggish schizophrenia. By the early 1930s Soviet psychiatrists no longer shared a basic consensus about schizophrenia. At the same time, the priorities of the Soviet government under Joseph Stalin ceased to support preventative psychiatry. The result was a 1936 ‘discussion’ at which the concept of mild schizophrenia was criticized and sluggish schizophrenia was held up as a model for how the discipline should develop in the future. (shrink)

This essay argues for the necessity of a phenomenological perspective on mind and mental disorder while also emphasizing the inherent difficulty of adopting such an orientation. Here I adopt a via negativa approach—by considering three forms of error that the phenomenologists Edmund Husserl, Martin Heidegger, and Maurice Merleau-Ponty recognize as needing to be guarded against, lest they subvert the project of attaining an adequate understanding of consciousness or subjectivity: namely (1) prejudices deriving from theory and common sense, (2) distorting effects (...) of reflection, and (3) what Heidegger termed the forgetting of the ontological difference. Phenomenology insists on the importance of studying subjective life while also acknowledging the epistemological paradoxes inherent to this domain—a domain whose very self-evidence is inseparable from mystery, whose visibility conceals a deeper invisibility. I consider these issues in light of phenomenology’s relevance for certain issues in psychopathology and literary representation. (shrink)

Advance Praise: "A distillation of the wisdom accumulated over a lifetime by one of our leading thinkers in psychiatry. . . .It should interest. . .anyone who has thought seriously about the brain, the mind and the meaning of illness." --Albert J. Stunkard, M.D., Professor of Psychiatry, University of Pennsylvania.

The three essays reprinted in this book were first published in 1963 as individual chapters of a psychiatric treatise entitled Psychiatrie der Gegen wart (Psychiatry of the Present Day). The editors, W. H. GRUHLE (Bonn), R. JUNG (Freiburg/Br. ), W. MAYER-GROSS (Birmingham, England), M. MUL LER (Bern, Switzerland), had not planned an encyclopedic presentation; they did not intend to present a "handbook" which would be as complete as possible in details and bibliographic reference. Their intention was to "raze the (...) walls" separating Continental and Anglo-Saxon psychiatries and to offer a synopsis of developments in psychiatry during the last decades on an international basis. The editors requested, therefore, cooperation of scholars from many foreign countries, large and small, on both sides of the Atlantic. A section entitled "Borderlands of Psychiatry", in which MARGARET MEAD (New York) discusses the relation of "Psychiatry and Ethnology", HANS HEIMAN (Bern), the relation of "Religion und Psychiatrie", and ROBERT VOLMER (Paris), "Art et Psychiatrie", is a good illustration of the trilingual character of the whole work. Two of the editors, GRUHLE and MAYER-GROSS, died before the publi cation had been completed. In a kind of posthumous eulogy, Professor JUNG and Professor MULLER praised the initiative and accomplishments of MAYER-GROSS, "who during the last five years of his life had given a great deal of his time to this work. He had set his mind on a synthesis of German and Anglo-Saxon psychiatry. (shrink)

This article analyzes how the recent call for accounting in health care interferes with daily care practice and raises the question of how accounting practices relate to the aim of good care. The most influential accounting methods in the Netherlands suggest ways for professionals to legitimize their activities. The analysis of washing patients in long-term mental health care shows that different styles of accounting evaluate and legitimize care while structuring notions of what good care is. A specific style of accounting (...) enforces certain values but does not tell about the tragic or unexpected effects that come with it, nor does it provide a repertoire to deal with these. Thus, care practices incorporating specific styles of accounting remain dependent on forms of care that are not accountable or ask for new forms of reflexivity. (shrink)

In _ Psychiatry in the Scientific Image, _Dominic Murphy looks at psychiatry from the viewpoint of analytic philosophy of science, considering three issues: how we should conceive of, classify, and explain mental illness. If someone is said to have a mental illness, what about it is mental? What makes it an illness? How might we explain and classify it? A system of psychiatric classification settles these questions by distinguishing the mental illnesses and showing how they stand in relation (...) to one another. This book explores the philosophical issues raised by the project of explaining and classifying mental illness. Murphy argues that the current literature on mental illness -- exemplified by the Diagnostic and Statistical Manual of Mental Disorders -- is an impediment to research; it lacks a coherent concept of the mental and a satisfactory account of disorder, and yields too much authority to commonsense thought about the mind. He argues that the explanation of mental illness should meet the standards of good explanatory practice in the cognitive neurosciences, and that the classification of mental disorders should group symptoms into conditions based on the causal structure of the normal mind. (shrink)

Volume 19, Issue 10, October 2019, Page W14-W17.

Compulsory psychiatric treatment is the norm in many Western countries, despite the increasingly individualistic and autonomous approach to medical interventions. Community Treatment Orders are the singular best example of this, requiring community patients to accept a variety of interventions, both pharmacological and social, despite their explicit wish not to do so. The epidemiological, medical/treatment and legal intricacies of CTOs have been examined in detail, however the ethical considerations are less commonly considered. Principlism, the normative ethical code based on the principles (...) of autonomy, beneficence, non-maleficence and justice, underpins modern medical ethics. Conflict exists between patient centred commentary that reflects individual autonomy in decision making and the need for supported decision making, as described in the Convention on the Rights of Persons with Disabilities and the increasing use of such coercive measures, which undermines this principle. What appears to have been lost is the analysis of whether CTOs, or any coercive measure in psychiatric practice measures up against these ethical principles. We consider whether CTOs, as an exemplar of coercive psychiatric practice, measures up against the tenets of principalism in the modern context in order to further this debate. (shrink)

Preview: Where should we look for an answer to the question whether a psychiatrist is an expert? In analyses of the concept of “expert”? In sociological studies? Or perhaps in opinions formulated by psychiatrists themselves? The subject is not as simple as it might first seem and the answer cannot be obvious. Certainly, psychiatrists are considered to be experts when they are called in by the court to act as expert witnesses. They are also deemed experts when they make a (...) diagnosis, prescribe medication, or write out a sick note – similarly to other doctors. We typically trust that, just like other healthcare professionals, they will help us to recover or at least that they can alleviate our suffering. (shrink)

These remarks preface two volumes consisting of the proceedings of the Third International Conference on the History and Philosophy of Science of the International Union of History and Philosophy of Science. The conference was held under the auspices of the Union, The Social Sciences and Humanities Research Council of Canada, and the Canadian Society for History and Philosophy of Science. The meetings took place in Montreal, Canada, 25-29 August 1980, with Concordia University as host institution. The program of the conference (...) was arranged by a Joint Commission of the International Union of History and Philosophy of Science consisting of Robert E. Butts (Canada), John Murdoch (U. S. A. ), Vladimir Kirsanov (U. S. S. R. ), and Paul Weingartner (Austria). The Local Arrangements Committee consisted of Stanley G. French, Chair (Concordia), Michel Paradis, treasurer (McGill), Fran~ois Duchesneau (Universite de Montreal), Robert Nadeau (Universite du Quebec it Montreal), and William Shea (McGill University). Both committees are indebted to Dr. G. R. Paterson, then President of the Canadian Society for History and Philosophy of Science, who shared his expertise in many ways. Dr. French and his staff worked diligently and efficiently on behalf of all participants. The city of Montreal was, as always, the subtle mixture of extravagance, charm, warmth and excitement that retains her status as the jewel of Canadian cities. The funding of major international conferences is always a problem. (shrink)

Psychiatry is increasingly dominated by the reductionist claim that mental illness is caused by neurobiological abnormalities such as chemical imbalances in the brain. Critical psychiatry does not believe that this is the whole story and proposes a more ethical foundation for practice. This book describes an original framework for renewing mental health services in alliance with people with mental health problems. It is an advance over the polarization created by the "anti-psychiatry" of the past.