"This book represents the fruition of four years labor--most of it, fortunately, a labor of love. The idea of translating these papers, originating with Ernest Angel, was welcomed by Basic Books because of their enthusiasm for bringing out significant new material in the sciences of man. I was glad to accept their invitation to participate as one of the editors since I, too, had long been convinced of the importance of making these works available in English, particularly at this crucial (...) moment in the development of modern psychiatry and psychology. We asked Dr. Ellenberger to join us as the third editor because of his extensive knowledge of the literature of phenomenological and existential psychiatry and his clinical experience in using these methods in Switzerland. He and Mr. Angel are chiefly responsible for the selection of the particular papers translated. In our introductory chapters, Dr. Ellenberger and I have undertaken the task of making a bridge between these contributions and American psychiatry and psychology, while Mr. Angel has borne the major weight of the translations themselves"--Preface. (shrink)

This article seeks to clarify the way in which phenomenology is conceptualized and applied in empirical research in psychiatry and psychology, emphasizing the suitability of qualitative research. It will address the What, Why, and How of phenomenological interviews, providing not only preliminary answers but also a critical analysis, and pointing to future directions for research. The questions it asks are: First, what makes an interview phenomenological? What are phenomenological interviews used for in empirical research in psychiatry and (...) psychology? Second, why do we carry out phenomenological interviews with patients? Is merely contrasting phenomenological hypotheses or concepts enough to do justice to the patients’ involvement? Third, how should we conduct phenomenological interviews with patients? How can we properly perform analysis in empirical phenomenological research in psychiatry and psychology? In its conclusion, the article attempts to go a step beyond these methodological questions, highlighting the “bigger picture”: namely, the phenomenological scientific paradigm and its core philosophical claim of reality as mind-dependent. (shrink)

This article demonstrates that there is no free will problem in forensic psychiatry by showing that free will or its lack is not a criterion for any legal doctrine and it is not an underlying general foundation for legal responsibility doctrines and practices. There is a genuine metaphysical free will problem, but the article explains why it is not relevant to forensic practice. Forensic practitioners are urged to avoid all usage of free will in their forensic thinking and work (...) product because it is irrelevant and spawns confusion. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Close Enemies: The Relationship of Psychiatry and Psychology in the Assessment of Mental DisordersPhilippe Le Moigne, PhDAs Peter Zachar rightly points out in his comment, the assessment of mental disorders underwent new developments with the release of the Diagnostic and Statistical Manual of Mental Disorders-V in 2013 (American Psychiatric Association, 2013). Whereas in 1980, the manual had been thought of in a rigorously categorical way, on the (...) basis of distinct and closed syndromic entities, this new version advocated the development of a radically dimensionalist approach, with the diagnosis aiming this time to restore the whole symptomatological picture of the patient on a spectrum of ratings are supposed to cover the entirety of psychiatric semiology (American Psychiatric Association, 2013).For its part, my article aimed to show how standardized assessment, guided by the return of psychiatry’s authority and the assertion of its legitimacy in the diagnostic field, gave the ascendancy in the 1980s to the classificatory tradition and thus to the categorical model, to the detriment of personality approach and test psychology which offered a competing solution here. This perspective, historically dated, may have led the reader to think that there is an antagonism that cannot be overcome here. Rather, it should be seen as a form of structuring opposition, or even a “complementarity inscribed in rivalry,” between psychiatry and psychology, which is naturally susceptible to change over time.Indeed, the reversal operated by the Diagnostic and Statistical Manual of Mental Disorders-V is not total because it cannot be total. The defense of the dimensionalist approach, dear to the psychological testing tradition, was intended here to allow the identification of co-morbidities, present in most patients but poorly apprehended by the categorical approach, and to open up diagnosis to prevention by screening for minor manifestations of psychopathology when they suggest the [End Page 259] development of a manifest episode of the disease in the more or less long term. The risk here is that we end up with overdiagnosis and thus an over-representation of false positives (Wakefield, 2015). In other words, this type of approach does not escape the obligation to determine threshold scores, likely to indicate the lower limit of the disorder, and thus to resort to a categorical approach. There is a first affinity between the two perspectives which obeys, beyond the divergences in principle, a technical requirement.But the two approaches have even more in common when we look at their epistemological background: they share the idea that the representation and the intervention on mental disorder, to use Ian Hacking’s expression (1983), must be based on the model proposed by the physical and natural sciences. And as Greta Kaluzeviciute aptly points out in her comment, this orientation leads to the idea of measuring mental disorder in particular to conduct elaborate quantification operations to determine, for example, whether two entities are statistically distinct or whether a drug has a significant effect on the evolution of a pathology.This is in fact an old question that can be formulated as follows, to use the expression of the psychometrician Joel Michell (1999): are psychological dimensions metric? In other words, if we want to apply the language of numbers to mental disorders, they must share its properties, two of which seem essential: it must be possible to establish that each mental disorder, in the same way as qualities attributable to length for example, has a zero and can be divided by means of gradients (or degrees of intensity) whose interval is constant (Le Moigne, 2018; Michell, 1999). For lack of space, let us only address the second condition. This one has already been denied by many, starting with Bergson at the end of the nineteenth century (1889). He does not believe in the quantification of psychological expressions, starting with sensations. What is the common point, he wrote, between the feeling of a mild pain, as one feels a stiffness, and the sensation of a needle being hammered into your flesh? For him, one and the other of these intensities are incomparable, so that they do not belong to a similar register of sensations that one could stage from a 0 toward a... (shrink)

This article reviews professional mental health publications before and after the Eichmann trial. Psychiatrists rejected the massive denial of survivors' emotional reactions that was prevalent in Israeli society at the time. The Eichmann trial permitted the opening up of survivors' experiences in public. Legal procedure enabled the witnesses to speak about what they had hidden until then. The judge's presence gave legitimacy and power to the accusations, transforming the survivors from outlaws to partners in justice. The audience came to support (...) this stronger survivor identity. Through a slow process, it became a valid issue for psychotherapy, allowing the weaker aspects of the survivors' personalities to be addressed. This article reviews professional mental health publications before and after the Eichmann trial. Psychiatrists rejected the massive denial of survivors' emotional reactions that was prevalent in Israeli society at the time. The Eichmann trial permitted the opening up of survivors' experiences in public. Legal procedure enabled the witnesses to speak about what they had hidden until then. The judge's presence gave legitimacy and power to the accusations, transforming the survivors from outlaws to partners in justice. The audience came to support this stronger survivor identity. Through a slow process, it became a valid issue for psychotherapy, allowing the weaker aspects of the survivors' personalities to be addressed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Concurrent Contents: Recent and Classic References at the Interface of Philosophy, Psychiatry, and PsychologyArticlesAntonak, R. J., C. R. Fielder, and J. A. Mulick. 1993. A scale of attitudes toward the application of eugenics to the treatment of people with mental retardation. Journal of Intellect Disabilities Research 37:75–83.Arens, K. 1996. Commentary on “Lumps and bumps.” Philosophy, Psychiatry, & Psychology 3:15–16.Bavidge, M. 1996. Commentary on “Minds, memes, and (...) multiples.” Philosophy, Psychiatry, & Psychology 3:29–30.Blashfield, R. K. 1973. Evaluation of the DSM-II classification of schizophrenia as a nomenclature. Journal of Abnormal Psychology 85(2):140–150.Braude, S. E. 1996. Multiple personality and moral responsibility. Philosophy, Psychiatry, & Psychology 3:37–54.Broverman, I. K., S. R. Vogel, D. M. Broverman et al. 1972. Sex-role stereotypes: a current appraisal. Journal of Social Issues 28:59–78.Broverman, I. K., D. M. Broverman, P. E. Clarkson et al. 1975. Sex-role stereotypes and clinical judgments of mental health. Journal of Consulting and Clinical Psychology 34:1–7.Checkland, D., and M. Silberfeld. 1996. Mental competence and the question of beneficient intervention. Theoretical Medicine 17(2):121–134.Clark, S. R. L. 1996. Commentary on “Multiple personality and moral responsibility.” Philosophy, Psychiatry, & Psychology 3:55–57.Clark, S. R. L. 1996. Minds, memes, and multiples. Philosophy, Psychiatry, & Psychology 3:21–28.Dickenson, D., and D. Jones. 1995. True wishes: The philosophy and developmental psychology of children’s informed consent. Philosophy, Psychiatry, & Psychology 2:287–303.Donaldson, T. 1978. Psychoanalyzing the practical inference model. Philosophical Research Archives 4:1215.Eekelaar, J. 1995. Commentary on “True wishes.” Philosophy, Psychiatry, & Psychology 2:305–307.Fisher, S., and R. P. Greenberg. 1993. How sound is the double-blind design for evaluating psychotropic drugs? Journal of Nervous and Mental Disease 181:345–350.Fulwiler, C., and M. F. Folstein. 1995. Commentary on “Chris Walker’s interpretation of Karl Jaspers’ phenomenology.” Philosophy, Psychiatry, & Psychology 2:345–346.Heinze, M. 1995. Commentary on “Moralist or therapist?” Philosophy, Psychiatry, & Psychology 2:31–32.Iturrate, M. 1977. Man’s freedom: Freud’s therapeutic goal. Review of Existential Psychology and Psychiatry 15:32–45.Littlewood, R. 1991. From diseae to illness and back again. Lancet 337:1013–1015.Maddox, J. 1993. New genetics means no new ethics. Nature 364:97.McCormick, S. 1995. Commentary on “True wishes.” Philosophy, Psychiatry, & Psychology 2:309–310.Murray, T. H. 1995. Commentary on “True wishes.” Philosophy, Psychiatry, & Psychology 2:311–312.Muzika, E. G. 1989. Object relations theory, Buddhism, and the self-synthesis of eastern and western approaches. International Philosophical Quarterly 30(1):59–74.Parker, M. 1995. Commentary on “True wishes.” Philosophy, Psychiatry, & Psychology 2:313–314.Phillips, J. 1996. Key concepts: Hermeneutics. Philosophy, Psychiatry, & Psychology 3:61–69.Pole, D. 1970. Self and personality. The Journal of the British Society for Phenomenology 1:30–36.Priebe, S. 1989. On the subjectivity of psychiatric diagnosis. Psychiatric Praxis 16:86–89.Radden, J. 1996. Lumps and bumps: Kantian faculty psychology, phrenology, and twentieth-century psychiatric classification. Philosophy, Psychiatry, & Psychology 3:1–14.Sampson, E. E. 1981. Cognitive psychology as ideology. American Psychologist 36:730–743.Sarbin, T. R. 1976. Contextualism: A worldview for modern psychology. Nebraska Symposium on Motivation 24:1–41.Senft, P. A. 1975. The self-contradictions (antinomies) of psychotherapy: Is a solution in social action possible? The Human Context 7:367–372.Shuman, D. W. 1996. Commentary on “Multiple personality and moral responsibility.” Philosophy, Psychiatry, & Psychology 3:59–60.Sprigge, T. 1996. Commentary on “Minds, memes, and multiples.” Philosophy, Psychiatry, & Psychology 3:31–36.Wallace, K. 1996. Commentary on “Lumps and bumps.” Philosophy, Psychiatry, & Psychology 3:17–20.Wells, L. A. 1995. Commentary on “True wishes.” Philosophy, Psychiatry, & Psychology 2:315–317.Wiggins, O. P., and M. A. Schwartz. 1995. Chris Walker’s interpretation of Karl Jaspers’ phenomenology: a critique. Philosophy, Psychiatry, & Psychology 2:319–343.BooksAmerican Hospital Association. 1994. Values in conflict: Resolving ethical issues in health care. 2nd ed. Chicago: American Hospital Association.American Medical Association. 1992. Code of medical ethics: Annotated current opinions of the council on ethical and judicial affairs. Chicago: American Medical Association.———. 1994. Council on ethical and judicial affairs... (shrink)

Philosophy of mind as traditionally understood has rarely engaged directly with psychology and psychiatry. This collection establishes the importance of this interdisciplinary approach and explores new directions in the 'philosophy of psychiatry and psychology'. The essays are by a distinguished group of contributors whose interests and expertise embrace the cognitive, biological and medical sciences as well as the social sciences and humanities. The topics are wide ranging and raise fundamental questions such as what establishes personality or (...) personal identity; how should insanity - or sanity - be defined; what is 'consent'? Readers, like the contributors, will come from a wide range of backgrounds, and find the volume suggests new approaches and offers new insights. (shrink)

This essay focuses on the meaning that the term “experimental” acquires within spiritualism during the second half of the nineteenth century. It builds upon Paul Janet’s notions of “experience” and “experimentation” in psychology, by stressing the role of physiology and pathology in his reflection. Regardless of the role the concept of “experimentalism” took on in Victor Cousin’s psychology, which arguably indicated more an “internal affection” than actual experimentation, in Janet’s spiritualism the term regains its original meaning of empirical (...) verification. Janet highlights the importance of madness to the development of a new psychological paradigm that could reconcile philosophy and medicine, reason and experience, by taking up pathology as a form of natural and indirect experimentation. (shrink)

Summary In his series of lectures, Le pouvoir psychiatrique, Michel Foucault employs concepts from the military field of knowledge in order to analyse the founding scenes of psychiatry. I focus on three issues connected to Foucault's use of these military terms. Firstly, I examine why Foucault was reluctant to use concepts from sociology and psychology in Le pouvoir psychiatrique and how this affects the notions that he had formulated in his earlier work, Histoire de la folie. Secondly, I (...) show how he challenges traditional understandings of the founding scenes of psychiatry by using concepts from a different field of knowledge. In doing this, he creates metaphors, and this is something that he himself had previously been critical of doing. Thirdly, I reflect upon the fact that Foucault's creative use of concepts from different disciplines and examples from different historical times can be related to episodes in his own life; I argue why it is important to supplement a structural analysis with linguistic, phenomenological and hermeneutical ones. (shrink)

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

Ethical Considerations at the Intersection of Psychiatry and Religion aims to give mental health professionals a conceptual framework for understanding the role of R/S in ethical decision-making and serve as practical guidance for approaching challenging cases. Part I addresses general considerations, including the basis of therapeutic values in a pluralistic context, the nature of theological and psychiatric ethics, spiritual issues arising in diagnosis and treatment, unhealthy and harmful uses of religion, and practical implications of personal spirituality. Part II examines (...) how these considerations apply in specific contexts: inpatient and outpatient, consultation-liaison, child and adolescent, geriatric, disability, forensic, community, international, addiction and disaster and emergency psychiatry, as well as in the work of religious professionals, ethics committees, psychiatric education, and research. Thick descriptions of case examples analyzed using the framework of Jonson and Winslow show the clinical relevance of understanding the contributions of religion and spirituality to patient preferences, quality of life, decision making, and effective treatment. (shrink)

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

In lieu of an abstract, here is a brief excerpt of the content:Religion, Psychiatry, and “Radical” Epistemic InjusticesRosa Ritunnano, MD (bio) and Ian James Kidd, PhD (bio)Hermeneutical injustice as a concept has evolved since its original formulation by Miranda Fricker (2007). The concept has been taken up in psychiatry, with its moral, epistemic and clinical premium on the interpretation of extremely complex and difficult experiences (Kidd et al., 2022). There are many varieties of hermeneutical injustice with different forms, (...) sources, degrees, effects, and interpersonal and socio-structural aspects (Medina, 2017). José Eduardo Porcher has proposed the addition of a new form of ‘radical’ hermeneutical injustice, with a case study of psychotic symptoms involving religious content.He offers different characterizations of this injustice:a particularly radical form of injustice, namely, having their own interpretation of their experiences unjustifiably undermined.a form of hermeneutical injustice that occurs when a patient diagnosed with psychosis is denied the opportunity of interpreting their own experiences within their own religious framework.These are different things. Denying someone the opportunity to interpret their experiences in their own, preferred framework is one way of undermining their interpretations. Another is forcing someone to use your own preferred framework and then belittling their own, which seems doubly wrong. Misusing some preferred interpretive framework can be as unjust as not using it. The two definitions could be combined, but then much will depend on what it means to undermine someone’s interpretation of an experience. We think there is a form of radical hermeneutical injustice—different to the one described by Porcher. Some interpretations of kinds of experience with religious content can be undermined if one is committed to a metaphysical naturalism. In these cases, one person cannot regard someone’s interpretive framework as coherent or intelligible (one that involves supernatural entities, for instance).Most discussions of hermeneutical injustice focus on social structures. Fricker notes structural dimensions to hermeneutical injustice. In a standard case, a group has unequal participation in collective practices for making and using interpretive resources (Ritunnano, 2022). In a rich analysis, José Medina describes four ‘axes’ or dimensions for distinguishing forms of hermeneutical injustice [End Page 235] (Medina, 2017). The source of these injustices can be semantic or performative. The dynamics may be structural or interpersonal, or both. Moreover, there are different degrees of breadth and depth, defined here in terms of the ‘reach’ of the injustice across one’s life, and the depth of damage to one’s hermeneutic agency, respectively (Medina, 2017, p. 45). On this model, what might count as ‘radical’ hermeneutical injustices? Deep and broad hermeneutical injustices can be radical when they are very broad in scope and very deeply damaging. This might be what Porcher has in mind. But we think there is a further option, relevant to his case study.Porcher focuses on a case where individuals experience unusual beliefs and perceptions with religious content receive a ‘psychosis’ diagnosis. The alleged injustice is that the possibility of a genuine religious experience is not recognized and validated. The example is Femi, a young man with Christian background, who enters the mental health system following the onset of psychotic ‘symptoms’. After being found “disoriented and depleted in public” – tired and undernourished—Femi is compulsorily admitted to hospital, explaining he undertook fasting and isolation in response to orders from God. During this time, Femi devoted himself to Bible reading and stopped going to work. In hospital, where the authenticity of God’s voice is challenged by clinicians, Femi is treated for acute psychosis with pharmacotherapy. While remission of symptoms follow, there is no functional recovery, and Femi is described as “unmotivated and apathetic”.Femi interpreted his experiences in religious terms, but this interpretation is not accepted or pursued by the clinicians. Is this a hermeneutical injustice? If so, is it a ‘radical’ one? Granted, Femi’s religious interpretation may be psychologically adaptive—enhancing his sense of life as meaningful (Ritunnano & Bortolotti, 2022). But this is consistent with it being a hermeneutical injustice. Plus, a religious framing may be conducive to his functional recovery after being discharged, especially in conjunction with a supportive religious community, able to help him articulate, understand, and respond to those religious experiences (see Cottingham, 2005; Wynn, 2005). However, none of... (shrink)

This book presents new philosophical work on delusions and their impact on everyday human behavior. It explores a cluster of related topics at the intersection of philosophy of mind and psychiatry, while also charting the historical development of work on delusions. Within psychiatry, there are several disputes about the nature and origin of delusions. Whereas some authors see only an abnormal phenomenon that needs to be treated by psychological or pharmacological means, others hold that delusions can be psychologically (...) adaptive and even have epistemic benefits. This book brings together an interdisciplinary group of contributors to build consensus around what delusions are and how they impact the human mind. Part 1 provides readers with an informed historical discussion of delusions and carefully examines the contemporary impact of these historical perspectives. Part 2 analyzes the impact of contemporary views of delusions on the mental and emotional life of human agents. Finally, Part 3 explores the normative frameworks of delusions and analyzes the impact of some of their behavioral consequences on the daily life of subjects and their caregivers. The Philosophy and Psychology of Delusions is essential reading for researchers and graduate students working at the intersection of philosophy, psychiatry, and psychology. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 3.2 (1996) 139-142 Concurrent Contents: Recent and Classic References at the Interface of Philosophy, Psychiatry, & Psychology Articles Abramowitz, S., C. Abramowitz, C. Jackson et al. 1973. The politics of clinical judgment. Journal of Consulting and Clinical Psychology 41: 385-391.Audi, R. N. 1972. Psychoanalytic explanation and the concept of rational action. The Monist 56: 444- 464.Barondess, J. A. 1979. Disease (...) and illness--a crucial distinction. American Journal of Medicine 66: 375-376.Barrett, R. J. 1988. Interpretations of schizophrenia. Culture, Medicine and Psychiatry 12: 357-388.Bechtel, W. 1993. The case for connectionism. Philosophical Studies 7: 119-154.Belzen, J. A. 1995. The impact of phenomenology on classical psychiatry: Rümke's position between Jaspers and Kraepelin. History of Psychiatry 6: 349-385.Benda, C. E. 1967. Neuroses of conscience. Journal of Existentialism 7: 425-442.Binns, P. 1995. Commentary on "Contentless consciousness." Philosophy, Psychiatry, & Psychology 2: 61-63.Blankenburg, W. 1980. Phenomenology and psychopathology. Journal of Phenomenological Psychology 11: 50-78.Bloomfield, T. M. 1979. Psychoanalysis: A human science? Journal for the Theory of Social Behavior 9: 271-287.Blumenfeld, D. 1972. Free action and unconscious motivation. The Monist 56: 426-443.Boudreaux, G. 1977. Freud on the nature of unconscious mental processes. Philosophy of the Social Sciences 7: 1-32.Bracken, P. J. 1995. Beyond liberation: Michael Foucault and the notion of a critical psychiatry. Philosophy, Psychiatry, & Psychology 2, no. 1: 1-13.Brazier, M. 1995. Commentary on "Who should be committable?." Philosophy, Psychiatry, & Psychology 2, no. 1: 49-50.Bursztajn, J., and A. Brodsky. 1995. Authenticity and autonomy in the managed-care era: Forensic psychiatric perspectives. Journal of Clinical Ethics 5, no. 3: 237-242.Byrnes, J. F. 1979. Suggestions on writing the history of psychological data. History and Theory 16: 297-305.Campbell, E. J., J. G. Scadding, and R. J. Roberts. 1979. The concept of disease. British Medical Journal 2: 757-762.Carveth, D. 1988. In reply to Eagle's reply on "The epistemological foundations of psychoanalysis." Philosophy of the Social Sciences 18: 377-378.Chadwick, R. F. 1995. Commentary on "Karl Jaspers and Edmund Husserl." Philosophy, Psychiatry, & Psychology 2, no. 1: 83-84.Christiansen, B. 1964. The scientific status of psychoanalytic clinical evidence (III). Inquiry 7: 47-79.Davis, M. 1987. Realistic utilitarianism and the social conditions of cognitive psychotherapy. Social Theory & Practice 13: 237-259.Dega, W., et al. 1978. Ethics and mental health: Discussion. Dialectics and Humanism 5: 219-235.Dingle, H. 1949. The logical status of psycho-analysis. Analysis 9: 63-66.Dupeau, J. 1977. Freud and degeneracy. Diogenes Spring: 43-64.Eagle, M. 1988. A reply to Carveth's "The epistemological foundations of psychoanalysis. Philosophy of the Social Sciences 18: 371-375.Elevitch, B. 1974-75. Reasons, motives and psychoanalysis. Philosophical Forum (Boston) 6: 143- 162.Elliot, P. 1995. Policies, identity, and social change: Contested grounds in psychoanalytic feminism. Hypatia 10: 41-55.Fabrega Jr, H. 1980. The position of psychiatric illness in biomedical theory: A cultural analysis. Journal of Medicine and Philosophy 5: 145-168.Fisk, G. 1993. Accreditation of psychotherapists. British Journal of Hospital Medicine 50: 437-438.Flynn, B. G. 1985. Reading Habermas reading Freud. Human Studies 8: 57-76.Forrow, L., R. M. Arnold, and J. Frader. 1991. Teaching clinical ethics in the residency years--preparing competent professionals. Journal of Medicine and Philosophy 16: 93-112.Friedman, M. 1982. Philosophical anthropology and psychotherapy. Philosophical Context 12: 9-19.Galdston, I. 1969. The ontologic foundations of morality. Existential Psychiatry 7: 69-75.Gardner, S. 1995a. Commentary on "Irrationality and the dynamic unconscious." Philosophy, Psychiatry, & Psychology 2, no. 2: 175-176.Gardner, S. 1995b. Psychoanalysis, science, and commonsense. Philosophy, Psychiatry, & Psychology 2, no. 2: 93-113.Handelsman, M. M. et al. 1995. Does legally mandated consent to psychotherapy ensure ethical appropriateness? The Colorado experience. Ethics and Behavior 5, no. 2: 119-129.Hanlon, M. D. 1977. Commentary on Dunham's "Psychiatry, Sociology and Civil Liberties." Values and Ethics in Health Care 2: 275-278.Heaton, J. M. 1972. Insight in... (shrink)

Evidence-based medicine (EBM) made its first appearance in the medical lexicon in 1990 and since then has enjoyed widespread support from within the medical profession, including among psychiatrists. Proponents of evidence-based psychiatry (EBP) point to its ability to demonstrate the efficacy of various psychiatric treatments, promising improved mental health outcomes and more efficient use of healthcare resources as a result. Policymakers and insurers have embraced EBP in hopes that these goals will be realized. However, the question of whether EBM (...) is even applicable to psychiatry remains largely unaddressed, even though it is an urgent one, given the various corporate, professional, and governmental pressures .. (shrink)

Maladapting Minds discusses a number of reasons why philosophers of psychiatry should take an interest in evolutionary explanations of mental disorders and, more generally, in evolutionary thinking. First of all, there is the nascent field of evolutionary psychiatry. Unlike other psychiatrists, evolutionary psychiatrists engage with ultimate, rather than proximate, questions about mental illnesses. Being a young and youthful new discipline, evolutionary psychiatry allows for a nice case study in the philosophy of science. Secondly, philosophers of psychiatry (...) have engaged with evolutionary theory because evolutionary considerations are often said to play a role in defining the concept of mental disorder. The basic question here is: Can the concept of mental disorder be given an objective definition, or is it rather a normative concept? Thirdly and finally, evolutionary thinking in psychiatry has often been a source of inspiration for a philosophical view on human nature. Thus evolutionary psychiatrists have suggested, for example, that man's vulnerability to mental disorders may well be one of the defining features of our species. -/- Written by leading authors in philosophy, psychiatry, biology and psychology, this volume illustrates that many debates in contemporary philosophy of psychiatry are profoundly influenced by evolutionary approaches to mental disorders. Conversely, it also reveals how philosophers can help contribute to the burgeoning field of evolutionary psychiatry. It is important reading for a wide range of readers interested in mental health care and philosophy. (shrink)

The language of evolutionary biology and psychology is built on concepts applicable in the first instance to individual strategic rationality but extended to the level of genetic explanation. Current discussions of mental disorders as evolutionary adaptations would apply that extended language back to the individual level, with potentially problematic moral/political implications as well as possibilities of confusion. This paper focuses on one particularly problematic area: the explanation of women's greater tendency to depression. The suggestion that there are "good evolutionary (...) reasons" for depression makes sense, and might be helpful to note in therapy, as implying that the tendency is not a defect. However, evolutionary adaptiveness should not be confused with individual or psychological adaptiveness. Besides making reference to an earlier environment, it presupposes a strategic standpoint that may not accord with the legitimate interests of the individual, as this example makes vivid. (shrink)

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

A Democratic Mind: Psychology and Psychiatry with Fewer Meds and More Soul focuses on how an individual lives her life, and on the extent of harm that an individual can inflict on herself or others. In this book, I.W. Charny provides a new lens for understanding regular people rather than treatments that alleviate symptoms.

Freud, working from a background in clinical neurology and against a backdrop of burgeoning theory development in biology and neurophysiology, thought that the layers of the mind mirrored the layers of the brain although he was well aware of the conceptual problems involved in trying to identify the two. His associationist view, based on a neurobiological and evolutionary approach to the mind tends to underestimate the role of consciousness in a holistic conception of the psyche. The role of language and (...) the disciplines and practices which structure the psyche make it a domain in which negotiated solutions to life challenges are produced from the socio-cultural resources of discourse applied to the biological propensities resulting from innate dispositions and learning history. Although the biological and social realms obey fundamentally different rules, their psychological effects are realised in a common medium — the brain — a fact that can be detached from reductive approaches to psychology or psychiatry and can give substance to the idea of the body being inscribed like a surface on which events have left their trace. (shrink)

The language of evolutionary biology and psychology is built on concepts applicable in the first instance to individual strategic rationality but extended to the level of genetic explanation. Current discussions of mental disorders as evolutionary adaptations would apply that extended language back to the individual level, with potentially problematic moral/political implications as well as possibilities of confusion. This paper focuses on one particularly problematic area: the explanation of women's greater tendency to depression. The suggestion that there are "good evolutionary (...) reasons" for depression makes sense, and might be helpful to note in therapy, as implying that the tendency is not a defect. However, evolutionary adaptiveness should not be confused with individual or psychological adaptiveness. Besides making reference to an earlier environment, it presupposes a strategic standpoint that may not accord with the legitimate interests of the individual, as this example makes vivid. (shrink)

The COVID-19 pandemic has had a widespread effect on the thoughts, emotions and behavior of millions of people all around the world. In this context, a large body of scientific literature examining the mental health impact of this global crisis has emerged. The majority of these studies have framed this impact in terms of pre-defined categories derived from psychiatric nosology, such as anxiety disorders, depression or post-traumatic stress disorder. These constructs often fail to capture the complexity of the actual experiences (...) of the individuals being studied; more specifically, they describe these experiences exclusively in terms of disease, while neglecting their potentially adaptive or “salutogenic” aspects. Similarly, discussion of psychological assistance for these individuals has largely been confined to a reiteration of “evidence-based” psychological or pharmacological techniques which can be delivered using remote access technology. In the context of the COVID-19 pandemic, these approaches are likely to be of mixed efficacy. Conversely, “negative emotions” or distressing psychological experiences may actually be functional in the setting of a disaster or crisis, serving to minimize harm, maximize social coherence and compliance, and facilitate adherence to safety measures. The limitations of the “conventional” approach are, to a certain degree, inherent to the prevailing medical model of mental health. Beyond these considerations lies the concept of “salutogenesis,” a term which refers to the innate capacity of individuals to create and maintain health and well-being in the face of adversity. Using principles derived from the second wave of positive psychology, particularly its emphasis on the totality of human experience and the possibility of deriving meaning and character growth from suffering, this paper conceptually analyses the relevant aspects of salutogenesis and PP2.0, and proposes an alternate approach for addressing mental health concerns during the COVID-19 pandemic. Such an approach, while acknowledging the utility of the conventional medical-psychotherapeutic model in specific cases, reduces the risk of medicalizing human experience, and provides individuals and communities with opportunities for growth and adaptation. The benefits of this proposal could potentially extend far beyond the current crisis, offering an opportunity for the field of psychiatry and mental health research to move away from a purely “disease-centered” model. (shrink)

The past few years have witnessed an exponentially growing body of work conducted under the ‘second person’ heading. This idea has been explored in various areas of philosophy , in developmental psychology, in psychiatry, and even in neuroscience. We may call this interest in the second person the ‘You Turn’. To put it at its most general, and ambitious, the idea driving much of the work is this: proper attention to the ways in which we relate to one (...) another when we stand in second person relation to each other can deliver something like a paradigm shift in the way in which we address questions about a range of fundamental issues in these fields. There is, however, very little agreement about what second person relations are, and a huge variation in why people think they are important. The contributions to this book focus on developing key second-person claims in the philosophy of mind, ethics and epistemology, with the aim of beginning to provide a framework for assessing and relating the multitude of fascinating new questions that come up under the second person heading. This book was originally published as a special issue of Philosophical Explorations. (shrink)

Psychiatry is a discipline on the border between the biomedical sciences on the one hand and the humanities and social sciences (most notably psychology and anthropology) on the other. This unique position undoubtedly contributes to the attractiveness of psychiatry as a medical specialism for many young doctors, but it also causes significant problems. Unlike other medical disciplines, in which the definitions of diseases are based on objective, measurable pathophysiological underpinnings, psychiatric diagnosis and classification has been based on (...) descriptions of inherently subjective mental and behavioral symptoms that are supposed to be deviant from "normal" psychology or behavior, as reflected in the current .. (shrink)

We discuss delusions with religious components, suggesting that there are kinds of 'radical epistemic injustices' which involve conflicting metaphysical claims, specifically concerning the difficulties of interpreting religious testimonies within a naturalistic framework.

This special issue is a follow-up on a previous issue in this journal on self-management in psychiatry and psychosomatic medicine. It is the concluding chapter of a research project that sought to unpack and develop the implications of an understanding of self-management in psychiatry and psychosomatic medicine as “management of the self.”Over the last, 20 years, self-management has gained a central place in treatment programs across various medical disciplines. It positions patients as “expert-clients,” who share knowledge, responsibilities and (...) expertise with health professionals, and it actively involves them in the management of their own care (Crawford, Lee, May, & Active Self-Care... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 63-66 [Access article in PDF] The Pragmatics of Psychiatry and the Psychiatry of Cross-Cultural Suffering Jennifer Radden I AM IN SUBSTANTIAL AGREEMENT with many of the conclusions David Brendel draws in his thoughtful discussion. Misleading language aside, I particularly applaud his use of my plea for ontological descriptivism to support clinical practice, which respects, as he puts it, the (...) subjectively "melancholic" person living behind the objectively "depressed" clinical presentation.Brendel offers two main critiques of my discussion about the relationship between today's depression and melancholia of past eras. First, he asserts that I neglect the relevance of causal reasoning in my preference for a descriptivist over a causal ontology. Second, arguing that pragmatic considerations ought to be, as he says, front and center when philosophers and psychiatrists "grapple with the complexities of psychiatric explanation," (Brendel 2003, 54) he questions what he sees as my too ready dismissal of pragmatism in this discussion. Allegiance to pragmatism seems to me to sit strangely with support for a causal ontology, as I shall try to demonstrate. But first let me comment on these two sides of Brendel's commentary.The case of Van Gogh's alleged melancholia is particularly well chosen because there has been continuing debate about Van Gogh's condition, including scholarly work attributing it to an inherited metabolic disorder (Arnold 1992). Brendel's suggestion that a causal ontology might allow us to use historical evidence to throw light on the relation between depression and melancholia is an interesting and fruitful one that I had overlooked. Brendel also holds hope for drug cartography as a means of determining the causes of mental disorders. I admit to the initial plausibility of the approach to classification employed by drug cartography, of course. Diagnostic maps must be evaluated according to their effectiveness for the purposes they serve, and cannot—or should not—be seen as mere descriptions of natural phenomena. And maps based on psychopharmacological effects will serve one of the most important purposes we can have in relation to mental disorders: their successful treatment. Nonetheless, as I indicated in my essay, there are conceptual limitations to drug cartography. That several different syndromes respond to the same drug is suggestive, but it does not tell us anything definitive about structural similarities or differences between those different disorders. Nor, from the fact that a condition is alleviated by drugs, does it follow that a particular brain state was the initiating cause of that condition.My dismissal of a pragmatic approach in the foregoing discussion may have been overly hasty. [End Page 63] But in trying to make good this omission, I find myself struck by the complexity of the task. There appear to be at least five different places where a pragmatic response might be called for: (1) in deciding what to say about the relationship between depression and melancholia; (2) in determining the structure of any given psychiatric classification; (3) in choosing between what I have called descriptivist and causal ontologies; (4) in electing a course or method of treatment in the clinical context; and (5) in evaluating psychiatric explanations.With regard to (1), I have sketched in a note one pragmatic consideration in favor of equating melancholia and depression: by so doing, we might reinvest depressive states with some of the glamorous associations from the past and so diminish the stigma and provide some compensation and consolation for the suffering attaching to depression. Pragmatic reasoning may be perfectly appropriate here. I beg to point out that pragmatic considerations let me neglect it.With regard to (2), I recognize that psychiatric classifications are not so much identifications of natural kinds as responses to our various purposes; indeed, this point is offered as one drawback of adopting a causal analysis, because there is little reason to expect our purposes, which are a product of culture, to correspond to natural arrangements, which are not.With regard to (3), if there were overriding pragmatic considerations that favored accepting one or the other of these ontologies, then perhaps this would be... (shrink)

In ‘Theorizing resistance: Foucault, cross-cultural psychiatry and the user/survivor movement,’ Swerdfager develops a rich argument about the relationship between user/survivor voices, cross-cultural psychiatry, and the emerging discipline of global mental health. The paper questions the future directions of cross-cultural psychiatry in the era of GMH, and discusses the implications for user/survivor voices. This commentary engages with Swerdfager, focusing on the historical development of cross-cultural psychiatry and the discipline’s evolving relationship with GMH, concluding with a brief discussion (...) of recent developments with potential to open up new spaces for user/survivor voices as mental health... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.4 (2002) 381-382 [Access article in PDF] The Borderlands of Psychiatry and Theology Stephen Sykes Keywords: psychiatry, theology, spirituality. THE DISCUSSION OF THE TERMS we use to speak of experiences on the boundaries between spirituality and mental disorder is very important. Jackson and Fulford (1997) have gone a long way to avoid flattening the concepts into a single conceptual scheme, too (...) far for some of their critics like Littlewood (1997) and Storr (1997), but not far enough for Bratton and Marzanski (2002), who eventually accuse them of "anthropocentric psychologism." They want to preserve theological categories intact, mainly because this is how the subjects themselves see their experiences, but also because there is, they hold, additional explanatory value in such a language schema. As evidence they point to unremarkable attitudes and practices, which are nonetheless demonstrably part of the Christian way of life.The borderlands between theology and psychiatry are not alone in witnessing this dispute. A similar conflict has arisen in the discussion of public policy. In politics, people of religious conviction or representatives of faith communities have sometimes been told either to hold their tongues (because "not many people believe these things nowadays" or because "it's wrong to impose your beliefs on other people") or to formulate their proposals in nonreligious language. It is far from obvious that this is not a sophisticated form of discrimination, nonetheless objectionable for its being practiced by nonreligious people. The creation of genuine equality of access to the space for public discussion of political proposals is not at all easy.I have personal experience of the analogous difficulty in psychiatric practice. In a discussion of the overinvolvement of carers for a person with mental health problems self-sacrificing behavior was used with a negative connotation. But, as in the case of Carol, how were these actions to be construed—were they normal for a Christian or psychopathological? My personal response is that it is correct to say that a boundary exists between ordinary Christian spiritual experience (the kind that religious believers would immediately recognize as part of their religious lives) and disturbed or distorted perceptions that are the result of mental illness and can be mitigated by appropriate treatment. But the fact that a boundary exists in principle does not necessarily imply that it is always easy to draw the distinction in practice. Typically the cases that cause the most difficulty lie on the borderlands. Although on the face of it, it looks attractive to demonstrate the security of the criteria by making discriminations in precisely this area (and the point of the cases in Jackson and Fulford is precisely that they raise these complexities), in [End Page 381] fact it may be that such instances require both languages. In this case, Bratton and Marzanski are correct to argue for the retention of a theological frame of reference. The strength of their argument lies precisely in the support that fellow members of the respective faith communities are able to give to the people who, despite their manifest illnesses, persist in religiously justifiable courses of action.The paper raises one very important matter that bedevils a lot of the current literature, namely how spirituality is to be understood. In my view, there is a lot of purely arbitrary definition of this term, whose meaning has developed rapidly under specific social conditions (Sykes 2000a). In medicine, it functions best when it is taken to be a reminder that a patient may have had contact with a specific religious tradition that has contributed or still contributes to her worldview. In modern Western society, account has to be taken both of residual religiosities or fallback positions, and of new religions, as well as of traditional religious groupings. In the case of mental illness, it may be very important for a medical practitioner to be aware of the impact of these religious promptings on the formulation of the narrative identity of an individual—no easy task (Sykes 2000b).The generality of spirituality ought not to deflect the professional from attending to the particular tradition or traditions which have... (shrink)

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

Exploring phenomenological philosophy as it relates to psychiatry and the social world, this book establishes a common language between psychiatrists, anti-psychiatrists, psychologists and social workers. It is an inter-disciplinary work by phenomenological philosophers, psychiatrists, and psychologists to discover the essence and foundations of social psychiatry. Using the phenomenology of Husserl as a point of departure, the meanings of empathy, interpersonal understanding, we-intentionality, ethics, citizenship and social inclusion are investigated in relation to psychopathology, nosology, and clinical research. This work, (...) drawing upon the rich classical and contemporary phenomenological tradition, touching on a broad range of thinkers such as Deleuze, Levinas, and R.D. Laing, also explicates how phenomenology is a method capable of capturing the human condition and its intricate relation to the social world and mental illness. (shrink)

This paper draws from the work of Michel Foucault to understand how the user/survivor movement exists within the context of a political mental health services apparatus. Such an analysis puts power at the center of mental health, and highlights the way in which specific relations of power—between the psychiatrist and patient,1 for example—work to produce discourse, which in turn works to reproduce these same relations of power. The first section of the paper briefly discusses how, for Foucault, psychiatry is (...) a self-perpetuating apparatus, built around the power of the psychiatrist to define what constitutes valid knowledge. This theoretical framework makes clear that, within the apparatus, there will be alternative... (shrink)

This ambitious, rich, detailed, and groundbreaking work attempts to develop a "synthetic analysis" of the nature and functioning of the mind by interrelating a philosophical analysis of human experience and knowledge with psychological and psychiatric theories of sensory and cognitive processes and neuroscientific empirical and theoretical accounts of brain functioning.

This book relates work in neuroscience, psychology and psychiatry to questions about what a person is and the nature of a persons unity across a lifetime. The neuropsychiatry is now dated. The philosophy has three themes still perhaps of interest. The first is a response to Derek Parfits powerful and influential work on personal identity, which, like many other people, I discussed with him as he worked it out. I accept his view that there is no ego that (...) owns the stream of our experiences, and the unity of a person over time is constructed out of continuities in our mental life. But I argue against Parfits view that personal unity thereby becomes less deep or less morally important. The second theme is an emphasis on the importance of self-creation and an attempt to work out how far it is possible. The third theme is about the way self-creation is linked to recognition by other people, and the importance of this for understanding the role of tribalism in human life. "This book is about what it is to be a person, to think of oneself as an "I". It is about the ways people think of themselves, and how they use these ideas in shaping their own distinctive characteristics. It is about how far we create ourslves." "When a way of life does not fit with what you think you are really like, you can feel like a plant away from the light, distorted by having to twist and grope towards the sun. This analogy suggests that we might have a genetic programme to unfold, in the way plants do. But no doubt it is too simple to think that "the real me" is genetically laid down. These strong affinities we have for some kinds of life, and the sense of drowning that others give us, are likely to have been created by the interaction of our genetic make-up with thigs we have come across and responded to... We care a bit like trees would be, if they were conscious and could partly choose their direction of growth. Perhaps oaks could not become beeches, and stunted trees could not become giants, but they could influence the angle and direction of their branches. Trees thinking about determinism and free will might find it impossible to assess their own contribution to their final shape.". (shrink)

This paper explores some issues concerning the nature and structure of causal explanation in psychiatry and psychology from the point of view of the “interventionist” theory defended in my book, Making Things Happen. Among the issues is explored is the extent to which candidate causal explanations involving “upper level” or relatively coarse-grained or macroscopic variables such as mental/psychological states (e.g. highly self critical beliefs or low self esteem) or environmental factors (e.g. parental abuse) compete with explanations that instead (...) appeal to underlying, “lower level” or more fine gained neural, genetic, or biochemical mechanisms. (shrink)