In this manuscript of the early 1950s, Foucault outlines the path of Freud’s psychoanalysis from a biological approach based on the evolutionary perspective to disease, towards the understanding of its psychological significance. However, since the evolutionary point of view is never abandoned by Freud, the question that arises is how, in the psychoanalytic definition of the disease and its relation to personality, the evolutionary analysis is combined with the perspective of a meaningful understanding: what equilibrium can be established between them, (...) and what image of the sick man does result? Moreover, if the disease has a sense, and if it is defined by a set of significant and consistent reactions, how can it still be defined as a disease? (shrink)

This article examines the role of time as a methodological tool and pathological focus of clinical psychiatry and psychology in the first half of the 20th century. Contextualizing ‘psychopathologies of time’ developed by practitioners in Europe and North America with reference to the temporal theories implicit in Freudian psychoanalysis and Henri Bergson’s philosophy of durée, it illuminates how depression, schizophrenia, and other mental disorders such as obsessive-compulsive behaviours and aphasia were understood to be symptomatic of an altered or disturbed (...) ‘time-sense’. Drawing upon a model of temporal synthesis whereby in healthy individuals, a subjective temporal sense ( Ichzeit, durée, or personal lifetime) was perceived and understood in relation to objective time frameworks ( Weltzeit, clock-time, or quantitative time models like historical chronology), clinicians argued that mentally ill patients were unable to synthesize Ichzeit and Weltzeit, using variations in this disturbance to define specific pathological conditions. (shrink)

The concept of citizenship is becoming more and more prominent in specific fields, such as psychiatry/mental health, where it is constituted as a solution to the issues of exclusion, discrimination, and poverty often endured by the mentally ill. We argue that such discourse of citizenship represents a break in the history of psychiatry and constitutes a powerful strategy to counter the effects of equally powerful psychiatric labelling. However, we call into question the emancipatory promise of a citizenship agenda. Foucault's (...) concept of governmentality is helpful in understanding the production of the citizen subject, its location within the 'art of government', as well as the ethical and political implications of citizenship in the context of mental health. (shrink)

Background Medical aid in dying (MAID) is legal in a number of countries, including some states in the U.S. While MAID is only permitted for terminal illnesses in the U.S., some other countries allow it for persons with psychiatric illness. Psychiatric MAID, however, raises unique ethical concerns, especially related to its effects on mental illness stigma and on how persons with psychiatric illnesses would come to feel about treatment and suicide. To explore those concerns, we conducted several focus groups (...) with persons with lived experience of mental illness.Methods We conducted three video-conference-based focus groups involving adults residing in the U.S. who reported a prior diagnosis of any psychiatric illness. Only participants who reported thinking that MAID for terminal illness was morally acceptable were included. Focus group participants were asked to respond to a series of four questions. Groups were facilitated by a coordinator who was independent of the research team.Results A total of 22 persons participated in the focus groups. The majority of participants had depression and anxiety disorders; no participants had psychotic disorders such as schizophrenia. Many participants strongly favored permitting psychiatric MAID, generally on the basis of respect for autonomy, its effects on stigma, and the severe suffering caused by mental illness. Others expressed concerns, typically related to difficulties in ensuring decision-making capacity and to the risk that MAID would be used in lieu of suicide.Conclusions Persons with a history of psychiatric illness, as a group, have a diverse array of views about the permissibility of psychiatric MAID, reflecting nuanced consideration of how it relates to the public perception of mental illness, stigma, autonomy, and suicide risk. (shrink)

The review highlights two main parts of the book: information about scientists who created psychoanalysis, developed and applied it, and Appendices. The first of them is devoted to classical psychoanalysis, starting with S. Freud. Here the author introduces the reader to British and Hungarian psychoanalysis, including in their modern version. It is noted that the changes that have occurred in the theoretical field of psychoanalysis have led to radical changes in therapeutic practice. The boundaries of psychoanalysis are fluid. They are (...) constantly expanding, and in our time psychoanalysis can be interpreted as a system of theories of human behavior, as a way to treat mental illness, etc. Appendices consisting mainly of scientific articles of philosophers and psychoanalysts translated by V.V. Starovoitov from English. They can be considered an interesting book in their own right. Particularly attractive to the reader are the articles of R. Fairburne and D. Winnicott, as well as an extensive article by Dr. Elizabeth Spillius. Overall, the whole book is informative and useful, it can not only benefit the novice psychoanalyst of a philosophical orientation, but also arouse interest in psychoanalysis in a person who previously considered the theory and practice of psychoanalysis to be theoretical fun. (shrink)

Since psychiatry remains a descriptive discipline, it is essential for its practitioners to understand how the language of psychiatry came to be formed. This important book, written by a psychiatrist-historian, traces the genesis of the descriptive categories of psychopathology and examines their interaction with the psychological and philosophical context within which they arose. The author explores particularly the language and ideas that have characterised descriptive psychopathology from the mid-nineteenth century to the present day. He presents a masterful survey of the (...) history of the main psychiatric symptoms, from the metaphysics of classical antiquity to the operational criteria of today. Tracing the evolution of concepts such as memory, consciousness, will and personality, and of symptoms ranging from catalepsy and aboulia to anxiety and self-harm, this book provides fascinating insights into the subjective nature of mental illness, and into the ideas of British, Continental and American authorities who sought to clarify and define it. (shrink)

How might critical realism provide a better metatheoretical framework to understand the complex causality behind experiences of mental illness? How do we understand the agency of people suffering from mental illness? Prior work on critical realism and disability has argued that critical realism helps move past one or another form of reductionist explanations for illness, whether that is biological, environmental or psychological. But using a critical realist framework to study mental illness also raises issues about the agency (...) of people whose rational capacities are thought to be diminished. In this article, I present the life history of one of 26 young adults I interviewed as part of a project on resilience. Because interviews reveal the complex causal forces in any person's life, they remind us that scientific explanations should not be reductionistic. Human agency can be diminished by biological illness, power structures in psychiatry, and cultural categories of mental illness diagnoses. But a critical realist framework allows me to explore how people who experience mental illness still exercise their capacity to reflect on the moral ends to which to direct their actions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Should Clinicians’ Views of Mental Illness Influence the DSM?Elizabeth H. Flanagan (bio) and Roger K. Blashfield (bio)Keywordsclinicians, DSM, values, psychopathology, scienceThe relationship between clinicians and the DSM is complex. Clinicians are the primary intended audience of the DSM. However, as Widiger (2007) pointed out in his commentary, there is a tension associated with trying to meet the clinical goals of the DSM and also trying to optimize the (...) scientific goals of the DSM. Most commentators would agree that the recent editions of the DSM (from the DSM-III onward) have favored scientific values (e.g., Sadler 2005). Some commentators have taken sides and aligned themselves with either clinicians or with the science of classification. For instance, Garb (2005) has argued that clinicians should receive incentives to align themselves more closely with the science of the DSM. In contrast, Westen and Shedler (1999) have favored a clinician-based approach to the DSM and have argued that an ideal classification should be based on the prototypes that clinicians use to conceptualize diagnostic categories. Perhaps an extreme suggestion on how to deal with this tension between the values of clinicians and the values of scientists is to adopt the ICD-10 solution and create two versions of the next DSM. One version would be written for clinicians and another for researchers (Phillips et al. 2003).Widiger (2007) wondered whether the two of us as authors are on the fence about how the views of clinicians should affect the DSM. As clinical psychologists who are both clinicians and researchers, we understand his comment, especially in light of our attempt in our article not to overgeneralize from the time-consuming, labor-intensive, yet methodologically limited study we reported in our major paper.Nonetheless, our answer to the question asked in the title of this response, “Should clinicians’ views of mental illness influence the diagnostic manual?” is a clear and unequivocal yes. In our view, too much of the research literature stimulated by the recent DSMs has primarily used the diagnostic criteria in these DSMs to specify patient samples and then perform various experiments to study the DSM categories. We favor a different approach to research which is consistent with a comment once made by the philosopher of science, Karl Popper: “scientific theories originate from myths, and... a myth may contain important anticipations of scientific theories” (1963, 39). We believe that clinicians, with their years [End Page 285] of experience dealing with the ambiguities, the emotionality, and the chaos of psychopathology, have formed complex conceptual systems to try to understand the mysteries of abnormal behavior. We strongly support increased research attempts that will use clinicians as subjects and that will attempt to understand how clinicians use diagnostic concepts to understand patients.Although research on clinicians has not attracted a large amount of attention in the field, there is a long history of such research studies. For instance, in the 1970s, Overall used multivariate techniques to create graphical maps of how clinicians represented relationships among diagnoses (Overall et al. 1977). Widiger has used a similar strategy in some of his research (Widiger et al. 1987). In the early 1980s, a view of concept formation from cognitive psychology was used by Cantor et al. (1980) to look at psychiatric diagnoses as representing prototypes. Horowitz and colleagues extended this research. Blashfield and his colleagues had a grant to use the prototype model to study personality disorders and performed research investigating both case histories (Blashfield et al. 1985) and analyses of diagnostic criteria (Blashfield and Breen 1989; Davis, Blashfield, and McElroy 1993). Westen and colleagues have attempted to reconceptualize DSM personality disorder categories using the prototype model (Westen and Shedler 1999). Ahn and her colleagues (Ahn et al. 2006; Kim and Ahn 2002) have taken more recent applications of ideas from cognitive psychology to study how clinicians use and understand diagnostic categories. Finally, Flanagan and colleagues (Flanagan and Blashfield 2006; Flanagan, Keeley, and Blashfield, in press; Flanagan, Miller, and Davidson, submitted) have used qualitative and quantitative data analysis techniques to try to understand the diagnostic concepts held by experienced clinicians.Besides empirical studies of how clinicians use diagnostic concepts, we also support the increased interest in... (shrink)

From his earliest published work, Mental Illness and Personality (1954), to his last project, The History of Sexuality , Foucault was critical of the human sciences as a dubious and dangerous attempt to model a science of human beings on the natural sciences. He therefore preferred existential therapy, which did not attempt to give a causal account of human nature, but rather described the general structure of the human way of being and its possible distortions. Foucault focused his attack (...) on psychiatry, which claimed to have an explanation of normal and abnormal functioning of the personality modeled on medicine. Freud typified for him this deep mistake which he traced first to the Kantian understanding of human beings as transcendental/ empirical doubles which must think their own unthought, and then later to the gradually developing confessional practices which lead people in our culture to try unsuccessfully to put all their desires into words so as to conform to the norms of psychoanalysis which in turn are based on an account of sexuality as a cause of personality. Foucault proposed his genealogical account of how our culture arrived at this view of man as sexual being as a form of therapy which was to help us free ourselves from this restrictive self- interpretation. Keywords: normal, mental illness, sexuality, psychoanalysis CiteULike Connotea Del.icio.us What's this? (shrink)

In The Rules of Insanity, Carl Elliott draws on philosophy and psychiatry to develop a conceptual framework for judging the moral responsibility of mentally ill offenders. Arguing that there is little useful that can be said about the responsibility of mentally ill offenders in general, Elliott looks at specific mental illnesses in detail; among them schizophrenia, manic-depressive disorders, psychosexual disorders such as exhibitionism and voyeurism, personality disorders, and impulse control disorders such as kleptomania and pyromania. He takes a particularly (...) hard look at the psychopath or sociopath, who many have argued is incapable of understanding morality. Making extensive use of psychiatric case histories, Elliott explores the various ways in which mental illness can affect a person's intentions and thus excuse him or her from moral responsibility. (shrink)

In this essay, the author describes how he faced institutionalized homophobia during his psychiatric training, and how he later wrote a play inspired by the life of a gay psychiatrist. Despite Freud’s supportive stance, homosexuality aroused the antipathy of American organized psychiatry and psychoanalysis and came to be listed as an illness in the Diagnostic and Statistical Manual. Dr. John E. Fryer outed himself as “Dr. H Anonymous” at a 1972 meeting of the American Psychiatric Association, and the next year (...) homosexuality was removed from the DSM. The 2014 play Doctor Anonymous offers a fictionalized account of this watershed moment in the history of the gay rights movement. The author discusses his own psychotherapeutic work with gay male patients, including those who had previously been treated with conversion therapy, and explores how the play mirrors his own life experience and the experience of his patients. (shrink)

What counts as health or ill health? How do we deal with the fallibility of our own bodies? Should illness and disease be considered simply in biological terms, or should considerations of its emotional impact dictate our treatment of it? Our understanding of health and illness had become increasingly more complex in the modern world, as we are able to use medicine not only to fight disease but to control other aspects of our bodies, whether mood, blood pressure, or cholesterol. (...) This collection of essays foregrounds the concepts of health and illness and patient experience within the philosophy of medicine, reflecting on the relationship between the ill person and society. Mental illness is considered alongside physical disease, and the important ramifications of society's differentiation between the two are brought to light. Health, Illness and Disease is a significant contribution to shaping the parameters of the evolving field of philosophy of medicine and will be of interest to medical practitioners and policy-makers as well as philosophers of science and ethicists. (shrink)

Practical and evidence-based, this unique book is the first comprehensive text focused on person-centered approaches to people with serious mental illness such as schizophrenia and bipolar disorder. It reflects a range of views and findings regarding assessment, treatment, rehabilitation, self-help, policy-making, education and research. It is highly recommended for all healthcare professionals, students, researchers and educators involved in general practice, psychiatry, nursing, social work, clinical psychology and therapy. Healthcare service providers, and policy makers and shapers, will find the book's (...) wide-ranging, multi-professional approach enlightening. 'Serious Mental Illness reflects a continued distancing from the outmoded and unsubstantiated belief that people with severe mental illnesses could not recover, and that they would respond positively only to goals and treatment plans chosen, designed and implemented by providers in order to prevent their further deterioration. Anyone with an interest in the concept of person-centered approaches will discover new ideas in this book. Indeed, anyone with an interest in person-centered approaches has to read this book. Not only is it the first such book on person-centered approaches, but it will serve as the gold standard in this topic area for years to come.' William A Anthony, in the Foreword. (shrink)

This volume contains monologues and dialogues in which the most basic questions of psychoanalysis, philosophy, and logic are given clear and cogent answers. Table of Contents: 30 Laws of Logic Different Kinds of Mathematical Functions: A Dialogue Functions, Bijections, and Mapping-relations What is Logic? Outline of a Theory of Knowledge Determinism, Indeterminism, and Personal Freedom A Dialogue Neurosis vs. Psychosis What determines whether one is happy? Compulsive Work Stuttering How men and women are different One learns from adversity, not from (...) failure Does everybody want money? The #1 Rule of Writing Lack of Coordination Mental Illness: The Ultimate Litmus Test The #1 Rule of Business Honesty and Integrity A Dialogue Anger A Dialogue What is Bullshit? A Short Treatise on Causality Part 1: Causality and Continuity Part 2 : Causation and Explanation Part 3: Causation and Counterfactual Truth Part 4: Program-causation Part 5: The four different kinds of causes involved in the development of mental illness Part 6: Singular Causation Obsessions and Compulsions A Dialogue concerning OCD Writing Animated Dialogues as Self-Analysis: A Dialogue Neurotic Anxiety as Rational Fear: A Dialogue Agency Analyticity Anomalous Monism Bullshit Two Kinds of Insanity Ignorance of the Future Justice Proof that Time-Travel is Impossible Rationality vs. Intelligence: A Dialogue. (shrink)

The article provides historical and philosophical reconstruction of the emergence and development of the philosophy of psychiatry. The main cases of interaction between philosophy and psychiatry in the context of the development of the history of philosophical thought from antiquity to the present are demonstrated. The key points of interaction between philosophy and psychiatry from Antiquity to the middle of the twentieth century are revealed. The phenomenon of existential-phenomenological psychiatry is described as one of the first attempts of thorough interaction (...) between psychiatry and philosophy. Its main task is defined – to describe the experience of mental illness. Which is an important and necessary task to raise awareness of the impact of mental disorders on people's lives, attempts to reduce stigma. Describing this type of experience creates a unique window into understanding a person with a mental disorder, and illustrates the common and distinctive features of the experience of people with different psychiatric nosologies. These studies provide a deeper understanding of how mental pathology impoverishes a person's relationship with themselves and their community, with the subsequent use of the findings and humanization of psychiatric practice. The prerequisites for the emergence of modern philosophy of psychiatry, in particular the cognitive revolution, the development of philosophy of science, the development of analytical and continental philosophy, in particular phenomenology, existential philosophy, hermeneutics, are determined. The main directions of research in the philosophy of psychiatry are determined. Which are aimed at clarifying the meaning of terms related to mental illness and describing the phenomenon of mental illness itself, analyzing and clarifying those definitions that are directly used in clinical practice and the basis of psychiatric knowledge, as such, to highlight the prerequisites behind certain theoretical positions of psychiatry, to describe the nature of mental illness. (shrink)

SWORD W, CLARK AM, HEGADOREN K, BROOKS S and KINGSTON D. Nursing Inquiry 2012; 19: 51–62 The complexity of postpartum mental health and illness: a critical realist studyPostpartum depression (PPD) is a major public health issue that profoundly impacts the woman, her infant and family. Although it may be linked to hormone changes, no direct hormonal aetiology has been established. A large body of evidence implicates numerous psychosocial predictors of PPD. While a history of depression predicts about 50% of (...) cases of PPD, it remains unclear why some women with a history do not develop depression following childbirth, even taking psychosocial factors into account. The aim of this study was to identify the main mechanisms and factors associated with the presence or absence of PPD in women with a history of depression, and the presence of PPD in women without a history, using a critical realist approach. The findings indicate a number of personal and contextual factors that influence postpartum mental health and illness. In addition, and perhaps most importantly, women who did not develop depression identified goal‐oriented actions that were protective. These factors and processes did not exist in isolation and the interplay among them in influencing health was apparent. More research is needed to explore the effects of these mechanisms in different contexts. (shrink)

Independent on Sunday October 2nd One of the country's lead­ing philosophical counsellers, and chairman of the Society for Philosophy in Practice (SPP), Tim LeBon, said it typically took around six 50 ­minute sessions for a client to move from confusion to resolution. Mr LeBon, who has 'published a book on the subject, Wise Therapy, said philoso­phy was perfectly suited to this type of therapy, dealing as it does with timeless human issues such as love, purpose, happiness and emo­tional challenges. `Wise (...) Therapy, is part of a series aimed at promoting an integrative attitude as its ethos. Among all the many perspectives of psychotherapists and counselors, philosophy needs to take its place and needs to find its voice. Tim LeBon has provided an effective means by which counselors can bring philosophy into their work with clients' - APPA journal `Tim Le Bon's Wise Therapy is a comprehensible and well argued book dealing with the practical therapeutic applications of philosophical research that may well be of interest to philosophers but -- as the author himself intends -- will be of most obvious benefit to therapists and counselors, both by informing their dialogue with clients in new ways and by helping them become more informed about ways to resolve the ethical dilemmas arising within the context of their own work' - Metapsychology `A fascinating workshop for therapists and clients, backed up a thorough degree if philosophical acuity' - Journal of the Society for Existential Analysis `I strongly recommend the book for philosophers as well as practitioners, teachers, students and supervisors in counselling and psychotherapy' - Self and Society `Provides some additional and valuable arrows for the therapist's quiver' - Irvin Yalom, author of Love's Executioner `Like Aristotle, Tim LeBon examines what is said and extracts what is best from it…. There are many fascinating exercises designed to bring out and enlighten the client's values, conception of the good life, well-being, happiness, pleasure, and the proper place of reason in life…. Wise Therapy is well written and engaging. The case histories are illuminating examples of therapeutic techniques at work, the thought experiments are well designed, and the philosophical position adapted from the internal debates of the philosophers is level headed…. I recommend it highly to philosophers with an interest in counselling, and psychological counsellors with an interest in philosophy' - Jeff Mason, The Philosophers' Magazine `Tim LeBon has… authored a text which should become a staple on the philosophical counsellor's bookshelf…. Wise Therapy is a concise, well-written book…. His ability to relate philosophical concepts to counselling concerns is admirable and attests to the skill and knowledge he possesses as a working counsellor. But, by far the most important part of Tim LeBon's book to PC is the last chapter, "The Counsellor's Philosophical Toolbox"' - Craig Munns in The Examined Life ` Tim LeBon has done a good job of offering practical approaches to some of the most important and vexing issues that arise in counselling…. Tim LeBon's book contains helpful suggestions, practical information, and useful examples, and would make a good addition to the library of any counsellors willing to allow philosophy to turn mere client sessions into wise therapy' - Peter Raabe, Practical Philosophy Wise Therapy is an original and practical guide to how philosophy can benefit counselling and psychotherapy. Tim LeBon argues that therapy, informed by philosophy, can help clients make better decision and achieve emotional wisdom. He uses philosophical approaches to explore issues of right and wrong, the emotions and reasons, well-being and the meaning of life, and develops a 'counsellor's toolbox' of techniques that can help practitioners apply the wisdom of philosophy to good therapeutic practice. For counsellors who may find philosophical approaches to therapy useful, this work addresses key philosophical topics - the emotions, free will, the meaning of life and ethics. It is jargon-free where possible and assumes no previous philosophical training. From The Independent, 16th November 2004 Plato is my agony aunt It was the end of a love affair that broke her heart. Could the wisdom of the great philosophers show her how to be happy again? Claire Smith tries a novel form of therapy "The unexamined life is not worth living," Socrates said. Nor is the life you're left with after your boyfriend has left you for another woman - at least, that's how it felt in October last year when mine broke rank and went off with an art student from Cleveland, Ohio. We were over there for the opening of his new art exhibition. He'd flown over four days before me and had met her at a party. Supposedly, they "connected". The five months that followed were a roller-coaster of confusion, vitriol and despair. I knew there'd been problems in our relationship. We saw the world very differently; he delighted in the charm of the ordinary, I wanted maximum divinity. He walked; I galloped. He drank tea; I loathed the stuff. But, along the banks of the Thames, we'd made a promise to always stick together. Our love was something unique: "transcendental", I called it. And besides, we recycled. Surely a commitment to save the world would save our relationship? Alas, no. So there I was, a woman scorned. Hell truly hath no greater fury. And what made it worse was that I still believed in our transcendental love. If I wanted to change the way I was feeling, I needed to alter the way I was thinking. But how? A few bottles of wine and a sharp blow to the head might have done the trick. Fortunately, there's an older, more trusted way of turning your head on its head that counsellors are starting to use: philosophy. The idea of employing Plato as an agony aunt was begun in 1981 by the German philosopher Gerd Achenbach. Although philosophy spends a lot of its time asking real-life questions that affect real-life people - What is happiness? And is it always wrong to lie? - most of the debate goes on in ivory towers. What Achenbach and subsequent philosophers including Tim LeBon, the chairman of the UK's Society for Philosophy in Practice, wanted to do was "give practical application" to this gigantic library of great thoughts. So how does it work? Like most types of therapy, you sign up for a set of sessions. "Two would give you a new perspective on one issue; six would help you to make a major life-decision, like a career change; with 12 you can start to rethink your entire life philosophy," explains LeBon. Each session lasts 50 minutes and costs £50 - and, no, you don't have to have any previous knowledge of philosophy. "If you think of Friends, it would suit Ross and Chandler more than Joey," LeBon says. "It's for anyone who wants to make their emotions more intelligent. Or for those who have tried other kinds of therapy, and want something more cerebral." The first session begins with the patient venting off about whatever's troubling them. The rant over, the counsellor then picks out some key concepts that are crucial to the problem - in the case of heartbreak, it is love and happiness that come hurtling to the fore - and then gets the patient to define what they mean. So, what is love? What is happiness? To kick-start the patient's thinking, LeBon describes what a great philosopher had to say about it. In my case, he tells me what Plato wrote about love in his Symposium: that to stop man fighting the gods, Zeus decided to cut each human in two, so they would lose their strength. "This, then, is the source of our desire to love each other," Plato said. "Each of us is a 'matching half' of a human whole, because each was sliced like a flatfish, two out of one, and each of us is always seeking the half that matches him." This method of probing what we might think are "obvious" ideas, such as love and happiness, was devised by Socrates in the squares of Athens. "The only I thing I know is that I know nothing at all," he boasted. What Socrates showed was that although many of the thinkers of his time thought they knew what justice, happiness and goodness meant, their understanding was tied in to their personal agenda and world view, and, what's more, when pushed, their ideas often contradicted themselves. A bit like me on love. Whereas part of my understanding of love was something that gave life meaning, made it worth living and bound us together, I also believed that true love was "transcendental": that it was out of this world, and it didn't matter if the two people who loved each other couldn't get along in the day-to-day. Love was bigger than the mundane. But when it came to the next stage of the therapy, critical thinking - "to check out whether your assumptions stand up to examination" - I walked head first into a contradiction. If I think love's purpose is to make life worth living, but then say it's irrelevant to daily life, surely my two ideas of love are not compatible? As the cogs in my brain start to creak into motion, I feel myself taking a step back from my predicament: thinking about how I've been thinking. This idea I had of transcendental love might have started off as a romantic dream. But when the relationship stopped working, and I found myself feeling trapped and frustrated, I used it to justify the mechanics of a relationship that just didn't work in the daily grind. I used it to lie to myself. In the final stage, LeBon gets me to start thinking about how to go forward. "You can't change what has happened," he says. "You can't change that he's left you, or how you behaved in the relationship. So, as the Stoics did, let's work on controlling the controllables: the things that you can change." To work out what can be changed, he gets me to try out a thought experiment, a method often used in philosophy to imagine other worlds where people can have different codes of behaviour. Thought experiments shatter your preconceived ideas of how the world should be and let your imagination run wild to how the world could be. "I find Viktor Frankl very useful here, the Austrian psychiatrist and concentration-camp survivor who actually believed that everything in life happens for a purpose," LeBon says. "Suppose this break-up did happen for a reason that will work to your benefit," he suggests. "What might that be? The answer might be that you can now focus on something important that was denied in the relationship. Or - the Hollywood version - so you'll meet someone who is really right for you." Temporarily freed of any sense of responsibility for the relationship that was, and its sorry demise, the list came fast. I could now travel more; he didn't like me travelling on my own, but too often he didn't want to go anywhere, preferring to stay in his studio and make art. I'd love to meet someone with a similar sense of adventure to mine. For the first time in two years, I was being honest with myself about what I really wanted - listening to those voices that we all have inside our heads, and too often try to muzzle. So did philosophy save me? Well, I'm now dating a travel writer I have to run to keep up with. I still haven't got over the fact that my replacement came from Cleveland, Ohio. But I guess I never will. Tim LeBon can be reached by e-mail at [email protected] A FEW WORDS FROM THE WISE Compiled by Ed Caesar · "At the touch of love, everyone becomes a poet" - Plato · "There is always some madness in love. But there is also always some reason in madness" - Friedrich Nietzsche · "That man shall live as his own master and in happiness who can say each day 'I have lived'" - Horace · "The good of man is the active exercise of his soul's faculties in conformity with excellence or virtue... Moreover this activity must occupy a complete lifetime; for one swallow does not make spring, nor does one fine day; and similarly one day or a brief period of happiness does not make a man supremely blessed and happy" - Aristotle · "There is nothing on this earth more to be prized than friendship" - Thomas Aquinas · "Whatever you do... love those who love you" - Voltaire · "Happiness is not an ideal of reason but of imagination" - Immanuel Kant · "Happiness is a state of which you are unconscious. The moment you are aware that you are happy, you cease to be happy" - Jiddu Krishnamurti · "Love is an ideal thing. Marriage is a real thing" - Johann Wolfgang von Goethe I shrink, therefore I am Therapy has many answers, but some questions require the help of a philosopher, says Clint Witchalls Sunday November 21, 2004 The Observer Danny had worked in the City of London for 10 years. As a research analyst, stockbroker and fund manager, he'd made a lot of valuable contacts, earnt a lot of cash, and learnt some important business skills. However, as he approached his mid-thirties, he no longer felt good about himself or what he did for a living, and he found his colleagues cold and unfriendly. A chronic illness made him realise his mortality, and he began to reassess his priorities. Danny had been struggling with his career conundrum for nearly five years when he met David Arnaud, a philosophical counsellor. After a few soul-searching sessions, Danny arrived at a decision. Today, he teaches economics to sixth-formers, and he loves it. 'It's a much better lifestyle,' he says. Many people are turning to philosophical counsellors to get answers to questions such as: 'How do I make sense of myself?' 'What is important to me?' 'Where am I going?' These are perhaps not the sort of questions that require psychiatric intervention, but Arnaud, who recently completed the first empirical study of philosophical counselling in the UK, has found that within just five sessions the majority of clients, with important decisions to make, tend to move from a state of concern and confusion to a resolution. Modern philosophical counselling can be traced back to 1981, when the philosopher Gerd Achenbach opened the first practice near Cologne. Achenbach referred to the new discipline as 'therapy for the sane.' Today, there are hundreds of philosophical counsellors around the world, with the movement particularly strong in the US, Britain and the Netherlands. 'The dilemmas people face aren't always primarily psychological,' says Alex Howard, a philosophical counsellor from Newcastle. 'If people face problems that are social or economic, it doesn't make sense to define their problems in purely psychological terms.' Tim LeBon, a founder member of the Society for Philosophy in Practice (SPP) and author of Wise Therapy, adds: 'We are faced with far more life choices than our grandparents, yet have far fewer resources to deal with them. Our grandparents may have gone to a priest or to other family members for advice; most people don't trust these solutions any more and so want to make their own well-informed, well thought-out choices. Philosophical counselling can help these people - people in mid-life crises who are wondering how to make the most of the rest of their life. People who want to take stock of their values.' Where stressed executives might once have been prescribed a course of tranquillisers or antidepressants, they can now get a dose of Bertrand Russell instead: 'Success is too dearly purchased if all the other ingredients have been sacrificed to obtain it.' While some philosophical counsellors do recommend books for their clients to read, most sessions are about helping the client identify faulty thoughts. For example, a briefing in Aristotelian logic might show a client why their beliefs are erroneous. The person might infer that they're a screw-up because they've screwed up. The counsellor could point out that they're making an error called 'fallacy of composition' - that is, what's true of the part isn't necessarily true of the whole. In philosophical counselling, problems aren't pathologised as they are by the psychiatric profession, and the dialogue between client and counsellor is more like a meeting of equals, compared to many therapies where the client is treated like a patient and seen as someone who is, in some way, inadequate. 'Anybody can benefit from philosophical counselling,' says Howard. 'But it does require someone who is willing to take stock.' Lou Marinoff, author of international bestseller Plato Not Prozac! has done much to promote philosophical counselling. 'Some people who have stabilised their neurochemistry and validated their emotions now wish to examine or re-examine the criteria of their beliefs, the principles of their conduct, or the meaning of their lives,' he says. 'With whom shall they do this? Psychologists and psychiatrists can shed light on such issues - as can rabbis, priests, imams and gurus. Philosophers are now rejoining the ranks of helpers.' LeBon believes certain therapies (such as cognitive behavioural therapy) don't go far enough in helping their clients. 'For instance, if you are anxious about your relationship, a cognitive therapist would try to dispute your catastrophising and jump to conclusions to make you feel less anxious,' says LeBon. 'A philosophical counsellor would do this, but would also look for existential meaning in your anxiety - perhaps you really don't want to be in the relationship and that is what your anxiety is telling you.' LeBon also gives short shrift to psychoanalysts. 'There's very little evidence for the Freudian unconscious, and it's time to move on to more intellectually satisfying and helpful therapies,' he says. However, Alain de Botton, the man who popularised philosophy as self-help, isn't ready to bury psychologists and their ilk just yet. 'The truth is that psychoanalysis grew out of philosophy - it's not some completely new idea, and in fact, done properly, psychoanalysis is philosophical anyway. It may even be dangerous to the mental health of some people to suggest a philosopher rather than a properly trained analyst. The knowledge of analysts when it comes to many emotional problems is now much greater than that of most philosophers.' Guardian Unlimited © Guardian Newspapers Limited 2004. (shrink)

First authoritative and comprehensive study in the field of Inkblot Personality Test, this book describes the historical roots of the three major projective inkblot measures: the Rorschach, the Holtzman Inkblot Technique (HIT) and the Somatic Inkblot Series (SIS). It presents the extensive psychometric background work accompanying the normative data and diagnostic indicators along with indices for selecting executives in a business organization. The book begins with a detailed history of Hermann Rorschach and his early experiments with inkblots in the diagnosis (...) of mentally ill patients. Special attention is given to the administration and scoring of the Rorschach, with the sections detailing the systems developed by Klopfer and Exner. The HIT and SIS are also reviewed in detail, emphasizing their psychometric qualities. (shrink)

Pictures in historical chapters of textbooks convey information about the values and assumptions of the authors’professions and the larger culture. We scrutinized 15 recent abnormal psychology textbooks for reproductions of art created before 1900. Thirteen works appeared in three or more textbooks. Overall, these pictures support a “Whiggish” account of history that celebrates the present and gives a distorted, incomplete rendering of the past. The 13 pictures tended to depict the mentally ill as an underclass who are released from their (...) literal and metaphorical shackles by men who are “ahead of their time” in their struggles against prevailing ignorance. The pictures also emphasized the difference of the mentally ill by presenting a catalogue of stereotypic visual elements attributed to insanity throughout Western history. We argue for the inclusion in textbooks of “history for the sake of the past” as a way of genuinely engaging different ideologies and thereby stimulating interest in our own implicit values and biases. (shrink)

The history of mental illnesses is as old as human history. Mental disorders are affected by changing social and cultural factors during the historical process, and have been conceptually restructured and their definitions and classifications have been changed. The evolution of obssessive-compulsive disorders with roots as old as human history into modern concepts took place in the 19th century. The first scientific views on the spiritual origin of OCD belong to S. Freud. Freud observed that mental causes (...) in OCD are different from other mental disorders, and he examined obsession as a separate and specific disorder. Over time, it has been understood that OCD is a very common disorder. The American Psychiatric Association (APA) has classified OCD under an independent title in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by removing it from the category of anxiety disorders. OCD is a mental disorder caused by mental actions such as obsessive thoughts (obsessions) and / or repetitive and compulsive behaviors (compulsion). The patient is often aware that such thoughts and behaviors are irrational and absurd. For this reason, he tries to get away obsessive thoughts that he finds contrary to his beliefs, opinions, moral values and logic from his mind. However, as he tries, obsessive thoughts become more and more frequent and create a great anxiety in the person. This time, the patient resorts to compulsions to alleviate the anxiety he feels or to get rid of it completely. As his compulsions repeat, his anxiety increases and he goes into a vicious circle. There are many symptom subgroups of OCD that seriously worsen the quality of life of the individual. One of these, and even the most overwhelming, is religious obsessions. It has been thought that there has been a relationship between religion and OCD for a long time in the psychology literature, and some remarkable studies have been conducted to clarify this relationship. Although there are many research findings showing that religion is an indispensable element in the protection of the mental health integrity of the individual, some forms of religious understanding and some experiences gained as a result of religious experiences may affect the concerns about OCD. This stage of religiosity is closely related to some sub-symptom groups of OCD. The explanations of the founder of the psychoanalytic method, Freud psychoanalytic method, and his followers made a great contribution to the understanding of OCD. However, since the psychoanalytic method exhibits a theoretically reductionist approach to religion, it is possible that the individual's devotion to religion is initially evaluated as a pathology or at least an important obstacle to insight. Today, cognitive behavioral psychotherapies are considered the most effective psychological treatment method for OCD, but their success rates in the treatment of religious OCD are low. Since religious OCD concerns often involve spiritual issues rather than concrete repeatable situations, behavioral methods can be quite difficult to apply in the treatment of religious OCD. Therefore, traditional psychotherapy approaches, even if they are not openly against religions, are insufficient to relieve the suffering in the lives of individuals with religious obsessions, as they generally neglect the religious dimension. Due to the vacuum that arises from restricting spiritual treatments to secular approaches, religious patients are threatened by the illegal practices of people who abuse religious feelings. Clinically, religious obsessions are more worrying and overwhelming. Therefore, their treatment is more difficult than others. Selective approaches that use different scientific disciplines together in the treatment of OCD and can stretch around religious beliefs and values can create more effective treatment models. Thus, the success rate in the treatment of religious OCD can be carried to higher levels thanks to the appropriate cooperation of the disciplines of medicine, psychology and theology. There is a rich religious cultural heritage that can support this collaboration in terms of theological disciplines. As an example, Abū Zayd al-Balkhī (d. 322/934), in his Maṣāliḥ al-abdān wa-l-anfus, probably made a clear distinction between neuroses and psychosis and classified neurotic disorders for the first time about ten centuries before Freud. In this study, the importance of approaching to religious obsessions as both a psychological disorder and a theological problem is emphasized. For this reason, cooperation of psychiatric and psychological approaches with spiritual counseling and guidance is recommended in the treatment of religious OCD. The difficulty in distinguishing whether the symptoms seen in a religious person are normal, natural religious thoughts and behaviors of religious life or abnormal appearances in the religious guise necessitates this interdisciplinary cooperation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Psychopathy, Other-Regarding Moral Beliefs, and ResponsibilityLloyd Fields (bio)AbstractIn this paper I seek to show that at least one kind of psychopath is incapable of forming other-regarding moral beliefs; hence that they cannot act for other-regarding moral reasons; and hence that they are not appropriate subjects for the assessment of either moral or legal responsibility. Various attempts to characterize psychopaths are considered and rejected, in particular the widely held view (...) that psychopaths are, in general, incapable of understanding moral concepts. The particular disability proposed here, the incapacity to form other-regarding moral beliefs, is then derived from an analysis of what is required for someone to be a responsible agent. This is illustrated with a detailed case history. A defect of this kind is shown to vitiate moral responsibility, because it renders the psychopath irresponsive to the social pressures which normally ensure respect for moral norms. It is also shown that the psychopath is not a suitable subject for the assessment of legal responsibility, because he lacks the capacity to act from common prudence to avoid sanctions. I conclude that the attempt to characterize particular defects from among the heterogeneity of psychopathic subjects, could lead to better targeted, and hence to more effective, management of particular cases.KeywordsCriminality, mental illness, personality disorder, blame, liability, moral beliefs, guilt, social moralityIntroductionThe term “psychopath” has been used with a wide variety of different meanings and, no doubt, covers a heterogeneous group of subjects (Criminal behaviour and mental health 1992). My aim in this paper is to argue that at least a subgroup of those subjects are characterized by an inability to form other-regarding moral beliefs—and hence, for this particular reason, are not morally responsible agents—and that they also lack the capacity for prudence, and hence are not legally responsible agents.I begin by distinguishing the particular sense in which I will be using the term “psychopathy.” I then consider some suggestions in the literature regarding the defect by which psychopaths might be characterized—that they are mentally ill, or incapable of understanding moral concepts. In rejecting these, I come to the suggestion that the relevant defect is an inability to form other-regarding moral beliefs, a defect which is graphically illustrated by a case report from the literature. I explore the implication of this kind of defect for [End Page 261] moral responsibility as a socially-embedded notion, and the implication of the psychopath’s inability to exercise prudence in relation to legal liability.Nothing in this paper should be taken to suggest that psychopaths are irredeemable. On the contrary, as I argue in an endnote, correctly characterizing the defect from which they suffer leads directly to forms of treatment whose effectiveness has acquired a measure of empirical support.The Nature of PsychopathyPsychopathy is not a homogeneous concept; there are different types of psychopaths. For example, Henderson identified a type of psychopath who he classified as “Predominantly Creative,” exemplified by such figures as T. E. Lawrence and Joan of Arc. In people of this type genius is associated with heightened sensitivity, psychosexual immaturity and emotional instability (Henderson 1939, 108–20; Henderson and Gillespie 1969, 317). Predominantly creative psychopaths do not come within my purview.By “psychopathy” I shall mean the specific form of personality disorder described by Cleckley in his book, The Mask of Sanity (Cleckley 1964). Cleckley’s description forms the basis of Hare’s Revised (20-item) Psychopathy Checklist. The Checklist includes the following personality traits and deviant behaviors:1. Glibness/superficial charm.2. Grandiose sense of self-worth.3. Need for stimulation/proneness to boredom.4. Pathological lying.5. Conning/manipulative.6. Lack of remorse or guilt.7. Shallow affect.8. Callous/lack of empathy.9. Parasitic lifestyle.10. Poor behavioral controls.11. Promiscuous sexual behavior.12. Early behavior problems.13. Lack of realistic, long-term plans.14. Impulsivity.15. Irresponsibility.16. Failure to accept responsibility for own actions.17. Many short-term marital relationships.18. Juvenile delinquency.19. Revocation of conditional release.20. Criminal versatility (Hare 1986, 18). 1This conceptualization resembles in many respects the category of Antisocial Personality Disorder as described in the American Psychiatric... (shrink)

This essay synthesizes the place of biological evolutionism in the early history of psychoanalysis, and shows the implicit significance of German Darwinism in Sigmund Freud’s whole psychoanalytical works. In particular, Freud, together with Sándor Ferenczi (1873–1933), applied to mental disorders hypotheses inspired by August Pauly’s (1850–1914) psychological Lamarckism and Ernst Heckel (1834–1919) theory of recapitulation. Both of these theories rested upon the principle of inheritance of acquired characteristics, and were disproved by biological discoveries during the interwar period. However, (...) despite these scientific progresses, Freud never gave up his idea of inherited unconscious memories, and we try here to sketch out what would have cost him a renunciation to such outdated biological principles. Notwithstanding, Sigmund Freud was the first to elaborate on evolutionary causes of mental syndromes, which makes of him the forerunner of current neo-Darwinian psychopathology, with few continuators to date within the psychoanalytic field. Nowadays, the extended neo-Darwinian synthesis and affective neuroscience may pave the way for a rational Darwinian approach to human mental disorders, which would take into account the whole neurological and psychological evolution of species, and be centered on emotions and their vicissitudes. (shrink)

Objectives: The mental health legislation of most developed countries includes either a dangerousness criterion or an obligatory dangerousness criterion (ODC). A dangerousness criterion holds that mentally ill people may be given treatment without consent if they are deemed to be a risk to themselves or others. An ODC holds that mentally ill people may be given treatment without consent only if they are deemed to be a risk to themselves or others. This paper argues that the dangerousness criterion is (...) unnecessary, unethical and, in the case of the ODC, potentially harmful to mentally ill people and to the rest of the community. Methods: We examine the history of the dangerousness criterion, and provide reasoned argument and empirical evidence in support of our position. Results: Dangerousness criteria are not required to balance the perceived loss of autonomy arising from mental health legislation. Dangerousness criteria unfairly discriminate against the mentally ill, as they represent an unreasonable barrier to treatment without consent, and they spread the burden of risk that any mentally ill person might become violent across large numbers of mentally ill people who will never become violent. Mental health legislation that includes an ODC is associated with a longer duration of untreated psychosis, and probably contributes to a poorer prognosis and an increase risk of suicide and violence in patients in their first episode of psychosis. Conclusions: Dangerousness criteria should be removed from mental health legislation and be replaced by criteria that focus on a patient’s capacity to refuse treatment. (shrink)

ArgumentThe Minnesota Multiphasic Personality Inventory (MMPI) was developed at the University of Minnesota, Minneapolis, in the 1930s and 1940s. It became a highly successful and highly controversial psychometric tool. In professional terms, psychometric tools such as the MMPI transformed psychology and psychiatry. Psychometric instruments thus readily fit into the developmental history of psychology, psychiatry, and neurology; they were a significant part of the narrative of those fields’ advances in understanding, intervening, and treating people with mental illnesses. At the same (...) time, the advent of such tools also fits into a history of those disciplines that records the rise of obsessional observational and evaluative techniques and technologies in order to facilitate patterns of social control that became typical during the Progressive Era in the United States and after. It was those patterns that also nurtured the resistance to psychometrics that emerged during the Vietnam War and after. (shrink)

B a c k g r o u n d. The article demonstrates the development and influence of the main diagnostic systems in psychiatry, such as the DSM and the ICD, on the concept of psychiatric diseases. The problem of classification of psychiatric disorders is one of the main topics that is the field of study of the philosophy of psychiatry. The correct diagnosis within a particular diagnostic system directly affects the choice of appropriate drug treatment, psychotherapy and social support (...) for people suffering from mental disorders. Misdiagnosis has not only negative medical but also social consequences, leading to stigmatization and avoidance of people suffering from mental disorders. M e t h o d s. The research uses an integrated approach to the analysis of psychiatric diagnostic systems, including historical, comparative and interdisciplinary methods. The application of the historical method contributed to a detailed study of the evolution of psychiatric diagnostic systems and changes in approaches to the classification of mental disorders. A comparative analysis of the main diagnostic systems was carried out, considering their structure, diagnostic criteria and interaction. The interdisciplinary method involves the integration of knowledge from psychiatry, philosophy, medical history, cultural studies, and psychology, providing a deep understanding of the medical, philosophical, social, and cultural aspects of mental disorders. R e s u l t s. The article analyzes the historical development of ideas and methodology for the classification of mental disorders from ancient Greece to the present. From Hippocrates and Plato to Sydenham, Kabanis, Pinel, and Eskierol, the authors trace the evolution of understanding of mental disorders, emphasizing the shift in emphasis from etiological theories to more descriptive and categorical models. The authors describe the current state of the DSM and ICD classification systems, which play a dominant role in psychiatric science and subsequent social support and welfare for people suffering from mental disorders. Changes that have occurred in these systems and their impact on psychiatric practice and research are discussed. Considerable emphasis is placed on the history of the diagnosis of post-traumatic stress disorder (PTSD), which becomes a symbolic indicator of the complexities and challenges associated with the modern classification of mental illness. The authors consider the phenomenological method as a tool for a deeper understanding of PTSD, especially in the context of the constant psychotraumatic factors of war, the consequences of which generate new challenges for Ukrainian psychiatric practice. The authors present a case study using the phenomenological approach to diagnose PTSD, which demonstrates the need for a detailed analysis of patients' internal experience for accurate diagnosis and effective treatment. C o n c l u s i o n s. The conclusions emphasize the importance of integrating philosophical methods into the diagnosis and analysis of mental illness in clinical practice. The authors call for the development of interdisciplinary research involving both philosophers and mental health professionals to develop more detailed and person-centered approaches to the diagnosis and treatment of mental disorders. (shrink)

Now available in a Harper Colophon edition, this classic book has revolutionized thinking throughout the Western world about the nature of the psychiatric profession and the moral implications of its practices. Book jacket.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.4 (2003) 369-372 [Access article in PDF] Unity of Agency and Volition:Some Personal Reflections Stephen Weiner The issues of unity of agency, self-as-narrative, and more generally, volition are highly personal to me. Indeed, I would say I have frequently been obsessed with them. I am 52 years old, and date the onset of my psychiatric symptoms—my long-term misery—very specifically: 11:00 pm Pacific Standard Time, August (...) 28, 1965. At almost precisely that time, I started obsessing that I was homosexual and, in fact, turning into a girl. Within days, derealization followed: for instance, the houses in my neighborhood seemed one-dimensional—they seemed as though they were painted, as though I could stick my hand or an object through them. Colors seemed less bright as well—but I hardly had words for all this at the time: it was an overwhelmingly preverbal feeling, but I found some words for it.I was also depressed, and knew I was depressed—that is, I was worried, had trouble sleeping, and had suicidal thoughts and feelings. Within weeks, I asked my parents if I could see a psychiatrist, and I did. I remember asking my psychiatrist if he ever thought about the possibility that everything might be an illusion, and he quoted the refrain from "Row, Row, Row Your Boat": "merrily, merrily, merrily, merrily, life is but a dream." But just asking him produced a chilling feeling that he did not exist and, largely for this reason, I did not mention unreality feelings again to therapists for another 20 years.So, like Dr. Wells' patient Edward, described by James Phillips (2003), I was in trouble; like Edward, I was starting to construct a narrative. I started feeling that I had "to tell my story" at about this time—before then, I had not felt a need to do that. That may be partly because young children take life for granted (at least, I did), and it may be partly because suffering, by its very nature, demands explanation; both reasons were probably operating—certainly, both my parents told me years later that I had seemed emotionally distressed as a child, and my mother told they would have given me Ritalin if it had been available. So, to other people (my parents and my teachers) I was mentally ill in some sense, and I have some pretty clear memories of what I now recognize as depression, especially in the second and third grades; but I did not think of myself as sick and I did not think of myself as suffering—and I did not experience the duality (at least) of selves that I started to experience almost immediately in August 1965.Phillips further points out that the "future Edward" could look back in his narrative, at a later age, and reconstruct his history either as someone with a continuing mental illness, or as someone who had attained a secure, healthy adulthood and saw his experience as adolescent pain in the service of ultimate adult health and integration. I see my story, I am sorry to report, as [End Page 369] one of unremitting basic pain but with the positive dimension that I was able to go on, obtain a good education, work a good deal in my adult life, and father a child. But my narrative—and am I not, as a highly verbal person, almost constrained to think of my life as a narrative?—has been one, as Phillips (following Kleinman) realizes, of suffering. It is, above all else, an illness narrative. I find the approach of J. Melvin Woody (2003)—of privileging performing and performing arts and spatial metaphors over story—less relevant and true to myself, although I see no reason to argue with Mary's preference for such forms. It may be that the temporal discontinuities she has experienced predispose her to see herself in such terms—may, in fact, necessitate doing so. I am not exactly sure why, but it probably has to do with acting, with trying on and performing one role... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.4 (2003) 369-372 [Access article in PDF] Unity of Agency and Volition:Some Personal Reflections Stephen Weiner The issues of unity of agency, self-as-narrative, and more generally, volition are highly personal to me. Indeed, I would say I have frequently been obsessed with them. I am 52 years old, and date the onset of my psychiatric symptoms—my long-term misery—very specifically: 11:00 pm Pacific Standard Time, August (...) 28, 1965. At almost precisely that time, I started obsessing that I was homosexual and, in fact, turning into a girl. Within days, derealization followed: for instance, the houses in my neighborhood seemed one-dimensional—they seemed as though they were painted, as though I could stick my hand or an object through them. Colors seemed less bright as well—but I hardly had words for all this at the time: it was an overwhelmingly preverbal feeling, but I found some words for it.I was also depressed, and knew I was depressed—that is, I was worried, had trouble sleeping, and had suicidal thoughts and feelings. Within weeks, I asked my parents if I could see a psychiatrist, and I did. I remember asking my psychiatrist if he ever thought about the possibility that everything might be an illusion, and he quoted the refrain from "Row, Row, Row Your Boat": "merrily, merrily, merrily, merrily, life is but a dream." But just asking him produced a chilling feeling that he did not exist and, largely for this reason, I did not mention unreality feelings again to therapists for another 20 years.So, like Dr. Wells' patient Edward, described by James Phillips (2003), I was in trouble; like Edward, I was starting to construct a narrative. I started feeling that I had "to tell my story" at about this time—before then, I had not felt a need to do that. That may be partly because young children take life for granted (at least, I did), and it may be partly because suffering, by its very nature, demands explanation; both reasons were probably operating—certainly, both my parents told me years later that I had seemed emotionally distressed as a child, and my mother told they would have given me Ritalin if it had been available. So, to other people (my parents and my teachers) I was mentally ill in some sense, and I have some pretty clear memories of what I now recognize as depression, especially in the second and third grades; but I did not think of myself as sick and I did not think of myself as suffering—and I did not experience the duality (at least) of selves that I started to experience almost immediately in August 1965.Phillips further points out that the "future Edward" could look back in his narrative, at a later age, and reconstruct his history either as someone with a continuing mental illness, or as someone who had attained a secure, healthy adulthood and saw his experience as adolescent pain in the service of ultimate adult health and integration. I see my story, I am sorry to report, as [End Page 369] one of unremitting basic pain but with the positive dimension that I was able to go on, obtain a good education, work a good deal in my adult life, and father a child. But my narrative—and am I not, as a highly verbal person, almost constrained to think of my life as a narrative?—has been one, as Phillips (following Kleinman) realizes, of suffering. It is, above all else, an illness narrative. I find the approach of J. Melvin Woody (2003)—of privileging performing and performing arts and spatial metaphors over story—less relevant and true to myself, although I see no reason to argue with Mary's preference for such forms. It may be that the temporal discontinuities she has experienced predispose her to see herself in such terms—may, in fact, necessitate doing so. I am not exactly sure why, but it probably has to do with acting, with trying on and performing one role... (shrink)

This chapter contains sections titled: Heidegger and the History of Truth Foucault and the History of Truth: First Pass Foucault and the History of Truth: Second Pass References.

_2015 Gradiva Award Winner_ _Clinical Implications of the Psychoanalyst’s Life Experience_ explores how leaders in the fields of psychoanalysis and psychotherapy address the phenomena of the psychoanalyst’s personal life and psychology. In this edited book, each author describes pivotal childhood and adult life events and crises that have contributed to personality formation, personal and professional functioning, choices of theoretical positions, and clinical technique. By expanding psychoanalytic study beyond clinical theory and technique to include a more careful examination of the psychoanalyst’s (...) life events and other subjective phenomena, readers will have an opportunity to focus on specific ways in which these events and crises affect the tenor of the therapist’s presence in the consulting room, and how these occurrences affect clinical choices. Chapters cover a broad range of topics including illness, adoption, sexual identity and experience, trauma, surviving the death of one’s own analyst, working during 9/11, cross cultural issues, growing up in a communist household, and other family dynamics. Throughout, _Steven Kuchuck_ shows how contemporary psychoanalysis teaches that it is only by acknowledging the therapist’s life experience and resulting psychological makeup that analysts can be most effective in helping their patients. However, to date, few articles and fewer books have been entirely devoted to this topic. _Clinical Implications of the Psychoanalyst’s Life Experience_ forges new ground in exploring these under-researched areas. It will be essential reading for practicing psychoanalysts, psychotherapists, psychologists, social workers, those working in other mental health fields and graduate students alike. (shrink)

Exactly when Philosophy of Psychiatry started as a subfield of Philosophy is hard to say. There are several different estimates of how old psychiatry itself is, from one hundred to three hundred years, and of course there has been discussion and treatment of mental illness for at least a couple of thousand years. A host of issues which could count as belonging to the field have been discussed just within the last hundred years. For instance, a large literature on (...) the philosophy of psychoanalysis dates back to the beginning of the century, and in the last thirty years there has been discussion of amnesia and multiple personality in the philosophy of mind, bioethical debate about involuntary hospitalization and the ability of the mentally ill to give informed consent to drug trials, and recent continental philosophy has shown much interest in madness, civilization, capitalism and schizophrenia. However, I suggest that Philosophy of Psychiatry reached a sense of itself as a separate field only in the 1990s. In this time, it has gained its own association, journal, and a book series with a prestigious press. I refer to the American Association for Philosophy and Psychiatry, the associated journal, Philosophy, Psychiatry, and Psychology, and the MIT Press series, Philosophical Psychopathology: Disorders of Mind, edited by Owen Flanagan and George Graham. Jennifer Radden's Divided Minds and Successive Selves is the first book in that series. (shrink)

From nursing's history comes the impetus and grounding for our current voice in gender/trans dialogue. Modern nursing struggled its way into being against restrictive, unjust, and oppressive social structures. Many of the obstructions and constraints that nurses and nursing leaders faced were shared by the general populace of women, and yet nurses were different from other women. Nurses worked outside the home, caring for strangers, including unrelated men, in a period when women were otherwise confined to the home. Nurses fought (...) for women's suffrage, for child labor laws, for the welfare of factory workers, for garment workers, for unionization, for vaccination, for housing reform, for the humane treatment of mentally ill persons, for access to birth control, for the amelioration of a panoramic terrain of terrible social injustices, and for the control of nursing education, registration, and practice. For 150 years, nursing has been intrinsically, practically, and politically feminist. The hard‐fought gains would eventually position nursing in tension with emerging trans issues. And yet, its history is exactly what situates nursing for fruitful participation in the developing trans discourse and to address issues of transinvisibility and unjust social and health structures that impede dignified and respectful health care. (shrink)

Revisiting the history of postwar LSD (lysergic acid diethylamide) research illuminates how the work of a chemist at the Rockefeller Institute contributed to the development of a biochemical paradigm for mental functioning. Dilworth Wayne Woolley proposed one of the first theories of the biochemistry of mental illness based on empirical evidence. His research with LSD and serotonin had wide-ranging repercussions for pharmacology and fit neatly into the emerging medicalization of mental illness. Reevaluating Woolley’s ideas and the fruits (...) of psychopharmacology leads to possible new approaches toward mental health and illness when considered alongside lessons learned from past research with psychedelic substances, and exemplifies a broader paradigm shift in cultural studies toward a biopsychosocial model that acknowledges the intersections between biology and culture. (shrink)

Personal recovery entails the idea of learning to live a good life in the face of mental illness. It takes place in a continuous dynamic between change and acceptance and involves the existential dimension in the broadest sense. With cognitive self-regulation and empowerment as central elements, however, current models of recovery mostly have an individual focus instead of a relational one. Furthermore, there seems to be an emphasis on the component of change. Little attention is payed to the role (...) and integration of dealing with loss in personal recovery. In this paper, the role of loss in mental illness will be elaborated from an existential perspective. This will be done by relating existential changes to possibly disruptive experiences of loss in wider experience. With the help of several perspectives on dealing with loss it will be argued this can be integrated in processes of recovery. Then, it will be elaborated how reexperiencing a state of being surrounded, or being included, being held is a necessary part of recovery. The result consists of a refinement of the view on personal recovery. The aim of this paper is therefore twofold: (1) to arrive at a better understanding of what existential loss and loss in wider experience in the context of psychopathology entails, and (2) to further develop perspectives on recovery in mental health care. (shrink)

The aim of this study was to identify and analyse ethical decision making in the home care of persons with long-term mental illness. A focus was placed on how health care workers interpret and deal with the principle of autonomy in actual situations. Three focus groups involving mental health nurses who were experienced in the home care of persons with chronic mental illness were conducted in order to stimulate an interactive dialogue on this topic. A constant comparative (...) analysis of the transcribed audiotaped sessions identified a central theme that concerned the moral symbolic meaning of ‘home’. This reflected the health care workers’ conflict between their professional role and their moral role, which they perceived as unclear. (shrink)

In recent years, the homeless population has received much attention as authorities attempt to comprehend this phenomenon and offer solutions. When striving to establish a relationship with the homeless person, many problems arise. We encounter this dilemma when respecting the right of the mentally ill to dwell neglected in the streets and simultaneously observe their inability to comprehend provisions such as housing, shelter, medical and mental care which contribute to their human dignity. The polarities of autonomy versus involuntary treatment (...) are highlighted when treating the homeless population. (shrink)

ArgumentSociologists and historians have long favored externalist over internalist accounts of practices in the clinical disciplines. This has been particularly true in the case of the so-called new patient or borderline personality, which a range of commentators have located in culturally resonant narratives of decline. I argue here that these narratives, while pleasing, do not hold up as history; most problematic is their assumption that the appearance of the borderline portends the emergence of altogether novel forms of modal personhood. Internalist (...) accounts of the category's consolidation are equally problematic in asserting a coherence and a stable referent that repeatedly proves elusive. In the end, I suggest that a complex account of disciplinary practice that attends to knowledge production in the clinical encounter supports the conclusion that the new patient was new to psychoanalysis. Whether or not he was altogether new cannot be established, undermining the critics' certitude and prophecies of decline. (shrink)

During the Nazi regime (1933–1945), more than 300 000 psychiatric patients were killed. The well‐calculated killing of chronic mentally ‘ill’ patients was part of a huge biopolitical program of well‐established scientific, eugenic standards of the time. Among the medical personnel implicated in these assassinations were nurses, who carried out this program through their everyday practice. However, newer research raises suspicions that psychiatric patients were being assassinated before and after the Nazi regime, which, I hypothesize, implies that the motives for these (...) killings must be investigated within psychiatric practice itself. An investigation of the impact of the interplay between the notes left by nurses and those by psychiatrists illustrates the active role of the psychiatric medical record in the killing of these patients. Using theoretical insights from Michel Foucault and philosopher Giorgio Agamben and analyzing one part of a particularly rich patient file found in the Langenhorn Psychiatric Asylum in the city of Hamburg, I demonstrate the role of the record in both constructing and deconstructing patient subjectivities. De‐subjectifying patients condemned them to specific zones in the asylum within which they were reduced to their ‘bare life’‐ a precondition for their physical assassination. (shrink)

Introduction. Eating Disorders (EDs) are serious psychiatric disorders, impacting physical and psychosocial functioning, often with a chronic course and high mortality rates. The two continua model of mental health states that mental health is a complete state, that is not merely the absence of mental illness, but also the presence of mental health. This model was studied among ED patients by comparing the levels of well-being to the Dutch general population and by examining the of well-being (...) and psychopathology. Method. A total of 468 female ED patients participated in this study during application and intake at a specialized ED treatment centre in the Netherlands. They filled out questionnaires about well-being (MHC-SF), general psychopathology (OQ-45), and ED psychopathology (EDE-Q). Categorical and mean well-being levels were calculated. Also, the correlates of these variables were examined with Pearson correlation and multiple hierarchical regression analysis. Results. ED patients showed lower levels of emotional, psychological and social well-being on average compared to the general population. About 26% of the ED patients experienced low levels of well-being (languishing). However, also 13% experienced high levels of well-being (flourishing), varying between 9% in Anorexia Nervosa to 25% in Binge Eating Disorder. ED psychopathology and general well-being showed a moderate negative correlation. For patients with Bulimia Nervosa and Binge Eating Disorder however no such correlation was found. Lower general psychopathology, not having a history of hospitalization for the ED, and adaptive personal functioning were correlated with well-being among ED patients. Conclusion This study shows initial support for the two continua model of mental health among ED patients. Psychopathology and well-being should be considered as related, but distinct dimensions of mental health in ED patients. Further research should focus on the possible reciprocal relationships between psychopathology and well-being during recovery. It is recommended to monitor well-being during treatment and to implement interventions for well-being to realize complete recovery for those patients with inadequate levels of well-being. (shrink)

Deep brain stimulation (DBS) represents a promising new frontier in medicine and neuroscience for managing disorders of mental health that represent an enormous burden of disease on our societies. The caution and significant restraint of leaders in the evolution of DBS today stand in sharp and refreshing contrast to previous episodes in history. In embracing the anticipatory and pragmatic problem-solving approach of neuroethics to clinical neuroscience, four significant paradoxes for DBS today come to the fore: caution and innovation, capacity (...) and allocation of resources, notions of wellness and disease, and the high-stakes/high-benefit imperative of communicating about science. Tackling these paradoxes is the focus of this article. (shrink)

This book is psychiatry's reply to the diverse group of antipsychiatrists, including Laing, Foucault, Goffman, Szasz and Bassaglia, that has made fashionable the view that mental illness is merely socially deviant behaviour and that psychiatrists are agents of the capitalist society seeking to repress such behaviour. It establishes, by the use of evidence from historical and transcultural studies, that mental illness has been recognised in all cultures since the beginning of history and goes on to explore the philosophical (...) and medical basis for psychiatry's diagnosis and treatment of mental illness. Finally, it tackles two issues where psychiatry has recently been seen as at odds with the values prevailing in society: involuntary hospitalization and the insanity defence. The Reality of Mental Illness does not pretend to offer simple answers to the complex problems it discusses, but will leave the reader with a much greater understanding of psychiatry's aims, practices and problems. (shrink)

This seminal early work of Foucault is indispensable to understanding his development as a thinker. Written in 1954 and revised in 1962, _Mental Illness and Psychology _delineates the shift that occurred in Foucault's thought during this period. The first iteration reflects the philosopher's early interest in and respect for Freud and the psychoanalytic tradition. The second part, rewritten in 1962, marks a dramatic change in Foucault's thinking. Examining the history of madness as a social and cultural construct, he moves outside (...) of the psychoanalytic tradition into the radical critique of Freud that was to dominate his later work. _Mental Illness and Psychology _is an important document tracing the intellectual evolution of this influential thinker. A foreword by Foucault scholar Hubert Dreyfus situates the book within the framework of Foucault's entire body of work. (shrink)