In general, in our ordinary life, we manage to make the difference between “strange” behavior and error or extravagant beliefs. The question is here to know how we do so, and against what background. There are also specialized contexts for evaluating whether certain types of behavior or discourse are normal or abnormal: courts of law and psychiatric hospitals are two examples. In these contexts, judgments are formed against a background of technical or scientific knowledge, but they also result from epistemic (...) means of evaluation that are similar to habitual ones. The paper seeks to highlight this similarity with respect to recognizing mental disturbance. Starting from Wittgenstein’s On Certainty, it attempts at extending it by drawing on notions of reciprocal perspectives and of judgments of incongruity. It documents its investigation by analyzing sequences from Malek Bensmail’s documentary, Aliénations, which examines the treatment of mental suffering in contemporary Algeria. (shrink)

Wittgenstein likens philosophy both to an illness and to a therapy. The reflections he dedicates to mental disturbance in On Certainty shed some light on this ambivalence, by pointing at the intertwined themes of common sense, doubt, mistake, reasonableness, and normality. Wittgenstein’s remarks have sometimes been compared to the description of the symptoms of what psychopathologists have called the loss of natural self-evidence, or the loss of common sense. Besides briefly recalling some of the outcomes of this debate (...) in literature, I focus on Wittgenstein’s conception of “hinges”, the basic practical certainties which patients suffering from the loss of common sense seem to lack. By working on this comparison, I offer an interpretation of Wittgenstein’s idea of philosophy that clarifies both its insane and its therapeutic side. (shrink)

In his article, “Wittgenstein and Basic Moral Certainty,” Nigel Pleasants argues that killing an innocent, non-threatening person is wrong. It is, he argues, “a basic moral certainty.” He believes our basic moral certainties play the “same kind of foundational role as [our] basic empirical certaint[ies] do.” I believe this is mistaken. There is not “simply one kind of foundational role” that certainty plays. While I think Pleasants is right to affiliate his proposition with a Wittgensteinian form of certainty, he exposes (...) himself to a tension that exists in On Certainty regarding how we acquire it: is certainty natural, is it social? In this paper, I present two ways in which we come to possess certainty: a bottom-up approach, where certainty is part of our instinctual predisposition, and a top-down approach, where certainty is acquired through positive reinforcement by family and culture. (shrink)

The subjective experience of time is a fundamental constituent of human consciousness and can be disturbed under conditions of mental disorders such as schizophrenia or affective disorders. Besides the scientific domain of psychiatry, time consciousness is a topic that has been extensively studied both by theoretical philosophy and cognitive neuroscience. It can be shown that both approaches exemplified by the philosophical analysis of time consciousness and the neuroscientific theory of cross-temporal contingencies as the neurophysiological basis of human consciousness implemented (...) in the prefrontal cortex converge in 2 respects. Firstly, a tripartite conception of consciousness divides human cognition in 3 different temporal domains comprising retention, presentation, and protention and the past, the present, and the future corresponding to working memory, interference control, and preparatory set. Secondly, both concepts refer to the present as an extended duration that integrates information from the recent past and the future. We propose that the integration of phenomenological and neuroscientific approaches can stimulate the development of enriched pathophysiological concepts of mental disorders. This approach appears to be particularly fruitful with respect to schizophrenia that is interpreted as a structural disturbance of time consciousness. (shrink)

Mental health, in one awake, guarantees that person knowledge of the central phenomenon-contents of his own mind, under an adequate classificatory heading. This is the primary thesis of the paper. That knowledge is not itself a phenomenon-content, and usually is achieved in no way. Rather, it stems from the natural accessibility of mental phenomenon-contents to wakeful consciousness. More precisely, when mental normality obtains, such knowledge necessarily obtains in wakeful consciousness. This thesis conjoins a version of Cartesianism with (...) the concepts of mental health and human nature. Demonstration of the thesis requires that we show that a particular human mental potential fails fully to be realized when such self-awareness is impaired. That potential is for consciousness of the world (w-Cs), wakefulness. W-Cs divides into consciousness of the outer world (ow-Cs), and consciousness of the inner world (iw-Cs), and we need to demonstrate an essential dependence of ow-Cs upon iw-Cs. Now w-Cs is the adoption of the correct occurrent epistemological posture to the world, and this involves free rational determination of occurrent cognitive attitudes via the internal systematized knowledge of the world, which requires adequate awareness of mental phenomenon-contents. Therefore ow-Cs needs iw-Cs. This is displayed in mental structural accounts of hypnotic, drunken, and psychotic disturbances of consciousness. (For we endorse a structural account of mental health.) We show how failures of self-consciousness entail disturbed modes of determination of cognitive attitudes by the knowledge-system, which is loss of contact with the personal yet true internal representation of the world, which is loss of contact with reality, which is a disturbance both of w-Cs and of consciousness itself. (shrink)

The interface between mental health services and the criminal justice system presents challenges both for professionals and patients. Both systems are stressed and inherently complex. Section 136 of the Mental Health Act is unusual being both an aspect of the Mental Health Act and a power of arrest. It has a long and controversial history related to concerns about who has been detained and how the section was applied. More recently, Section 136 has had a public profile (...) stemming from the use of police cells as places of safety for young, mentally disturbed individuals. This paper explores the current state of health of this piece of legislation. Specifically, we consider whether alternative approaches are more suitable for those individuals in crisis and/or distress who come into contact with the police. This requires careful thought as to the proper role of both health and criminal justice professionals who are daily grappling with an ethically contentious domain of multiagency work. (shrink)

Teachers face significant stressors in relation to their work, placing them at increased risk for burnout and attrition. The COVID-19 pandemic has brought about additional challenges, resulting in an even greater burden. Thus, strategies for reducing stress that can be delivered virtually are likely to benefit this population. Mental and Physical (MAP) Training combines meditation with aerobic exercise and has resulted in positive mental and physical health outcomes in both clinical and subclinical populations. The aim of this pilot (...) study was to evaluate the feasibility and potential effectiveness of virtual MAP Training on reducing stress and improving mood and well-being in teachers. Participants (n= 104) were from recruited online from kindergarten to grade twelve (K-12) schools in the Northeastern region of the United States and randomly assigned to a 6-week program of virtual MAP Training (n= 58) or no training (n= 13). Primary outcomes included pre-intervention and post-intervention ratings on self-report measures of social and emotional health. Changes in cognitive functioning and physical health were also examined in secondary analyses. By intervention end, participants in the MAP Training group reported less anxiety and work-related stress compared to those who received no training (ds = −0.75 to −0.78). Additionally, MAP Training participants reported improvements in depressive symptoms, rumination, work-related quality of life, perceived stress, and self-compassion (ds = 0.38 to −0.82), whereas no changes were observed in the no training group. Participants also reported increased subjective ratings of executive functioning, working memory, cognitive flexibility, and fewer sleep disturbances (ds = −0.41 to −0.74). Together, these results suggest that the combination of meditation and aerobic exercise is an effective virtual intervention for improving mental health and well-being among K-12 teachers and may enhance resilience to stressful life events such as occurred during the coronavirus pandemic. (shrink)

In his account of Pyrrhonism, Sextus Empiricus talks about the disturbance concerning matters of opinion that afflicts his dogmatic rivals and that he himself was afflicted by before his conversion to Pyrrhonism. The aim of the present paper is to identify the distinct sources of doxastic disturbance that can be found in that account, and to determine whether and, if so, how they are related. The thesis to be defended is that it is possible to discern three sources (...) of doxastic disturbance and that two of them are to be explained by reference to the third, which is the real cause of mental distress. The paper also considers whether the thesis in question entails that there is no reason for the Pyrrhonist to suspend judgment across the board, but only to suspend judgment about evaluative matters. (shrink)

Mental health acts allow for interference with the liberty of the individual. As such, they serve as test cases for theories of liberty, and thus the question of what Mill would think about them arises. My aim is to answer this question. I argue that Mill would embrace mental health acts to protect mentally disturbed individuals from themselves and others from them, and that they should have broad admission criteria, allow capable patients to refuse treatment, and have treatment (...) decisions made by patients or their families on the basis of substituted judgements rather than representatives of the state acting on best interest judgements. This interpretation will show that many writers who claim Mill's support cannot properly do so. It is also a combination of views that cannot be readily found in mental health acts themselves, but which, as Mill's reasons for it show, is a serious candidate for legislative adoption. (shrink)

Often understood as a dissolution of the ego, mental illness implies a process of deconstruction where the psychotic faces the most frightening limits one can encounter: the limits of perception, the limits of understanding, the limits of vulnerability, and above all, the limits of intersubjectivity. The present paper aims to explore mental illness phenomenologically, taking it as both a limited and an unlimited experience of intersubjectivity. On the one hand, mental illness is widely regarded as a limited (...) experience of intersubjectivity, for it alters and hence limits access to the Other. But on the other hand, it can equally be taken as an unlimited experience of intersubjectivity, because it opens up a new world to the psychotic that can be transposed into and improved through artistic expression. The present article will bring together these two dimensions in order to reflect on the limits of experience in general. To do so, I will first address the clinical studies of the analyst Marguerite Sechehaye and of Rosemarie Samaritter. By retracing Marguerite Sechehaye’s deconstruction of the ego in a case of schizophrenia that she successfully treated, I attempt to circumscribe three distinctive experiential layers that have been disturbed by her patient’s mental illness: (1) the affective layer, (2) the symbolic layer, and (3) the kinesthetic layer, which is indicative of the fact that our spatial presence and body movements are constitutive elements of our sense of self and of our being in the world. Second, I will focus on the relationship between art and schizophrenia, and subsequently on the limits of experience that a psychotic transcends when undergoing his/her illness. (shrink)

PERRON A and HOLMES D. Nursing Inquiry 2011; 18: 191–204Constructing mentally ill inmates: nurses’ discursive practices in correctionsThe concepts of discourse, subjectivity and power allow for innovative explorations in nursing research. Discourse take many different forms and may be maintained, transmitted, even imposed, in various ways. Nursing practice makes possible many discursive spaces where discourses intersect. Using a Foucauldian perspective, were explored the ways in which forensic psychiatric nurses construct the subjectivity of mentally ill inmates. Progress notes and individual interviews (...) constitute discursive spaces within which nurses construct patients’ subjectivities. Progress notes provide a written (and permanent) form of discourse, while interviews set the space for a more fluid and contextual form of discourse. We identified five types of subjectivities – the (in)visible patient, the patient as risk, the deviant patient, the disturbed patient and the disciplined patient. These subjectivities were rooted in various types of discourses circulating in the selected setting. Despite the multiple discursive dimensions of forensic psychiatric nursing, progress notes remain the main formal source of information regarding nursing care even though it is not representative of the care provided nor is it representative of nurses’ complex discursive practices in corrections. (shrink)

While the UK Home Office’s proposals to preventively detain people with what it has called dangerous severe personality disorder have been subjected to debate and criticism the deeply troubling jurisprudential issues in these proposals have not yet entered into public debate in a way that their seriousness deserves.1 It is good that a commentator as well known as Professor Szasz is speaking out on this issue.Professor Szasz focuses upon a crucial question by calling into question the medicalisation of terms like (...) dangerousness and mental illness.2 There is a great temptation for legislators and the public to treat these terms as if they are purely scientific terms and to think of risk assessment as a precise science. I don’t share Professor’s Szasz’s worry about how psychiatry is using these terms but I think there are some important questions about how these concepts function in the public sphere.This issue is important enough to justify the use of some rhetorical claims because such claims can serve to bring out what are neglected and important issues. In raising the following objections I am not attempting to refute the message that is in Szasz’s article or to say that he is not making an important point but rather to attempt to sharpen the issues and to suggest ways that we can respond to Professor Szasz’s challenge.Psychiatry has progressed in a number of ways since Professor Szasz wrote The Myth of Mental Illness.3 The science is much better, we have much better medications, and psychiatrists are acutely aware of the tension between treating their patient and their obligations to the public interest.So when Professor Szasz says: “Psychiatrists offer to relieve the disturbed person of the burden of coping …. (shrink)

The maternal deprivation hypothesis was arguably the most discussed debate in midcentury psychiatry. Combined with the gender ideology prevalent in America and Britain, it solidified the idea that the mother-child relationship had formative influence on personality development. This essay explores the formation of this hypothesis by situating its knowledge claims against an institutional innovation set to prevent juvenile delinquency and promote mental hygiene, the establishment of child guidance clinics on both sides of the Atlantic in the late 1920s. It (...) then tracks the development of investigative agendas by child guidance practitioners, examining the practices they adopted to construct psychological knowledge claims in conformity with preventive objectives and positivist standards. Shifting the historiographical focus toward the clinical scenes in which psychological assertions were made, the essay examines how investigators sought to determine the “pathogenic” influence of early parental environment by way of estimating its emotional qualities. It argues that it was this positivist-determinist effort to achieve preventive goals that foregrounded the role of the mother in the etiology of personality disturbance and marked the knowledge field that came to be called the maternal deprivation debate. (shrink)

The DSM–5 characterizes mental disorders as significant disturbances in cognition, emotion, or behavior. But what might unite the disturbances on this list? We hypothesize that mental disorders can all be meaningfully characterized as failures of attention. We understand these as failures to distribute attention in the way one has most reason to, and we include both failures of tendency and of ability. We discuss six examples of mental disorders and offer a preliminary gloss of how to recast (...) each as centrally involving a failure of attention. We close by highlighting theoretical and practical upshots of our proposal. (shrink)

A growing number of theorists have looked to the enactivist approach in philosophy of mind or the affordance-based approach from ecological psychology to make sense of a wide variety of phenomena; some theorists believe that these theoretical accounts can offer rich insights about the nature of mental disorders, their etiology, and their characteristic symptoms. I argue that theorists who adopt such approaches also should embrace the further claim that all mental disorders are affective disorders. First, enactivist accounts of (...) mental disorder push us toward such a view insofar as they characterize such conditions in terms of disordered sense-making and conceptualize sense-making as fundamentally affective. Second, conceptions of mental disorder that emphasize affordance perception likewise motivate such a view insofar as they highlight the role that affectivity plays in the disclosure of action possibilities. What is more, both sense-making and affordance disclosure are best understood as processes of selective attention and responsiveness that rely heavily on affectivity. To illustrate and support these claims, I discuss how (a) language disturbances in schizophrenia and (b) “context blindness” in autism both result from disruptions to affectivity and selective attention that make it difficult for subjects to engage effectively with relevant affordances. (shrink)

I strongly endorse many of the suggestions made by the authors of the extremely useful reviews in this issue. In particular, the need to identify the complex causal mechanisms underlying the major health risk factors requires urgent attention of the research community. I suggest considering the important role of emotional disturbances as contributors to health risks given the empirically established comorbidity between mental and somatic illness. Better knowledge of these mechanisms is an essential prerequisite to develop tailored personalized prevention (...) and intervention programs, including reliable and valid assessment of deficits. (shrink)

Mental health has been declared as the essential component of overall human wellbeing. However, there has been a very steep rate of depression and anxiety in students that exhibit their social and personal burdens. It has been widely accepted that the wellbeing and mental health of individuals are a mix of psychological, genetic, social, lifestyle factors, and environmental exposure. Due to the pandemic, the shift from traditional classroom learning to e-learning has also disturbed the mental health of (...) students, which consequently affects environmental stability. The current study has also measured the effect on the mental health of e-learning behaviors. The population of the study was the undergraduate students enrolled in the colleges of China, and they were chosen via convenient sampling. The findings of the study show that mental health has a significant positive effect on the e-learning behavior of the students and consequently affects environmental sustainability. Educational institutions are improving their e-learning programs by understanding the preferences and challenges of students regarding online learning. Educational institutions should revise their policies on online education and teaching methodologies. Furthermore, the current study has taken undergraduate students as the sample. In future studies, these relationships can be checked in higher education as well. (shrink)

The COVID-19 pandemic outbreak has led to a general reorganization of health services and an increase in outpatient telemedicine in mental healthcare for physically ill people. Current literature highlights facilitators and obstacles concerning the use of new technologies in psychotherapy, an underrated topic of research in the context of supportive expressive psychotherapy. More insight is needed to explore the characteristics of video in therapeutic alliance for treatment of specific mental disorders experienced in psychosomatics, particularly with people suffering from (...) a disturbed body- and self-image. Using two clinical vignettes, it is the authors’ intention to enrich the critical debate on current knowledge in psychosomatic remote psychotherapy, with special focus on mentalization deficits and their impact on therapeutic alliance in the consultation-liaison psychiatry setting. In particular, we will question the interpersonal processes at stake related to mirroring and the disruption caused by the use of videoconference applications. We will also reflect upon the relationship between the therapeutic alliance and the medical team, and that between patient and psychotherapist. The aim is to improve psychotherapeutic alliance maintained during the pandemic for specific mental disorders and to inform about possible clinical factors that could be the subject of future empirical studies or professional guidelines. (shrink)

Background: The purpose of the current study was to assess the prevalence of sleep disturbances among Chinese people during the COVID-19 pandemic in a large national survey, analyze the relationship between sleep disturbances and mental health status, and explore the influencing factors of the relationship between sleep disturbances and mental health status.Methods: An online survey was accessed by 19,740 people throughout China from February 14 to 21, 2020. The survey included the Depression Anxiety Stress Scale-21 to measure psychological (...) distress and two questions about sleep disturbances. Logistic regression analyses and moderation analysis were performed.Results: Among the 14,505 respondents included in analyses, 3,783 reported sleep disturbances at least 3 days during the past week. Sleep disturbances increased the risk of depression, anxiety, and stress. Gender, age, education, occupation, frequency of attending to epidemic information, nervousness about supplies, receiving provisions of living necessities from the service department during the outbreak, number of correct responses to questions about the epidemic, and isolation/quarantine affected the risk of mental health problems among participants experiencing sleep disturbances. A moderation analysis found that sleep problems were more likely to affect depression, anxiety, and stress scores in men than women during the COVID-19 outbreak.Conclusion: During the COVID-19 outbreak, 26.08% people surveyed experienced sleep disturbances, and the presence of sleep disturbances was positively related to depression, anxiety, and stress, especially among front-line anti-epidemic workers, younger people, people living in isolation/quarantine, people with a college or greater education, and males. (shrink)

In this paper, I propose an existentialist-phenomenological model that conceives of mental illness through the terminology of Heidegger’s Being and Time. In particular, the concepts of existentiality, disturbance and the relation between ‘being-with’ and ‘the one’, will be implemented in order to reconstruct the experience of mental illness. The proposed model understands mental illness as a disturbance of a person’s existentiality. More precisely, mental illness is conceptualized as the disturbance of a person’s existential (...) structure, the process of which leads to a becoming explicit of the otherwise implicit dynamical structure that constitutes a person’s experience. In particular, the existential component of ‘being-with’ comes to play a central role in the disturbance of existentiality, thus, I will claim, that it enables a person’s structure of experience to be ‘open for normativity’. By adopting a pragmatist stance on Heideggerian phenomenology, the suggested model proves compatible with naturalist and normativist theories of mental illness while still offering a phenomenological description of the phenomenon. (shrink)

BackgroundThe outbreak of novel coronavirus disease 2019 has caused a global panic and public concern due to its mortality ratio and lack of treatments/vaccines. Reduced levels of physical activity have been reported during the outbreak, affecting the normal daily pattern.ObjectiveTo investigate the relationship of physical activity level with sleep quality and the effects of reduction physical activity levels on sleep quality.MethodsA Google form was used to address personal information, COVID-19 personal care, physical activity, and mental health of 1,907 adult (...) volunteers. Binary logistic regression was used to verify the association of physical activity parameters and sleep quality.ResultsInsufficient physical activity levels were a risk factor to have disturbed sleep pattern [OR: 1.28, 95% CI ]; however, when the BMI was added to the analysis, there was no more statistical difference [OR: 1.23, 95% CI ]. On the other hand, we found that the reduction of physical activity levels was associated with negative changes in sleep quality [OR: 1.73, 95% CI ], regardless all the confounders [OR: 1.30, 95% CI ], unless when feeling of depression was added in Model 6 [OR: 1.28, 95% CI ].ConclusionDisruption in daily physical activity routine, rather than physical activity level, negatively influences sleep quality during the COVID-19 quarantine. (shrink)

Studies investigating differences in mental health problems between self-employed and employed workers have provided contradictory results. Many of the studies utilized scales validated for employed workers, without collecting validity evidence for making comparisons with self-employed. The aim of this study was to collect validity evidence for three different scales assessing depressive symptoms, emotional exhaustion, and sleep disturbances for employed workers, and combinators; and to test if these groups differed. We first conducted approximate measurement invariance analysis and found that all (...) scales were invariant at the scalar level. Self-employed workers had least mental health problems and employed workers had most, but differences were small. Though we found the scales invariant, we do not find them optimal for comparison of means. To be more precise in describing differences between groups, we recommend using clinical cut-offs or scales developed with the specific purpose of assessing mental health problems at work. (shrink)

This chapter seeks to recover an approach to consciousness from a general theory of brain function, namely the prediction error minimization theory. The way this theory applies to mental and developmental disorder demonstrates its relevance to consciousness. The resulting view is discussed in relation to a contemporary theory of consciousness, namely the idea that conscious perception depends on Bayesian metacognition; this theory is also supported by considerations of psychopathology. This Bayesian theory is first disconnected from the higher-order thought theory, (...) and then, via a prediction error conception of action, connected instead to the global neuronal workspace theory. Considerations of mental and developmental disorder therefore show that a very general theory of brain function is relevant to explaining the structure of conscious perception; furthermore, this theory can subsume and unify two contemporary approaches to consciousness, in a move that seeks to elucidate the fundamental mechanism for selection of representational content into consciousness. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.4 (2003) 373-378 [Access article in PDF] The Forgotten Self:Training Mental Health and Social Care Workers to Work With Service Users Kim Woodbridge Keywords self, workers perspective, them and us, win-win situation The three main papers and the case studies presented in this issue of Philosophy, Psychiatry, & Psychology all focus on the service user perspective in relation to the self as illustrated by (...) different aspects of philosophy. This is also in the context of the service user looking for help during a time when they are experiencing levels of distress and difficulty.Important as this is, evident by the substantial clinical and philosophical literature in this area, what has been overlooked is the perspective of the mental health and social care worker responsible for the care of individuals whose sense of self is disturbed. The significance of this omission has been brought home to me through my experiences in running training workshops for workers working with service users with a diagnosis of personality disorder. (From here on, in this paper, the terms worker and trainee are used interchangeably to refer to the mental health and social care worker).During these workshops challenges to the worker's sense of self have been revealed emotionally ("this doesn't feel like me"), ideologically ("I am not a bad person"), and/or practically ("I don't usually behave like this") when discussing their work with service users. This paper draws from the workshop experiences to explore and consider the workers perspective in relation to the self in more detail.There follows a descriptive account of three workshop sessions which include the trainees responses. With each activity the responses are considered within the context of the self, particularly from the worker's perspective. In the conclusion the argument is made, as evidenced by these illustrations, for the importance of including the workers' perspective when attempting to understand the self. The Trainees and Service Users Workers from various professional and nonprofessional backgrounds attend the workshops. They include psychiatrists, nurses, social workers, support workers, and occupational therapists who work in both in-patient and community settings. They usually have several years of clinical experience working with people with a [End Page 373] diagnosis of personality disorder, but rarely have they had any formal education or training in the area. Discussing their experiences of working with this service user group generates strong and highly emotionally charged personal responses during training.It is their experiences of the relationships with service users whose sense of self is absent, inconsistent, or unstable, that make a substantial contribution to the content of the workshops.Often service users are struggling with fragmented, distorted, or threatening perceptions of the world, themselves, and others. The worker, while embedded within their own sense of self, is engaged in a relationship with the service user. The issues that arise as a part of this relationship can be challenging and distressing for the workers. There are two main areas:The impact the service user's chaotic, fragmented, and unstable sense of self has on the worker's own sense of self.The response of the workers when their sense of self is challenged, and the impact that response has on the service user. These can be seen in more detail in the examples taken from the training sessions presented later in this paper. The Training Sessions The training sessions are either run alone or form part of a 1- or 2-day workshop. As mentioned, the groups are composed of a variety of professionally and nonprofessionally qualified staff. The experiences they share mainly relate to people with a diagnosis of Borderline Personality Disorder, although other subcategories are mentioned occasionally. Information regarding these and other related sessions can be found in two recent publications: Making positive connections (Duff, Meredith, & Woodbridge,2003) and "Whose good practice?" (Woodbridge & Fulford, 2003). The First Activity: Revealing Internal Models Given the lack of available evidence, even the best-informed trainees are likely to have to fill in the knowledge gaps with their own interpretations of... (shrink)

This article argues in favor of modifying the medical model of severe psychiatric disturbances that underlies calling them "mental illness." The key reason for this proposal is that numerous specialists other than physicians as well as non-specialists contribute to the process of assisting a person recover from what the author suggests might better be called "extraordinary functional disability." There is little uniformity in existing definitions under state laws, but all involve three types of intervention: civil commitment; civil determination of (...) legal competency; and standing to be subject to criminal law. Physicians typically make relevant determinations in each of these areas; but non-physicians are the principal care-givers once a determination has been made. (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)

This article explores how the intersections of gendered, racialized and neoliberal dynamics reproduce social inequality and shape the violence that nurses face. Grounded in the interviews and focus groups conducted with a purposeful sample of 17 registered nurses (RNs) and registered practical nurses (RPNs) currently working in Ontario's mental health sector, our analysis underscores the need to move beyond reductionist notions of violence as simply individual physical or psychological events. While acknowledging that violence is a very real and disturbing (...) experience for individual nurses, our article casts light on the importance of a broader, power structure analysis of violence experienced by nurses in this sector, arguing that effective redress lies beyond blame shifting between clients/patients and nurses. Our analysis illustrates how assumptions about gender, race and care operate in the context of global, neoliberal forces to reinforce, intensify and create, as well as obscure, structural violence through mechanisms of individualization and normalization. (shrink)

A species like ours, whose life critically depends on the ability to foresee, plan, and shape future events, is vulnerable to dysfunction if any one facet contributing to what Suddendorf & Corballis (S&C) call (MTT) is affected by disease. Although the authors mention brain pathology as a potential cause of disturbed MTT, they fail to explore psychopathological syndromes as a source to better understand the significance of MTT for normal functioning and adaptive behaviour.

ABSTRACTPreviously depressed individuals experience disturbances in affect. Affective disturbances may be related to visual mental imagery, given that imagery-based processing of emotional stimuli causes stronger affective responses than verbal processing in experimental laboratory studies. However, the role of imagery-based processing in everyday life is unknown. This study assessed mental imagery in the daily life of previously and never depressed individuals. Higher levels of visual mental imagery was hypothesised to be associated with more affective reactivity to both negatively (...) and positively valenced mental representations.This study was the first to explore mental imagery in daily life using experience sampling methodology. Previously depressed and matched never depressed individuals participated in this study. Momentary affect and imagery-based processing were assessed using the “Imagine your mood” smartphone application. Participants recorded on average 136 momentary reports ove... (shrink)

This “open letter” to Christopher Boorse is a response to his influential naturalist analysis of disease from the perspective of linguistic-analytic value theory. The key linguistic-analytic point against Boorse is that, although defining disease value free, he continue to use the term with clear evaluative connotations. A descriptivist analysis of disease would allow value-free definition consistently with value-laden use: but descriptivism fails when applied to mental disorder because it depends on shared values whereas the values relevant to mental (...) disorders are highly diverse. A part-function analysis, similarly, although initially persuasive for physical disorders, fails with the psychotic mental disorders because these, characteristically, involve disturbances of the rationality of the person as a whole. The difficulties encountered in applying naturalism to mental disorders point, linguistic-analytically, to the possibility that there is, after all, an evaluative element of meaning, deeply hidden but still logically operative, in the concept of disease. (shrink)

In this paper, we explore psychosis and schizophrenia as prototype disturbances, where mentalizing failures are widely seen. We attempt to describe how the process of rekindling mentalizing within attachment relationships (here, the patient-therapist relationship) can have a protective effect not just on the onset of the disturbance, but also when psychosis is already actively installed. We start by discussing mentalizing in training, practice and supervision. We also try to understand it contextually, as a relational concept, within the history of (...) psychological therapies. (shrink)

Purpose of the article American university and college campus law enforcement, like their peers in American munipal law enforcement agencies, find themselves interacting frequently with civilians experiencing mental health disturbances. An innovative model for law enforcement, the Crisis Intervention Team model, has been developed to address the difficulties law enforcement professionals and civilians in mental health crisis face during encounters. This article explores how CIT can enhance police response to mental health crisis on the college campus. Methodology/methods (...) Methods of applied research were conducted, borrowing from a benchmarking model and including interviews with multiple key informants representing law enforcement and mental health. Informants were affiliated with three universities and multiple municipal jurisdictions in Virginia, USA. Scientific goal The goal was to assess the relevance of CIT on the college campus and explore creative approaches to enhancing campus police response to mental health crisis. Findings The results supported the scholarly literature regarding the efficacy of the CIT model. Creative adaptations to the CIT model for campus possibly can be implemented to address concerns of mental health crisis on campus. Conclusions CIT is a highly innovative model requiring extensive collaboration between law enforcement, mental health agencies, and mental health advocates. As standard qualitative research was not conducted, the sample size of key informants may not have reached saturation. However, findings from the interviews support the body of literature on CIT. The implementation of CIT on the college campus could possibly help to alleviate difficulties on campus arising from mental health crisis, including reducing inappropriate arrest or disciplinary action, improving campus safety, addressing concerns related to threat assessment and management, and enhancing collaborative efforts on campus and with resources in the broader community. (shrink)

The Caraka Saṃhitā (ca. first century BCE–third century CE), the first classical Indian medical compendium, covers a wide variety of pharmacological and therapeutic treatment, while also sketching out a philosophical anthropology of the human subject who is the patient of the physicians for whom this text was composed. In this article, I outline some of the relevant aspects of this anthropology – in particular, its understanding of ‘mind’ and other elements that constitute the subject – before exploring two ways in (...) which it approaches ‘psychiatric’ disorder: one as ‘mental illness’ ( mānasa-roga), the other as ‘madness’ ( unmāda). I focus on two aspects of this approach. One concerns the moral relationship between the virtuous and the well life, or the moral and the medical dimensions of a patient’s subjectivity. The other is about the phenomenological relationship between the patient and the ecology within which the patient’s disturbance occurs. The aetiology of and responses to such disturbances helps us think more carefully about the very contours of subjectivity, about who we are and how we should understand ourselves. I locate this interpretation within a larger programme on the interpretation of the whole human being, which I have elsewhere called ‘ecological phenomenology’. (shrink)

Due to the COVID-19 pandemic, cities and states adopted social distancing, social isolation, or quarantine measurements to slow the transmission of the disease. Negative mental health outcomes including depression and anxiety have been associated with social distancing or social isolation. The purpose of the present study was to examine changes in psychological health and physical activity over an 8 week period under social distancing policies during the COVID-19 pandemic.Methods: Ninety individuals participated in this study. Qualifying participants answered questions using (...) an online survey regarding their loneliness, depressive symptoms, anxiety symptoms, mood state, and physical activity over four time points each lasting two weeks.Results: Symptoms of depression and state anxiety were increased in the population when compared to nationwide statistics from before the COVID-19 pandemic. Time point 2, ~1 month into social isolation, showed the most significant effects on mental health. During this time point, 100% of the participants showed symptoms of depression. There were no significant changes in physical activity over the 8 weeks. Loneliness, depressive symptoms, fatigue, and mood state were negatively associated with participation in physical activity. Vigor and state anxiety were associated with participation in physical activity.Conclusion: Social isolation and social distancing practices have had a negative effect on depression, anxiety, and mood over time. It appeared that depressive symptoms and total mood disturbance was elevated during time point two. Depressive symptoms were much higher than average compared to previous epidemiological data. Physical activity amount did not change over time but was associated with poor mental health. (shrink)

Going beyond the scope of psychiatric diagnoses, this study introduces the concept of human vulnerability as a means of linking the phenomenological approach—focusing on the patient’s experience—with psychotherapeutic treatment. To this end, it applies Karl Jaspers’ concept of “limit situation” to the existential vulnerability in the manifestation of mental illness and the ontological vulnerability in schizophrenia. From a psychological or empathic standpoint, vulnerability, as experienced in different cases of mental illness, refers to the condition of being confronted with (...) disturbing meaningful social encounters with others. In these social encounters, existential meanings acquire disturbing qualities for a person’s integrity, giving rise to various psychopathological phenomena. This study incorporates the practice of psychotherapy and empirical research to suggest that the experience of vulnerability is crucial not only in understanding the manifestation of mental illness but also a key element of phenomenological psychotherapeutic treatment, and it uses schizophrenia as an example. (shrink)

Since the revolutionary mood of the 1960s, patient-centered mental health care and a research emphasis on service users as experts by experience have emerged hand in hand with a view of service users as consumers. What happens to knowledge derived from firsthand experience when mental health users become experts and actively choose care? What kind of perspective do service users pursue on psychological distress? These are important questions in a field where psychiatric expertise on mental illness is (...) socially structured and constrained as an intra-personal disturbance of the mind. We argue that experience experts have lost a coherent perspective on care and health. We illustrate this by rationally reconstructing how the interpersonal view of mental health first gained and then lost coherence between the conception of mental health, the practice of mental health care, and the user experience. Harry Stack Sullivan’s interpersonal theory was a paradigm case for such coherence. The inclusion of mental health consumers as ‘experts by experience’ in the mental health field took place at the cost of Sullivan’s coherent interpersonal theory. Service users who interact side by side with medical experts as experience experts are constrained by the evidence-based imperative and consumerism. Service users are caught up in a race among experts to gain knowledge about mental problems from a third-person perspective instead of from first-person experience. To make a contribution service users have more to gain from a research approach that appreciates that they are persons among persons rather than experts among experts. (shrink)

Being surrounded by bullshit is one thing. Having your mind fucked is quite another. The former is irritating, but the latter is violating and intrusive . If someone manipulates your thoughts and emotions, messing with your head, you naturally feel resentment: he or she has distorted your perceptions, disturbed your feelings, maybe even usurped your self. Mindfucking is a prevalent aspect of contemporary culture and the agent can range from an individual to a whole state, from personal mind games to (...) wholesale propaganda.In "Mindfucking", Colin McGinn investigates and clarifies this phenomenon, taking in the ancient Greeks, Shakespeare and modern techniques of thought control. McGinn assembles the conceptual components of this most complex of concepts - trust, deception, emotion, manipulation, false belief, vulnerability - and explores its very nature. Is philosophy, as a discipline, a type of mindfuck, asks McGinn? Is romantic love a species of mindfuck? The essence is psychological upheaval or disorientation, often abetted by the weaknesses of the victim. Jealousy, insecurity and prejudice can aid the mindfuck. Delusion is the general result, sometimes insanity. How mindfucked are you? It's hard to say from the inside, but being aware of the phenomenon offers at least some protection. (shrink)

Alienation has been recently revived as a central theme in critical theory. Current debates, however, tend to focus on normative rather than on explanatory issues. In this paper, I confront the latter and advance an account of alienation that bears on the mechanisms that bring it about in order to locate alienation as a distinctive social and psychological fact. In particular, I argue that alienation can be explained as a disruption induced by social factors in the sense of mental (...) ownership that comes with the first personal awareness of being a subject of attitudes, emotions, and actions, and outline how social factors can play a structuring causal role in the process that brings it about. In the first section, I introduce the theme and explain why it is important to focus on the mechanisms that underlie alienation. In the second section, I maintain that understanding how alienation works is crucial to make sense of false consciousness. In the third section, I consider the relevance of mental ownership to explaining alienation and discuss existing evidence about whether and how it can fail. In the final section, I argue that disturbances in the simulation routines that support social cognition might underpin alienation, and outline how social factors might play a structuring causal role in this connection. (shrink)

A brief theoretical review of the current state of the art of embodiment research in clinical psychology has been expounded in order to highlight the key role that embodied conceptualization has on the understanding and explanation of several mental disorders, such as eating disorders, schizophrenia and depression. Evidence has suggested that mental disorders may be explained as disturbances of embodiment, from the disembodiment to the hyperembodiment. In order to understand how some clinical conditions are affected by cultural models, (...) we propose and define a new framework called Exbodiment, complementary to the Embodiment approach to cognition. Mental disorder is strictly related to the subject-culture interaction that may be explained as a two way process in which embodiment and exbodiment are complementary points of view. In this perspective, embodiment may be seen as the “top-down” process, while exbodiment the “bottom-up” one. The introduction of exbodiment conceptualization highlights how subject is both receiver and interpreter of social influence. Subject is the target of a cultural pressure and, at the same time, enacts its own embodied culture in world. Exbodiment conceptualization may help clinicians to better understand and explain the role of culture in the onset and maintenance of mental disorders. (shrink)

Borderline Personality disorder is a severe personality dysfunction characterized by behavioural features such as impulsivity, identity disturbance, suicidal behaviour, emptiness, and intense and unstable relationships. Approximately 2% of the population are thought to meet the criteria for BPD. The authors of this volume - Anthony Bateman and Peter Fonagy - have developed a psychoanalytically oriented treatment to BPD known as mentalization treatment. With randomised controlled trials having shown this method to be effective, this book presents the first account of (...) mentalization treatment for BPD. The first section gives an overview of BPD, including discussion of nosology, epidemiology, natural history, and psychosocial aetiology. It additionally summarises the present state of our research knowledge about effective psychotherapeutic treatments and use of medication. The second section outlines the authors' theoretical approach and contrasts it with other well known methods, including DBT, CAT, and CBT. In the extensive final section, the authors outline their clinical approach starting with how treatment is organised. A detailed account of the transferable features of the model is provided along with the main strategies and techniques of treatment. Numerous clinical examples are given to illustrate the core techniques and detailed information provided about how to apply aspects of the mentalization based treatment approach in everyday practice. Aimed at mental health professionals, along with counsellors, psychotherapists, and psychoanalysts, the book will be a valuable tool, providing an effective means of treating those suffering from Borderline Personality Disorder. (shrink)

In recent years, there has been growing interest in bridging bodies of knowledge from introspective and contemplative traditions with modern neuroscience. By making the primary object of study an individual’s subjective experience, scientists are then confronted with the challenging problem of how to record a given mental state at a given point in time. For simple experiences, such as in facial recognition tasks, an external recording device such as a button box or computer keyboard is adequate. However, these devices (...) pose fundamental problems when attempting to record more subtle states of mind, or to do so in situations where the presence of an external input device would disturb the subject, such as in the case of studying the evolution of internal states of highly advanced meditators. Here, I suggest that variants of the mnemonic techniques used in memory competitions can be used to make measurements in experiments where an external device would be impractical to use, or would unnecessarily disturb the subject. Demographic and performance data from memory competitions suggest that these techniques can be learned by ordinary subjects participating in multi-session experiments, and that, for highly trained individuals, events can be recorded at roughly 400 millisecond intervals for timescales on the order of tens of seconds, and at roughly one-second intervals for sustained periods of one hour or longer. Finally, I discuss the relationship of the current proposal to descriptive experience sampling (DES) and the visualization techniques of the Tibetan meditative tradition. (shrink)

The task of being oneself lies at the heart of human existence and entails the possibility of not being oneself. In the case of schizophrenia, this possibility may come to the fore in a disturbing way. Patients often report that they feel alienated from themselves. Therefore, it is perhaps unsurprising that schizophrenia sometimes has been described with the heideggerian notion of inauthenticity. The aim of this paper is to explore if this description is adequate. We discuss two phenomenological accounts of (...) schizophrenia: Binswanger’s account of schizophrenia as a form of inauthenticity and Blankenburg’s account of schizophrenia as a loss of common sense, which seems construable as a loss of inauthenticity. We argue that the accounts are highlighting aspects of the same underlying phenomenon, viz. schizophrenic autism. Moreover, we argue that Binswanger’s description of schizophrenia as a form of inauthenticity is inadequate and we discuss experiences of self-alienation in schizophrenia. (shrink)

Most studies on refugee populations are organized around trauma-related issues and focus on explaining pathological factors. Few studies are anchored in general developmental psychology with the aim of exploring normal age-specific developmental tasks and how the special circumstances associated with forced migration can influence how developmental tasks are negotiated. This study is part of a larger mixed method study seeking to identify resilience-promoting and resilience-inhibiting factors, on individual and contextual levels, among asylum seekers and refugees on the move and settled (...) in reception centers in Norway. A strategic sample of 20 adolescent and young adult refugees/asylum seekers during flight in Serbia and after arrival in Norway was chosen from a sample of 178 refugees interviewed in depth in Serbia and at receptions centers in Norway. The sample reflects the focus of this paper, which is to explore adolescent and young adult refugees/asylum seekers’ psychological and social needs and resources during flight to and after arrival in the host country, including how developmental tasks are negotiated. Through qualitative analysis, experiences associated with the developmental changes the participants experienced before, during, and after flight are contextualized. Their sense of self, their relationships with their families and their perceptions of their situation as adolescents or young adults in a highly unpredictable situation are presented in the light of relevant theory and findings from similar refugee studies. All the participants have fled from dangerous and intolerable situations in their home countries. They describe extreme dangers during flight in contexts that are unpredictable and where they feel lonely and unsupported. Most have unmet psychosocial needs and have received little support or help for their mental health issues during flight or after arrival in Norway. Suggestions for interventions and resilience-promoting actions are given based on the findings of the study. (shrink)

This paper aims to contribute to the exploration of the shift from a problematisation of ‘unwed motherhood’ to ‘teenage motherhood’ in late twentieth century Britain. It does so by exploring the dominant social scientific understanding of ‘unwed mothers’ during the 1950s and 1960s which suggested that these women suffered from a psychological disorder. I then analyse the conceptualisation of ‘adolescent unwed mothers’ exploring why professionals deemed them to be less disturbed than older women in their predicament. This finding is discussed (...) in light of contemporary social scientific concern with adolescent motherhood. (shrink)

Virilio constructs concepts as mental images for disturbing conventional, commonsensical views of world events but with the added visual warp of a life lived at the speed of cinema, video, light itself. It is not, then, a criticism (nor, for that matter, an unqualified recommendation) to say that reading Virilio will probably leave one feeling mentally disturbed, usually compounded by a bad case of vertigo, since speed is not only the subject but the style of Virilio (helping to account (...) for a dozen books in as many years). In a typical Virilio sentence, which often elongates into a full paragraph, the concepts can spew out like the detritus of a Mir supply-ship. Many get recycled in later books. Some, benefiting from refinement and new empirical settings, stand out like polished gems. But almost all of them provide radically different takes on the social implications of new technological forces, liberating their analysis from the customary academic dullness and expert narrowness. (shrink)

The medical assessments of criminal responsibility and competence to consent to treatment are performed, developed and debated in distinct domains. In this paper I try to connect these domains by exploring the similarities and differences between both assessments. In my view, in both assessments a decision-making process is evaluated in relation to the possible influence of a mental disorder on this process. I will argue that, in spite of the relevance of the differences, both practices could benefit from the (...) recognition of this similarity. For cooperative research could be developed directed at elucidating exactly how various mental disturbances can affect decision-making processes. (shrink)

Freud’s metapsychology has been interpreted in a number of different ways. Some scholars see him committed to classical scientism, others to genuine hermeneutics. Many Freud philologists suggest that he moved from an early scientism to hermeneutic methods in his later writings, and some think he misunderstood his own angle, thinking himself to be a natural scientist, but actually practising hermeneutics. The article first looks at Freud’s model of the soul and his remarks about psychoanalytic explanations and concludes that there is (...) overwhelming evidence for the contention that he conceived of psychoanalytic explanations in terms of causal explanations and that his metapsychology is, all things considered, scientistic. However, it seems that Freud did not clearly distinguish between causal and rational explanations. The article emphasizes that he could have found this distinction in the writings of Max Weber. In the last two sections, the article turns to a meticulous analysis of two vignettes describing Freud’s own treatment of two cases that he takes to be fine examples of the technique used in psychoanalytic treatment. It turns out that Freud himself looks at these cases and their treatment, throughout, in terms of rationality and irrationality. In particular, he seems to distinguish between an “external” irrationality and an “internal” rationality of neurotic diseases. He also seems to point to functions of neuroses representing certain solutions for mental disturbances. Thus, there is much evidence for assuming that in his psychoanalytic technique, Freud relied on genuine hermeneutic and functional methods; and therefore, Freud’s official metapsychology seems to be methodologically inconsistent with his analytic technique. (shrink)

Recently in Porter v. McCollum, the United States Supreme Court, citing “a long tradition of according leniency to veterans in recognition of their service,” held that a defense lawyer’s failure to present his client’s military service record as mitigating evidence during his sentencing for two murders amounted to ineffective assistance of counsel. The purpose of this Article is to assess, from the just deserts perspective, the grounds to believe that veterans who commit crimes are to be blamed less by the (...) State than offenders without such backgrounds. Two rationales for a differential treatment of military veterans who commit crimes are typically set forth. The Porter Court raised each, stating that we should treat veterans differently “in recognition of” both “their service” and “the intense stress and mental and emotional toll” of combat. The former factor suggests there being a “social contributions” or gratitude-based discount, whereas the latter factor points towards a “mental disturbance” discount. This Article analyzes the two accounts and raises some doubts about both. This Article then argues that a military veteran who commits a crime should not be blamed to the full extent of his blameworthiness, not necessarily because of his mental capacity nor because of his social contribution, but because the State’s hand in producing his criminality undermines its standing to blame him. (shrink)