Debates on dualism continue to plague psychiatry. I suggest that these debates are based on false dichotomies. According to metaphysical physicalism, reality is ultimately physical. Although this view excludes the idea of entities distinct from physical reality, it does not compel us to favour neural over psychological interventions. According to methodological dualism, both physical and mental interventions on the world can be deemed effective, and both perspectives can therefore be thought to be equally ‘real’.

Clinicians in their everyday practice of psychiatry face permanently the following epistemological and methodological problem: currently available psychiatric knowledge, like all types of scientific and technological knowledge, is general—at least in certain respects—in sharp contrast with the obvious particularities and even idiosyncrasies of each real individual mental patient they meet in the clinical encounter. This problem is admittedly the source of a permanent tension in the practice and above all in the philosophy of psychiatry. In the practice of (...) psychiatry, conscientious clinicians always try to find a necessarily pragmatic solution to this problem, mainly with the means of their psychiatric knowledge .. (shrink)

The purpose of this article is to demonstrate the epistemic position of psychiatry between the science of general laws in relation to frequently encountered generality and the science of specific events which is directed towards the particular. In this respect the development of the dichotomy of nomothetic and idiographic methodology from its generally forgotten neo-Kantian origins is delineated within the context of a historical-philosophical analysis and then its incorporation into psychology and psychopathology is reconstructed. In the course of this (...) analysis and also in the discussion of the currently accepted theories of analytical philosophy and critical rationalism it becomes clear that, in spite of widespread current opinions to the contrary, individualizing concept formation is an indispensable element in the methodological inventory of psychiatric science. (shrink)

Background: In psychiatry, the issue of providing palliative and end-of-life care for what would be a “terminal psychiatric condition” or considering a palliative approach to severe and persistent mental health problems is still a taboo. Methodology: This question is addressed through an analysis of a case arising during a clinical ethics consultation, using Hubert Doucet’s scenario method. It is about Mrs. Sanchez, a patient over 90 years of age with a psychiatric profile, expressing the desire to die by suicidal (...) gestures, refusing the proposed treatments, and refusing as well to drink and eat. Her clinical history is told through the filter of reflexive support offered in clinical ethics to the various stakeholders. Results: The case analysis, far from responding to the challenges posed by the concept of palliative and end-of-life care in a psychiatric context, nevertheless presents an opportunity to name its main ethical issues: psychic suffering, refusal to eat and drinking as well as refusal of treatment, palliative sedation and medical assistance in dying, wishes and advanced medical directives and clinical-organizational challenges for geriatric psychiatry clients. Conclusion: There are still many challenges for professionals and decision-makers to meet the needs of older mental health clients. We call for further development of knowledge on this specific topic. (shrink)

The computational approach to psychiatric disorders, including delusions, promises explanation and treatment. Here, we argue that an information processing approach might be misleading to understand psychopathology and requires further refinement. We explore the claim of computational psychiatry being a bridge between phenomenology and physiology while focussing on the ontological commitments and corresponding methodology computational psychiatry is based on. Interconnecting ontological claims and methodological practices, the paper illustrates the structure of theory-building and testing in computational psychiatry.First, we will (...) explain the ontological commitments computational psychiatry is grounded in, theBayesian Brain hypothesis(BBH) of unconscious inference, paired with normative deontic approaches applied to gauge psychopathology. We then turn to the steps taken in empirical paradigms, from definitions, which are used as starting points, to the operationalisation and isolation of cognitive processes and hypothesis testing based on algorithmic models, to consecutive interpretations regarding the aetiology of psychiatric disorders. We outline how experimental paradigms in computational psychiatry are specifically designed to confirm aberrations in assumed inferential processes, which are thought of as being the underlyingcore invariant features.We will illustrate a gap between the ontological commitments of computational psychiatry and the operationalisation and testing of the cognition assumed to be relevant for psychopathology. This conceptual gap is of utmost importance when designing computational paradigms and may impede a crisp understanding of the approach. Lastly, in evaluating the conceptual gap, it becomes apparent that the information processing formalism used in computational psychiatry is still grounded in rational cognitive psychology. (shrink)

Psychiatry presents a unique array of difficult ethical questions. However, a major challenge is to approach psychiatry in a way that does justice to the real ethical issues. Recently there has been a growing body of research in empirical psychiatric ethics, and an increased interest in how empirical and philosophical methods can be combined. Empirical Ethics in Psychiatry demonstrates how ethics can engage more closely with the reality of psychiatric practice and shows how empirical methodologies from the (...) social sciences can help foster this link. -/- The book is divided into two sections. In the first section there are discussions of the possibility of empirical ethics from a theoretical standpoint and an overview of the history of empirical medical ethics in general. The second, larger section is made up of chapters, discussing specific research projects in empirical psychiatric ethics. The contributors reflect on their choice of method: how and why they combine empirical and philosophical work, and how the two approaches relate to each other. The chapters in the second part thus have two purposes. The first is to present examples of empirical ethics in psychiatry; the second is to reflect on the way in which empirical research can support ethical analysis. -/- Empirical Ethics in Psychiatry is a unique contribution to bioethics and will be fascinating reading for all those working within the field, as well as mental health care professionals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Externalist Psychiatry, Mindshaping, and Embodied InjusticeMichelle Maiese, PhD (bio)Ongaro maintains that although enactivist approaches to psychiatry help to account for the integration of biological, psychological, and social factors, they gloss over an important distinction between patient-centered (bio and psycho) approaches and externalist (social) approaches to mental illness. The central problem is that they lack the means to account for the social causes of illness and do not (...) specify how social determinants can be addressed in the clinic. Since much of an organism’s interaction with the external world is social in kind, the implementation of externalist psychiatry could make the enactivist model truly biopsychosocial and usher in novel forms of treatment.According to Ongaro, this externalist orientation gives rise to an important question about ontology: what are the social causes of psychiatric illness made of, and how can these be conveyed in the clinic to facilitate treatment? A “shared social etiology” would allow for a “rich explanatory framework” that accounts for the social causes of mental disorder. For example, by pointing to spirit affliction as the social cause of mental illness, the Akha transform amorphous pains (which are difficult to capture naturalistically) into meaningful and familiar experiences. Such an approach involves combining a realist understanding of biopsychosocial integration with an anti-realist, social constructivist outlook on social etiology. For them, an illness that is explained as a rupture of a human-spirit relationship is experienced as a ‘problem in living’ that affects the person in an immediate and meaningful way, and can be treated via ritual action.Ongaro then considers social causation in a more familiar context, one where social determinants of mental illness include factors such as employment. Losing one’s job is a significant life event because it signals a change in social status and prompts feelings of uselessness. Ongaro characterizes these feelings of low subjective status as “socially constructed experiences that depend on collectively ingrained ideas about status, value, and self-realization that a person accepts—one could say ‘believes in’—by virtue of living in a particular society.” Because social worlds differ and what counts as social defeat is culturally specific, [End Page 333] social determinants of illness such as unemployment are either negligible or non-applicable in Ahka (non-capitalist) society.To acknowledge the impact of these social constructions, Ongaro maintains, clinical psychiatry should abandon its commitment to naturalism and embrace methodological constructivism instead. Methodological naturalism treats social causes as ‘real’ and holds that the social causes of disorder should be investigated using the scientific method; research focuses on social determinants, social stressors, and social capital. However, despite acknowledging that declining mental health correlates significantly with political and economic factors, Ongaro maintains that methodological naturalism when it comes to social causes will be insufficient to bring about meaningful changes in clinical practice. For one thing, individual psychiatrists lack the political power and economic resources to bring about the sorts of societal changes that are needed to address social determinants of health. Second, social determinants are probabilistic factors rather than definitive causes of mental disorder; psychiatric illnesses often do not have a well-defined cause or a clear-cut social trigger. Third, an explanation that points to ‘lack of social capital’ does “not possess the immediacy, emotional charge, and embodied meaning that could make them therapeutically effective in the same way that Akha explanations for spirit afflictions are.”Philosophically, Ongaro’s embrace of ‘methodological constructivism’ when it comes to social etiology entails a commitment to antirealism about social causation and fictionalism more specifically. Wilkinson (2022) notes that the core tenet of psychiatric fictionalism is that “when we engage in psychiatric discourse... we are not attributing a robust, objective property, but are instead engaging with a useful, perhaps even an indispensable, fiction” (p. 91). For Ongaro, this fiction consists in a meaningful explanatory narrative about the social causes of illness. However, if we take the notion of integration seriously, and characterize this integration naturalistically (as Ongaro does), then questions arise as to how these fictional narratives about social causes can impact people both biologically and psychologically, and thereby have such a powerful impact.I argue that an enactivist approach to treatment will be... (shrink)

As a discipline, psychiatry is in the process of finding the right set of concepts to organize research and guide treatment. Dissatisfaction with the status quo as expressed in standard manuals has animated a number of computational paradigms, each proposing to rectify the received concept of mental disorder. We explore how different computational paradigms: normative modeling, network theory and learning-theoretic approaches like reinforcement learning and active inference, reconceptualize mental disorders. Although each paradigm borrows heavily from machine learning, they differ (...) significantly in their methodology, their preferred level of description, the role they assign to the environment and, especially, the degree to which they aim to assimilate psychiatric disorders to a standard medical disease model. By imagining how these paradigms might evolve, we bring into focus three rather different visions for the future of psychiatric research. Although machine learning plays a crucial role in the articulation of these paradigms, it is clear that we are far from automating the process of conceptual revision. The leading role continues to be played by the theoretical, metaphysical and methodological commitments of the competing paradigms. (shrink)

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

Neuroscience and psychiatry -- Psychotherapy and psychiatry -- Diagnosis in psychiatry -- The boundaries of mental disorders -- Mood and mental illness -- Psychiatry's problem children -- Evidence-based psychiatry -- Psychiatric drugs: miracles and limitations -- Talk therapies: the need for a unified method -- Psychiatry in practice -- Training psychiatrists -- Psychiatry and society -- The future of psychiatry.

Originally put forward to defend history from the encroachment of physics, the distinction between understanding and explanation was built into the foundations of Karl Jaspers’ ‘phenomenological’ psychiatry, and it is revised, used and defended by many still working in that tradition. On the face of it, this is rather curious. I examine what this notion of ‘understanding’ amounts to, why it entered and remains influential in psychiatry, and what insights for contemporary psychiatry are buried in the notion. (...) I argue that it is unhelpfully associated with the view that the mental is epistemologically and methodologically autonomous, but that it nevertheless highlights an important lacuna in many views of psychiatry and the scientific study of humans more generally. (shrink)

The movement of a pendulum is often used as a metaphor to represent the history of twentieth century American psychiatry. On this view, American psychiatry evolved by swinging back and forth between two schools of thought in constant competition: somatic accounts of mental illness and psychodynamic ones. I argue that this narrative partly misrepresents the actual development of American psychiatry. I suggest that there were some important exchanges of ideas and practices in the transition from German biological (...) approaches to American psychodynamic approaches. In particular, two kinds of pragmatism played an important role in this transition: Kraepelin’s methodological pragmatism, and pragmatic values present in the American psychiatric context, due in part to the influence of William James. From a historical standpoint, I suggest that the metaphor of the pendulum doesn’t capture the full complexities of this shift in psychiatry at the turn of the century; from a philosophical standpoint, my discussion brings to light two strands of pragmatism salient to scientific psychiatry. (shrink)

This is a comprehensive resource of original essays by leading thinkers exploring the newly emerging inter-disciplinary field of the philosophy of psychiatry. The contributors aim to define this exciting field and to highlight the philosophical assumptions and issues that underlie psychiatric theory and practice, the category of mental disorder, and rationales for its social, clinical and legal treatment. As a branch of medicine and a healing practice, psychiatry relies on presuppositions that are deeply and unavoidably philosophical. Conceptions of (...) rationality, personhood and autonomy frame our understanding and treatment of mental disorder. Philosophical questions of evidence, reality, truth, science, and values give meaning to each of the social institutions and practices concerned with mental health care. The psyche, the mind and its relation to the body, subjectivity and consciousness, personal identity and character, thought, will, memory, and emotions are equally the stuff of traditional philosophical inquiry and of the psychiatric enterprise. A new research field--the philosophy of psychiatry--began to form during the last two decades of the twentieth century. Prompted by a growing recognition that philosophical ideas underlie many aspects of clinical practice, psychiatric theorizing and research, mental health policy, and the economics and politics of mental health care, academic philosophers, practitioners, and philosophically trained psychiatrists have begun a series of vital, cross-disciplinary exchanges. This volume provides a sampling of the research yield of those exchanges. Leading thinkers in this area, including clinicians, philosophers, psychologists, and interdisciplinary teams, provide original discussions that are not only expository and critical, but also a reflection of their authors' distinctive and often powerful and imaginative viewpoints and theories. All the discussions break new theoretical ground. As befits such an interdisciplinary effort, they are methodologically eclectic, and varied and divergent in their assumptions and conclusions; together, they comprise a significant new exploration, definition, and mapping of the philosophical aspects of psychiatric theory and practice. (shrink)

Evidence-based psychiatry (EBP) has arisen through the application of evidence-based medicine (EBM) to psychiatry. However, there may be aspects of psychiatric disorders and treatments that do not conform well to the assumptions of EBM. This paper reviews the ongoing debate about evidence-based psychiatry and investigates the applicability, to psychiatry, of two basic methodological features of EBM: prognostic homogeneity of clinical trial groups and quantification of trial outcomes. This paper argues that EBM may not be the best (...) way to pursue psychiatric knowledge given the particular features of psychiatric disorders and their treatments. As a result, psychiatry may have to develop its own standards for rigour and validity. This paper concludes that EBM has had a powerful influence on how psychiatry investigates and understands mental disorders. Psychiatry could influence EBM in return, reshaping it in ways that are more clinically useful and congruent with patients’ needs. (shrink)

This chapter examines the history of philosophy of psychology and philosophy of psychiatry as subfields of philosophy of science that emerged in the late twentieth and early twenty-first century. The chapter also surveys related literatures that developed in psychology and psychiatry. Philosophy of psychology (or philosophy of cognitive science) has been a well-established subfield of philosophy of mind since the 1990s and 2000s. This field of philosophy of psychology is narrowly focused on issues in cognitive psychology and cognitive (...) science. Compared to the thriving subfield of philosophy of cognitive science, there has been a lack of corresponding interest among philosophers of science in broader methodological questions about different paradigms and fields of study in psychology. These broader methodological questions about psychology have been addressed in the field of theoretical psychology, which is a subfield of psychology that materialized in the 1980s and 1990s. Philosophy of psychiatry emerged as a subfield of philosophy of science in the mid-2000s. Compared to philosophy of psychology, the philosophy of psychiatry literature in philosophy of science engaged with issues examined in an older and more interdisciplinary tradition of philosophy of psychiatry that developed after the 1960s. The participation of philosophers of science in the literature on theoretical psychology, by contrast, has been limited. (shrink)

The aim of this paper is to highlight the rationale behind the use of data from neuroscience, particularly neuroimaging, in psychiatric legal expert procedures and their interference with the mind-brain problem.The critical argument is that the employment of mental health evaluation of the defendants and/or witnesses as collected with clinical assessment methods in court proceedings should not be considered irrespective to the data from neuroscience. Essentially, neuroscience methods belong to the domain of nomothetic (natural explanatory) knowledge, whereas clinical evaluation methods (...) in psychiatry belong to the domain of intra- and inter-subjective narratives. There exists an explanatory gap between those two groups of disciplines which concerns the ability to translate and integrate data across diverse methodological and terminological systems. Furthermore, it depends largely on the implicit positions in the mind-brain debate and the brain-to-behavior connections, which reflect on the professional and legal reasoning in terms of prioritizing certain solutions or approaches over another in the expert judgements. There are described those tacit positions adopted in the mind-brain debate by different traditions in psychiatry, with special emphasis on reductive and non-reductive forms of physicalism.In conclusion, a cognitive pluralist stance is adopted which sets priority for the supervenience theory of mind. (shrink)

Current health care standards, in many countries, Australia included, are regrettably poor. Surprisingly, practitioners and treating teams alike in mental health and disability sectors, in particular, make far too many basic care-related mistakes, in addition to the already abundant diagnostic mistakes that cause and amplify great harm. In part, too many practitioners also fail to distinguish adverse effects for what they are and all too often treat adverse effects, instead, as comorbidities. Diagnostic failures are dangerous, the result of which generates (...) and perpetuates harms that are extremely costly in terms of patient welfare, in addition to the financial burden placed on everyone. In this essay, I contend that the authority bestowed upon psychiatry is misplaced. Subsequently, this misplaced authority affects the governing and investigatory institutions reliant and informed by psychiatry. The examination process undertaken in this investigation traces the metaphysics of psychiatric disorders relative to the Diagnostic-Statistical-Manual (DSM) in all its iterations and to the epistemological construction process that serves to underpin the fundamentals of psychiatric practice. There exists a crisis of confidence in psychiatric practice and I urge drastic reform be undertaken to arrest the damage. (shrink)

Gupta effectively probes the methodological and ethical presuppostions of Evidence Based Medicine, and its more contestable application to psychiatry. She concludes with an endorsement of a very modest reformulation of it as one guide to practice among many.

ArgumentThe paper focuses on a research project launched by Norwegian psychiatrists immediately following World War II. The project sought to investigate the roots of quislingism through psychiatric research on the collaborators. Considered with hindsight, however, the methodology of the project seems puzzlingly shallow. The paper discusses whether this was due to a general lack of adequate methodology in the contemporaneous sciences, or whether the explanation must be sought in the project's social and historical context. Ultimately, I conclude that considerable weight (...) must be placed on the latter explanation, and that the general political ostracism of the collaborators in the postwar years played a major role in the psychiatrists' attitude. (shrink)

Evolutionary psychiatry suggests that mental disorders can be explained in evolutionary terms (a) as failures of psychological mechanisms to produce the adaptive effects for which they were naturally selected, (b) as mismatches between naturally selected psychological mechanisms and contemporary environmental pressures, or (c) as naturally selected psychological mechanisms whose effects continue to be adaptive. In this paper, I present a philosophical critique of evolutionary psychiatry that draws on Subrena Smith’s matching problem for evolutionary psychology. For evolutionary psychiatry (...) hypotheses to be empirically supported, proponents of evolutionary psychiatry must demonstrate (1) that the contemporary psychological mechanisms involved in mental disorders resemble the psychological mechanisms of our evolutionary ancestors, (2) that the contemporary psychological mechanisms are phylogenetically descended from the ancestral psychological mechanisms, and (3) that the ancestral psychological mechanisms were naturally selected because their effects had adaptive benefits. However, for many mental disorders, evolutionary psychiatry lacks the methodological resources to demonstrate these conditions. Therefore, many evolutionary psychiatry hypotheses are empirically untestable and remain indefinitely underdetermined by data. (shrink)

The Inherent inseparability of psychopathology and phenomenology is generally a known fact, established and popularised by Karl Jaspers in Allgemeine Psychopathologie. In the following paper, I will show the development of interdisciplinary methodology initiated by Jaspers, and discuss it by combining M. Merleau Ponty`s theory of embodiment, R. D. Laing`s existential-phenomenological approach, and T. Fuchs` concept of brain resonance and integral causality with the hermeneutical thoughts of Paul Ricœur regarding the notion of selfhood. The main thesis proposes that fusion of (...) hermeneutics and phenomenology with psychiatry can play a significant methodological role in the approach to diagnosis and treatment of the psychotic disorders spectre, especially regarding the most complex yet inaccurately defined and evaluated mental disorder – schizophrenia. Due to the fundamental interpretative capacity of both disciplines regarding the understanding of the displacement (translocation) of subject, disembodiment, delusions and consciousness, I am considering them as a prerequisite for the effective expansion of psychiatric practice. (shrink)

The uniqueness of Psychiatry as a medical speciality lies in the fact that aside from tackling what it considers as illnesses, it has perchance to comment on and tackle many issues of social relevance as well. Whether this is advisable or not is another matter; but such a process is inevitable due to the inherent nature of the branch and the problems it deals with. Moreover this is at the root of the polarization of psychiatry into opposing psychosocial (...) and biological schools. This gets reflected in their visualization of scope, in definitions and in methodology as well. Whilst healthy criticism of one against the other school is necessary, there should be caution against hasty application of one's frame of reference to an approach that does not intend to follow, or conform to, one's methodology. This should be done within the referential framework of the school critically evaluated, with due consideration for its methods and concepts. Similarly, as at present, there is no evidence to prove one or the other of these approaches as better, aside from personal choice. We can say so even if there is a strong paradigm shift towards the biological at present. A renaissance of scientific psychoanalysis coupled with a perceptive neurobiology which can translate those insights into testable hypotheses holds the greatest promise for psychiatry in the future. This suggests the need for unification of diverse appearing approaches to get a more comprehensive and enlightened worldview. It requires a highly integrative capacity. Just as a physicist thinks simultaneously in terms of particles and waves, a psychiatrist must think of motives, emotions and desires in the same breath as neurobiology, genetics and psychopharmacology. However, the integration must be attempted without destroying the internal cohesiveness of the individual schools. This will give a fair chance for polarization in which a single proper approach in psychiatry could emerge, which may be a conglomerate of diverse appearing approaches of today, or one which supersedes the rest. A synthesis of cognitive psychology and neuroscience offers the greatest promise at present. (shrink)

A large part of the controversy surrounding the publication of DSM-5 stems from the possibility of replacing the purely descriptive approach to classification favored by the DSM since 1980. This paper examines the question of how mental disorders should be classified, focusing on the issue of whether the DSM should adopt a purely descriptive or theoretical approach. I argue that the DSM should replace its purely descriptive approach with a theoretical approach that integrates causal information into the DSM’s descriptive diagnostic (...) categories. The paper proceeds in three sections. In the first section, I examine the goals (viz., guiding treatment, facilitating research, and improving communication) associated with the DSM’s purely descriptive approach. In the second section, I suggest that the DSM’s purely descriptive approach is best suited for improving communication among mental health professionals; however, theoretical approaches would be superior for purposes of treatment and research. In the third section, I outline steps required to move the DSM towards a hybrid system of classification that can accommodate the benefits of descriptive and theoretical approaches, and I discuss how the DSM’s descriptive categories could be revised to incorporate theoretical information regarding the causes of disorders. I argue that the DSM should reconceive of its goals more narrowly such that it functions primarily as an epistemic hub that mediates among various contexts of use in which definitions of mental disorders appear. My analysis emphasizes the importance of pluralism as a methodological means for avoiding theoretical dogmatism and ensuring that the DSM is a reflexive and self-correcting manual. (shrink)

The uniqueness of Psychiatry as a medical speciality lies in the fact that aside from tackling what it considers as illnesses, it has perchance to comment on and tackle many issues of social relevance as well. Whether this is advisable or not is another matter; but such a process is inevitable due to the inherent nature of the branch and the problems it deals with. Moreover this is at the root of the polarization of psychiatry into opposing psychosocial (...) and biological schools. This gets reflected in their visualization of scope, in definitions and in methodology as well. Whilst healthy criticism of one against the other school is necessary, there should be caution against hasty application of one's frame of reference to an approach that does not intend to follow, or conform to, one's methodology. This should be done within the referential framework of the school critically evaluated, with due consideration for its methods and concepts. Similarly, as at present, there is no evidence to prove one or the other of these approaches as better, aside from personal choice. We can say so even if there is a strong paradigm shift towards the biological at present. A renaissance of scientific psychoanalysis coupled with a perceptive neurobiology which can translate those insights into testable hypotheses holds the greatest promise for psychiatry in the future. This suggests the need for unification of diverse appearing approaches to get a more comprehensive and enlightened worldview. It requires a highly integrative capacity. Just as a physicist thinks simultaneously in terms of particles and waves, a psychiatrist must think of motives, emotions and desires in the same breath as neurobiology, genetics and psychopharmacology. However, the integration must be attempted without destroying the internal cohesiveness of the individual schools. This will give a fair chance for polarization in which a single proper approach in psychiatry could emerge, which may be a conglomerate of diverse appearing approaches of today, or one which supersedes the rest. A synthesis of cognitive psychology and neuroscience offers the greatest promise at present. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.1 (2002) 93-96 [Access article in PDF] Phenomenological Methods in Psychiatry:A Necessary First Step M. Gupta and L. Rex Kay Keywords: behavior, empathy, human science, methodology, natural science, phenomenology. WE ARE GRATEFUL to the journal for prviding the opportunity for exchange and discussion of some of the themes raised in our paper, "The impact of phenomenology on North American psychiatric assessment" and we (...) are pleased to be able to reply to the two excellent commentaries by McMillan and Morley. Both McMillan and Morley question the prospect of employing phenomenology and its methods in psychiatric assessment, and in psychiatric practice more generally. McMillan questions the utility of such a step, and Morley is pessimistic about its feasibility. We shall address each author's concerns in turn.Initially, let us restate the aims of our paper to contextualize our arguments and those made in the commentaries. First, we sought an understanding of what is meant by North American psychiatrists, working within the DSM framework, when they refer to the phenomenological approach to psychiatric assessment. To elucidate this meaning, we compared the contemporary North American usage to a small number of definitions of phenomenology, particularly those definitions that were, and are now, applied to clinical psychiatric work. Contrary to McMillan's suggestion, we did not intend to state definitively what should or should not count as phenomenological, but rather to compare North American psychiatric assessment to what typically has counted as phenomenological. Second, we sought to examine phenomenology's influence on North American psychiatric practice, particularly psychotherapy.Morley argues that such influences usually exemplify the inappropriate appending of phenomenology to psychiatric practice rather than true integration of different paradigms. Although we do not disagree with this general contention, we will argue that the deployment of phenomenological methods in psychiatric assessment is a necessary first step toward the kind of integration he proposes.McMillan makes two related but unintegrated points. First, he argues that objective, behavioral data are phenomenological, according to his broad definition of the term. Second, he proposes that, if the behavioral and the phenomenological are different, we are better off staying with the behavioral when it comes to psychiatric nosology. Let us consider these two points in succession.McMillan seeks to broaden Jasper's definition of phenomenology to include objective observations [End Page 93] as phenomenological. To this end, he distinguishes methods from aims. He summarizes Jasper's definition of phenomenology as "an empirical method for investigating 'individual psychic experience (p 55)" and claims that this is a statement of aim or objectives. He then urges us to "consider the merits of different phenomenological methodologies in terms of their success in achieving this objective" whether or not they utilize "all the methods" of phenomenology. This is much like saying that if we treat waving one's hand as a method for greeting someone, we are then free to treat the objective of the wave as one of greeting someone, and then say that anything that serves as a greeting is, by definition, a "wave." Whatever else McMillan's objective observations are, he has not convinced us that they are phenomenological, anymore than we are likely to convince you that a kiss on the lips is really just a wave.Nonetheless, it is worthwhile seeing what McMillan does with this argument. He tells us that we can "read the first-person experience from behavior in a fairly accurate and informative way." He uses the example of a father gazing at his young child and notes that it is not unreasonable to infer that he is experiencing loving and nurturing feelings. It is, indeed, not unreasonable to draw such an inference. But it is far more reasonable to infer that the father is experiencing a cacophony of feelings, including, but not limited to, love, concern, anxiety, pride, envy, hope, and sadness (Stern 1995, 18-58). If we are able to distinguish which of these feelings is dominant at any given moment—which we are—and if we are also able to track subtle shifts in such feelings... (shrink)

Explanatory models in psychiatry reflect what clinicians deem valuable in rendering people's behavior intelligible and thus help guide treatment choices for mental illnesses. This article outlines some key scientific and ethical principles of clinical explanation in twenty-first century psychiatry. Recent work in philosophy of science, clinical psychiatry, and psychiatric ethics are critically reviewed in order to elucidate conceptual underpinnings of contemporary explanatory models. Many explanatory models in psychiatry are reductionistic or eclectic. The former restrict options for (...) diagnostic and therapeutic paradigm choice, while the latter lack a well-defined theoretical basis. These two methodological approaches stand in a dialectical relation to one another insofar as clinicians often move from one approach to its antithesis, ultimately seeking a synthesis of the two approaches that satisfies clinical needs. Pragmatic considerations can help to transcend the reductionism/eclecticism dialectic. In the absence of a completed science of mental disorders, psychiatrists must tolerate ambiguity and uncertainty as they strive to integrate diverse explanatory concepts in a rigorous and evidence-based fashion. A pragmatic explanatory model in clinical psychiatry must focus on favorable treatment outcomes for patients by respecting the pluralistic, participatory, and provisional nature of psychiatric explanation. (shrink)

Because psychiatry deals specifically with ‘mental’ suffering, its efforts are always centrally involved with the meaningful world of human reality. As such, it sits at the interface of a number of discourses: genetics and neuroscience, psychology and sociology, anthropology, philosophy, and the humanities. Each of these provides frameworks, concepts, and examples that seek to assist our attempts to understand mental distress and how it might be helped. However, these discourses work with different assumptions, methodologies, values, and priorities. Some are (...) in dispute with one another. At various times in the history of psychiatry, a particular form of understanding has become dominant and worked to marginalize .. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:From Methodological Naturalism to Interpretive Exclusivism About Religious PsychopathologyJosé Eduardo Porcher, PhDA particularly deep form of hermeneutical injustice arises when clinicians undermine a patient’s meaningful interpretation of their alleged psychotic symptoms within a religious framework. Cases like Femi’s (Rashed, 2010) illustrate how diagnosing and treating psychotic symptoms with religious content can perpetuate this injustice. Femi’s symptoms, which were very real, were interpreted solely as indicative of a psychotic episode, (...) without considering the possibility of a religious experience. Although hermeneutical injustice is often caused by negative stereotypes, lack of conceptual resources, implicit biases, practices of epistemic privileging, patronizing attitudes, and wrongful pathologization, I propose that interpretive exclusivism about religious psychopathology plays a pivotal role in causing hermeneutical injustice when attributing psychotic symptoms with religious content—that is, the view that an experience is either psychopathological or religious (Scrutton, 2023). Routinely, on attributing psychosis, the potential for the patient to have a genuine religious experience is disregarded and excluded from the therapeutic process and from the very realm of possibility. Why?In their thoughtful commentary, Rosa Ritunnano and Ian James Kidd do me the favor of not only giving careful attention to my argument, but also elucidating my position and providing avenues for further clarification. Although I have not gone much into what is behind interpretive exclusivism, they are right to point to unquestioning adherence to some form of naturalism. Contrary to what they intimate, however, I do not think we are speaking of different kinds of hermeneutical injustice. As I see it, we are speaking about the same kind of injustice, only at different levels of explanation. In my article, I rhetorically ask why [End Page 241] it is assumed that psychotic and religious experiences cannot coexist, and why it is assumed that the same experience cannot be both a genuine religious experience and an instance of psycho-pathology. Ritunnano and Kidd point in the right direction when they say, “Some interpretations of kinds of experience with religious content can be undermined if one is committed to a metaphysical naturalism” (2024, p. 235).Naturalism can be divided into two components: metaphysical and methodological (Papineau, 2020). The metaphysical component concerns the contents of reality, affirming the absence of “supernatural” or other metaphysically elusive entities. In contrast, the methodological component focuses on approaches to investigating reality and attributes a general authority to the scientific method. Therefore, metaphysical naturalism is the more comprehensive view, as it outright denies the existence of the supernatural. Meanwhile, methodological (or scientific) naturalism refers to a pragmatic approach within scientific inquiry, stating that the right methodology to investigate and research something (where this something might not be immediately obvious to be a scientific topic) is that of science, often particular of natural sciences.Although a commitment to metaphysical naturalism may at times be what lies behind interpretive exclusivism, we do not need to go that far, since a commitment to methodological naturalism is enough to breed unwarranted ontological exclusion in practice (Plantinga, 1997; Ratcliffe, 2003). This in turn leads to interpretive exclusivism which is, I argue, the main theoretical flaw behind the kind of hermeneutical injustice I am trying to flesh out. As Ritunnano and Kidd observe, either tacit or explicit adherence to such ontological exclusion causes individuals to struggle to view another person’s spiritual or religious interpretive framework as coherent or even intelligible. Note, however, that the opposite of interpretive exclusivism—that is, interpretive inclusivism—does not need to affirm that the experience is exclusively or even genuinely religious but rather keeps that question open while considering significant epistemic and meaning-making possibilities.Finally, in his commentary, Alasdair Coles (2024) proposes that I overlook the fact that some individuals undergo psychoses featuring deeply distressing and dark religious imagery, the dismissal of which can be therapeutically beneficial. He also contends that therapists often default to considering all religious content as inauthentic, contrasting this with my alleged stance, which he believes assumes the opposite extreme and may be equally or more harmful. In making these assertions, he misrepresents my argument on two counts. I took care to avoid implying that all religious experiences should be uncritically accepted and that all religious content is inherently... (shrink)

Any progress in shaping up an externalist psychiatry, so previous discussion suggested, must begin from questions about the ontology of social causation. So far, research and theory have adhered to a naturalistic approach to the social causes of illness, concentrating mostly on the ‘social determinants of mental health’ (inequality, discrimination, housing insecurity, etc.). The paper starts with an assessment of ‘social determinants’ through the lens of epidemiology and critical psychiatry. It illustrates existing practical and political approaches that fight (...) these constraints and it highlights their therapeutic value. It argues, though, that a focus on social determinants is not sufficient for fully realizing externalism because a great portion of sociogenic illness remains causally indeterminate. Alongside political action, externalism requires a social etiology that is established by virtue of the meaning that it holds for patients, rather than by virtue of its capacity to identify objective social causes of illness. This entails abandoning naturalism about social causation and embracing constructivism. The paper shows that this methodological shift is less contradictory and more effective than it is commonly imagined. Drawing from further anthropological evidence, it concludes that only by lending support to projects that balance a focus on constraints with social construction will psychiatry be truly externalist. At stake is a prospect of effective treatment for sociogenic illness for the countless in struggle. (shrink)

Informed consent represents a cornerstone of the endeavours to make health care research ethically acceptable. Based on experience of qualitative research on power dynamics in nursing care in acute psychiatry, we show that the requirement for informed consent may be practised in formalistic ways that legitimize the researcher's activities without taking the patient's changing perception of the situation sufficiently into account. The presentation of three patient case studies illustrates a diversity of issues that the researcher must consider in each (...) situation. We argue for the necessity of researchers to base their judgement on a complex set of competencies. Consciousness of research ethics must be combined with knowledge of the challenges involved in research methodology in qualitative research and familiarity with the therapeutic arena in which the research is being conducted. The article shows that the alternative solution is not simple but must emphasize the researcher's ability to doubt and be based on an awareness of the researcher's fallibility. (shrink)

This article offers a new reading of the US–UK Diagnostic Project (1965–75), a series of influential collaborative studies that tested the ability of psychiatrists on either side of the Atlantic to diagnose schizophrenia, exploring its historical origins, significance, and legacy. Using archival materials to trace the contest between two of the key players in the Diagnostic Project, Aubrey Lewis and Morton Kramer, it explores how the methodological allegiance between biostatistics and clinical psychiatry was forged in a decade in which (...) psychiatry was undergoing a public crisis. The article unpacks how the place of diagnosis in psychiatry was fundamentally transformed through this important and overlooked collaboration, in which computational methods were strategically used to steer post-war psychiatry from crisis to consensus. (shrink)

The contemporary epistemic status of mental health disciplines does not allow the cross validation of mental disorders among various genetic markers, biochemical pathway or mechanisms, and clinical assessments in neuroscience explanations. We attempt to provide a meta-empirical analysis of the contemporary status of the cross-disciplinary issues existing between neuro-biology and psychopathology. Our case studies take as an established medical mode an example cross validation between biological sciences and clinical cardiology in the case of myocardial infarction. This is then contrasted with (...) the incoherence between neuroscience and psychiatry in the case of bipolar disorders. We examine some methodological problems arising from the neuro-imaging studies, specifically the experimental paradigm introduced by the team of Wayne Drevets. Several theoretical objections are raised: temporal discordance, state independence, and queries about the reliability and specificity, and failure of convergent validity of the inter-disciplinary attempt. Both modern neuroscience and clinical psychology taken as separate fields have failed to reveal the explanatory mechanisms underlying mental disorders. The data acquired inside the mono-disciplinary matrices of neurobiology and psychopathology are deeply insufficient concerning their validity, reliability, and utility. Further, there haven’t been developed any effective trans-disciplinary connections between them. It raises the requirement for development of explanatory significant multi-disciplinary “meta-language” in psychiatry (Berrios, 2006, 2008). We attempt to provide a novel conceptual model for an integrative dialogue between psychiatry and neuroscience that actually includes criteria for cross-validation of the common used psychiatric categories and the different assessment methods. The major goal of our proactive program is the foundation of complementary “bridging” connections of neuroscience and psychopathology which may stabilize the cognitive meta-structure of the mental health knowledge. This entails bringing into synergy the disparate discourses of clinical psychology and neuroscience. One possible model accomplishment of this goal would be the synergistic (or at least compatible) integration of the knowledge under trans-disciplinary convergent cross-validation of the commonly used methods and notions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.3 (2003) 267-271 [Access article in PDF] Likening Strikes Twice:Psychiatry, Osteopathy, and the Likeness Argument Stephen Tyreman PRIMA FACIE PSYCHIATRY and osteopathy do not appear to share much common ground; however, in at least one important respect they pursue similar goals. By seeking to consolidate their independent identities, each is challenging the dominance of the medical model. This involves justifying what they (...) do and why they should exist as independent professions. With osteopathy the situations are different in the United Kingdom and the United States, but in both countries the same challenge exists (Howell 1999; Tyreman 1998). Broadly, it boils down to how osteopathy is positioned in relation to conventional (orthodox or allopathic) medicine and, particularly, to how its practice and theory is validated by scientific methodology. Howell, an allopathic practitioner, sums up the situation as he sees it in the United States by concluding in his New England Journal of Medicine editorial, "many people—even osteopaths—question what it is that osteopathy has to offer that is distinctive.... The paradox is this: if osteopathy has become the functional equivalent of allopathy, what is the justification for its continued existence? And if there is value in therapy that is uniquely osteopathic—that is, based on osteopathic manipulation or other techniques—why should its use be limited to osteopaths?" (1999, 1468). In the United Kingdom, with the passing of the Osteopaths Act in 1993 and the establishment of statutory self-regulation, the profession has been trying to define itself by identifying its raison d'être and the extent to which it aligns itself with medical assumptions.Fueling this dilemma, which in different ways affects psychiatry and osteopathy (and other professions supplementary to, allied with, or complementary to medicine), is the same question: does the paradigm of physical illness, explained and validated by the biological sciences, provide the basic model for understanding and treating all forms of illness—physical, mental, and functional? How are the concepts of illness and disease to be defined and how do such definitions relate to the justification for treatment and other health interventions?Neil Pickering has produced an interesting contribution to the mental illness side of this debate by analyzing the likeness argument, wherein mental illness is said to be a real illness and therefore a legitimate reason for providing treatment, because, in significant respects, it has the same features as other forms of illness acknowledged as being real illnesses. In criticizing the argument he identifies two key assumptions: "that there are features of human conditions... that decide what category or kind, these conditions are a member of" and "that, with respect to the [End Page 267] presence or absence of these features, a condition... is describable independent of the category it is assigned to" (2003, p. 245). He rightly points out that these assumptions do not stand up to analysis and therefore, if indeed they are fundamental assumptions for the argument, the likeness argument must fail. His reason for requiring the argument to fail is that it is not possible to describe (illness) features independently of the category to which they are assigned, which undermines both key assumptions. Therefore all such attempts must fail. He is not clear about what replaces it other than implying that it entails value judgments and human selection.My comments are not so much criticisms of Pickering's conclusion, which I think is correct, but of his reasons for coming to that conclusion, which I think are based on false assumptions; with a different emphasis his argument could be made much stronger.Pickering's argument appears to rest on (at least) three assumptions: he explicitly states that (for the purposes of his argument) illness and disease can be used interchangeably; second, that physical illness is a natural kind; third, that for conventional/allopathic medicine, illness is best understood and explained in physical terms. In addition, and partly as a consequence of the above, there is an implicit assumption that physical illness is the standard against which all other claims to be illnesses should be tested; that is, that... (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)

Machine learning algorithms have begun to enter clinical settings traditionally resistant to digitalisation, such as psychiatry. This raises questions around how algorithms will be incorporated in professionals’ practices, and with what implications for care provision. This paper addresses such questions by examining the pilot of an algorithm for the prediction of inpatient violence in two acute psychiatric clinics in the Netherlands. Violence is a prominent risk in acute psychiatry, and professional sensemaking, corrective measures (such as patient isolation and (...) sedation), and quantification instruments (such as the Brøset Violence Checklist, henceforth BVC) have previously been developed to deal with it. We juxtapose the different ways in which psychiatric nurses, the BVC, and algorithmic scores navigate assessments of the potential of future inpatient violence. We find that nurses approach violence assessment with an attitude of doubt and precaution: they aim to understand warning signs and probe alternative explanations to them, so as not to punish patients when not necessary. Being in charge of quantitative capture, they incorporate this attitude of doubt in the BVC scores. Conversely, the algorithmic risk scores import a logic of pre-emption into the clinic: they attempt to flag targets before warning signs manifests and are noticed by nurses. Pre-emption translates into punitive attitudes towards patients, to which nurses refuse to subscribe. During the pilots, nurses solely engage with algorithmic scores by attempting to reinstate doubt in them. We argue that pre-emption can hardly be incorporated into professional decision-making without importing punitive attitudes. As such, algorithmic outputs targeting ethically laden instances of decision-making are a cause for academic and political concern. (shrink)

Can there be scientific theories in psychology, medicine or psychiatry? I approach this question through an in-depth analysis of a typical experiment for clinical depression involving the monoamine hypothesis, drug action, and placebos. I begin my discussion with a reconstruction of Adolph Grünbaum's conceptual analysis of 'placebo,' and then use his notion of "intentional placebo" to discuss a typical experiment using the monoamine hypothesis, two drugs and a placebo. I focus on the theoretical aspects of the experiment, especially on (...) the notion of causal explanation. I then raise five conceptual and methodological problems for theory construction. These problems focus on questions of the causal efficacy of placebos and drugs; ad hoc versus ceteris paribus explanations in biomedicine and psychology; and the falsifiability of the monoamine hypothesis. I conclude by pointing out the need for further, rigorous philosophical analysis concerning the possibility of theory construction in psychology, medicine, or psychiatry. (shrink)

There is much to admire in Michelle Ciurria’s provocative approach to ascribing moral responsibility. Her work is detailed and spells out explicitly her methodological assumptions. In this commentary, my main focus is on the methodological assumptions she makes. Ciurria’s arguments often depend on our reactions to actual cases and thought experiments. She takes it for granted that we need a theory that matches certain of our intuitions. This is not an unreasonable way to proceed. We definitely need a good reason (...) if we are going to adopt a theory that does not fit with well-established moral intuitions. Nevertheless, we need to be cautious in using these cases to guide our theory choice, especially when our .. (shrink)

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

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

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

In this paper I focus on the emergence of the concept of the “historical a priori” at the origin of Foucault’s archeology. I emphasize the methodological function of this concept within Foucault’s archaeology, and I maintain that despite the different thesis it entails as compared to its philosophical sources, it pertains to one of the main issues of phenomenology, that is, the problematization of the relation between reality as it appears in its historicity, and transcendentality. I start from the interest (...) of the young Foucault in existential psychiatry, and I focus on the French philosophical context in which Foucault’s Introduction to Ludwig Binswanger’s “Dream and Existence” (1954) was conceived. My aim is to show that the first “phenomenological” phase of Foucault’s work is coherent, from a methodological point of view, with the development of archaeology intended as “historical epistemology.” I conclude by arguing that Foucault’s archaeology is methodologically linked to Canguilhem’s epistemology, in that the latter presents itself as an important attempt at linking together historicity and transcendentality. (shrink)

Cognitive neuropsychiatry attempts to understand psychiatric disorders as disturbances to the normal function of human cognitive organisation, and it attempts to link this functional framework to relevant brain structures and their pathology. This recent scientific discipline is the natural extension of cognitive neuroscience into the domain of psychiatry. We present two examples of recent research in cognitive neuropsychiatry: delusions of control in schizophrenia, and affective disorders. The examples demonstrate how the cognitive approach is a fruitful and necessary supplement to (...) the otherwise successful biological psychiatry paradigm, which tend to bypass the cognitive level. Philosophy concerns some of the core concepts involved in psychiatric illness, particularly concerning rationality, thought and action, reality testing, and the self. We present concrete examples that illustrate how philosophical conceptual tools can be particularly important for the construction and interpretation of the cognitive models relevant to the understanding of psychiatric illness. We conclude that cognitive neuropsychiatry is a fruitful and necessary supplement to biological psychiatry. Furthermore, cognitive neuropsychiatry itself may benefit significantly from employing philosophical conceptual tools in the interpretation and construction of its cognitive models. The cognitive and philosophical approaches may thus be further steps towards a scientific psychopathology. (shrink)

I am grateful to the authors for their comments, and for the opportunity to respond. To clarify my approach, I sought to discuss the centrality of ‘set and setting’ at descriptive and normative levels in the Psychedelic Renaissance by focusing on the language of containment prevalent during my ethnographic research. Inspired by the study of material culture, I took up certain questions that can be asked of any container—how they are constructed and maintained, how leaks and overflows are dealt with, (...) the work done by their boundaries, and relationship of these containers to their contents. There are undoubtedly more questions but these are the ones I found fruitful to think with. My goal was to explore how the... (shrink)

Critics who are concerned over the epistemological status of psychiatric diagnoses often describe them as being constructed. In contrast, those critics usually see symptoms as relatively epistemologically unproblematic. In this paper I show that symptoms are also constructed. To do this I draw upon the demarcation between data and phenomena. I relate this distinction to psychiatry by portraying behaviour of individuals as data and symptoms as phenomena. I then draw upon philosophers who consider phenomena to be constructed to argue (...) that symptoms are also constructed. Rather than being ready made in the world I show how symptoms are constructs we apply to the world. I highlight this with a historical example and describe methodological constraints on symptom construction. I show the epistemic problems with psychiatric diagnoses are also applicable to symptoms. Following this, I suggest that critics of psychiatric diagnoses should extend their criticism to symptoms or, if they still believe symptoms are relatively epistemologically unproblematic, should rethink their concerns over psychiatric diagnoses. (shrink)

As one aspect of China's modernization, the importation of Western psychiatric ideas poses a mystery. How are such ideas integrated with traditional assumptions? The apparently wholesale adoption of Western psychiatric categories runs counter to the fact that the Chinese have been generally reluctant to define problems in highly individualized psychiatric terms. Our lack of knowledge as to how the Chinese and Western medical models interface raises questions about the cross-cultural applicability of psychiatric theory. Ironically, the very conceptual categories intended to (...) facilitate professional discourse obscure cultural, political, and epistemological differences between Chinese and Western thought.This paper focuses on certain incongruities in psychiatric theory and practice in order to underscore many unresolved issues that still exist with respect to our cross-cultural understandings of mental illness. Insofar as the trend has been towards standardizing methodology, taxonomies have been generated without a corresponding development in textured comparison. Originating from Western theoretical frameworks, comparative analyses have been otherwise devoid of culture-specific knowledge. (shrink)

This dissertation is a contribution to the contemporary field of phenomenological psychopathology, or the phenomenological study of psychiatric disorders. The work proceeds with two major aims. The first is to show how a phenomenological approach can clarify and illuminate the nature of psychopathology—specifically those conditions typically labeled as major depressive disorder and bipolar disorder. The second is to show how engaging with psychopathological conditions can challenge and undermine many phenomenological presuppositions, especially phenomenology’s status as a transcendental philosophy and its corresponding (...) anti-naturalistic outlook. In the opening chapter, I articulate the three layers of the subject matter of phenomenological research—what I refer to as “existentials,” “modes,” and “prejudices.” As I argue, while each layer contributes to what we might call the “structure” of human existence, they do not do so in the same way, or to the same degree. Because phenomenological psychopathology—and applied phenomenology in general—aims to characterize how the structure of human existence can change and alter, it is paramount that these layers be adequately delineated and defined before investigating these changes. In chapters two through five, I conduct hermeneutic and phenomenological investigations of psychopathological phenomena typically labeled as major depressive disorder or bipolar disorder. These investigations address the affective aspects of depression and mania, and the embodied aspects of depression. In addition to clearly articulating the nature of these phenomena, I show how certain psychopathological conditions involve changes in the deepest or most fundamental layer of human existence—what I refer to as existentials. As I argue, many of the classical phenomenologists (including Husserl and Heidegger) believed that these structural features were necessary, unchanging, and universal. However, this presupposition is challenged through the examination of psychopathological and neuropathological conditions, undermining the status of phenomenology as a transcendental philosophy. While this challenge to classical phenomenology is only sketched in the early chapters, in chapters six and seven I develop it in more detail in order to achieve two distinct ends. In chapter six I argue that psychopathology and neuropathology not only challenge phenomenology’s status as a transcendental philosophy, but also supply a key to developing a phenomenological naturalism (which I contrast with a naturalized phenomenology). Phenomenological naturalism, as I articulate it, is a position in which phenomenology is not subsumed by the metaphysical and methodological framework of the natural sciences, but nonetheless maintains the capacity to investigate how the natural world stands independent of human subjectivity (and how events in the natural world can bring about changes in the most fundamental structures of human existence). In the seventh chapter I argue that a phenomenology in which existentials are contingent and variable rather than necessary and unchanging allows phenomenologists to contribute to new dimensional approaches to psychiatric classification. Rather than begin from distinct categories of disorder, these approaches begin from distinct core features of human existence. These features, referred to as either dimensions or constructs, can vary in degree and are studied in both normal and pathological forms. (shrink)

The subjective experience of time in depression has been described to be altered in complex ways, with sensations of particular slowness, delay or stillness being the most often named articulations. However, the attempts to provide empirical evidence to the phenomenon of “time slowing down in depression” have resulted in inconsistent findings. In consequence, the overall claim that depressive time somehow differs from ordinary time has often been discarded as unfounded. The article argues against such conclusion, contending that the described ambiguity (...) might be caused by the methods employed to assess the phenomenon under observation. In the first part of the article, a reconceptualization of the experience of time in depression is proposed on the grounds of classic and contemporary phenomenological psychiatry. This leads to identify the essential features of depressive time as described both in clinical and philosophical contexts. In the second part, a critique of the existing methods of time perception assessment is conducted, with a specific focus on duration estimation and time passage perception tasks. The above-mentioned core features serve as guidelines in discussing to what degree such methods fit the phenomenon at stake. Finally, an alternative and innovative method is put forward, that might not only help to explore the scope of existing methods but might itself present an alternative to such: the micro-phenomenological interview. (shrink)

This book is an extremely comprehensive review of the status of contemporary psychiatry, both in its theoretical and clinical aspects. While heavily dominated by a psychoanalytic bias, it explores other theoretical and clinical approaches. Included in its contents are the historical beginnings and later development of psychiatry, psychological testing and its utility for psychiatry, nosology of psychiatric disorders, various types of therapies currently in vogue, the organic as well as the psychotic disorders, psychopathic and sociopathic behavior, drug (...) and alcohol addiction, and the general usefulness of psychiatry to medicine, law, and society. The authors generally discuss the investigations and proposals of other behavioral scientists, and then offer their own view of the topic at issue. Of interest to students of philosophy are: considerations relevant to the mind-body problem, problems of normative statements inherent in attempts to determine criteria for distinguishing normal from abnormal behavior, and general matters of methodology, confirmation, and other problems in the philosophy of science which pervade all of behavioral science as well as physical science. The authors may have their personal axe to grind, but freely admit to the tenuous theoretical status of every psychodynamic system so far advanced. Their style is tedious and sometimes cumbersome. However, the book is an extremely contemporary survey, in some depth, of the state of psychiatry, and serves as a valuable reference for both lay and professional reader.—L. P. K. (shrink)