Psychiatry’s inchoate wish for a paradigm shift and the biopsychosocial model of mental illness’ critically examines the much discussed goal of a paradigm shift in psychiatric taxonomy. The chapter first highlights some illustrative calls for such a change and then sets these against the Kuhnian account of science from which the idea is taken, highlighting the connection to incommensurability. Relative to a distinction drawn from Winch, between putative sciences where the self-understanding of subjects plays no role and those where (...) it is fundamental, psychiatry falls into the latter kind. This suggests that the wish for a paradigm shift in psychiatry is either incoherent or a wish for a radical but unpredictable overhaul of a significant aspect of our self-understanding as subjects and agents. The biopsychosocial model of mental illness is thus a helpful reminder of the cost of a paradigm shift in psychiatry. (shrink)

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

Linda Morrison brings the voices and issues of a little-known, complex social movement to the attention of sociologists, mental health professionals, and the general public. The members of this social movement work to gain voice for their own experience, to raise consciousness of injustice and inequality, to expose the darker side of psychiatry, and to promote alternatives for people in emotional distress. Talking Back to Psychiatry explores the movement's history, its complex membership, its strategies and goals, (...) and the varied response it has received from psychiatry, policy makers, and the public at large. (shrink)

This book focuses on two important, interlinked themes in psychiatry, i.e., the relation between self (or: person), context and psychopathology; and the intrinsic value-ladenness of psychiatry as a practice. -/- Written against the background of scientistic tendencies in today’s psychiatry, it is argued in Part I that psychiatry needs a clinical conception of psychopathology alongside more traditional scientific conceptions; that this clinical conception of psychopathology must be based on a fundamental rethinking of the interaction between illness (...) manifestations, contextual influences and the patient as person, such that psychopathology is conceived as the product of this interaction rather than as the outward manifestation of a broken mechanism within the patient. -/- In Part II, it is shown that self- and context-related factors have a large impact on who one is as a professional. I argue that an analysis is needed of the normative aspects of the relations that sustain and frame professional role-fulfilment. This analysis culminates into a so-called normative practice model (NPM) which distinguishes between qualifying, conditioning and foundational principles (or: rules, norms). The normative practice model helps to locate and resist scientistic defenses of the legitimacy of psychiatry and to replace them by a positive account that provides clinicians (and scientists) the conceptual tools they need to justify what they do in broader contexts. The main thrust of the argument is to show that psychiatry needs a value-sensitive account of its legitimacy, in which other normative dimensions are recognized than those that sustain the expert role. Psychiatrists should in other words not defend the legitimacy of their profession by referring to the expert role solely but provide a broader account in which justice is done to the broader social, legal, and economic contexts of professional activity. The analysis of this inherent normativity begins within clinical practice, it extends to the concept of disease as well as to wider domains of psychiatric care and the sociology of professions, and, finally, amounts into an analysis of the value-ladenness of interactions between healthcare institutions, the government, professional organizations and patient groups. (shrink)

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

Psychiatric language and concepts, and the norms they embed, have come to influence more and more areas of our daily lives. This has recently been described as a feature of the ‘psychiatrization of society.’ This paper looks at one aspect of psychiatrization that is still little studied in the literature: the psychiatrization of our emotional lives. The paper develops an extended account of emotion pathologizing as a form of affective injustice that is related to psychiatrization and that specifically harms psychopathologized (...) people, i.e., people who are socially perceived to be mentally ill. After introducing an initial account of emotion pathologizing as articulated in Pismenny et al. (2024), we extend the account by demonstrating how processes and practices of emotion pathologizing are informed by (1) the dominant biomedical approach to psychiatry and (2) sanism, a system of discrimination and oppression that disadvantages people who have received a psychiatric diagnosis, or are perceived as in need of psychiatric treatment. We then argue that emotion pathologizing can manifest as an affect-related hermeneutical injustice that disadvantages psychopathologized individuals by unfairly constraining how they make sense of and understand their own emotional experiences. (shrink)

Background This study used a scenario- and discussion-based approach to teach preclinical medical students the socio-philosophical aspects of psychiatry and qualitatively evaluated the learning outcomes in a medical humanities course in Taiwan. Methods The seminar session focused on three hypothetical psychiatry cases. Students discussed the cases in groups and were guided by facilitators from multiple disciplines and professions. At the end of the semester, students submitted a narrative report comprising their reflections on the cases and discussions. The authors (...) utilized content analysis to categorize students’ narratives into three facets, namely, the philosophical, social and individual. Results In total 163 preclinical medical students participated in the class; 150 of them mentioned the scenario-based lesson in their reports; 33.3% of these reports discussed the case at the philosophical dimension (n = 50), 45.3% at the social dimension (n = 68), and 26.6% at the individual dimension (n = 40). Four major themes emerged: (1) a psychiatric diagnosis has far-reaching consequences for an individual’s life, (2) the social structure affects how patients experience psychiatric disorders, (3) students related personal experience or those of friends and family to understand psychiatric disorders, and (4) medical humanities are of particular importance in psychiatric education. Conclusions This study demonstrated that the scenario-based discussions led by a multidisciplinary team of facilitators can benefit medical students with limited clinical experience to contemplate the socio-philosophical aspects of psychiatry. The authors suggest that this pedagogical model during preclinical education should be encouraged. (shrink)

This thesis investigates the nature of psychiatric disorders, and to what extent they can form a basis for classification, explanation, and treatment interventions. These questions are important in the light of the “crisis of validity” in psychiatry, according to which current diagnostic categories do not pick out real disorders. I address the questions by defending an account of psychiatric disorders that can better accommodate social aspects and non-epistemic values than the symptom-based model of the Diagnostic and Statistical Manual (...) of Mental Disorders (DSM) and the brain disease model of the biomedical approach, including the Research Domain Criteria (RDoC). I concentrate on three ways that psychiatric disorders can differ from prototypical natural kinds, such as biological species and chemical elements. First, the concept of psychiatric disorder or mental disorder is partly value-laden and cannot be defined based only on scientific facts. Second, the objects of psychiatric classifications are interactive human kinds because people with disorders respond to their classifications through looping effects. Third, sociocultural factors can shape disorders in complex ways, which is indicated by their cross-cultural variation. I argue that these challenges can be overcome with a pluralistic explanatory account that grants an explicit role to value-sensitive considerations and social scientific research. Based on this, I argue that particular disorders can in principle support inductive inferences. ------------------------------------------------------------------------------------------ My key argument is that although whether a condition is considered pathological is partly a value-laden question, this does not rule out a realist account of particular psychiatric disorders as homeostatic property cluster kinds (HPC). I assert that causal mechanisms responsible for psychiatric kinds can be understood non-metaphysically based on the contrastive-counterfactual and interventionist theories of explanation. An advantage of this account is that it can address the concern that psychiatric explanations require one to relate heterogeneous causal factors on different levels, such as genetic, neurological, psychological, and social. My novel argument is that mechanistic explanations of scientific kinds have applicability domains over which they account for specific aspects of kinds and warrant inductive inferences. That is, identifying the applicability domain of an explanation spells out the conditions under which the explanation is expected to be reliable and when it can break down. This helps to understand how different discipline approaches, including social and cultural ones, can be complementary and make an explanation of a psychiatric kind more reliable. On the other hand, the account also shows how the complex nature of psychiatric kinds can license re-classifications for different epistemic and non-epistemic purposes. Finally, in the light of the social implications of psychiatric classifications, I suggest a value-sensitive or ameliorative approach to engineering the concept of psychiatric disorder. In conclusion, my account shows that research on the social and cultural factors that shape psychiatric disorders, and weighing the non-epistemic values that influence classificatory practices, can and should inform classificatory choices as well as policy and treatment interventions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Incorporating Religion into Psychiatry:Evidenced–Based Practice, Not a Bioethical DilemmaMary D. MollerFor over sixteen years I was the owner and clinical director of an advanced practice nurse–managed outpatient rural psychiatric clinic staffed by APNs, a social worker, a licensed counselor and several graduate students. Many of our patients were victims of severe and often brutal trauma and abuse suffered at the hands of family, friends, and various professionals (...) including spiritual leaders. We also uncovered sources of abuse suffered from those involved in occult practices ranging from seemingly innocent white witchcraft (Wicca, Paganism, New Age) that includes such activities as astral projection and remote viewing to the darkest possible black witchcraft (perpetrating evil, incanting evil spirits, casting spells and hexes, creating dissociative identities) such as occurs in ritual abuse and satanic rites. Both types of witchcraft also typically involved family, friends, various professionals, and spiritual leaders. Recognizing the controversy surrounding the reality of witchcraft I am sharing a story that I hope will help break down the barriers that prevent many patients from receiving the treatment that would provide the most benefit to recovery.Seeking services for these patients led me on an intense personal and professional journey that included a profound Christian born–again experience at almost 50 years of age. My professional career grew in nearly indescribable terms as a result of the incorporation of prayer and deliverance ministry as part of the services we selectively provided. Today I always include assessment of spiritual experiences a patient has as well as spiritual supports that are available with every new patient intake. For patients who indicate that prayer is one of their supports, I ask if they would like prayer at the conclusion of the session. The gratitude that is expressed by individuals who appreciate being able to pray with a psychiatric provider is often profound.In the field of psychiatry there has been a long–standing and distinct taboo regarding incorporating religious and spiritual aspects of life experience into treatment unless it is to frame most of these discussions within the context of psychosis. This stems from the advent of psychoanalysis in which religion was deemed a neurosis and atheism became the goal. Some still hold to that belief and there certainly remains controversy regarding the incorporation of prayer into routine outpatient or inpatient care. The essential starting point is the determination of accurate differential diagnosis, which can often be a lengthy process. The clinician must be careful about distinguishing between religious experiences and religious delusions, and often this takes time to sort out. The determination of the etiology of hearing the voice of God or the devil or demons must be carefully parsed and framed within the context of the situation and culture the patient describes. If the clinician denies the existence of God or the devil or demons or the practice of witchcraft, the patient’s descriptions of such experiences will be quickly [End Page 206] labeled psychotic. The patient may then experience a lengthy hospitalization and treatment with psychotropic medications that can have an extremely negative effect on the possibility of recovery. Once I witnessed the level of healing that occurs with carefully administered spiritual interventions that are related to specific spiritual experiences that are based on the patient’s belief system, there was no going back to using only allopathic medication and non–spiritual psychosocial interventions, even in spite of the criticisms from others. The key is to understand and respect the patient’s belief system, if this is not congruent with the practitioner’s belief system, then practitioner must refer out.In the United States, an increasing persecution of Christianity and a devaluing of the Judeo–Christian heritage of our Constitution are creating a climate of intolerance to the expression of religious values resulting in an expectation that Christians should compromise their beliefs for the sake of political correctness. As a doctorally prepared psychiatric–mental health advanced practice nurse I experienced a profound born–again Christian experience that ultimately led to study of the Hebrew roots of Christianity and I now worship in a Messianic Jewish synagogue. It is impossible for me to not include the concept of spirituality into... (shrink)

Due to the progress being made in the neurosciences, higher expectations for the use of medication, even against the patient’s will, are arising in mental hospitals. In this article, we will discuss whether the neurosciences and new psychopharmacological solutions really support patients who suffer from mental illnesses. To answer this question, we will focus on the perspective of patients and their experiences with psychiatric (coercive) treatments. The analysis of one person’s story shows that other issues besides appropriate medication are important (...) for recovery from a mental illness. In daily life, issues such as coping, rehabilitation and social support are of major importance for a patient suffering from psychiatric disease. Thus, although progress in the neurosciences is a positive development for clinical practice, it does not mean that (coercive) medication alone will carry a patient into recovery. A patient’s recovery is dependent, not only upon the process of finding the appropriate medication and trust between the psychiatrist and the patient, but also upon relational aspects, such as being recognised as a person, belonging, accepting responsibilities, developing friendships and trusting others. These findings lead to the conclusion that dealing with psychiatric diseases is more complex than what the biomedical model of neuroscience suggests and that one should include the social context of the patient in the recovery process. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Wilhelm Griesinger: Psychiatry between Philosophy and PraxisKatherine Arens (bio)AbstractThis essay discusses Wilhelm Griesinger’s seminal work on mental illness, Mental Pathology and Therapeutics (1867, trans. 1882), in the context of transcendental idealism, as an outgrowth of the work of Kant, Herbart, and Hegel. Griesinger drew on an adaptation of Hegel’s dialectical model of history and science to offer both a new way to interpret mental illness as a product (...) of an individual’s long-term interactions with both nature and culture and a new norm for therapeutic practice based on the patient’s role in his community and history.Mental Pathology and Therapeutics rests on Griesinger’s adaptation of the Hegelian dialectic to the context of pragmatic science, first by adopting its model of the mind, then by describing the etiology of mental disease and a taxonomy of its forms. Griesinger’s work thus stands in a largely unacknowledged tradition alive as late as Sigmund Freud and Jacques Lacan.KeywordsGriesinger, history of psychiatry/psychology, idealism, Hegel, dialecticIn the nineteenth century, Wilhelm Griesinger (1817–68) emerged as a leader in a range of fields: modern-day psychiatric clinical practice, neuropathology, and diagnostics of mental diseases. 1 Griesinger was a theoretician, a clinician, a textbook author, and the founding editor of major professional organs in his field during the political and social ferment in the German-speaking world that allowed new, more socially responsible institutional practices to be considered by intellectual communities. As a consequence of 1849 German civil reforms, theory and practice became mutually enlightening, actually allowing Griesinger to implement his theories into concrete institutional reforms in the German mental health system.Wilhelm Griesinger’s education and career were in many ways typical for his generation. He enrolled at the University of Tübingen in 1834 as a medical student; there, he became politically active (as a member of a forbidden fraternity), and, like many of his contemporaries, became familiar with Hegelian philosophy. After holding several private positions, he was appointed an associate professor (ausserordentlicher Professor) for pathology, “materia medica” and history of medicine at Tübingen in 1847. In 1848, he was called to Kiel; in 1850, to Egypt. Tübingen reappointed him as a full professor for clinical medicine and head of the university clinic in 1854. By 1860, he had moved to Zurich in a professorship for the medical clinic, where, starting in 1863, he was a key person in the planning of a new clinic for mental diseases—the Burghölzli, where Jung later worked. By 1865, he went to Berlin, as director of the Charité (mental institution), among other positions, and he wrote extensively about reform in asylum practice until his premature death in 1868.To a degree, the eminence of this career is contradicted today by his reputation. Contemporary wisdom describes Griesinger as a synthesizer [End Page 147] rather than an innovator, a man who mixed medical psychology with psychology and psychiatric practice, allowing neurology to take a major role in the treatment of mental disease. 2 In one version, Griesinger simply pulled the clinic and the laboratory together, and so bridged Romanticism (i.e., speculative natural philosophy) and materialism (i.e., empirical science) while failing to effect crucial modern reforms. 3 In other descriptions, Griesinger is identified as an activist (Doerner 1981), a key player in the debates between the Hegelian left and right about the reformulation of public institutions (cf. Verwey 1985), 4 or a typical (but effective) member of the intellectual elite of his age. 5 None of these options explains the attractive or threatening aspects of his clinical practice, or suggests why a psychiatrist of his rank could have been so thoroughly refuted after his death. 6The discussion which follows will try to remedy this lack by setting Griesinger’s approach to mental illness in the context of a transformation of a model from philosophy into medical practice. Griesinger’s scientific context strongly combined philosophical theorizing and empirical practice, a synthesis that later generations tended to denigrate as a “speculative” approach to a branch of medicine that required a more empirical foundation. Drawing on an adaptation of Hegel’s dialectical model of history and... (shrink)

A brief overview is provided of sociological and historical critiques of Western psychiatry before focusing on pre-empirical, non-empirical and empirical aspects of psychiatric diagnosis. These are then discussed using the analytical devices of the ontic fallacy, the epistemic fallacy and generative mechanisms. It is concluded that mental disorders do not really exist but particular presenting problems of unintelligibility, interpersonal dysfunction and common human misery, in particular social contexts, recur in modern life and thus constitute real problems for those (...) intimately implicated and for social order. These require new ways of understanding, beyond the option of deconstruction, which could displace categorical reasoning and be sensitive to causes, meanings and their situated social contexts. The paper concludes with an outline of an alternative future for research into mental health problems, which could be informed by critical realism. (shrink)

Luc Faucher Dans cet article, je soulèverai un problème qui a été négligé jusqu’ici dans les écrits portant sur la philosophie de la psychiatrie au sujet du Research Domain Criteria : le fait que l’initiative découle des priorités de recherche du National Institute of Mental Health et que l’orientation de celles-ci ne permet pas de traiter certains aspects des conditions des patients qui sont jugés essentiels par ceux-ci. Après avoir démontré l’existence de ce problème, je vais tenter de voir par (...) quel moyen on pourrait l’éviter. Pour ce faire, je considérerai un programme, européen cette fois, le Roadmap for Mental Health Research in Europe et sa méthode pour intégrer une diversité de voix, dont celles des patients, dans le processus d’établissement des priorités de recherche. Je me livrerai ainsi à un exercice d’épistémologie sociale comparée en montrant comment certaines caractéristiques organisationnelles d’un des programmes possèdent des vertus épistémiques qui font défaut à l’autre et comment une plus grande justice épistémique pourrait être obtenue par l’implantation de certains mécanismes qui permettent à la voix des patients d’être entendue. (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)

RésuméL’article se propose d’interroger la philosophie de la psychiatrie à partir du registre de la quotidienneté, et des questions que les bouleversements de cette dimension de l’expérience dans les psychoses sont susceptibles d’adresser à une phénoménologie du quotidien. Si cette dernière représente une jonction entre clinique et philosophie, elle questionne les articulations entre conditions transcendantales de l’expérience, construction d’une forme concrète de l’ordinaire, et incarnation d’une valeur sociale et anthropologique normative. La quotidienneté ouvre ainsi à une réflexion réciproque entre philosophie (...) et psychiatrie, sous ses aspects à la fois clinique, épistémologique et éthique. (shrink)

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

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

What if Wittgenstein and Popper were right after all? What is psychoanalysis is not “scientific,” not scientific by any contemporary definition—including Adolf Grünbaum’s—but what if it works all the same?1 What if psychoanalysis is all right in practice, but the theory isn’t scientific? Indeed, what if “science” is defined ideologically rather than philosophically? If we so redefine “science,” it is not to dismiss psychoanalysis but to understand its origin and impact, to follow the ideological dialectic between the history of (...) class='Hi'>psychiatry, its developing as a medical “science,” and the evolving self-definition of psychoanalysis which parallels this history. We know that Freud divided psychoanalysis into three quite discrete areas—first, a theory, a “scientific structure”; second, a method of inquiry, a means of exploring and ordering information; and last, but certainly not least, a mode of treatment. Let us, for the moment, follow the actual course of history, at least the course of a history which can be described by sorting out the interrelationship between psychoanalysis and psychiatry, and assume that we can heuristically view the mode of treatment as relatively independent of the other two aspects of psychoanalysis. What if the very claims for a “scientific” basis for psychoanalytic treatment and by extension the role of the psychoanalyst as promulgated by Freud and his early followers were rooted in an ideologically charged historical interpretation of the positivistic nature of science and the definition of the social role of the scientist? This may seem an odd premise to begin an essay on the mutual influence of psychoanalysis and psychiatry, but it is not stranger than the actual historical practice. Psychoanalysis originated not in the psychiatric clinic but in the laboratories of neurology in Vienna and Paris.2 Its point of origin was not nineteenth-century psychiatry but rather nineteenth-century neurology. That origin points to a major difference between the traditional practice of nineteenth-century psychiatry and modern clinical psychiatry in our post-positivistic age. Psychiatry in nineteenth-century Europe, in Vienna as well as in Paris, was an adjunct to the world of the asylum. Indeed, the second great battle which nineteenth-century psychiatry waged was the creation of the “alienist” as a new medical specialty. The alienist was the medical doctor in administrative charge of the asylum, rather than a medical adjunct to the lay asylum director as had earlier, in the age of “moral treatment,” been the practice. Sander L. Gilman is professor of human studies in the departments of German literature and Near Eastern studies, Cornell University, and professor of psychiatry at the Cornell Medical College. He is the author of numerous books on intellectual and literary history. His most recent study is Jewish Self-Hatred . Forthcoming is his study Oscar Wilde’s London and the English edition of his Conversations with Nietzsche. His previous contribution to Critical Inquiry is “Black Bodies, White Bodies: Toward an Iconography of Female Sexuality in Late Nineteenth-Century Art, Medicine, and Literature”. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.2 (2003) 161-167 [Access article in PDF] Social, Cognitive, and Neural Constraints on Subjectivity and Agency:Implications for Dissociative Identity Disorder Peter Q. Deeley In this commentary, I consider Matthew's argument after making some general observations about dissociative identity disorder (DID). In contrast to Matthew's statement that "cases of DID, although not science fiction, are extraordinary" (p. 148), I believe that there are natural (...) analogs of the disorder that, when considered, make it seem less puzzling and exotic. After discussing these examples, I examine the relations between social, cognitive, and neural processes supporting subjectivity and agency, to identify sources of personal identity in cases of DID that can be used as a basis for assessing Matthew's points against Behnke and Sinnott-Armstrong. I am not proposing a comprehensive theory, but rather identifying what I believe are components of such a theory. I then outline an approach to determining criminal responsibility in DID, drawing on analogies with other psychiatric disorders. Dissociative Identity Disorder DID is a disorder described in DSM-IV, which "is characterised by the presence of two or more distinct identities or personality states that recurrently take control of the individual's behaviour accompanied by an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness" (American Psychiatric Association, p. 519). Recognizing Personal Identity How is personal identity recognized in normal cognition? If we take personhood to involve recognition of continuity of social, psychological, and physical identity for a given individual, then such judgments are routinely made rapidly and automatically as an aspect of what has come to be termed social cognition (Adolphs 2003). There is likely to be considerable redundancy in [End Page 161] the types of information used to make judgments about whether a person is the same as one who was previously encountered, or perhaps heard about—for example, facial features, movement patterns, speech prosody, dress, speech content, gender, ethnicity, social role, among other features, all provide information about individual identity, and hence personhood. When uncertainty exists, it is likely to reflect a loss or alteration of cues that would ordinarily be used in a rapid, automatic, unexamined way (Adolphs 2003). In such extreme cases (for example, severe mental illness or disfigurement), the problem of identification becomes the subject of explicit reasoning (and hence of potential disagreement, because we then engage in post hoc rationalizations to establish criteria for determining personhood, whereas normally we rely on essentially automatic, implicit abilities that work in most circumstances, some of which make little use of linguistic representations and formal reasoning—for example, individual facial identity recognition, which may occur as quickly as 170 ms after stimulus onset [Adolphs 2003]). Nevertheless, examining our judgments and intuitions in cases that force us to explicitly consider whether personal identity is preserved may provide analogies and clues for how we should proceed with DID. Let us consider, then, some natural analogs of DID. Natural Analogs of DID Method Acting I suggest that method acting is an analog of DID (Manderino 1985). Method acting refers to an approach to acting training and performance in which emphasis is placed on intensely imagining and identifying with the mental life of the character being portrayed. Training courses and manuals list many techniques and practices that can be used to facilitate absorption in a role, drawing on different kinds of memory—for example, experiential memories, memories of others, general knowledge (semantic memory), and memories of sensations and feelings, to creative a vivid sense of the subjective experience and actions of the character. Manderino, a method acting teacher, comments: "it is important to investigate the way in which your own mental makeup can improperly influence a character. Insecurities, self-consciousness, shyness or self-doubts can maintain a strong hold, and permitting any of these feelings to enter a performance is to remain the actor and not enter into the mental life of the character. For some, acting allows personal problems to be left behind, and they are thankful for the complete escape that... (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)

_Despite advances in standard of living of the population, the condition of widows and divorced women remains deplorable in society. The situation is worse in developing nations with their unique social, cultural and economic milieu, which at times ignores the basic human rights of this vulnerable section of society. A gap exists in life expectancies of men and women in both developing and developed nations. This, coupled with greater remarriage rates in men, ensures that the number of widows continues (...) to exceed that of widowers. Moreover, with women becoming more educated, economically independent and aware of their rights, divorce rates are increasing along with associated psychological ramifications. The fact that widowed/divorced women suffer from varying psychological stressors is often ignored. It has been concluded in various studies that such stressors could be harbingers of psychiatric illnesses (e.g., depression, anxiety, substance dependence), and hence should be taken into account by treating physicians, social workers and others who come to the aid of such women. A change in mindset of the society is required before these women get their rightful place, for which a strong will is needed in the minds of the people, and in law-governing bodies._. (shrink)

The aim of this article is to give more insight into what ethical challenges clinicians in mental healthcare experience and discuss with a Clinical Ethics Committee in psychiatry in the Region of Southern Denmark. Ethical considerations are an important part of the daily decision-making processes and thereby for the quality of care in mental healthcare. However, such ethical challenges have been given little systematic attention – both in research and in practices. A qualitative content analysis of 55 written case-reports (...) from the Clinical Ethics Committee. The Committee offers clinicians in mental healthcare structured ethical analyses of ethical challenges and makes a thorough written case-report. The ethical challenges are grouped into three overarching topics: 1. Clinicians and their relation to patients and relatives. 2. Clinicians and institutional aspects of mental healthcare 3. Clinicians and mental healthcare in a wider social context. Through presentation of illustrative examples the complexity of daily clinical life in mental healthcare becomes evident, as well as typical interests, values and arguments. This qualitative study indicates that difficult ethical challenges are an inherent part of mental healthcare that requires time, space and competence to be dealt with adequately. (shrink)

Tehseen noorani’s article “Containment Matters: Set and Setting in Contemporary Psychedelic Psychiatry” presents a comprehensive, deeply researched ethnographic perspective on current research practices in psychedelic-assisted therapy. This is rapidly evolving terrain scientifically, clinically, legally, and socially. Noorani’s on-the-ground observations from within the Johns Hopkins research program are fascinating and timely given the numerous challenges faced in investigating and developing this emerging mode of psychiatric treatment as well as the complex history psychedelics represent. The level of detail afforded by Noorani’s (...) embedded work between 2015 and 2019 in characterizing the complexities of this... (shrink)

The public, mental health consumers, as well as mental health practitioners wonder about what kinds of values mental health professionals hold, and what kinds of values influence psychiatric diagnosis. Are mental disorders socio-political, practical, or scientific concepts? Is psychiatric diagnosis value-neutral? What role does the fundamental philosophical question "How should I live?" play in mental health care? In his carefully nuanced and exhaustively referenced monograph, psychiatrist and philosopher of psychiatry John Z. Sadler describes the manifold kinds of values and (...) value judgements involved in psychiatric diagnosis and classification systems like the DSM. Professor Sadler takes the reader on a fascinating conceptual tour of the inner workings of psychiatric diagnosis, considering the role of science, culture, sexuality, politics, gender, technology, human nature, patienthood, and professions in building his vision of a more humane psychiatric diagnostic process. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Social, the Outer and the ReflexiveSome More Dimensions of Subjectivity, Schizophrenia, and Its RecoveryThe author reports no conflicts of interest.First of all, I want to express my gratitude to the Association for the Advancement of Philosophy and Psychiatry, Philosophy, Psychiatry, & Psychology, and the Karl Jaspers Award Committee for their recognition of my paper "Institution or individuality? Some reflections on the lessons to be learned (...) from personal accounts of recovery from schizophrenia" (Wannberg, 2024). I am also very thankful for Dr. Paul B. Lieberman's (2024) and Pr. Elizabeth Pienkos' (2024) stimulating comments on the paper.In the original paper, I used the case of the first person accounts of recovery from schizophrenia as a paradigm to elucidate the components of subjectivity more generally, as well as their logical relations. My main point was that considering the "recovery claim" as potentially endowed with a meaning sufficiently close to the official definition of the "personal" sense of recovery at stake—that is, in brief, having "become oneself" despite recurring or residual symptoms—invites us to question current phenomenological, narrative and constructionist approaches of the self in psychopathology. By contrast to these, I stressed the need of a conception of the self more sensible to its social and interpersonal dimensions, which I attempted to sketch out notably by resorting to Wittgenstein's (1953/1997) idea of "grammar." I am very happy that both Lieberman and Pienkos see the appeal to the social as a welcome move with regard to prevailing approaches to schizophrenia and its recovery. But what does it really mean for the subjective or the individual to be socially and interpersonally constituted, and how are we to account for that? [End Page 75]At a first glance, appealing to the social seems to be in line with current trends in psychopathology, including, as Pienkos points out, in the phenomenological tradition. She elsewhere announces a "shift in emphasis" currently taking place within phenomenological psychopathology, characterized by an increasing interest in the situated and dated aspects of subjectivity (Pienkos et al., 2023). This is a valuable turn. However, I am quite dubious that the well-known distinction between an "experiential" and a "narrative" self to which Pienkos appeals is apt to do all the conceptual work required to attain a satisfactory conception of the self and its social dimensions. In my original paper, I took the "recovery account" to challenge both these notions. As concerns the experiential dimension, I held that this type of account questions the phenomenologist's assumption that subjectivity is ultimately grounded in lived (self-)experience. Provided that typical symptoms of schizophrenia (e.g., thought insertion) are expressions of a disorder situated at this most "fundamental" level of the self and provided that they are stemming, at least according to one of the most widespread phenomenological models, from a trait-like disposition present before the onset of psychosis (e.g., Henriksen et al., 2019), it is quite natural to think that these symptoms persist in some form in the context of recovery (e.g., as intrusive thoughts or as "thoughts spoken out loud"). This is indeed the case for several of the authors "in recovery" in the Schizophrenia Bulletin's archives (e.g., Greenblat, 2000), which provided the main source of my analysis. But if this is so, we cannot see their recovery claim as an expression of a "whole" self, so to speak. So we must either say that "personal" recovery from schizophrenia is an illusion or a contradiction, or else we must revise the foundational status of the experiential dimension (other possible options are left aside for the purposes of this brief comment). I argue for the revisionist option. For the equation between the subjective and the experiential does not only lead to an unwelcomed skepticism about the recovery account. There are also more straightforward philosophical reasons for refusing it. Wittgenstein (1980) made a first important step by inviting us to better take into account the variability of the psychological concepts. He notably made a crucial categorical distinction between "lived experiences" (like sensations and mental images) and "attitudes" (like beliefs and intentions) such that all concepts which, when used in the first person... (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)

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

Psychopathy has been the subject of investigations in both philosophy and psychiatry and yet the conceptual issues remain largely unresolved. This volume approaches psychopathy by considering the question of what psychopaths lack. The contributors investigate specific moral dysfunctions or deficits, shedding light on the capacities people need to be moral by examining cases of real people who seem to lack those capacities. -/- The volume proceeds from the basic assumption that psychopathy is not characterized by a single deficit--for example, (...) the lack of empathy, as some philosophers have proposed—but by a range of them. Thus contributors address specific deficits that include impairments in rationality, language, fellow-feeling, volition, evaluation, and sympathy. They also consider such issues in moral psychology as moral motivation, moral emotions, and moral character; and they examine social aspects of psychopathic behavior, including ascriptions of moral responsibility, justification of moral blame, and social and legal responses to people perceived to be dangerous. -/- As this volume demonstrates, philosophers will be better equipped to determine what they mean by “the moral point of view” when they connect debates in moral philosophy to the psychiatric notion of psychopathy, which provides some guidance on what humans need in order be able to feel the normative pull of morality. And the empirical work done by psychiatrists and researchers in psychopathy can benefit from the conceptual clarifications offered by philosophy. (shrink)

Though active in the arts herself, Dr. Richards (psychology, Saybrook Graduate School, San Francisco; psychiatry, Harvard Medical School; McLean Hospital, Belmont, Massachusetts) views creativity more broadly and as essential to survival. As someone who helped break new ground in the assessment of creativity in the general population, she introduces 13 chapters in which interdisciplinary thinkers probe the "originality of everyday life" in individual and societal contexts. Perspectives range from Piaget's developmental stages and the more positive aspects of television viewing (...) to chaos theory and Zen Buddhism. In integrating these views, the editor enumerates the benefits of living creatively. (shrink)

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders included the Social Communication Disorder as a new mental disorder characterized by deficits in pragmatic abilities. Although the introduction of SPCD in the psychiatry nosography depended on a variety of reasons—including bridging a nosological gap in the macro-category of Communication Disorders—in the last few years researchers have identified major issues in such revision. For instance, the symptomatology of SPCD is notably close to that of Autism Spectrum (...) Disorder. This opens up the possibility that individuals with very similar symptoms can be diagnosed differently and receive different clinical treatments and social support. The aim of this paper is to review recent debates on SPCD, particularly as regards its independence from ASD. In the first part, we outline the major aspects of the DSM-5 nosological revision involving ASD and SPCD. In the second part, we focus on the validity and reliability of SPCD. First, we analyze literature on three potential validators of SPCD, i.e., etiology, response to treatment, and measurability. Then, we turn to reliability issues connected with the introduction of the grandfather clause and the use of the concepts of spectrum and threshold in the definition of ASD. In the conclusion, we evaluate whether SPCD could play any role in contemporary psychiatry other than that of an independent mental disorder and discuss the role that non-epistemic factors could play in the delineation of the future psychiatry nosography. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Affectivity and Personality: Mediated by the SocialMartin Heinze (bio)Keywordsaffectivity, sociality, personalism, psychiatric anthropologyBy emphasizing the concept of the person, Rosfort and Stanghellini are to be congratulated for overcoming a reductive concept self driven by the limits of neurobiological research. In this commentary, I emphasize some points about the context of these thoughts concerning the dialectic of nature and freedom and the social realm in which the connections of (...) affectivity and personhood are situated.As discussed in philosophical anthropology, the concept “person” involves both the human capacity for freedom and the legal status given to an individual in society. Nevertheless, even in its most intensive understanding as personality and lived freedom, human existence cannot be separated from its being natural (including being emotional). Moreover, being natural is the condition sine qua non for a free conduct of life. The dialectic of freedom and naturality is addressed by Rosfort and Stanghellini as “ontologic ambiguity” or, to use an older phrase, the structure of “homo duplex”. The aspect of passivity in human existence in which we are determined by our physiology, our environment, and our biography becomes visible. On the other hand, we also see the active dimension of personhood: the possibility to put ourselves into question, to relate to ourselves, to undergo change, and to invent ourselves anew. In the Plessnerian sense, the “ec-centric” nature of the human condition enables us to become active in this way. Plessner supplanted the dialectic between passivity and activity with his notion of Leidenschaft—passion. In the German word Leiden we find the double meaning of suffering and being passionate. Humans are bound to act between the spheres of nature and free will. They suffer from being in the world and can also be passionate by acting in this reality. Leidenschaft thematizes both passivity and activity as well as their unity. Human beings are passive through being dependent on their circumstances. They are passionate, however, when they reflect on these conditions or attempt to come to terms with them. From the dialectical understanding, a unique structure emerges as mutually conditioned, both active and passive. The “passionate man” (a term that Plessner uses to define humanity) synthesizes his being dependent on others with his own freedom to create himself. Passion can be understood as an enhancement of sensuality and spirituality in the context of the conditio humana: “Human reflectivity does not stop in front of sensuality but rather enhances it or weakens it—and both directions can be dangerous for sensuality.” (Plessner 1976, 167, author's translation). [End Page 273]With Kierkegaard, we have to express this even more intensively: a human being is not only shaped by the dialectic of freedom and nature, but—through living—is himself this dialectic. Thus, human personality and human freedom cannot be disconnected from the dimension of passivity that lies at the very heart of freedom. In Jacob Böhme's words, the human situation is that of Naturfreiheit—being free by and through its very own nature. It is neither apart from nature (naturlos) nor is its freedom abstract.The fundamental characteristics of human personality, as described by Rosfort and Stanghellini, are activity, responsibility, freedom, will, reflexivity, and self-distance, but also corporality. In the conduct of life, the realm where this is all realizes is the realm of human relationships to other human beings, that is, a shared world only out of which a successful self-relation can develop. In this sense, the authors quote Grøn: “The normative dimension thus pertains to the self that one already is in relating to others, to a world in between, and to oneself.” Grøn refers to Kierkegaard's attempt—but now with regard to psychopathology—to overcome the duality of human nature by transforming the concept of the self to that of the person. For psychiatric anthropology, there is no way to circumvent this. Thus, psychiatric theories that concern human being inevitably involve a personalistic perspective.Ferdinand Tönnies was the first to use the concept of person to describe social realities. In his classical study from 1887, “Community and Society” (Gemeinschaft und Gesellschaft), he contributed to philosophical personalism. Insofar as the person seeks... (shrink)

Autism is a highly heterogeneous phenomenon. Not only is it difficult to understand the various and diverse aspects of autism, their relation to each other is also complex and still poorly understood. In my article, “Material encounters. A phenomenological account of social interaction in autism,” I have addressed this heterogeneity by presenting an understanding of how social features of autism relate to behavioral features. Straddling this divide between the social and the non-social that still pervades much (...) thinking in philosophy, psychiatry, and psychology is crucial for understanding the diverse experiences of autistic persons and... (shrink)

There is no profession where social change receives more approbation and less application than psychiatry. It is considered salubrious for patients and clinicians alike. This zeal for the innovative has produced an amazing proliferation of therapies. Beyond this psychiatry even preempts a trailblazing role among the behavioral sciences for its evolutionary approach. Freud's social side has been resurrected and now it is acknowledged that the founding father devoted considerable attention to the social aspects of psychoanalysis. (...) That this tendency is alive and prospering is inferred from the emergence of psychohistory, which may even replace community psychiatry—whose lustre has faded —as an example. However, before the profession is crowned with laurel, it might be well to determine whether this appraisal is apparent or real. A more critical analysis seems to indicate that psychiatry has incorporated social influences—up to a point. At first the social component was given consideration. (shrink)

Bioethics urges us to question and debate fundamental moral issues that arise in health-related sciences. However, as a result of Western dominance and globalization, bioethical thinking and practice has inevitably been shaped and defined by Western theories. With recent discussions centering on the relationship between culture and bioethics, it is important to consider how and to what extent can bioethics reflect and accommodate non-Western values and beliefs? Debatably, many scholars working in the field of ‘African bioethics’ seek to construct a (...) bioethical practice that is grounded in indigenous African values. Yet, how relevant are ancient African cultural norms to the lives and realities of the 21st century Sub-Saharan-Africans? This edited volume explores bioethics in Africa from pluralistic and inter-cultural perspectives. The selected papers offer diverse theoretical and practical perspectives on the bioethical challenges that are common and specific to the lives of Sub-Sahara Africans. The contributors define bioethics broadly (beyond ethical issues relating to biomedical and biotechnological science) to include applied ethics that concern all aspects of life. Multidisciplinary in approach, the contributions to this book consider bioethics in relation to philosophy, social work, psychiatry, African studies, religious studies, psychology, and medicine. The broad scope of this volume means it will be of interest to those studying and working in bioethics as well as the fields mentioned above. (shrink)

R. Srivatsan’s view of suicide as a historically specific event enfolded with meaning and Clare Shaw’s thoughtful elucidation of the transformative power of personal stories attest to the complexity and challenge of conducting research into the meanings and functions of narratives of suicide both methodologically and ethically. Because one of the aims of my original article was to bring narrative theories and methods to bear on issues relating to the ethical and political aspects of personal narrative within the practice of (...) suicidology, I hope this will again serve as a useful framework for responding to the commentaries and the specific challenges they present.Srivatsan’s call for a political view... (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)

Both accessible and definitive, Deleuze and Guattari provides a critical examination of the writing of two notoriously difficult thinkers. This important introduction is divided into three sections--knowledge, power, and desire--and provides a systematic account of the intellectual context as well as an exhaustive analysis of the key themes informing Deleuze and Guattari's work. Providing a framework for reading the important and influential study Capitalism and Schizophrenia, this volume is attentive to the needs of the student by providing a lexicon of (...) the difficult ideas used in Deleuze and Guattari's discussion of philosophy, art, and politics. Deleuze and Guattari is an important addition to the critical literature on some of the most challenging work in recent social theory. It will be the standard introduction to Deleuze and Guattari for students of philosophy and social theory. (shrink)

The question of how psychiatric classifications are made up and to what they refer has attracted the attention of philosophers in recent years. In this paper, I review the claims of authors who discuss psychiatric classification in terms referring both to the philosophical tradition of natural kinds and to the sociological tradition of social constructionism — especially those of Ian Hacking and his critics. I examine both the ontological and the social aspects of what it means for something (...) to be a mental disorder, and how the ontological status of these disorders hinges on social causation. Finally, I conclude by suggesting a way in which the biological and the social may be reconciled in an integrative model of variation in psychiatric disorder. (shrink)

A compelling and incisive book that questions the overuse of mental health terms to describe universal human emotions Public awareness of mental illness has been transformed in recent years, but our understanding of how to define it has yet to catch up. Too often, psychiatric disorders are confused with the inherent stresses and challenges of human experience. A narrative has taken hold that a mental health crisis has been building among young people. In this profoundly sensitive and constructive book, psychologist (...) Lucy Foulkes argues that the crisis is one of ignorance as much as illness. Have we raised a 'snowflake' generation? Or are today's young people subjected to greater stress, exacerbated by social media, than ever before? Foulkes shows that both perspectives are useful but limited. The real question in need of answering is: how should we distinguish between 'normal' suffering and actual illness? Drawing on her extensive knowledge of the scientific and clinical literature, Foulkes explains what is known about mental health problems-how they arise, why they so often appear during adolescence, the various tools we have to cope with them-but also what remains unclear: distinguishing between normality and disorder is essential if we are to provide the appropriate help, but no clear line between the two exists in nature. Providing necessary clarity and nuance, Losing Our Minds argues that the widespread misunderstanding of this aspect of mental illness might be contributing to its apparent prevalence. (shrink)

En la actualidad Cuba desarrolla un Programa de Atención Integral al Paciente con Úlcera de Pie Diabético mediante el uso del Heberprot-P, esencial para disminuir la amputación y la discapacidad. El trabajo tiene el objetivo de realizar un diagnóstico sobre la aplicación del Heberprot-P en el Servicio de Angiología del Hospital Provincial Universitario Manuel Ascunce Domenech de Camagüey. Se realizaron encuestas a pacientes para identificar necesidades sentidas relacionadas con el tratamiento y para las actitudes manifiestas, y se hicieron entrevistas al (...) personal médico y de enfermería. El diagnóstico permitió corroborar la necesaria investigación con enfoque social del servicio de salud escogido a nivel territorial. Destaca elevar el trabajo de captación de pacientes desde el nivel primario de salud para garantizar un mayor alcance del programa, así como la trascendencia del apoyo familiar y la relación profesional de la salud- paciente a fin de lograr la calidad requerida. At present Cuba is developing a program concerning the care of patient with ulcer of the diabetes foot by means of Heberprot-P essential to reduce the amputation and disability. The aim of this paper is to carry out a diagnosis about social aspects of the application of the Heberprot-P in the Angiology service at Manuel Ascunce Domenech Hospital in Camaguey. Some surveys were carry out to identify certain needs related with the treatment and the attitude shown and on the other hand some interview were made to the medical and nursing staff. The diagnosis allowed to verify the need of the research with social approach. The paper highlight how to incorporate patients from the primary health level, in order this program has a higher scope and the importance of the family support and the professional relationship to accomplish the quality required. (shrink)

The relevance of the study of the problem of Christian axiology is due to the growing interest in religion and the associated change in world outlook and values ​​in contemporary Ukrainian society. The study of religious values ​​is caused by the urgent problem of finding universal moral values ​​of social development and clarifying the content, structure and nature of their functioning. The scientific study of religious values ​​is also relevant because this problem is closely linked to the value aspects (...) of political life. Christian values ​​are one of the most important factors influencing the formation and development of Ukrainian culture. (shrink)

From its inception in 1987 social epistemology has been divided into analytic and critical approaches, represented by Alvin I. Goldman and Steve Fuller, respectively. In this paper, the agendas and some basic ideas of ASE and CSE are compared and assessed by bringing into the discussion also other participants of the debates on the social aspects of scientific knowledge—among them Raimo Tuomela, Philip Kitcher and Helen Longino. The six topics to be analyzed include individual and collective epistemic agents; (...) the notion of scientific community; realism and constructivism; truth-seeking communities; epistemic and social values; science, experts, and democracy. (shrink)

My comments on Jacqueline Taylor's rich and interesting study1 will focus on a theme which I found particularly thought provoking: the discussion of Hume's treatment of pride. I think the topic of pride is central to the book's structure—closely integrated with the recurring consideration of what is distinctive in Hume's approach to the social significance of the passions.I am going to come at this theme indirectly—through consideration of the differences between Hume and Spinoza on the nature and significance of (...) pride. Taylor shows that Hume has made it possible for pride to be considered as a positive trait, perhaps even as a virtue. Spinoza's attitude to pride in the Ethics is, in contrast, quite negative. The... (shrink)

This paper argues for psychological realism in the conception of psychiatric disorders. We review the following contemporary ways of understanding the future of psychiatry: (1) psychiatric classification cannot be successfully reduced to neurobiology, and thus psychiatric disorders should not be conceived of as biological kinds; (2) psychiatric classification can be successfully reduced to neurobiology, and thus psychiatric disorders should be conceived of as biological kinds. Position (1) can lead either to instrumentalism or to eliminativism about psychiatry, depending on (...) whether psychiatric classification is regarded as useful. Position (2), which is inspired by the growing interest in neuroscience within scientific psychiatry, leads to biological realism or essentialism. In this paper we endorse a different realist position, which we label psychological realism. Psychiatric disorders are identified and addressed on the basis of their psychological manifestations which are often described as violations of epistemic, moral or social norms. A couple of examples are proposed by reference to the pathological aspects of delusions, and the factors contributing to their formation. (shrink)

Particular social aspects of the nature of science, such as economics of, and entrepreneurship in science, are understudied in science education research. It is not surprising then that the practical applications, such as lesson resources and teaching materials, are scarce. The key aims of this article are to synthesize perspectives from the literature on economics of science, entrepreneurship, NOS, and science education in order to have a better understanding of how science works in society and illustrate how such a (...) synthesis can be incorporated in the practice of science education. The main objectives of this article are to argue for the role and inclusion of EOS and entrepreneurship in NOS and re-define entrepreneurship in the NOS context; explore the issues emerging in the “financial systems” of the Family Resemblance Approach to NOS and propose the inclusion of contemporary aspects of science, such as EOS and entrepreneurship, into NOS; conceptualize NOS, EOS, and entrepreneurship in a conceptual framework to explain how science works in the society; and transform the theoretical knowledge of how science operates in society into practical applications for science teaching and learning. The conceptual framework that we propose illustrates the links between State, Academia, Market and Industry. We suggest practical lesson activities to clarify how the theoretical discussions on the SAMI cycle framework can be useful and relevant for classroom practice. In this article, science refers to physics, chemistry, and biology. However, we also recommend an application of this framework to other sciences to reveal their social-institutional side. (shrink)