In this paper I examine Wittgenstein’s appeals to madness in On Certainty in light of Foucault’s Histoire de la folie. A close look at these works, usually conceived as disparate, belonging to entirely different schools of thought, reveals they actually have much in common. Both can be read as investigations into the grounds of reason, and while they offer quite different and distinct perspectives on the matter, they share some central insights. In both we find that the boundaries of (...) reason are not only vague but also largely founded upon the relations - social in Foucault, socio-linguistic in Wittgenstein - between the reasonable person and the unreasonable person. Both perspectives reveal a curious state of affairs whereby the reasonable person is the one who dominates discourse, and yet, in his claim for reason, remains forever dependent upon the unreasonable person and his rejection. The pressing question triggered by Foucault's account is whether the boundary between reason and unreason is at all necessary. This undermines Wittgenstein’s thesis that this boundary is a matter of logical necessity upon which discourse depends. I flesh this point out in the paper also by examining the differences in Wittgenstein’s and Foucault’s treatments of Descartes’ Meditations. I conclude that Wittgenstein’s criticism of Cartesian skepticism presented in On Certainty loses much of its fortitude once examined in light of Foucault's Histoire de la folie. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.2 (2002) 187-188 [Access article in PDF] Listening to Foucault Patrick J. Bracken ERICA LILLELEHT'S INTERESTING PAPER combines philosophy, history, service analysis, and social commentary. The philosophical themes are below the surface, implicit rather than explicit. As such the paper echoes the work of Foucault himself. The subjects of his books and other writings ranged from histories of madness and psychiatry, hospitals and medicine, prisons (...) and punishment, to sexuality and ethics. But these were clearly more than histories. In doing what he initially called archaeology and later genealogy, Foucault was writing about different dimensions of how the Western world has come to understand what it is to be human. In Foucault's hands history becomes philosophy. The essence of his work is an invitation to question the project of Enlightenment. However, his interrogation of the legacy of Enlightenment is far from a rejection of reason as has sometimes been claimed. Rather it represents a realization that there are different forms of reason, none of which can claim a place of privilege over others. Foucault challenged the idea that we have to choose to be for or against Enlightenment (Foucault, 1984).Of central concern for him is the idea that knowledge and power imply each other and cannot be separated. This, of course, is anathema to both Marxist and liberal analysts who hold out the idea that truth and ideology are mutually exclusive. The assumption is that if we get the starting point of our analysis right, the truth ("pure and simple") will emerge. For Foucault there are "regimes of truth," discourses through which certain things can be said and statements can be judged as true or false. Such regimes are social products, bound up with the economic, cultural, and political realities of their times. This is not some sort of mindless relativism nor a nihilistic advocacy that, when it comes to knowledge claims, "anything goes." As human beings in an imperfect world we have to struggle continuously toward a better understanding of ourselves and the make-up of this world. As individuals, we have to continue to debate and argue about ideas, facts, and the nature of knowledge. We have to present evidence, argue our case, and prepare to be contradicted as well as supported. This is not in question. Instead, what is involved here is recognition that there is no neutral asocial, acultural, or apolitical vantage point from we can judge the validity of one position over another. Foucault's work nurtures a healthy skepticism of those who claim to have found such a vantage point.Importantly, he rejected the idea that power is always repressive in its nature: working to silence, obscure, and suppress. Particularly in the modern era power is more characteristically productive. Its operations are bound up with the ever-multiplying discourses we produce about ourselves. While increasing scientific knowledge about the human condition appears to represent progress, listening to Foucault means coming to appreciate that things are a great deal more complex. The title of Lilleleht's paper reflects this. At [End Page 187] a time when there is a great deal of talk about "progress" in the area of mental health, her analysis is opportune. Unless we pay attention to the micropolitics of clinical encounters we are at some risk of simply endorsing new forms of professional power. In one light, the psychiatric rehabilitation approach of William Anthony and colleagues appears obviously progressive. It does not depend on the "medical model" and the use of medication and seems genuinely committed to the idea of empowerment. However, with the sort of sensibility engendered through an encounter with Foucault, other issues come into view. Beneath its focus on skills and training we see a very clear normative framework centered on the idea that the person with psychiatric problems should be guided and trained toward fitting in with "his or her particular environment." At stake here is the assumption that the deficit is in the patient. It is he or she who needs to change. Herein lies the issue of power: who is in control of the way in which... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Are Mental Health "Peer Support Workers" Experts by Experience?The author reports no conflict of interests.In this well-argued paper, Dr. Abdi Sanati asks whether a person's experience of mental illness could be the basis for professional expertise and concludes that, "on its own," it cannot be. Elsewhere he states that "the different forms of knowledge that are required for expertise … could not be produced solely on the (...) basis of personal experience" (Sanati, 2024, 107). The qualifications "on its own" and "solely" suggest that personal experience of mental illness could be the basis for professional expertise if other conditions are also met. What are these conditions, and can they be met? Gratefully, Sanati provides an excellent exposition of a concept of expertise and the conditions that are required for satisfying it.Expertise needs to be thought of as a "form of life" that requires more than the accumulation of knowledge and cannot happen in isolation. To become an expert, you need to be part of a community through which you can acquire factual knowledge (knowledge-that) and acquire the practical capacities and dispositions (knowledge-how) that enable you to conduct actions related to your area of expertise. With training over time, experts develop tacit knowledge that enables them to "ap ply background theories to new cases," which is why an expert is able to deal with a multitude of cases that appear different from each other. Experts should be able to hold a relatively cohesive view of their subject matter and see how it all 'holds together'.The importance of community for the possibility of becoming an expert is further emphasized by Sanati's appeal to Wittgenstein's Private-Language Argument. A 'private language,' if such a thing were to exist, is a language that enables the person to express mental states with reference only to what is occurring in the speaker's mind and known through introspection. This language, in being private, makes sense only to the speaker and is not comprehensible to others. Introspection allows privileged access to my mental states, which thus become a unique source of knowledge available only to me. And the argument against such a private language is that it is impossible, for in being unintelligible to others, it becomes nonsensical as such. The reasons behind this have to do with the nature of language as a rule-based activity that requires intersubjective agreement, engaging in which is to partake in a form-of-life. [End Page 113]Putting aside the details of the Private-Language Argument, I am interested in the conclusion that Sanati draws from it. He starts by pointing out that what is taken as the basis for expertise-by-experience is the supposed privileged access to one's mental states that leads to a unique form of knowledge. It is this knowledge that underlies the claim to expertise. Sanati's view is that one cannot acquire a kind of knowledge completely inaccessible to others yet expressed in language as this would amount to use of a private language, which is impossible. And so, the person is either expressing nonsense or is merely using shared language. If the latter, then the alleged uniqueness of the experience is lost as it has been brought under a rule-based form of life.Sanati seems to imply that experience can only constitute a unique form of knowledge if it arises from a single mind through introspection and use of a private language. Given that this is not possible, the experience can no longer be unique. But I do not see why it cannot be a form of knowledge which, while not being unique to a single individual, is still an expression of human experience that only a proportion of the population go through, the proportion who are diagnosed with a certain mental health condition. In other words, a form of knowledge does not to have to be unique to be distinct, and if it is distinct then perhaps it can constitute the basis for expertise if other conditions are also met. In fact, this is suggested by Sanati's conclusion when he writes: "for the community of experts to exist there... (shrink)

There is evidence that mental illness is partly socially constituted: diagnoses are historically “transient” (Hacking, _Rewriting the soul: Multiple personality and the sciences of memory_. Princeton University Press, 1998a; _Mad travelers_. University of Virginia, 1998b) and culturally variable (Toh, _Nature Reviews Psychology_, _1_(2), 72–86, 2022). However, this view risks pernicious relativism. On most social constitution views, mental illness is what (some suitably expert part of) society takes it to be. But this has morally abhorrent implications, e.g., it legitimizes (...) many spurious and harmful diagnoses (like “drapetomania”) and makes mental illness a matter of fashion rather than an objective challenge. This paper defends a conception of mental illness according to which it is partly socially constituted, yet which avoids such pernicious relativism: mental illness consists in an objective inability - a deficit in the skilled metacognitive self-regulation required to be rationally interpretable by one’s community, including oneself. Such reasons responsiveness requires skilled regulation of cognition, conation, and behavior, such that they respect relevant interpretive norms. Because such norms vary culturally, such skills are partly socially constituted. (shrink)

The body of the one deemed mad often remains a sexual body with sexual needs. Mental health services respond to these demands of the body in various ways, including constructing rules around physical movement. In this context, we were interested in how mental health clinicians problematized the sexual needs and practices of residents of a long‐stay mental health rehabilitation facility and how solutions were constructed in relation to the residents’ sexual desires. This paper reports findings from (...) class='Hi'>mental health clinicians, as part of a case study where we addressed this question. Mental health clinicians responded to residents’ sexuality from a discourse of risk. The notion of the engagement with each resident as a sexual subject was subordinated to the paternalistic notion of protecting the patient from risk. The resident became an object to be monitored and protected rather than a subject with sexual desire and agency. This paternalism also showed itself in relation to a ‘no‐sex on‐site’ rule that allowed for a shift of risk from the organization to the resident. Residents, rather than having a relatively safe place to have sexual relations, were required to find a place elsewhere, potentially unsafe, outside the facility. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Lynn Huffer's Mad For Foucault:An Analysis of Historical Eros?Laura HengeholdMad for Foucault is a remarkably beautiful book balanced on the edges between the personal, the impersonal, and the public and reflected through Foucault's own struggles to establish those divides. Huffer's goal in Mad for Foucault is to draw scholarly attention to the emotional and ethical content of Foucault's writing, as well as to assess the risks of queer theory's (...) dependence on dialectics and psychoanalytic theory. Reading History of Sexuality I in light of History of Madness, she argues, renders the ethical aspects of Foucault's early project clear and reveals the continuity with his later work on ethics, putting the central concerns of queer theory in a different light. But this continuity is only visible through attention to the lyrical force resulting from tensions between these edges, which also separate genders and epochs, as if Las Meninas were to draw the viewer's gaze toward a fractured mirror rather than a sovereign one.The elements of History of Sexuality I that have been most important for the queer theorists Huffer engages are Foucault's attempt to date the shifts from a perception of sinful acts to a perception of homosexual personality types, and his warning that reifying such personality types as "identities" in hopes of liberation from heterosexist oppression continues to support the social mechanisms that identify personal truth with sexuality. Some (associated with Judith Butler) have tried to develop an account of agency that owes less to the exclusions of traditional moral and psychological theories but risks establishing its own hierarchies of psychic "health." Others (Lee Edelman is exemplary) [End Page 226] have also argued that the affects associated with these acts and identities, and possibly the ethical attitudes arising from these affects, are historical effects that must be bracketed in the name of resisting biopower (Huffer 2010, 94-95).Both groups, Huffer argues, have merely performed a dialectical reversal within the order of sexualities inherited from the nineteenth century, without appreciating Foucault's effort to cast the very terms of that order into question—above all, in History of Madness (Huffer 2010, 113-16). What is more disturbing, both sides have enlisted psychoanalysis on their behalf, although Foucault remained skeptical of psychoanalysis. In History of Madness (2006a), Foucault's skepticism was justified in the name of the affective attachments of queer life and his deeply felt fascination for the traces of a sexual hybridity almost erased from European history. For Huffer, the real question posed by both History of Sexuality I and History of Madness is not, as queer theorists might believe, "why sexuality became a moral issue" (and how might it cease to be one) but who was buried when the nineteenth-century medicalization of sexuality replaced erotic experience with explanations of sexual abnormalities (2010, 229). She reads Foucault's work as a meditation on the ethical tragedy presented by the scattered ashes of even "infamous men."Although there are many themes I could address, I will let my comments be guided by Huffer's reading of the explicit and implicit critique of psychoanalysis found in Foucault's work, and its relation to Foucault's ambivalent Kantianism (2010, 127-33, 134). This critique comes from several directions. First, throughout all his works, including Archeology of Knowledge, Foucault criticizes interpretive approaches to the historical record and to human speech. Practices such as "commentary" reduce the variety of events that can be perceived in the historical field and turn some into the content or meaning of others, which are thereby privileged metaphysically as "more real." Second, Foucault criticizes power relations forcing some to confess and to interpret the products of their own confession in terms of the meanings religious or medical authorities insist on finding there. From the seventeenth century through the present, such authorities have identified work and family-oriented behavior as "reasonable" and have forced those whose behavior does not fit those terms to understand themselves as deviations from that norm (Huffer 2010, 105, 107-108).Third, according to Huffer, Foucault subjects belief in the psyche as scientific object and focus of work on the self to historical analysis... (shrink)

By examining an exemplar sample of mental health nursing educational policies and related legislation, in this article, we trace the discursive production of madness as an “othered” identity category. We engage in a critical discourse analysis of mental health nursing education in Canada, drawing on provincial and federal policies and legislation as the main sources of data. Theoretically framed by critical posthumanism and mad studies, this article outlines how the mad subjectivity becomes decontextualized out of its identity‐based understanding (...) and recontextualized as an inferior category of “the human,” circulating within discourses of pedagogy, economics, law, and psychiatry. The article maps the intertextual nexus of the discourse of mental health nursing education, making visible the complex, the arbitrary, and the sometimes‐contradictory nature of the discipline's grappling with identity‐based mental health concepts. We close with several implications for nursing policy, education, and practice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Though This Be Madness, Yet There Is Method in ’T”A Positive Account of MadnessValentina Cardella, PhD (bio)What does it mean to be mad? How can we define mental disorder? The question is still widely discussed among psychiatrists and philosophers, and what exactly distinguishes sanity and insanity remains unclear. Despite this lack of clarity, the common conceptualization of madness is that mental disorders are impairments in rationality: people (...) with mental disorders are generally believed to have impairments in reasoning and logic (Bermúdez, 2001; Edwards, 1981; Harvey, Watkins, Mansell, & Shafran, 2004).Yet, the result of this conception is that we fail to understand madness. We do not understand how, for example, schizophrenic patients can be more logical than healthy people in some reasoning tasks (Mellet et al., 2006; Owen, Cutting, & David, 2007), or delusional patients can be perfectly rational in defending their ideas (Cardella, 2020), or depressive people can be more realistic than non-clinical subjects (Moore & Fresco, 2012). In contrast, if we consider rationality as the core feature of sanity, we fail to understand sanity, too, because normal people exhibit many kinds of biases and heuristics, and thus irrationality is widespread in the general population (Bortolotti, 2020; Johnson-Laird, 2006; Evans, 2002; Kahneman, Tversky, & Slovic, 1982).In his paper, Garson focuses on Late Modern theorists of madness (Locke, Kant, Wigan, and Heinroth) to reframe the problem and provide a positive account of mental disorder. These authors contrast madness to idiocy, rather than sanity, and therefore their conception of madness is very different: “while idiocy is marked by the diminished, or even abolished, functioning of the reasoning power, madness is marked by its perverse functioning. The mad person “has” reason, but deploys it in a perverse, improper, or unseemly manner” (Garson, 2023, p. 286).In his reading of Late Modern authors, Garson provides a new ontology of mental disorder, that goes beyond an absence of reason, and has also political and social implications. Furthermore, he reminds us that every scientific discipline has its philosophical assumptions. In defining madness, [End Page 305] we cannot help but choose a contrasting class, and each choice will have very different consequences. Even if psychiatry is a medical discipline, which aims to endorse a neutral view of mental disorder, it is impossible for it to be unbiased and impartial. All the more so, for it has to deal with human suffering and fragility.But, in this article, there is one crucial question that remains unanswered. In his analysis of Late Modern theorization of madness, Garson comes to the conclusion that madness is marked by a perverse deployment of reason. Yet, who decides when reason is deployed in a perverse manner? While the lack of rationality is something that we can detect easily enough, the task of defining precisely what is an ‘improper’ or ‘perverse’ use of reason is much harder. In other words, it seems to me that, in replacing the ‘lack of rationality’ paradigm with ‘the perverse rationality paradigm,’ the question of what is madness still remains open, and, most important, some normative aspects remain necessary. To recognize when rationality is improperly used, we have to adopt an evaluative stance, which defines what a proper use of reason would be.Valentina [email protected] University of MessinaValentina Cardella Valentina Cardella is Associate Professor of Philosophy of Language at the University of Messina, Italy. Her research interests encompass cognitive sciences, philosophy of language, and psychopathology.The author reports no conflicts of interest.Commentary submitted on June 13, 2023Accepted on June 13, 2023ReferencesBermúdez, J. L. (2001). Normativity and rationality in delusional psychiatric disorders. Mind and Language 16, 457–93. Google ScholarBortolotti, L. (2020). The epistemic innocence of irrational beliefs. Oxford: Oxford University Press. Google ScholarCardella, V. (2020). Rationality in mental disorders: too little or too much? European Journal of Analytic Philosophy 16 (2), 13–36. Google ScholarEdwards, R. B. (1997). Mental health as rational autonomy. In Edwards, R. B. (ed.), Ethics of psychiatry: Insanity, rational autonomy, and mental health care. New York: Prometheus Books. Google ScholarEvans, J. (2002). Logic and human reasoning: an assessment of the deduction paradigm. Psychological Bulletin 128... (shrink)

In three parts, this volume in the AP-LS series explores the phenomena of captivity and risk management, guided and informed by the theory, method, and policy of psychological jurisprudence. The authors present a controversial thesis that demonstrates how the forces of captivity and risk management are sustained by several interdependent "conditions of control." These conditions impose barriers to justice and set limits on citizenship for one and all. Situated at the nexus of political/social theory, mental health law and jurisprudential (...) ethics, the book examines and critiques constructs such as offenders and victims; self and society; therapeutic and restorative; health; harm; and community. So, too, are three "total confinement" case law data sets on which this analysis is based. The volume stands alone in its efforts to systematically "diagnose" the moral reasoning lodged within prevailing judicial opinions that sustain captivity and risk management practices impacting: (1) the rights of juveniles found competent to stand criminal trial, the mentally ill placed in long-term disciplinary isolation, and sex offenders subjected to civil detention and community re-entry monitoring; (2) the often unmet needs of victims; and (3) the demands of an ordered society. Carefully balancing sophisticated insights with concrete and cutting-edge applications, the book concludes with a series of provocative, yet practical, recommendations for future research and meaningful reform within institutional practice, programming, and policy. (shrink)

How the insane asylum became a laboratory of democracy is revealed in this provocative look at the treatment of the mentally ill in nineteenth-century France. Political thinkers reasoned that if government was to rest in the hands of individuals, then measures should be taken to understand the deepest reaches of the self, including the state of madness. Marcel Gauchet and Gladys Swain maintain that the asylum originally embodied the revolutionary hope of curing all the insane by saving the glimmer of (...) sanity left in them. Their analysis of why this utopian vision failed ultimately constitutes both a powerful argument for liberalism and a direct challenge to Michel Foucault's indictment of liberal institutions. The creation of an artificial environment was meant to encourage the mentally ill to live as social beings, in conditions that resembled as much as possible those prevailing in real life. The asylum was therefore the first instance of a modern utopian community in which a scientifically designed environment was supposed to achieve complete control over the minds of a whole category of human beings. Gauchet and Swain argue that the social domination of the inner self, far from being the hidden truth of emancipation, represented the failure of its overly optimistic beginnings. Madness and Democracy combines rich details of nineteenth-century asylum life with reflections on the crucial role of subjectivity and difference within modernism. Its final achievement is to show that the lessons learned from the failure of the asylum led to the rise of psychoanalysis, an endeavor focused on individual care and on the cooperation between psychiatrist and patient. By linking the rise of liberalism to a chapter in the history of psychiatry, Gauchet and Swain offer a fascinating reassessment of political modernity. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Compelling ReasonsTim Thornton, MA, MPhil, PhD, DLitt (bio)There are many compelling reasons to have an interest in the philosophy of/and psychiatry. In 1994, when persuaded by Bill Fulford to walk down the corridor at Warwick University to join in his teaching of what seemed a newly developing subject—against my protestations that I knew nothing about mental health care—my main interest was in the irreducibility of meaning to the (...) 'realm of [natural scientific] law,' in Sellars's phrase. This had the bonus of complementing Bill's championing of the irreducibility and centrality of values in psychiatry. (It was only later we realized we disagreed about the not inconsequential issue of whether norms and values were subjective preferences or objective features of the world.) It seemed plausible to me that the irreducibility of the space of reasons to the realm of law might have interesting consequences for psychiatry. But mine was a purely disinterested academic interest. This is perhaps the usual approach to what is in part a professionalized academic subject with its formal rules for publication and dissemination of research.It has only been in the last decade that I have experienced things in a more personal way, following what I would term, though psychiatry would not, a nervous breakdown. My image of a breakdown came from reading Saul Bellow's novel Herzog. The titular Herzog has been left by his wife, cruelly, and retires from academic life to write letters. For example, to Heidegger. "Dear Doktor Professor Heidegger, I should like to know what you mean by the expression 'the fall into the quotidian.' When did this fall occur? Where were we standing when it happened?" I thought I would be able to maintain some sort of inquiring mind and write experientially grounded philosophy of psychiatry as a catharsis. I could study my own illness. This immediately proved a ridiculous hope.As a philosopher with a cognitivist bent—language, thought, and intentionality being guiding interests—I had always assumed that madness was only really a matter of what Jaspers calls 'primary delusions,' belief-like states that strain their belief-status, are hard for others to make sense of, and occur only with particularly severe forms of mental illness. But madness is also a matter of doing, saying and feeling as well as pure reasoning. What I would, previously and disinterestedly, have described as a dysregulation of emotional reactions turned out to transform my entire experience of the world and my ability to think rationally about it. I lost the ability to put my experiences into words. In truth, I lost all interest in that project. Only when not distressed could I take a view on my loss of world. Distressed, I did not understand myself.This is a neat illustration of epistemic disjunctivism. But it also highlights a challenge for, and some of the brilliance in those who have contributed to, the philosophy of mental health care, through their expertise by experience. While experience may be a necessary condition for particular forms of expertise, my own case reveals that it is not sufficient. Further, even an everyday and familiar mental illness (like my own) can render the articulation of experience, in a way that makes sense to others, very much harder. Hence the fact [End Page 11] that there is a thriving mental health service and patient movement, making their own experiences available to others combining first-person narratives with conceptual and phenomenological insight is both admirable and helps to set a part of PPP's future agenda: bringing first-person experience within a philosophically and clinically informed discipline. [End Page 12]Tim Thornton Tim Thornton, MA, MPhil, PhD, DLitt, is Professor of Philosophy and Mental Health and Mental Health and Deputy Head for Research in the School of Nursing at the University of Central Lancashire. As well as contemporary philosophy of thought and language, his research concerns conceptual issues at the heart of mental health care. He has published research papers on clinical judgement, idiographic and narrative understanding, the interpretation of psychopathology and reductionism and social constructionism in psychiatry.Copyright © 2023 Johns Hopkins University Press... (shrink)

In order to be able to provide informed, effective and responsive mental health care and to do so in an evidence‐based, collaborative and recovery‐focused way with those who use mental health services, there is a recognition of the need for mental health professionals to possess sophisticated critical thinking capabilities. This article will therefore propose that such capabilities can be productively situated within the context of the work of the French philosopher Michel Foucault, one of the most challenging, (...) innovative and influential thinkers of the 20th century. However, rather than focusing exclusively upon the content of Foucault's work, it will be suggested that it is possible to discern a general methodological approach across that work, a methodological approach that he refers to as “the history of the present.” In doing so, Foucault's history of the present can be understood as a productive, albeit provisional, framework in which to orientate the purpose and process of critical thinking for mental health professionals by emphasizing the need to both historicize and politicize the theoretical perspectives and therapeutic practices that characterize contemporary mental health care. (shrink)

This paper presents some annotations on mental health, from the point of view of implicit notions of madness. To this end, we propose a distinction between the medical, phenomenological existential and socio-critical models. We focus in the latter two in order to achieve a critical approach about the subject, dominated by the medical perspective. According to Foucault's earliest works, this article begins by evaluating criteria of normality in terms of the historical genesis of madness concept. Then, we describe the (...) medical model based on the distinction between illness and symptom. Later, we focus on the phenomenological-existential model to describe the ontological fragility in Laing, i.e. the original core of the self and the world experienced by the schizophrenic person. Finally, we add some considerations related to the social origin of schizophrenia, as stated in the Cooper's and Foucault's perspectives. (shrink)

Madness is a complex and contested term. Through time and across cultures it has acquired many formulations: for some, madness is synonymous with unreason and violence, for others with creativity and subversion, elsewhere it is associated with spirits and spirituality. Among the different formulations, there is one in particular that has taken hold so deeply and systematically that it has become the default view in many communities around the world: the idea that madness is a disorder of the mind. -/- (...) Contemporary developments in mental health activism pose a radical challenge to psychiatric and societal understandings of madness. Mad Pride and mad-positive activism reject the language of mental 'illness' and 'disorder', reclaim the term 'mad', and reverse its negative connotations. Activists seek cultural change in the way madness is viewed, and demand recognition of madness as grounds for identity. But can madness constitute such grounds? Is it possible to reconcile delusions, passivity phenomena, and the discontinuity of self often seen in mental health conditions with the requirements for identity formation presupposed by the theory of recognition? How should society respond? -/- Guided by these questions, this book is the first comprehensive philosophical examination of the claims and demands of Mad activism. Locating itself in the philosophy of psychiatry, Mad studies, and activist literatures, the book develops a rich theoretical framework for understanding, justifying, and responding to Mad activism's demand for recognition. (shrink)

The ability to reason ethically is an extraordinarily important aspect of professionalism in any field. Indeed, the greatest challenge in ethical professional practice involves resolving the conflict that arises when the professional is required to choose between two competing ethical principles. Ethical Reasoning in the Mental Health Professions explores how to develop the ability to reason ethically in difficult situations. Other books merely present ethical and legal issues one at a time, along with case examples involving "right" (...) and "wrong" answers. In dramatic contrast, Ethical Reasoning in the Mental Health Professions provides you with the needed background in methods of ethical reasoning and introduces an innovative nine-step model of ethical decision-making for resolving ethical dilemmas. Ethical Reasoning in the Mental Health Profession discusses the ethical codes of both psychology and counseling. This interdisciplinary approach promotes a better understanding of the similarities and differences in the points of emphasis in the two codes, which, in turn, enriches your understanding of the range of ethical considerations relevant to the practice of the mental health professions. (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)

In lieu of an abstract, here is a brief excerpt of the content:Madness, Reason, and PrideRichard G.T. Gipps, PhD (bio)MadnessQuestions such as “what’s madness?” or “what’s reason?” carry no singular sense about with them wherever they go—which isn’t to say that, asked out of a particular interest in a particular context, they can’t be perfectly intelligible. Garson (2023) is wise to this when he follows “what is madness?” with “as opposed to what?”, even if this latter question itself (...) hardly enjoys a clear sense in the initial context of his asking. What counts as a satisfactory answer to “what’s x?” varies, so that sometimes we’ll be satisfied with a name, at other times by information about something’s genus, origin, function, or composition. Things get notoriously tricky when in the philosophical context the question is asked with a presumption of intelligibility despite ‘x’ being, say, an abstract noun formed from an adjective (‘consciousness’ out of ‘conscious’; ‘happiness’ out of ‘happy’; ‘madness’ out of ‘mad,’ etc.). For “what is?” questions are typically most perspicuously mooted when what’s being pursued are enquiries into (what we might call) the ‘essential nature’ of (what philosophers used to call) ‘substances’ or (of what are more ordinarily called) types of ‘thing’ or ‘entity.’ Invoke, by taking one’s lead from the fact that an ‘x’ is grammatically speaking a substantive, the specter of substance, and you can endlessly baffle yourself by now pondering the mysteries of the putative thing. (Vide discussions of “the nature of consciousness.”) Hence the boon of instead pursuing questions of an ‘opposed to what?’ sort; hence Wittgenstein considering using the Earl of Kent’s “I’ll teach you differences” (King Lear) as a motto for his Investigations. Rather more reflective wisdom regarding ‘x’ may thus be gained when we learn to contrast it with ‘y’ and ‘z’ than when peering into x’s non-existent constitution or groping for its never-instituted genus.Later, I make the case that Garson’s conception of reason itself might suffer from a form of substantialization and that, if I’m right in this, troubling implications follow for his approach to madness. But let’s begin by considering his enquiry into the relation of madness, idiocy and reason. So perhaps we’re reflecting on matters legal, and considering—since we’d hitherto been inclined to take ‘reason’ as univocal—what justifies our different treatments of the insane, the intellectually subnormal, and the normal. Or perhaps—proceeding from the same inclination—we’re puzzled by how someone may boast an exceptional IQ or demonstrate marvelous formal rationality (i.e., make deductions of a sort which would please the logician if no-one else) and yet still be quite mad. And then we realize that at which Garson’s Late Moderns seem to have been gesturing: The lack of reason qua intelligence in idiocy is a different [End Page 307] species from the lack of reason qua sanity in madness. An amethyst is lifeless in a different manner than an expired possum (it was never living, never moribund); the arational lack reason in a different sense than do the irrational (and a baobab cannot jump to conclusions.) There is, say his Late Modern theorists, something ‘perverse’ rather than simply deficient about the irrationality of madness.Now an important part of Garson’s thesis has it that “idiocy is a better candidate for the opposite of reason than madness.” One of the reasons for his making this claim is that he follows his Late Moderns in claiming that madness has reason somehow alive within it, albeit in an unconventional or surprising form. I return to his own explication of this below. Consider first, though, the different thought-referencing descriptions under which the speech acts of the thought-disordered, the speech-disordered, the delusional, and the learning disabled subject may be brought. The sufferer of speech disorder has difficulty with fluency or sound production, but once we get used to this we can find our way to the bona fide rational thought immanent within their discourse. The speech acts of the intellectually impaired subject aren’t chaotic, but instead want for invention and richness; they fail to express... (shrink)

When it was first published in France in 1961 as Folie et Déraison: Histoire de la Folie à l'âge Classique , few had heard of a thirty-four year old philosopher by the name of Michel Foucault. By the time an abridged English edition was published in 1967 as Madness and Civilization , Michel Foucault had shaken the intellectual world. This translation is the first English edition of the complete French texts of the first and second edition, including all prefaces and (...) appendices, some of them unavailable in the existing French edition. History of Madness begins in the Middle Ages with vivid descriptions of the exclusion and confinement of lepers. Why, Foucault asks, when the leper houses were emptied at the end of the Middle Ages, were they turned into places of confinement for the mad? Why, within the space of several months in 1656, was one out of every hundred people in Paris confined? Shifting brilliantly from Descartes and early Enlightenment thought to the founding of the Hôpital Général in Paris and the work of early psychiatrists Philippe Pinel and Samuel Tuke, Foucault focuses throughout, not only on scientific and medical analyses of madness, but also on the philosophical and cultural values attached to the mad. He also urges us to recognize the creative and liberating forces that madness represents, brilliantly drawing on examples from Goya, Nietzsche, Van Gogh and Artaud. The History of Madness is an inspiring and classic work that challenges us to understand madness, reason and power and the forces that shape them. (shrink)

In my paper, I propose to investigate the philosophical underpinnings of representative indigenous Japanese psychotherapeutic approaches, particularly that of Morita and Naikan therapies, that have, at their foundations, distinctly Buddhist psychological tenets, and that offer to deal with mental health issues in a manifestly different way compared with their western counterparts. I offer a comprehensive account of how the characterizations of madness and mental illness have been shifting over the last two hundred years in Japanese society and culture, (...) and how this has affected mental health care in Japan. Finally, the ways in which modern day thinkers, such as Daisetz Teitaro Suzuki and Keiji Nishitani have been re-shaping the concepts of the self in Japanese religion and philosophy while, at the same time, taking care to remain faithful to the original East Asian sensibilities will also be expounded and connected to the themes of mental health and mental illness. (shrink)

The current experiments examine mental health clinicians’ beliefs about biological, psychological, and environmental bases of the DSM‐IV‐TR mental disorders and the consequences of those causal beliefs for judging treatment effectiveness. Study 1 found a large negative correlation between clinicians’ beliefs about biological bases and environmental/psychological bases, suggesting that clinicians conceptualize mental disorders along a single continuum spanning from highly biological disorders (e.g., autistic disorder) to highly nonbiological disorders (e.g., adjustment disorders). Study 2 replicated this finding by having (...) clinicians list what they thought were the specific causes of nine familiar mental disorders and rate their bio–psycho–environmental bases. Study 3 further found that clinicians believe medication to be more effective for biologically based mental disorders and psychotherapy to be more effective for psychosocially based mental disorders. These results demonstrate that even expert mental health clinicians make strong distinctions between psychological and biological phenomena. (shrink)

This essay is a defense of Platonic eudalmonism. Plato identified human excellence with mental health, mental health with psychic harmony, psychic harmony with the rule of reason, and he conceived reason to he the synergetic union of the power to know and the power to love. Plato believed that virtue is a constitutent of eudaimonia, that, therefore, it is its own reward. Plato was right on all these counts but one. He misunderstood the nature of the (...) love that is a constituent of reason. That love is not the eras of the Symposium. It is what I call'undemanding love'. In this essay I describe the structure of undemanding love and I explain its connections with reason, mental health, and the moral excellence that is characteristic of a rational being. (shrink)

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

Despite changes to research and practice, that, to some degree, acknowledge that people are shaped by their contexts, the treatment of mental illness remains largely focused on interventions that take place at the level of the individual. Conceptualizing mental illness as something that resides in individuals can lead to reliance on neurobiological and psychotherapeutic solutions, and away from conversations about not only contextual causes of mental distress, but also sociopolitical solutions to mental distress. Further, it can (...) lead to the use of mental health interventions that focus on the biology of an individual without a consideration for how those interventions themselves may have psychological, social, or political consequences that act to shape an individual's identity, agency, and relationship to their community. This paper examines one medicolegal intervention, the community treatment order, using the philosophical work of Grosz and Foucault to consider how this intervention affects the experience and construction of identity, and the impact of this on an individual's sense of agential membership in a community. This discussion aims to increase understanding of the individual and social implications of interventions for mental illness, and provide a conceptualization of the relationship between identity, agency, and ethics which can inform critical research and nursing practice more broadly. (shrink)

How are we to make sense of madness and psychosis? For most of us the words conjure up images from television and newspapers of seemingly random, meaningless violence. It is something to be feared, something to be left to the experts. But is madness best thought of as a medical condition? Psychiatrists and the drug industry maintain that psychoses are brain disorders amenable to treatment with drugs, but is this actually so? There is no convincing evidence that the brain is (...) disordered in psychosis, yet governments across the world are investing huge sums of money on mental health services that take for granted the idea that psychosis is an illness to be treated with medication. Although some people who use mental health services find medication helpful, many do not, and resist the idea that their experiences are symptoms of illnesses like schizophrenia. Consequently they are forced into having treatment against their wishes. So, how do we make sense of this situation? Postpsychiatry addresses these questions. It involves an attempt to rethink some of the fundamental assumptions of mental health work, showing how recent developments in philosophy and ethics can help us to clarify some of the dilemmas and conflicts around different understandings of madness. Throughout, the authors examine the conflicting ways in which politicians, academics, and mental health professionals appear to understand madness, and contrast this with voices and experiences that are usually excluded - those of the people who use mental health services. They then examine the power of psychiatry to shape how we understand ourselves and our emotions, before considering some of the basic limitations of psychiatry as science to make madness meaningful. In the final section of the book they draw on evidence from service users and survivors, the humanities and anthropology, to point out a new direction for mental health practice. This new direction emphasises the importance of cultural contexts in understanding madness, placing ethics before technology in responding to madness, and minimising 'therapeutic' coercion. (shrink)

This article reviews the development of a feminist analysis of female and male psychology from 1970 to 1990; the acceptance, rejection or indifference to feminist theory and practice by women in general and by female patients and mental health practitioners in specific. The article describes what feminist therapy ideally is and discusses the need for a Feminist Institute of Mental Health.

Mental health-related data generated by app users during the routine use of Consumer Mental Health Apps (CMHAs) are being increasingly leveraged for research and product improvement studies. However, it remains unclear which ethical safeguards and practices should be implemented by researchers and app developers to protect users during these studies, and concerns have been raised over their current implementation in CMHAs. To better understand which ethical safeguards and practices are implemented, why and how, 17 app developers and researchers (...) were interviewed who had been involved in using CMHA data for studies. Interviewees discussed the impact on stakeholder interests, sufficiency thresholds and procedural alterations of informed consent, data protection, gathering app user perspectives and representing users in app design and study conduct, and ensuring adequate support. Although the reasoning behind how and why these ethical safeguards and practices should be implemented showed considerable variability and several gaps, interviewees converged on various general lines of reasoning. This allowed for the development of a coherent and nuanced account that could prove useful for future CMHA studies and which could stimulate further normative investigation of the role of ethical safeguards and practices in these studies. (shrink)

Mental health legislation that requires patients to accept ‘care’ has come under increasing scrutiny, prompted primarily by a human rights ethic. Epistemic issues in mental health have received some attention, however, less attention has been paid to the possible epistemic problems of mental health legislation existing. In this manuscript, we examine the epistemic problems that arise from the presence of such legislation, both for patients without a prior experience of being detained under such legislation and for those (...) with this experience. We also examine how the doctor is legally obligated to compound the epistemic problems by the knowledge they prioritise and the failure to generate new knowledge. Specifically, we describe the problems of testimonial epistemic injustice, epistemic silencing, and epistemic smothering, and address the possible justification provided by epistemic paternalism. We suggest that there is no reasonable epistemic justification for mental health legislation that creates an environment that fundamentally unbalances the doctor–patient relationship. Significant positive reasons to counterbalance this are needed to justify the continuation of such legislation. (shrink)

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

Positive mental health involves not the absence of mental disorder but rather the presence of certain mental goods. Institutions, practitioners, and theorists often identify positive mental health with well‐being. There are strong reasons, however, to keep the concepts of well‐being and positive mental health separate. Someone with high positive mental health can have low well‐being, someone with high well‐being can have low positive mental health, and well‐being and positive mental health sometimes conflict. (...) But, while positive mental health and well‐being are not identical, there is an informative conceptual connection between them. Positive mental health usually contributes instrumentally to the living of a good human life, where a good human life includes (but is not limited to) well‐being. (shrink)

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

Literatures of Madness: Disability Studies and Mental Health brings together scholars working in disability studies, mad studies, feminist theory, Indigenous studies, postcolonial theory, Jewish literature, queer studies, American studies, trauma studies, and comics to create an intersectional community of scholarship in literary disability studies of mental health. The collection contains essays on canonical authors and lesser known and sometimes forgotten writers, including Sylvia Plath, Louisa May Alcott, Hannah Weiner, Mary Jane Ward, Michelle Cliff, Lee Maracle, Joanne Greenberg, Ann (...) Bannon, Jerry Pinto, Persimmon Blackridge, and others. The volume addresses the under-representation of madness and psychiatric disability in the field of disability studies, which traditionally focuses on physical disability, and explores the controversies and the common ground among disability studies, anti-psychiatric discourses, mad studies, graphic medicine, and health/medical humanities. (shrink)

It is contested whether and to what extent moral responsibility can be ascribed to persons with mental health disabilities. Will Cartwright (2006) evaluates two prevalent theories of responsibility in terms of their suitability for morally appraising sociopathic personality disorder, particularly as embodied in the famous homicidal bank robber Robert Harris. Cartwright argues that our intuitions about Harris conflict because we are instantly horrified by Harris’ actions, but we are forced to reconsider our initial moral reaction when we reflect on (...) Harris’ history of extreme abuse and neglect. After considering both candidate theories—the reflective-self view and the reasons view—Cartwright decides that neither is .. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Wittgenstein’s Reflection in Lewis Carroll’s Looking-GlassLeila S. MayAccording to one tradition in the theory of fiction, there is a kind of fantasy whose function is to invite the reader to "acknowledge the possibility of a different reality."1 In this essay I want to ask whether Lewis Carroll's Alice books fit into this category; that is, I want to explore the possibility that Alice's Adventures in Wonderland and Through the (...) Looking-Glass are not the pure nonsense that many readers take them to be. In considering the Alice books as fantasy offering a view of a "different reality" I do not deny that there are in these stories some mimetic elements alongside the fantastic—representations of things going on somewhere, somehow, in Victorian society—in which case the "different reality" presented will not be so terribly different as to be unrecognizable. For example, the Mad Tea Party in Alice's Adventures in Wonderland is not only an act of fantasy but also an act of mimesis. It certainly imitates the real tea parties often held throughout Victorian England—if caricature is a form of imitation—but it may also mime those mock tea parties held in English asylums whose goal was to model sane-like behavior to the inmates.2 An analogous question can be asked about Carroll's books in general: In addition to the component of fantasy, are they mimetic of Victorian culture itself, or merely of the Victorian conception of madness? Michel Foucault has argued that, while the very idea of la folie is an historical construct, the dialectical relationship between reason and unreason, with each pole parasitic on the other, is a structural constant. Carroll's Alice books produce images that are discharged in the confused nineteenth-century landscape where these two opposites meet. In that respect, his books are not so different from many of the more standard novels written in mid-century England. In this essay I [End Page 79] will explore features of this landscape, using a theoretical framework that has been synthesized from a number of related claims in the work of the linguistic philosopher Ludwig Wittgenstein. In addition to my long-range aim of urging further study of Wittgenstein's work by literary critics, one of my specific goals is to show that the application of Wittgensteinian methods to the works of Lewis Carroll reveals something about the hidden logic of Carroll's stories, and conversely that this procedure tests some of Wittgenstein's intuitions concerning language. Yet another goal is to suggest that the structure of the discourse of domesticity as reflected in many mid-nineteenth-century novels is curiously similar to the structure of discourse in Wonderland and Looking-Glass Land—that the language-games played at these sites are at the same time functional and dysfunctional in much the same way. That may seem like a lot to attempt in a few pages,... but to paraphrase Humpty-Dumpty, when I ask words to do that much extra work, I pay them overtime.In 1965 the philosopher George Pitcher published an essay, "Wittgenstein, Nonsense, and Lewis Carroll," in which he sought to demonstrate "the remarkable extent and depth of affinity between these two great writers with respect to nonsense." In addition, he showed that "the very same confusions with which Wittgenstein charged philosophers were deliberately employed by Carroll for comic effect," and that many of the examples that Wittgenstein used to illustrate his points "resemble, in varying degrees, examples that are found in the works of Carroll."3 While I agree with Pitcher's observation that the examples of nonsense that Wittgenstein offers are very similar to a primary strain of nonsense that runs through the Alice books, in the first section I intend to go beyond that observation and to apply some of Wittgenstein's tools to Carroll's work and show that Wittgenstein's work can be used to reveal features of literary narrative that might otherwise be obscured, and in the second section, to apply these tools to the works of fiction this side of the Looking-Glass.IWittgenstein says that a language is a "language-game." He... (shrink)

I argue in this essay that the phenomena we classify as "mental illness" result largely from the refusal of socially authorized "experts" to recognize - and thus to constitute - the Other as a subject. I suggest that Institutional Mental Health refuses to do this not merely because it seeks to aggrandize its own power but also because it fears to acknowledge that we are all participants in a process of historical development. It denies this because it is (...) historically conditioned by its own moment of origin in the project of the Enlightenment, It is conseqently wed to an ethos of rationalized order that does not accomodate, much less support, the unpredictable creative power of the Other and that sustains instead the project of mastery, of domination, of disovering eternal laws that will enable Reason to master history and to master the Other. For this reason Institutional Mental Health and its diverse ideologies, ranging from the pyschoanalytic to genetic defect models, constitute a major obstacle to the evolution of humanity. (shrink)

In this chapter we argue that the four principles of medical ethics -- beneficence, non-maleficence, respect for autonomy and justice (Beauchamp & Childress, 2001; Gillon, 1985), a new Family Interest Principle (introduced below) and a consideration of ‘capacity’ provide a reasoned practice guide for work with mothers experiencing health problems, focussing here on mental health when a parent is a patient. Our concern is the relationship of the clinician with a parent and through the parent their child. Ethics of (...) service provision or services planning (e.g. Culyer, 2001; McLachlan, 2005; see also Newbigging and Paul, chapter xxx), or the provision of other services (e.g. education, child protection) although intensely relevant to this area are not addressed in this chapter nor will we deal with the complex aspects of medical ethics relating to the treatment of children (Baines, 2008). We use the term ‘parent’ to refer to any adult person who fulfils a substantive parental role with a child. Defining what counts as a family will in certain circumstances be contentious. There are diverse patterns of family arrangements that may be influenced by cultural, political economic and temporal factors. For the purposes of our discussion, we define a family in terms of its role in childrearing, as a group of at least one adult and at least one child, living together in long term relationships on an ongoing basis with vested interest in the well being of each of the family members. (shrink)

Michel Foucault has become famous for a series of books that have permanently altered our understanding of many institutions of Western society. He analyzed mental institutions in the remarkable Madness and Civilization; hospitals in The Birth of the Clinic; prisons in Discipline and Punish; and schools and families in The History of Sexuality. But the general reader as well as the specialist is apt to miss the consistent purposes that lay behind these difficult individual studies, thus losing sight of (...) the broad social vision and political aims that unified them. Now, in this superb set of essays and interviews, Foucault has provided a much-needed guide to Foucault. These pieces, ranging over the entire spectrum of his concerns, enabled Foucault, in his most intimate and accessible voice, to interpret the conclusions of his research in each area and to demonstrate the contribution of each to the magnificent -- and terrifying -- portrait of society that he was patiently compiling. For, as Foucault shows, what he was always describing was the nature of power in society; not the conventional treatment of power that concentrates on powerful individuals and repressive institutions, but the much more pervasive and insidious mechanisms by which power "reaches into the very grain of individuals, touches their bodies and inserts itself into their actions and attitudes, their discourses, learning processes and everyday lives" Foucault's investigations of prisons, schools, barracks, hospitals, factories, cities, lodgings, families, and other organized forms of social life are each a segment of one of the most astonishing intellectual enterprises of all time -- and, as this book proves, one which possesses profound implications for understanding the social control of our bodies and our minds. (shrink)

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

This paper notes the re-ignited controversy surrounding the publication of a new edition of the Diagnostic and Statistical Manual of Mental Disorders, suggesting that the early work of Michel Foucault can explain why the mere diagnosis of or criteria for mental illness remains a heated flashpoint. In particular, it argues that Foucault articulates a common issue within the philosophical foundations of psychiatry and psychology that the paper terms the ‘subjectivity problem.’ It observes, using Foucault’s work, that these disciplines (...) treat not just simple objects but complex subjects that are capable of interacting with that labelling and who are shaped by it. Drawing on the related work of Ian Hacking on kind-making as world-making, the article fleshes out why the subjectivity problem remains persistent within psychiatry and psychology as forms of knowledge, preventing them from operating as many commentators might desire them to – as pure and objective sciences. Finally, the paper reflects on the relationship of psychiatry and psychology as forms of knowledge, the manner in which they constitute their objects, and how this might shape the biopolitical episteme in which we find ourselves today. (shrink)

Professionals within the mental health services face many ethical dilemmas and challenging situations regarding the use of coercion. The purpose of this study was to evaluate the significance of participating in systematic ethics reflection groups focusing on ethical challenges related to coercion. In 2013 and 2014, 20 focus group interviews with 127 participants were conducted. The interviews were tape recorded and transcribed verbatim. The analysis is inspired by the concept of ‘bricolage’ which means our approach was inductive. Most participants (...) report positive experiences with participating in ethics reflection groups: A systematic and well-structured approach to discuss ethical challenges, increased consciousness of formal and informal coercion, a possibility to challenge problematic concepts, attitudes and practices, improved professional competence and confidence, greater trust within the team, more constructive disagreement and room for internal critique, less judgmental reactions and more reasoned approaches, and identification of potential for improvement and alternative courses of action. On several wards, the participation of psychiatrists and psychologists in the reflection groups was missing. The impact of the perceived lack of safety in reflection groups should not be underestimated. Sometimes the method for ethics reflection was utilised in a rigid way. Direct involvement of patients and family was missing. This focus group study indicates the potential of ethics reflection groups to create a moral space in the workplace that promotes critical, reflective and collaborative moral deliberations. Future research, with other designs and methodologies, is needed to further investigate the impact of ethics reflection groups on improving health care practices. (shrink)

Jay Asher’s novel Thirteen Reasons Why and its Netflix adaptation have enjoyed widespread popularity. While they draw needed attention to issues like bullying and teen estrangement, they may have an unintended effect: they mislead about the etiology of suicide and even glamorize it to a degree. The medical literature has shown that suicide is almost always the result of psychiatric disorder, not provocative stress, in much the same way an asthmatic crisis is primarily the result of an underlying medical condition, (...) not an allergic stimulus. Both the novel and Netflix series ignore this premise and even belittle the idea. Thus, while the story has artistic merits, it also has the potential to be destructive if accessed by young readers and viewers seeking guidance. Approximately ten percent of teens suffer from depression, and suicide recently surpassed homicide as the second-leading cause of death among persons ages ten to twenty-four in the United States. A more balanced view addressing these misconceptions is provided for teens, parents, and mental health professionals. (shrink)

Bioethics, Volume 36, Issue 3, Page 290-297, March 2022.

This article offers a narrative analysis of the contributing factors of moral distress (MD) and moral injury (MI) among mental health clinicians working amidst humanitarian crises. It discusses the impact of moral stress on therapeutic relationships in mental health trauma. The article originated from the author's experience developing a peer-to-peer support program at a nongovernmental organization (NGO) and conducting peer-to-peer support for mental health clinicians and healthcare providers in Ukraine and Turkey. A significant amount of literature has (...) documented the detrimental effects of MD and MI on mental health, job sustainability, and resilience of healthcare providers and first responders. The negative effects of MD and MI are particularly relevant in trauma counseling, where clinicians must draw upon the use of self to develop therapeutic relationships with their clients. This process demands a high level of moral reasoning and self-awareness, which can be severely tested under the morally challenging conditions of a humanitarian crisis. There is an imperative need to deepen our understanding and to swiftly address the factors that precipitate MD and MI in mental health clinicians working in crisis zones. By doing so, we aim to bolster their resilience and the enduring nature of their commitment to help and save others. This, in turn, will not only contribute to saving more lives but also enable those who are affected by trauma to flourish in the aftermath of their experiences. (shrink)

With the proviso that Spinoza's concerns were philosophical, not medical, we examine the Ethics with a view to bringing out those aspects of it which are of import for mental health. We find that the Ethics surrounds the idea that man can be egoless in the Buddhist sense of that term. This concept provides a criterion of mental health. Further, according to Spinoza's theory of the Affections, those which are passive include some which are based on pain. These (...) he 'enumerates among the diseases'. And for them he provides, in Part V, specific 'remedies'. This in turn leads him to equate 'Mental Freedom or beatitude' with a 'healthy Mind'. We thus have in Part V additional possible criteria of mental health. Finally, there is the suggestion that philosophy for Spinoza was a kind of therapy.' There is not a philosophical method, though there are indeed methods, like different therapies. — The philosopher's treatment of a question is like the treatment of an illness. — A main cause of philosophical disease — a onesided diet . . . Wittgenstein This doctrine of knowledge first and action later is not a minor disease . . . My present advocacy of the unity of knowledge and action is precisely the medicine for that disease. Wang Yang-ming When asked by two disciples which of the views of each was correct, Wang replied: both are. Which is used depends on the kind of person you are trying to help. Some persons need this one, others that. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 27.1 (2003) 80-97 [Access article in PDF] Literary Truth as Dreamlike Expression in Foucault's and Borges's "Chinese Encyclopedia" Robert Wicks ALTHOUGH THE TOPIC REMAINS MOSTLY unexplored, Michel Foucault had an aesthetic and intellectual attraction towards writers and artists in the Spanish-speaking tradition. For example, at the conclusion of his Histoire de la folie (Madness and Civilization, 1961)—a book which brought him extensive intellectual recognition in France—Foucault (...) drew his readers' attention to José de Goya y Lucientes's (1746-1828) well-known etching, El Sueño de la Razón Produce Monstruos (The Sleep of Reason Brings Forth Monsters, Plate 43 of Los Caprichos, 1797). In Foucault's estimation, by revealing a "night which is doubtless that of classical unreason," Goya's work represented a socially removed condition within which people encounter "what is most solitary" and experience what is "deepest" within themselves. With his reference to Goya's imagery, Foucault illustrated a major theme of his history of madness, namely, how people referred to as "mentally ill" experienced a gradual, physical exclusion from participation in public society, and how they were eventually isolated in a more frightening way: within their physical confinement, they were subject to techniques of psychological and spiritual alienation that reduced them to a condition of utter solitude.In a comparable, if not more central manner, Foucault used as thematic motifs for the preface, first and second chapters of a book for which he is widely known, Les Mots et les choses (The Order of Things, 1966), the work of three major writers and artists from the Spanish-speaking world: Jorges Luis Borges (1899-1986), Diego Velázquez (1599-1660), and Miguel de Cervantes (1547-1616). Among these references, the most popular is probably Foucault's discussion of [End Page 80] Velázquez's Las Meninas—a painting which captured Foucault's interest as a perfect exemplar of its time period—and which inspired him to devote the entire first chapter of his book to decoding the mechanics of its perspectival arrangement. And within the community of those who read, write and discuss the interrelationship between Foucault's thought, literary theory and the contemporary emphasis upon the multivocal quality of textual meaning, Foucault's citation of an excerpt from a short story by Borges—the subject of this essay—is also familiar. Foucault introduced his 1966 book, The Order of Things, with the following words: This book first arose out of a passage in Borges, out of the laughter that shattered, as I read the passage, all the familiar landmarks of my thought—our thought, the thought that bears the stamp of our age and our geography—breaking up all the ordered surfaces and all the planes with which we are accustomed to tame the wild profusion of existing things, and continuing long afterwards to disturb and threaten with collapse our age-old distinction between the Same and the Other. This passage quotes a "certain Chinese encyclopedia" in which it is written that "animals are divided into: (a) belonging to the Emperor, (b) embalmed, (c) tame, (d) suckling pigs, (e) sirens, (f) fabulous, (g) stray dogs, (h) included in the present classification, (i) frenzied, (j) innumerable, (k) drawn with a very fine camelhair brush, (l) et cetera, (m) having just broken the water pitcher, (n) that from a long way off look like flies." In the wonderment of this taxonomy, the thing we apprehend in one great leap, the thing that, by means of the fable, is demonstrated as the exotic charm of another system of thought, is the limitation of our own, the stark impossibility of thinking that. 1The short story from which Foucault extracted the above, quasi-cubistic, excerpt was published in Borges's 1952 collection, Otras Inquisiciones (Other Inquisitions), and is entitled, "The Analytical Language of John Wilkins." Although this story's entirety is rarely surveyed in discussions of Foucault, appreciating its broader contents helps illuminate why Foucault began The Order of Things with this entertaining and bizarre segment. Borges's original... (shrink)

Although nearly 99% of abortions in New Zealand are permitted in order to prevent danger or injury to a woman’s mental health (the ‘mental health exception’), the reasons why mental health considerations should effectively control access to abortion are not altogether clear. This article analyses abortion case law, statutes and debates from New Zealand, the United Kingdom and the United States to attempt to explain the legal connection between mental health considerations and access to abortion. The (...) article argues that the mental health exception evolved in response to a change in the predominant construction of women seeking abortion from ‘selfish’ to ‘desperate’, coinciding with increasing societal subscription to an expanded view of psychological harm. By conceptually accommodating both constructions of women seeking abortion, the article argues that the mental health exception usefully enabled society generally to proscribe the practice of abortion on the basis that it was unnatural and irrational, while nevertheless permitting it in cases considered to be deserving. (shrink)