Other Mental Disorders

“Spousal revenge” killers murder their child apparently out of a desire to cause harm to their ex-partner, the child’s other parent. Standard explanations of these killings fail to provide an adequate solution to what I call the problem of spousal revenge filicide. This is the problem of how a killer comes to take their rage at their former partner out on their own child and how that child can be dehumanized to the point of murder. Although the dehumanization of the (...) victim is acknowledged to occur, why it occurs is not well understood. Here, I offer an hypothesis that the killer fails to represent their child as a moral subject with a mind of their own. This is due to a deficit in the killer’s capacity for person perception which is, by hypothesis, pathological. As such, the killer experiences the child as an object, rather than a person, which is of significant emotional value to the other parent. The specificity of this disorder explains why the ex-partner themselves is not targeted, and it explains how the killer is able to understand that killing the child will harm the other parent. (shrink)

The term “trauma” is ambiguous, even in formal academic literature. In this article, I will argue for a more precise definition of psychological trauma that I believe will aid researchers in investigating the phenomenon. Methodologically, I first focus on event-based trauma to form a definition. I begin with a brief exploration of the early development of trauma as a concept. Then I outline three criteria for a definition of event-based trauma: (1) the definition must provide a causal link between a (...) traumatic event, experience, and effects, (2) the definition must provide a way to demarcate trauma from nontrauma, and (3) the definition must broadly cohere with posttraumatic stress disorder research. From there, I move to examining and critiquing some of the most widespread definitions of trauma using insight from each definition to hone the discussion. As part of the critique, I examine neurobiological and psychological research to help clarify and narrow each definition. Once I arrive at a definition for event-based trauma, I will attempt to modify the definition in such a way as to preserve trauma’s essence as a mental wound and yet leave conceptual room to allow for instances of trauma that are not linked to a single extramental event. I conclude that trauma is a negative response to an extramental stimulus (or stimuli) whereby the stimulus (or stimuli) is judged to be too overwhelming to bear and the response is characterized by a disruption in the normal connection between identity and experience. Last, I consider this definition in light of accumulated trauma and collective trauma. (shrink)

According to Jerome Wakefield’s harmful dysfunction account, a mental disorder must involve an objective dysfunction couched in evolutionary terms. However, selected effects functions are indeterminate because (i) the same trait can be both selectively advantageous and disadvantageous, and (ii) the functional activity of a trait can be assessed according to conflicting norms, given the trait’s place in a hierarchy of functions. Therefore, there may be a dysfunction that can be described in multiple empirically adequate ways. The choices involved in these (...) cases are value-laden. Some cases of addiction may fit this mold, involving indeterminacy that invites opposing value judgments. (shrink)

According to a common philosophical intuition, the deep nature of things is hidden from us, and the world as we know it through perception and science is, just like a dream, shadows, or a computer simulation, somehow shallow and lacking in reality. This “intuition of unreality” clashes with a strong, but perhaps more naive, intuition to the effect that the world as we know it seems perfectly real. Shadows, dreams, or informational structures appear too unreal to be identical to the (...) world as we know it! This clash between the two intuitions forms the basis of the “problem of reality.” In the late nineteenth century psychiatrists encountered patients they referred to as “metaphysician doubters” who constantly questioned the reality of the world. This essay draws on studies of these patients in order to reject, and indeed diagnose, the intuition of unreality and recent metaphysical doctrines drawing on it, such as structuralism, digitalism, and virtual realism. (shrink)

Can the diagnosis ‘Social Anxiety Disorder’ (SAD) in women be understood as a rational response to life in postfeminist, neoliberal, twenty-first century Britain? By speaking to women with this diagnosis, and drawing on the author’s own lived experience, this book investigates the interplay between women’s social anxiety and Western culture. It argues that societal factors are implicated in women’s mental distress to a far greater extent than dominant (especially psychiatric) narratives would hold — narratives which, premised on individual pathology, often (...) present a biologically reductionist and medicalised account. Through deploying a unique blend of feminism and anti-psychiatry, this book critiques the framework which exists around diagnosing and treating SAD, but without dismissing distress. Inspired by feminist critiques of other gendered psychiatric diagnoses, such as Anorexia Nervosa, it conceptualises ‘SAD’ — which appears to be more prevalent in women — as a ‘culture-bound syndrome’. This book develops feminist scholarship which has explored women’s socialisation and gendered power relations: from the requirement to emulate beauty ideals and embody contradictory imperatives of femininity, to the newer, social media-fuelled pressure to present the ‘best version of oneself’. Laying bare these exigent demands, and their associated ‘no-win’ situations, women’s self-surveillance and concern with being evaluated negatively — both of which exemplify SAD — are, in the spirit of antipsychiatry, rendered comprehensible. This book will be of tremendous utility for those with interests in gender studies and sociology. (shrink)

It’s a common assumption in psychiatry and psychotherapy that mental health conditions are marked out by some form of epistemic irrationality. With respect to obsessive-compulsive disorder (OCD), the mainstream view is that OCD causes irrational beliefs. Recently, however, this ‘doxastic view’ has been criticized from a theoretical and empirical perspective. Instead a more promising ‘zetetic view’ has been proposed which locates the epistemic irrationality of OCD not in irrational beliefs, but in the senseless inquiries it prompts. Yet, in this paper (...) I present a special class of cases—sexual obsessive-compulsive disorder (S-OCD)—which cannot be explained by existing doxastic and zetetic accounts of the epistemic irrationality of OCD. In addition, some people with S-OCD appear to be adhering too well to a plausible set of norms for inquiry. Their suffering seems to be partially caused by an excess of rationality, and not a lack thereof. They seem, if anything, too rational. This shows firstly that it’s unlikely that there is one form of epistemic irrationality common to all persons living with OCD. Secondly, it should lead us to rethink the epistemic categories we use in classifying mental health conditions such as OCD. (shrink)

Formal thought disorder (FTD) is a clinical mental condition that is typically diagnosable by the speech productions of patients. However, this has been a vexing condition for the clinical community, as it is not at all easy to determine what “formal” means in the plethora of symptoms exhibited. We present a logic-based model for the syntax–semantics interface in semantic networking that can not only explain, but also diagnose, FTD. Our model is based on description logic (DL), which is well known (...) for its adequacy to model terminological knowledge. More specifically, we show how faulty logical form as defined in DL-based Conception Language (CL) impacts the semantic content of linguistic productions that are characteristic of FTD. We accordingly call this the dyssyntax model. (shrink)

The notion of harm is frequently used in the discussion of the nature of mental disorder. Harm also plays important roles in the prominent diagnostic manuals such as DSM and ICD. Recently, however, Cristina Amoretti and Elisabetta Lalumera have questioned the idea that harm should be a necessary constituent of mental disorders. They argue that the notion of harm is underspecified and potentially leads to false negatives in diagnosing mental disorders. Given that harm plays significant roles in medical diagnosis and (...) treatment indicates that we should be reluctant to remove it as a criterion for deciding whether some condition is a mental disorder. Instead, we argue that harm should be understood in the prudential sense and harm in this sense provides a way of responding to worries raised by Amoretti and Lalumera, while staying true to the conception of harm that is relevant for psychiatric practice. (shrink)

ObjectiveBulimia nervosa and binge eating disorder are eating disorders characterized by recurrent binge eating episodes. Overlap exists between ED diagnostic groups, with BE episodes presenting one clinical feature that occurs transdiagnostically. Neuroimaging of the responses of those with BN and BED to disorder-specific stimuli, such as food, is not extensively investigated. Furthermore, to our knowledge, there have been no previous published studies examining the neural response of individuals currently experiencing binge eating, to low energy foods. Our objective was to examine (...) the neural responses to both low energy and high energy food images in three emotive categories in BN and BED participants.MethodsNineteen females with BN or BED, comprising the binge eating group, and 19 age-matched healthy control ’s completed thorough clinical assessment prior to functional MRI. Neural response to low energy and high energy foods and non-food images was compared between groups using whole-brain exploratory analyses, from which six regions of interest were then selected: frontal, occipital, temporal, and parietal lobes; insula and cingulate.ResultsIn response to low energy food images, the BEG demonstrated differential neural responses to all three low energy foods categories compared to HCs. Correlational analyses found a significant association between frequency of binge episodes and diminished temporal lobe and greater occipital lobe response. In response to high energy food images, compared to HC’s, the BEG demonstrated significantly decreased neural activity in response to all high energy food images. The HC’s had significantly greater neural activity in the limbic system, occipital lobe, temporal lobe, frontal lobe, and limbic system in response to high energy food images.ConclusionResults in the low energy food condition indicate that binge frequency may be related to increased aberrant neural responding. Furthermore, differences were found between groups in all ROI’s except the insula. The neural response seen in the BEG to disgust food images may indicate disengagement with this particular stimuli. In the high energy food condition, results demonstrate that neural activity in BN and BED patients may decrease in response to high energy foods, suggesting disengagement with foods that may be more consistent with those consumed during a binge eating episode. (shrink)

In this opinion piece we propose the investigation of psychedelic-assisted psychotherapy for the treatment of body dysmorphic disorder (BDD). BDD is a psychiatric disorder characterised by appearance-based preoccupations and accompanying compulsions. While safe and effective treatments for BDD exist, non-response and relapse rates remain high. Therefore, there is a need to investigate promising new treatment options for this highly debilitating condition. Preliminary evidence suggests safety, feasibility, and potential efficacy of psychedelic treatments in disorders that share similar psychopathological mechanisms with BDD. (...) Drawing on this evidence, as well as on relevant qualitative reports and theoretical proposals, we argue that it would be worthwhile to conduct a phase 2a study aimed at assessing the safety and feasibility of psychedelic-assisted psychotherapy in BDD. We also offer some suggestions for how future research ought to proceed. (shrink)

This article explores histories of the science of stress and its measurement from the mid 19th century, and brings these into dialogue with critical sociological analysis of emerging responses to work stress in policy and practice. In particular, it shows how the contemporary development of biomedical and consumer devices for stress self-monitoring is based on selectively rediscovering the biological determinants and biomarkers of stress, human functioning in terms of evolutionary ecology, and the physical health impacts of stress. It considers how (...) the placement of the individual body and its environment within particular spatio-temporal configurations renders it subject to experimental investigation through standardized apparatus, electricity, and statistical normalization. Examining key themes and processes such as homeostasis, metricization, datafication, and emotional governance, we conclude that the figure of the ‘body electric’ plays a central limiting role in current technology-supported approaches to managing work stress, and that an historical account can usefully open these to collective scrutiny. (shrink)

Scrupulosity is a form of OCD where patients obsess about morality and sometimes compulsively confess or atone. It involves chronic doubt and anxiety as well as deviant moral judgments. This chapter argues that Scrupulosity is a mental illness and that its distortion of moral judgments undermines, or at least reduces, patients’ moral responsibility. The authors go on to argue that this condition challenges popular deep-self theories of responsibility, which assert that one is only blameworthy or praiseworthy for actions that arise (...) from one’s deep self, from what one truly values. Patients with ego-syntonic Scrupulosity, however, identify with their condition and seem to have cares that reflect their deep selves, yet do not seem fully responsible for their actions or their consequences, such as neglecting the needs of their loved ones. Other theories, particularly reasons-responsiveness theories, better capture the ways in which responsibility in Scrupulosity is reduced. (shrink)

Dissociative experiences have been associated with diachronic disunity. Yet, this work is in its infancy. Dissociative identity disorder is characterized by different identity states reporting their own relatively continuous sense of self. The degree to which patients in dissociative identity states experience diachronic unity has not been empirically explored. This study examined the degree to which patients in dissociative identity states experienced diachronic unity. Participants were DID adults assessed in adult and child identity states, adults with a psychotic illness, adults (...) from the general population, children from the general population and adults imagining themselves as children. They completed the Diachronic Disunity Scale, the Dissociative Experiences Scale, and the Self-Concept Clarity Scale. Diachronic disunity was not limited to psychiatric groups, but evident to some degree in all adult and child samples. The DID adult sample experienced more dissociation and self-confusion than the psychosis and adult comparison groups, but did not differ on the diachronic measure. DID patients in their child identity states and child comparisons showed disunity and were significantly different from child simulators, who showed relatively more unity. Results suggest that DID patients in either adult or child dissociative identity states, like those in other samples, do not universally experience themselves as having a consistent sense of self over time. (shrink)

Many intelligent, capable, and successful individuals believe that their success is due to luck and fear that they will someday be exposed as imposters. A puzzling feature of this phenomenon, commonly referred to as imposter syndrome, is that these same individuals treat evidence in ways that maintain their false beliefs and debilitating fears: they ignore and misattribute evidence of their own abilities, while readily accepting evidence in favour of their inadequacy. I propose a novel account of imposter syndrome as an (...) instance of self-deception, whereby biased evidence treatment is driven by the motivational benefit of negative self-appraisal. This account illuminates a number of interconnected philosophical and scientific puzzles related to the explanation, definition, and value of imposter syndrome. (shrink)

Anorexia Nervosa (AN) is an eating disorder characterised by self-starvation. Accounts of AN typically frame the disorder in individualistic terms: e.g., genetic predisposition, perceptual disturbances of body size and shape, experiential bodily disturbances. Without disputing the role these factors may play in developing AN, we instead draw attention to the way disordered eating practices in AN are actively supported by others. Specifically, we consider how Pro-Anorexia (ProAna) websites—which provide support and solidarity, tips, motivational content, a sense of community, and understanding (...) to individuals with AN—help drive and maintain AN practices. We use C. Thi Nguyen’s work on epistemic “echo chambers”, along with Maria Lugones’ work on “worlds” and “ease”, to explore the dynamics of these processes. Adopting this broader temporal and intersubjective perspective, we argue, not only helps to further illuminate the experiential character of AN but also has important clinical and therapeutic significance. (shrink)

In this paper I review how the notion of gender is understood in psychiatry, specifically in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). First, I examine the contraposition between sex and gender, and argue that it is still retained by DSM-5, even though with some caveats. Second, I claim that, even if genderqueer people are not pathologized and gender pluralism is the background assumption, some diagnostic criteria still conceal a residue of gender dualism and (...) essentialism. Third, I consider gender dysphoria, which is characterized by an incongruence between one’s experienced or expressed gender and one’s assigned gender; since this condition pertains to distress and disability, not to the incongruence per se, it does not pathologize transgender people. Still, I contend that it should be removed from DSM-5 for theoretical reasons. (shrink)

Enactive approaches to emotion are rare and to anxiety and anxiety disorder even more. This article aims to show how an enactive paradigm might be helpful in solving some problems in the clinical and scientific understanding of anxiety and anxiety disorder. I begin by pointing at a number of relevant clinical features of anxiety and anxiety disorder and by sketching how and why anxiety theories have difficulties with doing justice to these features. I specifically focus on two themes: a) how (...) to conceptualize anxiety as the expression of a dynamical interaction with the environment instead of as just a reaction to the environment (or to... (shrink)

‘Gender disappointment’ is the feeling of sadness when a parent’s strong desire for a child of a certain sex is not realised. It is frequently mentioned as a reason behind parents’ pursuit of sex selection for social reasons. It also tends to be framed as a mental disorder on a range of platforms including the media, sex selection forums and among parents who have been interviewed about sex selection. Our aim in this paper is to investigate whether ‘gender disappointment’ represents (...) a unique diagnosis. We argue that ‘gender disappointment’ does not account for a unique, distinct category of mental illness, with distinct symptoms or therapy. That said, we recognise that parents’ distress is real and requires psychological treatment. We observe that this distress is rooted in gender essentialism, which can be addressed at both the individual and societal level. (shrink)

In 1921, at the age of 65, 6 years after completing the final edition of his textbook, 22 years after first proposing the concept of dementia praecox (DP), and 1 year before retiring from clinical work, Emil Kraepelin completed the last edition of his “Introduction to Clinical Psychiatry,” which contained a mini-textbook for students, 10 pages of which were devoted to DP. This work also included a series of new detailed case histories, 3 of which examined DP. This neglected text (...) represents a distillation of what Kraepelin judged, near the end of his long career, to be the essential features of DP. The relevant text and case histories are translated into English for the first time. Kraepelin did not define DP solely by its chronic course and poor prognosis, acknowledging that remissions and even full recovery might be possible. His clinical description emphasized the frequency of bizarre delusions and passivity symptoms. He recognized the heterogeneity of the clinical presentations, outlining 6 subtypes of DP, including dementia simplex, depressive and stuporous dementia, and an agitated and circular DP. Kraepelin’s original concept of DP was not impervious to change and expanded somewhat, especially with the inclusion of Diem’s concept of simple DP. He also reviews several contributions of Bleuler, including his concept “latent schizophrenia.” He writes poignantly of the psychological consequences of DP. His 3 DP cases, for advanced students, included simple DP, “periodic catatonic,” and “speech confusion.”. (shrink)

Since its introduction into the Diagnostic and Statistical Manual of Mental Disorders, the diagnostic category of post-traumatic stress disorder has dominated public and legal discourse about the harm of sexual violence against women. There is, however, disagreement among some clinical psychologists and philosophers over whether a PTSD diagnosis further harms the victim. Clinical psychologists claim that focusing on a PTSD diagnosis risks undermining a victim’s agency and subjectivity if therapists neglect the victim’s own voice and experiences. Philosophers who acknowledge PTSD (...) in identifying the harm of sexual violence look to victims’ experience of PTSD symptoms rather than how it is used in clinical practice. They conclude that PTSD symptoms are compatible with agency and subjectivity insofar as they help illuminate what it is to be an agent and a subject. I argue that the latter are too optimistic and the former are too pessimistic. An examination of these conflicting views traces the disagreement to unacknowledged discipline-specific boundaries. I conclude with the very tentative suggestion that moral injury could bridge these boundaries. (shrink)

The principles that usually direct ethical decision making are not easily or straightforwardly applicable to the care and treatment of anorexia nervosa, particularly the care and treatment of severe and enduring anorexia nervosa, where the sufferer seems to be recalcitrant to treatment and where the condition has become life-threatening.There are exceptional circumstances that characterize this puzzling and still scarcely understood condition; I suggest that these exceptional circumstances provide moral reasons for partial derogation from the usual principles of ethical decision making.In (...) what follows I argue... (shrink)

In some neuropsychological disorders memory distortions seemingly fill gaps in people’s knowledge about their past, where people’s self-image, history, and prospects are often enhanced. False beliefs about the past compromise both people’s capacity to construct a reliable autobiography and their trustworthiness as communicators. However, such beliefs contribute to people’s sense of competence and self-confidence, increasing psychological wellbeing. Here we consider both psychological benefits and epistemic costs, and argue that distorting the past is likely to also have epistemic benefits that cannot (...) be obtained otherwise, such as enabling people to exchange information, receive feedback, and retain key beliefs about themselves. (shrink)

Selective mutism (SM) is a developmental disorder characterized by a child’s inability to speak in certain contexts and/or in the presence of unfamiliar interlocutors. This work proposes a critical discussion of the most recent studies on SM, with respect to clinical and diagnostic features, as well as the etiology and treatment of this disorder. At present, all research work supports the hypothesis that SM is a complex anxiety disorder with multifactorial etiology (interaction among biological and environmental causes). The latest edition (...) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) places SM mutism among “Anxiety Disorders”, and no longer among “Other Childhood, Infant and Adolescent Disorders” (as in DSM-IV). Other important aspects relate to cognitive biases and emotional states at the base of SM, which partly explain the disorder’s persistence and represent an important objective of intervention work. No data in the literature point to a total remission of SM, but good results are achieved with cognitive behavior intervention and multimodal therapy (MMT) involving a variety of child interaction contexts. (shrink)

The network approach to psychopathology has recently gen-erated enthusiasm in the research community. This is likely due in large part to network methods being promoted with the prom-ise of improving clinical prevention and intervention strategies by explicating the dynamic causal architecture of mental illness1. As a result, studies using network methods have proliferated with the aim of understanding causal interactions between psychiat-ric symptoms through empirical data.

Selected papers on OCD, Bureaucracy, and Psychopathy. Table of Contents: What are Some Characteristics of OCD in Children? The Failure of Political Philosophy to Engage Reality OCD and Philosophy How to Get Rid of OCD What are Some Characteristics of OCD in Children? OCD: The Philosopher’s Illness The Obsessive-compulsive Must Accept his Own Sadistic Sexuality Institutional Psychopathy The Psychology of the Bureaucrat Psychopaths are Rogue Bureaucrats And Bureaucrats are Non-rogue Psychopaths How Double-think is Possible Bureaucratic Bloat Responsible for OCD-spike Submitting (...) to Feminism Makes It More Psychopathic What is the Prognosis for People with OCD? The Way to Beat OCD is to Have a Purpose in Life Is OCD a Disease? Social Anxiety is about Rage Structural Therapy Effective Therapists Must Have and Project Inner Strength Reading-related Difficulties in People with OCD The Limitations of CBT in the Treatment of OCD Turn OCD Against Itself How do I get over my OCD? Intrusive Thoughts ​ Why People with OCD Have Them Physical vs. Mental Illness How to Treat Compulsions that are not Accompanied by Obsessions? Why Psychopaths Overachieve ​​ The Therapeutic Significance of a Healthy Sex Life Autism as Pseudo-self-containment The Two Ways in which Intellectual Activity Promotes Intelligence How Mental Illness Differs from Physical Illness Psychiatric Munchausen’s by Proxy What is the Prognosis for People with OCD? How is Rationalization Different from Auto-hypnosis? (shrink)

In this article we examine obsessive compulsive disorder (OCD). We examine and reject two existing models of this disorder: the Dysfunctional Belief Model and the Inference‐Based Approach. Instead, we propose that the main distinctive characteristic of OCD is a hyperactive sub‐personal signal of being in error, experienced by the individual as uncertainty about his or her intentional actions (including mental actions). This signalling interacts with the anxiety sensitivities of the individual to trigger conscious checking processes, including speculations about possible harms. (...) We examine the implications of this model for the individual's capacity to control his or her thoughts. (shrink)

It sometimes seems to us that our judgments about what we ought to believe diverge from what we in fact believe. I may be perfectly aware that I am not particularly risking my life by flying, for instance, and yet, as I tighten my seatbelt in preparation for takeoff, I may nevertheless embrace the seemingly paradoxical thought that I am likely to die in a matter of mere seconds. In moments like this, it can feel to us like we are (...) experiencing a failure of rationality, as we seem to embrace a belief that we ourselves judge to be unreasonable. That is why philosophers have characterized these kinds of cases as akratic believing. Certainly, they leave us with that same funny feeling, that familiar dread that... (shrink)

ABSTRACTRumination and worry are two perseverative, negatively valenced thought processes that characterise depressive and anxiety disorders. Despite significant research interest, little is known about the everyday precipitants and consequences of rumination and worry. Using an experience sampling methodology, we examined and compared rumination and worry with respect to their relations to daily events and affective experience. Participants diagnosed with Major Depressive Disorder, Generalized Anxiety Disorder, co-occurring MDD–GAD, or no diagnosis carried an electronic device for one week and reported on rumination, (...) worry, significant events, positive affect, and negative affect. Across the clinical groups, occurrences of everyday events predicted subsequent increases in rumination, but not worry. Further, higher momentary levels of rumination, but not worry, predicted subsequent decreases in PA and increases in NA. Thus, in these clinical groups, rumination was more susceptible to... (shrink)

We undergo a traumatic experience, such as a life-threatening accident or a brutal attack. We survive a period of relentless stress, perhaps because we are in a war zone and witness or commit atrocities. Raised by parents who are alcoholic or mentally ill, we endure traumatic experiences on a daily basis. Or, we are ignored, neglected, or treated as playthings by narcissistic parents, who themselves were ignored and neglected, and on and on through generations. To survive these experiences, perhaps we (...) dissociate. This can take various forms. In the extreme form, we remove ourselves, psychically speaking, from the situation, perhaps by adopting the role... (shrink)

This book deals with a series of problems associated with the contemporary psychiatric approach to trauma, encapsulated in the diagnostic category of PTSD, by means of a philosophical analysis inspired by the works of Jacques Lacan, Slavoj i ek and Alain Badiou.

Medical, psychological, educational and social interventions to modify the behaviour of autistic people are only justified if they confer benefit on those people. However, it is not clear how ‘benefit’ should be understood. Most such interventions are justified by referring to the prospect that they will effect lasting improvements in the well-being and happiness of autistic people, so they can lead good lives. What does a good life for an autistic person consist in? Can we assume that his or her (...) well-being is substantively the same as the well-being of non-autistic individuals? In this paper, we argue that, as it stands, the current approach to the study of well-being is for the most part unable to answer these questions. In particular, much effort is needed in order to improve the epistemology of well-being, especially so if we wish this epistemology to be ‘autism-sensitive’. Towards the end of the paper, we sketch a new, autism-sensitive approach and apply it in order to begin answering our initial questions. (shrink)

In her account of thought insertion, Pedrini follows the prevailing view that it is an error about ‘who is thinking a thought.’ This view is based on a particular characterization of thinking as analogous to physical actions, where an object can be made, possessed, moved about, and put in and out of containers. This picture is well-suited for explaining thought insertion where the speaker talks of having the thoughts of others put into his mind. The question, ‘Who is thinking?’ can (...) then be answered in at least two ways, as the person who has or possesses the thought, or the person who produces it. This leads into discussions about agency and its criteria. This move is understandable as part of a... (shrink)

The ultimate language of madness is that of reason.In short, under the chaotic and manifest delirium reigns the order of a secret delirium. In this second delirium, which is, in a sense, pure reason, reason delivered of all the external tinsel of dementia, is located the paradoxical truth of madness. And this in a double sense, since we find here both what makes madness true and what makes it truly madness.At the urging of his parents, Mr. A, a college-age young (...) man with a past diagnosis of Asperger’s... (shrink)

In his case report, A Logic in Madness, Aaron Hauptman details the case of Mr. A, an intelligent college student with Asperger’s syndrome, who became severely depressed subsequent to what he perceived as a rejection by what he viewed as “the love of his life.” Dr. Hauptman describes Mr. A as suicidal and as suffering from all the hallmarks of a major depression. At the urging of his family, he presents himself to a psychiatric inpatient unit and agrees to a (...) voluntary hospitalization. However, he refuses pharmacological treatment or electroconvulsive therapy, both of which his clinicians are considering given the severity of his case. Dr. Hauptman describes the young man’s response... (shrink)

From 1965, the Swedish penal law does not require accountability as a condition for criminal responsibility. Instead, severely mentally disordered offenders are sentenced to forensic psychiatric care. The process that led to the present legislation had its origins in a critique of the concept of accountability that was first launched 50 years earlier by the founding father of Swedish forensic psychiatry, Olof Kinberg. The concept severe mental disorder is part of the Criminal Code as well as the Compulsory Mental Act. (...) The medical conditions for being sentenced to forensic psychiatric care are supposed to be the same as those for being admitted to involuntary psychiatric care. What these conditions are is not regulated in any law. For the guidance of the courts and others, there is a collection of examples in the government bill drafting the legislation in question. On the basis of these examples the content of the concept of severe mental disorder is chiselled out. However, the purposes of imposing penal law sanction and admitting someone to psychiatric care are not the same, and therefore the content of the concept severe mental disorder is bound to differ accordingly. Severe mental disorder is a legal concept that masks as a psychiatric one. In its applications in penal law, the court determines its content. But for the forensic psychiatrist it is more natural to interpret the term as a medical one. This creates a tension that has led to several controversies in recent criminal cases in Sweden. The best way to alleviate the situation is to discard the concept of severe mental disorder from criminal law. This will allow for a better separation of the roles of the psychiatrist and the court. (shrink)

Before broaching our main subject, and exploring why, among all disorders of the mind, obsessive-compulsive disorders have a place apart, I would like to start from a dilemma that is well-known to historians interested in mental disorders. According to one approach, a mental illness X is considered as a bona fide or ‘genuine’ illness if, and only if, it originates from a disturbance of the brain. Its neurobiological form is in this case considered as invariant, whatever cultural veneer might give (...) it a different aspect in accord with historical and local settings. The assumption is that this veneer does not, properly speaking, have any deep grounding in reality... (shrink)

My article in this issue of PPP is based on a lengthy book, La Société du malaise, in which I examine the shift from Oedipal neurosis to narcissistic pathologies in France and in the United States, viewing this shift in connection with changes in social ideals regarding autonomy that I summarize as autonomy–aspiration and autonomy–condition. Using the notion of social pathology, I consider sociological/anthropological dimensions of so-called mental health problems by viewing them as individualistic ways of dealing with adversity or (...) misfortune in a form of life permeated with the autonomy–ideal. Changes in ways of acting in society go together with changes in forms of being.. (shrink)

The diagnosis of Fetal Alcohol Spectrum Disorders is embedded in a matrix of biological, social and ethical processes, making it an important topic for crossdisciplinary social and ethical research. This article reviews different branches of research relevant to understanding how FASD is identified and defined and outlines a framework for future social and ethical research in this area. We outline the character of scientific research into FASD, epidemiological discrepancies between reported patterns of maternal alcohol consumption during pregnancy and the incidence (...) of FASD, and the social and ethical considerations that may impact on who is, and is not, diagnosed. We highlight what further research investigating FASD diagnostic processes, as well as the multi-generational impacts of FASD, is needed. Important research priorities are to: 1) enumerate the variety of stakeholders involved in seeking FASD diagnoses; 2) understand the experiences and perspectives of mothers from different backgrounds who have consumed alcohol during pregnancy and their affected children; and 3) collect health histories of maternal alcohol consumption in families to determine the effect of FASD at sub-cultural and cultural levels. (shrink)

In a recent article in this journal, Schaefer et al. argue that it might be possible to enhance autonomy through the use of cognitive enhancements. In this article, I highlight an example that Schaefer et al. do not acknowledge of a way in which we already seem to be using pharmacological agents in a manner that can be understood as enhancing an agent’s autonomy. To make this argument, I begin by following other theorists in the philosophical literature in claiming that (...) impulsivity can serve to undermine an agent’s autonomy. I then explain that we are already able to reduce impulsivity through the use of pharmacological interventions, as is evidenced by the use of Methylphenidate in the treatment of ADHD. (shrink)

Can psychiatry distinguish social deviance from mental disorder? Historical and recent abuses of psychiatry indicate that this is an important question to address. Typically, the deviance/disorder distinction has been made, conceptually, on the basis of dysfunction. Challenges to naturalistic accounts of dysfunction suggest that it is time to adopt an alternative strategy to draw the deviance/disorder distinction. This article adopts and follows through such a strategy, which is to draw the distinction in terms of the origins of distress with the (...) relevant conditions. It is argued that psychiatry's ability to distinguish deviance from disorder rests on the ability to define, identify, and exclude socially constituted forms of distress. These should lie outside the purview of candidacy for mental disorder. In pursuing this argument, the article provides an analysis of the social origins of a form of distress with the personality and sexual disorders, and indicates in what ways it is constituted socially. (shrink)

This paper explores the factors that contribute to the degree of a mood disorder patient’s self- insight, defined here as her understanding of the particular contingencies of her life that are responsive to her personal identity, interpersonal relationships, illness symptoms, and the relationship between these three necessary components of her lived experience. I consider three factors: (i) the Diagnostic Statistical Manual of Mental Disorders (DSM), (ii) the DSM culture, and (iii) the cognitive architecture of the self. I argue that the (...) symptom-based descriptions of mood disorders which eliminate the subjective features of the patient’s illness experience, in conjunction with the features of the DSM-culture and the cognitive biases that guide the patient, contribute to the impoverishment of her self-insight. The resulting impoverished self-insight would prevent her from developing resourceful responses to her interpersonal problems. In analyzing how these factors combine to influence the patient’s self-insight, I distinguish the therapeutic impact of receiving a psychiatric diagnosis, which facilitates patient’s clinical treatment, from its reflective impact, how the diagnosis informs the patient’s reflection on who she is, how her mental disorder is expressed, and how her interpersonal relationships proceed. I substantiate my argument by considering a patient’s memoir of psychopathology. (shrink)