Philosophy Of Psychiatry Research Articles

Current Themes in the Philosophy of Psychiatry

Current Themes in the Philosophy of Psychiatry

Philosophy of psychiatry can gain greater vitality by engaging the implications of new science.

Philosophy of psychiatry can gain greater vitality by engaging the implications of new science.

Philosophy of psychiatry as study of paradigm changes.

Philosophy of psychiatry as study of paradigm changes.

Philosophy of psychiatry: theoretical advances and clinical implications.

Work at the intersection of philosophy and psychiatry has an extensive and influential history, and has received increased attention recently, with the emergence of professional associations and a growing literature. In this paper, we review key advances in work on philosophy and psychiatry, and their related clinical implications. First, in understanding and categorizing mental disorder, both naturalist and normativist considerations are now viewed as important - psychiatric constructs necessitate a consideration of both facts and values. At a conceptual level, this integrative view encourages moving away from strict scientism to soft naturalism, while in clinical practice this facilitates both evidence-based and values-based mental health care. Second, in considering the nature of psychiatric science, there is now increasing emphasis on a pluralist approach, including ontological, explanatory and value pluralism. Conceptually, a pluralist approach acknowledges the multi-level causal interactions that give rise to psychopathology, while clinically it emphasizes the importance of a broad range of "difference-makers", as well as a consideration of "lived experience" in both research and practice. Third, in considering a range of questions about the brain-mind, and how both somatic and psychic factors contribute to the development and maintenance of mental disorders, conceptual and empirical work on embodied cognition provides an increasingly valuable approach. Viewing the brain-mind as embodied, embedded and enactive offers a conceptual approach to the mind-body problem that facilitates the clinical integration of advances in both cognitive-affective neuroscience and phenomenological psychopathology.

Understanding, The Manifest Image, and 'Postmodernism' in Philosophy of Psychiatry

Understanding, The Manifest Image, and 'Postmodernism' in Philosophy of Psychiatry

Models and mechanisms in philosophy of psychiatry: Editorial introduction

The background for this special issue is the multidisciplinary workshop "Minds, Models and Mechanisms: Current Trends in Philosophy of
 Psychiatry" which was held at Saarland University in April 2021. Though we had to switch to an online format due to the pandemic, the
 discussions at the event have been extremely inspiring. It brought together experts from diverse disciplines, like clinical psychiatry,
 neuroscience, computational modelling, philosophy of mind and cognition, and philosophy of science. Joining forces, researchers from these
 disciplines presented their ideas on the subject. In the aftermath of the workshop, the organizers issued an open call for contributions.
 After a rigorous review process five papers made it into the final issue, each making an original contribution to the field.

How does the psychiatrist know?

An important question in the philosophy of psychiatry is: what is the proper method of psychiatric diagnostic reasoning? Let us call this the Methodological Question. In this paper, I criticize the answer that proponents of phenomenological psychiatry have given to this question and present an alternative. I argue that their answer fails to meet several adequacy conditions for a theory of psychiatric diagnostic reasoning. I then show how my own answer to the Methodological Question – the Model-Based Account of diagnostic reasoning – meets these adequacy conditions. I conclude that the Model-Based Account of diagnostic reasoning is preferable to the Phenomenological Account.

Phenomenological Method and Philosophy of Psychiatry: History and Prospects of Interaction

The article considers the possibilities of applying the phenomenological method in the philosophy of psychiatry. For this purpose, a brief analysis of the main stages of the development of the interaction of philosophy and psychiatry in modern times (20–21 centuries) was carried out: initial, syncretic, practical stages, and the formation of an interdisciplinary project, which is presented as the philosophy of psychiatry. An attempt to determine how exactly should the “phenomenological method” be understood when it comes to its application to the study of mental states in psychiatry and related disciplines (psychology and psychotherapy) is also made. It is shown that the phenomenological method tries to describe the human experience with the help of a more complete scheme of categories and concepts than is typical for the natural-scientific understanding of psychiatry. This method is also focused on human existence and helps a psychiatrist to “get used to” the structure and ways of being-in-the-world of a person. Therefore, the phenomenological method is practiced in psychology, psychotherapy, and psychiatry as a type of qualitative research. The historical review demonstrates that the phenomenological method has various manifestations in psychology, psychiatry, and psychotherapy (as a general philosophical method, a procedure for describing research in psychology, and a technique used in psychotherapeutic practice). Based on this, it is concluded that it is necessary to make a detailed analysis of the subject field of the direction of research where phenomenological method is implemented in order to explain the peculiarities of application of the phenomenological method. Although the problem of the expediency of using phenomenology as a research strategy in the philosophy of psychiatry is currently debatable, the author of the article believes that the use of the phenomenological method in philosophy of psychiatry can and should be implemented.

МАЯЧЕННЯ: МОЖЛИВОСТІ АНАЛІЗУ

The article presents the main concepts for defining and describing delusions and delusional ideas used in modern clinical psychiatry and philosophy of psychiatry. Their analysis and comparison are carried out, the main differences in the psychiatric and philosophical understanding of delusions are indicated. It is demonstrated that modern clinical psychiatry considers delusional ideas inaccessible to understanding, and therefore considers them purely as a symptom of mental disorder. The author proposes to reconsider this approach and focus on interpreting delusions, giving them meaning, and finding methods for their analysis. The author identifies the difficulties that arise in the process of interpreting delusions by a person who does not suffer from a mental disorder. The fundamental difference in building a picture of the world in mentally healthy people and people suffering from mental disorders is emphasised. The hypotheses put forward in the philosophy of psychiatry on how to understand delusional judgements are demonstrated. One of the hypotheses, the "doxastic" position, considers delusional judgements to be a special case of false statements and suggests that they should be analysed in the same way as any other false judgement. Another hypothesis, the reaction to pathological experience, suggests that delusional judgements are a reaction to a unique pathological experience. Delusional ideas arise in an attempt to explain these experiences, and this approach allows for a greater understanding of the mechanisms underlying delusional judgements. A rationalist approach to the interpretation of delusions is also presented, which assumes that pathological changes occur at a higher level than direct perceptions. This approach is based on the analysis of the delusional statements themselves, trying to find out what the changes in the patient's attitudes may be. According to the rationalist approach, the altered ideas of a mentally ill person are a consequence of their attitudes towards themselves and the world, and this is what sets the stage for the possible emergence of delusions. According to the rationalist approach, delusional ideas are not evaluated for their truth or falsity, as they are outside of any possible experience. Therefore, the rationalist approach allows us to understand what the patient's beliefs are that caused his or her delusions. It is determined that the described approaches change the perception of delusions as a sign or symptom of mental illness and do not ignore its own content in explaining mental disorder. The philosophy of psychiatry understands the space in which delusional discourse is constructed as a sphere that can be described and should be studied.

Parallel Debates: A Methodological Proposal

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

From psychiatric kinds to harmful symptoms

Much research in the philosophy of psychiatry has been devoted to the characterization of the normal and the pathological. In this article, we identify and deconstruct two postulates that have held sway in the philosophy of psychiatry. The first postulate concerns the belief that clinicians would benefit from conceiving of psychiatric disorders as stable entities with clear boundaries. By relying on a symptom-based approach, we support a conception of psychiatric disorders whose symptoms are the products of many activated mechanisms in mutual interactions. The second postulate concerns the way in which the philosophy of psychiatry has approached the question of harm. We posit that clinicians perceive harms primarily through networks of clinical manifestations. The identification and deconstruction of these two postulates leads us to propose a practical definition of a psychiatric disorder that is useful for the clinician, while adopting a principle of prudential conservatism that does not exclude other theoretical definitions of psychiatric disorder that are useful as an epistemic hub. Thus, we propose the following definition of a psychiatric disorder that is relevant to clinical practice: “a set of clinical manifestations belonging to the prototypical central core of psychiatry, organized in a causal network, involving at least one harm, and whose set of harms exceeds the traditional threshold of significance for a given psychiatric disorder, directly related to an activated mechanism. Such a network composed of clinical manifestations is frozen in a state that is unable to allow the deactivation of these manifestations spontaneously without a therapeutic intervention”.

Externalist argument against medical assistance in dying for psychiatric illness

Medical assistance in dying, which includes voluntary euthanasia and assisted suicide, is legally permissible in a number of jurisdictions, including the Netherlands, Belgium, Switzerland and Canada. Although medical assistance in...

Nosology of behavioral addictions: Intersections with philosophy of psychiatry •.

Writing in this journal, Brand and colleagues have proposed criteria for other specified disorders due to addictive behaviors. Their proposal intersects with key debates in philosophy of psychiatry, including how best to define mental disorders, to validate them, and to optimize their meta-structure. Review of these debates in the context of behavioral addictions suggests several conclusions. First, these debates involve “essentially contested” constructs that require ongoing consideration and judgment. Second, the complexity of psychopathology suggests multiple legitimate approaches to delineating traits and explicating mechanisms. Third, in optimizing meta-structure, non-psychobiological considerations are crucial - the overlapping public mental health approach to addictive disorders is paramount.

Karl Jaspers and artificial neural nets: on the relation of explaining and understanding artificial intelligence in medicine

Assistive systems based on Artificial Intelligence (AI) are bound to reshape decision-making in all areas of society. One of the most intricate challenges arising from their implementation in high-stakes environments such as medicine concerns their frequently unsatisfying levels of explainability, especially in the guise of the so-called black-box problem: highly successful models based on deep learning seem to be inherently opaque, resisting comprehensive explanations. This may explain why some scholars claim that research should focus on rendering AI systems understandable, rather than explainable. Yet, there is a grave lack of agreement concerning these terms in much of the literature on AI. We argue that the seminal distinction made by the philosopher and physician Karl Jaspers between different types of explaining and understanding in psychopathology can be used to promote greater conceptual clarity in the context of Machine Learning (ML). Following Jaspers, we claim that explaining and understanding constitute multi-faceted epistemic approaches that should not be seen as mutually exclusive, but rather as complementary ones as in and of themselves they are necessarily limited. Drawing on the famous example of Watson for Oncology we highlight how Jaspers’ methodology translates to the case of medical AI. Classical considerations from the philosophy of psychiatry can therefore inform a debate at the centre of current AI ethics, which in turn may be crucial for a successful implementation of ethically and legally sound AI in medicine.

Reconsidering harm in psychiatric manuals within an explicationist framework.

The notion of harm has been a recurring and a significant notion in the characterization of mental disorder. It is present in eminent diagnostic manuals such as DSM and ICD, as well as in the discussion on mental disorders in philosophy of psychiatry. Recent demotion of harm in the definition of mental disorders in DSM-5 shows a general trend towards reducing the significance of harm when thinking about the nature of mental disorders. In this paper, we defend the relevance of the notion of harm in the characterization of mental disorder against some of these attacks. We approach this issue by using the method of conceptual explication pioneered by Rudolf Carnap. Within this framework, we argue that keeping the notion of harm not only helps to discriminate what is pathological from the nonpathological but also prevents potential misuses of psychiatric authority.

Pratique clinique et pluralismes en psychiatrie

IntroductionThe consideration of a plurality of perspectives is highlighted in a various number of medical and scientific disciplines. For example, in psychiatry, many attempts claiming to be pluralism have been carried out over the course of the discipline, e.g. Kraepelinian and Meyerian approaches, biopsychosocial model, Jasperian approach or Freudian psychoanalytic model. At the same time, the starting point for Jean Garrabé’s views on psychiatric nosology refers to his consideration for the existence of different perspectives in the psychiatric landscape. The objective of this article is to highlight possible continuities between the Jean Garrabé’s developments and contemporary nosological issues. We will start from one of his leitmotifs, i.e. “History can inform the construction of psychiatric classifications”. MethodIn the first part, we present the diversity of perspectives in Philosophy of Psychiatry and in Philosophy of Science. In the second part, we will see how Jean Garrabé was able to discuss, in a more or less structured and explicit manner, three axes currently and widely studied in the proposals for contemporary models of psychiatry. ResultsIn a first part, we analyze the integration of Jean Garrabé into the general debates of the philosophy of science and modelisation. We will thus develop three examples of modelisation, based on contemporary psychiatric classifications, to testify this integration. The first example corresponds to staging models, which consider that psychiatric disorders could be better understood as subgroups of evolving elements – rather than as fixed categories in time. Indeed, staging models allow a sub-classification of psychiatric disorders according to their dynamical progression. The second example concerns the Hierarchical Taxonomy of Psychopathology project, which describes psychiatric disorders according to a continuum of quantitative variations, hierarchized in several dimensions. The third example concerns the Research Domain Criteria initiative, which targets some dimensions of mental functioning, i.e. areas of research from contemporary cognitive neurosciences allowing to organize psychiatric research on specific neuroscientific constructs. In a second part of this article, we analyze three axes developed both within the proposals of contemporary models and classifications and the Jean Garrabé’s views, namely dynamics, hierarchy and dimensionality of psychiatric disorders. Discussion and conclusionJean Garrabé’s conceptions seem marked by the footprint of pluralism and the three identified axes. The first axe concerns his interest for the temporal dynamics of psychopathological phenomena, evolving in time in a synchronic and diachronic manner. The second concerns his interest in the hierarchy of disorders and semiological elements, e.g. through validity or statistical analyzes. The third axe corresponds to the Jean Garrabé’s interest for the dimensionality, which considers elements underlying psychiatric disorders, whether they are phenomenological or physiopathological.

On the Brink of Disaster


 The notions of at-risk and subthreshold conditions are increasingly discussed in psychiatry to describe mild, brief, or otherwise atypical syndromes that fail to meet the criteria for clinical relevance. However, the concept of vulnerability is still underexplored in philosophy of psychiatry. This article discusses psychiatric vulnerability to clarify some conceptual issues about the various factors contributing to vulnerability, the notions of risk and protection, and the idea that there are multiple ways of crossing the threshold to clinical relevance. My goal is to lay the groundwork for a finer-grained discussion on psychiatric vulnerability that reflects the complex nature of mental conditions and illustrates the kind of thinking needed in clinical practice.

Le délire est-il « inconséquent » ?

How does delusion influence the patients’ behaviors within psychotic disorders? According to an ancient clinical intuition, patients with delusion do not act upon it (delusion would be inconsequent). The authors present how psychiatric and psychopathological literature addressed the issue of acting on delusion since the beginning of the twentieth century in both classical and contemporary works, in various epistemological settings (nosology, philosophy of psychiatry, phenomenology, psychoanalysis, and empirical studies). They propose to consider the notion of “delusional inconsequentiality”, defined as a lack of effect of delusional ideation on behaviors, which cannot be reduced to the negative symptomatology of schizophrenia. The authors highlight the scientific and clinical prospects opened up by taking this trait of delusion into consideration.

Narrate It Until You Become It

AbstractResearch in phenomenology and philosophy of psychiatry has suggested that psychopathological disturbances of experience often involve an alteration of one's ‘sense of possibility’, dependent upon the presence of specific ‘existential feelings’ (Ratcliffe 2012). In this paper I provide an extended account of how the engagement with certain narratives can lead to a transformation of one's sense of possibility by eliciting affective experiences that are not consonant with the person's existential feelings. More precisely, I claim that, even when the experience of some types of emotion is generally precluded by a restricted sense of possibility, such emotions may be aroused by particular self-narratives, and I explore how this dynamic can give rise to enduring and wide-ranging affective changes.

Schizophrenia, the Uncanny, and the Fragility of Ordinary Life

Schizophrenia, the Uncanny, and the Fragility of Ordinary Life Emily Hughes (bio) Schizophrenia involves significant disturbances to inter-subjective experience, the complex nature of which have become an increasingly important area for research in the philosophy of psychiatry. In “Schizophrenia as a Problem of Other Minds,” (2021), Brighupati Singh offers a thought-provoking contribution to this trajectory by engaging Stanley Cavell’s idea of skepticism: the recognition that ordinary life is inherently fragile, and that the affective attunement between self and other is something that can be undone. Through detailed ethnographic and literary studies, primarily undertaken in the Department of Psychiatry at the All India Institute of Medical Sciences in Delhi, Singh demonstrates how patients with schizophrenia and their caregivers are forced to reckon with the fragility of ordinary life. As Singh shows, schizophrenia involves a repeated confrontation with the inherent instability of inter-subjective experience, as something contingent that can be stressed, fractured and broken apart. Drawing on three signature concepts from Cavell’s interpretation of skepticism—attunement, tempo, and negation of voice—Singh aims to show how both the breakdown and the restoration of inter-subjective experience in schizophrenia might be understood according to relations that are either attuned or mis-attuned, harmonious or disharmonious, rhythmic or arrhythmic and so on. Singh’s appropriation of Cavellian skepticism into understanding inter-subjective experience in schizophrenia is novel, and his contention that caregivers might attune to the fragility of a patient’s lived experience by recognizing the fragility inherent in their own existence, holds significant therapeutic promise. If this approach is to be brought into meaningful dialogue with research into inter-subjective experience in schizophrenia more broadly, however, I wish to argue that misattunement, disharmony and arrhythmia between the patient and caregiver should not be understood as a loss of connection between minds, as Singh argues, but as a loss of affective attunement that is related to the loss of one’s “pre-reflective, unquestionable being-in-the-world” (Fuchs & Röhricht 2017, p. 138). Specifically, through recourse to Heidegger’s interpretation of affect and Jaspers’s conception of the delusional atmosphere, my aim in this article is to argue that the fragility of inter-subjective experience in schizophrenia is grounded in the affective atmosphere of uncanniness, of being radically not at home in the world. Further, in contrast with Singh, I suggest that, if Cavellian skepticism is interpreted in light of the radical uncertainty given by the affective atmosphere of the uncanny, then skepticism becomes commensurable with phenomenological psychopathology in several important ways. Through these clarifications, [End Page 281] it is hoped that the significant therapeutic potential of the concepts of attunement, tempo, and negation of voice might be made more salient, not as a means of appreciating the patient’s mind, but as a way of attuning to the affective atmosphere of uncanniness, with a view to restoring the patient’s being at home in the world. As Sass and Ratcliffe have argued (Ratcliffe, 2010, 2013a; Sass, 1992, 2004; Sass & Ratcliffe, 2017), the complementary themes of Heidegger’s conception of affect and Jaspers’s idea of the delusional atmosphere afford important insight into the affective dimensions of schizophrenia. In his ‘existential-ontological’ interpretation of affect, Heidegger argues firstly that, thrown into the world, human beings (Dasein) are always already immersed in an affective “atmosphere” and disposed through attunements (Heidegger, 1995, p. 67). Second, attunements are not an interior phenomenon; they are not confined to the detached psyche of the subject, which then imposes itself upon an object. Rather, attunements exist before the subject–object distinction and are disclosive of the fact that human beings are necessarily situated in the world as being-in-the-world. Third, attunements are that which enable human beings to “encounter something that matters” (Heidegger, 1962, p. 177). Depending on how one is attuned therefore (whether through anxiety, awe, despair, boredom or wonder), the world may seem familiar or unfamiliar, boring or enticing, unraveling or static, threatening or comforting, intrusive or at a distance. This means that one’s attunements determine the varying extents to which one may feel that they belong to, or are estranged from the world (Ratcliffe, 2013b). In this...