Philosophy of Psychiatry and Psychopathology, Misc

It has been claimed that cognitive therapists endorse sets of uplifting beliefs BECAUSE the client feels better believing them: not because they lead towards greater verisimilitude, a purported cognitivists’ hallmark of rational choice. Since standard cognitive therapists sometimes ask us to choose sets of beliefs that interpret evidence on the basis of greater individual happiness (all other things being equal), this suggests that the basis of choice goes beyond rationality. I contend that the case against the rationality of cognitive therapy (...) is not made if one allows a broadening of what to count as rational cognitive therapy. The rationality of therapy consists in how well it achieves its goal. My claim is that at least one goal is, or ought to be, greater information value of the client’ dialogues. Among other things, information values encode affect. Understanding reason in this way effectively transforms our understanding of rationality in a way that may be incommensurable with the standard view. If these radically divergent approaches to cognitive therapy are incommensurable, there is no way to discover that we are still talking about the same thing. So, a challenge for this competing view is to say on what basis the term cognitive therapy may be projectable. I identify some constraints on this project and sketch a possible solution. (shrink)

Some people believe that the premises that mainstream British psychiatry relies on are severely faulty. Lacanians believe this and so do I. But (unlike Lacanians) I suspect British psychiatry achieves a passable level with their conclusions. How can that be? The answer I vaguely propose is this. The British psychiatrist learns a system, which is useful for them to get going at an early stage and for communicating to outsiders with little knowledge of psychiatry, such as law courts. But they (...) don't mechanically apply the system. As they progress, they are heavily reliant on knowledge of past cases (and also unteachable diagnostic talent). "This case is similar to that case, we saw." My worry is this. Someone is going to say, "Talent?! Is this a good system then? We will send you a student. They are not the most talented but if your system is good, they will turn into a good psychiatrist and if it is bad, they will not. A good system reduces the reliance on cleverness, on individual talent." The psychiatrist is going to face severe problems with teaching this student. They don't class cases as similar and different in the way the psychiatrist does. Some psychiatrists leave because the student's judgments of similarly and difference are only slightly off and there is no way to block this dangerous new psychiatrist. (No Asians psychiatrists left?). (shrink)

Psychedelic-assisted therapy has produced strong empirical results across depression, anxiety, addiction, and end-of-life distress, but the field’s leading mechanistic model leaves several important questions unanswered. The Relaxed Beliefs Under Psychedelics (REBUS) model, developed by Carhart-Harris and Friston, explains the acute pharmacological action of psychedelics in terms of precision-weighting relaxation within a predictive processing hierarchy. What REBUS does not fully explain is why the therapeutic revision persists after the drug clears the system, why individual responses vary so widely under the same (...) pharmacological conditions, what ego dissolution consists of at the architectural level, how set and setting shape outcomes mechanistically, or why trauma-related conditions respond differently than non-trauma depression. This paper applies the Coherence Engine framework, a general architectural theory of consciousness developed through phenomenological observation and described in full elsewhere (Sowell, 2026), to psychedelic-assisted therapy. The relevant architectural components are summarized and then used to address each of these gaps. The framework extends to addiction through a three-layer model distinguishing identity, behavioral/cognitive, and physiological components, with implications for why different compounds, including ibogaine, work for different addictions. Architectural accounts of OCD, end-of-life anxiety, eating disorders, and the strengthening of fragile identity structures are also developed. The framework does not replace REBUS but provides the architectural context within which REBUS operates, generating nineteen testable predictions that REBUS alone cannot produce. Implications for clinical protocol design, patient selection, integration practice, and conditions under which psychedelic therapy should not proceed are described as hypotheses derived from the architecture. (shrink)

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

Emotion science remains theoretically fragmented, with major models offering incompatible explanations of what emotions are, how they arise, and how they change. This lack of a unifying architecture has limited the field's ability to generate cumulative theory, integrate findings across levels of analysis, and develop coherent clinical or computational models of affect. The Core Emotion Framework (CEF) is proposed as a unified structural–constructivist architecture that integrates interoceptive physiology, computational operations, and mechanisms of therapeutic change into a single testable model. CEF (...) conceptualizes emotional episodes not as discrete categories or linguistic labels but as dynamic sequences of ten functional operators distributed across three somatic centers—the Head, Heart, and Gut—with Accepting functioning as a global integrative capacity. These operators perform specific transformations on interoceptive signals, converting raw physiological inputs into structured affective states. By synthesizing evidence from diverse psychotherapy modalities, CEF identifies a cross-modal emotional ontology that unifies mechanisms of change across cognitive, behavioral, experiential, and relational approaches. The framework also provides a blueprint for synthetic affective systems by formalizing operator sequences as algorithmic modules capable of generating emergent affective dynamics in artificial agents. This article outlines the theoretical foundations, neurobiological substrates, computational formalization, and clinical implications of the Core Emotion Framework, and proposes it as a candidate for a unified theory of affect. -/- . (shrink)

The biomedical, cognitivist, and behaviorist frameworks through which mental illness is currently studied have each, in their own way, bracketed a question they did not need to answer in order to do their work. That question is not about mechanisms or correlates or symptom profiles. It is about the kind of thing a mental disorder is, what it means for a human being, already always embedded in a world, oriented toward a future, inhabiting a body that is normally not an (...) object but a medium, to undergo the specific transformations that depression, or schizophrenia, or anxiety involve. These frameworks have not needed that question because their methods do not depend on it. This book does depend on it, and so it begins there, with the structure of human existence itself, asking what has to already be in place for these kinds of experiences to be possible. Rather than beginning with a model of the subject and applying it to illness, the analysis begins with the ontological structures of Dasein, with what must already be structurally in place for anything resembling mental illness to be possible at all. Illness, understood from this vantage, is not alien to existence; it does not arrive from outside to disrupt an otherwise intact subject. It is a disclosure of what existence always already was, an achievement, recursive and precarious, rather than a given. The depressed person does not lose access to a world that continues to exist intact behind their diminished reception of it; the structure of world-disclosure itself is transformed, the ecstatic temporal unity that normally holds past, present, and future in a livable orientation fractured into the "frozen present" that clinical phenomenology has already documented. The question "what has gone wrong?" can only be answered, at the appropriate ontological depth, by a prior question. What kind of going-right constitutes the enactment of a human world? This book is a phenomenological analysis of mental disorders. Phenomenology, as it functions here, does not designate a description of the contents of disordered experience. It does not ask what sluggishness in depression feels like, or attend to the texture of symptoms through which mental illness announces itself. It asks what allows for that sluggishness. From where in human existence, experience and cognition does it arise? Why is human experience organized in such a way that these kinds of disruptions are possible at all? The analysis is thus directed at the organization, generation, and replication of experience. This requires a clarification that must be stated plainly. Nothing in the argument treats mental disorders as "illnesses of cognition" or as "illnesses of the mind." No claim of that kind is made here, and none follows from the framework. Nor is Dasein being described as something that can be ill in any straightforward sense. The biomedical and psychiatric research traditions that have documented mental illness empirically are taken seriously throughout; the question pursued here runs alongside that research, not against it. (shrink)

Philosophers have long been fascinated by the stream of consciousness––thoughts, images, and bits of inner speech that dance across the inner stage. Yet for centuries, such “mind-wandering” was deemed private and thus resistant to empirical investigation. Recent developments in psychology and neuroscience have reinvigorated scientific interest in the stream of thought, leading some researchers to dub this “the era of the wandering mind”. Despite this flurry of progress, scientists have stressed that mind-wandering research requires firmer philosophical foundations. The time is (...) therefore ripe for the philosophy of mind-wandering. Our review begins with a foundational question: what is mind-wandering? We then investigate the significance of mind-wandering for general philosophical topics, namely mental action, introspection, and the norms of thinking and attention. (shrink)

This paper develops and motivates a pluralist understanding of the concept of mental disorder within an explicationist framework. Recent debates in the philosophy of mental disorder have increasingly adopted conceptual engineering approaches that emphasize the theoretical and practical purposes concepts are intended to serve. Building on this methodological shift, the paper argues that traditional accounts of mental disorder—normativist, naturalist, and hybrid—need not be regarded as competing attempts to identify a single, universally correct concept. In particular, this claim is illustrated by (...) examining how domains such as psychiatry and criminal law may require different conceptions of mental disorder. The paper also considers and rejects the antipluralist view that the concept of mental disorder must be explicated uniformly across domains. Although some degree of coordination between domains may be desirable, it is argued that there is insufficient reason to treat uniformity as a general constraint on successful explication. (shrink)

Human behavior is frequently described both in abstract, general terms and in concrete, specific terms. We asked whether these two ways of framing equivalent behaviors shift the inferences people make about the biological and psychological bases of those behaviors. In five experiments, we manipulated whether behaviors are presented concretely (i.e. with reference to a specific person, instantiated in the particular context of that person’s life) or abstractly (i.e. with reference to a category of people or behaviors across generalized contexts). People (...) judged concretely framed behaviors to be less biologically based and, on some dimensions, more psychologically based than the same behaviors framed in the abstract. These findings held true for both mental disorders (Experiments 1 and 2) and everyday behaviors (Experiments 4 and 5) and yielded downstream consequences for the perceived efficacy of disorder treatments (Experiment 3). Implications for science educators, students of science, and members of the lay public are discussed. (shrink)

In this response to "Mild Mania and Well-Being" I propose a different analytic strategy and scrutinize the presented case of mild mania within the framework of a holistic theory of health. I distinguish between the following fundamental questions: (1) is mild mania a disease or illness? (2) does the mild mania of Mr. M. reduce his health significantly? and (3) should Mr. M. be recommended treatment with lithium or not? I answer the first question in the affirmative. I propose some (...) theoretical tools for resolving the second one. A complete resolution of it, however, requires a deeper analysis of Mr. M.'s state of mind and general situation. Finally, I hold that an affirmative answer to the first two questions does not imply an affirmative answer to the third, namely that Mr. M. should be recommended treatment with lithium. Other considerations, in particular ethical ones, should play a r. (shrink)

This essay argues for a mixed-resource approach to scientific modeling and applies it to questions in philosophy of mind. A mixed-resource approach makes use of whatever resources – at whatever scale, from whatever academic discipline – seem useful, freely combining such varied resources in individual models. The success of mixed-resource modeling challenges the widely shared commitment to a personal level in the context of which mental states are to be studied in relative isolation. The adoption of a mixed-resource perspective has (...) the potential to transform treatment of further matters in philosophy of mind, which is illustrated by discussion of psychological Frege cases. (shrink)

Crime is a serious social problem, but its causes are not exclusively social. There is growing consensus that explaining and preventing it requires interdisciplinary research efforts. Indeed, the landscape of contemporary criminology includes a variety of theoretical models that incorporate psychological, biological and sociological factors. These multi-disciplinary approaches, however, have yet to radically advance scientific understandings of crime and shed light on how to manage it. In this paper, using conceptual tools on offer in the philosophy of science in combination (...) with theoretical work represented in this special volume of Psychology, Crime and Law, I provide some perspective on why explanatory progress in criminology has remained elusive and evaluate some positive proposals for attaining it. -/- . (shrink)

To develop rehabilitative treatment programs for persons who have committed crimes, correctional psychologists build theoretical structures that weld theoretical ideas about the causes of criminal behavior, theoretical perspectives about appropriate targets for correctional intervention and normative assumptions about crime and the aims of correctional intervention. To differentiate the tri-partite theoretical structure with which correctional program designers' work, Ward and Durrant (2021) introduce the metatheoretical concept of “practice frameworks”. In this paper, I describe and evaluate this concept, situating my analysis within (...) the broader contexts of philosophical work on scientific theories and models and metatheoretical work on the structure of explanatory and intervention theories in correctional psychology. (shrink)

Autistic burnout (AB) is gaining recognition as a complex and frequently misunderstood state, characterised by persistent exhaustion, reduced functioning, and increased sensitivity to sensory and emotional stimuli. This work offers a novel perspective, grounded in both lived-experience and psychological awareness, to advance understanding of AB beyond current clinical framings. Using autoethnographic reflection, I explore how the cumulative strain of masking, navigating neurotypical expectations, and managing continuous social and sensory demands contributes to burnout. Driven by experiential insights, the paper introduces the (...) Social Presentation and Emotional Load model of AB: a conceptual tool designed to capture simply, the progressive nature of AB through five stages. The model provides people with autism a structured way of articulating and making sense of experiences, while equipping practitioners with a more contextually attuned lens for recognising and responding to autistic distress. Instead of pathologising burnout, this framing calls for systemic adjustments and compassionate recognition of diverse needs. (shrink)

This paper reconsiders Hegel’s account of madness in the Encyclopaedia of the Philosophical Sciences and the Lectures on the Philosophy of Subjective Spirit. Hegel characterizes mental disorder as a disruption rooted in the natural determinacy of the mind, while simultaneously insisting on its necessary relation to rationality and maintaining their conceptual separation. Against this background, his emphasis on humane treatment, grounded in the presupposed rationality of patients, raises tensions that invite further scrutiny. By examining the systematic position of madness within (...) the Anthropology, the paper explores whether it may be interpreted as a point of inflection in processes of social reproduction, drawing on the conceptual resources of Marxist-feminist theory. Madness emerges not merely as dysfunction but as a phenomenon embedded within the reproduction of forms of life. In dialogue with Freud’s theory of the symptom, the paper concludes by proposing that psychic disturbance may be understood as a mode of participation in sociality, rather than its breakdown. This interpretive shift re-evaluates Hegel’s account and outlines a framework for conceiving mental disorder as a moment within, rather than outside, minded and rational life. (shrink)

This article proposes a theoretical framework for understanding how digital environments and artificial intelligence modulate cognitive life prior to the formation of meaning. It introduces the concept of the pre-semantic threshold, defined as the level where sense emerges as a form of the possible before stabilizing into representations. Through the processes of activation, inhibition, and resonance, algorithmic architectures do not merely transmit data: they orient perceptual postures and cognitive predispositions. Conceptual epigenetics is presented as a transdisciplinary heuristic model that describes (...) the environmental modulation of sense, situating itself within the tradition of the philosophy of technology (McLuhan, Simondon, Kittler), the philosophy of information (Floridi), and enactive cognitive science (Varela, Thompson, Gallagher). The essay demonstrates a formal homology between the plasticity of memory studied by Ramirez and algorithmic modulation, clarifying that these are selective processes operating on distinct ontological planes. Finally, the clinical implications for AI psychiatry are discussed, with concrete examples of pathological resonance in contemporary digital ecosystems. (shrink)

Objectivity and patient-centered care represent twin commitments of psychiatry that existing diagnostic practices struggle to reconcile. This paper argues that integrating patients as experience-based experts (EBEs) into the American Psychiatric Association's DSM revision process advances both commitments simultaneously. Drawing on Thomas Gieryn's boundary-work framework, I examine how psychiatry's historically permeable disciplinary boundaries have enabled selective gatekeeping over knowledge production, generating epistemic injustices, particularly preemptive testimonial injustice and hermeneutical injustice, that undermine diagnostic validity and clinical outcomes. I first situate psychiatry's unique (...) sociocultural position relative to somatic medicine, demonstrating why its phenomena are epistemically inaccessible without patient testimony. Further, I address well-established reservations surrounding patient integration, including concerns about intersubjective validity, taxonomic disruption, and tokenism, before proposing a structured integration model responsive to these hesitations. Leveraging Şerife Tekin's Multitudinous Self (MuSe) model and recent recommendations from the DSM's Structure and Dimensions Subcommittee, I outline how patient-EBEs can contribute structured phenomenological testimony and participatory review within formal revision committees. As Gieryn anticipated, I conclude that strategic patient integration does not erode psychiatric expertise but rather reveals that its boundaries were always more permeable than their gatekeepers have claimed. (shrink)

This paper articulates and defends a precautionary norm for scientific gatekeeping in potentially harmful research, using a case study of Spectrum 10K, a proposed genomic study of autism that was ultimately abandoned following strong backlash from the autistic community due to concerns about the study’s possible eugenic implications, among other issues. Gatekeeping is generally understood as a practice carried out by the scientific community to uphold its epistemic standards, often through peer review and editorial decisions in publishing. However, gatekeeping might (...) sometimes also involve public stakeholders and include decisions about pursuing certain research, not just those related to publication. Moreover, in potentially harmful research, gatekeeping might serve other goals, such as harm prevention, in addition to upholding scientific standards. I argue that effective gatekeeping in these areas involves more than just quality control: it requires carefully balancing various epistemic and non-epistemic goals, a challenge that current gatekeeping practices and regulatory mechanisms often fail to address successfully. I therefore propose the “Epistemic Precautionary Principle” (EPP), a normative and procedural principle that guides epistemically and socially responsible gatekeeping in these areas. The EPP states that such research should be pursued only if it is well-motivated and conducted with a level of epistemic precaution proportionate to the severity of the potential societal harm. I argue that Spectrum 10K did not satisfy these conditions, so the decision to abandon the project was justified. I further argue that the involvement of the autistic community in this instance of gatekeeping was both justified and appropriate. (shrink)

Prof. dr. sc. Miro Jakovljevič je psihijatar, profesor emeritus, jedan od snivača i dugogodišnji urednik časopisa Psychiatria Danubina, jednog od vodećih regionalnih psihijatrijskih časopisa u srednjoj i jugoistočnoj Europi. Nalazi se na Stanford listi 2% svjetski prepoznatih znanstvenika u Republici Hrvatskoj i najcitiraniji je psihijatar u regiji.

This article draws on Ian Hacking’s notion of historical ontology to address ongoing controversies surrounding the concept of paranoia and its use beyond the boundaries of psychiatry. By tracing the genealogy of paranoia back to early nineteenth-century French psychiatry and the problem of monomania, the paper argues that paranoia has never been a purely clinical concept. From its inception, psychiatric descriptions of paranoia incorporated judicial, moral, and political concerns alongside medical observation. Nineteenth-century psychiatrists were confronted with individuals who appeared rational (...) and socially competent yet were regarded as mad. They claimed specific expertise in identifying such cases. The concept of paranoia thus came to designate forms of reasoning that appear coherent but are nonetheless regarded as the mechanical product of a pathology: reasons that are not genuine reasons. I argue that this conception carries an irreducible moral and political significance, as it underwrites psychiatrists’ claims to authority in legal and public contexts. The social and political dimensions of paranoia, therefore, were not later additions to an originally medical concept, but part of its original meaning. (shrink)

Although mental disorder categories were originally developed to explain and predict human psychology and behavior, in certain cases, namely, in cases involving animal caregiving and welfare, these categories have been extended to animal minds. This is in tension with the views of the majority of the scientific community, which tends towards skepticism about the utilization of mental health categories in non-human cases. This paper considers the feasibility of applying mental disorder categories to animals, and explores why different fields have drawn (...) different conclusions on the matter. Using a comparison between human obsessive-compulsive disorder (OCD) and animal stereotypic behavior, and drawing on literature in psychiatry, philosophy of science, animal models, and philosophy of disability, I explore the various considerations relevant to whether and how mental disorders can be attributed to cases of abnormal animal behavior. (shrink)

Medical records mediate clinical work at multiple levels. Focusing on the transition from paper-based medical records to Electronic Health Records (EHRs), we analyze how the incorporation of digital infrastructures reconfigures healthcare networks and reshapes practices of writing, reading, and narration. Our analysis draws on ethnographic research conducted between 2024 and 2025 in two psychiatric settings in southwestern Colombia. We trace how the implementation of EHRs redistributed agency within clinical documentation and altered relations among clinicians, administrative staff, software systems, and regulatory (...) arrangements. Four interrelated transformations are identified: (i) shifting distribution of agency across sociotechnical networks; (ii) coexistence of writing and capturing clinical information; (iii) alteration in reading practices shaped by user profiles and distinct interfaces; and (iv) changeover from case histories anchored in biography and temporality toward label-oriented case conceptualization. We show that the integration of clinical, administrative, and financial records within EHR infrastructures privileges charting practices oriented toward diagnostic coding and billable services, while weakening the temporal and biographical anchors that previously sustained continuity and meaning-making in psychiatric documentation aimed at understanding the patient as a whole. These changes may reshape which forms of information become consequential as clinical knowledge. (shrink)

In interactions characterized by agential epistemic injustice, the interpreter avoids engaging with the speaker’s perspective and challenges or distorts the speaker’s contribution before taking time to explore it. Where the success of the interaction depends on a genuine knowledge exchange between interpreters and speakers, epistemic injustice compromises the success of the interaction. Building on recent qualitative work on communication in youth mental health, I argue that clinical interactions are less likely to achieve their aims when practitioners fail to engage with (...) the perspective of the person seeking support, and challenge or distort the person’s contribution before taking time to explore it. (shrink)

The most common theoretical approaches to defining mental disorder are naturalism, normativism, and hybridism. Naturalism and normativism are often portrayed as diametrically opposed, with naturalism grounded in objective science and normativism grounded in social convention and values. Hybridism is seen as a way of combining the two. However, all three approaches share a common feature in that they conceive of mental disorders as deviations from norms. Naturalism concerns biological norms; normativism concerns social norms; and hybridism, both biological and social norms. (...) This raises the following two questions: (a) Are biological and social norms the only sorts of norms that are relevant to considerations of mental disorder? (b) Should addressing norm deviations continue to be a major focus of mental healthcare? This paper introduces several norms that are relevant to mental disorder beyond the biological and social. I argue that mental disorders often deviate from individual, well-being, and regulatory norms. I also consider approaches which question mental healthcare’s focus on addressing norm deviations in the first place, including the neurodiversity paradigm, social model of disability, and Mad discourse. Utilizing these critical approaches, I contend that whether mental health intervention is justified depends, in part, on the type of norm deviation being intervened upon. (shrink)

We are consumers of drugs and news, and sometimes call ourselves addicts or junkies of one or both. I propose to take the concept of news – more generally, doxastic – addiction seriously. I define doxastic addiction and relate this type of addiction to echo chambers and religious belief. I show how this analysis directs attention to appropriate interventions to help doxastic addicts, and how it offers a new type of justification for limits on free speech. -/- .

Thomas Szasz famously argued that mental illness is a myth. Less famously, Szasz argued that since mental illness is a myth, so too is psychotherapy. Szasz's claim that mental illness is a myth has been much discussed, but much less attention has been paid to his claim that psychotherapy is a myth. In the first part of this essay, I critically examine Szasz's discussion of psychotherapy to uncover the strongest version of his case for thinking that it is a myth. (...) As we'll see, this involves an understanding of psychotherapeutic interventions as treatments of psychopathological problems. In the rest of this essay, I turn to this directly and argue that psychotherapy has an important non-pathocentric dimension. I argue that we fail to appreciate the nature and variety of psychotherapy if we concentrate only on its pathocentric dimensions. Though I use Szasz as a stalking horse, the substantive topic is the nature of psychotherapy. This enquiry falls into the philosophy of psychotherapy as distinct from the philosophy of psychiatry and the philosophy of psychoanalysis. (shrink)

Embodied cognition and enactivism, as a philosophy and position in the cognitive sciences, represent the idea that the human experience is the kind of experience of a fundamentally embodied entity, and this embodiment manifests itself into consciousness through “common-sense” or “ready-at-hand” knowledge; It is in the way we interact and engage with the environment that this embodiment is experienced. But, It is only through psychopathology, or disturbances in typical engagement with the world, that this embodiment is brought into explicit awareness. (...) Phenomenology, with famous examples like Heidegger’s “Carpenter and his Hammer (Heidegger, 1967, p. 69),” or Merleau-Ponty’s “The Hand touching Itself (Merleau-Ponty, 2012, p. 106).”, illustrate that embodiment is our primary mode of being. This can be understood as embodied engagement, where cognition relies on experiences derived from having a body equipped with various sensorimotor capacities. These sensorimotor capacities exist within a broader ecological, historical, social, cultural, biological, and psychological context, known as the phenomenological life world, or being-in-the-world. Consequently, engagement implies that sensory and motor processes, perception, and action are fundamentally inseparable in lived cognition. Contrasting with the old Cartesian view, where perception is viewed as an information processing task aimed at recovering the pre-given properties of the world, the perspective here is that perception is about how the perceiver can navigate and act within their immediate environment. These local situations are in a state of constant flux due to the perceiver's activities. Therefore, the reference point for understanding perception shifts from a pre-given, perceiver-independent world to the sensorimotor structure of the perceiver. This structure, defined by how the perceiver is embodied, rather than an independent world, determines how the perceiver can act and be influenced by environmental events. A problem arises when we realize the fact, that we come into being within a world that precedes us, as Heidegger says: we are “thrown” into the world, gradually becoming aware of its presence (Heidegger, 1967, p. 135.). As we age and experience life, we start contemplating its nature. The world isn't a product of our making, but rather a revelation awaiting our discovery. However, it's this very world that enables us to engage in reflection. Thus, a cycle ensues: the world precedes our contemplation, yet it intertwines inseparably with our experience. (shrink)

Who would buy a book full of interviews that can be accessed online? Perhaps only some bibliophile readers. Hence, a quick glance at "Conversations in Critical Psychiatry"—consisting of a significant portion of interviews with philosophers, clinicians, and researchers previously published in Psychiatric Times—might lead one to conclude that this volume is of little interest. But such a conclusion would be premature.

In On Madness: Understanding the Psychotic Mind, published in 2022, Richard G.T. Gipps embarks on a philosophical exploration of psychosis. Generally speaking, Gipps’s book presents an approach he calls “apophatic psychopathology,” (Gipps 2022, 2) borrowing from negative (that is, apophatic) theology and its method of understanding God’s nature by seeing how it defeats the predication of even those most supreme qualities we are drawn to predicate of Him. Gipps’s central insight regarding psychotic phenomena is that we best come to understand (...) them not positively, by predicating of the psychotic subject this or that rationally intelligible, intentional state, but instead negatively, through seeing how such predications are here defeated. Sitting down with a person suffering from psychosis requires that we develop the capacity to stay with them in their brokenness, rather than projecting onto them an intentional structure that their illness has abrogated. Gipps comments critically on relativistic tendencies we encounter these days, concluding that people suffering from severe psychosis are not happily thought of as just living in an “alternative reality” as good as the one populated by nonpsychotic people. (shrink)

Psychedelic-assisted therapy (PAT) is an emerging intervention in psychiatry, for which there is preliminary evidence for effectiveness in eating disorders (EDs). The subjective psychedelic experience is considered an important driver of positive outcomes following PAT; however, conventional study design approaches often overlook many of the nuances inherent to the experience. Consequently, considerable information is lost between the first-person account and its scientific interpretation and documentation. Phenomenology—a philosophical and empirical approach to studying lived experience—offers tools to assess and understand the experiential (...) mechanisms of PAT. This commentary advances the case for a phenomenological approach to PAT research in EDs, focusing on key domains of experience that underlie both ED psychopathology and psychedelic experiences, including embodiment, intersubjectivity, affectivity, temporality, spatiality and selfhood. We define and outline these phenomenological domains of EDs and psychedelic experiences and critically examine current measurement approaches. Following, we provide specific research recommendations, including phenomenologically grounded qualitative research and microphenomenology (i.e., the assessment of short-lived, pre-conscious experiences), to more fully capture psychedelic experiences and determine their significance for ED outcomes. The application of phenomenology to the PAT study design may contribute to a better understanding of how individuals experience PAT and generate testable hypotheses to advance psychedelic interventions. (shrink)

This article critically examines the diagnostic criteria for Major Depressive Disorder as presented in the DSM-5-TR, with a particular focus on the symptoms of ‘depressed mood’ and ‘psychomotor agitation or retardation’. While existing literature in both humanistic psychology and phenomenological psychopathology has highlighted the limitations of the Diagnostic and Statistical Manual of Mental Disorders (DSM) symptom-based and externalist model, this article contributes to the discussion by grounding its critique in first-person accounts and by analysing how the aforementioned symptoms, as conceptualised (...) in the DSM, flatten and obscure the lived experience of depression. It argues that the symptom of ‘depressed mood’ is conceptually circular and diagnostically imprecise, while ‘psychomotor agitation or retardation’, insofar as it is diagnosed based on being ‘observable by others’, fails to capture the phenomenological nuances of the experience, such as the loss of volition. Such limitations point to the need for an approach that takes seriously the lived, first-person dimensions of depression, rather than reducing the experience to externally verifiable signs. In this regard, by advancing a symptom-specific critique grounded in phenomenology, this article calls for a more person-centred approach to psychiatric diagnosis, one that considers the role of first-person experience. Finally, this article reflects on the implications of a person-centred approach for the evaluation of psychotropic medication, especially with regard to experiential phenomena such as depersonalisation and derealisation. (shrink)

Debates about the genuine disease status of controversial diseases rely on intuitions about a range of factors. Adopting tools from experimental philosophy, this paper explores some of the factors that influence judgments about whether low sexual desire should be considered a disease and whether it should be medically treated. Drawing in part on some assumptions underpinning a divide in the literature between viewing low sexual desire as a genuine disease and seeing it as improperly medicalized, we investigate whether health and (...) disease judgments are affected by factors such as an individual’s gender, the cause of the low desire, whether the desire is high or low, and both personal and societal valuations of the condition. Our main findings indicate that (a) the cause of a condition influences whether it is judged a disorder, (b) how the individual values the condition influences whether the condition is seen as a proper target of medical intervention, and (c) perceived dysfunction influences judgments regarding health, disorder classification, medicalization, and medical intervention. Our findings help further illuminate the intricate interplay of factors that influence judgments about health and disease in controversial conditions. (shrink)

Highlights • Interfaces have evolved to ensure effective interaction with the environment. • Effective interaction results in remarkable simplicity. • Interfaces are a unique starting point to tackle the complexity of the brain. • Behavior is the interface between the brain and the environment.

Notwithstanding the huge progress in molecular and cellular neuroscience, our ability to understand the brain and develop effective treatments promoting mental health is still limited. This can be partially ascribed to the reductionist, deterministic and mechanistic approaches in neuroscience that struggle with the complexity of the central nervous system. Here, I introduce the Context theory of constrained systems proposing a novel role of contextual factors and genetic, molecular and neural substrates in determining brain functioning and behavior. This theory entails key (...) conceptual implications. First, context is the main driver of behavior and mental states. Second, substrates, from genes to brain areas, have no direct causal link to complex behavioral responses as they can be combined in multiple ways to produce the same response and different responses can impinge on the same substrates. Third, context and biological substrates play distinct roles in determining behavior: context drives behavior, substrates constrain the behavioral repertoire that can be implemented. Fourth, since behavior is the interface between the central nervous system and the environment, it is a privileged level of control and orchestration of brain functioning. Such implications are illustrated through the Kitchen metaphor of the brain. This theoretical framework calls for the revision of key concepts in neuroscience and psychiatry, including causality, specificity and individuality. Moreover, at the clinical level, it proposes treatments inducing behavioral changes through contextual interventions as having the highest impact to reorganize the complexity of the human mind and to achieve a long-lasting improvement in mental health. (shrink)

According to Marshall et al. (2024), some of the patients who refuse to stay in observation after being resuscitated following an opioid overdose are likely not making an autonomous choice. While I do not intend to dispute this claim, it merits discussion what is the concept of autonomy at play in making this assessment. I contend that the concept at work is more substantive than Marshall et al. acknowledge—and more substantive, too, than the form of autonomy usually thought to underpin (...) the moral justification of the requirement of informed consent. (shrink)

The received view about depression in the philosophical literature is that it is defined, in part, by epistemic irrationality. This status is undeserved. The received view does not fully reflect current clinical thinking and is motivated by an overly simplistic, if not false, account of depression’s phenomenal character. Equally attractive, if not more so, is a view that says depression can be instantiated either rationally or irrationally. This rival view faces challenges of its own: it appears to entail that there (...) are situations when not being depressed is rationally sub-optimal and that resilience to, and healthy coping strategies for avoiding, depression can be rationally remiss. I criticise an existing reply to these challenges before motivating a better one from the perspective of epistemic consequentialism. (shrink)

The use of philosophical phenomenology for conceptual debates in psychiatric nosology and psychopathology is beginning to be recognized. In this paper, we extend this trajectory to include Tourette Syndrome, focusing on so-called premonitory urges (PU) preceding Tourettic tics. We clarify some inconsistencies around typology in both phenomenological description and medical classification (i.e., in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision, International Classification of Diseases, 10th edition [World Health Organization, 2004], and the scales that elicit PU). (...) We show how a less typological approach might be usefully deployed in the field, that being the dimensional approach developed by Fernandez (2019a; 2019b). We test both the typological and dimensional approaches in relation to the experience and etiological role of PU in Tourette’s syndrome. Based on our synthesis of existing studies and new information garnered through phenomenological interviews (using an approach associated with “micro-phenomenology”), we argue that the role of PU in nosology challenges both the current “operational” criteria favored by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision, that are focused on behaviorally observed symptoms, as well as essential and prototypical phenomenological descriptions about a given “type” of experience. (shrink)