Who are we and what are we doing here? (original) (raw)
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Psychiatry, philosophy and the self
Current Opinion in Psychiatry, 2005
The aim of this article is to investigate psychopathology in order to illuminate the nature of personal identity. Predominantly, the authors reviewed here defend a more robust version of the narrative self against Dennett's claim that narrative self is ultimately a useful fiction. Authors explore the limit case of dissociative identity disorder in order to explore how apt an embodied, socially interactive and autonomous narrative self is for addressing legal and moral paradoxes intertwined with establishing personal identity. Psychiatric practice should embrace therapeutic approaches that restore the unity inherent to the capacity to narrate a life.
Getting Personal in the Philosophy of Psychiatry: Broadening Our Minds … and More
Under review, 2024
This paper show that there is a need to develop a proper characterisation of persons when theorising about psychiatry. It does so by analysing three prominent proposals in the philosophy of psychiatry that fail, we contend, to reflect the way persons are understood in our everyday life and in the psychiatric practice. Against this backdrop, this paper does three things: shows that there is a need to provide an appropriate characterisation of persons that is of use to psychiatry; demonstrates that this has not yet been adequately done; and, finally, offers some correctives and clarifications to get us started on developing a satisfactory philosophy of persons.
Whose Illness? Man, Mind, and Mental Illness
Proceedings of the 50th Anniversary Convention of the AISB, 2014
This paper argues that the conceptions of man and of mental illness are inter-linked, and that it is not possible to reconceptualize one without the other. In order to understand the understanding of man underlying biological psychiatry, this paper traces two inter-linked historical developments: first, that of the gradual disappearance of the patient from the production of medical knowledge, and second, that of how reductionist approaches in biological psychiatry have further neglected to place personhood in medical cosmologies. To illustrate this, first-person reports of the subjective experience of depression are given due consideration, as well as examples from applications of DBS. It is our conclusion that the personhood of the patient has to be reinstated, in a form of personal realism, thereby altering the modern modes of production of medical knowledge.
2016
What can philosophy offer psychiatry? What can psychiatry offer philosophy? Simply, there is nothing as harmful as a bad theory put into practice and conversely the constraints of practice and the recalcitrance of the realities of anomalous experiences offer instructive challenges to theory. We know well that the history of medicine and psychiatry have many examples of bad theory having been put into practice often with tragic consequences. Equally the extremes of armchair philosophy and far-fetched thought experiments, while keeping some philosophers busy chasing zombies or possible worlds in which minds can be uploaded into a computer harddrives, leave philosophy open to accusations of irrelevance and obfuscation. Andrew Scull, and he is not the first, calls our attention to the political, economic and social dimensions of insanity, he writes: "For the lunatic, the madman, the psychotic, the schizophrenic, call them what you will, suffer a sort of social and moral death. Their wishes and will, their very status as moral actors, as agents capable of expressing valid preferences, and exercising autonomous choice are deeply suspect in light of their presumed pathology, as the often dark history of their treatment under confinement abundantly shows." (Scull, The Insanity of Place-The Place of Insanity, 2006: 52). The stakes are thus immeasurably high and our efforts to avoid 'real mischief' demand critical appraisals of both philosophy and psychiatry, critical appraisals internal to each discipline and between these disciplines. The collection of original essays in Philosophy and Psychiatry: Problems, intersections, and new perspectives, edited by Daniel D. Moseley and Gary J. Gala brings together diverse philosophers and psychiatrists in this effort of mutual critical engagement spanning the domains of phenomenology, 2 psychoanalysis, neuroscience, neuroethics, behavioral economics,
The Crisis of Present-Day Psychiatry: Regaining the Personal
The Crisis of Present-Day Psychiatry: Regaining the Personal , 1999
(The following is the second of two articles adapted by the authors from lectures given at the University of Zurich upon their receiving the 1998 Dr. Magrit Egnér-Stiftung prize-Ed.) Present-day psychiatry has fallen into crisis because of the severe limitations of its conception of the person and, as a result, its conception of the patient. It objectifies the patient in a number of ways: 1) It lacks a conception of normality and consequently perceives most aspects of the patient's life in pathological terms; 2) It reduces the patient's problems to a list of pathological symptoms; 3) It tends to conceive of these symptoms as having primarily biological causes; and 4) Its methods of treatment are pharmacological and behavioral. Because of this reductionism, psychiatry fails to distinguish between healthy and pathological features of human life. It fails to view the pathological aspects of patients' lives within the larger context of their personalities and sociocultural milieus. It fails to consider adequately the psychological and social factors that cause and maintain each patient's problems. Finally, it fails to employ treatments that address whole people living daily in their sociocultural worlds. Yet this reductionism does alert us to important components of human life. To express our point as generally as possible: it alerts us to the anthropological fact that human beings are, in many respects, objects. Although the reductionist conception of the patient does, because of its limitations, signal the loss of the personal, our attempt to regain the personal must incorporate the object-like components of human existence that reductionism pinpoints. Because human beings are, in certain respects, objects, a full conception of people must not disregard this object-like-ness but must rather situate it within the broader philosophical context in which it rightfully belongs.
Phenomenology and the Crisis of Contemporary Psychiatry: Contingency, Naturalism, and Classification
My dissertation contributes to the contemporary field of phenomenological psychopathology. The work has two major aims. First, I show how a phenomenological approach can clarify and illuminate the nature of mental disorder, providing helpful distinctions between psychopathological conditions that can facilitate psychiatric research, classification, and diagnosis. Second, I argue that when psychopathological disturbances are taken seriously by phenomenologists, they have the potential to challenge both phenomenology’s status as a transcendental philosophy and its corresponding anti-naturalistic outlook. In the opening chapter, I articulate the subject matter of phenomenological research, arguing that phenomenologists study three distinct layers of human existence, which I refer to as “existentials,” “modes,” and “prejudices.” While each layer contributes to what we might call the “structure” of human existence, they do so in different ways, and to different degrees. Existentials—also referred to as transcendental, essential, or ontological structures—are the basic, categorial features of human existence, such as temporality, affectivity, and intersubjectivity. Modes are the particular manifestations of existentials; affectivity, for example, might manifest through the modes of joy, sorrow, or guilt. Prejudices, in contrast, are the tacit biases or presuppositions that determine how we interpret and understand our objects of experience. Because phenomenological psychopathology—and applied phenomenology in general—aims to characterize how the structure of human existence can change, I argue that these layers must be distinguished and defined before investigating psychopathological disturbances. This chapter has been published as “The Subject Matter of Phenomenological Research: Existentials, Modes, and Prejudices,” in Synthese. In chapters two through five, I conduct hermeneutic and phenomenological investigations of the psychopathological phenomena typically labeled as major depressive disorder and bipolar disorder. I employ hermeneutic studies of psychiatric language and terminology (chap. 2) to expose poorly defined categories of disorder, preparing the way for phenomenological investigations of the affective aspects of depression (chap. 3) and mania (chap. 4), and the embodied aspects of melancholic depression (chap. 5). Furthermore, I argue that these psychopathological conditions involve changes in the most fundamental layer of human existence—what I have referred to as the layer of existentials. As I argue, many of the classical phenomenologists (including Husserl and Heidegger) believed that these structural features were necessary, unchanging, and universal. However, examining psychopathological and neuropathological conditions challenges this presupposition, undermining the extent to which phenomenology is accurately characterized as transcendental philosophy. These chapters have been published in the Journal of Psychopathology (chaps. 2 & 4), Phenomenology and the Cognitive Sciences (chap. 3), and the Journal of Consciousness of Studies (chap. 5). In chapters six and seven I articulate these challenges in more detail in order to achieve two distinct ends: a defense of phenomenological naturalism and a phenomenological approach to psychiatric classification. In chapter six I argue that psychopathology and neuropathology not only challenge phenomenology’s status as a transcendental philosophy, but also supply a key to developing a phenomenological naturalism (which I contrast with a naturalized phenomenology). Phenomenological naturalism, as I articulate it, is a position in which phenomenology is not subsumed by the metaphysical and methodological framework of the natural sciences, but maintains the capacity to investigate the relationship between nature and human subjectivity. A portion of this chapter has been published as “Contaminating the Transcendental: Toward a Phenomenological Naturalism,” in the Journal of Speculative Philosophy. In chapter seven I argue that the kinds of contingency and variation articulated in the preceding chapters provide a framework for a dimensional approach to psychiatric classification. Such an approach dispenses with distinct categories of disorder, instead beginning from core features of human subjectivity, such as selfhood, affectivity, and temporality, showing how these features can alter or vary in degree. Such an approach, I argue, has strong parallels with recent developments in psychiatry, and would reduce the obstacles to fruitful dialogue and collaboration between psychiatrists and phenomenologists. For example, by paralleling the dimensional framework of contemporary psychiatry, phenomenologists will be able to draw conceptual distinctions that can guide new research into neurobiological and genetic substrates. This chapter has been published as “Phenomenology and Dimensional Approaches to Psychiatric Research and Classification,” in Philosophy, Psychiatry, & Psychology. By offering applied investigations of psychopathological conditions as well as foundational studies of phenomenology’s metaphysical presuppositions, my dissertation has both a contemporary and a historical component. The dissertation secures a sound footing for phenomenological psychopathology by clarifying its subject matter and proposing new avenues for interdisciplinary collaboration. But in so doing, it also initiates a return to the classical texts, reinterpreting the work of Husserl, Heidegger, and Merleau-Ponty in light of the implications of psychopathology.
Oxford University Press, 2024
This introductory chapter discusses the tension between biopsychosocial models and neurocentric approaches in psychiatry, motivating a turn to 4E (embodied, embedded, extended, and especially enactive) theories. The chapters that follow develop an interdisciplinary approach to integrative conceptions of psychiatry, distinguish between narrow and wide integration, and explicate a model based on the concept of self-pattern. According to this model, psychiatric disorders are self-disorders. This hypothesis extends the claim made by phenomenological psychiatrists about schizophrenia, namely, that schizophrenia is a disturbance affecting a very basic sense of self. The notion of self-pattern introduces a wider and more complex notion of self that facilitates the analysis of psychopathologies more generally. The chapter ends with a consideration of the difficulties involved in nosological classification.
Thaumàzein, 2018
The analysis of mental disorders necessarily requires careful and multilayered reflection. Psychiatry is indeed focused on complex phenomena and symptoms that can be only partly traced back to merely quantitative objectifiable data. This is the reason why we witness a growing methodological and conceptual “mutual enlightenment” between philosophy and psychiatry. Whereas philosophy offers notions that can help to take into account also the qualitative aspects and the lived experiences of pathologies, clinical psychiatry seems to represent one of the most relevant practical fields for philosophy to test its explanatory capacity in relation to its many important issues. The history of phenomenological psychopathology, in particular, shows that philosophers have demonstrated a keen interest in the practical consequences of these issues in the field of clinical psychopathology. It is important to note that, in diagnosing and analyzing some disorders as well as in providing therapeutic instructions, psychiatry turns to concepts that have a pronounced philosophical relevance. Human being, person, self, intersubjectivity, common sense, lived body (Leib) and inanimate body (Körper) are but some of the concepts employed to comprehend several psychopathologies – for instance, those entailing profound emotional and intersubjective disabilities such as schizophrenia, autism spectrum disorder and depression. These notions have been the object of lively philosophical discussions. It is therefore quite difficult to imagine, for example, that the connections between time, body and otherness which emerge in certain psychopathologies could be analyzed in complete detachment from the philosophical debate over these issues or without asking whether there is any relationship between mental disorders and the peculiarity of human existence. Considering these convergences, this special issue offers to its readers a series of contributions that investigate the possible relationships between specific psychopathological symptoms and some crucial philosophical issues from various viewpoints. Joel Krueger and Michelle Maiese argue that the notion of “mental institutions” – discussed in recent debates about extended cognition – can help better understand the origin and character of social impairments in autism, and also help illuminate the extent to which some mechanisms of autistic dysfunction extend across both internal and external factors (i.e., they do not just reside within an individual’s head). In his two papers, John Cutting explores the modus vivendi of schizophrenia and that of depression in relation to Max Scheler's phenomenology. Guido Cusinato develops a critical reflection on Cutting’s proposal, highlighting the intersubjective and enactive dimension of valueception impairments. Underlying this discussion between Cutting and Cusinato there is a different way of interpreting the relationship between the modus vivendi of schizophrenia and Scheler’s phenomenological reduction. The next issue of the journal will include Cutting’s response to Cusinato’s observations. Guilherme Messas and Melissa Tamelini analyze two concepts of a philosophical origin – that of dialectics and that of essence – which, in their strict application to psychopathology, could be of considerable value for diagnostic purposes and for the introduction and follow-up of therapeutic strategies. Lucas Bloc and Virginia Moirera propose an outline of clinical phenomenology for eating disorders inspired by Merleau-Ponty’s philosophical phenomenology. Francesca Brencio explores the “pathic” dimension of existence, which is the capacity of both being affected and being situated within moods and atmospheres. The broader purpose of her paper is to show how the “pathic” dimension of existence is related to psychopathology and clinical practice, for example in affective disorders and schizophrenia. Valeria Bizzari draws attention to the interaffective and intersubjective dimensions of Asperger’s subjects. Finally, Gilberto di Petta and Mario Rossi Monti highlight the importance of the debate on these issues that took place in Italy, retracing the history of the Italian Society for Phenomenological Psychopathology and the School of Phenomenological-Dynamic Psychotherapy. There will be a further issue of the journal on this topic. All together, these papers aim to promote a closer comparison and collaboration between psychiatry and philosophy, going beyond a reductive and merely symptomatological conception of mental illness and widening the horizon so as to research areas that so far have remained on the margins of phenomenological psychopathology, such as the dimensions concerning value and affectivity. John Cutting and Guido Cusinato