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What’s wrong with ‘mental’ disorders? : a commentary on ‘What is a mental/psychiatric disorder? : from DSM-IV to DSM-V’ by Stein et al
Full text linkThe editorial by Stein et al. (2010) is timely and
relevant given the development of DSM-V and the
likely impact that such a development will have on
mental health services in the USA. The revision of the
DSM will also affect international psychiatric research
and global practice thanks to the interplay between the
development of DSM and ICD (Fulford & Sartorius,
2009). The editorial by Stein and colleagues is very rich
and there are many themes suitable for further examination
and discussion. For this response, however,
we have chosen to focus on two themes: the use of the
term ‘mental’ and the idea of psychiatric disorders
being ‘in’ an individual
Delusional beliefs and reason giving
Full text linkDelusions are often regarded as irrational beliefs, but their irrationality is not sufficient to explain what is pathological about them. In this paper we ask whether deluded subjects have the capacity to support the content of their delusions with reasons, that is, whether they can author their delusional states. The hypothesis that delusions are characterised by a failure of authorship, which is a dimension of self knowledge, deserves to be
empirically tested because (a) it has the potential to account for the distinction between endorsing a delusion and endorsing a framework belief; (b) it contributes to a
philosophical analysis of the relationship between rationality and self knowledge; and (c) it informs diagnosis and therapy in clinical psychiatry. However, authorship cannot provide a demarcation criterion between delusions and other irrational belief states
The future of scientific psychiatry
No full textNeuroscience has long had an impact on the field of psychiatry, and over the last two decades, with the advent of cognitive neuroscience and functional neuroimaging, that influence has been most pronounced. However, many question whether psychopathology can be understood by relying on neuroscience alone, and highlight some of the perceived limits to the way in which neuroscience informs psychiatry
PSYCHIATRY AS COGNITIVE NEUROSCIENCE: PHILOSOPHICAL PERSPECTIVES
No full textNeuroscience has long had an impact on the field of psychiatry, and over the last two decades, with the advent of cognitive neuroscience and functional neuroimaging, that influence has been most pronounced. However, many question whether psychopathology can be understood by relying on neuroscience alone, and highlight some of the perceived limits to the way in which neuroscience informs psychiatry. Psychiatry as Cognitive Neuroscience is a philosophical analysis of the role of neuroscience in the study of psychopathology. The book examines numerous cognitive neuroscientific methods, such as neuroimaging and the use of neuropsychological models, in the context of a variety of psychiatric disorders, including depression, schizophrenia, dependence syndrome, and personality disorders. Psychiatry as Cognitive Neuroscience includes chapters on the nature of psychiatry as a science; the compatibility of the accounts of mental illness derived from neuroscience, information-processing, and folk psychology; the nature of mental illness; the impact of methods such as fMRI, neuropsychology, and neurochemistry, on psychiatry; the relationship between phenomenological accounts of mental illness and those provided by naturalistic explanations; the status of delusions and the continuity between delusions and ordinary beliefs; the interplay between clinical and empirical findings in psychopathology and issues in moral psychology and ethics. With contributions from world class experts in philosophy and cognitive science, this book will be essential reading for those who have an interest in the importance and the limitations of cognitive neuroscience as an aid to understanding mental illness
AFFECTIVE INSTABILITY AND PARANOIA
No full textThe phenomenon of affective instability is not well understood yet but is experienced widely in some of its manifestations. According to recent empirical studies, it
has an important role to play in the genesis of a variety of psychiatric disorders. In
this paper, we want to focus on the role of affective instability in paranoia. Paranoia
is characterised by having unjustified beliefs about being threatened by malevolent
others and thus is linked to persecutory delusions. Causal accounts of paranoia tend
to focus on how perceptual processes might be disrupted and cognitive processes
might be biased, causing people to accept unjustified beliefs about being under
threat. In this paper we argue that tracking affective instability helps us tell a fuller
story, where disturbances of mood are a mediating factor between trauma and paranoia, leading people to experience the world and themselves as unpredictable
If you didn't care, you wouldn't notice: recognition and estrangement in psychopathology
No full textIn this brief commentary, we address two interrelated issues. (1) Can estrangement from an object of experience be coherently distinguished from the failure of re-identification of that object?(2) Given that the delusional belief is what essen-tially characterizes the Capgras syndrome, can the experience of Capgras patients be accounted for independently of a reference to their delusional beliefs
Mental illness as mental: in defence of psychological realism
No full textPaper defending the notion of mental illnes
Philosophical issues in the prodromal phase of psychosis.
No full textIn this paper we try to examine some of the philosophical issues that arise from the clinical and scientific study of the prodromal phase of psychotic illness. These issues can be broadly grouped in to ethical concerns and those relating to the philosophy of psychology and science. Specifically, we discuss the notion of the prodrome as a discrete disorder as opposed to being a segment of the continuum of psychosis, and whether we can define psychopathology purely via the use of neuroscientific variables and concepts. We argue that many psychopathological terms have definitions that rely on normative notions that themselves may not be able to be reduced to terms in cognitive neuroscience and hence a purely neuroscientific conception of psychopathology and of the prodromal phase of psychosis may be unachievable. Ethical concerns arise around the treatment of 'false positives', that is, those who may clinically look to be at risk but do not develop psychosis, and the reification of a subtle research category into a DSM-5 diagnosis. More subtle issues lie in the clinical encounter where one has to balance communicating risk about developing psychosis with attempts to normalize experiences and decrease anxiety. We conclude by noting that studying the brain solely will not enable us to comprehensively understand prodromal phase of psychosis: a close attention to continua and normativity is also required and that several important clinical and ethical issues arise in both indentifying and intervening in this high risk group, and that these are now cast sharply in to focus with the inclusion of the risk syndrome in the draft DSM-5
A role for ownership and authorship in the analysis of thought insertion
No full textPhilosophers are interested in the phenomenon of thought insertion because it challenges the common assumption that one can ascribe to oneself the thoughts that one can access first-personally. In the standard philosophical analysis of thought insertion, the subject owns the 'inserted' thought but lacks a sense of agency towards it. In this paper we want to provide an alternative analysis of the condition, according to which subjects typically lack both ownership and authorship of the 'inserted' thoughts. We argue that by appealing to a failure of ownership and authorship we can describe more accurately the phenomenology of thought insertion, and distinguish it from that of non-delusional beliefs that have not been deliberated about, and of other delusions of passivity. We can also start developing a more psychologically realistic account of the relation between intentionality, rationality and self knowledge in normal and abnormal cognition
Affective dimensions of the phenomenon of double bookkeeping in delusions
No full textIt has been argued that schizophrenic delusions are "behaviourally inert." This is evidence for the phenomenon of "double bookkeeping," according to which people are not consistent in their commitment to the content of their delusions. The traditional explanation for the phenomenon is that people do not genuinely believe the content of their delusions. In the article, we resist the traditional explanation and offer an alternative hypothesis: people with delusions often fail to acquire or to maintain the motivation to act on their delusional beliefs. This may be due to avolition, to emotional disturbances, or to the fact that, given the peculiar content of some delusions, the surrounding environment does not support the agent's motivation to act. © 2012 The Author(s)
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