Thursday, 13 June 2019

The Medical Model in Mental Health

Today's post is by Dr Ahmed Samei Huda, a Consultant Psychiatrist working mostly in Early Intervention in Psychosis for Pennine Care NHS Foundation Trust. He is introducing his book, The Medical Model in Mental Health: An Explanation and Evaluation (OUP, 2019). Huda is on Twitter (@SameiHuda), and blogs here.

I am a clinician not an academic who became increasingly frustrated with the strawman depictions of psychiatry in the fraught conflicts between different professions and ideologies in mental health. So I decided to read more about what the medical model was and the more I read the more he realised there was an absence of a book explaining from first principles what the medical model was and how it was applied in mental health. 

I’m not a world class expert but my over 20 years experience of clinical practice combined with extensive reading including several volumes of the excellent International Perspectives in Philosophy and Psychiatry series and Davidson’s Textbook of Medicine as well as several hundred papers helped qualify me to write this book and luckily OUP agreed.

The book starts with an outline of the medical model as a model of practice – using the best evidence to guide clinical decision-making – and as a model of explanation (currently biopsychosocial not biomedical) and the lack of clear-cut definitions for disease and illness in all of medicine.

Categorical diagnostic constructs are used as an easy way to acquire, learn and recall relevant information for clinical practice. Doctors match the clinical picture of the patient to the best matching clinical picture of a diagnostic construct. These constructs carry attached information such as on prognosis, complications or treatment effectiveness. 

Diagnostic constructs are classified on similarities of clinical picture, changes in structure/ process and/or causes. They are used to represent several different types of conditions such as spectrums with health, spectrums of conditions, injuries or problems thought to benefit from healthcare professionals’ interventions. Doctors work as part of teams and the medical model is not the only way and not always the best way to help people with the problems they come with to services.

The book then discusses some relevant papers to identify criticisms of psychiatric diagnostic constructs and treatments. The best comparison is with general medicine and the rest of the book analyses the relevant evidence which shows there is significant overlap between psychiatry and general medicine – for example both their diagnostic constructs often lack clear boundaries with healthy states, lack clear boundaries between each other and require additional information apart from diagnosis to guide clinical decision making, lack of knowledge of biological mechanisms or causes and the importance of social factors as well as overlapping effectiveness of their treatments which in both psychiatry and medicine which in both specialties are usually not cures or reverse diseases. 

Psychiatry is thus a member of family of the medical specialties despite the claims of its’ critics but necessarily must work in a multidisciplinary way and diagnostic constructs whilst the most useful classification for social purpose such as access to welfare and administration are often not ideal for different ways of working with mental health patients such as psychotherapy.

Tuesday, 11 June 2019

Factor One, Familiarity and Frontal Cortex

In this post, Phil Corlett, Associate Professor of Psychiatry at Yale School of Medicine, discusses some of the ideas in his paper ‘Factor one, familiarity and frontal cortex: a challenge to the two-factor theory of delusions’ recently published in the Journal of Cognitive Neuropsychiatry.

Over recent years, Imperfect Cognitions has become the premier hub and outlet for work on the neurobiology and cognitive psychology of delusions. It has featured my work on aberrant prediction error and delusions in schizophrenia (Corlett et al., 2007), and work that conceptually replicates it (Kaplan et al., 2016). There has been work, also highlighted on the blog, from neurological patients that suggest instead that a 2-factor explanation of delusions may be more appropriate (Darby et al., 2017), although that work was not conclusive (McKay and Furl, 2017).

It has all garnered much interest. Partly because delusions inherently fascinating, I think, and partly because the arguments being waged have clinical import as well as more broad appeal – they are about our beliefs, which we all cherish and often find hard to relinquish. These debates also factor on how best to map the mind and brain. Whilst the debate is about delusions, it has more wide-ranging implications.

Recently I uncovered something in the literature which I believe undermines the 2-factor theory of delusions (Davies et al., 2001, Coltheart, 2010, Coltheart et al., 2011). I believe this discovery warrants our consideration, and, my own reflection has led me to raise four objections to the factor theory of delusions. Two of those are about the control cases who are a foundational for the 2-factor theory of Capgras delusion (the flagship of the 2-factor explanatory fleet). 

Thursday, 6 June 2019

Exploring Mental Health in Art and Film

In today's post we announce two events celebrating the work of project PERFECT, both to be held later this month. Both events are part of the Arts and Science Festival at the University of Birmingham. PERFECT hosted three academic workshops, one on belief in 2016, one on memory in 2017, and one on confabulation in 2018. In 2019 we want to see whether some core themes of the project can be conveyed to a wider public via the means of artistic expression.

We have planned the screening of a film, Mani Rosse (Red Hands) by Francesco Filippi; and an art exhibition entitled Pouring Water Through a Telescope in collaboration with the Art Recovery Group at the Barber Institute. Both events celebrate the role of imagination in promoting growth and healing. Both events explore the importance of personal relationships in wellbeing and success.


Film screening

Where: Midlands Arts Centre, Birmingham 
When: 18th June, doors open at 6pm.
For whom: All welcome. Film suitable for young adults (+12). Tickets free.

Luna and Ernesto in Red Hands

The film addresses issues of domestic violence and friendship. The screening will be followed by a panel discussion with experts in youth mental health and there will be an opportunity for the audience to ask questions to the film director and the experts.

For some more information, and to read a statement by the director, go here.

  • Francesco Filippi, director and screenwriter.
  • Michael Larkin, clinical psychologist, Aston University.
  • Bonny Astor, facilitator who leads philosophy and mental health discussion groups.
  • Gemma Hickman and Lucy Wright, experts by experience.
Register for the film screening for free on this Eventbrite page.


Art exhibition

Where: ERI Building Foyer, Edgbaston Campus, Birmingham
When: 26th June, 5:30-7:30pm. Just drop in.
For whom: All welcome. Refreshments available. Tickets free.

Every Passing Hour by Magdalena Antrobus

This is a special event, part of the Green Heart Festival at the University of Birmingham. This Summer, the theme of the Festival is CELEBRATION, and with this art exhibition we celebrate the power of imagination as a means of self-discovery, healing, and growth.

Please join us after work for a drink and some finger food to see some beautiful artwork, meet the artists, and learn more about project PERFECT. One of the artists exhibiting, Magdalena Antrobus, was a PhD student on project PERFECT in 2014-2017 (with a thesis on epistemic and psychological benefits of depression) and is now a full-time artist.

Register for the art exhibition for free on this Eventbrite page.

Tuesday, 4 June 2019

The Pursuit of Resonant Meaning

In which I confabulate (in a sense I’ll leave up to the reader to determine) about my recent paper “Confabulation, Explanation, and the Pursuit of Resonant Meaning”. This is the final post in our series dedicated to our special issue “Philosophical Perspectives on Confabulation” in Topoi, so let me take the opportunity to thank all of the authors for contributing to what I think has turned out to be a fantastic resource on current philosophical and psychological thinking on the topic. You can revisit the other posts in the the series (and find links to the full papers) here.

I don’t really understand ball sports.

I mean that in the sense that, if I’m ever a spectator to a bunch of people throwing/kicking/hitting an inflated spherical object around a pitch, I’m usually not familiar with the rules, and I just don’t get a lot of what’s going on, and end up losing interest.

But I also mean it in the sense that I am just not stirred up by a lot of the grandiose sports discourse: the highs, the lows, the dreams made and the dreams dashed, the operatics of the turf…honestly, isn’t it just a ball rolling around?

And yet, this sort of extravagant sports talk is a nice illustration of something we humans commonly do: explain events not simply with a view to ellucidating the causal relations therein, but imposing a sense of narrative which strikes a chord with our audience. Indeed, research suggests that sports teams commonly use narratives to illustrate the triumphs and tribulations of their game.

One example is the use of the hero to villain to hero narrative used to redeem a player who scores after a second attempt (Cunliffe and Coupland 2011). Scoring of course implicates the player’s skill, but also depends on factors beyond their control (e.g. trajectory and speed of the ball, the local effects of the weather, and so on…). Yet the notion of the redeemed hero makes a better story than “well, actually she just got lucky that time because the sun wasn’t in her eyes”.

Thursday, 30 May 2019

Extended Consciousness and Predictive Processing

This post is by Michael D. Kirchhoff and Julian Kiverstein. They present their recent book, Extended Consciousness and Predictive Processing: a Third Way.

Kirchhoff is a Senior Lecturer in Philosophy at the University of Wollongong, Australia. He has edited a special issue of Synthese on Predictive Brains and Embodied, Enactive Cognition. His research spans across topics in philosophy of mind and cognition, philosophy of neuroscience, and theoretical biology. He is currently a member of an Australian Research Council Discovery Project exploring the explanatory basis of minds in skillful performance.

Julian Kiverstein is Senior Researcher in Philosophy at the University of Amsterdam, Netherlands. He has published extensively on philosophy of 4e cognition and phenomenologically-inspired philosophy of mind. He is currently a member of an interdisciplinary project investigating changes in lived experience of patients being treated with deep brain stimulation for obsessive compulsive disorder.

In our book we defend the thesis of the extended consciousness: the view that a person’s conscious mental life, in addition to nonconscious standing states like beliefs, can be constituted by processes that extend beyond the boundary separating the brain from the body and the rest of the world. We defend the thesis of extended consciousness by weaving together predictive processing and third-wave extended mind.

Predictive processing provides a probabilistic and prediction-driven framework within which to make sense of the processes and mechanisms that explain consciousness. We provide a novel perspective on predictive processing staking out our own position within the debate surrounding the extended mind. 

We take the mind to be constituted diachronically, and as having a boundary that is neither fixed nor stable but fragile and hard-won, and always open to negotiation. This framing of predictive processing leads us to defend the following theses about the explanatory and metaphysical basis of consciousness:

  1. Predictive processing casts agents as generative models of their environment. A generative model is a probabilistic structure that generates predictions about the causes of sensory stimuli. The ongoing tuning and maintenance of the generative model by active inference entails the dynamic entanglement of the agent and environment.
  2. There is no single, fixed and permanent boundary separating the inner conscious mind from the outside world. The boundary separating conscious beings from the outside world is fluid and actively constructed through embodied activity.
  3. The predictive processes that lead to conscious experience do not only unfold within the individual but are mediated and permeated by cultural practice. The individual agent is thus better thought of as locus of coordination where the process of coordination is partly driven by cultural practices. Cultural practices are thus part of the constitutive basis of some forms of conscious experience.
  4. Adopting this third-wave perspective on predictive processing has as a consequence a new metaphysics of the constitution of conscious experience as diachronic, not synchronic. The generative model has a deep temporal structure that is necessary for phenomenal consciousness. We show how it follows from diachronic constitution that the agent and the wider cultural niche cannot be cleanly unplugged from one another in a way that would allow for a purely neural explanation of consciousness.