Imperfect Cognitions

Today's post is by Themistoklis Pantazakos, Assistant Professor of Psychology and Philosophy at the American College of Greece and Visiting Professor of Parenting and Special Education at KU Leuven. His research regards the philosophy of psychiatry, particularly issues of evidence based diagnosis, as well as phenomenological psychiatry and the use of client expertise in psychotherapy. In this post, he discusses the themes of his recent BJPsych editorial . Themistoklis Pantazakos For seventy years psychiatry has hunted biological markers to anchor its diagnoses in hard science. From brain imaging to genomics, each new tool promised parity with the rest of medicine, yet no major mental disorder has a specific biomarker. This gap feeds two linked accusations: psychiatric categories don’t track real diseases, and, without biomarkers, psychiatrists wield excessive, culturally loaded authority, sometimes inflating pathology in step with pharmaceutical incentives. Critics imply that bioma...

Today's post is by Orli Dahan (Tel-Hai College) on her recent paper, " The case of poor postpartum mental health: a consequence of an evolutionary mismatch–not of an evolutionary trade-off " ( Biology & Philosophy , 2023). Orli Dahan In my paper I criticize an evolutionary explanation to the phenomena of postpartum mood disorders and offer a different evolutionary explanation. These disorders develop shortly after childbirth in a significant proportion of women and have severe effects. I suggest that poor postpartum mental health is a classical mismatch situation: Namely, that a trait or function adaptive in a previous human environment becomes maladaptive in the modern environment. This is an argument used to explain many human health problems, such as diabetes and allergies.  The evolutionary explanation that I reject is the ‘evolutionary trade-off’ explanation. According to it, poor postpartum mental health is a consequence of an evolutionary trade-off – a comprom...

This blog post is by Zsuzsanna Chappell. Zsuzsanna is an independent scholar and research associate at the Centre for the Philosophy of Natural and Social Sciences, London School of Economics. She currently writes on the social philosophy and ethics of mental illness, and the role of researchers with subject-relevant lived experience in the human sciences. Previously, she held academic positions at the London School of Economics and the University of Manchester and is the author of  Deliberative Democracy: A Critical Introduction , Palgrave 2012. Zsuzsanna reports from the third annual  Philosophy of Psychiatry and Lived Experience workshop . The workshop was held on 17-18 April 2023, online (hosted by the University of Umeå). The aim of these workshops has been to bring together  philosophers and philosophy-adjacent scholars who self-identify as having lived experience of mental disability / difference, and are also writing on these topics.  University of Umeå Zsuzs...

This post is by Eleanor Harris, Lucienne Spencer, and Ian James Kidd. A version of this post was originally published on the EPIC blog on 24th May 2023. Harris is a M4C funded doctoral researcher at the University of Birmingham, working on epistemic injustice and epistemic vigilance.  Spencer is a postdoctoral researcher working on the Wellcome Trust-funded project ‘Renewing Phenomenological Psychopathology’ at the Institute of Mental Health, University of Birmingham.  Kidd is a lecturer in philosophy at the university of Nottingham and works on epistemology, philosophy of illness and healthcare.  Eleanor Harris Does epistemic injustice matter in psychiatric contexts? Brent Kious and colleagues have recently argued ‘No’ (see paper in Psychological Medicine ). While it is welcome to have our assumptions challenged, we think the answer should still be that epistemic injustice should matter to psychiatrists. (See our full response  in Philosophy of Medicine ). Befo...

Today's post is by  Sam Wilkinson  (University of Exeter) on his recent book Philosophy of Psychiatry: A Contemporary Introduction (2023, Routledge). When I started teaching philosophy of psychiatry about ten years ago I noticed that, while there was plenty of literature out of which a well-structured and coherent course could be built, there was (to my knowledge) no single textbook around which to base one.  Year-on-year, as my module was tweaked and improved, largely thanks to feedback from my students, it occurred to me (wrongly, as it turns out) that it would be relatively straightforward to turn said module into a textbook. And that’s what I’ve done - eventually! Like the module itself, the textbook is divided into two parts, which reflect two quite different enterprises that fall under the category “philosophy of psychiatry”.  The first enterprise involves philosophical scrutiny of psychiatry, with “psychiatry” here including both psychiatric practice and psyc...

Today's post is by Nimra Ahsan. Nimra is a fifth year medical student at the University of Birmingham, where she is currently completing a Masters in Mental Health. She is interested in how the study of mental health can help inform and improve future clinical practice, including her own. This is the last post in a series of perspectives from students taking the Philosophy and Ethics of Mental Health and Wellbeing module. Nimra Ahsan The interaction between psychiatry and psychopathology is one that is blending (Stanghellini and Broome, 2014). With a contemporary focus on patient experience, human subjectivity (or phenomenology) is creating a holistic perspective concerning mental health conditions, such as schizophrenia. Described as a ‘disturbance of minimal self’, our understanding of schizophrenia has deepened and the ipseity-disturbance model developed by Sass and Parnas has contributed to this substantially ( Nelson, Parnas and Sass, 2014 ). This model led to the formation o...

In today's post, Lucienne Spencer (University of Bristol) discusses the wrongful depathologization of serious mental conditions. The post is based on a paper co-authored with Havi Carel and published open access in Philosophy of Medicine. Lucienne Spencer The Mental Health Foundation states that ‘people with mental health problems are amongst the least likely of any group with a long-term health condition or disability to find work, be in a steady, long-term relationship, live in decent housing [or] be socially included in mainstream society’. Given the global decline in mental health following the coronavirus pandemic, addressing the marginalisation of people with psychiatric illness has never been more urgent. According to the literature, this marginalisation is grounded in sanist attitudes that portray people with psychiatric illness as ‘dangerous and frightening’, ‘incompetent to participate in “normal” activities’ and ‘morally repugnant’.  Comic by Michael Seymour Blake (Inst...

Today's post is by Emiliano Loria (Università La Sapienza, Roma). Here he summarises a recent paper he wrote, " A desirable convulsive threshold: Some reflections about electroconvulsive therapy ", published open access in a special issue of the  European Journal of Analytic Philosophy  on  Bounds of Rationality . Emiliano Loria Long-standing psychiatric practice confirms the pervasive use of pharmacological therapies for treating severe mental disorders. Nevertheless, we are far from triumphal therapeutic success. Despite the advances made by neuropsychiatry, this medical discipline remains lacking in terms of diagnostic and prognostic capabilities when compared to other branches of medicine.  An ethical principle remains as the guidance of therapeutic interventions: improving the quality of life for patients. Unfortunately, psychotropic drugs and psychotherapies do not always result in an efficient remission of symptoms. I corroborate the idea that therapists ...

The author of the post is Walter Glannon , who is a professor of philosophy at the University of Calgary in Canada. He has held other academic appointments at McGill University and the University of British Columbia.  Walter grew up and received all of his education in the US. Following a fellowship in clinical medical ethics at the University of Chicago, for 5 years (2000-2005) he was clinical ethicist at 3 hospitals in Montreal and Vancouver. This is largely how he developed his interest in research and clinical aspects of psychiatry. Advances in psychiatric research and clinical psychiatry in the last 30 years have given rise to a host of new questions that lie at the intersection of psychiatry, neuroscience, philosophy and law. Such questions include: Are psychiatric disorders diseases of the brain, caused by dysfunctional neural circuits and neurotransmitters? What role do genes, neuro-endocrine, neuro-immune interactions and the environment play in the ...

This post is by Alex Miller Tate , who works in the philosophy of the cognitive sciences, and is currently completing a PhD at the University of Birmingham. Here, he summarises his paper " Contributory Injustice in Psychiatry " recently published in the Journal of Medical Ethics. Significant service user involvement in the provision of and decisions surrounding psychiatric care (both for themselves as individuals and in the formation of policy and best practice) is, generally-speaking, officially supported by members of the medical profession (see e.g. Newman et al 2015 ; Tait & Lester 2005 ). Service user advocacy organisations and others, however, note that the experience of service users (especially in primary care) is of having their beliefs about, feelings regarding, and perspectives on their conditions ignored or otherwise thoughtlessly invalidated. Some deleterious consequences of this have been noted before, including impoverished clinical kn...