Nature and Narratives of Depression: 18th EPA and WPA Meeting in Paris

Salpetriere Hospital, Paris

The 18th Meeting of the Psychopathology Section of the European Psychiatric Association (EPA) and the World Psychiatric Association (WPA) took place on the 5th and 6th December 2014 at Salpetriere Hospital in Paris, France.

Over two days those invited to speak presented their talks related to the meeting’s leading theme – Nature and Narratives of Depression: Philosophical and Psychopathological Aspects, followed by plenary discussion. The meeting was chaired by Michael Musalek and the list of presenters included: Femi Oyebode, Pedro Varandas, Maria Luisa Figueira, Luis Madeira, Norbert Andersch, Raimo Salokangas and Gilberto Di Petta.

Inference and Epistemic Innocence

Will McNeill

This post is by Will McNeill, currently a teaching fellow at King's College London. He researches the epistemology of perception and recognition.

The main focus of PERFECT is on finding the epistemically valuable within mental pathologies of varying seriousness; of identifying pathological beliefs which are at least epistemically innocent. But in this post I want to bring our attention back to the cognitive processes of those with no serious cognitive impairments. It would not surprise me if many of our cognitive processes turn out to be epistemically innocent in a particularly direct way. They may turn out to be reliable, and to produce justified beliefs, while not being capable of explaining why the beliefs they produce are justified. Justified beliefs which are the direct products of such epistemically innocent processes are – I believe – foundational.

Suppose that we had good reason to think that someone was good at spotting emeralds. They tend to know, of emeralds, that they are emeralds. And they tend not to be fooled by the fakes. But suppose too that on other grounds we had good reason to think that the cognitive processes which generate their emerald beliefs relied in part on the thought that emeralds are grue.

On the one hand, we would have discovered something about the nature of their reliable capacity to spot emeralds. But on the other hand, we would not have produced any satisfying answer to the question of why they were warranted in their belief. At least, discovering that these deviant cognitive processes were at work would provide no more of an explanation of their warrant than the simple observation that they were de facto reliable at spotting emeralds.

Ellen White on OCD

Ellen White at the 2014 Mind Media Awards

Our new feature is a series of posts by experts by experience to be published on the last Monday of each month. Last month we had Roberta Payne who wrote about schizophrenia and "outsider art".

This month, we are delighted to host Ellen White who was recently awarded the 2014 Mind Media Award as Top Blogger. In her influential and inspirational blog, Ellen writes about the positive and negative effects of OCD and depression on her life, and challenges public attitudes towards mental illness. You can also follow her on Twitter.

Suffering from a mental health condition can be for the most part extremely distressing. An everyday battle with our minds. Not knowing what to believe, what not to believe, feeling like your own mind is working against you. However, living with a mental health condition can often go hand in hand with educating ourselves about the conditions we are suffering with and mental health in general. To recover from a mental illness, we first must understand our condition. This can often lead to people with mental health conditions being a lot more understanding of other people’s struggles. Whether that be struggling with the same mental health condition, or just struggling in general. We can almost put ourselves in the positions of others more easily.

Imagination Is Not Just For Fakers: a Reply to Neil

Anna Ichino

Thank you, Neil, for your greatly interesting post. I am very sympathetic to the negative part of your view: I definitely agree that the attitude of most religious people is not best described in terms of what you call ‘factual belief’. I am less persuaded by the positive part of your suggestion, though. The same reasons (some of which I summarized in a previous post) why I think that religious attitudes are not beliefs, lead me to think that they are imaginings, instead. So I do not clearly see the need for the new category of ‘religious credence’ that you suggest.

You argue that to describe religious attitudes as imaginings would force us to see religious people as fakers, which is obviously an undesirable consequence. On the other hand, you note, if we described religious attitudes as factual beliefs, we would be forced to see most religious people as fanatics: also undesirable. In order to make room, between fakers and fanatics, for a category of ‘normal religious believers’ – we need to posit, between imagination and belief, a category of ‘religious credence’.

I have some doubts on this, though. In particular, on your conditional premise that if we recognize that most religious attitudes are imaginings, then we are forced to say that most religious people as fakers. Why should the claim that Sarah imagines that demons exist and torment people lead us to conclude that she is a faker?

Understanding Psychosis and Schizophrenia

Launch of the report

On 27 November 2014 the British Psychological Society (Division of Clinical Psychology) launched a new ground-breaking report on Understanding Psychosis and Schizophrenia, edited by Anne Cooke. At the meeting, contributors and other interested parties offered their own view of the challenges that need to be met to ensure that people hearing voices and having unusual beliefs can get support in an effective way.

I only attended the morning session, and this is a brief report of the content of the talks I heard. Peter Kinderman (Professor of Clinical Psychology at the University of Liverpool) opened the session and welcomed the audience and the speakers.

The first speaker, Luciana Berger (MP and shadow Minister for Public Health and Mental Health) highlighted the need to invest more in mental health and make sure that mental health receives the same attention and resources as physical health. She praised those sections of the report suggesting that psychosis often is best tackled not with medication but with psychological therapies. This is something that she promised to work on to ensure that in the future the NHS can deliver better services.

The second speaker, Mike Pringle (President of the Royal College of General Practitioners) emphasised the important role of GPs in helping people who experience mental distress to navigate through the system. At present, GPs do not have the knowledge and resources to do that effectively and the temptation is to prescribe drugs, but prescribing drugs is not the answer to everything. GPs need to know what the options are.

Between Fakers and Fanatics

Neil Van Leeuwen

This post is by Neil Van Leeuwen, Assistant Professor at Georgia State University. 

Between the fanatics and the fakers lie the normal religious 'believers'. That is the view I defend in my recent paper, 'Religious credence is not factual belief'.

Joan of Arc, a fanatic, heard spiritual voices throughout her life. For her, the existence of these voices as external entities was, as far as we can tell, regarded with the same attitude of factual belief as, say, the voices of her baker or next-door neighbor. She took these voices as part of the furniture of the world around her.

The unbelieving clergy studied by Dan Dennett, on the other hand, are fakers. They are, in point of fact, atheists who, because of the momentum of their social circumstances, continue to pretend God exists. These fakers have fictional imaginings to the effect that Christ performed miracles—among other propositions. These imaginings guide their pretense in church every Sunday. The fakers, typically, experience a great deal of stress, because they are perpetually pretending.

But most religious believers are neither fanatics nor fakers, and it is the existence of this in-between level that my thesis seeks to capture. Furthermore, I have a novel proposal about how to capture the in-between level. First, let us pump intuitions a little more.

Consider a friend of yours who is sincerely religious. It could be any friend whose faith is genuine, but who is also not a fanatic. Now: what is your friend’s underlying attitude toward the metaphysical propositions of the religion she professes? If your friend is a certain kind of Christian, for example, one of those propositions could be that demons exist and torment people.

If we go with a traditional ontology of cognitive attitudes, we seem to have only two options for describing the attitude of your friend (let’s call her 'Sarah'):

          Sarah believes demons exist and torment people.

          Sarah imagines demons exist and torment people.

But if we have only these two options, we seem constrained to say that Sarah is either a faker or a fanatic.

World Association of Social Psychiatry Jubilee Congress

WASP 50th Jubilee Congress

On November 13th-15th 2014, the World Association of Social Psychiatry held its 50th Jubilee Congress. The event was a joint conference with the Royal College of Psychiatrists, organised in Park Plaza Hotel in Central London.

The Congress assembled a programme of wide scientific interest, marking the achievements of social psychiatry as a keystone to excellence in mental health care. It welcomed participants from 50 different countries and consisted of 60 lectures, seminars, workshops and talks as well as nearly 200 poster presentations. This report presents only a small selection of what was an enormously rich and interesting programme.

In his opening speech, the WASP President Dinesh Bhugra addressed current challenges to psychiatric practices in the 21st century. Bhugra put a particular emphasis on mental health issues arising as a result of globalization and use of modern technology, including cyber-bullying, internet-based religious radical movements and online advice forums for teenagers.

Unintended Consequences

The Forum (BBC World Service)

We all recall situations where our choice did not bring about the outcome we expected. This can happen to a couple planning a family, scientists predicting the result of a new experiment, politicians implementing a new policy to overcome a problem.

For each of these individual situations there may be specific reasons that explain why the outcome was unexpected, but I am interested in the general question, Why is it that our actions have unintended consequences? We can think about the issue of unintended consequences in terms of the capacities that would make it more likely for us as human agents to reliably predict the events our actions give rise to when we make decisions, reflecting on the wealth of empirical data coming from the psychological literature.

Being able to predict the outcomes of our actions would require good memory, sound reasoning, and effective deliberation. So, we could remember what consequences our previous actions have had, infer from our past experiences what consequences our future actions will be likely to have, and use this information when deciding on a course of action. Unfortunately, the recent psychological evidence suggests that the prospects for good memory, sound reasoning, and effective deliberation, even for those agents who are healthy and well-educated, are poor.

Classifying Psychopathology: Mental Kinds and Natural Kinds

In this post, Harold Kincaid and Jackie Sullivan present their edited volume titled Classifying Psychopathology: Mental Kinds and Natural Kinds (MIT Press, 2014)

Harold Kincaid

We are Harold Kincaid and Jackie Sullivan. Harold is Professor in the School of Economics and Director of the Research Unit in Behavioural Economics and Neuroeconomics at the University of Cape Town. He works primarily in the philosophy of the social sciences and has published numerous books and articles on topics in this research area. Jackie is Assistant Professor in the Department of Philosophy and a member of the Rotman Institute of Philosophy at the University of Western Ontario. She works primarily in the philosophy of neuroscience and is the author of multiple recent journal articles on topics in this research area.

Together, we edited a volume entitled Classifying Psychopathology: Mental Kinds and Natural Kinds, which was published by MIT Press in April 2014. The volume asks whether psychiatry as a science may better position itself to cure mental health disorders by considering whether improvements to current criteria for classifying mental disorders are warranted or whether the classification schemes are fine as they stand. Either directly or indirectly, the authors take up the question of whether mental disorders are natural kinds.

Lying, Truth, and Truthfulness

Stephen Wright

I'm Stephen Wright, a lecturer at the University of Oxford. I completed my PhD at the University of Sheffield in 2014, I mainly work on issues in epistemology and the philosophy of language. Whilst my research is primarily in the epistemology of testimony, I have recently been thinking about philosophical issues concerning lying, in preparing a piece for the forthcoming Oxford Handbook of Lying edited by Jörg Meibauer.

One of the questions at the centre of philosophical investigations into lying concerns what exactly lying is. In particular, I have been looking at the question of whether lying involves saying something that is untrue, or something that is untruthful. Put another way, the question is whether what I say can be a lie only if it is false, or if it merely seems to me that it is false.

Those that defend that idea that lying involves saying something untrue endorse the following claim:

(1) S’s statement that p is a lie only if p is false.

Thomas Carson (2010) endorses (1). According to Carson, someone’s statement is a lie only if it is false. The evidence for this comes from the observation that we cannot charge someone with lying once we find out that what she said was true. If you tell me that the portrait in the hall has been taken away and I accuse you of lying, it looks as though, when we go and check and find out that the portrait in the hall has in fact been taken away, I ought to retract my accusation.

Is Evidence-Based Psychiatry Ethical?

Is Evidence-Based Psychiatry Ethical?

This post is by Mona Gupta, psychiatrist and bioethics researcher at the University of Montreal in Canada.


For the last 15 years, I’ve been working on ethical issues relating to the use of evidence-based medicine (EBM) in psychiatric practice. EBM has been enormously influential in clinical medicine, particularly in psychiatry. This intersection between ethics, EBM and psychiatry is the theme I develop in my new book, Is Evidence-Based Psychiatry Ethical?, published by Oxford University Press in 2014.

EBM is a phrase that first appeared in the medical literature in the 1990s. It promotes a seemingly irrefutable principle: that clinical decision-making should be based, as much as possible, on the most up-to-date research findings. Nowhere has this idea been more welcome than in psychiatry, a field that continues to be dogged by a legacy of controversial clinical interventions. Many mental health experts believe that following the rules of EBM is the best way of safeguarding patients from unproven fads or dangerous interventions. If something is effective or ineffective, EBM will tell us.