Thursday 27 December 2018

Discourses of Men’s Suicide Notes

This post has been written by Dariusz Galasiński, who is Professor at the University of Wolverhampton and Visiting Professor at the Uniwersytet SPWS in Warsaw. He is a linguist interested in psychiatry and psychology and their discourses. He blogs hereIn this post, he presents his new book on discursive constructions of the suicide process.

My book is founded on a contradiction. Suicide and masculinity do not and cannot sit together easily. Suicide is stigmatised, and people who killed themselves are often thought to be weak and cowardly. Masculinity is anything but this. Its dominant model constructs men as strong ‘masters of the universe’. My book explores a number of resulting paradoxes.

1. The first paradox has to do with constructions of suicide. Even though suicide is constructed as a rational gift, it is not spoken of directly. The positive gift is outside discourse. For as the notes construct men as 'defenders' of the family (to which their suicide is constructed to contribute), they cannot construct themselves as committing suicide.

Even though suicide brings an end to a person’s life, the notes constructed it as non-final. Promises of continuing love, or meeting in the future were put together with friends’ brief farewells. Moreover, many notes were written from the future perspective, i.e. in time when the writing person is already dead. Life continues in the notes.

2. Paradoxically, the authors of the notes do not write as men. Masculinity was consistently diluted by being a husband/partner or a father. At the same time, however, it is the dominant model of masculinity which allows men to adopt speaking positions from which to issue sometimes very direct and brusque instructions. Moreover, the men position themselves as present in their families' lives also after killing themselves.

3. The note itself is invariably represented as special, and yet, can we imagine a more dramatic and special message? And while suicide is constructed to be rational, the notes are represented as difficult to write. You could argue that it is the construction of the note itself which shows suicide as, shall I say, 'it really is'. 

Tuesday 25 December 2018

Rethinking Disease in Psychiatry

This post is by Jennifer Radden, Professor Emerita of Philosophy at the University of Massachusetts Boston. Here, she discusses some of the ideas in and related to her paper “Rethinking Disease in Psychiatry: Disease Models and the Medical Imaginary” recently published in the Journal of Evaluation in Clinical Practice.

My philosophical research on the understanding, care and implications of mental disorder reflects an abiding interest in medical history. (Recent monographs with this focus include The Nature of Melancholy (2000), On Delusion (2011), and Melancholic Habits: Burton’s Anatomy for the Mind Sciences (2017).)

The era during which asylum-keepers were gradually being replaced by newly professional and medically scientific alienists, using observations from the asylum to consolidate ideas about a class of distinctly mental diseases, offer us intriguing hints about how to understand mental disorder today. 

Salient for my paper about the medical imaginary is the sheer range of separate, or at least apparently separable, disorders represented in nineteenth century asylums and clinics: the brain damaged and diseased alongside those diagnosed with “hysterical” (or, as they later came to be known, “functional”) syndromes, including the ubiquitous “melancholia,” the origin of whose symptoms would prove more elusive. 

And with their similar symptom profiles, melancholy (or melancholia) and late-stage syphilis are drawn from that historical setting to support my claims about a comparison so apparently indisputable that it likely directed the emergence of (much of) today’s diagnostic psychiatry. 

Thursday 20 December 2018

Religious Disagreement

Today's post is written by Helen de Cruz. Helen is Senior Lecturer in Philosophy at Oxford Brookes University, UK. Her publications are in empirically-informed Philosophy of Cognitive Science, Philosophy of Religion, Social Epistemology, and Metaphilosophy. 

Helen's overarching research project is an investigation of how human engage in thinking about abstract domains such as Theology, Mathematics, and Science, what it means for limited, embodied beings like us to think about these topics, and what epistemic conclusions we can draw from this. Here, she introduces her new book "Religious Disagreement".

I find myself frequently in disagreement about religion with academic colleagues and friends and family. Given that I'm a philosopher of religion, this is not surprising. But my experiences are far from unique: religious disagreement is widespread even among quite homogeneous religious communities. There is disagreement both between and within religious communities.

While religious disagreement is common, it remains quite intractable to philosophers. Unlike idealized and clean cases, such as adding up and dividing the bill in a restaurant or visually discerning which horse finishes first in a race, religious disagreement is messy and tied up to many features of our identity. Moreover, religion also seems to rely on private evidence that is not easily shared, such as personal religious experiences. Because of this, it seems difficult to apply the notion of an epistemic peer to a religious dissenter.

I argue in my brief monograph “Religious Disagreement” that disagreement presents a form of higher-order evidence even if we cannot ascertain that our interlocutor is an exact epistemic peer or epistemic superior.

I present a conciliationist point of view: I argue that the religious beliefs of others amount to evidence that should lead us to at the very least evaluate, and sometimes alter, our religious views.

This book does not provide a comprehensive survey of religious disagreement in all its different forms. Rather, I examine what practical conclusions we can draw in the face of particular forms of religious disagreement. These include disagreement with a purported peer (chapter 1), with possible other selves, who were raised in a different religious environment (chapter 2), and with our former self, before a religious conversion (chapter 3).

I also look at the epistemic significance of religious agreement, and how we should evaluate its evidential value (chapter 4). Chapter 5 looks at what we can learn from disagreement among religious experts. Finally, chapter 6 explores why philosophy matters for religious disagreement among non-philosophers, particularly in the public sphere.

Tuesday 18 December 2018

Mental Health Stigma and Theory of Mind

Wesley Buckwalter is an incoming Presidential Fellow and permanent faculty member at the University of Manchester. In this post, he discusses his paper “Mind-Brain Dichotomy, Mental Disorder, and Theory of Mind” recently published in Erkenntnis.

Stigmatization of mental illness is widespread. Misunderstanding, bias, and discrimination associated with mental health concerns pervade even our closest interpersonal relationships, continue despite educational background or medical training, and create major obstacles to treatment and recovery within our health care system. It is essential to understand this stigma and its origins to prevent these negative outcomes.

As surprising at it may at first sound, some misconceptions about mental health are thought to stem from a centuries-old philosophical theory about the mind. According to this theory, often labeled the “dualist approach” to psychiatry, the mind is essentially distinct in kind from other physical systems.

If it is thought that mental disorders are not brain disorders because the mind is distinct from the physical brain, then this suggests that mental health should be treated very differently than other biological pathologies. Treating these things differently in this way, though, has costs that may perpetuate biases about mental health.

In one set of studies researchers consistently found that others are judged much more blameworthy for behaviors when they follow from mental disorders than physical disorders. For example, researchers found that breaking a promise is judged much less harshly when the excuse involved a physical reason, like complications from a car accident, than a psychological reason, like suffering from serious depression.

Other researchers found that even highly trained medical professionals display similar effects when evaluating clinical vignettes. Patients displaying symptoms perceived as more psychologically determined were regarded as more blameworthy, in greater control of, and more responsible for their behaviors than when symptoms were seen as biologically determined.

Thursday 13 December 2018

Women's Voices in Psychiatry

Today's post was written by clinical psychiatrist, Gianetta Rands.

Women's Voices in Psychiatry was published in June 2018 by Oxford University Press. It is a collection of essays by women psychiatrists working, or who have worked, in the NHS. In addition, medical journalist Abi Rimmer writes on the history of women in British Medicine and Claire Murdoch, National Mental Health director at NHS England, reminisces about training as a registered mental nurse at Friern Hospital in the 1980s.

This anthology has had a momentum of its own from the very start. I was just in the right place, at the right time. With encouragement from Baroness Elaine Murphy, psychiatrist, researcher, senior manager and cross bench peer, and support from several individuals and committees at Oxford University Press this book was on its way.

In 2015, I retired from the NHS and presented an ‘exit seminar’ titled “Career Reflections of a 1970s Feminist” using my experiences of training and working in medicine and psychiatry from 1975 to 2015 to highlight women’s issues in general. Afterwards, I was surprised by comments from current women psychiatry trainees essentially saying that not much had changed over 40 years in terms of their work experiences. This seminar formed the basis of the first chapter of Women’s Voices.

I now work as an independent psychiatrist and my clinical practice focuses on dementias, brain injuries and mental capacity. A long-term preoccupation of mine has been post flight confusion. That is, air passengers being confused after flying. Many colleagues know about this and many of us have seen dozens of cases. It seems to mostly affect older people whose physiological autoregulation mechanisms may not be so good as those of younger people. And, of course, aviation and altitude medicine research is almost exclusively done on fit young men. I continue to rant about this because I think it is a public health scandal.

I have never aspired to write or edit a book but Women’s Voices was an important project and I had the energy, time and contacts needed to commit to it. For me it was essential to record, in real time, women’s experiences as professionals and as patients in mental health services. Too often women have been silenced and the gender publication gap in scientific publications is one example of this. There are many gender differences discussed in these essays. Whilst editing them I was constantly overwhelmed by their quality, integrity, and content, and so inspired by my wonderful colleagues. I can’t imagine that anyone won’t find every word fascinating.

The essays are a range of autobiographies, biographies, case based studies, reviews of clinical literature, and historical descriptions. For example, Fiona Subotsky scrutinizes the archives in her essay “The Entry of Women into Psychiatry”, and Jane Mounty, Anne Cremona and Rosalind Ramsey describe the more recent history of the Women’s Mental Health Special Interest Group.

Rosemary Lethem writes as psychiatrist and patient having suffered with bipolar affective disorder throughout her adult life. Her bravery and stamina are extraordinary and anyone doubting that they can manage their career and their mental illness will be inspired by her experiences and tips.

There are chapters about Perinatal Psychiatry (Jacqui Humphreys), The Role of Women in Intellectual Difficulties (Angela Hassiotis and Rupal Dave), Women in Forensic services (Jail Birds by Annie Bartlett), and a contemplation about whether or not women only mental health units are needed (Aoife Singh).

For the more psychodynamic essays, Jo O’Reilly considers the need for psychotherapist support in mental health units and proposes a model of the “Maternal Lap” with its changing concavities. An important update of our understanding of child sex abuse and complex trauma is presented by Joanne Stubley, Maria Eyres and Victoria Barker. Sandra Evans and Jane Garner write on “Old Age, Women, and Dynamic Psychotherapy” firmly refuting the belief that psychotherapy is only for the young.

There are chapters about Dementia and how to reduce its risks (Joanne Rodda), about difficult, life-and-death clinical decisions that have involved the Court of Protection (Clementine Maddock), and about the evolution of services - Claire Hilton’s biography of Barbara Robb, and Amanda Thomsell interviewing Nori Graham about Old Age Psychiatry and working with the Alzheimers Society UK and International.

A collection of essays by psychiatrists would not be complete without descriptions of our training (Philippa Greenfield and Georgina Fozard), and our experiences as trainers of psychiatrists (Hannah Fosker and Ann Boyle); but this time it’s women’s views. In addition, inspiring reflections from the Royal College of Psychiatrists President, Wendy Burn, and recent past president, Sue Bailey, give insights into their roads to success.

These essays are interspersed with short ‘profiles’ of pioneering colleagues such as Helen Boyle, Fiona Caldicott, Dora Black, Helen Green Allison, Eluned Woodford-Williams, and nurses Lisbeth Hockey and Annie Altschul. Poems by GP poet Emily Wills create pauses for reflection about women as doctors, as patients, and many aspects of women in general.

Tuesday 11 December 2018

Sweeping vs. Creeping Reductionism in Addiction Research

Şerife Tekin is an Assistant Professor of Philosophy at the University of Texas at San Antonio. Her research program in philosophy of science and mind aims to enhance psychiatric epistemology by developing methods for supplementing the existing scientific literature with a philosophical study of the first-person accounts of those with mental illness. 

She draws on the scientific literature on mental illness, philosophical literature on the self, and the ethics literature on what contributes to human flourishing to facilitate the expansion of psychiatric knowledge that will ultimately yield to effective treatments of mental illness. Here she discusses her article, “Brain Mechanisms and the Disease Model of Addiction: Is it the Whole Story of the Addicted Self? A Philosophical-Skeptical Perspective,” which recently appeared in the Routledge Handbook of Philosophy and Science of Addiction.

In my chapter in this anthology, which brings together cutting-edge work on the scientific and clinical research on addiction and various philosophical puzzles pertaining to addiction, I take issue with the disease model of addiction that construes addiction merely as a problem of the “broken brain.” I defend that self or person models of addiction are more resourceful for enhancing research on the mechanisms of addiction and developing effective interventions.

A common debate among scientists and philosophers is whether human sciences, such as psychology and psychiatry, involve phenomena distinct from those targeted in the physical sciences. According to reductionism, target phenomena in human sciences are only prima facie distinct from those in the physical sciences, lending themselves to explanation or even replacement by phenomena in the physical and chemical sciences.

Reductionism exists on a spectrum (Schaffner 2013). On the one extreme, human phenomena “are nothing but aggregates of physicochemical entities,” a view labeled “sweeping reductionism” (Schaffner 2013: 1003). For “sweeping” reductionists, “there is a theory of everything” and “there is nothing but those basic elements—for example, a very powerful biological theory that explains all of psychology and psychiatry” (ibid). 

Thursday 6 December 2018

How We Understand Others

Today’s post was written by Shannon Spaulding, Assistant Professor of Philosophy at Oklahoma State University. Her general philosophical interests are in the philosophy of mind, philosophical psychology, and the philosophy of science. 

The principal goal of her research is to construct a philosophically and empirically plausible account of social cognition. She also has research interests in imagination, pretense, and action theory. Here she introduces her new book, “How We Understand Others: Philosophy and Social Cognition”.

A question that has long interested me is how we understand others – that is, what are the cognitive processes that underlie successful social understanding and interaction – and what happens when we misunderstand others. In philosophy and the cognitive sciences, the orthodox view is that understanding and interacting with others is partly underwritten by mindreading, the capacity to make sense of intentional behavior in terms of mental states. 

On this view, successful social interaction often involves understanding what others are thinking and what they are trying to achieve. In our ordinary social interactions, we attribute beliefs, desires, emotions, and intentions to people to make sense of their behavior, and on the basis of that we predict what they are likely to do next. 

In this book, I argue that mindreading is an important tool in our folk psychological toolkit. But, I argue, mindreading is not as simple, uniform, or accurate as the orthodox view portrays it to be. The philosophical literature on mindreading suggests that neurotypical adult humans rarely make mindreading mistakes, that competent mindreaders all pretty much agree on the mentalistic explanations and predictions we infer, and all there really is to mindreading is attributing a belief, desire, or intention and explaining and predicting behavior. 

I challenge each of these ideas. I argue that individuals differ with respect to informational input to mindreading, their goals in mindreading, the kind of mindreading strategies they adopt, and the kind of mindreading output they produce. My claim is not simply that individuals use their mindreading judgments differently. That much is uncontroversial. 

Rather, my claim is that the input, processing, and output of mindreading all vary along many dimensions, which makes constructing an empirically adequate account of mindreading significantly more challenging than typically recognized. The overarching theme of the book is that mindreading is much more complex, messy, interesting, and relevant to other debates than philosophers have acknowledged. 

There are two particularly important dimensions of complexity for mindreading: the input and output of mindreading. Philosophical accounts of mindreading for the most part do not discuss the input into mindreading mechanisms. Discussions of mindreading rarely concern how social categorization (rapidly, spontaneously classifying individuals by their age, race, gender, and other categories), stereotypes, social biases, and situational context influence how we interpret social behavior. 

These aspects of social interaction filter the available information that serves as input to mindreading and thus directly influence the mental representations mindreaders end up attributing. Thus, realistic and accurate accounts of mindreading must explain how these aspects of social interaction shape both the input and output of mindreading judgments. 

Most contemporary mindreading theories presuppose that our primary goal in mindreading is to attribute beliefs in order to accurately explain behavior. Although this is the case in certain conditions, this presupposition is wrongheaded in two ways. First, mindreading is not limited to belief-based explanations. Existing mindreading theories often narrowly focus on how we attribute beliefs to others. 

Although there is good reason to think that belief attribution is a significant cognitive achievement, and there’s an interesting history of how belief attribution came to dominate philosophical discussion of social cognition, the result of this fixation on belief is that philosophical discussions neglect other important aspects of social interaction, such as attributing various kinds of mental states in order to influence others (mindshaping), to enforce social and moral norms (regulative folk psychology), to confirm our worldview, protect in-group members, and, in cases of competition or threat, vilify an outgroup member. 

Tuesday 4 December 2018

The Subjective Structure of Thought Insertion

Pablo López-Silva is a Reader in Philosophical Psychology at the Faculty of Medicine of the Universidad de Valparaíso in Chile. He is the leading researcher of the FONDECYT project ‘The Agentive Architecture of Human Thought’ granted by the National Commission for Scientific and Technological Research (CONICYT) of the Government of Chile. 

His current research focuses on cognitive phenomenology, attributions of mental agency, and delusions. In this post, he summarizes his new paper titled ‘Mapping the Psychotic Mind’ recently published in the Psychiatric Quarterly.

Thought insertion – TI henceforth – is regarded as one of the most complex symptoms of psychosis. People suffering from TI report that external human and non-human agents have inserted thoughts or ideas into their minds. Over the last years, the enigmatic nature of TI reports has become target of a number of phenomenological, empirical, and conceptual debates. In fact, TI has been used as a good excuse to debate about the nature of delusions, the nature of psychiatric reports, the nature of the self, self-consciousness, the adaptive role of beliefs, the principle of immunity to error through misidentification, among many other issues.

However, three problems underlie these discussions.

Thursday 29 November 2018

How to Feel Blue

Today's post is by Cheryl Wright.

In 1998 I gave birth to a beautiful baby girl who was missing part of her corpus callosum. She was quirky and didn’t learn to speak in a typical manner. She had echolalia for years and would only simultaneously repeat what was being said in seemingly stereo timing to what she heard. I had to spend years teaching her to answer, “I’m fine, thank you.” to the question, “How are you?” I walked around with her, and for years pointed to everything blue, telling her it was blue; hoping she would get the concept of color.

We had a blue and white checkered tile floor. I had every person that came in hop on the blue tiles and exclaim “BLUE!” At the age of seven, she finally got it. She said, “Mama, I walk blue!” and excitedly walked across the white tiles on the floor. She did understand blue and was able to demonstrate her understanding over the next week. The other colors came within the next six months.

Cheryl Wright

When she did start to share her observations of the world, I found out that she didn’t view things in the same way that I did. “Look! An airplane, Mama!” she called out to me one day as we were outside walking. Of course, I looked up. No airplanes. I looked down for a toy airplane. I even looked for a sticker of an aircraft.

Then I saw it. The shadow that made an airplane. I became observant of shadows and realized that they were very real to her. She avoided stepping on shiny tiles that reflected the ceiling. For to her, it looked like she was going to drop into a pool. She didn’t look at her reflection in mirrors, as she didn’t recognize it was a reflection of herself, only a disinterested other child. She avoided stepping on shadows as they were physical objects.

The 'plane'

Through my sincere desire to understand my daughter’s thought processes, I researched and studied. I obtained an advanced degree in Autism Spectrum Disorders and earned a Doctorate of Education. I’ve worked to advocate for individuals with disabilities and enjoy being an international educator, speaker, and author. I have worked as a life-skills coach for students with developmental disabilities in South Korea, Thailand, Kuwait, and the United States. In coordination with the wonderful educational leaders that I have met internationally, we have authored the Cultural Rainbow series of children's books about individuals with different abilities, acceptance, holidays, and cultures around the world.

Tuesday 27 November 2018

Intensity of Experience and Delusions in Schizophrenia

This post is by Eisuke Sakakibara, psychiatrist working at The University of Tokyo Hospital. In this post he writes about his paper “Intensity of experience: Maher’s schizophrenic delusion revisited” recently published in Neuroethics.

Delusion is one of the most frequently discussed themes in philosophy of psychiatry, and this is my second publication regarding delusions. In my first paper, entitled “Irrationality and pathology of beliefs,” I proposed that not all delusions are pathological, and some delusions are formed without any physical or mental dysfunction.

In my second paper, I focused on delusions accompanied by schizophrenia. As for schizophrenic delusions, it is beyond question that they are the result of dysfunction of some kind. The problem, then, is what kind of dysfunction is relevant for the development of schizophrenic delusions.

The theory of schizophrenic delusion has developed by the consecutive works made by Brendan Maher. He proposed in 1974 that schizophrenic delusions are hypotheses formed to explain anomalous experiences rather than the result of patients’ paralogical inferences. He stated that they are “rational, given the intensity of the experiences that they are developed to explain.”

But his theory was criticized by the two-factor theorists of delusion because 1) it does not explain why some patients with anomalous experiences do not develop delusions, and 2) adopting and adhering to delusional hypotheses is irrational, considering the totality of experiences and patients’ other beliefs.

In my second paper, the notion of the intensity of experience is reappraised to uphold Maher’s basic conception. Regarding 1), I propose that differences in the intensity of anomalous experience are vital to whether the patient forms delusions, while partially reforming his rationality claim regarding 2). Although adopting delusions is irrational, it is inevitable and excusable, given the intensity of the patient’s anomalous experience.

Thursday 22 November 2018

Philosophy Within its Proper Bounds

Edouard Machery is a Distinguished Professor in the Department of History and Philosophy of Science at the University of Pittsburgh, the Director of the Center for Philosophy of Science at the University of Pittsburgh, and a member of the Center for the Neural Basis of Cognition (University of Pittsburgh-Carnegie Mellon University). 

His research focuses on the philosophical issues raised by psychology and cognitive neuroscience with a special interest in concepts, moral psychology, the relevance of evolutionary biology for understanding cognition, modularity, the nature, origins, and ethical significance of prejudiced cognition, the foundation of statistics, and the methods of psychology and cognitive neuroscience. He also works in metaphilosophy, and he has been involved in the development of experimental philosophy. Here, he introduces his new book on philosophical methodology.

Philosophy Within Its Proper Bounds has four main goals. The first three are negative: I argue first that the method of cases that is so important to some parts of philosophy (roughly, the use of thought experiments) should not be used because it elicits unreliable judgments. Second, because the method of cases plays an irreplaceable role in getting knowledge about metaphysical necessities, this unreliability supports a restricted kind of modal skepticism. 

Many metaphysical necessities and possibilities that are pivotal to resolve fundamental philosophical issues (physicalism, the reduction of causation to some form of counterfactual dependence, compatibilism, etc.) are beyond our epistemic reach. Third, I conclude from this modal skepticism that these fundamental philosophical issues (which I call “modally immodest”) should be set aside and that philosophical ingenuity should be redirected in more modest, but ultimately more important directions. The positive goal of Philosophy Within Its Proper Bounds identifies one of these directions: the analysis and engineering of concepts, psychologically understood. 

Tuesday 20 November 2018

Self-admission to Inpatient Treatment

Mattias Strand is Consultant Psychiatrist at the Stockholm Centre for Eating Disorders. He is also a PhD student at Karolinska Institutet in Stockholm, where his main research focus is on self‐admission as a potential tool in the treatment of severe eating disorders. 

In this post, he discusses the background to, and main claims of, a recent paper, co-authored with Manne Sjöstrand, Senior Researcher at the Stockholm Centre for Healthcare Ethics at Karolinska Institutet, "Self‐admission in psychiatry: The ethics".

In recent years, self-admission to inpatient treatment has become an increasingly popular treatment tool in psychiatry in the Scandinavian countries as well as in the Netherlands. In self-admission, patients who are well known to a service and who have a history of high utilization of inpatient treatment are invited to decide for themselves when a brief admission episode – usually 3-7 days at a time – is warranted. Patients are also free to discharge at will.

Central to the concept is that the patients’ reasons for choosing to self-admit are not questioned. Participants are free to admit themselves because of deteriorating mental health, acute stress, lack of structure in everyday life, loneliness, or any other reason. In this way, the traditional inpatient admission model with a clinician serving as gatekeeper is bypassed, which means that potentially stressful repeated visits to an psychiatric emergency unit can be avoided.

The rationale behind self-admission is manifold. Proponents of the model argue that it can increase patient autonomy and agency, promote early help-seeking, reinforce the asylum function of the inpatient ward, reduce coercive interventions, and reduce total time spent in inpatient treatment.

Participants usually have a history of multiple and prolonged hospital admissions. Supposedly, encouraging self-monitoring of their mental health status and allowing swift help seeking can minimize the lag between first signs of deterioration and hospital admission, thus reducing the total time spent in hospital. Importantly, self-admission is an add-on tool rather than a replacement of other treatment options and admission through regular procedures is thus still available if needed.

Thursday 15 November 2018

Altered States of Consciousness

This post is by Marc Wittmann, Research Fellow at the Institute of Frontier Areas of Psychology and Mental Health in Freiburg, Germany. Here, he writes about his new book on altered states of consciousness.

Subjective time emerges through the existence of the self across time as an enduring and embodied entity. This is clearly revealed in everyday states of consciousness such as transiently being in states of boredom or flow. An increased awareness of the self is associated with an increased awareness of time when we are bored. In contrast, we lose track of time and the self when fully immersed in challenging activities accompanied by the feeling of enjoyment – experienced in the state of flow.

The relation between self-awareness and time is even more prominently disclosed in anecdotal reports and empirical studies on altered states of consciousness such as in meditative states, in music-induced trance, and after ingestion of psychedelic substances. In peak states the experience of ‘timelessness’ is reported together with a loss of the sense of self. This is in fact a universal spiritual experience where time is not experienced at all and the self becomes one with the world.

In my book Altered States of Consciousness: Experiences out of Time and Self, just published by MIT Press, I explore these facets of changes in consciousness awareness. After a prologue containing a warm-up with reports of extreme experiences by novelists and Nobel Prize winners, the first chapter covers phenomena under scientific investigation such as the experience of time expansion in moments of terror and accidents (the slow-motion effect), under the influence of drugs, in spiritual moments, and in near death when the heart and brain have apparently stopped functioning. In the second chapter I cover the experience of time and self in meditation.

An abundance of neuroscientific studies exist on meditation effects; and I interview a highly experienced meditator on what he can report to us about his states of “awakening”. In the third chapter I investigate the case of a puzzling psychiatric patient who has lost her emotional feelings, her bodily feelings and the sense of time. Depression and schizophrenia and the latest research on disturbed temporal processing in these patients as well as in certain individuals with epileptic auras are reported. Finally, the latest breathtaking studies on psychedelics such as psilocybin, LSD, and ayahuasca are discussed.

Tuesday 13 November 2018

Intellectual Servility and Timidity

Alessandra Tanesini is a Professor in Philosophy at Cardiff University (UK). She is the author of An Introduction to Feminist Epistemologies (Blackwell, 1999), of Wittgenstein: A Feminist Interpretation (Polity, 2004), and of several articles in epistemology, feminist philosophy, the philosophy of mind and language, and on Nietzsche. 

Her recent work lies at the intersection of ethics, the philosophy of language, and epistemology with a focus on epistemic vice, silencing, prejudice and ignorance. She is currently a co-PI on a two-year multidisciplinary research project Changing Attitudes in Public Discourse which is dedicated to reducing arrogance in debate. Open access copies of recent publications and work in progress can be found here.

Those who face discrimination, humiliation and intimidation on a daily basis suffer many harms as a result of these wrongful treatments. In my paper “Intellectual Servility and Timidity” I explore how subordination and discrimination damage the character of the oppressed. I argue that those who are repeatedly humiliated are likely to develop feelings of inferiority and a lack of pride in their achievements. They might also become extremely servile. 

I characterise this vice as a damaged form of self-esteem. It occurs when individuals have a low opinion of themselves as this self-evaluation is measured explicitly by means of questionnaires, and at the same time have a positive view of themselves as this is measured indirectly via the Implicit Association Test (IAT) or other implicit measures. These individuals are driven by a desire to fit in with a society that despises them. They are, in response, prepared to adopt the low opinion that others have of them to avoid social exclusion.

Thursday 8 November 2018

Red Hands

Today's post is by Francesco Filippi (pictured below), an Italian director, screenwriter, and animator whose work can be found here. In this post he tells us about his new film, Red Hands, which addresses the theme of domestic violence.

Can an animated film for teenagers have something to say to the readers of this very interesting blog which explores the boundaries of the human mind? Red Hands, an Italian 30' long film in stop-motion and 2D animation, had his premiere at the Rome Film Festival on October 20th, 2018.

As you can see from the trailer above, it's a story of domestic abuse. Ernesto, a 12 year-old boy, discovers that the magnificent red graffiti appeared on the walls of his street are made by Luna, a girl with a mysterious power. She can emit a blood-like liquid from her hands, but her power is a side-effect of her father's violence at home.

Tuesday 6 November 2018

What Does it Take to Be a Brain Disorder?

In this post, Anneli Jefferson, Leverhulme Early Career Fellow at the University of Birmingham summarizes her paper on the nature of brain disorder, recently published in Synthese.

A long-standing project pursued by some psychiatrists is to show that mental disorders are brain disorders and that mental dysfunction can best be explained as brain dysfunction. But what exactly is the relationship between mental disorders and brain disorders and when is a mental disorder a brain disorder? This is the question I address in my paper. Some psychiatrists believe that it follows from the acceptance of physicalism that all mental disorders are brain disorders. If all mental states are brain states, shouldn’t all disordered mental states be disordered brain states?

Many philosophers have resisted this conclusion, appealing to the hardware/software distinction to argue that even if dysfunctional mental processes are realised in the brain, this does not mean that the underlying brain processes are also disordered. Just as there can be a software problem without there being anything wrong with the hardware, there can in principle be a mental problem without any systematic problem in brain function.

This argument is often supported by appeal to multiple realizability: one mental dysfunction can be realised by many different brain processes in different individuals or in one individual over time. There may not be a stable underlying brain pattern that realises a specific psychological dysfunction.

In the paper, I suggest that when we do find an underlying brain difference that realises psychological dysfunction, we should characterize this as a brain dysfunction because it realises mental dysfunction. This means that in some cases (for example, amygdala hypofunction) the characterisation of brain difference as dysfunctional is derivative of the psychological level, because the reason the brain anomaly is characterized as dysfunctional is purely that it realises psychological dysfunction.

There is no independent, brain-internal criterion that characterizes these differences as dysfunctional, instead the characterization of brain dysfunction depends on the psychological level. This should not worry us, I argue, because the brain is the organ of thought, so it stands to reason that we look at the interaction between disordered processes of thought and feeling and brain anomaly when figuring out which brain differences constitute brain dysfunctions.

Thursday 1 November 2018

IMH Inaugural Forum

On 15th October the Institute for Mental Health (IMH) had its Inaugural Forum at Hornton Grange at the University of Birmingham. The event was live-tweeted by the Mental Elf and the IMH. The whole project PERFECT team attended the Forum and this report comes from their collective notes.

In the morning session, Eoin Killackey (Orygen) and Paul Burstow (IMH) started the day with two fascinating talks on youth mental health.

Killackey gave a very international talk, analysing a variety of interventions and forms of support available for young people across the world, reflecting on the many lessons those who wish to improve the UK youth mental health system can learn from these programs. 

Two particularly interesting focal points were on how to improve the transition from youth to adult services, and how to better separate services on the basis of demographic and developmental evidence about the prevalence and nature of youth mental health difficulties. 

Burstow spoke of the need not just to increase spending on youth mental health across the UK, but more importantly of the need to reallocate existing funding towards intervening on the causes of mental ill health, rather than simply tackling the consequences.

From Paul Burstow's talk

Before the lunch break, Karen Newbigging (IMH) and Sophie Stammers (Project PERFECT) facilitated a very interactive session asking what makes coproduction successful. Participants were divided into groups and asked to share their experiences of coproduction. 

Key themes were the need for (a) managing expectations in coproduction; (b) making young people participating in research aware of the remit and the constraints of the project they are asked to help with; (c) offering something back to people participating in research (e.g. training skills); (d) offering expertise to support good ideas coming from people with lived experience of mental health services.

Parallel to this session, Maria Michail (IMH) and Anna Lavis (IMH) facilitated a workshop on how the wide range of disciplines involved in mental health research at the IMH could break out of their own ‘silos’ and work together to better understand and prevent self-harming and suicidal behaviours in youth populations. 

Participants were divided into groups and worked together to begin to develop ways of overcoming existing personal and structural barriers to interdisciplinary research.

In the afternoon, Sophie Dix (Director of MQ) talked about the financial cost of mental illness and the cost in terms of loss of life. There is a lot in the press about raising public awareness of mental health, decreasing stigma, and improving services. But there is very little about making treatment better and research is part of the solution.

Sophie Dix

MQ raises money for research into mental illness. There is great disparity between funding for research for cancer and dementia and funding for research for mental health. And in mental health there is too much ‘trial and error’ and not enough prevention. Further, there is a lack of innovation when it comes to finding the best treatments. No huge progression has been made with psychological treatments either: those we have today were developed in the sixties.

MQ is focused on research that is: (1) multidisciplinary, (2) transdiagnostic, (3) international, (4) focused on impact, (5) aimed at investing in the future. MQ thus applauds the creation of multidisciplinary centres such as the IMH, where scientists from different disciplinary backgrounds work together from the start. 

MQ encourages international collaboration and funds the best research, whether it is based in the UK or elsewhere. Examples of the research they fund includes depression in people with HIV in Uganda; whether women are more responsive to psychological treatment for anxiety depending on where they are in their menstrual cycle; effects of folic acid for protecting people against schizophrenia.

One big focus is on youth mental health: it takes too long for people to get help since they show the first symptoms of mental illness. MQ created a consortium to address the challenges youth mental health poses and coproduce research ideas by people in the physical and social sciences. 

MQ used sandpits to attract people who had expertise in public engagement and collaborative projects. The result was people coming up with ideas (developing a screening tool for mental illness, e.g. suicide prevention and risk scores for depression in adolescents).

Tuesday 30 October 2018

Phenomenology Imported with EASE

Rolf Hvidtfeldt is postdoctoral fellow at the Humanomics Research Centre at Aalborg University in Denmark. His research is mainly focused on the philosophies of science evaluation, scientific communication, and conflicts of perspective. Currently he is working on a project focused on mapping the various ways in which research (in a broad sense) affects (in a broad sense) society at large.

He has recently published the book The Structure of Interdisciplinary Science in which he seeks to develop a method for examining epistemic aspects of interdisciplinary collaborations. The following blogpost briefly summarises key elements of ch. 8 of this book, which is a case study picked from schizophrenia research.

In the The Structure of Interdisciplinary Science I develop a method, approach-based analysis, for studying interdisciplinary science in deep detail. Chapter 8 of the book is a case study in which this method is applied to a case of interdisciplinary research. The case in question is part of an ongoing research programme, EASE – short for Examination of Anomalous Self-Experience, in which philosophical phenomenology is combined with more traditional (psychiatric and psychopathological) approaches to schizophrenia research. The core ambition of EASE is to link schizophrenia to certain disturbances of basic structures of consciousness. Intuitively, this seems reasonable, since schizophrenia seems to involve obviously abnormal subjective experiences.

Capturing the subjective experience of what it is like to suffer from schizophrenia would certainly enrich our best representations of schizophrenia considerably. And further, if specific disturbances in structures of consciousness could be determined, and these could be shown to be causally related to symptoms of schizophrenia, this ought to attract a lot of attention in psychopathological research. There is little doubt, that such a finding would have considerable impact on future developments in psychiatric nosology and diagnostics.

Thursday 25 October 2018

Delusions in Context

On 15th October at Hornton Grange Matthew Broome, director of the Institute for Mental Health in Birmingham, chaired the book launch of Delusions in Context (Palgrave Pivot, 2018), a collection of four new papers on delusions. The book is truly interdisciplinary, featuring authors with a background in psychiatry, lived experience, psychology, cognitive neuroscience, and philosophy, and is available open access on the Springer website.

I edited the book. At the launch, I explained how the book fits with the work we have been doing as part of project PERFECT. In the project one of the objectives is to examine whether beliefs that we consider as epistemically irrational (either not supported by existing evidence, or resistant to new counter-evidence) can nonetheless have some benefits for the person who adopts such beliefs. Benefits could be cashed out in terms of increased wellbeing or reduced anxiety, enhanced motivation to pursue epistemic goals, or better performance in some contexts. Can delusions play a positive role at all, maybe one often hidden from view?

The book consists of four chapters, written by Rachel Upthegrove and S.A. (chapter 1), Phil Corlett (chapter 2), Richard Bentall (chapter 3), and myself (chapter 4).

Tuesday 23 October 2018

A Two-factor Account of False Body Size Beliefs in Anorexia Nervosa

Stephen Gadsby is a PhD candidate in the Cognition and Philosophy lab, Monash University. His research spans a number of topics, including anorexia nervosa, body representation, delusions, psychiatric taxonomy, mental representation and predictive processing. In this post, he summarises his new paper "Self-Deception and the Second Factor: How Desire Causes Delusion in Anorexia Nervosa" recently published in Erkenntnis.

Research shows that anorexia patients don’t hold extreme body ideals, despite common misconception. Indeed, most patients are thinner than what they judge their ideal size to be. In this paper, I advance a two-factor explanation for why patients believe they haven’t yet reached their ideal size. This account attempts to answer two questions: how the content of this belief arises and why the belief is maintained in the face of contradictory evidence. Following from previous work (Gadsby 2017a; 2017b), I answer the first of these question by suggesting that patients experience their bodies as larger than reality.

By itself, however, this experience is insufficient to explain anorexia patients’ beliefs. Although they experience their bodies as larger than ideal, patients are also exposed to significant evidence suggesting the contrary: that they are (dangerously) thin. This evidence comes in a number of forms such as weight scale and clothes size readings and testimonial evidence from family, friends and clinicians attempting to convince them of their true body size. A second factor is thus needed to explain why this contradictory evidence doesn’t change their mind.

Thursday 18 October 2018

Illness Narratives: Interview with Maria Vaccarella

In this post I interview Maria Vaccarella on her latest project which concerns illness narratives. Maria is Lecturer in Medical Humanities at the University of Bristol. She works at the intersection of literature and medicine, and she is a member of the steering committee of the Centre for Health, Humanities and Science.

Her current research explores the genre of illness narratives, with a special focus on non-linear and non-triumphalistic plots. She is also interested in narrative medicine, critical disability studies, narrative bioethics, comparative literature, and graphic storytelling. Her current project is “Illness as Fiction: Textual Afflictions in Print and Online” and is funded by a British Academy / Leverhulme Small Research Grant.

LB: How did you first become interested in false accounts of illness?

MV: About two years ago, I was reading this article on health-related Internet hoaxes during my lunch break and had a lightbulb moment: these illness accounts, whether produced in cases of Munchausen by Internet/factitious disorder or as part of online scams, were an extreme form of the illness narratives I research and teach in my job as a Lecturer in Medical Humanities. 

This phenomenon has a printed counterpart in books marketed as memoirs and later revealed to be partially or completely fabricated. The best known example is probably James Frey’s best-selling memoir A Million Little Pieces (2003) on his alcohol and drug addiction, selected for Oprah Winfrey's book club in 2005, but later revealed to be only partly true in a tense interview for the same show.

As a literary scholar by training, I had many questions on the modalities of this form of self-narration, but they were inextricable from the psychological and often psychiatric aspects of the act of writing in question. This is how I devised my project Illness as Fiction: Textual Afflictions in Print and Online, as an interdisciplinary investigation of what counts as an illness experience nowadays beyond the clinical environment, without pathologizing, moralising or criminalising intents.

Credits: Julie Jablonski, Reflecting on Words CC BY-NC 2.0

LB: Do you believe that the opportunity most people now have to share personal information on the internet (via blogs and fora) has increased the occurrence and the influence of false illness narratives? Or is the internet just another medium for a pre-existing problem?

MV: I believe that some very elaborated hoaxes (such as Warrior Eli) can only be created and sustained online: they thrive on platforms dedicated to a specific condition or patient population, but at the same time require the corroboration of multiple social media profiles, which very often feature pictures uploaded on other, authentic profiles. 

I’m not sure whether access to the Internet will increase the occurrence or the influence of these false accounts in the long run, though some intricate form of Internet-mediated emulation seems to have played a crucial role in Belle Gibson’s case: apparently, she drew great inspiration from the online success of (real) cancer patient and alternative treatment advocate Jessica Ainscough– in the words of Beau Donelly and Nick Toscano, “For years before Aisncough’s death, Gibson was positioning herself as the next poster girl for holistic health and wellness. And the template she used in her story followed a similar path.”

So, this is a phenomenon that precedes and goes beyond the Internet, but its classification as a “problem” is quite complicated. Online fake illness stories with lucrative aims or promoting ineffective, possibly lethal, treatments are, of course, a problem. But, as psychiatrist Marc Feldman has written in his latest book on Munchausen by Internet Dying to Be Ill (coauthored with Gregory Yates), “It is not illegal to steal someone’s sympathy.” 

The abovementioned Warrior Eli case provides, for example, a perplexing moral conundrum: the woman behind the false story of Wilm's Tumor patient Eli didn’t make any money out of it or discredit evidence-based therapies – on the contrary, she encouraged her many followers to donate to a real charity.

Tuesday 16 October 2018

'Good' Biases

This post is about a paper by Andrea Polonioli, Sophie Stammers and myself, recently appeared in Revue philosophique de la France et de l'étranger, where we ask whether some common biases have any benefits for individuals or groups.

Our behaviour as agents can have a multiplicity of goals. These might be pragmatic in nature (for example, fulfilling practical goals such as being well fed). They might be psychological in nature (for example, increasing wellbeing or reducing anxiety). They might also be epistemic in nature, and have to do with the attainment of true beliefs about ourselves or the world. Epistemologists have identified different notions of epistemic attainment, and different senses in which one can fail epistemically by being doxastically irrational.

Doxastic irrationality is the irrationality of beliefs. It does manifest in different ways and comprises: (a) beliefs that do not cohere with each other and violate other basic principles of formal logic or pro- bability theory; (b) beliefs that are factually erroneous; (c) beliefs that are not well-supported by, or responsive to, evidence; (d) beliefs that are poorly calibrated because people assign inaccurate degrees of confidence to them; (e) beliefs that are well integrated in people’s behaviour. In this article we are interested in the effects of some biases leading to doxastic irrationality on individual agents and groups of agents.

So, doing well epistemically can mean fulfilling epistemic goals such as: (a) having beliefs that cohere, and which are based on principles of formal logic or probability theory; (b) having beliefs that are factually based; (c) having beliefs that are well supported by, or responsive to evidence; (d) having well calibrated beliefs; (e) having beliefs that are well integrated in people’s behaviour.

Agents’ behaviour may be assessed negatively when it fails to satisfy the epistemic goals above, or other epistemic goals such as attaining beliefs that encourage exchange of information with other agents, or developing an intellectual virtue such as curiosity or honesty. But there are other reasons why a behaviour may be negatively assessed, for instance by failing to fulfill other types of goals (pragmatic or psychological). Sometimes, an instance of behaviour can succeed at fulfilling some goals and fail to fulfil others. Furthermore, new costs and benefits may emerge when the behaviour in question is assessed in the context of groups to which the agent belongs, rather than simply at the individual level.

In the paper, we argue for the need for an analysis that is sensitive to the multiplicity of goals of human behaviour at both the individual and group level, when assessing failures of doxastic rationality. We argue that doing so can reveal some underexplored costs, as well as benefits, that can be pragmatic, psychological, and epistemic in nature. Examples of practices that may lead to doxastic irrationality include the overconfidence bias, biases about one’s own and other social group(s), and optimistically biased beliefs about the self. 

Thursday 11 October 2018

Interview with Mohammed Abouelleil Rashed

Mohammed Abouelleil Rashed is a Wellcome Trust ISSF Research Fellow in the Department of Philosophy, Birkbeck College, University of London; and a Visiting Lecturer in Philosophy at King's College London. He studied medicine at Cairo University Medical School, then trained in psychiatry in London on the Guy's, King's College, and St. Thomas' Hospitals training scheme. He gained a PhD in Philosophy from University College London in 2012, and is now a full-time researcher.

Sophie Stammers: Welcome to the Imperfect Cognitions blog, Mohammed! Thank you so much for coming on board to tell us more about your work. As readers will see from the bio above, you trained as a medical doctor, with postgraduate training in psychiatry, and have clinical experience in this area, as well as pursuing research in the philosophy of mental health. How did you become interested in philosophy?

Mohammed Abouelleil Rashed: Thank you, Sophie. I became interested in philosophy during my fourth year at medical school at Cairo University. I had come across Leo Tolstoy’s A Confession – a short autobiography where Tolstoy, then in his early 50s, reflected on his life during what we would now refer to as an existential crisis. Tolstoy questioned the value of his accomplishments and the meaning of his life, and reflected on ambition and faith, and this, mind you, was at the height of his success: he had published War and Peace a decade before and Anna Karenina just three years earlier. 

The book had a significant impact on me, especially that I was going through my own dissatisfaction with some of the givens in my life, and with medicine and with medical education, in particular with rote learning and the lack of critical thinking. A Confession introduced me to some of the big philosophical questions, which I then began to read about. In this sense, philosophy, for me at the time, was as much an intellectual as a personal exploration. A few years later during my psychiatric training in London, my philosophical knowledge found a natural home in reflecting on psychiatry and mental health, and I developed my knowledge further by studying philosophy of mental disorder at King’s College London with Derek Bolton.

SS: How does your clinical experience inform your current research?

MAR: Even though I no longer practice psychiatry, my previous clinical experience is central to my philosophical work both in terms of providing knowledge of mental health phenomena, as well as defining the concerns underlying my research. For example, during my time on the acute wards, rehabilitation units, and outpatient clinics of South London, I had the privilege of witnessing people’s accounts of their lives and their experiences; their detailed descriptions of ‘paranoia’, ‘passivity experiences’, ‘auditory hallucinations’, and other phenomena conveyed to me the richness of these experiences, how much they mattered to people, and the terror that often accompanied them. 

I was also able to see that while people do suffer cognitive and emotional challenges severe enough to require intensive support, the environment of mental health units and the narratives and therapeutic resources of psychiatry as a medical specialty were not always sufficient, and in some cases were clearly inadequate and even harmful, as a way of responding to these challenges.

SS: A main theme of your research addresses whether we can distinguish in a principled way between aspects of human suffering and experience that are legitimate targets for medical responses, and those which are not. Can you tell us more about your findings in this area?

MAR: As you know, there’s a lively debate on the concept of mental disorder in the philosophy and psychiatry literature. Part of the rationale for this debate is that if we can define mental disorder in a way that excludes values (at least in part), then we would be able to identify the appropriate domain of psychiatry and respond to the ongoing accusations that psychiatry medicalizes various aspects of life. The debate will no doubt continue, but I find that, so far, attempts to define a value-free concept of mental disorder have not been successful. 

That is not in itself an argument for a normative conception of mental health, but it certainly offers the occasion to consider what follows if we were to adopt such a conception. This is something I have explored in my work, for example Can Psychiatry Distinguish Social Deviance from Mental Disorder? (2014, with Rachel Bingham), and In Defence of Madness (2018) where I argue against the view that certain mental health phenomena are intrinsically disabling. I do so by defending a normative view on disability judgements and by demonstrating how we can apply the social model of disability to variations in mental function.

A normative conception of mental health also brings to light the many influences on the boundary problem, which is the problem you referred to in your question: what aspects of human suffering and experience are legitimate targets for medical concepts and responses? Once we are no longer limited by the project of seeking a purely scientific concept of mental disorder, a range of factors become relevant to this question including political, ethical, social, and cultural factors. Over a number of publications I have spent some time thinking about cultural influences on the boundary problem and the domain of healthcare. But it was only with my latest project on madness and recognition that I engaged with the most significant challenge yet to the boundary problem.

SS: Can you tell us about your research on madness and recognition?

MAR: For the past few years I have been working on my book Madness & the Demand for Recognition: A Philosophical Inquiry into Identity & Mental Health Activism. It will be coming out with Oxford University Press in February 2019. The book examines Mad Pride activism where some activists reject the concepts of mental disorder and mental illness. A key move is to reclaim the terms that for too long have been used to disqualify people and to replace the negative connotations of those terms with more positive understandings, hence constructions such as Mad culture and Mad identity. One of the most significant aspects of this kind of activism is that it is accompanied by a demand for recognition. 

In keeping with other social movements that have campaigned for respect and rights based on a shared identity, Mad activism seeks to change the dominant professional and social view of madness as a disorder of the mind. In the book I formulate three questions that I consider fundamental to the inquiry, and I work my way through them: Can madness be grounds for identity? Does the demand for recognition possess normative force? How should society respond to this demand? To address these questions, I engage with a range of literatures that have not been sufficiently recognized in philosophy and psychiatry: the activist literature, disability studies, mad studies, and the wide-ranging philosophical literature on the concepts, theories, and politics of identity and recognition.

SS: Now that you have completed your book, what are your future research plans?

MAR: My new project, which I am starting in my current position at Birkbeck, follows from my work on madness and recognition. As I conclude in the book, we should endeavour to approach Mad activism with an attitude of reconciliation, by which I mean the acknowledgment that other people’s ability to find their identity validated in the social world matters as much as one’s own. 

Adopting such an attitude is only the first step. For we would still have a range of interactions where radically opposed narratives are playing out. On one hand are the narratives advanced by activists of their experiences and situation, and on the other are social and professional understandings of those experiences or conditions. For these interactions to be able to achieve an outcome of reconciliation, it is necessary that they yield a shared account, or at least be structured in such a way that can, in principle, lead to such an account. It’s still early days, but I am very much looking forward to making progress here.

You can visit Mohammed’s personal website here, his department page here, read his blog here, find him on Researchgate here, and here.