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.