IPPP Synopses

Go to  Body Subjects and Disordered Minds

Go to Dementia: Mind, Meaning, and the Person

Go to Disembodied Spirits and Deanimated Bodies: The Psychopathology of Common Sense

Go to Empirical Ethics in Psychiatry

Go to Essential Philosophy of Psychiatry

Go to The Metaphor of Mental Illness

Go to Nature and Narrative: An Introduction into the New Philosophy of Psychiatry

Go to Philosophical Perspectives on Technology and Psychiatry

Go to A Portrait of the Psychiatrist as a Young Man: The Early Writing and Work of R D Laing, 1927-1960

Go to Reconceiving Schizophrenia

Go to Schizophrenia and the Fate of the Self

Go to The Sublime Object of Psychiatry: Schizophrenia in Clinical and Cultural Theory

Go to Trauma, Truth, and Reconciliation: Healing Damaged Relationships

Go to What is Mental Disorder: An Essay in Philosophy, Science, and Values 

 

 

body subjectsBody Subjects and Disordered Minds, Eric Matthews

Uses Merleau-Ponty’s existential-phenomenological understanding of the type of existence enjoyed by human beings to theorise the nature of many ‘mental illnesses’.

These are viewed as disturbed ways of being-in-the-world, constituted by disturbances of the ‘body subject’ or ‘lived body’, rather than as (essentially) a disturbance in neurological functioning, i.e. of the physiological body.

Accordingly, mental illnesses are understood as causing unhappiness because of deviations from human norms (i.e. problems in how we experience the world and especially other people) rather than straightforwardly biological norms (i.e. aberrations of physiological functioning). Matthews applies his analysis both to issues in clinical treatment and to the special ethical and legal questions of psychiatry.

Synopsis by Richard Gipps, March 2008

 

dementiaDementia: Mind, Meaning, and the Person, Julian Hughes (Editor), Stephen Louw (Editor), Steven R Sabat (Editor)

This collection, by philosophers and mental health practitioners, explores the nature of personal identity in dementia. The authors show how the lives and selfhood of people with dementia can be enhanced by attention to their psychosocial and spiritual environment.

Eighteen essays are presented by 21 authors:

  1. Seeing Whole. By Julian Hughes, Stephen Louw and Steven Sabat.
  2. Ageing and human nature. By Michael Bavidge.
  3. Dementia and personal identity. By A. Harry Lesser.
  4. Identity, self, and dementia. By John McMillan.
  5. Into the darkness: losing identity with dementia. By Jennifer Radden and Joan Fordyce.
  6. Can the self disintegrate? Personal identity, psychopathology, and disunities of consciousness. By E Jonathan Lowe.
  7. Keeping track, autobiography, and the conditions for self-erosion. By Michael Luntley.
  8. The discursive turn, social constructionism, and dementia. By Tim Thornton.
  9. The return of the living dead: agency lost and found? Carmelo Aquilina and Julian Hughes.
  10. Dementia and the identity of the person. Eric Matthews.
  11. Meaning-making in dementia: a hermeneutic perspective. By guy Widdershoven and Ron Berghmans.
  12. I am, thou art: personal identity in dementia. By Catherine Oppenheimer.
  13. Spiritual perspectives on the person with dementia: identity and personhood. By F Brian Allen and Peter Coleman.
  14. Respectare: moral respect for the lives of the deeply forgetful. By Stephen Post.
  15. Understandings of dementia: explanatory models and their implications for the person with dementia and therapeutic effort. By Murna Downs, Linda Clare, and Jenny Mackenzie.
  16. Personhood and interpersonal communication in dementia. By Lisa Snyder.
  17. From childhood to childhood? Autonomy and dependence through the ages of life. By Harry Cayton.
  18. Mind, meaning, and personhood in dementia: the effects of positioning. Steven Sabat.

Synopsis by Richard Gipps, March 2008

 

disembodiedDisembodied Spirits and Deanimated Bodies: The Psychopathology of Common Sense, Giovanni Stanghellini

Stanghellini’s book provides a valuable unifying phenomenological perspective on schizophrenia; it theorises the phenomenological core of schizophrenia in terms of ‘autistic dissociatility’, and views this as rooted in a failure of ‘embodiment’.

The book is conceived of as an essay composed of 10 studies (chapters). The introduction tells us that ‘The new perspective [outlined] is a kind of phenomenological psychopathology, mainly concerned with embodiment and intersubjectivity based on the concept of ‘common sense’. The main purpose of [the] book is an understanding of madness as embodied and situated.’

The general approach taken in the book is the phenomenological one, that schizophrenia, schizotypy and manic depression can be understood as particular disturbances of intentionality. What is novel is the way in which it establishes the mutual constitution of three aspects of what Stanghellini calls ‘common sense’. These are coenesthesia (here meaning cross-modal sensory integration), disturbed sensus communis (discursive social understanding), and attunement (non-discursive capacity for co-regulated social interaction). Along the way Stanghellini criticises certain phenomenological and also certain cognitivist approaches for their overly individualistic and intellectualised understanding of the self, endorses an interactive and empathic view of the required attitude for understanding psychopathology, and deploys a characterological perspective inspired by Kretschmer.

As suggested by the title, the phenomenological theorisation of schizophrenic experience allows an understanding of the schizophrenic condition as being a ‘disembodied spirit’ in a ‘deanimated body’. This understanding is made possible by the above-described reflection on ‘common sense’, and in particular by the phenomenological explication of the way in which our embodiment and our social interactivity are not simply two separate aspects of our selves, but are mutually constitutive. This extremely rich book also provides a model exemplar of a form of theoretical understanding quite other to the causal, statistical and reductive approaches common in psychology and psychiatry. The aim of this form of understanding is to show how we can comprehend diverse phenomena which might at first appear unrelated, or merely externally related, within the same breath – i.e. to develop understanding by revealing how they are in fact internally, mutually, constitutively, related.

Synopsis by Richard Gipps, March 2008

 

empiricalEmpirical Ethics in Psychiatry, Guy Widdershoven (Editor), John McMillan (Editor), Tony Hope (Editor), Lieke van der Scheer (Editor)

Demonstrates how ethics can engage more closely with the reality of psychiatric practice and shows how empirical methodologies from the social sciences can help foster this link. The book is presented in two parts. Chapters 2 to 4 consider what it might mean to talk of ‘empirical ethics’; chapters 5 to 15 are presented as case studies in empirical ethics.

So what is ‘empirical ethics’? McMillan and Hope (chapter 2) offer little more, positively, than the idea that it involves research on issues in medical ethics which closely combines philosophical (normative, non-empirical) analyses with empirical studies (involving systematic data collection). The principal point made in their chapter, and a central claim too of chapter 4 (by Borry, Schotsmans and Dierickx), is the need to avoid the ‘naturalistic fallacy’ ( i.e. any attempt to derive normative conclusions from empirical investigations) in empirical ethics.

Widdershoven and van der Scheer (chapter 3) offer more by way of positive characterisations of empirical ethics, combining pragmatism and hermeneutics. Empirical research can help identifymoral problems experienced in practice; furthermore the moral sensibilities, practical methods of inquiry and debate-stimulation, and theoretical understandings of empirical researchers (including clinicians and patients recruited as co-researchers) can themselves in turn inform ethical decision-making in practce. Guiding ideas of this chapter are ‘phronesis’ – that understanding of general (e.g. moral) rules requires knowledge of their application in concrete circumstances; and the related notion of ‘pragmatic hermeneutics’ – that practical processes of meaning making in concrete situations are essential to the provision of meaning to abstract concepts.

Later chapters consider methodological and substantive issues concerning: individualised mental health care, the impact of implicit models of mental health on decision making in mental health teams, dementia care and the family, advance directives and dementia, coercion in psychiatric care, Prader-Willi syndrome, Ulysses arrangements (i.e. advance directives by people with recurrent psychotic conditions concerning what should become of them when they are psychotic), treatment refusal and anorexia, issues in forensic psychiatry, and legal issues for old age psychiatry.

Synopsis by Richard Gipps, March 2008

 

essential philpsychEssential Philosophy of Psychiatry, Tim Thornton

This book summarises recent analytical research in the philosophy of psychiatry, paying particular attention to the limits of naturalism as a philosophical framework for psychiatry.

Part 1 considers values. The first chapter argues that psychiatric diagnosis cannot be made value-free (as would be desirable according to certain views of what it would mean for psychiatry to be a science). Instead the ineradicably evaluative character of diagnosis should be understood and acknowledged for what it is. The second chapter considers the basis of clinical judgement. The form of the argument is similar to chapter 1. The case is made that clinical judgement is not completely codifiable (reducible to an algorithm), and that this is not a problem for the objectivity of psychiatry – but only for certain optional and purely philosophical conceptions of what it would be for such judgement to be respectably objective.

Part 2 considers meanings. Chapter 3 considers the nature of our understanding of psychopathology, and especially the challenges that are placed upon our capacity to understand by cases of severe mental disturbance. Thornton concludes that phenomenological accounts which try to render psychotic experience comprehensible by bringing it within the fold of intelligible human experience may be misguided, but that an apt phenomenological theorisation of the structure of our contact with reality and of (what may amount to the same thing) the conditions of intelligibility for speech and action may be essential if we are to understand just what it is that psychosis can threaten and damage. The fourth chapter consides the ‘place of meaning in nature’. That is it considers cognitivist or information-processing accounts which reductively construe intentional and meaningful relations as forms of causal relation between ‘inner states’ and other such states or ‘external objects’, and contrasts these (unfavourably) with (preferred) Wittgensteinian accounts which view meaning and intentionality as irreducible, sui generis, aspects of the natural world.

Part 3 considers facts. Chapter 5 considers the validity of psychiatric classification. As in chapter 1, the presence of values is not seen to pose a problem for classification; the argument here turns on the conceptual validity of the hyper-objectivist criteria for classificatory validity that are somemtimes employed by foes and friends of psychiatric classification. Whether today’s psychiatric classification meets various other criteria (inference, explanation, causation) for validity is considered, and the localised and partial nature of these criteria is strerssed. The sixth chapter considers the conceptual status of evidence-based medicine in psychiatry. The (empirical or conceptual?) character of the principles deployed in EBM to assess reliability of evidence is critically considered, once again concluding that clinical jugement is ineliminable from the decision-making required to apply the evidence base critically in particular clinical instances.

The connections between the themes of these well-argued and well-written chapters are considered in a final chapter which concludes the book.

Synopsis by Richard Gipps, March 2008

 

metaphorThe Metaphor of Mental Illness, Neil Pickering 

A revaluation of the traditional sceptical and apologetical philosophical arguments about the existence and nature of mental illness. Pickering accepts many of the sceptical arguments (by authors such as Breggin, Boyle, and Szasz) against the concept of ‘mental illness’ or against the validity of specific diagnoses (‘schizophrenia’) but resists their conclusions.

Pickering’s core focus is on an argument – the ‘likeness argument’ – which he finds at work within the critiques of the validity of mental illness or specific illnesses. The likeness argument…

 

“is…that we can prove or disprove the existence of mental illness or the validity of some particular diagnostic category such as schizophrenia or ADHD by showing or discovering whether such human conditions are or are not illnesses. We do this, the likess argument says, by showing that schizophrenia or ADHD are or are not sufficiently similar to other illnesses to be illnesses themselves. The assumption about the question upon which the likeness argument is based is that it is answerable by evidence as to the nature of the conditions in question which is available to observation. It assumes that if we observe or investigate conditions such as schizophrenia, alcoholism, ADHD, or bipolar affective disorder for features of illness, then this will decide for us whether or not these are illnesses.”

 

Pickering’s basic argument against the likeness argument is that…

 

“the likeness argument is circular and that when we realize this we see that, and indeed where, human agency must come in. The features of conditions, such as schizophrenia, alcoholism, or ADHD, which the likeness argument relies upon to decide what kind of thing they are, change depending upon one’s conceptualisation of these conditions. … If one thinks [conditions such as schizophrenia and alcoholism] are illnesses, they will appear to have features such as causal brain abnormalities; but if one does not think they are illnesses these features will be absent. It is the argument of this book that this is role that human agency plays in mental illness: it is responsible for categorizing conditions such as illnesses, and thereby making the features of illness such as causality or dysfunction appear.”

 

Whilst Pickering accepts Szasz’s claim that the idea of ‘mental illness’ is a metaphor, he resists the idea that this ought to detract from it. Metaphors are seen instead as essential contributors to categorisation and description in science, including psychiatry. Just because we need to accommodate the human imagination in our understanding of the origin of the concepts of ‘mental illness’, ‘schizophrenia’, ‘ADHD’, etc., does not mean that the conditions referred to are themselves imaginary.

Synopsis by Richard Gipps, March 2008

 

natureNature and Narrative: An Introduction into the New Philosophy of Psychiatry, Bill Fulford (Editor), Katherine Morris (Editor), John Z. Sadler (Editor), Giovanni Stanghellini (Editor)

Essays on historical, metaphilosophical, ethical, psychological, phenomenological and psychotherapeutic themes in the field of mental health.

This book, the first in the IPPP series, contains a selection of essays in diverse fields in the ‘new philosophy of psychiatry’. Russell Meares provides a chapter (2) on the vicissitudes of the ‘inner self’ since the 19th century. The historical elements (on the history of dynamic psychiatry) are more successful than the philosophical (Meares once again presents Ryle as arguing against the very idea of the inner, rather than against common philosophical ways of understanding it.).

Gordon Baker develops his intriguing ‘therapeutic’ reading of Wittgenstein by elaborating on a previously unpublished remark of Wittgenstein’s in chapter 3: that “Our [Wittgenstein's] method resembles psychoanalysis in a certain sense. To use its way of putting things, we could say that a simile operating in the unconscious can be made harmless by being articulated. And the comparison with psychoanalysis can be developed even further. (And this analogy is certainly no coincidence.)”.

Eric Matthews corrects Meares’ philosophical mistake in chapter 4, providing an existential-phenomenological elucidation of the nature of ‘the mind’ and of ‘mental illness’. Matthews stresses, in particular, embodied intentionality and desire, regarding mental illnesses as disturbances of our being-in-the-world.

In chapter 5 Daniel Robinson discursively comments on several intersections of ethical, political and clinical issues in psychiatry.

In chapter 6 Widdershoven & Widdershoven-Heerding provide a hermeneutic approach to dementia, demonstrating how strange behaviours of people with dementia can be understood not simply as products of a disease, but rather as intelligible in the context of the person’s understanding of their world.

In chapter 7 Derek Bolton presents his own attempt to overcome the meaning-causality dualism and thereby to reconicile approaches towards mental illness which present themselves in either hermeneutic or natural-scientific terms.

Rom Harre considers the discursive construction of identity and disturbances of this in mental illness in chapter 8.

In chapter 9 Grant Gillett describes his own discursive position which, unlike Bolton’s, attempts to preserve the distinction between discursive and causal forms of explanation. Gillett considers the ways in which mental disorders of humans – disorders such as anorexia – can be understood once they are situated in relation to the preoccupations and concerns of the patient – e.g. seeking control, avoiding dependency, coping with inner conflict etc.

In chapter 10 Michael Musalek provides an account of delusions as ‘ideas with meaningful content characterized by extraordinary conviction and the outright rejection of alternatives, leading to a significant loss of the individual’s degree of freedom.’ He uses this understanding to consider issues of meaning (of delusional content, the meaning of a particular mental disorder, and the meaning of the behaviour of deluded patients).

Katherine Morris presents a Sartrean phenomenology of the body dysmorphic disorder in chapter 11. In particular she views BDD as a disturbance of the lived-body-for-others, in particular, a disturbance which leads to a failure to live the body-for-others, and to a tendency to attempt to think it instead.

In chapter 12 Natalie Depraz distinguishes between everyday expected un-thematised experiences and ‘limit experiences’ which are unique and which challenge the everyday attitude. She then considers how schizophrenic and meditative experience challenge this dichotomy, and through a prodrome or an apprenticeship, allow us to see how limit-style experience can be cultivated and be made part of one’s normal attitude.

Chapter 13 consists of Alfred Kraus’s considerations regarding the possible contribution of phenomenological/anthropological approaches towards diagnosis and nosology in psychiatry – by delineating different modes of being-in-the-world. Examples of melancholic, manic, and hysterical modes of existence are provided.

Markus Heinimaa consider incomprehensibility in chapter 14. He develops a Wittgensteinian conception of meaninglessness not as the positive abrogation of some rule, not as having a positive content, but rather as a kind of limit point to our understanding – a point when there is nothing that can be ‘done with’ our words, or with the words or deeds of the person we are failing to understand.

In chapter 15 Gerrit Glas considers existential and biological approaches to anxiety. He considers the possibility of reconciling these approaches by viewing existential considerations as relevant once we understand how biologically provided anxiety reactions are taken up in and reshaped by the socio-cultural and ethical and existential context of development of the living human being.

Erdie van Staden & Christa Kruger discuss, in chapter 16, how the semantic but not syntactic use of first-person pronouns changes with recovery during psychotherapy. That is, people came more often to use pronouns to express agential thoughts in which they owned their actions or experiences, and lessened their use of ‘I’ as a patient – i.e. as something to which actions were being done.

The final chapter by Paolo Rossi considers in careful and fascinating detail the relation between science and magic over history. It’s interest is not diminished by its apparent irrelevance to the ‘new philosophy of psychiatry’ outlined in the rest of this volume.

 

technologyPhilosophical Perspectives on Technology and Psychiatry, James Phillips

Documents the ambiguous impacts of technology on the science and practice of psychiatry, the benefits and the costs of the increasing technologisation of the field of mental health.

  1. John Sadler argues that instrumentalist thinking has invaded psychiatric practice and transformed its practice, giving rise to the ‘generic clinician’ who applies the same techniques as any other clinician and is readily interchangeable with other generic clinicians.
  2. Peter Zachar and Scott Bartlett criticise the idea that technology is the solution to all problems, and urge instead a dialectical relationship between problem-based techniques and global technological rationality.
  3. Louis Charland investigates the ways in which instrumentalist approaches to emotion regulation severely limit and distort the role of emotion in psychiatric practice.
  4. Miguel Uribe contrasts mechanistic explanations of psychopathology with the interpretative or aesthetic modes of explanation deployed in psychoanalysis.
  5. Sue Rosser demonstrates the different perspectives shed by different feminist theories on SSRIs and fMRI.
  6. Douglas Porter investigates the cultural context of the development of psychopharmacology.
  7. Donald Mender questions atempts to translate clinical phenomena into information that can be processed by computer software.
  8. Douglas Heinrichs describes the impact of technology on individuals with ADHD, Aspergers, and mood disorders.
  9. Mark Rego argues that the impact of the demands of modern technology on the prefrontal cortex has led to an increase in mental disorders.
  10. Phillip Sinaikin invokes Heidegger to argue that depression and boredom are the fundamental moods of our technological epoch.
  11. Abraham Rudnick looks at the technologies of psychiatric rehabilitation to consider how such technologies can be humanising rather than dehumanising.
  12. stuart Kaplan critiques the primitive technologies used to assess psychopharmacological agents in children.
  13. Iseminger and Theobald look at the use of the internet for psychiatric symptom monitoring and reporting.
  14. Robert Kruger examines the use of the video recorder in the assessment of emotional awareness in individuals with ASD.
  15. Jennifer Radden argues that an overemphasis on technical expertise has led us to forget and neglect the significance of moral virtue in the good doctor.
  16. Michael Cerullo criicises the report of the President’s council on bioethics, arguing that it is the product of neo-conservative ideology and misrepresents the nature of antidepressants and the issue of cosmetic psychopharmacology.
  17. Mark Jenkins addresses the ethical ambiguities in using antidepressants when they may foreclose a confrontation of ordinary human existential dilemmas.

Synopsis based on the Introduction by the editor, further edited by Richard Gipps, November 2008

 

portraitA Portrait of the Psychiatrist as a Young Man: The Early Writing and Work of R D Laing, 1927-1960, Allan Beveridge

This substantial work considers theoretical (part 1) and practical (part 2) themes from the early life (0-33 years) of R D Laing. As such it constitutes an investigation into those of Laing’s interests and practices which fed into the making of his classic The Divided Self, published when Laing was 33.

Part 1 considers Laing’s education – including his self-education.

  • Chapter 1 provides an overview of his life. Material from the biographies of Mullan, Burston, Clay, Adrian Laing and R D Laing’s autobiography is supplemented with archival material researched by Beveridge.
  • Chapter 2 considers what survives of Laing’s early notebooks, personal library, essays, papers and talks. Beveridge considers Laing’s self-education, the books he owned, and the views he came to form on a range of philosophical, medical, and theological matters.
  • Chapter 3 extends the discussion to consider Laing’s early thoughts on Freud, Kraepelin, Bleuler, Jung, Jaspers, Klein, Fairbairn, Winnicott, Sullivan, Fromm-Reichmann, Arieti, Rosen and Sechehaye.
  • Chapter 4 considers Laing’s relationship with continental strands in philosophy and psychopathology – in particular existentialism and phenomenology. Kierkeggard, Nietzsche, Heidegger and Sartre are the philosophers given most attention; Beveridge also considers Laing’s appreciation for and critique of the existential and phenomenological psychiatrists Minkowski, Binswanger and Boss.
  • Chapter 5 considers Laing’s relationship with religion, in particular his belief in the authenticity of religious discourse and experience;
  • Chapter 6 considers Laing’s intellectual and existential relationship with poets and writers such as Blake, Hopkins, Dostoyevsky, Chekhov, Kafka, Camus and Artaud.

Part 2 considers Laing’s clinical practice, and in particular draws on the archival records to provide informative new insights into Laing’s method of practice.

  • Chapter 7 considers Laing’s practice in the army, in particular his disenchantment with standard psychiatric methods, his assessments of soldiers, his method of dream analysis, his first paper on the Ganser syndrome, and the truth about the case of Peter (Peter in Laing’s autobiography = ‘David’ in The Divided Self).
  • Chapter 8 considers Laing’s time at Gartnavel Hospital (1953-5) and his ‘Rumpus Room’ experiment and engagement with Freeman, McGhie & Cameron.
  • Chapter 9 focuses on individual patients Laing encountered at Gartnavel, several of whom became cases described in The Divided Self (especially Edith = ‘Julie’ – the ghost of the weed garden). Laing’s mix of Klein and existentialism is explored well.
  • Chapter 10 considers Laing’s time at the Southern General Hospital (1955-6). Significant and interesting discrepancies between Laing’s written record and case notes from the time are noted.
  • Chapter 11 considers Laing’s life in London, where he began his Tavistock Clinic psychoanalytical training in 1956. Laing’s psychoanalytical and existential and group analytic methods are documented, and much interesting case material is provided.
  • The final chapter – 12 – considers The Divided Self - its writings, responses to the draft, and critical reception on being published. It also considers the question of Laing’s Scottish heritage and the detrimental impact on Laing of the fame he later attained.

Synopsis by Richard Gipps, October 2011

 

reconceivingReconceiving Schizophrenia, Man Cheung Chung, Bill Fulford, George Graham

Perspectives on the schizophrenia diagnosis drawing on phenomenological and analytical philosophy and psychology, introduced by the editors.

The second chapter in this edited book provides a service user perspective. Colin King describes the interplay between racial and psychiatric concerns, drawing on his own life, experiences of racism, and the work of Fanon to provide examples of the conflictual construction of identity.

In the third chapter Man Cheung Chung gives an overview of the philosophy of psychiatry literature regarding schizophrenia. The three foci are: conceptual analysis of the basis of diagnostic classification in psychiatry; phenomenological analysis of the nature of schizophrenic experience; cognitive neuroscientific accounts of schizophrenic symptoms.

The authors Louis Sass and Josef Parnas, central proponents of the resurgence today of the relevance of phenomenology to schizophrenia, provide the fourth chapter. What is particularly valuable about this chapter is its clear elucidation of the different forms of phenomenological understanding, both synchronic and diachronic. Schizophrenia is understood as a self disorder involving a basic diminished sense of one’s embodied existence along with an alienated and disembodied self-consciousness. Synchronically Sass and Parnas elucidate equiprimordial, constitutive and expressive forms of (non-causal) relationship between aspects of experience. Diachronically they consider primary, consequential and compensatory causal processes. This six-fold conceptual scheme constitutes a significant improvement over explanatory endeavours which reduce every relation to the form of the causal/consequential model.

In chapter 5 Alfred Kraus elaborates on his thesis that schizophrenic delusions (especially technical delusions and hallucinations (e.g. of an electronic capsule in the brain)) result from an underlying disturbance of what Heidegger described as the existentials (existential a prioris) – temporalisation, spatialisation, bodily being, and being-with others.

Chapter 6, by Osborne Wiggins and Michael Schwartz, complements this with a Husserlian perspective which makes reference to schizophrenic disturbances in the synthetic constitution of experience. At first overwhelmed by the complexity of inadequately automatically synthesised experience, the person with schizophrenia then experiences (ultimately unintelligible) new syntheses of experience (crystallising in delusions and hallucinations) which consequently reduce its complexity.

In the seventh chapter Giovanni Stanghellini provides us with something of a precis of his very rich phenomenological account of schizophrenia Disembodied Spirits and Deanimated Bodies (see below).

Chapter 8 contains Grant Gillett’s rich, ‘discursive naturalistic’, account of paranoid delusion. Gillett contrasts the austere and abstract rationality of logic and deduction with the grounded and pragmatic rationality of ongoing discursive practices or language games and human forms of life. Whilst the deluded person may have intact (or even hyper-rational) deductive powers, their capacity to weave a coherent narrative out of their experience, in and through their corrective interactions with others, is lost.

Jeffrey Poland provides a much-needed critique of the implicit inductivist and positivist philosophy of science underlying those critiques of the schizophrenia concept popular in the psychological community in the UK today (i.e. those critiques owed to Richard Bentall and Mary Boyle). Poland’s critique however does not let a neurodevelopmental model of schizophrenia off the hook: he goes on to provide a brief overview of the weakness of the empirical evidence supporting it. (Poland however does not consider other understandings of what unifies cases of schizophrenia – e.g. the idea expressed by several other authors of this volume that what may unify different schizophrenias is phenomenological (a particular disturbance of being-in-the-world) rather than neurological (a particular disturbance of the brain).)

G Lynn Stephens and George Graham provide a ‘delusional stance thesis’ (DST) in chapter 10. The DST urges that it is not what is believed (or thought or valued) that makes that mental content a delusion. It is rather how it is entertained. This stance is characterised by self-identification (taking the belief (or other mental state) to be part of one’s make-up, rather than being able to get any distance from it), lack of insight, and resistance.

Reasoned scepticism towards identifying delusions as beliefs is a theme also of chapter 11. Here Andy Hamilton argues that beliefs are too conceptually degraded, in terms of their groundlessness, behavioural intertia, and rational disconnection from other intentional states, to count as beliefs.

In chapter 12 Mike Jackson discusses the ‘clinician’s illusion’ (i.e. the distorting effect of looking at psychosis only through the lens of the problems encountered in the clinic). He considers dimensional accounts of psychosis, the possibilities of benign psychosis, positive manic experiences, non-pathological religious experiences which appear psychotic, and other cases which provide a more positive and extra-clinical perspective on psychosis.

Jennifer Radden reflects on the attitude of injudicious mistrust which underlies persecutory paranoia in chapter 13.

In chapter 14 the UK psychologists Peter Kinderman and Richard Bentall argue against the putatively Jasperian idea that delusions are simply to be considered blanket ‘ununderstandable’ and hence unamenable to psychotherapeutic intervention. (Different types of intelligibility or unintelligibility are not discussed, the precise way in which delusions have been thought of as ununderstandable are not considered, and psychotherapeutic interventions that are directed at underlying affects rather than contents are also not mentioned.) Unlike the phenomenological contributors to the volume, Bentall and Kinderman remain content to attempt to account for paranoid delusion in empirical rather than existential terms – i.e. in terms of cognitive processes of attribution, narrative sense-making, self-esteem preservation, and hypervigilance. Delusions are accordingly understood as ‘theories’ which may be wrong or right, qualitatively comparable with non-delusional beliefs, and amenable to cognitive therapy.

Chapter 15 contains Rom Harre’s soemwhat disjointed analysis of the ‘logical basis of psychiatric meta-narratives’. Narratives which define a type of oddness characterised by the challenging of local discursive rules are distinguished from narratives which also make reference to causally underlying (e.g. brain or societal) dysfunctions. The way in which chemical and organismic discourses can be taken up into personalistic discourses – in particular, the way in which talk of ‘schizophrenia’ constitutes such a hybrid discourse – is considered.

The final chapter is provided by Eric Matthews. Matthews provides a novel analysis and critique of philosophical assumptions built into anti-psychiatric discourses (of Szasz and Laing). Matthews unearths conceptual confusions inherent within Szasz’s critique (in particular Szasz’s unargued and arbitrary use of restrictive bodily criteria for ‘illness’), whilst also providing sympathetic and interpretatively charitable readings of his work to extract valuable reminders of the differences between mental and physical illnesses. Matthews claims that Laing’s understanding of schizophrenic people is inconsistent, since on the one hand he appears to hold that people with schizophrenia are simply ‘crazy’ and at heart unknowable, and on the other views schizophrenia as an intelligible existential problem with living. (Some of this appearance of straightforward contradiction might however be alleviated if we took note of the use of Laing’s use of the schizoid condition as an intermediate position on the slope between sane being-in-the-world and crazy full-blown schizophrenic psychopathology, and also if we took into account his peculiar sympathy for people who are precisely struggling to hold onto their humanity.) Finally Matthews deploys a phenomenological conception of the human being as a body-subject to aid our understanding of the way in which any genuine understanding of schizophrenic experience must be at one and the same time both causal and psychological.

Synopsis by Richard Gipps, March 2008

 

fateSchizophrenia and the Fate of the Self, Paul Lysaker, John Lysaker

This book deploys a ‘dialogical’ conception of the self to theorise disturbances in self-experience in schizophrenia.

  • Chapter 1 provides an overview of third-person biological and social explanations of schizophrenia.
  • Chapter 2 considers the ‘sense of self’ in schizophrenia – i.e. ‘how one’s being is disclosed to oneself, say as female, a citizen of Nigeria, generous, and a doctor… the character and welfare of one’s being… in the form of a ‘life’.’ Classical psychiatric perspectives on self-disturbances are surveyed. Existential and psychoanalytic approaches to loss of self in schizophrenia are also canvassed, as are psychosocial and phenomenological perspectives. Case examples provide the reader with a sense of the schizophrenic subject’s sense of losing their selves, their fear of dissolution, and the connections between such fears and paranoid thoughts of persecution.
  • Chapter 3 introduces a dialogical (but not necessarily discursive) theory of selfhood. The dialogical view is that ‘we relate to others and ourselves, we plan, imagine, remember, and lustonly on the basis of dialogical relations.’ Of particular importance to the theory is the claim that ‘sense of self occurs when one encounters oneself in movements among character-positions and meta-positions’ – i.e. in shifts between the different modes of habitual being-with-others, or ‘axes of self-world relations’ in which we are engaged.
  • Chapter 4 considers dialogical impairment and self-diminishment in schizophrenia. The uncomfortable experience of being in a room with significantly different people – family members, two former lovers and a present lover, old and new friends who don’t know one another, a supervisor, and old rivals who verge on being enemies – is used to demonstrate the feelings that overwhelm us when we are unable to move between different self-positions (the different ways we would naturally relate individually with all of the above), and to provide a model for schizophrenic self-experience. A taxonomy of 3 different kinds of self-experience is proposed: One, monological forms, in which only one (or a very few) self-positions come to predominate, and everything is filtered through these (e.g. self as persecuted). Two, barren forms, in which selfhood has generally diminished, and in which there is no ‘inter-animating play’ between self-positions. Third, the cacophanous self, in which sufferers become lost in a swirling morass of self-positions.
  • Chapter 5 considers what light the dialogical conception throws on the content of delusions and hallucinations, and on the occurrence of negative symptoms and lack of insight .
  • Chapter 6 considers the possible reciprocal influences of dialogical disturbances and psychosocial dysfunction.
  • Chapter 7 discusses the implications for psychotherapy of the dialogical conception – i.e. the ways that the therapist can help with establishing and sustaining dialogue, dialogical positions, and safe shifts between positions.
  • A Concluding chapter 8 discusses the limitations and future directions of the work.

The book is clearly written and a pleasure to read. It takes pains not to over-extend its thesis nor claim too much for it; nevertheless the resulting theorisation is a substantial contribution to both psychopathological theory and psychotherapeutic practice, as well as to the ‘dialogical’ conception of the self.

Synopsis by Richard Gipps, October 2008

 

sublimeThe Sublime Object of Psychiatry: Schizophrenia in Clinical and Cultural Theory, Angela Woods

Woods presents an analysis of schizophrenia 100 years after the term first appeared in print. She uses the concept of the sublime to examine many uses of the word “schizophrenia” (from the clinics of both psychiatry and psychoanalysis, to cultural theory and the writings of major protagonists of the antipsychiatry movement) and to probe the relationship between schizophrenia, modernism and postmodernism. In her analysis, a focus on the sublime reveals both connections and distinctions between the very different arenas covered. Woods’ fresh approach raises many questions, perhaps especially about the nature of projects which both seek to explain and yet paradoxically to maintain their object as veiled and mysterious.

Woods presents the philosophical concept of the sublime as key to her analysis. The sublime is not simply an object, but an “…encounter between subject and object… produced… through the interplay of temporal, spatial, and social factors” (26). Key philosophers are drawn upon to articulate a concept of the sublime which is not only contrasted to the merely beautiful or the promise of that which is outside of the frame, but is an active process of perpetual re-framing, a paradox of a fascination and a desire to explain or reveal combined with the need for the maintenance of opaqueness and distance.

In turning to the history of psychiatry, Woods shows firstly that many of the features and conceptions of schizophrenia have survived intact from Kraepelin, Bleuler and Schneider through to today’s DSM-IV-TR (34), as has the “grand narrative of modern Western selfhood” it reflects. Despite the attempted clarity in describing symptoms, the medical aetiology of schizophrenia has remained mysterious through a century of re-framing from different positions, and in this way it has found and retained the status of a sublime object, always fascinatingly close at hand yet never revealed or clearly understood, unknown or even unknowable.

The important influence of psychoanalysis is given a similar treatment, and despite the significant conflicts between psychiatry and psychoanalysis, Woods shows that they converge on schizophrenia as a sublime object: schizophrenia is the “textual sublime” of psychoanalysis. Woods’ analysis, especially of Freud’s and Lacan’s use of the autobiographical memoirs of Daniel Paul Schreber (64), is that psychoanalysis has historically preserved the sublime status of schizophrenia by offering us an understanding of it based largely on an encounter with this diversely interpretable text – rather than by establishing its understanding of schizophrenia within ongoing encounters with living patients whose reactions to their analyst’s interpretations could provide checks on, and further directions for, their interpretative activity.

The concept of the sublime in an analysis of antipsychiatry becomes a comprehensive method for understanding the work of a number of protagonists. This is especially helpful given that many of them refuse to acknowledge themselves as belonging to any such movement and write from very different positions. Woods focuses on the work of Goffman, Foucault, Szasz and Laing, with others mentioned and set in context. She shows that they essentially comprise three distinct responses to schizophrenia’s sublime object status: an anti-sublime position, an oscillating position, and a paradoxical stance which rejects schizophrenia as psychiatry’s sublime object but simultaneously recreates it as a non-clinical sublime. In the first analysis of its kind, Deleuze and Guattari’s work is also fearlessly examined. Once again, it is the notion of the sublime which holds the key to Woods account. Seen in part as an extension of antipsychiatry, Woods shows that assigning the schizo a heroic role of liberated desire is deeply problematic, especially in the difficultly keeping apart the concepts of schizo, paranoid and schizophrenic. It is the sublime nature of the schizophrenic in the Anti-Oedipus which calls into question their alleged ability to challenge capitalism.

Aside from the problematic anti-sublime position of Szasz, it seems that antipsychiatry has not adequately confronted schizophrenia’s sublime status. Woods turns to the radical work of Louis Sass, whose phenomenological psychology is viewed as uniquely operating outside of “the logic of the sublime” (163). Sass, it is suggested, rejects Jaspers’ abyss of understanding without creating a depathologised schizophrenia. The processes of schizophrenia lose their sublime-status as they are brought fully inside the frame with a description of a disturbance of the self or ipseity. This in turn illuminates modern and postmodern cultural theory. Woods examines the work of Baudrillard, Jameson, Harvey, Currie, Johnston and Frosh to finish her examination of the sublime and schizophrenia with the postmodern theorists’ return to a “paradoxical sublime” (183) and a close examination of the “schizophrenic” subjectivity in Bret Easton Ellis 1999 novel Glamorana.

Synopsis by Jonathan Gadsby, November 2011

 

trauamTrauma, Truth, and Reconciliation: Healing Damaged Relationships, Nancy Potter

This book of collected essays aims to situate recovery from psychological trauma within not merely a psychological, but a combined moral, political and philosophical context.

The editor provides an introductory overview, focusing particularly on the value and the limitations of forgiveness.

Chapters 1 to 4 examine analogies between truth and reconciliation commissions and psychotherapy. David Brendel sets out similarities and differences between the two. Christa Kruger argues that ongoing relationships between (those who were previously) oppressed and oppressors are important for the functioning of truth and reconciliation commissions. Peter Zachar considers reconciliation to be a necessary compromise between the satisfactions of rage and retributive justice and naive forgiveness. Colleen Murphy looks at the role of the breakdown of law in social conflict and a similar breakdown of expectations in personal PTSD.

In chapter 5 Alison Mitchell argues against the value of simple truth telling (confession) for the purposes of reconciliation, stressing instead the need to achieve moral agreement about the significance of past events.

In chapter 6 Deborah Spitz also looks at the ways in which reconciliation is limited by truth-telling, and explores the possibility of addressing intrapsychic and relational reconciliation in therapy and social reconciliation outside of it.

Chapters 7 to 9 advocate the role of forgiveness in our lives. The authors explore Hegelian, Christian, Nietzschian, and relational themes.

Chapter 10 by Sharon Lamb urges that many psychotherapies too readily push clients towards forgiveness whilst ignoring the need for truth-speaking and holding-accountable.

In chapter 11 Christian Perring argues for the use of narrative story telling to resist the self-constructions imposed on individuals by dominating groups. Perring uses examples of transsexualism and mental illness and the need to resist totalising and denigrating self-constructions by creating alternative narrative identities.

Lewis Mehl-Moadrona contributes the final chapter in which he argues that the kinds of healing and understandings of trauma (reconciliation, forgiveness, etc.) prevalent in Christian societies are unhelpfully extrapolated to Aboriginal peoples.

Synopsis by Richard Gipps, March 2008

 

what isWhat is Mental Disorder: An Essay in Philosophy, Science, and Values, Derek Bolton

Perspectives on the schizophrenia diagnosis drawing on phenomenological and analytical philosophy and psychology, introduced by the editors.

The book is presented in 5 chapters and a Conclusion. Chapter 1 considers the character and purpose of diagnostic classification. Four different theories as to what constitutes the disorderedness of a mental disorder are considered (absolute breakdown of meaningful connections such that behaviour makes no sense; primary neurological lesion; statistically abnormal functioning; failure in evolutionary function) and at least partially rejected. The question of the practical purposefulness of psychiatric classification is however held to run free from the question of its rationale.

Chapter 2 picks up the question of the character of the norms or forms of order which are deviated from in mental disorder, asking again whether they are social or causal in nature. Bolton answers by looking at genetics, Foucault and evolutionary psychology; there is no straightforward answer but rather a sustained attempt to deconstruct the question.

Chapter 3 develops the critique of evolutionary and statistical approaches to defining the norms broken by psychopathology, once again opting for a deconstructive mixture of the genetic, social and individual in determining the meaning of talk of mental disorder

Chapter 4 turns to the pragmatics of clinical definition, and the necessary focus on harmful disturbances in a person’s immediate social and personal environment.

Amongst other things Chapter 5, itself perhaps the richest and most informative chapter of the book, makes the point that the kinds of disorders which make their way into the manuals are determined as much or more by the kinds of problems people bring into the clinic than by any neat a priori taxonomy.

A Conclusion completes the book. Throughout, the arguments and working assumptions have it that we would do better to become aware of the plural criteria for what counts as mental normality or abnormality, order or disorder (the conclusion lists 8 such criteria) than to insist on isolation universal necessary or sufficient conditions.

Synopsis by Richard Gipps, March 2008