Cognitive psychologists have recently identified alterations in perception and reasoning that contribute to the formation and maintenance of beliefs that happen to be delusional. Clinically significant delusions, however, are often deeply unusual. An account of their formation and maintenance must explain not merely how someone can come to hold false or uncommon beliefs, but also how someone can arrive at beliefs that seem profoundly improbable and even bizarre. This paper uses the philosophical concepts of the Bedrock and the Background to (...) provide an account of that foundational, nonrepresentational, non–rule-governed, dispositional structure of everyday understanding that underpins both our perception and our reasoning. The central claim is that the formation and maintenance of delusions becomes intelligible once they are seen to reflect disturbances to this foundational dispositional structure. Different dimensions of the Background are described along with the delusions that might follow from distortions to these dimensions. We challenge the assumption of much recent cognitive psychological theorizing that delusions can be understood as explanations of unusual experiences or as the product of hasty reasoning. Finally, the implications of the theory for the therapy of the delusional patient are briefly discussed. (shrink)

Psychoanalysis is often equated with Sigmund Freud, but this comparison ignores the wide range of clinical practices, observational methods, general theories, and cross-pollinations with other disciplines that characterise contemporary psychoanalytic work. Central psychoanalytic concepts to do with unconscious motivation, primitive forms of thought, defence mechanisms, and transference form a mainstay of today's richly textured contemporary clinical psychological practice. -/- In this landmark collection on philosophy and psychoanalysis, leading researchers provide an evaluative overview of current thinking. Written at the interface between (...) these two disciplines, the Oxford Handbook of Philosophy and Psychoanalysis contains original contributions that will shape the future of debate. With 34 chapters divided into eight sections covering history, clinical theory, phenomenology, science, aesthetics, religion, ethics, and political and social theory, this Oxford Handbook displays the enduring depth, breadth, and promise of integrating philosophical and psychoanalytic thought. -/- Anyone interested in the philosophical implications of psychoanalysis, as well as philosophical challenges to and re-statements of psychoanalysis, will want to consult this book. It will be a vital resource for academic researchers, psychoanalysts and other mental health professionals, graduates, and trainees. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Autism and Intersubjectivity:Beyond Cognitivism and the Theory of MindRichard Gipps (bio)The papers that make up this special issue of Philosophy, Psychiatry, & Psychology are obviously united by both topic and approach. They all look at autism through a philosophical lens—both at infantile autism (Gallagher 2004a, 2004b; McGeer 2004; Shanker 2004) and at schizophrenic autism (Stanghellini and Ballerini 2004). Moreover, they are all concerned with the foundations of our understanding (...) of people and their minds, both the minds of others (Gallagher 2004a, 2004b; Shanker 2004; Stanghellini and Ballerini 2004) and that of oneself (McGeer 2004). The developmental disorder of infantile autism provides a conspicuous example of a disruption in the ability to develop such an understanding and enter into the social world, whilst schizophrenic autism provides a conspicuous example of what happens when one falls out of it (Stanghellini and Ballerini 2004).Yet what further affords the opportunity of this introduction is the possibility of discerning a strong common theme that runs through the philosophical treatment the papers provide. For they are united in their rejection of the primarily cognitive approach toward our capacity to relate to one another (or to ourselves) as to minded people taken by many in the mainstream of developmental psycho(patho)logy today.1 Such mainstream approaches ascribe to the developing child a 'theory of mind,' tacit knowledge of which supposedly enables them to negotiate the social world. In place of such an intellectualist, disengaged, cognition-focused psychology, we are offered perspectives that stress the primitive foundational character of our pre-reflective (noncognitive) engagement with one another, our emotion, our expression, and our embodiment.The grounds for this stressing of the affective and praxical dimensions of personal life over the cognitive and representational are twofold. First there is the developmental trajectory itself, and the claim is that the autistic child's interpersonal lacunae manifest themselves considerably before they develop the cognitive capacities for social knowledge (Gallagher 2004a; Shanker 2004). The principle ground, however, is philosophical, and the claim here is that what needs to be rejected in the developmental psycho(patho)logy is an alienated ontology and estranged epistemology that has implicitly become inscribed within it, constraining its explanatory project and limiting its vision of possibilities.2 That at least is how I [End Page 195] would put it and, by way of providing an overarching philosophical presentation of the papers of this issue, what follows shall be its elaboration.The ontology in question has it that the mind is an inner domain, that bodily behavior is an outer domain, that belief and thought epitomize the former, that intentionality is a function of the former and only derivatively manifest in the latter, that the form of our embodiment is contingent, that understanding is manifest primarily in thought and not intrinsically in praxis, that the mind is populated by free-standing inner representations, and that perception and the emotions are extrinsic to the understanding (Gallagher 2004a, 2004b; McGeer 2004; Shanker 2004). And such an ontology carries a host of epistemological implications. The self retreats from the interpersonal interactive domain, taking up residence even behind the subject's own mind, which itself becomes an objectified domain. In our own case, we are left in the predicament of needing to inspect (or intro-spect) our own inner states to find out how things are for us; our self-reports (avowals of what we think and feel) thereby become avowals of judgments of what we take ourselves to think and feel (McGeer 2004). And when we confront others the task becomes one of cognitively figuring out, from merely 'outer' clues, how things stand with them on the inside. The encounter with others is then epistemologically fraught, relying on inference and theory to take us from an outer domain of mere movement to a hidden inner world of intentionality (Gallagher 2004a, 2004b; Shanker 2004).Thus, an alienated ontology of the person and their mind bequeaths its own epistemological problematic, and the estranged epistemology gives to developmental psychology the task of filling in the details of the actual cognitive states and mechanisms which instantiate the theories and inferences which it has discerned a priori to be required. And psychopathology... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Madness, Reason, and PrideRichard G.T. Gipps, PhD (bio)MadnessQuestions such as “what’s madness?” or “what’s reason?” carry no singular sense about with them wherever they go—which isn’t to say that, asked out of a particular interest in a particular context, they can’t be perfectly intelligible. Garson (2023) is wise to this when he follows “what is madness?” with “as opposed to what?”, even if this latter question itself hardly enjoys (...) a clear sense in the initial context of his asking. What counts as a satisfactory answer to “what’s x?” varies, so that sometimes we’ll be satisfied with a name, at other times by information about something’s genus, origin, function, or composition. Things get notoriously tricky when in the philosophical context the question is asked with a presumption of intelligibility despite ‘x’ being, say, an abstract noun formed from an adjective (‘consciousness’ out of ‘conscious’; ‘happiness’ out of ‘happy’; ‘madness’ out of ‘mad,’ etc.). For “what is?” questions are typically most perspicuously mooted when what’s being pursued are enquiries into (what we might call) the ‘essential nature’ of (what philosophers used to call) ‘substances’ or (of what are more ordinarily called) types of ‘thing’ or ‘entity.’ Invoke, by taking one’s lead from the fact that an ‘x’ is grammatically speaking a substantive, the specter of substance, and you can endlessly baffle yourself by now pondering the mysteries of the putative thing. (Vide discussions of “the nature of consciousness.”) Hence the boon of instead pursuing questions of an ‘opposed to what?’ sort; hence Wittgenstein considering using the Earl of Kent’s “I’ll teach you differences” (King Lear) as a motto for his Investigations. Rather more reflective wisdom regarding ‘x’ may thus be gained when we learn to contrast it with ‘y’ and ‘z’ than when peering into x’s non-existent constitution or groping for its never-instituted genus.Later, I make the case that Garson’s conception of reason itself might suffer from a form of substantialization and that, if I’m right in this, troubling implications follow for his approach to madness. But let’s begin by considering his enquiry into the relation of madness, idiocy and reason. So perhaps we’re reflecting on matters legal, and considering—since we’d hitherto been inclined to take ‘reason’ as univocal—what justifies our different treatments of the insane, the intellectually subnormal, and the normal. Or perhaps—proceeding from the same inclination—we’re puzzled by how someone may boast an exceptional IQ or demonstrate marvelous formal rationality (i.e., make deductions of a sort which would please the logician if no-one else) and yet still be quite mad. And then we realize that at which Garson’s Late Moderns seem to have been gesturing: The lack of reason qua intelligence in idiocy is a different [End Page 307] species from the lack of reason qua sanity in madness. An amethyst is lifeless in a different manner than an expired possum (it was never living, never moribund); the arational lack reason in a different sense than do the irrational (and a baobab cannot jump to conclusions.) There is, say his Late Modern theorists, something ‘perverse’ rather than simply deficient about the irrationality of madness.Now an important part of Garson’s thesis has it that “idiocy is a better candidate for the opposite of reason than madness.” One of the reasons for his making this claim is that he follows his Late Moderns in claiming that madness has reason somehow alive within it, albeit in an unconventional or surprising form. I return to his own explication of this below. Consider first, though, the different thought-referencing descriptions under which the speech acts of the thought-disordered, the speech-disordered, the delusional, and the learning disabled subject may be brought. The sufferer of speech disorder has difficulty with fluency or sound production, but once we get used to this we can find our way to the bona fide rational thought immanent within their discourse. The speech acts of the intellectually impaired subject aren’t chaotic, but instead want for invention and richness; they fail to express... (shrink)

Talk of matters ethical is, in the psychotherapeutic context, typically relegated to therapy’s preconditions and setting, i.e., to its ‘frame’. What goes on within that frame, i.e., therapeutic action itself, gets theorised in psychological rather than ethical terms. An explanation for this is the frequent therapeutic imperative to extirpate self-directed moralising. Moralising, however, constitutes but a phoney pretender to the ethical life. A true ethical sensibility instead shows itself in such moments of life as involve our offering humane recognition to (...) one another and to ourselves. Being offered such recognition not only allows a patient to internalise it as a remoralising dignity or healthy pride. It also enables the patient to know herself by animating within herself a range of virtue concepts—courage, probity, repentance, etc.—which can then function as regulative ideals for a well-functioning psyche. Inchoate anxiety now takes shape as intelligible guilt. Repentance and the repair of damaged relationships now replace blame’s repression or projection. Conscience now becomes a motor for therapeutic change. In such ways, ethical concern constitutes not merely the frame but the living flesh of the therapeutic project. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.3 (2003) 255-259 [Access article in PDF] Illnesses and Likenesses Richard G. T. Gipps IN THIS RESPONSE to Neil Pickering's paper I shall focus only on what he describes as the "strong objection" to the typical use of the likeness argument. The likeness argument, to recap, has it that we can decide whether conditions such as schizophrenia, depression, or alcoholism do or do not deserve (...) the designation of illness depending on whether they possess features which, if they occurred in physical conditions, would enable one to decide for or against the designation. To take an implausible example, if it were decided that it would be enough to describe a physical condition as an illness if it involves pain not caused through injury, then a psychological condition would be appropriately described as an illness just to the extent that it too involved such pain.In arguing against typical deployments of the likeness argument, Pickering finds that it is only on questionable initial descriptions of psychological conditions that such conditions appear to share the features that, in physical conditions, would be taken to be indicative of illness. That is to say, theorists who deploy the likeness argument to urge either the reality or unreality of mental illnesses typically presuppose what both we and they had all along hoped would be demonstrated in their argument. In terms of the above example, we might say that a certain psychological condition can count as an illness if it involves psychic pain. The concept of psychic pain is however (so the argument would have it) contestable; there exist other descriptions that make no reference to pain and in so doing fail to provide what a user of the likeness argument would need to substantiate the claim that a conception of the condition as an illness is more than a façon de parler.By way of arriving at this conclusion the following precondition for the applicability of the likeness argument (Pickering's "assumption" (2)) is insisted on: "That, with respect to the presence or absence of [those features of conditions which features decide whether or not the conditions are illnesses], a condition such as schizophrenia [must be] describable independently of the category it is assigned to." This can seem a quite reasonable restriction, for—it could be said—one can only win an argument if it is first allowed that there is actually something to argue about. That is, it is only if both partisans and detractors of the illness conception first accept a certain description of schizophrenia as spelling out what schizophrenia essentially involves that they can then progress to determining whether or not such a condition so described is or is not an illness.Yet, whereas this seems like a perfectly reasonable requirement, it is I believe uncertain whether it will always capture the form of the intuitions of adherents and detractors of the illness conception—or of the form of philosophical arguments more generally. To be sure, some philosophical discussions can perhaps be reconstructed as debates about the validity of certain inferences [End Page 255] from mutually understood premises (i.e., given X, does Y follow or not?). Yet if this were the case, then genuinely interesting philosophical arguments would probably be few and far between. If we are agreed as to the precise significance of our premises, and are not furthermore just making straightforward mistakes in reasoning, it is hard to see how or why we could all fail to arrive at the same conclusions.In the Philosophical Investigations paragraph 128 Wittgenstein wrote that "If one tried to advance theses in philosophy, it would never be possible to question them, because everyone would agree to them" (Wittgenstein 1953). Now that proposition might seem on rather weak grounds, because all one has to do to actually disprove it is merely disagree with it. But presumably Wittgenstein is rather articulating his intuition that although philosophical arguments often take the form of clashes concerning what conclusions can be drawn from what premises, most of their substance comes from a prior failure to unpack the intrinsic significance... (shrink)

This chapter introduces the edited volume, The Oxford Handbook of Philosophy and Psychiatry. Published in 2013, the centenary of Karl Jaspers' General Psychopathology, the chapter draws lessons from the last hundred years for the coming century. No predictions are made. Instead, five 'conditions for flourishing' are set out: 1) Particular Problems - the importance of focussing on well-defined particular problems rather than general theory building, 2) Product- orientation - remaining always responsibly product oriented in the specific sense that both sides (...) put in the work necessary to 'go deep' with each other's fields, 3) Partnership - working in partnerships of one kind or another, 4) Process - constant reflection on process based on peer review but leaving scope for the occasional rogue voice to cut innovatively against the grain, and 5) Q - a condition of a different kind, Q is an empirically derived measure of the balance between in-group cohesion and out-group openness required to support creativity. Illustrations are given of how these five conditions for flourishing have underpinned the rapid expansion of philosophy and psychiatry in the closing decades of the twentieth century, and, correspondingly, are also reflected in the Handbook as a whole. Overviews and commentaries on individual contributions to the Handbook are given in extended editorial introductions to each of its eight sections. (shrink)

Today the concept of 'schizophrenia' is often presented in psychiatric texts as a construct, a construct bringing together a diverse and, allegedly, independently assailable range of signs and symptoms. According to such a diagnostic scheme two patients may both be allowed to count as suffering from schizophrenia despite sharing hardly a single symptom. The validity of the concept has accordingly been contested by psychologists for its apparent lack of unity. In the absence of clear independent evidence of a unitary physiological (...) disease process underlying such diverse phenomena, a natural enough suggestion has been to... (shrink)

This section concerns the question of how best to understand the scientific status of mental health care in general and psychiatry in particular. On the assumption that psychiatry is based, in part at least, on natural science, what is the nature or the general shape of that science? Some of the chapters aim at shedding light on component parts of a scientific world view: causation, explanation, natural kinds, models of medicine, etc. Others concern potentially fruitful scientific approaches to mental health (...) care, drawing on brain imaging results, phenomenology, enactivism and what can be learnt from debate of the status of psychoanalysis. One overall lesson is that twenty-first-century psychiatry needs twenty-first-century philosophy of science. (shrink)

This Section examines several moral dilemmas and epistemological aporias in clinical practice and shows how clinicians can benefit from the introduction of philosophical methods and discourse. The authors develop these issues having in mind emblematic mental disorders and typical clinical situations. One important claim shared by the Authors is that a great effort has been made to ground psychiatry on evidence-based science, and to tie it to our growing understanding of the human brain. This is obviously an exceedingly important project, (...) but it would be a mistake to assume that the central questions of psychiatry can be completely resolved through scientific inquiry. Science offers guidance for clinical practice only in light of our concepts and normative judgments. (shrink)

In the editorial introduction the stage is set for the chapters in the section by a brief discussion of the relationship between the disciplines of philosophy and psychiatry. Then each chapter briefly is summarized or highlighted.

In this introduction to the Section II, the thrust of the component chapters is described. An important strand in the philosophy of psychiatry since its beginnings has been sociopolitical critiques: criticism which aims to improve and humanize psychiatric practice and mental health systems. From this standpoint, the introduction provides an overview of this tradition, including considerations of "postpsychiatry," value commitments in psychiatry, the recovery movement, racism and sexism in the field, and technology.

A cross-disciplinary discussion of the basis of interpersonal relating is of interest to philosophers and psychiatrists for several reasons. The development of successful clinical practice may depend, at least partly, on having an accurate understanding of the basic character of unimpaired interpersonal relating because such understanding can shed light on the nature and source of its disturbed forms. How we think about the basis of "mind-minding" competencies influences how we think about the prognosis and possible treatment of dysfunctional interpersonal relating. (...) Another reason is that philosophical frameworks influence the way we think about and evaluate possible psychiatric disorders and philosophical discussions may be of direct practical importance to psychiatry given that different theories suggest different potential ways of devising therapies. (shrink)

The editorial introduction sets the stage for the chapter by identifying the roles that concepts and categories play not just in the field of mental health medicine but in the human mind itself. Then, each chapter is summarized or highlighted.

Following on from Section IV on summoning concepts, this section of the Handbook presents theoretically informed descriptions of psychopathologies. The topics of the chapters range from anxiety, depression, and body image disorders, through emotion and affective disorders, to delusion, thought insertion, and the fragmentation of consciousness. These phenomena call, not only for assessment and diagnosis, but also for understanding on the part of both the engaged clinician and the philosophical commentator. They also provide case studies for general philosophical questions about (...) different levels of description and conceptualisation and the relationships between them, and about the contributions to psychological understanding that are made by phenomenology, clinical expert knowledge, and the sciences of the mind. (shrink)

In this introduction to Section VI, the thrust of the component chapters is described. The classification and diagnosis of mental disorders collects a number of philosophical challenges to the field that call for responses from a variety of philosophical resources: hermeneutics, phenomenology, philosophy of mind, narrative theory, philosophy of science, epistemology-to name a few. The authors in this section address the general challenges in the classification of psychopathology, as well as address particular kinds of mental disorders, including autism, dementia, mania, (...) psychotic disorders, and personality disorders. (shrink)

Hauptman’s paper tells of a Mr. A, who refused exogenous treatment for the depression he felt consequent on the end of a romantic relationship, because such treatment seems to be inauthentic and despicable. It seemed this way because the depression felt like an apt response to the loss of the beloved.Like Hauptman, I have some sympathy with Mr. A’s position. To medicate away authentic emotional reactions to the trials of living is, it seems to me, to promote a form of (...) self-alienation and radical inauthenticity. Surely only the blandest form of life, which had substituted the virtues of living a truthful and meaningful life informed by those emotions that themselves embody essential information about our self in... (shrink)

Philosophical engagements with psychoanalysis have taken several forms. Some have offered a philosophical re-vision of psychoanalytical understandings of human nature. Thus, we have Boss, Binswanger, Sartre, and Merleau-Ponty offering us existential-phenomenological; Ricoeur hermeneutic; Lacan structuralist; and Heaton, Elder, and Fingarette Wittgensteinian, readings of unconscious life and of therapeutic action. Such philosophical elaborations of the most apt reflective and the most fruitful revisionary understanding of dynamic unconsciousness also involve parallel critique of such aspects of psychoanalytical psychology's immanent self-understanding as...

Journal of Philosophy of Education, Volume 56, Issue 1, Page 124-128, February 2022.

In lieu of an abstract, here is a brief excerpt of the content:Mental Disorder and Intentional OrderRichard Gipps (bio)Bengt Brülde and Filip Radovic inform the reader that they will assume "there is such a thing as a general category of disorder, of which mental and somatic disorders can be regarded as subcategories" (2006, 100). With this assumption in place, they take up a fascinating discussion of what warrants our categorizations of certain disorders as mental as opposed to physical. The answers (...) they then canvass include the possibilities that it is the mentality of the internal causes, or of the symptomatic effects, of these disorders which renders them mental, or that there is no single answer, or that there is no valid distinction to be drawn.In what follows I wish to question the initial assumption, and then offer an understanding of the nature of mentality that I hope will lead to a different way of answering the question, what is mental about mental disorder? It worries me that the views I develop here may share too little by way of common framework assumptions with the views developed in Brülde and Radovic's paper. I hope that this does not render dialogue impossible, or make the thoughts that were inspired by their thoughtful paper appear just too off field to be seriously entertained.The Concept of DisorderBrülde and Radovic assume that "mental disorders" and "physical disorders" are subtypes of a general category of disorder. (In what follows I describe this as the assumption.) They also distinguish between two questions: (1) What is mental about mental disorder? (in what follows I describe this as the question) and (2) What does it take for a condition to be a disorder? This latter question is, they acknowledge, certainly important, but is set aside for the time being.Mental disorder, physical disorder, and we might perhaps also add social disorder, are then subcategories of disorder. They are perhaps not natural kinds, but nevertheless they are subcategories within a general category. With their assumption in place it makes good sense to reject accounts of the mentality of mental disorders that seem to simply presuppose the concepts of mind and body when they address the question.There is of course a trivial sense in which everyone must agree that mental disorders and physical disorders are to be considered subcategories of disorder. There is what could be described as a logical sense of category and subcategory, in which any noun is said to designate a category and any adjectival qualification of it to introduce a subcategory. However, we can also distinguish what I call a "semantic" sense, in which talk of categories and subcategories is more restricted. Here we rely on there being a unitary sense to the putative category if we are to talk meaningfully of subcategories of this single category. [End Page 117]The philosophy of the individuation of senses is not within my expertise, but I am relying on an intuitive notion spelled out by the following. First, that a good dictionary would elaborate these senses by providing different definitions of the putative category rather than a single definition followed by examples. Second, that when we do not have to do with categories in the semantic sense, we would find ourselves more in want of true understanding of what was being said, and not so much in want of mere further knowledge, if we are offered a description that included the noun (disorder) without the qualifier (mental). Third, that we are less likely to be dealing with subcategories within a general semantic category if we easily can turn the adjective–noun pair (e.g., mental disorder) around to provide two nouns in a short phrase (e.g., disorder of the mind), or if there are verbal and adjectival forms of the second noun that can also be used in conjunction with the first noun (e.g., disordered mind).An example serves to make things clearer. Consider a chemist who has a reaction in her laboratory. What is referred to may be an emotional reaction (to her sudden scientific breakthrough), or a chemical reaction. In this case, I suggest, we do not have to do with a semantic category of "reaction," which... (shrink)

In his paper on 'The Science of Psychoanalysis,' Lacewing helpfully distinguishes a central psychodynamic model of the mind, elaborated in the clinical theory of psychoanalysis, from certain of its metapsychological and etiological theories. Critics who view psychoanalysis as unscientific have tended to focus on the lack of evidential support for certain of its developmental claims or the lack of reliability and validity in its theoretical posits. Lacewing claims, however, that the model contained in the clinical theory is much more scientifically (...) respectable than its critics have made out. The data may not always be in, but Lacewing's argument is that there is nothing pseudoscientific about the central model that... (shrink)

When assessing a new philosophical theory of psychopathology, a first question might be: is it descriptive or revisionary in intent? Does it aim to provide reflective understanding of what is already meant by correct uses of ‘mental disorder’? Or instead to redeploy that familiar term in articulating a new concept meeting particular desiderata? Nielsen offers us an ‘enactive conceptualization’ of mental disorder, and conceptualizations are typically understood as inventive rather than descriptive. However it was not entirely clear to me, from (...) reading his text, that this was indeed his ambition. My first question for Nielsen, then, is clarificatory: does he intend his project as descriptive or revisionary?If the... (shrink)

In her commentary, Dibitonto helpfully compares my understanding of schizophrenic ego disturbance with that of Blankenburg. His patient Anne described her true schizophrenic difficulty as obtaining in some sense 'before' those experiential disturbances she can articulate. Ordinary conversational modes misleadingly invite her and us to attempt describing her difficulties in terms which presuppose the intactness of, rather than capture the underlying disturbance to, her self-hood. They fail to locate the disturbance deep enough, fail to grasp how it arises 'before' what (...) is readily articulable in the psyche. I believe this is the same 'before' which prompts my own articulation of schizophrenic ego... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Pathology of the Mind: Disorder Versus DisabilityRichard G. T. Gipps (bio)Keywordsorder, disorder, ability, disability, mental illnessAlfredo Gaete (2008) describes mental disorders as impairments in intentionality, phenomenal consciousness, and intelligence that cause harm to the affected person. I found persuasive Gaete’s claim that the concept of ‘mental disorder’ is best understood as nontheoretical and nontechnical. I also find compelling his argument that a previous contribution of my own—which relied in (...) part on specifying different senses of ‘disorder’ in psychological, physiological, and social cases—was misguided. Further, his suggestion that we ought at least to attempt analysis in terms of necessary and sufficient conditions before we seek out less definitive characterizations (in terms of family resemblances) also persuades me, although I find myself less sanguine than he about the general possibility of achieving such analyses.One of Gaete’s principal claims is that mental disorder is helpfully understood in terms of an absence of a capacity—that is, as a disability. There are two related objections—or two aspects of the same objection—that I would like to offer the author with respect to this claim. These may well not be conclusive, but will I hope at least function as foils against which the author can usefully sharpen his argument. One objection suggests that there is a viable distinction between the concepts of mental disorder and mental disability, as commonly used in clinical contexts, which the account offered seems unable to respect. The second suggests that the account may not be able to theorize what is argued to be the essential contribution of the concepts of order and disorder (as opposed to ability and disability) to the everyday concept of mental disorder. Accordingly, it questions the power of a disability approach such as Gaete’s to capture the essential nature of mental disorder.In his paper, Gaete classifies mental retardation and developmental, or (what in the United Kingdom are known as) learning, disabilities (autism, etc.) as cases of mental disorder. I found this surprising because it is not common linguistic practice in the psychological circles in which I operate. It would also seem to make a nonsense of commonly accepted ideas like: “Mental disorders are more likely to occur in patients with developmental disabilities (e.g., in autism, Asperger, or Down syndrome) than in the general population.” (For an example, see Campbell and Malone [1991]). On Gaete’s classification, it would appear that people with autism eo ipso have a mental disorder, and [End Page 341] hence the commonly accepted idea would need to be interpreted as merely a statement about comorbidities of different disorders of the same general (i.e., mental) type. But that is not, I believe, how the term is commonly used, and Gaete’s suggestion must therefore be treated as revisionary rather than descriptively analytical.One way of reconstructing a rationale underlying the distinction between mental disabilities and mental disorders is as follows. A developmental disability involves a failure of (certain aspects of) the mind to grow and reach an expected level or type of organization. A mental disorder by contrast involves a disturbance or disorganization (not simply an impoverishment) within the mind at whichever level of organization it has reached. As the mind develops, and reaches new levels or types of organization, the forms which mental disorders may take accordingly change.Autism and schizophrenia provide helpful illustrations of this distinction. Autism represents a failure of (among other things) the social mind to develop in childhood. The person with moderate to severe autism may attain at best a very shaky grasp on the realities of other minds and social conventions. That is, the degree of mental structure they obtain—their social competencies or capacities—will likely remain limited. It is this fundamental deficit that marks out the disability, and not the social anxieties or other such disturbances that can beset the autistic person.Schizophrenia, by contrast, tends to occur at late adolescence, when the individual has developed higher levels of—albeit often fragile—mental structure. Yet it is not the fragility of such mental structure, but rather the disruptions that can occur within such structures as have developed, that mark them out... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Background Theory of Delusion and Existential PhenomenologyRichard G. T. Gipps (bio) and John Rhodes (bio)KeywordsPhenomenology, psychological explanation, epistemology, schizophreniaSituating and Clarifying the PaperThe commentaries of Nassir Ghaemi and Giovanni Stanghellini help to sketch out the intellectual landscape of philosophical perspectives in psychiatry, and situate our paper within it. A happy convergence between the analytical philosophy perspective from which we were writing, and the existential–phenomenological paradigm described by both (...) authors, is the result. Stanghellini in particular carefully describes three main theories of existential deformations, tracing delusion formation back to either (i) a disturbance of meaning synthesis conceived as a dysfunction of a Husserlian consciousness, (ii) a disturbance of pre-reflective self-consciousness resulting in a kind of paralyzing hyperreflexivity, and (iii) (Stanghellini’s preferred model) a disturbance of embodiment. This final account views delusion as springing from a failure in the subject’s corporeal and praxical being-in-the-world. As the subject’s practical, pre-reflective grip on the world is loosened, so their minds become unconstrained by that understanding and practical rationality immanent within that grip, and thought, now unconstrained, starts to travel through delusional worlds. Stanghellini accordingly views our model as an example of a disembodiment theory, which allows it to overcome the disadvantages of the first two models, which may both, in their own ways, overvalue the rôle of (disturbances of) reflective consciousness in the formation (and delusional deformation) of everyday understanding.Being situated within a preexisting landscape has both its benefits and its disbenefits, the principle example of the latter being the potential assimilation of anything new to what has already been said. Thus, although we are grateful to our commentators for placing us on the larger historical and conceptual map, it may be helpful to briefly rehearse our motivations for drawing on the philosophical ideas of the Bedrock and Background in our theory of delusion. Our paper was primarily motivated by a concern that current, psychologically mainstream, cognitive models of delusion, although helpfully drawing our attention to common reasoning and perceptual deficits in the person with psychosis, fail to adequately account for what is delusional about delusions. It was, in [End Page 321] particular, to account for the certainty with which the deluded person clings to often quite extraordinary beliefs that we drew on the epistemological notion of the background. And although this epistemological notion fits quite neatly with ontological concerns regarding the embodied and praxical character of human existence, it is the particular epistemic rôle that it played in our theory—to do with the extraratiocinative constraint on judgement provided by the Background—that we wish to stress here.We return to this shortly, but first wish to comment briefly on two specific considerations raised by the commentaries. The first concerns Stanghellini’s claim that, for us, “when studying delusions, the focus should be on providing an adequate framework for understanding, rather than providing empirical hypotheses to be tested” (2008, 311–314). It seems to us, however, that both are equally important. What we wished to stress, however, was that empirical hypothesis testing may be led astray if it is not informed by an adequate framework for understanding. For example, most cognitive psychological experiments on delusions concern themselves with the individual’s ability to make appropriate guesses (e.g., regarding the color of beads in a bag), and their tendency to jump to conclusions; they do not concern themselves with the kinds of extraordinary conviction and certainty met with in delusion. The risk run by empirical researchers of cognitive factors in delusion is that a lack of a prior adequate theorization of delusion makes for accounts that are ultimately only of the formation, not of delusion in particular but rather of false or unusual beliefs more generally. An analytical approach, however, can help to explicate the ways in which the psychiatric concept of delusion fails to be adequately characterized by the quite general ‘external criteria’ of delusion (as Jaspers [1963] called them: falsity, stubbornness, uncommon), and aids in the construction of empirical hypotheses this time constrained by an understanding of the true ‘internal criteria’ of psychotic belief. Such an approach helps to spell out the... (shrink)