Abstract: The past twenty years have seen an increase in the importance of the body in psychology, neuroscience, and philosophy of mind. This ‘embodied’ trend challenges the orthodox view in cognitive science in several ways: it downplays the traditional ‘mind-ascomputer’ approach and emphasizes the role of interactions between the brain, body, and environment. In this article, I review recent work in the area of embodied cognitive science and explore the approaches each takes to the ideas of consciousness, computation and representation. Finally, I look at the current relationship between orthodox cognitive science and the study of mental disorder, and consider the implications that the embodied trend could have for issues in psychopathology.

Abstract: 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.

Abstract: In this paper, we consider the nature of two aspects of human emotional experience—moods and affects—in their relation to the concept of the person. We argue for the importance of the concept of the person in an approach to human emotional experience. This paper differentiates between the concepts of minimal self, extended self, and person. Furthermore, it offers a phenomenological proposal to understand the feeling dimension of moods and affects as critical for the differentiation of human emotional experience, and hence an understanding of that experience. By way of conclusion, we opt for a narrative approach to the question of the normative dimension of emotional experience to clarify the intricate relationship between mood and personhood.

Abstract: This work begins by proposing the need for exploring the mode of being of mental disorders. It is a philosophical study in an Aristotelian perspective, with special emphasis on the anthropological–cultural dimension. It is difficult for such an inquiry to be carried out from within psychiatry or clinical psychology, committed as these fields are to their own logic and practical conditions. The issues are, in any case, more ontological than strictly clinical in nature. We therefore turn to Aristotle, and specifically his doctrine of the four “causes,” to flesh out the social and cultural dimensions of mental disorders. In accordance with the present analysis, the material cause of disorders would be found in the contingencies of life; the formal cause would pertain primarily to the way clinical conditions themselves can serve as models of ‘being ill’ in our society; the efficient cause would correspond to the patients themselves, understood as active (albeit less than fully conscious) agents as well as to the pharmaceutical industry and the mass media; the final cause would be found in different adaptive functions served by the disorder. We conclude that the “mode of being” of most (if not all) mental disorders—in particular, their status as mental disorders—can often have more to do with cultural forms than with biological factors.

Abstract: The central idea of values-based practice is that clinical judgements should accommodate 'dissensus' by concentrating on right processes rather than good outcomes. Dissensus, however, has a philosophical history in political theory, especially liberal political theory, which may provide further tools for values-based practice. But it is not without difficulty. Rawlsian political theory aims to limit dissensus by presupposing rational consensus. Agonistic liberalism, although more promising, still leaves the problem of how conflicting views can be understood without presupposing some basic shared agreement.

Abstract: I am very grateful to Charles Guignon and Andrew Warsop for their interesting, insightful, and helpful commentaries on my paper “Existential Feeling and Psychopathology” (2009a). In this response, I first address two concerns raised by Warsop, regarding the nature of pathology and the fact that we do not just experience a ‘world’ but a ‘social world.’ Then I respond to the criticism, made by both Guignon and Warsop, that I overemphasize bodily feeling and—in the process—fail to make the most of Heidegger’s work.

Abstract: This article considers the relationship between phenomenology and behaviorism in a new perspective. First, we present the phenomenological approach of the Spanish philosopher Ortega y Gasset (1883–1953). Ortega’s perspective involves a transformation of classical phenomenology in a direction that emphasizes ‘life as action’ and ‘historical reason’ as a form of explanation. These aspects of Ortega’s approach are of interest to contemporary phenomenology, and enable phenomenology’s relationship with behaviorism to be reconsidered. Second, we present Skinner’s radical behaviorism, the variant of behaviorism most relevant to phenomenology. Of particular importance here is radical behaviorism’s emphasis on final causality and its approach to ‘private events’ in terms of the interpersonal functions served by these events. Third, we propose a mutual correction, both of behaviorism by phenomenology and of phenomenology by behaviorism, in which behaviorism’s notion of the environment may better be conceptualized through the phenomenological notion of the ‘lived-world,’ and phenomenology could adopt radical behaviorism’s dialectical and constructivist perspective. Finally, we discuss several implications for understanding psychopathology.

Abstract: This article attempts to show the importance of the concept of superstition in understanding a range of psychological problems. With this aim, we critically analyze several constructs that, without actually using the term “superstition,” concern this phenomenon and its role in the development of mental disorders. First we discuss “Thought–Action Fusion” and “magical thinking,” two concepts from the cognitive tradition that view superstition as basically an ideational phenomenon. Second, we look at “Experiential Avoidance,” a post-Skinnerian concept that understands superstition as a type of avoidance behavior for certain private events. Third, we discuss superstition as an emotional phenomenon, in particular, Jean-Paul Sartre’s phenomenological analysis of emotions as magical operations. Finally, we review a cultural approach to superstition and its influence on psychopathology. In this perspective, superstition is seen as a cultural form linked to the historical–social context, which is fostered by certain social practices or institutions, including (perhaps surprisingly) certain features of modernity.

Abstract: • The formation and maintenance of delusions becomes intelligible once they are seen to reflect a basic disturbance. When studying delusions, the focus should be on providing an adequate framework for understanding, rather than providing empirical hypotheses to be tested. • The basic disturbance in delusions, and insanity in general, is not a deficiency in reasoning or a defect in the content of experience, but rather something more fundamental. • Delusions—this is their central claim—are caused by a failure of the Bedrock of beliefs (Wittgenstein) or the Background (Searle) to adequately inform or constrain the process of belief formation. • Our Bedrock certainties are defined—following Wittgenstein—as ultimately constituted by our ability to act in the world and demonstrate our primary engagement with the world. They are born out of our everyday experience of the world, conveying our direct, pre-reflective, and practical grasp of the world, rather than expressing judgments we make about it. • Similarly, the Background is defined as those abilities and dispositions that are neither representations nor rules, that function before we can make sense of our experiences. • Wittgenstein’s Bedrock and Searle’s Background in great part overlap with Blankenburg’s pre-reflective natural self-evidence and Stanghellini’s common sense, namely, our own unreflecting know-how, a set of nonpropositional skills, capacities, and dispositions that attune us with the world. • Without a fully functioning Background, the distinctions between imaginary and real (mind and world), self and non-self, and cause and coincidence fail to be adequately drawn within experience. Also, grasping the meaning of others’ behaviors and a weakening of contextual influences are entailed by an erosion of Background sensibilities.

Abstract: Feelings in general tune us into the world and give us a sense of where we stand (Taylor 1985, 47). Some rather subtle feelings present us with an all-pervasive sense of our existential predicament in the world. These include, for example, feeling “disconnected,” “not all there,” “out of it,” or, more commonly perhaps, feeling “on top of things,” “in charge,” or “with it.” In “Existential Feeling and Psychopathology,” Matthew Ratcliffe (2009) develops a detailed and insightful phenomenology of these sorts of “existential feeling,” as he calls them, illuminating them by contrasting them with pathological feelings as they are described in both literary works and in psychologists’ writings on schizophrenia and other disorders. He also develops a phenomenology of the experience of touch to show how feelings of touch provide us with a better understanding of existential feelings than do the examples most commonly considered in writings on perception, namely, visual perception and proprioception. Ratcliffe’s essay is a sample of the rare breed of genuinely original and consistently insightful papers written from the standpoint of both phenomenology and psychology. He has a fine grasp of Husserl and Merleau-Ponty, and he knows how to reap the most from telling quotations from their writings. He also expresses a debt to Heidegger, although I believe that Heidegger has more to offer than Ratcliffe realizes.

Abstract: The life of Saint Teresa of Jesus, the most famous mystic of sixteenth-century Spain, was characterized by recurrent visions and states of ecstasy. In this paper, we examine social components related to Teresa’s personal crises and the historical conditions of her times, factors that must be taken into account to understand these unusual forms of experience and behavior. Many of these factors (e.g., increasing individualism and reflexivity) are precursors of the condition of modern times. Indeed, certain parallels can be observed between Saint Teresa and certain present-day psychopathological disorders. The analogy should not, however, be carried too far. Religion played a particularly crucial role in Teresa’s cultural context; as a result, it would be misleading to view her mystical experiences as resulting from a mental disorder.

Abstract: In examining Hegel's and Kierkegaard's theories of language, I argue that both entail conceptions of the therapeutic power of language to heal us from madness and despair. I show that whereas Hegel quite straightforwardly celebrates the emancipatory power of language, Kierkegaard is more ambivalent; on the one hand, he devotes his life to a maieutic authorship in service of aiding the reader, but on the other, he believes that ultimately it is only faith in God that can cure us, and that faith requires silence. I use Lacan's psychoanalytic account of the role of language to explore Hegel's view that language constitutes the self and Kierkegaard's experimentation with an indirect form of communication that he hopes will enable him to fulfill each of his apparently conflicting goals, to write and yet to remain silent.

Abstract: Values-based medicine derives from an approach first introduced into the philosophy of psychiatry, which aims to demonstrate that the reality of mental illness is not inconsistent with the scientific status of medicine. Associated primarily with the work of K.W.M. Fulford, the argument is that practitioners need to be ethical anti-descriptivists if they are to avoid the authoritarianism of evidence-based medicine, which overlooks the fact that genuine value conflicts can arise during all clinical encounters, and that psychiatry is just the most explicit area in which these occur. This paper takes a philosophically therapeutic line and argues that, by reducing values to the status of preferences, antidescriptivism undermines the value of 'value' and leaves the practitioner with a reduced ability to discern and negotiate genuine conflicts of value. The conclusion is that patients should be respected, not as instantiations of preferences but as valuers ; and that this requires practitioners to become more cosmopolitan and sympathetic, not more theoretically sophisticated.

Abstract: Varelius seeks to redefine what constitutes mental disorder or mental illness. (I use these terms interchangeably.) “According to this account, ‘a person is mentally disordered when her psychological capacity for autonomy is diminished as compared with that of a typical member of our species of her age-group” (Varelius 2009). This is a stimulating and important paper. Varelius describes fruitfully the relationship between mental illness and autonomy, specifically the ways in which mental disorder can undermine autonomy. This is valuable in understanding the impact of mental illness on the lives of people who suffer from it, which is a serious issue in practical ethics. But is it what constitutes mental disorder or illness? There are logical, conceptual reasons why we should not redefine mental illness in this way.

Abstract: Dr. Aragona’s article in this issue of Philosophy, Psychiatry, & Psychology makes some important points regarding the relationship between comorbidity rates and the classification system currently used in psychiatry. Particularly persuasive is his claim that observed patterns of comorbidity are, in important respects, consequences of the structure of the classification system. I am not convinced, however, that comorbidity is best conceptualized as an artifact of the taxonic structure of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). Instead, I suggest that the use of dichotomies such as true versus artifactual should be used with caution when psychiatric classification is being discussed. In contrast with the artifact hypothesis, I argue that the phenomena covered by the term “comorbidity” are real, expectable features of the psychiatric domain. They are not the phlogiston and luminiferous ether of psychiatry. I am skeptical of the notion that high comorbidity rates as a whole can be understood as Kuhnian anomalies, or that there is a crisis, or that after a period of revolutionary science a new paradigm would eliminate these ‘anomalies.’ In short, high rates of comorbidity in psychiatry will not simply disappear once scientists develop a better nosological paradigm. High levels of comorbidity can, however, be both lowered and provided a better, evidence-based conceptual framework.

Abstract: Since the early 1990s, the philosophical de- bate over broad accounts of mental illness has stalled. Although there remains unresolved tension between mixed and medical models of mental illness, bioeth- ics seems to be moving from a naturalistic account of mental illness to one in which illness is determined by applying an evaluative notion of function. Nonetheless, existing models often underestimate the role of social norms in defining illness. Most important, such models have paid inadequate attention to the relevance of wider philosophical assumptions about the objectivity of ethics and the concept of personhood to our understanding of illness. I attempt to demonstrate that these concepts are integral for differentiating mental illnesses from the vast array of irrational and pre-rational drives and personality traits for which we usually wish to hold the bearer morally responsible. In emphasizing the normative component in accounts of mental illness, I am not attacking psychiatric expertise, but rather endeavoring to bring philosophical discussion closer to the actual, informal decisions that psychiatrists (in particular forensic psychiatrists) regularly make when asked to determine someone's moral responsibility for a mental condition.

Abstract: The epistemological principles underlying randomized, controlled trials and evidence-based medicine generally have not received the attention they require. Broadly speaking, they are the application of work done over several centuries in philosophy and scientific method. The epistemological base is sound, but it also implies internal limitations, having to do with decreasing generality, which particularly affect application to psychological problems. The principles also have nothing to say about values. The question of the 'objective validity' of scientific method is briefly discussed.

Abstract: Psychiatric interviewing highlights the apparent tension between psychiatry's quest for objectivity and its aim to chart the particular experiences and values of individuals. Neo-Kantian philosophy can help to shed light on this apparent tension. There need be no conflict between an exploration of individual values and scientific inquiry, not least because values play a central role in the selection of facts in scientific observation in general and psychiatric history taking in particular.

Abstract: The debate on the validity of the evidence-based medicine (EBM) paradigm in psychiatry and psychotherapy has tended to be rather polarized. Critics of the paradigm maintain that there is a basic conflict between the general knowledge of treatment of groups of patients ('techne') and the contextual understanding of individual patients ('phronesis'). This paper argues that the existence of firm general knowledge is crucial to the legitimacy of the psychiatric as well as the medical profession as a whole, and defends the controlled clinical trial as a central instrument to establish such knowledge. At the same time, however, the paradigm does not solve the old Aristotelian techne–phronesis dilemma, which seems to be more or less inescapable. Focusing on psychotherapy, the paper discusses problems connected with the 'techne-oriented' use of diagnostic principles and of therapy manuals, the criteria for therapeutic progress, and the apparent conflict between experimental efficacy and practical effectiveness.

Abstract: The evidence-based practice movement fails to pay attention to and to respect sufficiently the fundamental differences that exist between clinical practice and the kind of research that is modeled on the natural sciences. According to M. Polanyi knowledge, will always have a tacit dimension that is not possible to operationally define. This paper argues that the tacit dimension is especially important in clinical knowledge. This represents a challenge to the dominance of positiv- ism and to the evidence-based practice movement. As psychiatrists, we must be able to attend to the patient's perspective, his subjective experience and context. Clinical practice is a careful balance between dialogue and technique. Evidence-based psychiatry might tilt this balance toward a more technical attitude. This could pose problems, considering the importance of the so- called nonspecific factors in psychotherapy.

Abstract: During the last years, there has been an important discussion on the concept of mental disorder. Several accounts of such a concept have been offered by theorists, although neither of these accounts seems to have successfully answered both the question of what it means for a certain mental condition to be a disorder and the question of what it means for a certain disorder to be mental. In this paper, I propose an account of the concept of mental disorder that, if I am right, provides satisfactory answers to both of these questions. Furthermore, this account (unlike other accounts presented in the literature on the subject) meets the requirements for achieving a crucial goal underlying the project of sorting out the concept of mental disorder, namely the goal of allowing the existence of a dialogue between mental health professionals of different theoretical orientations. To achieve this goal, the account herein proposed is not based in any particular theoretical framework, but in both ordinary and technical theory-neutral concepts. In the last part of the paper, I argue that it follows from most accounts of the concept of mental disorder that the disciplines concerned with explaining some mental disorders are not branches of medicine, and that the treatment of some mental disorders is not a matter of medical intervention.

Abstract: Decision-making capacity (DMC) is normally taken to include (1) understanding (and appreciation); (2) the ability to deliberate or weigh up; and (3) the ability to express a choice. In an article published recently in PPP , Jacinta Tan and her colleagues (2006) suggest that DMC requires also (4) the absence of 'pathological values' (i.e., values that arise from mental disorder). In this paper, I argue that although (1)–(3) might be necessary for DMC, (4) is not necessary (barring cases where pathological values interfere with (1)–(3)). My argument will simply be that (4) fails to be supported by the empirical data provided by Tan et al., which I claim supports the view that people with pathological values do often have DMC. I also consider but reject the claim that pathological values entail incapacity because they are not 'authentic' to the person. I conclude that the absence of pathological values does not constitute an additional element of DMC and that we cannot justify compulsory treatment of people who have (1)–(3), but not (4), on the grounds they lack DMC.

Abstract: Anthropological ideas can effectively provide basic concepts for psychiatric understanding. However, the kind of anthropology used greatly determines the form psychopathology and psychiatric practice then assume. The use of certain phenomenological theories in so-called Anthropological Psychiatry runs the risk of overlooking the realm of human sociality. It furnishes an approach that tends to be reductionistic because it focuses on human beings as individuals. Helmuth Plessner’s more dialectically shaped anthropology with its central concept of the “eccentric positionality” can provide an alternative to this reductionism. More adequate anthropological descriptions can be developed, in my judgment, by adopting Plessner’s framework. In this paper, Plessner’s most important ideas about a dialectical anthropology are discussed. As a conclusion, a connection with psychiatric understanding and practice is established.

Abstract: A certain kind of externalism—"the view from nowhere"—lies at the heart of evidence-based medicine (EBM). As a consequence, the individual case glides out of focus. However, to judge to what extent external knowledge is applicable to an individual case, the clinician has to rely on some sort of knowledge of the case at hand. The article focuses on the tension between the externalism of EBM and the "internal evidence" one has to presuppose when making clinical judgments.