Abstract
Psychopathology is the study of the signs and symptoms of psychiatric disorders - delusions, hallucinations, phobias, depression, for example. This book gives an account of the terms currently in use and attempts an in-depth analysis of the nature of each. The matter is examined both from a philosophical perspective and from the point of view of what is known about the function of the hemispheres of the brain.
... It is what the phenomenological psychiatrist, Minkowski (1953Minkowski ( , 1970, calls the "loss of vital contact with reality." The latest proponent of this view is John Cutting (1997;1998) who aligns himself with Minkowski's concept of morbid objectification (or, morbid rationality) and Louis Sass' concept of hyperreflexivity. The patient with schizophrenia does not suffer from irrationality or a regression (in the psychoanalytic sense) to a more primitive state, but from a morbid and excessive rationality: it is " ... a disease of the intellect born at the highest pitches of self-consciousness and alienation" (Sass 1994, p. 12). ...
... One might say that there is hyper-mind and hypo-body or that the patient lives the mind-body problem which, for the philosopher, remains only a dilemma for thought or metaphysics. It involves a "detachment from rather than a being overwhelmed by emotion and desire" (1994, p. 12).7 Similarly, Cutting (1997) calls schizophrenia "an emotionless disorder." (p. ...
... The effects of "perceptual and cognitive satiation" are well known to cognitive psychologists (Esposito, 1987). Although Cutting (1997) acknowledges that there are anomalous perceptual experiences in schizophrenia, he nevertheless reports that the objects of experience remain intact, if "often nonvivid and out of context" (Cutting, 1997, p. 502). That is, the danger in schizophrenic psychosis and other symptoms comes from above, not below. ...
... They mainly express our ontic, everyday concerns (Stanghellini, 2008aStanghellini, , 2008b, Sass and Pienkos, 2013a, 2013b) about the consequences of losing one's prerogatives (rather than achieving new ones), that is, moral, physical and financial integrity. The following is an example of the depressives' anxieties exquisitely attuned to the anxieties of allTable 2. other human beings, to be contrasted to the kind of ontological concerns characterizing people with schizophrenia: 'Nothing works in the house; nothing to wear – no clothes; all plants in the house are dead; clothes and ties are placed in house by others' (Cutting, 1997). Delusions of guilt articulate the concern to have lost one's moral integrity, that is, one's commitment to be there for the others. ...
... s is a state whereby reality becomes suspended between meaninglessness and imminent revelation of a new meaningfulness: 'Something is going on. Please tell me what is going on!' (Jaspers, 1997). Such pre-delusional suspension involves some sort of ineffable change which rests upon a global quasi-perceptual transformation of the feeling of realness. Conrad (1958) named this pre-delusional prodrome 'das Trema' – a kind of atmosphere where everything feels strange, ominous, uncannily transformed. Reality is undergoing some inexplicable, ineffable, ungraspable change. The world is pervaded by a kind of latent meaningfulness: it has lost its habitual familiarity, and has not yet acquired a new kind ...
... These include experiences of 'dynamization' of bodily boundaries ('Areas of body where forces enter'), bodily construction ('Mouth was where hair should be'), body appearance ('Face changing'), and 'externalization' ('Vagina half outside'). Other typical phenomena are 'morbid objectivization' and devitalization ('Felt programmed like a robot') (Cutting, 1997; de Haan and Fuchs, 2010; Stanghellini, 2008b; Stanghellini et al., 2012; Stanghellini and Rosfort, 2013; Stanghellini et al., 2014b, in press). ...
It is a current trend in psychiatry to discard the Kraepelinian dichotomy schizophrenia vs. manic-depressive illness and use the overinclusive label ‘psychosis’ to broadly indicate the whole spectrum of severe mental disorders. In this paper we show that the characteristics of psychotic symptoms vary across different diagnostic categories. We compare delusions in schizophrenia and major depression and demonstrate how these phenomena radically differ under these two psychopathological conditions. The identification of specific types of delusions is principally achieved through the differential description of subjective experiences. We will use two general domains to differentiate schizophrenic and depressive delusions, namely the intrinsic and extrinsic features of these phenomena. Intrinsic features are the form and content of delusions, extrinsic ones include the background from which delusions arise, that is, changes in the field of experience, background feelings, ontological framework of experience, and existential orientation. This kind of systematic exploration of the patients’ experience may provide a useful integration to the standard symptom-based approach and can be used to establish a differential typology of the clinical manifestation of psychosis based on the fundamental alterations of the structures of subjectivity characterizing each mental disorder, particularly with respect to the Kraepelinian dichotomy schizophrenic vs. manic-depressive illness.
... Others (Bleuler 1922;Kretschmer 1922;Minkowski 1927;Blankenburg 1971;Kraus 1977;Parnas and Bovet 1991;Cutting 1997) consider impairments in the area of interpersonal competence not just as an outcome of psychotic syndromes, but also as a fundamental phenomenon of psychotic (schizophrenic and manic-depressive) vulnerability. Critics of DSM-IV's pseudo-atheoretical and syndromatological approach to the diagnosis of schizophrenia maintain that, although we lack established criteria to define the core features of schizophrenia, nonetheless, we feel, or intuit, the existence of a basic relational deficit characterizing schizophrenic patients (Maj 1998). ...
... When this balance between inclusiveness and separateness breaks down, and the polarization into one of these components takes place, we enter the field of psychopathology (Kretschmer 1922;Minkowski 1927;Stevens and Price 1996;Blankenburg 1969;Cutting 1997). The forerunner of this social-psychopathological approach is Blankenburg's analysis of the core disorder in hebephrenic schizophrenia. ...
... Typification disorders (level 2) are related to disturbances of the social knowledge network or to a lack of attunement. Social knowledge network disorders (level 2.1) are assessed either as atrophies of the social knowledge database (Cutting andMurphy 1988, 1990) or as a kind of hypertrophy due to a hyper-extended network of semantic associations between the concepts stored in the database itself (Spitzer 1992;Spitzer et al. 1993;Schwartz et al. 1997). Both disorders lead to deficits in interpersonal competence. ...
Philosophy, Psychiatry, & Psychology 8.4 (2001) 295-298
There are many ways to become a schizphrenic. Each individual has her own schizophrenia, coherent with her life history, her problems and alternatives deriving from them (Binswanger 1960). What clinical psychiatry calls "schizophrenia" is not a unitary illness but a common final state—a "syndrome" in the etymological sense, that is, a condition to which different psychopathological pathways may lead. Schizophrenic symptoms, like Schneiderian first-rank symptoms (delusions, hallucinations, experiences of passivity), are nothing but a rather uniform type of reaction. First-rank Schneiderian symptoms may be interpreted as attempts to explain disturbing basic experiences of change in self, body, and world perception (Klosterkoetter 1988) or as the epiphenomena of complex interactions between sensory disorders (aberrations in the perception of self, body, and world), conceptualisation disorders (impairments in the constitution of meanings and intentions), and attitudinal disorders (eccentric structure of values and beliefs) (Stanghellini 2000a). Since the schizophrenic syndrome, as defined by current diagnostic manuals, lacks any authentic core phenomena, and so-called schizophrenic symptoms are not specific (Berner and Kufferle 1982), the clinical diagnosis of schizophrenia finally becomes a diagnosis by exclusion (Maj 1998). This conceptual weakness is obviously unacceptable (not only for old dissenters from operational diagnostic criteria) and is kindling a velvet revolution in nosological studies and a renaissance of philosophically oriented psychopathological research (Parnas and Zahavi 2000).
Eugène Minkowski was a forerunner in the field of philosophical psychopathology: "The psychiatrist and the metaphysician become one in their common research concerning what is human and human experience" (Minkowski 1947). Indeed, his doctoral thesis on autism (Minkowski 1926) was dedicated to his teachers, the psychiatrist E. Bleuler and the philosopher H. Bergson, and his conceptualisation of autism is an ideal example of the link between philosophical perspectives and psychopathological research. The term "autism" was introduced by Bleuler (1911) to describe detachment from outer reality and immersion in inner life. Bleuler's concept of autism relied on Freud's (1905) notion of autoerotism and on associationistic psychology. According to Bleuler, autism was a consequence of the splitting of psychic functions: a defense mechanism serving to avoid conflicts between desires and reality testing, promoting the shift to inner fantasy life and entailing social withdrawal, emotional indifference, inappropriate behaviors, and idiosyncratic values and beliefs.
Minkowski, who was influenced by Bergson and phenomenology, departed from Bleuler's conceptualisation and defined autism as "loss of vital contact with reality" (Minkowski 1926, 1927). For Minkowski, autism is not a symptom, but a global phenomenon investing the whole person. Autism is a way of being whose essential feature is a pragmatic deficit: Autistic activity consists in the reduced capacity to interact with the external world. Autistic thought is characterized by its lack of communicative action. The pragmatic deviance of autistic language is a good example: The autistic person is not interested in communicating her inner world to the others; language is not a means of communication which serves mutual understanding, a cooperative process whose aim is interlacing one's own world with that of others. The autistic person's use of language is much like a soliloquy, the monologue of the solitary thinker more focused on ex-pression—the outward portrayal of immanent contents of consciousness—than on dialogue—the exchange of meanings between speaker and listener. Moreover, each meaning is presented in its manifold profiles or adumbrations and the task of selecting the context-relevant meaning is left to the listener.
The pragmatic weakening of the autistic person, according to Minkowski, is not simply a social or occupational dysfunction (APA 1994), that is, a renunciation or refusal to act according to social expectations and standards. It involves the loss of vital contact with reality. The meaning Minkowski attributes to the term "vital" is essential for understanding his philosophical approach to defining the schizophrenic condition. Minkowski assumes that contact with reality is vital when it is established through action (and language), since only through action (and language) can man shape his own identity. Minkowski seeks to construct a dialectical theory of autism, although he may...
... There is a possibility of experiencing tactile, auditory, musical, and lilliputian hallucinations [9]. Although musical hallucinations can be enjoyable, most hallucinations are unpleasant and terrifying [10]. Alcoholic hallucinosis Hallucinations, delusions, abnormalities in psychomotor activity, misidentification, and aberrant mood are the hallmarks of the syndrome [8,10]. ...
... Although musical hallucinations can be enjoyable, most hallucinations are unpleasant and terrifying [10]. Alcoholic hallucinosis Hallucinations, delusions, abnormalities in psychomotor activity, misidentification, and aberrant mood are the hallmarks of the syndrome [8,10]. Alzheimer's disorder Hallucinations are common in Alzheimer's disease (AD), with prevalence rates ranging from 12 to 53%. ...
The literature review on hallucinations is discussed, along with how they affect people with various psychiatric conditions, neurological issues, and healthy individuals; causation and types of hallucinations. Additionally, the diagnostic value of hallucinations is examined. There is a brief discussion of the various hallucination management techniques.
... There is a possibility of experiencing tactile, auditory, musical, and lilliputian hallucinations [9]. Although musical hallucinations can be enjoyable, most hallucinations are unpleasant and terrifying [10]. Alcoholic hallucinosis Hallucinations, delusions, abnormalities in psychomotor activity, misidentification, and aberrant mood are the hallmarks of the syndrome [8,10]. ...
... Although musical hallucinations can be enjoyable, most hallucinations are unpleasant and terrifying [10]. Alcoholic hallucinosis Hallucinations, delusions, abnormalities in psychomotor activity, misidentification, and aberrant mood are the hallmarks of the syndrome [8,10]. Alzheimer's disorder Hallucinations are common in Alzheimer's disease (AD), with prevalence rates ranging from 12 to 53%. ...
The literature review on hallucinations is discussed, along with how they affect people with various psychiatric conditions, neurological issues, and healthy individuals; causation and types of hallucinations. Additionally, the diagnostic value of hallucinations is examined. There is a brief discussion of the various hallucination management techniques.
... Although other research has provided substantial evidence for the lateralization of perceptual, cognitive, affective-emotional, and motor functions (for overviews, Cutting, 1997;Gainotti, 2012;Ocklenburg & Güntürkün, 2018), so far there has been little systematic inquiry into possible associations between motives and laterality. The present research aims to do this, both by exploring associations between dispositional motive measures and measures of functional cerebral asymmetries (FCA; e.g., Hausmann & Güntürkün, 2000) -that is, processing advantages of one hemisphere over the other for a given function -and by examining effects of lateralized motor activation on motivational changes. ...
... Note, however, that although we expect Motive x AI interactions to emerge more clearly in women under these conditions, we do not assume that they will necessarily resemble those we obtained for men. The main reasons for this caveat are the profound differential associations between sex and FCAs documented throughout neuropsychology in general (e.g., Cutting, 1997;Lezak et al., 2012;Ocklenburg & Güntürkün, 2018) and, consistent with this but more specifically, the recently observed robust sex-dimorphic associations between AI and motive measures on the one hand and lateralized morphological markers of organizing effects of prenatal (Schultheiss et al., 2019) and pubertal steroid changes (Köllner & Bleck, 2020) on the other. The latter observation suggests differential developmental trajectories of central nervous system lateralization patterns in women and men, which likely interact with activating effects of current fluctuations in steroid hormone concentrations in shaping lateralized cognitive and behavioral outcomes (see Ocklenburg & Güntürkün, 2018, pp. ...
Objectives
We explored associations between the needs for power, achievement, and affiliation and functional cerebral asymmetries (FCAs), guided by three established hypotheses about the nature of these associations.
Methods
One-hundred-and-seven participants completed picture-story measures of dispositional motives and activity inhibition (AI), a frequent moderator of motive-behavior associations, tasks measuring FCAs (line bisection, chimeric emotional face judgments, turning bias, perceptual and response asymmetries on the Poffenberger task), self-reported laterality preferences (handedness, footedness, ear and eye preference), and interhemispheric interaction (crossed-uncrossed difference). They also completed an experiment manipulating hand contractions (left, right, both, neither) while they worked on a second picture-story motive measure.
Results
Dispositional power motivation was associated with stronger rightward asymmetry and less interhemispheric transfer in high-AI and stronger leftward asymmetry and more interhemispheric transfer in low-AI individuals. For the affiliation motive, findings were fewer and in the opposite direction of those for the power motive. These findings emerged for men, but not for women. Left- or right-hand contractions led to increases in power and achievement motivation, but not affiliation motivation. Only left-hand contractions led to decreased AI.
Conclusions
We discuss these findings in the context of sex-dimorphic organizing and activating effects of steroids on motives and laterality.
... Cutting [6] reported an incidence of 34% visual hallucinations and 18% auditory hallucinations. A comprehensive literature review gave a higher figure of 40-75% for any type of hallucination. ...
... A comprehensive literature review gave a higher figure of 40-75% for any type of hallucination. [6] Alzheimer's disease ...
... Cutting, 1997 defined perception without an object or appearance of an individual thing in the world without any corresponding material event. Hallucination takes place at the same time as normal stimulus [22]. ...
... Hallucination is defined as "false perceptions of [interoceptive Smythies, 1956 or exteroceptive Jasper, 1962 percept] that [does not correspond to an actual object Esquirol, 1817; Cutting, 1997] are not in any way distortions of real perceptions [i.e., neither sensory distortion Fish, 1967;1974 in intensity, quality and location of shape or size in space nor misrepresentation, Fish, 1985 i.e., illusion of completion, affect and fantastic] but spring upon their own [unwilled, Slade, 1976 DSM-5, 2013] with [conviction of its reality Aggernaes, 1972] Further, research is required to validate the clinical utility and applicability of the operational definition for its internal consistency and reliability. ...
... Cutting reviewed the case reports and emphasized a striking preponderance of right-hemisphere damage (Cutting, 1997(Cutting, , 2011. Apart from the Penfield reports (which he considered to show six cases, all related to right-hemisphere foci), he found seven reports of the Zeitraffer phenomenon, all associated with right-hemisphere injury. ...
... Diaschisis, an alteration in function in V5 produced by dysfunction in areas connected to it, can also be considered as a possible cause of the abnormal phenomenon. Cutting (1997Cutting ( , 2011 asserted that the Zeitraffer phenomenon derived from a disturbance of the experience of time as personally relevant; in his formulation personal relevance is the general characteristic of right-hemisphere functioning. A different set of cases seems to evince the personal relevance of time, patients described under the rubrics of "loss of time orientation" and "thalamic chronoataraxis" (Kumral, Gulluoglu, & Dramali, 2007;Lee, Chu, Kim, & Roh, 2010). ...
The Zeitraffer phenomenon is the altered perception of the speed of moving objects. A single case is reported using the subject's own description of a transient alteration of the visual perception of motion. The literature on the subject is reviewed. The Zeitraffer phenomenon probably arises from dysfunction of brain networks subserving visual perception of speed. It shares characteristics with akinetopsia, the loss of visual ability to perceive motion.
... Additionally, in the article cited in the target article on the loss of thalamic reticular nucleus alpha-7 nicotinic receptor in schizophrenia (Court et al. 1999), there was greater loss of this receptor in AD and in DLB. AD has a lower average rate of CVH (23%) than schizophrenia (average 37%, Bracha et al. 1989;Cutting 1997;Howard et al. 1994;Ndetei & Singhe 1983;Zarroug 1975), whereas DLB has a higher rate (55%) -indicative of a lack of obvious relation between thalamic pathology and hallucinations. Because basal forebrain nuclei project to both the cerebral cortex and discrete thalamic nuclei, we would, however, not exclude thalamic dysfunction potentiating the effects of cortical cholinergic loss. ...
... In contrast to solipsism (also called absolute idealism), transcendental idealism acknowledges that there is a real world out there. However, the things that we see, hear, or feel are not copies of things in the real world and do not conform to rules of the real world (Kant, as reviewed in Cutting 1997). According to transcendental idealism, it is not the world we see around us but the material constraints beyond it that represent the physical world. ...
The cholinergic system is a good candidate for the role of determining the relative weight given in cortical information processing to new sensory information versus prior knowledge. We discuss the physiological data supporting this, and suggest that this Bayesian perspective can easily be reconciled with the dynamical framework proposed by Behrendt & Young (B&Y).
... Yet in spite of this centrality, delusions have remained largely enigmatic. Indeed, after nearly a hundred years of research, even their definition is still disputed (Cutting 1997: 194). However, despite disagreement on the specifics, a consensus has been reached that delusions are examples of irrationality (Gelder et al. 1989: 14, Busfield 1996: 69±75 and Bowers 1998: 158±60). ...
... In summary, the debate between psychiatry and microsociology centres on the nature of reality. Psychiatry holds a `naõÈ ve realist' position (Harper, 1992: 360 and Cutting 1997: v) in which beliefs can be labelled false if they contrast with external reality. From sociology's point of view, however, reality itself is fractured along cultural and political lines. ...
This paper addresses a foundational issue at the interface of psychiatry and medical sociology; namely, how the judgement of pathology is made. In particular, it examines a debate over how the symptom of delusion is identified. The psychiatric approach is realist in orientation with delusions being commonly defined in the American Psychiatric Association’s Diagnostic and Statistical Manual as ‘incorrect inferences about external reality’. However, from a social constructionist perspective, delusions are reconceptualised as the product of a power relationship in which the views of a less powerful patient are pathologised. Reviewing this argument reveals a number of ways in which constructionist sociology is critical of the psychiatric approach. However, the ‘debate’ has a paradoxical quality in that, although the constructionist critique addresses psychiatry’s foundations, it has been largely ignored. An ethnomethodological analysis of delusion is offered which attempts to account for, and move beyond, this paradox. This involves developing criticisms which are responsive to the sorts of phenomena that clinicians deal with. In other words, the argument points towards the development of a sub-discipline that deals with clinical phenomena and hence might be called ‘clinical sociology’.
... In the case of atrophy, there is a lack of available knowledge of socially shared categories to typify the actions of both others and oneself. People with schizophrenia, relative to those with neuroses or bipolar disorder (Cutting and Murphy 1988, 1990) are markedly deficient in "real-world knowledge"—the majority of people with schizophrenia seem to have deficient knowledge concerning events and behaviors in the world around them. Those with hebephrenia especially are impaired in their knowledge of how other people might behave in a certain situation (see also vignette 3). ...
... cal skepticism. The German philosopher Rosenzweig (1984) ironically defined this paralysis of common sense as "apoplexia philosophica"—an intellectualistic condition (vignette 9, very similar to self-reports of persons recovered from acute catatonic schizophrenia) derived from a distrust of common sense typification and related to hyperreflexivity. Cutting (1997) described this condition as related to a shift to the left along the intelligence-intuition axis. This issue is also addressed by Minkowski's (1927) "morbid rationalism" and Sass's (1992) hyperreflexivity (see also vignette 2). Whereas the latter emphasizes the schizophrenic mind's self-destruction, morbid rationalism is a coping reacti ...
This article explores the hypothesis that the relational deficit in schizophrenia is not a consequence of acute symptoms and course but instead is a fundamental aspect of schizophrenic vulnerability. This basic relational deficit could be better understood as disconnectedness from common sense. Common sense is a tool for adaptation whose main scope is establishing cause-and-effect and motivational relationships in the physical and social realms. The common sense deficit appears to involve a lack of intuitive attunement (impaired capacity to accurately typify the mental states of other persons because of the incapacity to be involved in their mental lives) and a damaged social knowledge network (disorders of the background of knowledge useful for organizing everyday experiences). Three dimensions of schizophrenic vulnerability can be distinguished: the sensory, conceptualization, and attitudinal dimensions. Sensory disorders are aberrations of self, body, and world perceptions. Conceptualization disorders are disturbances in the attribution of meanings and intentions. Attitudinal disorders consist of eccentricities in the individual's structure of values and beliefs, characterized by distrust toward conventional knowledge and attunement. This article describes the present state and possible future directions of qualitative analyses and empirical investigations relevant to assessing the interplay between vulnerability dimensions and disorders of common sense.
... Cutting [6] reported an incidence of 34% visual hallucinations and 18% auditory hallucinations. A comprehensive literature review gave a higher figure of 40-75% for any type of hallucination. ...
... A comprehensive literature review gave a higher figure of 40-75% for any type of hallucination. [6] Alzheimer's disease ...
The literature on hallucinations is reviewed, including its occurrence in different psychiatric disorders, neurological disorders and normal persons. The diagnostic significance of hallucinations is also discussed. Reports of hallucinations in normal people are reviewed. The different modes of the management of hallucinations are briefly discussed.
... Severe forms of unfounded suspicion and mistrust of people are referred to as paranoia and it is one of the most common symptoms of schizophrenia, occurring in roughly 50% of diagnosed individuals (Cutting, 1997). Recent research suggests that paranoia, like other psychiatric symptoms, may exist on a continuum from suspiciousness and ideas of reference at the mild end to persecutory ideation at the severe end (e.g., Bentall, Corcoran, Howard, Blackwood, & Kinderman, 2001;Freeman & Garety, 1999;Freeman, Garety, Bebbington, Smith, et al., 2005;Martin & Penn, 2001). ...
Recent research suggests that paranoia, like other psychiatric symptoms, may exist on a continuum with normal experiences. What pushes people from the normal to the severe end of the continuum has yet to be determined. Theoretical models of paranoia place importance on negative emotion, especially social anxieties, and cognitive reasoning biases. To fully understand the differences in paranoid ideation in non-clinical and schizophrenia populations, more information is needed regarding the causal mechanisms. Experimental paradigms provide the mechanism to test potential pathways through which persecutory ideation can develop. The goal of this study is to reveal mechanisms that may contribute to increases in paranoid ideation by experimentally manipulating fear and by identifying other potential individual factors. A sample of 253 undergraduates was randomly assigned to a neutral or fearful experimental emotion induction. In both conditions, the presence of self-referential thoughts and persecutory ideation was assessed. Following the induction, participants completed ratings of self-referential and persecutory ideation and additional measures of social anxiety, general anxiety, depression and cognitive reasoning biases. These responses were compared to the level of self-referential and persecutory ideation in a sample of 46 individuals diagnosed with schizophrenia who completed self-report ratings of self-referential and persecutory ideation, general anxiety and depression but did not participate in the emotion induction. We found that the fear manipulation increased persecutory and self-referential thoughts in undergraduates. Further, social anxiety and cognitive reasoning biases were related to increases in persecutory ideation, such that the undergraduate group who were high in social anxiety or cognitive biases at baseline had paranoia at equivalent level as the schizophrenia group following emotion induction. This study provides evidence that ideas of reference and persecutory thoughts are not confined to individuals diagnosed with psychotic disorders as they can be enhanced by fear in individuals high on social anxiety and cognitive biases. Together, the results suggest that fearful states, cognitive biases and social anxiety are potential mechanisms for increases in paranoid thought.
... Different kinds of language disturbances have been described during mood episodes of BD. Pressure of speech, with increased rapidity of speech and racing thoughts, is a common symptom of mania, second only to elevated mood 9 . Manic speech has also been characterized as extremely combinatory, shifting quickly from one discourse structure to another, which authors have linked to distractibility and overactivation 10 . ...
Bipolar disorder (BD) is characterized by speech abnormalities, reflected by symptoms such as pressure of speech in mania and poverty of speech in depression. Here we aimed at investigating speech abnormalities in different episodes of BD, including mixed episodes, via process-oriented measures of verbal fluency performance – i.e., word and error count, semantic and phonological clustering measures, and number of switches–, and their relation to neurocognitive mechanisms and clinical symptoms. 93 patients with BD – i.e., 25 manic, 12 mixed manic, 19 mixed depression, 17 depressed, and 20 euthymic–and 31 healthy controls were administered three verbal fluency tasks – free, letter, semantic–and a clinical and neuropsychological assessment. Compared to depression and euthymia, switching and clustering abnormalities were found in manic and mixed states, mimicking symptoms like flight of ideas. Moreover, the neuropsychological results, as well as the fact that error count did not increase whereas phonological associations did, showed that impaired inhibition abilities and distractibility could not account for the results in patients with manic symptoms. Rather, semantic overactivation in patients with manic symptoms, including mixed depression, may compensate for trait-like deficient semantic retrieval/access found in euthymia.
“For those who are manic, or those who have a history of mania, words move about in all directions possible, in a three-dimensional ‘soup’, making retrieval more fluid, less predictable.” Kay Redfield Jamison (2017, p. 279).
... The PDI measures the total number of delusional beliefs endorsed by the participant (PDI total score) as well as the levels of distress, preoccupation, and conviction associated with these beliefs (the distress, preoccupation, and conviction subscales). Given that: (1) the overall total number and degree of persistence of PEs are established risk factors for the development of clinical psychosis (Poulton et al., 2000;Dominguez et al., 2011;Kaymaz et al., 2012;van Os and Linscott, 2012) and (2) higher distress levels associated with delusional beliefs have been linked to both clinical severity (Freeman, 2006;Sisti et al., 2012) and persecutory ideation (Cutting, 1997;Yung et al., 2009;Wigman et al., 2011), we examined the contribution of each of these factors, as well as the presence of persecutory beliefs, to amygdala connectivity variation in this cohort. We adjusted the distress subscale score for the total number of items endorsed on the PDI by dividing each subject's distress subscale score by their total score. ...
Background
Subclinical delusional ideas, including persecutory beliefs, in otherwise healthy individuals are heritable symptoms associated with increased risk for psychotic illness, possibly representing an expression of one end of a continuum of psychosis severity. The identification of variation in brain function associated with these symptoms may provide insights about the neurobiology of delusions in clinical psychosis.
Methods
A resting-state functional magnetic resonance imaging scan was collected from 131 young adults with a wide range of severity of subclinical delusional beliefs, including persecutory ideas. Because of evidence for a key role of the amygdala in fear and paranoia, resting-state functional connectivity of the amygdala was measured.
Results
Connectivity between the amygdala and early visual cortical areas, including striate cortex (V1), was found to be significantly greater in participants with high ( n = 43) v. low ( n = 44) numbers of delusional beliefs, particularly in those who showed persistence of those beliefs. Similarly, across the full sample, the number of and distress associated with delusional beliefs were positively correlated with the strength of amygdala-visual cortex connectivity. Moreover, further analyses revealed that these effects were driven by those who endorsed persecutory beliefs.
Conclusions
These findings are consistent with the hypothesis that aberrant assignments of threat to sensory stimuli may lead to the downstream development of delusional ideas. Taken together with prior findings of disrupted sensory-limbic coupling in psychosis, these results suggest that altered amygdala-visual cortex connectivity could represent a marker of psychosis-related pathophysiology across a continuum of symptom severity.
... Body image disturbances in schizophrenia are often represented by symptoms of disembodiment, that is a sensation of lacking a physical form, and being disintegrated. Different classifications have been proposed in order to capture such a phenomenological variety of body-related psychopathology [54,[57][58][59][60]. Also in schizophrenia as in other mental conditions, body image represents an umbrella term for different aspects of such a multidimensional construct. ...
From a psychiatric standpoint, body image disturbances characterize multiple clinical conditions. In fact, body image is a multifaceted experience including thoughts, feelings, and behaviors related to the subjective perception of one’s own body, identity and self-esteem. Moreover, body image has a relational component as well: it develops along the life span and tends to be influenced by significant others and peers. Main body image disturbances can be found in eating disorders but also in body dysmorphic disorder (BDD) and delusional conditions like those of the psychotic spectrum. With more detail, the psychopathology of anorexia nervosa, bulimia nervosa, and BDD has as a hallmark a core emotional and cognitive disturbance of body image. Furthermore, body image is also strictly connected to personality. This chapter will provide the reader with an overlook of the main findings on body image across the aforementioned clinical conditions.
... An injury in the left hemisphere produces aphasia: the patient can't name objects or words. He can't relate objects with words, nor words with other words ( Cutting 1997). He can't relate signs with signs. ...
From a theoretical point of view the experiences in which the feeling of self is temporarily or permanently altered, pose opportunities to apply, critically verify or even renew theories of the self. The altered self, from a human point of view, gains its most relevance when it is related to psychological sufferings, their comprehension, relief or treatment. For some, self-alterations are desired as in technically achieved, or drug induced suspensions of a “fixed”, „regular“, „normalized“ or „orthodox“ experience of self. Altered Self and Altered Self-Experience (ASASE) explores different conceptual and clinical notions of the altered Self and different modes of altered self-experience in order to clarify the notion of self.
This book deals with questions on the self from an interdisciplinary point of view including decidedly divergent perspectives from different philosophical approaches to the Altered Self and Altered Self-Experience such as “neuro”-philosophies, philosophy of emotion, philosophy of psychiatry, phenomenology besides approaches from developmental psychology, mindfulness praxis, as well as religious studies, cinema and literature studies.
ASASE is the result of a selection of research papers of the project “Cognitive Foundation of the Self” with contributions of international scholars who mainly presented and discussed their work at the international workshop "Altered Self and Altered Self Experience" organized by Alexander Gerner (CFCUL) and Jorge Gonçalves (IFILNOVA) held at the Universidade Nova de Lisboa (FCSH-UNL) at the institute of philosophy IFILNOVA on the 30th and 31st of May 2013 in Lisbon, Portugal.
Authors of this volume include: Dina Mendonça, Amber Griffioen, Sara F. Bizzaro, Niccola Zippel, João Fonseca, Alexander Gerner, Michele Guerra, Iwona Janicka, Gabriel Levy, Bernardo Palmerim, Michaela Hulstyn, Vera Pereira, Jorge Gonçalves, Pablo López-Silva Pio Abreu, Georg Northoff, Inês Hipólito and Anna Ciaunica.
Chapters include: Emotional Aspects of the self; Disembodiment of Self-experience: Out-of-Body Experience, Full-Body Illusion and Cinematic Experience; Altered Self-Experience in Religious Self-Experience, Intimacy, Self Reports of Drug-Experiments and Mindfulness Meditation; Gender and Altered Self-Experience; Acting Theories and the Self; Altered Self in Schizophrenia; Altered Social Selves: Autism and intersubjectivity
... Il rapporto tra iper-razionalità e irrazionalità nelle psicosi schizofreniche rappresenta un ulteriore problema al centro del dibattito psicopatologico contemporaneo sul quale l'"intuizione" del nostro paziente richiama l'attenzione 9 . Il problema, delineato incisivamente più di mezzo secolo fa da Minkowski al capitolo "razionalismo morboso" (Minkowski 1966), è tornato sugli scudi della psicopatologia fenomenologica anche grazie ad autori come Luis Sass (1992; e John Cutting (1997) che hanno reagito al verbo imperante dei sintomi negativi e delle teorie del deficit cognitivo esplorando le contraddizioni della mente schizofrenica (e della mente moderna) sospesa tra l'estremizzazione del soggettivismo e quella dell'oggettivismo e attratta al contempo dal richiamo di entrambi. Il modello della iper-riflessività (Sass, 1992) si pone in antitesi ai modelli che ipotizzano alla base della mente schizofrenica la presenza di deficit cognitivi. ...
Nell'affrontare il tema dei disturbi dei confini dell'io, si profilano due ordini di problemi che verranno trattati separatamente: (1) il problema della specificità nosografica e (2) il problema dell'interpretazione psicopatologica. In questo capitolo intendiamo relativizzare l'importanza ai fini diagnostici dei disturbi dei confini dell'io e sottolinearne l'interesse nell'ottica della conoscenza dei mondi schizofrenici. 1. Specificità nosografica. Status quaestionis L'epoca classica: da Kraepelin a Eugen Bleuler Già l'autorità di Kraepelin sottolineava che un sintomo caratteristico della demenza precoce "sembra essere la sensazione che i propri pensieri siano influenzati" (Kraepelin, 1909-1915). Questo stretto rapporto tra disturbi dei confini dell'io e diagnosi di schizofrenia trova conferma in Eugen Bleuler (1911) il quale attribuì un importante valore diagnostico ai disturbi dei confini dell'io e in particolare al fenomeno del blocco del pensiero. Bleuler definì di fondamentale importanza questo sintomo ai fini del riconoscimento della sindrome schizofrenica. Inoltre, al riguardo del fenomeno del furto del pensiero, egli affermò che quando esso è presente "allora si può fare la diagnosi di schizofrenia con sufficiente certezza. Almeno finora non abbiamo trovato nessuna eccezione". Jaspers (1913-1959), cui si ascrive il merito di aver coniato il termine "disturbi dell'io", affronta il tema in una prospettiva non interessata alla definizione di criteri per la diagnosi di schizofrenia, ma piuttosto rivolta alla definizione dei modi dell'esperienza paranoidea. Nell'ambito delle alterazioni della coscienza dell'io, alla voce alterazioni della coscienza di operare, Jaspers annovera i fenomeni "schizofrenici" di imposizione e sottrazione del pensiero nei quali il paziente sente di non essere padrone dei propri pensieri e di essere in balìa di una forza estranea inafferrabile. Tali fenomeni vengono contrapposti alle esperienze ossessive in cui invece la
... Persecutory experiences are the most frequent forms of frank and attenuated delusions in psychotic and CHR patients [11,21], and, at the time of help-seeking, about a half of CHR patients participating in EPOS reported attenuated paranoid symptoms. Therefore, the clinical relevance of paranoia in psychosis, as well as in its risk states, is clearly high. ...
Background:
The link between depression and paranoia has long been discussed in psychiatric literature. Because the causality of this association is difficult to study in patients with full-blown psychosis, we aimed to investigate how clinical depression relates to the presence and occurrence of paranoid symptoms in clinical high-risk (CHR) patients.
Methods:
In all, 245 young help-seeking CHR patients were assessed for suspiciousness and paranoid symptoms with the structured interview for prodromal syndromes at baseline, 9- and 18-month follow-up. At baseline, clinical diagnoses were assessed by the Structured Clinical Interview for DSM-IV, childhood adversities by the Trauma and Distress Scale, trait-like suspiciousness by the Schizotypal Personality Questionnaire, and anxiety and depressiveness by the Positive and Negative Syndrome Scale.
Results:
At baseline, 54.3 % of CHR patients reported at least moderate paranoid symptoms. At 9- and 18-month follow-ups, the corresponding figures were 28.3 and 24.4 %. Depressive, obsessive-compulsive and somatoform disorders, emotional and sexual abuse, and anxiety and suspiciousness associated with paranoid symptoms. In multivariate modelling, depressive and obsessive-compulsive disorders, sexual abuse, and anxiety predicted persistence of paranoid symptoms.
Conclusion:
Depressive disorder was one of the major clinical factors predicting persistence of paranoid symptoms in CHR patients. In addition, obsessive-compulsive disorder, childhood sexual abuse, and anxiety associated with paranoia. Effective pharmacological and psychotherapeutic treatment of these disorders and anxiety may reduce paranoid symptoms in CHR patients.
... Persecutory experiences are the most frequent forms of frank and attenuated delusions in psychotic and CHR patients [11,21], and, at the time of help-seeking, about a half of CHR patients participating in EPOS reported attenuated paranoid symptoms. Therefore, the clinical relevance of paranoia in psychosis, as well as in its risk states, is clearly high. ...
Introduction
The link between depression and paranoia has long been discussed in the psychiatric literature. Because this association is difficult to study in patients with full-blown psychosis, we investigated clinical high-risk (CHR) patients.
Objective
To clarify the causal connection between depression and paranoia.
Aims
To investigate how clinical depression relates to presence and new occurrence of paranoid symptoms in CHR patients.
Methods
Altogether, 245 young help-seeking CHR patients were assessed for suspiciousness/paranoid symptoms with the Structured Interview for Prodromal Syndromes at baseline, 9-month and 18-month follow-up. At baseline, clinical diagnoses were assessed by the Structured Clinical Interview for DSM-IV, childhood stressful experiences by the Trauma and Distress Scale, trait of suspiciousness by the Schizotypal Personality Questionnaire, and anxiety and depressive symptoms by the Positive and Negative Syndrome Scale.
Results
At baseline, 54.3 % of CHR patients reported at least moderate paranoid symptoms. At 9- and 18-month follow-ups, the corresponding figures were 28.3 % and 24.4 %. Depressive disorder, sexual abuse and anxiety symptoms associated with paranoid symptoms. Depressive, obsessive-compulsive and somatoform disorders, sexual abuse, and anxiety predicted occurrence of paranoid symptoms.
Conclusion
Depressive disorder is one of the major clinical factors associating with and predicting paranoid symptoms in CHR patients; also childhood sexual abuse and anxiety symptoms associate with paranoia. In addition, obsessive-compulsive and somatoform disorders seem to predict paranoid symptoms. Low self-esteem may be a common mediator between affective disorders and paranoia. Effective treatment of these disorders may alleviate paranoid symptoms and improve interpersonal functioning in CHR patients.
... Such tacit experiential background is often perturbed in schizophrenia, giving rise to apparently unintelligible experiences such as abnormal feelings of violability, transformation (i.e. altered shape/structure or change in composition) or dramatically altered regional sensitivity (see descriptions in Jaspers, Huber, Ey, Cutting [6][7][8][9]). In this sense ABP manifest an aspect of the core features of schizophrenic vulnerability, i.e. the disruption in the basic sense of being an incarnated self [10][11][12][13][14][15][16][17][18][19][20]. ...
... Pour é claircir cette problé matique de l'é motion, nous allons d'abord dé finir clairement ce que nous entendons lorsque nous é voquons ce concept. Pour cela, en gardant à l'esprit que la psychopathologie peut être considé ré e comme une « philosophie appliqué e » [6], nous devons effectuer un passage par l'é tude phé nomé nologique de l'é motion, telle que proposé e par Sartre. Pour ce dernier, l'é motion « est dans la stricte mesure où elle signifie » [34, p. 16] ; elle est source du sens et de la signification que vont lui attribuer ses diffé rents interprè tes (le sujet de l'é motion et ses interlocuteurs). ...
L’objectif de cette étude est de proposer quelques éléments essentiels pour une conception clinique et psychopathologique de la psychopathie. L’auteur présente d’abord un historique de ce diagnostic et une description des tendances actuelles dans la littérature internationale : principalement les contributions de R.D. Hare sur la PCL-R, de D.J. Cooke sur le CAPP et de T.H. Pham pour les validations francophones. Ensuite, une définition de la psychopathologie est proposée en s’appuyant sur les propositions phénoménologiques d’E. Minkowski et de K. Jaspers. Cet essai théorique est parcouru par des situations cliniques rencontrées en prison ou dans des centres médicolégaux. L’auteur propose, ensuite, une comparaison entre la manie telle que la décrit Binswanger et le fonctionnement psychopathique. Par la suite, c’est une prise en compte du processus émotionnel du psychopathe qui est réalisée en interrogeant la dimension adaptative de ce type de fonctionnement psychologique. Le dernier point discuté consiste, après avoir différencié les concepts d’« éthique » et de « morale » selon les propositions de M. Foucault, en une analyse de l’empathie et la sympathie chez le psychopathe. La considération de la dimension éthique de la psychopathie conduit l’auteur à proposer de considérer la narrativité et l’identité narrative du sujet psychopathe à partir des propositions de P. Ricœur. La conclusion de cette contribution est de constater qu’il se révèle possible de mener une étude psychopathologique de la psychopathie.
... Los resultados de la nueva psiquiatría biológica trascienden las fronteras de la profesión y aún de la medicina en sentido habitual, e involucran los fundamentos de la ciencia de la vida biológica, la naturaleza orgánica del hombre y de la mente, las bases naturales de la bioética, los principios biológicos de la sociedad, en una palabra, se adentran en el área que ha sido tradicionalmente de la filosofía (10)(11)(12)(13)(14)(15) . Como señala Ortega, la concepción teórica surgida de la manipulación del científico, por los experimentos del biólogo, por los ensayos de los psiquiatras, es insuficiente para responder qué es, cuál es la consistencia de esa nueva realidad y, por esto, si se necesita dar razón precisamente de aquello que constituye su ser propiamente tal se debe acudir a la metafísica (16) . ...
Background. Practice and research in the field of biological psychiatry requires us to assume certain positions on several philosophical issues. Objective. To focus on the basic philosophical assumptions of modern biological psychiatry. Method. To inquire into Ortega y Gasset's interpretations of the nature of man and science in order to understand the presuppositions which biological psychiatry itself can never justify scientifically. Results. Biological psychiatry allows only the insigths of what its kind of representation has admitted in advance as a possible object, i.e., brain function, gene expression, neurotransmitter. On the contrary and according to Ortega: "The man is not his body that is a thing, neither his soul that is also a thing, a subtle thing: the man is not at all a thing, but a drama: his life" Conclusions. Ortega can help us to apprehend the level of understanding peculiar of the current biological psychiatry better because his "new level is a deeper stratum of the philosophical problems"
... These include Sass (1985Sass ( , 1987Sass ( , 1988aSass ( , 1990aSass ( , 1990bSass ( , 1992b)-culminating in his books, Madness and Modernism: Insanity in the Light of Modern Art, Literature, and Thought (1992a), and The Paradoxes of Delusion (1994)- Schwartz and Wiggins (1987; also Wiggins et al. 1990), Cutting and Dunne (1989), and Parnas and Bovet (1991;Bovet and Parnas 1993) . A superb anthology of classical European contributions on schizophrenia, edited by John Cutting andMichael Shepherd, appeared in 1987. Cutting's (1997) book on brain laterality had a strong phenomenological component. ...
The present paper clarifies key issues in phenomenology and phenomenological psychopathology (especially of schizophrenia) through a critique of a recent article that addresses these topics. Topics include (1) Phenomenology's role in clarifying issues not amenable to purely empirical methods; (2) The relationship between a phenomenological approach (focusing on the subjective life of the patient) and empirical science, including neuroscience; (3) The nature of self-experience, especially in its pre-reflective form ("ipseity"—involving "operative intentionality"), and its possible disturbance in schizophrenia ("hyper-reflexivity" and "diminished self-affection"); (4) The relationship between self-disturbance in schizophrenia and disorders of both temporality and (what Husserl termed) "passive syntheses"; (5) The role of intentional or quasi-volitional processes in the perceptual (and other) disorders in schizophrenia; (6) The nature and diversity of phenomenology's potential contribution to the enterprise of "explanation"; and (7) The meaning of several concepts: "hermeneutic" or "existential" approach, phenomenological "reflection," and "negative symptoms."
... The apparent stagnation of neo-Kraepelinian research and the increasing need for more detailed and, most importantly, more valid definitions of the psychiatric syndromes have brought along a renaissance in phenomenological psychopathology. In schizophrenia research, phenomenologically oriented contributions, both theoretical and empirical in nature, have emerged progressively (e.g., Mundt 1984;Parnas & Bovet 1991;Cutting 1997;Parnas et al. 2005b;. ...
In biological psychiatry, schizophrenic symptoms such as bizarre delusions and verbal
hallucinations are considered as causal outcomes of genetically inherited biological abnormalities.
This predominant, monocausal theory of schizophrenia reflects a widespread ambition to reclaim
the foundation of psychiatry within the domain of the natural sciences. The guiding presumption is
that schizophrenia is a disease comparable to other medical diseases. Despite notable advances in
the search for schizophrenia specific biological abnormalities, the emerging picture suggests that
biological factors form a necessary but not sufficient condition for the development of
schizophrenia. Other contributing factors and their interactions must be taken into account if we are
to reach a more proper understanding of the multifactorial etiology of this complex mental disorder.
This thesis presents a phenomenological approach to the psychopathology of schizophrenia
with emphasis on certain non-psychotic anomalies of self-experience. An increasing number of
empirical studies support the hypothesis that such experiential anomalies are characteristic of the
schizophrenia spectrum. However, many classic psychopathologists also shared the basic idea that
such anomalies are essential to schizophrenia and the idea is therefore not entirely new. The thesis’s
overall aim is to enrich our understanding of the psychopathological Gestalt of schizophrenia and
some of its symptoms, in particular, autistic traits, auditory verbal hallucinations, and bizarre
delusions.
The thesis is divided into four studies. The first study seeks to portray the
psychopathological Gestalt of schizophrenia. An increasing amount of empirical studies have
documented that the score of anomalies of self-experience is significant between spectrum and nonspectrum
individuals, but these studies have not provided an account of the coherence in the clinical
picture. This is the aim of the first study. The second study seeks to illuminate experiential
correlates of schizophrenic autism. In a qualitative, single-case study, we applied a
phenomenological model of the self-world relation to examine a paranoid schizophrenia patient’s
subjective experiences and we found a distinct disturbance in the patient’s self-world relation
characterized by pervasive and enduring experiences of estrangement, anxiety, and exposure. The
third study strives to provide a clinically grounded phenomenological account of the pathogenesis
of auditory verbal hallucinations in schizophrenia. It argues that verbal hallucinations tend to arise
from spatialization of experience and morbid objectification of inner speech, which reflect a
fundamental disturbance of primordial presence. Finally, the fourth study discusses the supposedly
ii
incomprehensibility of bizarre schizophrenic delusions. It engages in recent debates in philosophy
of psychiatry and argues that if we instead of focusing exclusively on the content of delusional
beliefs also take their form (i.e. the structural alterations of self-consciousness) into account, then it
is possible to understand them to a considerable extent.
Besides providing an understanding of schizophrenic symptoms that previously were
considered incomprehensible, the results from this thesis can play a role in diagnostic and
differential diagnostic procedures as well as in the psychotherapy for schizophrenia. Moreover, the
intention is to familiarize clinicians with experiential precursors to hallucinations and delusions,
thereby enriching the psychopathological resources to recognize impending psychotic states before
their full-blown manifestation and improve the possibility of early intervention.
... Persecutory ideation is one of the most commonly reported psychiatric symptoms in individuals suffering from psychosis 1,2 and is associated with significant patient distress and impairment. 3 When severe, paranoid beliefs constitute the type of delusion that individuals are most likely to act upon 4 and often predict subsequent patient hospitalization. ...
Contemporary theoretical models of paranoia suggest that negative emotions, perceptual anomalies, and recent life events are important predictors of experiencing persecutory ideation. In the current experience sampling study, these factors are examined prospectively for the first time as predictors of the occurrence of persecutory ideation, as well as persecutory belief conviction, and associated distress in real time in the context of daily life. One hundred and forty five community-dwelling participants with schizophrenia or schizoaffective disorder completed self-report assessments generated by a personal digital assistant multiple times a day for 1 week. Their responses were time lagged to allow examination of dynamic prospective relationships between variables as they occur within days. Approximately half of the participants reported having some persecutory thoughts, with a total of 378 reported occurrences of persecutory thoughts across participants during the week. Negative emotional states of anxiety and sadness were significant predictors of the occurrence of subsequent persecutory ideation, but hallucinations and recent life events were not. In a subsample of people who had multiple persecutory thoughts, anxiety was a significant predictor of belief conviction and associated distress, while sadness was only predictive of distress. The findings are consistent with recent cognitive theory that proposes a causal role for negative emotional states in the formation and maintenance of persecutory ideation and suggest that persecutory ideation may be addressed indirectly by interventions targeting anxiety and depression.
Urges psychiatry to get back to human nature because the concept, together with the idea of human freedom and classic and romantic perspectives, is required to calibrate the normal and the pathological in psychiatry. Highlights balance by showing how ‘sickly’ (Goethe) pictures of human nature and human freedom have adverse effects on psychiatry, including its interface with political life. Revisits the classicl and romantic perspectives, considering them in and out of balance in different ways. Distils a tripartite picture of the relationship between human nature, human freedom and mental disorder relevant to future research and teaching on psychiatric formulation and psychiatric ethics.
Silence is a byword for socially imposed harm in the burgeoning literature on epistemic injustice in psychiatry. While some silence is harmful and should be broken, this understanding of silence is untenably simplistic. Crucially, it neglects the possibility that silence can also play a constructive epistemic role in the lives of people with mental illness. This paper redresses that neglect. Engaging with first-person accounts of mania, it contends that silence constitutes a crucial form of epistemic agency to people who experience mania and that the prevailing failure to recognise this may harm them. The paper proceeds as follows. After briefly examining the negative understanding of silence in the epistemic injustice literature, it outlines three epistemically agential silences: communicative silence, listening silence, and withholding silence. It then deploys these concepts to explore how the ability to perform epistemically agential silence is impaired in mania and why such silences are vital to people. The penultimate section highlights two ways that the failure to recognise the epistemic value of silence can harm people with mania. The paper concludes by drawing out implications for future research on epistemic injustice in psychiatry.
Racing thoughts have been traditionally described in manic states in patients with bipolar disorder. Recently, attention has been raised to this symptom in depressive episodes. In this thesis, we aimed at investigating the phenomenology of racing thoughts, a phenomenon that has been understudied so far, via a self-report questionnaire that we have developed – the Racing and Crowded Thoughts Questionnaire (RCTQ) -, in patients with bipolar disorder and in healthy individuals. From a cognitive standpoint, we assessed the cognitive underpinnings of racing thoughts via temporal and verbal fluency tasks. Our results suggest that racing thoughts are a multi-faceted phenomenon, that can be observed even in healthy individuals with mild affective instability. Importantly, our results show that racing thoughts are associated with lexico-semantic and executive abnormalities as well as with a feeling of faster than usual passage of time.
Dissociative phenomena are characterised by alterations in the functions of conscienceness, memory, identity and perception. These are placed along a continuum ranging from normal daily experiences to real mental disorders that interfere with the performance of usual activities. Dissociation may represent the foundation for specific disorders, Dissociative Disorders, as well as the prospect of symptoms of psychopathological conditions of various kinds. This study has evaluated the clinical efficiency of quetiapine during dissociative episodes in the acute phase in patients referred in the last year to the Mental Health Centre (NHS Salerno). Participants in the study were subjected to the administration of a series of tests at the onset of symptoms (T0); after two weeks (T1); and after four weeks (T2). The assessment tools used were: the Dissociative Experience Scale (DES); the Brief Psychiatric Rating Scale (BPRS); the Clinical Global Impressions (CGI); the Global Assessment of Functioning (GAF). All observed patients showed an improvement in symptoms, no patients discontinued pharmacological therapy and side effects did not emerge which would have required the discontinuation of therapy. The analysis of the results showed that quetiapine monotherapy next to a good efficacy and tolerability may be a viable therapeutic option for the pharmacological treatment of dissociative episodes in the acute phase.
This article claims that the study of religion has overlooked a feature of the human mind that may yet help to explain certain aspects of religion. Awareness, it is here argued, can vary along a dimension that is characterized by the density of associations and other inputs that accompany it. The mechanism behind this is concentration, including the stronger form of concentration here called absorption. Absorption has cognitive effects, and is at least in part responsible for the human tendency to believe in a different, " higher, " reality. Various other features usually associated with religion— including ritual behavior and asceticism—also make sense in the light of this observation.
Self is a complex phenomenological construct. Disorders of self are a less often discussed phenomenon even with the wide prevalence. This article attempts to revisit the psychopathology of disorders of experience of self primarily based on phenomenological description. Descriptive, biological, etiological and social perspectives are discussed. [Archives Medical Review Journal 2016; 25(4.000): 571-585]
This chapter starts with three cases of bizarreness. These are used to discuss some interpretative issues in patients who present with bizarreness. Bizarre delusion in the Diagnostic and Statistical Manual (DSM) is critically examined, as is the relationship of bizarreness to the clinical phenomenology of schizophrenia. This chapter touches upon some of the communicative challenges that face clinicians and patients with bizarreness and the role of the lifeworld approach. The chapter ends with a summary of points relevant to the psychopathologist in training.
This article will explore the representation of certain mental and somatic phenomena in Beckett’s trilogy of novels Molloy, Malone Dies and The Unnamable, exploring how his understanding of schizophrenia and psychosis informs his representation of the relationship between mind and body. It will also examine recent phenomenological and philosophical accounts of schizophrenia (Louis Sass, Josef Parnas, Shaun Gallagher) that see the condition as a disorder of selfhood and concentrate in it on the disruption to ipseity, a fundamental and pre-reflective awareness of self that leads to a loss of ‘grip’ (in the term of Merleau-Ponty) on concepts and percepts. Beckett’s writing might, it is argued, make such disruptions more tangible and intelligible. The article will also consider John Campbell’s argument that immunity of the first person to error—Sydney Shoemaker’s foundational philosophical idea that we cannot misspeak the first person pronoun—is revoked in states of psychosis, and relate such states to the moments in Beckett’s writing where this immunity is challenged, and quasi-psychotic experiences represented.
This chapter begins with a discussion on studies of family therapy for child and adolescent anorexia nervosa (AN). Most family therapy approaches that have been studied emphasize the role of the parents in managing the eating disorder (ED) symptoms in the early stages of treatment with a broadening of focus to individual or family issues at a later stage. The focus of the therapeutic interventions is to help the family to find solutions and minimize the likelihood of the need for inpatient treatment. The four phases of the treatment, namely, engagement and development of therapeutic contract, helping the family to challenge anorexic symptoms, exploring issues of individual and family development, and ending and discussion of future plans, are discussed. The chapter describes a relatively recent development in family-oriented treatment for AN, and intensive multifamily therapy (MFT) for child and adolescent anorexia nervosa.
The profound transformation of the life-world of persons with schizophrenia involves changes in the ontological framework of experience and has serious consequences for how such persons live their life as embodied persons and how they understand the existence of other people. Drawing on classical as well as contemporary psychopathological accounts, we systematically and succinctly describe the basic features of these changes. Lived time, space, body, selfhood and otherness are used as the principal descriptors of this transformation. We offer a reconstruction of the life-world of persons with schizophrenia that discloses their primordial in esse, their basic sense of being in the world. We argue that detailed knowledge of these deep ontological changes is fundamental for the understanding of the schizophrenic style of experience and action as well as for making sense of the symptoms of schizophrenia. From our reconstruction, it emerges that the phenomenon of fragmentation is a candidate common denominator of the schizophrenic experience. Fragmentation appears a basic feature of lived time, as well as space, body and selfhood. The loss of a coherent Gestalt of experience seems to run through the manifold of schizophrenic abnormal phenomena, also affecting the related self-world and inter esse. This suggests the crisis of the synthetic function of consciousness, that is, of the temporal unity of consciousness, could be at the basis of characteristic of "disarticulation", distinctive of the schizophrenic world.
Philosophical insights into the nature of conscious experience allow us to relate neurobiological findings to a pathophysiological model of hallucinations. The world around us is a dreamlike and subjective experience that in the state of normal wakefulness, but not in states of dreaming or hallucinations, is constrained, through sensory input, by external physical reality. In patients diagnosed with schizophrenia and in some organic conditions, perception can be underconstrained by sensory data emanating from the physical world as a result of peripheral sensory impairment or increased random neural activity in specific thalamic nuclei. Sensory processing streams converge via the entorhinal cortex on the hippocampus, where self-organizing activity patterns in cornu ammonis region 3 (CA3) situate landmarks and objects within an allocentric representation. Conscious experience, which is primarily externalized and hence allocentric, may be an emergent property of self-organizing states adopted, at θ rhythm, by the CA3 autoassociation network. The ability of CA3 to bind various feature units into a coherent whole, the view-dependent and allocentric nature of information encoded by CA3, and the connectedness of CA3 with neocortical sensory processing streams-they all support the implication of CA3 in normal and abnormal consciousness. Excessive pyramidal cell activity in CA3, due to deficient inhibition by inhibitory basket interneurons, leading to event memory formation that is poorly modulated by entorhinal input, may be another mechanism for the generation of hallucinations in patients diagnosed with schizophrenia. © 2012 Springer Science+Business Media, LLC. All rights reserved.
Meaning is a concept which is discussed everywhere. Besides being a common word, it is relevant for cognitive and linguistic studies. Nevertheless, translation problems and the specific definition of similar concepts by different disciplines hamper the discussion. In this paper, the author discards some popular ideas about meaning (as being an image, an object or the relationship between signs), and highlights its relation with intentions, and the new concept of “embodied meaning”. Following a suggestion by Timothy Crow, who studied schizophrenia and brain lateralization, the authors conclude that the right hemisphere (in right handed people) processes intentions and meanings, whereas the left hemisphere processes the signifier part of signs, including words, and their relationship to each other (the sense). This vision can elucidate some problems of Psychopathology and Philosophy of Mind.
This paper explores the phenomenon of thought insertion, an experience reported by some schizophrenics where it is believed that other persons or forces are inserting thoughts into their minds. This relatively circumscribed symptom of schizophrenia raises difficult questions concerning our sense of agency for our thoughts. How is it possible that persons can think that their thoughts are not their own? Gallagher, drawing on Husserl's early work on time-consciousness, provides a subtle and sophisticated answer to this problem, suggesting that protention may underlie our sense of agency for thinking and that the experience of inserted thoughts may occur in the event of an intermittent failure in this protentional function. More recent Husserl scholarship suggests, however, that this account may face problems on phenomenological grounds. It is argued here that our sense of agency for thinking requires more than protention, and, consequently, that the absence of protention cannot fully explain the loss of agency for thinking characterizing the experience of thought insertion. In order to contextualize this discussion of the phenomenon theoretically and, in the process, to provide an introduction to the difficulties in explaining it, this paper proceeds with a consideration of Frith's early cognitive account of thought insertion and the contribution of Stephens and Graham in this regard. In conclusion, it is argued that, despite the merits of all three accounts presented, they remain unable to account for the phenomenon of inserted thoughts, and that we might more fruitfully understand this experience as being a type of uncontrollable passive or autochthonous thinking.
This paper presents the reasons for viewing the conflicts of inner mental life as arising from the problematic interaction of two different selves. A self that is involved in interpersonal relationships can be seen to be contending with a coexisting self who has a hatred of dependency on others. When the self that idealises independence is dominating the inner world, any means will be used to achieve the desired ends, regardless of the consequences for anyone. The paper makes links with the work of neuropsychiatrists such as McGilchrist and to the contributions of Bion, Britton, Winnicott and other analysts who have recognized the existence of different selves in the inner world. An analytic session is presented to illustrate the process of mapping out of ‘who is doing what to whom’ in the clinical interaction. We argue that transference misattributions can be better understood by recognizing the differences between the two selves internally. This detailed differentiation can then assist the patient to reduce the likelihood of internal takeovers both in the analytic setting and in other relationships.
In psychiatry there is still an important ambiguity concerning the causes of mental disorders in terms of their putative origin in purely neurobiological or on the contrary purely mental phenomena. The coexistence of antagonistic causal hypothesis can be considered as a product of a series of ideas and events that have been determinant in the evolution of psychiatry as a medical discipline. The present paper presents a summarized version of some relevant historical and conceptual issues related to this situation. In addition some ideas that can be useful for diminishing the existing tension between these notions about causality are enounced.
Introduction:
Theories of delusions which rely on a combination of abnormal experience and defective belief evaluation and/ or cognitive bias are the subject of an emerging consensus. This paper challenges the validity of these theories and constructs a two factor alternative.
Methods:
The paper starts by identifying the difficulty the current theories have explaining the complex delusions of schizophrenia and then, by considering, first, the aetiology of somatopsychotic symptoms, and second, the literature on the relationship between confabulation and allopsychotic symptoms, demonstrates that the natural solution is to retain the experiential factor whilst replacing the second factor with confabulation.
Results:
The paper is then able to demonstrate that the resultant two-factory theory can clarify recent work on the aetiological role of autonoetic agnosia and on the relationships between confabulation, delusion, and thought disorder.
Conclusions:
The theory supersedes currently available theories in terms of its simplicity, fruitfulness, scope and conservatism and represents an advance in the search for unified theory of psychosis.
Résumé Les expériences schizophrémque et mélancolique impliquent —in statu detrahendi — différents niveaux du soi. La dépersonnalisation schizophrénique révèle le plus profond niveau de la conscience de soi,
le niveau pré-réflexif — le soi comme dimension tacite de ce qui est donné en première personne. Ceci implique dans la schizophrénie
de faire l’expérience d’une forme dualiste cartésienne de l’existence dans laquelle une conscience de soi noétique désincarnée
se substitue à la conscience de soi incorporée La dépersonnalisation mélancolique met en lumière l’identité narrative, le
soi en tant que produit de la conception de soi-même dans une certaine direction. Une dialectique anormale de l’identité narrative
est le noyau du type d’existence mélancolique, une manière d’exister en accord avec une perspective finie d’ouverture au monde.
Les épisodes mélancoliques aigus surviennent quand la personne mélancolique ne peut pas échapper à la demande d’identité comme
processus dialectique en se restreignant à être-le-même et en évitant l’altérité en soi-même.
Collerton et al. propose that one and the same mechanism (PAD) underlies recurrent complex visual hallucinations (RCVH) in various disorders, including schizophrenia, dementia, and eye disease. The present commentary offers an alternative account of RCVH and other recurrent complex hallucinations specific to schizophrenia and related disorders only. The proposed account is consistent with the bias of schizophrenic RCVH contents toward animate, socially active entities.
Disorders of the self had already been considered in classic psychiatric literature and in phenomenological psychopathology as fundamental features of the spectrum of schizophrenic disorders. These experiential anomalies have been ignored by the contemporary psychiatry, because its behaviouristic orientation entails a mistrust of studying subjectivity. In this article, based on our own and other empirical studies, we present a phenomenologically-informed account of disorders of self-awareness that are detectable in the prodromal phases of schizophrenia as well as in the schizotypal conditions. We propose that a joint psychopathological and empirical emphasis on the disorders of self may facilitate an integration of the etiological search for neuro-developmental risk factors with the developmental-psychological approach to the ontogenesis of the self. Clinical familiarity with these subtle, yet crucial, symptomatic aspects of the vulnerability to schizophrenia may assist in the detection of pre-schizophrenic prodromal conditions in the non-psychotic clinical populations and thus enable early therapeutic interventions.
Artifizielle Störungen verweisen auf Patienten, die körperliche oder seelische Symptome vortäuschen, aggravieren oder bei
sich induzieren, um Ärzten gegenüber Krankheiten darzustellen. Die Tatsache der Täuschung ist den Patienten bewusst, nicht
unbedingt aber die zugrunde liegenden Motive ihres Handelns.
This is an empirical study exploring the personal level of experience of social dysfunction in persons with schizophrenia.
We adopted a qualitative method of inquiry based on a review of transcripts of individual therapy sessions conducted for 52 persons with chart diagnoses of schizophrenia or schizotypal disorder.
In our interviews, the experience of the social world in persons with schizophrenia emerged as an overall crisis of immediate, prepredicative, prereflexive attunement, typically accompanied by feelings of invasiveness and abnormalities in bodily and emotional sensations; a hyperreflexive mode for understanding the intentions of other persons, and a sceptical, aversive and sometimes utopian attitude towards sociality.
Social dysfunction in persons with schizophrenia may reflect a disorder of the process of corporeal identification/differentiation that allows both for the intersubjective understanding through body-to-body attunement and for the demarcation between self and other.
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