Pub Date : 2023-09-01DOI: 10.1353/ppp.2023.a908275
Philippe Le Moigne
Abstract: This article discusses the way how change in depressed patients included in clinical trials was both conceptualized and measured in the 1970s to decide on the efficacy of the first candidate drugs for the treatment of depression. Understanding how this issue was resolved is of major interest as the protocol designed to distinguish the diagnosis of the depressive syndrome from the measurement of its evolution over time built the contours of the methodological device to which the whole of standardized evaluation in psychiatry has since referred. This paper draws on the debates in nascent psychopharmacology in both the United States and Europe and examines the protocols and findings of the research programs on depression the National Institute of Mental Health (NIMH) has developed in the United States at the same time, as well as on the writings of the main authors of the standardized evaluation. This investigation suggests that measurement of patients’ improvement could not be characterized on the basis of psychiatric inventories that were not well-suited to quantification, nor on the basis of psychometric tests which were intended for the evaluation of psychological invariants. This is why the answer given to the characterization of change in depression under therapy rather reveals a syncretism both conceptual and technical, mixing classificatory and psychometric traditions, a syncretism that the distinction endorsed by the Diagnostic and Statistical Manual of Mental Disorders , 3rd edition,between syndromes and personality disorders no longer allows us to perceive.
{"title":"How to Measure Depression: Looking Back on the Making of Psychiatric Assessment","authors":"Philippe Le Moigne","doi":"10.1353/ppp.2023.a908275","DOIUrl":"https://doi.org/10.1353/ppp.2023.a908275","url":null,"abstract":"Abstract: This article discusses the way how change in depressed patients included in clinical trials was both conceptualized and measured in the 1970s to decide on the efficacy of the first candidate drugs for the treatment of depression. Understanding how this issue was resolved is of major interest as the protocol designed to distinguish the diagnosis of the depressive syndrome from the measurement of its evolution over time built the contours of the methodological device to which the whole of standardized evaluation in psychiatry has since referred. This paper draws on the debates in nascent psychopharmacology in both the United States and Europe and examines the protocols and findings of the research programs on depression the National Institute of Mental Health (NIMH) has developed in the United States at the same time, as well as on the writings of the main authors of the standardized evaluation. This investigation suggests that measurement of patients’ improvement could not be characterized on the basis of psychiatric inventories that were not well-suited to quantification, nor on the basis of psychometric tests which were intended for the evaluation of psychological invariants. This is why the answer given to the characterization of change in depression under therapy rather reveals a syncretism both conceptual and technical, mixing classificatory and psychometric traditions, a syncretism that the distinction endorsed by the Diagnostic and Statistical Manual of Mental Disorders , 3rd edition,between syndromes and personality disorders no longer allows us to perceive.","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135588171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1353/ppp.2023.a908273
John Nolte
Psychodramatic Psychotherapy for Schizophrenic Individuals John Nolte, MD, PhD (bio) As a long-time student, practitioner, trainer, author and advocate of J. L. Moreno, MD,’s works and specifically the psychodramatic method, I am always appreciative of efforts, like Chapy’s, to commend and advocate for psychodrama. This is especially so because for a time, Moreno and psychodrama were heavily criticized, even maligned in the mental health professions. At the same time, considering how poorly Moreno and his methods have been understood as well as the difficulty of accessing his original material, I feel an obligation to set the record straight when confronted with incomplete, inadequate, or sometimes incompetent expositions of Moreno’s psychodrama. Chapy’s article recommends psychodrama as a treatment method for schizophrenic people by calling upon existentialist and phenomenological concepts. Psychodrama, he proposes, opens up existence by allowing “schizophrenic patients to incorporate the experience of an ‘absolutely other.’” There are major flaws in Chapy’s presentation. His “clinical illustration,” the presentation of a psychodrama with a schizophrenic patient, while it may be considered psychodrama under the broadest definition of the term, hardly fulfills the requirements of a psychotherapeutic psychodrama. We must question the competence of the psychodramatist in Chapy’s example. Chapy’s description of the drama itself falls short of being an adequate account of a psychodrama, failing to convey the emotional intensity and realness which a well directed and reported psychodrama achieves. We do not learn, for example, if Damien’s perception of his father is introduced through role reversal with the father, a standard psychodramatic technique which is done in order to give the auxiliary ego taking that role an understanding how Damien experiences his father. We do not know if role reversals are made throughout the drama so that Damien can experience how he is perceived by father, can feel the force of his confrontation in the role of father, and is required to reply as his father to his confrontation. We are given little information about the psychodramatic techniques employed by the director other than the scene setting of the studio in which the psychodramatic [End Page 227] encounter takes place, and the soliloquy in which Damien expresses his worry and hopes for the outcome of the confrontation. It should be clear in the description of the drama whether the father’s statements in the drama were produced by Damien in role reversal, or by the auxiliary ego playing the role. There is a difference and it is significant. Although we are told that Damien “evokes a systematic relationship between him and his father” during the psychodrama, we do not see how this happens. Every psychodrama is an existential experience and its description should fully communicate its meaning and emotion. A more serious problem, however, is that this drama does not
{"title":"Psychodramatic Psychotherapy for Schizophrenic Individuals","authors":"John Nolte","doi":"10.1353/ppp.2023.a908273","DOIUrl":"https://doi.org/10.1353/ppp.2023.a908273","url":null,"abstract":"Psychodramatic Psychotherapy for Schizophrenic Individuals John Nolte, MD, PhD (bio) As a long-time student, practitioner, trainer, author and advocate of J. L. Moreno, MD,’s works and specifically the psychodramatic method, I am always appreciative of efforts, like Chapy’s, to commend and advocate for psychodrama. This is especially so because for a time, Moreno and psychodrama were heavily criticized, even maligned in the mental health professions. At the same time, considering how poorly Moreno and his methods have been understood as well as the difficulty of accessing his original material, I feel an obligation to set the record straight when confronted with incomplete, inadequate, or sometimes incompetent expositions of Moreno’s psychodrama. Chapy’s article recommends psychodrama as a treatment method for schizophrenic people by calling upon existentialist and phenomenological concepts. Psychodrama, he proposes, opens up existence by allowing “schizophrenic patients to incorporate the experience of an ‘absolutely other.’” There are major flaws in Chapy’s presentation. His “clinical illustration,” the presentation of a psychodrama with a schizophrenic patient, while it may be considered psychodrama under the broadest definition of the term, hardly fulfills the requirements of a psychotherapeutic psychodrama. We must question the competence of the psychodramatist in Chapy’s example. Chapy’s description of the drama itself falls short of being an adequate account of a psychodrama, failing to convey the emotional intensity and realness which a well directed and reported psychodrama achieves. We do not learn, for example, if Damien’s perception of his father is introduced through role reversal with the father, a standard psychodramatic technique which is done in order to give the auxiliary ego taking that role an understanding how Damien experiences his father. We do not know if role reversals are made throughout the drama so that Damien can experience how he is perceived by father, can feel the force of his confrontation in the role of father, and is required to reply as his father to his confrontation. We are given little information about the psychodramatic techniques employed by the director other than the scene setting of the studio in which the psychodramatic [End Page 227] encounter takes place, and the soliloquy in which Damien expresses his worry and hopes for the outcome of the confrontation. It should be clear in the description of the drama whether the father’s statements in the drama were produced by Damien in role reversal, or by the auxiliary ego playing the role. There is a difference and it is significant. Although we are told that Damien “evokes a systematic relationship between him and his father” during the psychodrama, we do not see how this happens. Every psychodrama is an existential experience and its description should fully communicate its meaning and emotion. A more serious problem, however, is that this drama does not ","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135588250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1353/ppp.2023.a908278
Philippe Le Moigne
A s Peter Zachar rightly points out in his comment, the assessment of mental disorders underwent new developments with the release of the Diagnostic and Statistical Manual of Mental Disorders-V in 2013 (American Psychiatric Association , 2013). Whereas in 1980, the manual had been thought of in a rigorously categorical way, on the basis of distinct and closed syndromic entities, this new version advocated the development of a radically dimensionalist approach, with the diagnosis aiming this time to restore the whole symptomatological picture of the patient on a spectrum of ratings are supposed to cover the entirety of psychiatric semiology (American Psychiatric Association, 2013). For its part, my article aimed to show how standardized assessment, guided by the return of psychiatry’s authority and the assertion of its legitimacy in the diagnostic field, gave the ascendancy in the 1980s to the classificatory tradition and thus to the categorical model, to the detriment of personality approach and test psychology which offered a competing solution here. This perspective, historically dated, may have led the reader to think that there is an antagonism that cannot be overcome here. Rather, it should be seen as a form of structuring opposition, or even a “complementarity inscribed in rivalry,” between psychiatry and psychology, which is naturally susceptible to change over time. Indeed, the reversal operated by the Diagnostic and Statistical Manual of Mental Disorders-V is not total because it cannot be total. The defense of the dimensionalist approach, dear to the psychological testing tradition, was intended here to allow the identification of co-morbidities, present in most patients but poorly apprehended by the categorical approach, and to open up diagnosis to prevention by screening for minor manifestations of psychopathology when they suggest the
正如Peter Zachar在他的评论中正确指出的那样，随着2013年《精神障碍诊断与统计手册- v》(美国精神病学协会，2013)的发布，精神障碍的评估经历了新的发展。而在1980年，该手册被认为是以严格的分类方式，基于不同的和封闭的综合征实体，这个新版本提倡一种激进的维度方法的发展，这次的诊断旨在恢复患者的整体症状，在一个应该涵盖整个精神病学符号学的评分范围内(美国精神病学协会，2013)。就其本身而言，我的文章旨在展示标准化评估是如何在精神病学权威的回归及其在诊断领域的合法性的主张的指导下，在20世纪80年代给分类传统带来了优势，从而给分类模型带来了优势，损害了人格方法和测试心理学，后者在这里提供了一个竞争性的解决方案。从历史的角度来看，这种观点可能会让读者认为这里存在着一种无法克服的对抗。相反，它应该被视为精神病学和心理学之间结构性对立的一种形式，甚至是一种“镌刻在竞争中的互补性”，它自然会随着时间的推移而改变。事实上，《精神疾病诊断与统计手册》(Diagnostic and Statistical Manual of Mental Disorders-V)所做的逆转并非全部，因为它不可能是全部。对维度方法的辩护，对心理测试传统来说是很重要的，在这里，它的目的是允许识别共存的疾病，存在于大多数患者中，但被分类方法所忽视，并通过筛选精神病理学的轻微表现来打开诊断的预防，当它们表明[endpage 259]在或多或少的长期内发展为明显的疾病发作。这里的风险是，我们最终会过度诊断，从而导致假阳性的过度呈现(Wakefield, 2015)。换句话说，这种类型的方法并没有逃避确定阈值分数的义务，这可能表明障碍的下限，从而诉诸于分类方法。除了原则上的分歧之外，这两种观点之间有一种最初的亲缘关系，这是一种技术要求。但当我们审视它们的认识论背景时，这两种方法甚至有更多的共同点:它们都认为，用Ian Hacking(1983)的话来说，对精神障碍的表征和干预必须基于物理和自然科学提出的模型。正如Greta Kaluzeviciute在她的评论中恰当地指出的那样，这种取向导致了测量精神障碍的想法，特别是进行详细的量化操作，以确定，例如，两个实体在统计上是否不同，或者一种药物是否对病理学的演变有重大影响。事实上，这是一个古老的问题，可以用心理测量学家乔尔·米歇尔(1999)的表述表述如下:心理维度是度量的吗?换句话说，如果我们想将数字语言应用于精神障碍，它们必须共享其属性，其中两个似乎是必不可少的:必须有可能确定每种精神障碍，就像可归因于长度的品质一样，都有一个零，并且可以通过间隔为常数的梯度(或强度度)来划分(Le Moigne, 2018;米歇尔,1999)。由于篇幅有限，让我们只讨论第二个条件。从十九世纪末(1889年)柏格森开始，这一观点已经被许多人否定了。他不相信从感觉开始的心理表达的量化。他写道，感觉轻微的疼痛，就像感觉僵硬一样，和感觉一根针扎进你的肉里，这两者之间的共同点是什么?对他来说，这些强度中的一种和另一种是无法比较的，所以它们不属于一个类似的感觉记录，一个人可以从0到……
{"title":"Close Enemies: The Relationship of Psychiatry and Psychology in the Assessment of Mental Disorders","authors":"Philippe Le Moigne","doi":"10.1353/ppp.2023.a908278","DOIUrl":"https://doi.org/10.1353/ppp.2023.a908278","url":null,"abstract":"A s Peter Zachar rightly points out in his comment, the assessment of mental disorders underwent new developments with the release of the Diagnostic and Statistical Manual of Mental Disorders-V in 2013 (American Psychiatric Association , 2013). Whereas in 1980, the manual had been thought of in a rigorously categorical way, on the basis of distinct and closed syndromic entities, this new version advocated the development of a radically dimensionalist approach, with the diagnosis aiming this time to restore the whole symptomatological picture of the patient on a spectrum of ratings are supposed to cover the entirety of psychiatric semiology (American Psychiatric Association, 2013). For its part, my article aimed to show how standardized assessment, guided by the return of psychiatry’s authority and the assertion of its legitimacy in the diagnostic field, gave the ascendancy in the 1980s to the classificatory tradition and thus to the categorical model, to the detriment of personality approach and test psychology which offered a competing solution here. This perspective, historically dated, may have led the reader to think that there is an antagonism that cannot be overcome here. Rather, it should be seen as a form of structuring opposition, or even a “complementarity inscribed in rivalry,” between psychiatry and psychology, which is naturally susceptible to change over time. Indeed, the reversal operated by the Diagnostic and Statistical Manual of Mental Disorders-V is not total because it cannot be total. The defense of the dimensionalist approach, dear to the psychological testing tradition, was intended here to allow the identification of co-morbidities, present in most patients but poorly apprehended by the categorical approach, and to open up diagnosis to prevention by screening for minor manifestations of psychopathology when they suggest the","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"139 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135588254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-01DOI: 10.1353/ppp.2023.a908280
Jennifer Radden
Diagnostic Wannabes Jennifer Radden, PhD (bio) Saunders explores challenges for the clinician faced with self-styled sufferers from attention deficit hyperactivity disorder, post-traumatic stress disorder, bipolar disorder, autism spectrum disorder (ASD), and fibromyalgia. The diagnostic system was not meant to be used as “a scaffold for identity,” she points out. Yet wannabe patients now step into the clinic wielding self-proclaimed diagnoses as social identities. Saunders explains the context where such phenomena arise, and offers guidelines for clinicians addressing this new reality. To do so, she enlists Rashed’s innovative normative approach to the so-called boundary problem of assigning, and providing justification for, the contested line between normal and disordered. The boundary problem itself seems to rise to prominence during our current era of increasingly dimensional thinking, it is worth noting, with psychiatric diagnoses taken to refer to points on a continuum, rather than to discrete categorical disease entities. On the likely sources of these ‘diagnostic’ social identities, as well as reasons why certain diagnoses attach to them more commonly than others, Saunders points to social trends (including what she asserts to be a “post-stigma” cultural environment), the failure of efforts to identify neurobiological markers for psychiatric disorder, the ubiquity of social media, the algorithms themselves, and the hyperconnected existence of contemporary times. Such narratives also offer the comforts of a sense of belonging and explanations for perceived inadequacies, she rightly observes. Despite today’s virtual and other inducements, the problem introduced here is not an entirely new one. The first part of the seventeenth century in Europe saw an apparent “epidemic” of what was known as “melancholy,” a condition associated with the spleen, whose symptoms loosely resembled those of today’s depression and anxiety. Much of this suffering was undeniably real, but much was a fashionable, identity-conferring pose. “Every distemper of the body now is complicated with spleen,” the poet John Donne ironically observes in a letter dated 1622, “and when we were young men we scarce ever heard of the spleen. In our declinations now, every accident is accompanied with heavy clouds of melancholy”1 (Gosse, 2019). By then, the Melancholic Man (or homo melancholicus), with his surfeit of spleen, was an unmistakable character type—or social identity, as we would now say. Recognized and saluted in centuries-long literary and illustrative traditions, the type was an anchoring element of the humoral medicine which, despite the gradual emergence of more empirical science, had endured since Galenic times. Melancholy’s closest descendants, affective depressive and anxiety disorders, are today less evident among the troubling identities Saunders discusses—somewhat preempted, she points out, by more cognitively-based diagnoses such as ASD. [End Page 279] This is
{"title":"Diagnostic Wannabes","authors":"Jennifer Radden","doi":"10.1353/ppp.2023.a908280","DOIUrl":"https://doi.org/10.1353/ppp.2023.a908280","url":null,"abstract":"Diagnostic Wannabes Jennifer Radden, PhD (bio) Saunders explores challenges for the clinician faced with self-styled sufferers from attention deficit hyperactivity disorder, post-traumatic stress disorder, bipolar disorder, autism spectrum disorder (ASD), and fibromyalgia. The diagnostic system was not meant to be used as “a scaffold for identity,” she points out. Yet wannabe patients now step into the clinic wielding self-proclaimed diagnoses as social identities. Saunders explains the context where such phenomena arise, and offers guidelines for clinicians addressing this new reality. To do so, she enlists Rashed’s innovative normative approach to the so-called boundary problem of assigning, and providing justification for, the contested line between normal and disordered. The boundary problem itself seems to rise to prominence during our current era of increasingly dimensional thinking, it is worth noting, with psychiatric diagnoses taken to refer to points on a continuum, rather than to discrete categorical disease entities. On the likely sources of these ‘diagnostic’ social identities, as well as reasons why certain diagnoses attach to them more commonly than others, Saunders points to social trends (including what she asserts to be a “post-stigma” cultural environment), the failure of efforts to identify neurobiological markers for psychiatric disorder, the ubiquity of social media, the algorithms themselves, and the hyperconnected existence of contemporary times. Such narratives also offer the comforts of a sense of belonging and explanations for perceived inadequacies, she rightly observes. Despite today’s virtual and other inducements, the problem introduced here is not an entirely new one. The first part of the seventeenth century in Europe saw an apparent “epidemic” of what was known as “melancholy,” a condition associated with the spleen, whose symptoms loosely resembled those of today’s depression and anxiety. Much of this suffering was undeniably real, but much was a fashionable, identity-conferring pose. “Every distemper of the body now is complicated with spleen,” the poet John Donne ironically observes in a letter dated 1622, “and when we were young men we scarce ever heard of the spleen. In our declinations now, every accident is accompanied with heavy clouds of melancholy”1 (Gosse, 2019). By then, the Melancholic Man (or homo melancholicus), with his surfeit of spleen, was an unmistakable character type—or social identity, as we would now say. Recognized and saluted in centuries-long literary and illustrative traditions, the type was an anchoring element of the humoral medicine which, despite the gradual emergence of more empirical science, had endured since Galenic times. Melancholy’s closest descendants, affective depressive and anxiety disorders, are today less evident among the troubling identities Saunders discusses—somewhat preempted, she points out, by more cognitively-based diagnoses such as ASD. [End Page 279] This is ","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135588424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1353/ppp.2023.a899943
C. Flores
* University of California, Irvine floreshc@uci.edu The author reports no conflict of interest. P ablo Hubacher Haerle’s excellent paper argues that there are cases of obsessivecompulsive disorder (OCD) (sexual OCD [S-OCD], specifically) in which people inquire in rational ways. If his analysis is correct, then OCD is not uniformly characterized by epistemic irrationality. The analysis of the cases is compelling, and it offers valuable new resources for understanding why (some) subjects with OCD persist in their inquiries. But I want to raise some questions about whether subjects really inquire rationally. To do so, I suggest a more comprehensive assessment of how these agents set different epistemic parameters. More generally, I will argue that by focusing on epistemic parameter settings and epistemic styles, we can clarify different loci of irrationality while de-stigmatizing OCD.
{"title":"Epistemic Style in OCD","authors":"C. Flores","doi":"10.1353/ppp.2023.a899943","DOIUrl":"https://doi.org/10.1353/ppp.2023.a899943","url":null,"abstract":"* University of California, Irvine floreshc@uci.edu The author reports no conflict of interest. P ablo Hubacher Haerle’s excellent paper argues that there are cases of obsessivecompulsive disorder (OCD) (sexual OCD [S-OCD], specifically) in which people inquire in rational ways. If his analysis is correct, then OCD is not uniformly characterized by epistemic irrationality. The analysis of the cases is compelling, and it offers valuable new resources for understanding why (some) subjects with OCD persist in their inquiries. But I want to raise some questions about whether subjects really inquire rationally. To do so, I suggest a more comprehensive assessment of how these agents set different epistemic parameters. More generally, I will argue that by focusing on epistemic parameter settings and epistemic styles, we can clarify different loci of irrationality while de-stigmatizing OCD.","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"33 1","pages":"147 - 150"},"PeriodicalIF":2.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74795173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1353/ppp.2023.a899947
Lydia Amir
{"title":"Narcissism A Focal Point for Examining the Interrelatedness of Psychology and Philosophy","authors":"Lydia Amir","doi":"10.1353/ppp.2023.a899947","DOIUrl":"https://doi.org/10.1353/ppp.2023.a899947","url":null,"abstract":"","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"1 1","pages":"169 - 172"},"PeriodicalIF":2.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75830387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1353/ppp.2023.a899950
A. Plutynski
Abstract:In this paper, I distinguish four ways in which aspects or features of mental illness may be said to be functional. I contend that discussion of teleological perspectives on mental illness has unfortunately tended to conflate these senses. The latter two senses have played important practical roles both in predicting and explaining patterns of behavior, cognition, and affective response, atnd relatedly, in developing successful interventions. I further argue that functional talk in this context is neither inconsistent with viewing some disorders as dysfunctional in one of several senses, nor inappropriately adaptationist, provided we keep these senses of function distinct, and are precise about which is in play in a given context.
{"title":"Four Ways of Going “Right” Functions in Mental Disorder","authors":"A. Plutynski","doi":"10.1353/ppp.2023.a899950","DOIUrl":"https://doi.org/10.1353/ppp.2023.a899950","url":null,"abstract":"Abstract:In this paper, I distinguish four ways in which aspects or features of mental illness may be said to be functional. I contend that discussion of teleological perspectives on mental illness has unfortunately tended to conflate these senses. The latter two senses have played important practical roles both in predicting and explaining patterns of behavior, cognition, and affective response, atnd relatedly, in developing successful interventions. I further argue that functional talk in this context is neither inconsistent with viewing some disorders as dysfunctional in one of several senses, nor inappropriately adaptationist, provided we keep these senses of function distinct, and are precise about which is in play in a given context.","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"37 1","pages":"181 - 191"},"PeriodicalIF":2.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89442515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.1353/ppp.2023.a899946
A. Fatic
Abstract:In this paper, I suggest that the moral incompetence in narcissism is associated with a particular type of emotional incompetence, namely the incompetence to experience the moral emotions, such as empathy, solidarity, loyalty, or love. I then move on to discussing the ethical ramifications of this incompetence, primarily from the point of view of sentimentalist ethics, and conclude that emotional incompetence does not in fact reduce the moral responsibility of a narcissist person, whether diagnosed with Narcissistic Personality Disorder or not. My argument is based on the three criteria of moral responsibility proposed by Philip Pettit, namely those of value relevance, value judgment, and value sensitivity. I suggest that a sentimentalist ethical perspective entails that the satisfaction of two of the mentioned criteria (awareness of the social meaning of one’s choices and sufficient control of one’s actions) constitutes a moral obligation for the agent to satisfy the third criterion, namely to develop the appropriate moral sensibility and competence to actually choose morally correctly. This type of structure of obligation elucidates why narcissism is at the same time a moral failure and a psychopathology. At the same time, my argument portrays narcissism as a particular type of personality disturbance that almost uniquely reaffirms the role of moral re-education as the psychotherapeutic approach. This conclusion points to a potential revival of some of the precepts of Pinel’s affective psycho-pathology, dating back to the very beginnings of the psychotherapeutic clinic.
{"title":"Narcissism as a Moral Incompetence","authors":"A. Fatic","doi":"10.1353/ppp.2023.a899946","DOIUrl":"https://doi.org/10.1353/ppp.2023.a899946","url":null,"abstract":"Abstract:In this paper, I suggest that the moral incompetence in narcissism is associated with a particular type of emotional incompetence, namely the incompetence to experience the moral emotions, such as empathy, solidarity, loyalty, or love. I then move on to discussing the ethical ramifications of this incompetence, primarily from the point of view of sentimentalist ethics, and conclude that emotional incompetence does not in fact reduce the moral responsibility of a narcissist person, whether diagnosed with Narcissistic Personality Disorder or not. My argument is based on the three criteria of moral responsibility proposed by Philip Pettit, namely those of value relevance, value judgment, and value sensitivity. I suggest that a sentimentalist ethical perspective entails that the satisfaction of two of the mentioned criteria (awareness of the social meaning of one’s choices and sufficient control of one’s actions) constitutes a moral obligation for the agent to satisfy the third criterion, namely to develop the appropriate moral sensibility and competence to actually choose morally correctly. This type of structure of obligation elucidates why narcissism is at the same time a moral failure and a psychopathology. At the same time, my argument portrays narcissism as a particular type of personality disturbance that almost uniquely reaffirms the role of moral re-education as the psychotherapeutic approach. This conclusion points to a potential revival of some of the precepts of Pinel’s affective psycho-pathology, dating back to the very beginnings of the psychotherapeutic clinic.","PeriodicalId":45397,"journal":{"name":"Philosophy Psychiatry & Psychology","volume":"23 1","pages":"159 - 167"},"PeriodicalIF":2.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85263353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：