Dialogues in Philosophy, Mental and Neuro Sciences 2012, Vol.5, Issue 1

The new issue of Dialogues in Philosophy, Mental and Neuro Sciences is online. As usual articles written from different perspectives enrich the interdisciplinary dialogue in Philosophy of Psychopathology.

Jakovljevic & Crnčevic present the most comprehensive article ever published on the epistemological implications of psychiatric comorbidity. The following is the abstract of their “Comorbidity as an epistemological challenge to modern psychiatry”: In spite of a considerable progress in comorbidity research and huge literature on it, this phenomenon is one of the greatest epistemological, research and clinical challenges to contemporary psychiatry and medicine. Mental disorders are very often comorbidly expressed, both among themselves and with various sorts of somatic diseases and illnesses. Therefore, comorbidity studies have been expected to be an impetus to research on the validity of current diagnostic systems as well as on establishing more effective and efficient treatment within the frame of person centered transdisciplinary psychiatry and integrative medicine. This review focuses first on conceptual chaos and different connotations, then on transdisciplinary perspectives of comorbidity and multimorbidity. The authors compiled an extensive set of various views and perspectives, dilemmas and controversies, in order to evaluate what we know and what we don't about comorbidity, what comorbidity is and what comorbidity is not, what are facts and what are non-facts on comorbidity and multimorbidity.

The entire article can be read directly at: http://www.crossingdialogues.com/Ms-A12-07.pdf

Brian Earp introduces the reader to the fascinating world of philosophy of mind. The article is entitled “I can't get no (epistemic) satisfaction: Why the hard problem of consciousness entails a hard problem of explanation”. It is an important contribution on the discussion of Chalmers’ famous challenge to cognitive research. In the abstract, Earp writes: Daniel Dennett (1996) has disputed David Chalmers' (1995) assertion that there is a "hard problem of consciousness" worth solving in the philosophy of mind. In this paper I defend Chalmers against Dennett on this point: I argue that there is a hard problem of consciousness, that it is distinct in kind from the so-called easy problems, and that it is vital for the sake of honest and productive research in the cognitive sciences to be clear about the difference.But I have my own rebuke for Chalmers on the point of explanation. Chalmers (1995, 1996) proposes to "solve" the hard problem of consciousness by positing qualia as fundamental features of the universe, alongside such ontological basics as mass and space-time. But this is an inadequate solution: to posit, I will urge, is not to explain. To bolster this view, I borrow from an account of explanation by which it must provide "epistemic satisfaction" to be considered successful (Rowlands, 2001; Campbell, 2009), and show that Chalmers' proposal fails on this account. I conclude that research in the science of consciousness cannot move forward without greater conceptual clarity in the field.

Here is the link, the download is free as usual: http://www.crossingdialogues.com/Ms-A12-04.pdf

In the section New Ideas, Prof. Korf proposes to consider the mind as an emerging configuration of the personal brain. It is a new and very interesting point of view that merits to be widely discussed by neuroscientists and philosophers of mind. This is the abstract: This essay examines the relationship between metabolic brain processes and psycho-physiological activities or mental activity. It is argued that metabolic brain processes, including those involved in the production of energy, proteins and other molecules are restorative and conditional, rather than directly involved in mental activities. This stance suggests that life-time acquired learning and memory is precipitated as a permanent and personal configuration of the brain, that is in principle accessible to neurophysiological examination. Current neuroscience largely ignores implicitly or explicitly the search for new emergent configurations of the brain.

The link is: http://www.crossingdialogues.com/Ms-C11-05.pdf

Biological and psychological reflections on Religion are the focus of “Mysticism and Science: Two Products of the Human Imagination”, by Trevors & Saier Jr. In the abstract the authors state: We examine that both science and religion were original products of the human imagination. However, the approaches taken to develop these two explanations of life, were entirely different. The precepts of evolution are well established through the scientific method. This approach has led to the accumulation of immense amounts of evidence for biological evolution, and much scientific progress has been made to understand the pathways taken for the appearance of organisms and their macromolecular constituents. The existence of spiritual beings has not and presumably cannot be documented via a scientific approach, no more than a fairy tale or a myth. However, science, education and knowledge coupled to proper actions are exactly what are needed to make the correct decisions so as to preserve and improve our common, shared biosphere which is currently confronted with two immense problems: human population growth and climate change.

The link for the open access is: http://www.crossingdialogues.com/Ms-C11-01.pdf

Finally, in the section Dialogues David Trafimow comments on the “Descriptive richness and abstract theorizing pertaining to schizophrenic disorders”. The author argues that: a) diagnosis

of clinical disorders is unlikely to work well in the absence of a theory on which the diagnostic

system can be based, and b) at present, there is very little theory concerning schizophrenic disorders. On this basis he argues that good descriptions are not enough and that researchers should

collect rich descriptions of subjective experiences of schizophrenics in the interest of generating

a strong theory.

The link to read his contribution is: http://www.crossingdialogues.com/Ms-D12-01.pdf

Trafimow’s paper is a comment to Gaetano’s contribution that can be downloaded at: http://www.crossingdialogues.com/Ms-A11-02.pdf

Towards a new epistemology of psychiatry - Prof. German Berrios at the Roman Circle of Psychopathology

On February 16, 2012 the Roman Circle of Psychopathology was honoured to meet Prof. German E. Berrios (Cambridge University) who lectured on Towards a new epistemology of psychiatry.

The lecture was co-organized with the Association Crossing Dialogues that supports the interdisciplinary dialogue between philosophy and psychopathology. The organizers thank the University of Rome La Sapienza for the hospitality, and Dr. Giorgio Kotzalidis for his kind help with the translation.

Abstract of the lecture
Prof. Berrios started his lecture by drawing a difference between macroepistemological and microepistemological questions concerning psychiatry. The last are about mental symptoms (e.g., What is their nature? What's their meaning? What kind of structure do they have? What kind of typology? Are they homogeneous or heterogeneous?), about mental disorders (How are they defined? Are they historical entities? What's their cultural impact? What's their ontology?), and about generators and configurators (Reductionism, Localisationism, Psychogenesis, Semantic Space, Reasons vs Causes, etc.).

The historical perspective shows that the primary phenomena are the mental symptoms, which are currently considered as the 'objects of psychiatry'. Against this predominant assumption, Prof. Berrios showed that mental symptoms originated and were constructed in a particular historical and cultural context and that they were from the start constructed as hybrid objects.
Mental symptoms are hybrid objects because they exhibit the following features: a physical kernel regularly subjected to cultural configuration, and a dense semantic wrapper or envelope. According to the Cambridge model of symptom formation, an original brain signal can reach the awareness domain. In this case the subjective experience is initially indefinite (the author talks of a "primordial soup"). Here a first semantic level is involved when the patient, on the basis of his own characteristics (i.e. styles of talking about the body: personal, familial, social, cultural, etc.) tries to define and denominate his experience. A second level is that of symptom expression, when symptom-formation occurs within a "dialogical encounter" between the patient and the psychopathologist. It is only after this "negotiation of meaning" that the originally indistinct experience becomes a recognized, delimited and denominated mental symptom.
In conclusion, according to the Cambridge model mental symptoms are brain signals configured by cultural codes. One signal may give rise to different mental symptoms and different signals can be configured as the same mental symptom.
In sum, this model challenges the opposition nature-culture in a way that reconciles dynamically the brain activity and the semantic sphere.

The study of subjective experience as a scientific task for psychopathology

Abstract: The debate on the scientific validity of mental disorders and psychopathological phenomena is considered in the broader context of the paradigmatic crisis occurring in nowadays psychiatry. The author comments a work of Stoyanov, Machamer and Schaffner appeared on this journal. There is a complete agreement on two basic assertions: a) practically, clinical interviews, structured interviews based on the DSM and psychometric scales are different but overlapping instruments exploring the same phenomenal level; b) psychiatry is not a unitary science but a multifaceted activity based on different domains of knowledge. However, the related assumption that instruments exploring psychopathological phenomenology are not enough scientific because they are too much subjective is questioned. At the epistemological level, it is shown that subjectivity is everywhere since all scientific observations are theory-laden. Nevertheless, it is suggested that this state of affairs does not necessarily lead to methodological anarchism and is compatible with a scientific stance. At the psychopathological level, it is shown that both mental disorders and symptoms are hermeneutical constructions and that Jaspers introduced phenomenology as the proper scientific equipment for the scientific study of subjective experience. In conclusion it is suggested that psychopathological phenomenology can be renewed to meet the present-day scientific needs, but psychopathology cannot work without the awareness that its scientific descriptions are always based on a semiotic activity.
The entire article can be freely downloaded at: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2753.2011.01794.x/full

THE EPISTEMOLOGICAL BASIS OF PSYCHIATRIC CONTROVERSIES

D. Kecmanovic recently published a paper on the reasons of the endless psychiatric controversies. A debate followed. Among the others, M. Aragona focused on the epistemology of psychiatry. He reminds that “taken as a whole the disciplines concerned with the mind and with mental pathologies do not constitute a mature science. While the various branches of medicine are all subtended by a common basic science grounded on a unique and shared view of the human body functioning, the various disciplines studying the mental phenomena are based on different theoretical principles, see their field of study from different viewpoints, use different techniques of inquiry and presuppose interpretations and solutions which are widely heterogeneous” (Aragona M. Aspettando la rivoluzione. Editori Riuniti, Roma, 2006, p.34). However, the author notes that to define psychiatry as a pre-paradigmatic scientific activity risks to pass unnoticed a fundamental assumption. In fact, the implicit idea is that psychiatry should conform to this model and that its current position is that of an immature science that in the future will be based on a unique scientific paradigm. This process will let all the other perspectives on the matter to progressively disappear from the scientific debate, being reconceptualized as non-scientific or proto-scientific cultural forms. This is the faith accompanying from its beginning any somatological theory about mental illness but the risk is to covertly introduce here a reductionist assumption: there are many perspectives and many models only because psychiatry is not scientific yet. Is it a correct picture of psychiatry, or at the opposite the peculiar object of study of our discipline (the mental suffering of the human being) cannot in principle be fully reduced to the materialistic study of his brain? The plurality of models is a transient phenomenon, or the multi-perspectivist approach is intrinsic to psychiatry and thus unavoidable? The methodological pluralism of Karl Jaspers is used here to support a multiperspectivist stance. In conclusion, psychological perspectivism and pragmatism (intended as choosing this or that model depending on the relevance of specific scientific/clinical questions and on the most appropriate model to answer) are proposed. It is suggested that the basic epistemological tension underlying psychiatric controversuies is that between a realist model (that sounds scientific but is historically untenable) and a constructivist model which is better corroborated by the historical inquiry but that by acknowledging the unavoidable role of hermeneutics risks to be perceived as anti-scientific and radically relativistic.
The link to read this article and the entire debate is: http://www.hdbp.org/psychiatria_danubina/pdf/dnb_vol23_no3/dnb_vol23_no3_02.pdf

Dialogues in Philosophy, Mental and Neuro Sciences 2011; Vol.4, Issue 2

The new issue of Dialogues in Philosophy, Mental and Neuro Sciences is online. Two articles focus on phenomenological psychopathology.
In the first one, Maria Luísa Figueira and Luís Madeira (Lisbon University) discuss the role of time and space in the phenomenology of bipolar disorders, particularly in mania. Theories by Heidegger, Husserl and Merleau-Ponty as well as by Minkowsky, Binswanger, Fuchs, Parnas, and Sass are reviewed in relation to euphoric and dysphoric manic and hypomanic states.
This article can be freely downloaded at: http://www.crossingdialogues.com/Ms-A11-01.pdf
In the second paper, Paola Gaetano discusses a previous paper published on a past issue of Dial Phil Ment Neuro Sci (Kraus A. Existential a prioris and the phenomenology of schizophrenia). She argues that the current diagnostic systems have inadvertently resulted in an impoverished clinical practice; From their purely descriptive point of view schizophrenic symptoms that would appear bizarre and senseless. On the contrary, Gaetano suggests that there is substantial meaning underlying psychotic phenomena and that an Heideggerian conception of human existence (the existence is always 'in the world', 'near the things' and 'with the others' in the unity of the Dasein) may help understand the subjective experience of a schizophrenic patient and increase diagnostic accuracy and treatment adequacy. This article is at this link: http://www.crossingdialogues.com/Ms-A11-02.pdf
A third article (Mari Stenlund: Involuntary antipsychotic medication and freedom of thought) deals with a complex issue in applied ethics: what is the relationship between the use of involuntary antipsychotic medication and a delusional person's freedom of thought? The author shows that clinical practice strictly depends on the way we conceive freedom. Accordingly, she discuss different stances in the psychopharmacological approach in the light of three different views of freedom, namely, freedom as negative freedom, freedom as having an autonomous mind and freedom as capability. Download at: http://www.crossingdialogues.com/Ms-C11-02.pdf
Another paper discusses the classic antipsychiatric text of Thomas Szasz (The myth of mental illness) from a semiotic point of view. It is shown that Szasz’s revolution is to consider the hysterical symptoms as a foreign language, thus allowing a semiotic analysis. Accordingly, the somatic language of the hysteric person is discussed as an iconic protolanguage. The conclusion is that the hysterical symptom speaks its proper language and our ethical commitment is primarily to empathically listen to it (Valeria Lelli: The body language: a semiotic reading of Szasz' Anti-psychiatry). The link to read this contribution is: http://www.crossingdialogues.com/Ms-C11-03.pdf
Finally, Sofia Siwecka presents the epistemological ideas of a great figure in the early philosophy of medicine: Ludwik Fleck. Fleck anticipated many ideas later defended by the “new philosophy of science” (e.g. Thomas Kuhn) but is only rarely cited because his main contributions are in Polish. Siwecka directly translated Fleck’s texts and introduces the reader to his theory of knowledge. Applied to psychiatry, the ideas of Fleck shed light on how psychiatric diagnoses are influenced by a specific thought style that directs the observations and affects the development of knowledge and the formation of connections between concepts. This article is at: http://www.crossingdialogues.com/Ms-C11-04.pdf

Melancholia and Arts

What is a melancholy from psychopatological perspective?
How has melancholia been interpreted through history?
Why does melancholia "pervade every arts" (Lars von Trier)?
Is melancholia connected with narcissim?
Some books on this topic?
These are the questions from an interview appeared on SATELLITE VOICES
To read it, the link is: http://www.satellitevoices.com/rome/culture/1790/melancholia-iii-massimiliano-aragona

Program of the 2011-2012 Seminars of the Roman Circle of Psychopathology