Jennifer Radden

: Extreme pain and suffering are associated with depression as well as tissue damage. The impossibility of imagining any feelings of pain and suffering intersect with two matters: the kind of imagining involved, and the nature of delusions. These two correspond to the sequence of the following discussion, in which it is contended first that feelings of pain and suffering resist being imagined in a certain, key way, and second that, given a certain analysis of delusional thought, this precludes the possibility of delusional affections while allowing delusions about affections. Keywords: Pain; Imagination; Delusion; Affection; Feelings Dolore immaginato e dolore illusorio Riassunto: Dolore estremo e sofferenza sono solitamente associati a depressione e danni tissutali. L’impossibilità di immaginare il provare dolore e sofferenza dipende da due fattori: il tipo di immaginazione coinvolta e la natura dell’illusione. Questi due fattori saranno trattati in parallelo nell’analisi che qui si propone, in cui si discuterà in primo luogo come il provare dolore e sofferenza oppongano resistenza all’essere immaginati in un certo modo e in secondo luogo come, secondo una certa analisi del pensiero illusorio, questo preclude la possibilità di affezioni illusorie mentre consente illusioni circa le affezioni. Parole chiave: Dolore; Immaginazione; Illusioni; Affezione; Sensazioni

Feelings associated with grief are regularly described as painful, but in what respect are they to be understood as pain? The acute pain of easily located tissue damage has long been the paradigm of pain in scientific and philosophical analysis, a dominance serving to obscure features the pain of grief might share not only with chronic pain but with some depressive suffering. Two examples of such commonalities are explored (ways pain feelings are experienced as in and of the body; and are often recessed to the background of consciousness). These features are introduced to illustrate how a preliminary search for additional pain paradigms might proceed, and in so doing to offer some support for the proposal that pain endured as part of grieving may be real pain, not merely 'pain'.

Because other cultures classify mental disorders very differently from ours, it behooves us to inquire into the philosophical and cultural sources of our own guiding nosological categories. This paper is a philosophical exploration into the historical and theoretical bases of the late nineteenth-century, Kraepelinian division between disorders of mood or affect, and schizophrenia, in which our present day nosological categories are rooted. By tracing the early nosologists’ divisions into eighteenth-century and Kantian faculty psychology, and following the fate of faculty psychology through the nineteenth century, we discover genealogical elements of our taxonomy likely to affect clinical diagnosis and understanding.

In this paper I shall first expose a weakness shared by several philosophical discussions of self-deception: I shall show that these discussions have failed to give it a complete analysis. The apparent phenomenon of self-deception is all too familiar, and yet its adequate characterization in general terms is wanting. More exactly, I shall argue that to understand self-deception statically, as these accounts have done, has been—and must be—to fail to give a characterization of it as a state of mind, sufficient to distinguish it from other mental states not born of self-deception.

Delusions play a fundamental role in the history of psychology, philosophy and culture, dividing not only the mad from the sane but reason from unreason. Yet the very nature and extent of delusions are poorly understood. What are delusions? How do they differ from everyday errors or mistaken beliefs? Are they scientific categories? In this superb, panoramic investigation of delusion Jennifer Radden explores these questions and more, unravelling a fascinating story that ranges from Descartes’s demon to famous first-hand accounts of delusion, such as Daniel Schreber’s Memoirs of My Nervous Illness. Radden places delusion in both a clinical and cultural context and explores a fascinating range of themes: delusions as both individually and collectively held, including the phenomenon of folies á deux ; spiritual and religious delusions, in particular what distinguishes normal religious belief from delusions with religious themes; how we assess those suffering from delusion from a moral standpoint; and how we are to interpret violent actions when they are the result of delusional thinking. As well as more common delusions, such as those of grandeur, she also discusses some of the most interesting and perplexing forms of clinical delusion, such as Cotard and Capgras

My thanks to Professors Hawkins and Szmukler for their thoughtful commentaries; I am particularly glad to see these scholars' valuable expertise directed toward what raises pressing issues not only for psychiatry but for contemporary society.Prof. Hawkins reasons that the use of forced feeding with some anorexia is justified, while emphasizing that this will occur rarely. She and I are in agreement that a mere handful of cases may be affected by our debate, since anecdotal evidence from clinical settings as well as the studies Hawkins cites suggest that forced feeding will often be contraindicated. Still, the matter can equally well be cast hypothetically, as I implied in my earlier discussion. If forced feeding...

In lieu of an abstract, here is a brief excerpt of the content:Diagnostic WannabesJennifer 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 itself an ironic reminder of the vagaries of cultural attitudes, cautioning us to remember the broader context where these particular social identities are selected for emulation and adoption.The lure of the melancholy man’s2 social identity is well understood: already normalized, within the humoral system in which excess black bile afflicted roughly one in four people, it had been valorized for centuries—arguably by Aristotelian writing (in the dubious ‘Problems’), during the Renaissance by Ficino, and Shakespeare—even by Freud in his 1916 ‘Mourning and Melancholia.’ Through most of Western history, the positive attributes and benefits of the dark moods of melancholy have needed no further explaining or justifying. They glow with glamorous associations.Applying Rashed’s conditions for appropriately acknowledging and recognizing the fit of a person’s chosen social identity, Saunders‘ guidance for clinicians clarifies boundary matters. And it illustrates how to understand, regulate and communicate the appropriate norms in ways that can dissuade those whose personal growth and mental health are not served by claiming such identities.With at least some of the popular social identities Saunders describes, I think we can helpfully continue the comparison with the homo melancholicus. For the ‘neurodiversity’ rhetoric of our own times contains forces promoting both the normalization and the valorization of syndromes such as ASD. Pointing to analogies with differences of gender, ethnicity and culture, neurodiversity theorizing argues for a respect for, and appreciation of, difference. Mental or cognitive variations are equally natural and valuable, it is...

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Psychopathy, Other-Regarding Moral Beliefs, and Responsibility”Jennifer Radden (bio)Fields’s line of reasoning may be summarized, though to do so is to lose much that is nice, and important, in the details. He begins by distinguishing the kind of disorder we are dealing with. Psychopathy is a personality disorder: an unchanging, trait-based condition, not a mental disease or illness. Then he asks why we might judge the presence of psychopathy to vitiate moral and legal responsibility, and answers that psychopathy must reflect some kind of disability. It has been hypothesized (by Duff) that this disability concerns moral understanding, but Fields offers an alternative account. Rather than lacking moral understanding, he argues, the psychopath is disabled in that he cannot form other-regarding moral beliefs. A very convincing argument is then made to persuade us that such a disability would—or should—constitute an excuse.Much of this reasoning is unassailable, and Fields’s careful and systematic approach is impressive. Yet I am left with a lingering concern. He has not convinced me that the psychopath is incapable of forming instead of merely disinclined to form the required sort of moral beliefs. And rather than furthering or supporting his incapacity explanation, Cleckley’s example of Milt undermines it.Maybe the example of Milt’s callousness is the place to start, although whether this is as strong an example as Fields and Cleckley seem to think of psychopathy, is questionable. It is a rather underdescribed example, certainly. We are told that this is the unvarying pattern of Milt’s behavior. Indeed, it has to be to fit the clinical definition of psychopathy as a trait-based character disorder rather than a short-lived “out of character” response. And yet Milt has reached driving age and his mother is still naive enough to expect he’ll pick her up! We need to know more. If mother hasn’t grasped Milt’s dispositional traits yet, why not? Perhaps these traits are not so unvarying and entrenched after all. Or mother is colluding, or denying? Perhaps the understanding between mother and son contained meanings not apparent in the bald clinical description provided by Cleckley. There may be more to this story than meets the eye.So I’m not sure that the example successfully illustrates the clinical definition of psychopathy. But let’s say it does. If we accept the story as we are told it, there remains a gap in the reasoning. That Milt lacks the capacity to form such (other regarding) beliefs, and to harbor guilt feelings as Fields asserts, would explain his irresponsible [End Page 287] behavior—why he “so easily gives way to whims, even though he knows that to do so is to leave his mother... stranded”(p. 33).An incapacity to form other-regarding beliefs may explain this behavior, true. But so equally might being someone given to whims. After all Milt might just have the personality trait, also long established and unchanging, that he gives in to whims more often than most. This is what people sometimes mean when they attribute impulsiveness. And impulsiveness is not only a rather common trait; as it happens it is also one associated with this particular disorder (among others).Fields recognizes the type of explanation which refers to the presence of an unthought out impulse to act, a whim explanation. But he fails to give this kind of explanation its due, using it only selectively and arbitrarily. If, as Field establishes, it is more coherent to think that Milt’s initial offer to his mother was a matter of whim—rather than evidence of the other-regarding belief that one ought to concern oneself with the welfare of one’s parents—then there is no reason to suppose that his failure to follow through and pick her up was not also a whim. This second whim represents an equally satisfactory (simple, plausible, explanatory, not ad hoc ) explanation: Milt might have come to pick up his mum but he whimfully chose not to.And this is a separate and distinct explanation from the one Fields proposes in terms of incapacity. A whim is not (immediate) evidence of incapacity...

A professor of philosophy at Western University in Ontario, with joint appointments in Philosophy and the School of Health Studies, Louis Charland unexpectedly passed away on May 9, 2021. In addition to Western, he taught at the Universities of Toronto, McGill, and Concordia. He had visiting appointments at Institute for Advanced Study at Princeton, the Australian Research Council Centre of Excellence for the History of Emotion in Perth, and the Max Planck Institute for Human Development in Berlin. Beyond his teaching and research, he also undertook consulting work for several hospitals and governmental and social service agencies.Louis was the son of a diplomat and was raised as a citizen of the world, with Paris...

This paper explores the two-factor theoretical model currently widely used to provide an explanatory analysis of the delusions that regularly accompany neurological disease or damage. The model hypothesizes a combination of an experiential factor – a strange or untoward experience – and a cognitive factor, such as an impairment of reasoning. The two-factor model has been devised formonothematicdelusions that are usually manifested in a single, implausible idea. These have to be distinguished from the more elaborated,polythematicdelusions that are found in psychiatry. Psychiatric delusions exceed neurological ones in frequency and, often, semantic complexity. This text offers a preliminary clarification of underlying assumptions about the breadth, terminology and presuppositions of two-factor theorizing, exploring its potential application to psychiatric delusions.

Among the ideas and themes in Burton’s Anatomy of Melancholy with apparent bearing on the treatment of depression in our own times, four are the subject of the present chapter. First, these herbal and other remedies were to be taken as part of a broader regimen of which no single part could be omitted. The regulation of exercise, fresh air, sleep, diet, evacuation, and feelings, believed to together keep the bodily humors in healthy balance, demanded habits and practices that were essential accompaniments to one another and to other measures. This was eclectic and holistic healing, only effective when combined. Second, adhering to this regimen was, for the most part, the individual’s own responsibility: it was an extensive self-help program. Third, it was preventive medicine, thought to ward off the symptoms of melancholy before they became entrenched and difficult to treat. And, finally, underlying and reinforcing these practical recommendations were ideas about the causes of, and remedies for, melancholy that are consonant with some recent challenges to the application of mainstream conceptions of disease in today’s medicine when it comes to the treatment of depression. Inasmuch as he seems to eschew “common cause” etiological models, Burton’s account corresponds more closely to the network-based models beginning to be proposed for disorders of mood or affect.

In considering the debate about the meaning of ‘disease’, the positions are generally presented as falling into two categories: naturalist, e.g., Boorse, and normativist, e.g., Engelhardt and many others. This division is too coarse, and obscures much of what is going on in this debate. I therefore propose that accounts of the meaning of ‘disease’ be assessed according to Hare's (1997) taxonomy of evaluative terms. Such an analysis will allow us to better understand both individual positions and their interrelationships. Most importantly, it will show that it is unlikely that there is a single unique disease-concept at issue. Rather, different authors are, for the most part, considering different concepts.