Jennifer Radden

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.

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...

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'.

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...

: 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

In recent years there has been increased recognition of the global burden of mental disorders, which in turn has led to the expansion of preventive initiatives at the community and population levels. The application of such public health approaches to mental health raises a number of important ethical questions. The aim of this collection is to address these newly emerging issues, with special attention to the principle of prevention and the distinctive ethical challenges in mental health. The collection brings together an interdisciplinary group of experts in bioethics, mental health, public health, and global health.

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 this chapter we outline ethical issues raised by the application of public health approaches to the field of mental health. We first set out some of the basics of public health ethics that are particularly relevant to mental health, with special attention to the ongoing debate over the traditional presumption of non-infringement, increased recognition of the social determinants of health, and the concept of prevention. Then we turn to the moral particularities of mental health, focusing on questions concerning coercion and treatment pressure, personal identity and sociocultural factors (including stigma), and unresolved conceptual and methodological issues in psychiatry that complicate its extension into the domain of public health.

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.

Psychiatry has a habit of ignoring its past, which is understandable but, in some instances, a mistake. It is my contention that some of the lacunae about mood disorder in today's psychiatric understanding and treatment may be illuminated by the medical lore captured in Burton's Anatomy of Melancholy (1621). The implications of the present analysis for network based accounts of depression seem to encourage a reconsideration of therapeutic and remedial principles based on those found in Burton's work.

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

In lieu of an abstract, here is a brief excerpt of the content:Sigewiza’s CureJennifer H. Radden (bio)Keywordsbiopsychosocial model, Hildegard of Bingen, associationist presuppositions, causation, power of suggestionSuzanne Phillips and Monique Boivin provide us with a sympathetic and compelling account of how the various elements of Hildegard’s sophisticated amalgam of ritual, magic, religion, dietary and other medical remedies, caring, and community, formed a seamless cure for Sigewiza’s affliction. Whether Hildgard’s approach reflects an early instance of the biopsychosocial “model” is a separate claim, and may be challenged. But that her ministrations somehow effected a cure in this case seems—if not without a doubt, then very likely.Descriptions of Sigewiza’s condition, with its “clumping together of blackness and steam” caused by a “constellation of humors,” echo those of other medieval writers speaking of the humoral disorder of melancholia—at that time an encompassing category for a range of symptoms and syndromes that would today be assigned as different mental disorders. In these descriptions a variety of explanations for mental illness are quite typically introduced, including biological, social, supernatural, dietary and astrological ones. Phillips and Boivin take care to point out that Hildegard was not offering her remedies as alternatives, but rather proposing them as at work jointly and in a range of causal directions, exhibiting mutual influence, and feedback loops. As these authors say, multiple explanations “were often held simultaneously... in reference to a specific case” (Phillips and Boivin 2007, XX). And the factors that might cause the system to move out of balance are many: food, emotions, the soul, the mind, actions, and spiritual forces. So although deeds may cause bodily changes and their psychological accompaniments, “problems in the diet might affect the humors which would then have psychological effects, which demons might... use as opportunities to cause further trouble in the spirit, mind, and body” (Phillips and Boivin 2007, 365).What first struck me about Hildegard’s description of these many distinct causes interacting in complex ways is its compatibility with the multi-causal accounts of depression (and other mental disorder) frequently proffered in our own time. Daily habits (e.g., diet, sleep and exercise regimes), genetic predispositions, including biological states of fragility, external events, experiences of loss, social roles, and cultural beliefs—not to mention spontaneous recovery, and placebo effects—are all regularly implicated in the onset and course of conditions such as depression.Still, the similarity to these modern causal accounts may be somewhat misleading and we must beware of overstating it. In favoring and pressing on Hildegard’s holistic understanding, moreover, Phillips and Boivin perhaps insufficiently emphasize significant dissimilarities between Hildegard’s and our contemporary accounts.It is the interaction between the various elements making up Sigewiza’s cure that is most noteworthy [End Page 373] in this account, as Phillips and Boivin recognize. Yet that relationship itself seems in some ways surprisingly problematic: difficult for us to make sense of, and profoundly unmodern. Granted, we think we see the way these approaches probably influenced how Sigewiza felt and responded; but it is not so clear how Hildegard saw things. Like a lot of thinking in medieval times, Hildegard’s account provides us with glimpses of an understanding of the world that today looks prescientific and in that respect, almost precausal. (So, to the extent that the biopsychosocial model is understood as a causal one, the case of Sigewiza may exemplify it only inexactly.)It is not merely the range and type of causes, including supernatural and astrological ones, in accounts such as Hildegard’s that distinguish it from today’s analyses. It is also the reliance of such accounts on what seems to be a different metaphysics, one of associations or qualities.Associationist presuppositions can be found in accounts of health and illness from before, during, and long after, Hildegard’s time. Three examples of this pervasive, but puzzling thinking serve to illustrate. The melancholiac’s perceived swarthiness and darkened skin color—regularly noted from the time of the Greek physicians and an established part of the medieval iconography in images of melancholy—were not, or not primarily, thought to be a causal result of the darkness of his bile, as one might suppose. Instead, this coloring seems...

Although employed throughout health-related rhetoric and research today, prevention it is an ambiguous and complicated category when applied to mental and behavioral health. It is analyzed here, along with four ethical issues arising when public health preventative methods and goals involve mental health: age of intervention; resource priorities between prevention and treatment; substantive issues in preventive pedagogies and trade-offs framed by differences of approach. Illustrations include some of the most widespread and ambitious recent preventive models: those aiming to avert subsequent mood disorders of depression and anxiety; those that would curb self-harming behavior, and efforts to anticipate and avoid or delay psychosis. To suppose that public mental health can be entirely modeled on other public health programs is mistaken. Instead, it must proceed with awareness of the particular features typifying many mental disorders. These include features of the disorders themselves; the preliminary nature of scientific knowledge about them; the contested applicability of traditional disease models to them; the dearth of established research data available about preventive interventions currently in place or proposed; and the effects of stigma and discrimination on any such interventions.

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.