Sarah Arnaud

Recent philosophical literature has called for more participatory approaches in psychiatric research, advocating for the inclusion of patients and other stakeholders in processes ranging from the classification of mental disorders to the evaluation of treatment standards. While the dominant scientific paradigm continues to emphasize statistical rigor and methodological control, this approach often fails to accommodate the complexities of psychiatric phenomena, particularly as experienced by those diagnosed with mental disorders. There is growing recognition that participatory methods—when implemented robustly—can offer epistemic advantages by incorporating forms of knowledge that are otherwise marginalized or excluded. This paper examines the epistemic case for participatory psychiatry through the lens of anorexia nervosa (AN), a condition in which patients’ first-person reports may diverge from clinical frameworks. We argue that these divergences are epistemically significant—they reveal structural gaps in current models of understanding AN—and evidence of the value for a social objectivity framework for psychiatry. Drawing on recent work in the philosophy of psychiatry, we assess how alternative philosophical approaches, that seek to redefine objectivity and the epistemic value of lived experience, can be appropriate for the AN case.

In this article, we delve in debates around the usefulness of the notion of epistemic injustice in psychiatry to show that the concept has been misportrayed in the literature. We suggest that epistemic injustice should revolve around phenomenology and regard first and foremost the failure of mental health professionals to acquire and utilize information that service users are experts in, i.e. first-person testimony pertaining to what it is like to be them. We use this conceptualization to demonstrate the unique benefits that the concept of epistemic injustice can bring to psychiatric practice, and we illustrate these through specific case studies, focusing particularly on autism.

The Neurodiversity (ND) movement demands that some psychiatric categories be de-pathologized. It has faced much criticism, leading some to despair whether it can ever be brought together with psychiatry. In this paper, we argue for a particular understanding of this central demand of the ND movement. We argue that the demand for de-pathologizing is the rejection of (paradigmatically) autism as a hypostatic abstraction; the ND movement is committed, first and foremost, to the reconceptualization of autism not as something one has, but as something one is. We distinguish between two senses of autistic identity —one pre-reflective, and one social and political— operative in this reconceptualization. This understanding of the ND movement is centrally about a rethinking of the relation between a subject and a psychiatric label. It is not about reconceptualizing psychiatric categories in terms of advantageous variations, as we believe critics fear. Our understanding of what the ND movement is asking for has the noteworthy consequence that many of the most influential criticisms of the ND movement are missing the mark and worries about the impossibility of reconciling the movement with psychiatry are unwarranted.

The practice of self-diagnosing, amplified by the spread of psychiatric knowledge through social media, has grown rapidly. Yet, the motivations behind this trend, and, critically, its psychological repercussions remain poorly understood. Self-ascribing a psychiatric label always occurs within a broader narrative context, with narratives serving as essential interpretive tools for understanding oneself and others.In this paper, we identify four principal motivators for people pursuing self-diagnosis, pertaining to 1. waiting time and cost of mental health resources, 2. recognition, 3. identity formation, and 4. destigmatization. We compare these motivators against the backdrops of psychiatric narratives, including DSM-based (operationalism), bio-medical, and Neurodiversity narratives, to evaluate the psychological implications of self-ascriptions. We show that while self-ascription aligns with many motivations, it also carries the risk of essentialism across all analyzed narratives, which can over-simplify and sometimes misrepresent people’s attempts to find meaning through psychiatric labels. Essentialism makes narratives less comprehensive, responsive, and resourceful.We contend that self-ascriptions are not inherently problematic; instead, they show the need for greater focus and understanding in psychiatric practices and the importance of incorporating people’s experiences and perspectives in clinical settings. However, both the narratives and the social climate from which they emerge may need adjustments to make self-ascriptions meaningful, comprehensive, and resourceful tools.

This paper advocates for the inclusion of patient perspectives in the diagnosis and treatment of eating disorders (EDs) for ethical, epistemological, and pragmatic reasons. We build upon the ideas of a recent editorial published in this journal. Using EDs as their example, the authors argue against dominant DSM-oriented approaches in favor of an increased focus on understanding patients’ subjective experiences. We argue that their analysis stops too soon for the development of practical—and actionable—insights into how to effect the integration of first-person and third-person accounts of EDs. Methods Contextual analysis was used to make the case for patient perspectives.

How should we seek to account for the qualitative aspect of emotion? Strong intentionalism presents one promising avenue for such an account. According to strong intentionalism, the phenomenology of a mental state is entirely determined by that state's intentional content. Given that many views of the emotions have it that the intentionality and phenomenology of the emotions are very closely related, this makes strong intentionalism an especially promising route. However, strong intentionalism has rarely been defended for emotions and, we argue, where it has, it has failed to be explanatory. This paper proposes a new explanatory form of strong intentionalism about emotion. We call it personal intentionalism. According to this view, the qualitative features of emotion are fully determined by the emotion's intentional content. This content varies inter- and intraindividually, according to one's cares and concerns, as well as one's other mental states. We assess its compatibility with theories of consciousness.

What role should the expertise of the autistic communities play in shaping the category of autism compared to the role played by science? This question led to a debate about the quantitative importance of science compared to first-person perspectives for the understanding of autism. I see this debate as lying on a false dichotomy between science and activism, according to which only scientific inquiry would reveal the empirical nature of autism, while the discourse of autistic communities would construct a socio-cultural conception of autism. I consider the problems associated with such a dichotomy and show that first-person perspectives should be considered a necessary step in the scientific investigation of autism.

Anorexia Nervosa (AN) is widely considered to be a bodily disorder accompanied by unrealistic perceptions about one’s own body. Some researchers thus have wondered whether deficits in interoception, a conscious or non-conscious sense of one’s own body, could be a primary cause of AN. In this paper, we make the case that rather than interoception being a primary cause, deficits in interoception may occur as by-products of emotions that arise upstream in the pathogenesis of AN and interact with feelings of a loss of self-control. We consider interoception, emotion, and self-control as a dynamical triad involved in the explanation of AN, with emotions as the central aspect of their interactions. We begin with a critical analysis of recent empirical literature on AN and differentiate three types of interoceptive processes. We then consider the role of self-control in AN. We go on to evaluate recent empirical and philosophical work on the role of emotions in AN and assess their importance in both interoception and self-control dynamics. We develop a testable integrative model that we believe best captures how self-control, emotional and interoceptive processes causally interact in the pathogenesis of AN. In this model, AN behaviors are not caused by interoceptive abnormalities, but rather interact with changes in emotional regulation and feelings of loss of self-control, subsequently leading to interoceptive deficits downstream. To capture a later stage in the pathogenesis of AN, we show how AN behaviors are maintained as a result of feedback among components in the model. We briefly explain future plans to further complement the model using a semi-structured interview to probe patient perspectives in AN. To develop a more valid understanding of AN, this model will have to be integrated into pluralistic approaches that include patient perspectives.

This paper suggests that autistic people relate to themselves via a third-person perspective, an objective and explicit mode of access, while neurotypical people tend to access the different dimensions of their self through a first-person perspective. This approach sheds light on autistic traits involving interactions with others, usage of narratives, sensitivity and interoception, and emotional consciousness. Autistic people seem to access these dimensions through comparatively indirect and effortful processes, while neurotypical development enables a more intuitive sense of self.

According to some authors, emotions can be unconscious when they are unfelt or unnoticed. According to others, emotions are always conscious because they always have a phenomenology. The aim of this paper is to resolve the ongoing debate about the possibility for emotions to be unfelt. To do so, I focus on the notion of “unconscious emotions”. While this notion appears paradoxical, by way of a distinction between two meanings of emotional consciousness I show that it is not so. These meanings are both compatible with the leading views of consciousness and they do not require one to distinguish different senses of “emotions” or “consciousness”. This distinction is helpful to define how emotions can be unconscious.

The anti-psychiatry movement of the 20th century has notably denounced the role of values and social norms in the shaping of psychiatric categories. Recent activist movements also recognize that psychiatry is value-laden, however, they do not fight for a value-free psychiatry. On the contrary, some activist movements of the 21st century advocate for self-advocacy in sciences of mental health in order to reach a more accurate understanding of psychiatric categories/mental distress. By aiming at such epistemic gain, they depart from the anti-psychiatry movement. Through the analysis of the epistemic and political influence of two of these movements – Neurodiversity and the Mad Studies, we show how this new activism has taken a scientific turn compatible with current philosophical scientific frameworks, while still developing a critical approach on psychiatry.

Sarah Arnaud C’est par une affirmation provocatrice que Hacking propose un ratio pour représenter le rapport entre science et militantisme dans le façonnement des notions sur l’autisme. Selon lui, la définition et la compréhension actuelles de l’autisme proviennent à 99 % de personnes « personnellement connectées à une personne autiste » plutôt que de la science. Kendler rejette un tel point de vue en suggérant au contraire que notre compréhension de l’autisme est le résultat d’un travail scientifique approfondi, notamment par la recherche en génétique. Je considère que leur désaccord se fonde sur une fausse dichotomie selon laquelle seule la recherche scientifique est à même d’envisager l’autisme de manière empirique, alors que le discours des « p-c-a » construirait au contraire une conception socioculturelle de l’autisme. J’envisage les problèmes éthiques inhérents à un tel ratio et suggère que la perspective des personnes autistes elles-mêmes représente une étape nécessaire à l’atteinte d’une validité scientifique.

An abundant literature on autism shows differences in emotional consciousness between neurotypical and autistic people. This paper proposes an interpretation of these results through a conceptual clarification of emotional consciousness. It suggests that autistic people generally access their emotions through a thirdperson's perspective whereas neurotypical people's emotions reach consciousness via first-person access. This interpretation is based on a model of 'emotional consciousness' that applies leading theories of consciousness to emotions as well as on research on the way autistic people relate to their own emotions. This model differentiates two routes through which emotions can access consciousness. Therefore, research on emotions in autism helps to give a more complete account for emotional consciousness in general.

Cet article propose une caractérisation de la sensibilité et de la conscience émotionnelle des personnes autistes grâce à des précisions terminologiques des concepts d’émotions et de conscience. Il met en évidence le caractère contradictoire qui semble caractériser la sensibilité des personnes autistes : alors que leurs états internes du corps parviennent à la conscience beaucoup plus fréquemment que pour les personnes neurotypiques, leurs émotions sont appréhendées de manière descriptive et non par le biais de ces ressentis corporels, comme c’est pourtant le cas pour les personnes neurotypiques. Chez les personnes autistes, la compréhension émotionnelle semble donc être détachée du ressenti émotionnel, pourtant très présent. La mise en commun des résultats d’études mettant en évidence ces particularités permet de proposer une hypothèse explicative de cette apparente contradiction ; hypothèse selon laquelle pour les personnes autistes, le caractère accablant des ressentis du corps est évité grâce à une stratégie compensatoire d’accès explicite aux émotions, détaché du ressenti émotionnel.