Five conceptual competences in psychiatry

World Psychiatry, Год журнала: 2024, Номер 23(2), С. 233 - 234

Опубликована: Май 10, 2024

Stein et al1 survey a range of recent developments in philosophy psychiatry that are relevant to clinicians. They recommend clinical training include the development "conceptual competences", i.e. philosophical skills and theoretical frameworks bring new intellectual resources into psychiatry2. Here I would like elaborate on conceptual competences al mention, discuss how they have grown last 30-40 years, add further one their account. Perhaps most important competence is humility, awareness partial provisional nature current psychiatric knowledge. This brings an expectation what called (in more general context medical knowledge as whole) "messy pluralism"3. Our grasp phenomena through variety with loosely demarcated scopes. These may lead productive directions, or be wrong ways we do not know anticipate, unexpected consequences will need investigate refine. Proceeding humility means accepting pluralism, rather than forcing premature choice between truths, well treating contradictions generated by multiple different curiosity epistemic horror. A second going beyond dualism. For much 20th century, several questions been approached from either "scientific" (such neuroscience) "humanistic" phenomenology) perspective. K. Jaspers' General Psychopathology4 typical example this kind dualism, P. Kramer's two approaching cases Listening Prozac5. approaches sometimes compete providing accounts causes conditions, neuroscientific eschewing "cognitive penetrability" favor mechanistic causes, phenomenological aiming, dubiously, for narrative completeness. Such dualism simple pluralism", involving approaches. Kramer shows skill making use both perspectives handling particular cases. What now expanded ability juggle these perspectives, complex nuanced pluralism. The common bifurcation scientific humanistic misleading oversimplification options, which scientific, mixed Hence, "beyond dualism" competence. third appreciation concepts often aim achieve goals addition traditional ones such descriptive accuracy, predictive success, explanatory power. Psychiatric expected identify appropriate subgroups specific treatments, underlie guidelines social/educational/legal eligibilities, provide categories research, support intuitions about moral responsibility, even supply social identities. Proposed can rejected modified because thought inaccurate, too difficult apply reliably, problematically stigmatizing some patient groups. One enduring lessons DSM process no single system satisfy all at times. There inevitable trade-offs goals. refer terms "interplay natural facts human interests". Zachar6 has introduced idea "practical kinds" supplement "natural kinds". good responsiveness shifting way intense prolonged grief symptoms handled DSM-III DSM-5-TR, trying strike balance effectively addressing suffering avoiding "pathologization" normal reactions loss. fourth groups, individuals, professions etc. control discourse psychiatry. By "control discourse" mean mixture earned unearned authority shapes ideas received public, patients, families, various health care professionals. era – 1980 until recently marked powerful American Association, group consensus experts, led psychiatrists participation psychologists, provided grounds accepted concepts. Recently, there calls democratic process, especially includes "experts experience" (traditionally "patients")7. As 2023, itself still conservative, allowing input experts experience only during stage public comment proposals. final useful al's suggestions call hembig awareness, taking neologism "hembig" Alvesson Blom8. Writing academic field organization studies, find key "leadership", "strategy", "institution") central important, but confusingly imprecise ambiguous. concept hegemonic (plays regulatory role), ambiguous big (wide unclear scope). It aware hembig, so problematic ambiguities inferences avoided. main term "psychiatric disorder", metaphor (the literal actual meaning "disorder" "lack order"). While attempts define disorder" technically, using necessary sufficient generally fallen short intended generality. included "maladaptive patterns sense making" (K. Nielsen), "harmful dysfunction" (J. Wakefield), harmful biological kinds Tsou), failures Bayesian processing (A. Clark, Friston), socially deviant judgments (T. Szatz), "madness strategy" Garson), box canyon (local minimum) solutions cognitive Kendler). L. Wittgenstein's alternative suggestion mark "family resemblances"9 helpful meta-metaphor starting explore work.

Язык: Английский

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Another “and”: philosophy as glue

World Psychiatry, Год журнала: 2024, Номер 23(2), С. 238 - 239

Опубликована: Май 10, 2024

Offering a timely perspective on contemporary philosophy of psychiatry, Stein et al's paper1 is part-review and part-pitch for an integrative model the mind, "embodied/4E". As such, paper nicely captures collegiality that defining feature field. Blossoming across world in 1990s, renaissance psychiatry has largely avoided tribal schisms by which so many "psy" disciplines have been marred. Indeed, al adopt stance: dominant connective throughout "and" ("Western Eastern" philosophies, "facts values"); "philosophy psychiatry" itself used interchangeably with psychiatry"; there helpful discussion varieties pluralism; "embodied/4E" presented not as panacea but integration (mind body, normativism naturalism, forth). The Swiss historian psychiatrist P. Hoff characterized history one serial collapses into single message mythologies2. After all, "binary positions", note, "have advantage being straightforward". That avoiding factional splitting thus particular strength. Yet, this brings it vulnerabilities. Which why another should be added. To expertise-by-training celebrated paper, we add expertise-by-experience patients carers. clear, emphasize importance what they call, variously, "lived experience", "subjective "individual experience" "first-person experience". But perhaps worth highlighting growing significance co-production between experts-by-training experts-by-experience clinical work, research, both internally its wider mental health care whole. Here, I comment briefly each these areas. contexts derives from recovery-oriented practice, i.e. practice aimed at recovering good quality life defined values – is, matters or important to individual concerned3. So defined, criteria recovery, any given case, are necessarily derived question. Expertise-by-training course remains important, inter alia, advising evidence-based interventions supporting interpreting recovery where (as anorexia nervosa) empathically obscure, balancing conflicting compulsory treatment). expense expertise-by-training. contrary, needed. requirement again, conjunctive disjunctive. point that, without expertise-by-experience, cannot even get started. Similar considerations apply research neurosciences, though instance translation mind. A notable challenge psychiatric scientists themselves become increasingly critical persistently low rates neuroscientific improvements care: architects DSM-5 criticse.g.,4 were aligned point. Expertise-by-experience, although demanded funders, offers no guarantees improved translation. Co-production, however, requiring adoption researchers shared aims, would least ensure vision success looks like. Co-production now feature, too, psychiatry. At post-1990s renaissance, analytic5 continental6 adopted co-productive methodologies. In Oxford, pre-pandemic institutional collaboration Faculty Philosophy Mental Health Foundation (a London-based non-governmental organization) highly productive. recently launched joint venture Welcome Trust-funded programme new models public health, co-led philosopher, A. Bergqvist, expert-by-experience, D. Crepaz-Keay. connected how function understood. note variety philosophies play out diverse formulations complex concepts such pluralism. This other similarly being, solve problems, rather forestall premature closure answers, indeed persuasive simplifications encourage, nonetheless wrong. "forestalling closure" barrier Hoff's above-mentioned "collapses mythologies". Again, success. indications positive: after all among celebrate; open systems (such multidisciplinary teamwork Darwinian evolution) offer proof-of-principle; examples5, 6 document effectiveness over earlier expert-by-training paradigms. extent, therefore, strengthens role forestalling areas work rightly acknowledge review balance depth against breadth, especially difficult task where, humanities, widely-accepted external excellence, like, say, evidence hierarchy medicine. perhaps, "good thing". limitations. But, mention North American philosopher H. Putnam, suggest greater attention his "distinction-without-dichotomy" position fact value (since this, "soft" otherwise, values-based underpinned theoretically7). normativity science, J. Sadler's seminal linguistic analysis guiding DSM8. Moreover, since described representing disorders "disruptions sense-making", emphasis "delusion", memorably British mind N. Eilan "solving simultaneously understanding utter strangeness"9. done service resurgent field demonstrating still collegial approach. Success comes challenges competition funding, prestige, forth turn come renewed risks provides conceptual glue needed bind together multiple messages required integrated kind argue. Highlighting making fully explicit experts-by-training, will locks tight.

Язык: Английский

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Philosophy of psychiatry as study of paradigm changes

World Psychiatry, Год журнала: 2024, Номер 23(2), С. 241 - 242

Опубликована: Май 10, 2024

Philosophy of psychiatry addresses many conceptual topics in that lie on the borderline between philosophy, science, culture and clinical practice. Stein et al have produced an excellent critical review these major approaches towards them1. In addition, philosophy always has itself as a topic enquiry – it is eminently self-reflective. Here I will make some observations what is. Briefly put, studies issues, but are they? While there long tradition supposing concepts timeless unchanging, which shows up positions psychiatry, general trend 20th century been to regard embedded symbolic systems practices vary from time place place. An example, refer several times, Kuhn's science. Science occasional revolutions fundamental theory, so-called paradigm shifts, when old assumptions inadequate for new problems or discoveries, replaced by kinds These followed periods "normal science", meaning implications methodology data worked through2. Of special interest health care generally changes their basic sciences biology psychology. Generally recognized occurred second half century: genetics/information revolution biology3, associated cognitive/information psychology4. Since then, normal science within paradigms advanced at pace, with ongoing explorations developments such epigenetics embodied cognition, discussed al. New typically usher ontology, merging into traditional subject-matter metaphysics. The above-mentioned shifts do exactly this. biology, 19th dominant view physiological processes were (no more than) physics chemistry was kind ontology involving coding, information, signalling regulatory mechanisms3. psychology, long-standing influence dualism, underpinning mental could not affect body behavior, gave way conceptualization cognitive involved regulation behavior4. appearance neuroscience guaranteed both ways. First, biological system like any other, central nervous dual aspect combined information processing. Second, particular function regulating behavior environment. concept this shift, increasing recognition representation already made states affairs, selected, processed used ways highly dependent needs goals living being. ontological status cognition among issues currently being out under heading "embodied cognition", al, illustrating point earlier scientific interpretations consequences theory discoveries out. interconnected psychology over last few decades sciences. example deconstruction priori supports reductionism. addition energy exchanges transformations covered fixed physical-chemical laws, posit system-specific, fragile mechanisms play causal roles other aspects organismic behavior. This causation removes basis presumed reductions chemistry. Physics break down. So, envisaging those alone never use conceptualizing (let explaining) breakdown, difference disease, life death. Regulatory mechanisms, contrast, can down, often do, eventually do. Another, interrelated dependence psychological functioning For social beings, environment, including status, influential access resources necessary functioning5. remark times importance range biological, factors while noting biopsychosocial model criticized able deliver specific content, conceptualize cross-domain interactions, resolve selection questions6, 7. Statements philosophical positions, comparisons contrasts them, perhaps inevitably simplified names brief claims. specialties, replete abbreviations: models, "biopsychosocial" contrasted "biomedical"; statements expressions "mental disorders kinds", brain disorders"; abbreviations using terms art, -isms, "pluralism", "naturalism" "normativism". use, probably inevitable debates, they clarify questions method sort becoming explicit no longer work ones needed. Some involve broader rather than narrowly conceived. shift past medical doctors having sole authority diagnosis disorder community claiming right interpret themselves values. A key moment successful lobbying gay 1970s homosexuality removed DSM8. Plausibly change owed emancipatory movements discovery. However, interact, follow complementary tracks one time. agency coincided theorizing personal As spread through its specialty areas, person-level constructs appraisals perceived appeared explanatory models well-being9. theoretical constructions unfold, cognates autonomy increasingly important note, clinic public health5, 6.

Язык: Английский

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Professionals in psychiatry need reflective competence

World Psychiatry, Год журнала: 2024, Номер 23(2), С. 234 - 235

Опубликована: Май 10, 2024

The paper by Stein et al1 provides a comprehensive and timely overview of key theoretical advances in work on philosophy psychiatry. authors respond to the grand epistemological questions psychiatry – classification debate, nature psychiatry, mind-body problem with soft naturalism, pluralism, 4E cognition, respectively. Though I empathically comply their considerations, was surprised self-centered view see as scientific clinical island splendid isolation without relationship society which it is embedded. Here address perspective that takes account: a) how shaped forces society; b) above-mentioned topics are influenced philosophical assumptions held global community; c) why concept conceptual competence, agreement al, indispensable for professionals Psychiatry not stand-alone discipline. It dialogues continuously other sciences such pharmacology, neuroscience psychology. In fact, except descriptive phenomenology, has been largely neglected lately, innovation often place outside through development new drugs, techniques imaging genetics, or psychotherapeutic restyling. Artificial intelligence predicts near future substantial innovations may be expected psychedelic-assisted therapy, neuromodulation (repetitive transcranial magnetic stimulation deep brain stimulation), digital personalized On closer inspection, we should even recognize more than any medical discipline, being determined science but society. All psychiatric symptoms ultimately defined background what commonly agreed upon normality. Normality established Normal individual behavior conforms most common behavior. Fluctuations prevalence mental disorder across culture time caused sophisticated adaptations criteria experts, pushed societal waves. Autism attention-deficit/hyperactivity have become 100-fold due changing perspectives education productivity. Long before misophonia became known sporadically entered articles, disease term circulated globally Internet between interest groups. Often lagging behind social developments. Only 1974 did homosexuality disappear from DSM-II, only 2019 conditions related sexual identity disorders ICD-11. We accept no longer shapes itself. course faith psychiatrists philosophers, socio-economic variations fueled influencers media. current ongoing crisis yet-to-be-embedded realization discipline lost control itself, sadly popularized universal theme well-being. profoundly changed. Whereas long "mental health" norm, now well-being" paramount. Every self-respecting institution, companies universities, appoints "well-being officers". Mental health refers absence illness. well-being presence favorable conditions, including experiencing positive emotions, maintaining relationships, feeling meaningful life. includes good your own skin, resilient able enjoy "norm" well-being, every person potential patient. reported highly prevalent. Around 1-in-7 people one disorders. 2020, rates depression anxiety climbed 25%. This increased rate changes processes reflecting values. Once you born this world, actualize yourself an autonomous person, i.e. absolute authentic perfectly self-determining subject. all brought up assumption freedom highest attainable thing Western ideal human who thrives best greatest freedom, surrounded convenience, striving self-determination maximum self-actualization. Each step towards greater autonomy us higher evolutionary ladder, further away animal instinct. unlimited globalized line consumerism technologism. Unfortunately, fail ideal. First, either unattainable untenable. Second, constant bombardment commands self-maximize, ourselves, prove worth it, makes feel stressed, exhausted, traumatized, burn-out, lonely, useless meaningless. Third, though suffer because they cannot meet high demands values autonomy, does allow suffering. Failure option. Individual dictates need successful; always happy. Since suffering unacceptable, distress allowed carry responsibility blame. spiking patients developing diseases, standard normality globe. coincidence They express our failure attempting fulfil impossible demand autonomy. anxious world dangerous contrary safer desire out proportion. depressed lives hopeless meaningless opposite actually true confronted too many choices, set unrealistically expectations, blame ourselves failures. delighted read about "conceptual competence" al's paper. want go further. competence psychiatrist include three different skills: professional knowledge training practice profession; experiential expertise years contact clients; reflective ability reflect profession, specific role hold affected Reflective transformative awareness shape care. presuppositions illness, mind body, normal abnormal constantly world. Imperceptibly, determine validity diagnosis treatment. That thinking profession part basic skills professional. Just jeweler designs jewelry also calculates gold prices, into account society's addition emerges his/her patients. Following colleagues called "a fundamental rethinking creation knowledge"2. A survey found 65.2% struggle 4.3% adequately prepared them face intellectual challenge3. Is task reflect, beyond psychopathology individuals, modern societies? But, then again, do choice?

Язык: Английский

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Hallucinating mice, psychotherapy in the brain, and computational psychiatry: the future of psychiatry is now

World Psychiatry, Год журнала: 2024, Номер 23(2), С. 242 - 243

Опубликована: Май 10, 2024

Stein et al1 provide a philosophically grounded overview of the conceptual foundations psychiatry, from its basis in psychopathology to applications clinical practice. They emphasize: a) importance facts and values health care; b) necessity taking pluralist approach science, regarding ontology, explanation values; c) usefulness "embodied cognition" as an integrative concept theory I have worked psychiatrist for over 40 years, with research focus on systems neuroscience last 30 applaud their thoughts field. In what follows, just want add few considerations my personal scientific perspective. endorse al's points wholeheartedly. Whoever maintains that medicine is science (by definition) only about facts, must be reminded terms "pain", "suffering", "illness" "disease" imply negative valuation, i.e., cannot understood by anybody who does not grasp statements like "I do x", or am so happy because y" mean. Together spatial temporal finiteness our minds embodied minds, joy pain give us agency purpose, let – most social primates evolution brought strive betterment lives. case success, psychiatrists are rarely needed; failure, contrast, calls upon us. As regards point b), propose considerations. Instead approach, would speak multimodal respect (ontology explanation), open tolerant when it comes cultural differences. Let me explain. There no British, Chinese, French, San Papuan science; there science. At empirical connections reality, has always been changing, battles between different schools thought big part history. However, remarkably stable at inner theoretical core. Set theory; Newtonian, Einsteinian quantum physics; periodic system, evolution, genetics, etc. incrementally grown produced huge body knowledge. It hard imagine which "ugly fact" epistemic force/weight contradict any approaches mentioned. Sure, (and will be) questioned progress. But, closer we get science's reality core, smaller probability doubt. exemplify psychiatry briefly touching three recent domains research: mouse models various forms allow establish causality brain states mind; concepts neuromodulation small molecules, such dopamine, acetylcholine, norepinephrine, serotonin many others) neuroplasticity (from synaptic cortical level); computational artificial intelligence research. For larger career, could cared less medicine, especially psychiatry. testing new drugs (even though arsenal was discovered serendipity) provided some quite limited insights into mechanisms action. understanding core symptoms psychosis (hallucinations, delusions formal disorder), well providing interactions genes complex human environment, appeared useless. This changed completely within past five years. examples. Eye movement desensitization reprocessing (EMDR) form psychotherapy used treat post-traumatic stress disorder (PTSD) alternating bilateral sensory stimulation (ABS). order study mechanism action, model implemented allowed induction conditioned fear, extinction, monitoring influence ABS extinction. conjunction ABS, extinction more pronounced lasted longer. Once this established, neural pathway superior colliculus via mediodorsal thalamus) suppressed activity fear-encoding cells basolateral amygdala, mediating persistent attenuation out. "Together, these results reveal circuit underlies effective strategy sustainably attenuating traumatic memories"2. auditory hallucinations model3, mice had trained hallucinate, firstly, perceive salient stimulus (a tone) random noise (false perception) and, secondly, take perception real (reality check). Both responses reliably induced. By optogenetic chemogenetic methods, discovered, elevated dopamine levels ventral tegmental area striatum, where distinct subregions encode kinds expectations. "These findings support idea arise… due producing bias favor prior expectations against current evidence"3. The term "dissociation" denotes broad spectrum involving perception, thought, consciousness, experience time, space, self. effects produce dissociative state, very specific rhythmic oscillation layer 5 retrosplenial cortex necessary sufficient state. Moreover, patient epilepsy, similar found corresponding during aura4. finding catapults ill-defined, little frequently 19th 21st century. Within developmental window development (days 2-9), adversity (murine analogs poverty, immigration, neglect abuse) establishes leads behavioral dysfunction adulthood (decreased reward sensitivity), much akin PTSD5. important realize allow, first mere correlation realm mind brain. Therefore, method should highly fruitful near future psychopathology. neuroscience-based parsimonious explanations wide range mental phenomena, acute (induced increased, decreased dysregulated neuromodulatory agents) long-term ("chronic") changes caused plasticity. model, (increased area) drive hallucinations, can readily treated antagonists (in acutely ill patients). experiences become entrenched plasticity, they dependent hyperactivity therefore treatable antipsychotic agents8, 6. Finally, networks started phenomena late 1980s 1990s psychiatrists8, 6, 7. While expected off eventually, none imagined applied anything deciphering cuneiform script protein folding, drug design, weather forecasting, designing next-generation hardware software9. Artificial going change but world, invention writing, printing press, Internet.

Язык: Английский

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Launching the social philosophy of psychiatry

World Psychiatry, Год журнала: 2024, Номер 23(2), С. 237 - 238

Опубликована: Май 10, 2024

Stein et al1 provide a state-of-the-art summary of the philosophy-psychiatry field that centers around mind-brain-world triumvirate. They do an astounding job summarizing 30 years activity in field, culminating present-into-the-future consideration embodied cognition. Here I look forward different direction. Borrowing internalist/externalist distinction from historiography, externalist philosophy psychiatry might be paraphrased as social psychiatry. Externalist would consider role and cultural world shaping conceptions mental illness its treatments. It phenomena environmental contributors to complex causalities converge on psychopathological phenomena. reconsider concepts free will terms structural features human organism alongside our increasingly environment. draw upon technology, epistemology, metaphysics, political philosophy, philosophical anthropology placing clinical diagnosis, research theory into sociocultural contexts. Through understanding these contexts, we can find new clarity health project. make abstract generalizations more vivid by considering some examples current, rapidly changing, era. mention very briefly three areas ripe for development philosophers psychiatry: engulfment electronic medical records; domination State health; psychopathology artificial intelligence (AI). Back 1977, Heidegger2 introduced concept "enframing" then-developing philosophies technology. "Enframing" involves tendency technologies appropriate resources their own purposes, forming "standing reserve" remote goals. Heidegger's thinking helped found now-familiar technology tropes such "technologies solve problems which turn generate problems, requiring technological solutions". This recursive expansion imperatives seen playing out clinics through records. Psychiatric training directors are already noting deterioration interviewing diagnostic skills when young trainees driven checking box after findings, being "enframed" metaphysical structure those records, missing big narrative picture patient. What made toxic Heidegger was change way think, above-mentioned check-box interviews. Fortunately, have been working this set while, rich literature. The response digital has begune.g.,3. archeologist/anthropologist team D. Graeber Wengrow4 history with particular interest origin inequity (e.g., government). As scientists, they access interpret archeological anthropological sciences freed limits written text "traces". By studying artifacts, evidence about diversity community living over millennia. One major insights is common threads constitute people other – e.g., control. identify factors apparent singly, doubly or triply virtually all forms dominated communities: control violence, knowledge, charisma. Control violence refers who authorized apply others, whether war-making managing crime (as just two examples). knowledge controlling what counts truth knowledge. charisma persuasiveness would-be empowered group; ability bring believers/followers fold. authors note most successful occurs triad seized. also means capturing not determinative; one democratic, imperial fascist dominations, example. need detail relevance current situation, but point We rise populist authoritarian rule past decade element. witnessed loss confidence "elites" professors, philosophers, intellectuals doctors. More importantly, talk "post-truth" transformation public lying vice virtue eroding prior shaken worldwide, media enable challenging conventional mechanisms (policing, courts, civil liberties, law, subordination) familiar #Icantbreathe, #metoo, unprecedented January 6 storming US Capitol building. For psychiatry, range tasks deriving changes huge. Some simple conceive: how clinicians communicate phenomena? Others definitional: many must believe something before false belief delusion? Still others insidious: post-truth where institutions diminishing? In recent months explosion AI proffered info-tech companies. gushing enthusiasm well apocalyptic worries users commentators. Somewhere in-between reactions resides systematic appraisal systems evolve. biases entrained AI, leading perpetuation bias later use5. both absurd frightening results natural language devices asked ordinary questions6. Social envision looping effects human-AI deviant interchanges online worry consequences. inquiries area treating responses analogues7. using tech explanatory models psychopathologies tools therapeutic developments8. engagement disputes misinformation environment, thus connecting social-domination described above. preliminaries work appealed "father" K. Jaspers9. All potential wide open, deep important.

Язык: Английский

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Philosophy of psychiatry can gain greater vitality by engaging the implications of new science

World Psychiatry, Год журнала: 2024, Номер 23(2), С. 235 - 237

Опубликована: Май 10, 2024

Stein et al1 introduce philosophy of psychiatry by presenting a series well-curated, historically grounded positions on topics with which the discipline has been centrally engaged. These include definition and boundaries psychopathology, unsettled nature diagnostic constructs in (including dialectic between naturalism normativism), perils essentialism, mind-brain relationships. They these partly through compelling device asynchronous "conversational" threads containing arguments from successive writers, accompany this exposition their own gently reflective comments. also provide intellectual frameworks to orient readers who are coming for first time. For example, they offer context within understand debate naturalist normativist definitions psychiatric disorders, that might be less familiar scientifically more mature fields medicine confidently ground diagnoses knowledge etiology pathophysiology2. al compare strong versions psychiatry, hold disorders can defined purely factual, value-free scientific terms, normativism, disorder always require value judgments, most extreme form devolve into relativism exploited antipsychiatry movement mid-late 20th century. then discuss compromise or bridging – epistemically defensible pragmatically useful than either extreme. Unfortunately, defending compromise, authors seem satisfied "soft naturalism", concept is too amorphous set conceptual structures much needed future nosology successfully captures diverse etiologies pathophysiologies, ranging monogenic neurodevelopmental associated autism highly polygenic significant developmental environmental etiological factors, such as depression post-traumatic stress disorder, there no bright line health. Indeed, it treacherous consider (e.g., all included DSM-5) natural grouping conceptually encompassed any single generalization. What contained DSM-5 list mental contingent, based part phenotypic similarities, ignorance neural mechanisms, importantly disciplinary claims practice patterns illustrated among chapters ICD-11 may contested other disciplines, neurology, sex endocrinology pediatrics2, 3. Philosophy abstract when focused basic principles being, knowing, causality, justifications ethical principles. In contrast, well al, concerned applications philosophical tools complex brew theories, cognitive schemata disease classifications), hypotheses, empirical observations, policies practices particular medical discipline. gains traction issues importance its stakeholders interdisciplinary stance, one foot concepts analytical methods, firmly planted theoretical constructs, science undergird context, paper especially timely, because basis evolving rapidly already changing some corners policy developments will clearly benefit analyses. During last two decades, advances technology computation machine learning data science) have not only opened new possibilities, but motivated changes organization biomedical science, creation international data-sharing consortia Psychiatric Genomics Consortium4) large deeply phenotyped genome sequenced populations cohorts UK Biobank). research produce remarkable genetics4; progress relevant aspects molecular neuroscience, connectomics neuroscience; powerful approaches phenotyping epidemiology electronic records, recontactable cohorts, sciences. Only fifteen years ago were zero replicable genetic associations disorders. Today hundreds, few examples integrated neurobiological yielded candidate mechanisms schizophrenia illnesses5. Such mechanistic hypotheses turn informing rational discovery efforts biomarkers therapeutic targets. translational realm, produced circuit-based therapies (such open- closed-loop deep brain stimulation) clinical trials use6. Growing evidence brains "prediction machines", emerging systems makes case construct subjective experience behavior Bayesian priors corrected interoceptive exteroceptive sensory information. If understandings function continue gain evidentiary support, I believe will, ideas about brain-mind relationships, sense self, personal identity, agency so central substantial revision. terms illness, model ways thinking conditions addiction, hallucinations delusions7, cognitive-behavioral psychotherapies exert beneficial effects. All profound implications classical problems range self volitional control behavior. Modern genetics neuroscience information should influence modern attempts define psychopathology classify Human demonstrates DNA sequence variants ("risk alleles") continuously distributed populations, without break inflection point would naturally demarcate categorical separation health2. Epidemiological studies demonstrate continuous distribution population symptoms impairments major depressive common conditions. addition, individual risk alleles act pleiotropically, influencing multiple bipolar share approximately 70% variant alleles. studied, unbiased cell analyses gene expression (from sequencing RNA) epigenomics chromatin accessibility) performed post-mortem find quantitative differences affected unaffected individuals, overlap findings impugn setting DSM strongly favor transdiagnostic dimensional definitions. Moreover, "within disorder" heterogeneity underlying confounds research, contributing failure attempts, structural functional imaging, robustly reliably distinguish cases controls. Thus, current impose artificial named fail yield homogeneity putative categories. One additional deserves emphasis here: at level, diagnosed do exclusively represent deficits. obsessive-compulsive autism, anorexia nervosa phenotypes, greater educational attainment and, ability8, 9. Overall, number impairing strengths opposite valences respect life success survival. observations certainly complicate, if defeat entirely, commentators claim speculative inferences selection. Psychiatry entering time change just starting clinic6 attention makers. This reflections importance, driven engagement science. done an important service providing lucid platform better address future.

Язык: Английский

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Phenomenology, delusions and justice

World Psychiatry, Год журнала: 2024, Номер 23(2), С. 239 - 240

Опубликована: Май 10, 2024

The paper by Stein et al1 offers a clear and magisterial introduction to philosophy of psychiatry, its key advances clinical implications. As the authors note, is often seen as not necessarily having made progress, but shows that this case for psychiatry. Philosophy psychiatry both science (similarly physics or biology) practice ethics. Indeed, many have used make sense of, interrogate, changes in our discipline: hope neo-Kraepelinians, advent functional neuroimaging, democratization psychiatric knowledge, partnership with those lived experience mental ill health. areas al cover their are broadly linked psychology/mind, tradition "Anglo-American" philosophy. This – inaugurated Russell, Frege Moore has focus on analysis concepts study logic language. My own philosophical work been partly tradition, also other dominant Western philosophy, namely "continental" "European" grew out German idealism, neo-Kantianism phenomenology, was initially very similar interests early analytic language, arithmetic. However, through Heidegger, Jaspers others, it subsequently took initial phenomenological insights Husserl, began using them understand concrete, historical, existential themes. Such themes reached apogee period after Second World War, existentialism Sartre De Beauvoir, related Merleau-Ponty Fanon. impacted series direct connections: Heidegger's teaching psychiatrists M. Boss, Binswanger's development Dasein-analysis, influence Laing. parallel dominance phenomenology European decades 20th century, there two strands tradition: interaction psychoanalysis Marxism. Hence, continental brings an interest "hidden" forces, whether unconscious capitalism, shape human experience, more contextualized historicized idea person. approach allowed "political" way thinking about self post-structuralism, colonial studies, feminist granted us tools reflect issues intersectionality, oppression, marginalization, migration colonialization, which relevant practitioners researchers2. In recent Renewing Phenomenological Psychopathology project, we tried bring some from later century back into psychopathology his successors3. Much "classical" written third-person perspective, typically male, trying describe structures illness. With project hoping increase international scholarship area, develop new intersection between academic disciplines and, most importantly, support who want area gain skills co-production partnerships. long-standing I fortunate worked "analytic" mode, particular nature delusions4. definition delusion vigorous debate Influenced Wittgenstein, Davidson, Dennett, McDowell provides useful think rationality. comes conversation Jaspers' "un-understandable" primary "true" delusions, empirical how psychosis develops continuum models. exploration distinction rationality irrationality, unusual beliefs, links wider issue one echoes Minkowski's critique namely, symptoms signs discrete "atomistic", rather form meaningful coherent whole informs all experience. An potential fertile future research would be try chart much structure categorize dependent upon prior historical ideas faculty psychology, may now no longer viable. example approach, together Humpston Broeker5-7, challenged traditional passivity experiences, such thought insertion, auditory verbal hallucinations, showed computational provide means empirically demonstrate cohere experientially. final theme like my reflection al's returns politics ethics epistemic injustice. Epistemic injustice term coined philosopher Fricker, theory. It refers lack justice experienced person when his/her ability knower discounted due non-epistemic factors (for example, gender, ethnicity, age). referred "testimonial injustice", literature accompanied "hermeneutic whereby people unjustly share knowledge. rich set conceptual help philosophers why voices subject intersectional marginalization silenced8, ways ameliorate that, scaffolding people's active valued knowers interactions maximize agency consultations9. brought close proximity studying real therapeutic encounters, young health problems, covering range care, important implications training education clinicians. view essential ally end first quarter 21st can see hopes simple biological, "neo-Kraepelinian", unlikely realized, suffering distress caused illness remains. clarity, rigorous questioning, expansion theoretical imagination addressing complex problems brings, field progressed with, detail paper, further advance answers to.

Язык: Английский

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Ignorance, Impairment and Quality of Will

Res Publica, Год журнала: 2024, Номер unknown

Опубликована: Окт. 23, 2024

Язык: Английский

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Regulation and Applied Science in Psychotherapies.

Psiquiatría Biológica, Год журнала: 2024, Номер 31(3), С. 100486 - 100486

Опубликована: Июнь 20, 2024

Язык: Английский

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