Many psychiatric disorders involve problems with the recognition and preservation of personal boundaries. Philosophy can help to clarify what is at stake, both socially and phenomenologically, in drawing such boundaries. In particular, assignments of responsibility and determinations of loss are deeply implicated in the determination of personal boundaries. Understanding these implications can help make sense of the volatile emotions of borderline personality disorder, for example, and it can clarify what is missing from DSM descriptions more generally.
Grant Gillett and Rom Harré
The discursive approach to psychiatry, taking as it does an ethological approach to the human organism, directs us to rules and story lines that structure our ways of dealing with the challenges thrown up by particular situated positions in our discursive world. For human beings this means engaging with the sense they are making of the world and the words they use to try and communicate that (to themselves and others). Doing things with words is behavior that draws on certain skills attuned to prompts, cues, expectations, and so on, all of which can go seriously awry in any setting where certain features are unfamiliar or where one of the participants is "impaired" or out of step with prevailing norms and assumptions. Discursive competence and the reality of the human psyche as a mode of being-in-relation-with others crucially depends on intact neural function and brain pathways slowly and cumulatively developed throughout life and is vulnerable to disruption of that substrate. Hysteria (or conversion disorder) and dementia represent two very different situations in which the discursive mismatch between an individual and his or her context of being causes the voice (and soul) of a person to be "lost in translation" so that understanding what is happening and then care and restoration demand a great deal of us not just as biomedical scientists but also as human beings who are reaching out to those who suffer and try to endure (patients) so as to help hold them in being.
William T. O'Donohue and Kyle E. Ferguson
Behavior therapy is heterogeneous and parallels what Wittgenstein called “family resemblances,” as it is impossible to delineate necessary or sufficient definitional criteria for what constitutes behavior therapy or cognitive-behavioral therapy. Since its infancy, behavior therapy has been sometimes associated with one or more forms of behaviorism, the basic learning and/or cognitive principles, and a grab bag of practical ideas, as well as the varieties of problems it endeavors to solve, among many other complex relations. Behavior therapy has become increasingly intricate as it matures and, to some extent, has developed into what Kuhn (2001) termed “micro-communities.” Subcommunities within behavior therapy employ different concepts, point to various influences, utilize different research methodologies, prioritize different problems, and incorporate diverse clinical strategies into routine practice. This chapter provides a general overview of the theoretical and philosophical underpinnings of behavior therapy.
Daniel D. Hutto
Getting clear about the nature and basis of interpersonal relating is a central concern of many recent debates in the philosophy of mind. The first section of this chapter highlights some basic facts about the complexity and multifaceted character of interpersonal relating and briefly overviews some of its most prominent dysfunctions. Popular mind-minding hypotheses which claim that the dysfunctions in question are rooted in impaired capacities for attending to and attributing mental states to others are then introduced. Next, recent evidence from cognitive psychology and neuroscience with which these mind-minding hypotheses must be made compatible is summarized. The important differences between two main philosophical frameworks-frameworks that offer opposing ways of understanding the nature of mind minding capacities are then highlighted. Focusing on these differences, the final section highlights how adoption of these philosophical frameworks matters to thinking about the prognosis and strategies for the treatment of certain mental disorders.
This chapter suggests that, when considering the philosophical problem of other minds, we distinguish between "thick" and "thin" versions of it. While traditional approaches take the problem to be a thick one, more recent work can be seen as addressing only a thin variant. Dretske, while acknowledging the thick problem, proposes a perceptual model of our knowledge of other minds which addresses only the thin version. The chapter proposes that, in the place of the thick problem, we consider the quality of our interactions with others. Following Wittgenstein, it suggests that where individuals share a nature their interactions exhibit a quality that it calls "depth." Where that nature is not, or is only partially, shared, there one might expect to find the quality of the interaction between persons disturbed. The chapter suggests that this disturbance might explain the impaired quality of interaction between autistic and non-autistic individuals.
Thor Grünbaum and Dan Zahavi
This chapter argues that explicit (reflective) self-conscious thinking is founded on an implicit (pre-reflective) form of self-awareness built into the very structure of phenomenal consciousness. In broad strokes, the argument is that a theory denying the existence of pre-reflective or minimal self-awareness has difficulties explaining a number of essential features of explicit first-person self-reference, and that this will impede a proper understanding of certain types of psychopathology. The chapter proceeds by discussion of a number of prominent theories of self-knowledge and self-reference relating them to forms of self-consciousness. It is then argued that getting these various relations right is important to a proper understanding of a number of psychopathological phenomena.