Psychotic phenomena include a far wider range of experiences than is captured by the brief descri... more Psychotic phenomena include a far wider range of experiences than is captured by the brief descriptions offered in contemporary diagnostic guides. Given the richness of historical clinical phenomenology, what can account for the recent ascendancy of relatively impoverished descriptions of psychosis? One possible explanation is provided by Hacking's notion of dynamic nominalism, where human categories change over time in tandem with those who they classify. But although dynamic nominalism makes sense of changes in behaviour, it fails to account for change at the level of subjective experience. In this paper, psychotic symptoms are addressed in the light of the indeterminacy of subjective mental content. A naïve-introspectionist approach to mental symptoms assumes that, notwithstanding practical difficulties, such symptoms are reliably describable in principle. Contemporary philosophy of mind challenges this assumption. Lighting upon a verbal description for ineffable phenomena changes their nature, resolving them into new forms. Declaration of interest None.
There is extensive debate about whether delusions are best considered beliefs. This debate is sel... more There is extensive debate about whether delusions are best considered beliefs. This debate is seldom addressed by clinicians though it bears on how delusions are conceived, managed and treated. Little empirical work exists to address this issue. This study explored whether individuals with first hand experiences of delusions spoke about those ideas in ways that were consistent with their being beliefs. Seventeen individuals identified as experiencing, or having experienced, delusions were recruited for a semi-structured interview. Responses to the interview were read and coded by two raters in terms of criteria relevant to whether a mental state is a belief. The majority of delusions examined here were spoken about as though they were beliefs. Most participants believed other things that were consistent with the delusions, attempted to defend their delusions with evidence, had frequently acted on their delusions and provided reasons for holding them. However, there was some varia- tion in the extent to which this was the case. This study provides tentative support for the claim that some delusions are beliefs.
For almost 30 years, the diagnosis of schizophrenia
has been subject to an extensive critique of ... more For almost 30 years, the diagnosis of schizophrenia has been subject to an extensive critique of its validity as an object of scientific research. It has also been identified with negative social consequences in its own right. This raises the question of why the label retains so much professional and social currency. Authors who have addressed this issue attribute schizophrenia’s success to the material interests of the profession of psychiatry, but it is here argued that this account is insufficient. I draw on what I call the reference account to explain why schizophrenia persists. Despite its problems, I suggest that the label continues to exist because, in certain usage contexts, it successfully refers to some aspects of reality. Schizophrenia will likely be decomposed and replaced by more precise diagnostic terms, but for the time being a coherent and unanimously agreed upon alternative is missing.
The discussion of splitting within mental health treatment teams emerged from British object rela... more The discussion of splitting within mental health treatment teams emerged from British object relations theory, a movement concerned with understanding the interplay between individuals in terms of their inner lives. Over time, the terminology used in this domain has become reified and splitting has been discussed in terms that are apt to frame the process as patient-precipitated. This is apt to encourage simplistic inferences, and attribute to patients responsibility for events that are beyond their control. In this article, the historical development of the psychoanalytic account of team splitting is examined and contemporary critiques are reviewed. It is suggested that the resultant one-person picture overlooks the ways that psychoanalytic theory has been subject to controversy and revision. In the last section of the article, I propose that relational innovations in psychoanalytic theory provide a way to rediscover the richness of early descriptions of splitting.
This case study outlines the process of play therapy with a beginning child therapist and an 8-ye... more This case study outlines the process of play therapy with a beginning child therapist and an 8-year-old female patient. Salient aspects of the content of this child’s play were consistent with an ongoing effort to master anxieties about departures and unpredictable goodbyes. After some months this theme faded, corresponding with some reported improvement in the child’s emotional experience outside of therapy. Later the therapy process ended in a manner which apparently bears echoes of the child’s early experiences. The process is discussed in the light of a new therapist’s experience of making shifting formulations about the child in the context of her past and her family.
16 years' standing and for the past 10 years he has been working as consultant for a psychiatric ... more 16 years' standing and for the past 10 years he has been working as consultant for a psychiatric intensive care unit in east London. He argues convincingly that a paradigm shift in our approach to mental distress is necessary and it is one which concentrates less on looking on patients as being 'diseased' and more on seeing them as experiencing a sense of disconnection from themselves, their community and life itself.
The debate about psychiatric nosology was reignited last year when the fifth
edition of the Diagn... more The debate about psychiatric nosology was reignited last year when the fifth edition of the Diagnostic and Statistical Manual (DSM) was published to widespread criticism. Critics cite a number of problems with ‘psychiatric diagnosis’, though it is sometimes unclear which classificatory practices are included under this broad heading. Although it may be possible to avoid the problems inherent in the DSM system, other difficulties associated with classification (labelling, stigma) may prove harder to escape. The first part of this article argues that some form of psychiatric classification is made inevitable by the communicative, epistemic and ethical pressures on psychiatry. In the second half it is suggested that there are ways to think differently about our relationship to psychiatric classification, and that these could play a role in mitigating the harms outlined by diagnosis’ critics.
Psychotic phenomena include a far wider range of experiences than is captured by the brief descri... more Psychotic phenomena include a far wider range of experiences than is captured by the brief descriptions offered in contemporary diagnostic guides. Given the richness of historical clinical phenomenology, what can account for the recent ascendancy of relatively impoverished descriptions of psychosis? One possible explanation is provided by Hacking's notion of dynamic nominalism, where human categories change over time in tandem with those who they classify. But although dynamic nominalism makes sense of changes in behaviour, it fails to account for change at the level of subjective experience. In this paper, psychotic symptoms are addressed in the light of the indeterminacy of subjective mental content. A naïve-introspectionist approach to mental symptoms assumes that, notwithstanding practical difficulties, such symptoms are reliably describable in principle. Contemporary philosophy of mind challenges this assumption. Lighting upon a verbal description for ineffable phenomena changes their nature, resolving them into new forms. Declaration of interest None.
There is extensive debate about whether delusions are best considered beliefs. This debate is sel... more There is extensive debate about whether delusions are best considered beliefs. This debate is seldom addressed by clinicians though it bears on how delusions are conceived, managed and treated. Little empirical work exists to address this issue. This study explored whether individuals with first hand experiences of delusions spoke about those ideas in ways that were consistent with their being beliefs. Seventeen individuals identified as experiencing, or having experienced, delusions were recruited for a semi-structured interview. Responses to the interview were read and coded by two raters in terms of criteria relevant to whether a mental state is a belief. The majority of delusions examined here were spoken about as though they were beliefs. Most participants believed other things that were consistent with the delusions, attempted to defend their delusions with evidence, had frequently acted on their delusions and provided reasons for holding them. However, there was some varia- tion in the extent to which this was the case. This study provides tentative support for the claim that some delusions are beliefs.
For almost 30 years, the diagnosis of schizophrenia
has been subject to an extensive critique of ... more For almost 30 years, the diagnosis of schizophrenia has been subject to an extensive critique of its validity as an object of scientific research. It has also been identified with negative social consequences in its own right. This raises the question of why the label retains so much professional and social currency. Authors who have addressed this issue attribute schizophrenia’s success to the material interests of the profession of psychiatry, but it is here argued that this account is insufficient. I draw on what I call the reference account to explain why schizophrenia persists. Despite its problems, I suggest that the label continues to exist because, in certain usage contexts, it successfully refers to some aspects of reality. Schizophrenia will likely be decomposed and replaced by more precise diagnostic terms, but for the time being a coherent and unanimously agreed upon alternative is missing.
The discussion of splitting within mental health treatment teams emerged from British object rela... more The discussion of splitting within mental health treatment teams emerged from British object relations theory, a movement concerned with understanding the interplay between individuals in terms of their inner lives. Over time, the terminology used in this domain has become reified and splitting has been discussed in terms that are apt to frame the process as patient-precipitated. This is apt to encourage simplistic inferences, and attribute to patients responsibility for events that are beyond their control. In this article, the historical development of the psychoanalytic account of team splitting is examined and contemporary critiques are reviewed. It is suggested that the resultant one-person picture overlooks the ways that psychoanalytic theory has been subject to controversy and revision. In the last section of the article, I propose that relational innovations in psychoanalytic theory provide a way to rediscover the richness of early descriptions of splitting.
This case study outlines the process of play therapy with a beginning child therapist and an 8-ye... more This case study outlines the process of play therapy with a beginning child therapist and an 8-year-old female patient. Salient aspects of the content of this child’s play were consistent with an ongoing effort to master anxieties about departures and unpredictable goodbyes. After some months this theme faded, corresponding with some reported improvement in the child’s emotional experience outside of therapy. Later the therapy process ended in a manner which apparently bears echoes of the child’s early experiences. The process is discussed in the light of a new therapist’s experience of making shifting formulations about the child in the context of her past and her family.
16 years' standing and for the past 10 years he has been working as consultant for a psychiatric ... more 16 years' standing and for the past 10 years he has been working as consultant for a psychiatric intensive care unit in east London. He argues convincingly that a paradigm shift in our approach to mental distress is necessary and it is one which concentrates less on looking on patients as being 'diseased' and more on seeing them as experiencing a sense of disconnection from themselves, their community and life itself.
The debate about psychiatric nosology was reignited last year when the fifth
edition of the Diagn... more The debate about psychiatric nosology was reignited last year when the fifth edition of the Diagnostic and Statistical Manual (DSM) was published to widespread criticism. Critics cite a number of problems with ‘psychiatric diagnosis’, though it is sometimes unclear which classificatory practices are included under this broad heading. Although it may be possible to avoid the problems inherent in the DSM system, other difficulties associated with classification (labelling, stigma) may prove harder to escape. The first part of this article argues that some form of psychiatric classification is made inevitable by the communicative, epistemic and ethical pressures on psychiatry. In the second half it is suggested that there are ways to think differently about our relationship to psychiatric classification, and that these could play a role in mitigating the harms outlined by diagnosis’ critics.
Uploads
Papers by Huw Green
has been subject to an extensive critique of its
validity as an object of scientific research. It has also
been identified with negative social consequences in its
own right. This raises the question of why the label retains
so much professional and social currency. Authors
who have addressed this issue attribute schizophrenia’s
success to the material interests of the profession of
psychiatry, but it is here argued that this account is
insufficient. I draw on what I call the reference account
to explain why schizophrenia persists. Despite its problems,
I suggest that the label continues to exist because,
in certain usage contexts, it successfully refers to some
aspects of reality. Schizophrenia will likely be decomposed
and replaced by more precise diagnostic terms,
but for the time being a coherent and unanimously
agreed upon alternative is missing.
edition of the Diagnostic and Statistical Manual (DSM) was published to widespread criticism.
Critics cite a number of problems with ‘psychiatric diagnosis’, though it is sometimes unclear
which classificatory practices are included under this broad heading. Although it may be
possible to avoid the problems inherent in the DSM system, other difficulties associated with
classification (labelling, stigma) may prove harder to escape. The first part of this article
argues that some form of psychiatric classification is made inevitable by the communicative,
epistemic and ethical pressures on psychiatry. In the second half it is suggested that there
are ways to think differently about our relationship to psychiatric classification, and that
these could play a role in mitigating the harms outlined by diagnosis’ critics.
has been subject to an extensive critique of its
validity as an object of scientific research. It has also
been identified with negative social consequences in its
own right. This raises the question of why the label retains
so much professional and social currency. Authors
who have addressed this issue attribute schizophrenia’s
success to the material interests of the profession of
psychiatry, but it is here argued that this account is
insufficient. I draw on what I call the reference account
to explain why schizophrenia persists. Despite its problems,
I suggest that the label continues to exist because,
in certain usage contexts, it successfully refers to some
aspects of reality. Schizophrenia will likely be decomposed
and replaced by more precise diagnostic terms,
but for the time being a coherent and unanimously
agreed upon alternative is missing.
edition of the Diagnostic and Statistical Manual (DSM) was published to widespread criticism.
Critics cite a number of problems with ‘psychiatric diagnosis’, though it is sometimes unclear
which classificatory practices are included under this broad heading. Although it may be
possible to avoid the problems inherent in the DSM system, other difficulties associated with
classification (labelling, stigma) may prove harder to escape. The first part of this article
argues that some form of psychiatric classification is made inevitable by the communicative,
epistemic and ethical pressures on psychiatry. In the second half it is suggested that there
are ways to think differently about our relationship to psychiatric classification, and that
these could play a role in mitigating the harms outlined by diagnosis’ critics.