Alterations of social attention in mental disorders: Phenomenology,scope, and future directions for research

Mental disorders often involve changes in the way subjects attend to other people. However, the nature of these modifications and how they unfold in different pathologies are not sufficiently clear. This article addresses these issues from the perspective of phenomenological psychopathology. The primary goal of the article is to suggest a new way of assessing and distinguishing the alterations of social attention in subjects with mental disorders. The first part of the article characterizes the essential properties of a capacity for social attention based on multidisciplinary evidence. This model is then used to examine anomalies in social attention in autism, schizophrenia, borderline personality disorder, and social anxiety disorder. The analysis of alterations in the way subjects with different types of pathologies attend to and with others is followed by a threefold typology, which clarifies the phenomenal nature of impairments of social attention in mental disorders.     

Delusions as harmful malfunctioning beliefs

Delusional beliefs are typically pathological. Being pathological is clearly distinguished from being false or being irrational. Anna might falsely believe that his husband is having an affair but it might just be a simple mistake. Again, Sam might irrationally believe, without good evidence, that he is smarter than his colleagues, but it might just be a healthy self-deceptive belief. On the other hand, when a patient with brain damage caused by a car accident believes that his father was replaced by an imposter or another patient with schizophrenia believes that “The Organization” painted the shops on a street in red and green to convey a message, these beliefs are not merely false or irrational. They are pathological. What makes delusions pathological? This paper explores the negative features because of which delusional beliefs are pathological. First, I critically examine the proposals according to which delusional beliefs are pathological because of (1) their strangeness, (2) their extreme irrationality, (3) their resistance to folk psychological explanations or (4) impaired responsibility-grounding capacities of people with them. I present some counterexamples as well as theoretical problems for these proposals. Then, I argue, following Wakefield’s harmful dysfunction analysis of disorder, that delusional beliefs are pathological because they involve some sorts of harmful malfunctions. In other words, they have a significant negative impact on wellbeing (=harmful) and, in addition, some psychological mechanisms, directly or indirectly related to them, fail to perform the jobs for which they were selected in the past (=malfunctioning). An objection to the proposal is that delusional beliefs might not involve any malfunctions. For example, they might be playing psychological defence functions properly. Another objection is that a harmful malfunction is not sufficient for something to be pathological. For example, false beliefs might involve some malfunctions according to teleosemantics, a popular naturalist account of mental content, but harmful false beliefs do not have to be pathological. I examine those objections in detail and show that they should be rejected after all.     

Slower access to visual awareness but otherwise intact implicit perception of emotional faces in schizophrenia-spectrum disorders

Schizophrenia-spectrum disorders are characterized by deficits in social domains. Extant research has reported an impaired ability to perceive emotional faces in schizophrenia. Yet, it is unclear if these deficits occur already in the access to visual awareness. To investigate this question, 23 people with schizophrenia or schizoaffective disorder and 22 healthy controls performed a breaking continuous flash suppression task with fearful, happy, and neutral faces. Response times were analysed with generalized linear mixed models. People with schizophrenia-spectrum disorders were slower than controls in detecting faces, but did not show emotion-specific impairments. Moreover, happy faces were detected faster than neutral and fearful faces, across all participants. Although caution is needed when interpreting the main effect of group, our findings may suggest an elevated threshold for visual awareness in schizophrenia-spectrum disorders, but an intact implicit emotion perception. Our study provides a new insight into the mechanisms underlying emotion perception in schizophrenia-spectrum disorders.     

Utilizing a Music Listening Technique in Inpatient Psychiatric Group Counseling

ABSTRACT

The purpose of this article is to describe and illustrate through a hypothetical case example how counselors can utilize an expressive arts technique called music listening in inpatient psychiatric group counseling. The authors give a rationale to implement here-and-now interventions, specifically music listening, in response to the critique of current inpatient therapy in psychiatric hospitals following a shift from long-term inpatient psychiatric care to brief stabilization admissions.