The potential of medicine as a resource for philosophy

In addition to the neglect of philosophy by medicine, emphasized in a recent editorial in this journal, there has been an equally important neglect of medicine by philosophy. Philosophy stands to gain from medicine in three respects: in materials, the conceptual difficulties arising in the practice of medicine being key data for philosophical enquiry; in methods, these data, through their problematic character, being ideally suited to the technique of linguistic analysis; and in results, the practical requirements of medicine placing a direct demand for progress on philosophical theory. The future of the relationship between philosophy and medicine depends on the development of a positive two-way trade between them.     

The hysterical organization

The term hysteria has been used in the history of the psychoanalytical movement to describe a large variety of psychic modalities. What is the common denominator of the hysterias? The author suggests that ambivalence in relation to penetration in its passive form (vaginal desire), in its pregenital and genital valences, constitutes the essence of hysteria. It seems that the issue of hysteria thus configured finds its best resolution in the fantasy of an incorporeal penetration, which leads to orgasm, and spares one from the anxiety of destruction to the internal space as well as from the anxiety of guilt following the hoped for climax. The author is attempting to discern, by means of two case studies, how disembodied penetration, depending on whether it is fantasized or delusional, constitutes a solution, neurotic or psychotic respectively, to the issue of hysteria: the private theatre in neurosis, as well as the inhabited and influenced mind in psychosis (delusion of control), act as psychic figurations of vagina.     

The phenomenological role of affect in the Capgras delusion

This paper draws on studies of the Capgras delusion in order to illuminate the phenomenological role of affect in interpersonal recognition. People with this delusion maintain that familiars, such as spouses, have been replaced by impostors. It is generally agreed that the delusion involves an anomalous experience, arising due to loss of affect. However, quite what this experience consists of remains unclear. I argue that recent accounts of the Capgras delusion incorporate an impoverished conception of experience, which fails to accommodate the role played by ‘affective relatedness’ in constituting (a) a sense of who a particular person is and (b) a sense of others as people rather than impersonal objects. I draw on the phenomenological concept of horizon to offer an interpretation of the Capgras experience that shows how the content ‘this entity is not my spouse but an impostor’ can be part of the experience, rather than something that is inferred from a strange experience.

Freud's theory of paranoid delusion based on the Schreber case contrasted with related theories

The historic importance of Freud's analysis of the Schreber case is acknowledged, even though the theory it expounds is largely disavowed. The theory ascribes the cause of paranoid delusion to homosexual impulses unresolved in infancy or early childhood. This paper summarizes Freud's monograph on Schreber and contrasts his theory with the views of various revisionists. The writers focus on the Freudian concept of projection, which is intended to explain how much meaning can become reversed under the impetus of stress, and the reversal lead to delusional thinking. Based on their work in family therapy, where they observed one form of pathogenic relating termed learning to be possessed, the writers concluded that this form was also based on a type of projection which could culminate in delusional ideation. A relationship between learning to be possessed and H. S. Sullivan's theory of paranoid transformation is described. A learning factor is present in several of the psychological theories advanced to explain delusion, and the factor is akin to if not identical with Freud's concept of projection.Gerald Zuk, PhD, is in private practice at 25316 Pacy Street, Santa Clarita, California 91321-3343. Carmen Zuk, MD, is a child psychiatrist-partner affiliated with the Southern California Permanente Medical Group at its psychiatric clinic in Van Nuys, California. Both may be reached by telephone at (805) 252-7702.     

Mental illness and the mind-brain problem: Delusion,belief and Searle's theory of intentionality

Until recently there has been little contact between the mind-brain debate in philosophy and the debate in psychiatry about the nature of mental illness. In this paper some of the analogies and disanalogies between the two debates are explored. It is noted in particular that the emphasis in modern philosophy of mind on the importance of the concept of action has been matched by a recent shift in the debate about mental illness from analyses of disease in terms of failure of functioning to analyses of illness in terms of failure of action. The concept of action thus provides a natural conduit for two-way exchanges of ideas between philosophy and psychiatry. The potential fruitfulness of such exchanges is illustrated with an outline of the mutual heuristic significance of psychiatric work on delusions and philosophical accounts of Intentionality.     

On presence in the psychoanalytic relation

This paper discusses presence in the psychoanalytic relation, the analysand’s and the analyst’s. Clinical situations with different qualities of presence will be considered focusing on what kind of interplay between analysand and analyst they may lead to. As examples, I have chosen three different clinical situations: In the first there is an interplay between the analysand’s free associations and the analyst’s ‘evenly suspended attention’. In connection with this I will discuss Bion’s concepts of ‘reverie’ and of ‘O’. In the second there is where the interaction is characterised by what Meltzer calls ‘geographical confusion’. In the third there is a ‘transference delusion’ in the psychoanalysis of breakdown as Winnicott describes it.     

Proneness to hallucinations and delusions in a non‐clinical sample: Exploring associations with metacognition and negative affect

Commonly, individuals prone to hallucinations and delusions hold dysfunctional metacognitive beliefs and report higher levels of negative affect, yet, these associations have not been clearly investigated in non‐clinical samples due to the failure to control for high intercorrelations between variables. The aim of the current study was to investigate how hallucination and delusion proneness are associated with dysfunctional metacognitions and negative affect. A cross‐sectional sample of 715 students free from psychiatric diagnoses (M_age = 28.1 years, SD = 10.9, range 18–65) completed the Launay‐Slade Hallucination Scale (LSHS‐R); Peters et al. Delusion Inventory (PDI‐21); Depression, Anxiety, and Stress Scale (DASS‐21); and the Metacognition Questionnaire (MCQ‐30). Findings that participants who were prone to both hallucinations and delusions reported elevated levels of negative affect support the need for targeted mental health treatment for individuals who experience psychological distress related to their hallucinatory and delusional experiences. While metacognition beliefs of need to control thoughts and cognitive self‐consciousness, along with the anxiety and stress DASS‐21 subscales appeared as significant cross‐sectional predictors of proneness to hallucinations and delusions, only metacognitions demonstrated any notable predictive value for delusion proneness. This finding questions the role of metacognitions in determining hallucination and delusion proneness in non‐clinical samples.     

Biased belief in the Bayesian brain: A deeper look at the evidence

A recent critique of hierarchical Bayesian models of delusion argues that, contrary to a key assumption of these models, belief formation in the healthy (i.e., neurotypical) mind is manifestly non-Bayesian. Here we provide a deeper examination of the empirical evidence underlying this critique. We argue that this evidence does not convincingly refute the assumption that belief formation in the neurotypical mind approximates Bayesian inference. Our argument rests on two key points. First, evidence that purports to reveal the most damning violation of Bayesian updating in human belief formation is counterweighted by substantial evidence that indicates such violations are the rare exception—not a common occurrence. Second, the remaining evidence does not demonstrate convincing violations of Bayesian inference in human belief updating; primarily because this evidence derives from study designs that produce results that are not obviously inconsistent with Bayesian principles.