Praxis makes perfect: Illness as a bridge between biological concepts of disease and social conceptions of health

Analyses of biological concepts of disease and social conceptions of health indicate that they are structurally interdependent. This in turn suggests the need for a bridge theory of illness. The main features of such a theory are an emphasis on the logical properties of value terms, close attention to the features of the experience of illness, and an analysis of this experience as action failure, drawing directly on the internal structure of action. The practical applications of this theory are outlined for a number of problems in each of the three main practical areas, clinical work, teaching and research. In each case the resources of the theory suggest new models and generate new results. The full practical significance of the theory, however, is shown to consist in the way in which it ties together biological and social theories into an integrated picture of the conceptual structure of medicine as a whole. It is argued, finally, that practical efficiency of this kind is a test of theory not only in the philosophy of medicine but also in general philosophy.     

Can we learn from the clinically significant face processing deficits,prosopagnosia and capgras delusion?

This review describes two clinically significant face processing deficits, prosopagnosia and Capgras delusion, and provides new knowledge about the face recognition process by a convergence of empirical findings. These empirical findings are structured around two questions that are viewed from the perspectives of the two deficits. First is the question of hemispheric specificity, which inquires into the degree of each hemisphere's contribution to the face recognition process. Second is the question of dual neural pathways, which addresses the possibility that the face recognition process proceeds along two parallel pathways in the brain. Findings from the hemispheric specificity studies reinforce the current view that right hemisphere involvement is necessary for face recognition while left hemisphere involvement is minimal. Findings from the dual neural pathways studies reinforce the plausible but yet unproven hypothesis that two neural pathways pass information from the visual association cortex in the occipital lobe toward the temporal lobes and limbic system when faces are seen and recognized. These findings, which also indicate that each of the dual neural pathways carries different, nonredundant information, could be instrumental in showing that the pathways play different roles in the manifestations of the clinically significant face processing deficits, prosopagnosia and Capgras delusion.     

Delusion‐proneness or miscomprehension? A re‐examination of the jumping‐to‐conclusions bias

Previous research has consistently shown that individuals with delusions typically exhibit a jumping‐to‐conclusions (JTC) bias when administrated the probabilistic reasoning ‘beads task’ (i.e., decisions made on limited evidence and/or decisions over‐adjusted in light of disconfirming evidence). However, recent work in this area has indicated that a lack of comprehension of the task may be confounding this finding. The purpose of the present study was to evaluate the influence of task administration, delusion‐proneness, and miscomprehension on the elucidation of the JTC bias. A total of 92 undergraduate university students were divided into one of two task conditions (i.e., non‐computerised and computerised) and were further identified as either delusion‐prone or non‐delusion‐prone and as comprehending or non‐comprehending the task. Overall, 25% of the sample demonstrated a JTC bias, and just over half made illogical responses consistent with a failure to comprehend the task. Qualitative evidence of comprehension revealed that these ‘illogical responses’ were being driven by a misunderstanding of task instructions. The way the task was administrated and levels of delusion‐proneness did not significantly influence JTC. However, miscomprehending participants were significantly more likely to exhibit the bias than those who did comprehend. These results suggest that miscomprehension rather than delusion‐proneness may be driving the JTC bias, and that future research should include measures of miscomprehension.     

A laboratory analogue of mirrored-self misidentification delusion: The role of hypnosis,suggestion, and demand characteristics

Mirrored-self misidentification is the delusional belief that one’s own reflection in the mirror is a stranger. In two experiments, we tested the ability of hypnotic suggestion to model this condition. In Experiment 1, we compared two suggestions based on either the delusion’s surface features (seeing a stranger in the mirror) or underlying processes (impaired face processing). Fifty-two high hypnotisable participants received one of these suggestions either with hypnosis or without in a wake control. In Experiment 2, we examined the extent to which social cues and role-playing could account for participants’ behaviour by comparing the responses of 14 hypnotised participants to the suggestion for impaired face processing (reals) with those of 14 nonhypnotised participants instructed to fake their responses (simulators). Overall, results from both experiments confirm that we can use hypnotic suggestion to produce a compelling analogue of mirrored-self misidentification that cannot simply be attributed to social cues or role-playing.     

Transcendence techniques and psychobiological mechanisms underlying religious experience

In this paper the author explores the process by which the combined influence of specific cultural factors and individual transcendence techniques activates psychobiological mechanisms that, in turn, trigger the appearance of special states of consciousness, namely religious trance. Most of these religious and spiritual experiences rationalize a threat common to all cultures, namely the risk of losing one's Ego.

The activation of individual transcendence techniques paraphrases denial defence mechanisms insofar as it involves avoidance of the external reality to preserve homeostasis. The mentioning in psychoanalytic terms of a ‘death instinct’ (i.e. a drive opposite to the attachment/life instinct) as a possible source of detachment/transcendence phenomena is still worth considering.

The Freudian example of ‘the cotton-reel mother’, whom the child could make disappear and then reappear again, is a powerful one of the phenomenon of detachment dynamics.

Cross-cultural research on the varieties of trance shows that Altered States of Consciousness can be induced by both collective and personal rituals that allow the subject to reach the altered states of consciousness by making the whole world appear or disappear in fantasy. While some of the highest forms of supernatural experience, such as ecstasy, mysticism and the communion with the Absolute, engender enough social approval to allow to believe that such experiences mitigate or prevent mental disorders, when the supernatural experiences occur in bizarre features they are indicators of a clear psychopathology.

The perspective of transcultural psychiatry offers the best method of outlining the great ethnographic variety of these experiences and, subsequently, making a comparative analysis of the links that exists among culture, psychopathology and the supernatural in a given situation.

From a clinical point of view, it becomes increasingly clear that psychiatrists need expertise to draw clinical inferences based on the specific patient's culture and his psychopathological presentation, especially when the patient's life history is characterized by the multi-faceted activity of transcendence techniques.     

Using hypnosis to model Fregoli delusion and the impact of challenges on belief revision

Fregoli delusion involves the belief that strangers are known people in disguise. We aimed to model aspects of this delusion for the first time using hypnosis. We informed hypnotised subjects that someone would enter the room (a confederate) and they would believe this person was someone they knew in disguise. After testing their reaction to the confederate, we challenged their delusion by directly contradicting their belief and then asking them to focus on the confederate’s voice and gait. Finally, we indexed whether they could identify photographs of the confederate. We found that just over half of our high hypnotisable subjects identified the confederate as someone they knew in disguise. Although many highs abandoned their belief in response to challenges, some maintained strong, unwavering conviction that the confederate was a known person. We discuss these findings in terms of how evidence might be evaluated during both hypnotic and clinical delusions.     

Interpreting delusions

This paper explores the phenomenology of the Capgras and Cotard delusions. The former is generally characterised as the belief that relatives or friends have been replaced by impostors, and the latter as the conviction that one is dead or has ceased to exist. A commonly reported feature of these delusions is an experienced 'defamiliarisation' or even 'derealisation' of things, which is associated with an absence or distortion of affect. I suggest that the importance attributed to affect by current explanations of delusional experience can serve to make explicit the manner in which we ordinarily experience the world under a taken-for-granted aspect of affective familiarity. This implicit feeling is, I argue, partly constitutive of our sense of reality. However, so-called 'folk psychology,' which is generally adopted by philosophers as an initial interpretive backdrop for delusional beliefs and for beliefs more generally, fails to accommodate it. As a consequence, some pervasive philosophical assumptions concerning the manner in which we experience and understand the world, ourselves, and each other are called into question.     

Infant psychopathology during the first year of life and its return during adolescence and adulthood

This is a presentation of different clinical cases having in common severe infantile traumatic events during the first year of life. From the disappearance of mother and father during Latin-American dictatorships, to another patient who hallucinates that bats fly out of his cheeks, this paper tries to bring light into the difficult times of these patients and how the analysts worked with infantile parts of the self which were inside the adult patients.