Thursday, 29 March 2018

Global Challenges in Mental Health: Children in Crisis

On 9th January at the Royal Society of Medicine an event took place, Global Mental Health: Children in Crisis



The first speaker, Vikram Patel (Harvard Medical School), presented a lecture on how to prevent mental health problems in children. He highlighted the importance of linking epidemiological and neuroscientific data. From en epidemiological perspective, deprivation is a very significant risk factor for mental health problems, comparable to what smoking is for lung cancer. And most mental health probelms begin before the age of 24. From a neuroscientific perspective, the brain is very plastic in young adulthood. The prefrontal region of the brain (linked to executive decision making) matures 5-8 years later than the limbic region (linked to basic emotional reactions).

Adversities associated with poor developmental outcomes include:
  • Malnutrition
  • Stressors
  • Infections
  • War and displacement
  • Parental ill-health
  • Abuse
The need for responsive parents and the experience of stressors (especially toxic stress, continuous state of stress without support by adults) determine the architecture of the brain and shape brain circuitry (Centre on the Developing Child, Harvard University). We need nurturing, stable and engaging enviroments for children to develop.

Vikram Patel

Theresa Betancourt

So risks factors for mental health issue are primarily (1) missing interactions with relevant adults and (2) excessive, prolonged stress. How these factors impact on health depends on the life stage of the child, whether the adversities occur in the first five years of the child's life or later on in adolescence.

In the first 5 years of life, home, school, and neighbourhood are the most significant environments. Structured play has a very strong impact on the wellbeing of young children. Children whose parents play engagingly with them become better educated, more healthy adults, and they go on to earn more than children who did not receive the same attention.

The principles of structured play are:
  • follow the child
  • use everyday objects
  • stimulate all senses
We know now much more than we previously did about the adolescent brain. The prefrontal cortex matures well after the limbic system and that is why juveniles in all species, not just humans, are more risk-taking. In the face of social adversities, teenagers are more vulnerable. Adversities include family disruption, early age of puberty, violence in the community, digital world, use of alcohol and energy drinks, rigid social norms about gender and life choices.

Interventions at this stage cover parental involvement, activities promoting agency and participation in schools, focus on emotional competence, reducing exposure to harmful behaviours (substance abuse). Interventions that aim at enhancing agency in young people and improving school climate have the following goals:
  • Promoting social skills
  • Engaging young people in decisions
  • Making information accessible
  • Enhancing problem solving skills
Interventions with the goals above have been shown to reduce bullying and depressive symptoms. But the problems with the current programmes are that interventions are fragmented and episodic and the focus tends to be on specific behaviours and risks. Moreover, there is a lack of youth leadership and engagement, and a lack of coordination across sectors.

To try and overcome some of these issues there is a Wellcome Trust Public Engagement initiative in India inviting young people to talk openly about they feel: www.itisoktotalk.in

Tuesday, 27 March 2018

Conceptual Centrality and Implicit Bias

Today's post introduces Guillermo Del Pinal and Shannon Spaulding's paper, "Conceptual Centrality and Implicit Bias", published in Mind and Language.

Guillermo Del Pinal is a Postdoctoral Research Fellow at the University of Michigan, Ann Arbor, and Leibniz-ZAS, Berlin. He works in the philosophy of language, mind and cognitive science. His main area of research is the relation between language and general cognition, focusing on topics such as the degree of modularity of language, and the role of natural logic within the language system.



Shannon Spaulding is an Assistant Professor of Philosophy at Oklahoma State University. Her general philosophical interests are in the philosophy of mind, philosophical psychology, and the philosophy of science. The principal goal of her research is to construct a philosophically and empirically plausible account of social cognition. She also has research interests in imagination, pretense, and action theory.



How are biases encoded in our representations of social categories? Current discussions of implicit bias overwhelmingly focus on salient associations between target features and representations of social categories. Salient associations track the prominence or availability of an association between a category (e.g., WOMAN) and a feature (e.g., +FAMILY ORIENTED). These are the sorts of associations probed by the Implicit Association Test and similar priming tasks. While these kinds of associations likely encode biases which affect judgment and behavior, we believe that other kinds of biases may affect social cognition in more dramatic ways.

In Del Pinal and Spaulding (2018), we argue that some social biases are likely encoded in the dependency networks that are part of our representations of social categories. Dependency networks encode information about the inter-dependencies and degree of centrality of features in a conceptual representation. For example, +MADE FOR SITTING is a central feature of CHAIR because various other features of chairs depend on their being made for sitting. Importantly, that a feature is central for a category doesn’t entail that it is also salient: +MADE FOR SITTING, although central, need not be more salient than other (less central) features such as +HAS A BACK or +FOUR LEGS. In our view, many socially relevant biases are likely encoded in dependency networks, and can’t be picked out by measures that track merely salient or typical features.

Why does this matter? Why should we care about how, precisely, biases are encoded? Here is why …


Thursday, 22 March 2018

Knowing Emotions

This post is by Rick Furtak.  Rick Anthony Furtak is Associate Professor of Philosophy at Colorado College, where he has taught for over twelve years. In addition to the philosophy of emotions, his other main area of focus is existential thought. He is also a poet and translator who is interested in the literary aspects of philosophy and the philosophical significance of literature. In this post, he talks about his new book Knowing Emotions.



This book investigates the question of how our emotions can enable us to know.  It claims that human emotions are not just feelings of physiological disturbance: rather, they are experiences in which we apprehend significant matters of concern.  When Pascal noted that the heart has its own reasons, he indicated that our dispassionate rational faculty alone cannot grasp what is revealed in our affective experience.  Knowing Emotions seeks to explain why human emotions are indeed capable of making us aware of significant truths that we could not know by any other means.

Recent philosophical and interdisciplinary research on the emotions has been dominated by a renewal and further development of the debate over how best to characterize the intentionality of emotions as well as their bodily character.  In Knowing Emotions, I argue that intentionality and feeling are not two discrete parts of affective experience, but conceptually distinguishable aspects of a single unified response.  My account captures how an emotion’s phenomenal or “felt” quality (what it is like) is related to its intentional content (what it is about).

Tuesday, 20 March 2018

What Makes a Belief Delusional?

In December 2016 an exciting volume entitled Cognitive Confusions: Dreams, Delusions and Illusions in Early Modern Culture has been published by Legenda. The book, edited by Ita McCarthy, Kirsty Sellevold and Olivia Smith, contains a chapter authored by Ema Sullivan-Bissett, Rachel Gunn and myself on the challenges we face when we want to tell delusional beliefs apart from other beliefs.




We start with the standard DSM definition of delusions, and explain that clinical delusions are characterised by surface features of two kinds, epistemic (fixity, implausibility) and psychological (negative impact on functioning). Then we ask whether we can decide whether a type of belief is delusional by using those criteria. We consider three cases of belief that match at least some of the criteria: the belief that some thoughts have been inserted in one's mind by a third party; the belief that one has been abducted by aliens; and the belief that one is better than average at just about everything.

Discussing the similarities and differences among such beliefs -- Are they based on evidence? Are they common or rare? Do they bring any benefit? Do they help explain anomalous experience? -- is relevant to two projects that have been featured on this blog before: the Costs and Benefits of Optimism project and the PERFECT project. In the end, our goal is to show that neither the epistemic nor psychological features mentioned in the definition of delusions can help us sort delusional beliefs from non-delusional ones. Some delusions do not meet the criteria and some beliefs that we would not class as delusions do.

Rachel Gunn (who successfully completed her PhD at the University of Birmingham, working on delusions) examines the phenomenon of thought insertion by using very interesting first-person reports by people who used internet forums to share their unusual experiences. She observes that the experience affects people in different ways. For some but not for all the thought is felt like an unwelcome intrusion. For some but not for all the content of the thought also generates a compulsion to think or do certain things. Thought insertion is regarded as a symptom of schizophrenia, but whether it involves a pathological experience, whether it is a delusional belief, or whether it is harmful cannot be established without reflecting on the specifics of the individual case.

Here is one of the first-person reports Rachel analyses:
i truly do have unwanted thoughts that are forced into my head from somewhere... I mean I will have a thought saying my grandmother is a bitch. I would never ever think of my grandmother as a bitch. She is one of the greatest women I know and I adore her. So how is that a delusion? It is an intrusive thought! I sure didnt imagine it!.... i really do not think my grandmother is a bitch. i think these thoughts are evil and came from an evil being. Some thoughts however that pop into my head all of a sudden are my own thoughts and i can recognize that even though they are unwanted, but some are just plain ridiculous and mean and i know must be from an outside force. 
Star-28, ‘Forum’, Mental Health Forum (2010)

Thursday, 15 March 2018

Unbelievable Errors

This post is by Bart Streumer. Bart Streumer is Professor of Philosophy at the University of Groningen. In this post he introduces his book Unbelievable Errors, which has recently been published by Oxford University Press.



Widespread beliefs can be systematically mistaken. Take religious beliefs: if God does not exist, these beliefs are all mistaken. But you may think that some widespread beliefs cannot be mistaken in this way. For example, consider normative judgements: our beliefs about what is right or wrong, or about what there is reason to do or to believe. Could these beliefs be systematically mistaken?

In my book Unbelievable Errors, I argue that they are. I argue that normative judgements ascribe normative properties, but that these properties do not exist. This means that all normative judgements are false. For example, the belief that stealing is wrong ascribes the property of being wrong to stealing, but this property does not exist, which means that this belief is false. The belief that stealing is permissible ascribes the property of being permissible to stealing, but this property does not exist either, which means that this belief is false as well. And similar claims apply to all other normative judgements.

The view I defend in the book is known as ‘error theory’. Some philosophers accept such a theory about moral judgements. But the error theory about all normative judgements that I defend may seem so bizarre as to be simply incredible. I agree. For in addition to defending the error theory, I also argue that we cannot believe this theory. If I am right that the theory is true of judgements about reasons for belief, the theory entails that there is no reason to believe the theory. I therefore think that we only really believe the error theory if we believe that there is no reason to believe the theory. And I argue that we cannot do this: we cannot have a belief while at the same time believing that there is no reason for this belief. If so, it follows that we cannot believe the error theory.

If I am right that we cannot believe the error theory, the arguments I give in my book cannot convince anyone that this theory is true. That is why I have called the book  Unbelievable Errors. But the fact that an argument cannot convince us does not show that this argument is unsound. Moreover, I argue that our inability to believe the error theory actually makes the theory more likely to be true, since it helps to answer objections to the theory, it makes it harder to reject the arguments for the theory, and it undermines revisionary alternatives to the theory. I therefore think that our inability to believe the error theory is an advantage rather than a problem for the theory.

When we have mistaken beliefs, it is normally possible for us to see that these beliefs are mistaken. But this may not always be possible. If I am right, our normative judgements are systematically mistaken in a way that we are unable to see.



Tuesday, 13 March 2018

The Paradoxical Self


Today's post is by Clara Humpston. Clara is a Research Associate at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London.



Not long ago I completed my PhD from Cardiff University and this paper was first written a couple of years ago when I was a PhD student there.

My PhD research focused on the pathogenesis of psychotic symptoms and adopted a cognitive neuropsychiatric approach by incorporating behavioural and phenomenological investigations. In my second post for Imperfect Cognitions, I summarise my most recent theoretical paper on the paradoxical nature of self-awareness in schizophrenia, published in Philosophical Psychology.

The primary manifestations of schizophrenia in my opinion, are basic self-disturbances leading to the adoption of a solipsistic lifeworld that provides fertile ground for the development of psychotic phenomena such as first-rank symptoms. First-rank symptoms are often disruptions of one’s ego-boundary: that is, one’s demarcation between the internal and external worlds, between self and other. This paper aims to provide an integrated account of the structure of self-disorders found in schizophrenia and shed further light on the issues of paradoxicality and solipsism which are often overlooked or ignored in the clinic.

Contemporary theorists such as Louis Sass and Josef Parnas have further disentangled anomalous self-experience (‘ipseity disturbance’, from Latin ipse – ‘self’) into a combination of factors termed ‘hyperreflexivity’ and ‘diminished self-affection’, which is a dominant theory which has guided many others’ pursuits in this matter. According to Sass and Parnas, ipseity is the most fundamental, pre-reflective and vital level of the broadly defined ‘sense of self’ and concerns the ‘experiential sense of being a vital and self-identical subject of experience or first-person perspective on the world’ which is tacit and property-less, but forms the very foundation of other more complex levels of the self.


Thursday, 8 March 2018

Real Hallucinations

This post is by Matthew Ratcliffe, Professor for Theoretical Philosophy at the University of Vienna, Austria. Ratcliffe also leads the Phenomenological Psychopathology and Philosophy of Psychiatry research group. Most of his recent work addresses issues in phenomenology, philosophy of mind, and philosophy of psychiatry. He is the author of: Rethinking Commonsense Psychology: A Critique of Folk Psychology, Theory of Mind and Simulation (Palgrave, 2007), Feelings of Being: Phenomenology, Psychiatry and the Sense of Reality (Oxford University Press, 2008), and Experiences of Depression: A Study in Phenomenology (Oxford University Press, 2015).

In this post Ratcliffe presents a review of his most recent book Real Hallucinations: Psychiatric Illness, Intentionality and the Interpersonal World.




When we perceive something, we seldom wonder whether we are actually perceiving it rather than imagining or remembering it. Perceptual experience ordinarily incorporates a pre-reflective sense of perceiving, an observation that applies equally to other types of intentional states. For instance, what we imagine is usually experienced as imagined. In Real Hallucinations, I develop an account of what this sense of being in an intentional state consists of, through an exploration of various changes in the structure of intentionality that can occur in psychiatric illness.

One might think that the sense of being in one or another type of intentional state is easy enough to characterize: it is a matter of experiential content. Certain aspects of perceptual content are specific to perception in one or another modality; aspects of imagined content are specific to one or another type of imagining; and so forth. However, I show that this cannot be the case, as sense and content are dissociable. To do so, I offer a detailed examination of thought insertion (TI) and auditory verbal hallucination (AVH). I argue that many of those experiences referred to as TI and/or AVH involve a sense of perceiving something, but without the usual perceptual content.

An experiential content resembling that of inner speech, autobiographical memory, or some form of imagination comes to be associated with the sense of encountering something perceptually. In such cases, the sense of perceiving is usually incomplete and often conflicted, resulting in an intrinsically strange experience that stands out as distinct from mundane forms of intentionality. I go on to show how experiences like this tend to arise in the context of much more pervasive but less pronounced disturbances of the structure of intentionality. This approach, I suggest, also applies to many other anomalous experiences that are labeled as “delusions” and “hallucinations”.

Tuesday, 6 March 2018

Taxonomising Delusions


Colin Klein

We are philosophers working on various topics that intersect with delusions. Colin Klein works on the philosophy of neuroscience and the application of interventionist accounts of causation to this area, and has also discussed the relation between psychopathologies like somatoparaphenia and his theory of pain. Stephen Gadsby works on distorted body representations and false body size beliefs in anorexia nervosa. And Peter Clutton has defended the doxastic status of delusions—offering a cognitive phenomenological account of delusions (forthcoming)—and explored the status of delusions on the harmful dysfunction account.


Peter Clutton

Any discussion of delusions needs some criteria by which patients are grouped together as having the same delusion. In our paper, ‘Taxonomising Delusions: content or aetiology?’, we compare content-based and aetiological taxonomies of delusions, arguing in favour of the latter.


Stephen Gadsby


Most authors taxonomise delusions by the content of the delusional belief: Capgras patients believe that their spouse has been replaced by an imposter, Cotard’s delusion involves the belief that one is dead, and so on. Taxonomising by belief content has intuitive appeal. Content is often what brings patients to clinical attention in the first place, and may be all a researcher has to work with. Additionally, content appears to offer a theory-neutral starting point, in that it does not presuppose any particular theoretical explanation of the underlying causes of delusions.

We argue that these intuitive advantages are not as strong as they seem, and that an aetiological taxonomy is to be preferred: that is, we think that patients ought to be grouped by the causes of their delusions, rather than by what they believe. An aetiological taxonomy has the advantage of supporting the kinds of empirical generalisations we want from scientific taxonomies. Good taxonomies identify similarities among group members that manifest across a variety of distinct circumstances. In studying the cognitive processes that lead to delusions (and thereby learning about the normal processes of cognition, as cognitive neuropsychiatrists aim to do), we want discoveries about one patient to guide our thinking about other patients we encounter with the same problem. Taxonomising delusions by their underlying cognitive causes allows for just such projectability.

Thursday, 1 March 2018

Philosophy of Mind Workshop Series

Does philosophy have a purpose outside academia? What does philosophy look like when it’s done beyond the walls of the lecture theatre and the seminar room? And who should get to do it? I got to think quite a bit about these questions recently. It was back at the start of 2017 that I travelled to London to meet some of the senior team from mental health charity Mind in Camden to discuss the possibility of developing a series of philosophy workshops, based on project PERFECT’s research, and running them at Mind in Camden, for people with lived experience of unusual beliefs and experiences, and mental distress, as well as for service providers and mental health advocates.


Mind in Camden runs training, support and capacity building services to benefit people who are struggling with mental distress, and I saw commonalities between its values and the sorts of conceptions of mental health and rationality that we’re arguing for through PERFECT. So, the organisation was a natural partner in this collaboration. 

The idea of the workshop series was this: in groups of around 10, we would learn some philosophical techniques, and set up a receptive space for debate in which to exercise these, and then, drawing on aspects of PERFECT’s research, and inviting reflection on lived experience, we would explore and critique different theories of mental health and rationality.

It’s the first time I’ve done something like this with project PERFECT. As I sat on the 29, chugging up Marylebone Road, on my way to the first session, I did wonder to myself: would any of this be of any use – or interest – to Mind in Camden’s members?