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The Human Nature Review Human Nature Review  2002 Volume 2: 433-443 ( 14 October )
URL of this document http://human-nature.com/nibbs/02/vaas.html

Essay Review

Introducing Philosophical Psychopathology

By Rüdiger Vaas

A review of Philosophical Psychopathology 
edited by George Graham & G. Lynn Stephens 
Cambridge, MA; London: MIT Press, 1994

One of the recipes for the success of science is to avoid some questions systematically, while using limited, but very effective methods to answer others. Historically speaking, philosophy is the mother of all sciences. But as the children grow up, they must go their own ways. Finally, though, they might reach limitations, and old questions reappear. Then it is – sometimes – reasonable and helpful to ask mother again. But this is not a one-way street, for mother might also learn much from her children's experiences. Then a fruitful cooperation could start which is different from mere dependence or coexistence. In the area of science, many such inter- and transdisciplinary approaches have evolved within and beyond what is now called philosophy of science, e.g. philosophical cosmology, philosophy of biology, philosophical anthropology, neurophilosophy and, after all, philosophical psychopathology. Of course such a field has existed in some respect long before the term was coined. For example, psychopathology has roots in continental phenomenology. Case-studies could prove fruitful for philosophy because the oddity and diversity of psychopathological phenomena represent a rich resource for philosophical research, as John Langshaw Austin (1956-7) anticipated. William James (1890) already saw psychopathology as a source of questions and data to advance philosophical debate. And two centuries earlier, John Locke (1690) offered an elementary discussion of various mental problems. It was only in recent years, however, that "work by philosophers on psychopathology has made a major contribution to our understanding of legal and public-policy issues related to psychopathology as well as the metaphysical and scientific assumptions behind psychiatric diagnosis and taxonomy". This statement appeared several years ago in the preface of a book (p. vii) which finally constituted or settled down philosophical psychopathology (and coined this term, which is also the book's title) – not as a textbook or as a program, but as a collection of articles which mark large parts of the field (cf. also Northoff 1997 and Graham 2002). The editors of Philosophical Psychopathology are George Graham and G. Lynn Stephens, philosophers from the University of Alabama at Birmingham. Meanwhile, the field has a journal (Philosophy, Psychiatry, and Psychology, edited by Bill Fulford and John Sadler and published by Johns Hopkins University Press) and two prominent book series (Philosophical Psychopathology: Disorders in Mind of MIT Press, and International Perspectives in Philosophy and Psychiatry of Oxford University Press). Other journals like The Monist (vol. 82, 1999) and Mind and Language (vol. 15, 2000) published special issues. And more than a dozen psychiatric and philosophical organizations promote the field, among them the Association for the Advancement of Philosophy and Psychiatry and the Philosophy of Psychiatry Special Interest Group of the Royal College of Psychiatrists. Further information and web-sites can be found in Perring (2001).

What might or should philosophical psychopathology be all about? In my opinion, there are at least four – of course interdependent and interacting – areas: Conceptual issues: The historical and systematic clarification of concepts and a critical reflection is and will always be a main philosophical duty. And sometimes this actually helps science to proceed (in psychopathology e.g. discussions about multiple personality disorder, delusions, "simulation theory" vs. "theory theory", rationality constraints, cognition of causation etc.). Metascience and theory of science: Making underlying premises explicit as well as the kinds of explanations and arguments involved; discussion and reflection of the implications of scientific theories beyond their own scope, assuming that these theories are (approximately) true – e.g. what follows from psychopathology for our understanding of human beings in general? Philosophical applications: What can philosophy learn from psychopathology? It is reasonable to assume – or at least worth to make an attempt – that empirical findings can stimulate and enrich discussions about the mind-body problem, self-control and free will, cognition and practical reasoning, personal identity, subjectivity and self-consciousness, emotions, folk psychology (regarding beliefs, reasons and causes as well as consciousness in general) and epistemological questions (e.g. constructivism, coherentism, self-deception). Thus, psychopathology can be very useful as an applied philosophy of mind. Ethics: Questions like how to treat patients, what status and impact should research have in society, what legal and juridical implications should be drawn (e.g. concerning personal legal and moral responsibility or insanity)? Philosophical psychopathology deals with both mental disorders and the subfield of medical practice and psychology that studies such disorders. It deals with phenomenology as well as theory. And it deals with psychodynamics as well as neuroscience (thus, there is an overlap with neurophilosophy, cf. Metzinger 2000 and Vaas 1999 & 2001). Two unifying concerns seem to be operating in much of the work that has been done (Graham 2002): metaphysical issues (reality, truth, facts, causal relevance), and normative issues (semantic, methodological, scientific, moral and legal norms).

Since many of the volume's chapters (altogether 332 pages) fall in more than one of the different categories, the editors did not attempt to establish a rigid sectioning. The main sequence is roughly ordered by proceeding from phenomenal consciousness in general (and deficits thereof) to emotions (especially despair), self-representation (schizophrenia, dissociative identity disorder), representing others (autism), moral agency (especially alcohol abuse), delusions, taxonomy problems, methodological concerns and epistemological issues of psychotherapy (including placebos). This cannot be managed other than by considering exemplary issues. A 23-page introduction (including 6 pages of references) from the editors is a helpful though somewhat cursory overview providing a useful context and background; for a detailed update with many more recent references cf. Graham (2002). Although none of the contributions is the last word about its topic nor can it be an exhaustive review, most of them are still worth reading both for historical and systematic reasons. With the exception of a reprint about the placebo concept by Adolf Grünbaum, which was published several times in the eighties, and the report on "Alcohol Addiction and Responsibility Attributions" by Ferdinand Schoeman, which is a shortened version of an article published in 1991, all papers are original papers. In the following I will not review each of the twelve contributions and their many aspects but focus on a – perhaps representative – sample. Hopefully, this shows that the editors did a good job with their fine selection of interesting papers. Furthermore, the book also serves as another evidence that, contrary to common beliefs both in the scientific community as well as in a broader audience, philosophers are not necessarily arm-chair thinkers in an ivory tower who have lost contact with the real world. There are well-educated philosophers who struggle hard to follow empirical research and make contributions to one or more of the four areas I sketched above. Philosophical Psychopathology shows that such contributions have some value and that scientists might be well-advised to listen to philosophers and learn from them – just at it is the other way round.

Robert Van Gulick deals with deficit studies and the function of phenomenal consciousness. Psychopathology teaches important lessons about pathologies of consciousness that result from specific types of brain damage. This helps us to understand its functional role in normal cases and how they depend on the properly functioning brain. (Of course there is the question whether consciousness has a function at all, i.e. whether and how mental causation is possible – for a critical review about this complex philosophical issue see e.g. Vaas 2002a.) It is important not only to explain what conscious states do for us but also how they do this. A "two-levelism", i.e. a simple distinction of mental functions and underlying structures, is not sufficient, for there are many different levels of description and explanation involved and the structure/function distinction is not absolute but always relative to a specific level of abstraction. Pluralist multilevel functional explanations might help to overcome or at least approach the mystery of consciousness. It is not likely that there is any single property that explains how consciousness arises from the brain. Thus, Colin McGinn (1991, cf. also his 1999 book) might be too pessimistic in thinking that neither introspection nor physical perception and inference will ever provide us with an adequate concept of that property. The impossibility of making one big leap to explain consciousness does not exclude the possibility of many small steps to make progress. Philosophical psychopathology and therefore psychophysical theorizing offers an obvious and promising third option apart from introspection and neuroscience. Double dissociations have special value here: If it can be shown by distinct single cases both that an ability A can be preserved while a distinct ability B is lost and vice versa, then this is strong reason to believe that those two abilities indeed depend in part on distinct functional units. Such single-case studies avoid research on many different subjects and the notorious problems of averaging, variations, exceptions etc., which makes replicability extremely difficult. Van Gulick considers two sorts of deficit cases in a specific sensory modality, namely vision: Firstly blindsight, where phenomenal consciousness has been lost but residual perceptual abilities have been preserved, and secondly visual agnosia, where phenomenal consciousness is allegedly present despite the absence of the sort of understanding that normally accompanies such consciousness, e.g. visual recognition. "The evidence from blindsight supports the view that phenomenal experience provides a highly integrative system of representation that allows many different items about our situation, plans, goals, capacities, and selves to be united in a single interconnected structure" (34). Van Gulick critically discusses other interpretations, especially that blindsighted subjects have conscious visual experiences but are introspectively unaware of having them (McGinn 1991) or that phenomenal consciousness has no causal role at all but is an epiphenomenon or after-effect of information processing like the display that appears on a computer screen and not the computations occurring in the central processing unit (Velmans 1991). Visual agnosia is an interesting case where phenomenal experience is not "semantically transparent" – a feature of consciousness for which Van Gulick argued earlier. So this is a challenge for semantical transparency as a fundamental feature of phenomenal experience. Van Gulick suggests: "Instead of saying that associative agnosics have normal phenomenal experience without any knowledge, we should rather say that because the knowledge is absent, they lack a major component of normal experience" (46), and he argues against a Cartesian-theater characterization of mind and brain (cf. Dennett 1991).

George Graham and G. Lynn Stephens tackle the problem of "Mind and Mine" and argue convincingly for the distinction of two aspects of self-consciousness: "One is being conscious of one's subjectivity or ego boundary, where thoughts are taken to occur within one's own stream of consciousness or psychological history. The other is being conscious of one's own actions, where thoughts are taken to express one's own underlying intentionality or agency" (107). Being self-conscious involves more than simply being aware of one's own mental episodes. It also involves the awareness of them as mine. People sometimes experience a kind of introspective alienation, e.g. maintaining that certain thoughts that they acknowledge to be occurring in their minds are not their own thoughts but rather someone else's (thought insertion). (And there are also cases where people experience some of their movements as controlled by others.) It is not that they deny that the thought happening in their mind is their thought or, to be more precise, that they are the subject in whose psychological history the thought occurs. But they deny that they are the agent or author of its occurrence. This might sound inconsistent for a healthy, external observer, but it is a phenomenologically adequate description for patients with schizophrenia. "Verbal hallucinations or 'voices' may seem to be an excellent example of the loss-of-ego-boundaries sort of disturbance of self-consciousness" (95). While patients undergoing verbal hallucinations consider themselves to be "hearing" such voices as if they come from another person (however, it is often not like an auditory perception but more similar to introspective awareness), they actually experience their own inner speech without recognizing that it is their own inner speech or thought. It is a bit like the "lyrics to an odious advertising jingle may run through my head unbidden and may continue despite my efforts to dismiss them" (99). Or, as Harry Frankfurt (1976, p. 241) observes: "Thoughts that beset us in these ways do not occur by our own active doing. It is tempting, indeed, to suggest that they are not thoughts that we think at all, but rather thoughts which we find occurring in us. […] It is not incoherent, despite the air of paradox, to say that a thought that occurs in my mind may or may not be something that I think." But how and why does such a strange introspective alienation occur? Graham and Stephens suggest "that the subject unproblematically accepts a thought as her action if, by her own lights, it accords with her intentional psychology […] a subject's failure to acknowledge her 'alien' thoughts as her own is motivated by her negatively evaluative attitudes toward the thoughts in question. […] Should a blasphemous thought occur in her, for example, her preference for maintaining an image of herself as a pious person might make her unwilling, or even unable, to accept the hypothesis that she harbors the sorts of beliefs and desires that would find their natural expression in blasphemous thoughts" (103). This is a quasi-psychoanalytic hypothesis. It might be supported by data showing that there is a clear difference between self-ascribed and inserted thoughts experienced by schizophrenics. However, Graham and Stephens present no such data. And it is questionable whether there could be a standard independent of the subject's psyche confirming and characterizing such a difference. Furthermore, there are cognitive and neuroscientific reasons that schizophrenia is or has to do with a disorder of self-monitoring, i.e. a deficit in creating self-attributing metarepresentations (Frith 1992, David & Cutting 1994).

John Heil investigates "Going to Pieces", i.e. divided minds. This concept goes back at least to Plato's account of the tripartite soul and plays a dominant role in psychopathology – from self-deceptions to the infamous multiple personality disorder which is nowadays called dissociative identity disorder. "We are driven by a unifying ideal: agents, qua agents, are coherent; they exhibit unity and consistency. When this is lacking, we find it natural to postulate multiple agents, each of whom exhibits what all, taken together, lack" (112). The question is, however, how straightforward such an account really is. Consider acratic action, i.e. acting on the strongest desire though not the way one thinks it is the best. This weakness of the will is in contradiction to Donald Davidson's (1986, 81) principle of continence: Act in accord with one's better judgment. But people often act irrationally by virtue of their own standards and desires. According to Davidson, this might be explained by imagining that irrational agents comprise subsystems or partitions. They overlap significantly, while multiple agents in the case of dissociative identity disorder do not. They are not independent subagents or permanent Freudian psychic divisions, but metaphorical entities that describe agents whose deeds might otherwise be indescribable and hence psychologically incomprehensible. Heil discusses and explains different versions of such accounts, but they "may seem needlessly complicated" (127), much too metaphorical, better explicable in other ways and, at least in the case of healthy subjects, misleading. "My action is irrational not because I fail to act on what is, in one obvious sense, my strongest desire but because I act against my considered better judgment, a better judgment that assigns a diminished ranking to that desire. By distinguishing in this way between the motivational strength possessed by desires and their evaluative standing, we can account for a broad range of irrational actions without resorting to mental divisions. […] The point of dividing the mind to explain particular sorts of irrationality and psychic malfunction is largely to maintain a measure of functional separation. This may be achieved by assigning elements to an unconscious realm. However, what is crucial for these elements is not that they persist outside of our awareness but that they fail to engage the rest of the system as they should" (129 f).

Owen Flanagan discusses multiple identity, character transformation, and self-reclamation. He considers the self a narrative autobiographical and social construct – like Dennett (1991) does and even James (1890, p. 46) did in some way. And he distinguishes the pathological multiple self, which is based on different narrators who cannot grasp the connection between or among the narratives due to amnesia, from the normal multiplex self, which is also constituted from narratives, but in a connected and psychological continuing manner. Thus, strictly speaking, no self is a unity, but multiplex selves are integrated. Self-representation, memory, action planning, social ascription etc. are crucial for being a "center of narrative gravity", as Dennett says, and for personal identity. The self might be seen as a fiction, for "it is an open-ended construction; it is filled with vast indeterminate spaces […] that can be filled out and revised post facto; it is pinned on culturally relative narrative hooks; and it expresses ideals of what one wishes to be but is not" (144). However, contrary to a fiction, the degrees of freedom for (the authorship of) self-constitution is much more limited than in the literature; and self-deception (which should not be underestimated) only makes sense if selves are not totally fictitious, but constrained by at least some facts. (Whether this guarantees the reality of selves is a difficult and somewhat merely terminological issue, for more sophisticated theories of self-models claim that in a some well-defined sense there is no 'real' self, cf. Metzinger 2003, Vaas 2002b; for a critical evaluation of the thesis that the self not only produces narratives but is necessarily based on them cf. Teichert 2000; for evolutionary aspects of self-consciousness, language and free will cf. Vaas 2000a). Flanagan reflects multiple identity disorder, self dissolution, the loss of self coherence and social attribution issues from his perspective of narrative self. However, without a much more specific model, this is not sufficient both for philosophical and psychopathological demands.

Robert M. Gordon and John A. Barker review autism and the theory of mind debate. The latter is about, roughly speaking, two views on natural theories of mind. According to what is called theory theory, the ability to explain and predict behavior is underpinned by a folk-psychological theory of the structure and functioning of the mind. It might be innate and modularised, learned individually, or acquired through a process of enculturation (these possibilities do not necessarily exclude each other). According to the simulation theory, what lies at the root of our mature mind-reading abilities is not any sort of theory, but rather an ability to project ourselves imaginatively or by analogous thinking into another person's perspective, simulating their mental activity with our own. In this model we have direct, privileged access to our own mental states, which are epistemologically primary, and we come to infer the mental states of others, which are derivative, through a process of imaginative simulation). – Children by the age of 4 to 5 normally understand that people sometimes respond to the world not as it actually is but merely as they believe it to be. They can adopt other peoples point of view, understand their knowledge deficits and are able to empathize. Thus, they have what is now called a "theory of mind". People with autism, even many of the most intelligent among them, apparently never succeed in developing such a theory of mind and thus a normal understanding of the psychological dimension of other people. (They also lack pretend play, particularly in the form of role play and mime play with imaginary objects.) That's why they fail to achieve normal interactions with other human beings – at least according to a nowadays popular theory developed by Simon Baron-Cohen, Alan M. Leslie, Uta Frith and others. Whether this theory of mind is based on an explicit theory or on an implicit simulation (or on something in between) is still a matter of debate. Gordon is one of the prominent figures in that discussion, and this review he wrote together with Barker is easy to understand and still a succinct introduction. However, in recent years the controversy between theory theorists and simulation theorists has become very complicated (cf. e.g. Carruthers and Smith 1996, Röska-Hardy 2000 and the upcoming Proceedings of the 25th International Wittgenstein Symposium 2002). Also there is much empirical work concerning autism. But the issues are not settled yet. Gordon and Barker believe that the psychological competence that autistic children do not develop is based not on a theory but rather on a skill which includes a capacity for egocentric recentering and a capacity to be engaged as an agent in a world imagined to deviate somewhat from the actual world. And since there is evidence of deficiency in the tendency to mimic emotional expression as well as evidence that gaze-tracking responses are largely absent, one should expect autistics to be deficient in both the tendency to search for reasons for (or objects of) action and emotion and the capacity to locate them in the environment.

Kent Bach's topic is emotional disorder and attention. He quotes Albert Camus ("Beginning to think is beginning to be undermined") and continues: "Some would say that philosophy can contribute more to the occurrence of mental disorder than to the study of it. Thinking too much does have its risks, but so do willful ignorance and selective inattention" (51). Thus, philosophy may not only be useful in analyzing and perhaps solving conceptual and other abstract problems, but it might have therapeutic implications or even applications. Indeed, personal philosophical therapy is now available in some countries like Germany and the Netherlands. This might sound strange for hard-boiled philosophers and extravagant for psychotherapists, but in the ancient world it was a widespread purpose of philosophy (think of the Stoics and Epicure's school); and it has recently been receiving renewed attention again, for example as the art of living ("Lebenskunst") (Schmid 1998) – important aspects which Bach does not mention. But he correctly observes that there is much disagreement and uncertainty about the nature, causes, and treatment of many emotional disorders. This begins already with conceptual issues like normality versus disorder, health versus disease, and rationality, emotion, attention, agency, control, compulsion, freedom, self etc. – "concepts that are grist for the mill of analytic philosophy" (52). Indeed there is a long tradition of dispute what emotions are (see e.g. Vaas 2000b for an overview). Bach touches some of the problems, comments on defense mechanisms like self-deception, selective attention, rationalization, denial, repression, displacement, and projection, classifies exclusionary categories like epistemic (e.g. absurd, hopeless, impossible), psychological (e.g. bigoted, crazy, misguided), social (e.g. embarrassing, forbidden, unspeakable), evaluative (e.g. dangerous, selfish, worthless) and ideological (e.g. blasphemous, communist, racist, un-American). And he conjectures that "applying an exclusionary category plays the role of getting something out of mind, in much the way that in the context of solving a problem one summarily rules a bad idea out of consideration" (63). Bach then sketches how insufficient and excessive uses of the categories lead to (sometimes pathological) traits like chronic anxiety, impulsiveness, obsessive-compulsiveness, overconfidence, guilt, denial, perfectionism, evasiveness, panic, depression and passive-aggressiveness. "All in all, it appears that attention plays a key role in emotion and emotional disorder" is his main conclusion. "In the simplest cases, they involve devoting either too much or too little attention to the object of emotion. In other cases an emotion or a mood […] produces attentional and evidential biases by heightening one's attention to certain considerations and possibilities and diverting one's attention from others" (66).

Bill Fulford reflects about value, illness, and failure of action and develops a framework for a philosophical psychopathology of delusions. What he calls the standard medical model of delusions and related psychotic symptoms seems to him essentially incomplete. It is only about facts, i.e. the concept of disease and failure of function, while an adequate account necessarily has to include also values, i.e. illness and failure of action. Only then, Fulford argues, can delusions be properly defined and understood. – Delusions, hallucinations and thought disorders form the core of psychotic disorders (traditional "madness" and "insanity"), which is characterized by a patient's lack of insight into his or her condition. This is of ethical and legal significance due to the apparent lack of responsibility and the risk of harm through suicide or homicide. There are strange examples like Capgras's syndrome (a near relative is believed to have been replaced by an impostor), Cotard's syndrome (in which one may believe to be dead or never born), Fregoli Delusion (belief to see friends or relatives everywhere or to be followed by someone who is in disguise), and the Othello syndrome (pathological, often all-consuming belief in the infidelity of one's sexual partner) (cf. Coltheart & Davies 2000, Glantz 2002). A definition of delusions is difficult, because they need not be necessarily false beliefs. They could accidentally be true or known to be true (as it is often the case with the Othello syndrome) or even paradoxical (e.g. in the case of a hypochondriacal delusion of being mentally ill), but they are exaggerated. Fulford argues that delusions should also be seen as value judgments. In depression, for example, delusions of guilt are common. They may be factual if the patient believes, say, that he is responsible for some famine or earthquake. But they may also be evaluative (indeed, despite much effort no impairment of specific cognitive functioning has been identified). For example, a patient has forgotten to give his children their pocket money and believed this was "the worst sin in the world" and that he was "worthless as a father". Such delusions are not confined to affective disorders. They occur in schizophrenia, in paranoid psychoses and in delusional dysmorphobia, in which the patient perceives himself or herself to be ugly (as often in the case of anorexia nervosa). Evaluative delusions are remarkable philosophically due to the dichotomy of fact and value as well as that of content and form. Delusions, by the way, might also shed light upon bizarre examples of epistemological skepticism (like René Descartes' arguments for deception by dreaming or an deus malignus, i.e. evil demon, or the popular brain-in-a-vat scenarios) and the normal processes of gaining knowledge, which is helpful for developing (externalistic) reliability theories of knowledge (cf., e.g., Grundmann 2000 for an introduction and references).

Richard Garrett worries about the problem of despair – "Is the good or meaningful life possible or not possible?" (77) – and asks whether or not philosophical despair is rational. He distinguishes three kinds of despair which all have in common that they entail a belief that something is hopeless and not worth pursuing, either because it lacks sufficient value or because it is not sufficiently possible: project-specific despair is about a specific task, trivial or earth-shaking (i.e. buying a yacht, saving a marriage or accelerating a career); personal despair is not about something specific within a life but the belief that all particular undertakings are futile and the feeling of a person that his or her life is meaningless and useless; and philosophical despair or pessimism which is an individual's grand conclusion that everyone's life is, as a whole, futile, that no one's life is (potentially) good or meaningful. This denies both an experiential perspective (that pleasure, joy etc. are better than pain etc.) and a tribunal or judicial perspective (that moral courage etc. is worthless). According to Garrett, being ideally wise entails having a fundamental understanding of how we can live the very best life of which we are capable, i.e. of a good and meaningful life. If the pessimist is correct, such wisdom is an illusion. Then Garrett summarizes four classes of reasons for philosophical despair: First, from an experiential perspective, for the pessimist everything seems to be conditional, and hence uncertain and impermanent. Unpredictable death, sickness, loss etc. follow necessarily from the nature of the world. According to, e.g., Arthur Schopenhauer there is no escape from this suffering. Second, from an tribunal or judicial perspective, for the pessimist all humans are by nature morally corrupt and therefore unworthy of praise (like the Christian doctrine of original sin claims, however due to the belief in God's grace Christians are optimists). Third, from both perspectives, a pessimist can say that there is a fundamental injustice, i.e. that morally good and innocent people suffer while the morally corrupt ones are happy and prosperous. This is a topic of the book Job in the Bible and Immanuel Kant's question "What can I hope for?", and one of the most horrible examples was the Holocaust. Fourth, if the judicial perspective has no objective grounds, then our lives have no meaning, objectively speaking, or so the pessimist might claim. This is one source of the absurdity of life, as Albert Camus characterized it. Next, Garrett sketches some solutions of the problem of despair which either averts despair or accepts it but offers a way of dealing with it. For example, Plato argues that the judicial perspective is objectively grounded in a world of ideas, and moral corruption is a function of ignorance which can be overcome; in theism God ensures ultimate justice; in Marxism (historical and dialectic materialism), the economic institutions which are responsible for despair can and will be changed; and for Burrhus Frederic Skinner, an intelligent application of science might enable people to learn to be happy. Garrett admits that if we evaluate purely in terms of standard epistemic criteria – logical consistency, consistency with science and common sense, overall coherence with the rest of our beliefs etc. –, "it is not possible to clearly reject the pessimist's arguments and so, clearly and decisively to say that philosophical despair is irrational" (83). But he argues that we can and must go beyond such criteria, because every solution to the problem of despair entails assumptions that reach beyond our standard epistemic practices, and every lifestyle presupposes some solutions. His main point is that "if it can be empirically shown that certain solutions to the problem of despair more readily lend themselves to a life that (to all appearances) is happier and more moral then their competitors, then this is a very good reason to adopt such solutions. For such solutions are more rational than those that produce lives that are unhappy and/or immoral. […] there is good evidence that pessimism is self-confirming, that it tends to produce the very unhappiness and immorality it predicts […] So it is not rational to hold such a view. For to be pessimistic is to undermine the very thing we all want most, namely, the good life" (85). – One may wonder what such considerations have to do with psychopathology. The connection is depression, which seems to be the cause of as many as 75 percent of all psychiatric hospitalizations (and even more suicides) and is, at least for cognitive theories of depression, closely linked with despair (Beck and Coleman 1981). For Garrett, "depressives hold as a matter of faith beliefs that make the pursuit of the good or meaningful life impossible", and he sees "no way of describing such beliefs as more rational or more realistic than beliefs that on the face of them make the good or meaningful life possible" (87). Thus, the depressive patients should "be encouraged to construct for themselves positive solutions to the problem of despair that are both epistemically sound and prudentially and morally beneficial" (88). This might be, in some cases at least, a helpful advice. However, the approach is questionable for at least three reasons. First and mainly, "negative thinking" in severe depressions is not the cause, but an effect. There are physiological causes which turn the patients into the suffering – beyond their abilities to do otherwise. Second, the approach is based on the assumption that depression rests on a wrong (or irrational) thinking and might be cured by adopting a different world-view, i.e. positive thinking. However, there are studies (and Garrett quotes some of them) showing that depressed people are in some respects more rational and than the nondepressed. Their self-descriptions are more accurate and less biased, their judgments are more correct and their evaluations more realistic. Garrett is correct that despair is maladaptive, but this has prima facie nothing to do with (ir)rationalism. It would be a natural fallacy, because rationality can operate on values, but not found them. And third, even if despair would be a root for depression, Garrett’s arguments against philosophical despair, even if they hold, could not refute personal despair. But this seems sufficient for being depressed in the light of his wrong-thinking premise, and it might make the patients even more desperate due to the comparison of their own bad life with the better life of others. Besides, philosophical despair is not necessarily a form of depression or reason for it – theoretical nihilism does not imply existential nihilism – but mainly an interpretation of existence. And it is not so rare as Garrett's quasi-transcendental argument against it suggests, for large parts of the history of philosophy could be interpreted as one form of philosophical despair or another (Horstmann 1983, cf. also Cioran 1973). Homer, Heraklit, Euripides, Sophokles, Theognis, Plinius, Leopardi, Schopenhauer and many others knew perfectly well, that it would be best not to be born. With Lord Byron's words (from Euthanasia): "Count o'er the joys thine hours have seen, / Count o'er thy days from anguish free, / And know, whatever thou hast been, / 'Tis something better not to be."

It is again and again a pleasure to thank André Spiegel for helpful comments.


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Vaas, R. (2002). Introducing Philosophical Psychopathology. Human Nature Review. 2: 433-443.

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