Alien Landscapes?

Alien Landscapes?: Interpreting Disordered Minds

Jonathan Glover
Copyright Date: 2014
Published by: Harvard University Press
Pages: 448
https://www.jstor.org/stable/j.ctt7zsx0k
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  • Book Info
    Alien Landscapes?
    Book Description:

    Do people with mental disorders share enough psychology with other people to make human interpretation possible? Jonathan Glover tackles the hard cases—violent criminals, people with delusions, autism, schizophrenia—to answer affirmatively. He offers values linked with agency and identity to guide how the boundaries of psychiatry should be drawn.

    eISBN: 978-0-674-73574-3
    Subjects: Health Sciences, Psychology, Philosophy

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. PREFACE
    (pp. ix-xiii)
  4. PROLOGUE Alien Landscapes?
    (pp. 1-6)

    An alien landscape? One of the landmarks when Earth is seen from space is the thirty-mile-wide Richat Structure, or Eye of the Sahara, found in Mauritania (Figure I.1). Some thought the Richat Structure was the work of extraterrestrials. Current evidence suggests it is a dome-shaped rock, first pushed to the surface and then eroded over hundreds of millions of years. The process of understanding is not yet over. We still do not know why the Eye of the Sahara is circular. But a dramatic “alien” landscape can yield to undramatic incremental interpretation.

    A century ago Karl Jaspers published a great...

  5. PART ONE “Antisocial Personality,” Values, Psychiatry
    • 1 Socratic Questions in Broadmoor
      (pp. 9-17)

      “Psychopaths” are at the extreme. The tool most used to diagnose “antisocial personality disorder” is the Hare Psychopathy Checklist, a scale devised by the Canadian psychologist Robert D. Hare. There is a cutoff score above which the test taker is given the diagnosis of antisocial personality disorder. Being a “psychopath” is widely considered to be an extreme version of this. Something often said about those called psychopaths, and by extension about the others within the broader category, is that they lack a conscience.

      This claim is intriguing. Are there really people who completely lack a conscience? If so, how does...

    • 2 The Contours of a Moral Landscape
      (pp. 18-37)

      One of the questions was, What sorts of things are wrong, and what makes them so? (This question was usually put in terms of what children should be taught, in an attempt to make it less threatening or accusing.) The question tapped into the continuum between what can be called moral “depth” and “shallowness.”

      The question about what things are wrong sometimes elicited answers of striking shallowness.

      CQ: They shouldn’t swear, you know, do what your mother tells you to do, you know, do well at school, when you grow up, you know. Be careful who you mix with. Don’t...

    • 3 Childhood and After
      (pp. 38-66)

      In the interviews I did not initiate discussion of either the interviewees’ crimes or their childhoods. But they often raised these topics. Many saw a strong connection between the two. It started to seem important to look more closely into their sense that their violent actions were linked to a disastrous childhood.

      LF: Well, I knew it was wrong, um, but there was a lot of, I’m not sort of mitigating but, I was getting married the next day and … it’s a long story really. Whenever things are going well, I sort of always, muck ’em up, mess ’em...

    • 4 Interpreting This Landscape
      (pp. 67-73)

      There are some obvious methodological problems for these interviews. First, how far can the answers given to the questions be accepted as truthful? Second, if my interpretations of what the interviewees said are right, how far is the psychology described special to people with their diagnosis? Third, if my descriptionsdosucceed in capturing something distinctive about this group of people, are there really any more general lessons to draw about psychiatric interpretation?

      (There is also a fourth, very deep, question: What is the appropriate attitude to have toward this group of people? Their tragic lives evoke sympathy in an...

    • 5 Shakespeare Comes to Broadmoor
      (pp. 74-86)

      Helping this group of people contain or outgrow their violent impulses is a complex affair. Most of them are people whose moral and emotional growth has been stunted. By their own accounts, this was to a great extent because they were not loved as children. Much of the damage cannot be undone. Nothing will bring back the people some of them killed. Nothing will remove the physical or psychological scars left on those they attacked or raped. And for themselves, nothing will wipe out the childhood rejection, followed by society’s rejection after their crimes, or the fact that so much...

  6. PART TWO On Human Interpretation
    • 6 Hopes for the Future of Psychiatry
      (pp. 89-96)

      My interpretation of the Broadmoor interviews, like all interpretation of people, has limitations. This has some striking ones. On the basis of meetings that lasted perhaps an hour or two with each person, I have given an interpretation of their values and of how their childhoods may have shaped them.

      Longer interviews might have brought out more, or corrected some of the impressions given here. If I had lived for a month with the people I talked to, I would have developed a deeper sense of what they are like. Even in interviews, other questions might have been more revealing....

    • 7 “A Skill So Deeply Hidden in the Human Soul”
      (pp. 97-105)

      We are not the only interpreting animal. The fox interprets the sounds and smell of hounds as a threat, the hawk interprets the mouse’s movement on the ground as food, and so on. But no other species on our planet has developed any serious competitor to the discriminating powers of human language or to our scientific powers of interpreting the natural world. And we are unique in the subtlety of our interpretation of ourselves and each other.

      For me, a landscape does not exist in its own right, since its appearance changes at every moment; but the surrounding atmosphere brings...

    • 8 Intuitive Interpretation
      (pp. 106-114)

      Intuitive first impressions of people we meet are often helpful clues. We are not Tolstoy, and Virginia Woolf consciously exaggerated in calling even his brain infallible. But we have layers of interpretation behind our intuitive understanding of people. Our brains, like Tolstoy’s, can refer a trick of the hands to something hidden in the character.

      Talking to children about how to write poems about people, Ted Hughes spoke of these first impressions, “which we cannot pin down by more than a tentative, vague phrase. That little phrase is like the visible moving fin of a great fish in a dark...

    • 9 Reflective Interpretation
      (pp. 115-122)

      The evolutionary approach has been extended to more cognitive predictions of the actions of others. Nicholas Humphrey noticed that the large brains of gorillas suggested minds more powerful than their simple environment called for. While wondering why they had such large brains, he was also thinking about his own personal life: “If I do this, what willshedo? But suppose I didthat, or if she did something else?” He thought that gorilla problems too might be mainly social. Perhaps they had evolved to interpret each other. Given the importance of society for humans, perhaps we too had evolved...

  7. PART THREE Human Interpretation in Psychiatry
    • 10 “A Gulf Which Defies Description”
      (pp. 125-129)

      We understand Koznyshev and Varenka because we have been there, stumbling in a personal encounter, blurting out what wasn’t what we meant to say, and not saying what we really want to. But most of us haven’t been where those with severe psychiatric problems are. We do not have the same feel for their experience, and a first-person account can be a shock.

      The poet Ivor Gurney fought in the First World War and was injured in a gas attack. His diagnosis, in the language of the time, was “nervous breakdown from deferred shell shock.” Later he was committed to...

    • 11 Autism and Interpretation
      (pp. 130-138)

      Autistic people do not find it easy to understand the world in ways other people do. And others often find them “strange” and hard to understand. Interpreting what they do is the first challenge their condition poses to psychiatric efforts to help them.

      The diagnosis of autism is based on patterns of behavior rather than on genetic or other biological evidence. Large variations in the severity of the problems show that an all-or-none diagnosis of “autism” would cover a very wide band indeed. This made it natural to move to the dimension approach implied by “the autistic spectrum.” It is...

    • 12 Interpreting Delusions
      (pp. 139-160)

      To understand delusions we need to work out the neurological or neurochemical changes linked to them. But we also need to interpret what is going on at the human or psychological level. Delusions themselves involve interpretations, although deviant ones, of what the deluded person experiences.

      Delusions may be distortions of either intuitive or reflective interpretation. Perhaps there is not always a sharp boundary between the two. As with night and day, there may be dusk in which the intuitive and the reflective shade into each other. The answer to this is relatively unimportant. Nearly all of the relevant cases are...

    • 13 Waking Dreams
      (pp. 161-186)

      Part of human interpretation in psychiatry is trying to get an idea of what a person’s disorder feels like from inside. Psychiatry textbooks and the flat prose of papers in journals can leave medical students unprepared for bizarre things they might encounter on a psychiatric ward. Even if all my conjectures were to turn out correct, what I’ve said so far about delusions would not do much to convey the feel of having a delusion. First-person accounts give a better idea. But people with psychiatric disorders sometimes find their inner world hard to express in words. Their art may get...

  8. PART FOUR The Boundaries of Psychiatry
    • 14 The Need for Boundaries: The Dark Side of Psychiatry
      (pp. 189-202)

      How should psychiatrists think about the people to whom their professional skills are directed? How should they act toward them? What are the professional limits to what they should do? Some answers to these questions have been morally disastrous and humanly catastrophic. These answers have led to different, though overlapping, dark strands in the history of psychiatry.

      Some psychiatrists advocated or took part in the murder of 70,000 patients in psychiatric hospitals as part of the Nazi “euthanasia” program. An early advocate was Alfred Hoche, a professor of psychiatry at Freiburg and one of the two authors of the 1920...

    • 15 Personality and Sexuality
      (pp. 203-210)

      Happily, psychiatric “treatment” of gay people or unmarried mothers is almost entirely a thing of the past. But even now the frontiers of psychiatric disorder are as fluid and disputed as those of eighteenth-century Poland. Notable attempts to map the boundaries are the two overlapping major systems of classification: TheDiagnostic and Statistical Manual of Mental Disorders (DSM), now in its fifth edition(DSM-5), and the relevant section of theInternational Classification of Diseases (ICD). Among the most controversial psychiatric diagnoses are the “personality disorders” and some deviant sexual tastes or orientations, known as the “paraphilias.”

      What are the “personality...

    • 16 Dysfunction?
      (pp. 211-217)

      Jerome Wakefield and his colleagues have argued that mental disorder is “harmful dysfunction.” This account has two parts. It is claimed to be a matter of scientific fact that a system honed by evolution has in some persons become dysfunctional. And then values come in: the dysfunction has to be harmful.¹ Harm will be discussed in Chapter 17. Here the question is whether psychiatric disorders should be seen in terms of dysfunctional systems.

      The gene that causes sickle-cell anemia also protects against malaria. One approach to evolutionary psychiatry explains the survival of some psychiatric disorders in terms of their possible...

    • 17 Harm
      (pp. 218-227)

      Some moods or emotional states are so distressing or inhibiting that they call for psychiatric help. Severe depression can be so devastating that medication or therapy can save the person’s life. But is the net drawn too widely? Critics say that feeling depressed over doing badly on an exam, or when left by someone you love, is not illness but normal response. They also say that extreme shyness is wrongly medicalized as “social anxiety disorder.” These expanding boundaries of psychiatry may benefit pharmaceutical companies, but should the range of “normal” emotional life be narrowed in this way? If a line...

    • 18 What Is Autism?
      (pp. 228-234)

      Jim Sinclair, campaigning for a new understanding of autism, has written against the hope of a “cure” for austim:

      Parents often report that learning their child is autistic was the most traumatic thing thaever happened to them. Nonautistic people see autism as a great tragedy … I invite you to look at our autism, and look at your grief, from our perspective. Autism isn’t something a personhas, or a “shell” a person is trapped inside. There’s no normal child hidden behind the autism. Autism is a way of being. It’spervasive;it colours every experience, every sensation, perception, thought,...

    • 19 Crossing the Medical Boundary?
      (pp. 235-239)

      On the human flourishing approach, it can be argued that psychiatrists need not confine themselves to offering treatment for the traditionally evolved psychiatric categories of illness or disorder. Psychological conditions that are not intrinsically harmful should not count as psychiatric disorders. But there are intrinsically harmful psychological conditions that do not fit the traditional disorders. The methods of psychiatry, whether psychotherapeutic or pharmacological, may also help someone escape a life-diminishing personality.

      Some thoughtful psychiatrists notice a shift in their own aims when prescribing antidepressants. Peter Kramer raised this issue in the context of his treatment of his patient “Tess.” Her...

    • 20 Strands in a Good Human Life
      (pp. 240-246)

      It is attractive to draw the boundaries of psychiatry in terms of trying to remove psychological obstacles to the good human life. One danger is seeing the good life too narrowly. The idea might have stifling consequences—some modern equivalent of imposing “treatment” on gays. Can we answer the question “What is a good life?” without forgetting that it takes all sorts to make a world?

      There is an influential idea in the debate about choosing children with some sets of genes rather than others. If children are to have a decent chance of a good life, they should have...

  9. PART FIVE Agency, Control, and Responsibility
    • 21 Brain, Mind, and Agency
      (pp. 249-261)

      Some psychiatrists, encouraged by scientific advances, may hope to avoid the philosophical issues discussed in this book. Pieter Geyl famously called history “an argument without end.” Isn’t philosophy even more so? For further progress do we need anything beyond the increasingly detailed causal accounts coming from epidemiology, genetics, pharmacology, and neuroimaging?

      The pull of this antiphilosophical view is easy to feel. But it depends on not asking questions that matter. It is the vision held by people living in a city with buildings so solid that they forget they are in an earthquake region. Psychiatry’s conceptual framework rests on the...

    • 22 Psychiatric Conditions and the Framework of Responsibility
      (pp. 262-274)

      When should or should not people be held responsible for things they do under the influence of psychiatric disorder?

      Questions about responsibility are often legal. Should this person be punished for an illegal act? Were there factors that diminish his responsibility or even absolve him altogether? The questions are often moral, often linked to praise or blame: If her terrible record of not meeting deadlines reflects her psychiatric problem, isn’t it unfair to blame her?

      Other questions about responsibility do not reflect the external standpoint of the law or the moral critic. People wonder about themselves. Should I feel bad...

    • 23 What Is Addiction?
      (pp. 275-282)

      Distortions of motivation occur in people who can and do carry out intentional actions. At the moment of acting, they intend what they do, but the intention may express an overwhelming desire they would not choose to have.

      Choices motivated by addiction seem less free than many other choices. Why is this so? This raises the question of what an addiction is. Most people think they have a clear intuitive idea of addiction, but the clarity fades when questions are asked. Here these questions will be raised by contrasting medical models of addiction with what Bennett Foddy and Julian Savulescu...

    • 24 Unwilling Addiction as Diminished Control
      (pp. 283-295)

      The modern debate between liberal views of addiction and the medical model reflects a moral debate with a long history. Are “unwilling” addicts to blame for their condition, because they just do not choose to change? Or are they victims because they are not able to give up their addiction?

      If Plato’s account is accurate, the “blaming” view goes back at least as far as Socrates:

      Socrates: You mean they’ll live like people who are ill, but lack the discipline to give up a way of life that is bad for them.

      Adeimantus: That’s it.

      Socrates: And what a nice...

    • 25 Character, Personality Disorder, and Responsibility
      (pp. 296-306)

      Some psychiatric conditions can take over a person’s character and change it. They include some dementias and also schizophrenia. They come on after the person’s original character and personality have developed. We can (to some extent) oppose the person to the character-distorting illness.

      Some other conditions go deeper, to shape a person’s original core. These “foundational” conditions, including autism and some personality disorders, are more fully present much earlier. They do not appear to strike people from outside. Even where early environment plays an important role, there is no alternative “real” person, remembered by friends and family but now submerged...

  10. PART SIX Identity
    • 26 The Sense of Self
      (pp. 309-312)

      As features of the good life, agency and identity are in mutual support. Awareness of one’s own agency is an important part of having a sense of self, and psychiatric conditions disrupting one often disrupt the other. In this chapter psychiatric disruptions will be used briefly to indicate some contours of the sense of self. People care about feeling at home in their own body, “being comfortable in their own skin.” They need recognition by others to create a secure awareness of being the person they are. Without this, efforts to create an identity may be shallow and self-defeating. People...

    • 27 Moral Identity and Moral Injury: Combat Trauma
      (pp. 313-328)

      In the 1982 Falklands War, 256 British combatants were killed. Twenty years later, in 2002, the South Atlantic Medal Association said that those killed during the war were outnumbered by the 264 former combatants who had committed suicide.¹ In both 2009 and 2010, more active-duty U.S. troops committed suicide than were killed fighting in Iraq and Afghanistan. In 2010 there were 468 suicides compared to 462 killed in combat.² By 2011 there were 197,074 soldiers (about 15 percent of the total number back from Iraq and Afghanistan) being treated for post-traumatic stress disorder.³ These psychiatric conditions are a major feature...

    • 28 Psychotherapy, Autonomy, and Self-Creation
      (pp. 329-344)

      The aims of psychotherapy vary with who is being helped: a child, an adult, or a family. The aims vary with different problems: depression, post-traumatic stress, anxiety, compulsions, and so forth. Further variety comes from the different schools and theories behind the approach. Underneath all this is a common aim: release from distress by removing psychological obstacles to a good life.

      This vague aim usually takes three more specific forms. One is helping people see and escape from cognitive and emotional traps. Another is helping people see how their relationships with each other may be working badly, and to find...

    • 29 Entrapment in Eating Disorders
      (pp. 345-353)

      Eating disorders are a case study in the interface between the scientific and the human sides of psychiatry. As suggested throughout this book, these “sides” are not warring but complementary.

      In trying to bring out the role of human interpretation of anorexia nervosa and bulimia nervosa (here shortened to anorexia and bulimia), I will contrast such interpretation with two brief and clear scientific accounts by respected leading researchers.

      The first is the textbook account given by Janet Treasure and Ulrike Schmidt.¹ They point out that the classification of eating disorders has “a degree of fluidity” and that many guidelines for...

    • 30 Authenticity and Identity in Eating Disorders
      (pp. 354-365)

      Ideas of identity and self-creation are central to the human interpretation of anorexia and bulimia. This will be supported by considering the decision to reject lifesaving treatment for anorexia. Does this reflect the person’s authentic values? Or distorted anorexic values? This contrast has obvious intuitive appeal, but giving a clear and defensible account of it raises issues of identity.

      Are there such things as distorted values? If there are, the anorexic fanaticism about weight and body shape, and the intense obsession with being in control, seem good candidates. Jacinta Tan, Tony Hope, and their colleagues asked women questions about their...

    • 31 Dementia, Responsibility, and Identity
      (pp. 366-371)

      Some major psychiatric disorders can change the central core of a person. This raises acutely the problem of the boundary between the person and the illness. There are questions about where the boundary comes between medical treatment to cure an illness and interventions to change someone’s character and personality. The boundary between the person and the illness is also important for decisions about responsibility. It seems unfair to blame people for things coming directly from illness.

      When a psychiatric or neurological disorder seems to take over and distort an individual’s whole personality and character, how should we respond to what...

    • 32 Schizophrenia: The Person or the Illness?
      (pp. 372-378)

      The boundary between the person and the illness is harder to draw in schizophrenia. Dementia mainly (but not always) comes on late in life. This makes it easier to see the demented period as a coda: something after the main part of someone’s life. But the radical personality changes of schizophrenia usually come on relatively young.

      Here I will put aside such issues as whether schizophrenia is a unitary condition or should be divided into subgroups, or whether it is a properly empirically based scientific concept.¹ At the start of this book I expressed my hopes that we might eventually...

    • 33 Self-Creation, Values, and Psychiatric Disorder
      (pp. 379-387)

      How far does the idea of self-creation help draw the boundary between the person and the illness in mood disorders and in schizophrenia?

      Anthropologists report that in some cultures depression is seen as “loss of soul,” expressed in metaphors of emptiness.¹ Metaphors are part of how people interpret and shape themselves.

      Jennifer Radden has asked why we think a bleak landscape is melancholy. Part of her answer cites the way traditional descriptions have linked melancholy with coldness, darkness, and isolation. In the ancient accounts of opposite humors, “melancholy was always placed with coldness (and dryness). As the seasons came to...

  11. EPILOGUE Psychiatry and Our Depths
    (pp. 388-392)

    “Our depths and our home.” A few words about the other metaphor taken from Rilke: the metaphor of depth.

    (Here I am conscious of cheating slightly. The word Rilke uses isBoden. Literally, this means “ground” or “bottom,” as in “the bottom of the sea.” To use the word “bottom” when talking of people has irrelevant associations. The translation could have read “our ground and our home.” I preferred to exploit the associations with the bottom of the sea, and chose “depths.” The idea of our bitter times as being part of the depths of a person seemed true to...

  12. NOTES
    (pp. 395-418)
  13. ACKNOWLEDGMENTS
    (pp. 419-422)
  14. INDEX
    (pp. 423-433)