Alien Landscapes? Interpreting Disordered Minds

448 Pages·2014·5.31 MB·English

by  Jonathan Glover

Ali en l A n ds cA p e s ?

A li e n l A n ds cA p e s ?
Interpreting Disordered Minds
Jonathan Glover
The Belknap Press of Harvard University Press
Cambridge, Massachusetts and London, England
2014
Copyright © 2014 by the President and Fellows of Harvard College
All rights reserved
Printed in Canada
First printing
Pages 419–422 constitute an extension of the copyright page.
Library of Congress Cataloging- in- Publication Data
Glover, Jonathan.
Alien landscapes? : interpreting disordered minds / Jonathan Glover.
pages cm
Includes bibliographical references and index.
ISBN 978- 0- 674- 36836- 1 (alk. paper)
1. Psychiatry— Decision making. 2. Mental illness— Diagnosis. I. Title.
RC455.2.D42G56 2014
616.89'17—dc23 2014005635
To Sam
alienist: former term for psychiatrist. Origin: mid 19th
century: from French aliéniste, based on Latin alienus “of
another”
—Oxford Dictionaries Online
Homo sum, humani nihil a me alienum puto.
I am human; I think nothing human alien to me.
—Terence
Contents
|
Preface ix
|
Prologue 1
Part one |
“Antisocial Personality,” Values, Psychiatry 7
|
1. Socratic Questions in Broadmoor 9
|
2. The Contours of a Moral Landscape 18
|
3. Childhood and After 38
|
4. Interpreting This Landscape 67
|
5. Shakespeare Comes to Broadmoor 74
Part two |
On Human Interpretation 87
|
6. Hopes for the Future of Psychiatry 89
|
7. “A Skill So Deeply Hidden in the Human Soul” 97
|
8. Intuitive Interpretation 106
|
9. Reflective Interpretation 115
Part three |
Human Interpretation in Psychiatry 123
|
10. “A Gulf Which Defies Description” 125
|
11. Autism and Interpretation 130
|
12. Interpreting Delusions 139
|
13. Waking Dreams 161
Part Four |
The Boundaries of Psychiatry 187
|
14. The Need for Boundaries 189
|
15. Personality and Sexuality 203
|
16. Dysfunction? 211
|
17. Harm 218
|
18. What Is Autism? 228
|
19. Crossing the Medical Boundary? 235
|
20. Strands in a Good Human Life 240
Part Five |
Agency, Control, and Responsibility 247
|
21. Brain, Mind, and Agency 249
22. Psychiatric Conditions and the Framework of
|
Responsibility 262
viii
Contents
|
23. What Is Addiction? 275
|
24. Unwilling Addiction as Diminished Control 283
|
25. Character, Personality Disorder, and Responsibility 296
Part six |
Identity 307
|
26. The Sense of Self 309
|
27. Moral Identity and Moral Injury 313
|
28. Psychotherapy, Autonomy, and Self- Creation 329
|
29. Entrapment in Eating Disorders 345
|
30. Authenticity and Identity in Eating Disorders 354
|
31. Dementia, Responsibility, and Identity 366
|
32. Schizo phre nia 372
|
33. Self- Creation, Values, and Psychiatric Disorder 379
|
Epilogue 388
|
Notes 395
|
Ac know ledg ments 419
|
Index 423
PreFaCe
This book is about mental disorders: how to think about them and how
well those of us outside can get a feel for what they are like from inside.
Some dispute the boundaries of mental disorder. Is autism a disorder,
or should it be seen as “neurodiversity”? Is antisocial personality disorder
rightly named, or is it just ruthless amorality? Is addiction mental illness
or just moral weakness? Is either medication or psychotherapy appropri-
ate to ease the devastating grief of bereavement, or should we avoid medi-
calizing this normal human experience?
When and how much do mental disorders impair agency and respon-
sibility? When should acting under the influence of severe depression ex-
cuse someone from responsibility for what she does? What do some disor-
ders do to a person’s identity? When someone with schizo phre nia shows
unprovoked hostility and aggression, does that reflect him, or is it his
illness? How should we draw boundaries here? How much is the original
person still present in severe dementia?
This book is about the human interpretation of disordered states. Are
mental disorders impenetrably alien? The ge ne tics and brain chemistry of
some of these states are starting to be understood, but do the inner land-
scapes of these states defy empathy at the psychological level? The ques-
tion of human interpretation is important, not only for psychiatrists, psy-
chotherapists, psychoanalysts, and psychiatric nurses. It is important for,
above all, people who have these disorders, and for their families and
friends, and for others who are simply interested in this area of human
experience. This book is written for anyone who hopes it may be possible
to interpret and understand disordered states— and for anyone who hopes,
despite a disorder, to be interpreted, to be understood.
It may be presumptuous for someone who is neither a psychiatrist nor
any other kind of mental health professional to write a book about these
questions. Inevitably the limits of my knowledge will sometimes show
through, although I hope these limits may be outweighed by the ideas
and the reasons behind them. Mental disorder straddles the boundary be-
tween the sciences and the humanities. The subject I teach— philosophy—is