The lived experience of mental disorders in adolescents: a bottom-up review co-designed, co-conducted and co-written by experts by experience and academics.

We provide here the first bottom-up review of the lived experience of mental disorders in adolescents co-designed, co-conducted and co-written by experts by experience and academics. We screened first-person accounts within and outside the medical field, and discussed them in collaborative workshops involving numerous experts by experience - representing different genders, ethnic and cultural backgrounds, and continents - and their family members and carers. Subsequently, the material was enriched by phenomenologically informed perspectives and shared with all collaborators. The inner subjective experience of adolescents is described for mood disorders, psychotic disorders, attention-deficit/hyperactivity disorder, autism spectrum disorders, anxiety disorders, eating disorders, externalizing disorders, and self-harm behaviors. The recollection of individuals' past histories also indexes the prodromal (often transdiagnostic) features predating the psychiatric diagnosis. The experience of adolescents with mental disorders in the wider society is described with respect to their family, their school and peers, and the social and cultural context. Furthermore, their lived experience of mental health care is described with respect to receiving a diagnosis of mental disorder, accessing mental health support, receiving psychopharmacological treatment, receiving psychotherapy, experiencing peer support and mental health activism, and achieving recovery. These findings can impact clinical practice, research, and the whole society. We hope that this co-designed, co-conducted and co-written journey can help us maintain our commitment to protecting adolescents' fragile mental health, and can help them develop into a healthy, fulfilling and contributing adult life.

The lived experience of depression: a bottom-up review co-written by experts by experience and academics.

We provide here the first bottom-up review of the lived experience of depression, co-written by experts by experience and academics. First-person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of depression, family members and carers, representing a global network of organizations. The material was enriched by phenomenologically informed perspectives and shared with all collaborators in a cloud-based system. The subjective world of depression was characterized by an altered experience of emotions and body (feeling overwhelmed by negative emotions, unable to experience positive emotions, stuck in a heavy aching body drained of energy, detached from the mind, the body and the world); an altered experience of the self (losing sense of purpose and existential hope, mismatch between the past and the depressed self, feeling painfully incarcerated, losing control over one's thoughts, losing the capacity to act on the world; feeling numb, empty, non-existent, dead, and dreaming of death as a possible escape route); and an altered experience of time (experiencing an alteration of vital biorhythms, an overwhelming past, a stagnation of the present, and the impossibility of the future). The experience of depression in the social and cultural context was characterized by altered interpersonal experiences (struggling with communication, feeling loneliness and estrangement, perceiving stigma and stereotypes), and varied across different cultures, ethnic or racial minorities, and genders. The subjective perception of recovery varied (feeling contrasting attitudes towards recovery, recognizing recovery as a journey, recognizing one's vulnerability and the need for professional help), as did the experience of receiving pharmacotherapy, psychotherapy, and social as well as physical health interventions. These findings can inform clinical practice, research and education. This journey in the lived experience of depression can also help us to understand the nature of our own emotions and feelings, what is to believe in something, what is to hope, and what is to be a living human being.

Disordered selves or persons with schizophrenia?

PURPOSE OF REVIEW: This study builds on the self-disorder hypothesis of schizophrenia and further develops it by integrating the notion of 'selfhood' with that of 'personhood'. The self-disorder hypothesis brings to light the patient's subjective abnormal experiences. What may remain out of focus is the person's attitude towards these anomalous experiences. RECENT FINDINGS: Taking into account the notion of personhood allows for an articulation of the way the suffering person reflectively responds to and makes sense of her troubled selfhood. This approach is conducive to the development of a person-centred dialectical (PCD) model of schizophrenia that is concerned not only with the phenomenological description of troubled selfhood but also with how persons with schizophrenia interact and cope with their abnormal experiences. The principal clinical implication is the development of a two-tier descriptive system including phenomenal assessment of disordered selfhood and appraisal of personal background. SUMMARY: The recognition of the patient's resources is necessary for effective treatment, as recovery requires not only the reduction of full-blown symptoms but also a change in the patient's attitude with respect to her basic abnormal phenomena. The latter involves the person's own effort to make sense of and cope with her vulnerability.

Empathy as a sense of autonomy.

In this paper, we examine Jaspers' ambiguous approach to empathy. We start by situating Jaspers' notion of empathic understanding in the context of contemporary philosophical discussions of empathy. We distinguish a phenomenological approach to interpersonal understanding from two influential accounts of other minds, namely, theory-theory and simulation-theory, and then we contrast Jaspers' notion of empathic understanding with a phenomenological approach. We distinguish two basic kinds of empathy, a prereflective nonconative kind and a more reflective conative kind. Then we argue that Jaspers' philosophical conception of human nature as restless and undefinable autonomy makes him reject any kind of comprehensive attempt to understand other people. We try to make sense of this rejection by discussing the epistemological and ethical nature of his notorious 'theorem of incomprehensibility'. This eventually leads us, by way of conclusion, to sketch a method required for making sense of those experiences that cannot be understood via ordinary empathy. The key notion of this method is called 'second-order empathy'.

Affective temperament and personal identity.

The complex relationship between temperament and personal identity, and between these and mental disorders, is of critical interest to both philosophy and psychopathology. More than other living creatures, human beings are constituted and characterized by the interplay of their genotype and phenotype. There appears to be an explanatory gap between the almost perfect genetic identity and the individual differences among humans. One reason for this gap is that a human being is a person besides a physiological organism. We propose an outline of a theoretical model that might somewhat mitigate the explanatory discrepancies between physiological mechanisms and individual human emotional experience and behaviour. Arguing for the pervasive nature of human affectivity, i.e., for the assumption that human consciousness and behaviour is characterised by being permeated by affectivity; to envisage the dynamics of emotional experience, we make use of a three-levelled model of human personal identity that differentiates between factors that are simultaneously at work in the constitution of the individual human person: 1) core emotions, 2) affective temperament types/affective character traits, and 3) personhood. These levels are investigated separately in order to respect the methodological diversity among them (neuroscience, psychopathology, and philosophy), but they are eventually brought together in a hermeneutical account of human personhood.