A Critical Perspective On Second-Order Empathy In Understanding Psychopathology: Phenomenology And Ethics

Article published in Theoretical Medicine & Bioethics 2015

You can find the final version HERE, and the pre-production version HERE

Abstract: The centenary of Karl Jaspers’ General Psychopathology was recognised in 2013 with the publication of a volume of essays dedicated to his work (edited by Stanghellini and Fuchs). Leading phenomenological-psychopathologists and philosophers of psychiatry examined Jaspers notion of empathic understanding and his declaration that certain schizophrenic phenomena are ‘un-understandable’. The consensus reached by the authors was that Jaspers operated with a narrow conception of phenomenology and empathy and that schizophrenic phenomena can be understood through what they variously called second-order and radical empathy. This article offers a critical examination of the second-order empathic stance along phenomenological and ethical lines. It asks: (1) Is second-order empathy (phenomenologically) possible? (2) Is the second-order empathic stance an ethically acceptable attitude towards persons diagnosed with schizophrenia? I argue that second-order empathy is an incoherent method that cannot be realised. Further, the attitude promoted by this method is ethically problematic insofar as the emphasis placed on radical otherness disinvests persons diagnosed with schizophrenia from a fair chance to participate in the public construction of their identity and, hence, to redress traditional symbolic injustices.

Mohammed Abouelleil Rashed   2015


Islamic Perspectives on Psychiatric Ethics

My chapter published online at Oxford Handbooks.

Will appear in print in the Oxford Handbook for Psychiatric Ethics Volume 1 next year.


Islamic Perspectives on Psychiatric Ethics explores the implications for psychiatric practice of key metaphysical, psychological, and ethical facets of the Islamic tradition. It examines: (1) the nature of suffering and the ways in which psychological maladies and mental disorder are bound up with the individual’s moral and spiritual trajectory. (2) The emphasis placed on social harmony and the formation of a moral community over personal autonomy. (3) The sources of normative judgements in Islam and the principles whereby ethical/legal rulings are derived from the Qur’an and the Prophetic Traditions. Finally, the perspective of the chapter as a whole is employed to present an Islamic view on a number of conditions, practices, and interventions of interest to psychiatric ethics.

Click HERE for Pre-Production version

Abstract for the 15th International Philosophy & Psychiatry Conference: July 2012: Autonomy and Agency in Islamic Culture & Theology: Implications for Psychiatric Ethics


Ethical practice in psychiatry is underpinned by a secular, anthropocentric concept of autonomy. While this reflects the cultural heritage of the communities where modern psychiatry was developed, it might not be suitable for populations with different understandings of autonomy. This presentation outlines some Islamic cultural/ethical issues of particular relevance to decision-making in psychiatry.


First, the scope of autonomy is considered. Outside one’s personal relation with God, autonomy is secondary to community. A collectivity can only achieve salvation when the conduct of each member is aligned with the norms of the faith. Moral/social violations are not individual choices but a threat to this order, and therefore of concern for others. Shared responsibility for the actions of others renders decision-making a collective enterprise guided by figures of authority. This has implications for informed consent, confidentiality, privacy, and the duty of clinicians towards patients.


Second, the paradox of agency is considered. Action in Islamic theology is both predetermined and the full responsibility of the agent. Suffering, in a determinist theodicy, is foreknown to God and is a trial and expiation for sins. This may promote fatalism towards treatment. With a free-will theodicy, humans bring suffering upon themselves through their actions, and must take an active attitude towards relieving it. Deterministic attitudes complicate the clinician’s duty to relieve suffering within the available means, and render sharing information (e.g. about prognosis) irrelevant. The presentation concludes by asking whether and to what extent a clinician should abandon her secular ethical principles in favour of other religious or cultural ones.


Intereseting blog on bioethics

Conference webpage