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Sam Fellowes

@samfellowes.bsky.social
4.5K followers 3.6K following 250 posts

Philosophy of psychiatry, history of autism, psychiatric diagnoses, EBE research, self-diagnosis. samfellowes.com www.youtube.com/@sfhps

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Sam Fellowes @samfellowes.bsky.social · 13/09/2026
The Routledge Handbook of Philosophy of Scientific Modeling is released in paper back. Based on reading the first 100 pages of the pdf, it is excellent.
routledge.com
The Routledge Handbook of Philosophy of Scientific Modeling
Models and modeling have played an increasingly important role in philosophy, going back to the nineteenth century. While philosophical interest in models has been remarkably lively over the last two ...
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Sam Fellowes @samfellowes.bsky.social · 22/08/2026
** occurring within our perception of the phenomenal world. Neo-Kantianism FTW.
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Sam Fellowes @samfellowes.bsky.social · 22/08/2026
Any subtype of #autism will be an idealisation and abstraction which does not reflect reality. But autism itself is also an idealisation and abstraction which does not reflect reality*, so why is that a problem? *Reality: the specific behaviour exhibited and specific causal interactions occurring**
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Sam Fellowes @samfellowes.bsky.social · 21/08/2026
empathy and there are some who do, then I want this emphasised (plus there is people who say they are hyper empathy). And this would not just be mentioning a single symptom, I think it interacts in so many different ways with other aspects of myself that subtypes becomes useful.
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Sam Fellowes @samfellowes.bsky.social · 21/08/2026
So my own issue is how often I see autistic people deny that there is a lack of empathy in autistic people (above and beyond anything covered by the double empathy problem), whereas I think lacking empathy is one of the biggest problems I face. If there are lots of autistic people who do not lack
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Sam Fellowes @samfellowes.bsky.social · 21/08/2026
We can think every life has intrinsic value whilst also wanting precision. But yes, fascists are a problem. But just as I think we should plough head in relation to making a better world in relation to race, gender, sexuality, and risk the fascist backlash, I think we can do that in psychiatry also.
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Sam Fellowes @samfellowes.bsky.social · 21/08/2026
The end of precise understanding, helping highlight rarer aspects which get subsumed under heterogeneity. For those autistic people who have characteristics which get concealed by heterogeneity. Now because it helps self-understanding, societal understanding, clinically and scientifically.
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Sam Fellowes @samfellowes.bsky.social · 21/08/2026
categories get broad. About 20,000 types of butterflies, thousands of types of particles, hundreds of types of stars. But not autism? Not even worth having a debate over? No significant possibility of important things being eclipsed (become statistical noise) by heterogeneity? 2/2
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Sam Fellowes @samfellowes.bsky.social · 21/08/2026
I have previously suggested that alternatives to expanding autism are 1) creating new diagnoses or 2) subtyping [not high vs low, they were bad subtypes]. This seemingly puts me in league with Frith and Baron, who are not so popular. Just about every science divides or subdivides when #autism 1/2
bbc.co.uk
A split in the spectrum? The ongoing battle to define autism
There is a continuing row over whether it matters if such a broad spectrum of people are defined as having autism
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Sam Fellowes @samfellowes.bsky.social · 13/08/2026
Wrote a book review: link.springer.com/article/10.1...
link.springer.com
Schizophrenia, perspectivism and competing perspectives - Metascience
Metascience -
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Sam Fellowes @samfellowes.bsky.social · 19/06/2026
Embodying Divergence: New Directions in Autism and Neurodiversity Research conference: #autism #phenomenology
event.au.dk
Eventværk
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Sam Fellowes @samfellowes.bsky.social · 15/06/2026
*There is significant evidence that self-diagnosis individuals view social media on diagnoses, but almost no evidence upon what stance they take towards it. Many will watch TikTok, but whether they do so just as light entertain or use it as the gospel truth on diagnosis, there is almost no data.
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Sam Fellowes @samfellowes.bsky.social · 15/06/2026
Given that self-diagnosis is stereotypically associated with social media*, it will be interesting to see if self-diagnosis rates decrease after the UK under-16s ban on social media comes into affect. *see below
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Sam Fellowes @samfellowes.bsky.social · 15/06/2026
If an academic job asked for "Research plan – description of current and future research plans", any ideas of what 'current' consists of (just stuff not yet published but in preperation, stuff published in the last two years, etc.)
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Sam Fellowes @samfellowes.bsky.social · 01/06/2026
I realise now alexithymia is being understood in quite a lot of different ways. My aim was to describe something more precise than empathy but it seems that alexithymia is also too broad a concept (or at least that people are using it in different ways).
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Sam Fellowes @samfellowes.bsky.social · 01/06/2026
I was just looking over this open access article which gives an overview of the field. Interestingly, the definition of alexithymia given seems to not cover inability to feel emotion (which seems to fit the definition you gave), yet discusses this in the actual text.
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Sam Fellowes @samfellowes.bsky.social · 01/06/2026
Usually defined as both in the stuff I read. Which admittedly does not help.
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Sam Fellowes @samfellowes.bsky.social · 01/06/2026
Surely something being due to trauma is fully compatible with subtyping? Also, someone might fall into both subtypes, or there could be a third subtype for someone who exhibits both characteristics.
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Sam Fellowes @samfellowes.bsky.social · 01/06/2026
True, it depends upon how we divide up empathy. So I really struggle with feeling what another feels, but at the same time I would probably qualify as hyper-moral (i.e. vegan, stopped flying, don't buy non-fairtrade clothing). Though admittedly I don't think empathy is relevant for morality.
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Sam Fellowes @samfellowes.bsky.social · 01/06/2026
I would be interested to know in what sense you have both. Admittedly, alexithymia is a broad term. I specifically have in mind emotional resonance, feeling what another feels. It is this bit which seems to me as being very distinct from hyper-empathy.
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Sam Fellowes @samfellowes.bsky.social · 01/06/2026
Yeah, there are a near infinite number of ways to subtype based upon the focusing upon any particular combination of characteristics. So it has to be done on practical grounds.
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Sam Fellowes @samfellowes.bsky.social · 01/06/2026
Interesting. I would have thought difficulty with emotions might actually increase self-understanding (given that emotion seem to play such a strong role in lack of self-understanding), so I would have thought alexithymia would actually increase reliability.
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Sam Fellowes @samfellowes.bsky.social · 01/06/2026
I think autistic subtypes are best understood as dynamic, whereby someone can move out of and move between subtypes, including due to environmental changes, so this is how I would think of these subtypes (although my attempts to move out of the alexithymia group has had little success so far).
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Sam Fellowes @samfellowes.bsky.social · 01/06/2026
Anyone up for subtyping autism on these grounds: hyper-empathy autism and alexithymia autism? Some autistic people would not fall into either camp, but I would put myself in the latter subtype. #autism
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Sam Fellowes @samfellowes.bsky.social · 22/05/2026
Also, the original post is obviously somewhat reductionist since many other things need occur than just neurology to get these outcomes, like culture and society. But that is not a barrier to neurodiversity given that the neurodiversity movement emphasises the role of culture and society.
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Sam Fellowes @samfellowes.bsky.social · 22/05/2026
*Yes, I said objective. Moral relativism is a terrible idea (because it gives equal support to, for example, pro gay right and anti-gay rights, or accept autism vs cure autism). If objectivity does not sound right, I can only suggest reading Kant and friends.
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Sam Fellowes @samfellowes.bsky.social · 22/05/2026
Back on twitter/X I used post how neurodiversity needs consider that there could be objectively* better and worse way to live. This sort of thing is what I had in mind (and not that I was being homophobic, as someone accused me of). Some types of minds might cause harm to themselves and others.
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Sam Fellowes @samfellowes.bsky.social · 22/05/2026
How might this relate to #neurodiversity? "The vibes are young male vibes,"... there's a strong neurological factor – young men's attitude to sports, money, and prediction markets is down to... "an underdeveloped pre-frontal cortex and a high appetite for risk". www.bbc.co.uk/news/article...
bbc.co.uk
Why young men are drawn to prediction markets
Prediction markets are a fast-growing, multi-billion-dollar industry, and appeal disproportionately to young men
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Sam Fellowes @samfellowes.bsky.social · 21/05/2026
New podcast episode about my undercover escapade at the Swedish Congress of Psychiatry.
youtube.com
Infiltrating the Swedish Congress of Psychiatry
YouTube video by Philosophy of Psychiatric Diagnoses
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Sam Fellowes @samfellowes.bsky.social · 14/05/2026
In relation to traits not being part of autism, evidence suggests that 50% of autistic people have significant levels of alexithymia. If (emphasis on if) 50% of autistic have a trait which is not common in the general population, it looks to me like it should be part of the concept of autism.
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Sam Fellowes @samfellowes.bsky.social · 14/05/2026
Some studies suggest no reduction in affective empathy, others suggest a reduction (but not as much as cognitive empathy). However, affective empathy is extremely difficult to study reliably (which is not to say the studies are less reliable than personal anecdotes).
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Sam Fellowes @samfellowes.bsky.social · 13/05/2026
To be more precise, I think I cannot do the 'feeling what another feels' aspect of affective empathy and this significantly diminishes the quality of my interpersonal interactions (see my chapter in Contemporary Philosophy of Autism for details).
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Sam Fellowes @samfellowes.bsky.social · 13/05/2026
I am not saying autistic people lack cognitive and affective empathy, only that the existing empirical literature on the double empathy problem is not providing evidence against this. That said, I think I lack affective empathy and this is a disorder because it compromises my valuable life goals.
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Sam Fellowes @samfellowes.bsky.social · 13/05/2026
My new article, I look at 20 empirical studies on the double empathy problem and argue that none show whether the double empathy problem is applicable to cognitive empathy and affective empathy. #autism #empathy
link.springer.com
Cognitive Empathy, Affective Empathy and Empirical Research on the Double Empathy Problem: A Critical Methodology Review - Journal of Autism and Developmental Disorders
Purpose The double empathy problem posits that autistic people and non-autistic people both lack empathy with the other side rather than the lack of empathy solely residing in one side. There have bee...
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Sam Fellowes @samfellowes.bsky.social · 23/04/2026
If anyone is interested in HiTOP, my recent article on expert-by-experience research related it to HiTOP. I presented it as a counter argument to the whole autistic people have access to deeper realities of autism claim. muse.jhu.edu/article/978091
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Sam Fellowes @samfellowes.bsky.social · 23/04/2026
New paper looking at the philosophical assumptions of HiTOP, written by the HiTOP crew. If you are not aware, HiTOP might be the most interesting thing happening in psychiatry currently. Also, I wrote a response article to it. muse.jhu.edu/pub/1/articl...
muse.jhu.edu
Project MUSE -- Verification required!
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Sam Fellowes @samfellowes.bsky.social · 18/04/2026
No connection to my own academic interests but reposting due to bigging up animals.
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Sam Fellowes @samfellowes.bsky.social · 17/04/2026
It is my birthday today. So I am taking a day off from the (alas non-academic) day job to do my favourite thing: go to the library and read philosophy of science articles on scientific models!
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Sam Fellowes @samfellowes.bsky.social · 08/04/2026
Has anyone ever written about adopting an identity as requiring some type of epistemic commitment, that most people will not adopt an identity unless they genuinely believe there is a significant level of fit between themselves and the identity. Any philosophy, psychology, sociology etc. on this?
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Sam Fellowes @samfellowes.bsky.social · 07/04/2026
Given the apocalyptic language in the news and the highly remote but non-negligible possibility that the end of the world is nigh, I would just like to reiterate my support of The Enlightenment. Largely failed in its aims but I cannot think of a better alternative. Science, truth, reason, etc.
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Sam Fellowes @samfellowes.bsky.social · 07/04/2026
Also @eikofried.bsky.social This gives support formative.jmir.org/2023/1/e39206 This claims to give support but some figures look questionable to me www.sciencedirect.com/science/arti... This suggests people are kind of close when selfdx with depression www.sciencedirect.com/science/arti...
formative.jmir.org
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Sam Fellowes @samfellowes.bsky.social · 25/03/2026
Put another way, my concern about self-diagnosis advocates is that they are aiming to produced improved DSM diagnoses, but they are effectively doing something fundamentally different to the DSM. Maybe better, maybe worse, but we need a clearer picture of what that different thing is intended to be.
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Sam Fellowes @samfellowes.bsky.social · 25/03/2026
upon these somehow reflecting reality but because the DSM is one way of modelling. Self-diagnosis advocates, HiTOP, psychodynamic, might model in a different way, and that is great as long as every one is clear about how they are idealising and abstracting and what they are ultimately producing.
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Sam Fellowes @samfellowes.bsky.social · 25/03/2026
Anyway, I never really answered your question. I think false positives and false negatives still make sense in an idealised and abstract sense, which then relates to standardisation. The DSM places various boundaries in various places and that sets, false positives and false negatives, not based
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Sam Fellowes @samfellowes.bsky.social · 25/03/2026
Strangely enough, the empirical evidence suggests that MDD (or possibly just 'depression, I forget exactly what the studies cover) is actually a diagnosis which has higher levels of accuracy when self-diagnosing compared to other conditions commonly self-diagnosed like autism, ADHD and DID.
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Sam Fellowes @samfellowes.bsky.social · 25/03/2026
what compromises their new diagnoses are based upon. The compromises of the DSM result in at least some standardisation. Self-diagnosis advocates should either show that they are getting similar levels of standardisation or admit they are compromising standardisation for some other goal. 4/4
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Sam Fellowes @samfellowes.bsky.social · 25/03/2026
criteria for various conditions providing explicit compromises are being made. The DSM is the product of a series of massive compromises (as is HiTOP, psychodynamic AFAIK), and to be a genuine alternative, I think that alternative diagnoses produced by diagnostic communities also need state 3/4
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Sam Fellowes @samfellowes.bsky.social · 25/03/2026
reliability). Having read every empirical study I can find on self-diagnosis, it looks like there is much less standardisation, especially given that some self-diagnosing individuals purposefully alter DSM criteria. I am 100% up for diagnostic communities coming up with alternative diagnostic 2/4
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Sam Fellowes @samfellowes.bsky.social · 25/03/2026
I'd give the DSM 3 out of 5. Could certainly be better but could also be worse. So self-diagnosis as an alternative only has to meet 3 out of 5, which is a low bar, but if there is one advantage to the DSM is that it has a level of standardisation (granted, I know there is debates over 1/4
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Sam Fellowes @samfellowes.bsky.social · 25/03/2026
If this is not obvious, I don't know what the answer is but strongly suspect things are more complicated than one side being right and the other wrong, and I don't think polarisation helps.
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