There is no satisfactory account for the general phenomenon of confabulation, for the following reasons: (1) confabulation occurs in a number of pathological and non-pathological conditions; (2) impairments giving rise to confabulation are likely to have different neural bases; and (3) there is no unique theory explaining the aetiology of confabulations. An epistemic approach to defining confabulation could solve all of these issues, by focusing on the surface features of the phenomenon. However, existing epistemic accounts are unable to offer sufficient (...) conditions for confabulation and tend to emphasise only its epistemic disadvantages. In this paper, we argue that a satisfactory epistemic account of confabulation should also acknowledge those features which are (potentially) epistemically advantageous. For example, confabulation may allow subjects to exercise some control over their own cognitive life which is instrumental to the construction or preservation of their sense of self. (shrink)

In English medical law, it is something of an axiom that adult competent patients have an absolute right to refuse all and any medical treatment, including potentially life-saving and life-sustaining treatment. This legal proposition, which is embedded in the doctrine of consent, has for the last few decades been regarded as the expression of the philosophical principle of personal autonomy and ethical right of self-determination. The Western ethical and legal traditions places heavy emphasis on notions of personal sovereignty reflected in (...) the strong rhetorical entrenchment of patient autonomy in judicial determinations of treatment refusal cases. In a spate of legal cases in the 1980s and 1990s judicial rhetoric .. (shrink)

Commentators agree that the Perception and Attention Deficit (PAD) model is a promising model for accounting for recurrent complex visual hallucinations (RCVH) across several disorders, though with varying detailed criticisms. Its central tenets are not modified, but further consideration of generative models of visual processing and the relationship of proto-objects and memory systems allows the PAD model to deal with variations in phenomenology. The commentaries suggest new ways to generate evidence that will test the model.

Anxious temperament (AT) in human and non-human primates is a trait-like phenotype evident early in life that is characterized by increased behavioural and physiological reactivity to mildly threatening stimuli1–4. Studies in children demonstrate that AT is an important risk factor for the later development of anxiety disorders, depression and comorbid substance abuse5. Despite its importance as an early predictor of psychopathology, little is known about the factors that predispose vulnerable children to develop AT and the brain systems that underlie its (...) expression. To characterize the neural circuitry associated with AT and the extent to which the function of this circuit is heritable, we studied a large sample of rhesus monkeys phenotyped for AT. Using 238 young monkeys from a multigenerational single-family pedigree, we simultaneously assessed brain metabolic activity and AT while monkeys were exposed to the relevant ethological condition that elicits the phenotype. High-resolution 18F-labelled deoxyglucose positron-emission tomography (FDG–PET) was selected as the imaging modality because it provides semi-quantitative indices of absolute glucose metabolic rate, allows for simultaneous measurement of behaviour and brain activity, and has a time course suited for assessing temperament-associated sustained brain responses. Here we demonstrate that the central nucleus region of the amygdala and the anterior hippocampus are key components of the neural circuit predictive of AT. We also show significant heritability of the AT phenotype by using quantitative genetic analysis. Additionally, using voxelwise analyses, we reveal significant heritability of metabolic activity in AT-associated hippocampal regions. However, activity in the amygdala region predictive of AT is not significantly heritable. Furthermore, the heritabilities of the hippocampal and amygdala regions significantly differ from each other. Even though these structures are closely linked, the results suggest differential influences of genes and environment on how these brain regions mediate AT and the ongoing risk of developing anxiety and depression. Anxiety disorders are among the most common forms of psychopathology6, and frequently begin during childhood and adolescence. Although all children experience acute anxiety, children with AT display extreme behavioural and physiological reactivity to novel stimuli, and in the presence of strangers inhibit their locomotor activity and vocalizations3.. (shrink)

The will is one of the three pillars of the trilogy of mind that has pervaded Western thought for millennia, the other two being affectivity and cognition (Hilgard 1980). In the past century, the concept of will was imperceptibly replaced by the cognitive-oriented behavioral qualifiers “voluntary,” “goal-directed,” “purposive,” and “executive” (Tranel et al. 1994), and has lost much of its heuristic merits, which are related to the notion of “human autonomy” (Lhermitte 1986). We view catatonia as the clinical expression of (...) impairment of the brain mechanisms that promote human will. Catatonia is to the brain systems engaged in will, as coma is to the reticular ascending systems that promote sleep and wakefulness (Plum 1991). (shrink)

The following theses are defended in this paper: (1) The concept of autonomous action is centrally relevant to understanding numerous psychiatric conditions, namely, conditions that subvert autonomy; (2) The details of an analysis of autonomous action matter; a vague or rough characterization is less illuminating; (3) A promising analysis for this purpose (and generally) is a version of the "multi-tier model". After opening with five vignettes, I begin the discussion by highlighting strengths and weaknesses of contributions by other authors who (...) examine the relationship between autonomy and autonomysubverting psychiatric conditions. I then present an analysis of the concept of autonomous action, before employing this analysis in a suggestive exploration of the conditions illustrated in the vignettes. Keywords: autonomy, multi-tier model, psychiatric conditions CiteULike Connotea Del.icio.us What's this? (shrink)

Progress in psychiatry depends on accurate definitions of disorders. As long as there are no known biologic markers available that are highly specific for a particular psychiatric disorder, clinical practice as well as scientific research is forced to appeal to clinical symptoms. Currently, the nosology of obsessive-compulsive disorder is being reconsidered in view of the publication of DSM-V. Since our diagnostic entities are often simplifications of the complicated clinical profile of patients, definitions of psychiatric disorders are imprecise and always indeterminate. (...) This urges researchers and clinicians to constantly think and rethink well-established definitions that in psychiatry are at risk of being fossilised. In this paper, we offer an alternative view to the current definition of obsessive-compulsive disorder from a phenomenological perspective.TranslationThis article is translated from Dutch, originally published in [Handbook Obsessive-compulsive disorders, Damiaan Denys, Femke de Geus (Eds.), (2007). De Tijdstroom uitgeverij BV, Utrecht. ISBN13: 9789058980878.]. (shrink)

Numerous questions remain unanswered concerning the functional determinants of symbolic behavior and perspective-taking, particularly regarding the capabilities of children with autism. An alternative approach that considers these behaviors to be forms of derived relational responding allows for the design of functional intervention programs to establish such repertoires in individuals for whom they are absent.

Georg Northoff employs a comparison with Parkinson's disease in an effort to tease apart the underlying pathophysiology of psychogenic catatonia. Northoff's extensive treatment of the subject is abetted by his own research as well as the research of others. Nevertheless, a number of points concerning basal ganglia/thalamocortical processing need to be raised, some adding support to his hypothesis and others detracting from it.

In agreement with Behrendt & Young (B&Y), we considered the role of perception disturbances in schizophrenia in our first clinical approaches, using the Bender test with schizophrenic patients. Following this, we reproduced nuclear symptoms of schizophrenia in animal models, showing that perceptual disturbances, acquisition disturbances, and decrease in affective levels can be induced by glutamatergic blockade within the nucleus accumbens septi. Our results link the proposed corticostriatal dysfunction with the thalamocortical disturbances underlying perceptual problems reviewed by B&Y.

Nativists about syntactic processing have argued that linguisticprocessing, understood as the implementation of a rule-basedcomputational architecture, is spared in Williams syndrome, (WMS)subjects – and hence that it provides evidence for a geneticallyspecified language module. This argument is bolstered by treatingSpecific Language Impairments (SLI) and WMS as a developmental doubledissociation which identifies a syntax module. Neuroconstructivists haveargued that the cognitive deficits of a developmental disorder cannot beadequately distinguished using the standard gross behavioural tests ofneuropsychology and that the linguistic abilities of the (...) WMS subject canbe equally well explained by a constructivist strategy of neurallearning in the individual, with linguisitic functions implemented in anassociationist architecture. The neuroconstructivist interpretation ofWMS undermines the hypothesis of a double dissociation between SLI andWMS, leaving unresolved the question of nativism about syntax. Theapparent linguistic virtuosity of WMS subjects is an artefact ofenhanced phonological processing, a fact which is easier to demonstratevia the associationist computational model embraced byneuroconstructivism. (shrink)

A short story of an assassin and a sleeping old Fisherman: Before I explain the rationale of this anecdote, let me begin my response by saying how grateful I am to Bratton and Tomasini for engaging with me over such a thorny and unpleasant topic. Many of us have either suffered eating disorders, or have a relative or a friend who has had an eating disorder, or who has died with anorexia. I still remember giving a talk on anorexia nervosa, (...) several years ago, and at the end of the talk one senior academic was very shaken and nearly in tears. He had lost his sister with anorexia. For many of us, eating disorders are an extremely sensitive issue, and for this very reason, I feel particularly indebted when .. (shrink)

During the paradoxical dreaming sleep stage, characterized by hallucinations and delusions, as in schizophrenia, the increased subcortical release of dopamine, the presynaptic inhibition of thalamic relay nuclei, and serotonergic disinhibition are in accordance with the model for the mechanism of hallucination-induction.

Autism is a neurodevelopmental condition characterized by difficulties in social interaction (APA, 2000). Successful social interaction relies, in part, on determining the thoughts and feelings of others, an ability commonly attributed to our faculty of folk or common-sense psychology. Because the symptoms of autism should be present by around the second birthday, it follows that the study of autism should tell us something about the early emerging mechanisms necessary for the development of an intact faculty of folk psychology. Our aims (...) in this chapter are threefold; (1) to examine the literature on "socialunderstanding" mechanisms in autism, particularly those assumed to develop in the first years of life; (2) to examine the related literature on typically developing infants and toddlers, and (3) to examine the theoretical approaches that attempt to characterize the early stages and development of this impressive skill. In doing so, we hope to help resolve some of the disagreements and sticking points that riddle the topic. In particular we will attempt to shift the focus from whether children have this or that specific mental-state concept (which they use to predict behavior of others) to a more developmentally friendly approach centered around the notion of reasons, recognizing that they may well exist before they are represented, and hence before they can be appreciated, or expressed. The peer commentary in Behavioral and Brain Sciences following Premack and Woodruff (1978) - "Does the chimpanzee have a theory of mind'" - not only introduced the "falsebelief' task (Dennett, 1978; Wimmer & Perner, 1983), but addressed a host of issues surrounding the characterization of second-order intentional systems, systems that may (or must) be interpreted as having beliefs about beliefs (or desires or intentions .... (shrink)

Multidisciplinary studies indicate that auditory hallucinations may arise from speech perception neurocircuitry without disrupted theory of mind capacities. Computer simulations of excessive pruning in speech perception neural networks provide a model for these hallucinations and demonstrate that connectivity reductions just below a “psychotogenic threshold” enhance information processing. These data suggest a process whereby vulnerability to schizophrenia is maintained in the human population despite reproductive disadvantages of this illness.

Cognitive neuropsychiatry attempts to understand psychiatric disorders as disturbances to the normal function of human cognitive organisation, and it attempts to link this functional framework to relevant brain structures and their pathology. This recent scientific discipline is the natural extension of cognitive neuroscience into the domain of psychiatry. We present two examples of recent research in cognitive neuropsychiatry: delusions of control in schizophrenia, and affective disorders. The examples demonstrate how the cognitive approach is a fruitful and necessary supplement to the (...) otherwise successful biological psychiatry paradigm, which tend to bypass the cognitive level. Philosophy concerns some of the core concepts involved in psychiatric illness, particularly concerning rationality, thought and action, reality testing, and the self. We present concrete examples that illustrate how philosophical conceptual tools can be particularly important for the construction and interpretation of the cognitive models relevant to the understanding of psychiatric illness. We conclude that cognitive neuropsychiatry is a fruitful and necessary supplement to biological psychiatry. Furthermore, cognitive neuropsychiatry itself may benefit significantly from employing philosophical conceptual tools in the interpretation and construction of its cognitive models. The cognitive and philosophical approaches may thus be further steps towards a scientific psychopathology. (shrink)

This paper builds on the insights of _[erome Bruner by underlining the central importance of narratives explaining actions in terms of reasons, arguing that by giving due attention to the central roles that they play in our everyday understanding of others provides a better way of explicating the nature and source of that activity than does simulation theory, theory-theory or some union of the two. However, although I promote Bruner`s basic claims about the role.: narratives play in this everyday enterprise, (...) I take issue with his characterization of the nature of narrative itself. In so doing, important questions are brought to the fore about what makes our understanding of narratives possible. In line with the idea that we ought to tell a developmental story that looks to the social arena for the source of narratives about reasons, I promote the idea that what is minimally i‘equii‘erl for becoming conversant in such everyday narratives need not be anything as sophisticated as a theory of mind or a capacity for simulation. The paper concludes using evidence concerning autism as a test case to help support this conclusion. (shrink)

The Hospital for Rehabilitation, Stavern, in Norway has treated patients with physical symptoms with no organic cause, so called conversion disorder patients, for over a decade. For four years research on the treatment has been carried out. Patients with conversion disorder seem not to fit in traditional somatic hospitals because their patienthood depends upon psychiatric diagnosis. Ironically, they appear not to belong in psychiatric hospitals because of their physical symptoms. The treatment offered these patients at hospitals for rehabilitation is adapted (...) physical activity consisting of behaviour elements such as positive reinforcement of normal function and lack of positive reinforcement at dysfunction. The pedagogical approach is seen as crucial in the successful rehabilitation of the patients. The disorder and treatment can be understood by using theories about the ecstatic body, radical behaviourism and phenomenology. When patients have problems in behaviour concerning both body and mind, it would be natural to employ both in the road to recovery. This article describes the various treatments and discusses them from phenomenological, ethical and philosophical perspectives. (shrink)

Northoff provides a compelling argument supporting a kind of “double dissociation” of Parkinson's disease and catatonia. We discuss a related form of akinetic mutism linked to mesodiencephalic injuries and suggest an alternative to the proposed “horizontal” versus “vertical” modulation distinction. Rather than a “directional” difference in patterned neuronal activity, we propose that both disorders reflect hypersynchrony within typically interdependent but segregated networks facilitated by a common thalamic gating mechanism.

The Depue & Collins model is intended to explain a normal human personality trait: extraversion. In contrast, attention-deficit/hyperactivity disorder (ADHD) is generally considered to be a type of psychopathology not found in so-called normals; however, the clinical and neurobiological research done on ADHD seems to amplify and support Depue & Collins's model.

There is a spectrum of child psychiatric and neurological disorders, in all of which a comorbidity with obsessive-compulsive disorder and ritualized behavior is very common. Therefore, they may appear as a basis for the rituals in children that cross into adolescence and adulthood. Resolving the nature of these disorders may help us to better understand “Why ritualized behavior?” (Published Online February 8 2007).

Caplan & Waters's neuropsychological evidence for two types of verbal working memory rests entirely on a very restricted definition of “syntactic complexity,” one in terms of word order. This opens the possibility that the dissociation they observe relates to the differential use of word-order strategies rather than to the structure of verbal working memory.

The question of the psychopath's responsibility for his or her wrongdoing has received considerable attention. Much of this attention has been directed toward whether psychopaths are a counterexample to motivational internalism (MI): Do they possess normal moral beliefs, which fail to motivate them? In this paper, I argue that this is a question that remains conceptually and empirically intractable, and that we ought to settle the psychopath's responsibility in some other way. I argue that recent empirical work on the moral (...) judgments of psychopaths provides us with good reason to think that they are not fully responsible agents, because their actions cannot express the kinds of ill-will toward others that grounds attributions of distinctively moral responsibility. I defend this view against objections, especially those due to an influential account of moral responsibility that holds that moral knowledge is not necessary for responsibility. (shrink)

To someone coming fairly fresh to this debate, Sykes’ paper is somewhat shocking. The psychogenic inference seems such an obvious fallacy, yet he shows, with detailed reference to both diagnostic practice and the literature on mental disorders, the extraordinary pervasiveness of its influence, extending even to the systematic ambiguities built into key diagnostic terms. Sykes characterizes the inference in the following terms: “If there is no known physical cause for a symptom or disorder, the cause must be psychological” (2010, 290). (...) He notes the glaring fallacy of mistaking an epistemological point (that a physical cause is not, at present, known) for an ontological one (that no such cause exists) and .. (shrink)

For the last thirty years, cognitive scientists have attempted to describe the cognitive architecture of typically developing human beings, using, among other sources of evidence, the dissociations that result from developmental psychopathologies such as autism spectrum disorders, Williams syndrome, and Down syndrome. Thus, in his recent defense of the massive modularity hypothesis, Steven Pinker insists on the importance of such dissociations to identify the components of the typical cognitive architecture (2005, 4; my emphasis): This kind of faculty psychology has numerous (...) advantages (...). It is supported by the existence of neurological and genetic disorders that target these faculties unevenly, such as a difficulty in recognizing faces (and facelike shapes) but not other objects, or a difficulty in reasoning about minds but not about objects or pictures. Similarly, Simon Baron-Cohen writes (1998, 335; my emphasis; see also Temple, 1997): I suggest that the study of mental retardation would profit from the application of the framework of cognitive neuropsychology (…). In cognitive neuropsychology, one key question running through the investigator’s mind is “Is this process or mechanism intact or impaired in this person?” When cognitive neuropsychology is done well, a patient’s cognitive system is examined with specific reference to a model of the normal cognitive system. And, not infrequently, evidence from the patient’s cognitive deficits leads to a revision of the model of the normal system. However, in recent years, the use of developmental psychopathologies to identify the components of the typical cognitive architecture has come under heavy fire. In a series of influential articles, neuropsychologist Annette Karmiloff-Smith has argued that findings about the pattern of impairments and preserved capacities in people with developmental psychopathologies say nothing about the cognitive architecture of.. (shrink)

Psychopaths are renowned for their immoral behavior. They are ideal candidates for testing the empirical plausibility of moral theories. Many think the source of their immorality is their emotional deficits. Psychopaths experience no guilt or remorse, feel no empathy, and appear to be perfectly rational. If this is true, sentimentalism is supported over rationalism. Here, I examine the nature of psychopathic practical reason and argue that it is impaired. The relevance to morality is discussed. I conclude that rationalists can explain (...) the moral deficits of psychopaths as well as sentimentalists. In the process, I identify psychological structures that underpin practical rationality. (shrink)

A new diagnostic system for organic psychiatry is presented. We first define "organic psychiatry", and then give the theoretical basis for conceiving organic psychiatric disorders in terms of hypothetical psychopathogenetic processes, HPP:s. Such hypothetical disorders are not strictly identical to the clusters of symptoms in which they typically manifest themselves, since the symptoms may be concealed or modified by intervening factors in non typical circumstances and/or in the simultaneous presence of several disorders. The six basic disorders in our system are (...) Astheno Emotional Disorder (AED), Somnolence Sopor Coma Disorder (SSCD), Hallucination Coenestopathy Depersonalisation Disorder (HCDD), Confusional Disorder (CD), Emotional Motivational Blunting Disorder (EMD) and Korsakoff's Amnestic Disorder (KAD). We describe their usual etiologies, their typical symptoms and course, and some forms of interaction between them. (shrink)

The theme of this conference is Consciousness and its pathologies. In my lecture, I will talk about a psychiatric disorder, which is usually not classified as a "disturbance of consciousness". However, it involves disturbances of subconscious cognitive functions, and so can help us understand the ways in which consciousness depends on such functions. I will also try to show that the disorder is worthy of the philosopher’s attention for several other reasons.

A philosophical question divides the field of addiction research. Can a psychological disorder count as an addiction absent a common underlying physical basis (neurological or genetic) for every case of the disorder in the category? Or is it appropriate to categorize a disorder as an addiction if the symptoms of and diagnostic criteria for it are sufficiently similar to those of other disorders also classified as addictions—regardless of whether there is some underlying physical basis common to each case of the (...) disorder? The question concerns the scope and validity of the scientific concept of addiction and, more broadly, what is required for a psychological concept to count as scientific. The case of pathological gambling (PG) raises this question nicely. ‘‘Should pathological gambling be considered an addiction?’’ asks Howard Shaffer (2003, 176). He specifies the question further (2003, 177–178): ‘‘When clinicians and scientists identify a behavior pattern as an addiction, even if they can identify it reliably according to DSM criteria, how do they know that it is indeed an addiction?’’ He warns that, as it stands, ‘‘the concept of addiction represents a troublesome tautology’’ (2003, 178): a subject S is addicted if and only if S engages in repetitive behavior with negative consequences against S’s better judgment. The problem with this concept is that it provides no way to distinguish behavior that cannot be controlled from behavior that is merely in fact not controlled. This ‘‘lay’’ concept is of little scientific value, Shaffer (2003, 179) argues, saying that ‘‘for addiction to emerge as a viable scientific construct . . . investigators need to establish a ‘gold standard’ against which the presence or absence of the disorder can be judged.’’ PG has no such gold standard, says Shaffer. What would such a gold standard be? Shaffer suggests ‘‘neurogenetic or biobehavioral attributes’’ (ibid.).. (shrink)

This commentary discusses the logic of inferring modularity or the lack of modularity from observed patterns of developmental disorders.

Rose seems to be arguing against an extreme ultra-Darwinism that probably has no adherents. He incorrectly argues that a number of psychological traits are very difficult to measure. This is not the case. Rose argues that intelligence has no biological correlates. In fact, it is correlated with brain size, EEG evoked potentials, and cerebral glucose uptake during problem solving. Data that Rose should be aware of are omitted when they do not fit the case he is trying to make.

“Identity disorders” constitute a large class of psychiatric disturbances that, due to deviant forms of self-modeling, result in dramatic changes in the patients’ phenomenal experience of their own personal identity. The phenomenal experience of selfhood and transtemporal identity can vary along an extremely large number of dimensions: There are simple losses of content (for example, complete losses of proprioception, resulting in a “bodiless” state of self-consciousness, see Cole 1995, Gallagher and Cole 1995, Sacks 1998). There are also various typologies of (...) phenomenal disintegration as in schizophrenia, in depersonalization disorders and in_ Dissociative Identity Disorder_ (DID), sometimes accompanied by multiplications of the phenomenal self within one and the same physical system. It is important to not only analyze these state-classes in terms of functional deficits or phenomenology alone, but as _self-representational _content as well. For instance, in the second type of cases just mentioned, we confront major redistributions of the phenomenal property of "mineness” in representational space, of what is sometimes also called the “sense of ownership”. Finally, there are at least four different delusions of misidentification (DM1; namely Capgras syndrome, Frégoli syndrome, intermetamorphosis, reverse intermetamorphosis and reduplicative paramnesia). Being a philosopher, I will discuss two particular types of identity disorder

2

in this contribution - disorders, which are of direct philosophical relevance: A specific form of DM, and the Cotard delusion. Why should philosophers do this? And why should psychiatrists care? (shrink)

Wegner’s argument on the illusory nature of conscious will, as developed in The Illusion of Conscious Will ( 2002 ) and other publications, has had major impact. Based on empirical data, he develops a theory of apparent mental causation in order to explain the occurrence of the illusion of conscious will. Part of the evidence for his argument is derived from a specific interpretation of the phenomenon of auditory verbal hallucinations as they may occur in schizophrenia. The aim of this (...) paper is to evaluate the validity of the evidence on auditory verbal hallucinations as employed by Wegner. I conclude that auditory hallucinations do not provide solid evidence for Wegner’s theory. Moreover, the phenomena in schizophrenia provide, in fact, an argument against part of Wegner’s theory of apparent mental causation. (shrink)

Now that consciousness is thoroughly out of the way, we can focus more precisely on the kinds of things that can happen underneath. A contrast can be made between dissociation and repression. Dissociation is where a memory record or set of autobiographical memory records cannot be retrieved; repression is where there is retrieval of a record but, because of the current task specification, the contents of the record, though entering into current processing, are not allowed into consciousness. I look at (...) hypnotic amnesia and dissociative identity disorder in relation to this contrast. (shrink)

This paper seeks to demonstrate the structural difference in communication of schizophrenia and autism. For a normal adult, spontaneous communication is nothing but the transmission of phantasía (thought) by means of perceptual objects or language. This transmission is first observed in a make-believe play of child. Husserl named this function perceptual phantasía, and this function presupposes as its basis the internalized affection of contact (which functions empirically in eye contact, body contact, or voice calling me). Regarding autism, because of the (...) innate lack of affection of contact, intersubjective perceptual phantasía does not occur spontaneously. Consequently, autistics do not engage in make-believe play but in stereotyped and solipsistic play. Without the formation of perceptual phantasía, there is no differentiation between phantasía and perception. For this reason, people with Asperger's syndrome consider conversation not an immediate communication of thought but a logical transmission of concepts. Schizophrenia is characterized by a distortion in the internalized affection of contact, resulting in a disturbance of perceptual phantasía, and this later is covered by various symptoms—for example, delusion as a pathological kind of communication of thought. This delusion is based on the pathological internalized affection of contact represented by a terrifying Other. (shrink)

Philosophical Psychology, Volume 0, Issue 0, Page 1-4, Ahead of Print.

I was delighted to be asked to comment on Peter Zachar’s paper, partly because he presents an elegant proposal for how personality disorders (PD) might be considered to fit into a broadly medical conception of disorder, but also because the overlap between moral and clinical elements of disorder, and more broadly moral and clinical psychiatric kinds, seems to me to be a question central to the theory and practice of psychiatry. The moral context of diagnosis and treatment is a question (...) not just in the PD field (Pearce and Pickard 2009, 2010). The fact that over half of prisoners in the United Kingdom have a PD and a similar number can be diagnosed with a neurotic disorder (Singleton, Meltzer, and Gatward 1998) .. (shrink)

A midbrain neural basis for the perceptualoscillations of binocular rivalry is suggestedon the basis of fMRI studies of rivalry andinferences from the properties of rivalry thatcannot be explained from the known propertiesof primary visual cortical (V1) neurons. Therivalry switch is proposed to activatehomologous areas of each cerebral hemispherealternately, by means of a bistable oscillatorcircuit that straddles the midline of theventral tegmentum. This bistable oscillatoroperates at the same slow rate that ischaracteristic of perceptual rivalryalternations. Whilst attempting to divert thepresent preoccupation with (...) cortical mechanismsfor rivalry, the new proposal integrates manycortical areas, in keeping with recent evidencethat binocular rivalry involves widespreadareas of the hemispheres. By linking rivalry tointerhemispheric switching mechanisms in thisway, the new proposal for the switch makes theprediction that binocular rivalry will besubject to high level influences such as moodand motivation. These predictions are beingfulfilled, with rivalry playing an increasingrole in the diagnosis and understanding if mooddisorders, schizophrenia and other psychiatricconditions. (shrink)

The DSM-IV-TR (American Psychiatric Association 1994, 689) defines personality disorder (PD) as: An enduring pattern of experience and behavior that deviates markedly from the expectations of an individual’s culture. This pattern is manifested in two (or more) of the following areas: 1 Cognition (i.e., ways of perceiving and interpreting self, other people, and events); 2 Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response); 3 Interpersonal functioning; and 4 Impulse control. B The enduring ..

Aspects of Northoff's argument lend themselves to the ongoing investigation of localizing the self in the brain. Recent data from the fields of neuropsychology and cognitive neuroscience provide evidence that the right hemisphere is a candidate for localization of self. The data on catatonia further that proposition and add insight into the continuing investigation of self in the brain across sensory and motor domains.

Wittgenstein once remarked: ?nobody can truthfully say of himself that he is filth. Because if I do say it, though it can be true in a sense, this is not a truth by which I myself can be penetrated: otherwise I should either have to go mad or change myself.? This has an immediate corollary, previously unnoted: that it may be true that someone is simply filth?a rotten person through and through?and also true that they don?t believe that they are (...) filth (or, in a certain sense, that they do), but that it is absurd or means nothing to say ?I?m filth.? Even considering the possibility seriously already prevents it from being true of one that one is (simply) filth. You just can't say ?I'm filth? and mean it. In the act of saying it, it is already untrue. Nor can you even say and mean it: ?it may be true that I?m filth,? and it still be true that you are filth. This paper considers cases of delusional belief and of depressive self-loathing in which people may find themselves believing things along the lines of ?I?m filth.? (shrink)

Georg Northoff encounters a problem regarding the logical status of “catatonia.” Whereas Parkinson's disease (PD) is a disease on the basis of Virchowian criteria, catatonia is not. PD is associated with pathognomonic neurological lesions. Catatonia does not require any such association. The diagnosis is rendered using social criteria rather than neuropathological ones. Therefore, Northoff is not comparing two disease states at all.

DSM-III and its revisions have provided little in the way of explicit historical or philosophical foundations. The logical empiricism embedded in its operational criteria and its external approach to validation are inadequate to account for the presumption of nosological regularities or the specific categories endorsed by the taxonomy. The nosologic operation that Jaspers referred to as the "synthesis of disease entities" is explored in connection with the central distinction in DSM-IV between mood disorders and schizophrenic disorders. This synthetic operation is (...) analyzed in terms of the paradigmatic shift from the mania-melancholia matrix of pre-modern psychiatry to the manic-depression/dementia praecox model defined by the work of Kraepelin. In the context of this analysis the self-evidence of these regularities is questioned. Keywords: DSM-III, DSM-IV, mood disorders, nosology, schizophrenic disorders CiteULike Connotea Del.icio.us What's this? (shrink)

People with personality disorders should be treated fairly. Potential crime victims should be protected. That much is uncontroversial. The hard questions ask what is fair, when is protection adequate, and how should we achieve fairness and protection together. Peay outlines five main hurdles that the law must jump to reach these goals. All five raise serious challenges. To begin to address these challenges, we must first clarify what a personality disorder is. The notion of a personality disorder is defined very (...) broadly in DSM-IV-TR as any inflexible, pervasive, enduring, stable, and early-onset pattern of experience and behavior that deviates markedly from cultural expectations, leads to clinically .. (shrink)

The present article undertakes a psychological reading of The Child's Conception of the World as a cultural artifact in which genetic psychology's naturalistic and positivistic assumptions reflect an Enlightenment model of science, and Piaget figures as an agent of technological rationality. A phenomenological analysis of the text reveals how Piaget's research engages in an active repression of specific dimensions of childhood experience. Young children's 'adualistic' conceptions of thought, self and language are deemed 'confused', and thereby discounted, by virtue of the (...) fact such children do not 'correctly' dichotomize experience in accord with the cultural norm of mechanistic rationality. Piaget's numerous associations of the child's 'primitive' views and the (childish) thought of the pre-Socratics are briefly explored. (shrink)

The feuding factions of the memory wars, that is, those concerned with the validity of recovered memories versus those concerned with false memories, are unified by Erdelyi's theory of repression. Evidence shows suppression, inhibition, and retrieval blocking can have profound yet reversible effects on a memory's accessibility, and deserve as prominent a role in the recovered memory debate as evidence of false memories. Erdelyi's theory shows that both inhibitory and elaborative processes cooperate to keep unwanted memories out of consciousness.

The paper argues that a functional reduction of ordinary psychology to neuropsychology is possible by means of constructing fine-grained functional, mental sub-types that are coextensive with neuropsychological types. We establish this claim by means of considering as examples the cases of the disconnection syndrome and schizophrenia. We point out that the result is a conservative reduction, vindicating the scientific quality of the mental types of ordinary psychology by systematically linking them with neuroscience. That procedure of conservative reduction by means of (...) functional sub-types is in principle repeatable down to molecular neuroscience. (shrink)

Many of Rose's criticisms of determinism in biology have clear relevance to modern cognitive and psychiatric science; too narrow a focus on the brain as an information processing machine runs the risk of neglecting the context in which information processing takes place, and too narrow a focus on the neuroscience of psychopathology runs the risk of neglecting other levels of explanation for these phenomena. It should be emphasized, however, that animal and genetic studies of phenomena of interest to cognitive and (...) psychiatric science (e.g., Alzheimer's disorder, schizophrenia, attention deficit/hyperactivity disorder, and violence), while perhaps only providing a partial perspective, may be useful in understanding these phenomena and in leading to appropriate psychiatric interventions. (shrink)

Tyreman and Loughlin make many varied and interesting comments, but neither, it is encouraging to find, is prepared to defend the psychogenic inference. Indeed, Loughlin finds the paper “somewhat shocking.” “The psychogenic inference,” Loughlin writes, “seems such an obvious fallacy, yet he [Sykes] shows, with detailed reference to both diagnostic practice and the literature on mental disorders, the extraordinary pervasiveness of its influence, extending even to the systematic ambiguities built into key diagnostic terms” (2010, 305). The main points of disagreement (...) are Tyreman’s defense of the term functional in certain contexts and Loughlin’s criticism of the claim that there has been a paradigm shift .. (shrink)

The Paper Begins by introducing the Siren “psychogenic inference”. It then deals with the impact of this inference on the navigation of medical and psychiatric seafarers. The next two parts are more theoretical; the first deals with the entrenchment of the psychogenic inference in some central terms used in discussing medically unexplained symptoms (MUS). The second uncovers the damaging influence of the psychogenic inference on the navigational charts—on the somatoform disorder sections of the two major classifications used internationally, namely the (...) Diagnostic and Statistical Manual, 4th edition Text revision (DSM-IV-TR; American Psychiatric Association [APA] 1994), produced by the APA and of the International .. (shrink)

This paper explores how the diagnosis of mental disorder may affect the diagnosed subject’s self-concept by supplying an account that emphasizes the influence of autobiographical and social narratives on self-understanding. It focuses primarily on the diagnoses made according to the criteria provided by the Diagnostic Statistical Manual of Mental Disorders (DSM), and suggests that the DSM diagnosis may function as a source of narrative that affects the subject’s self-concept. Engaging in this analysis by appealing to autobiographies and memoirs written by (...) people diagnosed with mental disorder, the paper concludes that a DSM diagnosis is a double-edged sword for self- concept. On the one hand, it sets the subject’s experience in an established classificatory system which can facilitate self-understanding by providing insight into subject’s condition and guiding her personal growth, as well as treatment and recovery. In this sense, the DSM diagnosis may have positive repercussions on self-development. On the other hand, however, given the DSM’s symptom-based approach and its adoption of the Biomedical Disease model, a diagnosis may force the subject to make sense of her condition divorced from other elements in her life that may be affecting her mental- health. It may lead her frame her experience only as an irreversible imbalance. This form of self-understanding may set limits on the subject’s hopes of recovery and may create impediments to her flourishing. (shrink)

In “Mad Narratives: Self-Constitutions Through the Diagnostic Looking Glass,” by using narrative approaches to the self, I explore how the diagnosis of mental disorder shapes personal identities and influences flourishing. My particular focus is the diagnosis grounded on the criteria provided by the Diagnostic Statistical Manual of Mental Disorders (DSM). I develop two connected accounts pertaining to the self and mental disorder. I use the memoirs and personal stories written by the subjects with a DSM diagnosis as illustrations to bolster (...) my claims. First, expanding on the narrative approaches to the self, I explain how narratives about a subject shape her self-constitution. I elucidate how this process is generated by drawing on research in developmental psychology, cognitive science, and social psychology. Next, using this account as a springboard, I argue that the DSM diagnosis of mental disorder serves as a source of narrative, entering into the patients’ autobiographical and social narratives. This plays an important role in the diagnosed subjects’ self-understanding, self-constitution and flourishing. In this vein, how mental disorders are classified is not only a theoretical question about accurately taxonomizing the various experiences related to mental distress but also an ethical question about which ways of talking about mental disorders will allow subjects to respond effectively to their psychological distress, to flourish and to live autonomous and fulfilling lives. Finally, I suggest that the DSM-based narratives wield a double-edged sword when it comes to the subject’s flourishing: On the one hand, there are problems with some DSM-based narratives that stem from the DSM diagnostic schema and the culture of DSM diagnoses. These problems render these DSM-based narratives unbeneficial for flourishing as they constrain the range of adoptive social, cognitive and emotional responses the subjects can give to their mental disorders. On the other hand, there are grounds to believe that some DSM-based narratives help subjects to flourish. For instance, they provide certainty to subjects' otherwise puzzling symptoms and help them reach out to others with similar experiences. Understanding how the DSM-based narratives can both benefit and harm will help us address problems with psychiatric diagnoses and the dissemination of knowledge about mental disorders in popular culture. The project aims to convince both philosophers and psychiatrists that no plausible theory of the self can be developed without attending to the topic of mental disorder and that no theory of mental disorder can be complete without devising the tools provided by the philosophical approaches to the self as well as developmental and social psychology. It also calls for methodological alterations in mental health ethics research, arguing that a careful scrutiny of mental disorder memoirs can advance the ethical underpinnings to the practice of psychiatry. (shrink)

Using connectionist modelling, Thomas & Karmiloff-Smith (T&K-S) claim that developmental disorders in children are characterised by atypical trajectories and an ultimate functional architecture that is fundamentally different from normal. We argue that there is no empirical evidence for these claims in any developmental disorder and that the available evidence provides support for Residual Normality in both developmental and acquired disorders. We also refute the claim that modular accounts cannot encompass developmental trajectories in children with developmental disorders.

This dissertation examines psychiatry from a philosophy of science perspective, focusing on issues of realism and classification. Questions addressed in the dissertation include: What evidence is there for the reality of mental disorders? Are any mental disorders natural kinds? When are disease explanations of abnormality warranted? How should mental disorders be classified? -/- In addressing issues concerning the reality of mental disorders, I draw on the accounts of realism defended by Ian Hacking and William Wimsatt, arguing that biological research on (...) mental disorders supports the inference that some mental disorders (e.g., schizophrenia, mood disorders, and anxiety disorders) are real theoretical entities, and that the evidence supporting this inference is causal and abductive. In explicating the nature of such entities, I argue that real mental disorders are natural kinds insofar as they are natural classes of abnormal behavior whose members share the same causal structure. I present this position in terms of Richard Boyd’s homeostatic cluster property theory of natural kinds, and argue that this perspective reveals limitations of Hacking’s account on the looping effects of human kinds, which suggests that the objects classified by psychiatrists are unstable entities. I subsequently argue that a subset of mental disorders (e.g., schizophrenia and Down syndrome) are mental illnesses insofar as they are disorders caused by a dysfunctional biological process that leads to harmful consequences for individuals. I present this analysis against Thomas Szasz’s argument that mental illness is a myth. -/- In addressing issues of psychiatric classification, my analysis focuses on the Diagnostic and Statistical Manual of Mental Disorders (DSM), which has been published regularly by the American Psychiatric Association since 1952, and is currently in its fourth edition. After examining the history of DSM in the twentieth century, and in particular, DSM’s shift to an atheoretical and purely descriptive system in the 1980s, I consider the relative merits of descriptive versus causal systems of classification. Drawing on Carl Hempel’s analysis of taxonomic systems in psychiatry, I argue that a causal classification system would provide a superior approach to psychiatric classification than the descriptive system currently favored by DSM. (shrink)

Richard sykes’s paper on medically unexplained symptoms (MUS) and its criticism of the inference that they must therefore be psychogenic makes a valuable contribution to the debate around issues of terminology in diagnosis and medical explanation. I would like to broaden the debate by suggesting that looking more explicitly at the context in which terms are used can enhance both clarity and honesty, which is Sykes’s main objective. In doing this, however, I want to defend the use of the term (...) “functional” in some contexts, and also to challenge the inference that physical and mental are antonyms. The loss of the term “functional” in a diagnostic context would, I believe, be a mistake. There is not time .. (shrink)

I propose a neuroscience and animat research-inspired model and a thought experiment to test the hypothesis of a developmental relation between fluid and crystallized intelligence. I propose that crystallized intelligence is the result of well-defined activities and structures, whereas fluid intelligence is the physiological catalytic adaptation mechanism responsible for coordinating and regulating the crystallized structures. We can design experiments to reproduce exemplified normal and anomalous phenomena, especially disorders, and study possible cognitive treatments. (Published Online April 5 2006).

A systemic phenomenological model that assumes the movability of the Cartesian cut is proposed and elucidated by means of a single exploratory case study. The model assumes that a continuum from purely psychosomatic disorders to RSPK cases exists. The degree of externalization (locus of control) of the affected person serves as an ordering parameter for the location of the Cartesian cut. It turns out that the dynamics of the disorder develops in four phases, like in the RSPK-model of the MPI. (...) However, in contrast to the decline phase of the RSPK cases (because of the NT-axiom), CER cases lead to petrification of the complaints. (shrink)

When i was in graduate school, I inadvertently walked in on a fellow student taking his comprehensive exams. He was extremely frustrated because two of the questions asked about conceptual issues in personality and personality disorders. This student was not expecting such questions and considered them to be unfair. I knew other students in that same program who would have considered it a gift to get such “interesting” questions. Those clinical and counseling psychologists with theoretical–philosophical interests are often attracted to (...) the topics of personality and personality disorders. It has, therefore, puzzled me why these same topics are largely ignored by those philosophers who study the conceptual issues of .. (shrink)

In the sociopolitical domain, psychiatry runs the risk of excusing immoral behavior by claiming it is ‘disordered’ and, conversely, of assigning moral blame to what are more properly considered illnesses (O’Malley 2004; Wiseman 1961). This debate is often played out in terms of the relationship between psychotic states and crimes such as murder. Examples include debates about whether Andrea Yates should have been executed for filicide. A similar controversy would have likely emerged had Seung-Hui Cho lived after committing mass murder (...) at Virginia Tech University. A longstanding problem in psychiatry, questions of whether certain people are mad or bad continue to haunt the field. In 1994, Susan Smith of .. (shrink)

We are thankful for the opportunity to reflect more on the difficult problem of the relationship between moral evaluations and the construct of personality disorders in response to the commentaries by Mike Martin and Louis Charland. We begin by emphasizing to readers that this important problem is complicated by the different perspectives of the various disciplines involved, especially, philosophy, psychiatry, and psychology. Incredulity, anger, and dismay are among the reactions we encountered in discussions of these issues, especially with some mental (...) health professionals. Strong reactions on either side of a disciplinary divide occasionally present barriers to a dispassionate discussion of the topic. .. (shrink)