In Italy, a judge reduced the sentence of a defendant by 1 year in response to evidence for a genetic predisposition to violence. The best characterized of these genetic differences, those in the monoamine oxidase A (MAOA), were cited as especially relevant. Several months previously in the USA, MAOA data contributed to a jury reducing charges from 1st degree murder (a capital offence) to voluntary manslaughter. Is there a rational basis for this type of use of MAOA evidence in criminal (...) court? This paper will review in context recent work on the MAOA gene–environment interaction in predisposing individuals to violence and address the relevance of such findings to murder trials. Interestingly, the MAOA genetic variants impact future violence and aggression only when combined with the adverse environmental stimuli of childhood maltreatment. Thus nature and nurture interact to determine the individual’s risk. Based on current evidence, I argue there is a weak case for mitigation. But should future experiments confirm the hypothesis that individual differences in impulse control and response to provocation found in MAOA-L men (without abuse) are significantly magnified when combined with childhood maltreatment, the case could turn into a stronger one. (shrink)

The commentators provide a wealth of additional neurobiological data that ought to be integrated in a comprehensive model. This response article, however, focuses on clarification of conceptual queries, thereby outlining the proposed theory of hallucinations more sharply, discussing its relationship with schizophrenia, and explaining why underconstrained thalamocortical activation may well be a candidate mechanism responsible for acute schizophrenic symptoms other than hallucinations.

In this paper I wish to address the question of the nature of psychopathology. It might naturally be felt that we already know a great deal about psychopathology, and thus that such a paper would be primarily a review and discussion of the literature; I will argue, however, that the most fundamental form of the question concerning the nature of psychopathology is rarely posed in the literature, that it is prevented from being posed by presuppositions inherent in standard theoretical approaches, (...) and that, on those rare occasions when it does get addressed, it has received inadequate answers. Therefore, the paper will have more of the character of a conceptual explication and theoretical exegesis than it will of a review of the literature. (shrink)

Psychopathy is a developmental disorder associated with specific forms of emotional dysfunction and an increased risk for both frustration-based reactive aggression and goal-directed instrumental antisocial behavior. While the full behavioral manifestation of the disorder is under considerable social influence, the basis of this disorder appears to be genetic. At the neural level, individuals with psychopathy show atypical responding within the amygdala and ventromedial prefrontal cortex (vmPFC). Moreover, the roles of the amygdala in stimulus-reinforcement learning and responding to emotional expressions and (...) vmPFC in the representation of reinforcement expectancies are compromised. The implications of these functional impairments for responsibility are discussed. (shrink)

Criminal offenders may be offered to participate in voluntary rehabilitation programs aiming at correcting undesirable behaviour, as a condition of early release. Behavioural treatment may include direct intervention into the central nervous system (CNS). This article discusses under which circumstances voluntary rehabilitation by CNS intervention is justified. It is argued that although the context of voluntary rehabilitation is a coercive circumstance, consent may still be effective, in the sense that it can meet formal criteria for informed consent. Further, for a (...) consent to be normatively valid ( take the wronging out of the act ) under a coercive circumstance, the subject to be treated must (1) have the sovereign authority to consent, and (2) the offer-giver must be in the right normative position to make the offer. While I argue that subjects do have the sovereign authority to consent to treatment, I also argue that inappropriate offers yield invalid consents. Considerations on inappropriate offers should therefore inform which kinds of CNS intervention-based rehabilitation schemes the state may propose as part of the criminal justice system. Yet as I conclude in this paper, while there are some intrinsic constraints on voluntary rehabilitation programs, the main constraints on voluntary rehabilitation are likely to be contingent overriders. However, CNS intervention is not ruled out as such in the context of voluntary rehabilitation. (shrink)

The determinative issue in applying the insanity defense is whether the defendant experienced a legally relevant functional impairment at the time of the offense. Categorical exclusion of personality disorders from the definition of mental disease is clinically and morally arbitrary because it may lead to unfair conviction of a defendant with a personality disorder who actually experienced severe, legally relevant impairments at the time of the crime. There is no need to consider such a drastic approach in most states and (...) in the federal courts, where the sole test of insanity is whether the defendant was “unable to appreciate the wrongfulness of his conduct at the time of the offense.” This is because the only symptoms that are legally relevant in such jurisdictions are those that impair reality-testing and thereby affect the person's capacity to understand the nature and consequences of her actions. However, if the test of insanity includes a “volitional prong” (inability to control one's behavior), some way must be found to limit the scope of the defense to the core cases (involving psychotic conditions) to which it has traditionally been applied, and to prevent a shift toward a deterministic account of criminal conduct — i.e., “people can't help being who they are and doing what they do.” The best way of accomplishing this is to limit the definition of mental disease to severe disorders characterized by gross disturbances of the person's capacity to understand reality. (shrink)

Philosophers are interested in the phenomenon of thought insertion because it challenges the common assumption that one can ascribe to oneself the thoughts that one can access first-personally. In the standard philosophical analysis of thought insertion, the subject owns the ‘inserted’ thought but lacks a sense of agency towards it. In this paper we want to provide an alternative analysis of the condition, according to which subjects typically lack both ownership and authorship of the ‘inserted’ thoughts. We argue that by (...) appealing to a failure of ownership and authorship we can describe more accurately the phenomenology of thought insertion, and distinguish it from that of non-delusional beliefs that have not been deliberated about, and of other delusions of passivity. We can also start developing a more psychologically realistic account of the relation between intentionality, rationality and self knowledge in normal and abnormal cognition. (shrink)

This paper offers an epistemological discussion of self-validating belief systems and the recurrence of ?epistemic defense mechanisms? and ?immunizing strategies? across widely different domains of knowledge. We challenge the idea that typical ?weird? belief systems are inherently fragile, and we argue that, instead, they exhibit a surprising degree of resilience in the face of adverse evidence and criticism. Borrowing from the psychological research on belief perseverance, rationalization and motivated reasoning, we argue that the human mind is particularly susceptible to belief (...) systems that are structurally self-validating. On this cognitive-psychological basis, we construct an epidemiology of beliefs, arguing that the apparent convenience of escape clauses and other defensive ?tactics? used by believers may well derive not from conscious deliberation on their part, but from more subtle mechanisms of cultural selection. (shrink)

Neuroscience has long had an impact on the field of psychiatry, and over the last two decades, with the advent of cognitive neuroscience and functional neuroimaging, that influence has been most pronounced. However, many question whether psychopathology can be understood by relying on neuroscience alone, and highlight some of the perceived limits to the way in which neuroscience informs psychiatry. Psychiatry as Cognitive Neuroscience is a philosophical analysis of the role of neuroscience in the study of psychopathology. The book examines (...) numerous cognitive neuroscientific methods, such as neuroimaging and the use of neuropsychological models, in the context of a variety of psychiatric disorders, including depression, schizophrenia, dependence syndrome, and personality disorders. Psychiatry as Cognitive Neuroscience includes chapters on the nature of psychiatry as a science; the compatibility of the accounts of mental illness derived from neuroscience, information-processing, and folk psychology; the nature of mental illness; the impact of methods such as fMRI, neuropsychology, and neurochemistry, on psychiatry; the relationship between phenomenological accounts of mental illness and those provided by naturalistic explanations; the status of delusions and the continuity between delusions and ordinary beliefs; the interplay between clinical and empirical findings in psychopathology and issues in moral psychology and ethics. With contributions from world class experts in philosophy and cognitive science, this book will be essential reading for those who have an interest in the importance and the limitations of cognitive neuroscience as an aid to understanding mental illness. (shrink)

It is far too early to say what global impact the neurocognitive and neuropsychiatric sciences will have on our intuitions about moral responsibility. And it is far too early to say whether the notion of moral responsibility will survive this impact (and if so, in what form). But it is certainly worth starting to think about the local impact that these sciences can or should have on some of our distinctions and criteria. It might be possible to use some of (...) the tools offered by these sciences in order to refine or revise some of the categories currently used, without – for the time being at least – worrying too much about the fate of the notion of moral responsibility. This is an area where a piecemeal approach might be more productive: only after an evaluation of many distinct cases and situations it will be possible to say something general about the current notion of moral responsibility. In this article, we will focus on a single clinical case: a young man who has been convicted for assault on a neighbour and whose sentence was affected by a pre-existing diagnosis of mental illness. We will use this case, and an analysis of the similarities and differences between this case and other possible cases, in order to raise some (local but important) issues about the implications that discoveries in neuropsychology and neuropsychiatry can have for the way moral responsibility is attributed to agents and, more specifically, to agents with diagnoses of mental illnesses. (shrink)

Keller & Miller (K&M) propose that many psychiatric disorders are best explained in terms of a genetic watershed model. This view challenges traditional evolutionary accounts of psychiatric disorders, many of which have tried to argue in support of a presumed balanced polymorphism, implying some hidden adaptive advantage of the alleles predisposing people to psychiatric disorders. Does this mean that evolutionary ideas are no longer viable to explain psychiatric disorders? The answer is no. However, K&M's critical evaluation supports the view that (...) psychiatric disorders are not categorically distinct from normalcy, and that evolutionary psychopathology should be grounded in rigorous empirical testing. (Published Online November 9 2006). (shrink)

Neuroscience has substantially advanced the understanding of how changes in brain biochemistry contribute to mechanisms of tolerance and physical dependence via exposure to addictive drugs. Many scientists and mental health advocates scaffold this emerging knowledge by adding the imprimatur of disease, arguing that conceptualizing addiction as a brain disease will reduce stigma amongst the folk. Promoting a brain disease concept is grounded in beneficent and utilitarian thinking: the language makes room for individuals living with addiction to receive the same level (...) of compassion and access to healthcare services as individuals living with other medical diseases, and promotes enlightened social and legal policies. However such claims may yield unintended consequences by fostering discrimination commonly associated with pathology. Specifically, the language of neuroscience used to describe addiction may reduce attitudes such as blame and responsibility while inadvertently identifying addicted persons as neurobiological others. In this paper, we examine the merits and limitations of adopting the language of neuroscience to describe addiction. We argue that the reframing of addiction in the language of neuroscience provides benefits such as the creation of empowered biosocial communities, but also creates a new set of risks, as descriptive neuroscience concepts are inseparable from historical attitudes and intuitions towards addiction and addicted persons. In particular, placing emphasis on the diseased brain may foster unintended harm by paradoxically increasing social distance towards the vulnerable group the term is intended to benefit. (shrink)

I defend the case for an evolutionary theory of schizophrenia and the social brain, arguing that such an exercise necessitates a broader methodology than that familiar to neuroscience. I propose a reworked evolutionary genetic model of schizophrenia, drawing on insights from commentators, buttressing my claim that psychosis is a costly consequence of sophisticated social cognition in humans. Expanded models of social brain anatomy and the spectrum of psychopathologies are presented in terms of upper and lower social brain and top-down and (...) bottom-up processes. Finally, I argue that cerebral asymmetry evolved as an emergent property of primary intrahemispheric reorganisation in hominoids. (shrink)

The idea that certain mental phenomena (e.g. emotions, depression, anxiety) can represent risk factors for certain somatic diseases runs through common thinking on the subject and through a large part of biomedical science. This idea still lies at the focus of the research tradition in psychosomatic medicine and in certain interdisciplinary approaches that followed it, such as psychoneuroimmunology. Nevertheless, the inclusion in the scientific literature of specifically mental phenomena in the list of risk factors pertaining to a specific pathological condition (...) would seem, to say the least, problematic when not completely absent, unlike what happens for certain behavioural factors, such as smoking, sedentary life, and alcohol abuse. It is also significant that insurance companies and health and welfare services do not pay for interventions and treatment for states of anxiety, disorders of mood and of the personality, alexithymia and stress reduction, as means of prevention or treatment of somatic diseases, as instead they do for the treatment of tobacco addiction. However, as I shall endeavour to argue here, there are numerous and well grounded reasons why this different consideration of psychic conditions compared with behaviours is valid and must be maintained in the evaluation of pathogenetic risk factors. (shrink)

There is growing evidence that dopamine replacement therapy (DRT) used to treat Parkinson’s Disease can cause compulsive behaviours and impulse control disorders (ICDs), such as pathological gambling, compulsive buying and hypersexuality. Like more familiar drug-based forms of addiction, these iatrogenic disorders can cause significant harm and distress for sufferers and their families. In some cases, people treated with DRT have lost their homes and businesses, or have been prosecuted for criminal sexual behaviours. In this article we first examine the evidence (...) that these disorders are caused by DRT. If it is accepted that DRT cause compulsive or addictive behaviours in a significant minority of individuals, then the following ethical and clinical questions arise: Under what circumstances is it ethical to prescribe a medication that may induce harmful compulsive behaviours? Are individuals treated with DRT morally responsible and hence culpable for harmful or criminal behaviour related to their medication? We conclude with some observations of the relevance of DRT-induced ICDs for our understanding of addiction and identify some promising directions for future research and ethical analysis. (shrink)

Evidence for a dysfunction in cognitive coordination in schizophrenia is emerging, but it is not specific enough to prove (or disprove) this long-standing hypothesis. Many aspects of the external world are spatially mapped in the brain. A comprehensive internal representation relies on integration of information across space. Focus on spatial integration in the perceptual and cognitive processes will generate empirical data that shed light on the pathophysiology of schizophrenia.

Blackwell, 2000 Review by George Graham, Ph.D on Oct 27th 2000 Volume: 4, Number: 43.

who are unrecognizable because they are in disguise. ¼ The person I see in the mirror is not really me. ¼ A person I knew who died is nevertheless in the hospital ward today. ¼ This arm [the speaker’s left arm] is not mine it is yours; you have..

George Engel’s biopsychosocial model was associated with the critique of biomedical dogmatism and acknowledged the historical precedence of the work of Adolf Meyer. However, the importance of Meyer’s psychobiology is not always recognized. One of the reasons may be because of his tendency to compromise with biomedical attitudes. This paper restates the Meyerian perspective, explicitly acknowledging the split between biomedical and biopsychological approaches in the origin of modern psychiatry. Our present-day understanding of this conflict is confounded by reactions to ‘anti-psychiatry.’ (...) Neo-Meyerian principles can only be reestablished by a challenge to biomedicine that accepts, as did Meyer, the inherent uncertainty of medicine and psychiatry. (shrink)

The past twenty years have seen an increase in the importance of the body in psychology, neuroscience, and philosophy of mind. This 'embodied' trend challenges the orthodox view in cognitive science in several ways: it downplays the traditional 'mind-as-computer' approach and emphasizes the role of interactions between the brain, body, and environment. In this article, I review recent work in the area of embodied cognitive science and explore the approaches each takes to the ideas of consciousness, computation and representation. Finally, (...) I look at the current relationship between orthodox cognitive science and the study of mental disorder, and consider the implications that the embodied trend could have for issues in psychopathology. (shrink)

Home Courses Selected Papers Selected Books C.V. Dreydegger.org Phil. Faculty Dept. Philosophy UC Berkeley.

The psychopathic personality disorder historically has been thought to include an insensitivity to morality. Some have thought that the psychopath's insensitivity indicates that he does not understand morality, but the relationship between the psychopath's defects and moral understanding has been unclear. We attempt to clarify this relationship, first by arguing that moral understanding is incomplete without concern for morality, and second, by showing that the psychopath demonstrates defects in frontal lobe activity which indicate impaired attention and adaptation to environmental conditions (...) which are relevant to the formation of complex intentions. We argue that these frontal lobe defects can help to explain both the psychopath's apparent insensitivity to morality and his characteristic imprudence. (shrink)

It is argued that philosophers can contribute indirectly to the cure of psychopathology by helping to resolve problems that impede the development of effective treatments. Two such problems are discussed. The first arises because different schools of therapy use conflicting criteria in evaluating therapeutic outcomes. A theory of Defective Desires is developed to deal with this problem. The second issue, which divides the field of psychotherapy, concerns the need for experiments, especially in validating claims of therapeutic efficacy. An epistemological foundation (...) is developed to support the need for experiments. (shrink)

Drawing on a conception of scientists and community members as partners in the construction of ethically responsible research practices, this article urges investigators to seek the perspectives of teenagers and parents in evaluating the personal and political costs and benefits of research on adolescent risk behaviors. Content analysis of focus group discussions involving over 100 parents and teenagers from diverse ethnic and socioeconomic backgrounds revealed community opinions regarding the scientific merit, social value, racial bias, and participant and group harms and (...) benefits associated with surveys, informant reports, intervention studies, blood sampling, and genetic research on youth problems. Participant comments highlight new directions for socially responsible research. (shrink)

This article elaborates on Putnam's ''discrete behavioral states'' model of dissociative identity disorder (Putnam, 1997) by proposing the involvement of the orbitalfrontal cortex in the development of DID and suggesting a potential neurodevelopmental mechanism responsible for the development of multiple representations of self. The proposed ''orbitalfrontal'' model integrates and elaborates on theory and research from four domains: the neurobiology of the orbitalfrontal cortex and its protective inhibitory role in the temporal organization of behavior, the development of emotion regulation, the development (...) of the self, and experience-dependent reorganizing neocortical processes. The hypothesis being proposed is that the experience-dependent maturation of the orbitalfrontal cortex in early abusive environments, characterized by discontinuity in dyadic socioaffective interactions between the infant and the caregiver, may be responsible for a pattern of lateral inhibition between conflicting subsets of self-representations which are normally integrated into a unified self. The basic idea is that the discontinuity in the early caretaking environment is manifested in the discontinuity in the organization of the developing child's self. (shrink)

We proceed to describe a model for the formation and maintenance of polythematic delusions encountered in schizophrenia, which is in adequacy with Brendan Maher's account of delusions. Polythematic delusions are considered here as the conclusions of arguments triggered by apophenia that include some very common errors of reasoning such as post hoc fallacy and confirmation bias. We describe first the structure of reasoning which leads to delusions of reference, of telepathy and of influence, by distinguishing between the primary, secondary, tertiary (...) and quaternary types of delusional arguments. These four levels of arguments correspond to a stage the nature of which is respectively instantial, inductive, interpretative at a monothematic level and interpretative at a polythematic level. We also proceed to identify accurately the fallacious steps in the corresponding reasoning. We expose then the role of apophenia in the elaboration of delusional ideas. Lastly, we describe the role played by the hallucinations in the present model. (shrink)

The paper first introduces the concept of implicit and explicit temporality, referring to time as pre-reflectively lived vs. consciously experienced. Implicit time is based on the constitutive synthesis of inner time consciousness on the one hand, and on the conative–affective dynamics of life on the other hand. Explicit time results from an interruption or negation of implicit time and unfolds itself in the dimensions of present, past and future. It is further shown that temporality, embodiment and intersubjectivity are closely connected: (...) While implicit temporality is characterised by tacit bodily functioning and by synchronisation with others, explicit temporality arises with states of desynchronisation, that is, of a retardation or acceleration of inner time in relation to external or social processes. These states often bring the body to awareness as an obstacle as well. On this basis, schizophrenia and melancholic depression are investigated as paradigm cases for a psychopathology of temporality. Major symptoms of schizophrenia such as thought disorder, thought insertion, hallucinations or passivity experiences may be regarded as manifesting a disturbance of the constitutive synthesis of time consciousness, closely connected with a weakening of the underlying pre-reflective self-awareness or ipseity. This results in a fragmentation of the intentional arc, a loss of self-coherence and the appearance of major self-disturbances. Depression, on the other hand, is mostly triggered by a desynchronisation from the social environment and further develops into an inhibition of the conative–affective dynamics of life. As will be shown, both mental illnesses bear witness of the close connection of temporality, embodiment and intersubjectivity. (shrink)

The structure of human embodiment is fundamentally characterized by a polarity or ambiguity between Leib and Körper, the subjective body and the objectified body, or between being-body and having-a-body. This ambiguity, emphasized, above all, by Helmuth Plessner and Maurice Merleau-Ponty, is also of crucial significance for psychopathology. Insofar as mental illnesses disturb or interrupt the unhindered conduct of one’s life, they also exacerbate the tension within embodiment that holds between being-body and having-a-body. In mental illnesses, there is a failure of (...) tacit mediations upon which one’s bodily being-toward-the-world is based. Instead of serving as a medium of relating to the world, the body makes .. (shrink)

Are delusions best understood as a species of belief? Can I be deluded that p without believing that p? Because delusion is a clinical symptom, there are conflicting data at every turn. Perhaps it is best to think of delusions as beliefs not because they necessarily are beliefs, but because doing so helps patients. If one thinks that “denying that delusions are beliefs” means denying deluded patients “a voice in their own treatment” and that this would cut them off from (...) alternative and healthier ways of thinking of themselves or the world, then one may wish to classify delusions as beliefs (see Kinderman and Bentall 2007, 288). I do not wish to classify delusions as beliefs (and I doubt .. (shrink)

This collection establishes the importance of this interdisciplinary approach and explores new directions in the "philosophy of psychiatry and psychology.

The aim of this contribution is to provide a few historical and conceptual insights on the question of the impact of current developments in the neurosciences on the concept of psychiatric disease. Alzheimer’s disease is a good example when considering this important question. On the one hand, Alzheimer’s disease has a somewhat ambiguous status in terms of disorders affecting the mind or the psyche. This ambiguous status is illustrated by the fact that one commonly qualifies Alzheimer’s disease as a ‘neuropsychiatric’ (...) disorder, because it cannot easily be classified as either a ‘neurological’ or ‘psychiatric’ disorder. On the other hand, the concept of Alzheimer’s disease was created at the beginning of the twentieth century, as the neurosciences were beginning to take shape themselves as scientific disciplines. To compare Alzheimer’s original ideas with current conceptions may thus help us to precisely specify current developments in the neurosciences. (shrink)

I argue that emotional sensitivity (or insensitivity) has a marked negative influence on ethical perception. Diminished capacities of ethical perception, in turn, mitigate what we are morally responsible for while lack of such capacities may altogether eradicate responsibility. Impairment in ethical perception affects responsibility by affecting either recognition of or reactivity to moral reasons. It follows that emotional insensitivity (together with its attendant impairment in ethical perception) bears saliently on moral responsibility. Since one distinguishing mark of the psychopath is emotional (...) insensitivity, emotional insensitivity and the resulting impairment in moral perception either excuses the psychopath from moral culpability or moderates the degree to which he is culpable. (shrink)

This first book-length study of confabulation breaks ground in both philosophy and cognitive science.

In this paper, I investigate in detail one theoretical approach to the symptom of thought insertion. This approach suggests that patients are lead to disown certain thoughts they are subjected to because they lack a sense of active participation in the occurrence of those thoughts. I examine one reading of this claim, according to which the patients’ anomalous experiences arise from a breakdown of cognitive mechanisms tracking the production of occurrent thoughts, before sketching an alternative reading, according to which their (...) experiences have to be explained in terms of a withdrawal, on the part of the patients themselves, from certain forms of active engagement in reasoning. I conclude with a discussion of the relationship between this view and the idea that patients’ reports of thought insertion reflect a situation in which the boundaries between the self and the world have become uncertain. (shrink)

The field of philosophical psychopathology is basically the philosophical study of mental disorders such as schizophrenia, bipolar disorder, depression, autism, as well as more specific symptoms and signs such as Capgras’ delusion (the delusion that your spouse, for example, is an impostor) or the anarchic hand sign (where your hand seems to act on its own intentions). This simple epithet covers a multitude of approaches: how can philosophy help to explain mental disorder? What does mental disorder tell us about consciousness, (...) cognition, emotion and ‘self’? What does the study of mental disorder tell us about phenomenology? What does philosophical phenomenology tell us about mental disorder? What do mental disorders tell us about reasoning, rationality and belief formation? What are the particular ethical aspects of mental disorder and its treatment? If philosophical.. (shrink)

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)

Many psychopathological disorders – clinical depression, borderline personality disorder, schizophrenia and autistic spectrum disorder (ASD) – are commonly classified as disorders of the self. In an intuitive sense this sort of classification is unproblematic. There can be no doubt that such disorders make a difference to one’s ability to form and maintain a coherent sense of oneself in various ways. However, any theoretically rigourous attempt to show that they relate to underlying problems with say, such things as minimal selves or, (...) even, so-called narrative selves – where these latter constructs are invoked to do genuine explanatory work – would require, inter alia, philosophical clarification of what it is that one is precisely committed to in talking of such things (if things they be). It would also require justification for believing in selves of these various kinds. I have elsewhere put on record some of my worries about proposed justifications for believing in minimal selves (Hutto 2008b). But – lest I be accused of favouritism – it should be noted that I also have concerns about the very idea of narrative selves. Several authors have made strong claims about the role of narratives in self constitution (e.g. Dennett 1991, Flanagan 1996, Schechtman 1996). Under standard interpretations these proposals are ambiguous, underdeveloped in key respects, embed obvious tensions or generate puzzles. For these reasons I think we should be cautious of lax talk of selves that are woven from narrative cloth. This is not to say that I agree with Strawson (2004) that adopting a narrative perspective might not be essential for being a self (or at least being a self of a certain sort – even an ethically interesting sort).1 It is rather that I think that before we get around to assessing such claims we need a better understanding of just what we are committed to in talking of selves in general. This is a major philosophical programme, and not one with which I will attempt to engage in this paper – not even in passing.. (shrink)

There continues to be a debate on whether addiction is best understood as a brain disease or a moral condition. This debate, which may influence both the stigma attached to addiction and access to treatment, is often motivated by the question of whether and to what extent we can justly hold addicted individuals responsible for their actions. In fact, there is substantial evidence for a disease model, but the disease model per se does not resolve the question of voluntary control. (...) Recent research at the intersection of neuroscience and psychology suggests that addicted individuals have substantial impairments in cognitive control of behavior, but this "loss of control" is not complete or simple. Possible mechanisms and implications are briefly reviewed. (shrink)

These are set against introductory essays describing the philosophical, historical and psychological approaches, making this a uniquely inclusive overview.

Due to the progress being made in the neurosciences, higher expectations for the use of medication, even against the patient’s will, are arising in mental hospitals. In this article, we will discuss whether the neurosciences and new psychopharmacological solutions really support patients who suffer from mental illnesses. To answer this question, we will focus on the perspective of patients and their experiences with psychiatric (coercive) treatments. The analysis of one person’s story shows that other issues besides appropriate medication are important (...) for recovery from a mental illness. In daily life, issues such as coping, rehabilitation and social support are of major importance for a patient suffering from psychiatric disease. Thus, although progress in the neurosciences is a positive development for clinical practice, it does not mean that (coercive) medication alone will carry a patient into recovery. A patient’s recovery is dependent, not only upon the process of finding the appropriate medication and trust between the psychiatrist and the patient, but also upon relational aspects, such as being recognised as a person, belonging, accepting responsibilities, developing friendships and trusting others. These findings lead to the conclusion that dealing with psychiatric diseases is more complex than what the biomedical model of neuroscience suggests and that one should include the social context of the patient in the recovery process. (shrink)

Abstract: How it is that one's own thoughts can seem to be someone else's? After noting some common missteps of other approaches to this puzzle, I develop a novel cognitive solution, drawing on and critiquing theories that understand inserted thoughts and auditory verbal hallucinations in schizophrenia as stemming from mismatches between predicted and actual sensory feedback. Considerable attention is paid to forging links between the first-person phenomenology of thought insertion and the posits (e.g. efference copy, corollary discharge) of current cognitive (...) theories. I show how deficits in the subconscious mechanisms regulating inner speech may lead to a 'fractured phenomenology' responsible for schizophrenic patients' reports of inserted thoughts and auditory verbal hallucinations. Supporting work on virtual environments is discussed, and lessons concerning the fixity of delusional belief are drawn. (shrink)

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)

George Engel designed his biopsychosocial model to be a broad framework for medicine and psychiatry. Although the model met with great initial success, it now needs conceptual attention to make it relevant for future generations. Engel articulated the model as a version of biological systems theory, but his work is better interpreted as the beginnings of a richly nuanced philosophy of medicine. We can make this reinterpretation by connecting Engel’s work with the tradition of American pragmatism. Engel initiates inquiry like (...) a pragmatist, he understands theory and philosophy like a pragmatist, he justifies beliefs like a pragmatist, and he understands the world like a pragmatist. By drawing out these similarities, medical and psychiatric scholars can revitalize the biopsychosocial model, and they can open medicine and psychiatry to a rich philosophic heritage and a flourishing interdisciplinary tradition. (shrink)

Recent developments in the field of neurosurgery, specifically those dealing with the modification of mood and affect as part of psychiatric disease, have led some researchers to discuss the ethical implications of surgery to alter personality and personal identity. As knowledge and technology advance, discussions of surgery to alter undesirable traits, or possibly the enhancement of normal traits, will play an increasingly larger role in the ethical literature. So far, identity and enhancement have yet to be explored in a neurosurgical (...) context, despite the fact that 1) neurological disease and treatment both potentially alter identity, and 2) that neurosurgeons will likely be the purveyors of future enhancement implantable technology. Here, we use interviews with neurosurgical patients to shed light on the ethical issues and challenges that surround identity and enhancement in neurosurgery. The results provide insight into how patients approach their identity prior to potentially identity-altering procedures and what future ethical challenges lay ahead for clinicians and researchers in the field of neurotherapeutics. (shrink)