In Deleuze and Guattari’s Anti-Oedipus volumes, revolution, social transformation, and the possibility of a new future are all linked to desire: minimally, to the freeing of desire from the false refuges of Oedipalization and its constructs of molar sexuality. Everywhere, they seek to uncover the potential of desire, sexuality, and love, asking us to consider that what we take to be the most personal is impersonal, how the most intimate is the collective and social. Thus, it calls us to rethink (...) our material and affective relations and reconceptualize the sphere of intimacy itself. I develop the concepts of delirium and revolutionary love, suggesting that we interpret these as perpetual processes of transformation and conjugation, initiating relations of intimacy and advocate for more nuanced, complex forms of subjectivity and to become more sensitive to the varying relational complexes within a given space. Revolutionary love gains its newness from both the extension of Deleuzian desire and from its return to several heritages of feminisms which have themselves been marginalized in the forward sweep of new materialist and posthumanist discussions. The point is to sharpen our focus on the conditions that produce certain social bodies, certain kinds of consciousness, and certain molar identities—not to deny the realities of the socius or reject subjectivity, but to move from a majoritarian to a minoritarian politics that widens our purview of what forces and desires exist within these spaces so that we may transform and build less fascistic, more attuned relational complexes. (shrink)

Why does Deleuze rely so heavily on Spinoza and Leibniz? At first glance, his critique of representation and the traditional ‘image of thought’ seems to oppose him to rationalism. However, Deleuze says that when the ‘cry of rationalism’ is pursued until the end, rationalism becomes ‘delirious’. In such a state, it undermines the model of representation. This delirium is found in Spinoza and Leibniz's critique of generality and their conflation of essence and existence, through which they ruin the traditional (...) mediation of difference by identity and generality. However, for this rationalism to completely break with representationalism it must undergo some Deleuzian corrections. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Excited DeliriumWhat’s Psychiatry Got to do With It?Paul B. Lieberman, MDIf in life we are surrounded by death, so too in the health of our intellect by madness.—WittgensteinDelirium is a medical syndrome defined as “a relatively acute decline in cognition that fluctuates over hours or days” whose primary manifestation is a deficit of attention. It is common, estimated to occur in 10% to more than 50% of hospitalized patients, (...) with higher prevalence rates among people in nursing homes and at the end of life. It is often fatal, with a mortality rate in the hospital estimated to be 25% to 33%. Caused by a wide variety of conditions and frequently difficult to diagnose, it lacks characteristic postmortem pathology (Josephson & Miller 2018)‘Excited delirium,’ as Byju and Friesen forcefully argue (Byju & Friesen, 2023), is, if nothing else, an excuse. The ‘diagnosis’ has not been empirically validated and remains controversial (American Psychiatric Association, 2020). And while delirium is usually treated by internists and emergency medicine physicians, psychiatrists should also be concerned about the misuse of a putative medical diagnosis and join actively in discussion about it. For one thing, patients mis-diagnosed with this condition, as Byju and Friesen’s examples suggest, may actually have another psychiatric condition and, so, be people for whose safety we should advocate. Moreover, the kinds of police interventions which Byju and Friesen document as involving excited delirium also befall patients with other psychiatric problems in whom the issue of delirium does not arise.There are at least two broad ways in which psychiatrists are qualified and obligated to engage with this issue. As physicians, we should join our medical colleagues in carefully but persistently telling the scientific, medical truth. As psychiatrists, we should bring psychiatric knowledge into the discussion, for example, by explaining what can happen when people who do not, apparently, have a diagnosable mental disorder interact under stress with other people who, apparently, do.Delirium is a clinical diagnosis, made when characteristic signs and symptoms are present which should not be made ‘by exclusion’ when, as may happen, other causes are not found. There is no evidence of delirium in any of the three clinical descriptions Byju and Friesen provide. Perhaps such evidence exists which is not in their brief reports, but these three people appear to have had, either, another psychiatric condition, such as psychosis or drug intoxication, or perhaps no [End Page 353] diagnosis at all. Psychiatrists are particularly wellpositioned to make this point since patients with mental health problems are often misdiagnosed when they seek medical attention and are told, and treated as if, “it’s all (“just”!) psychological.”Excited delirium, if it exists, is fatal in 10% of cases (Gonin, Beysard, Hersin, & Carron, 2018) and, although this is lower than the rate for delirium in general, it is still high. Medical personnel must be available to evaluate and ensure the safety of patients in custody.The potential conflict between protecting the patient and protecting the public should not be overstated. Although physical trauma and excessive administration of medications, including ketamine 500 mg IV (Orhurhu, Vashicht, Claus, & Cohen, 2023) can be lethal, mechanical restraint by itself is not (Chieze et al., 2019; Gleerup et al., 2019): something else is necessary, such as asphyxiation (Evans, Wood, & Lambert, 2003). Nor is restraint necessary in many cases in which ‘de-escalation’ techniques can be equally effective (Garriga et al., 2016; Fernández-Costa, 2020). Perhaps these points are best made by law enforcement leaders—and they have been—but psychiatrists can add that safe management of potential violence can be provided for agitated people with psychiatric conditions.Although it is not clear what kind of strength ‘superhuman’ strength might be (certainly not medical), relative imperviousness to pain is clinically described. Its locus classicus is Beecher’s observation, during World War II, that injured soldiers awaiting return home from the front, required lower than usual doses of analgesics (Beecher, 1946). And it’s a common experience, scientifically confirmed, that physical trauma may not become painful until sometime after the injury (Melzack, Wall, & Ty, 1982). But pain is a warning. Its absence is not a license, but a caution... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Excited DeliriumWhat’s Psychiatry Got to do With It?Paul B. Lieberman, MDIf in life we are surrounded by death, so too in the health of our intellect by madness.—WittgensteinDelirium is a medical syndrome defined as “a relatively acute decline in cognition that fluctuates over hours or days” whose primary manifestation is a deficit of attention. It is common, estimated to occur in 10% to more than 50% of hospitalized patients, (...) with higher prevalence rates among people in nursing homes and at the end of life. It is often fatal, with a mortality rate in the hospital estimated to be 25% to 33%. Caused by a wide variety of conditions and frequently difficult to diagnose, it lacks characteristic postmortem pathology (Josephson & Miller 2018)‘Excited delirium,’ as Byju and Friesen forcefully argue (Byju & Friesen, 2023), is, if nothing else, an excuse. The ‘diagnosis’ has not been empirically validated and remains controversial (American Psychiatric Association, 2020). And while delirium is usually treated by internists and emergency medicine physicians, psychiatrists should also be concerned about the misuse of a putative medical diagnosis and join actively in discussion about it. For one thing, patients mis-diagnosed with this condition, as Byju and Friesen’s examples suggest, may actually have another psychiatric condition and, so, be people for whose safety we should advocate. Moreover, the kinds of police interventions which Byju and Friesen document as involving excited delirium also befall patients with other psychiatric problems in whom the issue of delirium does not arise.There are at least two broad ways in which psychiatrists are qualified and obligated to engage with this issue. As physicians, we should join our medical colleagues in carefully but persistently telling the scientific, medical truth. As psychiatrists, we should bring psychiatric knowledge into the discussion, for example, by explaining what can happen when people who do not, apparently, have a diagnosable mental disorder interact under stress with other people who, apparently, do.Delirium is a clinical diagnosis, made when characteristic signs and symptoms are present which should not be made ‘by exclusion’ when, as may happen, other causes are not found. There is no evidence of delirium in any of the three clinical descriptions Byju and Friesen provide. Perhaps such evidence exists which is not in their brief reports, but these three people appear to have had, either, another psychiatric condition, such as psychosis or drug intoxication, or perhaps no [End Page 353] diagnosis at all. Psychiatrists are particularly wellpositioned to make this point since patients with mental health problems are often misdiagnosed when they seek medical attention and are told, and treated as if, “it’s all (“just”!) psychological.”Excited delirium, if it exists, is fatal in 10% of cases (Gonin, Beysard, Hersin, & Carron, 2018) and, although this is lower than the rate for delirium in general, it is still high. Medical personnel must be available to evaluate and ensure the safety of patients in custody.The potential conflict between protecting the patient and protecting the public should not be overstated. Although physical trauma and excessive administration of medications, including ketamine 500 mg IV (Orhurhu, Vashicht, Claus, & Cohen, 2023) can be lethal, mechanical restraint by itself is not (Chieze et al., 2019; Gleerup et al., 2019): something else is necessary, such as asphyxiation (Evans, Wood, & Lambert, 2003). Nor is restraint necessary in many cases in which ‘de-escalation’ techniques can be equally effective (Garriga et al., 2016; Fernández-Costa, 2020). Perhaps these points are best made by law enforcement leaders—and they have been—but psychiatrists can add that safe management of potential violence can be provided for agitated people with psychiatric conditions.Although it is not clear what kind of strength ‘superhuman’ strength might be (certainly not medical), relative imperviousness to pain is clinically described. Its locus classicus is Beecher’s observation, during World War II, that injured soldiers awaiting return home from the front, required lower than usual doses of analgesics (Beecher, 1946). And it’s a common experience, scientifically confirmed, that physical trauma may not become painful until sometime after the injury (Melzack, Wall, & Ty, 1982). But pain is a warning. Its absence is not a license, but a caution... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Excited DeliriumFalsifiability, Causality, and the Importance of AdvocacyArjun Byju, MD (bio) and Phoebe Friesen, PhD (bio)We want to begin by thanking both Kathryn Petrozzo and Paul B. Lieberman for taking the time to read and respond to our article, “Making Up Monsters, Redirecting Blame: An Examination of Excited Delirium,” so thoughtfully. They each offered us an opportunity to consider dimensions of excited delirium that we had not (...) encountered as of yet and encouraged us to think more carefully about them. In our response, we consider each of their commentaries in turn, given that, as a philosopher and a psychiatrist, they each speak to different aspects of our argument.First, we turn to Kathryn Petrozzo’s commentary “Excited Delirium: The Self-Fulfilling Prophecy of Police Brutality.” We are grateful for her generous comments and careful engagement with our arguments. While much of the commentary is supportive of our piece, Petrozzo makes three critical and insightful points that we hope to respond to here.The first point Petrozzo makes is that our assertion that excited delirium is non-falsifiable is not supported. She suggests that those “seeking to exonerate the police/first responders responsible for these deaths, are not accepting this evidence leading them to reject the excited delirium diagnosis, but rather, are crafting an incorrect causal narrative. This is deeply problematic, but it does not necessarily render excited delirium as nonfalsifiable.”Although we are intrigued by this challenge, we would like to hear more about what it would look like to falsify the phenomenon of excited delirium. The way that the causal theories related to it are structured are such that if one causal factor is not present (e.g., drug use), then another causal factor can be located (e.g., mental health), and if that is not found, another may be simply made up (e.g., genetic predisposition), making excited delirium multiply realizable in a seemingly endless fashion. This is precisely what took place in the case of Anthany Dawson, who was initially said to have been experiencing a mental health crisis, but was later said to have died from excited delirium related to a genetic condition never identified before (Hon, 2004; Razack, 2015). [End Page 361]In practice, confirmations of excited delirium are found on the basis of various unrelated factors, such that after a death involving police force, there is almost always the option to reach for excited delirium as an explanation/exoneration. According to proponents, there is no factor that could be present that could rule out the diagnosis of excited delirium as it is currently constructed. Indeed, even in the presence of video evidence showing police officers choking an individual until they stop breathing, these deaths are still attributed to excited delirium. This seems like a clear instance of non-falsifiability.Although Petrozzo might maintain that this is simply “an incorrect causal narrative,” it is a causal narrative that aligns with the current theoretical scaffolding surrounding excited delirium.The second point Petrozzo makes is regarding widespread criticisms of Popper’s demarcation criterion of falsifiability. Indeed, this criterion has been called too inclusive, in that any empirical claim can be called falsifiable in principle—even if it refers to a future apocalypse or a UFO landing. It has also been criticized for being too exclusive, in that it ignores the “remarkable tenacity of scientific theories,” as Lakatos puts it (2009, p. 516). In practice, scientists do not merely abandon a theory if it is not supported by facts; they tend to find other explanations (e.g., the measurement was faulty) rather than accept an instance of falsification.Despite this, we believe it is still worth discussing falsifiability in the context of excited delirium for two reasons. First, while falsifiability may not be successful as a criterion that draws a line between science and pseudoscience, in this case, we argue, it still works well as a signifier of pseudoscience. Recently, many interested in the demarcation question have turned towards pluralism as a way to identify pseudoscientific practices (Pigliucci & Boudry, 2013). And excited delirium offers an excellent example of a phenomenon that bumps up against many of the features that might indicate a pseudoscientific practice... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Excited DeliriumThe Self-Fulfilling Prophecy of Police BrutalityKathryn Petrozzo (bio)In their timely and pressing piece, Arjun Byju and Phoebe Friesen explore the contentious diagnosis of excited delirium; a syndrome characterized by erratic, aggressive, and “delusional” behavior (2023). Overwhelmingly, this term is used when individuals come in contact with police and/or first responders. Although much attention has been given to debating whether or not this is a “real” diagnosis, the (...) authors want to shift the focus to examining the work that excited delirium is doing in the world, as well as the underlying beliefs guiding it that are perpetuating substantial harm. Drawing significantly on the work of Ian Hacking (1998, 2006) and Sherene Razack (2015), Byju and Friesen explore what kinds of people are being made up by the label of “excited delirium” and the subsequent dehumanization that perpetuates violence towards those in this grouping.Despite the lack of an agreed upon definition, excited delirium tends to frequently group together young Black men and other marginalized people of color, who have a psychiatric history, and those who have taken or are suspected to have taken drugs (Byju & Friezen, 2023). As this is “observed” when individuals come into contact with law enforcement and/or first responders, those who are presumed to be suffering from excited delirium are typically met with physical restraints (chokeholds, hogties, etc.), forced injections of sedatives, and/or taser guns. The violent reactions are often justified not only by this “diagnosis,” but the employment of racial stereotypes; notably, the notion that Black bodies as being less susceptible to pain. As the authors aptly put it:This kind of symptom language helps make up the novel category of a person who suffers from excited delirium: a crazed and inhumane monster, a golem that must be met with unrelenting and superordinate force, who is fated, regardless of interventions, to die a spontaneous death. This paradox, that those with excited delirium are supposedly both too strong and too weak, is at the core of the illness narrative.(2023)It is evident that this label is reinforcing the combination of two harmful stereotypes: the notion that those suffering from severe mental illness occupy a space that is “less than fully human,” and racist stereotyping of Black bodies “superseding human strength.” This perpetuates total dehumanization of the individual, where it is then justified to invoke brutal tactics, as well as signal [End Page 357] to the greater community this is how individuals with mental illnesses and/or belonging to a particular racial group (chiefly, Black men), should be treated. This is despite the fact that those suffering from mental illnesses are significantly more likely to be victims of violent crimes, Black Americans are 3.2 times more likely to be murdered by police, and convergence of these factors (being Black and living with a mental illness) increases likelihood of such fatal interactions (Schwartz & Jahn 2020; Shadravan, Edwards, & Vinson 2021; Stuart, 2003).Although I am in wholehearted support of their account, I take issue with the authors’ conceptualization of excited delirium as non-falsifiable, as well as the notion that diseases, generally, are falsifiable. In an attempt to further criticize the utilization of excited delirium, Byju and Friesen call upon Karl Popper’s falsifiability criterion as a measure for what constitutes as scientific; arguing that excited delirium is not a legitimate scientific concept as it is impossible to falsify. First, I am not convinced that excited delirium is in principle non-falsifiable; as the way in which it’s conceptualized actually appears to be falsifiable. The authors point out that external factors, such as tasing and violent restraints, are clearly the causal explanation, which should in fact, lead one to reject the hypothesis of an excited delirium diagnosis. However, in practice, those who are seeking to exonerate the police/first responders responsible for these deaths, are not accepting this evidence leading them to reject the excited delirium diagnosis, but rather, are crafting an incorrect causal narrative. This is deeply problematic, but it does not necessarily render excited delirium as non-falsifiable. More broadly, I am concerned with the reliance on the falsifiability criterion, which has been widely criticized in the... (shrink)

Delirium has conventionally been considered a disorder of consciousness, but this remains a relatively unexamined precept. First, a review of the role of consciousness disruption in delirium is revised from an historical and diagnostic perspective. Second, consciousness measurement in routine assessment of delirium is considered. Conscious levels, comprising alertness and arousal, are most commonly used but are not representative of the multidimensionality of consciousness. Third, a justification for the exploration of phenomenal consciousness is presented. Three candidate dimensions (...) of phenomenal consciousness are identified as the pre-reflective state, phenomenal experience, and reflective thought. Finally, the clinical implications of a deeper understanding of delirium through measurement of phenomenal consciousness is considered. (shrink)

Here we describe how more important findings were obtained in a delirium study by using an informal assessment of mental capacity, and, in those who lacked capacity, obtaining consent later when or if capacity returned or a proxy was found. From a total of 233 patients 23 patients lacked capacity as judged by our informal capacity judgment and 210 did not. Of those who lacked capacity, 13 agreed to enter in the study. Six of them regained capacity later. When (...) these 13 participants were excluded from analysis, significant findings were no longer evident. These results show that by the inclusion of subjects who lacked capacity the results of analyses of the condition from whish they suffer are altered. We suggest that this approach to the study of delirium is more ethical than the usual system of strict exclusion of people who lack capacity to give consent and for whom assent is not available. (shrink)

Here Donald Livingston traces this distinction through all of Hume's writings and reveals its relevance for contemporary discussion.

ObjectivesThe purpose of this study was to identify risk factors for delirium after total joint arthroplasty and provide theoretical guidance for reducing the incidence of delirium after TJA.MethodsThe protocol for this meta-analysis is registered with PROSPERO. We searched PubMed, the Cochrane Library and Embase for observational studies on risk factors for delirium after TJA. Review Manager 5.3 was used to calculate the relative risk or standard mean difference of potential risk factors related to TJA. STATA 14.0 was (...) used for quantitative publication bias evaluation.ResultsIn total, 25 studies including 3,767,761 patients from 9 countries were included. Old age has been widely recognized as a risk factor for delirium. Our results showed that the main risk factors for delirium after TJA were patient factors, comorbidities, surgical factors and drug factors.ConclusionsMultiple risk factors were associated with delirium after TJA. These results may help doctors predict the occurrence of delirium after surgery and determine the correct treatment.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42020170031. (shrink)

1 Department of History and Philosophy of Science, University of Cambridge, Free School Lane, Cambridge, CB2 3RH, UK.

Delirium, a common syndrome in terminally ill people, presents specific challenges to a good death in end‐of‐life care. This paper examines the relational engagement between hospice nurses and their patients in a context of end‐of‐life delirium. Ethnographic fieldwork spanning 15 months was conducted at a freestanding residential hospice in eastern Canada. A shared value system was apparent within the nursing community of hospice; patients’ comfort and dignity were deemed most at stake and therefore commanded nurses’ primary attention. This (...) overarching commitment to comfort and dignity shaped all of nursing practice in this hospice, including practices related to end‐of‐life delirium. The findings of this study elaborate the ways in which hospice nurses interpreted and responded to the discomfort of their patients in delirium, as well as the efforts they made to understand their patients’ subjective experiences and to connect with them in supportive ways. In addition to what is already known about clinical assessment and treatment of delirium in palliative care settings, the findings of this study offer points of reflection for nurses anywhere who are contending with the relational challenges that delirium presents in end‐of‐life care. (shrink)

“Excited Delirium Syndrome” (ExDS) is a controversial diagnosis. The supposed syndrome is sometimes considered to be a potential cause of death. However, it has been argued that its sole purpose is to cover up excessive police violence because it is mainly used to explain deaths of individuals in custody. In this paper, we examine the epistemic conditions giving rise to the controversial diagnosis by discussing the relation between causal hypotheses, evidence, and data in forensic medicine. We argue that the (...) practitioners’ social context affects causal inquiry through background assumptions that enter inquiry at multiple stages. This analysis serves to better understand the wide usage of the controversial diagnosis of ExDS. (shrink)

BackgroundDelirium is highly prevalent in the general hospital patient population, characterized by acute onset, fluctuating levels of consciousness, and global impairment of cognitive functioning. Mental capacity, its assessment and subsequent consent are therefore prominent within this cohort, yet under-explored.AimThis study of patients with delirium sought to determine the processes by which consent to medical treatment was attempted, how capacity was assessed, and any subsequent actions thereafter.MethodA retrospective documentation review of patients identified as having a delirium for the twelve (...) months February 2013 to January 2014 was undertaken. Inclusion and exclusion criteria were used; demographic and descriptive data collected. A total of n=1153 patients were identified with n=310 meeting inclusion criteria.ResultA random sample of one hundred patients were subsequently reviewed. One third of patients had documentation relating to consent, while four patients had documentation relating to capacity. Median delirium duration was three days, with treatment refusal occurring in twenty-two patients and “duty of care” being used as an apparent beneficent related treatment framework in twelve patients.ConclusionsWhile impaired decision-making was indicated, the review was unable to indicate what patient characteristics flag the need for capacity assessment. Documentation relating to consent processes appeared deficient for this cohort. (shrink)

KJORVEN M, RUSH K and HOLE R. Nursing Inquiry 2011; 18: 325–335 A discursive exploration of the practices that shape and discipline nurses’ responses to postoperative deliriumAlthough delirium is classified as a medical emergency, it is often not treated as such by health care providers. The aim of this study was to critically examine, through a poststructural, Foucauldian concept of discourse, the language practices and discourses that shape and discipline nurses' care of older adults with postoperative delirium (POD) (...) with a purpose to question accepted nursing practice. The study was based on data collected from face‐to‐face, in‐depth, personal interviews with six nurses who work on an acute postoperative patient care unit. Five analytic readings of the data identified two prominent discourses at work in nursing practice which influenced the care of patients with POD. These were identified as discourses of legitimacy/illegitimacy and discourses of nursing work. Through the process of poststructural analysis it became evident that one overriding discourse – the biomedical/scientific discourse – served to direct, legitimize and govern all other discourses. The findings of this study have implications for nursing knowledge and practice, length of hospital stay and improved patient outcomes. This study builds on previous work and is the first study to conduct a discourse analysis illuminating nurses’ responses to POD through comparison with other acute medical emergencies from a poststructural perspective. (shrink)

SCHOFIELD I, TOLSON D and FLEMING V. Nursing Inquiry 2012; 19: 165–176 [Epub ahead of print]How nurses understand and care for older people with delirium in the acute hospital: a Critical Discourse AnalysisDelirium is a common presentation of deteriorating health in older people. It is potentially deleterious in terms of patient experience and clinical outcomes. Much of what is known about delirium is through positivist research, which forms the evidence base for disease‐based classification systems and clinical guidelines. There (...) is little systematic study of nurses’ day‐to‐day practice of nursing patients with delirium. The aim was to uncover the kinds of knowledge that informs nurses’ care and to explicate the basis of that knowledge. Critical Discourse Analysis is underpinned by the premise that powerful interests within society mediate how social practices are constructed. Links were made between the grammatical and lexical features of nurses’ language about care in interviews and naturalistic settings, and the healthcare context. Care focused on the continuous surveillance of patients with delirium by nurses themselves or vicariously through other patients, and containment. Nurses influenced by major discourses of risk reduction and safety, constructed patients with delirium as risk objects. The philosophy of person‐centred and dignified care advocated in nursing literature and government policy is an emerging discourse, though little evident in the data. The current dominant discourses on safety must give space to discourses of dignity and compassion. (shrink)

Immersive virtual environments can produce a state of behaviour referred to as ‘presence’, during which the individual responds to the virtual environment as if it were real. Presence can be arranged to scientifically evaluate and affect our consciousness within a controlled virtual environment. This phenomenon makes the use of virtual environments amenable to existing and in-development forms of therapy for various conditions. Delirium in the intensive care unit (ICU) is one such condition for which virtual reality (VR) technology has (...) not been evaluated to date. We are currently assessing the feasibility and utility of a delirium prevention and treatment system, which implements VR to improve quality of sleep, reduce pain, lower usage of sedatives, and stimulate cognition. The proposed system will consist of 3-axis wearable accelerometers, 6-DOF position trackers, a VR system and apps designed to promote sleep quality and mindfulness. Our a priori hypothesis is that our VR therapy system would lower the occurrence of delirium in patients admitted to ICUs. (shrink)

Objectives: To investigate whether different methods of obtaining informed consent affected recruitment to a study of delirium in older, medically ill hospital inpatients.Design: Open randomised study.Setting: Acute medical service for older people in an inner city teaching hospital.Participants: Patients 70 years or older admitted to the unit within three days of hospital admission randomised into two groups.Intervention: Attempted recruitment of subjects to a study of the natural history of delirium. This was done by either a formal test of (...) capacity, followed by either a request for consent or an attempt at obtaining assent from a proxy, or a combined informal capacity/consent process.Main outcome measures: Prevalence and severity of delirium, and, as case mix measures, length of hospital stay and destination on discharge.Results: Recruitment of subjects through establishing formal capacity and then informed consent was less successful and, compared with those recruited through the usual combined capacity/consent approach, yielded a sample with less cognitive impairment, lower severity of delirium, lower probability of case note diagnosis of delirium and lower rate of entering a care home.Conclusions: Methods of obtaining informed consent may significantly influence the case mix of subjects recruited to a study of delirium. Stringent testing of capacity may exclude patients with delirium from studies, thus rendering findings less generalisable. A different method is necessary to achieve an ethical balance between respecting autonomy through obtaining adequate informed consent and avoiding sample bias. (shrink)

This paper examines the controversial diagnosis of excited delirium, which is often employed after individuals die during an encounter with the police. Rather than asking the important, and widely explored, question of whether the diagnosis is real or not, here, we consider how it operates in the world and why it seems to stick around, despite growing controversy and resistance to its use. First, we consider the question of what kinds of people are made up through the diagnosis of (...) excited delirium, exploring how racial stereotypes are exploited and certain behaviors are engendered through the illness script offered by excited delirium. Next, we ask what work excited delirium doing is doing in the world, unpacking how it tends to justify force and redirect responsibility, as well as who is it serving, and who is it not benefitting. Finally, we interrogate the slippery logic of excited delirium, examining how the way it is employed renders it non-falsifiable, and therefore impossible to uncover as real or unreal. (shrink)

Introduction Hospital delirium is a frequent, serious, costly, and underrecognized acute disorder of attention and cognition. Therefore, the prevention of hospital delirium is not only desirable for patients, caregivers, healthcare professionals, and the health system itself, but also a moral duty. Objective To identify and synthetize the main ethical aspects that arise related to the prevention of hospital delirium in patients 65 years and older. Methods A scoping review was carried out in Embase, Medline, and Web of (...) Science. Articles published in English or Spanish analyzing any pharmacologic, non-pharmacologic, or multicomponent intervention for prevention of delirium in hospitalized patients aged 65 years and over were included. Results Twenty-seven studies were included. Based on the frequency of appearance and the relevance, our findings were organized into three main areas. The first one was related to the principle of nonmaleficence and collected findings about the iatrogenic causes of hospital delirium and the use of restraints systems. The second area analyzed the impact of delirium in patients, families, and healthcare professionals from a relational ethics perspective, and addressed the family presence as a factor to prevent delirium. Finally, the third area is related to the quality of care. Conclusion Prevention of delirium in hospitals is essential to avoid the discomfort and potential clinical complications of patients, as well as the suffering of their relatives, caregivers, and healthcare professionals. Policymakers and healthcare managers are encouraged to make the required efforts to prevent delirium in hospitalized older patients. (shrink)

This chapter address the value of Deleuzian ideas for performance. It attempts to establish the connection of Gilles Deleuze's works with various practitioners including Bertolt Brecht, the Living Theatre, and the KRAKEN Group. It analyses Deleuze and Félix Guattari's Anti-Oedipus and suggests that Deleuze considers performance as the autoerotic on automatic in runaway machines, given over to pure expenditure in the libidinal economy.

To arrive at a practical solution in the political problem, one must take the road of aesthetics because, in Schiller’s opinion, it is only through beauty that we arrive at freedom. This can only be demonstrated if we first know the principles by which reason is guided in political legislation; for, although in its aesthetic state human action is truly free and it is free to the highest degree from any constrictions, it is not, nevertheless, beyond laws. Reason and the (...) illumination of the mind, Friedrich Schiller believes, are not enough to make the truth triumph and heal the political: an education of feeling is necessary. The education of feeling represents the most stringent necessity as it becomes both a means to render efficient the improvement of ideas and judgments in practical life, and a cause generating this improvement. For, any amelioration in the sphere of the political must have in view the ennoblement of the character, and the instrument most at hand to this aim is the art of the beautiful.Beauty is the common object of the two impulses or instincts (reason and experience) and is best expressed through the concept of play; it is only play that renders man complete and develops his double nature. Making the beautiful a mere play does not involve a degradation of beauty; restricting the beautiful, which is regarded as an element of culture, to mere play is not in contradiction with the dignity of beauty, but we must look at the idea of play as it was expressed by Johan Huizinga also, and see man as the homo ludens providing the art of life. (shrink)

This article discusses the representation of AIDS in Guibert's posthumously published novel Le Paradis. The novel is situated in relation to Guibert's better known previous AIDS writings. The article proposes that Guibert's AIDS works fall in to three related categories: writings about other peoples' AIDS; autobiographical writings about AIDS, and, in the third, terminal stage in which Le Paradis fits, writing AIDS. As such the article suggests that Le Paradis manages to reflect and communicate some of the trauma of living (...) with AIDS by specifically trying not to write about it. The article raises issues related to constructions of sexualized and AIDS identities in fiction, and presents the novel as a form which represents a loss of self. The novel, it is argued, becomes a self-mourning for a healthy past which is memorialized in a fictional present, itself always-already haunted by the nostalgia for a lost future. (shrink)

Omnicide: Mania, Fatality and Future-in-Delirium (2019) finds Iranian-American philosopher and comparative literature theorist Jason Bahbak Mohaghegh carving the figure of the diffracted neo-Bedouin wanderer, whose mania we tail through the book’s haunted pages. The book’s namesake, “omnicide,” refers to the complete and total erasure of the Earth--the term has most recently been generally applied in ecological contexts, most markedly in regards to the Anthropocene and futurology. However, it is the explicitly poetic and literary intersection between mania and the grotesque (...) that Mohaghegh inches us towards, lifting omnicide from its proscriptive use in the Western philosophical/sociological tradition and goading it towards an unfamiliar cryptic terrain. Surveying ten contemporary Middle Eastern poets and fiction writers, including Sadeq Hedayat (Iran), Réda Bensmaia (Algeria), Samuel Adonis (Syria), Joyce Mansour (Egypt), Forugh Farrokhzad (Iran), Ibrahim al-Koni (Libya), Ahmad Shamlu (Iran), Ghada Samman (Lebanon), Mahmoud Darwish (Palestine) and Hassim Blasim (Iraq), Mohaghegh parses curious stanzas and plucks spectral paragraphs from myriad texts so as to navigate the largely occluded and excised narratives of the contemporary Middle Eastern philosophical-literary canon. Not only does Mohaghegh acuminate the multifaceted question of mania and its variegated networks, chambers, byways and sunken burrows--so as to juxtapose two different world literatures (East and West)--but Mohaghegh also illuminates this oeuvre to affront the Western psychoanalytic treatment of mania as an exclusionary vessel. Thus, despite Mohaghegh avoiding any explicit references to Western philosophers and scientists, both the codified dictum of the medical decree and the hyper-genealogical superlative tradition of Georges Canguilhem, Michel Foucault and their contemporaries rankle Omnicide’s annals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Weight of Rhetoric: Studies in Cultural DeliriumThomas B. FarrellThere is something of this anachronistic doggedness in all importance, and to use it as a criterion of thought is to impose on thought a spellbound fixity, and a loss of self-reflection. The great themes are nothing other than primeval rumblings which cause the animal to pause and try to bring them forth once again. This does not mean that (...) the hierarchy of importance should be ignored. Just as its narrow- mindedness reflects that of the system, so it is saturated with all the latter’s force and stringency. Thought ought not, however, to repeat this hierarchy, but by completing, end it. The division of the world into important and unimportant matters, which has always served to neutralize the key phenomena of social injustice as mere exceptions, should be followed up to the point where it is convicted of its own untruth. The division which makes everything objects must itself become an object of thought, instead of guiding it. The large themes will then make their appearance, though hardly in the traditional “thematic” sense, but refractedly and eccentrically.—Theodor Adorno, Minima MoraliaBoy, you’re going to carry that weight, carry that weight a long time.—The Beatles [End Page 467]Preface: on Attachments—Flowers and the InfinitesimalThe number of adjustments it takes to make a square into a circle, the number of times any real number may be subdivided before reaching zero, the grainy inflections differentiating snowflakes, the differences among petals in a tulip—these are the sort of qualitative distinctions some of us might call minute and other cynical souls might consider trivial. But if the attachment of real human interest to objects of longing is any measure of worth, then they are far from insignificant.Imagine the following sequence of events. A young kid, fourteen or so, is out with some friends one summer evening and decides—on a whimsical adolescent impulse—to pick some tulips from a neighbor’s garden to leave at a girlfriend’s front porch. What follows?The neighbors, one of whom turns out to be a self-professed horticulturist and gardening aficionado, call the police and file a criminal complaint. The girlfriend’s parents give the alleged offender’s name to the same authorities. When the kid comes to the door of the neighbors to apologize, he is verbally threatened. When he writes a letter of contrition and remorse to the neighbors, they turn the letter over to the police as evidence. One day later, the neighbors angrily phone local school officials to complain of his behavior. Two days later, when two of the kid’s accomplices are summarily removed from eighth grade, taken to the police station, fingerprinted, and booked (without being informed of their rights), the parents reluctantly secure the services of an attorney (two attorneys, actually). When an outof- court settlement is finally agreed to, it is discovered that the city police have already passed the case on to the State’s Attorney’s Office. A criminal hearing will now need to be held in juvenile court. When the hearing is held, the charges are summarily dismissed. The cost? Several hundred dollars a tulip (with side effects including migraines, despondency, two trips to the emergency room, not to mention rather hefty attorneys’ fees).As the reader has probably surmised by now, this thinly disguised episode did not occur to Gregor Samsa but to someone near and dear to your author. It did not occur in Singapore but in Evanston, Illinois. All of us can probably recall occasions when things seemed to careen wildly out of control and apparently minor matters took on disproportionately inflated significance. We struggle to “make sense” of these episodes, for ourselves and others. In the above example, two allegories about magnitude surfaced. One, relayed to me by our grizzled Chicago attorney, addressed the question [End Page 468] of how to explain these events to our son. “Tell him,” he said, “that there are a lot of jerks in the world” (except he didn’t use the word “jerks”). A second allegory emerged rather belatedly. There was more than one nonrational attachment in... (shrink)

As many as two million people in the United Kingdom repeatedly see people, animals, and objects that have no objective reality. Hallucinations on the border of sleep, dementing illnesses, delirium, eye disease, and schizophrenia account for 90% of these. The remainder have rarer disorders. We review existing models of recurrent complex visual hallucinations (RCVH) in the awake person, including cortical irritation, cortical hyperexcitability and cortical release, top-down activation, misperception, dream intrusion, and interactive models. We provide evidence that these can (...) neither fully account for the phenomenology of RCVH, nor for variations in the frequency of RCVH in different disorders. We propose a novel Perception and Attention Deficit (PAD) model for RCVH. A combination of impaired attentional binding and poor sensory activation of a correct proto-object, in conjunction with a relatively intact scene representation, bias perception to allow the intrusion of a hallucinatory proto-object into a scene perception. Incorporation of this image into a context-specific hallucinatory scene representation accounts for repetitive hallucinations. We suggest that these impairments are underpinned by disturbances in a lateral frontal cortex–ventral visual stream system. We show how the frequency of RCVH in different diseases is related to the coexistence of attentional and visual perceptual impairments; how attentional and perceptual processes can account for their phenomenology; and that diseases and other states with high rates of RCVH have cholinergic dysfunction in both frontal cortex and the ventral visual stream. Several tests of the model are indicated, together with a number of treatment options that it generates. Key Words: Blindness; Charles Bonnet; cholinergic; cortical release; delirium; dementia; dream intrusion; hallucination; Perception and Attention Deficit (PAD) model; schizophrenia. (shrink)

Deleuze a contribué à mieux nous faire entendre la puissance affirmative du désir et la portée métaphysique des hallucinations et délires. Une logique de la folie qui excède la question du langage et des choses... Cet essai prolonge une intuition restée en friche : la prise au sérieux de la dimension " théologique " des délires dont la catégorie psychiatrique obsolète des " délires mystiques " est une occultation au lieu d'être l'explication, le dépliement qu'elle aurait pu suggérer.

Recognized as a masterpiece of Nietzsche scholarship, NIETZSCHE AND THE VICIOUS CIRCLE is available here for the first time in English. Author Pierre Klossowski suggests that Nietzsche's ideas and beliefs did not stem from his personal pathology, but rather were applied in a pathological manner. Thereby Nietzsche's beliefs resonated dynamically and intellectually with his alternating lucidity and delirium.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.1 (2004) 35-41 [Access article in PDF] The Rationality of Psychosis and Understanding the Deluded Matthew R. Broome Campbell's important and influential paper (Campbell 2001) has framed the debate that Bayne and Pacherie (2004) most explicitly, and Klee (2004) and Georgaca (2004) more implicitly, engage in. Campbell has offered two broad ways of thinking about explanations of delusions—the empirical and the rational. He offers some (...) criticism of the former and an endorsement of the latter. Campbell uses examples from clinical psychopathology to illustrate his argument and Bayne and Pacherie in turn employ these. Campbell discusses the eponymously named delusions of Capgras and Cotard—the former a subtype of delusional misidentification and the latter a delusion whose content is colored predominantly with nihilistic and possibly hypochondriacal themes. Campbell, Bayne and Pacherie, and Klee discuss the empirical data in relation to such delusions and as an aid to discussing the empirical model more generally. It does seem a little unfortunate that these delusions, which are less than typical, become the focus of Campbell's paper, and Bayne and Pacherie's criticism of his work. Delusions are remarkably heterogeneous; this indeed may be part of the reason why there is so much difficulty in reaching a definition as Klee discusses, and occur in a wide variety of mental and neurological illnesses. The most common delusions are those of persecution and reference (World Health Organization [WHO] 1973) and typically occur in schizophrenia. By contrast, delusional misidentification occurs most commonly in patients with dementia, delirium, and focal cognitive impairment, but can occur in other functional psychoses such as an affective or schizophrenic psychosis. The most common form of delusional misidentification is not that of either the exotic Capgras or Fregoli syndromes but delusional misidentification for place; thus, although Bayne and Pacherie's arguments against Campbell may still hold, delusional misidentification tends to occur in the context of a patient believing that they are at home or on holiday rather than in hospital and may not necessarily involve close family members or other intimate relationships. Similarly, Cotard's syndrome tends to occur in the context of a severe depressive illness with mood-congruent psychotic symptoms, typically in an elderly individual. It does not have to have the content that the deluded is dead, but can include beliefs, for example, that the world no longer exists or that their internal organs are not present. Thus, a patient with either Capgras' or Cotard's syndrome is likely to differ from patients with delusions of persecution. They would [End Page 35] have different diagnoses, probably be older, and have a greater likelihood of structural abnormalities of the brain on imaging and consequent neuropsychological dysfunction. That is not to say that patients with schizophrenia have normal cerebral anatomy and neuropsychology, but rather that the Capgras' and Cotard's patients are likely to have neurological quality to their presentation that is clinically relevant, rather than what commonly the case in schizophrenia and the other functional psychoses, where the neurological abnormalities are only currently important at the level of academic research. Empirical Models of Delusion Formation Different delusions may not have that much in common, nor may the patients who believe in them. This in turn relates to the empirical paradigm that both Campbell and Bayne and Pacherie discuss. It is true that current research, and indeed the clinical practice of cognitive behavioral therapy for psychosis, is indebted to the work of Maher and it is within his legacy which we work. This, however, is not to say that we think his initial formulation was correct. Maher's (1988, 1992) work focused attempts in explaining delusions—both to support and refute his thesis that delusions are the consequence of normal cognitive mechanisms seeking to explain an anomalous sensory experience. Such a view initially led to work demonstrating delusions in the absence of anomalous perceptions, the presence of reasoning biases in the deluded population, and the possibility that abnormal sensory experience may be consequent upon biased cognitive processes (Garety and Freeman 1999). More recent work has demonstrated the prevalence of... (shrink)

This paper examines the ethical conundrum between a hospital's ethos of relieving distress, investigation and treatment, and its concurrent duties under English law to administer tests of decision-making capacity and safeguarding protection where it believes the patient may lack this capacity. Delirium, characterised by a precipitous decline in mental functioning exhibiting the shared symptomology of recoverable depressive disorders and terminal dementia, is not uncommon after emergency admission of elderly patients into acute medical hospital wards. The use of functional capacity (...) testing as a benchmark for decision-making capacity for post-discharge residence has been criticised as outdated, conceptually floored, subjective, lacking central guidance, transparent process, and accountability. A study of patient experience demonstrates the potential for hospital misuse of capacity testing, the failure of functional testing to differentiate decision making capacity from the disability of partial cognitive impairment, and how hospital capacity processes can interact and amplify patient pathology thereby decreasing recovery prospects. Prioritisation of mental capacity obligations above thorough investigation of emergent mental pathology and relief of patient anguish, results in extended detention in medical wards lacking bespoke facilities. Further understanding of patient experience is needed to inform policy with interventions tailored to avoid harm and increase wellbeing. (shrink)

Critique currently leads a life akin to a zombie. It is torn between attempts to surpass it and radical gestures of its dismissal, while moderate forces dwell on the business of inventorying its history. Starting from critique’s historical turn on itself, this essay focuses on destabilization and self-questioning as its essential features. Regarding Adorno’s model, it seeks to locate critique’s focal point before it was split by surpassing and dismissal. This model is still challenging because it is situated at a (...) crossroads in critical thinking where the historical aspect of failure is tied to structural aspects of critique: resistance, disruption, and dissolution. It concerns a movement of critique that leads into delirium—without thereby abandoning its claim to objectivity. In the contemporary situation, where critique is at once generalized and dismissed, it is precisely the specific link of disrupting and claiming objectivity that challenges the universalized regime of opinion. (shrink)

Introduction : schizoanalysis, digital screens and new brain circuits -- Schizoid minds, delirium cinema and powers of machines of the invisible -- Illusionary perception and powers of the false -- Surveillance screens and powers of affect -- Signs of time : meta/physics of the brain-screen -- Degrees of belief : epistemology of probabilities -- Powers of creation : aesthetics of material-force -- The open archive : cinema as world-memory -- Divine in(ter)vention : micropolitics and resistance -- Logistics of perception (...) 2.0 : multiple screens as affective weapons -- Conclusion : the neuro-image : brain-screens from the future. (shrink)

Photography tears the subject from itself -- Plastic intimacies -- Corneal abrasion -- Opticalterities -- The delirium of images -- Baroque vision -- Phanomenology -- The collector of eyes.

The ultimate language of madness is that of reason.In short, under the chaotic and manifest delirium reigns the order of a secret delirium. In this second delirium, which is, in a sense, pure reason, reason delivered of all the external tinsel of dementia, is located the paradoxical truth of madness. And this in a double sense, since we find here both what makes madness true and what makes it truly madness.At the urging of his parents, Mr. A, (...) a college-age young man with a past diagnosis of Asperger’s... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Back to the Nineteenth Century Is ProgressJeffrey L. Geller (bio)Keywordshistory, monomania, impulse control disorders, DSMJohn Sadler Eloquently Makes the case that the phenomena of criminality, wrongful conduct, and mental illness are befuddled in current diagnostic manuals, for example, the Diagnostic and Statistical Manual (DSM)-IV-TR. The lack of clarity in the “vice–mental disorder relationship” reflects centuries old struggles to create clear demarcations between “mad” and “bad.” Sadler points out that (...) the DSMs have been and are both the products of historical, cultural, and social forces and the purveyors of defining boundaries that shape contemporary psychiatric and judicial practices. Sadler does American psychiatry a great service by resurrecting a discussion that was quite rich in the nineteenth century, but generally dormant in the twentieth. I thought I could best use this commentary by bringing to the attention the readers of Philosophy, Psychiatry & Psychology the scope of the debate amongst Sadler’s nineteenth-century predecessors.Sadler’s PredecessorsPhilippe Pinel, who presented the first clear modern description of the form of mental illness subsequently named moral insanity appeared well aware, in the early years of the nineteenth century, of the difficulties there would be accepting the concept of a limited or partial moral mania:There are certain rare examples of a peculiar turbulent and embittered character, who otherwise show no evidence of disturbed reason. Ought they to be included under the heading of “mania without delirium?” At any rate the authorities have preferred to have them admitted to asylums rather than let them mix with delinquents in houses of correction.(As cited by Walk 1954, 821)James Cowles Prichard, a British physician, is credited with “inventing” the term moral insanity, which he defined as “a morbid perversion of the feelings, affections, and active powers, without any illusion or erroneous conviction impressed upon the understanding” (Prichard 1837, 20; 1842). Prichard warned against the failure to recognize this form of insanity, illustrating his point with what we might now refer to as pyromania:Many lunatics, whose disorder was merely a destructive propensity, have set fire to houses or public buildings, and it is not to be doubted that men have been occasionally executed as criminals for such actions, who, if they had been kept in confinement, would have proved to be insane. Until the existence of moral insanity is distinctly recognized, there will always be a danger of this event ensuing in the trials of mischievous lunatics.(Prichard 1837, 287)Prichard referred to such acts as “instinctive madness” (Prichard 1842). [End Page 19]Isaac Ray, the first American to specifically address these matters (in the first edition of his Treatise on The Medical Jurisprudence of Insanity (1838), defined “partial moral mania,” indicating that, “In this form of insanity, the derangement is confined to one or a few of the affective faculties, the rest of the moral and intellectual constitution preserving its ordinary integrity” (p. 186). Ray highlighted those partial moral mania he considered to “have the most important legal relations” (p. 187): “an irresistible propensity to steal,” “an inordinate propensity to lying,” “erotic mania,” “a morbid propensity to incendiarism,” and “homicidal insanity” or “homicidal monomania” (pp. 187–234). Ray cogently described what we would categorize today as an impulse disorder: “Amid the rapid and tumultuous succession of feelings that rush into his mind, the reflective powers are paralyzed, and his movements are solely the result of a blind, automatic impulse with which the reason has as little to do, as with the movements of a newborn infant” (p. 261). Ray believed these monomanias “completely annulled... all moral responsibility for acts committed under their influence,” and consequently “the laws can rightfully inflict no punishment on their unfortunate subjects” (p. 276).Ray, like his European predecessors, was not insensitive to the conundrum these partial moral manias would likely produce:True, cases of a disputable character sometimes occur—cases in which we may well doubt whether the active principle is depravity or disease. I have no wish to conceal any difficulty which this subject may present(Ray 1861, 120).The English translation of Esquirol’s treatise in 1854 supported Ray’s views. In a lengthy chapter on the different forms of... (shrink)

El delirio ha sido estudiado por la psiquiatría, la psicología y el psicoanálisis como una patología de la mente que puede tratarse clínicamente. Sin embargo, las raíces del delirio arrancan de la filosófica: autores como Spinoza, Schopenhauer o María Zambrano han profundizado sus bases metafísicas. El presente trabajo amplía el campo actual de análisis de esta entidad desde la óptica de la metafísica y explica cómo además de constituir un problema psíquico conforma un revulsivo que ayuda al desarrollo de la (...) identidad.Delirium has been studied as a treatable mental illness by psychiatry, psychology and psychoanalysis. However, delirium roots belong to philosophy: authors as Spinoza, Schopenhauer or María Zambrano have gone deep into its metaphysical groundings. This article broadens current delirium field through a metaphysical view. Here, it is explained how delirium is a psychological problem and a salutary lesson for developing personal identity. (shrink)