In this Introduction, I situate the underlying project “Autonomy and Mental Disorder” with reference to current debates on autonomy in moral and political philosophy, and the philosophy of action. I then offer an overview of the individual contributions. More specifically, I begin by identifying three points of convergence in the debates at issue, stating that autonomy is: 1) a fundamentally liberal concept; 2) an agency concept and; 3) incompatible with (severe) mental disorder. Next, I explore, in the context (...) of decisional capacity assessments, the difficulties to reconcile 1) and 2) with 3) which they at the same time seem to imply. Having clarified the centrality of a cogent notion of mental disorder for addressing these difficulties, I comment on three promising lines of inquiry about the nature and scope of autonomy that emerge from the following chapters. (shrink)
The theory of mind (ToM) deficit associated with autism has been a central topic in the debate about the modularity of the mind. Most involved in the debate about the explanation of the ToM deficit have failed to notice that autism’s status as a spectrum disorder has implications about which explanation is more plausible. In this paper, I argue that the shift from viewing autism as a unified syndrome to a spectrum disorder increases the plausibility of the explanation (...) of the ToM deficit that appeals to a domain-specific, higher-level ToM module. First, I discuss what it means to consider autism as a spectrum rather than as a unified disorder. Second, I argue for the plausibility of the modular explanation on the basis that autism is better considered as a spectrum disorder. Third, I respond to a potential challenge to my account from Philip Gerrans and Valerie Stone’s recent work (Gerrans, Biol Philos 17:305–321, 2002; Stone and Gerrans, Trends Cogn Sci 10:3–4, 2006a; Soc Neurosci 1:309–319, 2006b; Gerrans and Stone, Br J Philos Sci 59:121–141, 2008). (shrink)
Marya Schechtman argues that psychological continuity accounts of personal identity, as represented by Derek Parfit's account, fail to escape the circularity objection. She claims that Parfit's deployment of quasi-memory (and other quasi-psychological) states to escape circularity implicitly commit us to an implausible view of human psychology. Schechtman suggests that what is lacking here is a coherence condition, and that this is something essential in any account of personal identity. In response to this I argue first that circularity may be escaped (...) using quasi-psychological states even with the addition of the coherence condition. Second, I argue that there is something right about the coherence condition, and a major task of this paper is to identify its proper theoretical role. I do so by reflection on integration therapies for people with multiple personality disorder (MPD). The familiar distinction between the moral and the metaphysical concept of the person is developed alongside such reflection. Connecting these two issues I argue that coherence acts as a normative constraint on accounts of personal identity, but that the normative dimension of personhood is not essential to our notion of a person tout court. (shrink)
This paper explores how the diagnosis of mental disorder may affect the diagnosed subject’s self-concept by supplying an account that emphasizes the influence of autobiographical and social narratives on self-understanding. It focuses primarily on the diagnoses made according to the criteria provided by the Diagnostic Statistical Manual of Mental Disorders (DSM), and suggests that the DSM diagnosis may function as a source of narrative that affects the subject’s self-concept. Engaging in this analysis by appealing to autobiographies and memoirs written (...) by people diagnosed with mental disorder, the paper concludes that a DSM diagnosis is a double-edged sword for self- concept. On the one hand, it sets the subject’s experience in an established classificatory system which can facilitate self-understanding by providing insight into subject’s condition and guiding her personal growth, as well as treatment and recovery. In this sense, the DSM diagnosis may have positive repercussions on self-development. On the other hand, however, given the DSM’s symptom-based approach and its adoption of the Biomedical Disease model, a diagnosis may force the subject to make sense of her condition divorced from other elements in her life that may be affecting her mental- health. It may lead her frame her experience only as an irreversible imbalance. This form of self-understanding may set limits on the subject’s hopes of recovery and may create impediments to her flourishing. (shrink)
Many contemporary bioethicists claim that the possession of certain psychological properties is sufficient for having full moral status. I will call this thepsychological approach to full moral status. In this paper, I argue that there is a significant tension between the psychological approach and a widely held model of Dissociative Identity Disorder (DID, formerly Multiple Personality Disorder). According to this model, the individual personalities or alters that belong to someone with DID possess those properties that proponents of the (...) psychological approach claim suffice for full moral status. If this account of DID is true, then the psychological approach to full moral status seems to entail that the two standard therapies for treating DID might, on occasion, be seriously immoral, for they may well involve the (involuntary) elimination of an entity with full moral status. This result should give proponents of the psychological approach pause, for most people find the claim that current treatments of DID are ethically suspect highly counter-intuitive. (shrink)
Some would say that philosophy can contribute more to the occurrence of mental disorder than to the study of it. Thinking too much does have its risks, but so do willful ignorance and selective inattention. Well, what can philosophy contribute? It is not equipped to enumerate the symptoms and varieties of disorder or to identify their diverse causes, much less offer cures (maybe it can do that-personal philosophical therapy is now available in the Netherlands). On the other hand, (...) the scientific study of mental disorder has a long way to go. There is much disagreement and uncertainty about the nature, causes, and treatment of many specific disorders, as is evident from DSM's classification of them in predominantly symptomatic terms. And even if what is reflected in DSM were a consensus rather than a compromise, still this shifts periodically with each new edition. Moreover, it is a notorious fact that many patients who clearly have psychiatric abnormalities do not fit any of the recognized diagnostic categories.1. (shrink)
This paper outlines a multidimensional conception of Multiple Personality Disorder (MPD) that differs from the 'orthodox' conception in terms of the content of its commitment to the reality of the self. Unlike the orthodox conception it recognizes that selves are fuzzy entities. By appreciating the possibility that selves are fuzzy entities, it is possible to rebut a form of fictionalism about the self which appeals to clinical data from MPD. Realism about self can be preserved in the face of (...) multiple personalities. (shrink)
Dissociative Identity Disorder (DID) (formerly known as Multiple Personality Disorder) is a condition in which a person appears to possess more than one personality, and sometimes very many. Some recent criminal cases involving defendants with DID have resulted in "not guilty" verdicts, though the defense is not always successful in this regard. Walter Sinnott-Armstrong and Stephen Behnke have argued that we should excuse DID sufferers from responsibility, only if at the time of the act the person was insane (...) (typically delusional); otherwise the presumption should be that persons with DID are indeed responsible for their actions. We find their interpretation of DID and of the way in which the requirements for criminal insanity relate to this condition worrying and likely to result in injustice to DID sufferers. Our thesis is that persons with DID cannot be responsible for their actions if the usual features of the condition are present. A person with DID is a single person in the grip of a very serious mental disorder. By focusing on the features of DID which have, as we argue, the effect of deluding the patient, we try to show that such a person is unable to fulfill the ordinary conditions of responsible agency (namely, autonomy and self-control). (shrink)
I shall begin with the "anti-psychiatry" view that the lack of a physical basis excludes many familiar mental disorders from the category of "illness". My response to this argument will be that anti-psychiatrists are probably right to hold that most mental disorders do not involve any physical disorder, but that they are wrong to conclude from this that these mental disorders are not illnesses.
During the last years, there has been an important discussion on the concept of mental disorder. Several accounts of such a concept have been offered by theorists, although neither of these accounts seems to have successfully answered both the question of what it means for a certain mental condition to be a disorder and the question of what it means for a certain disorder to be mental. In this paper, I propose an account of the concept of (...) mental disorder that, if I am right, provides satisfactory answers to both of these questions. Furthermore, this account (unlike other accounts presented in the literature on the subject) meets the requirements for achieving a crucial goal underlying the project of sorting out the concept of mental disorder, namely the goal of allowing the existence of a dialogue between mental health professionals of different theoretical orientations. To achieve this goal, the account herein proposed is not based in any particular theoretical framework, but in both ordinary and technical theory-neutral concepts. In the last part of the paper, I argue that it follows from most accounts of the concept of mental disorder that the disciplines concerned with explaining some mental disorders are not branches of medicine, and that the treatment of some mental disorders is not a matter of medical intervention. (shrink)
In this paper we argue that dissociative identity disorder (DID) is best interpreted as a causal model of a (possible) post-traumatic psychological process, as a mechanical model of an abnormal psychological condition. From this perspective we examine and criticize the evidential status of DID, and we demonstrate that there is really no good reason to believe that anyone has ever suffered from DID so understood. This is so because the proponents of DID violate basic methodological principles of good causal (...) modeling. When every ounce of your concentration is fixed upon blasting a winged pig out of the sky, you do not question its species' ontological status. James Morrow, City of Truth (1990). (shrink)
Autonomy is a fundamental though contested concept both in philosophy and the broader intellectual culture of today’s liberal societies. For instance, most of us place great value on the opportunity to make our own decisions and to lead a life of our own choosing. Yet, there is stark disagreement on what is involved in being able to decide autonomously, as well as how important this is compared to other commitments. For example, the success of every group project requires that group (...) members make decisions about the project collectively rather than each on their own. This disagreement notwithstanding, mental disorder is routinely assumed to put a strain on autonomy; however, it is unclear whether this is effectively the case and, if so, whether this is due to the nature of mental disorder or the social stigma that often attaches to it. This book is the first exploration of the nature and value of autonomy with reference to mental disorder. By reflecting on instances of mental disorder where autonomy is apparently compromised, it offers a systematic discussion of the underlying presuppositions of the present autonomy debates in philosophy and psychiatry. In so doing, it helps address different kinds of emerging scepticism questioning either the appeal of autonomy as a concept or its relevance to specific areas of normative ethics, including psychiatric ethics. (shrink)
According to the predominant view within contemporary philosophy of psychiatry, mental disorders involve essentially personal and societal values, and thus, the concept of mental disorder cannot, even in principle, be elucidated in a thoroughly objective manner. Several arguments have been adduced in support of this impossibility thesis. My critical examination of two master arguments advanced to this effect by Derek Bolton and Jerome Wakefield, respectively, raises serious doubts about their soundness. Furthermore, I articulate an alternative, thoroughly objective, though in (...) part normative, framework for the elucidation of the concept of mental disorder. The concepts of mental dysfunction and impairment of basic psychological capacities to satisfy one’s basic needs are the building blocks of this framework. I provide an argument for the objective harmfulness of genuine mental disorders as patterns of mental dysfunctions with objectively negative biotic values, as well as a formally correct definition of the concept of mental disorder. Contrary to the received view, this objective framework allows for the possibility of genuine mental disorders due to adverse social conditions, as well as for quasi-universal mental disorders. I conclude that overall, the project of providing an objective account of the concept of mental disorder is far from impossible, and moreover, that it is, at least in principle, feasible. (shrink)
In Kise and Ngyuen’s “Adult Baby Syndrome and Gender Identity Disorder” (2011), the authors refer to their male subject as “Ms B” because he prefers to identify with being a female. But they do not refer to her as being a baby, even though the subject also prefers to identify with being a baby. This shows that although they respect the subject’s gender identity preferences, they do not respect the subject’s age identity preferences. One reason for this might be (...) that some people feel the term “adult baby syndrome” sounds a bit silly and therefore that the wishes of someone having this syndrome are not worthy of being taken seriously, not as seriously, at least, as someone who shows the more scientifically respectable gender identity disorder. A solution here might be to replace the term “adult baby syndrome” with the term “age identity disorder”, perhaps involving “age dysphoria”. This would also be more accurate because not all of those who are discussed under the heading of “adult baby syndrome” wish to be identified as babies, but rather as toddlers or older children. The problem then is that numerous people prefer to identify with being a different age. Such people do not believe they are older or younger than they really are, but neither do those with adult baby syndrome. (shrink)
Weakness of will has perplexed philosophers since Plato's time. This chapter places some of the literature on volitional disorders and addictions in a philosophical context dating back to Plato and Aristotle in an attempt to shed light on issues that a theorist who wishes to analyze the idea of a volitional disorder will face. Key here is the notion of the irresistability and resistability of pertinent desires, which is explored in relation to George Ainslie's work on the ability to (...) make and adhere to personal rules. (shrink)
The effects of mental disorder are apparent and pervasive, in suffering, loss of freedom and life opportunities, negative impacts on education, work satisfaction and productivity, complications in law, institutions of healthcare, and more. With a new edition of the 'bible' of psychiatric diagnosis - the DSM - under developmental, it is timely to take a step back and re-evalutate exactly how we diagnose and define mental disorder. This new book by Derek Bolton tackles the problems involved in the (...) definition and boundaries of mental disorder. It addresses two main questions regarding mental illness. Firstly, what is the basis of the standards or norms by which we judge that a person has a mental disorder - that the person's mind is not working as it should, that their mental functioning is abnormal? Controversies about these questions have been dominated by the contrast between norms that are medical, scientific or natural, on the one hand, and social norms on the other. The norms that define mental disorder seem to belong to psychiatry, to be medical and scientific, but are they really social norms, hijacked and disguised by the medical profession? Secondly, what is the validity of the distinction between mental disorder and order, between abnormal and normal mental functioning? To what extent, notwithstanding appearances, does mental disorder involve meaningful reactions and problem-solving? These responses may be to normal problems of living, or to not so normal problems - to severe psycho-social challenges. Is there after all order in mental disorder? With the closing of asylums and the appearance of care in the community, mental disorder is now in our midst. While attempts have been made to define clearly a concept of mental disorder that is truly medical as opposed to social, there is increasing evidence that such a distinction is unviable - there is no clear line between what is normal in the population and what is abnormal. 'What is Mental Disorder?' reviews these various crucial developments and their profound impact for the concept and its boundaries in a provocative and timely book. (shrink)
Philosophical ideas about the mind, brain, and behavior can seem theoretical and unimportant when placed alongside the urgent questions of mental distress and disorder. However, there is a need to give direction to attempts to answer these questions. On the one hand, a substantial research effort is going into the investigation of brain processes and the development of drug treatments for psychiatric disorders, and on the other, a wide range of psychotherapies is becoming available to adults and children with (...) mental health problems. These two strands reflect traditional distinctions between mind and body, and causal as opposed to meaningful explanations of behavior. In this book, which has been written for psychiatrists, psychologists, philosophers, and others in related fields, the authors propose a radical re-interpretation of these traditional distinctions. Throughout the discussions philosophical theories are brought to bear on the particular questions of the explanation of behaviors, the nature of mental causation, and eventually the origins of major disorders including depression, anxiety disorders, schizophrenia, and personality disorder. (shrink)
Autism spectrum disorder (ASD) is characterised by differences in unimodal and multimodal sensory and proprioceptive processing, with complex biases towards local over global processing. Many of these elements are implicated in versions of the rubber hand illusion (RHI), which were therefore studied in high-functioning individuals with ASD and a typically developing control group. Both groups experienced the illusion. A number of differences were found, related to proprioception and sensorimotor processes. The ASD group showed reduced sensitivity to visuotactile-proprioceptive discrepancy but (...) more accurate proprioception. This group also differed on acceleration in subsequent reach trials. Results are discussed in terms of weak top-down integration and precision-accuracy trade-offs. The RHI appears to be a useful tool for investigating multisensory processing in ASD. (shrink)
Body integrity identity disorder (BIID), previously called apotemnophilia, is an extremely rare condition where sufferers desire the amputation of a healthy limb because of distress associated with its presence. This paper reviews the medical and philosophical literature on BIID. It proposes an evidenced based and ethically informed approach to its management. Amputation of a healthy limb is an ethically defensible treatment option in BIID and should be offered in some circumstances, but only after clarification of the diagnosis and consideration (...) of other treatment options. (shrink)
The term body integrity identity disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or who desire a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or for the transection of their spinal cord. Psychologists and physicians explain this phenomenon in quite different ways; but a successful psychotherapeutic or pharmaceutical therapy is not known. Lobbies of persons suffering from BIID explain the desire for amputation (...) in analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss the controversy about elective amputations of healthy limbs: on the one hand the principle of autonomy is used to deduce the right for body modifications; on the other hand the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body image, for which parallels for stroke patients are known. If BIID were a neuropsychological disturbance, which includes missing insight into the illness and a specific lack of autonomy, then amputations would be contraindicated and must be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed to integrate the alien limb into the body image. (shrink)
Apotemnophilia, a disorder that blurs the distinction between neurology and psychiatry, is characterized by the intense and longstanding desire for amputation of a speci¢c limb. Here we present evidence from two individuals suggestive that this condition, long thought to be entirely psychological in origin, actually has a neurological basis. We found heightened skin conductance response..
The theory of mind (ToM) deficit associated with autism spectrum disorder has been a central topic in the debate about the modularity of the mind. In a series of papers, Philip Gerrans and Valerie Stone argue that positing a ToM module does not best explain the deficits exhibited by individuals with autism (Gerrans 2002; Stone & Gerrans 2006a, 2006b; Gerrans & Stone 2008). In this paper, I first criticize Gerrans and Stone’s (2008) account. Second, I discuss various studies of (...) individuals with autism and argue that they are best explained by positing a higher-level, domain-specific ToM module. (shrink)
It is now generally agreed that we have to rely on value judgments to distinguish mental disorders from other conditions, but it is not quite clear how. To clarify this, we need to know more than to what extent attributions of disorder are dependent on values. We also have to know (1) what kind of evaluations we have to rely on to identify the class of mental disorder; (2) whether attributions of disorder contain any implicit reference to (...) some specific evaluative standard; and (3) whether the concept of mental disorder is value laden in the definitional or in the epistemic sense. I will argue that the evaluations we have to rely on are mainly considerations of harm, but that we also need to rely on other evaluations; that there should be no references to specific evaluative standards; and that even though mental disorders are necessarily undesirable, "mental disorder" may well be a descriptive phrase. (shrink)
A striking feature of post-modernism is its distrust of the subject. If the modern period, beginning with Descartes, sought in the subject a source of certainty, an Archimedian point from which all else could be derived, post- modernism has taken the opposite tack. Rather than taking the self as a foundation, it has seen it as founded, as dependent on the accidents which situate consciousness in the world. The same holds for the unity of the subject. Modernity, in its search (...) for a single foundation, held the subject to be an indissoluble unity. Post-modernism’s position, by contrast, is announced by Nietzsche: “The assumption of one single subject is perhaps unnecessary; perhaps it is just as permissible to assume a multiplicity of subjects, whose interaction and struggle is the basis of our thought and our consciousness in general? ...My hypotheses: The subject as multiplicity.” Given this, there is a natural correspondence between the success of post- modernism and the current interest in multiple personality disorder. In the latter, we actually have the experience of a “multiplicity of subjects” in their interaction and struggle. The subject stands there before us “as multiplicity.” It gives us a concrete case, one which raises some of the pressing questions associated with the post-modern denial of the subject. Confronting it, we ask: how real are the personalities composing the multiplicity of this disordered self? What, in fact, does this multiplicity tell us about the self? about its genesis and status? What does it reveal about “our thought and consciousness in general”? I plan, in the short compass of this paper, to sketch some answers to these questions. §1. A brief description of MPD. The American Psychiatric Association gives two criteria for (MPD) multiple personality disorder. First, and most obviously, there is “the existence within the person of two or more distinct personalities or personality states (each with its own relatively enduring pattern. (shrink)
A link between mental disorder and freedom is clearly present in the introduction of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). It mentions “an important loss of freedom” as one of the possible defining features of mental disorder. Meanwhile, it remains unclear how “an important loss of freedom” should be understood. In order to get a clearer view on the relationship between mental disorder and (a loss of) freedom, in this article, (...) I will explore the link between mental disorder and free will. I examine two domains in which a connection between mental disorder and free will is present: the philosophy of free will and forensic psychiatry. As it turns out, philosophers of free will frequently refer to mental disorders as conditions that compromise free will and reduce moral responsibility. In addition, in forensic psychiatry, the rationale for the assessment of criminal responsibility is often explained by referring to the fact that mental disorders can compromise free will. Yet, in both domains, it remains unclear in what way free will is compromised by mental disorders. Based on the philosophical debate, I discuss three senses of free will and explore their relevance to mental disorders. I conclude that in order to further clarify the relationship between free will and mental disorder, the accounts of people who have actually experienced the impact of a mental disorder should be included in future 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)
Psychopathy is often characterized in terms of what I call “the language of disorder.” I question whether such language is necessary for an accurate and precise characterization of psychopathy, and I consider the practical implications of how we characterize psychopathy—whether as a biological, or merely normative, disorder.
All definitions of mental disorder are backed up by arguments that rely on general criteria (e.g., that a definition should be consistent with ordinary language). These desiderata are rarely explicitly stated, and there has been no systematic discussion of how different definitions should be assessed. To arrive at a well-founded list of desiderata, we need to know the purpose of a definition. I argue that this purpose must be practical; it should, for example, help us determine who is entitled (...) to publicly funded health care. I then propose eight conditions of adequacy that can be used to assess competing definitions (e.g., the ordinary language condition, the coherence condition, and the condition of normative adequacy). These conditions pull in different directions, however, and we must decide which are most important. I also suggest that there is no single definition that can help us deal with all the relevant practical issues. (shrink)
Upon first consideration, the desire of an individual to amputate a seemingly healthy limb is a foreign, perhaps unsettling, concept. It is, however, a reality faced by those who suffer from body integrity identity disorder (BIID). In seeking treatment, these individuals request surgery that challenges both the statutory provisions that sanction surgical operations and the limits of consent as a defence in New Zealand. In doing so, questions as to the influence of public policy and the extent of personal (...) autonomy become important. Beyond legal issues, BIID confronts dominant conceptions of bodily integrity, medical treatment, and ethical obligations. This paper seeks to identify the relevant public policy concerns raised by BIID in New Zealand and the limits of autonomy, before moving on to consider how BIID sufferers may legally seek the treatment they require and how a doctor might be protected from criminal proceedings for assault for performing this treatment. It will be argued that it is possible to legally consent to the amputation of a healthy limb as medical treatment and that public perception should not be allowed to take precedence over this right. (shrink)
The “hypervigilance, escape, struggle, tonic immobility” evolutionarily hardwired acute peritraumatic response sequence is important for clinicians to understand. Our commentary supplements the useful article on human tonic immobility (TI) by Marx, Forsyth, Gallup, Fusé and Lexington (2008). A hallmark sign of TI is peritraumatic tachycardia, which others have documented as a major risk factor for subsequent posttraumatic stress disorder (PTSD). TI is evolutionarily highly conserved (uniform across species) and underscores the need for DSM-V planners to consider the inclusion of (...) evolution theory in the reconceptualization of anxiety and PTSD. We discuss the relevance of evolution theory to the DSM-V reconceptualization of acute dissociativeconversion symptoms and of epidemic sociogenic disorder(epidemic “hysteria”). Both are especially in need of attention in light of the increasing threat of terrorism against civilians. We provide other pertinent examples. Finally, evolution theory is not ideology driven (and makes testable predictions regarding etiology in “both directions”). For instance, it predicted the unexpected finding that some disorders conceptualized in DSM-IV-TR as innate phobias are conditioned responses and thus better conceptualized as mild forms of PTSD. Evolution theory may offer a conceptual framework in DSM-V both for treatment and for research on psychopathology. (shrink)
The DSM-III, DSM-IV, DSM-IV-TR and ICD-10 have judiciously minimized discussion of etiologies to distance clinical psychiatry from Freudian psychoanalysis. With this goal mostly achieved, discussion of etiological factors should be reintroduced into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). A research agenda for the DSM-V advocated the "development of a pathophysiologically based classification system". The author critically reviews the neuroevolutionary literature on stress-induced and fear circuitry disorders and related amygdala-driven, species-atypical fear behaviors of clinical severity in (...) adult humans. Over 30 empirically testable/falsifiable predictions are presented. It is noted that in DSM-IV-TR and ICD-10, the classification of stress and fear circuitry disorders is neither mode-of-acquisition-based nor brain-evolution-based. For example, snake phobia (innate) and dog phobia (overconsolidational) are clustered together. Similarly, research on blood-injection-injury-type-specific phobia clusters two fears different in their innateness: 1) an arguably ontogenetic memory-trace-overconsolidation-based fear (hospital phobia) and 2) a hardwired (innate) fear of the sight of one's blood or a sharp object penetrating one's skin. Genetic architecture-charting of fear-circuitry-related traits has been challenging. Various, non-phenotype-based architectures can serve as targets for research. In this article, the author will propose one such alternative genetic architecture. This article was inspired by the following: A) Nesse's "Smoke-Detector Principle", B) the increasing suspicion that the "smooth" rather than "lumpy" distribution of complex psychiatric phenotypes (including fear-circuitry disorders) may in some cases be accounted for by oligogenic (and not necessarily polygenic) transmission, and C) insights from the initial sequence of the chimpanzee genome and comparison with the human genome by the Chimpanzee Sequencing and Analysis Consortium published in late 2005. Neuroevolutionary insights relevant to fear circuitry symptoms that primarily emerge overconsolidationally (especially Combat related Posttraumatic Stress Disorder) are presented. Also introduced is a human-evolution-based principle for clustering innate fear traits. The "Neuroevolutionary Time-depth Principle" of innate fears proposed in this article may be useful in the development of a neuroevolution-based taxonomic re-clustering of stress-triggered and fear-circuitry disorders in DSM-V. Four broad clusters of evolved fear circuits are proposed based on their time-depths: 1) Mesozoic (mammalian-wide) circuits hardwired by wild-type alleles driven to fixation by Mesozoic selective sweeps; 2) Cenozoic (simian-wide) circuits relevant to many specific phobias; 3) mid Paleolithic and upper Paleolithic (Homo sapiens-specific) circuits (arguably resulting mostly from mate-choice-driven stabilizing selection); 4) Neolithic circuits (arguably mostly related to stabilizing selection driven by gene-culture co-evolution). More importantly, the author presents evolutionary perspectives on warzone-related PTSD, Combat-Stress Reaction, Combat-related Stress, Operational-Stress, and other deployment-stress-induced symptoms. The Neuroevolutionary Time-depth Principle presented in this article may help explain the dissimilar stress-resilience levels following different types of acute threat to survival of oneself or one's progency (aka DSM-III and DSM-V PTSD Criterion-A events). PTSD rates following exposure to lethal inter-group violence (combat, warzone exposure or intentionally caused disasters such as terrorism) are usually 5-10 times higher than rates following large-scale natural disasters such as forest fires, floods, hurricanes, volcanic eruptions, and earthquakes. The author predicts that both intentionally-caused large-scale bioevent-disasters, as well as natural bioevents such as SARS and avian flu pandemics will be an exception and are likely to be followed by PTSD rates approaching those that follow warzone exposure. During bioevents, Amygdala-driven and locus-coeruleus-driven epidemic pseudosomatic symptoms may be an order of magnitude more common than infection-caused cytokine-driven symptoms. Implications for the red cross and FEMA are discussed. It is also argued that hospital phobia as well as dog phobia, bird phobia and bat phobia require re-taxonomization in DSM-V in a new "overconsolidational disorders" category anchored around PTSD. The overconsolidational spectrum category may be conceptualized as straddling the fear circuitry spectrum disorders and the affective spectrum disorders categories, and may be a category for which Pitman's secondary prevention propranolol regimen may be specifically indicated as a "morning after pill" intervention. Predictions are presented regarding obsessive-compulsive disorder (OCD) (e.g., female-pattern hoarding vs. male-pattern hoarding) and "culture-bound" acute anxiety symptoms (taijin-kyofusho, koro, shuk yang, shook yong, suo yang, rok-joo, jinjinia-bemar, karoshi, gwarosa, Voodoo death). Also discussed are insights relevant to pseudoneurological symptoms and to the forthcoming Dissociative-Conversive disorders category in DSM-V, including what the author terms fright-triggered acute pseudo-localized symptoms (i.e., pseudoparalysis, pseudocerebellar imbalance, psychogenic blindness, pseudoseizures, and epidemic sociogenic illness). Speculations based on studies of the human abnormal-spindle-like, microcephaly-associated (ASPM) gene, the microcephaly primary autosomal recessive (MCPH) gene, and the forkhead box p2 (FOXP2) gene are made and incorporated into what is termed "The pre-FOXP2 Hypothesis of Blood-Injection-Injury Phobia." Finally, the author argues for a non-reductionistic fusion of "distal (evolutionary) neurobiology" with clinical "proximal neurobiology," utilizing neurological heuristics. It is noted that the value of re-clustering fear traits based on behavioral ethology, human-phylogenomics-derived endophenotypes and on ontogenomics (gene-environment interactions) can be confirmed or disconfirmed using epidemiological or twin studies and psychiatric genomics. (shrink)
The concept of mental disorder is often defined by reference to the notion of mental dysfunction, which is in line with how the concept of disease in somatic medicine is often defined. However, the notions of mental function and dysfunction seem to suffer from some problems that do not affect models of physiological function. Functions in general have a teleological structure; they are effects of traits that are supposed to have a particular purpose, such that, for example, the heart (...) serves the goal of pumping blood. But can we single out mental functions in the same way? Can we identify mental functions scientifically, for instance, by applying evolutionary theory? Or are models of mental functions necessarily value-laden? I want to identify several philosophical problems regarding the notion of mental function and dysfunction and point out some possible solutions. As long as these questions remain unanswered, definitions of mental disorder that rest upon the concept of mental dysfunction will lack a secure foundation. (shrink)
Progress in psychiatry depends on accurate definitions of disorders. As long as there are no known biologic markers available that are highly specific for a particular psychiatric disorder, clinical practice as well as scientific research is forced to appeal to clinical symptoms. Currently, the nosology of obsessive-compulsive disorder is being reconsidered in view of the publication of DSM-V. Since our diagnostic entities are often simplifications of the complicated clinical profile of patients, definitions of psychiatric disorders are imprecise and (...) always indeterminate. This urges researchers and clinicians to constantly think and rethink well-established definitions that in psychiatry are at risk of being fossilised. In this paper, we offer an alternative view to the current definition of obsessive-compulsive disorder from a phenomenological perspective.TranslationThis article is translated from Dutch, originally published in [Handbook Obsessive-compulsive disorders, Damiaan Denys, Femke de Geus (Eds.), (2007). De Tijdstroom uitgeverij BV, Utrecht. ISBN13: 9789058980878.]. (shrink)
The DSM-IV-TR (American Psychiatric Association 1994, 689) defines personality disorder (PD) as: An enduring pattern of experience and behavior that deviates markedly from the expectations of an individual’s culture. This pattern is manifested in two (or more) of the following areas: 1 Cognition (i.e., ways of perceiving and interpreting self, other people, and events); 2 Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response); 3 Interpersonal functioning; and 4 Impulse control. B The enduring ..
This article has two aims. The first is to introduce some novel data that highlight rather surprising pragmatic abilities in autism spectrum disorder (ASD). The second is to consider a possible implication of these data for an emerging empirical methodology in philosophy of language and mind. In pursuing the first aim, we expect our main audience to be clinicians and linguists interested in pragmatics. It is when we turn to methodological issues that we hope to pique the interest of (...) philosophers. Still, the methodological issue becomes pressing precisely because of the empirical finding—thus the first part is important for the philosophical readers as well. The game plan is as follows. Given our intended dual audience, we begin with background on autism and pragmatics. Some of this material will be familiar to some of our readership, but few will know all of it. (Those who do are invited to skip these sections.) We then present some results from our pilot study on a corpus of speech by people with ASD. The heart of our finding is that certain speakers with ASD, who have severe trouble with familiar pragmatic phenomena such as metaphor and conversational implicature, exhibit surprising abilities with respect to what is often called “pragmatic determinants of what is said.” We turn next to a possible implication of this finding: It seems to suggest that hitherto seemingly promising evidence from ASD about the semantics/pragmatics boundary is.. (shrink)
In this chapter, I articulate the structure of a general concept of autonomy and then reply to possible objections with reference to Ulysses arrangements in psychiatry. The line of argument is as follows. Firstly, I examine three alternative conceptions of autonomy: value-neutral, value-laden, and relational. Secondly, I identify two paradigm cases of autonomy and offer a sketch of its concept as opposed to the closely related freedom of action and intentional agency. Finally, I explain away the autonomy paradox, to which (...) the previously identified pair of paradigm cases seems to give rise in the context of mental disorder. By addressing this paradox, we learn two valuable lessons. The first is about the relationships between the three conceptions of autonomy above. The second is about the relationship between autonomy and mental disorder. (shrink)
Long before i knew I had a personality disorder, I simply knew that my life felt unbearably difficult to live. For me, life has always been an uphill struggle, and at times I have just let myself tumble down the hill I have strived so hard to climb. Fortunately, I now understand how to keep going, and even to avoid falling down in the first place, but this learning process has taken the entire twenty-eight years of my life, and (...) I still feel I have a long way to go. It feels very difficult to describe the early years of my life. To me, it was like being stuck in a cage, gagged. I can remember feeling a great deal of fear, but being unable to express it. My dad would burst into anger very rapidly, and my .. (shrink)
Body integrity identity disorder (BIID), formerly also known as apotemnophilia, is characterized by a desire for amputation of a healthy limb and is claimed to straddle or to even blur the boundary between psychiatry and neurology. The neurological line of approach, however, is a recent one, and is accompanied or preceded by psychodynamical, behavioural, philosophical, and psychiatric approaches and hypotheses. Next to its confusing history in which the disorder itself has no fixed identity and could not be classified (...) under a specific discipline, its sexual component has been an issue of unclarity and controversy, and its assessment a criterion for distinguishing BIID from apotemnophilia, a paraphilia. Scholars referring to the lived body—a phenomenon primarily discussed in the phenomenological tradition in philosophy—seem willing to exclude the sexual component as inessential, whereas other authors notice important similarities with gender identity disorder or transsexualism, and thus precisely focus attention on the sexual component. This contribution outlines the history of BIID highlighting the vicissitudes of its sexual component, and questions the justification for distinguishing BIID from apotemnophilia and thus for omitting the sexual component as essential. Second, we explain a hardly discussed concept from Maurice Merleau-Ponty’s Phenomenology of Perception ( 1945a ), the sexual schema , and investigate how the sexual schema could function in interaction with the body image in an interpretation of BIID which starts from the lived body while giving the sexual component its due. (shrink)
Attention-deficit/hyperactivity disorder (ADHD) is currently defined as a cognitive/behavioral developmental disorder where all clinical criteria are behavioral. Inattentiveness, overactivity, and impulsiveness are presently regarded as the main clinical symptoms. The dynamic developmental behavioral theory is based on the hypothesis that altered dopaminergic function plays a pivotal role by failing to modulate nondopaminergic (primarily glutamate and GABA) signal transmission appropriately. A hypofunctioning mesolimbic dopamine branch produces altered reinforcement of behavior and deficient extinction of previously reinforced behavior. This gives rise (...) to delay aversion, development of hyperactivity in novel situations, impulsiveness, deficient sustained attention, increased behavioral variability, and failure to “inhibit” responses (“disinhibition”). A hypofunctioning mesocortical dopamine branch will cause attention response deficiencies (deficient orienting responses, impaired saccadic eye movements, and poorer attention responses toward a target) and poor behavioral planning (poor executive functions). A hypofunctioning nigrostriatal dopamine branch will cause impaired modulation of motor functions and deficient nondeclarative habit learning and memory. These impairments will give rise to apparent developmental delay, clumsiness, neurological “soft signs,” and a “failure to inhibit” responses when quick reactions are required. Hypofunctioning dopamine branches represent the main individual predispositions in the present theory. The theory predicts that behavior and symptoms in ADHD result from the interplay between individual predispositions and the surroundings. The exact ADHD symptoms at a particular time in life will vary and be influenced by factors having positive or negative effects on symptom development. Altered or deficient learning and motor functions will produce special needs for optimal parenting and societal styles. Medication will to some degree normalize the underlying dopamine dysfunction and reduce the special needs of these children. The theory describes how individual predispositions interact with these conditions to produce behavioral, emotional, and cognitive effects that can turn into relatively stable behavioral patterns. Key Words: catecholamine; clumsiness; dopamine; hyperkinesis; hyperkinetic disorder; impulsivity; monoamine; neuromodulator; overactivity; pollutants; reinforcement; reward; verbally governed behavior; soft signs; variability. (shrink)
The Depue & Collins model is intended to explain a normal human personality trait: extraversion. In contrast, attention-deficit/hyperactivity disorder (ADHD) is generally considered to be a type of psychopathology not found in so-called normals; however, the clinical and neurobiological research done on ADHD seems to amplify and support Depue & Collins's model.
This paper examines Boltzmann’s responses to the Loschmidt reversibility objection to the H-theorem, as presented in his Lectures on Gas Theory. I describe and evaluate two distinct conceptions of the assumption of molecular disorder found in this work, and contrast these notions with the Stosszahlansatz, as well as with the predominant contemporary conception of molecular disorder. Both these conceptions are assessed with respect to the reversibility objection. Finally, I interpret Boltzmann as claiming that a state of molecular (...) class='Hi'>disorder serves as a necessary condition for the application of probabilistic arguments. This in turn offers a way to bridge the conceptual gap between the H-theorem and his combinatorial argument. (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)
Abstract This paper aims to describe an objective account of sexual perversion. That is, it seeks to characterize sexual perversion as something which is not simply a deviation from a statistical norm but rather as something which violates an objective naturalistic norm. The central point is that perversion consists in the introduction of a strange and extraneous loop in the aetiology of sexual sensations, and this extraneous loop makes it possible to characterize sexual perversion as an objective disorder which (...) is in need of therapy. (shrink)
According to the traditional Western concept of freedom, the ability to exercise free will depends on the availability of options and the possibility to consciously decide which one to choose. Since neuroscientific research increasingly shows the limits of what we in fact consciously control, it seems that our belief in free will and hence in personal autonomy is in trouble. -/- A closer look at the phenomenology of Obsessive-Compulsive Disorder (OCD) gives us reason to doubt the traditional concept of (...) freedom in terms of conscious control. Patients suffering from OCD experience themselves as unfree. The question is whether their lack of freedom is due to a lack of will power. Do they have too little conscious control over their thoughts and actions? Or could it be the opposite: are they exerting too much conscious control over their thoughts and actions? -/- In this chapter, we will argue that OCD patients testify to the general condition that exercising an increased conscious control over actions can in fact diminish the sense of agency rather than increase the experience of freedom. The experiences of these patients show that the traditional conception of freedom in terms of ‘free will’ has major shortcomings. There is an alternative, however, to be found in the work of Hannah Arendt. She advocates a conception of freedom as freedom in action. Combined with phenomenological insights on action, Arendt’s account of freedom helps us to get a more adequate understanding of the role of deliberation in the experience of freedom. We argue that the experience of freedom depends on the right balance between deliberate control and unreflective actions. (shrink)
This article has two aims. The first is to introduce some novel data that highlight rather surprising pragmatic abilities in autism spectrum disorder (ASD). The second is to consider a possible implication of these data for an emerging empirical methodology in philosophy of language and mind.
This paper examines two influential theoretical frameworks, set forth by Russell Barkley (1997) and Thomas Brown (2005), and argues that important headway in understanding attention deficit hyperactivity disorder can be made if we acknowledge the way in which human cognition and action are essentially embodied and enactive. The way in which we actively make sense of the world is structured by our bodily dynamics and our sensorimotor engagement with our surroundings. These bodily dynamics are linked to an individual's concerns (...) and felt needs, so that what she attends to in perception, decision-making, and action is partially constituted by her cares and concerns. What I call ?affective framing? engages the whole living body, and ordinarily contributes to attentional focusing, working memory, goal-formulation, and action-monitoring. However, due to affective framing deficits, subjects with ADHD find it difficult to focus their attention, kindle their motivation, and systematically simplify cognitive procedures according to considerations of relevance, salience, and context. Thus, what is impaired in ADHD is not simply a set of executive brain functions, but rather a range of bodily dynamics through which subjects engage with their world. For this reason, intensive behavioral intervention that engages the whole living body may be the most effective, lasting treatment for ADHD. (shrink)
The present trend towards an atheoretical statistical method of psychiatric classification has prompted many psychiatrists to conceive of "mental disorder", or for that matter any other psychopathological designation, as an indexical cluster of properties and events more than a distinct psychological impairment. By employing different combinations of inclusion and exclusion criteria, the current American Psychiatric Association's scheme (called DSM-III) hopes to avoid the over-selectivity of more metaphysical systems and thereby provide the clinician with a flexible means of dealing with (...) a wide diversity of cases. In the hope of redirecting future inquiry, the paper will argue: (1) that this recent trend might appear to be clinically beneficial, but in point of fact it is riddled by unsound theoretical conclusions which leave the field without a deeply reaching base for understanding and treating mental disorder, and (2) that, a fortiori, "mental disorder" is best conceived as not a cluster of properties and events, nor a metaphorical reaction to a breakdown in social interpersonal relations, but as a deeply laid condition characterized by the absence of an imaginally integrated system. (shrink)
Background:The belief that we can control our thoughts is not inevitably adaptive, particularly when it fuels mental control activities that have ironic unintended consequences. The conviction that the mind can and should be controlled can prompt people to suppress unwanted thoughts, and so can set the stage for the intrusive return of those very thoughts. An important question is whether or not these beliefs about the control of thoughts can be reduced experimentally. One possibility is that behavioral experiments aimed at (...) revealing the ironic return of suppressed thoughts might create a lesson that could reduce unrealistic beliefs about the control of thoughts. Aims: The present research assessed the influence of the thought suppression demonstration on beliefs about the control of thoughts in a non-clinical sample, and among individuals with obsessive-compulsive disorder (OCD). Method: In Study 1, we assessed the effect of the thought suppression demonstration on beliefs about the control of thoughts among low and high obsessive individuals in the non-clinical population (N= 62). In Study 2, we conducted a similar study with individuals with OCD (N= 29). Results: Results suggest that high obsessive individuals in the non-clinical population are able to learn the futility of suppression through.. (shrink)
Current efforts to think holistically about mental disorder may be assisted by considering the integrative strategies used by Hildegard of Bingen, a twelfth-century abbess and healer. We search for integrative strategies in the detailed records of Hilde-gard’s treatment of the noblewoman Sigewiza and in Hildegard’s more general writings. Three strategies support Hildegard’s holistic thinking: the use of narrative approaches to mental illness, acknowledging interdependence between perspectives, and applying principles of balance to the relationships between perspectives. Applying these three strategies (...) to the present-day conceptualization and treatment of mental disorder could move us toward a more thoroughly integrated understanding of the field. (shrink)
This article argues in support of the proposition that “A Personality Disorder May Nullify Responsibility for a Criminal Act.” Building upon research in categorical and dimensional controversies in diagnosis, neurocognitive science and the behavioral genetics of mental disorders, and difficulties in differential diagnosis and co-morbidity with personality disorders, this article holds that a per se rule barring personality diagnosis as a basis for a defense of legal insanity is scientifically and conceptually indefensible. Rather, focus should be upon the severity (...) and impact in specific cases of any legally relevant functional deficits arising from a mental disorder (including personality disorders). Failure to do so risks potentially misleading “battles of the experts” about a defendant's diagnosis in criminal responsibility defenses and improper usurpation of the role of the legal finder of fact as mental health expert witnesses are inserted as gatekeepers indefensibly based upon diagnosis. Implications for practice and public policy are considered, including a “modest proposal” for post-trial management of defendants found not guilty by reason of insanity on the basis of functional deficits arising from personality disorder. (shrink)
Keller & Miller (K&M) assert that mental disorders could not have evolved as adaptations, but they fail to make their case against the theory of the evolutionary origin of bipolar disorder that I have proposed (Sherman 2001). Such an idea may be unorthodox, but it has considerable explanatory power and heuristic value. (Published Online November 9 2006).
The Hospital for Rehabilitation, Stavern, in Norway has treated patients with physical symptoms with no organic cause, so called conversion disorder patients, for over a decade. For four years research on the treatment has been carried out. Patients with conversion disorder seem not to fit in traditional somatic hospitals because their patienthood depends upon psychiatric diagnosis. Ironically, they appear not to belong in psychiatric hospitals because of their physical symptoms. The treatment offered these patients at hospitals for rehabilitation (...) is adapted physical activity consisting of behaviour elements such as positive reinforcement of normal function and lack of positive reinforcement at dysfunction. The pedagogical approach is seen as crucial in the successful rehabilitation of the patients. The disorder and treatment can be understood by using theories about the ecstatic body, radical behaviourism and phenomenology. When patients have problems in behaviour concerning both body and mind, it would be natural to employ both in the road to recovery. This article describes the various treatments and discusses them from phenomenological, ethical and philosophical perspectives. (shrink)
Due to several socio-political factors, to many psychiatrists only a strictly objective definition of mental disorder, free of value components, seems really acceptable. In this paper, I will explore a variant of such an objectivist approach to defining metal disorder, natural function objectivism. Proponents of this approach make recourse to the notion of natural function in order to reach a value-free definition of mental disorder. The exploration of Christopher Boorse's 'biostatistical' account of natural function (1) will be (...) followed an investigation of the 'hybrid naturalism' approach to natural functions by Jerome Wakefield (2). In the third part, I will explore two proposals that call into question the whole attempt to define mental disorder (3). I will conclude that while 'natural function objectivism' accounts fail to provide the backdrop for a reliable definition of mental disorder, there is no compelling reason to conclude that a definition cannot be achieved. (shrink)
Three reservations about Keller & Miller's (K&M's) argument are explored: Serious validity problems afflict epidemiological criteria discriminating disorders from non-disorders, so high rates may be misleading. Normal variation need not be mild disorder, contrary to a possible interpretation of K&M's article. And, rather than mutation-selection balance, true disorders may result from unselected combinations of normal variants over many loci. (Published Online November 9 2006).
The scene was pleasant on both sides. A cruder lover would have lost the view of her pretty ways and attitudes, and spoiled all by stupid attempts at caresses, utterly destructive of the drama. Grancourt preferred the drama. Gwendolen … found her spirits rising … as she played at reigning. Perhaps if Klesmer had seen more of her in this unconscious kind of acting, instead of when she was trying to be theatrical, he might have rated her chances [on stage] (...) higher.The histrionic personality disorder (HPD) stands at the intersection of ethics, ontology, and philosophy of psychiatry. Although HPD is a rarely probed diagnosis, it brings into relief the problems of gender and values in diagnosis, as well as nosological .. (shrink)
Popular and neurobiological accounts of addiction tend to treat it as a form of compulsion. This contrasts with personality disorder, where most problematic behaviours are treated as voluntary. But high levels of co-morbidity, overlapping diagnostic traits, and the effectiveness of a range of comparable clinical interventions for addiction and personality disorder suggest that this difference in treatment is unjustified. Drawing on this range of clinical interventions, we argue that addiction is not a form of compulsion. Rather, the misuse (...) of drugs and alcohol is like many of the problematic behaviours associated with personality disorder: it is typically a way of coping with psychological distress. We suggest that a satisfying explanation of why many addicts struggle to control their use can be given without departing from concepts employed in our basic folk psychological understanding of agency. In particular, we appeal to five rough-and-ready folk psychological factors to explain addiction: (i) strength of desire and habit; (ii) willpower; (iii) motivation; (iv) functional role; and (v) decision and resolve. (shrink)
Some commentaries suggest that the attention-deficit/hyperactivity disorder (ADHD) theory of this condition does not explain enough. Because the theory includes parameters of the delay gradient that vary across individuals and developmental modulation of behavioral outcomes by different environments, it accommodates a wide range of manifestations of ADHD symptoms. Thus, the argument could instead be made that the theory allows too many degrees of freedom. For many purposes, behavior is better defined in terms of function (e.g., consequences) than in terms (...) of structure (e.g., muscle movements), so cognition is treated here as a variety of behavior rather than as a different category of phenomena. The commentaries are discussed in the context of these and other distinctions, including those between association and selection, between operant and respondent behavior, and between fundamental processes and those that are derivative. Other issues include: prosthetic environments, rapidity of developmental change, the concept of inhibition, the form of the delay gradient, and possible directions for experimental research. (shrink)
The dynamic developmental theory (DDT) has benefited from the insights of the commentators, particularly in terms of the implications for the proposed steepened delay gradients in attention-deficit/hyperactivity disorder (ADHD). The introduction of modified memory processes as a basis for the delay gradients improved the links to aspects of ADHD. However, it remains unclear whether the hyperactive-impulsive and inattentive subtypes are separate subgroups or may be explained as different outcomes of the same genetic factors and thus explicable by the same (...) principles. The DDT suggests that altered reinforcement and extinction processes define an endophenotype in ADHD that can be related dimensionally to inattention, hyperactivity, and impulsivity. The relation between the suggested endophenotype, characterized by changes in basic learning mechanisms, and other endophenotypes characterized by delay aversion or response disinhibition, needs to be tested in future studies. (shrink)
ADHD is a psychiatric disorder characterised by persistent and developmentally inappropriate levels of inattention, impulsivity and hyperactivity. It is known that children with ADHD tend to produce incoherent discourses, e.g. by narrating events out of sequence. Here the aetiology of ADHD becomes of interest. One prominent theory is that ADHD is an executive function disorder, showing deficiencies of planning. Given the close link between planning, verb tense and discourse coherence postulated in van Lambalgen and Hamm (The proper treatment (...) of events, 2004), we predicted specific deviations in the verb tenses produced by children with ADHD. Here we report on an experiment corroborating these predictions. (shrink)
Sagvolden, Johansen, Aase, and Russell (Sagvolden et al.) examine attention-deficit/hyperactivity disorder (ADHD) at levels of analysis ranging from neurotransmitters to behavior. At the behavioral level they attribute aspects of ADHD to anomalies of delay-of-reinforcement gradients. With a normal gradient, responses followed after a long delay by a reinforcer may share in the effects of that reinforcer; with a diminished or steepened gradient they may fail to do so. Steepened gradients differentially select rapidly emitted responses (hyperactivity), and they limit the (...) effectiveness with which extended stimuli become conditioned reinforcers, so that observing behavior is less well maintained (attention deficit). Impulsiveness also follows from steepened gradients, which increase the effectiveness of smaller, more immediate consequences relative to larger, more delayed ones. Individuals who vary in the degree to which their delay gradients are steepened will show different balances between hyperactivity and attention deficit. Given the range of ADHD phenomena addressed, it may be unnecessary to appeal to additional behavioral processes such as extinction deficit. Extinction deficit is more likely a derivative of attention deficit, in that failure to attend to stimuli differentially correlated with extinction should slow its progress. The account suggests how relatively small differences in delay gradients early in development might engender behavioral interactions leading to very large differences later on. The steepened gradients presumably originate in properties of neurotransmitter function, but behavioral interventions that use consistently short delays of reinforcement to build higher-order behavioral units as a scaffolding to support complex cognitive and social skills may nonetheless be feasible. Key Words: ADHD; attention deficit; delay gradient; exponential decay; extinction deficit; hyperactivity; impulsiveness; intervention; observing responses; self-control. Footnotes1000 Jeffrey Gray was the BBS Editor for this treatment. When he accepted Sagvolden et al. for publication, he invited Catania, who was one of the reviewers of the original submission, to prepare a precommentary. Com-mentators were then invited to respond to the Sagvolden et al. article, to the Catania precommentary, or to both. (shrink)
The phenomenology of inner temporalizing developed by Edmund Husserl provides a helpful framework for understanding a type of experiencing that can be part of the Post-Traumatic Stress Disorder (PTSD). My paper extrapolates hints from Husserl's work in order to describe those memories — flashbacks — that come so strongly to consciousness as to overtake the experiencer. Husserl's work offers several clues: his view of inner temporalization by which conscious experiences flow in both a serial and a nonserial manner; a (...) characterization of process memory as distinct from representational memory; and the notion of telos, which takes human subjectivity as intrinsically changeable, for example, by means of a retroactive cancellation that would allow the PTSD experiencer to re-process the original meaning of the traumatic experience into a meaning that fits the current situation and thus allows a recovery. (shrink)
All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood. (Article 1, Universal Declaration of Human Rights 1948) This resounding statement encapsulates a number of problematic themes for lawyers with respect to personality disorder, and acutely so for the extremes of personality disorder embraced by designations such as psychopathy or dangerous and severe personality disorder (DSPD). These designations (...) are in themselves contentious; they do not have commonly agreed definitions either across disciplines or across jurisdictions. Morse (2008), for example, argues in a fascinating account that .. (shrink)
It is commonly thought that mental disorder is a valid concept only in so far as it is an extension of or continuous with the concept of physical disorder. A valid extension has to meet two criteria: determination and coherence. Essentialists meet these criteria through necessary and sufficient conditions for being a disorder. Two Wittgensteinian alternatives to essentialism are considered and assessed against the two criteria. These are the family resemblance approach and the secondary sense approach. Where (...) the focus is solely on the characteristics or attributes of things, both these approaches seem to fail to meet the criteria for valid extension. However, this focus on attributes is mistaken. The criteria for valid extension are met in the case of family resemblance by the pattern of characteristics associated with a concept, and by the limits of intelligibility of applying a concept. Secondary sense, though it may have some claims to be a good account of the relation between physical and mental disorder, cannot claim to meet the two criteria of valid extension. (shrink)
Stigma and prejudice have long affected the science and treatment of personality disorder (PD). It is widely recognized that PD is associated with social exclusion, unemployment, homelessness, and crime, together with addiction, eating disorders, anxiety, depression, and psychoses (National Institute of Mental Health in England 2003). The financial burden placed on psychiatric, medical, social, legal, and forensic services is high. The practical and emotional burden placed on family and friends of those with PD, as well as the clinicians who (...) seek to treat them, is equally real. PD is also associated with deliberate self-harm, suicide, mortality, violence, chaotic lifestyles, emotional instability, and severe and .. (shrink)
The reinforcement/extinction disorder hypothesis (Sagvolden et al.) is an important counterweight to the executive dysfunction model of attention-deficit/hyperactivity disorder (ADHD). However, like that model, it conceptualises ADHD as pathophysiologically homogeneous, resulting from a common core dysfunction. Recent studies reporting neuropsychological heterogeneity suggest that this common core dysfunction may be the scientific equivalent of a red herring.
The United States Food and Drug Administration's recent approval of the commercial use of Deep Brain Stimulation (DBS) as a treatment for Obsessive Compulsive Disorder (OCD) will be discussed within the context of the existing USA regulatory framework. The purpose will be to illustrate the current lack of regulation and oversight of the DBS market, which has resulted in the violation of basic ethical norms. The discussion will focus on: 1) the lack of available evidence on procedural safety and (...) efficacy, 2) the numerous conflicts of interest held by research investigators, and 3) the ambiguity of both aforementioned categories due to an inherent lack of transparency in the research. It is argued that in order to address these issues, ethical analyses of DBS for psychiatric disorders must include the role of the industry forces that have become the primary impetus for this research. As such, DBS for OCD serves as an important case example in studies of neurotechnology and innovative surgery. (shrink)
Worrying is the central feature of generalized anxiety disorder (GAD). Many people worry from time to time, but in GAD the worrying is prolonged and difficult to control. Worrying is a specific way of coping with perceived threats and feared situations. Meanwhile, it is not considered to be a helpful coping strategy, and the phenomenological account developed in this paper aims to show why. It builds on several phenomenological notions and in particular on Michael Wheeler's application of these notions (...) to artificial intelligence and the cognitive sciences. Wheeler emphasizes the value of 'online intelligence' as contrasted to 'offline intelligence'. I discuss and apply these concepts with respect to worrying as it occurs in GAD, suggesting that GAD patients overrate the value of detached contemplation (offline intelligence), while underrating their embodied-embedded adaptive skills (online intelligence). I argue that this phenomenological account does not only help explaining why worrying is used as a coping strategy, but also why cognitive behavioral therapy is successful in treating GAD. (shrink)
Numerous sex differences in obsessive-compulsive disorder (OCD) instantiations are likely universal, as the associated evolutionary threats and concerns onto which they map were differentially important to the two sexes. Hence, although some ritualized behaviors or thoughts are indeed culture-specific, others are both culturally and temporally invariant as they are rooted in universal Darwinian etiologies (e.g., the sex differences in OCD symptomatology posited here). (Published Online February 8 2007).
Theoretical models for physician-patient communication in clinical practice are described in literature, but none of them seems adequate for solving the communication problem in clinical practice that emerges in case of factitious disorder. Theoretical models generally imply open communication and respect for the autonomy of the patient. In factitious disorder, the physician is confronted by lies and (self)destructive behaviour of the patient, who in one way or another tries to involve the physician in this behaviour. It is no (...) longer controversial that the physician should communicate his consideration of a factitious disorder without insistence that the patient accepts this diagnosis. However, the balance between patient autonomy and open communication on the one hand, and the preservation of the patient's health, physician integrity and of a constructive physician-patient relationship on the other is easily disrupted. In this article, an epistemological model is described to facilitate a positive outcome of confrontation in treatment of factitious disorder. Analysing the problem in terms of systems theory will help the physician to assess what information is appropriate to use in which phase of the patient's treatment, while preserving the physician-patient relationship. (shrink)
Notwithstanding the many strengths of the dynamic developmental theory, there remain challenges to be overcome before it can be incorporated into a true causal model of attention-deficit/hyperactivity disorder (ADHD). These include the development of reliable measures of reinforcement delay gradients, the validation of shortened reinforcement delay as an endophenotype, and the integration of this pathway with other potential pathways.
Gender Identity Disorder (GID) is regarded as a mental illness and included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). It will also appear in the DSM-V, due to be published in 2013. The classification of GID as a mental illness is contentious. But what would happen to sufferers if it were removed from the diagnostic manuals? Would people lose their entitlement to funded medical care, or to reimbursement under insurance schemes? On what basis should medical treatment (...) for GID be provided? What are the moral arguments for and against funded or reimbursed medical care for GID? This paper starts out with a fiction: GID is removed from the diagnostic manuals. Then the paper splits in two, as in happened in the Howitt’s 1998 film Sliding Doors . The two scenarios run parallel. In one, it is argued that GID is on a par with other body modifications, such as cosmetic and racial surgery, and that, for ethical reasons, treatment for GID should be privately negotiated by applicants and professionals and privately paid for. In the other scenario, it is argued that the comparison between GID and other body modifications is misleading. Whether or not medical treatment should be funded or reimbursed is independent of whether GID is on a par with other forms of body dissatisfaction. (shrink)
Critics of attention-deficit/hyperactivity disorder (ADHD) have repeatedly argued that there is no proof for the condition being symptomatic of an organic brain disease and that the current "ADHD epidemic" is an expression of medicalization. To this, the supporters of ADHD can retort that the condition is only defined as a mental disorder and not a physical disease. As such, ADHD needs only be a harmful mental dysfunction, which, like other genuine disorders, can have a complex and obscure etiology. (...) This article argues that such a line of argument fails to save ADHD as a valid diagnostic category. Given the general diagnostic logic of the DSM-IV and how ADHD has been defined in terms of everyday (male) child behaviors, there are compelling grounds to disbelieve that ADHD can be a true medical syndrome united by some type of harmful dysfunction. Indeed, strong logical and empirical reasons will be adduced to show that people may qualify for ADHD diagnosis without suffering from any type of underlying pathology. (shrink)
The honeybee, Apis mellifera, has excited both literary and scientific interest since ancient times, and even modern entomological investigation has not entirely dispelled the mystery surrounding the corporate intelligence of the beehive. Yet this lingering mystique has not prevented the wholesale exploitation of the honeybee as pollinator of choice in present-day industrial agriculture. In the context of this industrialization of the apiary, honeybees around the world are succumbing to the condition known as “colony collapse disorder.” The consequent disappearance of (...) honeybees on a massive scale poses the question, what do honeybees mean to us? Is their loss a moral loss, and if so, is it merely a moral loss, or something more? Does the loss of honeybees portend further losses that will amount to the loss of the basic conditions for meaning, and hence for morality, per se? (shrink)
Dissociative identity disorder (DID; called multiple personality disorder in DSMIII-R) is a psychiatric condition in which two or more identity states recurrently take control of the person's behavior. A characteristic feature of DID is the occurrence of apparently severe amnestic symptoms. This paper is concerned with experimental research of memory function in DID and focuses on between-identity transfer of newly learned neutral material. Previous studies on this subject are reviewed and a pilot study with four subjects is described. (...) This study is specifically concerned with the question whether self-reported asymmetries in between-identity transfer can be replicated on experimental memory tests. A secondary aim was to examine whether, in the absence of explicit transfer, implicit transfer of information would occur. The results showed that the apparent amnestic asymmetry for explicit information was substantiated in the laboratory, although at least some leakage was present between the apparently amnestic identities. No evidence was found for better performance on implicit than on explicit memory tests in the apparently amnestic identities. In the discussion, parallels between apparent amnesia in DID and state-dependent memory are drawn, and the question of simulated amnesia is addressed. (shrink)
This review of Bolton & Hill's (B&H) Mind, Meaning, & Mental Disorder examines their non-reductionist yet realist position on mental content. Their arguments are compared to the writings of Dennett and Millikan, where determining function is central to determining information-processing capabilities. The normative nature of function (malfunction) is considered as is its relation to mental states more broadly. Their Wittgensteinian view of meaning as action is accepted as insightful and useful, though some questions remain about their theory of meaning (...) and its applicability to psychological phenomena. (shrink)
The National Institute of Mental Health (Bethesda, MD) reports that approximately 5.2 million Americans experience post-traumatic stress disorder (PTSD) each year. PTSD can be severely debilitating and diminish quality of life for patients and those who care for them. Studies have indicated that propranolol, a beta-blocker, reduces consolidation of emotional memory. When administered immediately after a psychic trauma, it is efficacious as a prophylactic for PTSD. Use of such memory-altering drugs raises important ethical concerns, including some futuristic dystopias put (...) forth by the President's Council on Bioethics. We think that adequate informed consent should facilitate ethical research using propranolol and, if it proves efficacious, routine treatment. Clinical evidence from studies should certainly continue to evaluate realistic concerns about possible ill effects of diminishing memory. If memory-attenuating drugs prove effective, we believe that the most immediate social concern is the over-medicalization of bad memories, and its subsequent exploitation by the pharmaceutical industry. (shrink)
. Current debates concerning the concept of mental disorder involve many different philosophical issues. However, it is not always clear from these discussions how, or whether, these issues relate to one another, or in exactly what way they are important for the definition of disorder. This article aims to sort through some of the philosophical issues that arise in the current literature and provide a clarification of how these issues are related to one another and whether they are (...) necessary for defining disorder. I argue that the main concern in defining disorder, namely demarcation, is obscured by a number of these other philosophical issues and that a focus on demarcation gives us a means of placing these other issues in a clarifying context. (shrink)
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. Alzheimerâs disease is a good example when considering this important question. On the one hand, Alzheimerâs 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 Alzheimerâs disease as a âneuropsychiatricâ (...)disorder, because it cannot easily be classified as either a âneurologicalâ or âpsychiatricâ disorder. On the other hand, the concept of Alzheimerâs disease was created at the beginning of the twentieth century, as the neurosciences were beginning to take shape themselves as scientific disciplines. To compare Alzheimerâs original ideas with current conceptions may thus help us to precisely specify current developments in the neurosciences. (shrink)
Obsessive-compulsive disorder (OCD) is considered to be one of the more common serious mental disorders, with a prevalence rate of about 1% (Heyman et al. 2006). It is characterized by obsessions, or compulsions, or both. According to the DSM-IV (American Psychiatric Association 1994), obsessions are “recurrent and persistent thoughts, impulses, or images that are experienced at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.” Compulsions, on the other hand, are repetitive behaviors (...) (e.g., hand washing, ordering, checking) or “mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied .. (shrink)
Background Previous research on informed consent for research in psychiatric patients has centered on disorders that affect comprehension and appreciation of risks. Little has been written about consent to research in those subjects with Borderline Personality Disorder, a prevalent and disabling condition. Discussion Despite apparently intact cognition and comprehension of risks, a borderline subject may deliberately choose self-harm in order to fulfill abnormal psychological needs, or due to suicidality. Alternatively, such a subject may refuse enrollment due to transference or (...) the desire to harm him or herself. Such phenomena could be precipitated or prevented by the interpersonal dynamics of the informed consent encounter. Summary Caution should be exercised in obtaining informed consent for research from subjects with Borderline Personality Disorder. A literature review and recommendations for future research are discussed. (shrink)
This paper argues that in liberal nations migration law orders chaotic images and is an important site for the construction of national identities. Empirical illustrations are drawn primarily from Australia, but the thesis is applicable to all immigrant nations and also provides insights for the “Old World”. The argument proceeds by first examining the role of migration laws in liberal democratic societies. Building on this framework, it then looks at how Australian migration law responds to images of disorder outside (...) the nation. Finally, it considers how migration law addresses disorder within the nation by reflecting a coherent picture of Australian national identity. (shrink)
The DSM-III-R definition of mental disorder is inconsistent with the DSM-III-R definition of paraphilias. The former requires the suffering or increased risk of suffering some harm while the latter allows that deviance, by itself, is sufficient to classify a behavioral syndrome as a paraphilia. This inconsistency is particularly clear when examining the DSM-III-R account of a specific paraphilia, Transvestic Fetishism. The author defends the DSM-III-R definition of mental disorder and argues that the DSM-III-R definition of paraphilias should be (...) changed. He recommends that the diagnostic criteria for specific paraphilias, particularly that for Transvestic Fetishism, be changed to make them consistent with the DSM-III-R definition of mental disorder. Keywords: diagnoses, disease, paraphilia, philosophy, psychiatry CiteULike Connotea Del.icio.us What's this? (shrink)
This paper will examine the way in which premenstrual symptomatology has been represented and regulated by psychology and psychiatry. It questions the truths about women's premenstrual experiences that circulate in scientific discourse, namely the fictions framed as facts that serve to regulate femininity, reproduction, and what it is to be woman. Hegemonic truths that define Premenstrual Dysphoric Disorder (PMDD) and its nosological predecessor Premenstrual Syndrome (PMS) are examined to illustrate how regimes of objectified knowledge and practices of assemblage come (...) to regulate individual women through a process of subjectification. Five interconnected truths are presented as objects of scrutiny: PMDD is a thing that can be objectively defined and measured; PMDD is a pathology to be eradicated; PMDD is caused and can be treated by one factor; PMDD is a bodily phenomenon; PMDD causes women's problems or symptoms. I examine the way in which these hegemonic truths function in framing the reproductive body as a cause of disorder or distress that leads women to interpret premenstrual experiences within a pathological framework deserving medical or psychological treatment. Finally, I offer an alternative framework drawing on Eastern models of selfhood that provides a more empowering model of women's premenstrual experiences. (shrink)
Traces are generally considered to constitute an ontologically distinct class of objects that can be distinguished from other objects. However, it can be observed on close inspection that the principles to demarcate traces from other objects are quite general, imprecise and intuitively unclear, except perhaps the entropic account envisaging traces as low entropy states. This view was developed by Hans Reichenbach, Adolf Grünbaum, and J. J. C. Smart on the basis of Reichenbach's theory of branch systems that are subsystems of (...) wider systems. According to this theory, traces form within subsystems as low entropy states as a result of interaction with wider systems. It is also claimed that entropy is the measure of disorder, and that traces are ordered states. I argue that the concepts of entropy and disorder are used beyond their legitimate limits of application, for there are clear-cut counter-examples in the literature. I also analyze the concept of trace together with some examples from classical mechanics and geology in order to show that traces are determined relative to a particular context in which they are so defined. (shrink)
We used Nunez's physiologically based dynamic theory of EEG to make predictions about a clinical population of children with Attention Deficit Hyperactivity Disorder (ADHD) known to have neuronanatomical abnormalities. Analysis of high-density EEG data (long-range coherence) showed expected age-related differences and surprising regional specificity that is consistent with some of the literature in this clinical area.
Preoccupation with LTP as a putative memory mechanism may have retarded the consideration of pathological modulation of synaptic plasticity in clinical disorders where memory dysfunction is not a primary feature. Encouraged by Shors & Matzel's review, we consider the relationship between stress, synaptic plasticity, and depressive disorder.
