Cognitive Disabilities and Disorders, Misc

In this paper we aim to offer a balanced argument to motivate (re)thinking about the mental illness clause within the insanity defence. This is the clause that states that mental illness should have a relevant causal or explanatory role for the presence of the incapacities or limited capacities that are covered by this defence. We offer three main considerations showing the important legal and epistemological roles that the mental illness clause plays in the evaluation of legal responsibility. Although we acknowledge (...) that these advantages could be preserved without having this clause explicitly stated in the law, we resist proposals that deny the importance of mental illness in exculpation. We argue, thus, that any attempt at removing the mental illness clause from legal formulations of the insanity defence should offer alternative ways of keeping in place these advantages. (shrink)

The distinction between students diagnosed with a learning disability and those considered merely slow learners is based on conceptually flawed assumptions that: 1) LD represents a brain dysfunction while SL does not; 2) LD is a well-defined disorder; 3) valid measurement instruments distinguish LD and SL; 4) special education for students with LD is fundamentally different from that for SL students. These erroneous beliefs are maintained because governmental legislation transformed a diagnosis of LD into an admission ticket to a variety (...) of government entitlements thereby subjecting it to political, legal, social and ideological forces. (shrink)

Summary Apotemnophilia, or body integrity image disorder (BIID), is characterised by a feeling of mismatch between the internal feeling of how one’s body should be and the physical reality of how it actually is. Patients with this condition have an often overwhelming desire for an amputation- of a specific limb at a specific level. Such patients are not psychotic or delusional, however, they do express an inexplicable emotional abhorrence to the limb they wish removed. It is also known that such (...) patients show a left-sided preponderance for their desired amputation. Often they take drastic action to be rid of the offending limb. Given the left-sided bias, emotional rejection and specificity of desired amputation, we suggest that there are clear similarities to be drawn between BIID and somatoparaphrenia. In this rare condition, which follows a right parietal stroke, the patient rejects (usually) his left arm as ‘‘alien’’. We go on to hypothesis that a dysfunction of the right parietal lobe is also the cause of BIID. We suggest that this leads to an uncoupling of the construct of one’s body image in the right parietal lobe from how one’s body physically is. This hypothesis would be amenable to testing by response to cold-water vestibular caloric stimulation, which is known to temporarily treat somatoparaphrenia. It could also be investigated using functional brain imaging and skin conductance response. If correct our hypothesis not only suggests why BIID arises, but also, in caloric stimulation a therapeutic avenue for this chronic and essentially untreatable condition. (shrink)

In this article we discuss the validity of previous preferences and advance directives in cases of severe mental illness.

This article proposes a formal model that integrates cognitive and psychodynamic psychotherapeutic models of psychopathy to show how two major psychopathic traits called lacks remorse and self-aggrandizing can be understood as a form of abnormal Bayesian inference about the self. This model draws on the predictive coding (i.e., active inference) framework, a neurobiologically plausible explanatory framework for message passing in the brain that is formalized in terms of hierarchical Bayesian inference. In summary, this model proposes that these two cardinal psychopathic (...) traits reflect entrenched maladaptive Bayesian inferences about the self, which defend against the experience of deep-seated, self-related negative emotions, specifically shame and worthlessness. Support for the model in extant research on the neurobiology of psychopathy and quantitative simulations are provided. Finally, we offer a preliminary overview of a novel treatment for psychopathy that rests on our Bayesian formulation. (shrink)

We are grateful to Paul S. Appelbaum and Wayne Martin for their thoughtful remarks on our paper. Among the various aspects that we might address and refute in return, we have decided to focus on just two issues that we believe have potential to advance the debate. According to Appelbaum, the “assessment of an intuitive process is being predicated on a patient having the ability to reflect on determinants of which he may be completely unaware.” In this passage, he points (...) to an apparently “self-evident paradox.” Also, Martin is skeptical about the assessment of intuitive reasoning ability. We agree that relying entirely on unarticulated gut feelings is problematic in terms of... (shrink)

As a starting point, Clegg, Murphy, and Almack contend that frameworks of policy fail both to engage with ethical theory and to fit with the complex realities of how services are delivered. Both of these points are well-supported both in their engagement with literature and in the research presented. Their Deleuzoguattarian analysis and Deleuzean ethical alternatives provide fresh and challenging insights. The key question in this rejoinder is whether their critique goes too far, or not far enough. To begin, however, (...) it is worth making a comment on terminology. Clegg et al. begin with a passing comment to the effect that ‘intellectual disability’ was ‘formerly learning disability in the UK and... (shrink)

The promotion of rights, autonomy and choice reacts against paternalism, an early twentieth-century response to intellectual disability that suppressed individual personhood through a combination of resource limitations and poor administration. These liberal individualist concepts reflect the contemporary zeitgeist of Anglophone nations, although the strength and certainty with which these concepts are expressed in ID policy when compared with policy for other vulnerable groups suggests that they also serve a secondary function. It has been argued that excessive certainty in ID evidences (...) a feared drop... (shrink)

A patient’s decision-making capacity or competence is among the prerequisites for valid consent to medical treatment, and is regarded as the gatekeeping element in ensuring respect for patients’ self-determination. The issue is especially relevant in the case of vulnerable persons, such as patients who are cognitively or mentally impaired, and where medical decisions carry far-reaching consequences. As a grounding principle, DMC is a priori assumed, and challenged only when substantial doubts arise owing to observed or assumed deficiencies of the capacities (...) commonly considered relevant for competent decision making ; in this sense, the onus is on... (shrink)

About 75% of subjects diagnosed with schizophrenia experience auditory-verbal hallucination and report "hearing voices" that are not actually present. One notable feature of AVH is that it seems involuntary and not directly in the subject's control. With regard to content, these represented voices make utterances, typically commands and evaluations, and either are directed to the patient or speak about her in the third person. Voices may echo the subject's thoughts or comment on the subject's behavior and, in some cases, the (...) voices seem to carry on conversations or even argue. Subjects often experience the voices as having pitch, timbre, and intensity, and as having a... (shrink)

In her 2006 book The Jumbled Jigsaw, Donna Williams, an autistic author and poet, presents an example of a list of traits associated with autism—one of many such lists commonly found in text books, academic publications, and information leaflets. Her list includes the following: a tendency to stick to well-tried routines and avoid change, a tendency to have a narrow range of interests, a tendency to develop irrational fears and anxieties, a tendency not to develop a sense of danger, a (...) tendency to demonstrate bizarre behaviors and mannerisms, a tendency to copy speech parrot fashion, and isolated areas of ability. "The problem with such a list," Williams explains, "is that the features of each of these areas can be... (shrink)

Recent literature has suggested that generics can harbor and propagate worrying ideologies in a manner which is often not appreciated by speakers. In this article, I argue that the use of generics to convey information about mental illness is unhelpful, whether the knowledge structure conveyed by the generic is 'accurate' or not. Inaccurate generics contribute to insidious forms of social stereotyping and stigma by encouraging us to simplistically generalize characteristics found in very few category members to other members of that (...) kind.Yet, even where the knowledge structure underlying the generic is accurate, generics remain an unhelpful way of talking about mental illness. This is because... (shrink)

Traditionalists affirm that in self-deception I intend to deceive myself; but, on the standard account of interpersonal deception, according to which deceiver intend to make their target believe a falsehood, traditionalism generates paradoxes, arising from the fact that I will surely know that I want to make myself believe a falsehood. In this thesis, I argue that these well-known paradoxes need not arise under my manipulativist account of deception. In particular, I defend traditionalism about self-deception by showing that what causes (...) paradoxes is not the idea that self-deception is an intrapersonal analogue of interpersonal deception but rather our incorrect conceptions of deception, interpersonal deception, and lying. I show, by way of counterexamples, that the essence of deception is not ending up epistemically worse off but rather being intentionally manipulated into forming or retaining a certain truth-evaluable mental state. Vitally, contra the standard view, the deceiver need not hold that the mental state he intends to produce in the deceived involves a falsehood; in fact, the targeted effect may involve a proposition believed by the deceiver to be true or about whose truth the deceiver suspends belief. Any phenomenon rightly called self-deception, I argue, involves an action in which the person intentionally manipulates (by way of a trick) her own way of forming or retaining some truth-evaluable mental state of her own (belief or a belief-like thought). Thus, on the manipulativist view, a self-deceiver may non-paradoxically intend to deceive himself: the relevant intention is to affect a particular truth-evaluable thought by way of non-deviantly manipulating his agential use of his own cognitive capacities. While all cases of self-deception involve intentional manipulation of the self by the self, how this manipulative trick works out varies in different kinds of cases. In some cases, the self-deceptive manipulative trick is not intentional under that description, a description that captures the so-called deflationary view. Although the manipulativist account allows for numerous different strategies of self-deception, and is consistent with both traditionalism and deflationism, it cannot, by itself, vindicate the idea of lying to oneself. On the standard conception, lying to myself is practically impossible (if the mind is not partitioned) and this is because the very forming the intention to lie to myself – as including the intention to make myself believe my own lie – seems very unlikely. Arguably, people will not φ if they think that φ-ing is impossible. I argue that some kinds of behaviour typically understood as self-deception are actually cases in which the person is lying to herself without the intention to deceive herself; rather, she avoids legitimising an unfavourable state of affairs by openly affirming its contrary. It may also be the case, however, that some lies to oneself are aimed at deceiving – this is because, as I argue, liars need not assert what they believe is false; hence, by lying to myself, I may intend to increase my confidence in the belief I already hold. Finally, the motive for self-deception is always a matter of preserving the person’s endorsed idealised picture of reality. This account allows me to explain all possible cases of self-deception. In the last chapter, I apply my theory to some paradigmatic cases first outlined in my introduction. (shrink)

The perceived meaning of life significantly affects the quality of human life. It is of particular significance in borderline situations. One of such situations is the birth of an intellectually disabled child. The article presents the results of the study concerning the perceived meaning of life in the case of parents who bring up a child with limited intellectual abilities. The study included 87 mothers and 65 fathers bringing up an intellectually disabled child. In the studied cases, parents perceived their (...) life as highly meaningful. The results indicated that the perceived meaning of life in the case of parents of intellectually disabled children was related with: suffering experienced by the parents as a result of a limited intellectual ability of their daughter/son, the manner of performing their parental role and the sense of parental identity. (shrink)

Argues for a form of humanism on which we have reason to care about human beings that we do not have to care about other animals and human beings have rights against us other animals lack. Humanism respects the equal worth of those born with severe congenital cognitive disabilities. I address the charge of 'speciesism' and explain how being human is an ethically relevant fact.

What are the duties of carers and health professionals to people with mental incapacity? How ought we to think about the ethical and legal issues? What can any of us do to improve and safeguard the lives of those cared for? This book seeks to examine in detail and find ethically robust answers to such questions. Among the topics discussed are withholding treatment, tube-feeding patients with dementia, the 'persistent vegetative state', medical research, and sterilisation of intellectually disabled adults. Contributors come (...) from a wide range of disciplines, including psychiatry, nursing, philosophy, theology and law. The book includes an account by Wendy Hiscox of non-voluntary euthanasia in the Netherlands and Belgium, and a chapter by John Finnis exploring some aspects of Britain's Mental Capacity Act 2005. (shrink)