The first edition of The Mind and its Discontents was a powerful analysis of how, as a society, we view mental illness, looking beyond just biological models of mental pathologies. In the ten years since, there has been growing interest in the philosophy of psychiatry, and a new edition of this text is more timely and important than ever.

The Generality Constraint is a condition discussed by Gareth Evans that is meant to distinguish candidate subjects into those who have conscious thought of the type needed for a neo-Fregean conception of an objective world and those who are not subjects of that type. I argue that it implicitly applies to free-ranging creatures in a world of objects that they perceive and on which they act. This is quite unlike the behaviour exhibited by pigeons who attempt to maximise rewards in (...) a limited operant response situation where those rewards are indexed to particular numbers of key pecks as the ability needed to master that task is not the kind of thing Evans is interested in and it can be explained much more parsimoniously. (shrink)

Abstract:Patients with repeated minor head injury are a challenge to our clinical skills of neurodiagnosis because the relevant evidence objectively demonstrating their impairment was collected in New Zealand (although published in theBMJandLancet) and, at the time, was mired in controversy. The effects of repeated closed diffuse head injury are increasingly recognized worldwide, but now suffer from the relentless advance of imaging technology as the dominant form of neurodiagnosis and the considerable financial interests that underpin the refusal to recognize that acute (...) accelerational injury is the most subtle and insidiously damaging (especially when seen in the light of biopsychosocial medicine), and potentially one of the most financially momentous (given the large incomes impacted and needing compensation) phenomena in modern sports medicine. The vested interests in downplaying this phenomenon are considerable and concentrated in North America where diffuse head injury is a widespread feature of the dominant winter sports code: Gridiron or American Rules football. The relationship of this to shattered lives among the brightest and best of young men and the relatively dated objective evidence are a toxic mix in terms of ethical analysis and, therefore, there is a malignant confluence of social forces that tends toward minimizing the injury. (shrink)

Informed consent is the practical expression of the doctrine of autonomy. But the very idea of autonomy and conscious free choice is undercut by the view that human beings react as their unconscious brain centres dictate, depending on factors that may or may not be under rational control and reflection. This worry is, however, based on a faulty model of human autonomy and consciousness and needs close neurophilosophical scrutiny. A critique of the ethics implied by the model takes us towards (...) a 'care of the self' view of autonomy and the subject's attunement to the truth as the crux of reasoning rather than the inner mental/neural state views of autonomy and human choice on offer at present. (shrink)

Abstract The phenomenology of Multiple Personality (MP) syndrome is used to derive an Aristotelian explanation of the failure to achieve rational integration of mental content. An MP subject is best understood as having failed to master the techniques of integrating conative and cognitive aspects of her mental life. This suggests that in irrationality the subject may lack similar skills basic to the proper articulation and use of mental content in belief formation and control of action. The view that emerges centres (...) mind on the activity of a subject rather than a structured causal nexus. (shrink)

Euripides’ Alcestis (1959) raises the issue of ethical duties within families and exposes the romantic postures and rhetoric that can dominate such discussions. Should anybody be asked to sacrifice themselves or even undergo significant health risks for members of their own family? (An issue that is also relevant in considering our duties to future generations in terms of the earth we leave to them.) The issue that is dramatized to a heroic level in Alcestis arises in live organ and tissue (...) donation within a family and challenges the idea that families should be trusted to sort out solutions that they can all live with. Alcestis intensifies the debate because the sacrifice of one life for another is its topic but, in doing so, it exposes many traps lying in wait for ethicists and medical jurists who boldly enter such debates (where emotions create shifting ground on which angels fear to tread). (shrink)

It is striking that some arguments in the bioethical literature seem implausible, counterintuitive, and even ridiculous when reported to competent moral agents. When examined, these arguments bear uncanny resemblances to the discourse of patients with debilitating mental disorders. I examine the kinds of irrationality involved, and discuss the fact that such irrationality is worrying in a discipline that purports to serve as a guide for real‐life practical reasoning. I offer some thoughts about correctives that we might use to temper some (...) of the odd opinions that bedevil our subject in the name of ethical analysis. It seems that one ought to be suspicious of neatly rational arguments that produce counterintuitive conclusions, but the alternative seems to be that we explore new constructions of old problems in Bioethics such that our discussion of them does justice to what we regard as of fundamental significance to our lives together as human beings. (shrink)

Examines the relationship between thought and language by considering the views of Kant and Wittgenstein alongside many strands of contemporary debate in the area of mental content.

The journey metaphor used by Nie and colleagues (2016) can be analyzed in terms of the way in which health care professionals can support well-being and attend to the aspects of illness that often...

Joseph Fins's book Rights Come to Mind: Brain Injury, Ethics, and the Struggle for Consciousness is a considerable addition to the literature on disorders of consciousness and the murky area of minimally conscious states. Fins brings to this fraught area of clinical practice and neuroethical analysis a series of stories and reflections resulting in a pressing and sustained ethical challenge both to clinicians and to health care systems. The challenge is multifaceted, with diagnostic and therapeutic demands to be met by (...) clinicians and a mix of moral, scientific-economic, and political resonances for health care analysts. Everything in the book resonates with my own clinical experience and the often messy and emotionally wrenching business of providing ongoing care for patients with severe brain injuries and disorders, people who frequently resist the categorizations that well-organized health care systems prefer and that can dictate terms of patient management. (shrink)

Patients with covert awareness who present as being vegetative raise the question of moral status and clinical decisions about those who have suffered major brain injuries. When the idea of moral s...

This symposium represents the first major foray of the Journal of Bioethical Inquiry into what may well become one of its significant strands of scholarship. The JBI has always encouraged critical and marginal areas of bioethics scholarship and particularly those which make use of contemporary continental philosophy and cultural theory in addition to traditional analytic methods. For that reason this symposium is an expression of a “natural fit” or a “match made in heaven” (or at least the Platonic version of (...) that idea). The authors span times and sites in history and culture, from ancient Greece to present day Brisbane. They draw on a variety of literary genres and figures, ranging from Greek tragedy to an epic Chinese novel; from Jane Austen to William Styron, a major American novelist and essayist; from the modern English science fiction of Kazuo Ishiguro, a Japanese expatriate in London, to the 20th-century English poetry of Philip Larkin. The symposium also engages with some recur. (shrink)

The idea of freedom of the will seems to conflict with the principle of causal efficacy implicit in many theories of mind. The conflict is normally resolved within a compatibilist view whereby the desires and beliefs of the agent, replete with a respectable if yet to be elucidated causal pedigree, are taken to be the basis of individual freedom. The present view is an alternative which erects mental content on a framework of rule following and then argues that rule‐following is (...) conceptually distinct from causally produced activity. The normative aspect of rule‐following defies reduction to descriptive or dispositional terms. According to this view we cannot get beyond the agent as a self‐determining rational individual in formulating a theory of mind and action. The theory is neo‐Kantian in that it identifies rules or conceptions of laws as central in human thought. It, follows Wittgenstein's treatment of rule‐following and generates a plausible (but non‐causal) account of mental explanation and weakness of the will. (shrink)

The idea that there is an inherent incentive in moral judgment or, in Classical terms, that there is an essential relationship between virtue and well?being is sharply criticized in contemporary moral theory. The associated theses that there is a way of living which is objectively good for human beings and that living that way is part of understanding moral truth are equally problematic. The Aristotelian argument proceeded via the premise that a human being was a rational social being. The present (...) reworking of that thesis builds on the internal connection between rationality and concept use. Moral judgment is linked to the grasp of moral concepts and thereby to an appreciation of how it is with other persons. The judgment that another person instances a morally relevant ascription is grounded on an empathic grasp of how it is with that person and thus tied to the thought that one ought to act in such and such a way or. in other words, to a disposition to act. Because the empathically grasped content of moral concepts is related to a number of mental ascriptions and reactive attitudes, the grasp of that content is interwoven deeply in the structure of human mental life and any attempt systematically to devalue or undermine it is threatening to one's mental integrity as a rational social being. Thus there is a deep link between moral sense or the disposition to act morally and an adequately grounded conception of human well?being. (shrink)

Abstract:What is in the best interests of a child, and could that ever include interventions that we might regard as prima facie detrimental to a child’s physical well-being? This question is raised a fortiori by growth attenuation treatments in children with severe neurological disorders causing extreme developmental delay. I argue that two principles that provide guidance in generating a conception of best interests for each individual child yield the right results in such cases. The principles are as follows: thepotentiality principle, (...) whereby every child should be able to develop its potential and is entitled to receive certain help in doing so, and theprinciple of psychosomatic harmony, whereby every human being is entitled to treatment that is appropriate to or enables a life in which mind and body are in tune with each other. These principles indicate a certain response to what we can call Ashley-type cases and admit certain caveats. (shrink)

Consciousness and its relation to the unconscious mind have long been debated in philosophy. I develop the thesis that consciousness and its contents reflect the highest elaboration of a set of abilities to respond to the environment realized in more primitive organisms and brain circuits. The contents of the states lesser than consciousness are, however, intrinsically dubious and indeterminate as it is the role of the discursive skills we use to construct conscious contents that lends articulation and clarity to the (...) mental acts which cumulatively make up our mental lives. I lay out a tripartite structure for the formation of mind in which the ongoing interaction between brain and world, the formative effect of socio-cultural context and the self production of a relatively coherent narrative all play an important part in making a mind. The latter two influences clearly transcend biological science and suggest that human minds have features which broadly align with certain Freudian insights but do not support the reification of the causally structured unconscious that Freud envisaged. (shrink)

Philosophical accounts of thought crucially involve an array of abilities to identify general properties or features of the world (corresponding to concepts) and objects that instantiate those general properties. Abilities of both types can be grounded in a naturalistic account of the usefulness of cognitive structures in adaptive behaviour. Language enhances these abilities by multiplying the experience bases giving rise to them and helping to overcome subjective biases.

The problematic features of the cognitive function of patients with brain damage are often taken to indicate that such persons have split or dual consciousness. An intentional or cognitive theory of consciousness which focuses on the structure and contents of conscious experience makes this thesis look quite unattractive. Consciousness is active and directed toward objects and in the human case it shows an internally reflective structure based on the abilities required to grasp and use concepts. On this view, consciousness is (...) a way of referring to the active, integrative, conceptualizing activity of a human thinker in a world of other objects and persons. When we look at consciousness this way and re-examine, in the light of that analysis, the performance of split brain patients, one sees such persons as individuals afflicted with internal difficulties in their information processing capacities but neither as split consciousnesses nor as split minds. (shrink)

The two commentators have examined and illuminated different aspects of the analysis of delusions that we have offered. Their discussions both raise points that clarify that analysis in helpful ways. Richard Bentall (2014) makes the telling point that distinguishing the mental phenomena that count as delusions is not always straightforward and that, at the margins, there is a perennial problem with patterns of thought that seem to fall outside the realm of shared meanings that most of us derive from our (...) experiences. The problem is evident in certain marginal conditions that come to psychiatric attention, like conversion reactions, body dysmorphic disorder, anorexia, and the many obsessions or strained .. (shrink)

Abstract Experience is structured by thoughts which are composed of general concepts and conceptions of objects. Both of these elements of thought are rule?governed and rest on norms which are shared by thinkers. Concepts and conceptions of objects as the elements of thoughts whose content is essentially communicable plausibly rest on abilities tied to the use of linguistic terms. This suggests that language plays an active part in structuring human experience and cognition as suggested by both Vygotsky and Luria. The (...) role of language in thought implies that the human brain which is the information processing structure realizing thoughts is itself subject to shaping by the social milieu. Neural network theory suggests that this might proceed via the use of cue stimuli based on the responses of other human beings and, therefore, supports the view that cognitive neuroscience may be radically mistaken in thinking that it can provide an individualistic analysis of human mental life. (shrink)

The legalisation of euthanasia creates a certain tension when it is compared with those traditional medical principles that seem to embody respect for the sanctity of life. It also creates a real need for us to explore what we mean by harm in relation to dying patients. When we consider that we must train physicians so that they not only understand ethical issues but also show the virtues in their clinical practice, it becomes important for us to strive to train (...) them in virtue rather than mere knowledge. We can only do this by conveying a real sense of the needs of the patient and an ability to relate to patients as people not problems. Such attitudes take shape in a training programme in which practical situations are explored and discussed and the limits of scientific medical responses to those challenges are exposed. Keywords: bioethics education, euthanasia, moral judgment, training, virtue CiteULike Connotea Del.icio.us What's this? (shrink)

The relationship between "causal" and "meaningful" (Jaspers) influences on behavior is explored. The nature of meaning essentially involves rules and the human practices in which they are imparted to a person and have a formative influence on that person's thinking. The meanings that come to be discerned in life experience are then important in influencing the shape of that person's conduct. The reasoning and motivational structures that develop on this basis are realized by the shape of the neural processing networks (...) that constitute the mature human brain. This implies that meaning is not only realized by brain micro-structure but, in part, explains its workings. This in turn entails that in psychiatry we must continue to avail ourselves both of neuropsychology/neurobiology and of dynamic/meaningful explanation. Keywords: brain and mind, causality and meaning, cognitive models, meaning, mind and brain, neuropsychology and meaning CiteULike Connotea Del.icio.us What's this? (shrink)

Perception is often analysed as a process in which causal events from the environment act on a subject to produce states in the mind or brain. The role of the subject is an increasing feature of neuroscientific and cognitive literature. This feature is linked to the need for an account of the normative aspects of perceptual competence. A holographic model is offered in which objects are presented to the subject classified according to rules governing concepts and encoded in brain function (...) in that form. This implies that the analysis of perception must consider not only the fact that there is an interaction between the perceiving subject and the perceived object but also that the interaction is shaped by a system of concepts which the subject uses in thought and action. (shrink)

In European philosophical psychology, the work of Jacques Lacan has exerted a great deal of influence but it has received little attention from analytic philosophers. He is famous for the view that the unconscious is a repository of influences arising from language and the meanings it captures, but the presentation of his ideas is sometimes perplexing and impenetrable and its conceptual links with analytic philosophers like Frege and Wittgenstein are not easily discerned. In fact, there are a number of such (...) links and they are worth pursuing for those interested in language, mind, and the unconscious. If we explore Lacan's claim about the link between signification and the tuchè (the encounter with the real) we find that the mental content of the subject is essentially tied to the external world both causally and linguistically. The means of tying the two together arise in the context of human interactions and therefore are charged with personal and emotive content as well as the semantic content with which we are normally concerned in philosophy of language. When we pursue the implications of his view it becomes plausible both that the unconscious is structured like a language and that language borrows much of its meaning and significance to a subject from the interpersonal medium through which it has been inscribed on that subject. His approach is therefore illuminating both for linguistics (especially psycholinguistics) and for the psychology of the unconscious. (shrink)