Despite a recent surge in publications on Tourette Syndrome, we still lack substantial insight into first-personal aspects of “what it is like” to live with this condition. This is despite the fact that developments in phenomenological psychiatry have demonstrated the scientific and clinical importance of understanding subjective experience in a range of other neuropsychiatric conditions. We argue that it is time for Tourette Syndrome research to tap into the sophisticated frameworks developed in the philosophical tradition of (...) phenomenology for describing experience in a way that integrates discrete symptoms into an overarching experiential framework concerning the self, the body, and its modes of experience. Following a historical introduction that contextualises the pertinence of phenomenology to psychopathology, we distinguish this approach from the existing, psychologically oriented studies on TS that are also qualitative. We then outline gaps and opportunities for future research, including the sorts of questions that might be utilised in phenomenological interviews and why they are of potential benefit to research programs in philosophy, psychology, and neuroscience. In conclusion we address some of the broader implications for phenomenology of the body and philosophy of action. (shrink)

Purpose: There is a widespread recognition that biomedical explanations offer benefits to those diagnosed with a mental disorder. Recent research points out that such explanations may nevertheless have stigmatizing effects. In this study, this ‘mixed blessing’ account of biomedical explanations is investigated in a case of philosophical interest: Tourette Syndrome. Method: We conducted a vignette survey with 221 participants in which we first assessed quantitative attributions of blame as well as the desire for social distance for behavior associated (...) with Tourette Syndrome. Results: In our study, it is confirmed that in the case of biomedical explanations, less blame is attributed than in the case of psychosocial explanations. When presented with a mixed explanation stressing an entanglement of biological and psychosocial factors this did not increase blame attribution. The desire for social distance is unaffected by the type of explanation but the participants’ free text feedback indicates this might obfuscate an underlying dilemma between stigma and blame revealed in recent research. Conclusion: There seems to be potential for blame reduction in explanations where biological and psychosocial factors are entangled. However, dynamic, ‘epigenetic’, explanations require further qualitative research to be performed as well as a philosophical framework to account for the ‘mixed blessings’ account. (shrink)

Philosophers generally assume that individuals with Tourette syndrome are not responsible for their Tourettic tics, and so not blameworthy for any harm their tics might cause. Yet this assumption is based largely on ignorance of the lived experience of Tourette syndrome. Individuals with Tourette syndrome often experience their tics as freely chosen and reason-responsive. Yet it still seems wrong to treat a Tourettic individual’s tic as on a moral par with others’ actions. In this (...) paper, I examine the options and argue that, if this is correct, then a surprising consequence follows: the standard, motivation-basedtheory of desire must be false. I go on to argue that, given what is known about the neurological basis of Tourette syndrome, this is a reasonable conclusion to draw. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Subjective Experiences of Tourette SyndromeBeyond the Premonitory UrgeThe authors report no conflicts of interest.There is an evolving recognition in healthcare that the patient's subjective experience needs to be privileged both in understanding clinical phenomena and also ensuring the salience of outcomes used to evaluate the impact of treatment interventions. This is reflected in the expansion of patient-reported outcome measures to capture a person's perception of their own health, (...) and the increasing requirement of involving people with lived experience in the co-design of research studies (National Health and Medical Research Council, 2016) and care improvement initiatives. In mental health it has been long understood that observable behavioral phenomena can only partially inform clinical understanding of the experience of the patient living with the condition. However, capturing the patient's subjective experience faithfully remains a challenge.Tourette syndrome (TS) is a complex condition in which there are clearly observable behavioral phenomena (vocal and motor tics, compulsive and socially inappropriate behaviors), but also a broad and varied range of subjective phenomena reported by different individuals. These may include sensory phenomena such as the premonitory sensory urge preceding a tic, compulsions to touch things a certain number of times or do something repeatedly until it feels "just right," or bothersome intrusive thoughts or images. To further complicate the picture most patients with TS have one or more co-occurring conditions such as attention deficit hyperactivity disorder, obsessive-compulsive disorder, and anxiety, which may actually cause a greater burden of dysfunction and distress than the Tourette symptoms.In their paper, Curtis-Wendlandt et al. (2024) challenge the dependence of current psychiatric diagnostic criteria (e.g., the Diagnostic and Statistical Manual of Mental Disorders, 5th edition) on observable tics, and propose a broader and more dimensional approach to nosology which incorporates sensory, cognitive and affective phenomena. [End Page 47] Data from interviews they conducted identified that premonitory phenomena and urge experiences in tic disorders are more complex and diverse than what is currently reflected in the literature and clinical scales. They also interviewed participants who reported "no urges" or "no premonitory sensations." They commented that the literature generally treats reports of urge absences at face value, and does not address the likelihood that such reports may be ambiguous or problematic. Overall, they concluded that their research suggests that premonitory urges in TS are a complex and diverse phenomenon that requires further study. This reflects with our clinical experience in working with TS patients. Although a large proportion of older patients describe sensory-based premonitory urges, descriptions are not homogenous, with many describing other experiences preceding their tics.When evaluating a patient's response to an intervention (either behavioral or pharmacological) clinicians incorporate a range of information. This includes the severity of their tics (number, type, frequency, intensity, and associated impairment), as well as their mood, participation and performance in study, work, and social activities, and overall quality of life. Standard clinical practice would not typically include assessment of some of the subjective experiences which precede tics. If it was accepted that these subjective phenomena are indeed salient to the patient's well-being, then a challenge would be how to consistently and reliably capture these feelings to operationalize a comprehensive patient-centered assessment.The primary evidence-based treatment for tic disorders, comprehensive behavioral intervention for tics (CBIT), involves training to increase the awareness of premonitory urges (Woods et al., 2008). Furthermore, successful 'blocking' of tics during the course of CBIT requires the patient to be aware of premonitory urges. Clinicians having a better understanding of the complexity and diversity of experiences which precede tics, as well as using open-ended questioning styles, may assist with improving CBIT outcomes. [End Page 48]Related ArticlesFeature Article: Dimensions, Not Types: On the Phenomenology of Premonitory Urges in Tourette SyndromeCommentary: Priming and Narrative Habits in the Phenomenological Interview: Reflections on a Study of Tourette SyndromeCommentary: Subjective Experiences of Tourette Syndrome: Beyond the Premonitory UrgeResponse: Phenomenological Interviews and Tourette’sDaryl EfronThe Royal Children's Hospital MelbourneIvan MathiesonThe Laneway ClinicDaryl Efron Daryl Efron is a Consultant Pediatrician, Royal Children's Hospital Senior Research Fellow, Murdoch... (shrink)

The use of philosophical phenomenology for conceptual debates in psychiatric nosology and psychopathology is beginning to be recognized. In this paper, we extend this trajectory to include Tourette Syndrome, focusing on so-called premonitory urges (PU) preceding Tourettic tics. We clarify some inconsistencies around typology in both phenomenological description and medical classification (i.e., in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision, International Classification of Diseases, 10th edition [World Health Organization, 2004], and the scales that (...) elicit PU). We show how a less typological approach might be usefully deployed in the field, that being the dimensional approach developed by Fernandez (2019a; 2019b). We test both the typological and dimensional approaches in relation to the experience and etiological role of PU in Tourette’s syndrome. Based on our synthesis of existing studies and new information garnered through phenomenological interviews (using an approach associated with “micro-phenomenology”), we argue that the role of PU in nosology challenges both the current “operational” criteria favored by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision, that are focused on behaviorally observed symptoms, as well as essential and prototypical phenomenological descriptions about a given “type” of experience. (shrink)

Gilles de la Tourette syndrome (TS) is a childhood neuropsychiatric disorder characterised by the presence of motor and vocal tics. Patients with malignant TS experience severe disease sequelae; risking morbidity and mortality due to tics, self-harm, psychiatric comorbidities and suicide. By definition, those cases termed ‘malignant’ are refractory to all conventional psychiatric and pharmacological regimens. In these instances, deep brain stimulation (DBS) may be efficacious. Current 2015 guidelines recommend a 6-month period absent of suicidal ideation before DBS is (...) offered to patients with TS. We therefore wondered whether it may be ethically justifiable to offer DBS to a minor with malignant TS. We begin with a discussion of non-maleficence and beneficence. New evidence suggests that suicide risk in young patients with TS has been underestimated. In turn, DBS may represent an invaluable opportunity for children with malignant TS to secure future safety, independence and fulfilment. Postponing treatment is associated with additional risks. Ultimately, we assert this unique risk-benefit calculus justifies offering DBS to paediatric patients with malignant TS. A multidisciplinary team of clinicians must determine whether DBS is in the best interest of their individual patients. We conclude with a suggestion for future TS-DBS guidelines regarding suicidal ideation. The importance of informed consent and assent is underscored. (shrink)

Introduction Tourette Syndrome is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation may be considered. Methods and Results We discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he (...) experienced a tic reduction of more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects. Discussion Specific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication. Conclusion Clinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Priming and Narrative Habits in the Phenomenological InterviewReflections on a Study of Tourette SyndromeThe author reports no conflicts of interest.In "Dimensions, Not Types: On the Phenomenology of Premonitory Urges in Tourette Syndrome," Lisa Curtis-Wendlandt and Jack Reynolds provide new insights into some of the experiences characteristic of Tourette syndrome (TS). Their study is an excellent example of applied phenomenology (Burch, 2021), combining philosophy and (...) qualitative research methods to illuminate experiences that have often been mischaracterized in the existing literature. In their study, they focus on what is commonly referred to as a "premonitory urge" (PU): the "anticipatory urge that is often thought to precede the onset of the motor and phonic tics that are part of Tourette Syndrome" (Curtis-Wendlandt & Reynolds, 2024, p. 26). They ask not only whether PU is a necessary feature of TS, but also whether the very concept of PU accurately portrays the experiences and behaviors that it's intended to refer to. They point out that existing scales used to assess PU, for example, seem to implicitly narrow the relevant experiences by assuming that they are a) always negative and b) always internal, or inwardly focused (Curtis-Wendlandt & Reynolds, 2024, 26). Curtis-Wendlandt and Reynolds question these in-built assumptions about PU, suggesting that they may provide an overly narrow depiction that misses the genuine diversity of experiences that precede the onset of a motor or phonic tic.To explore these phenomena in more detail, they conducted a study intended to elicit fresh descriptions of these experiences. They interviewed 12 teenagers with a diagnosis of TS about their experiences of ticcing and tic suppression. Using the micro-phenomenological method (Petitmengin, 2006), they asked participants to reflect on a specific tic or tic suppression event and to recall the event in detail. Throughout the interview, [End Page 43] they asked open-ended questions about sensory, cognitive, or affective experiences surrounding the event. Through these interviews, they were able to generate rich descriptions of these experiences and investigate how these descriptions differed from standard accounts in the existing literature.Curtis-Wendlandt and Reynolds provide a detailed account of how they designed their phenomenological study, both philosophically and empirically. However, there is an important aspect of their method that they discuss only in a cursory or implicit way, which is what I want to focus on here. Throughout their study, they were concerned that participants might simply parrot back well-worn medicalized characterizations of PU. Such characterizations risk simplifying or even occluding key aspects of the participants' experiences that might be difficult to reflect upon or describe. However, despite stressing the importance of eliciting fresh descriptions, Curtis-Wendlandt and Reynolds provide only glimpses of how the interviews actually unfolded and what kinds of techniques they used to elicit these descriptions.In my experience, it is quite common to hear phenomenological psychologists and psychiatrists express concern that people may simply repeat common psychiatric or medicalized characterizations of their condition, rather than genuinely reflect upon and describe their first-person experiences. The philosophical assumption is that we all fall back on culturally sedimented language and terminology when describing our experiences. Someone who has spent extended periods of time interacting with psychiatrists and other healthcare professionals, for example, is likely to have picked up common ways of describing their condition—ways that may have helped them receive a diagnosis or obtain treatment. There is nothing inherently wrong with falling into these culturally sedimented characterizations. They facilitate everyday communication through a shared language and terminology. But phenomenologists are often concerned that this kind of culturally sedimented language covers over or obscures the phenomenon or experience they are trying to investigate. For example, if a psychiatrist has often described their patient's depressed mood as "sadness," then that patient may be likely to self-describe their mood as sadness in an interview setting. It might, in fact, be the case that their mood is best described as sadness. But it could also be the case that their mood would be more accurately described as, for instance, a sense of emptiness or feeling deep despair. The challenge is therefore to know whether someone's self-description is... (shrink)

We describe our clinical experience in treating patients with Tourette syndrome and other tic disorders using infra-low frequency neurofeedback, often in conjunction with cognitive behavior therapy. Following a narrative description of our approach, we present outcome data for 100 successive cases. Many of the children and adolescents that we have treated since 2005 did not derive sufficient benefit from standard treatment for Tourette syndrome and other tic disorders. In our clinical experience, based on extensive before- and (...) after- testing and symptom tracking, this patient group derived significant additive benefit from complementary neurofeedback treatment. The majority of trainees attained a higher level of functioning and were able to live up to their potential in a way they were not able to prior to neurofeedback treatment. (shrink)

The closeness of somatosensory phenomena and emotional states can be critically extended into a clinical perspective by referring to Tourette's Syndrome (TS). Two examples are discussed in this commentary: (1) the neurodevelopmental approach to the pre- and post-tic sensorimotor urges, and (2) the TS treatment with deep brain stimulation. It is shown that in TS, both views (locationist and constructionist) need to be combined along the lifespan in order to get a more realistic picture of the brain basis (...) of emotion. (shrink)

This book offers a philosophical perspective on contemporary Tourette Syndrome scholarship, a field which has exploded over the last thirty years. Despite intense research efforts on this common neurodevelopmental condition in the age of the brain sciences, the syndrome’s causes and potential cures remain intriguingly elusive. How does this lack of progress relate to the tacitly operating philosophical concepts that shape our current thinking about Tourette Syndrome? This book foregrounds these tacit concepts and shows how (...) they relate to “big topics” in philosophy such as time, volition, and the self. By tracing how these topics relate to current research on Tourette’s, it invites us to re-think our approach to research and care. Such re-thinking is urgently needed: individuals and families living with Tourette Syndrome remain under-serviced as pharmacological and behavioural therapies provide relief for some but not all who need support. This book highlights what questions we ask and do not ask in contemporary scholarship, thereby surfacing invisible constraints and opportunities in the field. It is of interest to scholars, health professionals, students, and affected families who want to better understand this burgeoning field of research with its conceptual controversies, approaches to aetiology, and directions for new research and improved clinical care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Phenomenological Interviews and Tourette'sThe authors report no conflicts of interest.We appreciate the responses from the two clinicians, Efron and Mathieson. We agree with their reminder about the holistic nature of clinician's engagement (mood, sociality, and work life) and with their emphasis on patient-reported outcome measures, although this is not quite what we did in our interviews. As has recently been recognized in section 24 of the Victorian Mental (...) Health and Well-being Act (to provide a local Australian example), patients and caregivers' "lived experience makes them valuable leaders and active partners in the mental health and wellbeing service system."1In this paper, however, our aim was both more modest and immodest: modest, in that we aimed to work with those "leaders and active partners" to generate a more adequate account of lived experience in concert with behavioral symptomatology; immodest, in that we wondered how the lived experience of Tourette syndrome (TS) aligned (or not) with some of the commonly ascribed features of the condition. Although phenomenology as a discipline does not own lived experience, of course, it is more systematically treated in this tradition, starting with elaborations of Erlebnis.Efron and Mathieson note that older patients are more likely to describe urges or premonitory urges (PUs). This raises the priming question: Has greater exposure to and involvement in medical concepts and treatments transformed the nature of their self-report, or has it provided them with more phenomenological skills, enabling them to pick out discrete parts of experience? Or perhaps they have just been exposed more frequently to the experience over time? We address some related issues below, in our reply to Fernandez, where we outline our interview techniques more fully.They end by noting that the aim of comprehensive behavioral intervention for tics is to become attentive to PUs to better block tics. This is complex and understudied. In principle, becoming aware of something cognitively and experientially can foreground or even perhaps induce that experience. Conversely, from the TS scholarship, we know that attending to urges in certain ways (e.g., via acceptance training) can also reduce perceived urge frequency and intensity (see Gev et al., 2016). We would welcome further work on this link between attention and experience in TS. [End Page 49]Response to FernandezBecause our paper was partly framed around Fernandez' own work on phenomenological psychopathology, we welcome his invitation to provide further "inspiration and guidance" for other phenomenological researchers conducting empirical studies, who may also be dealing with the challenge posed by "narrative habits." When an interviewee uses well-worn medicalized terms to describe their experience, it is not clear whether these descriptions genuinely reveal or rather occlude the experience in question. There are sometimes, perhaps often, second-person phenomenological 'tells' regarding interviewees genuinely re-evoking an experience, but for interviewers it still raises the question of how to prompt alternative and potentially more accurate descriptions of experience.Because of this challenge, we purposely did not use the term "urge" or "premonitory urge" (PU) in our interview questions. Instead, we asked about (and used the broader term of) "experiences" that may occur prior, during, or after ticcing, without assuming that there are such experiences in the first place. We guided interviewees to evoke the memory of a specific, singular tic event (a tic token; see Curtis-Wendlandt 2020, 2023). Once a memory of such an event had been identified, we asked interviewees the following three lead questions:1. What, if anything, did you experience during this tic?2. What, if anything, did you experience before this tic?3. What, if anything did you experience after this tic?The temporal framing of these questions counters common trends and assumptions in the scholarship, which has focused heavily on pre-tic experiences, with little attention given to post-tic experiences (reduced to notions of "relief" and barely investigated), and even less to experiential explorations of the tic itself. Our catalogue of supporting questions sought to elicit fine-grained descriptions of evoked/recalled experiences along sensory and cognitive-affective dimensions:•. Did you see anything before, during, or after this tic? If so, what did you see?•. Did you hear anything... (shrink)

This paper advances a new agentially undemanding account of the conditions of attributability, the Minimal Approval account, and argues that it has a number of advantages over traditional Deep Self theories, including the way in which it handles agents with conditions like addiction, Tourette syndrome, and misophonia. It is argued that in order for an agent to be attributionally responsible, the mental process that leads to her action must dispose her to be such that she would, upon reflec-tion, (...) approve to some minimal degree of being moved to action by the motive on which she in fact acts. (shrink)

The last two decades have seen a dramatic increase in scientific publications on Tourette syndrome, but the etiology of this common neurodevelopmental condition is still unknown. Many questions remain—about the unitary nature of the syndrome, and the criteria used to define it in such internationally accepted manuals as the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Disorders. Meanwhile, individuals and families affected by TS remain underserviced, as pharmacological and behavioral therapies provide relief (...) for some but not all who need support. We urgently need new... (shrink)

ABSTRACTUsing authentic textual data from written personal narratives, we investigate how individuals with Attention Deficit Hyperactivity Disorder, Obsessive Compulsive Disorder, and Tourette Syndrome mediate their emotive and sensory experiences through language. Our study reveals that experiential comparisons of different kinds feature prominently as means of conveying such experiences. We identify a number of meaning domains that are recruited in correspondences between sources and targets, including motion and force, and detail how sensory modalities, bodily sensations, and emotions are exploited (...) to evoke emotive/sensory responses in readers. We conclude that comparative construal is a significant communicative strategy precisely because it elicits familiar situational meanings capable of evoking vicarious experiences in readers. By considering texts from actual uses of language in natural situations, our research sheds new light on how emotive/sensory... (shrink)

I have great sympathy for what seem to be two main goals in Michelle Ciurria’s (2014) “Moral Responsibility and Mental Health: Applying the Standard of the Reasonable Person,” although I am not sure the reasonable person standard achieves either of the goals. These central goals seem to be to preserve an objective standard of moral responsibility and to do so in a way that “does not depersonalize the target individual” (Ciurria 2014, 7). In this commentary, I focus on my doubts (...) about the adequacy of the reasonable person standard, at least as presented in Ciurria’s paper, to meet either of these goals. It might be that had she chosen the example of the psychopath rather than Tourette syndrome to work through in a .. (shrink)

William J. Ferrero was born in East Longmeadow, Massachusetts during "the Crash" of 29, and spent his entire life there. Willie, as he is better known, is a devoted member of the town and has a reputation for helping people. Not strange then that he was voted Rotarian of the Year and later named "Citizen of the Year." Organizing youth programs in sports for the young people and creating the Rotary Summer Concerts for seniors are some of his proud accomplishments. (...) Knowing his nature, it is easy to understand why he became so involved with the Tourette Syndrome awareness program. Using Pepper Belle as a vehicle to help children and people was his brain child and it has proven to be very successful. He dedicates this book to those suffering from Tourette Syndrome so their lives may be filled with peace, love and the understanding of those fortunate to be blessed with good health. (shrink)

How exactly do mental disorders affect one’s agency? How might therapeutic interventions help patients regain or improve their autonomy? Do only some disorders excuse morally inappropriate behavior, such as theft or child neglect? Or is there nothing about having a disorder, as such, that affects whether we ought to praise or blame someone for their moral success or failure? Our volume gathers together empirically-informed philosophers who are well equipped to tackle such questions. Contributors specialize in free will, agency, and responsibility, (...) but they are informed by current scientific and clinical approaches to a wide range of psychopathologies, including autism, addiction, Tourette syndrome, personality disorders, depression, dementia, phobias, schizophrenia, and obsessive-compulsive disorder. These conditions exhibit a diverse array of symptoms that can contribute quite differently to being blameworthy or praiseworthy. (shrink)

Orthodoxy holds that the difference between weakness of will and compulsion is a matter of the resistibility of an agent's effective motivation, which makes control-based views of agency especially well equipped to distinguish blameworthy weak-willed acts from non-blameworthy compulsive acts. I defend an alternative view that the difference between weakness and compulsion instead lies in the fact that agents would upon reflection give some conative weight to acting on their weak-willed desires for some aim other than to extinguish them, but (...) not to their compulsive desires. This view allows identificationist theorists of moral responsibility to explain why weak-willed actions, but not compulsive actions, are attributable to agents such that they can, in theory, be praised or blamed for them. After motivating and presenting the view in detail, I show how it has unique resources for explaining the ethics of managing one's compulsions. (shrink)

Self-injurious behavior is associated with diverse psychiatric conditions. Sometimes, SIB is the most dominant symptom, severely restricting the psychosocial functioning and quality of life of the patients and inhibiting appropriate patient care. In severe cases, it can lead to permanent physical injuries or even death. Primary therapy consists of medical treatment and if implementable, behavioral therapy. For patients with severe SIB refractory to conventional therapy, neuromodulation can be considered as a last recourse. In scientific literature, several successful lesioning and deep (...) brain stimulation targets have been described that can indicate a common underlying neuronal pathway. The objectives of this study were to evaluate the short- and long-term clinical outcome of patients with severe, therapy refractory SIB who underwent DBS with diverse underlying psychiatric disorders and to correlate these outcomes with the activated connectivity networks. We retrospectively analyzed 10 patients with SIB who underwent DBS surgery with diverse psychiatric conditions including autism spectrum disorder, organic personality disorder after hypoxic or traumatic brain injury or Tourette syndrome. DBS targets were chosen according to the underlying disorder, patients were either stimulated in the nucleus accumbens, amygdala, posterior hypothalamus, medial thalamus or ventrolateral thalamus. Clinical outcome was measured 6 months after surgery and at long-term follow-up after 10 or more years using the Early Rehabilitation Barthel index and time of restraint. Connectivity patterns were analyzed using normative connectome. Based on previous literature the orbitofrontal cortex, superior frontal gyrus, the anterior cingulate cortex, the amygdala and the hippocampus were chosen as regions of interest. This analysis showed a significant improvement in the functionality of the patients with DBS in the short- and long-term follow-up. Good clinical outcome correlated with higher connectivity to the amygdala and hippocampus. These findings may suggest a common pathway, which can be relevant when planning a surgical procedure in patients with SIB. (shrink)

In the spirit of the competitive-collaborative approach thatCarolina at Greensboro, Greensboro, NC 27412, Russ Hurlburt and Eric Schwitzgebel take to examining the Descrip-tive Experience Sampling method, I review 'Describing Inner Experience? Proponent Meets Skeptic' -- and consider the scientific potential of DES --from the inside, in light of my own subjective expe-rience as a DES subject, as a person who lives with the unusual symp-toms of Tourette Syndrome, and as a cognitive psychologist who conducts idiographic and experience-sampling work (...) on volitional control and mind-wandering experiences. (shrink)

I argue in favor of the Minimal Approval account, an original account of an agent’s moral responsibility for her actions, understood as the conditions that must be met so that an agent’s actions speak for her such that she can appropriately be blamed on their basis. My account shares a general theoretical orientation with Deep Self views, but diverges in several respects. I argue that Deep Self views tend to seriously over-generate exemptions, such that agents are exempt from responsibility even (...) from ordinary weak-willed actions. Accordingly, much of my focus is on giving a more nuanced, and in certain senses narrower, explanation of genuine exemption cases. While I address the advantages the Minimal Approval account has over competing accounts throughout these chapters, the account also aims to provide an empirically informed response to a certain sort of skeptical worry about how it could be the case that anyone is ever responsible for what they do at all. One commonplace thought is that when agents’ behaviors are due to compulsion their “brains make them do it.” But, in a literal sense, it might seem that our brains make all of us do everything that we do. In this dissertation I head off this worry by directly addressing both what the difference is, and what it should mean for our practices. (shrink)

You live your entire waking life immersed in your inner experiences – private phenomena created by you, just for you, your own way. Despite their intimacy and ubiquity, you probably do not know the characteristics of your own inner phenomena; neither does psychology or consciousness science. Investigating Pristine Inner Experience explores how to apprehend inner experience in high fidelity. This book will transform your view of your own inner experience, awaken you to experiential differences between people and thereby reframe your (...) thinking about psychology and consciousness science, which banned the study of inner experience for most of a century and yet continued to recognize its fundamental importance. The author, a pioneer in using beepers to explore inner experience, draws on his 35 years of studies to provide fascinating and provocative views of everyday inner experience and experience in bulimia, adolescence, the elderly, schizophrenia, Tourette's syndrome, virtuosity and more. (shrink)

_The Disordered Mind: An Introduction to Philosophy of Mind and Mental Illness, second edition_ examines and explains, from a philosophical standpoint, what mental disorder is: its reality, causes, consequences, and more. It is also an outstanding introduction to philosophy of mind from the perspective of mental disorder. Revised and updated throughout, this _second edition_ includes new discussions of grief and psychopathy, the problems of the psychophysical basis of disorder, the nature of selfhood, and clarification of the relation between rationality and (...) mental disorder. Each chapter explores a central question or problem about mental disorder, including: what is mental disorder and can it be distinguished from neurological disorder? what roles should reference to psychological, cultural, and social factors play in the medical/scientific understanding of mental disorder? what makes mental disorders undesirable? Are they diseases? mental disorder and the mind–body problem is mental disorder a breakdown of rationality? What is a rational mind? addiction, responsibility and compulsion ethical dilemmas posed by mental disorder, including questions of dignity and self-respect. Each topic is clearly explained and placed in a clinical and philosophical context. Mental disorders discussed include clinical depression, dissociative identity disorder, anxiety, religious delusions, and paranoia. Several non-mental neurological disorders that possess psychological symptoms are also examined, including Alzheimer’s disease, Down’s syndrome, and Tourette’s syndrome. Containing chapter summaries and suggestions for further reading at the end of each chapter, _The Disordered Mind, second edition_ is a superb introduction to the philosophy of mental disorder for students of philosophy, psychology, psychiatry, and related mental health professions. (shrink)

Deep brain stimulation (DBS) of the globus pallidus interna and subthalamic nucleus has restored some degree of motor control in many patients in advanced stages of Parkinson’s disease. DBS has also been used to treat dystonia, essential tremor (progressive neurological condition causing trembling), chronic pain, obsessive-compulsive disorder, Tourette’s syndrome, major depressive disorder, obesity, cerebral palsy, and the minimally conscious state. Although the underlying mechanisms of the technique are still not clear, DBS can modulate underactive or overactive neural circuits (...) and restore disrupted communication between and among groups of neurons in interacting regions of the brain. This can control and relieve many symptoms associated with a range of neurological and psychiatric disorders.But the procedures of implanting and stimulating the electrodes are brain-invasive and entail significant risks. Some patients receiving DBS have experienced intracerebral hemorrhage, infection, cognitive disturbances such as impulsive behavior, and affective disturbances such as mania. It is not known whether continuous electrical stimulation of the brain would reshape synaptic connectivity and permanently alter neural circuits in ways that may not be salutary. The risk of these effects indicates that DBS should be used only when a patient’s condition is refractory to all other interventions and when there is a high probability that the technique will benefit the patient and improve his or her quality of life. If a patient’s quality of life is poor and all other treatment options have been exhausted, then the likelihood of benefit can justify physicians’ exposing patients to some risk. The clinical and ethical significance of the risk in DBS underscores the obligation of physicians to obtain fully informed consent from patients undergoing the procedure. (shrink)

Case study: while on placement at a mental health day centre I was assigned to act as key-worker to Mr X, a working-class white man in his early 40s who has been diagnosed with several psychiatric disorders. Mr X also experiences poor physical health. Mr X has been diagnosed as ?having? obsessive compulsive disorder, major depressive disorder, anger management disorder, Tourette's syndrome and paranoia. He has also been diagnosed with fibromyalgia. For all these, he daily takes a powerful (...) cocktail of anti-depressants, mood-stabilizers, anti-psychotics and pain killers. From his file I noted that he had been discharged from the local community psychiatric team, so he no longer had regular and unproblematic access to either a psychiatrist or social worker. He had been receiving anger management therapy (AMT), but his attendance had been sporadic. Mr X had, he claimed, no real friends, or, as he put it, ?just mere acquaintances?. Mr X lives alone with his mother. Mr X was a new member at the day centre but had had a long career as a mental health service user (owing to his angry behaviours he had been ?asked to leave? his previous day centre). The stated and overt purpose of our relationship was to collaborate towards ameliorating his situation. This work more commonly consisted of offering emotional and practical support, but, when first assigned Mr X, I was told by my practice assessor that eventually I would be required to carry out a risk assessment of him. So, for the purposes of this essay, I will focus on the ethical problems and dilemmas I encountered in the progression leading towards, and the actual process of carrying out, an assessment of the supposed risk that Mr X may pose either to himself, others or both. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Response to the CommentariesSean A. SpenceIn “Free Will in the Light of Neuropsychiatry,” I have attempted to present an argument from the perspective of materialist neuroscience, pushing the latter to its logical conclusion: that if the human nervous system is consistent in its properties, then the only place for “free will” is in the non-conscious processes which underpin conscious awareness. This argument I have based on two supports: the (...) “spatial” and the “temporal” (Spence, 1995).I have contended that the sense of freedom may be lost from certain actions, thereby implying that “freedom” is a sensory process distinct from action. This might be conceptualized as having a distinct functional distribution within the nervous system (a spatial distinction). I have also argued that conscious awareness of events occurs at a finite delay, the period of “neuronal adequacy,” after those events themselves. The point here is that neurochemical events giving rise to phenomenology are likely to require a period of time (no matter how short) for their genesis. The process is “on line” before we perceive it (a temporal distinction). Thus the “freedom to act,” a motor process, is necessarily non-conscious at the point of initiation.I am grateful to Frith, Libet and Stephens for their comments. In the most part our disagreements are likely to be those of emphasis, perhaps compounded by my uses of the term “free will.”I have no major disagreement with Frith’s comments. I would, however, emphasize that it is likely that the Bereitschaftspotential, or readiness potential, does tell us something regarding intended actions. It is, for example, absent prior to the involuntary movements seen in Tourette’s syndrome (Obeso et al. 1982), and reduced in akinetic patients with Parkinson’s disease (Dick et al. 1989) or medial frontal lobe lesions (Deecke et al. 1987). The latter groups have difficulty initiating intended, internally generated, actions.With regard to the suspicion of dualism in my diagrams, the point is well taken, but I am attempting to describe a functional distinction, the precise coordinates of which remain obscure. It may well be that “consciousness” occupies no fixed location but is an activity temporarily co-extant with that association cortex (or cortices) subserving the sensory modality (or modalities) experienced phenomenologically (see Bottini et al. 1995).I have based much of my “temporal” argument on Libet’s work, and I am grateful for his response. Nevertheless, I am still of the opinion that there is a central inconsistency with his argument that conscious control exerts a veto on acts which is somehow free of material constraints. [Indeed he states that he has “no quarrel with the view that even a fully voluntary act is initiated unconsciously (non-consciously)”.] Whereas I can [End Page 99] not prove that this power of veto does not evade neurochemical processes, or that it somehow acts instantaneously and independently, with no origin in unconscious processing, I can say that I have restricted myself to arguing within a materialist perspective, with the aim of “pushing it” to its extreme. The free will which Libet retains in consciousness is one which is unique, and unconstrained by materialism. It is dualism in disguise!Stephens implies that there is a non-argument regarding consciousness acting as an initiator of events. The suggestion is that no one would argue this. Yet this is Libet’s argument. It cannot be disproved, but it is clearly (internally) inconsistent with Libet’s own impressive body of work.As for the role of consciousness in action, I have, I think, invoked a position similar to that adopted by Stephens; that consciousness is more a sensory state, allowing awareness of actions, and their consequences, and perhaps thereby facilitating the function of non-conscious initiators. It is clearly necessary for the performance of the “higher” acts which we equate with human nature, but it is not sufficient. (Indeed many of the most creative insights have “emerged” into consciousness [see Boden, 1992].) The man with a paralyzed arm may wish for his arm to move but to no avail. Over time function may slowly reappear. But if his lesion is such that he is unaware of his impairment (anosognosia), then his prognosis may... (shrink)

In order to judge how behavior caused by the positivity effect should be considered, comparisons were made between the positivity effect and two mental disorders. These disorders, Tourette’s syndrome and psychopathy, were selected due to their extreme differences in what Strawsonian attitudes they inspire and how they are perceived relative to disordered patients’ will. Disorder-affected behavior of Tourette’s patients inspires the objective attitude and is seen as a condition affecting an individual’s will, while disorder-affected behavior of psychopaths (...) inspires the interpersonal attitude and is seen as a character trait. Relevant distinctions between psychopathy and Tourette’s syndrome were found to include their neurological causes, the obviousness of the suffering they caused, and how easily their disorder-affected behavior could be mapped onto goal-seeking behavior. These considerations suggest the positivity effect should be viewed similarly to psychopathy in terms of responsibility, although this is complicated by its time of development and other factors. (shrink)

The neural networks that constitute corticostriatothalamocortical circuits between prefrontal cortex and subcortical structure provide a heuristic framework for bridging gaps between neurocircuitry and executive dysfunction in attention deficit hyperactivity disorder (ADHD). “Cool” and “Hot” executive functional theory and dual pathway models are supposed to be applied within the neuropsychology of ADHD. The theoretical model elaborated response inhibition and delayed gratification in ADHD. We aimed to review and summarize the literature about the circuits on ADHD and ADHD-related comorbidities, as well as (...) the effects of neurocircuitry on the executive dysfunction in ADHD. (shrink)

Many intelligent, capable, and successful individuals believe that their success is due to luck and fear that they will someday be exposed as imposters. A puzzling feature of this phenomenon, commonly referred to as imposter syndrome, is that these same individuals treat evidence in ways that maintain their false beliefs and debilitating fears: they ignore and misattribute evidence of their own abilities, while readily accepting evidence in favour of their inadequacy. I propose a novel account of imposter syndrome (...) as an instance of self-deception, whereby biased evidence treatment is driven by the motivational benefit of negative self-appraisal. This account illuminates a number of interconnected philosophical and scientific puzzles related to the explanation, definition, and value of imposter syndrome. (shrink)

Various psychopathologies of self-awareness, such as somatoparaphrenia and thought insertion in schizophrenia, might seem to threaten the viability of the higher-order thought (HOT) theory of consciousness since it requires a HOT about one’s own mental state to accompany every conscious state. The HOT theory of consciousness says that what makes a mental state a conscious mental state is that there is a HOT to the effect that “I am in mental state M.” I have argued in previous work that a (...) HOT theorist can adequately respond to this concern with respect to somatoparaphrenia and thought insertion. There is also Cotard syndrome which is a rare neuropsychiatric disorder in which people hold the delusional belief that they are dead, do not exist, or have lost their blood or internal organs. In this paper, I argue that HOT theory has nothing to fear from it either and can consistently account for what happens in such unusual cases. I analyze Cotard syndrome in light of my previous discussion of somatoparaphrenia and thought insertion, and argue that HOT theory can provide a somewhat analogous account without the worry of inconsistency. It is crucial to recognize that there are multiple “self-concepts” and levels of HOTs which can help to provide a more nuanced explanation. With regard to the connection between consciousness and self-consciousness, it is proposed that Cotard patients are indeed capable of having some “I-thoughts” about their bodies and mental states. (shrink)

Le syndrome de Kierkegaard est un essai libre de Jean- Luc Berlet, consacré à l'un de ses penseurs de prédilection, le Danois Seren Kierkegaard (1813-1855). Ce syndrome dont il est question, tel que défini par l'auteur, pourrait être conçu comme la tension qui résulte de l'impossible choix entre l'amour de la femme et l'amour de Dieu. Kierkegaard renonça en effet à l'amour charnel de la femme au profit d'une vie ascétique consacrée à I écriture et à la réflexion (...) sur l'Amour. A plus grande échelle ce syndrome pourrait être compris comme l'abandon du temporel au profit d'un idéal spirituel Et les regrets qui en découlent. En effet, comme nombre de contemporains opérant ce type de choix, Kierkegaard connut bien des tourments. Ces affres permirent néanmoins à Kierkegaard de développer une conception de l'Amour et du Divin d'une grande originalité qu'il est bon de redécouvrir dans notre époque marquée par le consumérisme sentimental. Tout au long des quatorze chapitres qui jalonnent cet ouvrage, Jean-Luc Berlet retrace le parcours littéraire de ce philosophe danois considéré par beaucoup comme le père de l'existentialisme, brossant ici un tableau complet de son énigmatique personnalité. En outre, chaque chapitre est accompagné d'un code QR, donnant chacun actes à une vidéo en ligne où Jean - Luc Berlet approfondit son développement et fournit des clefs de lecture pour une meilleure compréhension de l'oeuvre de Kierkegaard. (shrink)

In this important addition to the stroke literature, highly experienced clinicians set out the patterns to be expected in patients with stroke, drawing on illustrative case histories where appropriate. The book is intended as a guide to patterns and syndromes for clinicians encountering an unfamiliar presentation in a stroke patient. It will enable them to differentiate between possible locations on the basis of symptoms and signs, recognise lesion patterns found in patients with infarcts and haemorrhages in various vascular territories, and (...) refer to the clinical features associated with rare but important causes of stroke. Drawing on the experience and clinical authority of distinguished international contributors, this is a practical, highly illustrated companion and reference for students, trainees and physicians who wish to improve their skills in the accurate diagnosis of stroke syndromes, and their understanding of its clinical consequences. (shrink)

Williams syndrome is a genetic disorder that, because of its unique cognitive profile, has been marshalled as evidence for the modularity of both language and social skills. But emerging evidence suggests the claims of modularity based on WS have been premature. This paper offers an examination of the recent literature on WS. It argues the literature gives little support for mental modularity. Rather than being rigidly modular, the WS brain is an extremely flexible organ that that co-opts available neural (...) resource in a highly dynamic manner to cope in the world. (shrink)

As a human being possesses dual creation, certain reasons and conditions can oppose his inner and outside worlds. Giving preference one side to other, and to turn another into slavery enhance the syndrome of imbalance which inherent him in birth. To make harmony between them and their complementarities perfect the human being. This also emphasizes the necessity of parallel development of rational and irrational thinking and their complementarities. A human being is perfect in birth and he is the only (...) being who is able to understand his perfection. As it is reflected in Holy Books that the material world is a form of test, and the good and the evil return us. As it is seems that this material world is only the mean of choice in spiritual way. This choice is of the man. The man canchoose light or fire. Everybody understands his inferiority in his own and to solve it differently: it might be material things, divine love or science. What is the truth? It is the soul that defines it, if we can listen to it. (shrink)

Eyal et al have recently argued that researchers should consider conducting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) human challenge studies to hasten vaccine development. We have conducted (J. L.) and overseen (L. D.) human challenge studies and agree that they can be useful in developing anti-infective agents. We also agree that adults can autonomously choose to undergo risks with no prospect of direct benefit to themselves. However, we disagree that SARS-CoV-2 challenge studies are ethically appropriate at this time, (...) for 3 reasons: (1) current scientific knowledge of SARS-CoV-2 infection is insufficient to manage risks; (2) autonomous decision making, while necessary, does not override concerns about risk; and (3) undertaking challenge studies now would imperil confidence in the research enterprise, potentially undermining the global response to the coronavirus disease 2019 (COVID-19) pandemic. (shrink)

ABSTRACT Many intelligent, capable, and successful individuals believe that their success is due to luck, and fear that they will someday be exposed as imposters. A puzzling feature of this phenomenon, commonly referred to as imposter syndrome, is that these same individuals treat evidence in ways that maintain their false beliefs and debilitating fears: they ignore and misattribute evidence of their own abilities, while readily accepting evidence in favour of their inadequacy. I propose a novel account of imposter (...) class='Hi'>syndrome as an instance of self-deception, whereby biased evidence treatment is driven by the motivational benefit of negative self-appraisal. This account illuminates a number of interconnected philosophical and scientific puzzles related to the explanation, definition, and value of imposter syndrome. (shrink)

While some of mental disorders due to emotional distress occur cross-culturally, others seem to be much more bound to particular cultures. In this paper, I propose that many of these “cultural syndromes” are culturally sanctioned responses to overwhelming negative emotions. I show how tools from cultural evolution theory can be employed for understanding how the syndromes are relatively confined to and retained within particular cultures. Finally, I argue that such an account allows for some cultural syndromes to be or become (...) mental disorders and also steers clear of some of the anti-realist trappings associated with a social constructivism of cultural syndromes. (shrink)