Male sexual arousal (SA) has been known as a multidimensional experience involving closely interrelated and coordinated neurobehavioral components that rely on widespread brain regions. Recent functional neuroimaging studies have shown relation between abnormal/altered dynamics in these circuits and male sexual dysfunction. However, alterations in the topological1 organization of structural brain networks in male sexual dysfunction are still unclear. Here, we used graph theory2 to investigate the topological properties of large-scale structural brain networks, which were constructed using inter-regional correlations (...) of cortical thickness between 78 cortical regions (subcortical regions were not included due to the used cortical surface model) in 40 patients with psychogenic erectile dysfunction (pED) and 39 normal controls. Compared with normal controls, pED patients exhibited a less optimal global topological organization with reduced global and increased local efficiencies. Our results suggest disrupted neural integration among distant brain regions in pED patients, consistent with previous reports of impaired white matter structure and abnormal functional integrity in pED. Additionally, disrupted global network topology in pED was observed to be primarily relevant to altered subnetwork and nodal properties within the networks mediating the cognitive, motivational and inhibitory processes of male SA, possibly indicating disrupted integration of these networks in the whole brain networks and might account for pED patients’ abnormal cognitive, motivational and inhibitory processes for male SA. In total, our findings provide evidence for disrupted integrity in large-scale brain networks underlying the neurobehavioral processes of male SA in pED and provide new insights into the understanding of the pathophysiological mechanisms of pED. (shrink)

The current medical approach to erectile dysfunction (ED) consists of physiological, psychological and social components. This paper proposes an additional framework for thinking about ED based on phenomenology, by focusing on the theory of sexual projection. This framework will be complementary to the current medical approach to ED. Our phenomenological analysis of ED provides philosophical depth and illuminates overlooked aspects in the study of ED. Mainly by appealing to Merleau-Ponty’s Phenomenology of Perception, we suggest considering an additional etiology (...) of ED in terms of a weakening of a function of sexual projection. We argue that sexual projection can be problematized through cognitive interferences, changes in the ‘intentional arc’, and modifications in the subject’s ‘body schema’. Our approach further highlights the importance of considering the ‘existential situation’ of patients with ED. We close by reflecting briefly on some of the implications of this phenomenological framework for diagnosis and treatment of ED. (shrink)

A conflict of interest is a situation in which a person has competing loyalties or interests that make it difficult to fulfil his or her duties impartially. Conflict of interest is not categorically improper in itself but requires proper management. A SCOPUS literature search was performed for publications on the efficacy/safety of Phospho-Di-Esterase Inhibitors for treating erectile dysfunction. A categorization tool was used to review and classify the publications as supportive/not-supportive for the discussed active ingredient and reporting or (...) not reporting a COI for that specific drug or for the remaining PDEIs. Multivariable binary logistic regression was performed. In the 419 selected records the prevalence of supportive opinions was higher when a COI for the index label was declared. The CoOpCaT showed good internal consistency, discriminative validity and intra/inter-rater agreement. The strongest predictor for a supportive opinion was the total number of financial COIs for the index label. A mild protective effect of the total number of financial COIs for any competitor label was noted. Financial COIs have frequently been associated with bias, and the measures currently adopted to restrain it lack effectiveness. Some evidence for monitoring and/or compensating this bias is reported here, but the ultimate solution remains distant. (shrink)

BackgroundMental stress and imbalance of its two neural stress systems, the autonomic nervous system and the hypothalamic–pituitary–adrenal axis, are associated with chronic prostatitis/chronic pelvic pain syndrome and erectile dysfunction. However, the comprehensive analyses of psychological stress and stress systems are under-investigated, particularly in CP/CPPS patients complicated by lower urinary tract symptoms and ED.Materials and methodsParticipants were 95 patients in CP/CPPS+ED group, 290 patients in CP/CPPS group, 124 patients in ED group and 52 healthy men in control group. The (...) National Institutes of Health Chronic Prostatitis Symptom Index, the International Index of Erectile Function-5 and the International Prostate Symptom Score were used for assessing the disease severity of CP/CPPS, LUTS and ED. Psychometric self-report questionnaires including the Beck Anxiety Inventory, Perceived Stress Scale, Type A Personality Test and Symptom Checklist 90 were completed for distress from physical symptoms. Twenty-five subjects per group were randomly selected for further investigating the changes of the HPA axis and ANS. Saliva samples were taken on 3 consecutive days at 8 specific times with strict reference to time of morning awakening for evaluation of free cortisol. Heart rate variability as marker of the ANS was measured using 24 h electrocardiography, and time-and frequency-domain variables were analyzed.ResultsThe BAI and SCL-90 scores were significantly higher in the CP/CPPS+ED, CP/CPPS and ED groups compared with the control group. The PSS scores of both groups with ED were significantly higher than the control group. Compared with the CP/CPPS group, the differences of PSS, SCL-90 and TAPT scores were statistically significant in CP/CPPS+ED patients. The IPSS scores were shown to have significantly positive correlations with BAI, PSS and SCL-90 in the CP/CPPS patients. However, in all subjects, the IIEF-5 scores were shown to have significantly negative correlations with BAI, PSS, SCL-90 and quality of life score in NIH-CPSI. Cortisol awakening response parameters and diurnal cortisol levels did not significantly vary between the four groups. Time-dependent parameters of HRV also did not differ significantly across groups. In the frequency domain analysis, low frequency was significantly lower in ED patients when compared with CP/CPPS+ED patients and healthy controls, high frequency power was significantly higher in healthy controls compared to patients with ED, CP/CPPS and CP/CPPS+ED, and the CP/CPPS+ED group had significantly higher LF/HF ratio than the control group.ConclusionCP/CPPS and ED patients score exceedingly high on most psychosocial variables. The symptom scores of LUTS and ED positively correlate with the severity of psychological stress. Our findings also suggest that the ANS sympathovagal imbalance is associated with ED and LUTS in CP/CPPS, whereas HPA axis activity is not. (shrink)

The introduction of Viagra in Japan is largely associated with the construction of ‘abject masculinities’. The approval of the drug comes amidst worries about hormones polluting the environment and Japanese men's unwillingness to perform their ‘appropriate gender role’ in a country coping with problems in the economy, a growing number of unmarried people, an ageing population and declining birth rates. In this article, I analyse how impotence, gender and reproduction are entangled in the ways in which Japanese physicians report (...) class='Hi'>erectile dysfunction (ED) and prescribe Viagra. The accounts of physicians, taken from the media and scientific reports, show that medical doctors tend to uphold ‘the Viagrization of ED’, which will lead to the Viagrization of Japan. Despite discourses on medicalized sexuality, reproductive behaviour and promotion of childbirth, the politics of Viagra largely promote male recreational sex with substantial benefits for the pharmaceutical and sex industries. Also, the politics of Viagra seem to underpin the commodification of a sexualized male body that ignores the reproductive health concerns of Japanese men. (shrink)

Historically, male sexual fitness was framed by a patriarchal politics of life centred on regeneration, population and nation. In the later 20th century, as successful ageing became promoted by the lifestyle practices of an idealized healthy and active senior citizenry, traditional gerontocratic power over the sexual risks of youth gave way to a medical sexology concerned with sexual functionality across the lifecourse; in particular, erectility. Recently, erectile dysfunction has expanded to become a population-wide health problem with increasingly refined (...) diagnoses based on `phases', `early warning signs' and preventative regimes, especially as Viagra has become so widely available. This article explores a new bodily configuration in the making; arising, on the one hand, from the pharmacological and scientific technologization of male sexuality, and, on the other, from a contemporary politics of life that both contests the late-life ageism of the past and fosters a mid-life ageism in the present. (shrink)

Sildenafil citrate (Viagra) and other newly released pharmaceuticals that assist erectile dysfunction may be one of the most important categories of drugs released in the past decade. Sildenafil is distinctive because it creates a new therapeutic relationship not only between patient and physician, but also with sexual partner(s). Physicians must first evaluate the patient comprehensively, addressing not only erectile function and sexual performance, but overall physical and mental health. Since the drug does impact others, an expanded model (...) for informed consent needs to be considered. Three models to consider include the public health one, ethically justified limits on confidentiality, and a biopsychosocial one. The biopsychosocial model may be preferred because it expands the patient-physician dyad to directly include others. Physicians also need to distinguish between professional, role-related obligations and personal conscience when treating patients whose sexual beliefs and practices differ from their own. Other ethical issues include inappropriate prescribing over the Internet, dealing with unrealistic patient expectations, and fairness in paying for treatment for sexual conditions in both men and women. With these proposed guidelines, physicians can continue to provide steady, reliable guidance for patients while working with yet another scientific advance in medicine. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Minding Psychiatric PracticePaul B. Lieberman, MD (bio)In recent discussions of what makes or should make something 'a psychiatric disorder' (if anything does; Lange, 2007), attention and contention have mostly involved problems distinguishing disorder from normal life, expectable suffering, neurological disease, criminality, prejudice, error, religious experience and effects of injustice, but the question of what makes or should make something psychiatric is also important and difficult to answer. It's important (...) because general conceptions of what kinds of things we treat (e.g., disorders of the heart, brain, or mind) guide practice by specifying what constitutes, nurtures or poisons them, ways they may break apart or be repaired and processes that produce change, as well as by helping to draw appropriate boundaries between psychiatry and other fields. It's difficult because psychiatry comprises many kinds of objects, theories and forms of practice (primarily biomedical, psychodynamic and cognitive behavioral), and we don't know which, if any, are 'natural' or valid. It's also not established whether or why all or any should be called, 'psychiatric,' what explains their being so-called (if it is correct to do so), or which may be fundamental or constitutive and which derivative and potentially eliminable.One appealing answer (the Diagnostic and Statistical Manual of Mental Disorders [DSM] an swer; American Psychiatric Association, 2013) to the question of what makes something psychiatric is that it is mental in some essential way. But few psychiatrists could explain what that might mean, nor would many be able to say what a mental disorder is or defend the idea that the conditions they work with are (always?) such things (though many probably wouldn't deny it either; they wouldn't know what to say and most wouldn't think it mattered). But if the idea that 'psychiatric disorders are essentially mental' seems obvious yet unclear to psychiatrists, what's the alternative? And if no alternative leaps to mind, then are psychiatrists practicing without knowing what they're treating?In "What makes a disorder 'mental'? A practical treatment of psychiatric disorder," Joseph Gough (2023) addresses these problems with two bold proposals: first, that we abandon altogether using 'mental' (assuming we understand its meaning) in the definition of 'psychiatric disorder,' and, second, that we, instead, define psychiatric disorders as those conditions best treated by psychiatrists (including psychologists, social workers, nurses and other practitioners).To a psychiatrist, these proposals seem, both, a welcome validation of our work ("At last, someone appreciates us!"), but also a troubling destabilization of how we understand that work ("That can't be right: it's backwards!") In Gough's [End Page 37] wide-ranging and carefully reasoned defense of his two proposals, he offers many novel and provocative insights relevant to problems defining psychiatric disorders. I will consider only a few of the issues he raises, which I think are especially worth emphasis and further thought.Gough initially rejects mentality in the definition of psychiatric disorder by reminding us that it is neither sufficient nor necessary for inclusion in the DSM. Vision is mental but blindness is not in the manual; caffeinism and erectile dysfunction are not mental but are included. Later, he offers two additional reasons for abandoning mentality: it promotes stigma and encourages dualism. I think all these arguments are correct. (Although blindness is not the best example because DSM defines mental disorders as disturbances of "thought, feeling and behavior" and blindness is none of these. But many other examples (e.g., encephalopathies) could make the point.)But Gough passes over this issue too quickly: we should pause and consider more carefully possible reasons to keep or even privilege the mental in psychiatry as well as the losses we might suffer if we gave it up. The examples and arguments he offers for abandoning the mental could be contested if one were motivated to do so. For example, one could argue, as Gough does elsewhere, that the DSM is just wrong sometimes and should be revised. Perhaps, as Gough briefly considers, there is a subset of 'mental' disorders that are properly psychiatric (where, e.g., certain favored features such as meaning, agency, narrative, or connection of 'self and world' are preserved, and... (shrink)

How should governments balance saving people from very large individual disease burdens (such as an early death) against saving them from middling burdens (such as erectile dysfunction) and minor burdens (such as nail fungus)? This chapter considers this question through an analysis of a priority-setting proposal in the Netherlands, on which avoiding a multitude of middling burdens takes priority over saving one person from early death, but no number of very small burdens can take priority over avoiding one (...) death. It argues that there is some, albeit imperfect, evidence of substantial public support for such a policy. Furthermore, it provides a principled rationale for it in terms of respect for the person who faces the largest burden. (shrink)

The disability rights movement grounds material critiques of the treatment of people with disabilities in a social constructionist perspective, locating disability in the social rather than physical realm, and demedicalizing the concept of disability. However, this conceptualization is threatened by the medicalization of nonnormative erections as the biomedical pathology erectile dysfunction (ED). Although use of medical treatments for ED can have positive outcomes for individuals, the medical community's tendency to include sexual difference in the rubric of disability threatens (...) to remedicalize that category. Furthermore, medicalized conceptions of ED often serve to refocus sexuality around phallocentric, normative sex acts and gender roles, undoing the deconstructive work of disability sex studies. Finally, although aging Western populations targeted for ED treatment represent potentially expanded bases for disability movement activism, the pathologizing of nonnormative sexuality may have the power to instead focus this group on individualistic use of medical interventions geared toward “normalcy.”. (shrink)

Using material from the Pfizer sponsored website providing health information on erectile dysfunction to potential Swedish Viagra customers (www.potenslinjen.se), this article explores the public image of masculinity in relation to sexual health and the cultural techniques for creating pharmaceutical appeal. We zoom in on the targeted ideal users of Viagra, and the nationalized, racialized and sexualized identities they are assigned. As part of Pfizer’s marketing strategy of adjustments to fit the local consumer base, the ways in which Viagra (...) is promoted for the Swedish setting is telling of what concepts of masculinity are so stable and unassailable that they can withstand the association with a drug that is, in essence, an acknowledgement of ‘failed’ masculinity and ‘dysfunctional’ sexuality. With comparative national examples, this study presents an interdisciplinary take on the ‘glocalized’ cultural imaginary of Viagra, and the masculine subject positions it engenders. (shrink)

In this article I discuss the emergence of Female Sexual Dysfunction (FSD) within American psychiatry and beyond in the postwar period, setting out what I believe to be important and suggestive questions neglected in existing scholarship. Tracing the nomenclature within successive editions of the American Psychiatric Association’s Diagnostic and Statistical Manual ( DSM), I consider the reification of the term ‘FSD’, and the activism and scholarship that the rise of the category has occasioned. I suggest that analysis of FSD (...) benefits from scrutiny of a wider range of sources (especially since the popular and scientific cross-pollinate). I explore the multiplicity of FSD that emerges when one examines this wider range, but I also underscore a reinscribing of anxieties about psychogenic aetiologies. I then argue that what makes the FSD case additionally interesting, over and above other conditions with a contested status, is the historically complex relationship between psychiatry and feminism that is at work in contemporary debates. I suggest that existing literature on FSD has not yet posed some of the most important and salient questions at stake in writing about women’s sexual problems in this period, and can only do this when the relationship between ‘second-wave’ feminism, ‘post-feminism’, psychiatry and psychoanalysis becomes part of the terrain to be analysed, rather than the medium through which analysis is conducted. (shrink)

: Psychogenic pain is considered to be pain that has a psychological origin. In this paper, I provide a brief history of the ways in which such pain has been interpreted and classified, highlighting the problem that psychogenic pain is typically defined by excluding organic evidence that could account for the sufferer’s experience. This has led to ambiguous disease classifications, which challenges the authenticity of the patient’s suffering. Today psychogenic pain is no longer considered a valid diagnosis, (...) because it is deemed to stigmatize the patient by implying that their pain is imaginary. But such stigmatization continues in the modern approach to chronic pain. Addressing this issue requires us to understand the relationship between “emotional” and “physical” pain and acknowledge the reality of all suffering. Radden tackles these issues by showing that even though pain and suffering can be accompanied by mistaken beliefs, such experiences cannot be delusional. Keywords: Psychogenic Pain; Imaginary Pain; Chronic Pain; IASP; DSM Dolore psicogeno e dolore immaginario Riassunto: Con dolore psicogeno si intende un dolore di origine psicologica. In questo lavoro presento una breve storia delle interpretazioni e classificazioni di questa forma di sofferenza, evidenziando che queste si sono fondate perlopiù sull’esclusione di evidenze organiche a giustificazione dell’esperienza del sofferente. Ciò ha portato ad ambigue classificazioni di malattia che mettono in discussione l’autenticità della sofferenza del paziente. Oggi, quella di dolore psicogeno non è più considerata una diagnosi valida perché ritenuta stigmatizzante, implicando che il dolore del paziente sia immaginario. Ciononostante, la stigmatizzazione persiste nell’approccio odierno al dolore cronico. Affrontare questo problema comporta la comprensione della relazione tra dolore “emozionale” e dolore “fisico” ed il riconoscimento della realtà di tutte le forme di sofferenza. Nel suo lavoro, Radden esamina queste tematiche mostrando che, sebbene esperienze di dolore e sofferenza possano essere accompagnate da credenze errate, le esperienze stesse non possono essere illusorie. Parole chiave: Dolore psicogeno; dolore immaginario; dolore cronico; IASP; DSM. (shrink)

Paul Griffiths and John Matthewson argue that selected effects play the key role in determining whether a state is pathological. In response, it is argued that a selected effects account faces a number of difficulties in light of modern genomic research. Firstly, a modern history approach to selection is problematic as a basis for assigning function to human traits in light of the small population sizes in the hominin lineage, which imply that selection has played a limited role in shaping (...) these genomes in the evolutionarily recent past. Secondly, determining both the genetic basis of disease and selective histories of the various alleles involved may be experimentally intractable. Thirdly, the existence of “selected disorders” is well supported, and yet on the other hand many other common diseases may not reduce evolutionary fitness. In summary, the biological ends promoted by natural selection, as best modeled in recent research, do not adequately ground a concept of dysfunction that aligns well with the interests of human health. (shrink)

Some ‘naturalist’ accounts of disease employ a biostatistical account of dysfunction, whilst others use a ‘selected effect’ account. Several recent authors have argued that the biostatistical account offers the best hope for a naturalist account of disease. We show that the selected effect account survives the criticisms levelled by these authors relatively unscathed, and has significant advantages over the BST. Moreover, unlike the BST, it has a strong theoretical rationale and can provide substantive reasons to decide difficult cases. This (...) is illustrated by showing how life-history theory clarifies the status of so-called diseases of old age. The selected effect account of function deserves a more prominent place in the philosophy of medicine than it currently occupies. _1_ Introduction _2_ Biostatistical and Selected Effect Accounts of Function _3_ Objections to the Selected Effect Account _3.1_ Boorse _3.2_ Kingma _3.3_ Hausman _3.4_ Murphy and Woolfolk _4_ Problems for the Biostatistical Account _4.1_ Schwartz _5_ Analysis versus Explication _6_ Explicating Dysfunction: Life History Theory and Senescence _7_ Conclusion. (shrink)

Theorists analyzing the concept of disease on the basis of the notion of dysfunction consider disease to be dysfunction requiring. More specifically, dysfunction-requiring theories of disease claim that for an individual to be diseased certain biological facts about it must be the case. Disease is not wholly a matter of evaluative attitudes. In this paper, I consider the dysfunction-requiring component of Wakefield’s hybrid account of disease in light of the artifactual organisms envisioned by current research in (...) synthetic biology. In particular, I argue that the possibility of artifactual organisms and the case of oncomice and other bred or genetically modified strains of organism constitute a significant objection to Wakefield’s etiological account of the dysfunction requirement. I then develop a new alternative understanding of the dysfunction requirement that builds on the organizational theory of function. I conclude that my suggestion is superior to Wakefield’s theory because it (a) can accommodate both artifactual and naturally evolved organisms, (b) avoids the possibility of there being a conflict between what an organismic part is supposed to do and the health of the organism, and (c) provides a nonarbitrary and practical way of determining whether dysfunction occurs. (shrink)

Autobiographical–episodic memory is the conjunction of subjective time, autonoetic consciousness and the experiencing self. Understanding the neural correlates of autobiographical–episodic memory might therefore be essential for shedding light on the neurobiology underlying the experience of being an autonoetic self. In this contribution we illustrate the intimate relationship between autobiographical–episodic memory and self by reviewing the clinical and neuropsychological features and brain functional imaging correlates of psychogenic amnesia – a condition that is usually characterized by severely impaired retrograde memory functioning, (...) in absence of structural brain damage as detected by standard imaging. We demonstrate that in this disorder the autobiographical–episodic memory deficits do not exist in isolation, but occur with impairments of the autonoetic self-consciousness, emotional processing, and theory of mind or executive functions. Furthermore functional and metabolic brain alterations involving regions that are agreed upon to exert crucial roles in memory processes were frequently found to accompany the psychogenic memory “loss”. (shrink)

Emotion is normally regulated in the human brain by a complex circuit consisting of the orbital frontal cortex, amygdala, anterior cingulate cortex, and several other interconnected regions. There are both genetic and environmental contributions to the structure and function of this circuitry. We posit that impulsive aggression and violence arise as a consequence of faulty emotion regulation. Indeed, the prefrontal cortex receives a major serotonergic projection, which is dysfunctional in individuals who show impulsive violence. Individuals vulnerable to faulty regulation of (...) negative emotion are at risk for violence and aggression. Research on the neural circuitry of emotion regulation suggests new avenues of intervention for such at-risk populations. (shrink)

Michael Ing's The Dysfunction of Ritual in Early Confucianism is the first monograph in English about the Liji--a text that purports to be the writings of Confucius' immediate disciples, and part of the earliest canon of Confucian texts called ''The Five Classics,'' included in the canon several centuries before the Analects. Ing uses his analysis of the Liji to show how early Confucians coped with situations where their rituals failed to achieve their intended aims. In contrast to most contemporary (...) interpreters of Confucianism, Ing demonstrates that early Confucian texts can be read as arguments for ambiguity in ritual failure. (shrink)

I argue that despite the merits of Jefferson’s account of a brain disorder, which are many, the notion of function she deploys is unsuitable to the overall goals of that account. In particular, Jefferson accepts Cummins’ causal role theory of function and dysfunction. As the causal role view, in its standard elaborations, is wedded to human interests, goals, and values, it cannot serve as a value-neutral anchor for her hybrid “harm-dysfunction” account of disorder. I argue that the selected (...) effects theory, or some comparably value-neutral account, would serve her purposes better. (shrink)

Accounts of the concepts of function and dysfunction have not adequately explained what factors determine the line between low‐normal function and dysfunction. I call the challenge of doing so the line‐drawing problem. Previous approaches emphasize facts involving the action of natural selection (Wakefield 1992a, 1999a, 1999b) or the statistical distribution of levels of functioning in the current population (Boorse 1977, 1997). I point out limitations of these two approaches and present a solution to the line‐drawing problem that builds (...) on the second one. (shrink)

Psychogenic non epileptic seizures (PNES) are clinical events of psychological nature. Video-electroencephalography monitoring (V-EEGM) is a valuable method for the diagnosis of PNES and may be combined with provocative tests to induce seizures. The use of placebo in provocative tests for the diagnosis of PNES is controversial because of associated deception, and contrasts with the use of truly decreasing epileptogenic threshold techniques such as hyperventilation and photo stimulation. We present a clinical case of a pregnant woman with a past (...) history of refractory epilepsy, admitted in the obstetric department due to unremitting seizures. In this clinical context, non-deceiving provocative tests such as hyperventilation and photo stimulation could be potentially harmful, nevertheless, the use of intravenous saline injection presented as a safer alternative to diagnose PNES and hence obviate an urgent caesarean. This case illustrates a disproportionate risk of causing harm when telling the truth, in comparison with the benefit of avoiding such risk, although deceiving the patient. This is a clinical example of how considerations concerning the use of placebo must be evaluated in an individual basis. (shrink)

Tradicionalmente, a questão da identidade pessoal é considerada a questão a respeito ao que faz uma pessoa ser a mesma ao longo do tempo. Recentemente, porém, atenção à experiência fenomênica trouxe uma nova perspectiva ao debate. À luz dessa mudança de perspectiva, Klein sugere que indivíduos com amnésia episódica retrógrada retêm uma noção de quem são, além de terem senso de continuidade. Ele, portanto, argumenta que a memória episódica não é necessária para se ter sensação de si mesmo diacrônica. Desafiamos (...) a conclusão de Klein apontando que existem tipos mais extremos de amnésia—amnésia psicogênica—que parecem problemáticos à sua proposta de que o senso de continuidade é suficiente para se ter sensação de si mesmo diacrônico. Esse é o caso, porque alguns exemplos de amnésia psicogênica são casos de amnésia dissociativa, que mostram que ter uma experiência consciente contínua não resolve o problema. (shrink)

It has recently been suggested that delusions be conceived of as symptoms on the harmful dysfunction account of disorder: delusions sometimes arise from dysfunction, but can also arise through normal cognition. Much attention has thus been payed to the question of how we can determine whether a delusion arises from dysfunction as opposed to normal cognition. In this paper, we consider another question, one that remains under-explored: which delusions warrant treatment? On the harmful dysfunction account, this (...) question dissociates from the question about dysfunction—there are a broad range of “treatable conditions” beyond mere harmful dysfunctions. As such, many conditions that arise from normal cognition are also eligible for medical intervention. We argue that some delusions that arise from normal cognition may well fall under the banner of treatable conditions. We examine the practical and ethical questions surrounding such treatment, including the issue of coercive and deceptive treatment options. (shrink)

Using a multiple-trial stock market decision paradigm, the possibility that counterfactual thinking can be dysfunctional for learning and performance by distorting the processing of outcome information was examined. Correlational (Study 1) and experimental (Study 2) evidence suggested that counterfactuals are associated with a decrease in experiential learning. When counterfactuals were made salient, participants displayed significantly poorer performance compared to their counterparts for whom counterfactuals were relatively less salient. A counterfactual salience ? need for cognition (NFC) interaction qualified these findings. High (...) NFC participants outperformed their counterparts when counterfactuals were not salient. Evidence for a memory-based mechanism was also supported. (shrink)

Awareness of deficits in patients with neurological disorders may be described as a theoretical unitary phenomenon, which has been analysed reaching interesting results in the last decades. Awareness of deficits manifests itself in a continuum ranging from full awareness to total absence. In line with a neurocognitive approach, a reduction in self-awareness could be explained considering executive dysfunction associated with prefrontal cortex anatomo-functional changes. Our mini-review will focus on reduced self-awareness in neurological disorders, such as Alzheimer’s disease, behavioural Frontotemporal (...) Dementia and Acquired Brain Injuries. Results achieved thanks to an explanatory investigative approach combined with a theoretical reference model will be presented. Data suggest the key role of executive functions in supporting adequate self-awareness towards patients’ cognitive-behavioural profile and instrumental activity autonomy. The Cognitive Awareness Model seems to be one of the best theoretical model to better approach this phenomenon. (shrink)

Neither the pathogenesis nor the aetiology of Down's syndrome (DS) are clearly understood. Numerous studies have examined whether clinical features of DS are a consequence of specific chromosome 21 segments being triplicated. There is no evidence, however, that individual loci are responsible, or that the oxidative damage in DS could be solely explained by a gene dosage effect. Using astrocytes and neuronal cultures from DS fetuses, a recent paper shows that altered metabolism of the amyloid precursor protein and oxidative stress (...) result from mitochondrial dysfunction.1 These findings are consistent with considerable data implicating the role of the mitochondrial genome in DS pathogenesis and aetiology. BioEssays 24:681–684, 2002. © 2002 Wiley Periodicals, Inc. (shrink)

In an important and timely book, Anneli Jefferson outlines a view according to which a given mental disorder is a brain disorder if it is a (harmful) mental dysfunction realised by a brain dysfunction. Prima facie, Jefferson’s book is a study in the metaphysics of dysfunction: how does mental dysfunction relate to brain dysfunction, and what does this imply for the status of mental disorders and brain disorders? In what follows, I shall argue that Jefferson’s (...) contribution to this debate is better understood as a conceptual explication of how psychiatrists, some philosophers, scientists and clinicians in the field (broadly construed) think of the label ‘brain disorder’. I infer this on the basis that Jefferson’s thesis would not follow from any serious, well-worked out theory of proper function. Despite initial appearances, Jefferson’s book about brain dysfunction is not about function at all. (shrink)

A biological function is supposed to be performed adequately, and hence may fail to do so: this is dysfunction. This raises two questions. One is how to make explicit the way in which function can be discriminated from dysfunction without confusing dysfunction with non-function. The second question is how what is “right” and “wrong” can be legitimated by natural regulatory norms. A function can be viewed as a quality to which at least one variable with a definite (...) set of values is associated. Accordingly, function and dysfunction are the same quality of the same trait, but differ in the values associated to this variable. Dysfunction occurs when the associated set of values does not match this normal state. Biological systems have the epistemic singularity that their existence is the consequence of two distinct causal regimes, the so-called “proximate” and “ultimate” causes, whose convergence defines a system’s prescriptive normality. Each cause imposes restrictive rules that limit the possible ways these systems can putatively exist. When a system is insensitive to ultimate cause, it is determined by proximate causation alone, and hence escapes its own prescriptive norms. In conclusion: The normality of a biological system is defined by the convergence of proximate and ultimate causes. A function is a variable-associated quality whose values are defined relative to the norms of the system. Dysfunction occurs when the set of values of the same variable does not match the normality of the system, which can occur when the system is insensitive to ultimate causation. (shrink)

Naturalistic accounts of mental disorder aim to identify an objective basis for attributions of mental disorder. This goal is important for demarcating genuine mental disorders from artificial or socially constructed disorders. The articulation of a demarcation criterion provides a means for assuring that attributions of 'mental disorder' are not merely pathologizing different forms of social deviance. The most influential naturalistic and hybrid definitions of mental disorder identify biological dysfunction as the objective basis of mental disorders: genuine mental...

In their paper “Is psychopathy a mental disease?”, Thomas Nadelhoffer and Walter Sinnott-Armstrong argue that according to any plausible account of mental disorder, neural and psychological abnormalities correlated with psychopathy should be regarded as signs of a mental disorder. I oppose this conclusion by arguing that at least on a naturalistically grounded account, such as Wakefield’s ‘Harmful Dysfunction’ view, currently available empirical data and evolutionary considerations indicate that psychopathy is not a mental disorder.

Adequate temporal abilities are required for most daily activities. Traumatic brain injury (TBI) patients often present with cognitive dysfunctions, but few studies have investigated temporal impairments associated with TBI. The aim of the present work is to review the existing literature on temporal abilities in TBI patients. Particular attention is given to the involvement of higher cognitive processes in temporal processing in order to determine if any temporal dysfunction observed in TBI patients is due to the disruption of an (...) internal clock or to the dysfunction of general cognitive processes. The results showed that temporal dysfunctions in TBI patients are related to the deficits in cognitive functions involved in temporal processing rather than to a specific impairment of the internal clock. In fact, temporal dysfunctions are observed when the length of temporal intervals exceeds the working memory span or when the temporal tasks require high cognitive functions to be performed. The consistent higher temporal variability observed in TBI patients is a sign of impaired frontally mediated cognitive functions involved in time perception. (shrink)

Written for both theoretical and practical purposes, Dysfunctional Culture discusses how to understand and identify political ideologies as cultural systems. Using examples related to family morality and reproduction, this book argues that belief in individual rights as the main basis for morality is not an adequate response to the moral challenges of the future.

Justin Garson has recently argued that proper functions are proximal activities of traits selected by phylogenetic or ontogenetic selection processes, and that traits are dysfunctional only if they cannot perform their proper functions for constitutional reasons. We partially agree with Garson, but reject the view that functions are proximal activities, as well as his account of dysfunctions. Instead, we propose our own theory that biological functions are selected dispositions and that a trait is dysfunctional in virtue of not having the (...) dispositions for which it was selected. This account can explain both defects (or dysfunctions in Garson’s sense) and dysfunctions due to environmental factors. Moreover, it offers a neat way to explain the graduality of dysfunction. (shrink)

Despite increasing interest being given to dysfunctional customer behavior in multiple service sectors, it is unclear how and why different types of dysfunctional customer behavior affect frontline employees’ emotional labor during the service interactions. Drawing upon the conservation of resources theory, we propose a conceptual model in which verbal abuse, disproportionate demand, and illegitimate complaint differentially influence frontline employees’ emotional labor strategies. Further, the boundary conditions of these relationships are considered by introducing perceived organizational support and customer orientation as moderators. (...) Using survey data from 436 frontline employees of five call centers in China, hypotheses were tested through a hierarchical regression analysis. The results indicated that verbal abuse and illegitimate complaint exerted positive effects on surface acting. Particularly, these positive effects were weaker when frontline employees perceived organizational support was high. Also, verbal abuse’s positive effect on surface acting was weaker when frontline employees’ customer orientation was high. Customer’s verbal abuse, disproportionate demand, and illegitimate complaint negatively influenced frontline employees’ deep acting. The negative effect of disproportionate demand on deep acting was weaker when perceived organizational support was high. However, when frontline employees’ customer orientation was high, the negative effects of disproportionate demand and illegitimate complaints on deep acting were weaker. (shrink)

Schizophrenia (SCZ) is a severe neurodevelopmental disorder affecting 1% of populations worldwide with a grave disability and socioeconomic burden. Current antipsychotic medications are effective treatments for positive symptoms, but poorly address negative symptoms and cognitive symptoms, warranting the development of better treatment options. Further understanding of SCZ pathogenesis is critical in these endeavors. Accumulating evidence has pointed to the role of mitochondria and metabolic dysregulation in SCZ pathogenesis. This review critically summarizes recent studies associating a compromised mitochondrial function with people (...) with SCZ, including postmortem studies, imaging studies, genetic studies, and induced pluripotent stem cell studies. This review also discusses animal models with mitochondrial dysfunction resulting in SCZ‐relevant neurobehavioral abnormalities, as well as restoration of mitochondrial function as potential therapeutic targets. Further understanding of mitochondrial dysfunction in SCZ may open the door to develop novel therapeutic strategies that can address the symptoms that cannot be adequately addressed by current antipsychotics alone. (shrink)

This article examines one kind of conscientious refusal: the refusal of healthcare professionals to treat sexual dysfunction in individuals with a history of sexual offending. According to what I call the orthodoxy, such refusal is invariably impermissible, whereas at least one other kind of conscientious refusal—refusal to offer abortion services—is not. I seek to put pressure on the orthodoxy by (1) motivating the view that either both kinds of conscientious refusal are permissible or neither is, and (2) critiquing two (...) attempts to buttress it. (shrink)

Despite being written in 1941–1942, Long Day’s Journey into Night wasn’t released until 1956, two years after the author’s death. The Tyrone family is at the centre of the narrative, advancing the plot and creating further avenues for the characters to develop. The article explores the various aspects of the play that indicate that the Tyrones are a dysfunctional family. The critical analysis of the play and its various themes conclude that Tyrone in “Long Day’s Journey into Night” displays many (...) characteristics of a dysfunctional family while certain behavioural patterns of each one of the family are enough to show that the family is dysfunctional. The article presents a critical analysis of Eugene O’Neill’s Long Day’s Journey into Night. Various modes of reading were employed, including thematic analysis, close reading of the text, and a deconstructive reading of the play. These methods support the exploration of how the Tyrones are depicted as a dysfunctional family. James and Mary’s children, Edmund and Jamie, are central to the drama. Edmund is suffering from tuberculosis, while Mary struggles with a morphine addiction. The play is set at the Tyrones' Monte Cristo Cottage in seaside Connecticut, on a single day in August 1912, from roughly 8:30 a.m. until 12:00 a.m. The Tyrones are painted in a highly negative light as a dysfunctional family, as the parents and sons accuse, lash out, and harbor grudges against one another and in various situations. They possess traits that encourage pitiful and futile endeavours as well as strong desires for their circumstances to improve. (shrink)

Despite many authors in psychiatry endorsing a naturalist view of the mind, many still consider that mental dysfunctions cannot be reduced to brain dysfunctions. This paper investigates the main reasons for this view. Some arguments rely on the analogy that the mind is like software while the brain is like hardware. The analogy suggests that just as software can malfunction independently of hardware malfunctions, similarly the mind can malfunction independently of any brain malfunction. This view has been critically examined in (...) recent literature. However, other less discussed reasons suggest that mental dysfunctions cannot be reduced to brain dysfunctions because mental dysfunctions are appropri- ately ascribed at the level of intentional mental states, while brain dysfunctions are solely related to abnormalities in anatomy and physiological processes. This paper questions why such a view would be upheld. The discussion is framed within the interface problem in the philosophy of cognitive science, which concerns the relationship between personal and subpersonal levels of explanation. The paper examines the view that an autonomist perspective on the personal/ subpersonal distinction could justify the separation of mental dysfunctions, described in intentional terms, from brain dysfunctions, described in anatomical or physiological terms. Ultimately, the paper argues that the autonomist view cannot be upheld in psychiatry and, consequently, does not provide a principled justification for rejecting the reduction of mental dysfunctions to brain dysfunctions. (shrink)

The way in which we characterize the structural and functional differences between psychopath and normal brains – either as biological disorders or as mere biological differences – can influence our judgments about psychopaths’ responsibility for criminal misconduct. However, Marga Reimer (Neuroethics 1(2):14, 2008) points out that whether our characterization of these differences should be allowed to affect our judgments in this manner “is a difficult and important question that really needs to be addressed before policies regarding responsibility... can be implemented (...) with any confidence”. This paper is an attempt to address Reimer’s difficult and important question; I argue that irrespective of which of these two characterizations is chosen, our judgments about psychopaths’ responsibility should not be affected, because responsibility hinges not on whether a particular difference is (referred to as) a disorder or not, but on how that difference affects the mental capacities required for moral agency. (shrink)

Dysfunctional customer behavior is common in service settings. For frontline employees, negative encounters can cause short-term despondency or have profound, long-term psychological effects that often result in both direct and indirect costs to service firms. Existing research has explored the influence of dysfunctional customer behavior on employee emotions, but it has not fully investigated the psychological mechanism through which customer misbehavior transforms into employee responses. To maintain service quality and employee well-being, it is important to understand the impact of customer (...) misconduct on employee emotions and its effect on subsequent service behavior. To assess the process through which dysfunctional customer behavior manifests as negative emotions in frontline service employees, and the influence of negative employee emotions on their prosocial service behavior, we surveyed 185 frontline banking service employees. We sought information on service employee experiences, attitudes, and feelings regarding dysfunctional customer behaviors, the perceived level of supervisor support, and employee prosocial service behavior intentions. Structural equation modeling and hierarchical linear modeling were used for statistical analysis and hypothesis verification. Results indicate that dysfunctional customer behavior has a positive relationship with bank service employee negative emotions and a negative influence on employee prosocial service behavior. The study found that negative emotions fully mediated the relationship between dysfunctional customer behavior and prosocial service behavior. The moderating role that perceived supervisor support plays on the relationships between dysfunctional customer behavior and negative emotion was also investigated. The results show that perceived supervisor support moderates the relationship between dysfunctional customer behavior and negative employee emotions. Finally, the study provides bank managers with effective strategies to assist frontline employees to manage and deter dysfunctional customer behavior, and presents employees with internal recovery strategies when encountering dysfunctional customer behavior. (shrink)

Human individuals often exhibit important differences in their sensitivity to ionising radiation. Extensive literature links radiation sensitivity with impaired DNA repair which is due to a lack of correct functioning in many proteins involved in DNA‐repair pathways and/or in DNA‐damage checkpoint responses. Given that ionising radiation is an important and widespread diagnostic and therapeutic tool, it is important to investigate further those factors and mechanisms that underlie individual radiosensitivity. Recently, evidence is accumulating that telomere function may well be involved in (...) cellular and organism responses to ionising radiation, broadening still further the currently complex and challenging scenario. BioEssays. BioEssays 28: 1172–1180, 2006. © 2006 Wiley Periodicals, Inc. (shrink)