Recent advances in the brain sciences have dramatically improved our understanding of brain function. As we find out more and more about what makes us tick, we must stop and consider the ethical implications of this new found knowledge. This ground-breaking book on the emerging field of neuroethics answers many pertinent questions, such as: What makes monitoring and manipulating the human brain so ethically challenging? Will having a new biology of the brain through imaging make us less responsible for our (...) behavior and lose our free will? Should certain brain scan studies be disallowed on the basis of moral grounds? A distinguished group of contributors from a wide range of fields make this an invaluable introduction to neuroethics. (shrink)

As one of the most compelling technologies for imaging the brain, functional MRI (fMRI) produces measurements and persuasive pictures of research subjects making cognitive judgments and even reasoning through difficult moral decisions. Even after centuries of studying the link between brain and behavior, this capability presents a number of novel significant questions. For example, what are the implications of biologizing human experience? How might neuroimaging disrupt the mysteries of human nature, spirituality, and personal identity? Rather than waiting for an (...) ethical agenda to emerge from some unpredictable combination of the concerns of ethicists and researchers, the attention of journalists, or after controversy is sparked by research that cannot be retracted, we queried key figures in bioethics and the humanities, neuroscience, media, industry, and patient advocacy in focus groups and interviews. We identified specific ethical, legal and social issues (ELSI) that highlight researcher obligations and the nonclinical impact of the technology at this new frontier. (shrink)

Due to a lack of engagement with the embodied dimensions of mindfulness, third-wave CBT has misleadingly construed mindfulness interventions as cognitive restructuring and behavioural modification agents. When the relationship between the mind and body is understood according to the model of embodied cognition, however, mindfulness’s process of change can be better articulated. We propose a novel understanding of the ‘decentring’ skills fostered through mindfulness via non-conceptual attention to the processes underlying cognition. Mindfulness, understood as a skilful mode of embodied social (...) cognition, cultivates operative intentionality whereby attention to the lived body, and one’s internal representations, allows one to intervene in the complex feedback structure of the mind???body system, influencing cycles of organismic self-regulation. Mindfulness-based exposure therapies, on this model, are understood not cognitively or behaviourally, but through insights generated via the practitioner’s orientation towards internal representations, and how these habituated patterns of representation generate transformations in their exteroceptive, pre-reflective enactment of both self and world perception. (shrink)

Although postgraduate research is increasingly supported through the formalisation of supervision and programs providing generic support, those programs have seldom addressed the intention, often stated by universities in their graduate profiles, that postgraduates should have integrity, and ethical values. What methodology is required – how will universities support students to cultivate such sensitivity, assess this, and fulfill the expectation? The paper provides evidence that quality statements including some aspect of integrity are used in many UK and Australian universities. The importance (...) of integrity, or ethical behaviour more generally, in postgraduate degrees and in professional practice is confirmed by reference to Sandor Kopatsy’s model of intellectual capital, where knowledge, morality, talent and effort are multiplied together to determine the level of intellectual capital. The main section of the paper considers how assessment might be achieved and the desired qualities fostered. Three distinct forms of moral qualities or skills can be found among those identified by the universities – some refer to technical skills, some describe graduates sensitive to ethical and social issues and some talk of graduates committed to ethical action and social responsibility. The paper draws on the authors’ experience in Europe, Australia and Asia. (shrink)

The history and genesis of major public clinical ethics controversies is intimately related to the publication of opinions and responses in media coverage. To provide a sample of public response in the media, this paper reports the results of a content analysis of letters to editors published in the four most prolific American newspapers for the Schiavo controversy. Opinions expressed in the letters sampled strongly supported the use of living wills and strongly condemned public attention to the case as well (...) as political interventions. Letters tended to be against withdrawal of life support, proxy consent and associated procedures as well as against court decisions and legal procedures. In comparison with reports written by journalists, letters to editors contained fewer controversial claims about Schiavo''s neurological condition and behavioural repertoire but similar loaded language to describe withdrawal of life support. Distinct public discourses can be encountered in different stakeholders suggesting complex and extensive pluralism even within the media. (shrink)

Although there is a large and growing literature on children’s developing concepts of illness transmission, little is known about how children develop contagion knowledge before formal schooling begins, and how these informal learning experiences can impact children’s health behaviors. Here we asked two important questions: First, do children’s informal learning experiences, such as their experiences reading storybooks, regularly contain causal information about illness transmission; and second, what is the impact of this type of experience on children’s developing knowledge (...) and behavior? In Study 1, we examined whether children’s commercial books about illness regularly contain contagion-relevant causal information. In Study 2, we ran a pilot study examining whether providing children with causal information about illness transmission in a storybook can influence their knowledge and subsequent behavior when presented with a contaminated object. The results from Study 1 suggest that very few (15%) children’s books about illness feature biological causal mechanisms for illness transmission. However, results from Studies 2 suggest that storybooks containing contagion-relevant explanations about illness transmission may encourage learning and avoidance of contaminated objects. Altogether, these results provide preliminary data suggesting that future research should focus on engaging children in learning about contagion and encouraging adaptive health behaviors. (shrink)

What counts as health or ill health? How do we deal with the fallibility of our own bodies? Should illness and disease be considered simply in biological terms, or should considerations of its emotional impact dictate our treatment of it? Our understanding of health and illness had become increasingly more complex in the modern world, as we are able to use medicine not only to fight disease but to control other aspects of our bodies, whether mood, blood pressure, (...) or cholesterol. This collection of essays foregrounds the concepts of health and illness and patient experience within the philosophy of medicine, reflecting on the relationship between the ill person and society. Mental illness is considered alongside physical disease, and the important ramifications of society's differentiation between the two are brought to light. Health, Illness and Disease is a significant contribution to shaping the parameters of the evolving field of philosophy of medicine and will be of interest to medical practitioners and policy-makers as well as philosophers of science and ethicists. (shrink)

SummaryMalaria is a major cause of under-five mortality in Mali and many other developing countries. Malaria control programmes rely on households to identify sick children and either care for them in the home or seek treatment at a health facility in the case of severe illness. This study examines the involvement of mothers and other household members in identifying and treating severely ill children through case studies of 25 rural Malian households. A wide range of intra-household responses to severe (...) illness were observed among household members, both exemplifying and contravening stated social norms about household roles. Given their close contact with children, mothers were frequently the first to identify illness symptoms. However, decisions about care-seeking were often taken by fathers and senior members of the household. As stewards of the family resources, fathers usually paid for care and thus significantly determined when and where treatment was sought. Grandparents were frequently involved in diagnosing illnesses and directing care towards traditional healers or health facilities. Relationships between household members during the illness episode were found to vary from highly collaborative to highly conflictive, with critical effects on how quickly and from where treatment for sick children was sought. These findings have implications for the design and targeting of malaria and child survival programming in the greater West African region. (shrink)

While research has consistently found that general distress and psychopathology are not predictive of sexual recidivism, examination of specific syndromes and their relationship to offending has revealed a potentially more complicated relationship. One proposed mechanism for the mixed findings with respect to major mental illness and sexual offending may be the confound of neurological injury. As identified in Mann et al. work on psychologically meaningful risk factors, mental illness represents an area in need of more study given the (...) indirect influence it may exert on risk. To this end, the current paper summarizes the study of the relationship between neurological injury, psychosis and problematic sexual behavior among two Canadian samples of forensic and civil psychiatric patients. In the first study we observed higher than expected rates of sexually-themed psychotic symptoms and problematic sexual behavior among a combined group of forensic and civil psychiatric patients. Indeed 70 percent of those individuals who engaged in PSB endorsed sexually-themed psychotic symptoms. While comorbidity is common amongst this group, brain injury appeared to represent a specific liability. Compared to those who did not engage in PSB, those who did were almost 4x more likely to have a documented history of brain injury. In the second study we sought to replicate this finding in a larger forensic sample of 1,240. However, the recorded rates of brain injury were significantly less, such that no relationship to PSB was observed. Based on the mixed findings to date, including our own data, questions remain about the nature of a potential shared vulnerability for psychosis and PSB previously postulated. Among psychiatrically complex individuals who engage in PSB, understanding etiology and links to risk are helpful, but perhaps more importantly is attention to the mechanisms through which symptoms confer risk and how best to treat and manage them. (shrink)

In this article, I propose that illness is philosophically revealing and can be used to explore human experience. I suggest that illness is a limit case of embodied experience. By pushing embodied experience to its limit, illness sheds light on normal experience, revealing its ordinary and thus overlooked structure. Illness produces a distancing effect, which allows us to observe normal human behavior and cognition via their pathological counterpart. I suggest that these characteristics warrant illness (...) a philosophical role that has not been articulated. Illness can be used as a philosophical tool for the study of normally tacit aspects of human existence. I argue that illness itself can be integral to philosophical method, insofar as it facilitates a distancing from everyday practices. This method relies on pathological or limit cases to illuminate normally overlooked aspects of human perception and action. I offer Merleau-Ponty’s analysis of the case of Schneider as an example of this method. (shrink)

From the sixties on it has become clear how the human physical condition could be influenced by human behavior. Although hypothesis were lacking to understand these connections, nursing research especially proved how systematically introduced patient behavior during illness and hospitalization could induce better recovery results and better prognosis for the patient.Information andattitude proved to be crucial elements in these processes of improved patient expectations. It took less than two decades to get to the insights we have in (...) 1994. Recent research shows the interlocking mechanisms of nervous and endocrine systems with the immune system as significantly being influenced by behavior and especially psychic and or psychosocial stress.This special issue of Theoretical Medicine briefly describes the historical development with contributions on the most recent state of the scientific art. These developments are emphasized by discussion on the clinical reality of the (breast) cancer patient and recent findings on the complexity of the prevalence of cancer in epidemiology. An attempt is made to consider practical consequences of the actual knowledge if applied to patient care. (shrink)

Psychiatric patients sometimes ask where to draw the line between who they are – their selves – and their mental illness. This problem is referred to as the self-illness ambiguity in the literature; it has been argued that solving said ambiguity is a crucial part of psychiatric treatment. I distinguish a Realist Solution from a Constructivist one. The former requires finding a supposedly pre-existing border, in the psychiatric patient’s mental life, between that which belongs to the self and (...) that which belongs to the mental illness. I argue that no such border exists, and that attempts to find it might even render the felt ambiguity worse. Instead, any solution must be constructivist; the patient (and others) should deliberate and discuss what to identify with or not. I further argue that psychiatric patients need not see their mental illness as wholly distinct from themselves to avoid ‘identifying with their diagnoses' in a problematic way. Finally, we can excuse problematic behaviour by mentally ill people – in fact, we can do so in a more nuanced and constructive way – while rejecting the view that the mental illness is wholly distinct from the patient’s self. (shrink)

In this surprising book, Allan V. Horwitz argues that our current conceptions of mental illness as a disease fit only a small number of serious psychological conditions and that most conditions currently regarded as mental illness are cultural constructions, normal reactions to stressful social circumstances, or simply forms of deviant behavior.

As a contribution to a wider discussion on moral discernment in theological anthropology, this paper seeks to answer the question “What is the impact of mental illness on an individual’s ability to make moral decisions?” Written from a clinical psychiatric perspective, it considers recent contributions from psychology, neuropsychology and imaging technology. It notes that the popular conception that mental illness necessarily robs an individual of moral responsibility is largely unfounded. Most people who suffer from mental health problems do (...) not lose the capacity to make moral decisions, and mental illness on its own rarely explains anti-social or criminal behaviour. Moreover, the assumptions of some scientists, that recent developments in neuropsychology and brain imaging suggest biological determinism, must be treated with caution. (shrink)

This book attempts to synthesize two apparently contradictory views of psychology: as the science of internal mental mechanisms and as the science of complex external behavior. Most books in the psychology and philosophy of mind reject one approach while championing the other, but Rachlin argues that the two approaches are complementary rather than contradictory. Rejection of either involves disregarding vast sources of information vital to solving pressing human problems--in the areas of addiction, mental illness, education, crime, and decision-making, (...) to name but a few. Where previous books have focused either on psychology as an abstract science of the mind or as a strictly empirical approach to behavioral problems, this is the only book that attempts to show how the best modern theoretical work on mental mechanisms relates to the best modern empirical work on complex behavioral problems. It will be of considerable interest to psychologists and philosophers across many disciplines and perspectives. (shrink)

In physics, we use the same laws to explain why airplanes fly, and why they crash. In psychiatry, we use one set of laws to explain sane behaviour, which we attribute to reasons (choices), and another set of laws to explain insane behaviour, which we attribute to causes (diseases). God, man's idea of moral perfection, judges human deeds without distinguishing between sane persons responsible for their behaviour and insane persons deserving to be excused for their evil deeds. It is hubris (...) to pretend that the insanity defence is compassionate, just, or scientific. Mental illness is to psychiatry as phlogiston was to chemistry. Establishing chemistry as a science of the nature of matter required the recognition of the non-existence of phlogiston. Establishing psychiatry as a science of the nature of human behaviour requires the recognition of the non-existence of mental illness. (shrink)

pSara Ahmed’s emWillful Subjects/em develops an account of willfulness as a site of simultaneous oppression and resistance: a diagnosis attributed to particular (not-quite-)subjects and to modes of behavior that are thereby diminished, pathologized, and controlled, and a “diagnosis” that may be positively affirmed as a way of living and doing otherwise. This essay puts Ahmed’s work on willfulness in conversation with María Lugones’ decolonial feminism, particularly her theory of active subjectivity. With Lugones, we offer, one can better understand the (...) resistant potential of willfulness, not simply as the willful subject possessing an oppositional “will of her own” (which risks reinscribing a unitary notion of the self), but rather, as exercising a different kind of subjectivity altogether—one that relies on multiplicity and arises through relationships across non-dominant difference. Extending the connections that Ahmed herself draws between willfulness and “madness,” we further explore the willful elements in experiences relating to mental illness and cognitive disability, categories of experience that we understand to be important (and undertheorized) aspects of what Aníbal Quijano has termed “the coloniality of power.”/p. (shrink)

Does having a mental disorder, in general, affect whether someone is morally responsible for an action? Many people seem to think so, holding that mental disorders nearly always mitigate responsibility. Against this Naïve view, we argue for a Nuanced account. The problem is not just that different theories of responsibility yield different verdicts about particular cases. Even when all reasonable theories agree about what's relevant to responsibility, the ways mental illness can affect behavior are so varied that a (...) more nuanced approach is needed. (shrink)

The central thesis of Schizotypy: Implications for Illness and Health is both challenging and controversial: that the features of psychotic disorders actually lie on a continuum with, and form part of, normal behaviour and experience. The dispositional or 'schizotypal' traits associated with psychotic disorders certainly predispose an individual to mental illness, but they may also lead to positive outcomes such as enhanced creativity or spiritual experience. Discussion of each aspect of this theme is supported by extensive experimental and (...) clinical evidence, questioning the received medical wisdom which treats psychotic illness in the narrow context of neurological disease. The result is an authoritative and provocative overview of an important topic in psychological research and clinical practice. (shrink)

Summary and ConclusionsThis paper presents the argument that the character of illness in psychiatry requires embracing phenomena which falls outside the area of concern of basic biologic sciences. The argument is developed by introducing the idea of a “theory of illness,” a cultural trait of a society, and by examining features of our biomedical theory of illness. The disease “depression” is then examined in terms of this theory. A basic point made is that an appraisal of any (...) medical system involves dealing with social factors and cultural conventions. Another one is that the effective and prudent application of biomedical knowledge requires dealing with neurobiologic as well as social and cultural factors that in a complementary fashion provide understanding about the organization and meaning of behavior. An emphasis on the organization and meaning of behavior, with the aim of uncovering illness conditions which can be effectively controlled, is and very likely will continue to be a central concern of psychiatry. (shrink)

As a result of evolution, human babies are born with outstanding abilities for human communication and cooperation. The other side of the coin is their great sensitivity to any clear and durable violation in their relationship with caregivers. Infant sustained social withdrawal behavior was first described in infants who had been separated from their caregivers, as in Spitz's description of “hospitalism” and “anaclitic depression.” Later, ISSWB was pointed to as a major clinical psychological feature in failure-to-thrive infants. Fraiberg also (...) described freezing behavior as one of the earliest modes of infant defense in the face of adverse situations threatening the infant's ability to synchronize with caregivers. We hypothesize that ISSWB behaviors are associated with poor vagal brake functioning and that an impaired social engagement system is induced by an impoverished and/or dangerous environment. Recent research using animal models highlight the neurobiology and the genetics of the social Approach/Withdrawal Behavior in infants. The present paper is therefore a plea for social withdrawal behavior to be attributed a more important role as a major psychological defensive mechanism in infancy, and for research into early development and early intervention to make more practical and theoretical use of this concept, thus decreasing the challenge of translation in social neurosciences. This work presents several situations involving developmental hazards in which assessment of ISSWB by means of the Alarm Distress Baby Scale has proven useful, i.e., malnutrition, effects of major maternal depression and or traumatization, assessing social withdrawal in infants with an chronic organic illness or assessing ISSWB in out of home placed infants during parental visitation. Relationships between ISSWB and other biophysiological behavioral systems are discussed, particularly links with attachment processes and Porges's polyvagal theory. (shrink)

Respiratory illness continues to be a leading cause of paediatric morbidity and mortality in Indonesia. The Indonesian government is moving towards a more managed care-based approach as it reforms its health care system following the 1997 financial crisis. In order to better design contractual relationships between the payor and different providers, there needs to be a better understanding of the patterns and predictors of health services utilization for respiratory illness. This study uses the Indonesia Demographic and Health Survey (...) to study the determinants of private, public and non-formal provider utilization for respiratory illness. Multinomial logistic regression models for predicting use were constructed using the Andersen Behavioural Model as the conceptual framework. The findings indicate that age, household size, maternal education, religion, the asset index, location and illness severity play a role in determining use of private, public or non-formal providers. The results indicate that from a policy perspective, the Indonesian government needs be inclusive rather than exclusive in the choice of providers that are contracted by the managed care plans, in order to safeguard the health of the under-five population. (shrink)

Once we perceive a situation as a danger, threat, or shock, the information about a fearful stimulus is immediately sent to the amygdala, which, being a component of the limbic system, is responsible for fear and anxiety processing, and plays an important role in emotion and behaviour. As the research suggests, the message about a potentially frightening situation can reach the amygdala long before we are even consciously aware of it. Then, the amygdala is to trigger a fight-or-flight reaction, marked (...) by our increased heart rate and respiration to prepare for action (cf. LeDoux 2007). The aim of the research is, first, to account for the most prototypical cognitive scenario of fear through the prism of Cognitive Linguistics (cf. Kövecses 1986, 2015) and supply it with this neuroscientific and psychological knowledge of fear. We learn that in addition to the most common human reactions to fear, i.e. the one of a fighter or the one of a runaway, a modern man reacts to fear by denying it as well as by displacing fear from their subconscious mind. Second, by investigating the novel metaphor FEAR IS AN ILLNESS OF THE BRAIN, we aim to propose a novel constructive cognitive scenario of fear, which helps us deal with this unwanted emotion in contemporary situations that generate fear, e.g. in the era of (post)Covid-19 pandemic (WHO 2021, July 15). (shrink)

The concept of mental illness is explored through an examination of four key foundational issues. These are the notion of the “mental” as it relates to psychopathology; the concept of illness; the relationship of mental illness to concepts of function and malfunction; and sociocultural dimensions of psychopathology. The problematic status of the concept of mental illness is investigated through locating it within the various discourses of biomedicine, psychology, law, and sociology and by explicating and relating the (...) philosophical underpinnings of those discourses. (shrink)

The article examines the gender disparities as women are at a greater risk to exertional heat illness that may go unreported in the industry, according to several reports. It is important to study the behavioural heat adaptations and prevalent behaviours for workers in order to understand the magnitude of the danger they face. Cooking is considered a safe occupation, but hazards certainly do exist and can represent a risk to the health and safety of the workers. Controls can be (...) established to reduce the risk of illness. To attract and retain workers, the food service business must provide a good quality of life. Contribution: The study suggests how female workers in the catering establishments can adjust their behaviour to improve their experience at work. Are women more vulnerable to environmental parameters? Christian theology provides women equal status with men (Kategile 2020 ), however there are traces of androcentric aspects within the Bible. Women’s involvement in development is based on the theological premise that true development must have a holistic approach towards human development (Onwunta 2009 ). However, Sibani ( 2017 ) stated that the role of God or a creator of a religion, is always taken by a male and a woman’s place is in the household. The article conducts a comprehensive analysis of the literature on the various behavioural adaptation mechanisms used by kitchen staff to cope with heat exposure at work. Thermal tolerance variations are becoming more pronounced because of ethnicity and cultural differences. Health interventions and enhanced work performance are important objectives of workplace safety. Regulated heat in the workplace can be factored into the theory concerning the relationship between gender differences and contextual components. This would increase female food service workers’ understanding of thermal comfort, which is beneficial to productivity efficiency, worker satisfaction and well-being of workers. (shrink)

Testimony about the future dangerousness of a person has become a central staple of many judicial processes. In settings such as bail, sentencing, and parole decisions, in rulings about the civil confinement of the mentally ill, and in custody decisions in a context of domestic violence, the assessment of a person’s propensity towards physical or sexual violence is regarded as a deciding factor. These assessments can be based on two forms of expert testimony: actuarial or clinical. The purpose of this (...) paper is to examine the scientific and epistemological basis of both methods of prediction or risk assessment. My analysis will reveal that this kind of expert testimony is scientifically baseless. The problems I will discuss will generate a dilemma for factfinders: on the one hand, given the weak predictive abilities of the branches of science involved, they should not admit expert clinical or actuarial testimony as evidence; on the other hand, there is a very strong tradition and a vast jurisprudence that supports the continued use of this kind of expert testimony. It is a clear case of the not so uncommon conflict between science and legal tradition. (shrink)

Radical psychiatrists and others assert that mental illness is a myth. The opening and closing portions of the paper deal with the impact such argument has had in law and psychiatry. The body of the paper discusses the five versions of the myth argument prevalent in radical psychiatry: (A) that there is no such thing as mental illness; (B) that those called ?mentally ill? are really as rational as everyone else, only with different aims; that the only reasons (...) anyone ever thought differently was (C) because of unsophisticated category mistakes or (D) because of an adherence to the epistemology of a sick society; and (E) that the phrase ?mental illness? is used to mask value judgments about others? behavior in pseudo?scientific respectability. Reasons are given for rejecting each of these versions of the argument that mental illness is a myth. (shrink)

According to Information-Motivation-Behavioural Skills model, accurate Information, strong Motivation and adequate Behavioural skills are prerequisites of treatment adherence. This model has been verified among chronically ills patients, usually suffering from one particular disorder. No studies report how the model fits data from a more diverse group. The aim of the study was to analyze adherence and its barriers in a group of three hundred patients suffering from various, common chronic disorders. They filled out IMB and Adherence Questionnaire. Information and Motivation (...) correlated moderately. Behavioural Skills was the strongest predictor of adherence. An additional relationship was found: Information and Motivation interacted and the role of either of these dimensions vanished if the indices of the other were high enough. The relationships between IMB dimensions and adherence were confirmed in a varied clinical sample. Behavioural skills must be considered when working with non-adherent patients, as they are the strongest predictor of adherence. Other interventions may be limited to either Information or Motivation only if there is a chance of raising one of them to extreme levels. This may be useful with special cases, when increasing both is problematic. (shrink)

Setting the terms of praise‐ and blameworthiness has long dominated philosophers’ discussions of responsibility. Analytic philosophy has most often looked to reason and the abstract relations between individual rational judgements and actions to advance the discourse on moral responsibility. Those whose capacity for reasoned judgement is impaired are deeply problematic. Is it proper to morally appraise ‘the mentally ill’? The philosopher T.M. Scanlon discusses moral responsibility as a precondition of moral appraisal and contends that it is not appropriate to appraise (...) a person as (morally) praise‐ or blameworthy if that person cannot be held responsible for the action(s) for which he is being praised or blamed. What are the conditions, then, under which one can properly be said to be responsible for one's actions? Can one hold ‘the mentally ill’ responsible for their actions? If not, can it in any way be reasonable to expect them to ‘take responsibility’ for their actions and/or characters? The expectation that ‘the mentally ill’ will attempt to control, i.e. take responsibility for their behaviour despite the fact of their mental illness is a pervasive feature of psychiatric approaches to the care and treatment of ‘the mentally ill’. It would seem that such treatment approaches are coherent only to the degree ‘the mentally ill’ can be considered responsible moral agents. This paper explores these issues with regard to that form of mental illness categorized as the personality disorders. It describes the morally and clinically relevant features of personality disorder, explains how they do not fit traditional analytic paradigms of ‘mental illness’ and elaborates the argument that persons with this category of mental illness are fully moral persons who are rightly subject to praise and blame. (shrink)

MDI.4 So much as I have been able to put together the pieces of the universe in my small head, there is no absolute right or wrong; there is only a relativity, depending on the consciously though very slowly altering condition of a social race in respect to the rest of the world. Right and wrong are social conceptions: mind, I do not say human conceptions. The names “right” and “wrong,” truly, are of human invention only; but the conception “right” (...) and “wrong,” dimly or clearly, has been wrought out with more or less effectiveness by all intelligent social beings. And the definition of Right, as sealed and approved by the successful conduct of social beings, is: That mode of behavior which best serves the growing need of that society. MDI.5 As to what that need is, certainly it has been in the past, and for the most part indicated by the unconscious response of the structure to the pressure of its environment. Up till a few years since I believed with Huxley, Von Hartman, and my teacher Lum, that it was wholly so determined; that consciousness might discern, and obey or oppose, but had no voice in deciding the course of social development: if it decided to oppose, it did so to its own ruin, not to the modification of the unconsciously determined ideal. MDI.6 Of late years I have been approaching the conclusion that consciousness has a continuously increasing part in the decision of social problems; that while it is a minor voice, and must be for a long time to come, it is, nevertheless, the dawning power which threatens to overhurl old processes and old laws, and supplant them by other powers and other ideals. I know no more fascinating speculation than this, of the rôle of consciousness in present and future evolution. However, it is not our present speculation. I speak of it only because in determining what constitutes well being at present, I shall maintain that the old ideal has been considerably modified by unconscious reaction against the superfluities produced by unconscious striving towards a certain end. MDI.7 The question now becomes: What is the growing ideal of human society, unconsciously indicated and unconsciously discerned and illuminated? MDI.8 By all the readings of progress, this indication appears to be the free individual ; a... (shrink)

Distinct sources of stress have emerged during the COVID-19 pandemic. Particularly, fear is expected to generate significant psychological burden on individuals and influence on either unsafe behavior that may hinder recovery efforts or virus-mitigating behaviors. However, little is known about the properties of measures to capture them in research and clinical settings. To resolve this gap, we evaluated the psychometric properties of a novel measure of fear of illness and viruses and tested its predictive value for future development (...) of distress. We extracted a random sample of 450 Chilean adult participants from a large cross-sectional survey panel and invited to participate in this intensive longitudinal study for 35 days. Of these, 163 ended up enrolling in the study after the demanding nature of the measurement schedule was clearly explained to them. For this final sample, we calculated different Confirmatory Factor Analyses (CFA) to evaluate the preliminary proposed structure for the instrument. Complementarily, we conducted a content analysis of the items to qualitatively extract its latent structure, which was also subject to empirical test via CFA. Results indicated that the original structure did not fit the data well; however, the new proposed structure based on the content analysis did. Overall, the modified instrument showed good reliability through all subscales both by its internal consistency with Cronbach’s alphas ranging from 0.814 to 0.913, and with test–retest correlations ranging from 0.715 to 0.804. Regarding its convergent validity, individuals who scored higher in fears tended to also score higher in depressive and posttraumatic stress symptoms at baseline. Furthermore, higher fears at baseline predicted a higher score in posttraumatic stress symptomatology 7 days later. These results provide evidence for the validity, reliability, and predictive performance of the scale. As the scale is free and multidimensional potentially not circumscribed to COVID-19, it might work as a step toward understanding the psychological impact of current and future pandemics, or further life-threatening health situations of similar characteristics. Limitations, practical implications, and future directions for research are discussed. (shrink)

This paper will explore both the ways in which the practices of self-care, specifically related to mental health, have emerged as responses to the increasingly precarious status of life after the economic shocks of the Global Financial Crisis, whilst also looking to the work of Silvia Federici and Kathi Weeks to propose models for immanent critique of these practices. Although it cannot be taken as a pure origin, post-GFC mental health discourse has increasingly seen mental health discussed as a form (...) of resilience to precarity. Furthermore, practices of self-care, and psychological forms of treatment such as cognitive behavioural therapy have become vehicles for the intensification of personal resilience in the face of systemic crisis. If self-care involves an inward looking and depoliticised subject, surely political emancipation lies elsewhere. The possibility of some alternative to our present state of affairs, where self-care increasingly appears as a form of ‘voluntary servitude,’ that is to say, a form of self-subjugation with serious political risks, must surely be taken as a continual project for those engaged in critical inquiry. Then again, to suggest that those engaging in self-care are simply reproducing neoliberal subjectivity would surely miss the ways in which such forms of self-preservation might appear as unavoidable for the individuals in question. Through an engagement with their work—and one that draws parallels between their strategic critiques of reproductive labour broadly speaking, and the more specific area of mental illness and neoliberal governmentality—the question of the “necessity” of self-care will be brought into alignment with the possibilities of its practicality. (shrink)

This book is psychiatry's reply to the diverse group of antipsychiatrists, including Laing, Foucault, Goffman, Szasz and Bassaglia, that has made fashionable the view that mental illness is merely socially deviant behaviour and that psychiatrists are agents of the capitalist society seeking to repress such behaviour. It establishes, by the use of evidence from historical and transcultural studies, that mental illness has been recognised in all cultures since the beginning of history and goes on to explore the philosophical (...) and medical basis for psychiatry's diagnosis and treatment of mental illness. Finally, it tackles two issues where psychiatry has recently been seen as at odds with the values prevailing in society: involuntary hospitalization and the insanity defence. The Reality of Mental Illness does not pretend to offer simple answers to the complex problems it discusses, but will leave the reader with a much greater understanding of psychiatry's aims, practices and problems. (shrink)

Various authors have argued that progress in the neurocognitive and neuropsychiatric sciences might threaten the commonsense understanding of how the mind generates behavior, and, as a consequence, it might also threaten the commonsense ways of attributing moral responsibility, if not the very notion of moral responsibility. In the case of actions that result in undesirable outcomes, the commonsense conception—which is reflected in sophisticated ways in the legal conception—tells us that there are circumstances in which the agent is entirely and (...) fully responsible for the bad outcome and circumstances in which the agent is not at all responsible for the bad outcome. (shrink)

Some theorists have argued that we should understand the notion of free will from a functional perspective: free will just is our ability to choose effectively and adaptively in an ever-changing environment. Although far from what many philosophers normally mean by free will, those who adopt this biological-evolutionary perspective can clearly define and defend a notion of personal responsibility. One consequenceof this point of view is that addicts become responsible for their actions, for at each choice point, there is a (...) real sense in which the addict could have elected not to use or abuse. As a result, it has been argued that addiction is not a disease, that addictive behavior is voluntary, and that sometimes it is even rational. This paper defends a different way of thinking about addiction, one that aligns it with other complex chronic illnesses. The perspective put forth here suggests that these discussions about responsibility and free will represent an over-simplified and neuropsychologically inaccurate portrait of basic human capacities for behavioral choice. (shrink)

My three main points are: Mental disease is a metaphor, but mental illness is not. Feeling ill and having a physical illness are logically related. If there were no such thing as feeling ill, there would be no such thing as suffering from a physical illness. Yet there is no logical connection between feeling ill and being mentally ill. Mental illness is manifested in various forms of behaviour, for example, suspiciousness, elation, depression, etc.; if a form (...) of behaviour is to count as mental illness, it has to be an insane form; yet it is possible to be mentally ill without being insane and it is possible to be insane without being mentally ill. (shrink)

One might be inclined to assume, given the mouse donning its cover, that the behavior of interest in Nicole Nelson's book Model Behavior (2018) is that of organisms like mice that are widely used as “stand-ins” for investigating the causes of human behavior. Instead, Nelson's ethnographic study focuses on the strategies adopted by a community of rodent behavioral researchers to identify and respond to epistemic challenges they face in using mice as models to understand the causes of (...) disordered human behaviors associated with mental illness. Although Nelson never explicitly describes the knowledge production activities in which her behavioral geneticist research subjects engage as “exemplary”, the question of whether or not these activities constitute “model behavior(s)”—generalizable norms for engaging in scientific research—is one of the many thought-provoking questions raised by her book. As a philosopher of science interested in this question, I take it up here. (shrink)

The ways human behavior is conceptualized need to be refined. Major stumbling blocks have been the reification of verbal descriptions of behavior and the construction of ill-defined clusters of dissimilar problems. The effect of behavior-modifying drugs can be completely dependent on situational details. Behavior is a complex product of many interacting factors and cannot be rigorously predictable as the same behavior may be arrived at in different ways. Thus similar-looking behaviors can be functionally different and (...) conversely different-looking behaviors can be functionally identical. More answerable questions about behavior need to be formulated. (shrink)

This article proposes a Social Determinants of Health framework as a counter to the prominence of bio-determinist tropes in understandings of the relationship between concussion and later life neurodegenerative conditions in athletic populations. It is argued that debates about concussion (or repetitive head impacts) causing CTE have been particularly influenced by broader social trends towards neuro-essentialism. This paradigm reduces complex social behaviour to brain matter and continues to dominate the field despite the recent diversification of evidence from autopsy-based studies of (...) neuropathology to epidemiological studies comparing recorded causes of death among former elite athletes. In contrast, this article explores the ‘causes of causes’ of neurodegenerative conditions. It outlines the ways in which the distinct dynamics of: a) employment, b) education, income and wealth, c) health systems and services, and d) social environment and public safety relate to the specific occupational conditions of elite sport and likely negatively shape health outcomes of athletic populations. The article concludes by arguing that to more effectively address these particular health harms we must move beyond narrow, mono-causal models and evoke a cultural change that extends beyond making rule changes and adjusting psychological attitudes and behavioural norms, to redress the social structural parameters of elite sports participation. The continuation of narrower, neuro-centric and reductionist paradigms obscures the causes of the causes of neurodegenerative decline and limits the scope for change. (shrink)

There is evidence that mental illness is partly socially constituted: diagnoses are historically “transient” (Hacking, _Rewriting the soul: Multiple personality and the sciences of memory_. Princeton University Press, 1998a; _Mad travelers_. University of Virginia, 1998b) and culturally variable (Toh, _Nature Reviews Psychology_, _1_(2), 72–86, 2022). However, this view risks pernicious relativism. On most social constitution views, mental illness is what (some suitably expert part of) society takes it to be. But this has morally abhorrent implications, e.g., it legitimizes (...) many spurious and harmful diagnoses (like “drapetomania”) and makes mental illness a matter of fashion rather than an objective challenge. This paper defends a conception of mental illness according to which it is partly socially constituted, yet which avoids such pernicious relativism: mental illness consists in an objective inability - a deficit in the skilled metacognitive self-regulation required to be rationally interpretable by one’s community, including oneself. Such reasons responsiveness requires skilled regulation of cognition, conation, and behavior, such that they respect relevant interpretive norms. Because such norms vary culturally, such skills are partly socially constituted. (shrink)

Although an invasive medical intervention, Deep Brain Stimulation (DBS) has been regarded as an efficient and safe treatment of Parkinson’s disease for the last 20 years. In terms of clinical ethics, it is worth asking whether the use of DBS may have unanticipated negative effects similar to those associated with other types of psychosurgery. Clinical studies of epileptic patients who have undergone an anterior temporal lobectomy have identified a range of side effects and complications in a number of domains: psychological, (...) behavioural, affective and social. In many cases, patients express difficulty adjusting from being chronically ill to their new status as ‘treated’ or ‘seizure free’. This postoperative response adjustment has been described in the literature on epilepsy as the ‘Burden of Normality’ (BoN) syndrome. Most of the discussion about DBS postoperative changes to self is focused on abnormal side effects caused by the intervention (ie, hypersexuality, hypomania, etc). By contrast, relatively little attention is paid to the idea that successfully ‘treated’ individuals might experience difficulties in adjusting to becoming ‘normal’. The purpose of this paper is (1) to articulate the postoperative DBS psychosocial adjustment process in terms of the BoN syndrome, (2) to address whether the BoN syndrome illustrates that DBS treatment poses a threat to the patient’s identity, and (3) to examine whether the current framework for rehabilitation after DBS procedures should be updated and take into account the BoN syndrome as a postoperative self-change response. (shrink)

Cognitive biases play an important role in creating and perpetuating problems that lead to foodborne illness outbreaks. By using insights from behavioral ethics, we argue that sometimes people engage in unethical behavior that increases the likelihood of foodborne illness outbreaks without necessarily intending to or being consciously aware of it. We demonstrate these insights in an analysis of the 2011 Listeriosis outbreak in the U.S. from the consumption of contaminated cantaloupes. We then provide policy implications that can (...) improve our understanding of other kinds of disease outbreaks and epidemics. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Should Clinicians’ Views of Mental Illness Influence the DSM?Elizabeth H. Flanagan (bio) and Roger K. Blashfield (bio)Keywordsclinicians, DSM, values, psychopathology, scienceThe relationship between clinicians and the DSM is complex. Clinicians are the primary intended audience of the DSM. However, as Widiger (2007) pointed out in his commentary, there is a tension associated with trying to meet the clinical goals of the DSM and also trying to optimize the (...) scientific goals of the DSM. Most commentators would agree that the recent editions of the DSM (from the DSM-III onward) have favored scientific values (e.g., Sadler 2005). Some commentators have taken sides and aligned themselves with either clinicians or with the science of classification. For instance, Garb (2005) has argued that clinicians should receive incentives to align themselves more closely with the science of the DSM. In contrast, Westen and Shedler (1999) have favored a clinician-based approach to the DSM and have argued that an ideal classification should be based on the prototypes that clinicians use to conceptualize diagnostic categories. Perhaps an extreme suggestion on how to deal with this tension between the values of clinicians and the values of scientists is to adopt the ICD-10 solution and create two versions of the next DSM. One version would be written for clinicians and another for researchers (Phillips et al. 2003).Widiger (2007) wondered whether the two of us as authors are on the fence about how the views of clinicians should affect the DSM. As clinical psychologists who are both clinicians and researchers, we understand his comment, especially in light of our attempt in our article not to overgeneralize from the time-consuming, labor-intensive, yet methodologically limited study we reported in our major paper.Nonetheless, our answer to the question asked in the title of this response, “Should clinicians’ views of mental illness influence the diagnostic manual?” is a clear and unequivocal yes. In our view, too much of the research literature stimulated by the recent DSMs has primarily used the diagnostic criteria in these DSMs to specify patient samples and then perform various experiments to study the DSM categories. We favor a different approach to research which is consistent with a comment once made by the philosopher of science, Karl Popper: “scientific theories originate from myths, and... a myth may contain important anticipations of scientific theories” (1963, 39). We believe that clinicians, with their years [End Page 285] of experience dealing with the ambiguities, the emotionality, and the chaos of psychopathology, have formed complex conceptual systems to try to understand the mysteries of abnormal behavior. We strongly support increased research attempts that will use clinicians as subjects and that will attempt to understand how clinicians use diagnostic concepts to understand patients.Although research on clinicians has not attracted a large amount of attention in the field, there is a long history of such research studies. For instance, in the 1970s, Overall used multivariate techniques to create graphical maps of how clinicians represented relationships among diagnoses (Overall et al. 1977). Widiger has used a similar strategy in some of his research (Widiger et al. 1987). In the early 1980s, a view of concept formation from cognitive psychology was used by Cantor et al. (1980) to look at psychiatric diagnoses as representing prototypes. Horowitz and colleagues extended this research. Blashfield and his colleagues had a grant to use the prototype model to study personality disorders and performed research investigating both case histories (Blashfield et al. 1985) and analyses of diagnostic criteria (Blashfield and Breen 1989; Davis, Blashfield, and McElroy 1993). Westen and colleagues have attempted to reconceptualize DSM personality disorder categories using the prototype model (Westen and Shedler 1999). Ahn and her colleagues (Ahn et al. 2006; Kim and Ahn 2002) have taken more recent applications of ideas from cognitive psychology to study how clinicians use and understand diagnostic categories. Finally, Flanagan and colleagues (Flanagan and Blashfield 2006; Flanagan, Keeley, and Blashfield, in press; Flanagan, Miller, and Davidson, submitted) have used qualitative and quantitative data analysis techniques to try to understand the diagnostic concepts held by experienced clinicians.Besides empirical studies of how clinicians use diagnostic concepts, we also support the increased interest in... (shrink)