Résumé Nous interrogeons la participation d’un individu à un collectif dans la pensée de Sartre. Bien qu’ils agissent de la même manière, les agents n’ont pas toujours conscience qu’ils participent à un collectif ou bien telle n’est pas leur intention. Il faut alors se demander à quelles conditions l’action des agents peut devenir commune. Pour traiter ces perspectives, l’article étudie la série avant d’expliquer comment elle peut devenir un véritable groupe. Ainsi, il est possible de montrer l’originalité de la pensée (...) sartrienne, comme forme d’individualisme qui met l’action au principe de la constitution du groupe. (shrink)

Il s’agit dans cet article d’éclairer la méthode et la philosophie de Simone de Beauvoir pour comprendre l’aliénation et l’action des femmes. Dans un premier temps, l’article met au jour sa méthode généalogique pour comprendre comment « la femme » a pu être considérée comme « l’Autre » de l’homme. Puis, il s’agit de montrer comment Beauvoir déplace la thèse sartrienne de la liberté en situation pour critiquer l’aliénation et la domination subies par les femmes. Enfin, cet article étudie les (...) solutions qu’elle propose pour la libération des femmes. (shrink)

In 1889, TheBritish Medical Journalpublished a piece titled, “Detective Medicine,” which describes feats of medical detection performed by physicians attending malingering prisoners. Though simulating illness had a long history, the medicalization of malingering at thefin de siècleled to a proliferation of such case histories and cheerful records of pathological feigners thwarted.

Amnesia is a frequent claim in major crimes, and it is estimated that the complete or partial absence of memory following a crime ranges from 25% to 50% of total cases. Although some cases may constitute a genuine form of amnesia, due to organic-neurological defects or psychological causes, and possibly combined with a dissociative or repressive coping style after an extreme experience, malingering is still fairly common in offenders. Therefore, one of the main goals in medico-legal proceedings is to (...) find methods to determine the credibility of crime-related amnesia. At present, a number of lie and memory detection techniques can assist the forensic assessment of the reliability of declarative proof, and have been devised and improved over the past century: for example, modern polygraphs, event-related potentials, thermal imaging, functional magnetic resonance imaging, kinematic, and facial analysis. Other ad hoc psychological tests, such as the so-called Symptom Validity Test (SVT) and Performance Validity Test (PVT), as well as the autobiographical Implicit Association Test (aIAT), can also be used. To date, however, there is little evidence or case reports that document their real usefulness in forensic practice. Here, we report two cases of crime-related amnesia, whereby both defendants, who were found guilty of homicide, appeared to exhibit dissociative amnesia but where the application of SVTs, PVTs, and aIAT detected a malingered amnesia. (shrink)

Every year millions of people suffer minor brain injuries, many of which occur in collision sports. While there has been substantial commentary and debate about the nature of this public health crisis, it is clear that the scientific and clinical arguments reflect values preferences and judgments that are often invisible in documents which combine artful language with undue focus paid to sources of uncertainty at the cost of clarity and transparency. This essay gives a brief history of these patterns and (...) proposes a remedy. (shrink)

This essay explores the long Western history of anxieties about feigned illness connected specifically to social policy. There is a remarkable consistency of such anxieties across time, as they appear in almost every major historical period in the West since the Middle Ages.

During a clinical ethics fellow’s first week of independent supervised service, two unhoused patients on the same floor were resisting the medical team’s recommendations to discharge. In the team’s view, both were medically stable and no longer required hospitalization in an acute setting. The medical team suspected malingering for both. The social worker and case manager had employed their usual means of gentle persuasion and eliminating psychosocial barriers to no avail. Rather than call the police, the attending physician, social (...) worker, and case manager decided to call ethics. These cases lead the fledgling fellow to consider the appropriate role for ethicists in difficult discharge cases. The article analyzes each case, evaluates their similarities and differences in the context of suspected malingering, and comments on ethical issues surrounding cases of suspected malingering. Finally, I reflect on the value and importance of developing and maintaining epistemic and professional independence. (shrink)

The invention of psychopathology -- Malingering -- Doctoring -- Inculpating -- Sheltering -- Cheating -- Lying -- The burden of responsibility.

Factitious disorder is the deliberate simulation of illness for the purpose of seeking the sick role. It is a 20th-century diagnosis, though the grounds for its introduction are uncertain. While previous authors have considered the social changes contributing to growth in the disorder, this article looks at some of the pressures on doctors that may have created the diagnostic need for a disorder between hysteria and malingering. The recent history of those disorders suggests that malingering would no longer (...) be acceptable when applied to the potentially larger numbers involved in workers’ compensation or in mass conscription. Equally, the absolution given to hysteria on the basis of the Freudian subconscious would survive only as long as that model retained credibility. Growing egalitarianism and changing doctor—patient relationships in the 20th century would no longer tolerate a sharp division between culpable malingering and exculpated hysteria, which may previously have been made on grounds of class or gender. They would contribute to the need for a mediating diagnosis, such as factitious disorder. (shrink)

This paper proposes that human expression of pain in the presence or absence of caregivers, and the detection of pain by observers, arises from evolved propensities. The function of pain is to demand attention and prioritise escape, recovery, and healing; where others can help achieve these goals, effective communication of pain is required. Evidence is reviewed of a distinct and specific facial expression of pain from infancy to old age, consistent across stimuli, and recognizable as pain by observers. Voluntary control (...) over amplitude is incomplete, and observers can better detect pain that the individual attempts to suppress rather than amplify or simulate. In many clinical and experimental settings, the facial expression of pain is incorporated with verbal and nonverbal vocal activity, posture, and movement in an overall category of pain behaviour. This is assumed by clinicians to be under operant control of social contingencies such as sympathy, caregiving, and practical help; thus, strong facial expression is presumed to constitute an attempt to manipulate these contingencies by amplification of the normal expression. Operant formulations support skepticism about the presence or extent of pain, judgments of malingering, and sometimes the withholding of caregiving and help. To the extent that pain expression is influenced by environmental contingencies, however, could equally plausibly constitute the release of suppression according to evolved contingent propensities that guide behaviour. Pain has been largely neglected in the evolutionary literature and the literature on expression of emotion, but an evolutionary account can generate improved assessment of pain and reactions to it. (shrink)

With the aim of ascertaining if child-to-parent offenders have impairments in the executive functions and psychological maladjustment, and to quantify the potential harm and epidemiology, a field study was designed. As for this, 76 juvenile offenders sentenced for child-to-parent violence were assessed in executive functions and psychological adjustment. The results showed valid responses for 75 juveniles and that data were not generally biased in line with defensiveness or malingering. In psychological adjustment, the results revealed a significantly higher maladjustment among (...) offenders on all the basic clinical scales with 23% more symptoms of hysteria than the normative population, 37% more of depressive symptoms, 44% more of hypochondriac symptoms, 68% more of psychopathic deviation symptoms, 46% more of paranoid symptoms, 26% more of psychasthenic symptoms, 24% more symptoms of schizophrenia, 17% more symptoms of hypomania, and 13% more symptoms of social introversion. Epidemiologically, the prevalence rates of clinical deterioration were significantly greater than expected in hypochondria, depression, hysteria, psychopathic deviation, paranoia, psychasthenia, and schizophrenia. As for the cognitive functions, the offenders exhibited impairments estimated at 62.0% in word reading, 47.9% in color naming, 45.8% in color-word, and 11.9% in interference and a significantly higher prevalence of caseness than expected in word reading, color naming, and color-word. The implications of the results for intervention are discussed. (shrink)

The assessment of chronic pain is a highly unmet medical need. Chronic pain is also the subject of a large and costly category of legal claims. Yet, with pain cases, the jury always face a doubt: is the claimant faking or malingering? How can we be assured that the claimant is 'really' in pain? Most recently, several new neuroimaging technologies are promising to solve these questions, by rendering pain visible, measurable and, to some degree, verifiable. The results of these (...) advancements have prompted us to think of pain in a different way, i.e. as an altered brain state in which functional connections are modified, with components of degenerative aspects. But, does this imply the stronger claim that these technologies allow us to 'know', or to literally 'see', the pain of others? Is the pain being objectified by these techniques? And if so, what might the law do differently, or do better? (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mental Disorder and Moral Responsibility:Disorders of Personhood as Harmful Dysfunctions, With Special Reference to AlcoholismJerome C. Wakefield (bio)Keywordsalcohol dependence, philosophy of psychiatry, mental disorder, harmful dysfunction, psychiatric diagnosis, person, moral responsibilityIn his paper, Ethical Decisions in the Classification of Mental Conditions as Mental Illness, Craig Edwards grapples with a profound problem: why is it that when we classify a mental condition as a mental disorder, that tends to take (...) the condition out of the sphere of moral responsibility or virtuousness of character? For example, it is not uncommon when someone commits suicide and the question is raised as to why he or she did it, that instead of a reason or character trait that would place the act within a moral calculus, one is offered the explanation "she was clinically depressed" or "he was bipolar," and this tends to terminate discussion and make reasons and moral evaluation superfluous. Why does such a comment have that effect?As Edwards notes, this can get complicated as the moral and the disordered interact. Certainly people are sometimes morally responsible for acting on their disordered impulses (as in pedophilia), and they are responsible for putting themselves in the way of disorder, as when someone imbibes in a way likely to lead to alcoholism. But at the normal/disorder divide, there seems to be a consistent lifting of some responsibility, reflecting the application of the sick role. For example, the rough equivalent of our current category of post-traumatic stress disorder (PTSD) was recognized as a disorder in earlier wars ("shell shock," "war neurosis"), but often considered an expression of cowardice; the cowardice was morally evaluable as a failure of virtue (even if, like many personality traits, being a coward is not within the person's direct voluntary control) and led to contempt for those with PTSD, but nonetheless—except in cases thought to be malingering—the PTSD that resulted constituted a disorder for which the individual was [End Page 91] not in the same direct sense blameworthy. This moral shift requires explanation.This topic also has important social ramifications. Relief from responsibility may sound like a good thing, and it is trumpeted by mental health advocates as a reason for supporting the classification of many conditions as disorders. But as Edwards is aware, it is a two-edged sword. Disordered status may allow escape from censure and offer the protections of the sick role, but it also changes the relationship of the agent to his or her own actions and imposes the responsibility of the sick role on the individual to attempt to change ("get better"). The sick role allows for no defense of an idiosyncrasy based on normal variation ("It takes all kinds…") or the individual's eccentric vision or steadfast integrity, for that vision or sense of integrity are now seen as pathological and not morally legitimate. The individual is subjected to endless entreaties to seek help and it is implied that not to do so is irresponsible, so that a decision to embrace one's nature and remain as one is becomes illegitimate. Moreover, the sick role allows for no explanation in terms of the individual's normal defensive response to unjust, deprived, or challenging social or environmental circumstances, thus weakening the motives for social change rather than individual intervention.In sum, there is an inevitable sense in which being placed in the sick role inherently stigmatizes the "sick" condition in virtue of the special moral attitudes extended to the disordered. Cultures can thus easily exploit the sick role and its much-touted relief from responsibility to extend the reach of social control processes. This is one reason why the distinction between disorder and non-disorder is so important, and why it is crucial to identify when non-disordered conditions are mislabeled as disorders—as when, for example, psychiatry gets it wrong about the distinction between normal and disordered sadness (Horwitz and Wakefield, 2007). Such overpathologization can redefine the boundaries of our moral universe on mistaken grounds.Edwards offers two provocative answers—not entirely at ease with each other—to the question of why mental disorders relieve the patient from moral responsibility: (1) mental disorders are... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Still Defining Mental Disorder in Terms of Our Goals for Demarcating Mental DisorderJukka Varelius (bio)Keywordsmental disorder, definition, psychological capacity for autonomy, Matthews, SavulescuI thank Eric Matthews and Julian Savulescu for their thought-provoking comments. Unfortunately, I am not here able to discuss all the important points they raise, but must settle for briefly addressing their main criticisms of my view.Reply to MatthewsI believe that some arguments are rationally irresolvable, but (...) do not think that about all philosophical arguments. In terms of moral philosophical argumentation, though not only that, I share the rather common belief that we should proceed by seeking reflective equilibrium between requirements of logic, the best factual knowledge about ourselves and our environment, and our strongly held evaluative intuitions. (This is not to say that there would always be a clear distinction between facts and values.) By such intuitions I refer, for example, to the intuition that it is morally wrong to torture babies for fun. If we are considering whether it is morally permissible to act in a particular way and realize that acting in that way is in the morally relevant respects similar to torturing babies for fun, we conclude that it is not morally permissible to act in that way. That question is solved for persons who accept the moral intuition that it is wrong to torture babies for fun and wish to take facts and logic into account. This method is useful in the context of defining mental disorder, too.Although we have some strongly held intuitions as to what mental disorder is about, such as that person A is a paradigm case of a mentally disordered person, referring to them has not sufficed to solve the controversy concerning the demarcation of mental disorder. Therefore, I want to consider the possibility that referring also to the goals we have for demarcating mental disorder could help us in solving it. At this stage of enquiry at least, I thus believe that the controversy is solvable, but only among persons who share certain points of departure. Accordingly, the "our" in expressions like 'our goals for demarcating mental disorder,' whose reference Matthews enquires about, refer to those who share the intuition that A is a paradigm example of a mentally disordered person, consider the demarcation goals significant, want to take [End Page 67] facts into account, and wish to make logically valid inferences.If one cares about the other things but does not want to consider A's case, one can focus on some other case of a person whose psychological capacity for autonomy is diminished. (Unless, of course, one thinks that no such persons exist and all whom we believe to lack psychological capacity for autonomy are really playacting, malingering, etc.) I, however, now continue with A's case. We have, ex hypothesi, sufficient reason to believe that A lacks not merely relevant information, but also the psychological capacity that understanding it and making use of it in assessing her beliefs and desires presupposes. If someone who knows this about A still insists that A is in perfect mental health and wants, say, to treat her as an object of entertainment in a human zoo, my argument is unlikely to reach him. But who is he to say that we should not care about A's loss of capacity for autonomy and the misfortunes it involves?And of course, also rationally establishing that a person who lacks such capacity is mentally healthy or that the controversy on the nature of mental disorder is not rationally resolvable presupposes that the discussants share some points of departure, including evaluative intuitions. Instead of the intuitions that to be ill is essentially to suffer harm, that behavior governed by one's feelings is always autonomous, and so on, that Matthews refers to, proponents of such views are, however, well advised to resort to less obscure and less controversial intuitions. What, for example, is meant by 'harm'? Is a person who is so overwhelmed by emotions that she is unable to think clearly always autonomous with respect to the actions she performs while in that state? If one takes that all intuitions are useless... (shrink)

In terms of medical science and legal responsibility, the sleep disorder category of parasomnias, chiefly REM sleep behavior disorder and somnambulism, pose an enigmatic dilemma. During an episode of parasomnia, individuals are neither awake nor aware, but their actions appear conscious. As these actions move beyond the innocuous, such as eating and blurting out embarrassing information, and enter the realm of rape and homicide, their degree of importance and relevance increases exponentially. Parasomnias that result in illegal activity, particularly violence, are (...) puzzling phenomena for medicine and the law. Via a review of the pertinent medical literature, a general overview of the current scientific knowledge of parasomnias will be provided. Though this knowledge is far from complete, it can provide some neurobiological information about the nature of parasomnia, including conclusions about a sleepwalker’s level of intention as well as factors that predispose one to such episodes. Although a parasomniac’s complete lack of consciousness warrants acquittal from criminal liability, it does not exclude responsibility for subjecting oneself to exacerbating factors that result in these violent parasomnias. Individuals should be held accountable if they could be expected to control these factors. In addition, they should undergo appropriate treatment and management in order to prevent future parasomnia behaviors. Establishing a legal defense for parasomnia will prove difficult due to the strong potential for malingering, so specific criteria will be outlined in order to distinguish between true and fraudulent claims of crimes committed during parasomniac states. (shrink)

The diagnosis of Functional Neurological Disorder (FND) requires differentiation from other neurologic diseases/syndromes, and from the comparatively rare diagnosis of feigning (Malingering and Factitious Disorder). Analyzing the process of diagnosing FND reveals a necessary element of presumption, which I propose underlies some of the uncertainty, discomfort, and stigma associated with this diagnosis. A conflict between the neurologist’s natural social cognition and professional judgement (cognitive dissonance) can be understood by applying a framework originally designed for the determination of moral responsibility. (...) Understanding the source of this cognitive dissonance may effect its alleviation, and in turn, allow more compassionate treatment of patients with FND. (shrink)

Hysteria has been the subject of controversy for many years, with theorists arguing about whether it is best explained by a hidden organic cause or by malingering and deception. However, it has been shown that hysterical paralysis cannot be explained in any of these terms. With the recent development of cognitive psychiatry, one may understand psychiatric and organic delusions within the same conceptual framework. Here I contrast hysterical conversion with anosognosia. They are indeed remarkably similar, though the content of (...) their respective delusions is the opposite. In hysterical paralysis, patients are not aware of their preserved ability, whereas in anosognosia for hemiplegia, patients are not aware of their disability. Four main explanations have been provided to account for anosognosia: metacognitive, attentional, motor, and motivational views. I will apply each of these accounts to hysterical paralysis and show that, at each level, hysterical conversion is the reverse of anosognosia. I will suggest that hysterical paralysis results from the interaction between attentional somatosensory amplification and affective inhibition of action. (shrink)

The Americans With Disabilities Act (ADA) promotes social justice by protecting disabled persons from discrimination and prejudice. It seeks equality of opportunity for them and protects their well being by giving them fair access to goods, services and benefits. These rights are circumscribed in the ADA, however, by constraints of cost, efficiency, utility, and certain social mores. The ADA offers little direction about how to set priorities when these values come into conflict, or about whether equality of opportunity favors equivalent (...) or preferential treatment for disadvantaged people. Until these ambiguities and potential value conflicts are resolved, a central moral and social problem remains unresolved: How can we demonstrate commitment to the rights and welfare of those with severe disabilities while placing fair limits upon their claims? Five special concerns are discussed: (1) eligibility and the allocation of health care; (2) the meaning of ‘qualified but disabled’ in employing people with mental disabilities; (3) equal opportunity and problems of envy and malingering; (4) ADA accommodation and public protection through testing and licensure; and (5) ADA protection and problems of backlash. Rather than simply wait to see what courts and administrative agencies decide, we should evaluate the moral conflicts, articulate criteria, and help make some difficult choices on morally defensible grounds. Keywords: disabled, health benefit plans, health care rationing, health care reform, health priorities, health services accessibility, Oregon, Rawls, selection bias, social justice CiteULike Connotea Del.icio.us What's this? (shrink)

Drug recalls and lawsuits against pharmaceutical manufacturers are accompanied by announcements emphasizing harmful drug side-effects. Those with elevated health anxiety may be more reactive to such announcements. We evaluated whether health anxiety and financial incentives affect subjective symptom endorsement, and objective outcomes of cognitive and physiological functioning during a mock drug recall. Hundred and sixty-one participants reported use of over-the-counter pain medications and presented with a fictitious medication recall via a mock Food and Drug Administration website. The opportunity to join (...) a class-action lawsuit was manipulated. We assessed health anxiety, recalled drug usage, blood pressure, heart rate, and performance on a computerized Trail Making Test. Symptom endorsement was strongly predicted by health anxiety. When combined, three health anxiety measures explained 28.5% variance. These effects remain strong after controlling for depression and anxiety. Litigation condition did not predict symptom endorsement. Blood pressure and heart rate were modestly predicted by health anxiety, but not by litigation condition. TMT performance was consistently predicted by health anxiety, with higher scores associated with poorer performance. Although there were no main effects for litigation, interactions consistently emerged for the TMT, with generally poorer performance for those with higher health anxiety in the non-litigation condition; whereas health anxiety was unrelated to performance for the litigation condition. All but one participant joined the litigation when given the opportunity, despite a healthy sample and minimal use of pain medication. Subsequent data from 67 individuals with no mention of the FDA scenario or litigation showed that health anxiety still significantly predicts symptom endorsement, but the explained variance is less than half that obtained in the FDA scenario. The findings suggest that health anxiety plays a significant role in adverse symptom reporting, beyond anxiety or depression, and this effect is independent of the presence of the FDA recall. The lack of differences for health anxiety and symptom endorsement between litigation and non-litigation conditions rules out malingering. Although it is general practice in drug recalls to list potential adverse side effects caused by medications, this may elicit unintended symptom experiences and health anxious individuals may be more susceptible. (shrink)

Tissue plasminogen activator (tPA) is administered to patients with suspected ischemic stroke to improve blood flow to the brain In rare cases, patients present with complaints of stroke symptoms that appear to be non-organic due to malingering, factitious disorder, or conversion disorder (psychogenic stroke mimics). Deciding whether or not to administer tPA to these patients can be challenging. The risk of hemorrhage after administration of tPA is low, but not zero. The ethical principles of beneficence and nonmaleficence need to (...) be weighed carefully in these situations. We present two cases of patients with suspected psychogenic stroke mimics to illustrate the ethical challenges faced in identifying and managing psychogenic stroke mimics. Further research is needed to demonstrate effective treatment strategies for patients with acute stroke symptoms of psychogenic etiology. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Minds, Memes, and Multiples”Michael Bavidge (bio)Multiple Personality Disorder challenges the idea we have of ourselves—selves whose essential characteristics are simplicity, identity, transparency. Stephen Clark argues that we should look behind the myth of a unitary self to an older tradition which represents personal integration not as a given but as something to be striven for, “a distant, luminous goal,” a “light” over the multiple parts of the (...) human personality, a therapeutic and personal ideal of ourselves as persons separate from the ideas that invade us and the experiences that flow through us.He argues that this notion has a number of advantages. It is compatible with the data of Multiple Personality Disorder. It avoids Cartesian myths while providing a self substantial enough to meet both philosophers’ demands for an explanation of the coherence of experience and clinicians’ requirements for a therapeutic objective.Clark sees Multiple Personality Disorder as an exotic manifestation of the unstable and fractured nature of familiar experience. He points up the complexities of our personalities and the passivity of our normal experience. So our everyday experience comes together with the psychiatric disorder to encourage a looser, more dispersed notion of the self than has been felt necessary since Descartes.The notion of self which we think of as Cartesian (though, Clark suggests, Descartes may never have accepted it), caught on as part of the settlement between the emerging sciences and older wisdom. The basis of the settlement was that the world was to be made amenable to scientific investigation and our innermost selves were to be protected from it. This requires that the self has to be all the things that the rest of the world is not—non-spatial, privately accessible, outside determinist, causal chains, simple and indivisible. The settlement was never stable, and, as contemporary arguments over the cognitive sciences demonstrate, it is as controversial today as ever. Multiple Personality Disorder adds psychiatric considerations to the evidence piling up against the Cartesian self.However, the diagnosis is extremely controversial. A highly critical editorial in the British Journal of Psychiatry in March 1995 suggests that the condition is largely generated within therapy. 1 The diagnosis, as the New Scientist (June 17, 1995) reported, seems excessively subject to trends and fashions. 2 Clark shares these reservations, but he concludes that there is now strong evidence of a “real condition.” Yet he does not discuss what he means by a “real condition.” Certainly he intends to exclude malingering or mere therapist suggestion. Nevertheless, he prefers to interpret the disorder as a matter of one [End Page 29] person having different strategies for dealing with a stressful world, rather than as the emergence of a plurality of persons. Some psychiatrists will think that his acceptance, however qualified, is too much of a concession, while others may feel that he is not allowing the alters, and therefore the condition itself, to be “real” enough.Clark’s philosophical remarks are also circumspect, but ambitious claims are there. He wants a re-appraised, strong theory of the self, though he doubts that the truth of such a theory could ever be established. Nevertheless, for Clark, we need a notion of self as “substance, a real being”; we discover and rediscover it; “it becomes aware of itself in me.”Apart from its philosophical advantages, the notion of self he wishes to revive has therapeutic value. Autonomy is the therapeutic target. Understood in Cartesian terms, Multiple Personality Disorder presents paradoxes of autonomy. Cognitive autonomy is the defining characteristic of the Cartesian self; when we have multiple persons, the question arises: autonomy for whom? The difficulties are softened if our idea of self allows for plurality, opacity and divergence within the one person, so the prospect held out to the patient is the possibility of repossessing the fragmented parts of his or her life.Clark engages in a two-fold maneuver for making sense of Multiple Personality Disorder. He revives a looser philosophical concept of self, and he interprets the disorder as an extension of ordinary experience in which there is a divergence of coping strategies rather than a plurality of egos. One could argue that Clark is too optimistic... (shrink)

This paper analyzes S. Weir Mitchell and his son John Kearsley Mitchell’s views on phantom limb pain in late 19th c. America. Drawing on a variety of primary sources including journal articles, letters, and treatises, the paper pioneers analysis of a cache of surveys sent out by the Mitchells that contain amputee Civil War veterans’ own narratives of phantom limb pain. The paper utilizes an approach drawn from the history of ideas, documenting how changing models of medicine and objectivity help (...) explain the Mitchells’s attitudes, practices, and beliefs regarding the enigma of phantom limb pain as experienced by their patients. The paper also assesses concerns over malingering, pain, authenticity, and deception through these intellectual frameworks of somaticism and mechanical objectivity. The paper concludes that much of relevance to the ways in which the Mitchells and other late 19th c. neurologists regarded and treated their patients’ pain is explicable in terms of the larger intellectual frameworks that structured these healers’ ideas about lesionless pain. (shrink)

The existence or questionability of “repressed memories” can be discussed as being a matter of definition. It seems, however, far-fetched to consider all “lost” memories as caused by encoding problems, brain damage, forgetfulness, failure to disclose events, and so on. We argue that dissociative amnesia (DA) (or “psychogenic amnesia,” or “functional amnesia,” or, as we favor to call it, “mnestic block syndrome”) is caused by psychic alterations, but ultimately they can be traced to changes in the physiology of the brain, (...) as we are of the opinion that all memory processes—positive or negative—alter brain functions, sometimes more permanently, sometimes transiently. We have proven this idea using functional imaging techniques, in particular fluoro-deoxy-d-glucose positron emission tomography. Having investigated dozens of patients with severe and long-lasting DA conditions, we believe it to be disrespectful to many (but not to all) of the affected patients to question their disease condition, which can be proven to be not caused by feigning, malingering, or direct brain damage. (shrink)

This paper proposes that human expression of pain in the presence or absence of caregivers, and the detection of pain by observers, arises from evolved propensities. The function of pain is to demand attention and prioritise escape, recovery, and healing; where others can help achieve these goals, effective communication of pain is required. Evidence is reviewed of a distinct and specific facial expression of pain from infancy to old age, consistent across stimuli, and recognizable as pain by observers. Voluntary control (...) over amplitude is incomplete, and observers can better detect pain that the individual attempts to suppress rather than amplify or simulate. In many clinical and experimental settings, the facial expression of pain is incorporated with verbal and nonverbal vocal activity, posture, and movement in an overall category of pain behaviour. This is assumed by clinicians to be under operant control of social contingencies such as sympathy, caregiving, and practical help; thus, strong facial expression is presumed to constitute an attempt to manipulate these contingencies by amplification of the normal expression. Operant formulations support skepticism about the presence or extent of pain, judgments of malingering, and sometimes the withholding of caregiving and help. To the extent that pain expression is influenced by environmental contingencies, however, “amplification” could equally plausibly constitute the release of suppression according to evolved contingent propensities that guide behaviour. Pain has been largely neglected in the evolutionary literature and the literature on expression of emotion, but an evolutionary account can generate improved assessment of pain and reactions to it. Key Words: adaptation; evolutionary psychology; facial expression; pain. (shrink)

"If" and "then," wrapped around enough content to form at least two propositions that seem to be conditionally assertible together as antecedent and consequent, are, of course, the key denizens of this very deep work. It's a commonplace among philosophers that what so innocently malingers in indicative language as, "If Bennett didn't write this excellent Guide, then someone else did," can rapidly morph by a little fancy into the eyebrow-arching subjunctive/counterfactual, "If Bennett hadn't written this marvelous work, then someone else (...) would have." The hulking literature on the logic and semantics of conditionals is cunning and daunting, and few thinkers on the world stage are equipped to corral and tame the beast as Bennett has. Even given his nontruth-functional stance on indicative conditionals, one might still rightly call Bennett "The Horseshoe Whisperer.". (shrink)

Reports of the intent to kill oneself are not always met with the credibility they deserve, with potentially fatal results. We recognise this as testimonial injustice, whereby a person’s testimony is not taken seriously due to a pervasive identity prejudice attached to the speaker (Fricker 2007). To meet the government’s ‘zero suicide ambition’ for mental health patients, we need to adopt epistemically just methods of evaluating suicide claims.

On 6 September 1966, the prime minister of South Africa, Dr HF Verwoerd was killed by Mr Tsafendas, a Portuguese national of Greek descent, in parliament by stabbing him in the chest. Mr Tsafendas was a messenger in parliament. At the enquiry trial of Mr Tsafendas, he was found unfit to stand trial on the ground that he suffered from schizophrenia. The psychiatric evidence during the enquiry trial was reviewed and discussed under the following headings: Diagnosis of schizophrenia; Consideration of (...) cultural factors in forensic psychiatric settings; Delusional infestation v. extreme overvalued beliefs; Simulation of psychosis; Ethical considerations in criminal capacity and trial competency assessments. Lessons from the Mr Tsafendas enquiry trial for forensic psychiatrists where a defendant previously diagnosed with schizophrenia commits a prominent political murder, are summarised. It is emphasised that the personhood of an accused referred for forensic observation should be respected and protected, instead of focusing exclusively on a specific diagnosis. (shrink)