In this paper, I examine the connections between bipolar disorder and consent. I defend the view that many (although far from all) individuals with bipolar disorder are competent to consent to a wide variety of things when they are in a manic state.

Bipolar neutrosophic sets are the extension of neutrosophic sets and are based on the idea of positive and negative preferences of information. Projection measure is a useful apparatus for modelling real life decision making problems. In the paper, we define projection, bidirectional projection and hybrid projection measures between bipolar neutrosophic sets. Three new methods based on the proposed projection measures are developed for solving multi-attribute decision making problems. In the solution process, the ratings of performance values of (...) the alternatives with respect to the attributes are expressed in terms of bipolar neutrosophic values. We calculate projection, bidirectional projection, and hybrid projection measures between each alternative and ideal alternative with bipolar neutrosophic information. All the alternatives are ranked to identify the best alternative. Finally, a numerical example is provided to demonstrate the applicability and effectiveness of the developed methods. Comparison analysis with the existing methods in the literature in bipolar neutrosophic environment is also performed. (shrink)

Bipolar soft set is formulated by two soft sets; one of them provides us the positive information and the other provides us the negative information. The philosophy of bipolarity is that human judgment is based on two sides, positive and negative, and we choose the one which is stronger. In this paper, we introduce novel belong and nonbelong relations between a bipolar soft set and an ordinary point. These relations are considered as one of the unique (...) characteristics of bipolar soft sets which are somewhat expression of the degrees of membership and nonmembership of an element. We discuss essential properties and derive the sufficient conditions of some equivalence of these relations. We also define the concept of soft mappings between two classes of bipolar soft sets and study the behaviors of an ordinary point under these soft mappings with respect to all relations introduced herein. Then, we apply bipolar soft sets to build an optimal choice application. We give an algorithm of this application and show the method for implementing this algorithm by an illustrative example. In conclusion, it can be noted that the relations defined herein give another viewpoint to explore the concepts of bipolar soft topology, in particular, soft separation axioms and soft covers. (shrink)

Information was a frequently used concept in many fields of investigation. However, this concept is still not really understood, when it is referred for instance to consciousness and its informational structure. In this paper it is followed the concept of information from philosophical to physics perspective, showing especially how this concept could be extended to matter in general and to the living in particular, as a result of the intimate interaction between matter and information, the human body (...) appearing as a bipolar informed-matter structure. It is detailed on this way how this concept could be referred to consciousness, and an informational modeling of consciousness as an informational system of the human body is presented. Based on the anatomic architecture of the organism and on the inference of the specific information concepts, it is shown that the informational system of the human body could be described by seven informational subsystems, which are reflected in consciousness as corresponding cognitive centers. These results are able to explain the main properties of consciousness, both the cognitive and extra-cognitive properties of the mind, like that observed during the near-death experiences and other similar phenomena. Moreover, the results of such a modeling are compared with the existing empirical concepts and models on the energetic architecture of the organism, showing their relevance for the understanding of consciousness. (shrink)

There is a strong presumption that mental disorder injures a person's autonomy, understood as a set of capacities and as an ideal condition of agency which is worth striving for. However, recent multidimensional approaches to autonomy have revealed a greater diversity in ways of being autonomous than has previously been appreciated. This presumption, then, risks wrongly dismissing variant, neuro-atypical sorts of autonomy as non-autonomy. This is both an epistemic error, which impairs our understanding of autonomy as a phenomenon, and a (...) moral error, which withholds recognition and respect that autonomous agents are due. I argue that careful attention to the different 'shapes' of agent's autonomy reveals that there are indeed distinctive kinds of neuro-atypical autonomy that are widely mistaken for non-autonomy. This project argues for two propositions. First, that there is a kind of autonomy, with a distinctive shape and texture, available to bipolar agents. This is a variant sort of autonomy, but not a defective or deficient sort. It is the ideal of autonomy that it is worth bipolar agents striving for, given the range and intensity of experiences that they will have to confront. Whilst bipolar autonomy will look unlike more neurotypical kinds of autonomy, it continues to be owed recognition. The second proposition is that we should understand the ideal of autonomy to be both pluralist and highly context sensitive. Given the range of starting points from which agents will strive to an ideal of autonomy, there will be some variation in the ideals worth striving for. The variation in ideals will reflect the existential realities they are local to. Theory of autonomy must be adapted to recognise bipolar, and other neuro-atypical, kinds of autonomy, and to reflect this wider pluralism. These propositions will be argued for with careful attention to the experiences and agency of people living with bipolar, or related, disorders. Understanding the ways that manic or depressive episodes, and the shifts between them, alter and apply pressure to our agency will inform an account of the distinctively bipolar autonomy that can be built on top of it. (shrink)

Interval bipolar neutrosophic set is a significant extension of interval neutrosophic set where every element of the set comprises of three independent positive membership functions and three independent negative membership functions. In this study, we first define correlation coefficient, and weighted correlation coefficient measures of interval bipolar neutrosophic sets and prove their basic properties. Then, we develop a new multi-attribute decision making strategy based on the proposed weighted correlation coefficient measure. Finally, we solve an investment problem with interval (...) bipolar neutrosophic information and comparison is given to demonstrate the applicability and effectiveness of the proposed strategy. (shrink)

Medical ghostwriting is the practice in which pharmaceutical companies engage an outside writer to draft a manuscript submitted for publication in the names of “honorary authors,” typically academic key opinion leaders. Using newly-posted documents from paroxetine litigation, we show how the use of ghostwriters and key opinion leaders contributed to the publication of a medical journal article containing manipulated outcome data to favor the proprietary medication. The article was ghostwritten and managed by SmithKline Beecham, now GlaxoSmithKline (GSK) and Scientific Therapeutics (...) Information, Inc. without acknowledging their contribution in the published article. The named authors with financial ties to GSK, had little or no direct involvement in the paroxetine 352 bipolar trial results and most had not reviewed any of the manuscript drafts. The manuscript was originally rejected by peer review; however, its ultimate acceptance to the American Journal of Psychiatry was facilitated by the journal editor who also had financial ties to GSK. Thus, GSK was able to take an under-powered and non-informative trial with negative results and present it as a positive marketing vehicle for off-label promotion of paroxetine for bipolar depression. In addition to the commercial spin of paroxetine efficacy, important protocol-designated safety data were unreported that may have shown paroxetine to produce potentially harmful adverse events. (shrink)

Discussion among individuals about a given issue often induces polarization and bipolarization effects, i.e. individuals radicalize their initial opinion towards either the same or opposite directions. Experimental psychologists have put forward Persuasive Arguments Theory as a clue for explaining polarization. PAT claims that adding novel and persuasive arguments pro or contra the debated issue is the major cause for polarization. Recent developments in abstract argumentation provide the tools for capturing these intuitions on a formal basis. Here Bipolar Argumentation Frameworks (...) are employed as a tool for encoding the information of agents in a debate relative to a given issue a. A probabilistic extension of BAF allows to encode the likelihood of the opinions pro or contra a before and after information exchange. It is shown, by a straightforward example, how these measures provide the basis to capture the intuitions of PAT. (shrink)

A substantial body of evidence suggests that autobiographical recollection and simulation of future happenings activate a shared neural network. Many of the neural regions implicated in this network are affected in patients with bipolar disorder , showing altered metabolic functioning and/or structural volume abnormalities. Studies of autobiographical recall in BD reveal overgeneralization, where autobiographical memory comprises primarily factual or repeated information as opposed to details specific in time and in place and definitive of re-experiencing. To date, no study (...) has examined whether these deficits extend to future event simulation. We examined the ability of patients with BD and controls to imagine positive, negative and neutral future events using a modified version of the Autobiographical Interview that allowed for separation of episodic and non-episodic details. Patients were selectively impaired in imagining future positive, negative, and neutral episodic details; simulation of non-episodic details was equivalent across groups. (shrink)

Two lecture styles were examined to determine which was more effective for enhancing content learning in college students. The same experienced guest lecturer presented information about bipolar disorder (a combination of depression and mania) to college students in human service-related fields. Students in classes assigned to the control group received a standard, didactic lecture. In classes assigned to the experimental group, the presenter began the lecture by informing the students that she had bipolar disorder and enhanced the (...) standard didactic lecture by interspersing descriptions of her personal experiences living with bipolar disorder. Content-specific pre-tests and post-tests developed by the researchers were used to compare acquisition of knowledge about the disorder across groups of students. Results showed that students who received the personal/experiential lecture acquired significantly more knowledge about bipolar disorder than did students who received the standard, didactic lecture. Theories and procedures that may enhance student learning and thinking in related areas are discussed. (shrink)

BackgroundCognitive impairments are prevalent in patients with unipolar and bipolar depressive disorder. Considering the fact assessing cognitive functions is increasingly feasible for clinicians and researchers, targeting these problems in treatment and using them at baseline as predictors of response to treatment can be very informative.MethodIn a naturalistic, retrospective study, data from 120 patients with UDD and BDD were analyzed. Patients received 20 sessions of bilateral rTMS and were assessed regarding their depressive symptoms, sustained attention, working memory, and executive functions, (...) using the Beck Depression Inventory and Neuropsychological Test Automated Battery Cambridge, at baseline and after the end of rTMS treatment course. Generalized estimating equations and logistic regression were used as the main statistical methods to test the hypotheses.ResultsFifty-three percentage of all patients responded to treatment. In particular, 53.1% of UDD patients and 46.9% of BDD patients responded to treatment. Bilateral rTMS improved all cognitive functions except for visual memory and resulted in more modulations in the working memory of UDD compared to BDD patients. More improvements in working memory were observed in responded patients and visual memory, age, and sex were determined as treatment response predictors. Working memory, visual memory, and age were identified as treatment response predictors in BDD and UDD patients, respectively.ConclusionBilateral rTMS improved cold cognition and depressive symptoms in UDD and BDD patients, possibly by altering cognitive control mechanisms, and processing negative emotional bias. (shrink)

The concept of positional information is applied to a large amount of data obtained previously in experiments on developing and regenerating amphibian limbs. Only the proximo-distal axis of the limb is considered. It is shown that the concept provides a simple, unitary hypothesis which satisfactorily accounts for the experimental data, and may moreover suggest meaningful new approaches. It is suggested that the boundaries of the bipolar limb system lie in the girdle skeleton and at the distal end of (...) the limb, respectively, and that it is the apical epidermis of the growing or regenerating limb which defines the distal boundary conditions. A relatively stable gradient of positional information is assumed to be set up in the mesoderm . It is further shown that the differentiated limb retains its positional information and upon amputation imparts it to the base of the blastema. To explain an apparent discrepancy between the developing and the regenerating limb, it is proposed that dedifferentiation of mesodermal limb tissues upon amputation entails a change of positional value in the mesenchyme. Consequently, the amputation level does not once and for all specify the positional value at the proximal end of a mass of blastemal mesenchyme, particularly when the mesenchyme is transplanted in such a way that its linear size decreases or increases. (shrink)

This paper attempts to highlight some weaknesses of European integration by technology. It is argued that these weaknesses of integration arise out of misunderstanding of the relationships between economics and technology. Mainstream economics considers technology as being external to the sphere of economy. It is treated as an external stock of knowledge or information rather than the result of a process of interaction between the actors belonging to the sphere of economy. The theoretical status of technology influences the focus (...) and process of economic development through technology. If technology is considered as being exogenous to the sphere of economics, the resulting stock of technology can be considered as transferable. If technology is considered as the result of an interaction of economic actors, so belonging to the economic sphere, its transfer becomes impossible because of its endogenous nature. In this last frame, technology concept transfer may become a danger for the development of less developed countries as well as for the cohesion of the European Community. (shrink)

Whilst considerable research exists on determining consumer responses to pre-determined statements within numerous ad ethics contexts, our understanding of consumer thoughts regarding ad ethics in general remains lacking. The purpose of our study therefore is to provide a first illustration of an emic and informant-based derivation of perceived ad ethics. The authors use multi-dimensional scaling as an approach enabling the emic, or locally derived deconstruction of perceived ad ethics. Given recent calls to develop our understanding of ad ethics in different (...) cultural contexts, and in particular within the Middle East and North Africa region, we use Lebanon—the most ethically charged advertising environment within MENA—as an illustrative context for our study. Results confirm the multi-faceted and pluralistic nature of ad ethics as comprising a number of dimensional themes already salient in the existing literature but in addition, we also find evidence for a bipolar relationship between individual themes. The specific pattern of inductively derived relationships is culturally bound. Implications of the findings are discussed, followed by limitations of the study and recommendations for further research. (shrink)

Mitigating response distortion in answers to sensitive questions is an important issue for business ethics researchers. Sensitive questions may be asked in surveys related to business ethics, and respondents may intend to avoid exposing sensitive aspects of their character by answering such questions dishonestly, resulting in response distortion. Previous studies have provided evidence that a surveying procedure called the randomized response technique is useful for mitigating such distortion. However, previous studies have mainly applied the RRT to individual dichotomous questions in (...) face-to-face survey settings. In this study, we focus on behavioral research examining the relationships between latent variables, which are unobserved variables measured by multiple items on Likert or bipolar scales. To demonstrate how the RRT can be applied to obtain valid answers from respondents answering a self-administered online questionnaire with Likert and bipolar scales, we build a behavioral model to study the effect of punishment severity on employees’ attitudes toward misuse of information systems resources in the workplace, which in turn influence misuse behavior. The survey findings meet our expectations. The respondents are generally more willing to disclose sensitive data about their attitudes and actual behavior related to misuse when the RRT is implemented. The RRT’s implications for causal modeling and the advantages and challenges of its use in online environments are also discussed. (shrink)

Balancing the pros and cons of two options is undoubtedly a very appealing decision procedure, but one that has received scarce scientific attention so far, either formally or empirically. We describe a formal framework for pros and cons decisions, where the arguments under consideration can be of varying importance, but whose importance cannot be precisely quantified. We then define eight heuristics for balancing these pros and cons, and compare the predictions of these to the choices made by 62 human participants (...) on a selection of 33 situations. The Levelwise Tallying heuristic clearly emerges as a winner in this competition. Further refinements of this heuristic are considered in the discussion, as well as its relation to Take the Best and Cumulative Prospect Theory. (shrink)

Mood disorders, including major depressive disorder and bipolar disorder, are highly prevalent, frequently disabling, and sometimes deadly. Additional research and more effective medications are desperately needed, but clinical trials research in mood disorders is fraught with ethical issues. Although many authors have discussed these issues, most do so from a theoretical viewpoint. This manuscript uses available empirical data to inform a discussion of the primary ethical issues raised in mood disorders research. These include issues of consent and decision-making capacity, (...) including patients’ motivations for participating in research. We also address drug withdrawals, placebo controls, and the overall safety of research. Finally, we examine the extant literature for studies discussing potential indirect benefits of clinical trials research to participants. Taken together, the evidence suggests that clinical trials research incorporating drug withdrawals and placebo controls can be conducted safely and ethically, even in patients with severe or treatment-resistant mood disorders. In fact, given the dearth of effective treatment options for this population, it is our opinion that a moral imperative exists to extend the offer of research participation to severely ill or treatment-resistant groups. (shrink)

Background Next Generation Sequencing (NGS) is expected to help find the elusive, causative genetic defects associated with Bipolar Disorder (BD). This article identifies the importance of NGS and further analyses the social and ethical implications of this approach when used in research projects studying BD, as well as other psychiatric ailments, with a view to ensuring the protection of research participants. Methods We performed a systematic review of studies through PubMed, followed by a manual search through the titles and (...) abstracts of original articles, including the reviews, commentaries and letters published in the last five years and dealing with the ethical and social issues raised by NGS technologies and genomics studies of mental disorders, especially BD. A total of 217 studies contributed to identify the themes discussed herein. Results The amount of information generated by NGS renders individuals suffering from BD particularly vulnerable, and increases the need for educational support throughout the consent process, and, subsequently, of genetic counselling, when communicating individual research results and incidental findings to them. Our results highlight the importance and difficulty of respecting participants’ autonomy while avoiding any therapeutic misconception. We also analysed the need for specific regulations on the use and communication of incidental findings, as well as the increasing influence of NGS in health care. Conclusions Shared efforts on the part of researchers and their institutions, Research Ethics Boards as well as participants’ representatives are needed to delineate a tailored consent process so as to better protect research participants. However, health care professionals involved in BD care and treatment need to first determine the scientific validity and clinical utility of NGS-generated findings, and thereafter their prevention and treatment significance. (shrink)

Our thesis is that proprioception is not a sixth sense distinct from the sense of touch, but a part of that tactile (or haptic) sense. The tactile sense is defined as the sense whose direct intentional objects are macroscopic mechanical properties. We first argue (against D. Armstrong, 1962; B. O'Shaughnessy 1989, 1995, 1998 and M. Martin, 1992, 1993,1995) that the two following claims are incompatible : (i) proprioception is a sense distinct from touch; (ii) touch is a bipolar modality, (...) that intrinsically has both a subjective-bodily pole and objective pole. We then argue that the bipolarity of touch should be preferred over the introduction of a sui generis sense of the body. We try to revive Aristotle suggestion according to which the body is the tactile medium (like the air for sight). Since this medium is constantly changing its shape, we need some specific channel of information about its state : proprioception, functionally defined, is that part of touch which informs us about the state of this changing tactile medium. Though muscular and articular receptors are usually dedicated to inform us about the mechanical properties of the tactile media, and the skin receptors about the mechanical properties of the tactile objects, this is not essentially so. In weighting or wielding experiments we access the weight of external objects even when skin sensitivity is absent; in prosthetic touch, the skin receptors play the role usually assigned to muscle and articular receptors, namely to inform us about the mechanical state of the tactile medium. So proprioception, anatomically defined, can play both the role of informing us about the tactile medium, or about the tactile objects. That other sensory modalities also rely on proprioceptive information should be understood in terms of cross-modal dependencies: of sight, hearing, smell, taste...on touch. (shrink)

For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD and (...) efforts to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being 'protected' through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician-patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research. (shrink)

Narratives structure and inform how we understand our experiences and identity, especially in instances of suffering. Suffering in mental disorder (e.g. bipolar disorder) is often uniquely distressing as it impacts capacities central to our ability to make sense of ourselves and the world—and the role of narratives in explaining and addressing these effects is well-known. For many with a mental disorder, spiritual/religious narratives shape how they understand and experience it. For most, this is because they are spiritual and/or religious. (...) For others, spiritual/religious narratives still often influence secular approaches to mental disorder, more than approaches to other disabilities (e.g. intellectual, physical) or causes of suffering (e.g. physical disease). Such narratives are often harmful, especially insofar as they ‘over-spiritualize’ mental disorder; and undercut ‘spiritual meaning-making’. Here I address the impact of spiritual/religious narratives that helpfully avoid over-spiritualizing mental disorder while enabling spiritual meaning-making about it. First, I address the role of narratives in meaning-making more generally; then, I present results from my recent empirical study testing the impact of such narratives on participants’ meaning-making about their mental disorder. I conclude by addressing implications and potential worries. (shrink)

Near-death experiences, transcendental experiences that frequently occur on the threshold of death, precipitate profound personality transformations that have defied explanation in terms of current psychodynamic and neurophysiologic models. A biosociological approach based on information and systems theories can elucidate anomalous features of both near-death phenomenology and the bipolar aftereffects of these mystical experiences. This biosociological model makes testable predictions about near-death experiencers and suggests fruitful future directions for the scientific study of mystical experience.

Military affairs have been affected by major changes in the 19902. The bipolar world of two superpowers has gone. The Cold War and the global military confrontation that accompanied it have ended. A new military and political order has emerged, but the world has not become more stable, indeed, wars and armed conflict have become much more common. Forecasting the contours of future armed conflict is the primary object of this work. Focusing on the impact of new technologies, General (...) Gareev considers whether war is still a "continuation of politics by other means" or whether political, ideological and technical transformations have broken that connection. He explores the linkage beween threats to Russian national interests and war as an instrument of policy, and concludes that there is very little prospect either of nuclear war or widespread conventional war. However, he does see local armed conflicts and local wars increasing, with greater emphasis on subversion. He argues that coming decades wil see a shift toward reliance upon indirect means to accomplish limited political ends, and analyzes both information warfare and the revolution in military affairs from this perspective. (shrink)

: The development of the interdisciplinary areas of cognitive, affective and action neurosciences contributes to the identification of neurobiological bases of conscious experience. The structure of consciousness was philosophically conceived a century ago as consisting of a subjective pole, the bearer of experiences, and an objective pole composed of experienced contents. In more recent formulations, Nagel refers to a “point of view”, in which qualitative experiences are anchored, while Velmans understands that phenomenal content is composed of mental representations “projected” to (...) the space external to the brains that construct them. In Freudian psychology, the conscious mind contains a tension between the Id and the Ego. How to relate this bipolar structure with the results of neuroscience? I propose the notion of projection [also used by Williford et al. ] as a bridge principle connecting the neurobiological systems of knowing, feeling and acting with the bipolar structure. The projective process is considered responsible for the generation of the sense of self and the sense of the world, composing an informational phenomenal field generated by the nervous system and experienced in the first-person perspective. After presenting the projective hypothesis, I discuss its philosophical status, relating it to the phenomenal and high-order thought approaches, and a mathematical model of projection. Eight ways of testing the status of the projective hypothesis are briefly mentioned. Resumo: O desenvolvimento de áreas interdisciplinares das neurociências, contribui para a identificação das bases neurobiológicas da experiência consciente. A estrutura intrínseca da experiência consciente foi filosoficamente concebida há um século como consistindo de um pólo subjetivo, o portador de experiências, e um pólo objetivo, composto dos conteúdos experimentados. Em formulações mais recentes, Thomas Nagel refere-se a um “ponto de vista”, no qual experiências qualitativas são ancoradas, enquanto Max Velmans entende que o conteúdo fenomenal é composto de representações mentais “projetadas” para o espaço externo ao cérebro que as constrói. Na psicologia freudiana, a mente consciente contém uma tensão entre o Id e o Ego. Como relacionar esta estrutura bipolar com os resultados da neurociência? Proponho a noção de projeção como princípio-ponte, conectando os sistemas neurobiológicos do saber, sentir e agir com a estrutura bipolar. O processo projetivo é considerado responsável pela geração do sentido do eu e do sentido do mundo, compondo um campo fenomenal informacional gerado pelo sistema nervoso e vivenciado na perspectiva da primeira pessoa. Após apresentar a hipótese projetiva, discuto seu status filosófico, relacionando-o às abordagens fenomenológicas, à teoria do pensamento de ordem superior e ao modelo matemático da projeção. Oito maneiras de testar o status da hipótese projetiva são brevemente mencionadas. (shrink)

On the basis of knowledge prior to 1988, Ashbrook pointed out that whereas most men are primarily dependent on the left cerebral hemisphere (“dominant hemisphere”) for verbally related functions, women show a greater hemispheric balance in this respect. For men, he argues, their possession of a “speaking” and a “non‐speaking hemisphere” results in a positive‐negative, bipolar way of thinking that may be characterized as dualistic and dialectically hierarchical. In contrast, the greater balance of hemispheric function in women appears to (...) promote greater generalization and synthesis in their thinking.In this article I cite more recent neuroanatomical and brain imaging studies that provide further evidence of disparities in structure and function of the brains of men and women. As background for an attempt to explain these differences, I give a brief review of the triune evolution of the mammalian brain leading up to the human cerebrum. It is of major significance that the female has played a central role in mammalian evolution for more than 180 million years and that the evolutionary transition from reptilian therapsids to mammals is characterized by the develoment of (1) nursing conjoined with maternal care; (2) audiovocal communication or aiding mother‐offspring contact; and (3) play. In human beings, the infant‐carrying hypothesis suggests one means by which, over generations, certain parts of a woman's right hemisphere could undergo functional and eventual anatomical expansion. The mother‐infant communication of basic mammalian sounds with vowel and consonant components suggests a basis for the origination of speech.Finally, in an expansion of Ashbrook's original thesis, we arrive at the rovocative consideration that, unlike men, with their dialectical reasoning, women, with their more balanced brain, are provided with a trialectial ladder for climbing to achieve knowledge. In terms of quantum mechanics, the particle and wave would correspond to the substance and strength of the sides of the ladder, and the derived psychic information (which is neither matter nor energy) would compare to the rungs in between. (shrink)

Argumentation is a form of reasoning where a claim is accepted or rejected according to the analysis of the arguments for and against it; furthermore, it provides a reasoning mechanism able to handle contradictory, incomplete and uncertain information in real-world situations. We combine Bipolar Argumentation Frameworks (an extension of Dung’s work) with an Algebra of Argumentation Labels modeling two independent types of interaction between arguments, representing meta-information associated with arguments, and introducing an acceptability notion that will give (...) more information for arguments acceptability. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Karl Popper, the Vienna Circle, and Red ViennaMalachi H. Hacohen*A stranger in his homeland even before emigrating in 1937, the philosopher Karl Popper is rarely considered an Austrian. Although he was born in Vienna in 1902 and buried there in 1994, he is known as an Atlantic intellectual and an anti-Communist prophet of postwar liberalism. He first became famous for The Open Society and Its Enemies (1945). 1 He (...) wrote the book during World War II in his New Zealand exile, intending it as a defense of democracy against fascism. The defeat of Austrian socialism and the collapse of Central European democracies were the major experiences informing his analysis. But The Open Society quickly became, with Popper’s full support, a charter of Atlantic Cold War liberalism. His philosophy of science, exemplified best in Logik der Forschung, went through a similar transformation. 2 To be sure, it is commonly debated in the context of logical positivism and the Vienna Circle; but the circle’s emigration and the postwar triumph of analytic philosophy in the Anglo-American academy transformed positivism, too, into an Atlantic philosophy. The “fugue of exile’s disruptions” severed the thread connecting Popper to Austria. 3Yet Popper was the foremost philosopher to carry the progressive Viennese legacy into the postwar era. In his critiques of the Vienna Circle and Red Vienna he confronted the philosophical and political problems of Viennese late enlightenment [End Page 711] and the interwar crises of scientific reason and Central European democracy. Refashioning the fin-de-siècle progressive legacy, he drew novel visions of liberal science and politics, imagining utopian scientific and political communities that were engaged in the pursuit of truth and reform. He made critical debate the acid test of political and scientific rationality, the center of a new liberalism. Establishing a free public sphere as the sine qua non of the Open Society, he innovated on a familiar liberal motif, shared by thinkers as different as Kant, De Staël, Guizot, Mill, and Habermas.In The Open Society Popper also wrote the political platform of the postwar Social-Democratic Consensus that legislated for the welfare state and mobilized against Communism. During World War II he opted for a liberal-socialist alliance that would contain postwar Central European fascism. Instead, his “Popular Front” platform proved adaptable to postwar anti-Communism. He made a few naïve pronouncements on deterrence and the free world during the Cold War. 4 They reflect badly on his political philosophy. Yet disentangled from its Cold War associations, his liberalism contains an abiding cosmopolitan vision for an age that is looking beyond the nation-state. His cosmopolitanism originated as a solution to dilemmas of ethnic identity faced by the assimilated-Jewish Viennese intelligentsia. His Open Society expressed their dream of integration into a community that discounted religion, ethnicity, and nationality. 5 He refused to give up on cosmopolitanism in the bipolar world when Machtpolitik seemed the order of the day. Almost alone among postwar liberals, he retained a belief in an international legal order and challenged national self-determination. His vision has regained relevance today. Cosmopolitanism and critical debate provide a starting-point for renegotiating liberal dilemmas.“My theory of knowledge, my philosophy of science and my political philosophy are original only in their interdependence,” stated Popper in a 1976 interview. 6 His epistemology has major political and scientific significance. Well before cultural studies began deconstructing science, Popper countered philosophers’ and scientists’ claims of expertise. There is no philosophical method. Every person is a problem-solver, and so every person is a philosopher. “Science is nothing but enlightened and responsible common sense—common sense broadened by imaginative critical thinking.” 7 Demystifying science, he never gave up on the growth of knowledge. He conceived of science as an unending quest for uncertain but growing knowledge. A non-foundationist, [End Page 712] he insisted that objectivity meant intersubjectivity. Rationality was a product of critical debate. In today’s intellectual world, devoid of certainty, where systems of knowledge and identities have been thrown into flux, Popper’s unique synthesis of contingency, convention, and change with logical certainty, objectivity, and tradition suggests a promising direction in the... (shrink)

Comparing and sharing selectionist terms and concepts from disparate domains can aid understanding in each domain. But constraints of interpretive language will make this difficult – such as the bipolar constraint of interpretive language when addressed to intrinsically tripolar phenomena. Hull et al. acknowledge that some key terms in their account remain problematic; the term, “information,” probably needs to be replaced.

Since 1991, the Patient Self-Determination Act (PSDA) has required all health care institutions that receive Federal funds to inform patients upon admission of their rights to make decisions about medical care and to execute advance directives. Implementation of the PSDA presents a special challenge for state mental hospitals. The relevance and possible negative therapeutic impact of discussing end of life decisions at the time of an acute psychiatric admission has recently been raised in the literature. Other ethical dilemmas arising from (...) the interplay between mental illness and informed consent for medical treatment, particularly for older patients committed to state mental hospitals, have been highlighted by the PSDA. In this article we discuss some of the issues raised by implementation of the PSDA in this setting. (shrink)

Meaning-making plays a central role in how we deal with experiences of suffering, including those due to mental disorder. And for many, religious beliefs, experiences, and practices (hereafter, religious engagement) play a central role in informing this meaning-making. However, a crucial facet of the relationship between experiences of mental disorder and religious engagement remains underexplored—namely the potentially positive effects of mental disorder on religious engagement (e.g. experiences of bipolar disorder increasing sense of God’s presence). In what follows, I will (...) present empirical findings from two recent studies of mine which shed light on the extent to which participants experienced these positive effects, specific components of these effects, and how they fit into their understanding of their mental disorder and its relationship to their religious identity. In doing so, I will draw on and expand Tasia Scrutton’s Potentially Transformative view (2015a, 2015b, 2020) according to which mental disorders may provide opportunities for spiritual growth. My empirical results align with and help deepen an account according to which mental disorders are potentially spiritually transformative by providing further insight into such instances: specifically, which symptoms and internal and external factors are often involved, as well as which religious beliefs, experiences, and/or practices are often affected. After presenting these results and articulating their relevance for a potentially transformative view of mental disorder, I will then address some potential objections to the theoretical account as well as some limitations of the empirical work, before sketching possible promising directions for future research. (shrink)

Meaning-making plays a central role in how we deal with experiences of suffering, including those due to mental disorder. And for many, religious beliefs, experiences, and practices (hereafter, religious engagement) play a central role in informing this meaning-making. However, a crucial facet of the relationship between experiences of mental disorder and religious engagement remains underexplored—namely the potentially positive effects of mental disorder on religious engagement (e.g. experiences of bipolar disorder increasing sense of God’s presence). In what follows, I will (...) present empirical findings from two recent studies of mine which shed light on the extent to which participants experienced these positive effects, specific components of these effects, and how they fit into their understanding of their mental disorder and its relationship to their religious identity. In doing so, I will draw on and expand Tasia Scrutton’s Potentially Transformative view (2015a, 2015b, 2020) according to which mental disorders may provide opportunities for spiritual growth. My empirical results align with and help deepen an account according to which mental disorders are potentially spiritually transformative by providing further insight into such instances: specifically, which symptoms and internal and external factors are often involved, as well as which religious beliefs, experiences, and/or practices are often affected. After presenting these results and articulating their relevance for a potentially transformative view of mental disorder, I will then address some potential objections to the theoretical account as well as some limitations of the empirical work, before sketching possible promising directions for future research. (shrink)

This paper proposes a synthetic presentation of the proof construction paradigm, which underlies most of the research and development in the so-called “logic programming” area. Two essential aspects of this paradigm are discussed here: true non-determinism and partial information. A new formulation of Focussing, the basic property used to deal with non-determinism in proof construction, is presented. This formulation is then used to introduce a general constraint-based technique capable of dealing with partial information in proof construction. One of (...) the baselines of the paper is to avoid to rely on syntax to describe the key mechanisms of the paradigm. In fact, the bipolar decomposition of formulas captures their main structure, which can then be directly mapped into a sequent system that uses only atoms. This system thus completely “dissolves” the syntax of the formulas and retains only their behavioural content as far as proof construction is concerned. One step further is taken with the so-called “abstract” proofs, which dissolves in a similar way the specific tree-like syntax of the proofs themselves and retains only what is relevant to proof construction. (shrink)

Current research suggests that there are three major groups of psychiatric conditions: the externalizing disorders (characterized by behavioural problems and lack of inhibition); the internalizing disorders (characterized by depression and anxiety) and the psychotic disorders (characterized by hallucinations and delusions, and typically leading to diagnoses such as schizophrenia and bipolar disorder). Abnormal conscious experience is evident in the latter two groups and especially the psychoses. Research shows that depression is associated with selective attention to negative information and a (...) tendency to ruminate (brood about negative lief events). Anxiety is associated with vigilance for threatening information and abnormal meta‐cognitive beliefs (beliefs and worries about the content of consciousness). In the case of the psychotic disorders, research suggests that hallucinations are associated with difficulties in source monitoring (discriminating between self‐generated and external stimuli) and trauma‐linked dissociative states. Some delusional beliefs appear to be associated with anomalous experiences and, although a range of cognitive biases are involved, may arise partly as an attempt to make sense of these experiences. (shrink)

The field of neutrosophic set theory and its applications has been rapidly expanding, particularly since the introduction of the journal "Neutrosophic Sets and Systems." New theories, techniques, and algorithms are being developed at a very high rate. One of the most notable trends in neutrosophic theory is its hybridization with other set theories such as rough set theory, bipolar set theory, soft set theory, hesitant fuzzy set theory, and more. Various hybrid structures like rough neutrosophic sets, neutrosophic soft set, (...) single valued neutrosophic hesitant fuzzy sets, among others, have been proposed in a short period. Neutrosophic sets have proven to be crucial tools across a wide array of fields including data mining, decision making, e-learning, engineering, medical diagnosis, social sciences, and beyond. -/- The third volume in the series “New Trends in Neutrosophic Theories and Applications” focuses on theories, methods, and algorithms for decision making, as well as applications involving neutrosophic information. Some topics introduce new sets such as the Pythagorean neutrosophic vague soft set, the triangular fuzzy penta-partitioned neutrosophic set, interval-valued neutrosophic b-open sets, and interval-valued neutrosophic b-closed sets. Other topics present applications in medical diagnosis, non-preemptive neutrosophic priority queues with uneven services (labeled as NM/NM/1), AHP in an interval neutrosophic set environment, MAGDM in a triangular fuzzy neutrosophic number environment, MAGDM in a pentapartitioned neutrosophic environment, the entropy-ARAS strategy in a single-valued neutrosophic number environment, and the MABAC strategy in a rough neutrosophic set environment. (shrink)

Online support groups are common sources of both health information and social support. To augment existing qualitative understandings of member roles and identities in OSGs, this article presents a corpus-based investigation of shifts in member lexicogrammatical and discourse-semantic choices in a bipolar disorder OSG. In total, 8.4 million words in 57,000 posts were transformed into a structured, grammatically annotated corpus and investigated using systemic functional linguistics as a theoretical framework, focusing on interpersonal and experiential meanings. The findings of (...) mood and transitivity analyses show marked differences between new and veteran members’ language choices over the course of membership in the OSG: particularly, in how veteran members provide advice, and in how new and veteran members ascribe and attribute bipolar disorder to both the self and others. Discussion addresses the affordances and limitations of corpus linguistics and SFL as strategies for providing quantitative support for key claims of earlier research in this field. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Bad, the Ugly, and the Need for a Position by PsychiatryLloyd A. Wells (bio)Keywordsvice, psychiatric education, psychiatry-law interface, medicalizationSadler’s paper is thought provoking and will resonate with many psychiatrists who deal with the interface of vice and psychiatric syndromes. This interface and the dilemmas it poses are perhaps most discussed by residents, who are dealing with the issue for the first time and who often debate what is (...) “psychiatric” about these cases. Many residents have their own informal systems of classifying vice, often with a divide between the criminal population and those perceived as avoiding work and responsibility. These unofficial classifications are usually judgmental and often pejorative, but the residents rarely get much help from faculty in this area. Indeed, many of the faculty have equally judgmental and pejorative views, which are neither systematized nor subject to systematic analysis.By clarifying the importance of the issue of the vice–mental disorder relationship (VMDR) to psychiatry, Sadler may move this topic to one that receives Socratic discourse in our training programs and serious consideration in the training of psychiatrists rather than an idiosyncratic lumping of these patients into the broad category of “patients I don’t like.”Sadler asks for comments in several categories: historical intractability, goals of psychiatry, taxonomy, implications for the criminal justice system, implications for the law, and ethical/political implications.Issues of historical intractability are long standing. In A Tour of the Whole Island of Great Britain, written in the early eighteenth century, Daniel Defoe (1724–1727) describes many asylums, often with the comment, “as it is a madhouse, so is it also a house of correction.” Some of the great public hospitals of the seventeenth and eighteenth centuries were built at least as much to get antisocial and homeless people off the streets as to provide care for the mentally ill. The moral treatment of France and Great Britain, which added much to the practice of psychiatry, clearly had punitive “treatments” for patients with vice-laden behaviors, and this was very explicit in the American moral model of treatment of the late nineteenth century with its obsessive need to prevent patients from masturbating. In the nineteenth and early twentieth centuries, there was great debate about the inclusion of Pritchard’s “moral insanity”—now sanitized into “personality disorders”—into the psychiatric domain, and Kraepelin referred to this group as “enemies of society.”Sadler next asks us to consider the goals of psychiatry in regard to “a proper VMDR.” He wonders [End Page 43] whether a strict medicalization account can be defended. I think it is clear from a large literature and from clinical experience that it cannot be defended —now. But it may become defensible in this century, which will pose enormous challenges to psychiatry, lawmakers, and the courts (vide infra). A strict moralization model is defended by many in society, including some psychiatrists, but has severe limitations and seems illogical. It is hard to make a case (though juries have done so) that, for example, a very delusional young woman with postpartum psychosis who murders her children because of the belief that far worse things than death will happen to them imminently if they live, fits the moralization approach. The Dahmer case is especially instructive. Although there was enormous “vice” (and perhaps “evil”), it is hard to make a case that a sane man would make temples out of the body parts of victims and would attempt to commune with the dead through them.He wonders whether a “mixed” version of medicalization/moralization can be developed and defended. I would argue for both a mixed approach and a “shared” approach. A middle adolescent with bipolar disorder burned his house to the ground. (Fortunately, he and family members were injured but not killed.) He was wildly manic at the time and set the fire because he wanted to prove that he was immortal and totally impervious to flames. He was delusional, extraordinarily impulsive, and completely without judgment, and it would be extraordinarily difficult to exclude the medical frame in any consideration of the vice involved. The vice, indeed, may be more involved in his decision while euthymic to stop taking... (shrink)

Mental and substance use disorders have been identified as the leading cause of global disability, and the global burden of mental illness is concentrated among those experiencing disability due to serious mental illness. Music has been studied as a support for SMIs for decades, with promising results; however, a lack of synthesized evidence has precluded increased uptake of and access to music-based approaches. The purpose of this scoping review was to identify the types and quantity of research at intersections of (...) music and SMIs, document evidentiary gaps and opportunities, and generate recommendations for improving research and practice. Studies were included if they reported on music's utilization in treating or mitigating symptoms related to five SMIs: schizophrenia, bipolar disorder, generalized anxiety disorder, major depressive disorder, or post-traumatic stress disorder. Eight databases were searched; screening resulted in 349 included studies for data extraction. Schizophrenia was the most studied SMI, with bipolar disorder studied the least. Demographics, settings, and activity details were found to be inconsistently and insufficiently reported; however, listening to recorded music emerged as the most common musical activity, and activity details appeared to have been affected by the conditions under study. RCTs were the predominant study design, and 271 unique measures were utilized across 289 primary studies. Over two-thirds of primary studies reported positive results, with 2.8% reporting worse results than the comparator, and 12% producing indeterminate results. A key finding is that evidence synthesis is precluded by insufficient reporting, widely varied outcomes and measures, and intervention complexity; as a result, widespread changes are necessary to reduce heterogeneity, increase replicability and transferability, and improve understandings of mechanisms and causal pathways. To that end, five detailed recommendations are offered to support the sharing and development of information across disciplines. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethics CommentaryMichael Robertson, Senior Research FellowThe French philosopher Michel Foucault once recounted the story of the English King, George III, being restrained by his guards at the direction of his physician Dr. Willis. King George, presumably deranged by a psychotic mania consequent upon porphyria, was incapable of self-rule and his power was usurped by the medical profession in an act of coercion tantamount to treason. This for Foucault was (...) a profound metaphor of psychiatric power.1The plight of Mdm. W yokes the two most emotive issues in psychiatry — involuntary treatment and the administration of ECT. Whilst only utilised at an extremity of clinical practice, both of these are the most misunderstood of actions performed by the psychiatric profession. Yet, in many circumstances, they are life-saving.In essence, we are confronted with a profoundly depressed woman, whose illness is seemingly resistant to first line treatment and poses a serious, credible risk of harm. Most psychiatrists would regard this as somewhat of a psychiatric emergency. We are informed that Mdm. W’s family has transcended any cultural taboos about mental illness and is engaged in her care, has an extensive lived experience of her severe mood disorder and accepts, indeed welcomes, the use of ECT to terminate a severe episode of depression. In the course of a psychotic depression, Mdm. W is suffering profound distress and presents a risk of either suicide or serious medical complications if the episode persists. Despite the minimal discomfort during the actual administration of ECT, Mdm. W’s distress will be compounded by the further restraint needed to prevent from her eating and drinking prior to anaesthesia.It is difficult to know what Mdm. W’s experience of this situation would [End Page 230] be. Through the prism of her disturbed mental state, with its derangements in thinking, cognitive functioning and apprehension of reality, she would likely experience the situation as one of fear or terror; she would likely interpret ECT and the enforced restriction of oral intake prior to the procedure as punitive — further evidence of her “sins”, reinforcing her delusional guilt and nihilism. Yet to speak to Mdm. W in circumstances of euthymia or normal mood, where such derangements no longer occur, might reveal an utterly different perspective on the situation. Like many people with episodic mental illnesses, Mdm. W might, when such a scenario was put to her, consent to future treatment with ECT without equivocation. Indeed, many patients with bipolar disorder formulate advance directives in regard to the specific management of their possible future episodes of illness.If the clinical and legal aspects of this situation are so clear, why is there a sense of a dilemma in the realm of clinical ethics? Beyond the emotive nature of the situation, we see a deeply distressed woman being provided potentially life-saving treatment, which is being denied to her by the profound impairments of insight and judgement consequent upon her illness.In Singapore, such detention and enforced treatment under the Mental Capacity Act (2010) applies to a person with a mental illness or disorder who lacks capacity to make decisions in their own best interests based upon impairment of mind or brain. This would be considered a “capacity” based mental health law. In other jurisdictions, the legal test and evidentiary justification for such care may be predicated upon risk of harm to self or others. In either setting, Mdm. W’s clinical situation provides adequate legal justification for such enforced care.The moral justification of such laws falls into two general categories — the “risk” argument and the “capacity” argument. In mental health legislation, the “harm principle”, as first elaborated in John Stuart Mill’s On Liberty,2 is usually defined in terms of the construct of “risk”. Risk is a term that has multiple meanings in different disciplinary contexts, although all approaches to “risk” attempt to apply knowledge to an area of uncertainty.3 The notion of “risk assessment” is usually considered as the process of categorising individuals by their perceived likelihood of causing serious harm to themselves or harm to others. In the insurance industry, actuarial assessment is a mathematical discipline aimed at computing a probability of adversity... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical CommentaryTor Phern Chern, Associate ConsultantThe case scenario describes a difficult clinical and ethical challenge of a psychiatric patient refusing treatment in the context of a treatment-resistant condition that may be affecting her capacity to refuse treatment.The patient described in the case scenario displayed partial treatment refusal as evidenced by her refusal of ECT and adherence with medication and her voluntary hospital admission. Partial treatment refusal is generally more (...) common than absolute treatment refusal1 and can be sporadic, time-limited, periodic or continuous. It is important for the medical team to clarify which category of treatment refusal this patient’s refusal falls under. These broad categories include the doctor-patient relationship, religion, secondary gain, treatment- or illness-based refusals.2 The proper identification of category of treatment refusal will guide subsequent management.Refusal of treatments may be in response to reality-based transference issues like fear, distrust or pressure from the patient’s family. In this particular case, there is little data about her relationship with her treating psychiatrist, but the lack of a trusting doctor-patient relationship could be a factor for treatment refusal. The treating psychiatrist at the inpatient setting could be different from the patient’s routine outpatient psychiatrist and this could result in the lack of a trusting doctor-patient relationship. The remedy for this would be to develop a trusting relationship between her treating psychiatrist and the patient via understanding the patient’s needs and concerns. A useful adjunct would be to identify someone with whom the patient has a trusting relationship and recruit that person to help develop trust in the doctor-patient relationship. On this point, it is interesting to note that the patient’s family was noted to be highly supportive and influential in previous treatment decisions, agreed [End Page 235] with the treating psychiatrist’s treatment recommendation and yet both the treating psychiatrist and the patient’s family were unable to convince her to accept ECT. One possibility is that the patient may see her family’s support of the treating psychiatrist’s recommendation as one reason to refuse treatment. This possibility warrants deeper explorations of her premorbid underlying cultural and religious beliefs and attitudes towards her family and her perceived role in her community.Religion-based refusals of treatment (e.g. blood transfusions for Jehovah’s Witnesses) are less prominent in psychiatry than in general medicine but may manifest in treatment refusal due to advice from religious leaders on the need for spiritual solutions to the patient’s challenges. Religion-based refusals need to be distinguished from an illness-based refusal but if truly present will require the support of appropriate religious leaders to allow the patient more management options other than spiritual support for her psychiatric disorder. There is no specific information about the patient’s religion and religion-based refusals of ECT are not particularly common so this is unlikely to be a major reason for treatment refusal in this case.Treatment-based refusals of care are related to the specific treatment modality being offered and are often motivated by concerns about the side effects of treatment or past traumas that the treatment elicits. In this particular case, the patient has demonstrated some degree of treatment resistance as evidenced by the relapse of her bipolar disorder despite adherence to medication, and a change in management is certainly warranted. However, a change in medication management may be possible before proceeding to ECT in view of the patient’s acceptance of medication and no clear evidence of violent or disturbed behaviour in the ward. The occasional refusal of food and water is worrying, but if the patient can be coaxed to continue oral nutrition, there is no absolute indication to have ECT for rapid treatment response. Other options that may be acceptable to the patient are to optimise the dosage of current medications, switch medications or add augmenting pharmacological agents before proceeding to ECT. A change in pharmacotherapy must take into account her past treatment response and side effects to individual medications. Psychotherapy may also be considered to augment treatment response before ECT is considered.3Illness-based refusals are the most challenging category and... (shrink)

Teaching business ethics and corporate social responsibility should neither be misconstrued as a plea for moral rectitude, nor as a limited utilitarian recipe for managing public interest issues or stakeholders — as it too often is. Rather, teaching CSR should allow students to recognize corporations as social institutions so that they can gauge their impact on a social scale and better weigh the values that inform them.However, this vision of CSR training has not found many supporters in North American schools (...) of management, even as the demand for ethics education continues to increase. Our paper endeavours to clarify the bipolar origins of the rising concern around ethics in the business world and how demand for more ethical corporate management is impacting demand for ethics education in management programs. We have noted that despite the intensity of demand, there is a great deal of skepticism and strong resistance to the integration of ethics and social responsibility into the education of management students. Therefore, while providing a preliminary assessment of ethical training in North American schools of management, we raise questions regarding current objectives and those that could be pursued. With these factors in mind, teaching choices that inspired the development of a new course in economic and social ethics can be presented and justified. (shrink)

Diagnostic terms in psychiatry like ‘schizophrenia’ and ‘bipolar disorder’ are deeply contested in the professional community, by mental health activists and the public. In this paper, we provide a theoretical framework for considering diagnostic terms as ordinary linguistic expressions and illustrate this approach by a corpus linguistic analysis of ‘schizophrenia.’ Our aim is to show how a focus on language itself can inform current and future debates about psychiatric terminology and provide new insights on relevant processes concerning their actual (...) usage and change over time. We hope that this contributes to enhancing mutual understanding between different discourse spheres and stakeholders. (shrink)

Galvanic vestibular stimulation is a non-invasive method of electrically stimulating the vestibular system. We investigated whether the application of GVS can alter the learning of new functional mobility and manual control tasks and whether learning can be retained following GVS application. In a between-subjects experiment design, 36 healthy subjects performed repeated trials, capturing the learning of either a functional mobility task, navigating an obstacle course on a compliant surface with degraded visual cues or a manual control task, using a joystick (...) to null self-roll tilt against a pseudo-random disturbance while seated in the dark. In the “learning” phase of trials, bilateral, bipolar GVS was applied continuously. The GVS waveform also differed between subjects in each task group: white noisy galvanic vestibular stimulation at 0.3 mA high-level random GVS at 0.7 mA, or with the absence of stimulation. Following the “learning” trials, all subjects were blindly transitioned to sham GVS, upon which they immediately completed another series of trials to assess any aftereffects. In the functional mobility task, we found nGVS significantly improved task learning. Further, improvements in learning the functional mobility task with nGVS were retained, even once the GVS application was stopped. The benefits in learning with nGVS were not observed in the manual control task. High level GVS tended to inhibit learning in both tasks, but not significantly so. Even once the high-level stimulation was stopped, the impaired performance remained. Improvements in learning with nGVS may be due to increased information throughput resulting from stochastic resonance. The benefit of nGVS for functional mobility, but not manual control nulling, may be due to the multisensory, strategic, motor coordination, or spatial awareness aspects of the former task. Learning improvements with nGVS have the potential to benefit individuals who perform functional mobility tasks, such as astronauts, firefighters, high performance athletes, and soldiers. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Deep Listening and Virtuous Friendship:Spiritual Care in the Context of Religious MultiplicityDuane R. BidwellA monk asked Zen master Yunmen: “What is the teaching of the Buddha’s entire lifetime?” Yunmen answered:“An appropriate response.”1In a pivotal scene from the 1988 film A Fish Called Wanda, con artist Wanda Gershwitz is fed up—finally—with her partner, Otto West. When his jealousy and ersatz intellectualism repeatedly jeopardize their attempts to steal $20 million in (...) diamonds, Wanda yells: “Now let me correct you on a few things, okay? Aristotle was not Belgian. The central message of Buddhism is not ‘Every Man for Himself.’ And the London Underground is not a political movement. Those are all mistakes, Otto, I looked them up.”2 It’s a funny moment, of course. But Otto’s (mis)understanding of Gautama’s teaching demonstrates a challenge in translating a spiritual-religious tradition from one cultural setting to another. Too often, and usually without intention, we are like Otto; we colonize and domesticate unfamiliar ideas, assimilating them into our existing worldview instead of experiencing and accommodating their challenging differences. Otto’s facile appropriation of Buddhism confirms rather than confronts his pre-critical, individualistic, and perhaps Darwinist worldview. A Buddhist caregiver might say that Otto was not “listening deeply” to the myriad voices that shaped his perspective.Similar hazards face someone writing about deep listening in relation to religious multiplicity.3 Deep listening, as a caring practice, “belongs” to the emerging field of Buddhist contemplative care,4 in which it has a technical (although perhaps undertheorized) usage richly informed by Buddhist thought and practice. But when I reflect as a pastoral theologian and spiritual caregiver trained in the Christian traditions of cura animarum, the cure or care of souls, deep listening can become unmoored from its origins. Someone marinated in the discourses and practices of Christian care can easily and perhaps unintentionally conflate deep listening with classic Christian [End Page 3] concepts of care such as the ministry of presence, the practice of unconditional positive regard,5 and the giving of oneself to God for the sake of the care seeker. Although I identify as a Buddhist Christian, habitual Christian views shape my thinking the way a canyon or streambed shapes the flow of water; unless I am attentive to the ways that Buddhist thought and practice seek fissures and carve new channels through the sediment of Christian spiritual care, I risk appropriating or erasing the practices that Buddhist caregivers call deep listening.Mindful of these waters, I want to immerse myself and readers in a particular question: In the context of spiritual care, what happens at the confluence of deep listening and a practitioner’s multiple religious voices? In responding to this question I have three aims: to describe deep listening, to provide a theoretical and experiential account of deep listening in the context of religious multiplicity, and to suggest an image from the Pāli canon that can help practitioners engage religious multiplicity in ways that minimize harm, increase compassion, and realize wisdom. A particular moment in spiritually integrative psychotherapy serves as a touchstone for my reflection; thus, I begin where the canyon creates a slender and fast-moving channel for deep listening: psychotherapy with Julie.6violence, karma, and compassionAt twenty-seven years of age, Julie was a soft-spoken, biracial graduate student who radiated mindful presence. She identifies as Asian American, and with her shaved head and tendency to wear dark colors and dramatic scarves, she might seem a typical LA hipster to other passengers on the commuter train she rode to and from our appointments. One year before our psychotherapeutic work, Julie had been beaten and raped by a boyfriend; subsequent thoughts of suicide led to a brief hospitalization. At that time she was assigned diagnoses of bipolar II and post-traumatic stress disorders. Daily, she swallowed a powerful mood stabilizer; monthly, she visited a psychiatrist. The symptoms of bipolar disorder, substance abuse, addiction, schizophrenia, depression, and suicide were present in her extended family. Julie sought counseling because of tension between what she called her “Buddhist identity” and the mental health diagnoses assigned to her. She said she... (shrink)

L'interconnexion globale du monde redistribue beaucoup plus en profondeur qu'on ne voudrait l'admettre les enjeux technolinguistiques et technoculturels. L'Extrême-Orient notamment devient un acteur incontournable tant pour la production de contenus que pour les composants et les machines à communiquer. La montée en puissance de cette production la conduit à devenir un acteur de premier plan dans la recherche et la définition normative des TIC. Cette nouvelle donne peut à moyen terme influer radicalement sur le monopole nord-américain. Si la diversité culturelle (...) des sociétés d'écriture partiellement ou entièrement idéographique s'accommode déjà très mal de cette vision unique, elle ne l'exprimera certainement pas par des discours mais plutôt par des actes notamment en tissant de nouvelles alliances. L'Afrique, le Moyen-Orient, l'Amérique latine, la Francophonie, l'Europe non anglophone et le reste de l'Asie ont sans doute intérêt à s'inscrire dans la redistribution favorisée par l'émergence de cette bipolarité latente, en déployant leur diversité culturelle et en l'instrumentalisant dans les nouveaux paradigmes d'une information structurée, normalisée, et réellement articulée sur la diversité et non plus sur un marché unique, quelquefois dissimulé sous des localisations incertaines.The global interconnectedness of the world redistributes much deeper one would like to admit and techno-technolinguistic issues. The Far East in particular is a key player in both content production for components and communication devices. The rise of this production led to become a leading player in research and the normative definition of ICT. This new medium-term can radically affect the North American monopoly. If the cultural diversity of companies partially or wholly ideographic writing adapts already badly this unique vision, it does not certainly express by words but by actions including forging new alliances. Africa, the Middle East, Latin America, La Francophonie, the non-English speaking Europe and the rest of Asia may have to register interest in the redistribution favored by the emergence of latent bipolarity, deploying their cultural diversity and the instrumentalisation in the new paradigms of structured information, standardized, and actually articulated on diversity rather than on a single market, sometimes hidden under uncertain locations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Can Two Wrongs Make a Right?Toby Williamson (bio)"Service users, carers, and professionals disagree about the nature of mental disorder in startling new revelation!" On first appearances Fulford and Colombo's use of linguistic-analytic and empirical methods to demonstrate this point may not seem as if it is telling those in the mental health world anything that they do not already know. The bipolar/dialectical axis (choose your preferred term depending (...) on your ideological position) with the anti-psychiatry movement at one end and the biogeneticists at the other is both well-known and well-documented. Yet it is precisely that flippancy, and the practical implications that flow from it, that make this work so fundamentally important to the theory, application, and experience of mental health practice at the beginning of the twenty-first century.Discussions about different models of mental disorder usually play themselves out in arguments within services, or between services and service users and informal carers, about the most appropriate approach to take in addressing a service users needs, or in abstract discussions (often over a drink after work) about the nature of mental health and mental health problems. From blood and fur flying in the bull pit, to swallows endlessly chasing their tails high in the sky. Sadly, the results of this all too often are bitter and unresolved conflicts, different parties digging themselves even further into defensive, entrenched positions, and the least powerful (usually service users) suffering the most as a consequence. Both sides believe the other to be wrong yet cannot convince them of this; an example, albeit with slight variation, of two wrongs not making a right. Rarely are the debates grounded in a constructive, creative, and problem-solving approach on a day-to-day basis, partly because hitherto there does not seem to have been either sufficient empirical evidence to base this upon, or the conceptual as well as practical tools with which to grapple with the issues.Generally speaking, mainstream research in mental health has tended to focus on issues such as symptoms and treatment interventions (James and Burns 2002). However, surveys of service users' views still show considerable problems in the way services are received and experienced by users (Rose 2001). Other surveys, together with user-led research, such as Strategies for Living at the Mental Health Foundation, have also shown how the focus of users' concerns maybe very different to that of service providers (Faulkner and Layzell 2000; Nicholls et al, 2003; Repper 2000). Indeed, a piece of research carried out in the 1990s, which would probably still hold true today, showed that service users prioritized practical issues such as personal finance, housing, and social support, whereas professionals saw issues such as treatment and monitoring as being the highest priority (Shepherd, Murray, and Muijen 1995). Combining this, one might well argue that there is fairly clear evidence of the [End Page 159] differences in value bases and models of mental disorder deployed by service users and mental health professionals. However, actually trying to scientifically map this, and taking into account differences between professions, not to mention the views of informal carers, would appear to be a gargantuan task. Yet Fulford and Colombo appear to have very successfully done this in the research supporting this article, as well as the article itself. Their discussion of the concept of mental disorder, and the difficulties of defining it, not only effortlessly demonstrates the theoretical and philosophical problems that lie at the heart of psychiatry and mental health systems, of which Professor Fulford along with others has already written extensively (Dickenson and Fulford 2000), but also should resonate at a very practical level for most people who have been at the providing or receiving end of mental health services. But going beyond this they also provide perhaps the simplest, yet most effective solution—to embrace diversity and find ways of working with it, rather than running shy of it or even worse, attempting to homogenize it. As they say, "the difficulties in use presented by the concept of mental disorder are not a liability, heuristically speaking, but an asset" (Fulford and Colombo 2004, 132).The article is also very timely because... (shrink)

Failings of a categorical systemFor decades, standardized classification systems have attempted to define psychiatric disorders in our mental health care system, with the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association (APA), 2013) and International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10; World Health Organization, 2010) being internationally best-known. One of the major advantages of the DSM must be that it has seriously diminished the international linguistic confusion regarding psychiatric disorders. Since (...) its introduction, it contributed extensively towards one common international language for defining and conceptualizing psychiatric disorders. Strikingly, within the field of psychological testing a similar step forward seems to have not yet been taken. At present, there exists no international standard for the use of psychological tests that takes the definition of a specific symptom as listed in DSM-5 as its starting point, and reliably and validly measures this symptom. Rather, the majority of tests are measuring constructs consisting of a multitude of symptoms. For example, the Beck’s Depression Inventory (Beck et al., 1996) measures core symptoms of depression summing up to a depression score. Accordingly, we believe it is time for a change. The diagnostics of psychiatric disorders, where disorders are defined as nosological units with a single cause, a single organic substrate, and a single time course, has been problematic for centuries. The field of psychiatry has always been ambivalent about its desire to follow a medical model (Blaney, 2015), but afflicted due to its definitions of pathology. The definition of a psychiatric disorder in DSM-5 offers little room for a clear cut pathogenesis and harsh demarcation of syndromes. This is reflected in the DSM-5, where it states: “A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning” (APA, 2013, p.20). An unfortunate and recognized consequence of this definition within the current system is that many symptoms overlap within categories of psychiatric disorders and patients end up diagnosed with many co-morbid disorders.Two fundamental problemsRegardless of new attempts to improve the diagnostics of psychiatric disorders, the DSM-5 represents the status quo. Consequently, the distinction between diagnosis and classification remains substantial and more than a discussion on semantics. We identify two fundamental problems within the current framework. Generally, a psychiatric diagnosis is considered to be descriptive (Hengeveld and Schudel, 2003). The clinician will describe a syndrome (its nature, timespan, and severity) within the framework of a disorder, and often include a differential diagnosis, predisposing protective or vulnerability factors, and provoking or maintaining factors. Within the DSM-5 framework, a similar ‘approach to clinical case formulation’ is taken (APA, 2013, p. 19). Evidently, a descriptive diagnosis has a hypothetical character. It consists of the clinician’s hypothesis and is based on his or hers professional considerations according to the abovementioned factors. Once the clinician has formulated a descriptive diagnosis, it is then complementary ‘translated’ into a DSM-5 classification. Herein lies the problem. For the layman, the existence of this distinction between diagnosis and classification is usually unknown. Preceding treatment, the clinician will give the client a classification of the existing psychiatric problems and the client may attribute more meaning to it than appropriate, thereby fostering the risk of reification. Second, the DSM-5 is a categorical system. Thus, individual disorders are regarded as discrete units – ‘you either have it, or you don’t’. DSM-5 states about this: “(…) scientific evidence places many, if not most, disorders on a spectrum with closely related disorders that have shared symptoms, shared genetic and environmental risk factors (…)”. And “(…) we have come to recognize that the boundaries between disorders are more porous than originally perceived.” (APA, 2013, p. 6). This leads to a fundamental problem. Because the overwhelming majority of psychiatric disorders examined thus far using taxometric methods appear to be dimensional in nature (Haslam, 2003; Widiger and Samuel, 2005), consequently all of their categorizations become artificial and debatable. Even though DSM-5 took a modest step towards a more dimensional approach, its core remains categorical. To illustrate, consider the Borderline Personality Disorder (BPD). This classification consists of nine diagnostic criteria of which a minimum of five need to be present for the diagnosis of BPD. A simple numerical combination algorithm leads to a staggering number of 256 distinct presentations of BPD (Albion et al., 2013). Due to this chameleon-like nature, the disorder’s diagnostic validity becomes questionable. Strikingly, this number is relatively small when compared to other conditions, e.g., there are 636,120 ways to have posttraumatic stress disorder (Galatzer-Levy and Bryant, 2013).DSM-5 does propose an alternative model for personality disorders based on personality functioning and traits (APA, 2013, p. 761), as a possible answer to the problem that most patients fit with multiple co-morbid personality disorders or to the category of personality disorder not otherwise specified. In November 2012, the chair committee of APA decided to move this alternative model to section III of DSM-5 and to sustain the categorical system in section II. A potential solutionDSM-5 and its predecessors have brought about an invaluable improvement regarding the formulation of a common international language for psychiatric disorders. However, the individual disorders fit poorly with its starting point of discrete units and strict boundaries. Van Os (2014) has argued for a better balance between the categorical and personalized aspects of psychiatric disorders. We argue for a two-step approach.Particularly due to the ‘weak boundaries’ between disorders, it might be beneficial to limit ourselves by merely categorizing clients into the main categories of the DSM-5 according to their most prominent symptoms (Van Os, 2014), i.e. their main complaint. In other words, clinicians could first ask themselves whether the symptomatology is concerning a neurodevelopmental disorder, or a bipolar and related disorder, or a depressive disorder, and so on. It will drastically reduce the over 400 classifications in DSM-5 down to 20 categories. Van Os (2014) even argues to combine some of the main categories, reducing this number even further to 15 categories. The advantages of reducing the over 400 classifications are fivefold: 1) a syndrome, being an aggregation of symptoms, creates a false relation between symptoms that are that are already heterogeneous themselves; 2) 15 broad categories are functional: it results into a very heterogeneous group of clients within a category and thus prevents stereotypes and invites further personalizing of complaints; and 3) a dimensional measure of a symptom rather than a syndrome will correspond better with the client regardless of it not providing the complete picture. Focusing on the main complaint will indicate where there is an immediate need for care (Van Os, 2014); 4) it will allow clinicians to recognise subthreshold conditions more easily (Magruder and Calderone, 2000); and 5) it might facilitate the development of clear demarcations between normal and abnormal functioning (Kessler, 2002; Widiger and Samuel, 2005). Please, see also Table 1.This also fits well within scientific advances, as thus far strongest evidence has been found for a distinction between internalizing and externalizing disorders, even superseding these 15 main categories (DSM-5; APA, 2013, p.13, but see Weiss et al., 1998). The second step would concern the personalized aspect, which we argue to define on a level of core symptoms of the specific main category, to be agreed upon later. To assess these core symptoms, the field of psychological testing could develop an internationally applicable instrument to reliably and validly measure each (core) symptom on a dimensional scale. Many of these instruments are readily available and have proven its psychometric properties within scientific research. Elements from these instruments could be easily transformed to work within the new system. Within the field of psychology, this approach could aid development of a common international language to define symptoms, analogous to the field of psychiatry. Importantly, current psychological testing mainly implies the use of self-report measures. This leads to an abundance of auto-amnestic information. To increase the reliability and validity of psychological tests to assess DSM-5 symptoms, it may be important to add two additional information resources. This would entail psychological tests where a next of kin answers questions about the symptom of the client, and psychological tests that include the clinicians’ judgment, such as structured clinician-based interviews. Conversely, we also need to acknowledge the well-known limitations of clinical judgment (e.g., Faust, 1986; Garb, 1998). Advantages of a new frameworkThe changes we suggest have big implications and are not easily implemented in the current framework. Clients may prefer the comfort of a single clear label, similar to what they are used to in other areas of medicine. Health insurance providers and policy makers may argue for single labels as well. Therefore, it would require a lot of explanation from our clinicians to promote a change. Our suggestions for broader categories may not disambiguate the current situation better than the existing approach, but it will promote personalisation of health care. Difficulties in diagnostic reliability will remain in disorders that fall on the boundaries of the taxons, e.g., schizoaffective disorder versus bipolar disorder with psychotic characteristics, which may benefit from further study. There are also some politically tinged questions to keep in mind: How will we finance our health care, and how will we ensure a gradual transition from the current financing system, including clients who already have their labels? What about visitations from insurers and health inspection? How can they control for a good standard of quality in health care when considering the increasing heterogeneity? Nevertheless, we argue that the benefits outweigh the disadvantages. We will see a shift from a categorical to a personalized approach, which will lead to less (self) stigmatizing, less estrangement, and it will challenge reification thinking. DSM-V states that “a reformulation of research goals should also keep DSM-5 central to the development of dimensional approaches to diagnosis that will likely supplement or supersede current categorical approaches to diagnosis in coming years” (APA, 2013, p. 13). Our proposition for psychological testing on symptom level could contribute to this development. Furthermore, this new approach will do more justice to the heterogeneity of symptoms within and outside of classification categories, see also Table 1. Moreover, in this new approach we join forces of expert knowledge from the fields of psychiatry and psychological science. Finally, it offers new and potentially better opportunities to map health care needs. This in turn will lead to a better interface for allocation of appropriate treatment. It will present a clearer picture of when preventative care is preferred over treatment and vice versa. Importantly, health care needs will be more closely attuned to the ‘own story’ of the client.We argue for the national and international psychological associations in Europe and the United States of America to support the idea of a collective approach to develop an internationally standardized psychological testing battery to reliably assess all the core symptoms of the main categories in DSM-5. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hermeneutics, Neuroscience and PsychiatryMichael T. H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM (bio)Hermeneutic practice in mental health has been a theme in Philosophy, Psychiatry, & Psychology (PPP) since its very beginnings. In this essay I argue that hermeneutics, the theory and practice of interpretation, promotes therapeutic interaction between mental health professionals, patients and their family.Why does this patient present in such a way at this particular (...) point in time? The distressing symptoms are there. The changes in behavior are obvious. Impairments of functions are hurting. A mental illness clearly runs in the family. There were early losses of loved ones, physical abuse at home, bullying by peers and self-medication with drugs and alcohol. Three in four adults with a mental illness first experienced that before they turned 24. The brain goes through major reorganization during adolescence and early adulthood. If synaptic pruning went wrong, psychoses emerged. When stresses activated the hypothalamic–pituitary–adrenal axis the elevated cortisol level impacted the size and function of the hippocampus and amygdala in the genetically vulnerable; anxiety, depression, bipolar, and personality disorders developed. The patient needs a voice/language to describe all these experiences and events and the psychiatrist needs a discourse to make sense of them.Eisenberg laments the swings between "brainlessness" and "mindlessness" in psychiatry. Engel argues for a "biopsychosocial" discourse. The major challenge for psychiatry is how to organize clinical information of different nature (categories, dimensions, narratives; i.e., objective vs. subjective, personal vs. interpersonal) into a coherent and comprehensible account for us all. Mental illnesses are not only neuropsychiatric spectrum disorders but also dysfunctions of social relationship and environmental/ecological adaptation. Psychiatry as a clinical neuroscience per se lacks the semantics to address the rich interactions between the physical, psychological, social, cultural, and spiritual in the illness experience of our patients. Explanation in the diagnostic formulation (objective scientific discourse on cause and effect) and understanding in the patient narrative (subjective ordinary everyday discourse on significance and meaning) are irreducible to each other (Wong, 2018). They instead interact with one another to achieve an integrative formulation, not through merging different discourses into a single assertion/monologue but via the dialectic/dialogue of "explaining more in order to understand better," as Ricoeur puts it, and between "the whole and the parts," as Schleiermacher highlights.This "therapeutic hermeneutic circle" of "explanation vs understanding" and "the whole vs the parts" includes symptoms behavior function and life events. It correlates between bio-psychosociocultural-spiritual dimensions/perspectives and does not reduce them to any particular/single [End Page 13] stance. The whole integrates the parts and the parts enrich the whole. It explains but does not explain away. It understands through an articulation of meaning and significance. This discourse is a multilayered (bio-psycho-social-cultural-spiritual) personal narrative that formulates diagnosis and care in a correlative (linking different voices/discourses) and non-reductive (no particular voice/discourse is prejudiced against) manner that is comprehensible to us all (Wong, 2021).PPP will be an excellent forum for discussing clinical hermeneutics in the future. In this digital era of social media and virtual reality, hermeneutics has the never-ending task to tackle the unprecedented challenges to meaning illness and health posed by polarizing discourses.Michael T. H. Wong Michael T.H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM, is Hon Clinical Professor, Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, HKSAR, China. Michael is Chair, Section of Philosophy & Humanities in Psychiatry, World Psychiatric Association. He is an Organizational Partner & International Lead with The Collaborating Centre for Values-Based Practice in Health and Social Care, St Catherine's College Oxford. He is Advisor to the Chinese Health Foundation of Australia.ReferencesWong M. T. H. (2018). Ricoeur and the third discourse of the person: From philosophy and neuroscience to psychiatry and theology. London: Lexington Books. Google ScholarWong, M. T. H. (2021). Values, meanings, hermeneutics and mental health. In Stoyanov, D., Fulford, K. M. W. F., Stanghellini, G., Van Staden, W., & Wong, M. TH. (Eds.), International perspectives in values-based mental health practice: Case studies and commentaries (pp. 341–349... (shrink)

Directional deep brain stimulation contacts provide greater spatial flexibility for therapy than traditional ring-shaped electrodes, but little is known about longitudinal changes of impedance and orientation. We measured monopolar and bipolar impedance of DBS contacts in 31 patients who underwent unilateral subthalamic nucleus deep brain stimulation as part of a randomized study. At different follow-up visits, patients were assigned new stimulation configurations and impedance was measured. Additionally, we measured the orientation of the directional lead during surgery, immediately after surgery, (...) and 1 year later. Here we contrast impedances in directional versus ring contacts with respect to local anatomy, active stimulation contact, and over time. Directional contacts display larger impedances than ring contacts. Impedances generally increase slightly over the first year of therapy, save for a transient decrease immediately post-surgery under general anesthesia during pulse generator placement. Local impedances decrease at active stimulation sites, and contacts in closest proximity to internal capsule display higher impedances than other anatomic sites. DBS leads rotate slightly in the immediate postoperative period but otherwise remain stable over the following year. These data provide useful information for setting clinical stimulation parameters over time. (shrink)