Carole Pateman is one of the leading political theorists writing today. This wide-ranging volume brings together for the first time a selection of her work on democratic theory and feminist criticism of mainstream political theory. The volume includes substantial discussions of problems of democracy, citizenship and the welfare state, including the largely unrecognized difficulties surrounding women's participation. The inclusion of essays from both a mainstream and feminist perspective provides concrete examples of the differences between these two approaches to democracy, to (...) questions of consent and political obligation, and to the relationship between the private and public spheres. This scholarly and highly challenging work will be of interest to students and researchers in political theory, political science, women's studies and sociology. (shrink)

Our concept of disorder is changing. This causes problems for projects of descriptive conceptual analysis. Conceptual change means that a criterion that was necessary for a condition to be a disorder at one time may cease to be necessary a relatively short time later. Nevertheless, some conceptually based claims will be fairly robust. In particular, the claim that no adequate account of disorder can appeal only to biological facts can be maintained for the foreseeable future. This is (...) because our current concept of disorder continues to be laden with ethical and political values in multiple ways. (shrink)

Borderline Personality disorder is a severe personality dysfunction characterized by behavioural features such as impulsivity, identity disturbance, suicidal behaviour, emptiness, and intense and unstable relationships. Approximately 2% of the population are thought to meet the criteria for BPD. The authors of this volume - Anthony Bateman and Peter Fonagy - have developed a psychoanalytically oriented treatment to BPD known as mentalization treatment. With randomised controlled trials having shown this method to be effective, this book presents the first account of (...) mentalization treatment for BPD. The first section gives an overview of BPD, including discussion of nosology, epidemiology, natural history, and psychosocial aetiology. It additionally summarises the present state of our research knowledge about effective psychotherapeutic treatments and use of medication. The second section outlines the authors' theoretical approach and contrasts it with other well known methods, including DBT, CAT, and CBT. In the extensive final section, the authors outline their clinical approach starting with how treatment is organised. A detailed account of the transferable features of the model is provided along with the main strategies and techniques of treatment. Numerous clinical examples are given to illustrate the core techniques and detailed information provided about how to apply aspects of the mentalization based treatment approach in everyday practice. Aimed at mental health professionals, along with counsellors, psychotherapists, and psychoanalysts, the book will be a valuable tool, providing an effective means of treating those suffering from Borderline Personality Disorder. (shrink)

This chapter examines naturalistic accounts of mental disorder: accounts that define disorder as biological dysfunction. There are three such accounts: an eliminativist account ; a forward-looking or goal-contribution account and a backward-looking or evolutionary account. I argue first, and contra Szasz, that biological functions can be attributed at a mental level. But our mental architecture might simultaneously support many different ways of attributing function claims, which might undermine a strong naturalism about mental disorder. Second, I argue that (...) Boorse's forward-looking account of disorder as dysfunction is not value-free. Third, I argue that Wakefield's backward-looking account does not accurately map onto our disorder judgments or medical purposes. I conclude that whilst Boorse's forward-looking account of disorder as dysfunction tracks medical usage better than Wakefield's evolutionary account, a truly value-free account of mental disorder cannot be sustained. (shrink)

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

Competent patients suffering from treatment-resistant depressive disorder should be treated no different in the context of assisted dying to other patients suffering from chronic conditions that render their lives permanently not worth living to them. Jurisdictions that are considering, or that have, decriminalised assisted dying are discriminating unfairly against patients suffering from treatment-resistant depression if they exclude such patients from the class of citizens entitled to receive assistance in dying.

Autism continues to fascinate researchers because it is both debilitating in its effects and complex in its nature and origins. The prevalent theory is that autism is primarily characterised by difficulties in understanding mental concepts, but the contributors to this book present new and compelling arguments for an alternative theory. Their research points strongly to the idea that autism is primarily a disorder of "executive functions", those involved in the control of action and thought. As such, the book provides (...) a new and controversial perspective on this important question. (shrink)

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

Extensive and diverse conceptual work towards developing a definition of ‘mental disorder’ was motivated by the declassification of homosexuality from the Diagnostic and Statistical Manual in 1973. This highly politicised event was understood as a call for psychiatry to provide assurances against further misclassification on the basis of discrimination or socio-political deviance. Today, if a definition of mental disorder fails to exclude homosexuality, then it fails to provide this safeguard against potential abuses and therefore fails to do an (...) important part of the work it was intended to do. We argue that fact-based definitions of mental disorder, relying on scientific theory, fail to offer a robust definition of mental disorder that excludes homosexuality. Definitions of mental disorder based on values do not fare better: these definitions are silent on questions about the diagnostic status of individuals in oppressive societies and over-inclusive of mental or behavioural states that happen to be negatively valued in the individual's social context. We consider the latest definition proposed for the Diagnostic and Statistical Manual-5 (DSM-5) in light of these observations. We argue that definition fails to improve on these earlier deficiencies. Its inclusion in the manual may offer false reassurance against repetition of past misclassifications. We conclude with a provocation that if candidate definitions of mental disorder are unable to exclude homosexuality, it might perhaps be preferable not to attempt a definition at all. (shrink)

Premenstrual dysphoric disorder (PMDD) was recently moved to a full category in the DSM-5 (the latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders). It also appears set for inclusion as a separate disorder in the ICD-11 (the upcoming edition of the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems). This paper argues that PMDD should not be listed in the DSM or the ICD at all, adding to the (...) call to recognise PMDD as a socially constructed disorder. I first present the argument that PMDD pathologises understandable anger/distress and that to do so is potentially dangerous. I then present evidence that PMDD is a culture-bound phenomenon, not a universal one. I also argue that even if (1) medication produces a desired effect, (2) there are biological correlates with premenstrual anger/distress, (3) such anger/distress seems to occur monthly, and (4) women are more likely than men to be diagnosed with affective disorders, none of these factors substantiates that premenstrual anger/distress is caused by a mental disorder. I argue that to assume they do is to ignore the now accepted role that one’s environment and psychology play in illness development, as well as arguments concerning the social construction of mental illness. In doing so, I do not claim that there are no women who experience premenstrual distress or that their distress is not a lived experience. My point is that such distress can be recognised and considered significant without being pathologised and that it is unethical to describe premenstrual anger/distress as a mental disorder. Further, if the credibility of women’s suffering is subject to doubt without a clinical diagnosis, then the way to address this problem is to change societal attitudes towards women’s suffering, not to label women as mentally ill. The paper concludes with some broader implications for women and society of the change in status of PMDD in the DSM-5 as well as a sketch of critical policy suggestions to address these implications. (shrink)

Mental capacity and autonomy are often understood to be normatively neutral? the only values or other norms they may presuppose are those the assessed person does or would accept. We show how mental disorder threatens normatively neutral accounts of autonomy. These accounts produce false positives, particularly in the case of disorders (such as depression, anorexia nervosa and schizophrenia) that affect evaluative abilities. Two normatively neutral strategies for handling autonomy-undermining disorder are explored and rejected: a blanket exclusion of mental (...) disorder, and functional tests requiring consistency, expression of identity, reflective non-alienation or lack of compulsion. Finally, we suggest ways in which substantivist alternatives to neutrality can be made more promising through increased transparency, democratic contestability of conditions for capacity and autonomy, and a historically sensitive caution concerning restrictions of liberty. (shrink)

In _Sentient Flesh _R. A. Judy takes up freedman Tom Windham’s 1937 remark “we should have our liberty 'cause... us is human flesh" as a point of departure for an extended meditation on questions of the human, epistemology, and the historical ways in which the black being is understood. Drawing on numerous fields, from literary theory and musicology, to political theory and phenomenology, as well as Greek and Arabic philosophy, Judy engages literary texts and performative practices such as music and (...) dance that express knowledge and conceptions of humanity appositional to those grounding modern racialized capitalism. Operating as critiques of Western humanism, these practices and modes of being-in-the-world—which he theorizes as “thinking in disorder,” or “poiēsis in black”—foreground the irreducible concomitance of flesh, thinking, and personhood. As Judy demonstrates, recognizing this concomitance is central to finding a way past the destructive force of ontology that still holds us in thrall. Erudite and capacious, _Sentient Flesh _offers a major intervention in the black study of life. (shrink)

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

Although borderline personality disorder can manifest in different ways, instability and dysregulation appear to be key symptomatic features; subjects commonly exhibit affective dysregulation, an unstable sense of self, and instability and their interpersonal relationships. To make sense of such instability, some theorists have argued that this condition centers around disruptions to self-narration and the absence of a unifying life story. If this account is roughly correct, it would support the use of narrative psychotherapy to treat BPD. However, because buried (...) traces of childhood trauma can interfere with the formation of a coherent verbal narrative, psychotherapy on its own may not prove to be sufficient. To devise a more adequate treatment approach, I propose that we draw upon insights from enactivism and the notion of equilibration. Self-equilibration, as I understand it, is an ongoing process whereby an agent regulates and adjusts their sensorimotor and affective habits so that they become more well-integrated, coherent, and responsive to relevant considerations. In cases of BPD, trauma results in engrained, repetitive habits that keep subjects locked into defensive response patterns. Associated disruptions to self-equilibration manifest as affective instability, an unstable sense of self, and unstable interpersonal relationships. This account of BPD highlights the need for a bottom-up, body-oriented treatment approach that more directly targets implicit memories of trauma and helps subjects to modify habitual impulses. I propose that dance-movement therapy (used in conjunction with narrative psychotherapy) can help subjects with BPD to develop self-regulative capacities. (shrink)

Individuals with major depressive disorder (MDD) often ruminate about past experiences, especially those with negative content. These repetitive thoughts may interfere with cognitive processes related to attention and conflict monitoring. However, the temporal nature of these processes as reflected in event-related potentials (ERPs) has not been well-described. We examined behavioral and ERP indices of conflict monitoring during a modified flanker task and the allocation of attention during an attentional blink (AB) task in 33 individuals with MDD and 36 healthy (...) controls, and whether their behavioral performance and ERPs varied with level of rumination. N2 amplitude elicited by the flanker task was significantly reduced in participants with MDD compared to healthy controls. Level of self-reported rumination was also correlated with N2 amplitude. In contrast, P3 amplitude during the AB task was not significantly different between groups, nor was it correlated with rumination. No significant differences were found in behavioral task performance measures between groups or by rumination levels. These findings suggest that rumination in MDD is associated with select deficits in cognitive control, particularly related to conflict monitoring. (shrink)

Due to the severe impairments in intra- and interpersonal interaction and communication, dementia will be hypothesized as a social disorder. Despite the increasing societal relevance of dementia this aspect is surprisingly under-researched in phenomenological philosophy. First, the symptomatic disturbance of the dynamic relationship between orientation, language and memory in Alzheimer’s Dementia (AD) is analyzed with the tools of a phenomenological psychopathology in terms of a lifeworld account. Due to the severe impairments of AD, two therapeutic strategies are discussed: first, (...) the situation-specific strategy, which examines communication resources in the here and now in the face-to-face situation; second, the context-specific strategy, which examines whether habitūs can soften the disruption of contextual knowledge by making it accessible as a resource of meaning that informs and thus orients the here and now. The guiding question of this enquiry is how AD changes the social experience in intra- and interpersonal terms. (shrink)

This paper employs the methodological framework of linguistic analytic philosophy to explore the conceptual issues arising from a study of the different models of disorder implicit in five groups of stakeholders concerned in the community care of people with a diagnosis of long-term schizophrenia. Linguistic analysis, gives a precise fix on the nature of the practical difficulties presented by such models, suggests a powerful heuristic for displaying and comparing models, is the basis of a methodology which is neutral as (...) between users and providers of services, provides an intuitively powerful way of understanding the results of work of this kind, and facilitates the translation of research into practice. (shrink)

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.

While the UK Home Office’s proposals to preventively detain people with what it has called dangerous severe personality disorder have been subjected to debate and criticism the deeply troubling jurisprudential issues in these proposals have not yet entered into public debate in a way that their seriousness deserves.1 It is good that a commentator as well known as Professor Szasz is speaking out on this issue.Professor Szasz focuses upon a crucial question by calling into question the medicalisation of terms (...) like dangerousness and mental illness.2 There is a great temptation for legislators and the public to treat these terms as if they are purely scientific terms and to think of risk assessment as a precise science. I don’t share Professor’s Szasz’s worry about how psychiatry is using these terms but I think there are some important questions about how these concepts function in the public sphere.This issue is important enough to justify the use of some rhetorical claims because such claims can serve to bring out what are neglected and important issues. In raising the following objections I am not attempting to refute the message that is in Szasz’s article or to say that he is not making an important point but rather to attempt to sharpen the issues and to suggest ways that we can respond to Professor Szasz’s challenge.Psychiatry has progressed in a number of ways since Professor Szasz wrote The Myth of Mental Illness.3 The science is much better, we have much better medications, and psychiatrists are acutely aware of the tension between treating their patient and their obligations to the public interest.So when Professor Szasz says: “Psychiatrists offer to relieve the disturbed person of the burden of coping …. (shrink)

According to a popular line of thought, being excluded from interpersonal life is to be exempted from accountability, and vice versa. In ordinary life, this is most often illustrated by the treatment of people with serious psychological disorders. When people are excluded from valuable domains on the basis of their arbitrary characteristics (such as race and sex), they are discriminated against, prevented from receiving the benefits of participation in those domains for morally irrelevant reasons. Exemption from accountability—via exclusion from the (...) interpersonal domain—seems to prevent exempted parties from receiving crucial human goods for morally irrelevant reasons. This chapter discusses two widely deployed ways of trying to ameliorate morally costly disabilities. Both fail to apply viably to various psychopathologies. The solution involves disentangling accountability and interpersonality in a way that also provides insights into our shared human nature. (shrink)

Authenticity has recently emerged as an important issue in discussions of mental disorder. We show, on the basis of personal accounts and empirical studies, that many people with psychological disorders are preoccupied with questions of authenticity. Most of the data considered in this paper are from studies of people with bipolar disorder and anorexia nervosa. We distinguish the various ways in which these people view the relationship between the disorder and their sense of their authentic self. We (...) discuss the principal modern ac-counts of authenticity within the analytic philosophical tradition. We argue that accounts based on autonomous, or wholehearted, endorsement of personal characteris-tics fail to provide an adequate analysis of authenticity in the context of mental disorder. Significant elements of true self accounts of authenticity are required. The concept of authenticity is a basic one that can be of particular value, in the context of self-development, to people with mental disorder and to others experiencing substantial inner conflict. (shrink)

Children with developmental language disorder (DLD) served as a test case for determining the role of extant vocabulary knowledge, endogenous attention, and phonological working memory abilities in cross-situational word learning. First-graders (Mage = 7 years; 3 months), 44 with typical development (TD) and 28 with DLD, completed a cross-situational word-learning task comprised six cycles, followed by retention tests and independent assessments of attention, memory, and vocabulary. Children with DLD scored lower than those with TD on all measures of learning (...) and retention, a performance gap that emerged in the first cycle of the cross-situational protocol and that we attribute to weaknesses in initial encoding. Over cycles, children with DLD learned words at a similar rate as their TD peers but they were less flexible in their strategy use, demonstrating a propose-but-verify approach but never a statistical aggregation approach. Also, they drew upon different mechanisms to support their learning. Attention played a greater role for the children with DLD, whereas extant vocabulary size played a greater role for the children with TD. Children navigate the problem space of cross-situational learning via varied routes. This conclusion is offered as motivation for theorists to capture all learners, not just the most typical ones. (shrink)

Obsessive-compulsive disorder (OCD) symptoms arise when a “natural” feeling of certainty is lost. OCD patients typically attempt to regain this feeling of certainty by means of overly conscious thinking, magical rituals, and repetitive behaviors. Ironically, these OCD symptoms might provide some relief in the short term but lead to a further loss of certainty over the long term. The loss of certainty that is clinically observed in OCD patients has been made more tangible by recent neuroscientific research. It has (...) been shown that the feeling of certainty or uncertainty is likely to be encoded by distinct firing patterns of dopaminergic neurons in the brain’s reward system. As OCD is often associated with dopamine alterations in the striatum, this might very well explain the altered subjective feeling of certainty and its phenomenology in OCD. Additionally, treatment with deep brain stimulation in OCD patients, in which specific brain targets are stimulated directly with implanted electrodes, reveals from direct clinical observations that patients experience primarily more “confidence” as a first sign of improvement. Linking the phenomenological study of the subjective experience of certainty and its implicated mechanisms is an important start toward a neurophenomenology of OCD. (shrink)

The question of 'what is a mental disorder?' is central to the philosophy of psychiatry, and has crucial practical implications for psychiatric nosology. Rather than approaching the problem in terms of abstractions, we review a series of exemplars - real-world examples of problematic cases that emerged during work on and immediately after DSM-5, with the aim of developing practical guidelines for addressing future proposals. We consider cases where (1) there is harm but no clear dysfunction, (2) there is dysfunction (...) but no clear harm, and (3) there is possible dysfunction and/or harm, but this is controversial for various reasons. We found no specific criteria to determine whether future proposals for new entities should be accepted or rejected; any such proposal will need to be assessed on its particular merits, using practical judgment. Nevertheless, several suggestions for the field emerged. First, while harm is useful for defining mental disorder, some proposed entities may require careful consideration of individual v. societal harm, as well as of societal accommodation. Second, while dysfunction is useful for defining mental disorder, the field would benefit from more sharply defined indicators of dysfunction. Third, it would be useful to incorporate evidence of diagnostic validity and clinical utility into the definition of mental disorder, and to further clarify the type and extent of data needed to support such judgments. (shrink)

Disordered wrongdoing describes wrongdoing which is causally connected to a wrongdoer’s mental disorder. A common attitude toward disordered wrongdoing is that the disorder is an “explanation” but not an “excuse” for the wrongdoing. Mental disorders, though, are often thought to be conditions that limit one’s freedom to choose alternative courses of action. These sorts of constraints on freedom are taken in ethical philosophy and democratic judicial systems to strongly reduce one's moral responsibility for a wrong act, if not (...) remove it altogether in many cases. Rather than focusing on this legal interpretation of responsibility, I will focus on the “holistic” ethical context of how we treat disordered wrongdoers: our ethical comportment. I argue that our basic attitude toward disordered wrongdoers, on account of these constraints in freedom, should be compassionate. I explicitly focus on the meaning of compassion as it relates to a moral obligation to be understanding toward the reasons disordered wrongdoers have for their actions. We close out by giving a formal statement of our thesis, as well as a summary of what we have concluded throughout the paper. (shrink)

In this paper, I review the case of Jahi McMath, who was diagnosed with brain death. Nonetheless, ancillary tests performed nine months after the initial brain insult showed conservation of intracranial structures, EEG activity, and autonomic reactivity to the “Mother Talks” stimulus. She was clinically in an unarousable and unresponsive state, without evidence of self-awareness or awareness of the environment. However, the total absence of brainstem reflexes and partial responsiveness rejected the possibility of a coma. Jahi did not have uws (...) because she was not in a wakefulness state and showed partial responsiveness. She could not be classified as a LIS patient either because LIS patients are wakeful and aware, and although quadriplegic, they fully or partially preserve brainstem reflexes, vertical eye movements or blinking, and respire on their own. She was not in an MCS because she did not preserve arousal and preserved awareness only partially. The CRS-R resulted in a very low score, incompatible with MCS patients. mcs patients fully or partially preserve brainstem reflexes and usually breathe on their own. MCS has always been described as a transitional state between a coma and UWS but never reported in a patient with all clinical BD findings. This case does not contradict the concept of BD but brings again the need to use ancillary tests in BD up for discussion. I concluded that Jahi represented a new disorder of consciousness, non-previously described, which I have termed “reponsive unawakefulness syndrome”. (shrink)

Understanding alterations of selfhood (termed self-disorders or self-disturbances) that are considered typical of the schizophrenia-spectrum is a central focus of phenomenological research. The currently most influential way of phenomenologically conceiving self-disorders in schizophrenia is as disorders of the so-called most basic or “minimal self”. In this paper, we first highlight some challenges for the minimal self-view of self-disorders, focusing on (1) problems arising from the supposedly “essential” or “universal” nature of minimal self with respect to phenomenal awareness and (2) the (...) critical implications of alterations of self-experience in schizophrenia that involve heightened or exaggerated sense of self. In the second part, we tentatively explore how a (non-egological) transparency-view of consciousness may offer an alternative way of understanding the experiential abnormalities involved in self-disorders in schizophrenia. We discuss how such a transparency-view (1) may account for loss-of-self experiences; (2) is compatible with the key notion of “hyper-reflexivity”; and (3) can help explain instances of self-disorder involving increased sense of self. In conclusion, we consider some possible advantages of this alternative view for research on self-disorders and clinical approaches. (shrink)

Dissociative identity disorder is a dissociative disorder that gained a significant rise in the past few decades. There has been less than 50 DID cases recorded between 1922 and 1972, while 20,000 cases are recorded by 1990. Therefore, it becomes of great significant to assess the various concepts related to DID to further understand the disorder. The current review has a goal of understanding whether an individual suffering from DID is legally responsible for the committed crime, and (...) whether or not he or she can be considered competent to stand trial. These two questions are to be raised in understanding DID, by first shedding a light on the nature of the disorder and second by examining the past legal case examples. Despite the very nature of the disorder is characterized by dissociative amnesia and the fact that the host personality may have limited or no contact with the alters, there is no consensus within the legal system whether the DID patients should be responsible for their actions. Further to that, courts generally deny the insanity claims for DID suffering patients. In conclusion, more studies in the field are suggested to incorporate primary data into research, as the extensive reliance on secondary data forces us to believe the conclusions that were previously made, and no opportunity to verify those conclusions is present. (shrink)

BackgroundAttention deficit hyperactivity disorder is clinically diagnosed; however, quantitative analysis to statistically analyze the symptom severity of children with ADHD via the measurement of head movement is still in progress. Studies focusing on the cues that may influence the attention of children with ADHD in classroom settings, where children spend a considerable amount of time, are relatively scarce. Virtual reality allows real-life simulation of classroom environments and thus provides an opportunity to test a range of theories in a naturalistic (...) and controlled manner. The objective of this study was to investigate the correlation between participants’ head movements and their reports of inattention and hyperactivity, and to investigate how their head movements are affected by different social cues of different sensory modalities.MethodsThirty-seven children and adolescents with and without ADHD were recruited for this study. All participants were assessed for diagnoses, clinical symptoms, and self-reported symptoms. A virtual reality-continuous performance test was conducted under four conditions: control, no-cue, visual cue, and visual/audio cue. A quantitativecomparison of the participants’ head movements was conducted in three dimensions using a head-mounted display in a VR classroom environment. Task-irrelevant head movements were analyzed separately, considering the dimension of movement needed to perform the VR-CPT.ResultsThe magnitude of head movement, especially task-irrelevant head movement, significantly correlated with the current standard of clinical assessment in the ADHD group. Regarding the four conditions, head movement showed changes according to the complexity of social cues in both the ADHD and healthy control groups.ConclusionChildren and adolescents with ADHD showed decreasing task-irrelevant movements in the presence of social stimuli toward the intended orientation. As a proof-of-concept study, this study preliminarily identifies the potential of VR as a tool to understand and investigate the classroom behavior of children with ADHD in a controlled, systematic manner. (shrink)

. According to Horgans transvaluationist approach, the robustness that characterizes vague terms is inherently incoherent. He analyzes that robustness into two conceptual poles, individualistic and collectivistic, and ascribes the incoherence to the former. However, he claims vague terms remain useful nonetheless, because the collectivistic pole can be realized with a suitable non-classical logic and can quarantine the incoherence arising out of the individualistic pole. I argue, on the contrary, that the nonclassical logic fails to resolve the difficulty and that the (...) incoherence afflicts Horgans collectivistic pole as well, consequently invalidating the entire transvaluationist approach. An alternative, coherent conception of robustness is suggested. (shrink)

Stuttering is a disorder characterized by intermittent loss of volitional control of speech movements. This hypothesis and theory article focuses on the proposal that stuttering may be related to an impairment of the energy supply to neurons. Findings from electroencephalography, brain imaging, genetics, and biochemistry are reviewed: Analyses of the EEG spectra at rest have repeatedly reported reduced power in the beta band, which is compatible with indications of reduced metabolism. Studies of the absolute level of regional cerebral blood (...) flow show conflicting findings, with two studies reporting reduced rCBF in the frontal lobe, and two studies, based on a different method, reporting no group differences. This contradiction has not yet been resolved. The pattern of reduction in the studies reporting reduced rCBF corresponds to the regional pattern of the glycolytic index. High regional GI indicates high reliance on non-oxidative metabolism, i.e., glycolysis. Variants of the gene ARNT2 have been associated with stuttering. This gene is primarily expressed in the brain, with a pattern roughly corresponding to the pattern of regional GI. A central function of the ARNT2 protein is to act as one part of a sensor system indicating low levels of oxygen in brain tissue and to activate appropriate responses, including activation of glycolysis. It has been established that genes related to the functions of the lysosomes are implicated in some cases of stuttering. It is possible that these gene variants result in a reduced peak rate of energy supply to neurons. Lastly, there are indications of interactions between the metabolic system and the dopamine system: for example, it is known that acute hypoxia results in an elevated tonic level of dopamine in the synapses. Will mild chronic limitations of energy supply also result in elevated levels of dopamine? The indications of such interaction effects suggest that the metabolic theory of stuttering should be explored in parallel with the exploration of the dopaminergic theory. (shrink)

This paper begins with some brief intellectual autobiography, recalling my first engagement with philosophy of biology. The substantive part of the paper then focuses on the plurality of possible classifications central to the theses of scientific disunity and metaphysical disorder developed in my early career. After discussing this in terms of biological classification, and introducing the reasons for thinking of classifications as typically value-laden, I discuss two sets of human classifications bearing on normatively vital questions, those around sex and (...) gender and those involved in the distinctions between human races. (shrink)

The philosophy of psychopathology faces a foundational problem: no existing account provides a principled, unified characterisation of what mental disorder is that is neither purely biological, purely normative, nor purely statistical, while remaining applicable across the full range of diagnostic categories and integrating the biological, psychological, and social levels at which mental disorder manifests. Wakefield’s harmful dysfunction analysis correctly identifies dysfunction as central but cannot ground the concept of natural function without circularity. The biopsychosocial model correctly identifies the (...) multi-level character of psychopathology but lacks a unifying structural principle. The DSM and ICD classification systems provide operationally useful symptom clusters but rest on no coherent ontological foundation. -/- This paper proposes that Constraint Theory (CT) — the thesis, established by transcendental argument, that constraint is the ontological primitive constitutive of determinate existence as such — provides that foundation. Mental health, on the CT account, is the condition of appropriate constraint calibration: the maintenance of constraint structures at cognitive, affective, behavioural, and interpersonal levels that are sufficiently determinate to constitute a coherent self and enable goal-directed action, yet sufficiently flexible to respond adaptively to novel constraint environments. Mental disorder is constraint dysregulation: systematic deviation from appropriate constraint calibration in the direction of either excess constraint (rigidity, repetition, foreclosed possibility) or constraint insufficiency (dissolution, disorganisation, loss of coherent selfhood). This account dissolves the demarcation problem by providing a structural criterion for dysfunction that does not depend on contested notions of natural function or statistical norms. It unifies apparently heterogeneous diagnostic categories under a single structural principle. It integrates biological and psychological levels through structural homology rather than reductive identity. It connects naturally to the predictive processing account of psychopathology, interpreting prediction-error dysregulation as a specific form of constraint propagation failure. And it provides a principled foundation for dimensional rather than categorical psychiatric nosology. The paper develops each of these contributions in detail and addresses the principal objections. (shrink)

Funding: Research funded by Canadian Institutes of Health Research, NNF 80045, States of Mind: Emerging Issues in Neuroethics. While there are those who object to the prospective use of propranolol to prevent or treat post-traumatic stress disorder (PTSD), most obstreperous among them the President’s Council on Bioethics, the use of propranolol can be justified for patients with severe PTSD. Propranolol, if effective, will alter the quality of certain memories in the brain. But this is not a serious threat to (...) the self understood in terms of narrative identity. A narrative identity framework acknowledges that memory is always being subtly altered or modified. For severe cases of PTSD propranolol may help victims who don’t respond to any other therapy or therapy combination regain their authentic self-narrative and engage once more in life activities. For those whose symptoms are not so severe the potential risks and side-effects of the drug may outweigh the benefits. Patients and family members should be allowed to decide, in consultation with their physician, whether this drug is appropriate in their case. (shrink)

This paper explores the possibility of defining the concept of mental disorder through conceptual engineering. This method proposes shaping a concept ac- cording to the goals it should serve. I argue that mental disorders should be understood as unitary mental conditions involving harm. Such harm should be assessed against justifiable standards and arise from factors beyond an individual’s ordinary control. The paper examines this proposal through five components of the proposed concept of mental disorder: unity, harm, normative standards, (...) factors beyond control, and mental nature. The aim is to provide a framework that could support clearer diagnosis, ethical justification of treat- ment, and improved theoretical understanding. (shrink)