Editorial introduction to series of papers resulting from a European Commission Project on mental capacity.

Cases of severe and enduring Anorexia Nervosa (SEAN) rightly raise a great deal of concern around assessing capacity to refuse treatment (including artificial feeding). Commentators worry that the Court of Protection in England & Wales strays perilously close to a presumption of incapacity in such cases (Cave and Tan 2017, 16), with some especially bold (one might even say reckless) observers suggesting that the ordinary presumption in favor of capacity ought to be reversed in such cases (Ip 2019). (...) -/- Those of us who worry that such trends and proposals amount to (or at least pose a serious threat of) wrongful discrimination on the grounds of disability nevertheless feel the pull of judging many SEAN service users to be incapacitous with respect to decisions regarding (perhaps amongst other things) treatments involving feeding, artificial or otherwise. But it is difficult to get to grips with exactly what their incapacity consists in. Many such service users seem able to understand, retain, use and weigh information, and express a decision (i.e. they seem, prima facie, to satisfy the ‘MacArthur’ criteria). At the very least, they do not, generally. (shrink)

Mackenzie Graham has made an important contribution to the literature on decisionmaking for patients with disorders of consciousness. He argues, and I agree, that decisions for unresponsive patients who are known to retain some degree of covert awareness ought to focus on current interests, since such patients likely retain the kinds of mental capacities that in ordinary life command our current respect and attention. If he is right, then it is not appropriate to make decisions for such patients by (...) appealing to the values they had in the past, either the values expressed in an advance directive or the values recalled by a surrogate. There are two things I wish to add to the discussion. My first point is somewhat critical, for although I agree with his general conclusion about how, ideally, such decisions should be approached, I remain skeptical about whether his conclusion offers decisionmakers real practical help. The problem with these cases is that the evidence we have about the nature of the patient’s current interests is minimal or nonexistent. However—and this is important—Graham’s conclusion will be extremely relevant if in the future, our ability to communicate with such patients improves, as I hope it will. This leads to my second point. Graham’s conclusion illustrates a more general problem with our standard framework for decisionmaking for previously competent patients, a problem that has not been adequately recognized. So, in what follows, I explain the problem I see and offer some brief thoughts about solutions. (shrink)

This article draws upon the civic republican tradition to offer new conceptual resources for the normative assessment of mental capacity law. The republican conception of liberty as non-domination is used to identify ways in which such laws generate arbitrary power that can underpin relationships of servility and insecurity. It also shows how non-domination provides a basis for critiquing legal tests of decision-making that rely upon ‘diagnostic’ rather than ‘functional’ criteria. In response, two main civic republican strategies are recommended (...) for securing freedom in the context of the legal regulation of psychological disability: self-authorisation techniques and participatory shaping of power. The result is a series of proposals for the reform of decisional capacity law, including a transition towards purely functional assessment of decisional capacity, surer legal footing for advanced care planning, and greater control over the design and administration of decision-making capacity laws by those with psychological disabilities. (shrink)

It is a characteristic feature of our mental make-up that the same perceptual input situation can simultaneously elicit conflicting mental perspectives. This ability pervades our perceptual and cognitive domains. Striking examples are the dual character of pictures in picture perception, pretend play, or the ability to employ metaphors and allegories. I will argue that traditional approaches, beyond being inadequate on principle grounds, are theoretically ill-equipped to deal with these achievements. I will then outline a theoretical perspective that has (...) been emerging from a theoretical convergence of perceptual psychology, ethology, linguistics, and developmental research. On the basis of this framework, I will argue that corresponding achievements are brought forth by a specific type of functional architecture whose core features are: (i) a perceptual system that is biologically furnished with a rich system of conceptual forms, (ii) a triggering relation between the sensory input and conceptual forms by which the same sensory input can be exploited by different types or systems of conceptual forms, and (iii) computational principles for handling semantically underspecified conceptual forms. Characteristic features of the proposed theoretical framework will be pointed out using the Heider-Simmel phenomenon as an example. (shrink)

It is well documented that people with moderate-to-severe traumatic brain injury (TBI) can undergo personality changes, including becoming more impulsive in terms of how they behave. Legal guidance and academic commentary support the view that impulsiveness can render someone decisionally incompetent as defined by English and Welsh law. However, impulsiveness is a trait found within the healthy population. Arguably, impulsiveness is also a trait that gives rise to behaviours that should normally be tolerated even when they cause harm to the (...) person enacting the behaviours. The purpose of this paper is to show why both of these considerations present as significant challenges to the law in England and Wales. (shrink)

In this Introduction, I situate the underlying project “Autonomy and Mental Disorder” with reference to current debates on autonomy in moral and political philosophy, and the philosophy of action. I then offer an overview of the individual contributions. More specifically, I begin by identifying three points of convergence in the debates at issue, stating that autonomy is: 1) a fundamentally liberal concept; 2) an agency concept and; 3) incompatible with (severe) mental disorder. Next, I explore, in the context (...) of decisional capacity assessments, the difficulties to reconcile 1) and 2) with 3) which they at the same time seem to imply. Having clarified the centrality of a cogent notion of mental disorder for addressing these difficulties, I comment on three promising lines of inquiry about the nature and scope of autonomy that emerge from the following chapters. (shrink)

While many aspects of cognition have been shown to be shared between humans and non-human animals, there remains controversy regarding whether the capacity to mentally time travel is a uniquely human one. In this paper, we argue that there are four ways of representing when some event happened: four kinds of temporal representation. Distinguishing these four kinds of temporal representation has five benefits. First, it puts us in a position to determine the particular benefits these distinct temporal representations afford (...) an organism. Second, it provides the conceptual resources to foster a discussion about which of these representations is necessary for an organism to count as having the capacity to mentally time travel. Third, it enables us to distinguish stricter from more liberal views of mental time travel that differ regarding which kind(s) of temporal representation is taken to be necessary for mental time travel. Fourth, it allows us to determine the benefits of taking a stricter or more liberal view of mental time travel. Finally, it ensures that disagreement about whether some species can mentally time travel is not merely the product of unrecognised disagreement about which temporal representation is necessary for mental time travel. We argue for a more liberal view, on the grounds that it allows us to view mental time travel as an evolutionarily continuous phenomenon, and to recognise that differences in the ways that organisms mentally time travel might reflect different temporal representations, or combinations thereof, that they employ. Our ultimate aim, however, is to create the conceptual framework for further discussion regarding what sorts of temporal representations are required for mental time travel. (shrink)

Despite their importance in the history of philosophy and in particular in the work of Aristotle and Kant, mental capacities have been neglected in recent philosophical work. By contrast, the notion of a capacity is deeply entrenched in psychology and the brain sciences. Driven by the idea that a cognitive system has the capacity it does in virtue of its internal components and their organization, it is standard to appeal to capacities in cognitive psychology. The main benefit (...) of invoking capacities in an account of the mind is that it allows for an elegant counterfactual analysis of mental states: it allows us to analyze mental states on three distinct yet interrelated levels. A first level of analysis pertains to the function of mental capacities. A second level of analysis pertains to the mental capacities employed, irrespective of the context in which they are employed. A third level of analysis pertains to the mental capacities employed, taking into account the context in which they are employed. This paper develops an account of perceptual capacities. This account involves an analysis of their function, their individuation and possession conditions, the relation between perceptual capacities and their employment, as well as their informational and neural base conditions. (shrink)

It is usually appropriate for adults to make significant decisions, such as about what kinds of medical treatment to undergo, for themselves. But sometimes impairments are suffered - either temporary or permanent - which render an individual unable to make such decisions. The Mental Capacity Act 2005 sets out the conditions under which it is appropriate to regard an individual as lacking the capacity to make a particular decision (and when provisions should be made for a decision (...) on their behalf). -/- To what extent does having capacity require the endorsement of certain values? Drawing on Owens et al (2009), I assess the extent to which understanding relevant information and weighing it in coming to a decision requires certain evaluative commitments. With reference to literature on anorexia nervosa and decisions informed by religious beliefs, I argue that it is difficult to avoid the conclusion that the conditions for capacity are value-laden, and that if this is so it is important to open discussion about which patterns of distorted valuing undermine capacity, and why. (shrink)

Among the cognitive capacities of evolved creatures is the capacity to represent. Theories in cognitive neuroscience typically explain our manifest representational capacities by positing internal representations, but there is little agreement about how these representations function, especially with the relatively recent proliferation of connectionist, dynamical, embodied, and enactive approaches to cognition. In this talk I sketch an account of the nature and function of representation in cognitive neuroscience that couples a realist construal of representational vehicles with a pragmatic account (...) of mental content. I call the resulting package a deflationary account of mental representation and I argue that it avoids the problems that afflict competing accounts. (shrink)

The problem of amodal perception is the problem of how we represent features of perceived objects that are occluded or otherwise hidden from us. Bence Nanay (2010) has recently proposed that we amodally perceive an object's occluded features by imaginatively projecting them into the relevant regions of visual egocentric space. In this paper, I argue that amodal perception is not a single, unitary capacity. Drawing appropriate distinctions reveals amodal perception to be characterized not only by mental imagery, as (...) Nanay suggests, but also by genuinely visual representations as well as beliefs. I conclude with some brief remarks on the role of object-directed bodily action in conferring a sense of unseen presence on an object's occluded features. (shrink)

An ongoing philosophical discussion concerns how various types of mental states fall within broad representational genera—for example, whether perceptual states are “iconic” or “sentential,” “analog” or “digital,” and so on. Here, I examine the grounds for making much more specific claims about how mental states are structured from constituent parts. For example, the state I am in when I perceive the shape of a mountain ridge may have as constituent parts my representations of the shapes of each peak (...) and saddle of the ridge. More specific structural claims of this sort are a guide to how mental states fall within broader representational kinds. Moreover, these claims have significant implications of their own about semantic, functional, and epistemic features of our mental lives. But what are the conditions on a mental state's having one type of constituent structure rather than another? Drawing on explanatory strategies in vision science, I argue that, other things being equal, the constituent structure of a mental state determines what I call its distributional properties—namely, how mental states of that type can, cannot, or must co‐occur with other mental states in a given system. Distributional properties depend critically on and are informative about the underlying structures of mental states, they abstract in important ways from aspects of how mental states are processed, and they can yield significant insights into the variegation of psychological capacities. (shrink)

Aryeh Goldberg compellingly argues for a Narrative Coherence Standard (NCS) to bolster existing methods of assessing patients' mental capacity. But his account fails to distinguish between the cognitive abilities of children and adults; consequently, worries may be raised about the scope of the NCS, in particular when we consider child patients. In this article, I argue the NCS cannot plausibly apply to children. Since children's self-conception does not arrive fully formed — but rather is a product of both (...) incomplete cognitive development and socializing factors — I claim children may not possess a sufficiently intimate knowledge of self, and therefore a sufficiently coherent sense of self, as Goldberg demands. Therefore, we should either revise the NCS to accommodate children, adopt an incremental view of consent, or revert to the relevant form of the MacArthur competence criteria to establish children’s capacity to consent. (shrink)

Until recently, philosophers debating the rationality of time-biases have supposed that people exhibit a first-person hedonic bias toward the future, but that their non-hedonic and third-person preferences are time-neutral. Recent empirical work, however, suggests that our preferences are more nuanced. First, there is evidence that our third-person preferences exhibit time-neutrality only when the individual with respect to whom we have preferences—the preference target—is a random stranger about whom we know nothing; given access to some information about the preference target, third-person (...) preferences mirror first-person preferences. As a result, the simulation hypothesis has been proposed, according to which third-person preferences will mirror first-person preferences when we can simulate the mental states of the preference target. Second, there is evidence that we prefer negative hedonic events to be in our past (we are first-person negatively hedonically future-biased) only when we view future events as fixed and in no way under our control. By contrast, when we perceive it to be within our power to mitigate the badness of future events, we are first-person negatively hedonically past-biased. This is the mitigation hypothesis. We distinguish two versions of the mitigation hypothesis, the squirrelling version and the heuristic version. We ran a study which tested the simulation hypothesis, and which aimed to determine whether the squirrelling or the heuristic version of the mitigation hypothesis enjoys more empirical support. We found support for the heuristic version of the hypothesis, but no support for the squirrelling version. (shrink)

Factive mental states, such as knowing or being aware, can only link an agent to the truth; by contrast, nonfactive states, such as believing or thinking, can link an agent to either truths or falsehoods. Researchers of mental state attribution often draw a sharp line between the capacity to attribute accurate states of mind and the capacity to attribute inaccurate or “reality-incongruent” states of mind, such as false belief. This article argues that the contrast that really (...) matters for mental state attribution does not divide accurate from inaccurate states, but factive from nonfactive ones. (shrink)

We argue that the most ambitious version of the mental files theory of singular thought, according to which mental files are a wide-ranging psychological natural kind underlying all and only singular thinking, is unsupported by the available psychological data. Nevertheless, critical examination of the theory from a psychological perspective opens up promising avenues for research, especially concerning the relationship between our perceptual capacity to individuate and track basic individuals, and our higher level capacities for singular thought.

I argue that perceptual consciousness is constituted by a mental activity. The mental activity in question is the activity of employing perceptual capacities, such as discriminatory, selective capacities. This is a radical view, but I hope to make it plausible. In arguing for this mental activist view, I reject orthodox views on which perceptual consciousness is analyzed in terms of peculiar entities, such as, phenomenal properties, external mind-independent properties, propositions, sense-data, qualia, or intentional objects.

It is widely accepted among medical ethicists that competence is a necessary condition for informed consent. In this view, if a patient is incompetent to make a particular treatment decision, the decision must be based on an advance directive or made by a substitute decision-maker on behalf of the patient. We call this the competence model. According to a recent report of the United Nations (UN) High Commissioner for Human Rights, article 12 of the UN Convention on the Rights of (...) Persons with Disabilities (CRPD) presents a wholesale rejection of the competence model. The High Commissioner here adopts the interpretation of article 12 proposed by the Committee on the Rights of Persons with Disabilities. On this interpretation, CRPD article 12 renders it impermissible to deny persons with mental disabilities the right to make treatment decisions on the basis of impaired decision-making capacity and demands the replacement of all regimes of substitute decision-making by supported decision-making. In this paper, we explicate six adverse consequences of CRPD article 12 for persons with mental disabilities and propose an alternative way forward. The proposed model combines the strengths of the competence model and supported decision-making. (shrink)

Could there be a cognitive zombie – that is, a creature with the capacity for cognition, but no capacity for consciousness? Searle argues that there cannot be a cognitive zombie because there cannot be an intentional zombie: on this view, there is a connection between consciousness and cognition that is derived from a more fundamental connection between consciousness and intentionality. However, I argue that there are good empirical reasons for rejecting the proposed connection between consciousness and intentionality. Instead, (...) I argue that there is a connection between consciousness and cognition that is derived from a more fundamental connection between consciousness and rationality. On this view, there cannot be a cognitive zombie because there cannot be a rational zombie. (shrink)

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

Many philosophers and psychologists have attempted to elucidate the nature of mental representation by appealing to notions like isomorphism or abstract structural resemblance. The ‘structural representations’ that these theorists champion are said to count as representations by virtue of functioning as internal models of distal systems. In his 2007 book, Representation Reconsidered, William Ramsey endorses the structural conception of mental representation, but uses it to develop a novel argument against representationalism, the widespread view that cognition essentially involves the (...) manipulation of mental representations. Ramsey argues that although theories within the ‘classical’ tradition of cognitive science once posited structural representations, these theories are being superseded by newer theories, within the tradition of connectionism and cognitive neuroscience, which rarely if ever appeal to structural representations. Instead, these theories seem to be explaining cognition by invoking so-called ‘receptor representations’, which, Ramsey claims, aren’t genuine representations at all—despite being called representations, these mechanisms function more as triggers or causal relays than as genuine stand-ins for distal systems. I argue that when the notions of structural and receptor representation are properly explicated, there turns out to be no distinction between them. There only appears to be a distinction between receptor and structural representations because the latter are tacitly conflated with the ‘mental models’ ostensibly involved in offline cognitive processes such as episodic memory and mental imagery. While structural representations might count as genuine representations, they aren’t distinctively mental representations, for they can be found in all sorts of non-intentional systems such as plants. Thus to explain the kinds of offline cognitive capacities that have motivated talk of mental models, we must develop richer conceptions of mental representation than those provided by the notions of structural and receptor representation. (shrink)

Episodic memory has a distinctive phenomenology. One way to capture what is distinctive about it is by using the notion of mental time travel: When we remember some fact episodically, we mentally travel to the moment at which we experienced it in the past. This way of distinguishing episodic memory from semantic memory calls for an explanation of what the experience of mental time travel is. In this paper, I suggest that a certain view about the content of (...) memories can shed some light on the experience of mental time travel. This is the view that, when a subject remembers some fact episodically, their memory represents itself as coming from a perception of that fact. I propose that the experience of mental time travel in memory is the experience of representing one of the elements in this complex content, namely, the past perceptual experience of the remembered fact. In defence of this proposal, I offer two considerations. Firstly, the proposal is consistent with the idea that memories enjoy a temporal phenomenology (specifically, a feeling of pastness). Secondly, the proposal is consistent with the possibility that some of our other cognitive capacities might yield an experience of mental time travel which can be oriented towards the future. I argue that the received conception of mental time travel is in tension with those two ideas. (shrink)

It is not uncommon for people to hold bizarre views. Sometimes, these views appear before the courts in mental capacity cases. Judges must then decide if the views are so bizarre that they constitute evidence of incapacity or, instead, if those views are the everyday sort that do not constitute such evidence. The idea behind the distinction is that the everyday sort can be false but, in some important sense, not that unreasonable. But what should tip the balance (...) of reasons for a view to count as severely unreasonable rather than merely so? It turns out that capacity law is unable to provide a principled answer to this question because it lacks a standard to parse beliefs. This paper offers such a standard, focussing on the ability to reason, or the ‘use and weigh’ criterion, which features in most capacity statutes. The standard takes the form of a threshold with four necessary conditions. The main idea is that when a person's belief satisfies those conditions, it counts as evidence of an inability to reason. The standard's objective is to displace the various unarticulated conceptions of reasonableness which judges are currently compelled to use to determine questions of reasoning ability. (shrink)

A crucial question in relation to support designed to enable the legal capacity of people with mental disabilities concerns when support constitutes undue influence. This article addresses this question in order to facilitate the development of law and policy in England and Wales, by providing a normative analysis of the different approaches to undue influence across decisions about property, contracts, health, finances, and accommodation. These are all potential contexts for supporting legal capacity, and, in doing so, the (...) article compares approaches to undue influence that are rarely considered together. -/- Drawing on the UN Convention on the Rights of Persons with Disabilities, third sector and public body documents, and law in England and Wales, the analysis identifies six models that conceptualise undue influence in terms of: modes of influence; an overborne will; an inference from the situation; an overborne will understood as a mental incapacity; an overborne will in connection with vulnerability; and impaired discursive control. This final approach is a novel proposal for understanding undue influence. The analysis highlights key policy-relevant issues that distinguish the models, and generates a deliberative framework for navigating them, with the ‘overborne will’, ‘inference-based’, and ‘discursive control’ models identified as potentially fitting for the support context. (shrink)

This paper develops a mechanistic account of basic mental agency by identifying similarities between two of its major exemplars: endogenous attention and imagination. Five key similarities are identified: i) that both capacities are driven by currently prioritised goals that are either person-level or apt to become person-level. ii) that both deliver their outputs to the working memory iii) that both range across all and only conceptual contents; iv) that both proceed under the guidance of norms and/or habits; and v) (...) that both directly activate rather than inhibit content. These five features are consolidated by proposing that basic mental agency is essentially the power to call for conceptual content and hold it within our working memories. (shrink)

In a recent paper, Gray, Knickman, and Wegner present three experiments which they take to show that people judge patients in a persistent vegetative state to have less mental capacity than the dead. They explain this result by claiming that people have implicit dualist or afterlife beliefs. This essay critically evaluates their experimental findings and their proposed explanation. We argue first that the experiments do not support the conclusion that people intuitively think PVS patients have less mentality than (...) the dead. And second, we provide an alternative explanation of our ascriptions of mentality to the dead and PVS patients, one which turns on Epicurean considerations about the nature of death. (shrink)

Introduction: representationalismMost theorists of cognition endorse some version of representationalism, which I will understand as the view that the human mind is an information-using system, and that human cognitive capacities are representational capacities. Of course, notions such as ‘representation’ and ‘information-using’ are terms of art that require explication. As a first pass, representations are “mediating states of an intelligent system that carry information” (Markman and Dietrich 2001, p. 471). They have two important features: (1) they are physically realized, and so (...) have causal powers; (2) they are intentional, in other words, they have meaning or representational content. This presumes a distinction between a representational vehicle—a physical state or structure that has causal powers and is responsible for producing behavior—and its content. Consider the following characterization of a device that computes the addition functionReaders will recognize the similarity t. (shrink)

This article investigates the ability of mental incapacity tests to account for problems of control, through a study of the approach to alcohol dependence and a comparison with the approach to anorexia nervosa, in England and Wales. The focus is on two areas of law where questions of legal and mental capacity arise for people who are alcohol dependent: decisions about treatment for alcohol dependence and diminished responsibility for a killing. The mental incapacity tests used in (...) these legal contexts are importantly different—one involves a ‘cognitive’ test, while the other includes an explicit impaired-control limb—and the comparison provides insight into a longstanding debate about the virtues of one type of test over the other. It is shown that both kinds of test can take control problems into account, but also that both can be interpreted in narrow and wide ways that significantly influence the outcome of the assessment. It is therefore argued that to a large extent, it is not the kind of mental incapacity test that matters, but how the test is interpreted. It is further proposed that value judgements are playing an unrecognised and inappropriate role in shaping this interpretation. This raises concerns about the current approach to assessing the impact of alcohol dependency on the capacity to make decisions about alcohol use or treatment, as well as broader concerns about flexibility within incapacity tests. (shrink)

Many philosophers consider that memory is just a passive information retention and retrieval capacity. Some information and experiences are encoded, stored, and subsequently retrieved in a passive way, without any control or intervention on the subject’s part. In this paper, we will defend an active account of memory according to which remembering is a mental action and not merely a passive mental event. According to the reconstructive account, memory is an imaginative reconstruction of past experience. A key (...) feature of the reconstructive account is that given the imperfect character of memory outputs, some kind of control is needed. Metacognition is the control of mental processes and dispositions. Drawing from recent work on the normativity of automaticity and automatic control, we distinguish two kinds of metacognitive control: top-down, reflective control, on the one hand, and automatic, intuitive, feeling-based control on the other. Thus, we propose that whenever the mental process of remembering is controlled by means of intuitive or feeling-based metacognitive processes, it is an action. (shrink)

In this commentary on Marino and Merskin's "Intelligence, complexity, and individuality in sheep", I argue that their literature review provides further evidence of the fundamental theoretical shift in psychology towards a non-anthropocentric psychological taxonomy, in which cognitive capacities are classified in a structure that provides an overall understanding of the place of mind (including human minds) throughout nature.

This chapter examines the mechanistic psychology of Descartes in the _Passions_, while also drawing on the _Treatise on Man_. It develops the idea of a Cartesian “psychology” that relies on purely bodily mechanisms by showing that he explained some behaviorally appropriate responses through bodily mechanisms alone and that he envisioned the tailoring of such responses to environmental circumstances through a purely corporeal “memory.” An animal’s adjustment of behavior as caused by recurring patterns of sensory stimulation falls under the notion of (...) “learning,” behavioristically conceived. Indeed, Descartes’s animal-machine hypothesis may well be a distant ancestor to Watsonian behaviorism, via T. H. Huxley (1884). The final two sections of the chapter take stock of what psychological capacities Descartes ascribed to mind, body, or both, and consider those capacities that we might now plausibly construe as being explicable by nonmentalistic mechanisms as opposed to those that at present remain unreducedly mentalistic. -/- This chapter derives from a lecture delivered at the University of King's College (Halifax, Nova Scotia) as part of a year-long series on Descartes and the Modern. The lecture series was co-sponsored by the programs in History of Science and Early Modern and Contemporary Studies. (shrink)

Any ethical inquiry into addiction research is faced with the preliminary challenge that the term “addiction” is itself a matter of scientific and ethical controversy. Accordingly, the chapter begins with a brief history of the term “addiction.” The chapter then turns to ethical issues surrounding consent and decision-making capacity viewed from the perspective of the current opioid epidemic. One concern is the neglect of the cyclical nature of addiction and the implications of this for the validity of current psychometric (...) instruments used to evaluate decision-making capacity in addiction. Another is the apparent discrepancy—possibly an ethical double standard—in the manner in which society and addiction researchers view the mental capacity and vulnerability of individuals who suffer from severe addiction. On the whole, the main ethical concern of the chapter is the puzzling lack of clinical research on decision-making capacity in research on addiction. (shrink)

Schellenberg sheds light on the recent debate between Dreyfus and McDowell about the role and nature of concepts in perceptual experience, by considering the following trilemma: (C1) Non-rational animals and humans can be in mental states with the same kind of content when they are perceptually related to the very same environment. (C2) Non-rational animals do not possess concepts. (C3) Content is constituted by modes of presentations and is, thus, conceptually structured. She discusses reasons for accepting and rejecting each (...) of the three claims. By developing a substantive notion of modes of presentation as constituting nonconceptual content, she argues that the trilemma is best resolved by giving up (C3). In doing so, she discusses the nature of mental content and its relation to bodily skills and conceptual capacities as well as the notion of conceptual and nonconceptual content. (shrink)

Recently, mental strength education requires to change in a way that establishes a military value system suitable for a liberal democracy while facing the need to strengthen mental strength in response to unpredictable security situations. The key to fulfilling these twofold objectives lies in the fact that there is a positive correlation between the enhancement of a soldier’s democratic awareness and intangible force. Therefore, it is of great importance to emphasize the concept of ‘citizen in uniform’ as one (...) of the central military values. However, this concept has one problem before its use in military mental strength in which the orders of the military status and the orders of the civic seem heterogeneous and even conflicting. This study aims to dissolve the internal tension of this concept through a new philosophical interpretation of citizens in uniform, freedom, people and state, thereby providing the foundation for establishing for establishing new military values and enhancement of mental force. To this end, it examines the explanation of the current curriculum regarding these concepts first and diagnoses its several problems (II). The current curriculum presents a brief explanation of the compatibility of civil rights and military obligations but does not resolve the conflict between the two. A new understanding of them is possible by introducing Hegelian insights in Philosophy of Rights (III). From Hegel's point of view, freedom is not the mere absence of coercion but a capacity for self-determination. Freedom is difficult to realize wholly at the level of an isolated individual, and it calls for an ethical community to give it a specific form. A state that is the best entity in humanity is the supreme unit that defines individual freedom and identity. Then it naturally derives that national defense is one of the supreme missions directly related to the freedom and identity of its people. A re-description of the contents of the curriculum based on these insights can conceptually resolve the aforementioned problem and even strengthen its arguments (IV). The state and the people are in a more essential correlation than previously depicted, and liberal democratic values such as freedom, human rights and welfare are proved as constitutive of a state itself. The superiority of liberal democracy, which the current textbook attempts to prove, also becomes transparent. Finally, military duties do not conceptually conflict with civil freedom but are considered as a form of it. (shrink)

In a recent paper, Gray, Knickman, and Wegner present three experiments which they take to show that people perceive patients in a persistent vegetative state to have less mentality than the dead. Following on from Gomes and Parrott, we provide evidence to show that participants' responses in the initial experiments are an artifact of the questions posed. Results from two experiments show that, once the questions have been clarified, people do not ascribe more mental capacity to the dead (...) than to PVS patients. There is no reason to think that people perceive PVS patients as more dead than dead. (shrink)

In this article, we describe a project in which philosophy, in combination with methods drawn from mental modeling, was used to structure dialogue among stakeholders in a region-scale climate adaptation process. The case study we discuss synthesizes the Toolbox dialogue method, a philosophically grounded approach to enhancing communication and collaboration in complex research and practice, with a mental modeling approach rooted in risk analysis, assessment, and communication to structure conversations among non-academic stakeholders who have a common interest in (...) planning for a sustainable future. We begin by describing the background of this project, including details about climate resiliency efforts in West Michigan and the Toolbox dialogue method, which was extended in this project from academic research into community organization involving the West Michigan Climate Resiliency Framework Initiative. This extension involved application of several methods, which are the focus of the Methods section. We then present and discuss preliminary results that suggest the potential for philosophical dialogue to enhance mutual understanding in complex community initiatives that focus on sustainable responses to climate change. Overall, the article supplies a detailed, instructive example of how philosophy can support policy-relevant decision-making processes at the community level. (shrink)

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) is being used to argue for wider recognition of the legal capacity of people with mental disabilities. This raises a question about the implications of the Convention for attributions of criminal responsibility. The present paper works towards an answer by analysing the relationship between legal capacity in relation to personal decisions and criminal acts. Its central argument is that because moral and political considerations play an (...) essential role in setting the relevant standards, legal capacity in the context of personal decisions and criminal acts should not be thought of as two sides of the same coin. The implications of particular moral or political norms are likely to be different in these two legal contexts, and this may justify asymmetries in the relevant standards for legal capacity. However, the analysis highlights a fundamental question about how much weight moral or political considerations should be given in setting these standards, and this is used to frame a challenge to those calling for significantly wider recognition of the legal capacity of people with mental disabilities on the basis of the Convention. (shrink)

Inner speech vs. anendophasia: Questions of information, serendipity, and the mental realm’s connection with nature.

Drawing on what we know about priming effects, informational encapsulation, lucid dreaming, imaginative practice, and the “mirror box” illusion, this article argues that self-reflexive fictions may enhance our capacity for simultaneous belief and disbelief, a capacity of surprising importance for human flourishing.

In “Neurosentimentalism and Moral Agency”, Philip Gerrans and Jeanette Kennett argue that prominent versions of metaethical sentimentalism and moral realism ignore the importance, for moral agency and moral judgment, of the capacity to experientially project oneself into the past and possible futures – to engage in ‘mental time travel’. They contend that such views are committed to taking subjects with impaired capacities for MTT to be moral judgers, and thus confront a dilemma: either allow that these subjects are (...) moral agents, or deny that moral agency is required for moral judgment. In reply, we argue for two main claims. First, it is implausible that moral agency is required for moral judgment, and Gerrans and Kennett give us no good reason for thinking it is. Second, at least some of the subjects in question seem able to make moral judgments, and Gerrans and Kennett give us no good reason to doubt that they can. We conclude that they have not shown a problem for any of the metaethical views in question. (shrink)

In this paper, I defend a reasons-first view of epistemic justification, according to which the justification of our beliefs arises entirely in virtue of the epistemic reasons we possess. I remove three obstacles for this view, which result from its presupposition that epistemic reasons have to be possessed by the subject: the problem that reasons-first accounts of justification are necessarily circular; the problem that they cannot give special epistemic significance to perceptual experience; the problem that they have to say that (...) implicit biases provide epistemic. The first problem will be overcome by introducing presentational attitudes that are not in need of justification as basic ways of possessing epistemic reasons. The latter two problems will be solved by introducing epistemic rational capacities of two different kinds, which are exercised in mental states that are ways of possessing epistemic reasons, and by distinguishing these from mental states that are not exercises of epistemic rational capacities. (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)

The dominant approach to assessing decision-making capacity in medicine focuses on determining the extent to which individuals possess certain core cognitive abilities. Critics have argued that this model delivers the wrong verdict in certain cases where patient values that are the product of mental disorder or disordered affective states undermine decision-making without undermining cognition. I argue for a re-conceptualization of what it is to possess the capacity to make medical treatment decisions. It is, I argue, the ability (...) to track one’s own personal interests at least as well as most people can. Using this idea, I demonstrate that it is possible to craft a solution for the problem cases—one that neither alters existing criteria in dangerous ways (e.g. does not open the door to various kinds of abuse) nor violates widely accepted ethical constraints on decision-making assessment. (shrink)

Under the current Mental Health Act of England and Wales, it is lawful to perform deep brain stimulation in the absence of consent and independent approval. We argue against the Care Quality Commission's preferred strategy of addressing this problematic issue, and offer recommendations for deep brain stimulation-specific provisions in a revised Mental Health Act.

Reigning orthodoxy in the philosophical study of human rational capacities, such as being able to act intentionally and to reason, is to characterize them in causal psychological terms. That is, to analyze these capacities in terms of mental states and their causal relations. It is against this background that the work of G.E.M. Anscombe has gained renewed interest. The main goal of this chapter is twofold. First, I will explicate Anscombe’s philosophical approach by analyzing her account of intentional action (...) and by relating it to the misperceptions of that account in (the history of) the philosophy of action. Importantly, Anscombe holds that an analysis of intentional action in terms of what it is, e.g., an event with certain specific features, cannot provide non-circular explanations. Instead, following Aristotle, Thomas Aquinas and Wittgenstein, Anscombe seeks to explicate intentional action in terms of its form, i.e., the way in which it exists. The second aim of the chapter is to show the import of Anscombe’s approach by applying it to the philosophy of reasoning. After discussing two main problems for the current orthodox view in epistemological debates on reasoning, I will propose an alternative Anscombe-inspired view of reasoning. In this so-called form view of reasoning, reasoning is characterized as a tool to drag out implications, embodied in judgments of the form p as following from q. The upshot of the chapter is that concepts of our rational capacities do not depict certain psychological states or processes, but rather our involvement with rational connections that exist in our lives and practices. (shrink)

Expression is the central concept in Wittgenstein’s philosophy of mind, and our experiences are reflected in our bodily expressions or gestures, facial expressions, behaviors and linguistic expressions. It seems true that we have no access of other people’s experiences but we can know or talk about them in so far as they are the common experiences of all. This inaccessibility of other’s experiences may create a genuine thinking that one’s experiences are private and the first person present tense psychological utterances (...) are not descriptive at all. They are understood solely as expressive and expression is the outer concept of a mental phenomenon. In this paper, an attempt will be made on the basis of Wittgenstein’s critique of the relationship between the concepts of experience and expression we shall argue that certain uses of the dichotomy between the inner and the outer are mistakes. According to Wittgenstein, the inner is not a set of experiences which are or are not expressed by our immediate (primitive) expressions or linguistic expressions rather it is the capacity of the subject to express himself genuinely. (shrink)

In this chapter, our focus is the role played by notions of rationality in the diagnosis of mental disorders, and in the practice of overriding patient autonomy in psychiatry. We describe and evaluate different hypotheses concerning the relationship between rationality and diagnosis, raising questions about what features underpin psychiatric categories. These questions reinforce widely held concerns about the use of diagnosis as a justification for overriding autonomy, which have motivated a shift to mental incapacity as an alternative justification. (...) However, this approach too has recently been criticized from a mental disability rights perspective. Our analysis of the relationship between mental capacity and rationality is used to illuminate these concerns, and to investigate further the relationship between rationality and psychiatric diagnosis. (shrink)