Some ‘naturalist’ accounts of disease employ a biostatistical account of dysfunction, whilst others use a ‘selected effect’ account. Several recent authors have argued that the biostatistical account offers the best hope for a naturalist account of disease. We show that the selected effect account survives the criticisms levelled by these authors relatively unscathed, and has significant advantages over the BST. Moreover, unlike the BST, it has a strong theoretical rationale and can provide substantive reasons to decide difficult cases. This (...) is illustrated by showing how life-history theory clarifies the status of so-called diseases of old age. The selected effect account of function deserves a more prominent place in the philosophy of medicine than it currently occupies. _1_ Introduction _2_ Biostatistical and Selected Effect Accounts of Function _3_ Objections to the Selected Effect Account _3.1_ Boorse _3.2_ Kingma _3.3_ Hausman _3.4_ Murphy and Woolfolk _4_ Problems for the Biostatistical Account _4.1_ Schwartz _5_ Analysis versus Explication _6_ Explicating Dysfunction: Life History Theory and Senescence _7_ Conclusion. (shrink)

Accounts of the concepts of function and dysfunction have not adequately explained what factors determine the line between low‐normal function and dysfunction. I call the challenge of doing so the line‐drawing problem. Previous approaches emphasize facts involving the action of natural selection (Wakefield 1992a, 1999a, 1999b) or the statistical distribution of levels of functioning in the current population (Boorse 1977, 1997). I point out limitations of these two approaches and present a solution to the line‐drawing problem that builds (...) on the second one. (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...

Scientists, philosophers, and even the lay public commonly accept that schizophrenia stems from a biological or internal ‘dysfunction.’ However, this assessment is typically accompanied neither by well-defined criteria for determining that something is dysfunctional nor empirical evidence that schizophrenia satisfies those criteria. In the following, a concept of biological function is developed and applied to a neurobiological model of schizophrenia. It concludes that current evidence does not warrant the claim that schizophrenia stems from a biological dysfunction, and, in (...) fact, that unusual neural structures associated with schizophrenia may have functional or adaptive significance. The fact that current evidence is ambivalent between these two possibilities (dysfunction versus adaptive function) implies that schizophrenia researchers should be much more cautious in using the ‘dysfunction’ label than they currently are. This has implications for both psychiatric treatment as well as public perception of mental disorders. (shrink)

Counterfactual thinking—the capacity to reflect on what would, could, or should have been if events had transpired differently—is a pervasive, yet seemingly paradoxical human tendency. On the one hand, counterfactual thoughts can be comforting and inspiring (Carroll & Shepperd, Chapter 28), but on the other they can be anxiety provoking and depressing (Zeelenberg & Pieters, Chapter 27). Likewise, such thoughts can illuminate pathways toward better future outcomes (Wong, Galinsky, & Kray, Chapter 11), yet they can also promote confusion and lead (...) us astray (Sanna, Schwarz, & Kennedy, Chapter 13). The first part of this chapter focuses on work that supports the prevailing Zeitgeist in the counterfactual thinking literature: Counterfactual thinking is beneficial. The second part of the chapter, however, strikes a more cautionary tone by reviewing work that describes some deleterious consequences of counterfactual thinking. We conclude by offering a tentative reconciliation of these conflicting perspectives and suggesting directions for future research. (shrink)

Review of: "Further Chaos and Dysfunction in the Brickyard and the Systems That Support It".

High blood pressure is an important component of pre-eclampsia. The underlying mechanism of development of hypertension in pre-eclampsia is complicated and still remains obscure. Several theories have been advanced including endothelial dysfunction, uteroplacental insufficiency leading to generalized vasoconstriction, increased cardiac output, and sympathetic hyperactivity. Increased blood flow and pressure are thought to lead to capillary dilatation, which damages end-organ sites, leading to hypertension, proteinuria and edema. Additional theories have been put forward based on epidemiological research, implicating immunological and genetic (...) factors. None of these theories have been substantiated. Based on a review of literature this paper postulates that the initiating event for the development of preeclampsia is intermittent hypoxia associated with irregular breathing during sleep, hypoapnea, apnea,inadequate respiratory excursions during the waking hours and inadequate cardiopulmonary synchronization (abnormal sympatho-vagal balance). (shrink)

Artefacts do not always do what they are supposed to, due to a variety of reasons, including manufacturing problems, poor maintenance, and normal wear-and-tear. Since software is an artefact, it should be subject to malfunctioning in the same sense in which other artefacts can malfunction. Yet, whether software is on a par with other artefacts when it comes to malfunctioning crucially depends on the abstraction used in the analysis. We distinguish between “negative” and “positive” notions of malfunction. A negative malfunction, (...) or dysfunction, occurs when an artefact token either does not or cannot do what it is supposed to. A positive malfunction, or misfunction, occurs when an artefact token may do what is supposed to but, at least occasionally, it also yields some unintended and undesirable effects. We argue that software, understood as type, may misfunction in some limited sense, but cannot dysfunction. Accordingly, one should distinguish software from other technical artefacts, in view of their design that makes dysfunction impossible for the former, while possible for the latter. (shrink)

How do people understand the concepts of mental health and disorder? The objective of this paper is to examine the impact of several factors on people’s judgments about whether a condition constitutes a mental disorder or a healthy state. Specifically, this study examines the impact of the source of the condition, its outcome, individual valuation (i.e., the value the individual attaches to the condition), and group valuation (i.e., the value the relevant group attaches to the condition). While we find that (...) people’s health and disorder judgments are driven by perceived dysfunction, we also find that health and disorder judgments are impacted differently by these factors. Health judgements are impacted by outcome and individual valuation, and disorder judgments are impacted by condition source. These results suggest that the folk concept of mental health is positive (i.e., mental health is more than the absence of mental disorder) and normativist (i.e., value judgments play a significant role in determining whether a condition counts as healthy), while the concept of mental disorder aligns with a naturalist perspective, at least to the extent that dysfunction plays an important role in categorizing a condition as a disorder. However, our finding that people’s dysfunction judgments are influenced by individual valuation and outcomes poses a strong challenge to naturalist accounts. To provide access to our supplementary data, an appendix has been included. (shrink)

In view of the publication of the DSM-V researchers were asked to discuss the theoretical implications of the definition of mental disorders. The reasons for the use, in the DSM-III, of the term disorder instead of disease are considered. The analysis of these reasons clarifies the distinction between the general definition of disorder and its implicit, technical meaning which arises from concrete use in DSM disorders. The characteristics and limits of this technical meaning are discussed and contrasted to alternative definitions, (...) like Wakefield’s harmful/dysfunction analysis. It is shown that Wakefield’s analysis faces internal theoretical problems in addition to practical limits for its acceptance in the DSM-V. In particular, it is shown that: a) the term dysfunction is not purely factual but intrinsically normative/evaluative; b) it is difficult to clarify what dysfunctions are in the psychiatric context (the dysfunctional mechanism involved being unknown in most cases and the use of evolutionary theory being even more problematic); c) the use of conceptual analysis and commonsense intuition to define dysfunctions leaves unsatisfied empiricists; d) it is unlikely that the authors of the DSM-V will accept Wakefield’s suggestion to revise the diagnostic criteria of any single DSM disorder in accordance with his analysis, because this is an excessively extensive change and also because this would probably reduce DSM reliability. In conclusion, it is pointed up in which sense DSM mental disorders have to be conceived as constructs, and that this undermines the realistic search for a clear-cut demarcation criterion between what is disorder and what is not. (shrink)

Justin Garson introduces the distinction between two views on Madness we encounter again and again throughout history: Madness as dysfunction, and Madness as strategy. On the latter view, Madness serves some purpose for the person experiencing it, even if it’s simultaneously harmful. The strategy view makes intelligible why Madness often holds a certain allure – even when it’s prima facie terrifying. Moreover, if Madness is a strategy in Garson’s metaphorical sense – if it serves a purpose – it makes (...) sense to use consciously chosen strategies for living with Madness that doesn’t necessarily aim to annihilate or repress it as far as possible. In this paper, we use our own respective stories as case studies. We have both struggled to resist the allure of Madness, and both ended up embracing a kind of Pyrrhonian scepticism about reality instead of clinging to sane reality. (shrink)

“Gettier cases” have played a major role in Anglo-American analytic epistemology over the past fifty years. Philosophers have grouped a bewildering array of examples under the heading “Gettier case.” Philosophers claim that these cases are obvious counterexamples to the “traditional” analysis of knowledge as justified true belief, and they treat correctly classifying the cases as a criterion for judging proposed theories of knowledge. Cognitive scientists recently began testing whether philosophers are right about these cases. It turns out that philosophers were (...) partly right and partly wrong. Some “Gettier cases” are obvious examples of ignorance, but others are obvious examples of knowledge. It also turns out that much research in this area of philosophy is marred by experimenter bias, invented historical claims, dysfunctional categorization of examples, and mischaracterization by philosophers of their own intuitive judgments about particular cases. Despite these shortcomings, lessons learned from studying “Gettier cases” are leading to important insights about knowledge and knowledge attributions, which are central components of social cognition. (shrink)

This case study deals with failure to ejaculate intravaginally during sexual intercourse. The causative factors were thought to be unconscious in nature. The patient showed significant improvement after only one session, when these unconscious factors were interpreted to and accepted by the patient. We discuss briefly the application of psychodynamic theory in sex therapy and possible implementations in training settings.

Since 2016, there has been an explosion of academic work and journalism that fixes its subject matter using the terms ‘fake news’ and ‘post-truth’. In this paper, I argue that this terminology is not up to scratch, and that academics and journalists ought to completely stop using the terms ‘fake news’ and ‘post-truth’. I set out three arguments for abandonment. First, that ‘fake news’ and ‘post-truth’ do not have stable public meanings, entailing that they are either nonsense, context-sensitive, or contested. (...) Secondly, that these terms are unnecessary, because we already have a rich vocabulary for thinking about epistemic dysfunction. Thirdly, I observe that ‘fake news’ and ‘post-truth’ have propagandistic uses, meaning that using them legitimates anti-democratic propaganda, and runs the risk of smuggling bad ideology into conversations. (shrink)

Much of the characteristic symptomatology of schizophrenia can be understood as resulting from a pervasive sense of disembodiment. The body is experienced as an external machine that needs to be controlled with explicit intentional commands, which in turn leads to severe difficulties in interacting with the world in a fluid and intuitive manner. In consequence, there is a characteristic dissociality: Others become problems to be solved by intellectual effort and no longer present opportunities for spontaneous interpersonal alignment. This dissociality goes (...) hand in hand with a progressive loss of the socially extended mind, which normally affords opportunities for co-regulation of cognitive and affective processes. However, at times people with schizophrenia report that they are confronted by the opposite of this dissociality, namely an unusual fluidity of the self-other boundary as expressed in experiences of ambiguous body boundaries, intrusions, and even merging with others. Here the person has not lost access to the socially extended mind but has instead become lost in it, possibly due to a weakened sense of self. We argue that this neglected aspect of schizophrenic social dysfunction can be usefully approached via the concept of genuine intersubjectivity: We normally participate in a shared experience with another person by implicitly co-regulating how our interaction unfolds. This co-regulation integrates our respective experience’s dynamical bases into one interpersonal process and gives the interaction an ambiguous second-person character. The upshot is that reports of abnormal self-other fluidity are not indicative of hallucinations without any basis in reality, but of a heightened sensitivity and vulnerability to processes of interpersonal alignment and mutual incorporation that form the normal basis of social life. We conclude by discussing implications of this view for both the science of consciousness as well as approaches to intervention and therapy. (shrink)

Nowadays there is a general acknowledgment of the importance of place in Italian crime novels. In Caponapoli, Massimo Siviero articulates a narrative way in which he approaches the structures, city, and the built environment to reflect the society, cultural relations, transformations and dysfunctions of contemporary Naples. Joe Pazienza, the private detective, has been seen by him recently before he was a reporter. When hired by his first client, Nada Mormile, someone with all the requirements of the dark lady in the (...) right place, he immediately smells “serious” trouble. There is a strange message full of threats at stake, and the construction sites of a substantial building, soon found “suicidal” with his head inside a bag. There is also someone who does not appreciate Joe’s new job as too nosy and goes out of his way to make him understand. Also, there is the Caponapoli. The health complex around which all the mysteries of a violent and fascinating city seem to gather. (shrink)

The notion that there exists a fundamental need to exert control over or to influence one’s environment has enjoyed a long history in psychology (e.g., DeCharms, 1968; Heider, 1958) and has stimulated considerable theoretical work. Such a need has been characterized by theorists at multiple levels of analysis. Control motivation, for example, has been characterized broadly in terms of proactive (White, 1959) or reactive (e.g., Abramson, Seligman, & Teasdale, 1978; Brehm, 1966; Brehm & Brehm, 1981) strivings for control over general (...) or specific (Brehm & Brehm, 1981) and central or peripheral outcomes (Thompson, 1993). Additionally, various types of control strategies used to gain or maintain a sense of personal control have been proposed (e.g., Averill, 1973; Heckhausen & Schulz, 1995; Rothbaum, Weisz, & Snyder, 1982; Thompson, 1981). Modes of control, for instance, have been categorized as either primary or secondary. Primary strategies involve direct action undertaken to produce desirable and avoid undesirable outcomes in the external world, whereas secondary strategies employ primarily cognitive processes undertaken to produce a change within the person. Recently, Heckhausen and Schulz (1995) have further delineated these primary and secondary forms of control according to whether they are based on veridical or illusory causal understandings of the world and whether they are functional or dysfunctional. While most control theorists view primary control as preferable to secondary control, the latter is viewed as critical in the process of adaptation to control failures and in the promotion of future primary control attempts. (shrink)

This chapter defends the thesis that feeling conviction is sufficient for belief: if you feel conviction that p, then you believe that p. I begin with a neutral characterization of belief in terms of its normative profile: belief is a state that is subject to certain distinctive norms of rationality. The main argument of the chapter is that feelings of conviction are beliefs because they are subject to the same norms of rationality that govern our beliefs. Functionalists often deny that (...) feelings of conviction constitute beliefs when they play dysfunctional causal roles, as in cases of mad belief or delusion or implicit bias, but this only serves to obscure the kind of irrationality involved in such cases. These are dysfunctional beliefs, rather than non-doxastic states, or "in-between" cases. (shrink)

Jonathan Y. Tsou examines and defends positions on central issues in philosophy of psychiatry. The positions defended assume a naturalistic and realist perspective and are framed against skeptical perspectives on biological psychiatry. Issues addressed include the reality of mental disorders; mechanistic and disease explanations of abnormal behavior; definitions of mental disorder; natural and artificial kinds in psychiatry; biological essentialism and the projectability of psychiatric categories; looping effects and the stability of mental disorders; psychiatric classification; and the validity of the DSM's (...) diagnostic categories. The main argument defended by Tsou is that genuine mental disorders are biological kinds with harmful effects. This argument opposes the dogma that mental disorders are necessarily diseases that result from biological dysfunction. Tsou contends that the broader ideal of biological kinds offers a more promising and empirically ascertainable naturalistic standard for assessing the reality of mental disorders and the validity of psychiatric categories. (shrink)

Theories of function are conventionally divided up into historical and ahistorical ones. Proponents of ahistorical theories often cite the ahistoricity of their accounts as a major virtue. Here, I argue that none of the mainstream “ahistorical” accounts are actually ahistorical. All of them embed, implicitly or explicitly, an appeal to history. In Boorse’s goal-contribution account, history is latent in the idea of statistical-typicality. In the propensity theory, history is implicit in the idea of a species’ natural habitat. In the causal (...) role theory, history is required for making sense of dysfunction. I elaborate some consequences for the functions debate. (shrink)

Even though the evidence‐based medicine movement (EBM) labels mechanisms a low quality form of evidence, consideration of the mechanisms on which medicine relies, and the distinct roles that mechanisms might play in clinical practice, offers a number of insights into EBM itself. In this paper, I examine the connections between EBM and mechanisms from several angles. I diagnose what went wrong in two examples where mechanistic reasoning failed to generate accurate predictions for how a dysfunctional mechanism would respond to intervention. (...) I then use these examples to explain why we should expect this kind of mechanistic reasoning to fail in systematic ways, by situating these failures in terms of evolved complexity of the causal system(s) in question. I argue that there is still a different role in which mechanisms continue to figure as evidence in EBM: namely, in guiding the application of population‐level recommendations to individual patients. Thus, even though the evidence‐based movement rejects one role in which mechanistic reasoning serves as evidence, there are other evidentiary roles for mechanistic reasoning. This renders plausible the claims of some critics of evidencebased medicine who point to the ineliminable role of clinical experience. Clearly specifying the ways in which mechanisms and mechanistic reasoning can be involved in clinical practice frames the discussion about EBM and clinical experience in more fruitful terms. (shrink)

Having a body is one of those unquestionable certainties of which we could not really understand the negation: the latter would not be a legitimate doubt in our linguistic, and therefore the epistemic game. In facts, according to Wittgenstein, contravening certain cornerstones of our language game implies that the used combination of words is being excluded from the game, withdrawn from circulation. The idea of this paper is that the external labelling of a behaviour as a mental illness, prima facie, (...) comes from here. Seriously questioning whether someone else controls my actions or my thoughts or whether I am actually dead, then, are not just doubts, as Wittgenstein's critique of G.E. Moore shows: such believes are constitutively excluded from our way of seeing the world and characterized as illnesses, anomalies; otherwise, it would the complete destruction of the language game we inhabit and therefore of the world as we know it, because we would not know on which bases something could be said truthfully or falsely if we did not even know that "this one is my hand". Therefore, even if mental illnesses objectify themselves in correlative physiological dysfunctions, such a discovery comes only after the external recognition of some symptoms, and to recognize the external symptoms of an illness we have to treat them as such; hereby is suggested that we do treat something this way when it threatens the certainties around which the language game we play revolves. (shrink)

Psychiatric and neurological disorders have historically provided key insights into the structure-function rela- tionships that subserve human social cognition and behavior, informing the concept of the ‘social brain’. In this review, we take stock of the current status of this concept, retaining a focus on disorders that impact social behavior. We discuss how the social brain, social cognition, and social behavior are interdependent, and emphasize the important role of development and com- pensation. We suggest that the social brain, and its (...) dysfunction and recovery, must be understood not in terms of specific structures, but rather in terms of their interaction in large-scale networks. (shrink)

Background: Obstetrics and gynaecology are many and common, where a woman suffers from problems related to pregnancy or her reproductive organs. Any part of her body may be affected due to some symptoms that are completely related to the reproductive organs when she is in a critical period for her, whether in her menstrual cycle, pregnancy, or disease conditions. The bulk of cases of diseases related to women and childbirth are dealt with great care and special care, as all diseases (...) related to women are considered very sensitive diseases due to the presence of the disease in sensitive and not simple places. A gynaecologist is a specialist in all diseases and problems related to the female sexual organs. They perform regular preventive medical exams, such as cervical smear tests and breast exams. It also provides consultations for women of all ages about the problems of contraception, infertility and menopause. Objectives: The objective of this expert system is to help and facilitate women in diagnosing diseases related to their obstetrics and gynaecology, a simple expert system has been designed consisting of ten various common diseases that affect women whether During or without pregnancy, Methods: In this system, the system consists of a list of some common symptoms, the correct diagnosis adopted for these diseases, and how to treat diseases in the correct way with the help of a consultant obstetrician and gynaecologist, Dr. Fathi Muhammad Al-Habibi, and these diseases are: uterine cancer, cervical cancer, Infertility, double uterus, ectopic pregnancy, endometrial cancer, female sexual dysfunction, endometriosis, faecal incontinence, female infertility, CLIPS Expert System language was used to design and implement the proposed expert system. Results: The proposed ten obstetrics and gynaecology diagnostic expert system was evaluated by medical students and they were satisfied with its performance. Conclusions: The proposed expert system is very useful for obstetricians and gynaecologists, patients with reproductive system problems, and recent graduates. (shrink)

We argue that the notion of "mental institutions"-discussed in recent debates about extended cognition-can help better understand the origin and character of social impairments in autism, and also help illuminate the extent to which some mechanisms of autistic dysfunction extend across both internal and external factors (i.e., they do not just reside within an individual's head). After providing some conceptual background, we discuss the connection between mental institutions and embodied habits of mind. We then discuss the significance of our (...) view for understanding autistic habits of mind and consider why these embodied habits are sometimes a poor fit with neurotypical mental institutions. We conclude by considering how these insights highlight the two-way, extended nature of social impairments in autism, and how this extended picture might assist in constructing more inclusive mental institutions and intervention strategies. (shrink)

What form must a theory of epistemic injustice take in order to successfully illuminate the epistemic dimensions of struggles that are primarily political? How can such struggles be understood as involving collective struggles for epistemic recognition and self-determination that seek to improve practices of knowledge production and make lives more liveable? In this paper, I argue that currently dominant, Fricker-inspired approaches to theorizing epistemic wrongs and remedies make it difficult, if not impossible, to understand the epistemic dimensions of historic and (...) ongoing political struggles. Recent work in the theory of recognition— particularly the work of critical, feminist, and decolonial theorists—can help to identify and correct the shortcomings of these approaches. I offer a critical appraisal of recent conversation concerning epistemic injustice, focusing on three characteristics of Frickerian frameworks that obscure the epistemic dimensions of political struggles. I propose that a theory of epistemic injustice can better illuminate the epistemic dimensions of such struggles by acknowledging and centering the agency of victims in abusive epistemic relations, by conceptualizing the harms and wrongs of epistemic injustice relationally, and by explaining epistemic injustice as rooted in the oppressive and dysfunctional epistemic norms undergirding actual communities and institutions. (shrink)

In this article we examine obsessive compulsive disorder (OCD). We examine and reject two existing models of this disorder: the Dysfunctional Belief Model and the Inference‐Based Approach. Instead, we propose that the main distinctive characteristic of OCD is a hyperactive sub‐personal signal of being in error, experienced by the individual as uncertainty about his or her intentional actions (including mental actions). This signalling interacts with the anxiety sensitivities of the individual to trigger conscious checking processes, including speculations about possible harms. (...) We examine the implications of this model for the individual's capacity to control his or her thoughts. (shrink)

Nietzsche’s injunction to examine “the value of values” can be heard in a pragmatic key, as inviting us to consider not whether certain values are true, but what they do for us. This oddly neglected pragmatic approach to Nietzsche now receives authoritative support from Bernard Reginster’s new book, which offers a compelling and notably cohesive interpretation of Nietzsche’s On the Genealogy of Morality. In this essay, I reconstruct Reginster's account of Nietzsche’s critique of morality as a “self-undermining functionality critique” and (...) raise three problems for it: (i) Is there room within an etiological conception of function for the notion of self-undermining functionality? (ii) If Nietzsche’s critique is internal and based solely on the function it ascribes to morality, where does that critique derive its normative significance from? (iii) Does Reginster’s account not make out ascetic morality to be more universally dysfunctional than it in fact is, given that some priestly types have done remarkably well out of morality? (shrink)

No two individuals with the autism diagnosis are ever the same—yet many practitioners and parents can recognize signs of ASD very rapidly with the naked eye. What, then, is this phenotype of autism that shows itself across such distinct clinical presentations and heterogeneous developments? The “signs” seem notoriously slippery and resistant to the behavioral threshold categories that make up current assessment tools. Part of the problem is that cognitive and behavioral “abilities” typically are theorized as high-level disembodied and modular functions—that (...) are assessed discretely (impaired, normal, enhanced) to define a spectral syndrome. Even as biology reminds us that organic developing bodies are not made up of independent switches, we remain often seduced by the simplicity of mechanistic and cognitive models. Developmental disorders such as autism have accordingly been theorized as due to different modular dysfunctions—typically of cortical origin, i.e., failures of “theory of mind” (Baron-Cohen et al., 1985), of the “mirror neuron system” (Ramachandran and Oberman, 2006), of “weak central coherence” (Happe and Frith, 2006) or of the balance of “empathizing” and “systemizing” (Baron-Cohen, 2009), just to list a few. -/- The broad array of autonomic (Ming et al., 2005; Cheshire, 2012) and sensorimotor (Damasio and Maurer, 1978; Maurer and Damasio, 1982; Donnellan and Leary, 1995; Leary and Hill, 1996; Donnellan and Leary, 2012; Donnellan et al., 2012) differences experienced and reported by people with autism have by such theories typically been sidelined as “co-morbidities,” possibly sharing genetic causes, but rendered as incidental and decisively behaviorally irrelevant symptoms—surely disconnected from cognition. But what if the development of cortically based mental processes and autonomous control relies on the complexities and proper function of the peripheral nervous systems? Through such an “embodied” lens the heterogeneous symptoms of autism invites new interpretations. We propose here that many behavioral-level findings can be re-defined as downstream effects of how developing nervous systems attempt to cope and adapt to the challenges of having various noisy, unpredictable, and unreliable peripheral inputs. (shrink)

Legal theorists have characterized physical evidence of brain dysfunction as a double-edged sword, wherein the very quality that reduces the defendant’s responsibility for his transgression could simultaneously increase motivations to punish him by virtue of his apparently increased dangerousness. However, empirical evidence of this pattern has been elusive, perhaps owing to a heavy reliance on singular measures that fail to distinguish between plural, often competing internal motivations for punishment. The present study employed a test of the theorized double-edge pattern (...) using a novel approach designed to separate such motivations. We asked a large sample of participants (N = 330) to render criminal sentencing judgments under varying conditions of the defendant’s mental health status (Healthy, Neurobiological Disorder, Psychological Disorder) and the disorder’s treatability (Treatable, Untreatable). As predicted, neurobiological evidence simultaneously elicited shorter prison sentences (i.e., mitigating) and longer terms of involuntary hospitalization (i.e., aggravating) than equivalent psychological evidence. However, these effects were not well explained by motivations to restore treatable defendants to health or to protect society from dangerous persons but instead by deontological motivations pertaining to the defendant’s level of deservingness and possible obligation to provide medical care. This is the first study of its kind to quantitatively demonstrate the paradoxical effect of neuroscientific trial evidence and raises implications for how such evidence is presented and evaluated. (shrink)

Jerome Wakefield has argued that a disorder is a harmful dysfunction. This paper develops how Wakefield should construe harmful in his harmful dysfunction analysis. Recently, Neil Feit has argued that classic puzzles involved in analyzing harm render Wakefield’s HDA better off without harm as a necessary condition. Whether or not one conceives of harm as comparative or non-comparative, the concern is that the HDA forces people to classify as mere dysfunction what they know to be a disorder. (...) For instance, one can conceive of cases where simultaneous disorders prevent each other from being, in any traditional sense, actually harmful; in such cases, according to the HDA, neither would be a disorder. I argue that the sense of harm that Wakefield should employ in the HDA is dispositional, similar to the sense of harm used when describing a vile of poison: “Be careful! That’s poison. It’s harmful.” I call this harm in the damage sense. Using this sense of harm enables the HDA to avoid Feit’s arguments, and thus it should be preferred to other senses when analyzing harmful dysfunction. (shrink)

Cognitive Behavioral Therapy has become the dominant form of psychotherapy in North America. The CBT model is theoretically based on the idea that all external and internal stimuli are filtered through meaning-making, consciously accessible cognitive schemas. The goal of CBT is to identify dysfunctional or maladaptive thoughts and beliefs, and replace them with more adaptive cognitive interpretations. While CBT is clearly effective as a treatment, there is good reason to be skeptical that its efficacy is due to the causal mechanisms (...) posited by the CBT model. This paper will argue that the specific cognitive schemas posited by the CBT model likely do not play a direct role in the development or treatment of psychological illness. Cognitive schemas, as identified in CBT interventions, are likely to be the result of patient confabulation and epistemically under-supported practitioner-based identification. CBT interventions appear to impose coherence on patients’ psychological states, rather than identifying and modifying preexistent causally efficacious core beliefs. (shrink)

Many cognitive scientists, having discovered that some computational-level characterization f of a cognitive capacity φ is intractable, invoke heuristics as algorithmic-level explanations of how cognizers compute f. We argue that such explanations are actually dysfunctional, and rebut five possible objections. We then propose computational-level theory revision as a principled and workable alternative.

Bortolotti argues that we cannot distinguish delusions from other irrational beliefs in virtue of their epistemic features alone. Although her arguments are convincing, her analysis leaves an important question unanswered: What makes delusions pathological? In this paper I set out to answer this question by arguing that the pathological character of delusions arises from an executive dysfunction in a subject’s ability to detect relevance in the environment. I further suggest that this dysfunction derives from an underlying emotional imbalance—one (...) that leads delusional subjects to regard some contextual elements as deeply puzzling or highly significant. (shrink)

Just as sadness is not always a symptom of mood disorder, irrational beliefs are not always symptoms of illness. Pathological irrational beliefs are distinguished from non-pathological ones by considering whether their existence is best explained by assuming some underlying dysfunctions. The features from which to infer the pathological nature of irrational beliefs are: un-understandability of their progression; uniqueness; coexistence with other psycho-physiological disturbances and/or concurrent decreased levels of functioning; bizarreness of content; preceding organic diseases known to be associated with irrational (...) beliefs; treatment response to medical intervention, etc. Severe irrationality is sometimes caused by normal human motivation rather than by mental or physical dysfunction. Pure forms of self-deception may satisfy the diagnostic criteria of delusional disorder, but there may be no evidence that suggests that they are caused by illness. Although those with pathological delusions do not recognize their delusions as symptomatic of illness, differentiating pathological beliefs from normal irrational beliefs is vitally important: If a belief is pathological, psychiatrists must seriously consider treating the patient against her will. If it is not pathological, conversely, involuntary treatments are prohibited because they offend her basic autonomy. (shrink)

I argue that ductal carcinoma in situ (DCIS), the tumor most commonly diagnosed by breast mammography, cannot be confidently classified as cancer, that is, as pathological. This is because there may not be dysfunction present in DCIS—as I argue based on its high prevalence and the small amount of risk it conveys—and thus DCIS may not count as a disease by dysfunction-requiring approaches, such as Boorse’s biostatistical theory and Wakefield’s harmful dysfunction account. Patients should decide about treatment (...) for DCIS based on the risks it poses and the risks and benefits of treatment, not on its disease status. (shrink)

In a recent contribution to conceptual ethics, Joshua Habgood-Coote argues that philosophers should refrain from using the term “fake news,” which is commonly employed in public discussions focusing on the epistemic health of democracies. In this short discussion note, I take issue with this claim, discussing each of the three arguments advanced by Coote to support the conclusion that we should abandon this concept. First, I contend that although “fake news” is a contested concept, there is significant agreement among contemporary (...) philosophers about its key feature. Second, I argue against the claim that “fake news” is an unnecessary concept by underlying that it is not reducible to other terms we customarily use to describe the epistemic dysfunctions of democracies. Lastly, I suggest that using the term “fake news” need not serve propagandistic aims, and that philosophers can use this concept without engaging in epistemic policing, that is, commanding their interlocutors not to believe specific news stories or sources. (shrink)

As we look beyond our terrestrial boundary to a multi-planetary future for humankind, it becomes paramount to anticipate the challenges of various human factors on the most likely scenario for this future: permanent human settlement of Mars. Even if technical hurdles are circumvented to provide adequate resources for basic physiological and psychological needs, Homo sapiens will not survive on an alien planet if a dysfunctional psyche prohibits the utilization of these resources. No matter how far we soar into the stars, (...) our psychologies for future generations will be forever tethered to the totality of our surroundings. By shaping our environment toward survival and welfare during the voyage to Mars and in a Martian colony, we indirectly shape our psyches and prepare them for a mission of unprecedented alienation and duration. Once on Mars, human factors such as leadership structure, social organization and code of conduct, group size, gender balance, developmental cycle, mobility, length of stay and the ecological settings and type and manner of subsistence, will create a novel Martian culture. The degree that settlers are severed from the Earth will affect how radically foreign this culture will be when compared with cultures on Earth. (shrink)

Temporal experience and its radical alteration in schizophrenia have been one of the central objects of investigation in phenomenological psychopathology. Various phenomenologically oriented researchers have argued that the change in the mode of temporal experience present in schizophrenia can foreground its psychotic symptoms of delusion. This paper aims to further the development of such a phenomenological investigation by highlighting a much-neglected aspect of schizophrenic temporal experience, i.e., its non-emotional affective characteristic. In this paper, it denotes the type of an experience (...) wherein an afflicted individual experiences a pervasive pull or attraction coming from the past, present, and future. By employing Husserl’s account of affection, I argue that such an affectively prominent temporal experience is not yet another abnormality that happens to be present in schizophrenia. Instead, it is indicative of the core disturbance that underpins the schizophrenic temporal mode of experience. I identify such a disturbance as ‘affective modification dysfunction’ and employ it as a core concept with which I synthesize and organise heterogeneous components of schizophrenic temporal experience in their conceptual unity. For the sake of clear description, I organise those components into the following categories: 1.) Time Stop 2.) Ante-festum 3.) Déjà vu/vécu and 4.) Time Fragmentation. I conclude by demonstrating how approaching schizophrenic temporal experience from its affective dimension can further help us better understand its pre-psychotic phase known to precipitate schizophrenic primary delusion, i.e., delusional mood. (shrink)

Abstract:In this paper, I distinguish four ways in which aspects or features of mental illness may be said to be functional. I contend that discussion of teleological perspectives on mental illness has unfortunately tended to conflate these senses. The latter two senses have played important practical roles both in predicting and explaining patterns of behavior, cognition, and affective response, atnd relatedly, in developing successful interventions. I further argue that functional talk in this context is neither inconsistent with viewing some disorders (...) as dysfunctional in one of several senses, nor inappropriately adaptationist, provided we keep these senses of function distinct, and are precise about which is in play in a given context. (shrink)

In this paper, we theoretically address the relevance of unintentional and inconsistent interactional elements in human–robot interactions. We argue that elements failing, or poorly succeeding, to reproduce a humanlike interaction create significant consequences in human–robot relational patterns and may affect human–human relations. When considering social interactions as systems, the absence of a precise interactional element produces a general reshaping of the interactional pattern, eventually generating new types of interactional settings. As an instance of this dynamic, we study the absence of (...) metacommunicative abilities in social artifacts. Then, we analyze the pragmatic consequences of the aforementioned absence through the lens of Paul Watzlawick’s interactionist theory. We suggest that a fixed complementary interactional setting may be produced because of the asymmetric understanding, between robots and humans, of metacommunication. We highlight the psychological implications of this interactional asymmetry within Jessica Benjamin’s concept of “mutual recognition”. Finally, we point out the possible shift of dysfunctional interactional patterns from human–robot interactions to human–human ones. (shrink)

The crisis of our times is science without wisdom. It is the outcome of an astonishingly successful tradition of scientific and technological research pursued within the context of an academic inquiry that is profoundly and damagingly irrational, in a structural way, when judged from the standpoint of helping humanity make progress towards a wise, enlightened world. This damaging irrationality of academia goes back to the 18th century Enlightenment. The philosophes of the French Enlightenment, in implementing the profound idea that we (...) might learn from scientific progress how to achieve social progress towards an enlightened world, made three gross blunders – and it is these blunders, still uncorrected, that are built into academia today, and result in its current dysfunctional character. We urgently need to correct these blunders and transform academia, so that it becomes rationally, effectively and actively engaged in helping humanity discover what to do to solve the global problems that threaten our future, and thus make progress towards a good, enlightened world. (shrink)

The goals and tasks of neuroethics formulated by Farahany and Ramos (2020) link epistemological and methodological issues with ethical and social values. The authors refer simultaneously to the social significance and scientific reliability of the BRAIN Initiative. They openly argue that neuroethics should not only examine neuroscientific research in terms of “a rigorous, reproducible, and representative neuroscience research process” as well as “explore the unique nature of the study of the human brain through accurate and representative models of its function (...) and dysfunction”, but also its responsibilities or social consequences. In our commentary, we would like to concentrate on problem selection, which is shortly noticed by Farahany and Ramos, and by BRAIN Initiative’s Neuroethics Report itself. The document raises an important issue related to problem selection, which is strengthening or perpetuating existing prejudices and biases by choosing a research subject: “scientists are prompted to consider how the questions they choose to study in the laboratory might amplify existing biases.” This leads to several further problems: what constitutes bias?; how biases may be embedded in the selection of research programs?; is it possible to conduct completely unbiased research?; who should be a gatekeeper in the case of research that may amplify biases? We try to notice possible answers to these questions in the context of the research on differences (e.g., cognitive, medical, behavioral) between human populations. (shrink)

Obsessive-compulsive disorder is a commonly occurring neuropsychiatric condition characterized by bothersome intrusive thoughts and urges that frequently lead to repetitive dysfunctional behaviours such as excessive handwashing. There are well-documented alterations in cerebral function which appear to be closely related to the manifestation of these symptoms. Controlled studies of cognitive-behavioural therapy techniques utilizing the active refocusing of attention away from the intrusive phenomena of OCD and onto adaptive alternative activities have demonstrated both significant improvements in clinical symptoms and systematic changes in (...) the pathological brain circuitry associated with them. Careful investigation of the relationships between the experiential and putative neurophysiological processes involved in these changes can offer useful insights into volitional aspects of cerebral function. (shrink)

Some researchers and autistic activists have recently suggested that because some ‘autism-related’ behavioural atypicalities have a function or purpose they may be desirable rather than undesirable. Examples of such behavioural atypicalities include hand-flapping, repeatedly ordering objects (e.g., toys) in rows, and profoundly restricted routines. A common view, as represented in the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV-TR (APA, 2000), is that many of these behaviours lack adaptive function or purpose, interfere with learning, and constitute the non-social behavioural (...) dysfunctions of those disorders making up the Autism Spectrum. As the DSM IV-TR continues to be the reference source of choice for professionals working with individuals with psychiatric difficulties, its characterization of the Autism Spectrum holds significant sway. We will suggest Extended Mind and Enactive Cognition Theories, which theorize that mind (or cognition) is embodied and environmentally embedded, as coherent conceptual and theoretical spaces within which to investigate the possibility that certain repetitive behaviours exhibited by autistics possess functions or purposes that make them desirable. As lenses through which to re-examine ‘autism-related’ behavioral atypicalities, these theories not only open up explanatory possibilities underdeveloped in the research literature, but also cohere with how some autistics describe their own experience. Our position navigates a middle way between the view of autism as understood in terms of impairment, deficit and dysfunction and one that seeks to de-pathologize the Spectrum. In so doing we seek to contribute to a continuing dialogue between researchers, clinicians and self- or parent advocates. (shrink)

Our cultural situation is to seek a moral form of self-constitution, rather than an ontological or epistemological foundation. Such a moral ground lies in the paradox of willing surrender of the will to do wrong or dysfunctional acts in order to enter temporally-extended processes of moral change. But the paradox of willing surrender of the will requires analysis. The propositional form of it cannot be sustained and must instead give way to willingness as an ongoing choice. The self-reflexivity of the (...) will with which we accomplish this turns out to be a core activity of human activity that seeks openness to moral growth through humility. The paper suggests that self-constitution in this manner this is what freedom is for us and is therefore the source of our hope. (shrink)

Does a diagnosis of brain dysfunction matter for ascriptions of moral responsibility? This chapter argues that, while knowledge of brain pathology can inform judgments of moral responsibility, its evidential value is currently limited for a number of practical and theoretical reasons. These include the problem of establishing causation from correlational data, drawing inferences about individuals from group data, and the reliance of the interpretation of brain findings on well-established psychological findings. Brain disorders sometimes matter for moral responsibility, however, because (...) they change an individual’s moral psychology in a way that is beyond their control. While control over psychological changes is not an excusing factor, brain disorders can mitigate moral responsibility because they confront individuals with new psychological deficits or urges for which their previous moral education and existing external and internal moral resources have not prepared them. (shrink)

This paper defines and defends a notion of teleological function which is fit to figure in explanations concerning how organic systems, and the items which compose them, are able to perform certain activities, such as surviving and reproducing or pumping blood. According to this notion, a teleological function of an item (such as the heart) is a typical way in which items of that type contribute to some containing system's ability to do some activity. An account of what it is (...) for an item to contribute to a containing system's ability to perform an activity is provided. I argue that the view acquires its normative status in virtue of the fact that it obeys a function-accident distinction and obeys a function-dysfunction distinction; that the view is ahistorical; and, that its ahistoricity provides it with an advantage over one of its main competitors. (shrink)

This paper explores the enduring impact of Cartesian dualism on the formulation of autism diagnosis and its subsequent implications for our contemporary understanding of the condition. It presents a concise historical overview tracing the evolution of autism diagnosis through the lenses of two traditional reductionist paradigms: a psychological framework (emphasizing it as a mental disorder) and a biological framework (viewing it as a neurological dysfunction). However, the paper argues for a revised perspective that transcends the limitations inherent in both (...) conventional viewpoints and challenges the Cartesian dichotomy between the physical and the mental realms. Instead, it proposes an instrumentalist conception of mental phenomena. This conceptual shift is motivated by the ethical imperative of affording autistic individuals a more dignified and inclusive standing within society, one that acknowledges their moral value. (shrink)