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.

How should governments balance saving people from very large individual disease burdens (such as an early death) against saving them from middling burdens (such as erectile dysfunction) and minor burdens (such as nail fungus)? This chapter considers this question through an analysis of a priority-setting proposal in the Netherlands, on which avoiding a multitude of middling burdens takes priority over saving one person from early death, but no number of very small burdens can take priority over avoiding one (...) death. It argues that there is some, albeit imperfect, evidence of substantial public support for such a policy. Furthermore, it provides a principled rationale for it in terms of respect for the person who faces the largest burden. (shrink)

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)

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

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)

Parkinson’s disease is a common movement disorder associated primarily with oxidative stress-mediated degeneration of dopaminergic neurons. Earlier studies showed that Sorghum bicolor-based supplement (SbS) exhibited antioxidant and neuroprotective activities and might likely rescue the death of dopaminergic neurons in Parkinson’s disease. This study examined the effect of SbS on rotenone-induced Parkinsonian-like motor deficits in rats and the involvement of oxidative stress and pro-inflammatory cytokines. Rats were divided into six groups and treated orally with sunflower oil (vehicle-control), rotenone (2.5 mg/kg) alone (...) or in combination with each dose of SbS (50, 100, and 200 mg/kg) and levodopa-carbidopa (10 mg/kg) on an alternate day for 28 days. The changes in motor functions were evaluated on day 28 and the brain concentrations of oxidative stress biomarkers and pro-inflammatory cytokines (tumor necrosis factor-alpha and interleukin-6) were determined. Rotenone caused motor deficits by impaired locomotor activity in the open field test and induced catalepsy in the bar test, which were attenuated by SbS. Rats pretreated with SbS had reduced brain levels of malondialdehyde, nitrite, and pro-inflammatory cytokines compared to rotenone controls. SbS mitigated rotenone-induced depletion of reduced glutathione and antioxidant enzymes in the rat brain. The results suggest that SbS ameliorated rotenone-induced Parkinsonian-like motor dysfunctions by reducing neuronal oxidative stress and pro-inflammatory cytokines in rats. (shrink)

One way in which bioethicists can benefit the medical community is by clarifying the concept of disorder. Since insurance companies refer to the DSM for whether a patient should receive assistance, one must consider the consequences of one’s concept of disorder for who should be provided with care. I offer a refinement of Jerome Wakefield’s hybrid concept of disorder, the harmful dysfunction analysis. I criticize both the factual component and the value component of Wakefield’s account and suggest how they (...) might be improved. I propose that the factual component should be statistical variation analyzed in multilevel and chronological compilations of physiological data. I propose that the value component should prioritize the individual’s authority regarding the experience of suffering from a physiological condition. My account preserves the insight of using a factual and a value component while avoiding the problems that Wakefield’s original account faces. (shrink)

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)

This paper argues that, in its pre-Biblical version (pre-J), the Cain and Abel story principally dealt with tensions distinctive for dry-farming families identifying the social structure as their main cause. The social structure was problematic because it involved two important imbalances, one between the spouses and one between the children. Pre-J offers a novel solution to problems caused by these interfamilial imbalances: rather than accepting their pre-established social roles, people should develop a merit-based social structure. This is why Yahweh says (...) that acceptance and honour are in doing what is right. Focusing on a pre-J narrative in this way and situating the story within the broader motive of sibling rivalry, solve three puzzles: Yahweh’s preference (God challenges unjust social institutions), Cain’s reactions (he is angry because his expectations were unmet and depressed because he thought that this was his failure), and Yahweh’s final forgiveness to Cain (the conflict was not due to Cain’s wicked character). (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)

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)

This dissertation aims to develop a program resource for helping and mental health professionals to foster proactive coping and diminish dysfunctional coping from work stressors. Professionals succumb to chronic stressors and secondary traumatic stress due to their vocation, often disregarding self-care. Should this type of resource be implemented, psychological and social resources would be required. The need for proactive coping is a generally accepted concept, but helping and mental health professionals often lack resources, limiting advocacy and resilience. Self-help resources are (...) frequently perceived as self-indulgence, in addition to the concept that professionals provide care, not the clients receiving care. Moreover, victimization by stigmas and emotional contagion surrounds helping and mental health professions. Addressing these concerns by implementing an accessible and advocate-heavy website may mitigate experienced ramifications by increasing retention, psychological well-being, resilience, and support. Most importantly, it may reduce maladaptive behaviors and standardize professional self-care. (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)

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)

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)

This paper compares criticisms of Singapore’s meritocracy, especially against its impact on income disparities and class divisions, with Michael Sandel’s critique of the meritocratic ethic in the United States. Despite significant differences in their history and politics, meritocracy has similar dysfunctions in both societies, allowing us to draw theoretical conclusions about meritocracy as an ideal of governance. It then contrasts Sandel’s communitarian critique of meritocracy with recent Confucian promotion of political meritocracy and meritocratic justice and argues that the Confucian principle (...) of “promoting the virtuous and talented” is different from the contemporary conception of meritocracy. Textual evidence indicates that a Confucian understanding of “merit” is contrary to the technocratic expertise of contemporary meritocracies. Furthermore, pre-Qin Confucian texts do not support a conception of justice that emphasizes individual desert; they address distributive problems from the perspective of needs and sustaining social relations. The texts also support limiting the reign of merit when it results in inequalities that cause suffering, inhibit personal cultivation of some groups, or undermine social relations. The paper concludes with an assessment of Singapore’s on-going attempts to improve its meritocracy from a Confucian perspective. (shrink)

We recently suggested that there are both pragmatic and normative reasons to classify pregnancy as a disease. Several scholars argued against our claims. In this response, we defend the disease view of pregnancy against their criticism. We claim that the dysfunctional account of disease that some of our critics rely on has some counterintuitive results. Furthermore, we claim that our critics assume what needs to be argued that the primary function of our sexual organs is to reproduce. Since only a (...) small percentage of sexual intercourse leads to pregnancy, it is far from obvious that reproduction is the primary biological function of our sexual organs. We also claim that while taking pregnancy itself as a reference class could avoid the conclusion that pregnancy is a disease, the strategy is problematic since it renders the Boorsean approach to disease and health circular and effectively deprives it of any utility in determining whether a particular phenomenon is a disease or not. (shrink)

In their article ’Is Pregnancy a Disease? A Normative Approach’, Anna Smajdor and Joona Räsänen contend that, on several of the most prominent accounts of disease, pregnancy should be considered a disease. More specifically, of the five accounts they discuss, each renders pregnancy a disease or suffers serious conceptual problems otherwise. They take issue specifically with the dysfunction account of disease and argue that it suffers several theoretical difficulties. In this response, we focus on defending the dysfunction account (...) against their main objections and show why a version of the dysfunction account is viable on account of the indispensability of normativity in biology and medicine. After disarming their main objections to the dysfunction account, we briefly respond to their treatment of the normality of pregnancy and then draw a distinction between adverse symptoms and underlying causes to show why even though pregnancy may have ’disease-like’ features, it is not a disease. (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)

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)

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)

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)

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)

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)

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)

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)

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.

“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)

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)

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)

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 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)

William Paley ( Natural Theology , 1802) developed the argument-from-design. The complex structure of the human eye evinces that it was designed by an intelligent Creator. The argument is based on the irreducible complexity ("relation") of multiple interacting parts, all necessary for function. Paley adduces a wealth of biological examples leading to the same conclusion; his knowledge of the biology of his time was profound and extensive. Charles Darwin’s Origin of Species is an extended argument demonstrating that the "design" of (...) organisms can be explained by natural selection. Moreover, the dysfunctions, defects, waste, and cruelty that prevail in the living world are incompatible with a benevolent and omnipotent Creator. They come about by a process that incorporates chance and necessity, mutation and natural selection. In addition to science, there are other ways of knowing, such as art, literature, philosophy, and religion. Matters of value, meaning, and purpose transcend science. (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)

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)

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)

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)

Inner speech represents the activity of talking to oneself in silence. It can be assessed with questionnaires, sampling methods, and electromyographic recordings of articulatory movements. Inner speech has been linked to thought processes and self-awareness. Private speech (speech-for-self emitted aloud by children) serves an important self-regulatory function. The frequency of private speech follows an inverted-U relation with age, peaking at 3-4 years of age and disappearing at age 10. Social and inner speech share a common neurological basis: Broca’s area. Dysfunctional (...) self-talk is known to mediate many pathological conditions; negative selfverbalizations have a more significant debilitating impact than positive ones. (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)

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)

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)

In this paper, I defend a version of the medical model of disability, which defines disability as an enduring biological dysfunction that causes its bearer a significant degree of impairment. We should accept the medical model, I argue, because it succeeds in capturing our judgments about what conditions do and do not qualify as disabilities, because it offers a compelling explanation for what makes a condition count as a disability, and because it justifies why the federal government should spend (...) hundreds of billions of dollars, annually, on aid and accommodations for disabled people. After responding to a pair of objections Elizabeth Barnes has raised against the medical model, I contrast it with Guy Kahane and Julian Savulescu's welfarist account of disability, and with Barnes's own mere-difference view. Both of these accounts face serious challenges, although elements of Barnes's view can—and, in my opinion, should—be adopted by proponents of the medical model. (shrink)

This paper advances a theory of disease as domino dysfunction. It is often argued that diseases are biological dysfunctions. However, a theory of disease as biological dysfunction is complicated by some plausible cases of dysfunction, which seem clearly non-pathological. I argue that pathological conditions are not just dysfunctions but domino dysfunctions, and that domino dysfunctions can be distinguished on principled biological grounds from non-pathological dysfunctions. I then show how this theory can make sense of the problem cases; (...) they are not diseases because they are not domino dysfunctions. (shrink)

Skeptical atheism is deeply concerned with the development of a true atheistic belief-system which competes with allegedly false theistic belief-systems. Spiritual atheists are concerned with building a successful atheistic culture to compete with an allegedly dysfunctional theistic culture. These atheisms are compared in terms of their epistemologies, metaphysics, axiologies, eschatologies, soteriologies, prosocial activities, and individual practices. Skeptical atheism is likely to remain a perpetually marginal community. Spiritual atheism may become a significant alternative to theism.

Emotions might contribute to our being rational cognitive agents. Anxiety – and more specifically epistemic anxiety – provides an especially interesting case study into the role of emotion for adaptive cognition. In this paper, I aim at clarifying the epistemic contribution of anxiety, and the role that ill-calibrated anxiety might play in maladaptive epistemic activities which can be observed in psychopathology. In particular, I argue that this emotion contributes to our ability to adapt our cognitive efforts to how we represent (...) the practical factors relevant to the task at hand, by sig- naling the need for increased cognitive processing and evidence gathering in high- stakes situations. I hypothesize that dysfunctional or ill-calibrated epistemic anxiety might play an important role in the motivation driving persons with obsessive- compulsive disorder (OCD) to invest high amounts of cognitive resources into the resolution of apparently simple and innocuous questions. As I argue, OCD might be conceived as a case in which epistemic anxiety is inappropriately elicited, represent- ing these as high-stakes questions, and inadequately signaling a need for cognition. In this paper, I thus make use of the concept of (epistemic) anxiety as developed in the philosophy of emotion and in epistemology, to propose an account of the role of anxiety in the pathological doubt that is central to obsessive-compulsive disorder. (shrink)

The present study examined relationships among counterfactual thinking, perceived control, and depressive symptoms. Undergraduate participants, grouped according to nondepressed, mild–to–moderately depressed, and severely depressed symptom categories, described potentially repeatable negative academic events and then made upward counterfactuals about those events. Whereas participants endorsing mild–to–moderate depressive symptom levels generated more counterfactuals about controllable than uncontrollable aspects of the events they described, participants endorsing severe levels of depressive symptoms generated counterfactuals that were less controllable, less reasonable, and more characterological in nature. Furthermore, (...) controllable (relative to uncontrollable) counterfactual thinking enhanced retrospective control perceptions for less depressed participants, but depleted control perceptions for more depressed participants. Discussion focuses on the possibility that whereas controllable counterfactual thinking may be functional for nondepressed individuals, it may be less functional, if not dysfunctional, with increasingly depressed symptoms. (shrink)