Tourette’s Syndrome can involve disruptive “ticcing” behavior. Past work suggests that people sometimes blame those making tics for such disruptions. In the current work, we examined how blame perceptions vary depending on the person’s obligation and capacity to refrain from ticcing. Across two studies, we manipulated whether a person ticced in a formal versus informal social situation (obligation), after a weak versus strong urge to tic (capacity). We assessed perceptions of blame, free will, and moral character. Blame increased with (...) increasing obligation and capacity, and perceptions of free will primarily increased with increasing capacity, with perceived obligation playing a smaller role. Moral character ratings were largely unaffected by the manipulations, but people rated the person higher in moral character when their perceived obligation and capacity were low. Generally, women, younger people, and people who knew someone with Tourette’s rated the person who ticced more positively. Overall, these results suggest that whereas blame is sensitive to a person’s obligation and capacity, these perceptions do not map cleanly onto moral character perceptions, in part perhaps due to reduced free will perceptions. Efforts to normalize tics may reduce the perceived obligation to refrain, thereby avoiding both the pitfalls of blaming people with Tourette’s or viewing them as lower in free will. (shrink)

The closeness of somatosensory phenomena and emotional states can be critically extended into a clinical perspective by referring to Tourette's Syndrome (TS). Two examples are discussed in this commentary: (1) the neurodevelopmental approach to the pre- and post-tic sensorimotor urges, and (2) the TS treatment with deep brain stimulation. It is shown that in TS, both views (locationist and constructionist) need to be combined along the lifespan in order to get a more realistic picture of the brain basis (...) of emotion. (shrink)

This book offers a philosophical perspective on contemporary Tourette Syndrome scholarship, a field which has exploded over the last thirty years. Despite intense research efforts on this common neurodevelopmental condition in the age of the brain sciences, the syndrome’s causes and potential cures remain intriguingly elusive. How does this lack of progress relate to the tacitly operating philosophical concepts that shape our current thinking about Tourette Syndrome? This book foregrounds these tacit concepts and shows how they relate (...) to “big topics” in philosophy such as time, volition, and the self. By tracing how these topics relate to current research on Tourette’s, it invites us to re-think our approach to research and care. Such re-thinking is urgently needed: individuals and families living with Tourette Syndrome remain under-serviced as pharmacological and behavioural therapies provide relief for some but not all who need support. This book highlights what questions we ask and do not ask in contemporary scholarship, thereby surfacing invisible constraints and opportunities in the field. It is of interest to scholars, health professionals, students, and affected families who want to better understand this burgeoning field of research with its conceptual controversies, approaches to aetiology, and directions for new research and improved clinical care. (shrink)

The use of philosophical phenomenology for conceptual debates in psychiatric nosology and psychopathology is beginning to be recognized. In this paper, we extend this trajectory to include Tourette Syndrome, focusing on so-called premonitory urges (PU) preceding Tourettic tics. We clarify some inconsistencies around typology in both phenomenological description and medical classification (i.e., in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision, International Classification of Diseases, 10th edition [World Health Organization, 2004], and the scales that elicit (...) PU). We show how a less typological approach might be usefully deployed in the field, that being the dimensional approach developed by Fernandez (2019a; 2019b). We test both the typological and dimensional approaches in relation to the experience and etiological role of PU in Tourette’s syndrome. Based on our synthesis of existing studies and new information garnered through phenomenological interviews (using an approach associated with “micro-phenomenology”), we argue that the role of PU in nosology challenges both the current “operational” criteria favored by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision, that are focused on behaviorally observed symptoms, as well as essential and prototypical phenomenological descriptions about a given “type” of experience. (shrink)

We reply to commentaries by Anthony Fernandez and Daryl Efron and Ivan Mathieson, outlining the nature of our phenomenological interviews.

Philosophers generally assume that individuals with Tourette syndrome are not responsible for their Tourettic tics, and so not blameworthy for any harm their tics might cause. Yet this assumption is based largely on ignorance of the lived experience of Tourette syndrome. Individuals with Tourette syndrome often experience their tics as freely chosen and reason-responsive. Yet it still seems wrong to treat a Tourettic individual’s tic as on a moral par with others’ actions. In this paper, I examine (...) the options and argue that, if this is correct, then a surprising consequence follows: the standard, motivation-basedtheory of desire must be false. I go on to argue that, given what is known about the neurological basis of Tourette syndrome, this is a reasonable conclusion to draw. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Subjective Experiences of Tourette SyndromeBeyond the Premonitory UrgeThe authors report no conflicts of interest.There is an evolving recognition in healthcare that the patient's subjective experience needs to be privileged both in understanding clinical phenomena and also ensuring the salience of outcomes used to evaluate the impact of treatment interventions. This is reflected in the expansion of patient-reported outcome measures to capture a person's perception of their own health, and (...) the increasing requirement of involving people with lived experience in the co-design of research studies (National Health and Medical Research Council, 2016) and care improvement initiatives. In mental health it has been long understood that observable behavioral phenomena can only partially inform clinical understanding of the experience of the patient living with the condition. However, capturing the patient's subjective experience faithfully remains a challenge.Tourette syndrome (TS) is a complex condition in which there are clearly observable behavioral phenomena (vocal and motor tics, compulsive and socially inappropriate behaviors), but also a broad and varied range of subjective phenomena reported by different individuals. These may include sensory phenomena such as the premonitory sensory urge preceding a tic, compulsions to touch things a certain number of times or do something repeatedly until it feels "just right," or bothersome intrusive thoughts or images. To further complicate the picture most patients with TS have one or more co-occurring conditions such as attention deficit hyperactivity disorder, obsessive-compulsive disorder, and anxiety, which may actually cause a greater burden of dysfunction and distress than the Tourette symptoms.In their paper, Curtis-Wendlandt et al. (2024) challenge the dependence of current psychiatric diagnostic criteria (e.g., the Diagnostic and Statistical Manual of Mental Disorders, 5th edition) on observable tics, and propose a broader and more dimensional approach to nosology which incorporates sensory, cognitive and affective phenomena. [End Page 47] Data from interviews they conducted identified that premonitory phenomena and urge experiences in tic disorders are more complex and diverse than what is currently reflected in the literature and clinical scales. They also interviewed participants who reported "no urges" or "no premonitory sensations." They commented that the literature generally treats reports of urge absences at face value, and does not address the likelihood that such reports may be ambiguous or problematic. Overall, they concluded that their research suggests that premonitory urges in TS are a complex and diverse phenomenon that requires further study. This reflects with our clinical experience in working with TS patients. Although a large proportion of older patients describe sensory-based premonitory urges, descriptions are not homogenous, with many describing other experiences preceding their tics.When evaluating a patient's response to an intervention (either behavioral or pharmacological) clinicians incorporate a range of information. This includes the severity of their tics (number, type, frequency, intensity, and associated impairment), as well as their mood, participation and performance in study, work, and social activities, and overall quality of life. Standard clinical practice would not typically include assessment of some of the subjective experiences which precede tics. If it was accepted that these subjective phenomena are indeed salient to the patient's well-being, then a challenge would be how to consistently and reliably capture these feelings to operationalize a comprehensive patient-centered assessment.The primary evidence-based treatment for tic disorders, comprehensive behavioral intervention for tics (CBIT), involves training to increase the awareness of premonitory urges (Woods et al., 2008). Furthermore, successful 'blocking' of tics during the course of CBIT requires the patient to be aware of premonitory urges. Clinicians having a better understanding of the complexity and diversity of experiences which precede tics, as well as using open-ended questioning styles, may assist with improving CBIT outcomes. [End Page 48]Related ArticlesFeature Article: Dimensions, Not Types: On the Phenomenology of Premonitory Urges in Tourette SyndromeCommentary: Priming and Narrative Habits in the Phenomenological Interview: Reflections on a Study of Tourette SyndromeCommentary: Subjective Experiences of Tourette Syndrome: Beyond the Premonitory UrgeResponse: Phenomenological Interviews and Tourette’sDaryl EfronThe Royal Children's Hospital MelbourneIvan MathiesonThe Laneway ClinicDaryl Efron Daryl Efron is a Consultant Pediatrician, Royal Children's Hospital Senior Research Fellow, Murdoch... (shrink)

Introduction Tourette Syndrome is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation may be considered. Methods and Results We discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he experienced (...) a tic reduction of more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects. Discussion Specific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication. Conclusion Clinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Priming and Narrative Habits in the Phenomenological InterviewReflections on a Study of Tourette SyndromeThe author reports no conflicts of interest.In "Dimensions, Not Types: On the Phenomenology of Premonitory Urges in Tourette Syndrome," Lisa Curtis-Wendlandt and Jack Reynolds provide new insights into some of the experiences characteristic of Tourette syndrome (TS). Their study is an excellent example of applied phenomenology (Burch, 2021), combining philosophy and qualitative research methods (...) to illuminate experiences that have often been mischaracterized in the existing literature. In their study, they focus on what is commonly referred to as a "premonitory urge" (PU): the "anticipatory urge that is often thought to precede the onset of the motor and phonic tics that are part of Tourette Syndrome" (Curtis-Wendlandt & Reynolds, 2024, p. 26). They ask not only whether PU is a necessary feature of TS, but also whether the very concept of PU accurately portrays the experiences and behaviors that it's intended to refer to. They point out that existing scales used to assess PU, for example, seem to implicitly narrow the relevant experiences by assuming that they are a) always negative and b) always internal, or inwardly focused (Curtis-Wendlandt & Reynolds, 2024, 26). Curtis-Wendlandt and Reynolds question these in-built assumptions about PU, suggesting that they may provide an overly narrow depiction that misses the genuine diversity of experiences that precede the onset of a motor or phonic tic.To explore these phenomena in more detail, they conducted a study intended to elicit fresh descriptions of these experiences. They interviewed 12 teenagers with a diagnosis of TS about their experiences of ticcing and tic suppression. Using the micro-phenomenological method (Petitmengin, 2006), they asked participants to reflect on a specific tic or tic suppression event and to recall the event in detail. Throughout the interview, [End Page 43] they asked open-ended questions about sensory, cognitive, or affective experiences surrounding the event. Through these interviews, they were able to generate rich descriptions of these experiences and investigate how these descriptions differed from standard accounts in the existing literature.Curtis-Wendlandt and Reynolds provide a detailed account of how they designed their phenomenological study, both philosophically and empirically. However, there is an important aspect of their method that they discuss only in a cursory or implicit way, which is what I want to focus on here. Throughout their study, they were concerned that participants might simply parrot back well-worn medicalized characterizations of PU. Such characterizations risk simplifying or even occluding key aspects of the participants' experiences that might be difficult to reflect upon or describe. However, despite stressing the importance of eliciting fresh descriptions, Curtis-Wendlandt and Reynolds provide only glimpses of how the interviews actually unfolded and what kinds of techniques they used to elicit these descriptions.In my experience, it is quite common to hear phenomenological psychologists and psychiatrists express concern that people may simply repeat common psychiatric or medicalized characterizations of their condition, rather than genuinely reflect upon and describe their first-person experiences. The philosophical assumption is that we all fall back on culturally sedimented language and terminology when describing our experiences. Someone who has spent extended periods of time interacting with psychiatrists and other healthcare professionals, for example, is likely to have picked up common ways of describing their condition—ways that may have helped them receive a diagnosis or obtain treatment. There is nothing inherently wrong with falling into these culturally sedimented characterizations. They facilitate everyday communication through a shared language and terminology. But phenomenologists are often concerned that this kind of culturally sedimented language covers over or obscures the phenomenon or experience they are trying to investigate. For example, if a psychiatrist has often described their patient's depressed mood as "sadness," then that patient may be likely to self-describe their mood as sadness in an interview setting. It might, in fact, be the case that their mood is best described as sadness. But it could also be the case that their mood would be more accurately described as, for instance, a sense of emptiness or feeling deep despair. The challenge is therefore to know whether someone's self-description is... (shrink)

You live your entire waking life immersed in your inner experiences – private phenomena created by you, just for you, your own way. Despite their intimacy and ubiquity, you probably do not know the characteristics of your own inner phenomena; neither does psychology or consciousness science. Investigating Pristine Inner Experience explores how to apprehend inner experience in high fidelity. This book will transform your view of your own inner experience, awaken you to experiential differences between people and thereby reframe your (...) thinking about psychology and consciousness science, which banned the study of inner experience for most of a century and yet continued to recognize its fundamental importance. The author, a pioneer in using beepers to explore inner experience, draws on his 35 years of studies to provide fascinating and provocative views of everyday inner experience and experience in bulimia, adolescence, the elderly, schizophrenia, Tourette's syndrome, virtuosity and more. (shrink)

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

Deep brain stimulation (DBS) of the globus pallidus interna and subthalamic nucleus has restored some degree of motor control in many patients in advanced stages of Parkinson’s disease. DBS has also been used to treat dystonia, essential tremor (progressive neurological condition causing trembling), chronic pain, obsessive-compulsive disorder, Tourette’s syndrome, major depressive disorder, obesity, cerebral palsy, and the minimally conscious state. Although the underlying mechanisms of the technique are still not clear, DBS can modulate underactive or overactive neural circuits and (...) restore disrupted communication between and among groups of neurons in interacting regions of the brain. This can control and relieve many symptoms associated with a range of neurological and psychiatric disorders.But the procedures of implanting and stimulating the electrodes are brain-invasive and entail significant risks. Some patients receiving DBS have experienced intracerebral hemorrhage, infection, cognitive disturbances such as impulsive behavior, and affective disturbances such as mania. It is not known whether continuous electrical stimulation of the brain would reshape synaptic connectivity and permanently alter neural circuits in ways that may not be salutary. The risk of these effects indicates that DBS should be used only when a patient’s condition is refractory to all other interventions and when there is a high probability that the technique will benefit the patient and improve his or her quality of life. If a patient’s quality of life is poor and all other treatment options have been exhausted, then the likelihood of benefit can justify physicians’ exposing patients to some risk. The clinical and ethical significance of the risk in DBS underscores the obligation of physicians to obtain fully informed consent from patients undergoing the procedure. (shrink)

In order to judge how behavior caused by the positivity effect should be considered, comparisons were made between the positivity effect and two mental disorders. These disorders, Tourette’s syndrome and psychopathy, were selected due to their extreme differences in what Strawsonian attitudes they inspire and how they are perceived relative to disordered patients’ will. Disorder-affected behavior of Tourette’s patients inspires the objective attitude and is seen as a condition affecting an individual’s will, while disorder-affected behavior of psychopaths inspires the (...) interpersonal attitude and is seen as a character trait. Relevant distinctions between psychopathy and Tourette’s syndrome were found to include their neurological causes, the obviousness of the suffering they caused, and how easily their disorder-affected behavior could be mapped onto goal-seeking behavior. These considerations suggest the positivity effect should be viewed similarly to psychopathy in terms of responsibility, although this is complicated by its time of development and other factors. (shrink)

Case study: while on placement at a mental health day centre I was assigned to act as key-worker to Mr X, a working-class white man in his early 40s who has been diagnosed with several psychiatric disorders. Mr X also experiences poor physical health. Mr X has been diagnosed as ?having? obsessive compulsive disorder, major depressive disorder, anger management disorder, Tourette's syndrome and paranoia. He has also been diagnosed with fibromyalgia. For all these, he daily takes a powerful (...) cocktail of anti-depressants, mood-stabilizers, anti-psychotics and pain killers. From his file I noted that he had been discharged from the local community psychiatric team, so he no longer had regular and unproblematic access to either a psychiatrist or social worker. He had been receiving anger management therapy (AMT), but his attendance had been sporadic. Mr X had, he claimed, no real friends, or, as he put it, ?just mere acquaintances?. Mr X lives alone with his mother. Mr X was a new member at the day centre but had had a long career as a mental health service user (owing to his angry behaviours he had been ?asked to leave? his previous day centre). The stated and overt purpose of our relationship was to collaborate towards ameliorating his situation. This work more commonly consisted of offering emotional and practical support, but, when first assigned Mr X, I was told by my practice assessor that eventually I would be required to carry out a risk assessment of him. So, for the purposes of this essay, I will focus on the ethical problems and dilemmas I encountered in the progression leading towards, and the actual process of carrying out, an assessment of the supposed risk that Mr X may pose either to himself, others or both. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Response to the CommentariesSean A. SpenceIn “Free Will in the Light of Neuropsychiatry,” I have attempted to present an argument from the perspective of materialist neuroscience, pushing the latter to its logical conclusion: that if the human nervous system is consistent in its properties, then the only place for “free will” is in the non-conscious processes which underpin conscious awareness. This argument I have based on two supports: the (...) “spatial” and the “temporal” (Spence, 1995).I have contended that the sense of freedom may be lost from certain actions, thereby implying that “freedom” is a sensory process distinct from action. This might be conceptualized as having a distinct functional distribution within the nervous system (a spatial distinction). I have also argued that conscious awareness of events occurs at a finite delay, the period of “neuronal adequacy,” after those events themselves. The point here is that neurochemical events giving rise to phenomenology are likely to require a period of time (no matter how short) for their genesis. The process is “on line” before we perceive it (a temporal distinction). Thus the “freedom to act,” a motor process, is necessarily non-conscious at the point of initiation.I am grateful to Frith, Libet and Stephens for their comments. In the most part our disagreements are likely to be those of emphasis, perhaps compounded by my uses of the term “free will.”I have no major disagreement with Frith’s comments. I would, however, emphasize that it is likely that the Bereitschaftspotential, or readiness potential, does tell us something regarding intended actions. It is, for example, absent prior to the involuntary movements seen in Tourette’s syndrome (Obeso et al. 1982), and reduced in akinetic patients with Parkinson’s disease (Dick et al. 1989) or medial frontal lobe lesions (Deecke et al. 1987). The latter groups have difficulty initiating intended, internally generated, actions.With regard to the suspicion of dualism in my diagrams, the point is well taken, but I am attempting to describe a functional distinction, the precise coordinates of which remain obscure. It may well be that “consciousness” occupies no fixed location but is an activity temporarily co-extant with that association cortex (or cortices) subserving the sensory modality (or modalities) experienced phenomenologically (see Bottini et al. 1995).I have based much of my “temporal” argument on Libet’s work, and I am grateful for his response. Nevertheless, I am still of the opinion that there is a central inconsistency with his argument that conscious control exerts a veto on acts which is somehow free of material constraints. [Indeed he states that he has “no quarrel with the view that even a fully voluntary act is initiated unconsciously (non-consciously)”.] Whereas I can [End Page 99] not prove that this power of veto does not evade neurochemical processes, or that it somehow acts instantaneously and independently, with no origin in unconscious processing, I can say that I have restricted myself to arguing within a materialist perspective, with the aim of “pushing it” to its extreme. The free will which Libet retains in consciousness is one which is unique, and unconstrained by materialism. It is dualism in disguise!Stephens implies that there is a non-argument regarding consciousness acting as an initiator of events. The suggestion is that no one would argue this. Yet this is Libet’s argument. It cannot be disproved, but it is clearly (internally) inconsistent with Libet’s own impressive body of work.As for the role of consciousness in action, I have, I think, invoked a position similar to that adopted by Stephens; that consciousness is more a sensory state, allowing awareness of actions, and their consequences, and perhaps thereby facilitating the function of non-conscious initiators. It is clearly necessary for the performance of the “higher” acts which we equate with human nature, but it is not sufficient. (Indeed many of the most creative insights have “emerged” into consciousness [see Boden, 1992].) The man with a paralyzed arm may wish for his arm to move but to no avail. Over time function may slowly reappear. But if his lesion is such that he is unaware of his impairment (anosognosia), then his prognosis may... (shrink)

The neural networks that constitute corticostriatothalamocortical circuits between prefrontal cortex and subcortical structure provide a heuristic framework for bridging gaps between neurocircuitry and executive dysfunction in attention deficit hyperactivity disorder (ADHD). “Cool” and “Hot” executive functional theory and the models of dual pathway are supposed to be applied within the neuropsychology of ADHD. The theoretical model elaborated response inhibition and delayed gratification in ADHD. We aimed to review and summarize the literature about the circuits on ADHD and ADHD-related comorbidities, as (...) well as the effects of neurocircuitry on the executive dysfunction in ADHD. (shrink)

Despite a recent surge in publications on Tourette Syndrome, we still lack substantial insight into first-personal aspects of “what it is like” to live with this condition. This is despite the fact that developments in phenomenological psychiatry have demonstrated the scientific and clinical importance of understanding subjective experience in a range of other neuropsychiatric conditions. We argue that it is time for Tourette Syndrome research to tap into the sophisticated frameworks developed in the philosophical tradition of phenomenology for (...) describing experience in a way that integrates discrete symptoms into an overarching experiential framework concerning the self, the body, and its modes of experience. Following a historical introduction that contextualises the pertinence of phenomenology to psychopathology, we distinguish this approach from the existing, psychologically oriented studies on TS that are also qualitative. We then outline gaps and opportunities for future research, including the sorts of questions that might be utilised in phenomenological interviews and why they are of potential benefit to research programs in philosophy, psychology, and neuroscience. In conclusion we address some of the broader implications for phenomenology of the body and philosophy of action. (shrink)

Purpose: There is a widespread recognition that biomedical explanations offer benefits to those diagnosed with a mental disorder. Recent research points out that such explanations may nevertheless have stigmatizing effects. In this study, this ‘mixed blessing’ account of biomedical explanations is investigated in a case of philosophical interest: Tourette Syndrome. Method: We conducted a vignette survey with 221 participants in which we first assessed quantitative attributions of blame as well as the desire for social distance for behavior associated with (...) Tourette Syndrome. Results: In our study, it is confirmed that in the case of biomedical explanations, less blame is attributed than in the case of psychosocial explanations. When presented with a mixed explanation stressing an entanglement of biological and psychosocial factors this did not increase blame attribution. The desire for social distance is unaffected by the type of explanation but the participants’ free text feedback indicates this might obfuscate an underlying dilemma between stigma and blame revealed in recent research. Conclusion: There seems to be potential for blame reduction in explanations where biological and psychosocial factors are entangled. However, dynamic, ‘epigenetic’, explanations require further qualitative research to be performed as well as a philosophical framework to account for the ‘mixed blessings’ account. (shrink)

Ordinary cases of object seeing involve the visual perception of space and spatial location. But does seeing an object require such spatial perception? An empirical challenge to the idea that it does comes from reflection upon Bálint's syndrome, for some suppose that in Bálint's syndrome subjects can see objects without seeing space or spatial location. In this article, I question whether the empirical evidence available to us adequately supports this understanding of Bálint's syndrome, and explain how the (...) aforementioned empirical challenge can be resisted. (shrink)

This chapter highlights the complexity of the relationship between enhancement of mood and cognition on the one hand and the improvement of people's well‐being on the other. To do so, two psychiatric conditions, Asperger's syndrome and bipolar disorder, are presented in the chapter. Even though there are both negative and positive aspects to Asperger's syndrome or to bipolar disorders, taking away even these negative aspects would not necessarily promote well‐being. It might also be impossible to isolate the positive (...) aspects of these disorders. An increase in specific forms of cognition might be intrinsically connected to a decrease in specific aspects of mood. A decrease in specific aspects of mood might be intrinsically connected to an increase in creativity. Neither is necessarily linked to any changes in some general form of “well‐being.”. (shrink)

This paper advances recent efforts to re-integrate Tourette Syndrome (TS) with phenomenological psychiatry by centring discussions on the ticcing person as an agent interacting with her world. To achieve this, I will draw on a concept which rarely appears in the literature on tic disorders, but which is central to phenomenological psychiatry: the self and, more specifically, the notion of agency. First, I will present emerging experimental evidence for altered agency dynamics in TS, as expressed by both heightened attributions (...) of agency (AA) and a weakened pre-reflective sense of agency (SA). I will explore possible explanations for these agency dynamics by drawing on contemporary neuroscientific experiments on perception–action binding in TS and suggest that there is a person-level “phenomenological correlate” to the strong binding effect observed between perception and action in the experimental literature. Next, I will ask how hypo-SA and hyper-AA may be interrelated, and what other factors might influence agency dynamics in TS. In conclusion, I call for more nuanced phenomenological research into Tourettic experiences of agency and their implications and opportunities for research and care. (shrink)

Kant, Wittgenstein, and Husserl all held that visual awareness of objects requires visual awareness of the space in which the objects are located. There is a lively debate in the literature on spatial perception whether this view is undermined by the results of experiments on a Balint’s syndrome patient, known as RM. I argue that neither of two recent interpretations of these results is able to explain RM’s apparent ability to experience motion. I outline some ways in which each (...) interpretation may respond to this challenge, and suggest which way of meeting the challenge is preferable. I conclude that RM retains some awareness of the larger space surrounding the objects he sees. (shrink)

Gilles de la Tourette syndrome (TS) is a childhood neuropsychiatric disorder characterised by the presence of motor and vocal tics. Patients with malignant TS experience severe disease sequelae; risking morbidity and mortality due to tics, self-harm, psychiatric comorbidities and suicide. By definition, those cases termed ‘malignant’ are refractory to all conventional psychiatric and pharmacological regimens. In these instances, deep brain stimulation (DBS) may be efficacious. Current 2015 guidelines recommend a 6-month period absent of suicidal ideation before DBS is offered (...) to patients with TS. We therefore wondered whether it may be ethically justifiable to offer DBS to a minor with malignant TS. We begin with a discussion of non-maleficence and beneficence. New evidence suggests that suicide risk in young patients with TS has been underestimated. In turn, DBS may represent an invaluable opportunity for children with malignant TS to secure future safety, independence and fulfilment. Postponing treatment is associated with additional risks. Ultimately, we assert this unique risk-benefit calculus justifies offering DBS to paediatric patients with malignant TS. A multidisciplinary team of clinicians must determine whether DBS is in the best interest of their individual patients. We conclude with a suggestion for future TS-DBS guidelines regarding suicidal ideation. The importance of informed consent and assent is underscored. (shrink)

. The present study applies results and methods of psychobiology to intellectual history. Pascal's syndrome is a depressive neurosis associated with morbid effects of scientific certainty. The syndrome is characterized by self‐mortification and conversion experience that represses distressing certainties. The dynamics of the syndrome are assessed from Blake Pascal's psychosis. The ideation of the syndrome is evaluated by reference to the neurology of altered states of consciousness and the biogenic amine hypothesis of depression and mania. The (...) evaluation yields a description of the relation between psychogenic and biogenic factors in the syndrome's etiology. (shrink)

Philosophers have recently argued that since there are people who are blind, but don't know it, and people who echolocate, but don't know it, conscious introspection is highly unreliable. I contend that a second look at Anton's syndrome, human echolocation, and ‘facial vision’ suggests otherwise. These examples do not support skepticism about the reliability of introspection.

Attention-Deficit Hyperactivity Disorder (ADHD) and Tourette Syndrome (TS) present as distinct conditions clinically; however, comorbidity and inhibitory control deficits have been proposed for both. Whilst such deficits have been studied widely within clinical populations, findings are mixed—partly due to comorbidity and/or medication effects—and studies have rarely distinguished between subtypes of the disorders. Studies in the general population are sparse. Using a continuity approach, the present study examined (i) the relationships between inattentive and hyperactive/impulsive aspects of ADHD and TS-like behaviors (...) in the general population, and (ii) their unique associations with automatic and executive inhibitory control, as well as (iii) yawning (a proposed behavioral model of TS). One hundred and thirty-eight participants completed self-report measures for ADHD and TS-like behaviors as well as yawning, and a conditioned inhibition task to assess automatic inhibition. A sub-sample of fifty-four participants completed three executive inhibition tasks. An exploratory factor analysis of the TS behavior checklist supported a distinction between phonic and motor like pure TS behaviors. Whilst hyperactive/impulsive aspects of ADHD were associated with increased pure and compulsive TS-like behaviors, inattention in isolation was related to reduced obsessive-compulsive TS-like behaviors. TS-like behaviors were associated with yawning during situations of inactivity, and specifically motor TS was related to yawning during stress. Phonic TS and inattention aspects of ADHD were associated with yawning during concentration/activity. Whilst executive interference control deficits were linked to hyperactive/impulsive ADHD-like behaviors, this was not the case for inattentive ADHD or TS-like behaviors, which instead related to increased performance on some measures. No associations were observed for automatic conditioned inhibition. (shrink)

Asperger's syndrome is a pervasive developmental condition characterized by features of autism. As observed in clinical practice, individuals with Asperger's syndrome present an impairment related to inflexibility in their everyday routine, an immediate manner of experiencing and relating, and difficulties in estimating periods of time. Following a phenomenological perspective, this study is an attempt to examine these aforementioned aspects in terms of temporality. Thirteen participants with Asperger's syndrome, from 13 to 20 years old, were interviewed about their (...) experience of periods of time, personal history, their past, present and future; and their concept of time and finitude. After the interviews, it was possible to identify three general themes which emerged in the invariant aspects of their experience of time: factual experience of present and future dimensions, chronological time and the past experience. Moreover, participants' descriptions evidenced aspects of experience based on the specificity of lived facts and a sense of time specifically related to what was lived in the past. (shrink)

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

I have great sympathy for what seem to be two main goals in Michelle Ciurria’s (2014) “Moral Responsibility and Mental Health: Applying the Standard of the Reasonable Person,” although I am not sure the reasonable person standard achieves either of the goals. These central goals seem to be to preserve an objective standard of moral responsibility and to do so in a way that “does not depersonalize the target individual” (Ciurria 2014, 7). In this commentary, I focus on my doubts (...) about the adequacy of the reasonable person standard, at least as presented in Ciurria’s paper, to meet either of these goals. It might be that had she chosen the example of the psychopath rather than Tourette syndrome to work through in a .. (shrink)

We describe our clinical experience in treating patients with Tourette syndrome and other tic disorders using infra-low frequency neurofeedback, often in conjunction with cognitive behavior therapy. Following a narrative description of our approach, we present outcome data for 100 successive cases. Many of the children and adolescents that we have treated since 2005 did not derive sufficient benefit from standard treatment for Tourette syndrome and other tic disorders. In our clinical experience, based on extensive before- and after- testing (...) and symptom tracking, this patient group derived significant additive benefit from complementary neurofeedback treatment. The majority of trainees attained a higher level of functioning and were able to live up to their potential in a way they were not able to prior to neurofeedback treatment. (shrink)

This article focusses upon defining those factors which may contribute to the pathogenesis of cancer. The molecular basis of tumour etiology is discussed with reference to cancer predisposing syndromes, and in particular to the human inherited disease, Bloom's sysdrome. In Bloom's syndrome, patients are predisposed to a wide variety of malignant disease. We propose a model in which overexpression of the ubiquitous c‐myc proto‐oncogene contributes to this process.

This paper investigates confabulations in Korsakoff’s syndrome (KS) from the perspective of error-based teleosemantics, a framework that emphasizes the role of error detection in mental representation. I introduce a distributed and communicative model of memory, framing it as a network of information transfer encompassing both internal cognitive processes and external social interactions. This model, grounded in teleosemantics, allows for an understanding of how confabulations arise not solely from internal memory deficits, but also from disruptions in the feedback loops between (...) individuals and their social environments. By analyzing cases of provoked and spontaneous confabulations in KS patients, I demonstrate how this framework illuminates the crucial role of external consumers (e.g., caregivers) in either reinforcing or correcting erroneous memory reports. This approach, emphasizing error detection mechanisms, offers a new lens for examining the interplay between individual cognitive processes and social scaffolding in shaping memory and its pathologies. (shrink)

Sorensen raises the issue of whether it is logically possible to fake Munchausen's syndrome by way of a fictional exchange between a physician and an insurance company. In this paper, it is shown that it is possible to fake Munchausen's syndrome and to fake faking Munchausen's syndrome. The implications of this on deeper philosophical issues such as Lewis' puzzle of iterated pretence and “internalist” versus “externalist” accounts of faking are discussed. An externalist account of faking is defended (...) and offered as a solution to Lewis' puzzle as it arises in this context. (shrink)

Neither the pathogenesis nor the aetiology of Down's syndrome (DS) are clearly understood. Numerous studies have examined whether clinical features of DS are a consequence of specific chromosome 21 segments being triplicated. There is no evidence, however, that individual loci are responsible, or that the oxidative damage in DS could be solely explained by a gene dosage effect. Using astrocytes and neuronal cultures from DS fetuses, a recent paper shows that altered metabolism of the amyloid precursor protein and oxidative (...) stress result from mitochondrial dysfunction.1 These findings are consistent with considerable data implicating the role of the mitochondrial genome in DS pathogenesis and aetiology. BioEssays 24:681–684, 2002. © 2002 Wiley Periodicals, Inc. (shrink)