Cyberbiosecurity is an emerging field that relates to the intersection of cybersecurity and the clinical and research practice in the biosciences. Beyond the concerns that usually arise in the areas of genomics, this paper highlights ethical concerns raised by cyberbiosecurity in clinical neuroscience. These concerns relate not only to the privacy of the data collected by imaging devices, but also the concern that patients using various stimulatory devices can be harmed by a hacker who either obfuscates the (...) outputs or who interferes with the stimulatory process. The paper offers some suggestions as to how to rectify these increasingly dire concerns. (shrink)

: This paper investigates epistemological differences in the cognitive neuroscientific and phenomenological approaches to outstanding questions in psychiatry. We argue that clinical neuroscience provides scientific explanation in line with a mechanistic approach and describe several examples from computational approaches that illustrate what research on neural processing can tell us about psychiatric diseases. By contrast, phenomenology offers complex descriptions of experiential phenomena. Through a discussion of executive function and the related construct of impulsivity, we show that both cognitive (...) class='Hi'>neuroscience and phenomenology provide valuable types of explanation. Our focus on psychopathology also allows us to address some important epistemic differences between these two disciplines. Keywords: Phenomenology; Consciousness; Clinical Neuroscience; Computational Neuroscience; Cognitive Mechanisms Coscienza e meccanismi cerebrali: ricerche epistemologiche tra fenomenologia e neuroscienza clinica Riassunto: Il presente lavoro propone di esaminare le differenze epistemologiche tra la fenomenologia e le neuroscienze cognitive riguardo dibattiti psichiatrici. Le neuroscienze cliniche saranno discusse in linea con un approccio meccanicista della spiegazione scientifica, mentre descrizioni fenomenologiche saranno proposte nel momento in cui complessi fenomeni esperenziali dovranno essere indagati. Un’interpretazione meccanicista delle neuroscienze cognitive sarà esemplificata ricorrendo ad alcuni esempi dagli approcci computazionali che si occupano di questi temi, i quali ci aiuteranno a definire cosa le ricerche sui processi neurali ci stanno dicendo rispetto alle sintomatologie psichiatriche. Questi argomenti saranno sviluppati attraverso una discussione che verterà sulle funzioni esecutive e il costrutto di impulsività a esse legato. Sarà discusso come sia le neuroscienze cognitive sia la fenomenologia possano fornire specifiche forme di spiegazione. Allo stesso tempo, si proporrà un’argomentazione che consentirà di discernere differenze epistemiche che caratterizzano i suddetti approcci, le quali potranno con più facilità emergere nel dibattito psichiatrico. Parole chiave : Fenomenologia; Coscienza; Neuroscienza clinica; Neuroscienza computazionale; Meccanismi cognitivi. (shrink)

Objective: Caloric vestibular stimulation has traditionally been used as a tool for neurological diagnosis. More recently, however, it has been applied to a range of phenomena within the cognitive neurosciences. Here, we provide an overview of such studies and review our work using CVS to investigate the neural mechanisms of a visual phenomenon - binocular rivalry. We outline the interhemispheric switch model of rivalry supported by this work and its extension to a metarivalry model of interocular-grouping phenomena. In addition, studies (...) showing a slow rate of binocular rivalry in bipolar disorder are discussed, and the relationship between this finding and the interhemispheric switch model is described. We also review the effects of CVS in various clinical contexts, explain how the technique is performed and discuss methodological issues in its application. (shrink)

This book offers fundamental insights into three main fields of education and expertise: phenomenology, neuroscience, and clinical practice. The richness and pluralism of the contributions aim to overcome the reductionist and dualistic approach to mental health and shed new light on clinical practice. Designed as both an education tool for mental health professionals, and a theoretical investigation for philosophers on the use of phenomenology in clinical practice, this book highlights the need for a new direction on (...) mental health, and more general, on human wellbeing. This volume aims to fill the gap between philosophers and mental health professionals on an educational level, in a space unique in its open and transdisciplinary approach. It appeals to students and researchers but also very much to professionals and clinicians in the field. (shrink)

This volume explores how conceptions of pragmatism set forth in American philosophy serve as orienting perspectives in psychotherapy. Drawing on the influential contributions of William James and John Dewey, the author demonstrates how realistic, comparative approaches to understanding strengthen everyday therapeutic practice. He also examines recent developments in neuroscience that shape training and practice in the broader field of psychotherapy, encompassing psychodynamic, behavioral, cognitive and humanistic traditions. By following a clinical pragmatism, psychotherapy can be viewed as an instrumental (...) project that is governed by _results_ rather than a commitment to particular theoretical perspectives, empirical findings, or technical strategies. Through a variety of case studies, this volume emphasizes the crucial role of experiential learning in change and growth, and the recognition of the person as an individual. (shrink)

: Hypotheses are the first step in scientific and clinical enquiry. They guide all of the subsequent steps in an investigation, and influence data collection, analysis, and interpretation. But how do we build scientific and clinical hypotheses? In both research and clinical contexts, a professional’s idiosyncratic way of perceiving reality, her prejudices and biases will influence the process of hypothesis formulation. We compare the process of formulating a scientific hypothesis in the field of neuroscience with the (...) process of building a clinical hypothesis in the systemic therapeutic approach. This comparison is intended to highlight the biases that influence researchers and clinicians when formulating hypotheses. Our aim is to raise awareness of the most common biases, and to point out how the tools developed by clinicians could be useful to researchers, and vice versa. Keywords: Hypotheses; Clinical Psychology; Neuroscience; Bias; Interdisciplinary Approach La costruzione di ipotesi nella psicologia clinica e nella neuroscienza: similitudini e differenze Riassunto: Le ipotesi sono il primo passo della ricerca scientifica e clinica. Sono la guida di tutti i passi successivi e influenzano la racconta dei dati, la loro analisi e l’interpretazione. Come si costruiscono le ipotesi scientifiche e quelle cliniche? Sia nell’ambito della ricerca che nei contesti clinici le idiosincrasie con cui un professionista percepisce la realtà, i suoi bias e pregiudizi influenzeranno il processo di formulazione dell’ipotesi. In questa sede intendiamo confrontare il processo di formulazione di un’ipotesi scientifica nel campo della neuroscienza e il processo di costruzione dell’ipotesi clinica nell’approccio della terapia sistemica. Questo confronto vuole mettere in luce i bias che influenzano ricercatori e terapeuti nella formulazione delle ipotesi. Il nostro scopo è mettere in luce gli errori sistematici più comuni, mostrando come gli strumenti sviluppati dai terapeuti possano essere utili per i ricercatori e viceversa. Parole chiave: Ipotesi; Psicologia clinica; Neuroscienza; Bias; Approccio interdisciplinare. (shrink)

Recent multidisciplinary activity has provided the impetus to break down these boundaries and encourage a freer exchange of information across disciplines. This text reflects these developments.

In the target article, Grant Gillett (2009) has taken an important step toward greater synthesis of neuroethics, philosophy, and neuroscience. In his neo-Aristotelian account, Gillett posits a nece...

Paul MacLean, founder and long-time chief ofthe Laboratory of Brain Evolution and Behavior,National Institutes of Health, is a pioneeringfigure in the emergent field of evolutionaryneuroscience. His influence has been widelyfelt in the development of biologicalpsychiatry and has led to a considerableliterature on evolutionary approaches toclinical issues. MacLean's work is alsoenjoying a resurgence of interest in academicareas of neuroscience and evolutionarypsychology which have previously shown littleinterest or knowledge of his extensive work. This chapter builds on MacLean's work to bringtogether new (...) insights into the neuralarchitecture of human development, hierarchy,conflict behavior, and reciprocity in the formof the Conflict Systems Neurobehavioral Model. Hamilton 's rule of kinship altruism orinclusive fitness is proposed to be the gene'seye complement to MacLean's evolutionaryneuroscience and the CSN Model derivedtherefrom. Hierarchy, conflict behavior andreciprocity are also central issues in healthydevelopment as well as in clinical syndromes ofdepression, mania, and other socialmaladjustments. The emerging insights permitthe integration of the concept of inclusivefitness underpinning evolutionary psychologywith MacLean's perspective on evolutionaryneuroscience as well as the definition of newchallenges for mental health and socialstability. The policy implications areindicated. (shrink)

Pain is not a single entity but is instead a collection of sensory experiences commonly associated with tissue damage. There is growing recognition that not all pains are equivalent, that pains and pathologies are not related in a simple manner, and that acute pains differ in many respects from persistent pains. Great strides have been made in improving our understanding of the neuronal mechanisms responsible for acute pain, but the studies leading to these advances have also led to the realization (...) that a bewildering array of processes are interposed between tissue damage and sensations of pain, especially in persistent pains. Persistent pains often seem unrelated or disproportionate to identifiable pathology, and they are modulated by a multitude of factors. This complexity in such a vital function serves as a challenge both to scientists seeking fundamental understanding and to clinicians faced with the immediate need to treat patients with painful disorders. (shrink)

Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/uws) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial (...) nutrition and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/uws more respondents agreed with treatment withdrawal when they considered that VS/uws patients did not feel pain (77%) as compared to those who thought VS/uws did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hermeneutics, Neuroscience and PsychiatryMichael T. H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM (bio)Hermeneutic practice in mental health has been a theme in Philosophy, Psychiatry, & Psychology (PPP) since its very beginnings. In this essay I argue that hermeneutics, the theory and practice of interpretation, promotes therapeutic interaction between mental health professionals, patients and their family.Why does this patient present in such a way at this (...) particular point in time? The distressing symptoms are there. The changes in behavior are obvious. Impairments of functions are hurting. A mental illness clearly runs in the family. There were early losses of loved ones, physical abuse at home, bullying by peers and self-medication with drugs and alcohol. Three in four adults with a mental illness first experienced that before they turned 24. The brain goes through major reorganization during adolescence and early adulthood. If synaptic pruning went wrong, psychoses emerged. When stresses activated the hypothalamic–pituitary–adrenal axis the elevated cortisol level impacted the size and function of the hippocampus and amygdala in the genetically vulnerable; anxiety, depression, bipolar, and personality disorders developed. The patient needs a voice/language to describe all these experiences and events and the psychiatrist needs a discourse to make sense of them.Eisenberg laments the swings between "brainlessness" and "mindlessness" in psychiatry. Engel argues for a "biopsychosocial" discourse. The major challenge for psychiatry is how to organize clinical information of different nature (categories, dimensions, narratives; i.e., objective vs. subjective, personal vs. interpersonal) into a coherent and comprehensible account for us all. Mental illnesses are not only neuropsychiatric spectrum disorders but also dysfunctions of social relationship and environmental/ecological adaptation. Psychiatry as a clinical neuroscience per se lacks the semantics to address the rich interactions between the physical, psychological, social, cultural, and spiritual in the illness experience of our patients. Explanation in the diagnostic formulation (objective scientific discourse on cause and effect) and understanding in the patient narrative (subjective ordinary everyday discourse on significance and meaning) are irreducible to each other (Wong, 2018). They instead interact with one another to achieve an integrative formulation, not through merging different discourses into a single assertion/monologue but via the dialectic/dialogue of "explaining more in order to understand better," as Ricoeur puts it, and between "the whole and the parts," as Schleiermacher highlights.This "therapeutic hermeneutic circle" of "explanation vs understanding" and "the whole vs the parts" includes symptoms behavior function and life events. It correlates between bio-psychosociocultural-spiritual dimensions/perspectives and does not reduce them to any particular/single [End Page 13] stance. The whole integrates the parts and the parts enrich the whole. It explains but does not explain away. It understands through an articulation of meaning and significance. This discourse is a multilayered (bio-psycho-social-cultural-spiritual) personal narrative that formulates diagnosis and care in a correlative (linking different voices/discourses) and non-reductive (no particular voice/discourse is prejudiced against) manner that is comprehensible to us all (Wong, 2021).PPP will be an excellent forum for discussing clinical hermeneutics in the future. In this digital era of social media and virtual reality, hermeneutics has the never-ending task to tackle the unprecedented challenges to meaning illness and health posed by polarizing discourses.Michael T. H. Wong Michael T.H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM, is Hon Clinical Professor, Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, HKSAR, China. Michael is Chair, Section of Philosophy & Humanities in Psychiatry, World Psychiatric Association. He is an Organizational Partner & International Lead with The Collaborating Centre for Values-Based Practice in Health and Social Care, St Catherine's College Oxford. He is Advisor to the Chinese Health Foundation of Australia.ReferencesWong M. T. H. (2018). Ricoeur and the third discourse of the person: From philosophy and neuroscience to psychiatry and theology. London: Lexington Books. Google ScholarWong, M. T. H. (2021). Values, meanings, hermeneutics and mental health. In Stoyanov, D., Fulford, K. M. W. F., Stanghellini, G., Van Staden, W., & Wong, M. TH. (Eds.), International perspectives in values-based mental health practice: Case studies and commentaries (pp. 341–349... (shrink)

Assessment of decision-making capacity (DMC) can be difficult in acquired brain injury (ABI) particularly with the syndrome of organic personality disorder (OPD) (the “frontal lobe syndrome”). Clinical neuroscience may help but there are challenges translating its constructs to the decision-making abilities considered relevant by law and ethics. An in-depth interview study of DMC in OPD was undertaken. Six patients were purposefully sampled and rich interview data were acquired for scrutiny using interpretative phenomenological analysis. Interview data revealed that awareness (...) of deficit and thinking about psychological states can be present. However, the awareness of deficit may not be “online” and effectively integrated into decision-making. Without this online awareness of deficit the ability to appreciate or use and weigh information in the process of deciding some matters appeared absent. We argue that the decision-making abilities discussed are: (1) necessary for DMC, (2) threatened by ABI, and (3) assessable at interview. Some advice for practically incorporating these abilities within assessments of DMC in patients with OPD is outlined. (shrink)

Due to the progress being made in the neurosciences, higher expectations for the use of medication, even against the patient’s will, are arising in mental hospitals. In this article, we will discuss whether the neurosciences and new psychopharmacological solutions really support patients who suffer from mental illnesses. To answer this question, we will focus on the perspective of patients and their experiences with psychiatric (coercive) treatments. The analysis of one person’s story shows that other issues besides appropriate medication are important (...) for recovery from a mental illness. In daily life, issues such as coping, rehabilitation and social support are of major importance for a patient suffering from psychiatric disease. Thus, although progress in the neurosciences is a positive development for clinical practice, it does not mean that (coercive) medication alone will carry a patient into recovery. A patient’s recovery is dependent, not only upon the process of finding the appropriate medication and trust between the psychiatrist and the patient, but also upon relational aspects, such as being recognised as a person, belonging, accepting responsibilities, developing friendships and trusting others. These findings lead to the conclusion that dealing with psychiatric diseases is more complex than what the biomedical model of neuroscience suggests and that one should include the social context of the patient in the recovery process. (shrink)

In this article, I present an argument that suggests neuroscience should inform judgments of decision-making capacity. First, I review key behavioral and neurocognitive data to demonstrate that neuroscientific tests might be predictive of decision-making capacity, and that these tests might inform clinical judgments of capacity. Second, I argue that, consistent with the principles of autonomy and justice, such data should inform judgements of decision-making capacity. While the neuroscience of decision-making capacity still requires time to mature, there is (...) strong reason to believe that neuroscience might assist clinicians in adjudicating difficult cases in the future. This article focuses on the assessment of capacity in brain injury patients who have profound communication impairments, however, the overarching aim of the article is to highlight the potential use of neuroscience to improve our understanding of the relationship between cognition and decision-making capacity. (shrink)

Morality, ethics, and the law : an overview of the foundations of contemporary clinical ethical analysis -- Case studies : ethical and legal challenges in the care of the neurologically injured critically ill patient -- Civil law and liability : the law of medical malpractice -- Legal reasoning, legal process, legal proof, and why it is confusing to clinician scientists -- Regulatory law and the clinical practice of the neurosciences -- Digital medicine and the data revolution managing digital (...) distraction and EMR : liability while leveraging opportunities in teleneurology and telecritical care -- Developing and leading a sustainable high reliability high performing unit : theories of quality, teamwork, medical error, and patient safety -- Neurolaw and the integration of neuroscience, ethics, and the law : the new frontiers. (shrink)

BackgroundAs a discipline, neuroethics addresses a range of questions and issues generated by basic neuroscientific research, and its use and meanings in the clinical and social spheres. Here, we present Part 4 of a four-part bibliography of the neuroethics literature focusing on clinical and social applications of neuroscience, to include: the treatment-enhancement discourse; issues arising in neurology, psychiatry, and pain care; neuroethics education and training; neuroethics and the law; neuroethics and policy and political issues; international neuroethics; and (...) discourses addressing "trans-" and "post-" humanity.MethodsTo complete a systematic survey of the literature, 19 databases and 4 individual open-access journals were employed. Searches were conducted using the indexing language of the U.S. National Library of Medicine. A Python code was used to eliminate duplications in the final bibliography.ResultsWhen taken with Parts 1-3, this bibliography aims to provide a listing of international peerreviewed papers, books, and book chapters published from 2002 through 2016. While seeking to be as comprehensive as possible, it may be that some works were inadvertently and unintentionally not included. We therefore invite commentary from the field to afford completeness and contribute to this bibliography as a participatory work-in-progress. (shrink)

This article explores a literary tradition situated at the intersection of scientific reports, memoirs, and creative writing, termed “clinical narrative.” This genre offers a profound approach to the painful aspects of conscious experience, particularly the phenomenological states associated with mental illness and brain disease, seen as unsettling landscapes of phenomenal experience. Through case studies providing multifaceted viewpoints – first-person, second-person, and third-person perspectives – we argue that clinical narratives are valuable resources for a transepistemic study of consciousness. By (...) examining clinical conundrums such as somatic and nihilistic delusions, and anosognosia, we highlight the importance of detailed phenomenological, hermeneutic, and narrative accounts while acknowledging the significance of subpersonal, mechanistic models from cognitive and affective neuroscience. The tradition embodies the tension between the diverse perspectives in the field of mental health, including stories that directly challenge the medical discourse. However, the narrative arts can act as mediators or even peacemakers, by fostering an understanding between the opposing views. Stories are open to multiple interpretations, preserving the diversity of discourses on human meaning and avoiding the imposition of monolithic versions of our humanness. (shrink)

Neuroscience was the basic science behind Freud's psychoanalytic theory and technique. He worked as a neurologist for 20 years before being aware that a new approach to understand complex diseases, namely the hysterias, was needed. Solms coined the term neuropsychoanalysis to affirm that neuroscience still belongs in psychoanalysis. The neuropsychoanalytic field has continued Freud's original ideas as stated in 1895. Developments in psychoanalysis that have been created or revised by the neuropsychoanalysis movement include pain/relatedness/opioids, drive, structural model, dreams, (...) cathexis, and dynamic unconscious. Neuroscience has contributed to the development of new psychoanalytic theory, such as Bazan's ( 2011 ) description of anxiety driven by unconscious intentions or “phantoms.” Results of adopting the “dual aspect monism” approach of idiographic psychoanalytic clinical observation combined with nomothetic investigation of related human phenomena include clarification and revision of theory, restoration of the scientific base of psychoanalysis, and improvement of clinical treatments. By imbricating psychoanalytic thinking with neuroscience, psychoanalysts are also positioned to make contributions to neuroscience research. Freud's original Project for a Scientific Psychology/Psychology for Neurologists can be carried forward in a way that moves psychoanalysis into the twenty-first century as a core contemporary science (Kandel, 1999 ). Neuroscience as the basic science of psychoanalysis both improves the field, and enhances its scientific and cultural status. (shrink)

Social anxiety disorder has been widely recognised as one of the most commonly diagnosed mental disorders. Individuals with social anxiety disorder experience difficulties during social interactions that are essential in the regular functioning of daily routines; perpetually motivating research into the aetiology, maintenance and treatment methods. Traditionally, social and clinical neuroscience studies incorporated protocols testing one participant at a time. However, it has been recently suggested that such protocols are unable to directly assess social interaction performance, which can (...) be revealed by testing multiple individuals simultaneously. The principle of two-person neuroscience highlights the interpersonal aspect of social interactions that observes behaviour and brain activity from both constituents of the interaction, rather than analysing on an individual level or an individual observation of a social situation. Therefore, two-person neuroscience could be a promising direction for assessment and intervention of the social anxiety disorder. In this paper, we propose a novel paradigm which integrates two-person neuroscience in a neurofeedback protocol. Neurofeedback and interbrain synchrony, a branch of two-person neuroscience, are discussed in their own capacities for their relationship with social anxiety disorder and relevance to the paradigm. The newly proposed paradigm sets out to assess the social interaction performance using interbrain synchrony between interacting individuals, and to employ a multi-user neurofeedback protocol for intervention of the social anxiety. (shrink)

Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial (...) nutrition and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/UWS more respondents agreed with treatment withdrawal when they considered that VS/UWS patients did not feel pain (77%) as compared to those who thought VS/UWS did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments. (shrink)

In this response we address additions to as well as criticisms and possible misinterpretations of our proposal for a second-person neuroscience. We map out the most crucial aspects of our approach by (1) acknowledging that second-person engaged interaction is not the only way to understand others, although we claim that it is ontogenetically prior; (2) claiming that spectatorial paradigms need to be complemented in order to enable a full understanding of social interactions; and (3) restating that our theoretical proposal (...) not only questions the mechanism by which a cognitive process comes into being, but asks whether it is at all meaningful to speak of a mechanism and a cognitive process when it is confined to intra-agent space. We address theoretical criticisms of our approach by pointing out that while a second-person social understanding may not be the only mechanism, alternative approaches cannot hold their ground without resorting to second-person concepts, if not in the expression, certainly in the development of social understanding. In this context, we also address issues of agency and intentionality, theoretical alternatives, and clinical implications of our approach. (shrink)

BackgroundIn recent years, there have been many studies using the Affective Neuroscience Personality Scales (ANPS) to investigate individual differences in primary emotion traits. However, in contrast to other primary emotion traits proposed by Jaak Panksepp and colleagues, there is a considerable lack of research on the LUST (L) dimension – defined as an individual’s capacity to attain sexual desire and satisfaction – a circumstance mainly caused by its exclusion from the ANPS. Therefore, this study aims to take a first (...) step toward the development of a standardized self-rate measurement for the L-disposition. For this purpose, two versions of the L-scales (L-12 and L-5) were developed and evaluated regarding reliability and aspects of validity.Materials and MethodsAfter a pilot study (N= 204; female: 81%) with an initial 20-item pool item reductions were conducted. This led to the construction of a 12-item (L-12) version and a 5-item version (L-5), which were assessed in a second sample consisting of 371 German-speaking healthy adults (58.50% female) aged 18–69 years (M= 28;SD= 9.75). Aspects of external validity were assessed by investigation of correlations with the ANPS, psychiatric symptoms (Brief Symptom Inventory-18), attachment security (Adult Attachment Scales) and personality functioning (Operationalized Psychodynamic Diagnostics Structure Questionnaire). To evaluate structural validity, both L-scales were investigated via confirmatory factor analysis (CFA).ResultsCronbach’s α indicated excellent internal consistency regarding L-12 (α = 0.90), while L-5 showed acceptable reliability (α = 0.82). CFA of a bifactor model of the L-12 indicated excellent model fit. Moreover, an excellent model fit was observed regarding a single factor model of L-5. For both scales small to moderate positive correlations were observed with SEEKING, PLAY, and secure attachment, while they exhibited small to moderate negative correlations with SADNESS, insecure attachment, lower personality functioning, and increased psychiatric symptom load.ConclusionBoth newly developed scales exhibit satisfying psychometric properties, indicating high reliability, good structural validity and plausible correlations with external criteria. Hence, this study poses an important step toward the operationalization of the LUST concept. However, more research is needed in particular with respect to the scale’s external validity and its applicability in clinical populations. (shrink)

In 1895 in the Project for a Scientific Psychology Freud tried to integrate psychology and neurology in order to develop a neuroscientific psychology. Since 1880 Freud made no distinction between psychology and physiology. His papers from the end of the 1880s to1890 were very clear on this scientific overlap: as with many of its contemporaries, Freud thought about psychology essentially as the physiology of the brain. Years later he had to surrender, realizing a technological delay, not capable to pursue its (...) ambitious aim, and until that moment psychoanalysis would have to use its more suitable clinical method. Also, he seemed skeptical about the phrenology drift, typical of that time, in which any psychological function needed to be located in its neuroanatomical area. He could not see the progresses of neurosciences and its fruitful dialogue with psychoanalysis, occurred also thanks to the improvements in the field of neuroimaging, which has made possible a remarkable advance in the knowledge of the mind-brain system and a better observation of the psychoanalytical theories. After years of investigations, deriving from research and clinical work of the last century, the discovery of neural networks, together with the free energy principle, we are observing under a new light the psychodynamic neuroscience in its exploration of the mind-brain system. In this narrative review we summarize the important developments of the psychodynamic neuroscience, with particular regard to the free energy principle, the resting state networks, especially the Default Mode Network in its link with the Self; finally we suggest a discussion by approaching the concept of Alpha Function, proposed by the psychoanalyst Wilfred Ruprecht Bion, trying to speculate about the connection with neuroscience. (shrink)

What happens when neuroscientific knowledges move from laboratories and clinics into therapeutic settings concerned with the care of children? ‘Brain-based parenting’ is a set of discourses and practices emerging at the confluence of attachment theory, neuroscience, psychotherapy and social work. The neuroscientific knowledges involved understand affective states such as fear, anger and intimacy as dynamic patterns of coordination between brain localities, as well as flows of biochemical signals via hormones such as cortisol. Drawing on our own attempts to adopt (...) brain-based parenting, and engaging with various strands and critiques of new materialism and affect theory, we explore the ways in which the social sciences and humanities might fruitfully engage with neuroscientific concepts and affects. How does science-affected indeterminacy, with all its promises of ontological and experiential agency, help us to observe, wait, bind or hold together volatile mixtures of habit, speech and action? (shrink)

A scientific understanding of pain requires an experiential‐phenomenological approach and method, one that precedes mechanistic explanations provided by neuroscience, molecular neurobiology, and even the rest of psychology. A key challenge in this approach is to find ways to observe and characterize the experience of pain. An experiential method applied to both clinical and experimental pain has found three common factors in all instances of pain: a somatic or visceral experience that is comprised of 1) unique sensory qualities that (...) are like those which occur during tissue damaging stimulation, 2) a closely related meaning of intrusion and/or threat, and 3) a feeling of unpleasantness and/or other possible negative emotion(s) in response to 1 and 2. These three factors comprise an experiential definition of pain and they are each correlated with brain activities and functional connections that serve them. Much more is to be learned about the factors and their neural basis. (shrink)

The Unconscious in Neuroscience and Psychoanalysis presents a unique and provocative approach to the assimilation of these two disciplines while offering a thorough assessment of the Unconscious from a neuropsychoanalytic and Lacanian perspective. Marco Máximo Balzarini offers a comprehensive overview of Freud's theory of the unconscious and its importance within psychoanalysis, before looking to how it has been integrated into contemporary neuropsychoanalytic work. Paying close attention to the field-defining work of neuropsychoanalysts such as Mark Solms, Francois Ansermet and Pierre (...) Magistretti, Balzarini considers the dichotomy between neuroscience and psychoanalysis, and the omnipresent debate on if and how they should be integrated when working with the unconscious. Throughout, he provides a fascinating Lacanian interpretation, showing how the work of Lacan can offer a new way of developing the dialogue and understanding around this vital topic. Part of the Routledge Neuropsychoanalysis Series, this book will be of interest to any psychoanalyst seeking to explore the foundations of the relationship between neuropsychoanalytic and Lacanian ideas in their clinical and theoretical work. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.1 (2005) 1-7 [Access article in PDF] Clinical Practice, Science, and the Unconscious Douglas McConnell Neil Pickering Keywords psychotherapy, cognitive science, neuroscience, computational view of mind. This volume of Philosophy, Psychiatry, & Psychology is devoted to questions about the unconscious mind. The philosophical complexities and difficulties associated with the unconscious are many and, despite widespread confusion and disagreement as to the nature of (...) the unconscious mind, it is used as a concept informing psychotherapy. It is therefore not surprising that papers in a special edition on the unconscious might be weighted heavily toward uncovering a justifiable conceptual niche for the unconscious and elaborating on some of the main conceptual connections. Although this makes for a slightly more philosophical edition of PPP than usual, those perhaps less interested in philosophy and more interested in actual psychiatric practice can incorporate the concepts and insights developed in these papers into their practice as they see fit.The three main articles take three quite distinct approaches to the unconscious. Schechtman (2005) addresses the need for a theory of personal identity to incorporate the unconscious and presents one that does so by developing some central Lockian intuitions. Church (2005) investigates whether the kinds of things happening in the unconscious can be explained by cognitive operations not normally associated with consciousness, specifically, spatial structuring of experience. McConnell and Gillett (2005) clarify some of Lacan's ontology of the mind where the language encountered and used by the subject provides the structure for their unconscious.The aim of this introduction is to ask and try to answer a question that logically precedes those raised in the articles in the light of the therapeutic use of the unconscious. When dealing with psychoanalysis or psychoanalytic concepts in an Anglo-American context, the struggle that psychoanalysis has had and continues to have in a psychiatric domain ruled by science is never far from the spotlight. Indeed Hinshelwood (2005) also picks up the importance of this conflict when replying to McConnell and Gillett. It seems to be historically true that the unconscious has fallen out of favor in scientific and psychiatric circles (it is no surprise that psychiatric training is largely based in "hard," that is, biological and biochemical science) particularly over the last 50 years or so. But is the scientific skepticism to be found about the use of the unconscious well-founded? And how does the continued utilization [End Page 1] of the unconscious by the therapist fit into current practice given this skepticism? Psychotherapy and the Unconscious In psychotherapy, the therapist and the client together construct a story that explains why the client is having some form of difficulty in his or her life. The stated aim is to enable the client to overcome this difficulty by gaining an understanding of what has generated it. Doing so may be a first step to dealing with that conflict. For example, an office worker who is scared of the boss and whose life at work is a misery as result may come to think that the boss is a reminder of some threatening figure from childhood and that the reaction is a regression to infantile behavior. Knowing this, the fear of the boss can be revisited—perhaps reconfigured, perhaps overcome—and life may improve. In the process of therapy, the relation of the figure from childhood to the boss is made conscious. But it was still operative before it was made explicit, even though the client did not realize it and some would say that the client's unconscious had somehow buried the memory from childhood or hidden from the client the relation of this memory of a threatening figure to the boss.A description of the content of the unconscious is, then, an intentional description involving the client's thought life, one made to help an individual understand otherwise unintelligible (to that individual) feelings, beliefs, desires, actions, and so on. Subjects' intentions are their normatively structured mental representations of, and attitudes toward, the world (e.g., "He is my boss"; "I am afraid of him"). An intentional unconscious description then takes an intentional form... (shrink)

The focus of this paper are the ethical, legal and social challenges for ensuring the responsible use of “big brain data”—the recording, collection and analysis of individuals’ brain data on a large scale with clinical and consumer-directed neurotechnological devices. First, I highlight the benefits of big data and machine learning analytics in neuroscience for basic and translational research. Then, I describe some of the technological, social and psychological barriers for securing brain data from unwarranted access. In this context, (...) I then examine ways in which safeguards at the hardware and software level, as well as increasing “data literacy” in society, may enhance the security of neurotechnological devices and protect the privacy of personal brain data. Regarding ethical and legal ramifications of big brain data, I first discuss effects on the autonomy, the sense of agency and authenticity, as well as the self that may result from the interaction between users and intelligent, particularly closed-loop, neurotechnological devices. I then discuss the impact of the “datafication” in basic and clinical neuroscience research on the just distribution of resources and access to these transformative technologies. In the legal realm, I examine possible legal consequences that arises from the increasing abilities to decode brain states and their corresponding subjective phenomenological experiences on the hitherto inaccessible privacy of these information. Finally, I discuss the implications of big brain data for national and international regulatory policies and models of good data governance. (shrink)

Neuroscience has long had an impact on the field of psychiatry, and over the last two decades, with the advent of cognitive neuroscience and functional neuroimaging, that influence has been most pronounced. However, many question whether psychopathology can be understood by relying on neuroscience alone, and highlight some of the perceived limits to the way in which neuroscience informs psychiatry. -/- Psychiatry as Cognitive Neuroscience is a philosophical analysis of the role of neuroscience in (...) the study of psychopathology. The book examines numerous cognitive neuroscientific methods, such as neuroimaging and the use of neuropsychological models, in the context of a variety of psychiatric disorders, including depression, schizophrenia, dependence syndrome, and personality disorders. -/- Psychiatry as Cognitive Neuroscience includes chapters on the nature of psychiatry as a science; the compatibility of the accounts of mental illness derived from neuroscience, information-processing, and folk psychology; the nature of mental illness; the impact of methods such as fMRI, neuropsychology, and neurochemistry, on psychiatry; the relationship between phenomenological accounts of mental illness and those provided by naturalistic explanations; the status of delusions and the continuity between delusions and ordinary beliefs; the interplay between clinical and empirical findings in psychopathology and issues in moral psychology and ethics. -/- With contributions from world class experts in philosophy and cognitive science, this book will be essential reading for those who have an interest in the importance and the limitations of cognitive neuroscience as an aid to understanding mental illness. (shrink)

Despite recent increasing support for the brain disease model of alcohol and drug addiction, the extent to which the model may clinically impact addiction treatment and client behaviour remains unclear. This qualitative study explored the views of community-based clinicians in Australia and examined: whether Australian community-based clinicians support the BDM of addiction; their attitudes on the impact the model may have on clinical treatment; and their views on how framing addiction as a brain disease may impact addicted clients’ behaviour. (...) Six Australian community-based clinicians participated in semi-structured in-depth interviews that were analysed using thematic analysis. Whilst the BDM was not fully supported by this purposive sample of Australian community-based clinicians, there was acceptance that addiction neuroscience formed a key part of a wider addiction framework. Participants believed the BDM ignored key social, psychological and environmental factors important for successful treatment. The BDM was seen as potentially irrelevant for certain client types, however the model was believed to integrate with particular therapies. Participants believed that for clients viewing their addiction in terms of a brain disease, there were potential positive and negative impacts on client behaviour. Implications for addiction treatment practice and public health policy are discussed. (shrink)

In the present manuscript, we comment upon a paper that strongly criticized an expert report written by the consultants of the defense in a case of pedophilia, in which clinical and neuro-scientific data were used to establish the causal link between brain alterations and onset of criminal behavior. These critiques appear to be based mainly on wrong pieces of information and on a misinterpretation of the logical reasoning adopted by defense consultants. Here we provide a point-by-point reply to the (...) issues raised in the above paper and also discuss the potential role that neuroscience may contribute in the forensic context. Did the forensic neuroscience defense consultants claim the existence of a deterministic relationship between brain structure or function and behavior? How did the neuroscientific logic work in this specific case? How may the classic psychiatric/neurologic examination and neuroscientific evidence work side by side? Does the rarity of a disease impact on the causal relationship between the disease and the crime? Do neuroscientific data need to be interpreted? We address the above questions and conclude that neuroscience may strengthen the results of psychiatric evaluations, thus reducing uncertainty in the forensic settings. (shrink)

In _The Biology of Clinical Encounters_, Gedo utilizes recent findings in neuroscience and cognitive psychology to elaborate his conception of psychobiology and to consider its implications in clinical analysis. He pursues this challenging undertaking in several directions. He illuminates the way in which psychobiology enters into his hierarchical model of mental functioning, and goes on to examine three clinical syndromes - phobias, obsessions, and affective disturbances - in which biological considerations are particularly important. Of special note (...) are chapters examining the implications of a biological approach for clinical psychoanalysis. Gedo explores the notion of transference that grows out of attentiveness to psychobiological factors, elaborates the concept of therapeutics that follows from looking beyond mental contents, and discusses the problem of assessing clinical evidence produced by analyses informed by a psychobiological orientation. Drawing on his own analytic work of over three decades, he compares analyses conducted with a psychobiological orientation with the outcome of analyses conducted earlier in his career with a more traditional psychological approach. A stimulating introduction to the interpenetration of the biological and the psychological in clinical work, _The Biology of Clinical Encounters_ is quintessential Gedo: scholarly in conception, elegant in tone, provocative in import, and illuminating, always, of fundamental issues about the status of psychoanalysis as a science of mind. (shrink)

As a young medical student, I was frustrated by the rather mechanistic, though undoubtedly therapeutic, way in which I was taught. It seemed to want me to approach patients clinically, and though with respect also with a distance which reduced simple human contact. We were not expected to be interested in what it was like to be ill, but rather to elicit the correct signs and symptoms in order to diagnose. At the time I was also reading more widely, within (...) literature and philosophy, searching – in part – for a more humane perspective. Much philosophy was beyond me – and still is – but then, as a young man I found myself sympathetic to the phenomenological approach. In medicine, by day, I learnt lists of diseases and their presentation, whilst by night I would read of other approaches respectful of the first person experience, which might help me reach what it was like to live, say, with a chronic neurological impairment. (shrink)

This essay addresses the question: What is the probative value of including neuroscience data in court cases where the defendant might have had a traumatic brain injury? That is, this essay attempts to articulate how well we can connect scientific data and clinical test results to the demands of the Daubert standard in the United States’ court system, and, given the fact that neuroimaging is already being used in our courts, what, if anything, we should do about this (...) fact. Ultimately, I am not sure that there are completely satisfactory answers to this query at this particular time in our legal history. I briefly rehearse the recent use of brain research in our legal system, summarize how neuroscience data regarding TBI and its relation to poor behavioral outcomes are currently used in the courtroom, review challenges with using these data, and highlight fundamental tensions between how the legal system views the causes of behavior and how medicine, neuroscience, and psychology do. Until these tensions are resolved, it is unclear the place neuroscience data should have in courts. (shrink)

Clinical neuroethics and neuroskepticism are recent entrants to the vocabulary of neuroethics. Clinical neuroethics has been used to distinguish problems of clinical relevance arising from developments in brain science from problems arising in neuroscience research proper. Neuroskepticism has been proposed as a counterweight to claims about the value and likely implications of developments in neuroscience. These two emergent streams of thought intersect within the practice of neurology. Neurologists face many traditional problems in bioethics, like end (...) of life care in the persistent vegetative state, determination of capacity in progressive dementia, and requests for assisted suicide in cognition-preserving neurodegenerative disease (like amyotrophic lateral sclerosis). Neurologists also look to be at the forefront of downstream clinical applications of neuroscience, like pharmacological enhancement of mental life. At the same time, the practice of neurology, concerned primarily with the structure, function, and treatment of the nervous system, has historically fostered a kind of skeptical attitude toward its own subject matter. Not all problems that appear primarily neurological are primarily neurological. This disciplinary skepticism is generally clinical in orientation and limited in scope. The rise of interest in clinical neuroethics and in neuroskepticsim generally suggests a possible broader application. The clinical skepticism of neurology provides impetus for thinking about the appropriate role for skepticism in clinical areas of neuroethics. After a brief review of neuroskepticism and clinical neuroethics, a taxonomy of clinical neuroskepticism is offered and reasons why a stronger rather than weaker form of clinical neuroskepticism is currently warranted. (shrink)

Anger is probably one of the mostly debated basic emotions, owing to difficulties in detecting its appearance during development, its functional and affective meaning (is it a positive or a negative emotion?), especially in human beings. Behaviors accompanied by anger and rage serve many different purposes and the nuances of aggressive behaviors are often defined by the symbolic and cultural framework and social contexts. Nonetheless, recent advances in neuroscientific and developmental research, as well as clinical psychodynamic investigation, afford a (...) new view on the role of anger in informing and guiding many aspects of human conducts. Developmental studies have confirmed the psychophysiological, cognitive and social acquisition that hesitate in the pre-determined sequence appearance of anger and rage in the first two years of life. The so-called affective neurosciences have shown the phylogenetic origin of the two circuits underlying the emergence of anger along with its evolutionary role for promoting survival. This view has been integrated by the psychodynamic theory of motivational systems that attribute a double role to anger: on the one hand, this affect works as an inwardly directed signal concerning a pressure to overcome an obstacle or an aversive situation; on the other hand, anger is also an outwardly directed communicative signal establishing differentiation and conflict within interpersonal relationships and affective bonds. Of course, human peculiar mental functioning requires the appraisal of such signals by higher cortical functions and, there is little doubt that the meaning that orientates individual behaviors is, eventually, construed on a social and cultural level. At the same time, everyday life experiences as well as clinical insights into psychopathic, narcissistic and borderline personality pathology clearly illustrate the necessity to correctly interpret and give answers to the basic questions raised around the topic of anger as a basic emotion. (shrink)

In _Awakening the Dreamer: Clinical Journeys_, Philip Bromberg continues the illuminating explorations into dissociation and clinical process begun in _Standing in the Spaces_. Bromberg is among our most gifted clinical writers, especially in his unique ability to record peripheral variations in relatedness - those subtle, split-second changes that capture the powerful workings of dissociation and chart the changing self-states that analyst and patient bring to the moment. For Bromberg, a model of mind premised on the centrality of (...) self-states and dissociation not only offers the optimal lens for comprehending and interpreting clinical data; it also provides maximum leverage for achieving true intersubjective relatedness. And this manner of looking at clinical data offers the best vantage point for integrating psychoanalytic experience with the burgeoning findings of contemporary neuroscience, cognitive and developmental psychology, and attachment research. Dreams are approached not as texts in need of deciphering but as means of contacting genuine but not yet fully conscious self-states. From here, he explores how the patient's "dreamer" and the analyst's "dreamer" can come together to turn the "real" into the "really real" of mutative therapeutic dialogue. The "difficult," frequently traumatized patient is newly appraised in terms of tensions within the therapeutic dyad. And then there is the "haunted" patient who carries a sense of preordained doom through years of otherwise productive work - until the analyst can finally feel the patient's doom as his or her own. Laced with Bromberg's characteristic honesty, humor, and thoughtfulness, these essays elegantly attest to the mind's reliance on dissociation, in both normal and pathological variants, in the ongoing effort to maintain self-organization. _Awakening the Dreamer_, no less than _Standing in the Spaces_, is destined to become a permanent part of the literature on therapeutic process and change. (shrink)