An estimated 15% of patients seen by neurologists have neurological symptoms, such as paralysis, tremors, dystonia, or seizures, that cannot be medically explained. For a long time, such patients were diagnosed as having conversion disorder (CD) and referred to psychiatrists, but for the last two decades or so, neurologists have started to pay more serious attention to this patient group. Instead of maintaining the commonly used label of conversion disorder – which refers to Freud’s idea that (...) traumatic events can be converted into deviant behaviour – these neurologists use the term functional neurological disorder (FND) and explain that the problems are due to abnormal central nervous system functioning. The situation that some patients with medically unexplained neurological symptoms are diagnosed with CD and treated by psychiatrists while others are diagnosed with FND and stay under the control of neurologists provides a unique case for analysing how neurological and psychological explanations affect subjectivity. In this article, I compare patient reports from English-language websites from the past 15 years to find out how minds, bodies, brains, and selves act and interact in the accounts of both patient groups. I conclude that the change in label from CD to FND has not only influenced ideas of medically unexplained disorders, but also affected ideas of the self and the body; of self-control and accountability. (shrink)

The Hospital for Rehabilitation, Stavern, in Norway has treated patients with physical symptoms with no organic cause, so called conversion disorder patients, for over a decade. For four years research on the treatment has been carried out. Patients with conversion disorder seem not to fit in traditional somatic hospitals because their patienthood depends upon psychiatric diagnosis. Ironically, they appear not to belong in psychiatric hospitals because of their physical symptoms. The treatment offered these patients at hospitals (...) for rehabilitation is adapted physical activity consisting of behaviour elements such as positive reinforcement of normal function and lack of positive reinforcement at dysfunction. The pedagogical approach is seen as crucial in the successful rehabilitation of the patients. The disorder and treatment can be understood by using theories about the ecstatic body, radical behaviourism and phenomenology. When patients have problems in behaviour concerning both body and mind, it would be natural to employ both in the road to recovery. This article describes the various treatments and discusses them from phenomenological, ethical and philosophical perspectives. (shrink)

In this paper, I present a challenge for Michael McKenna’s conversational theory of moral responsibility. On his view, to be a responsible agent is to be able to engage in a type of moral conversation. I argue that individuals with autism spectrum disorder present a considerable problem for the conversational theory because empirical evidence on the disorder seems to suggest that there are individuals in the world who meet all of the conditions for responsible agency that the theory (...) lays out but who are nevertheless not responsible agents. Attending to the moral psychology of such individuals will, I think, help shed light on an important gap in the conversational theory. (shrink)

This study evaluates the comprehension of generalized conversational implicatures (GCI) in children with and without autism spectrum disorder (ASD), using a GCI test constructed based on the Levinson model, which distinguishes between three types of implicatures: type Q (or scalar: “what is not referred to does not occur”); type I (“by default, it is not necessary to say what can be assumed”); and type M (“if someone is expressing something in a not very simple or marked way, it is (...) because s/he is describing a situation that is not very typical, frequent, or prototypical”). In addition to the ASD group ( n = 22), two comparison groups were utilized: a group matched on chronological age with the ASD group, but with a higher linguistic age (TCD group, n = 22), and a group matched on linguistic age with the ASD group, but with a lower chronological age (TLD group, n = 22). In all cases, linguistic age was assessed with the Peabody test. The performance of the three groups on the GCI test was compared (overall and on each type of implicature), and performance on the three types of implicature was compared within each group. The ASD group obtained worse performance than the other two groups, both overall and for each implicature type, without also obtaining differences in performance on the three implicature types. The TCD group obtained better performance than the TLD group on overall performance, but not on each implicature type, and both groups obtained lower performance on the type M heuristics than on the type I. Based on these results, the children with ASD in our study presented limitations in the comprehension of the three types of GCI, but it was not possible to obtain evidence for an inferential continuum of the three types of GCI. However, in the two typical development groups, this evidence was obtained, leading us to propose an inferential continuum model based on the different levels of dependence on the context of each of the three types of implicatures, with type M implicatures being more contextually dependent. (shrink)

Factitious disorder is the deliberate simulation of illness for the purpose of seeking the sick role. It is a 20th-century diagnosis, though the grounds for its introduction are uncertain. While previous authors have considered the social changes contributing to growth in the disorder, this article looks at some of the pressures on doctors that may have created the diagnostic need for a disorder between hysteria and malingering. The recent history of those disorders suggests that malingering would no (...) longer be acceptable when applied to the potentially larger numbers involved in workers’ compensation or in mass conscription. Equally, the absolution given to hysteria on the basis of the Freudian subconscious would survive only as long as that model retained credibility. Growing egalitarianism and changing doctor—patient relationships in the 20th century would no longer tolerate a sharp division between culpable malingering and exculpated hysteria, which may previously have been made on grounds of class or gender. They would contribute to the need for a mediating diagnosis, such as factitious disorder. (shrink)

It was [Maria] Edgeworth’s deeply personal motive in writing Harrington that made possible the special self-reflexive quality that informs her novel. In the act of reviewing her role as a reader and a writer of anti-Semitic portraits, she was able to recognize a tradition of discourse she had at once inherited and perpetuated. And only by recognizing such a tradition was she able both to subvert it in Harrington and to articulate for future writers the way to move beyond it. (...) In short, she boldly turned her personal self-examination into a cultural critique: she diagnosed a disorder in “the imaginations of the good people of England,”4 and in so doing she issued a challenge and founded a new tradition. In Harrington Edgeworth inquires into the trials that the English imagination must undergo if it is to exorcise the powerful figure of Shylock, and thereby issues a challenge taken up in subsequent novels : the tradition I am designating “the novel of Jewish Identity” attempts to articulate, investigate, and subvert The Merchant of Venice’s function as the English master text for representing “the Jew.” Maria Edgeworth, Harrington, vol. 9 of Tales and Novels , p. 148; hereafter cited by page number. Michael Ragussis, professor of English at Georgetown University, is the author of The Subterfuge of Art: Language and the Romantic Tradition and Acts of Naming: The Family Plot in Fiction . He is currently working on a book-length study entitled “Figures of Conversion: Jewish Identity and British Fiction.”. (shrink)

Les troubles du langage font partie des troubles cognitifs présents dans la maladie d’Alzheimer. Ils sont le plus souvent étudiés dans des tâches cliniques ciblées, éloignées des situations de communication naturelle. Leur but est de mettre en évidence les déficits linguistiques comme par exemple les troubles lexico-sémantiques présents dès le début de l’évolution et spécifiques de la maladie. Nous avons choisi de compléter les épreuves classiques d’évaluation du langage par l’étude d’une situation d’échange conversationnel en essayant de dégager de nouveaux (...) critères cliniques fonctionnels. Notre étude porte sur l’analyse automatique de corpus conversationnels recueillis auprès de 10 personnes âgées (moyenne d’âge = 90 ans) dont 5 présentant une maladie d’Alzheimer à un stade débutant à modéré (MMS moyen = 15/30). Nos analyses montrent des différences quantitatives et qualitatives entre les deux populations étudiées et proposent de s’intéresser davantage à l’interaction verbale pour mieux décrire le retentissement des troubles du langage sur la communication verbale des sujets avec maladie d’Alzheimer. (shrink)

Pragmatic disorders in children and adults have been the focus of clinical investigations for approximately 40 years. In that time, clinicians and researchers have established a diverse range of pragmatic phenomena that are disrupted in these disorders. Pragmatic deficits include problems with the use and understanding of speech acts, the processing of non-literal language, failure to adhere to Gricean maxims in conversation and discourse deficits. These deficits are found in several clinical populations including individuals with autistic spectrum disorders, schizophrenia, traumatic (...) brain injury and right-hemisphere damage. However, what is less often investigated is the social impact of pragmatic disorders on the children and adults who are affected by them. In this paper, I examine what is known about pragmatic disorders in these clinical groups. I then consider the wider social consequences of these disorders, where consequences are broadly construed to include factors that act as indicators of social adjustment. (shrink)

Introduction: Previous findings that inattention and hyperactive/impulsive symptoms predict later peer problems have been mixed. Utilizing two culturally diverse samples with shared methodologies, we assessed the predictive power of dimensionally measured childhood IA and HI symptoms regarding adolescent peer relationships.Methods: A US-based, clinical sample of 228 girls with and without childhood diagnosed attention-deficit/hyperactivity disorder was assessed and followed 5 years later. A Norwegian, population-based sample of 3,467 children was assessed and followed approximately 4 years later. Both investigations used parent (...) and teacher reports of ADHD symptoms and peer relations. Multivariate regression analyses examined the independent contributions of IA and HI symptoms to later peer problems, adjusting for baseline childhood peer problems. We also examined childhood sex as a potential moderator within the Norwegian sample.Results: Higher levels of childhood HI symptoms, but not IA symptoms, independently predicted adolescent peer problems in the all-female clinical sample. Conversely, higher levels of IA symptoms, but not HI symptoms, independently predicted preadolescent peer problems in the mixed-sex population sample. Results did not differ between informants. Associations between ADHD symptom dimensions and peer problems within the Norwegian sample were not moderated by child sex.Discussion: Differential associations between childhood hyperactive/impulsive and inattention symptoms and adolescent peer problems were found across two diverse samples using a shared methodology. Potential explanations for different findings in the clinical vs. population samples include symptom severity as well as age, sex, and cultural factors. We discuss implications for future research, including the importance of dimensional measures of ADHD-related symptoms and the need for shared methodologies across clinical and normative samples. (shrink)

Functional Neurological Symptom Disorder or Conversion Disorder, is a fairly common diagnosis among mental health patients in Pakistan. Despite its prevalence there's a dearth of research on the phenomenon, particularly on the experience of FNSD. The study was conducted with the aim to ascertain the lived experiences of individuals with Functional Neurological Symptom Disorder around stressful situations in their families in Pakistan. For this purpose, a total sample of 10 participants were recruited from the psychiatry department (...) of a tertiary care hospital in Lahore, Pakistan. Semi-structured interviews were conducted and analyzed through Interpretative Phenomenological Analysis. The two main themes revealed in the analyses were quarrels and unexpressed emotions. The sub-themes of quarrels included quarrels with family members, quarrels within family, parental/marital discord, and quarrels with extended family members. The subthemes for unexpressed emotions were hurt, anger, sadness, and jealousy. In conclusion, this study revealed that in Pakistan, stressors related to family serve as significant contributing factors in the development of FNSD. (shrink)

In this paper, I discuss the view defended by Manuel Rebuschi, Maxime Amblard, and Michel Musiol that schizophrenia is not entirely irrational but that the rationality of disordered discourse can be accounted for from the first-person point of view—which, by their account, is not wholly introspective but is rather defined by a certain use of the charity principle, by contrast with what they call third-person approaches. I argue in favor of the idea of continuity between the two points of view: (...) ordinary and schizophrenic. On the basis of this claim, I propose a hypothesis for understanding what Rebuschi et al. call the interactional deficiency of schizophrenic conversations, and I make further exploratory suggestions of ways of understanding the so-called rationality of schizophrenic discourse, notably in relation to the complex notions of “context” and “meaning”. (shrink)

Using the methodology and findings of conversation analysis, we analyze changes in the talk of a man with aphasia (a language disorder acquired following brain damage) at two points in his spontaneous recovery period in the first months post-stroke. We note that in the earlier conversation (15 weeks post-stroke) two of the turn constructional methods he particularly makes use of are replacement (a form of repair) and extension. By the time of the latter conversation (30 weeks poststroke) these methods (...) are less prevalent, while another repair operation, insertion, is now used in a particular way not seen in the earlier conversation. We suggest that these methods are means by which the aphasic speaker adapts his limited linguistic resources to the demands of constructing a turn-at-talk in conversation in order to lessen the extent of repair and delay with the turn and thus lessen the exposure of his linguistic noncompetence and his identity as ‘different’, ‘disabled’, or ‘language impaired’. These turn constructional methods are dynamic and change as the speaker recovers. We suggest that communication disorders such as aphasia can be problematic not only because of difficulties they can cause in conveying information or producing other social actions, but also because they can create difficulties in the presentation of self in everyday life. (shrink)

If someone with dissociative identity disorder commits a wrongful act, is she responsible? If one adopts the Multiple Persons Thesis, it may seem that one alter cannot be responsible for the actions of another alter. Conversely, if one regards the subject as a single person, it may seem that she is responsible for any actions she performs. I will argue that this subject is a single person, but one who suffers from delusions of disownership and therefore does not fulfill (...) ordinary requirements for responsible agency. This is because she suffers from extreme ambivalence: her deep-seated needs and desires conflict, and she forms alter-personalities as a way to cope with inner discord without abandoning any of these contradictory impulses. However, although the ability to exercise autonomous agency is eroded in such cases, the capacity for autonomous agency is preserved. The subject with DID is weakly responsible for her wrongful acts. (shrink)

The study of the cognitive substrates of pragmatic disorders is a relatively recent development in clinical pragmatics. This development has been ushered in by calls from researchers and clinicians on two fronts. First, it has been urged that the field of pragmatics should undergo a cognitive turn, such that a cognitive examination of pragmatic concepts is afforded equal significance to societal, philosophical and linguistic approaches to the discipline. Second, clinicians have increasingly acknowledged that it is not possible to assess and (...) treat clients with pragmatic disorders in isolation from cognitive concerns. The chapter begins with an examination of the various cognitive processes that play a role in a standard communicative exchange. From this examination the two main components of any cognitive treatment of pragmatic disorders—executive functions and theory of mind—are established. The findings of clinical studies of clients with pragmatic disorders are discussed. These studies suggest an association between cognitive processes such as theory of mind on the one hand and a range of pragmatic impairments on the other hand. Conversational data from clients with pragmatic disorders are used to illustrate these cognitive-based pragmatic impairments. Finally, three theoretical frameworks with the potential to explain the cognitive basis of pragmatic disorders are examined. (shrink)

Several researchers point to disorganized attachment as a core feature of borderline personality disorder (BPD). However, recent studies suggest that specific internal working models (IWMs) of each parent combine to account for child outcomes and that a secure relationship with one parent can protect against the deleterious effects of an insecure relationship with the other parent. It was thus hypothesized that adolescents with BPD are more likely to be disorganized with both their parents, whereas non-clinical controls are more secure (...) with at least one of their caregivers. Thirty-six adolescents with BPD and 30 control participants (aged 13-19) were included. Psychiatrist diagnosis was verified with the SIDP-IV and comorbidity was assessed using the Kiddie-SADS. Reported trauma was assessed with the Childhood Trauma Questionnaire. Attachment IWMs of each parent were assessed with the Attachment Multiple Model Interview (AMMI), which enables separate coding for each attachment figure and in which disorganization is conceptualized as conflicting attachment strategies within a specific relationship. Results of a logistic regression analysis suggested that beyond insecure attachment, being disorganized not just with one but with both parents is particularly characteristic of adolescents with BPD. Conversely, belonging to the non-clinical group was predicted by higher security scores with the father and lower deactivation with the mother. Although higher levels of childhood abuse or neglect were reported by adolescents with BPD, the retained attachment dimensions predicted group membership over and above reported trauma. These findings have important implications for clinical intervention and highlight the protective role fathers may have. (shrink)

Medical professionals, including mental health professionals, largely agree that moral judgment should be kept out of clinical settings. The rationale is simple: moral judgment has the capacity to impair clinical judgment in ways that could harm the patient. However, when the patient is suffering from a "Cluster B" personality disorder, keeping moral judgment out of the clinic might appear impossible, not only in practice but also in theory. For the diagnostic criteria associated with these particular disorders (Antisocial, Borderline, Histrionic, (...) Narcissistic) are expressed in overtly moral language. I consider three proposals for dealing with this problem. The first is to eliminate the Cluster B disorders from the DSM on the grounds that they are moral, rather than mental, disorders. The second is to replace the morally laden language of the diagnostic criteria with morally neutral language. The third is to disambiguate the notion of moral judgment so as to respect the distinction between having morally disvalued traits and having moral responsibility for those traits. Sensitivity to this distinction enables the clinician, at least in theory, to employ morally laden diagnostic criteria without adopting the sort of morally judgmental (and potentially harmful) attitude that results from the tacit presumption of moral responsibility. I argue against the first two proposals and in favor of the third. In doing so, I appeal to Grice's distinction between conventional and conversational implicature. I close with a few brief remarks on the irony of retaining overtly moral language in an ostensibly medical manual for the diagnosis of mental disorders. (shrink)

In this chapter, I explore moral competence as a central condition on moral responsibility. I distinguish two main conceptions. On the first, a morally competent agent is someone who knows right from wrong. On the second, a morally competent agent is someone who responds aptly to reasons. These two conceptions merit separate treatment as they offer different insights on how and why moral competence might be compromised. This distinction is of particular relevance since the chapter critically examines a standard assumption (...) stating that whenever a mental disorder impacts moral competence, it decreases its scope (on the first conception) or precision (on the second). In close conversation with the memoir literatures on bipolar disorder, autism and schizophrenia, I argue that moral competence may also be affected by what looks like increases in scope or precision; moreover, neither impact – decrease or increase – necessarily undermines moral competence in and of itself; oftentimes, either could enhance it in a reliable way. Finally, by critically revisiting the ecological or scaffolding approach to moral responsibility, I show that moral competence is best understood as a practical way of knowing right from wrong embedded in daily routines and habits, and irreducible to propositional understanding or intellectual skills. (shrink)

This paper presents an applied approach to conversation analysis in a setting comprising student dietitians and patients attending an outpatient clinic for heart disease and related disorders. In the first phase of the study interactions involving students deemed competent by supervisors were closely examined for distinctive configurations which could be attributed to satisfactory entry level practice. Reference was made to studies in similar settings and a particular emphasis was placed on the narrative structure for producing the diet history account. In (...) the second phase a different group of students were taught history taking skills using findings and materials from the initial analysis. This focused on how to introduce the history and how to support its progression to achieve the outcomes required by the professional. In the final phase, interactions involving this second group of students were studied in detail to determine whether the interactional patterns taught were displayed in subsequent interactions. A further application of conversation analysis demonstrated that the second group of students co-constructed history phases which befitted the preferred narrative structure. These findings displayed the way in which conversation analysis could be applied in the teaching setting, bearing in mind that there is no escape from the situated order of professional interaction (nor indeed of the teaching context). The perspective presented of the interaction was one of 'professional medicine', that is it exposed issues of accountability and practical circumstances, when, in this case, novice dietitians 'do' nutrition counselling. (shrink)

Based on conversations between 10 Chinese children with Autism Spectrum Disorders and five therapists in the context of Naturalistic Intervention, this study investigated the therapists’ agreement expressions in this typical setting. The study found that the therapists mainly used four agreement strategies: acknowledgment, positive evaluation, repetition and blending. These four strategies could be used individually or in combination. The first three strategies and their combinations were used frequently during the therapeutic conversation. With the major occurrences in the post-expansion position, the (...) agreement expressions in the therapeutic conversation mainly performed three functions, namely, creating a supportive therapeutic relationship, serving as positive reinforcers and implementing interventions pertinent to communication skills. This study proposed that the therapists’ preferred use of agreement expressions in the intervention process could be explained by the features of Naturalistic Intervention. (shrink)

This article has two aims. The first is to introduce some novel data that highlight rather surprising pragmatic abilities in autism spectrum disorder (ASD). The second is to consider a possible implication of these data for an emerging empirical methodology in philosophy of language and mind. In pursuing the first aim, we expect our main audience to be clinicians and linguists interested in pragmatics. It is when we turn to methodological issues that we hope to pique the interest of (...) philosophers. Still, the methodological issue becomes pressing precisely because of the empirical finding—thus the first part is important for the philosophical readers as well. The game plan is as follows. Given our intended dual audience, we begin with background on autism and pragmatics. Some of this material will be familiar to some of our readership, but few will know all of it. (Those who do are invited to skip these sections.) We then present some results from our pilot study on a corpus of speech by people with ASD. The heart of our finding is that certain speakers with ASD, who have severe trouble with familiar pragmatic phenomena such as metaphor and conversational implicature, exhibit surprising abilities with respect to what is often called “pragmatic determinants of what is said.” We turn next to a possible implication of this finding: It seems to suggest that hitherto seemingly promising evidence from ASD about the semantics/pragmatics boundary is.. (shrink)

Due to improvements in medicine, the figures of patients with disorders of consciousness (DoC) are increasing. Diagnostics of DoC and prognostication of rehabilitation outcome is challenging but necessary to evaluate recovery potential and to decide on treatment options. Such decisions should be made by doctors and patients’ surrogates based on medico-ethical principles. Meeting information needs and communicating effectively with caregivers as the patients´ most common surrogate-decision makers is crucial, and challenging when novel tech-nologies are introduced. This qualitative study aims to (...) explore information needs of informal DoC caregivers, how they manage the obtained information and their perceptions and experiences with caregiver-physician communication in facilities that implemented innovative neurodiagnostics studies. In 2021, we conducted semi-structured interviews with nine caregivers of clinically stable DoC patients in two rehabilitation centers in Italy and Germany. Participants were selected based on consecutive purposeful sampling. Caregivers were recruited at the facilities after written informed consent. All interviews were recorded, transcribed verbatim and translated. For analysis, we used reflexive thematic analysis according to Braun & Clarke (2006). Caregivers experienced the conversations emotionally, generally based on the value of the information provided. They reported to seek positive information, comfort and empathy with-in the communication of results of examinations. They needed detailed information to gain a deep understanding and a clear picture of their loved-one’s condition. The results suggest a mismatch between the perspectives of caregivers and the perspectives of medical profession-als, and stress the need for more elaborate approaches to the communication of results of neu-rodiagnostics studies. (shrink)

BackgroundIn the ruling inY[2018], the UK Supreme Court has confirmed that there is no general requirement for the courts in England and Wales to authorise the withdrawal of clinically assisted nutrition and hydration from patients with prolonged disorders of consciousness. The perceived requirement, which originated in a court ruling in 1993, encompassed those in the vegetative state and those in the minimally conscious state. The ruling inYconfirms that the court may still be approached to decide difficult or contested cases, but (...) there is otherwise no routine requirement that the judges be approached.Main bodyThere is much to welcome in this ruling, particularly as it means that these decisions for these patients are no longer (unusually) singled out for a judicial decision, with all the financial and emotional costs that court proceedings can entail. However, there is also a risk that the ruling might have unwelcome consequences. First, there is the possibility that patients might die too soon, particularly if doctors should now adopt the courts’ previous reasoning, which has suggested that patients in the vegetative state lack interests, so treatment may – perhaps must – be withdrawn. Secondly, there is the converse possibility that patients might live too long, since empirical research suggests that – whether intentionally or not – patients’ families, clinicians, and the health system appear to promote treatment-by-default.ConclusionRather than adopt general positions, which may be contestable and potentially risky, this article argues, on a pluralistic basis, that the individual patient should be the focus of any decision made in his or her ‘best interests’. The existing legal framework in England and Wales, which is provided by the Mental Capacity Act 2005, already points in this direction, although more efforts may be needed to ensure that those involved in making these decisions are suitably educated and supported. Fortunately, new guidance from the British Medical Association could help clinicians and families to make decisions in the future, which are appropriate for the incapacitated individual patient in question. (shrink)

This article explores the idea that there is a spectrum of individuals who feel compelled to dwell in the past, either due to psychological or social conditions. I analyze both conditions respectively by critically examining two cases: post-traumatic stress disorder and racialized oppression. I propose that individuals with PTSD can feel psychologically compelled to dwell in the past in a dually negative sense: the individual lives in the past but also broods on it, causing them to feel “stuck” in (...) the past. This kind of “dwelling” can cause individuals to suffer disruptions to their sense of self and intersubjectivity. After exploring the psychological case of dwelling in the past, I explore the social sense in which individuals can dwell in the past due to oppressive social structures by examining the case of racialized oppression. The case of racialization is philosophically stimulating because of its intersubjective dimensions—it subverts the idea that dwelling in the past is simply a psychological phenomenon by capturing that others can help or hinder us with maintaining a sense of self and future-directed intentionality. By putting the phenomenological work of Al-Saji into conversation with recent phenomenological research on incarceration, I propose that racialization can be similarly disruptive to one’s sense of self and intersubjectivity. The proposed account is suggestive that traumatic and oppressive experiences may amplify and compound each other in ways not yet well elucidated in the literature. If this account is taken to be persuasive, it is indicative that both psychological and social conditions mediate one’s temporality and well-being. (shrink)

The well-known impairments in the social use of eye-gaze by children with autism have been chiefly explored through experimental methods. The present study aims to contribute to the naturalistic analysis of social eye-gaze by applying Conversation Analysis to video recordings of three Finnish children with a diagnosis of autism, each interacting with familiar others in ordinary settings . The analysis identifies two interactional environments where some children with autism show eye-gaze related competence with respect to gazing at their co-participants: these (...) are when the child carries out an initiating action or a responsive action . We discuss how this qualitative analysis of interactional structure could be extended using quantitative methods and eye-tracking technology in order to develop a better understanding of the disorder. Keywords: Autism; eye-gaze; conversation analysis; social interaction; interactional competence. (shrink)

Failings of a categorical systemFor decades, standardized classification systems have attempted to define psychiatric disorders in our mental health care system, with the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association (APA), 2013) and International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10; World Health Organization, 2010) being internationally best-known. One of the major advantages of the DSM must be that it has seriously diminished the international linguistic confusion regarding psychiatric disorders. Since (...) its introduction, it contributed extensively towards one common international language for defining and conceptualizing psychiatric disorders. Strikingly, within the field of psychological testing a similar step forward seems to have not yet been taken. At present, there exists no international standard for the use of psychological tests that takes the definition of a specific symptom as listed in DSM-5 as its starting point, and reliably and validly measures this symptom. Rather, the majority of tests are measuring constructs consisting of a multitude of symptoms. For example, the Beck’s Depression Inventory (Beck et al., 1996) measures core symptoms of depression summing up to a depression score. Accordingly, we believe it is time for a change. The diagnostics of psychiatric disorders, where disorders are defined as nosological units with a single cause, a single organic substrate, and a single time course, has been problematic for centuries. The field of psychiatry has always been ambivalent about its desire to follow a medical model (Blaney, 2015), but afflicted due to its definitions of pathology. The definition of a psychiatric disorder in DSM-5 offers little room for a clear cut pathogenesis and harsh demarcation of syndromes. This is reflected in the DSM-5, where it states: “A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning” (APA, 2013, p.20). An unfortunate and recognized consequence of this definition within the current system is that many symptoms overlap within categories of psychiatric disorders and patients end up diagnosed with many co-morbid disorders.Two fundamental problemsRegardless of new attempts to improve the diagnostics of psychiatric disorders, the DSM-5 represents the status quo. Consequently, the distinction between diagnosis and classification remains substantial and more than a discussion on semantics. We identify two fundamental problems within the current framework. Generally, a psychiatric diagnosis is considered to be descriptive (Hengeveld and Schudel, 2003). The clinician will describe a syndrome (its nature, timespan, and severity) within the framework of a disorder, and often include a differential diagnosis, predisposing protective or vulnerability factors, and provoking or maintaining factors. Within the DSM-5 framework, a similar ‘approach to clinical case formulation’ is taken (APA, 2013, p. 19). Evidently, a descriptive diagnosis has a hypothetical character. It consists of the clinician’s hypothesis and is based on his or hers professional considerations according to the abovementioned factors. Once the clinician has formulated a descriptive diagnosis, it is then complementary ‘translated’ into a DSM-5 classification. Herein lies the problem. For the layman, the existence of this distinction between diagnosis and classification is usually unknown. Preceding treatment, the clinician will give the client a classification of the existing psychiatric problems and the client may attribute more meaning to it than appropriate, thereby fostering the risk of reification. Second, the DSM-5 is a categorical system. Thus, individual disorders are regarded as discrete units – ‘you either have it, or you don’t’. DSM-5 states about this: “(…) scientific evidence places many, if not most, disorders on a spectrum with closely related disorders that have shared symptoms, shared genetic and environmental risk factors (…)”. And “(…) we have come to recognize that the boundaries between disorders are more porous than originally perceived.” (APA, 2013, p. 6). This leads to a fundamental problem. Because the overwhelming majority of psychiatric disorders examined thus far using taxometric methods appear to be dimensional in nature (Haslam, 2003; Widiger and Samuel, 2005), consequently all of their categorizations become artificial and debatable. Even though DSM-5 took a modest step towards a more dimensional approach, its core remains categorical. To illustrate, consider the Borderline Personality Disorder (BPD). This classification consists of nine diagnostic criteria of which a minimum of five need to be present for the diagnosis of BPD. A simple numerical combination algorithm leads to a staggering number of 256 distinct presentations of BPD (Albion et al., 2013). Due to this chameleon-like nature, the disorder’s diagnostic validity becomes questionable. Strikingly, this number is relatively small when compared to other conditions, e.g., there are 636,120 ways to have posttraumatic stress disorder (Galatzer-Levy and Bryant, 2013).DSM-5 does propose an alternative model for personality disorders based on personality functioning and traits (APA, 2013, p. 761), as a possible answer to the problem that most patients fit with multiple co-morbid personality disorders or to the category of personality disorder not otherwise specified. In November 2012, the chair committee of APA decided to move this alternative model to section III of DSM-5 and to sustain the categorical system in section II. A potential solutionDSM-5 and its predecessors have brought about an invaluable improvement regarding the formulation of a common international language for psychiatric disorders. However, the individual disorders fit poorly with its starting point of discrete units and strict boundaries. Van Os (2014) has argued for a better balance between the categorical and personalized aspects of psychiatric disorders. We argue for a two-step approach.Particularly due to the ‘weak boundaries’ between disorders, it might be beneficial to limit ourselves by merely categorizing clients into the main categories of the DSM-5 according to their most prominent symptoms (Van Os, 2014), i.e. their main complaint. In other words, clinicians could first ask themselves whether the symptomatology is concerning a neurodevelopmental disorder, or a bipolar and related disorder, or a depressive disorder, and so on. It will drastically reduce the over 400 classifications in DSM-5 down to 20 categories. Van Os (2014) even argues to combine some of the main categories, reducing this number even further to 15 categories. The advantages of reducing the over 400 classifications are fivefold: 1) a syndrome, being an aggregation of symptoms, creates a false relation between symptoms that are that are already heterogeneous themselves; 2) 15 broad categories are functional: it results into a very heterogeneous group of clients within a category and thus prevents stereotypes and invites further personalizing of complaints; and 3) a dimensional measure of a symptom rather than a syndrome will correspond better with the client regardless of it not providing the complete picture. Focusing on the main complaint will indicate where there is an immediate need for care (Van Os, 2014); 4) it will allow clinicians to recognise subthreshold conditions more easily (Magruder and Calderone, 2000); and 5) it might facilitate the development of clear demarcations between normal and abnormal functioning (Kessler, 2002; Widiger and Samuel, 2005). Please, see also Table 1.This also fits well within scientific advances, as thus far strongest evidence has been found for a distinction between internalizing and externalizing disorders, even superseding these 15 main categories (DSM-5; APA, 2013, p.13, but see Weiss et al., 1998). The second step would concern the personalized aspect, which we argue to define on a level of core symptoms of the specific main category, to be agreed upon later. To assess these core symptoms, the field of psychological testing could develop an internationally applicable instrument to reliably and validly measure each (core) symptom on a dimensional scale. Many of these instruments are readily available and have proven its psychometric properties within scientific research. Elements from these instruments could be easily transformed to work within the new system. Within the field of psychology, this approach could aid development of a common international language to define symptoms, analogous to the field of psychiatry. Importantly, current psychological testing mainly implies the use of self-report measures. This leads to an abundance of auto-amnestic information. To increase the reliability and validity of psychological tests to assess DSM-5 symptoms, it may be important to add two additional information resources. This would entail psychological tests where a next of kin answers questions about the symptom of the client, and psychological tests that include the clinicians’ judgment, such as structured clinician-based interviews. Conversely, we also need to acknowledge the well-known limitations of clinical judgment (e.g., Faust, 1986; Garb, 1998). Advantages of a new frameworkThe changes we suggest have big implications and are not easily implemented in the current framework. Clients may prefer the comfort of a single clear label, similar to what they are used to in other areas of medicine. Health insurance providers and policy makers may argue for single labels as well. Therefore, it would require a lot of explanation from our clinicians to promote a change. Our suggestions for broader categories may not disambiguate the current situation better than the existing approach, but it will promote personalisation of health care. Difficulties in diagnostic reliability will remain in disorders that fall on the boundaries of the taxons, e.g., schizoaffective disorder versus bipolar disorder with psychotic characteristics, which may benefit from further study. There are also some politically tinged questions to keep in mind: How will we finance our health care, and how will we ensure a gradual transition from the current financing system, including clients who already have their labels? What about visitations from insurers and health inspection? How can they control for a good standard of quality in health care when considering the increasing heterogeneity? Nevertheless, we argue that the benefits outweigh the disadvantages. We will see a shift from a categorical to a personalized approach, which will lead to less (self) stigmatizing, less estrangement, and it will challenge reification thinking. DSM-V states that “a reformulation of research goals should also keep DSM-5 central to the development of dimensional approaches to diagnosis that will likely supplement or supersede current categorical approaches to diagnosis in coming years” (APA, 2013, p. 13). Our proposition for psychological testing on symptom level could contribute to this development. Furthermore, this new approach will do more justice to the heterogeneity of symptoms within and outside of classification categories, see also Table 1. Moreover, in this new approach we join forces of expert knowledge from the fields of psychiatry and psychological science. Finally, it offers new and potentially better opportunities to map health care needs. This in turn will lead to a better interface for allocation of appropriate treatment. It will present a clearer picture of when preventative care is preferred over treatment and vice versa. Importantly, health care needs will be more closely attuned to the ‘own story’ of the client.We argue for the national and international psychological associations in Europe and the United States of America to support the idea of a collective approach to develop an internationally standardized psychological testing battery to reliably assess all the core symptoms of the main categories in DSM-5. (shrink)

Integral to the diagnosis of autism spectrum disorder is the initial assessment through which the existence of a ‘problem’ is first ascertained. Despite this, there remains limited research on this early part of the diagnostic pathway. In this article, we utilised conversation analysis to examine relevant issues in relation to the practitioner–family interactions that take place within this initial assessment context. Our findings illustrated that parents typically first raised the possibility of the presence of an autism spectrum disorder (...) diagnosis through ‘building a case’, which professionals were then able to ratify or negate. Furthermore, we found that the assessments unfolded sequentially and clinical decisions were typically reached through a distinctive pattern of interaction. These findings have important implications for clinical practice, including for the study of autism spectrum disorder assessments and diagnosis. (shrink)

This chapter argues that the conditions under the umbrella “personality disorders” actually constitute two very different kinds of theoretical entities. In particular, several core personality disorders are actually moral, and not medical, conditions. Thus, the categories that are held to represent them are really moral, and not medical, theoretical kinds. The chapter works back from the possibility of treatment to the nature of the kinds that are allegedly treated, revisiting 18th-century ideas of moral treatment along the way. The discussion closes (...) with a reflection on how the ambiguous medical status of personality disorders and their treatment today is reminiscent of the ideological tug of war that pits alienist “mad doctors” like Pinel against their lay counterparts such as Tuke as they battled over who should be in charge of treating the mad. (shrink)

Immediately before the release of DSM-5, a group of psychiatric thought leaders published the results of field tests of DSM-5 diagnostic criteria. They characterized the interrater reliability for diagnosing major depressive disorder by two trained mental health practitioners as of “questionable agreement.” These field tests confirmed an open secret among psychiatrists that our current diagnostic criteria for diagnosing major depressive disorder are unreliable and neglect essential experiences of persons in depressive episodes. Alternative diagnostic criteria exist, but psychiatrists rarely (...) encounter them, forestalling the discipline’s epistemological crisis. In Alsadair MacIntyre’s classic essay, such crises occur in science when a person encounters a rival schemata that is incompatible with their current schemata and subsequently constructs a narrative that allows them to reconstruct their own tradition. In search of rival schemata that are in conversation with their own tradition, psychiatric practitioners can utilize alternative diagnostic criteria like the Cultural Formulation Interview, embrace an epistemologically humble psychiatry, and attend to the narrative experience of a person experiencing a depressive episode. (shrink)

The American Psychological Association's (APA's) as well as other professional organizations' (e.g., American Psychiatric Association) removal of homosexuality as a mental disorder represented a paradigmatic shift in thinking about exual orientation. Since then, APA (2000) disseminated guidelines for working with lesbian, gay, and bisexual (LGB) clients, and a variety of scholars and researchers alike have advocated affirmative therapeutic interventions with LGB individuals. Despite these efforts, the controversy over treating individuals with LGB orientations using nonaffirmative techniques continues. In this discussion, (...) the limited evidence regarding the efficacy and effects of conversion therapy is surveyed, particularly in the context of empirically supported treatment criteria summarized by Division 12 (clinical psychology) of the APA. Authors then consider the resulting ethical considerations in performing conversion therapy and propose alternative uses of affirmative therapy on the basis of ethical standards defined by APA. Finally, options for treating LGB individuals who are coming to terms with their sexual orientations are discussed. (shrink)

Immanuel Kant’s theory of imagination is a surprisingly fruitful nexus of explanation for the prima facie disparate characteristics of autism spectrum disorder (ASD), especially the sub-spectrum best characterized by the Sensory Integration (SI) and Intense World (IW) theories of ASD. According to the psychological theories that underpin these approaches to autism, upstream effects of sensory processing atypicalities explain a cascade of downstream effects that have been characterized in the diagnostic triad, e.g., poor sensory integration contributes to weak central coherence, (...) which in turn contributes to difficulty participating in a back and forth conversation. To see why Kant’s theory of imagination might be useful, consider that ASD is neither a sensory disorder nor an intellectual disorder per se. Cognitive dysfunction is a common comorbidity of ASD, not a characteristic of it. If we exclude sense and intellect, what’s left? According to Kant, imagination is a synthesizing faculty that mediates between sense and understanding. It does so by transforming intuition from the canonic and vital senses. The uses of imagination include our spatially formative, temporally associative, and communicatively affinitive production, where affinitive production includes sympathy and fantasy. Imagination is thus the faculty of sensory integration, embodied subjectivity, empathy, mindreading, and social cooperation. The wide range of how autism presents and how it is experienced can thus be understood in terms of the atypical development of specific functions of imagination. Kant’s theory of imagination provides a new perspective on how to organize our understanding of autism at the psychological level, one that makes sense of how some of the disparate characteristic phenomena of autism are systematically related and which might lead to novel predictions, research targets, or intervention recommendations. (shrink)

It has become something of a truism that people with Autism Spectrum Disorders (ASD) have difficulties with pragmatics. Granting this, however, it is important to keep in mind that there are numerous kinds of pragmatic ability. One very important divide lies between those pragmatic competences which pertain to non-literal contents – as in, for instance, metaphor, irony and Gricean conversational implicatures – and those which pertain to the literal contents of speech acts. It is against this backdrop that our question (...) arises: Are certain pragmatic tasks more difficult than others for people with ASD? (shrink)

Scholars in language and social interaction have long been concerned with the role of texts in institutional settings, studying, for example, how interview schedules actively shape conversational dynamics between participants. While texts have been acknowledged as active in this way, their generative capacity remains largely overlooked. This article argues that like human subjects, texts in interaction enact agency. One text in particular, a screening form used to diagnose the learning disability attention deficit/hyperactivity disorder, is analyzed to claim that this (...) text brings about the very condition it is designed to measure: a learning disability. Drawing from work in discursive psychology, I show how the measurement requires the client to adopt certain speaking positions, which then enables the text to speak for the client. I also demonstrate how the text constructs otherwise normal behavior as pathological through punctuation and nominalization. Finally, I illustrate how the spatial organization of the text constrains clients’ choices for interacting with it. This article claims that texts produce, rather than reflect, cognitive phenomena, and it moreover encourages that the notion of text as agent be taken seriously, especially when it presents the capacity to disable. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:A Report from the Front Lines: Conversations on Public Theology. A Festschrift in Honor of Robert Benne, and: Explorations in Christian Theology and Ethics: Essays in Conversation with Paul L. LehmannJeffrey P. GreenmanA Report from the Front Lines: Conversations on Public Theology. A Festschrift in Honor of Robert Benne Edited by Michael Shahan Grand Rapids, Mich.: Eerdmans, 2009. 184 pp. $30.00.Explorations in Christian Theology and Ethics: Essays in (...) Conversation with Paul L. Lehmann Edited by Philip G. Ziegler and Michelle J. Bartel Farnham, Surrey, UK: Ashgate, 2009. 206 pp. $99.95.The volumes reviewed here each recognize an important thinker in Christian social ethics in America: Robert Benne, emeritus professor of religion at Roanoke College, a Lutheran social ethicist; and Paul L. Lehmann (1906–94), a Presbyterian who was an influential teacher associated with Princeton Theological Seminary, Harvard University Divinity School, and Union Theological Seminary in New York.The first volume honors Benne’s seventieth birthday. His major writings include The Ethic of Democratic Capitalism: A Moral Reassessment (1981), Ordinary Saints: An Introduction to the Christian Life (1988), The Paradoxical Vision: A Public Theology for the Twenty-First Century (1995), Quality with Soul: How Six Premier Colleges and Universities Keep Faith with Their Religious Traditions (2001), and most recently, Good and Bad Ways to Think about Religion and Politics (2010). Since Benne is known for his traditionalist moral views, some unmistakably conservative voices, including a number of prominent Lutherans and neoconservative political thinkers, are represented in this book. The broad theme is public theology, working from Benne’s definition of public theology as “the engagement of a living religious tradition with its public environment—the economic, political, and cultural spheres of our common life.”The book has three parts. The first section, “The Imperative of a Public Theology,” includes essays by editor Michael Shahan, Carl Braaten, Jean Bethke Elshtain, and Richard John Neuhaus. Shahan’s essay provides a helpful exposition of Benne’s intellectual trajectory. Braaten offers a defense of the historic, bodily resurrection of Jesus as the “crux of Christianity’s case.” Elshtain takes [End Page 206] up C. S. Lewis’s concerns in his Abolition of Man (1944) as she diagnoses the “cultural disorder” reflected in current debates about euthanasia and abortion. Neuhaus’s wistful essay looks back over his efforts in the public square, stating that he and Benne have shared a common concern: “A renewal of Christian confidence in providing a morally informed philosophy for a more just and virtuous society in the tradition of liberal democracy” (47). Taken together, these four chapters sketch the assumed intellectual and cultural landscape that sets the context for the volume as a whole.The second section, “The Lutheran Necessity in Public Theology,” begins with a largely autobiographical essay by James Nuechterlein about his journey in Lutheranism and the value of its theological distinctives, especially the famous simul. Next is Gilbert Meilaender’s account (exploring an insight from Kierkegaard) of the place for a Lutheran “corrective” within the wider normative tradition, then Mark Noll’s chapter that underscores the value of robust Lutheran social thinking against the backdrop of the more revivalist and pietist tendencies of Protestant evangelicalism.The final section, “Contested Issues in Public Theology,” includes chapters by Paul Hinlicky, Ronald Thiemann, Gerald McDermott, Donald Schmeltekopf and Michael Beaty, and Joseph Swanson. The chapters by Hinlicky on Luther’s relation to liberal political theory, and by Thiemann on the idea of the public theologian’s prophetic role as “connected critic,” are the most densely argued material in the book. These two essays will probably be of the most interest for scholars in theological ethics. The chapter by McDermott deals with Lutheran church-related colleges. A coauthored essay by Schmeltekopf and Beaty champions the vocation of Christian university education. Swanson situates Benne’s economic writings within neo-conservative thought.The book takes up some of Benne’s favorite themes and interest areas, but only rarely do the authors engage Benne’s own thought. Virtually nowhere do they prod Benne to become clearer, to strengthen his arguments, or to modify his conclusions. I would have preferred a deeper engagement with Benne’s ideas; in several... (shrink)

In a 2007 paper, we argued that speakers with Autism Spectrum Disorders exhibit pragmatic abilities which are surprising given the usual understanding of communication in that group. That is, it is commonly reported that people diagnosed with an ASD have trouble with metaphor, irony, conversational implicature and other non-literal language. This is not a matter of trouble with knowledge and application of rules of grammar. The difficulties lie, rather, in successful communicative interaction. Though we did find pragmatic errors within literal (...) talk, the transcribed conversations we studied showed many, many successes. A second paper reinforced our finding of a general level of success. It considered differences within the class of pragmatically-inflected yet literal speech acts. The present paper carries our project forward. It overcomes some of the methodological limitations of the second paper, by increasing sample size, and looking at frequency of use rather than just seeming errors. It also includes a control sample. The emerging results are two-fold. On the one hand, there was a slight, statistically significant difference in frequency of use between our participants and the controls in four sub-categories: indexicals, possessives, polysemy and degree on a scale. In all four, the participants diagnosed with ASDs had fewer occurrences overall, relative to controls. On the other hand, there was no significant difference in error rates between ASDs and controls — not in any of the eight categories of pragmatic determinants of literal content that we coded for. The upshot is that, though there were less-preferred forms for participants with ASDs, they do very well indeed with pragmatic determinants of literal content. (shrink)

The development of speech language therapy students into clinicians is an area of increasing interest as educators focus on how knowledge, skills and attitudes are taught and learnt within the profession. The personal journeys of students through experiences of service learning have potential to further our understanding of the impact of civic engagement on the student experience and their learning. This paper explores the journeys of first year speech and language therapy students through a Thematic Analysis of reflective letters written (...) by students to themselves at the beginning and completion of a service learning module. Analysis demonstrates development of interpersonal and preclinical skills as well as an understanding of attitudes and values inherent in the social model of disability. The skills and attitudes developed by the students through participation in the Conversation Partner Scheme are consistent with social model principles that support therapists to fully address the long-term, real life needs of clients with aphasia (the acquired communication disorder that frequently follows stroke). The interface between the social model of disability and the role of service learning in nurturing the attitudes and values which underpin this model are explored. (shrink)

ABSTRACT: After World War Two a gigantic effort was made in order to build a viable and stable international order, beginning with the Bretton Woods agreement that was aimed to stabilize the international monetary system, and with the United Nations, that were intended to restore legality in interstate affairs and somehow initiate a cosmopolitan conversation among Nation States. This order is now slowly crumbling down, paradoxically through globalization, and a triumphant neoliberalism. A new, but indeed quite old narrative, rather a (...) myth, of what a national identity means is again getting the upper hand.KEYWORDS: international relations, international law, European Union, globalization, national identity. (shrink)

Previous studies seldom touch on aspects of psychotherapeutic encounters between therapists and clients with particular disorders. Little attention has been paid to the sequence organization of psychotherapeutic interaction between therapists and clients with depression in Chinese medical settings. By adopting conversation analysis, we investigated the specifics of psychotherapeutic encounters, specifically, the transformative sequences of psychotherapeutic interaction between therapists and Chinese adolescents with depression. We identified the fourth aspect of clients’ experience transformed in the Chinese psychotherapeutic interaction with adolescents with depression: (...) cognition, and described how the sequential organization of therapists’ actions facilitates the momentary transformation of clients’ experience in the psychotherapeutic processes. This study not only adds to the conversation analytic study on the transformative sequences in psychotherapeutic interaction but also sheds some light on the study of how therapists transform clients’ experience in Chinese psychotherapeutic interaction. (shrink)

BackgroundThere is a growing interest in using cognitive–behavioural therapy (CBT) with people who have Asperger syndrome and comorbid mental health problems.AimsTo examine whether modified group CBT for clinically significant anxiety in an Asperger syndrome population is feasible and likely to be efficacious.MethodUsing a randomised assessor-blind trial, 52 individuals with Asperger syndrome were randomised into a treatment arm or a waiting-list control arm. After 24 weeks, those in the waiting-list control arm received treatment, while those initially randomised to treatment were followed (...) up for 24 weeks.ResultsThe conversion rate for this trial was high (1.6:1), while attrition was 13%. After 24 weeks, there was no significant difference between those randomised to the treatment arm compared with those randomised to the waiting-list control arm on the primary outcome measure, the Hamilton Rating Scale for Anxiety.ConclusionsTrials of psychological therapies with this population are feasible. Larger definitive trials are now needed. (shrink)

Psychedelics such as psilocybin reliably produce significantly altered states of consciousness with a variety of subjectively experienced effects. These include certain changes to perception, cognition, and affect,1 which we refer to here as the acute subjective effects of psychedelics. In recent years, psychedelics such as psilocybin have also shown considerable promise as therapeutic agents when combined with talk therapy, for example, in the treatment of major depression or substance use disorder.2 However, it is currently unclear whether the aforementioned acute (...) subjective effects are necessary to bring about the observed therapeutic effects of psilocybin and other psychedelics. This uncertainty has sparked a lively—though still largely hypothetical—debate on whether psychedelics without subjective effects (“nonsubjective psychedelics” or “non-hallucinogenic psychedelics”) could still have the same therapeutic impact, or whether the acute subjective effects are in fact necessary for this impact to be fully realized.3,4,5. (shrink)

Contrary to the widely held belief in the humanities that hysteria no longer exists, this article shows that the advent of new brain imaging technologies has reignited scientific research into this age-old disorder, once again linking it to hypnosis. Even though humanities scholarship to date has paid no attention to it, image-based research of hysteria via hypnosis has been hailed in specialist circles for holding the potential to finally unravel the mystery of this elusive disorder. Following a succinct (...) overview of how hypnosis was used in the nineteenth century hysteria research, the article details how the relationship between hysteria and hypnosis is currently renegotiated in the context of brain imaging studies. It shows that the current research has so far failed to deliver on its promise of uncovering the link between hysteria and hypnosis. It further argues that despite huge technological advances in imaging technologies, contemporary researchers grapple with conceptual problems comparable to those that plagued their nineteenth century predecessors. (shrink)

Schizophrenia is a mental disorder that calls the mineness of one's own sensations, thoughts and actions into question and threatens the person with a loss of self. In order to understand this illness in its essence, an approach based on phenomenological psychopathology is therefore indispensable. Conversely, disorders of the self in schizophrenia should be of crucial interest for any philosophy of subjectivity in order to test its concepts of self-awareness, personhood and intersubjectivity by reference to empirical phenomena.Contemporary neurobiological concepts (...) of schizophrenia predominantly emphasize the importance of impaired integration of somatosensory inputs into stable central-nervous representations... (shrink)

The psychopathological analysis of hysteria is a victim of narrow conceptualizations. Among these is the inscription of hysteria in the feminine sphere, about body and sexuality, which incentivized conceptual reductionism. Hysteria has been mainly considered a gendered pathology, almost exclusively female, and it has been associated with cultural and/or religious features over time rather than treated as a psychopathological world. Further, hysteria has been dominated by conceptual inaccuracies and indecision, not only in terms of clinical features but also in terms (...) of its definition. For this reason, it seems necessary to “undress” hysteria from this feminization, sexualization, and corporealization with which it has been abundantly clothed over the years. “Undressing” hysteria will make possible a reconfiguring and deconstructing of the explanatory-causal model of Charcot and Freud. However, if we take out this cultural heritage, the stigma accompanying this diagnosis, and the weight of the enormous historical tradition that hysteria carries, the world of hysteria continues to constitute a domain full of complexity and nosographic challenges. Hysteria has been considered a sum of psychological behaviors and states illustrated by drama, mystery, or falsity. The difficulty in understanding the multiple somatic manifestations which characterize this clinical condition created several controversies and much confusion. In the current nosography, the personological component of hysteria has been separated from its symptomatic manifestation, in the Histrionic Personality Disorder and Conversion Disorder categories, respectively. This segmentation by descriptive nosography does contribute to a unitary understanding of the phenomenon and, consequently, of daily clinical practice. Clinical complexity can be grasped and deciphered only if the symptom is inscribed in the patient’s lifeworld and his/her subjective life history. Clinical practice is thus thought of in terms of a structural aggregation of a homogeneous set of phenomena, together constituting a specific way of being in the world. The starting point of this article is the evident modalities characterizing this life-world, taking care not to confuse the point of origin with the point of expression. (shrink)

Tissue plasminogen activator (tPA) is administered to patients with suspected ischemic stroke to improve blood flow to the brain In rare cases, patients present with complaints of stroke symptoms that appear to be non-organic due to malingering, factitious disorder, or conversion disorder (psychogenic stroke mimics). Deciding whether or not to administer tPA to these patients can be challenging. The risk of hemorrhage after administration of tPA is low, but not zero. The ethical principles of beneficence and nonmaleficence (...) need to be weighed carefully in these situations. We present two cases of patients with suspected psychogenic stroke mimics to illustrate the ethical challenges faced in identifying and managing psychogenic stroke mimics. Further research is needed to demonstrate effective treatment strategies for patients with acute stroke symptoms of psychogenic etiology. (shrink)