Thursday, 18 September 2014

Self Harm: The Philosophical, Ethical and Policy Issues

My primary research interests are in ethics and philosophy of psychiatry. For the past ten years I have worked as a lecturer and researcher in bioethics at the Centre for Ethics in Medicine, University of Bristol.

During the past four years, my research has focused on the ethical, legal, philosophical and policy issues of self harm. In particular, I have been concerned with the ethical questions which arise when doctors or nurses allow patients to self harm in psychiatric hospitals. I first encountered this issue when it was reported in the British press that patients were being allowed to self cut in some NHS hospitals. For example, one inpatient was allowed to keep a piece of glass in a locked draw in her room and use it to cut her knees. This idea is of course controversial. Many people find the idea of allowing patients to self harm in medical institutions at best counter intuitive and at worst sickening and morally wrong. However, I argue that in certain circumstances patients should be allowed to self harm.

Self Harm
by Kerry Gutridge

Tuesday, 16 September 2014

Another Perspective on Anosognosia

Sahba Besharati
I am currently in the 3rd year of my PhD undergoing a split-site collaboration project with the University of Cape Town and University College London. This post will focus on a recent publication featured in Neuropsychological Rehabilitation with my supervisor, Katerina Fotopoulou, and our collaborator in Italy, Valentina Moro, on a prototypical form of unawareness called anosognosia for hemiplegia (AHP).

Neurological disturbances in awareness can offer an important avenue to explore the construction of the bodily self. AHP is one such example of a disorder of self-awareness, where patients have a lack of recognition or awareness of their motor paralysis following a stroke. AHP can have various clinical presentations, ranging from blatant denial of limb paralysis and associated delusional beliefs to emotional indifference of one’s motor disabilities.

Although AHP is often transient (sometimes recovering within days or weeks), motor unawareness can significantly obstruct rehabilitation efforts. For example, patients often refuse treatment or do not engage in therapy, have longer hospital stays, and are often less likely to return to independent living. Unfortunately there is currently no failsafe treatment available. However, in a recent study, Dr. Fotopoulou and colleagues showed that self-observation using video replay led to the permanent and total recovery of motor awareness in an acute patient. This is a simple, psychophysical intervention used at the bedside, where AHP patients watch a video replay of themselves falsely claiming that they can move their paralysed arm despite blatant evidence to the contrary.

Thursday, 11 September 2014

Being Amoral

Being Amoral
by Thomas Schramme
This post is by Thomas Schramme. Thomas introduces his new edited collection, Being Amoral: Psychopathy and Moral Incapacity (MIT Press).
 
It would be useful to know what kind of capacities human beings require in order to be moral. This piece of information would have tremendous practical significance, as we could try to organize institutions, such as education, to provide an environment where these capacities can develop and flourish. It would also be an interesting theoretical piece of information, as philosophers have for a long time quarrelled over the issue whether moral capacities are mainly due to reason or emotion.

One way of making progress in this debate on the necessary faculties in becoming a moral person is to study people who apparently lack morality; who are, in philosophical parlance, amoral persons. There seem to be indeed real-life exemplars of such amoral persons, and to study them might lead us exactly in the desired direction. The really amoral people seem to be psychopaths. So to scientifically study psychopaths' lack of capacities might well help us to solve theoretical problems. But we cannot simply apply such empirical research to solve philosophical riddles, because the conceptual basis of the construct of psychopathy is shaky. It is simply not always clear what phenomenon psychiatrists talk about when they refer to psychopathy. Yet, philosophers cannot decide either, by conceptual stipulation, what is means to lack moral knowledge or to be amoral. So both psychiatry and philosophy can benefit from working together in this area of research, but it requires genuine interdisciplinary research.

Tuesday, 9 September 2014

The Representation of Agents in Auditory Verbal Hallucinations

Sam Wilkinson
In this post, I will sketch some ideas from a paper that I have been working on with Vaughan Bell.

Current aetiological models of auditory verbal hallucinations (AVHs) tend to focus on the mechanisms underlying their occurrence, but often fail to address more fine-grained aspects of the content of the auditory experience. In other words, they tend to ask why there are AVHs at all, instead of asking, given that there are AVHs, why they have the properties that they have. One such property, which has been somewhat overlooked, is why the voices are often experienced as coming from (or being the voices of) agents, and often specific agents.

One reason why this has been overlooked (more by theorists than by clinicians) is perhaps the – explicit or implicit – view that, if we can account for the auditory experience, then the agency will follow. Thus Cho and Wu (2013, p.2) claim that ‘it is simple to explain why the patient misattributes the event to another person: that is what it sounds like’. According to such a view, I hear the voice of, e.g., my stepfather because my auditory experience has the properties that resemble those of my stepfather’s voice.

Thursday, 4 September 2014

A Metaphysics of Psychopathology

A Metaphysics of Psychopathology
by Peter Zachar
My name is Peter Zachar and I am a Professor in the Psychology Department at Auburn University Montgomery in the U.S. I have spent two decades writing about the philosophy of psychiatry, particularly in the area of psychiatric classification. About four years ago I decided it was time to systematize what I have learned in a book – which has recently been published by the MIT Press with the title A Metaphysics of Psychopathology.  

There is an ongoing tension between belief in the reality of psychiatric disorders versus the metaphysical skepticism of social constructionism and the anti-psychiatry movement. Within the mental health professions themselves, people have differing views about how much reality to attribute to conditions such as schizophrenia and post-traumatic stress disorder. For instance, some professionals consider schizophrenic psychosis to be real, others consider it to be a reified diagnostic category. 

Because psychiatrists and other mental health professionals are deeply involved in what behaviors society considers abnormal, deserving of sympathy, and even excusable, metaphysical questions such as “is PTSD a real disorder” are more than academic. Whether something such as PTSD is considered real matters – in many ways.

In the history of science, metaphysical concepts have been regarded suspiciously by thinkers inclined toward empiricism. Currently, however, the traditional empiricist skepticism that sought to expunge metaphysics from science is considered unworkable. For example, to assert that there is a categorical distinction between metaphysics and science is itself a metaphysical stance. 

In this book I re-introduce some metaphysical scrutiny into psychiatry (in the tradition of a pragmatic empiricism), but do not advocate for anti-psychiatry or its current descendants. If we examine the Science Wars of the 1990s, one of the outcomes was a more discerning use of metaphysical concepts on the part of both the participating scientists and social constructionists. This reduced the extent to which they talked past each other. The lessons learned there can also be applied to psychiatry.

Tuesday, 2 September 2014

One Year of Epistemic Innocence

Epistemic Innocence logo
Yesterday, on September 1st, 2014 our project, Epistemic Innocence of Imperfect Cognitions, funded by an AHRC fellowship awarded to myself, came to an end. As my work on the project has been the main reason for starting this blog, I thought I would offer some thoughts on how things have gone, and invite your comments.

Fellowships are forms of funding awarded to an individual, but this project has been from the very beginning a collective effort. The researcher working on the project, Ema Sullivan-Bissett, has contributed to its development and its success in several ways: writing one new paper after the other, giving talks to very demanding audiences and taking excellent care of the blog by commissioning and authoring posts, editing material, all while preparing her (very successful) viva and honouring her teaching commitments.

Ema and I were supported by a wider group of Birmingham-based people who greatly helped us by contributing to the blog, running public engagement events and promoting the project far and wide: Kengo Miyazono (the author of the first post on this blog), Magdalena Antrobus (working on cognitive benefits of bipolar disorder), Gregory Yates (working on schizophrenia and its complexities), Ben Costello (writing about agent responsibility and psychiatric diagnosis) and Rachel Gunn (researching delusions) all deserve a special mention.

We were all inspired by the members of the Imperfect Cognitions research network, a fantastic international group of researchers who were happy to share their results and offer feedback on our preliminary ideas. Some debates on this blog have also helped make progress on some thorny issues outside the scope of the project narrowly conceived, such as the nature of beliefs and delusions, delusion formation theories, and how to understand human memory and what its limitations are.

What was new about Epistemic Innocence? The thought that "imperfect cognitions" (e.g., false beliefs) can be good for a variety of purposes had been explored before. But what we wanted to do was highlight their potential contribution to the advancement of knowledge. That false beliefs can be epistemically beneficial was a counter-intuitive thesis but it sounded promising to us and to those who followed and supported the project from the beginning, via social media (Facebook and Twitter) or by participating in our May workshop. At the core of our research efforts was the sense that there need not be a simple trade-off between epistemic and pragmatic benefits. Here is an example of the trade-off. Take Sarah's false belief that she is more generous than the average person. Of course having that belief may be beneficial to Sarah in a number of ways. She can feel better about herself if she thinks she is very generous, for instance. But if her belief is false, it is not likely to promote her epistemic standing. It is a form of deception.