This study investigates the ability of individuals with psychopathy to perform passive avoidance learning and whether this ability is modulated by level of reinforcement/punishment. Nineteen psychopathic and 21 comparison individuals, as defined by the Hare Psychopathy Checklist Revised (Hare, 1991), were given a passive avoidance task with a graded reinforcement schedule. Response to each rewarding number gained a point reward specific to that number (i.e., 1, 700, 1400 or 2000 points). Response to each punishing number lost (...) a point punishment specific to that number (i.e., the loss of 1, 700, 1400 or 2000 points). In line with predictions, individuals with psychopathy made more passive avoidance errors than the comparison individuals. In addition, while the performance of both groups was modulated by level of reward, only the performance of the comparison population was modulated by level of punishment. The results are interpreted with reference to a computational account of the emotional learning impairment in individuals with psychopathy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Psychopathy, Other-Regarding Moral Beliefs, and ResponsibilityLloyd Fields (bio)AbstractIn this paper I seek to show that at least one kind of psychopath is incapable of forming other-regarding moral beliefs; hence that they cannot act for other-regarding moral reasons; and hence that they are not appropriate subjects for the assessment of either moral or legal responsibility. Various attempts to characterize psychopaths are considered and rejected, in particular the widely held (...) view that psychopaths are, in general, incapable of understanding moral concepts. The particular disability proposed here, the incapacity to form other-regarding moral beliefs, is then derived from an analysis of what is required for someone to be a responsible agent. This is illustrated with a detailed case history. A defect of this kind is shown to vitiate moral responsibility, because it renders the psychopath irresponsive to the social pressures which normally ensure respect for moral norms. It is also shown that the psychopath is not a suitable subject for the assessment of legal responsibility, because he lacks the capacity to act from common prudence to avoid sanctions. I conclude that the attempt to characterize particular defects from among the heterogeneity of psychopathic subjects, could lead to better targeted, and hence to more effective, management of particular cases.KeywordsCriminality, mental illness, personality disorder, blame, liability, moral beliefs, guilt, social moralityIntroductionThe term “psychopath” has been used with a wide variety of different meanings and, no doubt, covers a heterogeneous group of subjects (Criminal behaviour and mental health 1992). My aim in this paper is to argue that at least a subgroup of those subjects are characterized by an inability to form other-regarding moral beliefs—and hence, for this particular reason, are not morally responsible agents—and that they also lack the capacity for prudence, and hence are not legally responsible agents.I begin by distinguishing the particular sense in which I will be using the term “psychopathy.” I then consider some suggestions in the literature regarding the defect by which psychopaths might be characterized—that they are mentally ill, or incapable of understanding moral concepts. In rejecting these, I come to the suggestion that the relevant defect is an inability to form other-regarding moral beliefs, a defect which is graphically illustrated by a case report from the literature. I explore the implication of this kind of defect for [End Page 261] moral responsibility as a socially-embedded notion, and the implication of the psychopath’s inability to exercise prudence in relation to legal liability.Nothing in this paper should be taken to suggest that psychopaths are irredeemable. On the contrary, as I argue in an endnote, correctly characterizing the defect from which they suffer leads directly to forms of treatment whose effectiveness has acquired a measure of empirical support.The Nature of PsychopathyPsychopathy is not a homogeneous concept; there are different types of psychopaths. For example, Henderson identified a type of psychopath who he classified as “Predominantly Creative,” exemplified by such figures as T. E. Lawrence and Joan of Arc. In people of this type genius is associated with heightened sensitivity, psychosexual immaturity and emotional instability (Henderson 1939, 108–20; Henderson and Gillespie 1969, 317). Predominantly creative psychopaths do not come within my purview.By “psychopathy” I shall mean the specific form of personality disorder described by Cleckley in his book, The Mask of Sanity (Cleckley 1964). Cleckley’s description forms the basis of Hare’s Revised (20-item) Psychopathy Checklist. The Checklist includes the following personality traits and deviant behaviors:1. Glibness/superficial charm.2. Grandiose sense of self-worth.3. Need for stimulation/proneness to boredom.4. Pathological lying.5. Conning/manipulative.6. Lack of remorse or guilt.7. Shallow affect.8. Callous/lack of empathy.9. Parasitic lifestyle.10. Poor behavioral controls.11. Promiscuous sexual behavior.12. Early behavior problems.13. Lack of realistic, long-term plans.14. Impulsivity.15. Irresponsibility.16. Failure to accept responsibility for own actions.17. Many short-term marital relationships.18. Juvenile delinquency.19. Revocation of conditional release.20. Criminal versatility (Hare 1986, 18). 1This conceptualization resembles in many respects the category of Antisocial Personality Disorder as described in the American Psychiatric... (shrink)

Boddy and his colleagues have published several articles on “corporate psychopathy” using what they refer to as a Psychopathy Measure—Management Research Version. They based this measure on the items that comprise the Interpersonal and Affective dimensions of the Hare Psychopathy Checklist-Revised, a widely used copyrighted and controlled instrument. The PM-MRV not only misspecifies the construct of psychopathy, but also serves as an example of the problems associated with an attempt to form a “new” scale (...) by adapting items from a proprietary scale. The PCL-R measures a superordinate construct underpinned by four correlated dimensions or first-order factors, not just the two in the PM-MRV. The other two dimensions are Lifestyle and Antisocial, which together form Factor 2 of the PCL-R. As defined by the PCL-R, psychopathy requires high scores on both Factor 1 and Factor 2. Lack of validity aside, even if the PM-MRV were to be a useful measure of Factor 1, it would not discriminate between psychopathy and other “dark personalities,” such as Machiavellianism and narcissism, which, along with psychopathy, form the Dark Triad. This lack of discrimination stems from the fact that each of these personalities shares features measured by Factor 1 and, by implication, by the PM-MRV. Research findings based on the PM-MRV may have some meaning with respect to dark personalities in general, but their relevance to psychopathy, as measured with the PCL-R, is tenuous at best. (shrink)

There are indications that the interpersonal affective factor and the social deviation factor, both of which are underlying dimensions of psychopathy, have a positive and a negative relationship, respectively, with executive functioning. However, this is seldom taken into consideration in the research on the relationship between executive functioning and psychopathy, which may be an explanation for the many inconsistent results in this area as reported in the literature (e.g., Rogers, 2006). In the present study, executive functioning was studied (...) using the Wisconsin Card Sorting Test (WCST) in 53 inpatients of a Dutch forensic psychiatric clinic who were classified by means of the Psychopathy Checklist-Revised (PCL-R). Special attention was given to the relationship between the two separate factors and executive functioning. Age, educational level, and substance abuse were controlled for in the analysis. No difference was found between psychopathic (N = 17) and nonpsychopathic (N = 36) patients in the WCST scoring categories, nor was there a significant difference in the four diagnostic subgroups defined by the two factors. However, the trends observed do justify further study in this direction. (shrink)

The aim of this paper is to analyze, from a philosophical perspective, the scientific robustness of the construct of psychopathy as measured by the Psychopathy Checklist Revised that was developed by Robert Hare (1991; 2003). The scientific robustness and validity of classifications are topics of many debates in philosophy of science and philosophy of psychiatry more specifically. The main problem consists in establishing whether scientific classifications reflect natural kinds where the concept of a natural kind refers (...) to the existence of some objective divisions in nature that do not depend exclusively on subjective judgments of the classifier. The construct of psychopathy is especially interesting since the diagnosis of psychopathy has substantial social consequences. In the light of the recent debates regarding the problem of natural kinds in philosophy of psychiatry, we advocate the following distinction between two types of scientific classifications: natural and practical kinds. Natural kinds refer to those categories that are united by common causal mechanisms or properties. Practical kinds refer to categories that fulfill some practical classificatory goals such as prediction. We argue that the construct of psychopathy can fulfill the role of a practical kind. In addition, we contend that our current scientific knowledge about psychopathy does not allow us to conclude that this category is a natural kind. (shrink)

Psychopathy is a disorder characterized by severe and frequent moral violations in multiple domains of life. Numerous studies have shown psychopathy-related limbic brain abnormalities during moral processing; however, these studies only examined negatively valenced moral stimuli. Here, we aimed to replicate prior psychopathy research on negative moral judgments and to extend this work by examining psychopathy-related abnormalities in the processing of controversial moral stimuli and positive moral processing. Incarcerated adult males (N = 245) completed a functional (...) magnetic resonance imaging protocol on a mobile imaging system stationed at the prison. Psychopathy was assessed using the Hare Psychopathy Checklist–Revised (PCL-R). Participants were then shown words describing three types of moral stimuli: wrong (e.g., stealing), not wrong (e.g., charity), and controversial (e.g., euthanasia). Participants rated each stimulus as either wrong or not wrong. PCL-R total scores were correlated with not wrong behavioral responses to wrong moral stimuli, and were inversely related to hemodynamic activity in the anterior cingulate cortex in the contrast of wrong > not wrong. In the controversial > noncontroversial comparison, psychopathy was inversely associated with activity in the temporal parietal junction and dorsolateral prefrontal cortex. These results indicate that psychopathy-related abnormalities are observed during the processing of complex, negative, and positive moral stimuli. (shrink)

Psychopathy continues to be a challenge in forensic contexts, and evidence of its association with destructive behaviors, such as aggressive antisocial behaviors, is extensive. However, the potential role of intelligence as moderator of the well-established association between psychopathy and aggressive antisocial behaviors has largely been neglected, despite intelligence having been independently related to both concepts. Increased knowledge of whether intelligence is relevant to this association is needed because of its possible implications on the assessment and treatment of individuals (...) with psychopathic traits and aggressive antisocial behaviors. This study aimed to investigate the association between psychopathic traits, aggressive antisocial behaviors, and intelligence in young violent offenders and to test whether intelligence moderates the relationship between psychopathic traits and aggressive antisocial behaviors. Participants were 269 male violent offenders aged 18 to 25 years, assessed on the Psychopathy Checklist-Revised (PCL-R), the Life History of Aggression (LHA), and the General Ability Index from the Wechsler Adult Intelligence Scale, 3rd edition. Associations were tested with Spearman’s rho and moderation analysis was performed through ordinary least squares regressions. The PCL-R four-facet structure was used for the analyses. We found a positive association between psychopathic traits and aggressive antisocial behaviors, and a small, negative association between the Affective PCL-R facet and intelligence. In the moderation analyses, a small yet statistically significant moderation effect of intelligence on the association between the Interpersonal facet and LHA total scores was demonstrated. However, the amount of variance in the LHA total score explained by the model was very small; 2.9%. We suggest that intelligence, however important for rehabilitation strategies and everyday functioning, is not necessarily pertinent to understanding aggressive antisocial behaviors in young offenders with psychopathic traits. (shrink)

This study presents the first neuroimaging investigation of female psychopathy in an incarcerated population. Prior studies have found that male psychopathy is associated with reduced limbic and paralimbic activation when processing emotional stimuli and making moral judgments. The goal of this study was to investigate whether these findings extend to female psychopathy. During fMRI scanning, 157 incarcerated and 46 non-incarcerated female participants viewed unpleasant pictures, half which depicted moral transgressions, and neutral pictures. Participants rated each picture on (...) moral transgression severity. Psychopathy was assessed using the Psychopathy Checklist-Revised (PCL-R) in all incarcerated participants. Non-incarcerated participants were included as a control group to derive brain regions of interest associated with viewing unpleasant vs. neutral pictures (emotion contrast), and unpleasant pictures depicting moral transgressions vs. unpleasant pictures without moral transgressions (moral contrast). Regression analyses in the incarcerated group examined the association between PCL-R scores and brain activation in the emotion and moral contrasts. Results of the emotion contrast revealed a negative correlation between PCL-R scores and activation in the right amygdala and rostral anterior cingulate. Results of the moral contrast revealed a negative correlation between PCL-R scores and activation in the right temporo-parietal junction. These results indicate that female psychopathy, like male psychopathy, is characterized by reduced limbic activation during emotion processing. In contrast, reduced temporo-parietal activation to moral transgressions has been less observed in male psychopathy. These results extend prior findings in male psychopathy to female psychopathy, and reveal aberrant neural responses to morally-salient stimuli that may be unique to female psychopathy. (shrink)

Recent studies lend support to the two-pathway model of the evolution of sociopathy with evidence that: 1) psychopathy (primary sociopathy) is a discrete type and 2) in general, sociopaths have relatively high levels of reproductive success. Hare's Psychopathy Checklist may provide a start for the revision of terminology that will be necessary to distinguish between primary and secondary trajectories.

The Hare Psychopathy Checklist (PCL; Hare, Neumann, & Mokros 2018) scales are among the most widely used forensic assessment tools. Their perceived utility rests partly on their ability to assess stable personality traits indicative of a lack of conscience, which then facilitates behavioral predictions useful in forensic decisions. In this systematic review, we evaluate the empirical evidence behind 3 fundamental justifications for using the PCL scales in forensics, namely, that they are empirically predictive of (1) criminal behavior, (2) (...) treatment outcomes, and (3) a lack of conscience. We found the PCL scales can predict criminal behavior to a statistically significant degree, though with important limitations. We found no evidence of PCL psychopathy being predictive of treatment and rehabilitation outcomes. We found no evidence of PCL psychopathy being predictive of a lack of conscience. These findings disprove widespread beliefs about PCL psychopathy among forensic practitioners and questions the current and future role of the PCL scales in forensic settings. (shrink)

Baccarini and Malatesti (2017) defend the idea that we must use coercively biomedical means to enhance the morality of a specific group of individuals: psychopaths, diagnosed through the Psychopathy Checklist-Revised (PCL-R) standards (Hare, 2003). Their argument is theoretical, thus it goes independently from the actual effectiveness of existent treatments, and it is based on a logical reasoning. Moral bioenhancement (MB) means include psychotropic drugs, brain stimulations, neurosurgeries, genetic editing, etc. -/- In short, the authors apply Gerald Gaus' (...) account of open justification (Gaus, 1996, 2011), according to which “a prescription addressed to an agent is a reasoning that includes premises that consider the system of reasons (such as beliefs, preferences, etc.) of that agent” (Baccarini and Malatesti, 2017, p. 1). In their view, coercive MB of psychopaths is morally sound and deducible by reasons within the psychopath's cognitive-affective system—even if the psychopath needs not to be able to consciously or sincerely endorse them. We believe that this argument is flawed. In sum, we argue that the psychopath's cognitive-affective system would consistently justify reasons against mandatory MB to herself, even if she wishes differently for others, and that the prescription cannot be extended. (shrink)

In this chapter we argue that Robert Hare's psychopathy checklist revised (PCL-R) offers a construct of psychopathy that is valid enough for philosophical investigations of the moral and legal responsibility of psychopathic offenders.

Prior studies provide consistent evidence of deficits for psychopaths in processing verbal emotional material but are inconsistent regarding nonverbal emotional material. To examine whether psychopaths exhibit general versus specific deficits in nonverbal emotional processing, 34 psychopaths and 33 nonpsychopaths identified with Hare's (R. D. Hare, 1991) Psychopathy Checklist-Revised were asked to complete a facial affect recognition test. Slides of prototypic facial expressions were presented. Three hypotheses regarding hemispheric lateralization anomalies in psychopaths were also tested (right-hemisphere dysfunction, reduced (...) lateralization, and reversed lateralization). Psychopaths were less accurate than nonpsychopaths at classifying facial affect under conditions promoting reliance on right-hemisphere resources and displayed a specific deficit in classifying disgust. These findings demonstrate that psychopaths exhibit specific deficits in nonverbal emotional processing. (shrink)

Reports of increasing family violence abound in Nigeria. Although studies have implicated cultural constructs as the basis for this trend, this study specifically contemplated the nexus between the increased violence and Anti-Social Personality Disorder (ASPD). The purpose of this study was to connect these abusive and violent behaviours in their specific contexts as evidence of ASPD. The study was hinged on autoethnographic research which I systematically analysed as lived experiences with a sociopath. Data for the analyses was drawn from purposively (...) sampled participants (n-70) of victims of family violent abuse. Thematic, interpretative analytical approach and the theories of sociopathy, particularly Hare, Psychopathy Checklist-revised (PCL-R) were used to analyse the data from my personal experiences, and the interviews. The results indicated that only five participants representing 7.14% of the purposively selected population, admitted knowing sociopaths as conscienceless murderers and serial killers. The majority of participants (90%) contemplated sociopaths in religious terms (as incarnated evil beings). Only 2.86% rightly expressed their understanding of sociopathy and related personality disorders in a much-informed manner. Although the results of this study contrast with conventional propositions on ASPD, they revealed how religious belief and superstition among Nigerians frame the conversation on sociopathy and other variants of ASPD. Findings suggested that the growing superstitious beliefs on the causes, nature and remedy to ASPD particularly those associated with sociopathy provide the space for people living with these behavioural conditions (particularly violent sociopaths) to continue abusing unsuspecting individuals in the society. Contribution: The finding of this study specifically challenged the faith-based misconceptions associated with ASPD. Therefore, it is expected that the new insight on ASPD, particularly sociopathy ushers in proper understanding and ways of dealing with the morally insane. (shrink)

Reports of increasing family violence abound in Nigeria. Although studies have implicated cultural constructs as the basis for this trend, this study specifically contemplated the nexus between the increased violence and Anti-Social Personality Disorder (ASPD). The purpose of this study was to connect these abusive and violent behaviours in their specific contexts as evidence of ASPD. The study was hinged on autoethnographic research which I systematically analysed as lived experiences with a sociopath. Data for the analyses was drawn from purposively (...) sampled participants (n-70) of victims of family violent abuse. Thematic, interpretative analytical approach and the theories of sociopathy, particularly Hare, Psychopathy Checklist-revised (PCL-R) were used to analyse the data from my personal experiences, and the interviews. The results indicated that only five participants representing 7.14% of the purposively selected population, admitted knowing sociopaths as conscienceless murderers and serial killers. The majority of participants (90%) contemplated sociopaths in religious terms (as incarnated evil beings). Only 2.86% rightly expressed their understanding of sociopathy and related personality disorders in a much-informed manner. Although the results of this study contrast with conventional propositions on ASPD, they revealed how religious belief and superstition among Nigerians frame the conversation on sociopathy and other variants of ASPD. Findings suggested that the growing superstitious beliefs on the causes, nature and remedy to ASPD particularly those associated with sociopathy provide the space for people living with these behavioural conditions (particularly violent sociopaths) to continue abusing unsuspecting individuals in the society. Contribution: The finding of this study specifically challenged the faith-based misconceptions associated with ASPD. Therefore, it is expected that the new insight on ASPD, particularly sociopathy ushers in proper understanding and ways of dealing with the morally insane. (shrink)

This study investigates the performance of psychopathic individuals on tasks believed to be sensitive to dorsolateral prefrontal and orbitofrontal cortex (OFC) functioning. Psychopathic and non-psychopathic individuals, as defined by the Hare psychopathy checklist revised (PCL-R) [Hare, The Hare psychopathy checklist revised, Toronto, Ontario: Multi-Health Systems, 1991] completed a gambling task [Cognition 50 (1994) 7] and the intradimensional/extradimensional (ID/ED) shift task [Nature 380 (1996) 69]. On the gambling task, psychopathic participants showed a global tendency to (...) choose disadvantageously. Specifically, they showed an impaired ability to show learning over the course of the task. On the ID/ED task, the performance of psychopathic individuals was not significantly different from incarcerated controls on attentional set-shifting, but significant impairments were found on response reversal. These results are interpreted with reference to an OFC and amygdala dysfunction explanation of psychopathy. (shrink)

Although Mealey's account provides several interesting hypotheses, her integration across disparate samples renders the value of her explanation for psychopathy ambiguous. Recent evidence on Psychopathy Checklist-identified samples (Hare, 1991) suggests primary emotional and cognitive deficits inconsistent with her model. Whereas high-anxious psychopaths display interpersonal deficits consistent with Mealey's hypotheses, low-anxious psychopaths' deficits appear more sensitive to situational parameters than predicted.

Cleckley's Mask of Sanity is indeed a brilliant and seminal work, but to read it is to recognize that the condition delineated in its pages differs importantly from the psychopathy most of us have in mind today, and certainly from the psychopathy Hare had in mind when he devised Psychopathy Checklist-Revised in "an attempt to develop a new research scale for the assessment of psychopathy in prison populations."1 Cleckley's psychopaths stay out of prison as (...) a rule, instead passing into and out of psychiatric hospitals in what Cleckley depicts as an absurd, unending cycle. Such crimes as they commit are almost never crimes of violence, and they appear to Cleckley, and the reader, not so much as threats to society as... (shrink)

Taxometric analyses were applied to the construct of psychopathy (as measured by the Psychopathy Checklist) and to several variables reflecting antisocial childhood, adult criminality, and criminal recidivism. Subjects were 653 serious offenders assessed or treated in a maximum-security institution. Results supported the existence of a taxon underlying psychopathy. Childhood problem behaviors provided convergent evidence for the existence of the taxon. Adult criminal history variables were continuously distributed and were insufficient in themselves to detect the taxon.

Background: Psychopathy and substance use disorders are highly co-morbid and their co-occurrence is associated with higher severity of addictive behavior and increased risk of violent offending. Both substance use disorders and psychopathy are related to prominent impairments in emotion processing, which are also central features of alexithymia. The nature of the relationship between psychopathy and alexithymia is not well understood and has been particularly understudied among substance dependent individuals. Aims: Our goal was to evaluate the levels of (...) psychopathy and alexithymia in a relatively homogeneous sample of heroin dependent individuals and healthy controls and to examine group differences in the pattern of associations between these constructs. Methods: We examined 62 participants (31 heroin dependent individuals and 31 healthy controls) with the Psychopathy Checklist: Screening version (PCL:SV, Hart et al., 1995) and the Toronto Alexithymia Scale-20 (TAS-20, Bagby et al., 1994). Results: Heroin dependent individuals were characterized by higher levels of both psychopathy and alexithymia as compared to the control group. In addition, heroin dependent individuals with higher levels of psychopathy reported more difficulties in identifying and verbalizing emotional states. In the heroin group, alexithymia was more strongly associated with the impulsive/antisocial characteristics (impulsivity, irresponsibility, antisocial behavior) than with the interpersonal/affective features of psychopathy (grandiosity, manipulativeness, lack of empathy and remorse). Conclusions: Our findings suggest that alexithymia may be one potential mechanism linking psychopathy with opioid use disorders. The development of interventions targeting alexithymia could have significant applications in relapse prevention programs and psychotherapy of substance use disorders with concurrent psychopathy. (shrink)

Psychopaths have emotional and rational impairments that can be expressed in persistent criminal behaviour. UK and US law has not traditionally excused disordered individuals for their crimes citing these impairments as a cause for their criminal behaviour. Until now, the discussion of whether psychopaths are morally responsible for their behaviour has usually taken place in the realm of philosophy. However, in recent years, this debate has been informed by scientific and psychiatric advancements, fundamentally so with the development of Robert Hare's (...) diagnostic tool, the Psychopathy Checklist. Responsibility and Psychopathy explores the moral responsibility of psychopaths. It engages with problems at the interface between law, psychiatry, and philosophy, and is divided into three parts offering relevant interdisciplinary background information to address this main problem. The first part discusses the public policy and legal responses to psychopathy. It offers an introduction to the central practical issue of how public policy should respond to psychopathy, providing insights for those arguing about the responsibility of psychopaths. The second part introduces recent scientific advancements in the classification, description, explanation, and treatment of psychopathy. The third part of the volume includes chapters covering the most significant dimensions of philosophical debate on the moral and criminal responsibility of psychopaths. (shrink)

Checklists have been used to improve quality in many industries, including healthcare. The use of checklists, however, has not been extensively evaluated in clinical ethics consultation. This article seeks to fill this gap by exploring the efficacy of using a checklist in ethics consultation, as tested by an empirical investigation of the use of the checklist at a large academic medical system (Cleveland Clinic). The specific aims of this project are as follows: (1) to improve the quality of (...) ethics consultations by providing reminders to ethics consultants about process steps that are important for most patient-centered ethics consultations, (2) to create consistency in the ethics consultation process across the medical system, and (3) to establish an effective educational tool for trainers and trainees in clinical ethics consultation. The checklist was developed after a thorough literature review and an iterative process of revising and testing by a group of experienced ethics consultants. To pilot test the checklist, it was distributed to 46 ethics consultants. After a six-month pilot period in which ethics professionals used the checklist during their clinical activities, a survey was distributed to all of those who used the checklist. The 10-item survey examined consultants’ perceptions regarding the three aims listed above. Of the 25 survey respondents, 11 self-reported as experts in ethics consultation, nine perceived themselves to have mid-level expertise, and five self-reported as novices. The majority (68 percent) of all respondents, regardless of expertise, believed that the checklist could be a “helpful” or “very helpful” tool in the consultation process generally. Novices were more likely than experts to believe that the checklist would be useful in conducting consultations. The limitations of this study include: reduced generalizability given that this project was conducted at one medical system, utilized a small sample size, and used self-reported quality outcome measures. Despite these limitations, to the authors’ knowledge this is the first investigatation of the use of a checklist systematically to improve quality in ethics consultation. Importantly, our findings shed light on ways this checklist can be used to improve ethics consultation, including its use as an educational tool. The authors hope to test the checklist with consultants in other healthcare systems to explore its usefulness in different healthcare environments. (shrink)

Both individuals with diagnosed with Autism Spectrum Disorder and individuals high in psychopathic traits show reduced susceptibility to contagious yawning; that is, yawning after seeing or hearing another person yawn. Yet it is unclear whether the same underlying processes are responsible for the relationship between reduced contagion and these very different types of clinical traits. College Students watched videos of individuals yawning or scratching while their eye movements were tracked. They completed the Interpersonal Reactivity Index, the Autism-Spectrum Quotient, the (...) class='Hi'>Psychopathy Personality Inventory-Revised, and the Adolescent and Adult Sensory Processing Disorder Checklist. Both psychopathic traits and autistic traits showed an inverse relationship to contagious yawning, consistent with previous research. However, the relationship between autistic traits and contagious yawning was moderated by eye gaze. Furthermore, participants high in autistic traits showed typical levels of contagious itching whereas adults high in psychopathic traits showed diminished itch contagion. Finally, only psychopathic traits were associated with lower overall levels of empathy. The findings imply that the underlying processes contributing to the disruptions in contagious yawning amongst individuals high in autistic vs. psychopathic traits are distinct. In contrast to adults high in psychopathic traits, diminished contagion may appear amongst people with high levels of autistic traits secondary to diminished attention to the faces of others, and in the absence of a background deficit in emotional empathy. (shrink)

The main objective of this work is to examine the prevalence of psychopathy in the general adult population from the main currently existing theoretical perspectives of psychopathy, using for this purpose the five-factor or Big Five model as a common language that allows the comparison and integration of the personality traits considered as defining psychopathy by these different perspectives. The NEO Personality Inventory-Revised was applied to a sample of 682 adults of the general Spanish population. The (...) prevalence of clinical and subclinical psychopathy was calculated according to six different definitions of these two constructs based on Hare’s, Lilienfeld’s, triarchic, and DSM-5-hybrid models, and the simultaneous presence of a minimum number of personality traits that differed from the sample mean by one standard deviation. Prevalence rates for the different definitions were consistently low, indicating that the prevalence of clinical psychopathy in the general Spanish population is around 0.55%, and that of subclinical psychopathy is around 1.65%. There were no significant sex differences in the prevalence of psychopathy. These results question the alarmist claims that warn about the existence in society of a very high number of people with psychopathy who can cause many social, economic, physical, and psychological damage to others. (shrink)

Kidder's checklistfor ethical decrsion making is recommended as an addition to the existing canon of modelsfor mass media ethics. Contributions in Kidder's approach include his dichotomy between ethical dilemmas m d moral temptations, his tests for right-versus-wrong and right-versus-right issues, his framework by which to clarify values in ethical dilemmas, nnd his sequencing of the decision-making process. Kidder's model is surnmnrized nnd discussed, revisions are suggested for classroom use in medin ethics courses, nnd tke revised model is applied to (...) media ethics cases. (shrink)

Psychopathy attracts considerable interdisciplinary interest. The idea of a group of people with abnormal morality and interpersonal relations raises important philosophical, legal, and clinical issues. However, before engaging these issues, we ought to examine whether this category is scientifically grounded. We frame the issue in terms of the question whether ‘psychopathy’ designates a natural kind according to the cluster approaches. We argue that currently there is no sufficient evidence for an affirmative answer to this question. Furthermore, we examine (...) three ways of dealing with the category of psychopathy. We could eliminate the category, revise it, or subscribe to a more encompassing account of kinds, which could capture psychopathy as it is currently conceptualized. We argue that while a revision of the category of psychopathy is to be expected with empirical and theoretical advancements, we also emphasize its role in clinical and forensic research that makes it an important pragmatic kind. (shrink)

Psychopathy fascinates. Modernist writers construct out of it an image of alienated individualism pursuing the moment, killing they know not why, exploiting in passing, troubled, if troubled at all, not by guilt, but by perplexity (Camus 1989; Gide 1995; Mailer 1957; Musil 1996). Psychiatrists and psychologists—even those who should know better—are drawn by it to take off into philosophical speculation about morality, evil, and the beast in man (Mullen 1992; Simon 1996). Philosophers succumb to the temptation of attempting to (...) ground speculation in the supposed facticity of psychopathy. -/- Psychopathy is a cultural construct with roots going back to the eighteenth century, but which only came to full flower over the last fifty years (Hare 1998; Lewis 1974). The currently fashionable constructions of psychopathy find wide acceptance among clinicians and academics. The problem is, however, whether the concept has connections that have been established to the behavior, psychopathology, or the structure and function of brain worthy of according even a modest level of scientific status. There is little point in basing an argument on some supposed scientific gold standard if what glitters is iron pyrites (fools' gold). -/- Neil Levy's opening paragraph contains the statement "Yet in other respects they seem quite irrational; so much so that the term moral insanity has sometimes been applied to them" (p. 129). This both asserts that there is a category "them," namely the psychopaths, and connects them to "moral insanity." Moral insanity entered the language of psychiatry when Pritchard chose to use the term to translate Pinel's category of mania sans deliré (Pritchard 1836). Pinel was attempting to conceptualize a range of disorders that bordered on insanity in the sense of severe disturbances of affect, judgment, and behavior, but that were not accompanied by hallucinations or delusions (Pinel 1798/1964). In today's terminology, the cases he described would probably fall into diagnostic groups, including major depression, bipolar disorder, epilepsy, and a range of personality disorders. A number of his more striking case histories involved antisocial and even murderous behavior, which probably reflected Pinel's role in assessing offenders for the criminal courts of Paris. Pritchard's use of the English word "moral" reflected an appeal first to its use at the time to designate something which was like or similar, but not identical (a usage the OED labels "vulgar"), and second moral in the sense of ethical, conforming to virtuous behavior. Anglophones seized on the latter meaning, although Pinel emphasized the former. Forty years later, Henry Maudsley, the most widely read psychiatrist of his generation, could assert that moral insanity was as real as Colour blindness, some people being Colour blind and some moral blind (Maudsley 1879). Moral insanity became connected variously to phrenology with its own bump over the underlying moral cortex, with the twisted genetics of degeneration, with atavistic theories of criminality, and with a range of disorders of brain from epilepsy to frontal lobe damage (Combed 1853; Ellis 1890; Pick 1989). Although it is anachronistic to use the terms "psychopathy" and "moral insanity" together, it is clear they occupied a similar social and psychiatric space, albeit in different era. This should caution against too ready acceptance of psychopathy which may turn out to be as empty and dangerous a conceptualization as moral insanity. Why dangerous? Dangerous to those labeled, because the morally insane and the moral imbeciles were placed in preventive detention in asylums and prisons, and even sterilized in some jurisdictions. Dangerous to society, because it gave a spurious scientific justification for viewing crime not as reflecting the social evils of deprivation, ignorance, and inequality but as the ravages of the born criminals. -/- Psychopaths are not, as Levy asserts, "(causally) responsible for … more than fifty percent of violent crime" (p. 129). A proportion of violent offenders, which varies widely between observers, are labeled psychopaths. This is often on the basis of Hare's psychopathy checklist, which is a subjective, albeit through training aspiring to be reproducible, and to some extent self-sustaining, evaluation system (Hare 1980, 2003). Part of the checklist gathers data on prior antisocial behavior; part constrains the examiner to subjectively estimate such matters as glibness and callousness, part requires judgments about whether the... (shrink)

Tankersley has provided an interesting collection of data about various groups of antisocial individuals. Is this a paper about the moral reasoning of psychopaths, or is it an attempt to address a philosophical question—whether moral behavior is primarily driven by emotions (moral sentimentalism) or by reasons (moral rationalism)—empirically? I think it attempts a little of both, although I concentrate on the latter. -/- The trouble with much of the literature on psychopathy is the terminological confusion, and Tankersley has not (...) escaped this. Several disciplines, with their own languages, have an interest in antisocial individuals and use similar sounding words in different ways. It is easy to get confused. Doctors make diagnoses. Antisocial (or dissocial) personality disorder is a medical diagnosis, and has a clear, operationalized definition. By virtue of being a disorder, it must result in some impairment in the functioning of the individual. Psychopathy is a psychological construct, not a diagnosis, and attempts to measure (in a reliable and valid way, using the Psychopathy Checklist) aspects of a person's mind particularly relevant to antisocial behavior. Psychopathy and antisocial personality disorder are different approaches to the same natural phenomenon, but they are not coterminous. There are many individuals with antisocial personality disorder who are not psychopaths. There are some individuals who are psychopaths who do not have any medical diagnosis (e.g., the so-called white collar psychopath). Psychopathy is not a subset of antisocial personality disorder (pace Tankersley 2011, and Herpertz and Habermeyer 2004). (shrink)

BackgroundThe 11th revision of the International Classification of Diseases included two distinct trauma-related diagnoses—Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder. The initial diagnostic factor for both disorders is exposure to a traumatic event. This study aimed to explore whether exposure to different traumatic experiences distinguish risk for PTSD and CPTSD.MethodsThe study sample comprised 158 trauma-exposed participants, Mage = 33.61. The Life Events Checklist-Revised was used to evaluate trauma exposure, and the International Trauma Questionnaire was used to assess (...) risk for ICD-11 PTSD and CPTSD. Multinomial logistic regression was used to determine traumatic events as predictors of risk for PTSD and CPTSD.ResultsAnalysis revealed that sexual abuse experienced in childhood or adulthood was associated with both PTSD and CPTSD. History of other unwanted sexual experiences and childhood physical abuse predicted CPTSD compared to PTSD, whereas exposure to natural disasters predicted PTSD compared to CPTSD.ConclusionsThe results showed that experiences of certain traumatic events, such as sexual trauma, childhood physical abuse or natural disasters, might help distinguish risk for PTSD and CPTSD. Nevertheless, future studies on specific aspects of trauma exposure are necessary. (shrink)

In this study, we investigated whether differences in the experience of regret may be a potential explanation for damaging behaviours associated with psychopathy and criminal offending. Participants were incarcerated offenders (n = 60) and non-incarcerated controls (n = 20). Psychopathic traits were characterised with the Psychopathic Checklist: Screening Version. Regret was assessed by responses to outcomes on a simulated gambling task. Incarcerated offenders experienced a reduced sense of regret as compared to non-incarcerated controls. We obtained some evidence that (...) specific psychopathic factors and facets could differentially relate to the experience and use of emotions. Our data provide initial evidence of important associations between negative emotions and decision behaviour in the context of criminal offending. (shrink)

Effective and specifically targeted social and therapeutic responses for antisocial personality disorders and psychopathy are scarce. Some authors maintain that this scarcity should be overcome by revising current syndrome - based classifications of these conditions and devising better biocognitive classifications of antisocial individuals. The inspiration for the latter classifications has been embedded in the Research domain criteria approach (RDoC). RDoC - type approaches to psychiatric research aim at transforming diagnosis, provide valid measures of disorders, aid clinical practice, and improve (...) health outcomes by integrating the data on the genetic, neural, cognitive, and affective systems underlying psychiatric conditions. In the first part of the paper, we discuss the benefits of such approaches in comparison to the dominant syndrome-based ones and review recent attempts at building biocognitive classifications of antisocial individuals. Other researchers, how ever, have objected that biocognitive approaches in psychiatry are committed to an untenable form of explanatory. (shrink)

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

In ‘Rethinking Disease’, Powell and Scarffe1 propose what in effect is a modification of Jerome Wakefield’s2 3 harmful dysfunction analysis of medical disorder. The HDA maintains that ‘disorder’ is a hybrid factual and value concept requiring that a biological dysfunction, understood as a failure of some feature to perform a naturally selected function, causes harm to the individual as evaluated by social values. Powell and Scarffe accept both the HDA’s evolutionary biological function component and its incorporation of a value component. (...) Their proposed ‘new twist’ is to revise the value component: ‘Our proposed definition of disease is as follows: a biomedical state is a disease only if it implicates a biological dysfunction that is, or would be, properly disvalued’. So, they propose that a disorder is a ‘properly disvalued dysfunction’ rather than a ‘harmful dysfunction’, an approach they term ‘thickly normative’ in contrast to the thin normative approach of the HDA. There has been a surge of interest recently in better understanding the ‘harm’ component of the HDA. Powell and Scarffe’s analysis is a helpful contribution to this discussion. We focus here exclusively on their proposal regarding the analysis of the concept of disorder and ignore many important related issues that the authors address, ranging from prioritising resource allocation between disorders and non-disorders to whether the concept of disorder should be replaced by a generic welfarist concept. The resolution of these additional issues depends on first understanding ‘disorder’. The authors’ proposed changes to the HDA also deserve evaluation because the HDA, which has been endorsed by leading nosologists,4 plays an influential role in nosological debate across categories of disorder ranging, for example, from sexual paraphilias5 to psychopathy.6 A basic problem is that Powell and Scarffe misinterpret …. (shrink)

Each book in the Access to Religion and Philosophy series provides a concise and readable introduction to a key area in religious studies and philosophy for A Level students. The third edition of Philosophy of Religion has been updated in line with the revised 2008 A level specification requirements. It examines key issues including the proofs for the existence of God, the problem of evil and suffering and the relationship between mind, body and religious language. It provides a solid (...) basis for those who are starting A level courses in Religious Studies or Philosophy. The new edition combines all the strengths of the second edition with a new design and features to make the content more accessible to all students in order to develop their understanding of the topic. New features include: - Key questions throughout the chapters to help students focus on the key issues - Key terms defined and explained throughout the chapters - Profiles of key individuals - their contribution and significance - More summary diagrams throughout to aid revision - Revision checklists at the end of chapters - New exam-style questions and tips at the end of each chapter. (shrink)

OCR Religious Ethics for AS and A2 is a textbook for students of Advanced Subsidiary or Advanced Level courses, endorsed by OCR for use with the OCR GCE Religious Studies specification. The book covers all the topics of the Religious Ethics component of the A Level specification in an enjoyable and student-friendly fashion. This second edition has been restructured for the revised specification and now includes a section on business ethics. Each chapter includes: a list of key issues, to (...) introduce students to the topic OCR specification checklist, to allow students to see which topics from the specification are covered in each chapter explanations of key terminology exam-style practice questions self-test review questions helpful summaries annotated further reading suggestions. To maximize students' chances of exam success, the book includes a chapter dedicated to answering examination questions. The book comes complete with lively illustrations, a comprehensive glossary, a full bibliography and a companion website at www.routledge.com/textbooks/9780415468251. (shrink)

Parental substance use is a major risk factor for child development, heightening the risk of drug problems in adolescence and young adulthood, and exposing offspring to several types of traumatic event. First, prenatal drug exposure can be considered a form of trauma itself, with subtle but long-lasting sequalae at the neuro-behavioural level. Second, parents’ addiction often entails a childrearing environment characterised by poor parenting skills, disadvantaged contexts and adverse childhood experiences, leading to dysfunctional outcomes. Young adults born from/raised by parents (...) with drug problems and who develop a Substance Used Disorder (SUD) themselves might display a particularly severe condition in terms of cognitive deficits and impaired personality function. This preliminary study aims to investigate the role of early exposure to drugs as a traumatic event, capable of affecting the psychological status of young drug addicts. In particular, it intends to examine the neuropsychological functioning and personality profile of young adults with severe SUDs who were exposed to drugs early in their family context. The research involved 3 groups each consisting of 15 young adults (aged 18-24): a group of inpatients diagnosed with SUDs and exposed to drugs early, a comparison group of non-exposed inpatients and a group of non-exposed youth without SUDs. A neuropsychological battery (Esame Neuropsicologico Breve-2), an assessment procedure for personality disorders (Shedler-Westen Assessment Procedure-200) and the Symptom CheckList-90-Revised were administered. According to present preliminary results, young drug addicts exposed to drugs during their developmental age were characterised by elevated rates of neuropsychological impairments, especially at the expense of attentive and executive functions; personality disorders were also common but did not differentiate them from non-exposed young people with SUDs. Alternative multi-focused prevention and intervention programs are needed for children of drug-misusing parents, addressing executive functions and adopting a trauma-focused approach. (shrink)

Several lines of evidence show that systematic exposure to negative social acts at the workplace i.e., workplace bullying, results in symptoms of depression and anxiety among those targeted. However, little is known about the association between bullying, inflammatory genes and sleep problems. In the present study, we examined the indirect association between exposure to negative social acts and sleep through distress, as moderated by the miR-146a genotype. The study was based on a nationally representative survey of 1179 Norwegian employees drawn (...) from the Norwegian Central Employee Register by Statistics Norway. Exposure to workplace bullying was measured with the 9-item version of Negative Acts Questionnaire – Revised (NAQ-R) inventory. Seventeen items from Hopkins Symptom Checklist (HSCL-25) was used to measure distress. Insomnia was assessed with three items reflecting problems with sleep onset, maintenance of sleep and early morning awakening. Genotyping with regard to miR-146a rs2910164, previously linked to inflammatory processes, was carried out using Taqman assay. The data revealed that individuals systematically exposed to negative social acts at the workplace reported higher levels of sleep problems than non-exposed individuals. Moreover, the relationship between distress induced by exposure to negative social acts and insomnia was significantly stronger for individuals with the miR-146a GG genotype. Thus, the miR-146a genotype moderated the association between distress and insomnia among individuals exposed to negative social acts. The present report support the hypothesis that inflammation could play a role in stress-induced insomnia among individuals exposed to workplace bullying. (shrink)

The Coronavirus Disease 2019 pandemic has broadly impacted university students’ customary life, resulting in remarkable levels of stress and psychological suffering. Although the acute phase of the crisis has been overcome, it does not imply that perceived stress related to the risk of contagion and to the changes in the relational life experienced over more than 1 year of the pandemic will promptly and abruptly decrease. This study aims at comparing university students’ psychological health conditions before and during the COVID-19 (...) pandemic, but also at providing information on how psychological health conditions evolved over the 1 year of the pandemic. We analyzed data from a repeated cross-sectional survey on different samples of university students before the pandemic in 2017 and during the pandemic. During the pandemic, data were collected at three stages. The COVID-19 Student Stress Questionnaire and the Symptom-Checklist-90-Revised were used to assess, respectively, COVID-19-related stressors and the presence of psychological symptoms. Psychological health conditions were compared at baseline and during the pandemic, whereas both psychological health conditions and perceived levels of COVID-19-related stressors were compared over the three pandemic stages. In addition, Logistic Regression was used to explore the associations between COVID-19-related stressors and psychological symptoms. Findings revealed a significant increase in symptoms of Depression, Phobic-Anxiety, Obsessive-Compulsive, and Psychoticism from pre to during the pandemic. Perceived levels of COVID-19-related stress and specific psychological symptoms significantly increased as the pandemic was progressing. COVID-19-related stressors emerged as significantly associated with several psychopathological symptoms. Findings are discussed with the aim of providing tailored interventions to prevent mental disease and promote psychological adjustment in this specific stage of transition within this exceptional global emergency. (shrink)

BackgroundThe boundaries between health-related research and practice have become blurred as initiatives traditionally considered to be practice increasingly use the same methodology as research. Further, the application of different ethical requirements based on this distinction raises concerns because many initiatives commonly labelled as “non-research” are associated with risks to patients, participants, and other stakeholders, yet may not be subject to any ethical oversight. Accordingly, we sought to develop a tool to facilitate the systematic identification of risks to human participants and (...) determination of risk level across a broad range of projects and health-related contexts. This paper describes the development of the Public Health Ontario Risk Screening Tool.MethodDevelopment of the PHO Risk Screening Tool included: preparation of a draft risk tool ; expert appraisal; internal stakeholder validation; external validation; pilot testing and evalution of the draft tool; and revision after 1 year of testing.ResultsA risk screening tool was generated consisting of 20 items organized into five risk domains: Sensitivity; Participant Selection, Recruitment and Consent; Data/Sample Collection; Identifiability and Privacy Risk; and Commercial Interests. The PHO Risk Screening Tool is an electronic tool, designed to identify potential project-associated risks to participants and communities and to determine what level of ethics review is required, if any. The tool features an easy to use checklist format that generates a risk score associated with a suggested level of ethics review once all items have been completed. The final score is based on a threshold approach to ensure that the final score represents the highest level of risk identified in any of the domains of the tool.ConclusionsThe PHO Risk Screening Tool offers a practical solution to the problem of how to maintain accountability and appropriate risk oversight that transcends the boundaries of research and practice. We hope that the PHO Risk Screening Tool will prove useful in minimizing the problems of over and under protection across a wide range of disciplines and jurisdictions. (shrink)

Callous unemotional (CU) traits (i.e., a lack of empathy/remorse and poverty of emotion) that co-occur with childhood antisocial behaviour are believed to be the developmental precursor to psychopathy in adulthood. An increasing volume of evidence supports two distinct variants of CU traits/psychopathy, known as primary and secondary. Primary variants are thought to show core deficits in emotional reactivity (e.g., attenuated autonomic activity), whereas secondary variants present with high levels of anxiety and this may be reflected in increased emotional (...) sensitivity to negative stimuli. -/- Aims: The current study is the first of its kind to examine the role of anxiety in modulating emotional processing as indexed by heart rate (HR) in incarcerated boys with CU traits. -/- Methods: HR was recorded continuously while 205 adolescents (aged 14 to 18 years) completed an emotional pictures dot-probe task. The task consisted of four blocks of 18 trials, beginning with a 500 ms central fixation cross, a 250 ms picture pair presentation (i.e., neutral, positive, negative valence), followed by a probe appearing in either the top or bottom picture location until response, and lastly a 2000 ms inter-trial interval recovery period. Four groups were formed on the basis of median-split scores on the Revised Children's Manifest Anxiety Scale and the Inventory of Callous Unemotional Traits, reflecting a primary variant (high CU/low anxiety), secondary variant (high CU/high anxiety), and two nonpsychopathic groups (low CU/high anxiety and low CU/low anxiety). -/- Results: The HR data indicated relative HR deceleration during the picture-probe period, regardless of group. Additionally, compared to all other groups, HR deceleration was greatest for the high CU/high anxiety secondary group and smallest for the high CU/low anxiety primary group during negative stimuli. Conclusions: This result is thought to reflect differences between CU/psychopathy variants in attentional orienting to distressing stimuli, consistent with theory. (shrink)

BackgroundCommunities’ engagement in priority-setting is a key means for setting research topics and questions of relevance and benefit to them. However, without attention to dynamics of power and diversity, their engagement can be tokenistic. So far, there remains limited ethical guidance on how to share power with communities, particularly those considered disadvantaged and marginalised, in global health research priority-setting. This paper generates a comprehensive, empirically-based “ethical toolkit” to provide such guidance, further strengthening a previously proposed checklist version of the (...) toolkit. The toolkit places community engagement and power-sharing at the heart of priority-setting for global health research projects.MethodsA two part method was used to generate a revised toolkit. Part one was conceptual, consisting of novel analysis of empirical data (previously collected as part of the same overall project) to identify additional concepts relevant to power-sharing between researchers and communities in global health research priority-setting. Part two was empirical, seeking feedback on the initial checklist version of the toolkit in interviews with researchers, ethicists, community engagement practitioners, and community organisation staff.ResultsThe conceptual process identified two additional components of engagement and six additional features that affect who defines, who participates, and who is heard in research priority-setting. New ethical considerations related to sharing power in global health research priority-setting are articulated in relation to those components and features. Interviewees provided suggestions for revising the toolkit’s content and language. The implications of these suggestions and the analytic process for the toolkit are described.ConclusionsThe resultant toolkit is a reflective project planning aid for researchers and their community partners to employ before priority-setting is undertaken for global health research projects. It consists of three worksheets (to be completed collectively) and a companion document detailing how to use them. It is more comprehensive than the initial toolkit, as worksheet questions for discussion cover all phases of priority-setting. (shrink)

The steep rise in diagnosed depression in the United States was enabled by the use of simplistic checklists of diagnostic criteria as codified in the authoritative Diagnostic and Statistical Manual, which underwent a fundamental change in 1980 and has been revised several times since. The DSM criteria for depression disregard the traditional distinction between the sadness incident to human life and habitual, excessive melancholy. However, tradition—in particular the satiric tradition, to which Burton’s Anatomy of Melancholy belongs—not only reminds us (...) that sadness has many shapes, but by the same token cautions against the fallacies of codification as such. (shrink)

_OCR Philosophy of Religion for AS and A2_ is a textbook for students of Advanced Subsidiary or Advanced Level courses, endorsed by OCR for use with the OCR GCE Religious Studies specification. The book covers all the topics of the Philosophy of Religion component of the A Level specification in an enjoyable and student-friendly fashion. This second edition has been restructured for the revised specification and now includes new chapters on the 'Nature of God' and 'Religion and Science'. Each (...) chapter includes: a list of key issues, to introduce students to the topic OCR specification checklist, to allow students to see which topics from the specification are covered in each chapter explanations of key terminology discussion questions, thought points and activities exam-style practice questions self-test review questions helpful summaries annotated further reading suggestions. To maximize students' chances of exam success, the book includes a chapter dedicated to answering examination questions. The book comes complete with lively illustrations, a comprehensive glossary, a full bibliography and a companion website at _www.routledge.com/textbooks/9780415468244_. (shrink)