Northoff provides a compelling argument supporting a kind of “double dissociation” of Parkinson's disease and catatonia. We discuss a related form of akinetic mutism linked to mesodiencephalic injuries and suggest an alternative to the proposed “horizontal” versus “vertical” modulation distinction. Rather than a “directional” difference in patterned neuronal activity, we propose that both disorders reflect hypersynchrony within typically interdependent but segregated networks facilitated by a common thalamic gating mechanism.

In this article we will draw on experiences from our own research on deep brain stimulation of the central thalamus in the minimally conscious state. We describe ethical challenges faced in clinical research involving medical devices and offer several cautionary notes about its funding and the interplay of market forces and scientific inquiry and suggest some reforms.

This is the first article in a two-part series describing subject and family perspectives from the central thalamic deep brain stimulation for the treatment of traumatic brain injury using the Medtronic PC + S first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury, with subjects who were deemed capable of providing voluntary informed consent. In this article, we report on interviews conducted prior to surgery wherein we asked participants about their experiences recovering from (...) brain injury and their perspectives on study enrollment and participation. We asked how risks and benefits were weighed, what their expectations and fears were, and how decisions were reached about trial participation. We found that informed consent and enrollment decisions are fraught. Subjects and families were often split, with subjects more focused on putative benefits and families concerned about incremental risk. Both subjects and families viewed brain injury as disruptive to personal identity and relationships. As decisions were made about study enrollment, families struggled with recognizing the re-emergent agency of subjects and ceding decision-making authority to subjects who had previously been dependent upon them for protection and guidance. Subjects and family members reported a hope for the relief of cognitive disabilities, improved quality of life, normalization of interpersonal interactions, and a return to work or school as reasons for study participation, along with altruism and a desire to advance science. Despite these aspirations, both subjects and families appreciated the risks of the intervention and did not suffer from a therapeutic misconception. A second essay to be published in the next issue of Cambridge Quarterly of Healthcare Ethics—Clinical Neuroethics will describe interviews conducted after surgery, the effects of cognitive restoration for subjects, families, and challenges presented to the social structures they will call upon to support them through recovery. This subsequent article will be available online prior to its formal publication in October 2023. (shrink)

This is the second paper in a two-part series describing subject and family perspectives from the CENTURY-S (CENtral Thalamic Deep Brain Stimulation for the Treatment of Traumatic Brain InjURY-Safety) first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury (msTBI). To participate, subjects were independently assessed to formally establish decision-making capacity to provide voluntary informed consent. Here, we report on post-operative interviews conducted after a successful trial of thalamic stimulation. All five msTBI subjects met (...) a pre-selected primary endpoint of at least a 10% improvement in completion time on Trail-Making-Test Part B, a marker of executive function. We describe narrative responses of subjects and family members, refracted against that success. Interviews following surgery and the stimulation trial revealed the challenge of adaptation to improvements in cognitive function and emotional regulation as well as altered (and restored) relationships and family dynamics. These improvements exposed barriers to social reintegration made relevant by recoveries once thought inconceivable. The study’s success sparked concerns about post-trial access to implanted devices, financing of device maintenance, battery replacement, and on-going care. Most subjects and families identified the need for supportive counseling to adapt to the new trajectory of their lives. (shrink)

DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers can freely discuss current and emerging deep brain stimulation technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in (...) its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury. (shrink)

Essays discuss the evolution of consciousness, self-knowledge, aesthetics, religious ecstasy, ghosts, and dreams.

The Diagnostic and Statistical Manual of Mental Disorders classifies “anorexia nervosa” as a mental disorder, yet individuals with anorexia often characterize it as an identity. The author describes the identity of being an anorectic and compares it with what it takes to have anorexia in the diagnostic sense. This furthers the existing scholarship on anorexia and identity, most notably by revealing a disconnect between being an anorectic and having anorexia: Some individuals inhabit the identity of being an anorectic but do (...) not have anorexia because they do not have a significantly low body weight. The author explores whether expanding the diagnostic criteria for anorexia would be beneficial for anorectics by examining the implications of classifying the identitive phenomenon of being an anorectic in terms of a medical concept of mental disorder. In the short term, the answer depends on whether being an anorectic calls for interventions that require a diagnosis. Either way, it would be beneficial to develop nonmedical frameworks for understanding anorexia that facilitate interventions that do not require a diagnosis. Understanding being an anorectic as an identity lays the scaffolding for a nonmedical way of conceptualizing anorexia that illuminates innovative approaches to assisting anorectics. (shrink)

In mainstream analytic epistemology, Reformed theology has made its presence prominently felt in Reformed epistemology, the view of religious belief according to which religious beliefs can be properly basic and warranted when formed by the proper functioning of the sensus divinitatis, an inborn capacity or faculty for belief in God that can be prompted to generate certain religious beliefs when presented with things (e.g., certain majestic aspects of creation). A major competitor to Reformed epistemology is Wittgensteinian quasi-fideism, a position drawn (...) from the epistemology of Wittgenstein’s On Certainty, according to which some foundational religious commitments are not properly basic beliefs but some kind of apodictic, unshakeable certainties that form part of the structure of one’s rationality and worldview. I argue that the Reformed tradition has contained elements of quasi-fideism at least as far back as Calvin’s account of faith from the Institutes of the Christian Religion, book 3, chapter 2. (shrink)

The increasingly lively controversy over scientific realism has become one of the principal themes of recent philosophy. 1 In watching this controversy unfold in the rather technical way currently in vogue, it has seemed to me that it would be useful to view these contemporary disputes against the background of such older epistemological issues as fallibilism, scepticism, relativism, and the traditional realism/idealism debate. This, then, is the object of the present book, which will recon sider the newer concerns about scientific (...) realism in the context of these older philosophical themes. Historically, realism concerns itself with the real existence of things that do not "meet the eye" - with suprasensible entities that lie beyond the reach of human perception. In medieval times, discussions about realism focused upon universals. Recognizing that there are physical objects such as cats and triangular objects and red tomatoes, the medievels debated whether such "abstract objects" as cathood and triangularity and redness also exist by way of having a reality indepen dent of the concretely real things that exhibit them. Three fundamen tally different positions were defended: (1) Nominalism. Abstracta have no independent existence as such: they only "exist" in and through the objects that exhibit them. Only particulars (individual substances) exist. Abstract "objects" are existents in name only, mere thought fictions by whose means we address concrete particular things. (2) Realism. Abstracta have an independent existence as such. (shrink)

A clearly written, authoritative introduction to Taylor's work.

Can findings from psychology and cognitive neuroscience about the neural mechanisms involved in decision-making can tell us anything useful about the commonly-understood mental phenomenon of making voluntary choices? Two philosophical objections are considered. First, that the neural data is subpersonal, and so cannot enter into illuminating explanations of personal level phenomena like voluntary action. Secondly, that mental properties are multiply realized in the brain in such a way as to make them insusceptible to neuroscientific study. The paper argues that both (...) objections would be weakened by the discovery of empirical generalisations connecting subpersonal properties with the personal level. It gives three case studies that furnish evidence to that effect. It argues that the existence of such interrelations are consistent with a plausible construal of the personal-subpersonal distinction. Furthermore, there is no reason to suppose that the notion subpersonal representation relied on in cognitive neuroscience illicitly imports personal-level phenomena like consciousness or normativity, or is otherwise explanatorily problematic. (shrink)

According to the ‘One Object’ reading of Kant's transcendental idealism, the distinction between the appearance and the thing in itself is not a distinction between two objects, but between two ways of considering one and the same object. On the ‘Metaphysical’ version of the One Object reading, it is a distinction between two kinds of properties possessed by one and the same object. Consequently, the Metaphysical One Object view holds that a given appearance, an empirical object, is numerically identical to (...) the thing in itself that appears as that object. I raise various indiscernibility arguments against that view; because an appearance has different spatiotemporal and modal properties than a thing in itself, no appearance can be identical to a thing in itself. I point out that these arguments are similar to arguments against Monism, the view that material objects are numerically identical to the matter of which they are made. I outline some strategies Monists have developed to respond to these indiscernibility arguments and then develop parallel responses on behalf of the Metaphysical One Object view. However, I then raise another indiscernibility argument, to which, I argue, the Metaphysical One Object view cannot respond, even using the resources I have developed thus far. I develop a modified version of the Metaphysical One Object view that can respond to this new indiscernibility argument, but, I argue, this modified version of the One Object view is only a terminological variant of the Two Object view. When the Metaphysical One Object view is fully thought through it becomes the Two Object view. I conclude that Kantian appearances are not numerically identical to the things in themselves that appear to us. (shrink)

The uncanny is the weird, the strange, the mysterious, a mingling of the familiar and the unfamiliar. Even Freud, patron of the uncanny, had trouble defining it. Yet the uncanny is everywhere in contemporary culture. In this elegant book, Nicholas Royle takes the reader across literature, film, philosophy, and psychoanalysis as he marks the trace of the uncanny in the modern world. Not an introduction in the usual sense, Nicholas Royle's book is a geography of the uncanny as (...) it manifests itself - and disturbs our thinking - in a range of disciplines. (shrink)

How can we think about things in the outside world? There is still no widely accepted theory of how mental representations get their meaning. In light of pioneering research, Nicholas Shea develops a naturalistic account of the nature of mental representation with a firm focus on the subpersonal representations that pervade the cognitive sciences.

This article questions whether the ‘problem’ of trans issues lies more in the binary, patriarchal structures of our society than it does in our bodies. I utilize Marcella Althaus-Reid’s ‘Hermeneutic of Mutilation’, arguing that, much as ‘to give hospitality to our own fragmentations may require sometimes acts of transformations’, we must not support the heteropatriarchal pattern and system as it attempts to normalize, police, control or punish the ‘deviant’ bodies of transgender individuals, from ‘wrong’ and ‘less than’ into ‘right’ and (...) ‘cured’. As postmodern deconstruction has informed and influenced our thinking around identity, the modern, biological approach to sex/gender has been profoundly challenged. I will make a parallel between current debates around trans issues and disability, body and liberation theology; if disability only ‘becomes’ a disability when the able-bodied majority designates it as ‘other’, are trans folk being similarly ‘othered’, as their different bodies, perspectives or identities challenge the fearful, defended mind-sets of society? Should we continue to prioritize ‘fixing’ trans bodies, in order to have them fit more neatly within that society? Or, should we challenge the patriarchal, heteronormative moulds of a culture that would rather trans individuals ‘accept’ their ‘wrongness’ and take steps to ‘correct’ that wrongness? This is not to say that trans+ individuals should not continue to make exactly the same medical/surgical choices as are currently the norm and even to choose modes of gender expression that are binary or ‘traditional’, should that be their desire and choice. Rather, this is an appeal for all of us to challenge a society that deems some bodies ‘right’ and others as ‘wrong’, and expects such painful conformity. (shrink)

How is consciousness possible? What biological purpose does it serve? And why do we value it so highly? In Soul Dust, the psychologist Nicholas Humphrey, a leading figure in consciousness research, proposes a startling new theory. Consciousness, he argues, is nothing less than a magical-mystery show that we stage for ourselves inside our own heads. This self-made show lights up the world for us and makes us feel special and transcendent. Thus consciousness paves the way for spirituality, and allows (...) us, as human beings, to reap the rewards, and anxieties, of living in what Humphrey calls the "soul niche." Tightly argued, intellectually gripping, and a joy to read, Soul Dust provides answers to the deepest questions. It shows how the problem of consciousness merges with questions that obsess us all--how life should be lived and the fear of death. Resting firmly on neuroscience and evolutionary theory, and drawing a wealth of insights from philosophy and literature..."--Jacket. (shrink)

This is the first modern interpretation of Leibniz's comprehensive critique of Locke, the New Essays on Human Understanding. Arguing that the New Essays is controlled by the overriding purpose of refuting Locke's alleged materialism, Jolley establishes the metaphysical and theological motivation of the work on the basis of unpublished correspondence and manuscript material. He also shows the relevance of Leibniz's views to contemporary debates over innate ideas, personal identity, and natural kinds.

Draws on a broad range of scientific evidence to theorize an evolutionary basis for religion, considering how religion may have served as an essential component of early society survival and that the brain may be inherently inclined toward religious behavior.

Nicholas Rescher presents a critical reaction against two currently influential tendencies of thought. On the one hand, he rejects the facile relativism that pervades contemporary social and academic life. On the other hand, he opposes the rationalism inherent in neo-contractarian theory--both in the idealized communicative-contract version promoted in continental European political philosophy by J;urgen Habermas, and in the idealized social contract version of the theory of political justice promoted in the Anglo-American context by John Rawls. Against such tendencies, Rescher's (...) pluralist approach takes a more realistic and pragmatic line, eschewing the convenient recourse of idealization in cognitive and practical matters. Instead of a utopianism that looks to a uniquely perfect order that would prevail under ideal conditions, he advocates incremental improvements within the framework of arrangements that none of us will deem perfect but that all of us "can live with." Such an approach replaces the yearning for an unattainable consensus with the institution of pragmatic arrangements in which the community will acquiesce--not through agreeing on their optimality, but through a shared recognition among the dissonant parties that the available options are even worse. (shrink)

Authors De Marco and colleagues have presented a new model on the concept of invasiveness, redefining both its technical definition and practical implementation.1 While the authors raise valid critiques regarding the discrepancy in definitions, I cannot help but wonder about the purpose of redefining terms for which little confusion, if any, exists? This commentary seeks to scrutinise the rationale supporting the new model in the absence of significant clinical confusion and to explore the implications for clinical practice. Initially, one may (...) notice there is no mention of clinical relevancy, confusion among patients or whether the discrepancy in terms is causing miscommunication. It seems reasonable that some clinical confusion may exist, but so too does a similar imbalance of terms when speaking technically across the specialties; take depression and its definition as a primary example. While I certainly agree with the illustration of non-invasive prenatal testing being compared with venous blood draws as a disparity in terminology, little evidence suggests confusion concerning the nosology.2 The medical community, including both physicians and patients, recognises that the terminology is specifically used within the …. (shrink)

In this entertaining and provocative introduction, Royle offers lucid explanations of various key ideas, including deconstruction, undecidability, iterability, differance, aporia, the pharmakon, the supplement, a new enlightenment, and the democracy to come. He also gives attention, however, to a range of less obvious key ideas of Derrida, such as earthquakes, animals and animality, ghosts, monstrosity, the poematic, drugs, gifts, secrets, war, and mourning. Derrida is seen as an extraordinarily inventive thinker, as well as a brilliantly imaginative and often very funny (...) writer. Other critical introductions tend to highlight the specifically philosophical nature and genealogy of his work. Royle's book proceeds in a new and different way, in particular by focusing on the crucial but strange place of literature in Derrida's writings. He thus provides an appreciation and understanding based on detailed reference to Derrida's texts, interwoven with close readings of such writers as Shakespeare, Coleridge, P.B. Shelley, Poe, Emily Brontë, Franz Kafka and Elizabeth Bowen. In doing so, he explores Derrida's consistent view that deconstruction is "a coming-to-terms with literature". He emphasizes the ways in which "literature", for Derrida, is indissociably bound up with other concerns, such as philosophy and psychoanalysis, politics and ethics, responsibility and justice, law and democracy. (shrink)

From Knowledge to Wisdom argues that there is an urgent need, for both intellectual and humanitarian reasons, to bring about a revolution in science and the humanities. The outcome would be a kind of academic inquiry rationally devoted to helping humanity learn how to create a better world. Instead of giving priority to solving problems of knowledge, as at present, academia would devote itself to helping us solve our immense, current global problems – climate change, war, poverty, population growth, pollution... (...) of sea, earth and air, destruction of natural habitats and rapid extinction of species, injustice, tyranny, proliferation of armaments, conventional, chemical, biological and nuclear, depletion of natural resources. The basic intellectual aim of inquiry would be to seek and promote wisdom – wisdom being the capacity to realize what is of value in life for oneself and others, thus including knowledge and technological know-how, but much else besides. This second edition has been revised throughout, has additional material, a new introduction and three new chapters. (shrink)

We discuss the rational role of highly inattentive experiences, and argue that they can provide rational support for beliefs.

In endeavoring to secure our knowledge against the skeptic's critique, we can acquire a great deal of useful insight into its nature. For it emerges that our knowledge of matters of objective fact is potentially defeasible and that what we claim as "our knowledge of the world" is and is bound to remain presumably incomplete, potentially incorrect, and possibly inconsistent as well. The explanation and analysis of these circumstances is the object of the present critique of skepticism. The book will (...) accordingly endeavor to sift the wheat from the chaff in the skeptic's argument. (shrink)

Block’s well-known distinction between phenomenal consciousness and access consciousness has generated a large philosophical literature about putative conceptual connections between the two. The scientific literature about whether they come apart in any actual cases is rather smaller. Empirical evidence gathered to date has not settled the issue. Some put this down to a fundamental methodological obstacle to the empirical study of the relation between phenomenal consciousness and access consciousness. Block (2007) has drawn attention to the methodological puzzle and attempted to (...) answer it. While the evidence Block points to is relevant and important, this paper puts forward a more systematic framework for addressing the puzzle. To give it a label, the approach is to study phenomenal consciousness as a natural kind. The approach allows consciousness studies to move beyond the initial means of identifying instances of the kind, like verbal report, and to find its underlying nature. It is wellrecognised that facts about an underlying kind may allow identification of instances of the kind that do not match the initial means of identification (cp. non-liquid samples of water). This paper shows that the same method can be deployed to investigate phenomenal consciousness independently of access consciousness. (shrink)

This chapter provides an introduction to higher-order metaphysics as well as to the contributions to this volume. We discuss five topics, corresponding to the five parts of this volume, and summarize the contributions to each part. First, we motivate the usefulness of higher-order quantification in metaphysics using a number of examples, and discuss the question of how such quantifiers should be interpreted. We provide a brief introduction to the most common forms of higher-order logics used in metaphysics, and indicate a (...) number of questions which can be raised in such systems using logical vocabulary alone. Using a further example, we return to applications of higher-order logics in metaphysics. We also mention key developments in the history of higher-order logic as it pertains to metaphysics. Finally, we mention certain arguments which have been raised against the use of higher-order logic, and some ways of responding to them. (shrink)

This chapter outlines improvements and developments made to aim-oriented empiricism since "From Knowledge to Wisdom" was first published in 1984. It argues that aim-oriented empiricism enables us to solve three fundamental problems in the philosophy of science: the problems of induction and verisimilitude, and the problem of what it means to say of a physical theory that it is unified.