Cognitive Disabilities and Disorders

(OPEN ACCESS) In this article, I explore the implications of three moral grounds for the justification of supported voting – respect as opacity, respect as equal status, and respect as political care. For each ground, I ask whether it justifies surrogate voting for voters unable to either communicate or give effect to their electoral judgments, due to some cognitive or communicative disability. (Henceforth: incommunicability cases.) I argue that respect as opacity does not permit surrogate voting, and equal status does not (...) justify such support – although the latter account can make sense of the value loss involved in the persistent non-participation of individuals with cognitive and communicative disabilities. Finally, I argue that an account of supported voting based on the ethics of political care can accommodate a pro tanto moral permission to provide surrogate voting as a form of support in incommunicability cases, and it can account for the inclusive approach of the UN Convention on the Rights of Persons with Disabilities to supported decision-making. However, I show that in incommunicability cases, what the political community and individual caretakers ultimately owe to adult fellow citizens as equal members of the political community is some adequate form of political care – but not necessarily surrogate voting. (shrink)

In this paper, I draw on phenomenological analyses of religious voice-hearing and related experiences to elucidate the role of phenomenology in discerning benign from pathological religious experience. First, I present phenomenological discontinuities between cases of benign and pathological voice-hearing by drawing on a study of first-person accounts of voice-hearers within the Pentecostal movement which evinces that voice-hearing is not inherently pathological. Second, I introduce the epidemiological continuity of psychotic-like phenomena by drawing on a study of the contextual and responsive differences (...) between clinical and non-clinical voice-hearers which point to the contexts wherein voice-hearing does not lead to pathology. Third, I present a successful case where the meaning of the anomalous experiences is validated and normalized by drawing on studies of mediumistic experience which illuminate its therapeutic benefits. Finally, I argue that failing to take the voice-hearer’s lived experience into account in the diagnostic moment can result in the pathologization of benign experiences. (shrink)

Epistemic Injustice in the Education of People with Mental Disabilities. This article offers a perspective on inclusive education based on Fricker's conception of epistemic injustice. What is the relationship between inclusive education and epistemic injustice in the case of students with mental deficiencies? By adapting Fricker's thesis to this extreme case, epistemic injustice can be explored via the social model of disability (SMD). Accordingly, we propose that epistemic injustice harms the entire educational community and society. -/- Mental Disability. Epistemic Injustice. (...) Inclusive Education. Social Model of Disability. (shrink)

RESUMEN ‒ Injusticias Epistémicas en la Educación de Personas con Dis- capacidad Mental. Se ofrece en este artículo una perspectiva de la educa- ción inclusiva a partir de la concepción de las injusticias epistémicas de Fricker. Se pregunta cuál es la relación entre la educación inclusiva y la in- justicia epistémica en el caso de estudiantes con deficiencias mentales. Es necesario adaptar las tesis de Fricker a este caso límite, por lo que se debe pensar la injusticias epistémicas a partir (...) del modelo social de la discapaci- dad. Se propone que la injusticia epistémica perjudica a toda la comunidad educativa y a la sociedad. -/- . (shrink)

Who should be diagnosed with intellectual disability and who should not? For borderline cases, the answer to this question may be as difficult to decide on as determining the borderline between being bald or not. While going bald may be upsetting to some, it is also an inevitable and relatively undramatic course of nature. In contrast, getting a diagnosis of intellectual disability is likely to have more far-reaching consequences. This makes the question of where the cutoff point for intellectual disability (...) lies more imperative. Philosophy of science may help psychologists to understand the nature of this dilemma in a more profound manner. This article builds on the sorites paradox to explore the vagueness that surrounds the concept of intellectual disability and the consequences of this vagueness for the diagnostic process. While epistemicists argue that vagueness is a consequence of our limited knowledge of the world that we live in, semantic theorists claim that there is nothing that we do not know, but that our language allows for indecisiveness. What these different lines of understanding mean for psychologists who are diagnosing intellectual disability, is described in this article. Furthermore, the article discusses practical implications of these philosophical underpinnings. (shrink)

Introduction to The Oxford Handbook of Phenomenological Psychopathology.

Self-control is that which is enacted to align our behaviour with intentions, motives, or better judgment in the face of conflicting impulses of motives. In this paper, I ask, what explains interpersonal differences in self-control? After defending a functionalist conception of self-control, I argue that differences in self-control are analogous to differences in mobility: they are modulated by inherent traits and environmental supports and constraints in interaction. This joint effect of individual biology and environmental factors is best understood in terms (...) of access to self-control behaviours. I sketch an account of access as including the three criteria of means, awareness, and non-excessive effort. I further demonstrate that people with disorders such as ADHD have limited access to self-control behaviours and stand therefore at a disadvantage with regard to self-control. (shrink)

This letter was submitted to the Senate Standing Committee on Legal and Constitutional Affairs, Government of Canada, on 29th January, 2021, as final debate over Bill C-7 was being undertaken in the Senate regarding MAiD and the strong opposition to the legislation expressed across the Canadian disability community. It draws on our individual and joint work on eugenics, well-being, and disability.

Individuals with what are usually referred to as ‘profound’ or ‘severe’ cognitive disabilities are primarily discussed in philosophy and bioethics to determine their moral status. Nothing approaching a consensus view has emerged from this intractable debate. In this paper it is argued that theories of moral status have limited relevance to the unjust ways in which people with cognitive disabilities are routinely treated in the actual world. To address these injustices we need to focus much more on neglected issues of (...) social inequality and social hierarchy. After explaining what is meant by moral status and social status respectively, I discuss three possible relationships between them, demonstrating that determinate answers about the moral status of individuals with profound cognitive disabilities are neither necessary nor sufficient for defending the imperative that they be treated as our social equals. (shrink)

How we ought to diagnose, categorise and respond to spectrum disabilities such as autism and Attention Deficit/Hyperactivity Disorder (ADHD) is a topic of lively debate. The heterogeneity associated with ADHD and autism is described as falling on various continua of behavioural, neural, and genetic difference. These continua are varyingly described either as extending into the general population, or as being continua within a given disorder demarcation. Moreover, the interrelationships of these continua are likewise often vague and subject to diverse interpretations. (...) -/- In this paper, I explore geneticists' and self-advocates’ perspectives concerning autism and ADHD as continua. These diagnoses are overwhelmingly analysed as falling on a continuum or continua of underlying traits, which supports the notion of “the neurodiversity spectrum”, i.e., a broader swath of human neural and behavioural diversity on which some concentrations of different functioning are diagnosed. I offer a taxonomy of conceptions of the genetic, phenotypic, and endophenotypic dimensionality within and beyond these diagnostic categories, and suggest that the spectrum of neurodiversity is characteristically endophenotypic. (shrink)

How does doubt come about? What are the mechanisms responsible for our inclinations to reassess propositions and collect further evidence to support or reject them? In this paper, I approach this question by focusing on what might be considered a distorting mirror of unreasonable doubt, namely the pathological doubt of patients with obsessive–compulsive disorder. Individuals with OCD exhibit a form of persistent doubting, indecisiveness, and over-cautiousness at pathological levels :743–758, 1992; Reed in Obsessional experience and compulsive behaviour: a cognitive-structural approach, (...) Academic Press, Cambridge, 1985; Tolin et al. in Cogn Ther Res 27:657–669, 2003). I argue that the failure in OCD is of an affective nature, involving both excessive epistemic anxiety and hyperactive feelings of uncertainty. I further argue that our adaptive disposition to inquire about the right matters—that is, about propositions which are both epistemically risky and imply harmful possibilities—might depend on these affective mechanisms. (shrink)

Objective: This study aimed to explore the relationship among cognitive fusion, experiential avoidance, and obsessive–compulsive symptoms in patients with obsessive–compulsive disorder.Methods: A total of 118 outpatient and inpatient patients with OCD and 109 healthy participants, gender- and age-matched, were selected using cognitive fusion questionnaire, acceptance and action questionnaire−2nd edition, Yale–Brown scale for obsessive–compulsive symptoms, Hamilton anxiety scale, and Hamilton depression scale for questionnaire testing and data analysis.Results: The levels of cognitive fusion and experiential avoidance in the OCD group were significantly (...) higher than those in the healthy control group. Regression analysis results showed that, in predicting the total score of obsessive–compulsive symptoms, AAQ-II and CFQ entered the equation, which explained 17.1% variance. In predicting anxiety, only AAQ-II entered the equation, which explained 13% variance. In the prediction of depression, AAQ-II entered the equation, which explained 17.7% variance.Conclusion: Cognitive fusion and experiential avoidance may be important factors for the maintenance of OCD, and experiential avoidance can positively predict the anxiety and depression of OCD patients. (shrink)

Despite technological innovations, clinical expertise remains the cornerstone of psychiatry. A clinical expert does not only have general textbook knowledge, but is sensitive to what is demanded for the individual patient in a particular situation. A method that can do justice to the subjective and situation-specific nature of clinical expertise is ethnography. Effective deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) involves an interpretive, evaluative process of optimizing stimulation parameters, which makes it an interesting case to study clinical expertise. The (...) aim of this study is to explore the role of clinical expertise through an ethnography of the particular case of DBS optimization in OCD. In line with the topic of the special issue this article is a part of, we will also use our findings to reflect on ethnography as a method to study complex phenomena like clinical expertise. This ethnography of DBS optimization is based on 18 months of participant observation and nine in-depth interviews with a team of expert clinicians who have been treating over 80 OCD patients since 2005. By repeatedly observing particular situations for an extended period of time, we found that there are recurrent patterns in the ways clinicians interact with patients. These patterns of clinical practice shape the possibilities clinicians have for making sense of DBS-induced changes in patients’ lived experience and behavior. Collective established patterns of clinical practice are dynamic and change under the influence of individual learning experiences in particular situations, opening up new possibilities and challenges. We conclude that patterns of clinical practice and particular situations are mutually constitutive. Ethnography is ideally suited to bring this relation into view thanks to its broad temporal scope and focus on the life-world. Based on our findings, we argue that clinical expertise not only implies skillful engagement with a concrete situation but also with the patterns of clinical practice that shape what is possible in this specific situation. Given this constraining and enabling role of practices, it is important to investigate them in order to find ways to improve diagnostic and therapeutic possibilities. (shrink)

A cognitive assessment strategy that is not limited to examining a set of summary test scores may be more helpful for early detection of emergent illness such as Alzheimer’s disease (AD) and may permit a better understanding of cognitive functions and dysfunctions in those with AD and other dementia disorders. A revisit of the work already undertaken by Kaplan and colleagues using the Boston Process-Approach provides a solid basis for identifying new opportunities to capture data on neurocognitive processes, test-taking strategies (...) and response styles. Thus, this critical review will combine traditional process-based assessment strategies with support provided or offered by newer technologies that have the potential to add value to data collection and interpretation. There is now considerable interest in neuropsychological test administration using computer/digital technology, both in research and in clinical settings. To add value, any computerized version of an existing cognitive test should respect the administration procedure for which normative data were obtained, should be time-saving in terms of scoring and interpretation, and should, we argue, facilitate gathering information about the processes and strategies followed in test completion. This article will offer an overview of the steps needed when implementing computerization of neuropsychological tests using a Process-Based Approach (PBA) to these technology-based adaptations and will discuss further developments in this area by linking it to future technological developments that may be possible in the area of neuropsychological assessment. Additionally, an overview of neuropsychological tests that may benefit from computerization will be presented, together with suggestions on the specific processes, strategies and features that may be captured with the aid of such computerization. Finally, hypotheses on how virtual reality could be an asset for the future of the PBA to neuropsychological assessment will also be discussed. (shrink)

Borsboom and colleagues have recently proposed a “network theory” of psychiatric disorders that conceptualizes psychiatric disorders as relatively stable networks of causally interacting symptoms. They have also claimed that the network theory should include non-symptom variables such as environmental factors. How are environmental factors incorporated in the network theory, and what kind of explanations of psychiatric disorders can such an “extended” network theory provide? The aim of this article is to critically examine what explanatory strategies the network theory that includes (...) both symptoms and environmental factors can accommodate. We first analyze how proponents of the network theory conceptualize the relations between symptoms and between symptoms and environmental factors. Their claims suggest that the network theory could provide insight into the causal mechanisms underlying psychiatric disorders. We assess these claims in light of network analysis, Woodward’s interventionist theory, and mechanistic explanation, and show that they can only be satisfied with additional assumptions and requirements. Then, we examine their claim that network characteristics may explain the dynamics of psychiatric disorders by means of a topological explanatory strategy. We argue that the network theory could accommodate topological explanations of symptom networks, but we also point out that this poses some difficulties. Finally, we suggest that a multilayer network account of psychiatric disorders might allow for the integration of symptoms and non-symptom factors related to psychiatric disorders and could accommodate both causal/mechanistic and topological explanations. (shrink)

Objective: This meta-analysis evaluated the efficacy of acupuncture in improving cognitive impairment of post-stroke patients.Design: Randomized controlled trials investigating the effects of acupuncture compared with no treatment or sham acupuncture on post-stroke cognitive impairment before December 2019 were identified from databases. The literature searching and data extracting were independently performed by two investigators. Study quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analyses were performed for the eligible RCTs with Revman 5.3 software.Results: Thirty-seven RCTs were included (...) in this meta-analysis. Merged Random-effects estimates of the gain of MMSE or MoCA were calculated for the comparison of acupuncture with no acupuncture or sham acupuncture. Following 2–8 weeks of intervention with acupuncture, pooled results demonstrated significant effects of acupuncture in improving PSCI assessed by MMSE or MoCA.Conclusion: The results suggest that acupuncture was effective in improving PSCI and supported the needs of more rigorous design with large-scale randomized clinical trials to determine its therapeutic benefits. (shrink)

The considerable prominence of internet addiction (IA) in adolescence is at least partly explained by the limited knowledge thus far available on this complex phenomenon. In discussing IA, it is necessary to be aware that this is a construct for which there is still no clear definition in the literature. Nonetheless, its important clinical implications, as emerging in recent years, justify the lively interest of researchers in this new form of behavioral addiction. Over the years, studies have associated IA with (...) numerous clinical problems. However, fewer studies have investigated what factors might mediate the relationship between IA and the different problems associated with it. Ours is one such study. The Italian version of the SCL-90 and the IAT were administered to a sample of almost 800 adolescents aged between 16 and 22 years. We found the presence of a significant association between IA and two variables: somatization (β = 7.80; p < 0.001) and obsessive-compulsive symptoms (β = 2.18; p < 0.05). In line with our hypothesis, the results showed that somatization predicted the relationship between obsessive-compulsive symptoms and IA (β = −2.75; t = −3.55; p < 0.001), explaining 24.5% of its variance (ΔR2 = 1.2%; F = 12.78; p < 0.01). In addition, simple slopes analyses revealed that, on reaching clinical significance (+1 SD), somatization showed higher moderation effects in the relationship between obsessive-compulsive symptoms and IA (β = 6.13; t = 7.83; p < 0.001). These results appear to be of great interest due to the absence of similar evidence in the literature, and may open the way for further research in the IA field. Although the absence of studies in the literature does not allow us to offer an exhaustive explanation of these results, our study supports current addiction theories which emphasize the important function performed by the enteroceptive system, alongside the more cited reflexive and impulsive systems. (shrink)

In this paper, I offer a solution to the Capacity/Equality Puzzle. The puzzle holds that an account of the franchise may adequately capture at most two of the following: (1) a political equality-based account of the franchise, (2) a capacity-based account of disenfranchising children, and (3) universal adult enfranchisement. To resolve the puzzle, I provide a complex liberal egalitarian justification of a moral requirement to disenfranchise children. I show that disenfranchising children is permitted by both the proper political liberal and (...) the proper political egalitarian understandings of the relationship between cognitive capacity and the franchise. Further, I argue, disenfranchising children is required by a minimalistic, procedural principle of collective competence in political decision-making. At the same time, I show that political equality requires the enfranchisement of all adults, regardless of cognitive capacities, and that the collective competence principle does not ground adult disenfranchisement. This justifies the progressive legal trend that holds the capacity-based disenfranchisement of adults to be incompatible with liberal democratic principles. (shrink)

People whose person-making capacities or status are diminished or who lack them altogether are mostly ignored in mainstream theories of recognition. This entry clarifies the conceptual landscape around and some of the key questions about recognition in relation to these people. The concept of personhood is analyzed into three different sub-concepts – juridical, moral and psychological – and the connection of these to recognition on relevant concepts of recognition is discussed.

Body Integrity Identity Disorder, formerly also known as apotemnophilia is characterized by a desire for amputation of a healthy limb and is claimed to straddle or to even blur the boundary between psychiatry and neurology. The neurological line of approach, however, is a recent one, and is accompanied or preceded by psychodynamical, behavioural, philosophical, and psychiatric approaches and hypotheses. Next to its confusing history in which the disorder itself has no fixed identity and could not be classified under a specific (...) discipline, its sexual component has been an issue of unclarity and controversy, and its assessment a criterion for distinguishing BIID from apotemnophilia, a paraphilia. Scholars referring to the lived body -- a phenomenon primarily discussed in the phenomenological tradition in philosophy -- seem willing to exclude the sexual component as inessential, whereas other authors notice important similarities with gender identity disorder or transsexualism, and thus precisely focus attention on the sexual component. This contribution outlines the history of BIID highlighting the vicissitudes of its sexual component, and questions the justification for distinguishing BIID from apotemnophilia and thus for omitting the sexual component as essential. Second, we explain a hardly discussed concept from Maurice Merleau-Ponty's Phenomenology of Perception, the sexual schema, and investigate how the sexual schema could function in interaction with the body image in an interpretation of BIID which starts from the lived body while giving the sexual component its due. (shrink)

In psychiatry, many scientists desire to move from a classification system based on symptoms toward a system based on biological causes. The idea is that psychiatric diseases should be redefined such that each disease would be associated with specific biological causes. This desire is intelligible because causal disease models often facilitate understanding and identification of new ways to intervene in disease processes. In its attempt to move from syndromal to specific etiological definitions, psychiatry follows the trend of general medicine.Current psychiatric...

Emotions might contribute to our being rational cognitive agents. Anxiety – and more specifically epistemic anxiety – provides an especially interesting case study into the role of emotion for adaptive cognition. In this paper, I aim at clarifying the epistemic contribution of anxiety, and the role that ill-calibrated anxiety might play in maladaptive epistemic activities which can be observed in psychopathology. In particular, I argue that this emotion contributes to our ability to adapt our cognitive efforts to how we represent (...) the practical factors relevant to the task at hand, by sig- naling the need for increased cognitive processing and evidence gathering in high- stakes situations. I hypothesize that dysfunctional or ill-calibrated epistemic anxiety might play an important role in the motivation driving persons with obsessive- compulsive disorder (OCD) to invest high amounts of cognitive resources into the resolution of apparently simple and innocuous questions. As I argue, OCD might be conceived as a case in which epistemic anxiety is inappropriately elicited, represent- ing these as high-stakes questions, and inadequately signaling a need for cognition. In this paper, I thus make use of the concept of (epistemic) anxiety as developed in the philosophy of emotion and in epistemology, to propose an account of the role of anxiety in the pathological doubt that is central to obsessive-compulsive disorder. (shrink)

Does life have meaning? What is flourishing? How do we attain the good life? Philosophers, and many others of us, have explored these questions for centuries. As Eva Feder Kittay points out, however, there is a flaw in the essential premise of these questions: they seem oblivious to the very nature of the ways in which humans live, omitting a world of co-dependency, and of the fact that we live in and through our bodies, whether they are fully abled or (...) disabled. Our dependent, vulnerable, messy, changeable, and embodied experience colors everything about our lives both on the surface and when it comes to deeper concepts, but we tend to leave aside the body for the mind when it comes to philosophical matters. Disability offers a powerful challenge to long-held philosophical views about the nature of the good life, what provides meaning in our lives, and the centrality of reason, as well as questions of justice, dignity, and personhood. These concepts need not be distant and idealized; the answers are right before us, in the way humans interact with one another, care for one another, and need one another--whether they possess full mental capacities or have cognitive limitations. We need to revise our concepts of things like dignity and personhood in light of this important correction, Kittay argues. This is the first of two books in which Kittay will grapple with just how we need to revisit core philosophical ideas in light of disabled people's experience and way of being in the world. Kittay, an award-winning philosopher who is also the mother to a multiply-disabled daughter, interweaves the personal voice with the philosophical as a critical method of philosophical investigation. Here, she addresses why cognitive disability can reorient us to what truly matters, and questions the centrality of normalcy as part of a good life. With profound sensitivity and insight, Kittay examines other difficult topics: How can we look at the ethical questions regarding prenatal testing in light of a new appreciation of the personhood of disabled people? What do new possibilities in genetic testing imply for understanding disability, the family, and bioethics? How can we reconsider the importance of care, and how does it work best? In the process of pursuing these questions, Kittay articulates an ethic of care, which is the ethical theory most useful for claiming full rights for disabled people and providing the opportunities for everyone to live joyful and fulfilling lives. She applies the lessons of care to the controversial alteration of severely cognitively disabled children known as the Ashley Treatment, whereby a child's growth is halted with extensive estrogen treatment and related bodily interventions are justified. This book both imparts lessons that advocate on behalf of those with significant disabilities, and constructs a moral theory grounded on our ability to give, receive, and share care and love. Above all, it aims to adjust social attitudes and misconceptions about life with disability. (shrink)

Mental retardation is an invented bureaucratic category, currently undergoing radical rethinking and likely renaming, that includes many who have biologically based brain disorders, but is itself determined on functional criteria that are purely arbitrary. People with MR are socially vulnerable and thus are more likely to be "naíve confessors," "naíve defendants," and "naíve offenders." That is most likely the rationale and justification for the Supreme Court's decision, in Atkins v. Virginia, to exempt the class from execution. Although the decision is (...) to be applauded as a step in a more humane direction, it is problematic to use an indirect, artificial, and insufficiently inclusive category to determine who should or should not be executed. Limited social intelligence is a characteristic of a wide range of brainbased syndromes and disorders, including many who fall above the upper IQ limit and, thus, are ineligible for the MR label and the legal protections associated with it. A more equitable, and logical, policy would be to extend execution exemption to all who demonstrate the same kinds of vulnerabilities, especially if they can be linked to some brain-based medical condition, regardless of whether one qualifies for the label of MR. (shrink)

The republican ideal of non-domination identifies the capacity for arbitrary interference as a fundamental threat to liberty that can generate fearful uncertainty and servility in those dominated. I argue that republican accounts of domination can provide a powerful analysis of the nature of legal and institutional power that is encountered by people with mental disorders or cognitive disabilities. In doing so, I demonstrate that non-domination is an ideal which is pertinent, distinctive, and desirable in thinking through psychological disability. Finally, I (...) evaluate republican strategies for contesting domination, focusing on the limits of contestatory democracy, and proposing a participatory alternative which better addresses problems of political agency in the mentally disordered and cognitively disabled. (shrink)

The Eugenic Mind Project is a wide-ranging, philosophical book that explores and critiques both past and present eugenic thinking, drawing on the author’s intimate knowledge of eugenics in North America and his previous work on the cognitive, biological, and social sciences, the fragile sciences. Informed by the perspectives of Canadian eugenics survivors in the province of Alberta, The Eugenic Mind Project recounts the history of eugenics and the thinking that drove it, and critically engages contemporary manifestations of eugenic thought, newgenics. (...) An accessible, original work of scholarship adopting what the author calls a standpoint eugenics, this book focuses on the roots of eugenic thinking past and present. It will provoke and enrich discussions about human nature and human diversity, the social uses of biotechnology, and social policy governing future generations. You can download the preface and acknowledgements here. (shrink)

Review of Bloomsbury Companion to Contemporary Philosophy of Medicine, ed James A Marcum.

Self-management interventions are a heterogeneous group of interventions that are regarded as important tools for the management of chronic diseases. They consist of a broad range of techniques and are available for a large variety of chronic organic as well as mental conditions or illnesses, which are by definition generally chronic. These interventions aim that the individual concerned takes substantial responsibility for managing the symptoms, treatment, and physical and psychosocial consequences associated with having a chronic medical condition, disability or disease. (...) Alternate terms used in this context, among others, are self-care... (shrink)

We discuss applications of our account of moral status grounded in person-rearing relationships: which individuals have higher moral status or not, and why? We cover three classes of cases: (1) cases involving incomplete realization of the capacity to care, including whether infants or fetuses have this incomplete capacity; (2) cases in which higher moral status rests in part on what is required for the being to flourish; (3) hypothetical cases in which cognitive enhancements could, e.g., help dogs achieve human-like cognitive (...) capacities. We thereby show that our account does not have the counterintuitive implications alleged by DeGrazia and other critics. (shrink)

Leading researchers describe the field of special education as sharply divided between two different theories of disability. In this article Scot Danforth takes as his project addressing that division from the perspective of a Deweyan philosophy of the education of students with intellectual disabilities. In 1922, John Dewey authored two articles in New Republic that criticized the use of intelligence tests as both undemocratic and impractical in meeting the needs of teachers. Drawing from these two articles and a variety of (...) Dewey’s other works, Danforth puts forward a Deweyan educational theory of intellectual disability. This theory is perhaps encapsulated in Dewey’s observation that “The democratic faith in human equality is belief that every human being, independent of the quantity or range of his personal endowment, has the right to equal opportunity with every other person for development of whatever gifts he has.”1. (shrink)

Traditional accounts conceive of the autistic individual as being locked in his/her own world due to difficulties in social interaction, communication and imagination. The paradoxical association between autism and creativity is one of the reasons the condition causes such fascination and yet remains an enigma. This essay draws upon practical research exploring applications of performance to engage with atypical neuro-cognitive experience. The research explores new insights into the imagination and perception in autism through the multisensory multimodalities of performance, which, it (...) is speculated, offer a space for ‘encounters’ with autistic states of being. We draw upon our AHRC practice-based project ‘Imagining Autism’, which explores the phenomenology of autism through a series of immersive, multi-sensory installations, puppetry and interactive digital media, to facilitate communication and social interaction with 7-11 year olds across the spectrum. These methods are developing new understanding of the imagination in autism and how it may be differently inflected from the recreative imaginations of neurotypicals. How can atypical experience be accessed through performance vocabularies? Does autism predispose to talents and if so, why? What is the nature of autistic creativity alongside neurotypical creativity? We reconceptualise the imagination in autism, challenging dualisms between the rational and the intuitive, the aesthetic and non-aesthetic and most crucially, imaginative creativity versus the recreative imagination. Two interactions between facilitators and children in the immersive and deeply sensory performance environments of ‘Imagining Autism’ are closely analysed to evidence cognitive development via the autistic imagination at work. A comedic exchange between a practitioner and a non-verbal child reveals ideation in the child building in rhythmic stages of somatic interaction; another child evidences imaginative engagement through shape, colour, texture, sound and movement while immersed in ‘outer space’. These examples suggest that the somatic interaction of body and the environment are as much part of cognition and the creative imagination as the brain and its functioning. (shrink)

The aim of this empirical investigation is to analyse the role of associations in the development of intervention on children with autism in Iasi. Research methodology is a qualitative fieldwork based on observation and semi-structured interview. Professionals from two NGOs and a special school and parents of children with autism were interviewed. Research results show that associations have set up establishment of specialized structures, adapted to children with autism care. The development of these services was achieved through financial and logistical (...) support received from outside, by attracting local authorities who provided locations, conducting awareness campaigns and fundraising etc. If before the parents of children with autism were desperate they did not know where to go, now they have several alternatives after receiving the diagnosis. The study concludes that the transition from resigned and submissive attitude of Romanian Government to provide a small financial support for families in an active attitude in which the emphasis is on development of educational and behavioural methods social integration of people with autism was made possible by the development of the NGO sector. (shrink)

The official birth of hysterical anorexia is attributed to the French alienist Ernest Charles Lasègue (1816-1883). Starting from his 1873 article, anorexia as a ‘new’ psychopathological picture is subjected to extensive clinical and theoreticalstudy. This paper is not an analysis about the process through which anorexia was formalized as specific psychiatric condition. Rather, it focuses on another important issue: the possibility that the ‘same’ disorder may have different meaning depending on the historical period considered. Furthermore, it is asserted that the (...) study of every pathological form is conditioned by social, individual and cultural conditions. For example, in the same year the English Sir William Gull publishes a paper about “anorexia nervosa” which is described in a different way depending on the different perspective. Lasègue’s description is a way of seeing a kind of sufferance, that is he ‘sees’ this pathology through the hysterical paradigm. Starting from these considerations, this article discusses the construct of ‘hysterical anorexia’ trying to understand why, in late nineteenth century France, hysteria and anorexia were viewed as two aspects of the same specific disorder. Finally, it is discussed why anorexia gradually emerged as an independent mental disorder just after the death of Charcot (1893). (shrink)

In cases where one sense-modality is stimulated by another, we speak of synesthesia, i.e., of a subjective experience of multiple distinct sensations as being quite literally conjoined. The term “synesthesia” is derived indirectly from the Greek words “syn,” meaning “together,” and “aisthesis,” meaning “sensation.” This article focuses on the question of whether synesthesia is in fact a mental disorder or a creative gift. Both the commonsense views that have emerged in recent times, and neurological research, demonstrate that our knowledge of (...) this relatively uncommon phenomenon is slowly but constantly expanding. Proper experimental research conducted with the right sorts of synesthete, and philosophically and scientifically nuanced conceptual studies of synesthesia, can all be helpful when seeking answers to the question posed above, while also confirming general claims about the extent to which our perceptions are reallysubjective. Most synesthetes see themselves as gifted, and claim that this “conjoining of the senses” enriches the quality of their lives. (shrink)

This paper presents a series of 4 single subject experiments aimed to investigate whether children with autism show more social engagement when interacting with the Nao robot, compared to a human partner in a motor imitation task. The Nao robot imitates gross arm movements of the child in real-time. Different behavioral criteria were analyzed based on the video data of the interaction. The results are mixed and suggest a high variability in reactions to the Nao robot. The results are as (...) follows: For Child2 and Child3, the results indicate no effect of the Nao robot in any of the target variables. Child1 and Child4 showed more eye gaze and smile/laughter in the interaction with the Nao robot compared to the human partner and Child1 showed a higher frequency of motor initiations in the interaction with the Nao robot compared to the baselines, but not with respect to the human-interaction. The robot proved to be a better facilitator of shared attention only for Child1. Keywords: human-robot interaction; assistive robotics; autism. (shrink)

Autistic disorders are characterized by deficits in social interactions and communication, strong aversion or non-response to social stimuli. However, these children are often reported to develop strong bonds with companion animals. We hypothesized that children with autism would present different behavioural profiles when encountering an unfamiliar animal in aStrange Animal Situationclose-to-life test. Twenty seven CAD were compared to 59 children with typical development. Our results. revealed similarities in the behaviour of both groups of children as well as patterns specific to (...) the CAD. Different profiles emerged depending on everyday living conditions. This study constitutes, to our knowledge, the first clear description of how children with autism react when encountering an unfamiliar animal and one of the first direct comparisons between CAD and CTD using a naturalistic but standardized setting. Keywords: autism; animal; profile; interaction; ethology. (shrink)

Lionel Penrose (1898–1972) was an important leader during the mid-20th century decline of eugenics and the development of modern medical genetics. However, historians have paid little attention to his radical theoretical challenges to mainline eugenic concepts of mental disease. Working from a classification system developed with his colleague, E. O. Lewis, Penrose developed a statistically sophisticated and clinically grounded refutation of the popular position that low intelligence is inherently a disease state. In the early 1930s, Penrose advocated dividing “mental defect” (...) (low intelligence) into two categories: “pathological mental defect,” which is a disease state that can be traced to a distinct genetic or environmental cause, and “subcultural mental defect,” which is not an inherent disease state, but rather a statistically necessary manifestation of human variation in intelligence. I explore the historical context and theoretical import of this contribution, discussing its rejection of typological thinking and noting that it preceded Theodosius Dobzhansky’s better-known defense of human diversity. I illustrate the importance of Penrose’s contribution with a discussion of an analogous situation in contemporary medicine, the controversial practice of using human growth hormone injections to treat “idiopathic short stature” (mere diminutive height, with no distinct cause). I show how Penrose’s contributions to understanding human variation make such treatments appear quite misguided. (shrink)

This paper is about the moral status of those human beings with profound intellectual disabilities (PIDs). We hold the common sense view that they have equal status to ‘normal’ human beings, and a higher status than any non-human animal. We start with an admission, however: we don’t know how to give a fully satisfying theoretical account of the grounds of moral status that explains this view. And in fact, not only do we not know how to give such an account, (...) but the most satisfying account of moral status that we know (which we call ‘the standard account’) entails that our view is false. It entails that those with PIDs have a lower status than ordinary human beings and an equal status to non-human animals. Now, in this paper, we do absolutely nothing to try to show where the standard account goes wrong, and we do absolutely nothing to resolve the difficulties we see in developing an alternative account that supports our view. Indeed, we do not give any argument against the standard account or in favour of our own view. Instead, we raise the following question: in order to be justified in continuing to hold our view, are we obliged to give such an account? Our answer will be that we are not. (shrink)

To fulfill their crucial duty of relieving suffering in their patients, physicians may have to administer palliative sedation when they implement treatment-limitation decisions such as the withdrawal of life-supporting interventions in patients with poor prognosis chronic severe brain injury. The issue of palliative sedation deserves particular attention in adults with serious brain injuries and in neonates with severe and irreversible brain lesions, who are unable to express pain or to state their wishes. In France, treatment limitation decisions for these patients (...) are left to the physicians. Treatment-limitation decisions are made collegially, based on the presence of irreversible brain lesions responsible for chronic severe disorders of consciousness. Before these decisions are implemented, they are communicated to the relatives. Because the presence and severity of pain cannot be assessed in these patients, palliative analgesia and/or sedation should be administered. However, palliative sedation is a complex strategy that requires safeguards to prevent a drift toward hastening death or performing covert euthanasia. In addition to the law on patients' rights at the end of life passed in France on April 22, 2005, a recent revision of Article 37 of the French code of medical ethics both acknowledges that treatment-limitation decisions and palliative sedation may be required in patients with severe brain injuries and provides legal and ethical safeguards against a shift towards euthanasia. This legislation may hold value as a model for other countries where euthanasia is illegal and for countries such as Belgium and Netherlands where euthanasia is legal but not allowed in patients incapable of asking for euthanasia but in whom a treatment limitation decision has been made. (shrink)

Frances Tustin's classic text _Autistic States in Children_ put forward convincing clinical evidence that some forms of childhood autism are psychogenic and respond to methods of treatment very different from the behavioural techniques often adopted without success. Her pioneering work with such children has gained ground since the book was first published and she herself has revised her understanding of the aetiology of psychogenic autism. This revised edition of the book incorporates her new thinking based on recent infant observational studies (...) and her own clinical experience. (shrink)

This book examines autism from the tradition of analytic philosophy, working from the premise that Autism Spectrum Disorders raise interesting philosophical questions that need to be and can be addressed in a manner that is clear, jargon-free, and accessible. The goal of the original essays in this book is to provide a philosophically rich analysis of issues raised by autism and to afford dignity and respect to those impacted by autism by placing it at the center of the discussion.