The closeness of somatosensory phenomena and emotional states can be critically extended into a clinical perspective by referring to Tourette's Syndrome (TS). Two examples are discussed in this commentary: (1) the neurodevelopmental approach to the pre- and post-tic sensorimotor urges, and (2) the TS treatment with deep brain stimulation. It is shown that in TS, both views (locationist and constructionist) need to be combined along the lifespan in order to get a more realistic picture of the brain basis (...) of emotion. (shrink)

Tourette’s Syndrome can involve disruptive “ticcing” behavior. Past work suggests that people sometimes blame those making tics for such disruptions. In the current work, we examined how blame perceptions vary depending on the person’s obligation and capacity to refrain from ticcing. Across two studies, we manipulated whether a person ticced in a formal versus informal social situation (obligation), after a weak versus strong urge to tic (capacity). We assessed perceptions of blame, free will, and moral character. Blame increased with (...) increasing obligation and capacity, and perceptions of free will primarily increased with increasing capacity, with perceived obligation playing a smaller role. Moral character ratings were largely unaffected by the manipulations, but people rated the person higher in moral character when their perceived obligation and capacity were low. Generally, women, younger people, and people who knew someone with Tourette’s rated the person who ticced more positively. Overall, these results suggest that whereas blame is sensitive to a person’s obligation and capacity, these perceptions do not map cleanly onto moral character perceptions, in part perhaps due to reduced free will perceptions. Efforts to normalize tics may reduce the perceived obligation to refrain, thereby avoiding both the pitfalls of blaming people with Tourette’s or viewing them as lower in free will. (shrink)

This book offers a philosophical perspective on contemporary Tourette Syndrome scholarship, a field which has exploded over the last thirty years. Despite intense research efforts on this common neurodevelopmental condition in the age of the brain sciences, the syndrome’s causes and potential cures remain intriguingly elusive. How does this lack of progress relate to the tacitly operating philosophical concepts that shape our current thinking about Tourette Syndrome? This book foregrounds these tacit concepts and shows how they relate (...) to “big topics” in philosophy such as time, volition, and the self. By tracing how these topics relate to current research on Tourette’s, it invites us to re-think our approach to research and care. Such re-thinking is urgently needed: individuals and families living with Tourette Syndrome remain under-serviced as pharmacological and behavioural therapies provide relief for some but not all who need support. This book highlights what questions we ask and do not ask in contemporary scholarship, thereby surfacing invisible constraints and opportunities in the field. It is of interest to scholars, health professionals, students, and affected families who want to better understand this burgeoning field of research with its conceptual controversies, approaches to aetiology, and directions for new research and improved clinical care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Phenomenological Interviews and Tourette'sThe authors report no conflicts of interest.We appreciate the responses from the two clinicians, Efron and Mathieson. We agree with their reminder about the holistic nature of clinician's engagement (mood, sociality, and work life) and with their emphasis on patient-reported outcome measures, although this is not quite what we did in our interviews. As has recently been recognized in section 24 of the Victorian Mental Health (...) and Well-being Act (to provide a local Australian example), patients and caregivers' "lived experience makes them valuable leaders and active partners in the mental health and wellbeing service system."1In this paper, however, our aim was both more modest and immodest: modest, in that we aimed to work with those "leaders and active partners" to generate a more adequate account of lived experience in concert with behavioral symptomatology; immodest, in that we wondered how the lived experience of Tourette syndrome (TS) aligned (or not) with some of the commonly ascribed features of the condition. Although phenomenology as a discipline does not own lived experience, of course, it is more systematically treated in this tradition, starting with elaborations of Erlebnis.Efron and Mathieson note that older patients are more likely to describe urges or premonitory urges (PUs). This raises the priming question: Has greater exposure to and involvement in medical concepts and treatments transformed the nature of their self-report, or has it provided them with more phenomenological skills, enabling them to pick out discrete parts of experience? Or perhaps they have just been exposed more frequently to the experience over time? We address some related issues below, in our reply to Fernandez, where we outline our interview techniques more fully.They end by noting that the aim of comprehensive behavioral intervention for tics is to become attentive to PUs to better block tics. This is complex and understudied. In principle, becoming aware of something cognitively and experientially can foreground or even perhaps induce that experience. Conversely, from the TS scholarship, we know that attending to urges in certain ways (e.g., via acceptance training) can also reduce perceived urge frequency and intensity (see Gev et al., 2016). We would welcome further work on this link between attention and experience in TS. [End Page 49]Response to FernandezBecause our paper was partly framed around Fernandez' own work on phenomenological psychopathology, we welcome his invitation to provide further "inspiration and guidance" for other phenomenological researchers conducting empirical studies, who may also be dealing with the challenge posed by "narrative habits." When an interviewee uses well-worn medicalized terms to describe their experience, it is not clear whether these descriptions genuinely reveal or rather occlude the experience in question. There are sometimes, perhaps often, second-person phenomenological 'tells' regarding interviewees genuinely re-evoking an experience, but for interviewers it still raises the question of how to prompt alternative and potentially more accurate descriptions of experience.Because of this challenge, we purposely did not use the term "urge" or "premonitory urge" (PU) in our interview questions. Instead, we asked about (and used the broader term of) "experiences" that may occur prior, during, or after ticcing, without assuming that there are such experiences in the first place. We guided interviewees to evoke the memory of a specific, singular tic event (a tic token; see Curtis-Wendlandt 2020, 2023). Once a memory of such an event had been identified, we asked interviewees the following three lead questions:1. What, if anything, did you experience during this tic?2. What, if anything, did you experience before this tic?3. What, if anything did you experience after this tic?The temporal framing of these questions counters common trends and assumptions in the scholarship, which has focused heavily on pre-tic experiences, with little attention given to post-tic experiences (reduced to notions of "relief" and barely investigated), and even less to experiential explorations of the tic itself. Our catalogue of supporting questions sought to elicit fine-grained descriptions of evoked/recalled experiences along sensory and cognitive-affective dimensions:•. Did you see anything before, during, or after this tic? If so, what did you see?•. Did you hear anything... (shrink)

The use of philosophical phenomenology for conceptual debates in psychiatric nosology and psychopathology is beginning to be recognized. In this paper, we extend this trajectory to include Tourette Syndrome, focusing on so-called premonitory urges (PU) preceding Tourettic tics. We clarify some inconsistencies around typology in both phenomenological description and medical classification (i.e., in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision, International Classification of Diseases, 10th edition [World Health Organization, 2004], and the scales that elicit (...) PU). We show how a less typological approach might be usefully deployed in the field, that being the dimensional approach developed by Fernandez (2019a; 2019b). We test both the typological and dimensional approaches in relation to the experience and etiological role of PU in Tourette’s syndrome. Based on our synthesis of existing studies and new information garnered through phenomenological interviews (using an approach associated with “micro-phenomenology”), we argue that the role of PU in nosology challenges both the current “operational” criteria favored by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision, that are focused on behaviorally observed symptoms, as well as essential and prototypical phenomenological descriptions about a given “type” of experience. (shrink)

Philosophers generally assume that individuals with Tourette syndrome are not responsible for their Tourettic tics, and so not blameworthy for any harm their tics might cause. Yet this assumption is based largely on ignorance of the lived experience of Tourette syndrome. Individuals with Tourette syndrome often experience their tics as freely chosen and reason-responsive. Yet it still seems wrong to treat a Tourettic individual’s tic as on a moral par with others’ actions. In this paper, I examine (...) the options and argue that, if this is correct, then a surprising consequence follows: the standard, motivation-basedtheory of desire must be false. I go on to argue that, given what is known about the neurological basis of Tourette syndrome, this is a reasonable conclusion to draw. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Subjective Experiences of Tourette SyndromeBeyond the Premonitory UrgeThe authors report no conflicts of interest.There is an evolving recognition in healthcare that the patient's subjective experience needs to be privileged both in understanding clinical phenomena and also ensuring the salience of outcomes used to evaluate the impact of treatment interventions. This is reflected in the expansion of patient-reported outcome measures to capture a person's perception of their own health, and (...) the increasing requirement of involving people with lived experience in the co-design of research studies (National Health and Medical Research Council, 2016) and care improvement initiatives. In mental health it has been long understood that observable behavioral phenomena can only partially inform clinical understanding of the experience of the patient living with the condition. However, capturing the patient's subjective experience faithfully remains a challenge.Tourette syndrome (TS) is a complex condition in which there are clearly observable behavioral phenomena (vocal and motor tics, compulsive and socially inappropriate behaviors), but also a broad and varied range of subjective phenomena reported by different individuals. These may include sensory phenomena such as the premonitory sensory urge preceding a tic, compulsions to touch things a certain number of times or do something repeatedly until it feels "just right," or bothersome intrusive thoughts or images. To further complicate the picture most patients with TS have one or more co-occurring conditions such as attention deficit hyperactivity disorder, obsessive-compulsive disorder, and anxiety, which may actually cause a greater burden of dysfunction and distress than the Tourette symptoms.In their paper, Curtis-Wendlandt et al. (2024) challenge the dependence of current psychiatric diagnostic criteria (e.g., the Diagnostic and Statistical Manual of Mental Disorders, 5th edition) on observable tics, and propose a broader and more dimensional approach to nosology which incorporates sensory, cognitive and affective phenomena. [End Page 47] Data from interviews they conducted identified that premonitory phenomena and urge experiences in tic disorders are more complex and diverse than what is currently reflected in the literature and clinical scales. They also interviewed participants who reported "no urges" or "no premonitory sensations." They commented that the literature generally treats reports of urge absences at face value, and does not address the likelihood that such reports may be ambiguous or problematic. Overall, they concluded that their research suggests that premonitory urges in TS are a complex and diverse phenomenon that requires further study. This reflects with our clinical experience in working with TS patients. Although a large proportion of older patients describe sensory-based premonitory urges, descriptions are not homogenous, with many describing other experiences preceding their tics.When evaluating a patient's response to an intervention (either behavioral or pharmacological) clinicians incorporate a range of information. This includes the severity of their tics (number, type, frequency, intensity, and associated impairment), as well as their mood, participation and performance in study, work, and social activities, and overall quality of life. Standard clinical practice would not typically include assessment of some of the subjective experiences which precede tics. If it was accepted that these subjective phenomena are indeed salient to the patient's well-being, then a challenge would be how to consistently and reliably capture these feelings to operationalize a comprehensive patient-centered assessment.The primary evidence-based treatment for tic disorders, comprehensive behavioral intervention for tics (CBIT), involves training to increase the awareness of premonitory urges (Woods et al., 2008). Furthermore, successful 'blocking' of tics during the course of CBIT requires the patient to be aware of premonitory urges. Clinicians having a better understanding of the complexity and diversity of experiences which precede tics, as well as using open-ended questioning styles, may assist with improving CBIT outcomes. [End Page 48]Related ArticlesFeature Article: Dimensions, Not Types: On the Phenomenology of Premonitory Urges in Tourette SyndromeCommentary: Priming and Narrative Habits in the Phenomenological Interview: Reflections on a Study of Tourette SyndromeCommentary: Subjective Experiences of Tourette Syndrome: Beyond the Premonitory UrgeResponse: Phenomenological Interviews and Tourette’sDaryl EfronThe Royal Children's Hospital MelbourneIvan MathiesonThe Laneway ClinicDaryl Efron Daryl Efron is a Consultant Pediatrician, Royal Children's Hospital Senior Research Fellow, Murdoch... (shrink)

Introduction Tourette Syndrome is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation may be considered. Methods and Results We discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he experienced (...) a tic reduction of more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects. Discussion Specific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication. Conclusion Clinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Priming and Narrative Habits in the Phenomenological InterviewReflections on a Study of Tourette SyndromeThe author reports no conflicts of interest.In "Dimensions, Not Types: On the Phenomenology of Premonitory Urges in Tourette Syndrome," Lisa Curtis-Wendlandt and Jack Reynolds provide new insights into some of the experiences characteristic of Tourette syndrome (TS). Their study is an excellent example of applied phenomenology (Burch, 2021), combining philosophy and qualitative research methods (...) to illuminate experiences that have often been mischaracterized in the existing literature. In their study, they focus on what is commonly referred to as a "premonitory urge" (PU): the "anticipatory urge that is often thought to precede the onset of the motor and phonic tics that are part of Tourette Syndrome" (Curtis-Wendlandt & Reynolds, 2024, p. 26). They ask not only whether PU is a necessary feature of TS, but also whether the very concept of PU accurately portrays the experiences and behaviors that it's intended to refer to. They point out that existing scales used to assess PU, for example, seem to implicitly narrow the relevant experiences by assuming that they are a) always negative and b) always internal, or inwardly focused (Curtis-Wendlandt & Reynolds, 2024, 26). Curtis-Wendlandt and Reynolds question these in-built assumptions about PU, suggesting that they may provide an overly narrow depiction that misses the genuine diversity of experiences that precede the onset of a motor or phonic tic.To explore these phenomena in more detail, they conducted a study intended to elicit fresh descriptions of these experiences. They interviewed 12 teenagers with a diagnosis of TS about their experiences of ticcing and tic suppression. Using the micro-phenomenological method (Petitmengin, 2006), they asked participants to reflect on a specific tic or tic suppression event and to recall the event in detail. Throughout the interview, [End Page 43] they asked open-ended questions about sensory, cognitive, or affective experiences surrounding the event. Through these interviews, they were able to generate rich descriptions of these experiences and investigate how these descriptions differed from standard accounts in the existing literature.Curtis-Wendlandt and Reynolds provide a detailed account of how they designed their phenomenological study, both philosophically and empirically. However, there is an important aspect of their method that they discuss only in a cursory or implicit way, which is what I want to focus on here. Throughout their study, they were concerned that participants might simply parrot back well-worn medicalized characterizations of PU. Such characterizations risk simplifying or even occluding key aspects of the participants' experiences that might be difficult to reflect upon or describe. However, despite stressing the importance of eliciting fresh descriptions, Curtis-Wendlandt and Reynolds provide only glimpses of how the interviews actually unfolded and what kinds of techniques they used to elicit these descriptions.In my experience, it is quite common to hear phenomenological psychologists and psychiatrists express concern that people may simply repeat common psychiatric or medicalized characterizations of their condition, rather than genuinely reflect upon and describe their first-person experiences. The philosophical assumption is that we all fall back on culturally sedimented language and terminology when describing our experiences. Someone who has spent extended periods of time interacting with psychiatrists and other healthcare professionals, for example, is likely to have picked up common ways of describing their condition—ways that may have helped them receive a diagnosis or obtain treatment. There is nothing inherently wrong with falling into these culturally sedimented characterizations. They facilitate everyday communication through a shared language and terminology. But phenomenologists are often concerned that this kind of culturally sedimented language covers over or obscures the phenomenon or experience they are trying to investigate. For example, if a psychiatrist has often described their patient's depressed mood as "sadness," then that patient may be likely to self-describe their mood as sadness in an interview setting. It might, in fact, be the case that their mood is best described as sadness. But it could also be the case that their mood would be more accurately described as, for instance, a sense of emptiness or feeling deep despair. The challenge is therefore to know whether someone's self-description is... (shrink)

The fist and the open hand -- The sisyphean and the Tantalic : an ontological personality typology -- Separant and participant cultures : the social component of the Tantalus ratio -- Jews and Arabs : the relationship between personality types and social characters -- Interaction, objectlessness, and the self-contiuum -- Self, choice, and uniqueness -- Man, other, and things : the phenomenology of interaction -- The Isaac syndrome -- Rebellion and yearning.

Resumen. El presente documento tiene como finalidad plasmar la importancia que tiene el tomar encuenta los deseos y necesidades de los espectadores para el éxito económico de las organizaciones deproducción cinematográfica mexicanas. Se establecen las funciones culturales y económicas quedeben considerar los directores y productores de las organizaciones aquí estudiadas. Por otro lado, seubica los diferentes grados de insatisfacción en los que cae un espectador al que no le agradó lapelícula. Se propone el concepto “Síndrome Lozano-Barragán”* para ubicar a aquellasorganizaciones (...) de producción cinematográfica que culpan a los espectadores que quedaroninsatisfechos, del fracaso en taquilla, además de argumentar que dichos espectadores no supieronentender la película o que no saben de la naturaleza de la misma. Por último, hacemos algunasrecomendaciones que pueden seguir las organizaciones de producción cinematográfica para evitareste síndrome e incrementar la satisfacción de los espectadores.Palabras Claves. Organizaciones de producción cinematográfica, industria cultural, síndrome Lozano-Barragán, espectadores, insatisfacción.. The main purpose of this document is to state the importance of taking into considerationthe desires and needs of the spectators by the Mexican film production organizations has for theireconomical success. It establishes the cultural and economic functions that filmmakers studied onthis document must consider. On the other hand, it locates the different degrees of the dissatisfactionin which a spectator can falls into when he or she doesn´t like the movie. We propose the “Lozano-Barragan syndrome”* concept, to distinguish those film production organizations that blame thedissatisfied spectator, for the box office failure, as well as, they argued that those spectators didn´tunderstand the movies or that they don´t understand the nature of it. Finally, we make somerecommendations that could de followed by the film production organizations to avoid this syndromeand increase the spectator satisfaction.Keywords. Film production organizations, cultural industry, Lozano-Barragan syndrome,spectators, dissatisfaction. (shrink)

Assessment of decision-making capacity (DMC) can be difficult in acquired brain injury (ABI) particularly with the syndrome of organic personality disorder (OPD) (the “frontal lobe syndrome”). Clinical neuroscience may help but there are challenges translating its constructs to the decision-making abilities considered relevant by law and ethics. An in-depth interview study of DMC in OPD was undertaken. Six patients were purposefully sampled and rich interview data were acquired for scrutiny using interpretative phenomenological analysis. Interview data revealed that awareness (...) of deficit and thinking about psychological states can be present. However, the awareness of deficit may not be “online” and effectively integrated into decision-making. Without this online awareness of deficit the ability to appreciate or use and weigh information in the process of deciding some matters appeared absent. We argue that the decision-making abilities discussed are: (1) necessary for DMC, (2) threatened by ABI, and (3) assessable at interview. Some advice for practically incorporating these abilities within assessments of DMC in patients with OPD is outlined. (shrink)

Patients with right parietal lesions often deny their paralysis , but do they have "tacit" knowledge of their paralysis? I devised three novel tests to explore this. First, the patients were given a choice between a bimanual task vs a unimanual one . They chose the former on 17 of 18 trials and, surprisingly, showed no frustration or learning despite repeated failed attempts. I conclude that they have no tacit knowledge of paralysis . Second, I used a "virtual reality box" (...) to convey the optical illusion to the patient that she was moving her paralyzed left hand up and down to the rhythm of a metronome, and yet she showed no sign of surprise. Third, I irrigated patient BM′s left ear canal with cold water, a procedure that is known to shift that patient′s spatial frame of reference by stimulating the vestibular system. Surprisingly, this allowed her "repressed" memory of paralysis to come to the surface; she said she had been paralyzed continuously for several days. I suggest that the vestibular stimulation produces these remarkable effects by mimicking REM sleep. These patients also emply a whole arsenal of grossly exaggerated Freudian "defense mechanisms" to account for their paralysis. To explain this, I propose that in normal individuals the left hemisphere ordinarily deals with small, local anomalies by trying to impose consistency but, when the anomaly exceeds threshold, an interaction with the right hemisphere forces a "paradigm shift". A failure of this process, in patients with right hemisphere damage, might partially account for anosognosia. Finally, I present a new conceptual framework that may help link several psychological and neurological phenomena such as Freudian defense mechanisms, vestibular stimulation, anosognosia, memory repression, visual illusions, anterograde amnesia, REM sleep, dreaming, and humor. (shrink)

In his last papers about deontic logic, von Wright sustained that there is no genuine logic of norms. We argue in this paper that this striking statement by the father of deontic logic should not be understood as a death sentence to the subject. Rather, it indicates a profound change in von Wright's understanding about the epistemic and ontological role of logic in the field of norms. Instead of a logical constructivism of deontic systems revealing a necessary structure of prescriptive (...) discourse, which marked his earlier efforts, he adopted the view that such systems should be seem as mere objects of comparison, i.e. as providing practical standards of rationality for normgiving activity. Within such view he proposed an interpretation of standard deontic logic in such a way to free deontic logicians from the philosophical difficulties related to the so-called Jørgensen's dilemma and deontic paradoxes. This effort, as we claim in the present paper, is an application of Wittgenstein's therapeutic method to dissolve philosophical difficulties caused by the use of logical tools to model relations between norms. (shrink)

This response to “A rational cure for pre-reproductive stress syndrome” first suggests it is existence that is essential and prerequisite to everything good or bad, therefore it deserves to be protected and respected. Secondly, it argues that every life is worth living, even if it is worse than some other lives, if the only alternative is non-existence. Finally, it takes a critical view of and challenges Häyry’s suggestion that in a good clinical situation, the idea of the irrationality of (...) having children could be a legitimate part of the guidance given, since it is not the counsellor’s or doctor’s duty to advise a couple who wish to have children that it is irrational or even immoral to bring a child into life. (shrink)

Neurological syndromes in which consciousness seems to malfunction, such as temporal lobe epilepsy, visual scotomas, Charles Bonnet syndrome, and synesthesia offer valuable clues about the normal functions of consciousness and ‘qualia’. An investigation into these syndromes reveals, we argue, that qualia are different from other brain states in that they possess three functional characteristics, which we state in the form of ‘three laws of qualia’. First, they are irrevocable: I cannot simply decide to start seeing the sunset as green, (...) or feel pain as if it were an itch; second, qualia do not always produce the same behaviour: given a set of qualia, we can choose from a potentially infinite set of possible behaviours to execute; and third, qualia endure in short-term memory, as opposed to non-conscious brain states involved in the on-line guidance of behaviour in real time. We suggest that qualia have evolved these and other attributes because of their role in facilitating non-automatic, decision-based action. We also suggest that the apparent epistemic barrier to knowing what qualia another person is experiencing can be overcome by using a ‘bridge’ of neurons; and we offer a hypothesis about the relation between qualia and one's sense of self. (shrink)

Emil Kraepelin's nosology has been reinvented, for better or worse. In the United States, the rise of the neo-Kraepelinian nosology of DSM-III resuscitated Kraepelin's work but also differed from many of his ideas, especially his overtly biological ontology. This neo-Kraepelinian system has led to concerns regarding overdiagnosis of psychiatric syndromes (.

A number of papers have appeared recently arguing for the conclusion that it is ethically acceptable to infect healthy volunteers with severe acute respiratory syndrome coronavirus 2 as part of research projects aimed at developing COVID-19 vaccines or treatments. This position has also been endorsed in a statement by a working group for the WHO. The papers generally argue that controlled human infection is ethically acceptable if the risks to participants are low and therefore acceptable, the scientific quality of (...) the research is high, the research has high social value, participants give full informed consent, and there is fair selection of participants. All five conditions are necessary premises in the overall argument that such research is ethically acceptable. The arguments concerning risk and informed consent have already been critically discussed in the literature. This paper therefore looks specifically at the arguments relating to condition 3 ‘high social value’ and condition 5 ‘fair selection of participants’ and shows that whereas they may be valid, they are not sound. It is highly unlikely that the conditions that are necessary for ethical CHI trials to take place will be fulfilled. Most, if not all, CHI trials will thus be well intentioned but unethical. (shrink)

A t first glance you might not noorder, which afflicts about 0.5 percent of tice anything odd on meeting a American children. Neither researcher young boy with autism. But if had any knowledge of the other’s work, you try to talk to him, it will and yet by an uncanny coincidence each quickly become obvious that gave the syndrome the same name: autism, something is seriously wrong. He may not which derives from the Greek word autos, make eye contact (...) with you; instead he may meaning “self.” The name is apt, because avoid your gaze and fidget, rock his body the most conspicuous feature of the disorto and fro, or bang his head against the der is a withdrawal from social interacwall. More disconcerting, he may not be tion. More recently, doctors have adopted able to conduct anything remotely resemthe term “autism spectrum disorder” to bling a normal conversation. Even though make it clear that the illness has many rehe can experience emotions such as fear, lated variants that range widely in severity rage and pleasure, he may lack genuine but share some characteristic symptoms. empathy for other people and be oblivious Ever since autism was identified, reto subtle social cues that most children searchers have struggled to determine would pick up effortlessly. what causes it. Scientists know that sus- In the 1940s two physicians—Americeptibility to autism is inherited, although.. (shrink)

Misidentification syndromes occur commonly in neuropsychiatric practice and can be explained through aberrant integration of recollection and familiarity, in keeping with a dysfunction at the level of the attributional system in the new integrative memory model. We examine neuroimaging findings associated with Fregoli and Capgras syndromes and compare these with the proposed neural substrate of the integrative memory model supporting the core and attribution functions.

K L Kahlbaum published in 1874 the first recorded description of catatonia. Akinetic catatonia is now defined as a neuropsychiatric syndrome principally characterised by akinesia, mutism, stupor, and catalepsy. 1 Even if some advances have been made in the recognition of catatonia, in particular by the development of different rating scales, 1 the pathophysiology of this syndrome is not clearly established. A right handed 14 year old girl presented with akinetic catatonia during an episode of depression in the (...) context of a bipolar type I disorder. Her catatonic status was characterised by akinesia with brief episodic spontaneous stereotyped movements, mutism, no spontaneous oral intake, catalepsy, waxy flexibility, and stupor with brief occasional eye contacts. This corresponded to a total score of 19 on the Northoff Catatonia Scale.1 Electroencephalogram performed one day after onset of symptoms showed diffuse theta activity with sporadic diffuse delta activity. Cerebral magnetic resonance imaging was normal. Brain positron emission tomographies (PET) were obtained on a CTI-Siemens HR+ tomograph. A first PET (PET1) using (18F(- fluorodeoxyglucose (FDG) was performed on day 2 in a drug free state. Thereafter, intramuscular injection of 2 mg of lorazepam induced rapid clinical remission of the akinetic phase. Oral lorazepam was then given (3.75 mg/day) during five days. On day 8, a second PET with FDG was performed while the patient was treated by olanzapine (15 mg/day) and presented hyperactivity, logorrhoea, and disinhibition characterised by uncontrolled social interactions and physical contacts. Neuropsychological testing performed some days after remission revealed no apraxia or language disturbances but dysfunction of executive tasks manifested in the revised Wisconsin card sorting, the Tower of London, Stroop, and Trailmaking tests. Voxel based analyses comparing patient’s cerebral glucose metabolism with that of 29 right handed healthy controls (16 women and 13 men, mean age 32) were performed using Statistical Parametric Mapping (SPM99) (Wellcome Department of Cognitive Neurology, London, UK).. (shrink)

In this article, tragedy and utopia are juxtaposed, and it is proposed that the problem of “medicalisation” is better understood in a framework of tragedy than in a utopian one. In utopia, it is presupposed that there is an error behind every setback and every side effect, whereas tragedy brings to light how side effects can be the result of irreconcilable conflicts. Medicalisation is to some extent the result of such a tragic conflict. We are given power by medical progress, (...) but are also confronted with our fallibility, thus provoking insecurity. This situation is illustrated by the sudden infant death syndrome . Recent epidemiological investigations have shown that infants sleeping in a prone position have a 15–20 times higher risk of dying from SIDS than infants sleeping in a supine position. A simple means of preventing infant death is suggested by this discovery, but insecurity is also created. What else has been overlooked? Perhaps a draught, or wet diapers, or clothes of wool are just as dangerous as sleeping prone? Further investigations and precautions will be needed, but medicalisation prevails. (shrink)

Neurological syndromes in which consciousness seems to malfunction, such as temporal lobe epilepsy, visual scotomas, Charles Bonnet syndrome, and synesthesia offer valuable clues about the normal functions of consciousness and ‘qualia’. An investigation into these syndromes reveals, we argue, that qualia are different from other brain states in that they possess three functional characteristics, which we state in the form of ‘three laws of qualia ’ based on a loose analogy with Newton’s three laws of classical mechanics. First, they (...) are irrevocable: I cannot simply decide to start seeing the sunset as green, or feel pain as if it were an itch; second, qualia do not always produce the same behaviour: given a set of qualia, we can choose from a potentially infinite set of possible behaviours to execute; and third, qualia endure in short-term memory, as opposed to non-conscious brain states involved in the on-line guidance of behaviour in real time. We suggest that qualia have evolved these and other attributes (e.g. they are ‘filled in’) because of their role in facilitating non-automatic, decision-based action. We also suggest that the apparent epistemic barrier to knowing what qualia another person is experiencing can be overcome simply by using a ‘bridge ’ of neurons; and we offer a hypothesis about the relation between qualia and one’s sense of self. (shrink)

There is a disparity between the multitude of apparently successful expert system prototypes and the scarcity of expert systems in real everyday use. Modern tools make it deceptively easy to make reasonable prototypes, but these prototypes are seldom made subject to serious evaluation. Instead the development team confronts their product with a set of cases, and the primary evaluation criterion is the percentage of correct answers: we are faced with a “95% syndrome”. Other aspects related to the use of (...) the system are almost ignored. There is still a long way to go from a promising prototype to a final system.It is maintained in the article that a useful test must be performed by future users in a situation that is as realistic as possible. If this is not done claims of usefulness cannot be justified. It is also stated that prototyping does not make “traditional” analysis and design obsolete, although the contents of these activities will change.In order to discuss the effects of using the systems a distinction between expert systems as media, tools and experts is proposed. (shrink)

Response to: A rational cure for prereproductive stress syndrome.