“Excited Delirium Syndrome” (ExDS) is a controversial diagnosis. The supposed syndrome is sometimes considered to be a potential cause of death. However, it has been argued that its sole purpose is to cover up excessive police violence because it is mainly used to explain deaths of individuals in custody. In this paper, we examine the epistemic conditions giving rise to the controversial diagnosis by discussing the relation between causal hypotheses, evidence, and data in forensic medicine. We (...) argue that the practitioners’ social context affects causal inquiry through background assumptions that enter inquiry at multiple stages. This analysis serves to better understand the wide usage of the controversial diagnosis of ExDS. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Excited DeliriumThe Self-Fulfilling Prophecy of Police BrutalityKathryn Petrozzo (bio)In their timely and pressing piece, Arjun Byju and Phoebe Friesen explore the contentious diagnosis of excited delirium; a syndrome characterized by erratic, aggressive, and “delusional” behavior (2023). Overwhelmingly, this term is used when individuals come in contact with police and/or first responders. Although much attention has been given to debating whether or not this is a (...) “real” diagnosis, the authors want to shift the focus to examining the work that excited delirium is doing in the world, as well as the underlying beliefs guiding it that are perpetuating substantial harm. Drawing significantly on the work of Ian Hacking (1998, 2006) and Sherene Razack (2015), Byju and Friesen explore what kinds of people are being made up by the label of “excited delirium” and the subsequent dehumanization that perpetuates violence towards those in this grouping.Despite the lack of an agreed upon definition, excited delirium tends to frequently group together young Black men and other marginalized people of color, who have a psychiatric history, and those who have taken or are suspected to have taken drugs (Byju & Friezen, 2023). As this is “observed” when individuals come into contact with law enforcement and/or first responders, those who are presumed to be suffering from excited delirium are typically met with physical restraints (chokeholds, hogties, etc.), forced injections of sedatives, and/or taser guns. The violent reactions are often justified not only by this “diagnosis,” but the employment of racial stereotypes; notably, the notion that Black bodies as being less susceptible to pain. As the authors aptly put it:This kind of symptom language helps make up the novel category of a person who suffers from excited delirium: a crazed and inhumane monster, a golem that must be met with unrelenting and superordinate force, who is fated, regardless of interventions, to die a spontaneous death. This paradox, that those with excited delirium are supposedly both too strong and too weak, is at the core of the illness narrative.(2023)It is evident that this label is reinforcing the combination of two harmful stereotypes: the notion that those suffering from severe mental illness occupy a space that is “less than fully human,” and racist stereotyping of Black bodies “superseding human strength.” This perpetuates total dehumanization of the individual, where it is then justified to invoke brutal tactics, as well as signal [End Page 357] to the greater community this is how individuals with mental illnesses and/or belonging to a particular racial group (chiefly, Black men), should be treated. This is despite the fact that those suffering from mental illnesses are significantly more likely to be victims of violent crimes, Black Americans are 3.2 times more likely to be murdered by police, and convergence of these factors (being Black and living with a mental illness) increases likelihood of such fatal interactions (Schwartz & Jahn 2020; Shadravan, Edwards, & Vinson 2021; Stuart, 2003).Although I am in wholehearted support of their account, I take issue with the authors’ conceptualization of excited delirium as non-falsifiable, as well as the notion that diseases, generally, are falsifiable. In an attempt to further criticize the utilization of excited delirium, Byju and Friesen call upon Karl Popper’s falsifiability criterion as a measure for what constitutes as scientific; arguing that excited delirium is not a legitimate scientific concept as it is impossible to falsify. First, I am not convinced that excited delirium is in principle non-falsifiable; as the way in which it’s conceptualized actually appears to be falsifiable. The authors point out that external factors, such as tasing and violent restraints, are clearly the causal explanation, which should in fact, lead one to reject the hypothesis of an excited delirium diagnosis. However, in practice, those who are seeking to exonerate the police/first responders responsible for these deaths, are not accepting this evidence leading them to reject the excited delirium diagnosis, but rather, are crafting an incorrect causal narrative. This is deeply problematic, but it does not necessarily render excited delirium as non-falsifiable. More broadly, I am concerned with the reliance on the falsifiability criterion, which has been widely criticized in the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Excited DeliriumWhat’s Psychiatry Got to do With It?Paul B. Lieberman, MDIf in life we are surrounded by death, so too in the health of our intellect by madness.—WittgensteinDelirium is a medical syndrome defined as “a relatively acute decline in cognition that fluctuates over hours or days” whose primary manifestation is a deficit of attention. It is common, estimated to occur in 10% to more than 50% of (...) hospitalized patients, with higher prevalence rates among people in nursing homes and at the end of life. It is often fatal, with a mortality rate in the hospital estimated to be 25% to 33%. Caused by a wide variety of conditions and frequently difficult to diagnose, it lacks characteristic postmortem pathology (Josephson & Miller 2018)‘Excited delirium,’ as Byju and Friesen forcefully argue (Byju & Friesen, 2023), is, if nothing else, an excuse. The ‘diagnosis’ has not been empirically validated and remains controversial (American Psychiatric Association, 2020). And while delirium is usually treated by internists and emergency medicine physicians, psychiatrists should also be concerned about the misuse of a putative medical diagnosis and join actively in discussion about it. For one thing, patients mis-diagnosed with this condition, as Byju and Friesen’s examples suggest, may actually have another psychiatric condition and, so, be people for whose safety we should advocate. Moreover, the kinds of police interventions which Byju and Friesen document as involving excited delirium also befall patients with other psychiatric problems in whom the issue of delirium does not arise.There are at least two broad ways in which psychiatrists are qualified and obligated to engage with this issue. As physicians, we should join our medical colleagues in carefully but persistently telling the scientific, medical truth. As psychiatrists, we should bring psychiatric knowledge into the discussion, for example, by explaining what can happen when people who do not, apparently, have a diagnosable mental disorder interact under stress with other people who, apparently, do.Delirium is a clinical diagnosis, made when characteristic signs and symptoms are present which should not be made ‘by exclusion’ when, as may happen, other causes are not found. There is no evidence of delirium in any of the three clinical descriptions Byju and Friesen provide. Perhaps such evidence exists which is not in their brief reports, but these three people appear to have had, either, another psychiatric condition, such as psychosis or drug intoxication, or perhaps no [End Page 353] diagnosis at all. Psychiatrists are particularly wellpositioned to make this point since patients with mental health problems are often misdiagnosed when they seek medical attention and are told, and treated as if, “it’s all (“just”!) psychological.”Excited delirium, if it exists, is fatal in 10% of cases (Gonin, Beysard, Hersin, & Carron, 2018) and, although this is lower than the rate for delirium in general, it is still high. Medical personnel must be available to evaluate and ensure the safety of patients in custody.The potential conflict between protecting the patient and protecting the public should not be overstated. Although physical trauma and excessive administration of medications, including ketamine 500 mg IV (Orhurhu, Vashicht, Claus, & Cohen, 2023) can be lethal, mechanical restraint by itself is not (Chieze et al., 2019; Gleerup et al., 2019): something else is necessary, such as asphyxiation (Evans, Wood, & Lambert, 2003). Nor is restraint necessary in many cases in which ‘de-escalation’ techniques can be equally effective (Garriga et al., 2016; Fernández-Costa, 2020). Perhaps these points are best made by law enforcement leaders—and they have been—but psychiatrists can add that safe management of potential violence can be provided for agitated people with psychiatric conditions.Although it is not clear what kind of strength ‘superhuman’ strength might be (certainly not medical), relative imperviousness to pain is clinically described. Its locus classicus is Beecher’s observation, during World War II, that injured soldiers awaiting return home from the front, required lower than usual doses of analgesics (Beecher, 1946). And it’s a common experience, scientifically confirmed, that physical trauma may not become painful until sometime after the injury (Melzack, Wall, & Ty, 1982). But pain is a warning. Its absence is not a license, but a caution... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Excited DeliriumWhat’s Psychiatry Got to do With It?Paul B. Lieberman, MDIf in life we are surrounded by death, so too in the health of our intellect by madness.—WittgensteinDelirium is a medical syndrome defined as “a relatively acute decline in cognition that fluctuates over hours or days” whose primary manifestation is a deficit of attention. It is common, estimated to occur in 10% to more than 50% of (...) hospitalized patients, with higher prevalence rates among people in nursing homes and at the end of life. It is often fatal, with a mortality rate in the hospital estimated to be 25% to 33%. Caused by a wide variety of conditions and frequently difficult to diagnose, it lacks characteristic postmortem pathology (Josephson & Miller 2018)‘Excited delirium,’ as Byju and Friesen forcefully argue (Byju & Friesen, 2023), is, if nothing else, an excuse. The ‘diagnosis’ has not been empirically validated and remains controversial (American Psychiatric Association, 2020). And while delirium is usually treated by internists and emergency medicine physicians, psychiatrists should also be concerned about the misuse of a putative medical diagnosis and join actively in discussion about it. For one thing, patients mis-diagnosed with this condition, as Byju and Friesen’s examples suggest, may actually have another psychiatric condition and, so, be people for whose safety we should advocate. Moreover, the kinds of police interventions which Byju and Friesen document as involving excited delirium also befall patients with other psychiatric problems in whom the issue of delirium does not arise.There are at least two broad ways in which psychiatrists are qualified and obligated to engage with this issue. As physicians, we should join our medical colleagues in carefully but persistently telling the scientific, medical truth. As psychiatrists, we should bring psychiatric knowledge into the discussion, for example, by explaining what can happen when people who do not, apparently, have a diagnosable mental disorder interact under stress with other people who, apparently, do.Delirium is a clinical diagnosis, made when characteristic signs and symptoms are present which should not be made ‘by exclusion’ when, as may happen, other causes are not found. There is no evidence of delirium in any of the three clinical descriptions Byju and Friesen provide. Perhaps such evidence exists which is not in their brief reports, but these three people appear to have had, either, another psychiatric condition, such as psychosis or drug intoxication, or perhaps no [End Page 353] diagnosis at all. Psychiatrists are particularly wellpositioned to make this point since patients with mental health problems are often misdiagnosed when they seek medical attention and are told, and treated as if, “it’s all (“just”!) psychological.”Excited delirium, if it exists, is fatal in 10% of cases (Gonin, Beysard, Hersin, & Carron, 2018) and, although this is lower than the rate for delirium in general, it is still high. Medical personnel must be available to evaluate and ensure the safety of patients in custody.The potential conflict between protecting the patient and protecting the public should not be overstated. Although physical trauma and excessive administration of medications, including ketamine 500 mg IV (Orhurhu, Vashicht, Claus, & Cohen, 2023) can be lethal, mechanical restraint by itself is not (Chieze et al., 2019; Gleerup et al., 2019): something else is necessary, such as asphyxiation (Evans, Wood, & Lambert, 2003). Nor is restraint necessary in many cases in which ‘de-escalation’ techniques can be equally effective (Garriga et al., 2016; Fernández-Costa, 2020). Perhaps these points are best made by law enforcement leaders—and they have been—but psychiatrists can add that safe management of potential violence can be provided for agitated people with psychiatric conditions.Although it is not clear what kind of strength ‘superhuman’ strength might be (certainly not medical), relative imperviousness to pain is clinically described. Its locus classicus is Beecher’s observation, during World War II, that injured soldiers awaiting return home from the front, required lower than usual doses of analgesics (Beecher, 1946). And it’s a common experience, scientifically confirmed, that physical trauma may not become painful until sometime after the injury (Melzack, Wall, & Ty, 1982). But pain is a warning. Its absence is not a license, but a caution... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Excited DeliriumFalsifiability, Causality, and the Importance of AdvocacyArjun Byju, MD (bio) and Phoebe Friesen, PhD (bio)We want to begin by thanking both Kathryn Petrozzo and Paul B. Lieberman for taking the time to read and respond to our article, “Making Up Monsters, Redirecting Blame: An Examination of Excited Delirium,” so thoughtfully. They each offered us an opportunity to consider dimensions of excited delirium that (...) we had not encountered as of yet and encouraged us to think more carefully about them. In our response, we consider each of their commentaries in turn, given that, as a philosopher and a psychiatrist, they each speak to different aspects of our argument.First, we turn to Kathryn Petrozzo’s commentary “Excited Delirium: The Self-Fulfilling Prophecy of Police Brutality.” We are grateful for her generous comments and careful engagement with our arguments. While much of the commentary is supportive of our piece, Petrozzo makes three critical and insightful points that we hope to respond to here.The first point Petrozzo makes is that our assertion that excited delirium is non-falsifiable is not supported. She suggests that those “seeking to exonerate the police/first responders responsible for these deaths, are not accepting this evidence leading them to reject the excited delirium diagnosis, but rather, are crafting an incorrect causal narrative. This is deeply problematic, but it does not necessarily render excited delirium as nonfalsifiable.”Although we are intrigued by this challenge, we would like to hear more about what it would look like to falsify the phenomenon of excited delirium. The way that the causal theories related to it are structured are such that if one causal factor is not present (e.g., drug use), then another causal factor can be located (e.g., mental health), and if that is not found, another may be simply made up (e.g., genetic predisposition), making excited delirium multiply realizable in a seemingly endless fashion. This is precisely what took place in the case of Anthany Dawson, who was initially said to have been experiencing a mental health crisis, but was later said to have died from excited delirium related to a genetic condition never identified before (Hon, 2004; Razack, 2015). [End Page 361]In practice, confirmations of excited delirium are found on the basis of various unrelated factors, such that after a death involving police force, there is almost always the option to reach for excited delirium as an explanation/exoneration. According to proponents, there is no factor that could be present that could rule out the diagnosis of excited delirium as it is currently constructed. Indeed, even in the presence of video evidence showing police officers choking an individual until they stop breathing, these deaths are still attributed to excited delirium. This seems like a clear instance of non-falsifiability.Although Petrozzo might maintain that this is simply “an incorrect causal narrative,” it is a causal narrative that aligns with the current theoretical scaffolding surrounding excited delirium.The second point Petrozzo makes is regarding widespread criticisms of Popper’s demarcation criterion of falsifiability. Indeed, this criterion has been called too inclusive, in that any empirical claim can be called falsifiable in principle—even if it refers to a future apocalypse or a UFO landing. It has also been criticized for being too exclusive, in that it ignores the “remarkable tenacity of scientific theories,” as Lakatos puts it (2009, p. 516). In practice, scientists do not merely abandon a theory if it is not supported by facts; they tend to find other explanations (e.g., the measurement was faulty) rather than accept an instance of falsification.Despite this, we believe it is still worth discussing falsifiability in the context of excited delirium for two reasons. First, while falsifiability may not be successful as a criterion that draws a line between science and pseudoscience, in this case, we argue, it still works well as a signifier of pseudoscience. Recently, many interested in the demarcation question have turned towards pluralism as a way to identify pseudoscientific practices (Pigliucci & Boudry, 2013). And excited delirium offers an excellent example of a phenomenon that bumps up against many of the features that might indicate a pseudoscientific practice... (shrink)

This paper examines the controversial diagnosis of excited delirium, which is often employed after individuals die during an encounter with the police. Rather than asking the important, and widely explored, question of whether the diagnosis is real or not, here, we consider how it operates in the world and why it seems to stick around, despite growing controversy and resistance to its use. First, we consider the question of what kinds of people are made up through the diagnosis (...) of excited delirium, exploring how racial stereotypes are exploited and certain behaviors are engendered through the illness script offered by excited delirium. Next, we ask what work excited delirium doing is doing in the world, unpacking how it tends to justify force and redirect responsibility, as well as who is it serving, and who is it not benefitting. Finally, we interrogate the slippery logic of excited delirium, examining how the way it is employed renders it non-falsifiable, and therefore impossible to uncover as real or unreal. (shrink)

Delirium, a common syndrome in terminally ill people, presents specific challenges to a good death in end‐of‐life care. This paper examines the relational engagement between hospice nurses and their patients in a context of end‐of‐life delirium. Ethnographic fieldwork spanning 15 months was conducted at a freestanding residential hospice in eastern Canada. A shared value system was apparent within the nursing community of hospice; patients’ comfort and dignity were deemed most at stake and therefore commanded nurses’ primary attention. (...) This overarching commitment to comfort and dignity shaped all of nursing practice in this hospice, including practices related to end‐of‐life delirium. The findings of this study elaborate the ways in which hospice nurses interpreted and responded to the discomfort of their patients in delirium, as well as the efforts they made to understand their patients’ subjective experiences and to connect with them in supportive ways. In addition to what is already known about clinical assessment and treatment of delirium in palliative care settings, the findings of this study offer points of reflection for nurses anywhere who are contending with the relational challenges that delirium presents in end‐of‐life care. (shrink)

The sudden infant death syndrome (SIDS) is the sudden, unexpected death of an infant that is not explained by autopsy, death scene examination, and history. The etiology is unknown. Recent postmortem studies have discovered abnormalities in brainstem serotonergic neurons, but how these translate into dysfunction and cause SIDS is uncertain. Recently, lethal effects in transgenic mice with overexpression of the serotonin 1A autoreceptor have been described. Many die spontaneously between postnatal day 40 (P40) and P80, and some spontaneously exhibit (...) bradycardias and drops in body temperature. The severity of the autonomic dysfunction and its age dependence suggest relevance to SIDS. However, SIDS cases have decreased serotonin 1A autoreceptor binding, which is opposite to its overexpression in the mice, and the peak incidence of SIDS is between 2 and 6 months of age, which is arguably younger (in relative terms) than the ages at which the mice die. Nevertheless, the description of an animal model with serotonin defects that has autonomic dysfunction and spontaneous mortality at a young age is an exciting finding of possible importance for understanding SIDS. (shrink)

An exciting attempt to establish and elaborate in some detail a method which will achieve the proper compromise between "scientific precision" and "humanistic significance" in cultural anthropology and the history of ideas. The author begins by distinguishing theoretical from overt behavior; the former is his concern, and is defined to encompass the higher products of a given culture: poetry, painting, politics, and metaphysics are the chief examples utilized. A set of seven linear and bi-polar "axes-of-bias" are then detailed as a (...) schematic tool for arriving at the common denominator which may be said to characterize each of these cultural expressions. Sample axes are the Continuity/discreteness axis-bias, Static/dynamic axis-bias, and Order/disorder axis-bias. In addition, the claim is made that the question of whether or not the works of a given personality coincide with a previously determined syndrome can be significantly decided through a content analysis of his works, which results in a profile drawn from his placement on each of these axes. The title of the book is taken from the fact that Romanticism is the chief phenomenon by which the method is tested. The author is careful to guard himself against claiming "objective truth" for any of his analyses, let alone for any of the syndromes he has detailed; and it is this, namely his heuristic theory of theories, that the philosopher will find most interesting, and, perhaps, most debatable.—E. A. R. (shrink)

The DNA hypomethylating agents (HMA) azacitidine (AZA) and decitabine (DAC) improve survival and transfusion independence in myelodysplastic syndrome (MDS) and enable a low intensity cytotoxic treatment for aged AML patients unsuitable for intensive chemotherapy, particularly in combination with novel agents. The proposed mechanism of AZA and DAC relies on active DNA replication and therefore patient responses are only observed after multiple cycles of treatment. Although extended dosing may provide the optimal scheduling, the reliance of injectable formulation of the drug (...) limits it to intermittent treatment. Recently, an oral formulation of AZA demonstrated significantly improved patient relapse free survival (RFS) and overall survival (OS) when used as maintenance after chemotherapy for AML. In addition, both DAC and AZA were found to be highly effective to improve survival in elderly patients with AML through combination with other drugs. These recent exciting results have changed the therapeutic paradigm for elderly patients with AML. In light of this, we review current knowledge on HMA mechanism of action, clinical trials exploring dosing and scheduling, and recent HMA combination therapies to enhance efficacy. (shrink)

Psychological Aspects of Risk and Aggression among Motorcyclists - "Mad Max" Syndrome The primary objective of this study was the psychological examination of a group of Polish motorcyclists against a group of students and graduates of Technical Universities. This work poses a question regarding the differences in temperament, aggression and the level of risk between motorcyclists and the control group. The second question was whether it was possible to create a typology of Polish motorcyclists taking into account the variables (...) describing risk, temperament and aggression. This study used the Pavlovian Temperamental Scale, Stimulating-Instrumental Risk Inventory, SIRI 2001, Multifactor Risky Behavior Scale, Unhealthy behavior Inventory and the Buss and Perry Aggression Questionnaire. The tests were performed on 267 motorcyclists and 188 students and graduates of Technical Universities. A number of important differences was observed between the motorcyclists and the control group. Motorcyclists had a higher level of mobility of nervous processes and higher degree of excitation at the lower level of inhibitory processes. In terms of the measured level of risk they also had a higher level of stimulating, instrumental and unhealthy risk, at the lower levels of physical, social, ethical and financial risk in relation to the control group. Cluster and confirmation analyses showed the existence of three sub-groups of motorcyclists: prevaricators, ones with a Mad Max syndrome, and adventurers. The confirmation analysis was carried out on an additional group of 243 motorcyclists. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.1 (2004) 35-41 [Access article in PDF] The Rationality of Psychosis and Understanding the Deluded Matthew R. Broome Campbell's important and influential paper (Campbell 2001) has framed the debate that Bayne and Pacherie (2004) most explicitly, and Klee (2004) and Georgaca (2004) more implicitly, engage in. Campbell has offered two broad ways of thinking about explanations of delusions—the empirical and the rational. He offers some (...) criticism of the former and an endorsement of the latter. Campbell uses examples from clinical psychopathology to illustrate his argument and Bayne and Pacherie in turn employ these. Campbell discusses the eponymously named delusions of Capgras and Cotard—the former a subtype of delusional misidentification and the latter a delusion whose content is colored predominantly with nihilistic and possibly hypochondriacal themes. Campbell, Bayne and Pacherie, and Klee discuss the empirical data in relation to such delusions and as an aid to discussing the empirical model more generally. It does seem a little unfortunate that these delusions, which are less than typical, become the focus of Campbell's paper, and Bayne and Pacherie's criticism of his work. Delusions are remarkably heterogeneous; this indeed may be part of the reason why there is so much difficulty in reaching a definition as Klee discusses, and occur in a wide variety of mental and neurological illnesses. The most common delusions are those of persecution and reference (World Health Organization [WHO] 1973) and typically occur in schizophrenia. By contrast, delusional misidentification occurs most commonly in patients with dementia, delirium, and focal cognitive impairment, but can occur in other functional psychoses such as an affective or schizophrenic psychosis. The most common form of delusional misidentification is not that of either the exotic Capgras or Fregoli syndromes but delusional misidentification for place; thus, although Bayne and Pacherie's arguments against Campbell may still hold, delusional misidentification tends to occur in the context of a patient believing that they are at home or on holiday rather than in hospital and may not necessarily involve close family members or other intimate relationships. Similarly, Cotard's syndrome tends to occur in the context of a severe depressive illness with mood-congruent psychotic symptoms, typically in an elderly individual. It does not have to have the content that the deluded is dead, but can include beliefs, for example, that the world no longer exists or that their internal organs are not present. Thus, a patient with either Capgras' or Cotard's syndrome is likely to differ from patients with delusions of persecution. They would [End Page 35] have different diagnoses, probably be older, and have a greater likelihood of structural abnormalities of the brain on imaging and consequent neuropsychological dysfunction. That is not to say that patients with schizophrenia have normal cerebral anatomy and neuropsychology, but rather that the Capgras' and Cotard's patients are likely to have neurological quality to their presentation that is clinically relevant, rather than what commonly the case in schizophrenia and the other functional psychoses, where the neurological abnormalities are only currently important at the level of academic research. Empirical Models of Delusion Formation Different delusions may not have that much in common, nor may the patients who believe in them. This in turn relates to the empirical paradigm that both Campbell and Bayne and Pacherie discuss. It is true that current research, and indeed the clinical practice of cognitive behavioral therapy for psychosis, is indebted to the work of Maher and it is within his legacy which we work. This, however, is not to say that we think his initial formulation was correct. Maher's (1988, 1992) work focused attempts in explaining delusions—both to support and refute his thesis that delusions are the consequence of normal cognitive mechanisms seeking to explain an anomalous sensory experience. Such a view initially led to work demonstrating delusions in the absence of anomalous perceptions, the presence of reasoning biases in the deluded population, and the possibility that abnormal sensory experience may be consequent upon biased cognitive processes (Garety and Freeman 1999). More recent work has demonstrated the prevalence of... (shrink)

We present a theory of human artistic experience and the neural mechanisms that mediate it. Any theory of art has to ideally have three components. The logic of art: whether there are universal rules or principles; The evolutionary rationale: why did these rules evolve and why do they have the form that they do; What is the brain circuitry involved? Our paper begins with a quest for artistic universals and proposes a list of ‘Eight laws of artistic experience’ -- a (...) set of heuristics that artists either consciously or unconsciously deploy to optimally titillate the visual areas of the brain. One of these principles is a psychological phenomenon called the peak shift effect: If a rat is rewarded for discriminating a rectangle from a square, it will respond even more vigorously to a rectangle that is longer and skinnier that the prototype. We suggest that this principle explains not only caricatures, but many other aspects of art. Example: An evocative sketch of a female nude may be one which selectively accentuates those feminine form-attributes that allow one to discriminate it from a male figure; a Boucher, a Van Gogh, or a Monet may be a caricature in ‘colour space’ rather than form space. Even abstract art may employ ‘supernormal’ stimuli to excite form areas in the brain more strongly than natural stimuli. Second, we suggest that grouping is a very basic principle. The different extrastriate visual areas may have evolved specifically to extract correlations in different domains , and discovering and linking multiple features into unitary clusters -- objects -- is facilitated and reinforced by direct connections from these areas to limbic structures. In general, when object-like entities are partially discerned at any stage in the visual hierarchy, messages are sent back to earlier stages to alert them to certain locations or features in order to look for additional evidence for the object . Finally, given constraints on allocation of attentional resources, art is most appealing if it produces heightened activity in a single dimension rather than redundant activation of multiple modules. This idea may help explain the effectiveness of outline drawings and sketches, the savant syndrome in autists, and the sudden emergence of artistic talent in fronto-temporal dementia. In addition to these three basic principles we propose five others, constituting a total of ‘eight laws of aesthetic experience’. (shrink)

In this view from 2007–2009, the ethical challenges facing a potential global effort to control infectious disease are explored; they provide sobering insight into the challenges of later decades. Despite the devastating pandemic of HIV/AIDS that erupted in the early 1980s, despite the failure to eradicate polio and the emergence of resistant forms of tuberculosis that came into focus in the 1990s, and despite newly emerging diseases like Severe Acute Respiratory Syndrome (SARS) in 2003 and the fearsome prospect of (...) human-to-human avian flu, it is nevertheless a time of some excitement over prospects for effective control of much of infectious disease. Funded by national and international governmental and nongovernmental organizations (NGOs), private foundations, and even popular entertainers, large-scale new efforts are under way to address global killers like AIDS, tuberculosis, and malaria, among others. This “marvelous momentum” can be seen as part of a continuing effort from the time of Jenner onward. Extrapolating from this, we explore the notion of a “comprehensive global effort for the eradication, elimination or control of infectious disease”, with particular attention to the ethical issues that arise. This is to “think big” about disease-control efforts that are now often done in piecemeal ways. This chapter identifies five tracks along which such efforts need to be pursued: (1) national and international organizations and the development of collective will; (2) epidemiological and health care infrastructure; (3) scientific development; (4) religious, social, and cultural considerations; (5) legal and social protections for individuals and groups. Each of these poses significant ethical issues which, we argue, should be viewed in a comprehensive way, to ensure that practice, research, and policy in each of these areas understands the person with communicable infectious disease as both victim and (potential) vector. (shrink)

Botanical preparations used by shamans in rituals for divination, prophecy, and ecstasy contain widely different psychoactive compounds, which are incorrectly classified under a single denomination such as “hallucinogens,” “psychedelics,” or “entheogens.” Based on extensive ethnopharmacological search, I proposed a psychopharmacological classification of magic plants in 1979. This paper re-evaluates this taxonomy in the context of consciousness research. Several groups of psychodysleptic magic plants are proposed: (1) hallucinogens—psilocybin mushrooms, mescaline cacti, dimethyltryptamine snuffs, and the synthetic ergoline lysergic acid diethylamide induce strong (...) perceptual changes, affective intensification, and cognitive enhancement. Their ethnobotanical uses include long lasting divination rituals, prophecy, and sacramental practice. (2) Trance-inducers—ergoline Convolvulaceae and South American Banisteriopsis produce quietness, abstraction, lethargy, mild sensorial and cognitive changes, and salient visual imagery changes used in trance rituals and specific divination practices. (3) Cognodysleptics—marijuana (tetrahydrocannabinol) and other terpene-containing plants induce changes in thought, imagination, and affective functions and are used in short-term divination or oneiromancy. (4) Deliriants—tropane-containing Solanaceae, wild tobacco, and Amanita muscaria (muscimol) induce a delirium characterized by dim and clouded consciousness, stupor, confusion, disorientation, perception distortion, difficulties in recollection, anxiety, irritability, excitation, and behavioral disorganization employed in sorcery, purification, or exorcism rituals. The core mental effects required for a drug to be used in shamanistic rituals include light-headedness, enhanced imagery, and experience intensification. This constellation was the reason why, in his classification of psychoactive compounds, the pioneer German psychopharmacologist Louis Lewin established in 1924 a group of drugs under the appropriate name of Phantastica. (shrink)

The metamorphosis of human beings into wolves is well known in mythology, legend, and scripture, and has been extensively surveyed in history, theology, and literature. Werewolf cases have attracted the attention of both ancient and modern physicians, particularly during the development of modern psychiatry and behavioral neurology. Some writers have suggested that lycanthropes suffered from schizophrenia or had intentionally or involuntarily ingested hallucinogens. Hysteria and affective disorder, either mania or intense depression, could also be invoked as causes. Lycanthropy has often (...) been linked with, and sometimes treated by, henbane and nightshade, and its manifestations could be explained in terms of atropinic delirium. Discoloration of teeth and urine, bizarre behavior, nocturnal wandering, and episodic skin and facial changes have suggested a role for porphyria in the werewolf transformation. Through many historical periods and cultures, persons believed to be werewolves have reportedly exhibited alterations in consciousness, depersonalization and derealization, acute anxiety and agitation, preoccupation with demonic possession, and compulsive or perseverative behavior, sometimes of a violent, sexually deviant or impulsive nature. Such features of werewolf behavior might also be explained by ictal and interictal manifestations of complex partial seizures, or as symptoms of the episodic dyscontrol syndrome associated with frontal lobe or limbic system disease or injury. Lycanthropy was often considered a manifestation of demonic possession or a consequence or indication of participation in necromancy. As such, self-proclaimed or suspected werewolves were often persecuted along with other practitioners of the black arts. It is generally believed that such persecution represented the last efflorescence of medieval demonology, but it has also been suggested that clinical description of illnesses of diabolical origin was part of the evolution of Renaissance medicine from the Galenic past toward the scientifically-based future. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Drama on the Run:A Prelude to Mapping the Practice of Process DramaPamela Bowell (bio) and Brian Heap (bio)In the current educational climate prevailing in a number of countries, increased emphasis is being placed on the concept of "the artist in schools." Funding is being channeled to support a range of initiatives and schemes that are designed to bring arts professionals from all the art forms into the classroom where (...) they place their artistic talents, knowledge, and insights alongside the pedagogic skills of the teacher.We see exciting projects in which artists work with children in school—visual artists to create murals, musicians to compose and perform operas, dancers to choreograph new ballets, and actors and directors to devise plays. Many of the outcomes are of high quality, and the children who have been fortunate enough to be involved have enjoyed the experiences and have gained a great deal from them. This would seem to be a state of affairs to be applauded unreservedly, as such projects surely enrich the lives of the pupils and schools in which they take place. In one sense, of course, this is undeniably true, and we have no intention of suggesting otherwise. However, in reality, this is a much more complex situation. It raises a number of key issues for us as educational practitioners who work in the field of applied theatre, sharing with others, as Judith Ackroyd describes, "a belief in the power of the theatre form to address something beyond the form itself."1The most critical issue is the perceived separation of the artist from the teacher that can sometimes be encouraged by artists in schools projects. We sense a dangerous precedent here. It becomes all too easy for two erroneous assumptions to be made, namely that teachers cannot be considered to be artists in their own right, while artists on the other hand can be accorded [End Page 58] the status of teacher. In our own experience too, the nature of educational funding can be extremely volatile, subject to all kinds of shifts in the prevailing political and economic climate, as well as adjustments to the ways in which funding is applied according to the social and educational priorities of the time. Too frequently, education falls victim to what might be described as "the-flavor-of-the-month syndrome."Those who are involved with teacher education, both pre- and in-service, make superhuman efforts to respond with alacrity to the new demands as courses are reviewed and reorganized accordingly. The trainees of the next generation find themselves with a new "party line" to toe as their courses conform to the new priority. This is all well and good—until the priority changes and gaps suddenly appear in the knowledge or skills or understanding of teachers. What was received wisdom becomes a deficit model as focus changes, and the circle is now expected to be squared.Under these circumstances, it would seem a more prudent policy to train teacher-artists who would have the ability to meld their pedagogical understanding and skill with an aesthetic craft and sensibility than to rely on visiting artists as the "natural" or "normal" providers of arts education. This would ensure not only that teachers would make better, more informed use of visiting artists but also that children's expertly guided engagement with the arts would be a permanent and enduring aspect of their regular schooling rather than a "special" event subject to the vagaries of arts funding or policy. This might seem an easy statement to make for people such as ourselves, who have spent whole careers working as teacher-artists within the field of drama in education. But it might seem an altogether more daunting prospect for teachers, or intending teachers, who are not specialists in the arts.Having spent a great deal of our respective careers working in teacher education, we are very conscious of this possibility. To this end, our research collaboration has been centered on exploring and coming to understand more fully, clearly, and precisely how the teacher functions as an artist within the particular genre of applied theatre known as process drama. Embedded within the increase of our... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Changing Human Nature: Ecology, Ethics, Genes, and God by James C. PetersonDolores L. ChristieChanging Human Nature: Ecology, Ethics, Genes, and God James C. Peterson Grand Rapids, Mich.: Eerdmans, 2010. 259 pp. $18.00Grounding himself in the Christian tradition, James Peterson argues for the moral efficacy of human genetic manipulation. Interpreting intentional intervention as part of human stewardship rather than as a wrongful interference with some divine plan, he takes (...) on the sticky questions, making critical distinctions, for example, between cure and enhancement or welcoming children as they come and making them “better.” Not neglecting future implications of current tinkering with human biology, even in such taboo areas as gamete selection, he contends that engineering a baby free of harmful genes (for example, Tay-Sachs or Down syndrome) not only makes that person better, but it also eliminates an ongoing burden to family, to society, and perhaps to future generations. Treading gingerly among the sacred cows of some Christian ethicists, he advocates the implanting of selected embryos free of unwanted genes; in his view, embryos are not yet persons.Peterson considers serious concerns such as eugenics projects and racial bias but offers standards to address them. He contends that intentionally increasing choices for our children is not only acceptable but also praiseworthy. What parents would not optimize the educational and social opportunities for their child, even without the child’s consent? Interventions should be safe, offer genuine improvement, increase the recipient’s capacity, and make the best use of limited resources. Peterson is not so naive that he does not recognize that technology does not always make us better. He recognizes, too, that his standards do not eliminate risk.Fair enough, but the issue of what “improvement” may mean to the individual as well as to the greater community remains somewhat ambiguous. Peterson suggests that broadening the decision making among a variety of professional and individual cohorts would help, but his argument is not totally persuasive. In sum, Peterson’s treatment falls short of offering a totally satisfying standard for determining which characteristics should be manipulated and which should be accepted. Nor does he demonstrate definitively how a [End Page 187] Christian perspective would contribute to sorting out possible choices. Does the deaf parents’ desire for their child to be deaf like them constitute an instance where intervention should not be attempted? Can the disparate cohorts he suggests as arbiters rise above their own biases? Does Christianity and its belief system offer answers? Readers—even readers who call themselves Christian—will likely be persuaded that genetic intervention is a good, and even compatible with their religious perspective. Nonetheless, they will harbor lingering doubts about how the questions can best be solved, who should solve them, and how Christian belief helps sort among the possibilities. In his closing comments Peterson appears to agree.The book is rich in research and in provocative ideas. It is an exciting book. It is a readable and enlightened contribution to the professional conversation on gene therapy. Peterson’s research is extensive, his argumentation balanced. His attempt to locate the question within the Christian tradition is laudable. Happily, Peterson eschews a creationist approach to world and human origins. Unhappily, his approach to the scriptural text is not always nuanced. His assertion that Jesus himself was different biologically from other human beings (132) seems a stretch. If one takes the passages of Jesus’s biological origins literally, as apparently does the author, what happens to the assertion that Jesus is like other human beings “in all things but sin”? And where did Jesus get the Y chromosomes? While he persuades the reader that genetic intervention is compatible with a Christian worldview, Peterson does not offer—at least in this reviewer’s view—an adequate criterion for navigating this new world of the possible.Dolores L. ChristieJohn Carroll UniversityCopyright © 2013 Society of Christian Ethics... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Standing UpEmily QuinnA 10–year old and her mother walk into a male gynecologist’s office. That sounds like the beginning of a sick joke, right? Imagine how it must have felt to actually be that 10–year–old. I walked into the Salt Lake City ob–gyn office, terrified out of my mind. It was the year 1999 and due to the recent accessibility of the Internet, there was a surprising amount of (...) information about complete androgen insensitivity syndrome (CAIS) available. There was also an active and prominent support group for women with CAIS and other similar conditions. Despite all of this, I was standing in the office of a doctor who knew nothing about my body. He did not direct me to any actual support, and for the next twelve years I went from doctor to doctor, none of them really knowing what to do with me. For as much as I was in and out of the doctor’s office, I never seemed to receive any “care.”It was really difficult to have doctors who knew nothing about my condition. It was scary to be a kid with hundreds of questions but without an adult who had the answers. So many doctors were excited to look at me, to talk to me, to get the chance to meet me. As a child it made me feel like a freak. I felt alone, and scared, like I was on parade for all of these people who didn’t know anything about me except that I was “special.”I was savvy enough to turn to the Internet for help, but searching for “sex disorders” online was a terrifying thing to do back then. Even now, it’s not a safe space for a pre–teen looking for answers. I was so scared and ashamed of my body, and I desperately wanted someone to talk to about it. I found articles about celebrities who were rumored to be like me, and I saw the word “hermaphrodite” thrown around as carelessly as it had been used in my doctor’s office. I wished desperately that one of those celebrities would admit to having a body like mine. Because if any of them were like me, maybe I wouldn’t be the freak that the adults made me feel like I was. Maybe then I wouldn’t be so alone.As hard as all of this was, in a way my doctor’s lack of knowledge turned out to be both a blessing and a curse. I felt cursed and ashamed of this different, “broken” body that couldn’t be “fixed.” I felt like a problem that nobody had the solution to. I was told so many lies—that I would definitely get cancer, that I could never have sex, that I needed surgery immediately. Not once was I ever told the truth—that there were hundreds of others out there I could talk to, that I didn’t do anything wrong, that I was going to be okay. My doctors didn’t point me in the direction of a support group or a therapist who could help me work through what it all meant. In Utah, the most important thing a woman can do is to have children, and it was devastating to learn I would not to be able to conceive. I wish any of my doctors had pointed me in the direction of a professional I could talk to about it.It wasn’t until I was older that I discovered the blessing amongst all of this pain. As it turns out, my doctors were so entirely ignorant about my condition that they didn’t know how to remove or even find my internal testes. I’ve managed to make it 25 years without surgery. Now, when I speak to medical students, many of them balk at this idea that surgery is something I’ve “escaped.” But I know how many affected individuals see it as I do. It’s incredibly lucky that somebody with CAIS is surgically untouched, and I fully believe that rarity to be the saddest thing. It shouldn’t be the norm to... (shrink)

The ubiquitin–proteasome system (UPS) is the major proteolytic pathway that degrades intracellular proteins in a regulated manner. Deregulation of the UPS has been implicated in the pathogenesis of many neurodegenerative disorders like Alzheimer's disease, Parkinson's diseases, Huntington disease, Prion‐like lethal disorders, in the pathogenesis of several genetic diseases including cystic fibrosis, Angelman's syndrome and Liddle syndrome and in many cancers. Multiple lines of evidence have already proved that UPS has the potential to be an exciting novel therapeutic target (...) for the treatment of these diseases. Here I review how aberrant functions of various genes have implicated UPS in many human disorders including neurodegeneration and cancers. I also discuss the finding that some proteasome inhibitors possess a therapeutic potential as drugs against many such diseases. BioEssays 30:1172–1184, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Circumcision:Ordinary and Universal in My CommunityAllan J. JacobsMy1 circumcision experiences are remarkable mostly for their ordinariness. My wife Danaë gave birth to our son Perseus2 while I was a resident in obstetrics and gynecology in a city where we had no family. Perseus was circumcised in a Jewish brit milah3 ceremony on the eighth day of his life, as were my wife's and my male ancestors back into ancient (...) times. We were relieved because Perseus had just recovered from a potentially serious condition. After a difficult forceps delivery, his blood bilirubin rose almost to the point where he might have developed the dreaded kernicterus syndrome. Kernicterus can cause permanent severe motor, intellectual and visual impairment. It was unclear whether he would be discharged from the hospital in time. He had to spend a week in restraints under a bright light whose frequency degraded bilirubin. Happily, he came home the day before the scheduled brit.Our four parents attended the brit. Danaë's father was the sandek,4 being granted the honor of holding our son on his lap during the circumcision ceremony. The mohel, or circumciser, was the local Conservative rabbi. We were mildly anxious because he didn't do many circumcisions in this city with few Jews. Perseus cried briefly after he was circumcised. The circumcision undoubtedly was far less stressful than treatment of elevated bilirubin. The circumcision certainly was less painful than the prodding and sticks for the many blood tests he had to undergo in the hospital, not to mention the pain of his difficult forceps delivery. Perseus did not seem to have much discomfort in his penis afterward, and had no circumcision complications.After the brit, our parents and my resident colleagues ate refreshments and chatted for an hour or so. A brit milah is a happy occasion, but not an elaborate one. It marks the end of the joy, anxiety, and excitement of the child's birth and its aftermath and is followed by the less exalted rhythm of feedings, diaper changes, and sleep deprivation.At the brit, our boys are assigned Hebrew names and confirmed in the Biblical covenant between God and the Hebrew people established between God and Abraham, and reaffirmed between God and Moses. Regardless of the historical truth of the formation of the covenant, it is accepted as a myth tantamount to [End Page 71] truth. In other words, regardless of its literal truth, such a myth is to be regarded as true because it concretizes God's demands or a moral truth. The covenant is real for me whether or not there was a historical Abraham. As with other religious commitments, the obligation to circumcise our sons is unprovable, but binding. On this basis, Perseus's ancestors on both sides were circumcised in brit milah ceremonies for many centuries into the past.My two grandsons were circumcised as well. Achilles was circumcised among friends and relatives. The mohel was an experienced obstetrician who was certified to officiate at a brit milah following the practices of Conservative Judaism. He administered adequate analgesia with topical local anesthetic cream followed by an injected regional block. Achilles slept through his circumcision, suffered no complications, and had little discomfort afterward. My other grandson had a circumcision performed as an infant outside the context of Judaism and is not being raised as a Jew.The two brit milah in my family were beautiful, dignified ceremonies, welcoming the infants into the Jewish fold, and bestowing their Hebrew names.5 Some of my relatives, including Perseus's son, had circumcisions performed in a medical setting without a ceremony. None of the many boys in my family had obvious short- or long-term problems with their circumcisions. My social circle has many Reform and Conservative Jews. I have never heard any Jewish man in my circle of acquaintances complain about his circumcision. Circumcision is a given. Problems are rare, and an exposed glans is the norm. Our men typically enjoy sex and have no difficulty in fathering children. Circumcision is part of the comforting cocoon of custom and tribe that helps to protect us as a group. It also reinforces Jewish endogamy... (shrink)

Launched in 1971, _Adolescent Psychiatry_, in the words of founding coeditors Sherman C. Feinstein, Peter L. Giovacchini, and Arthur A. Miller, promised "to explore adolescence as a process...to enter challenging and exciting areas that may have profound effects on our basic concepts." Further, they promised "a series that will provide a forum for the expression of ideas and problems that plague and excite so many of us working in this enigmatic but fascinating field." For over two decades, _Adolescent Psychiatry_ has (...) fulfilled this promise. The repository of a wealth of original studies by preeminent clinicians, developmental researchers, and social scientists specializing in this stage of life, the series has become an essential resource for all mental health professionals working with youth. Volume 20 of the series serves as a tribute to editor emeritus Sherman C. Feinstein. In addition to an appreciation of, and contributions by, Dr. Feinstein, it contains heretofore unpublished papers by two other major figures in adolescent psychiatry, founding father William Schonfeld and a Viennese colleague transplanted to America, Siegfried Bernfeld. With sections on general considerations of adolescence, specific syndromes, and treatment modalities, volume 20 presents the work of many of today's preeminent minds in adolescent psychiatry. (shrink)

The title of this paper deserves an explanation—or rather two explanations, one for the portion preceding the colon, the other for that following as the subtitle. The first part is derived from a short essay by Emily Perl Kingsley, written in 1987 in response to questions she had received about what it is like to raise a child with Down Syndrome.1 Kingsley suggests that planning for a child is like planning a trip to some wonderful destination—in her example, Italy. (...) She asks us to imagine the anticipation: searching out guidebooks, learning important sites to visit, the excitement at being able to see things one has heard about an entire lifetime—seeing Michelangelo's David, for instance. But, when the plane. (shrink)

Melanie presented at twenty weeks of gestation to an obstetrics clinic in a critical access hospital in rural Vermont. She was excited to undergo routine fetal ultrasonography, but her obstetrician gave her grave news: the ultrasound revealed hypoplastic left heart syndrome, a devastating congenital heart defect. Initially, Melanie agreed in general to pursue surgical care for her fetus—a three‐stage process that has somewhat uncertain results and could only be done in tertiary care facilities far from her home in (...) Vermont. A week later, while the maternal fetal medicine and pediatric cardiology units made arrangements with colleagues in Boston, Melanie began having second thoughts. An ethics meeting was called to discuss conflicting clinician reactions to Melanie's dilemma. Most of the clinicians were stunned that the patient would change her mind. What advice should the ethics consultant offer the team about caring for Melanie? (shrink)

If the question ``What is a gene?'' proves to be worth asking it must be able to elicit an answer which both recognizes and address the reasons why the concept of the gene ever seemed to be something worth getting excited about in the first place as well analyzing and evaluating the latest develops in the molecular biology of DNA. Each of the preceding papers fails to do one of these and sufferrs the consequences. Where Rolston responds to the (...) apparent failure of molecular biology to make good on the desideratum of the classical gene by veering off into fanciful talk about ``cybernetic genes,'' Griffiths and Stotz lose themselves in the molecular fine print and forget to ask themselves why ``genes'' should be of any special interst anyway. (shrink)

In Deleuze and Guattari’s Anti-Oedipus volumes, revolution, social transformation, and the possibility of a new future are all linked to desire: minimally, to the freeing of desire from the false refuges of Oedipalization and its constructs of molar sexuality. Everywhere, they seek to uncover the potential of desire, sexuality, and love, asking us to consider that what we take to be the most personal is impersonal, how the most intimate is the collective and social. Thus, it calls us to rethink (...) our material and affective relations and reconceptualize the sphere of intimacy itself. I develop the concepts of delirium and revolutionary love, suggesting that we interpret these as perpetual processes of transformation and conjugation, initiating relations of intimacy and advocate for more nuanced, complex forms of subjectivity and to become more sensitive to the varying relational complexes within a given space. Revolutionary love gains its newness from both the extension of Deleuzian desire and from its return to several heritages of feminisms which have themselves been marginalized in the forward sweep of new materialist and posthumanist discussions. The point is to sharpen our focus on the conditions that produce certain social bodies, certain kinds of consciousness, and certain molar identities—not to deny the realities of the socius or reject subjectivity, but to move from a majoritarian to a minoritarian politics that widens our purview of what forces and desires exist within these spaces so that we may transform and build less fascistic, more attuned relational complexes. (shrink)

Why does Deleuze rely so heavily on Spinoza and Leibniz? At first glance, his critique of representation and the traditional ‘image of thought’ seems to oppose him to rationalism. However, Deleuze says that when the ‘cry of rationalism’ is pursued until the end, rationalism becomes ‘delirious’. In such a state, it undermines the model of representation. This delirium is found in Spinoza and Leibniz's critique of generality and their conflation of essence and existence, through which they ruin the traditional (...) mediation of difference by identity and generality. However, for this rationalism to completely break with representationalism it must undergo some Deleuzian corrections. (shrink)

Many intelligent, capable, and successful individuals believe that their success is due to luck and fear that they will someday be exposed as imposters. A puzzling feature of this phenomenon, commonly referred to as imposter syndrome, is that these same individuals treat evidence in ways that maintain their false beliefs and debilitating fears: they ignore and misattribute evidence of their own abilities, while readily accepting evidence in favour of their inadequacy. I propose a novel account of imposter syndrome (...) as an instance of self-deception, whereby biased evidence treatment is driven by the motivational benefit of negative self-appraisal. This account illuminates a number of interconnected philosophical and scientific puzzles related to the explanation, definition, and value of imposter syndrome. (shrink)

Various psychopathologies of self-awareness, such as somatoparaphrenia and thought insertion in schizophrenia, might seem to threaten the viability of the higher-order thought (HOT) theory of consciousness since it requires a HOT about one’s own mental state to accompany every conscious state. The HOT theory of consciousness says that what makes a mental state a conscious mental state is that there is a HOT to the effect that “I am in mental state M.” I have argued in previous work that a (...) HOT theorist can adequately respond to this concern with respect to somatoparaphrenia and thought insertion. There is also Cotard syndrome which is a rare neuropsychiatric disorder in which people hold the delusional belief that they are dead, do not exist, or have lost their blood or internal organs. In this paper, I argue that HOT theory has nothing to fear from it either and can consistently account for what happens in such unusual cases. I analyze Cotard syndrome in light of my previous discussion of somatoparaphrenia and thought insertion, and argue that HOT theory can provide a somewhat analogous account without the worry of inconsistency. It is crucial to recognize that there are multiple “self-concepts” and levels of HOTs which can help to provide a more nuanced explanation. With regard to the connection between consciousness and self-consciousness, it is proposed that Cotard patients are indeed capable of having some “I-thoughts” about their bodies and mental states. (shrink)

Le syndrome de Kierkegaard est un essai libre de Jean- Luc Berlet, consacré à l'un de ses penseurs de prédilection, le Danois Seren Kierkegaard (1813-1855). Ce syndrome dont il est question, tel que défini par l'auteur, pourrait être conçu comme la tension qui résulte de l'impossible choix entre l'amour de la femme et l'amour de Dieu. Kierkegaard renonça en effet à l'amour charnel de la femme au profit d'une vie ascétique consacrée à I écriture et à la réflexion (...) sur l'Amour. A plus grande échelle ce syndrome pourrait être compris comme l'abandon du temporel au profit d'un idéal spirituel Et les regrets qui en découlent. En effet, comme nombre de contemporains opérant ce type de choix, Kierkegaard connut bien des tourments. Ces affres permirent néanmoins à Kierkegaard de développer une conception de l'Amour et du Divin d'une grande originalité qu'il est bon de redécouvrir dans notre époque marquée par le consumérisme sentimental. Tout au long des quatorze chapitres qui jalonnent cet ouvrage, Jean-Luc Berlet retrace le parcours littéraire de ce philosophe danois considéré par beaucoup comme le père de l'existentialisme, brossant ici un tableau complet de son énigmatique personnalité. En outre, chaque chapitre est accompagné d'un code QR, donnant chacun actes à une vidéo en ligne où Jean - Luc Berlet approfondit son développement et fournit des clefs de lecture pour une meilleure compréhension de l'oeuvre de Kierkegaard. (shrink)

To commemorate 40 years since the founding of the Journal of Business Ethics, the editors-in-chief of the journal have invited the editors to provide commentaries on the future of business ethics. This essay comprises a selection of commentaries aimed at creating dialog around the theme Bringing Excitement to Empirical Business Ethics Research (inspired by the title of the commentary by Babalola and van Gils). These editors, considering the diversity of empirical approaches in business ethics, envisage a future in which quantitative (...) business ethics research is more bold and innovative, as well as reflexive about its techniques, and dialog between quantitative and qualitative research nourishes the enrichment of both. In their commentary, Babalola and van Gils argue that leadership research has stagnated with the use of too narrow a range of perspectives and methods and too many overlapping concepts. They propose that novel insights could be achieved by investigating the lived experience of leadership (through interviews, document analysis, archival data); by focusing on topics of concern to society; by employing different personal, philosophical, or cultural perspectives; and by turning the lens on the heroic leader (through “dark-side” and follower studies). Taking a provocative stance, Bal and Garcia-Lorenzo argue that we need radical voices in current times to enable a better understanding of the psychology underlying ethical transformations. Psychology can support business ethics by not shying away from grander ideas, going beyond the margins of “unethical behaviors harming the organization” and expanding the range of lenses used to studying behavior in context. In the arena of finance and business ethics, Guedhami, Liang, and Shailer emphasize novel data sets and innovative methods. Significantly, they stress that an understanding the intersection of finance and ethics is central to business ethics; financial equality and inclusion are persistent socio-economic and political concerns that are not always framed as ethics issues, yet relevant business policies and practices manifest ethical values. Finally, Charles Cho offers his opinion on the blurry line between the “ethical” versus “social” or “critical” aspects of accounting papers. The Journal of Business Ethics provides fertile ground for innovative, even radical, approaches to quantitative methods (see Zyphur and Pierides in J Bus Ethics 143(1):1–16, https://doi.org/10.1007/s10551-017-3549-8, 2017), as part of a broad goal of ethically reflecting on empirical research. (shrink)

The study examines the argumentative competencies of people with Asperger syndrome (AS) and compares this with those of normal – or what are called neurotypical (NT) – subjects. To investigate how people with AS recognise, evaluate and engage in argumentation, we have adapted and applied the empirical instrument developed by van Eemeren, Garssen and Meuffels to study the conventional validity of the pragma-dialectical freedom rule (van Eemeren, Gars- sen & Meuffels 2003a; 2003b; 2005a; 2005b; van Eemeren & Meuffels, 2002). (...) Our paper begins with some background information on Asperger syndrome and how it impacts upon communication and argumentation; then it addresses the research questions and methods used; thirdly, it presents some initial findings; finally, it will conclude with some im- plications for those people with AS, for those they come into contact with and for the pragma-dialectic model in general. (shrink)

With the same intellectual courage with which she addressed issues of gender, Judith Butler turns her attention to speech and conduct in contemporary political life, looking at several efforts to target speech as conduct that has become subject to political debate and regulation. Reviewing hate speech regulations, anti-pornography arguments, and recent controversies about gay self-declaration in the military, Judith Butler asks whether and how language acts in each of these cultural sites.

With the same intellectual courage with which she addressed issues of gender, Judith Butler turns her attention to speech and conduct in contemporary political life, looking at several efforts to target speech as conduct that has become subject to political debate and regulation. Reviewing hate speech regulations, anti-pornography arguments, and recent controversies about gay self-declaration in the military, Judith Butler asks whether and how language acts in each of these cultural sites.

Delirium has conventionally been considered a disorder of consciousness, but this remains a relatively unexamined precept. First, a review of the role of consciousness disruption in delirium is revised from an historical and diagnostic perspective. Second, consciousness measurement in routine assessment of delirium is considered. Conscious levels, comprising alertness and arousal, are most commonly used but are not representative of the multidimensionality of consciousness. Third, a justification for the exploration of phenomenal consciousness is presented. Three candidate dimensions (...) of phenomenal consciousness are identified as the pre-reflective state, phenomenal experience, and reflective thought. Finally, the clinical implications of a deeper understanding of delirium through measurement of phenomenal consciousness is considered. (shrink)

Here we describe how more important findings were obtained in a delirium study by using an informal assessment of mental capacity, and, in those who lacked capacity, obtaining consent later when or if capacity returned or a proxy was found. From a total of 233 patients 23 patients lacked capacity as judged by our informal capacity judgment and 210 did not. Of those who lacked capacity, 13 agreed to enter in the study. Six of them regained capacity later. When (...) these 13 participants were excluded from analysis, significant findings were no longer evident. These results show that by the inclusion of subjects who lacked capacity the results of analyses of the condition from whish they suffer are altered. We suggest that this approach to the study of delirium is more ethical than the usual system of strict exclusion of people who lack capacity to give consent and for whom assent is not available. (shrink)

In this important addition to the stroke literature, highly experienced clinicians set out the patterns to be expected in patients with stroke, drawing on illustrative case histories where appropriate. The book is intended as a guide to patterns and syndromes for clinicians encountering an unfamiliar presentation in a stroke patient. It will enable them to differentiate between possible locations on the basis of symptoms and signs, recognise lesion patterns found in patients with infarcts and haemorrhages in various vascular territories, and (...) refer to the clinical features associated with rare but important causes of stroke. Drawing on the experience and clinical authority of distinguished international contributors, this is a practical, highly illustrated companion and reference for students, trainees and physicians who wish to improve their skills in the accurate diagnosis of stroke syndromes, and their understanding of its clinical consequences. (shrink)

1Neurology Department and Cyclotron Research Center, University of Lie`ge, Sart Tilman B30, 4000 Liege, Belgium 2Neurorehabilitation Medicine, Hoˆpital Caremeau, CHU Nıˆmes, 30029 Nıˆmes Cedex, France 3Department of Speech Therapy, Hospital Pitie´ Salpe´trie`re, Paris and French Association Locked in Syndrome (ALIS), 225 Bd Jean-Jaures, MBE 182, 92100 Boulogne-Billancourt, France 4Neurosciences et Syste`mes Sensoriels Unite´ Mixte de Recherche 5020, Universite´ Claude Bernard Lyon 1 – CNRS, 69007 Lyon, France 5Intensive Care Medicine, Hoˆpital Erasme, Universite´ Libre de Bruxelles, Route de Lennik 808, (...) 1070 Brussels, Belgium 6Anesthesiology, Reanimation and Pain Clinic, CHU University Hospital, Sart Tilman B33, 4000 Liege, Belgium 7German Association Locked in Syndrome LIS e.V., Evangelischen Krankenhaus Ko¨ningin Elisabeth Herzberge gGmbh (Lehrkrankenhaus der Charite´), Haus 30, Herzbergstrasse 79, 10365 Berlin, Germany 8Intensive Care Medicine, Centre Hospitalier Re´gional de la Citadelle, Boulevard du 12e de Ligne 1, 4000 Liege, Belgium 9Biomedical PET Unit, Hoˆpital Erasme, Universite´ Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium.. (shrink)

As a human being possesses dual creation, certain reasons and conditions can oppose his inner and outside worlds. Giving preference one side to other, and to turn another into slavery enhance the syndrome of imbalance which inherent him in birth. To make harmony between them and their complementarities perfect the human being. This also emphasizes the necessity of parallel development of rational and irrational thinking and their complementarities. A human being is perfect in birth and he is the only (...) being who is able to understand his perfection. As it is reflected in Holy Books that the material world is a form of test, and the good and the evil return us. As it is seems that this material world is only the mean of choice in spiritual way. This choice is of the man. The man canchoose light or fire. Everybody understands his inferiority in his own and to solve it differently: it might be material things, divine love or science. What is the truth? It is the soul that defines it, if we can listen to it. (shrink)

Eyal et al have recently argued that researchers should consider conducting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) human challenge studies to hasten vaccine development. We have conducted (J. L.) and overseen (L. D.) human challenge studies and agree that they can be useful in developing anti-infective agents. We also agree that adults can autonomously choose to undergo risks with no prospect of direct benefit to themselves. However, we disagree that SARS-CoV-2 challenge studies are ethically appropriate at this time, (...) for 3 reasons: (1) current scientific knowledge of SARS-CoV-2 infection is insufficient to manage risks; (2) autonomous decision making, while necessary, does not override concerns about risk; and (3) undertaking challenge studies now would imperil confidence in the research enterprise, potentially undermining the global response to the coronavirus disease 2019 (COVID-19) pandemic. (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)

While some of mental disorders due to emotional distress occur cross-culturally, others seem to be much more bound to particular cultures. In this paper, I propose that many of these “cultural syndromes” are culturally sanctioned responses to overwhelming negative emotions. I show how tools from cultural evolution theory can be employed for understanding how the syndromes are relatively confined to and retained within particular cultures. Finally, I argue that such an account allows for some cultural syndromes to be or become (...) mental disorders and also steers clear of some of the anti-realist trappings associated with a social constructivism of cultural syndromes. (shrink)

Williams syndrome is a genetic disorder that, because of its unique cognitive profile, has been marshalled as evidence for the modularity of both language and social skills. But emerging evidence suggests the claims of modularity based on WS have been premature. This paper offers an examination of the recent literature on WS. It argues the literature gives little support for mental modularity. Rather than being rigidly modular, the WS brain is an extremely flexible organ that that co-opts available neural (...) resource in a highly dynamic manner to cope in the world. (shrink)

ABSTRACT Many intelligent, capable, and successful individuals believe that their success is due to luck, and fear that they will someday be exposed as imposters. A puzzling feature of this phenomenon, commonly referred to as imposter syndrome, is that these same individuals treat evidence in ways that maintain their false beliefs and debilitating fears: they ignore and misattribute evidence of their own abilities, while readily accepting evidence in favour of their inadequacy. I propose a novel account of imposter (...) class='Hi'>syndrome as an instance of self-deception, whereby biased evidence treatment is driven by the motivational benefit of negative self-appraisal. This account illuminates a number of interconnected philosophical and scientific puzzles related to the explanation, definition, and value of imposter syndrome. (shrink)

Previous studies on body ownership illusions have shown that under certain multimodal conditions, healthy people can experience artificial body-parts as if they were part of their own body, with direct physiological consequences for the real limb that gets ‘substituted’. In this study we wanted to assess (a) whether healthy people can experience ‘missing’ a body-part through illusory ownership of an amputated virtual body, and (b) whether this would cause corticospinal excitability changes in muscles associated with the ‘missing’ body-part. Forty right-handed (...) participants saw a virtual body from a first person perspective but for half of them the virtual body was missing a part of its right arm. Single pulse transcranial magnetic stimulation was applied before and after the experiment to left and right motor cortices. Motor evoked potentials (MEPs) were recorded from the first dorsal interosseous (FDI) and the extensor digitorum communis (EDC) of each hand. We found that the stronger the illusion of amputation and arm ownership, the more the reduction of MEP amplitudes of the EDC muscle for the contralateral sensorimotor cortex. In contrast, no association was found for the EDC amplitudes in the ipsilateral cortex and for the FDI amplitudes in both contralateral and ipsilateral cortices. Our study provides evidence that a short-term illusory perception of missing a body-part can trigger inhibitory effects on corticospinal pathways and importantly in the absence of any limb deafferentation or disuse. (shrink)