The goal of this article is to shed light on Deep Brain Stimulation (DBS) postoperative suicidality risk factors within Treatment Resistant Depression (TRD) patients, in particular by focusing on the ethical concern of enrolling patient with history of self-estrangement, suicide attempts and impulsive–aggressive inclinations. In order to illustrate these ethical issues we report and review a clinical case associated with postoperative feelings of self-estrangement, self-harm behaviours and suicide attempt leading to the removal of DBS devices. Could prospectively identifying and (...) excluding patients with suicidality risk factors from DBS experimental trials—such as history of self-estrangement, suicide attempts and impulsive–aggressive inclinations—lead to minimizing the risk of suicidality harm? (shrink)

The present study had two main aims: to determine whether deaf children show higher rates of key behaviors of ADHD and of Conduct Disorder—CD— than hearing children, also examining whether the frequency of these behaviors in deaf children varied based on cochlear implant use, type of school and level of receptive vocabulary; and to determine whether any behavioral differences between deaf and hearing children could be explained by deficits in inhibitory control. We measured behaviors associated with ADHD and CD (...) in 34 deaf and hearing children aged 9–10 years old, using the revised Spanish version of the Conners scale. We then assessed inhibitory control ability using a computerized Stroop task and a short version of the Attention Network Test for children. To obtain a measure of the level of receptive vocabulary of the deaf children we used a Spanish version of the Carolina Picture Vocabulary Test for Deaf and hearing-impaired children. Deaf children showed significantly higher rates of behaviors associated with ADHD and CD, and over 85% of cases detected with high risk of ADHD-inattentive type in the entire present sample were deaf children. Further, in the group of deaf children a negative correlation was found between receptive vocabulary and frequency of disruptive, aggressive, or antisocial behaviors associated with CD. However, inhibitory control scores did not differ between deaf and hearing children. Our results suggested that the ADHD-related behaviors seen in deaf children were not associated with a deficit in inhibitory control, at least in the interference suppression subcomponent. An alternative explanation could be that these behaviors are reflecting an adaptive strategy that permits deaf children to access information from their environment which is not available to them via audition. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clarifying the Relationship Between Vice and Mental Disorder: Vice as Manifestation of a Psychological DysfunctionMichael B. First (bio)KeywordsDSM-IV, psychiatric diagnosis, impulse control disorders, sexually violent predator commitmentIndividuals generally present for psychiatric evaluation for one of two reasons: either because they themselves are suffering from a psychiatric symptom that causes distress (e.g., severe panic) or impairs their ability to function effectively (e.g., memory loss), or else they are brought (...) to clinical attention because their behavior or attitudes are considered by others to be problematic. There are a wide range of behaviors that fall into this second category. In some cases, the individual is pressured to seek treatment because of the negative impact that a behavior has on a relationship partner (e.g., sexual dysfunction, anger outbursts) or an employer (e.g., excessive alcohol use). Often, however, the external trigger for a clinical evaluation falls under Sadler’s definition of vice, that is, criminal (illegal) behaviors or attitudes that could be considered “wrongful” or “immoral” in the social arena because the behavior violates the law or an important social more.Given that one of the most important goals of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is to facilitate clinical practice (First et al. 2004) and in doing so provide a diagnostic code to cover any patient that might present himself or herself to a mental health professional, the DSM has evolved over its various editions to become a veritable laundry list of psychological and behavioral ills, some of which may constitute a violation of the rights of others or society. The DSM-III (and its successors) have adopted a descriptive approach wherein disorders are defined in terms of their presenting surface symptomatology, which was necessitated by the field’s lack of knowledge about the underlying etiology of mental disorders. Given this reliance on presenting symptoms, it is therefore inevitable that some disorders are defined in terms of behaviors that can be considered vices. For example, impaired impulse [End Page 35] control often leads to acting out behavior that, at its mildest is inappropriate, and at its most severe is destructive to self and others. Many of the disorders cited by Sadler as being vice-laden fall into this category, namely, pyromania (failure to resist impulses to set fires), kleptomania (failure to resist impulses to steal), intermittent explosive disorder (failure to resist aggressive impulses), certain forms of substance abuse (i.e., those involving possession and use of illegal substances) and paraphilias (i.e., those involving nonconsenting victims).It is important to clarify from the outset that the criteria for determining whether a behavior is a “vice” (i.e., whether it is illegal or immoral) is not equivalent to the criteria for determining whether a behavior is indicative of a mental disorder. According to the DSM-IV-TR definition, a mental disorder is conceptualized as a “clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom” (American Psychiatric Association [APA] 2000, xxxi). The definition warns against considering “deviant behavior[s] (e.g., political, religious, or sexual)” and “conflicts that are primarily between the individual and society” to be evidence of mental disorder except in those cases in which the “deviance or conflict is a symptom of a dysfunction in the individual.” Thus, when considering whether a particular “vice” behavior is a component of a mental disorder, it is crucial to determine whether the behavior is a manifestation of an underlying psychological dysfunction, such as a dysfunction in impulse control. If so, it may potentially be appropriate for that individual to be treated as “medically ill” in addition to, or instead of, being treated simply as a criminal.Let us examine some illustrative examples of cases that demonstrate the relationship between vice and mental disorders and the different ways in which the legal and mental health systems might deal with such cases. Consider the case of an individual who breaks... (shrink)

Aggressive-sadistic personality disorder (SPD) involves derivation of pleasure from another's physical or emotional suffering, or from control and domination of others. Findings from a head-injured sample indicate that SPD traits are associated with neuropsychological deficits in executive function and language, suggesting difficulties in frontal-lobe-mediated self-regulation of aggressive and emotional impulses. Implications for rehabilitation of aggressive offenders are discussed.

The scientific literature highlights the risk of the appearance of internalizing and externalizing symptoms, together with difficulties in the academic area, linked to diagnosis of Attention Deficit Hyperactivity Disorder. This is normally assessed by teachers and primary caregivers, disregarding the self-perception of the adolescents themselves, which limits detection of this disorder at an evolutionary stage. Our aim was to analyze the psychometric properties of a self-report for ADHD in adolescence and its relationship with psychopathology and academic performance. This (...) study assessed an incidental sample of 267 students from secondary schools in the Region of Murcia, Spain, using the EDAH questionnaire adapted for self-report, in order to analyze its psychometric properties in assessing ADHD. The Youth Self-Report and the Brief Self-Control Scale were also used to determine their association with psychopathological, self-control and academic performance variables. An ADHD prevalence of between 3.7 and 13.1% was observed depending on the established cut-off point. The adapted EDAH showed adequate reliability indices and explained a high variance percentage. Adolescents with anxiety/depression difficulties, dissocial behavior, aggressiveness, and poor performance in mathematics showed a higher amount of ADHD symptoms. Moreover, self-control, dissocial behavior, age, and performance in Social Sciences acted as predictors of the disorder. The good psychometric properties of this questionnaire and its adequate correspondence with other variables of interest suggest it is an appropriate self-report instrument to assess ADHD in adolescence. (shrink)

Background:To date, most research on aggression in mental disorders focused on active-aggressive behavior and found self-directed and other-directed active aggression to be a symptom and risk-factor of psychopathology. On the other hand, passive-aggressive behavior has been investigated less frequently and only in research on psychodynamic defense mechanisms, personality disorders, and dysfunctional self-control processes. This small number of studies primarily reflects a lack of a reliable and valid clinical assessment of passive-aggressive behavior. To address this gap, we developed the Test of (...) Passive Aggression (TPA), a 24-item self-rating scale for the assessment of self-directed and other-directed passive-aggressive behavior.Method:Study 1 examined the internal consistency and factorial validity of the TPA in an inpatient sample (N= 307). Study 2 investigated the retest-reliability, internal consistency, and construct validity (active aggression, personality traits, impulsivity) of the TPA in a student sample (N= 180).Results:In line with our hypothesis, Exploratory Structural Equation Modeling revealed an acceptable to good fit of a bi-factorial structure of the TPA (Chi-square-df-ratio= 1.98;RMSR= 0.05, fit.off = 0.96). Both TPA scales showed good to excellent internal consistency (α= 0.83–0.90) and 4-week retest-reliability (rtt= 0.86). Correlations with well-established aggression scales, measures of personality, and impulsivity support discriminant and convergent validity of the TPA.Conclusions:The TPA is a reliable and valid instrument for the assessment of self-directed and other-directed passive-aggressive behavior. (shrink)

There is growing evidence that dopamine replacement therapy (DRT) used to treat Parkinson’s Disease can cause compulsive behaviours and impulse control disorders (ICDs), such as pathological gambling, compulsive buying and hypersexuality. Like more familiar drug-based forms of addiction, these iatrogenic disorders can cause significant harm and distress for sufferers and their families. In some cases, people treated with DRT have lost their homes and businesses, or have been prosecuted for criminal sexual behaviours. In this article we first examine the evidence (...) that these disorders are caused by DRT. If it is accepted that DRT cause compulsive or addictive behaviours in a significant minority of individuals, then the following ethical and clinical questions arise: Under what circumstances is it ethical to prescribe a medication that may induce harmful compulsive behaviours? Are individuals treated with DRT morally responsible and hence culpable for harmful or criminal behaviour related to their medication? We conclude with some observations of the relevance of DRT-induced ICDs for our understanding of addiction and identify some promising directions for future research and ethical analysis. (shrink)

School anti-violence programs are united in their radical condemnation of aggression, generally equated with violence. The programs advocate its elimination by priming children's emotional and cognitive controls. What goes unrecognized is the embeddedness of aggression in human beings, as well as its positive psychological and moral functions. In attempting to eradicate aggression, schools increase the risk of student disaffection while stifling the goods associated with it: status, power, dominance, agency, mastery, pride, social-affiliation, social-approval, loyalty, self-respect, and self-confidence. It is argued (...) that the distribution of power and authority to students as plausible substitutes for aggression, would enable them to express aggression in a legitimate manner and simultaneously encourage their attachment to school. A vibrant anti-violence program that attracts children will find a way for caring, amiability, sympathy, and kindness to live in tandem with competition, power, assertiveness, and anger tamed by institutional constraints. (shrink)

Aggressive behavior is instinctively driven behavior that helps animals to survive and reproduce and is closely related to multiple behavioral and physiological processes. The dorsal raphe nucleus (DRN) is an evolutionarily conserved midbrain structure that regulates aggressive behavior by integrating diverse brain inputs. The DRN consists predominantly of serotonergic (5‐HT:5‐hydroxytryptamine) neurons and decreased 5‐HT activity was classically thought to increase aggression. However, recent studies challenge this 5‐HT deficiency model, revealing a more complex role for the DRN 5‐HT system in aggression. (...) Furthermore, emerging evidence has shown that non‐5‐HT populations in the DRN and specific neural circuits contribute to the escalation of aggressive behavior. This review argues that the DRN serves as a multifaceted modulator of aggression, acting not only via 5‐HT but also via other neurotransmitters and neural pathways, as well as different subsets of 5‐HT neurons. In addition, we discuss the contribution of DRN neurons in the behavioral and physiological aspects implicated in aggressive behavior, such as arousal, reward, and impulsivity, to further our understanding of DRN‐mediated aggression modulation. (shrink)

Attention-deficit/hyperactivity disorder (ADHD) is currently defined as a cognitive/behavioral developmental disorder where all clinical criteria are behavioral. Inattentiveness, overactivity, and impulsiveness are presently regarded as the main clinical symptoms. The dynamic developmental behavioral theory is based on the hypothesis that altered dopaminergic function plays a pivotal role by failing to modulate nondopaminergic (primarily glutamate and GABA) signal transmission appropriately. A hypofunctioning mesolimbic dopamine branch produces altered reinforcement of behavior and deficient extinction of previously reinforced behavior. This gives rise (...) to delay aversion, development of hyperactivity in novel situations, impulsiveness, deficient sustained attention, increased behavioral variability, and failure to “inhibit” responses (“disinhibition”). A hypofunctioning mesocortical dopamine branch will cause attention response deficiencies (deficient orienting responses, impaired saccadic eye movements, and poorer attention responses toward a target) and poor behavioral planning (poor executive functions). A hypofunctioning nigrostriatal dopamine branch will cause impaired modulation of motor functions and deficient nondeclarative habit learning and memory. These impairments will give rise to apparent developmental delay, clumsiness, neurological “soft signs,” and a “failure to inhibit” responses when quick reactions are required. Hypofunctioning dopamine branches represent the main individual predispositions in the present theory. The theory predicts that behavior and symptoms in ADHD result from the interplay between individual predispositions and the surroundings. The exact ADHD symptoms at a particular time in life will vary and be influenced by factors having positive or negative effects on symptom development. Altered or deficient learning and motor functions will produce special needs for optimal parenting and societal styles. Medication will to some degree normalize the underlying dopamine dysfunction and reduce the special needs of these children. The theory describes how individual predispositions interact with these conditions to produce behavioral, emotional, and cognitive effects that can turn into relatively stable behavioral patterns. Key Words: catecholamine; clumsiness; dopamine; hyperkinesis; hyperkinetic disorder; impulsivity; monoamine; neuromodulator; overactivity; pollutants; reinforcement; reward; verbally governed behavior; soft signs; variability. (shrink)

It has recently been argued that persons diagnosed with a personality disorder ought to be held responsible for their actions because these actions are voluntary. Defending this claim, Hannah Pickard contends that exercising choice and control are definitive of voluntary action, and that the behaviors that are constitutive of PD are behaviors over which we have choice and control. Thus PD behaviors are voluntary, and on this basis, their agents can be held properly responsible for this type of behavior. (...) In what follows, I examine this claim with reference specifically to agents who display impulsive behavior, where this behavior is taken to be diagnostic of antisocial personality disorder... (shrink)

BackgroundIndividuals who use methamphetamine for a long period of time may experience decreased inhibition and increased impulsivity. In order to reduce impulsivity or improve inhibitory control ability, high-frequency repetitive transcranial magnetic stimulation has attracted much attention of researchers. Recent studies on addiction have shown that rTMS can stimulate different brain regions to produce different therapeutic effects. Recent work also suggests that HF-rTMS over right dorsolateral prefrontal cortex does not affect the impulsivity of patients with alcohol use disorder; while HF-rTMS (...) over left DLPFC could improve the impulsivity of patients with alcohol use disorder and cigarette smokers. However, it should be noted that empirical studies applying HF-rTMS over left DLPFC of patients with MA use disorders are still lacking.MethodsTwenty-nine patients with MAUD underwent five sessions of HF-rTMS on the left DLPFC per week for 4 consecutive weeks. The cue-induced craving and stop-signal and NoGo task were assessed pre-rTMS and post-rTMS. In addition, 29 healthy controls were recruited. There was no rTMS intervention for the controls, the performance of the stop-signal and NoGo task was evaluated on them.ResultsIn total, HF-rTMS of the left DLPFC significantly decreased MA-dependent patients’ cue-induced craving and stop-signal reaction time. For SSRT, the pre-test of experimental group was significantly higher than the score of control group. In the experimental group, the pre-test score was significantly higher than the post-test score. For Go and stop-signal delay, the pre-test scores of the experimental group was significantly lower than the scores of the control group. No significant difference was found between the pre-test and the post-test scores of the experimental group.ConclusionAdd-on HF-rTMS of left DLPFC may be an effective intervention for reducing impulsivity and cue-induced craving of patients with MAUD. Future research with a control group of MAUD that does not undergo the treatment is needed to confirm the effectiveness. (shrink)

Name der Zeitschrift: Jahrbuch für Wissenschaft und Ethik Jahrgang: 19 Heft: 1 Seiten: 163-188.

We propose that human self-domestication favored the emergence of a less aggressive phenotype in our species, more precisely phenotype prone to replace (reactive) physical aggression with verbal aggression. In turn, the (gradual) transition to verbal aggression and to more sophisticated forms of verbal behavior favored self-domestication, with the two processes engaged in a reinforcing feedback loop, considering that verbal behavior entails not only less violence and better survival, but also more opportunities to interact longer and socialize with more conspecifics, ultimately (...) enabling the emergence of more complex forms of language. Whereas in the case of self-domestication sexual selection has been proposed to work against physical aggression traits, in the case of verbal insult the selection has been proposed to work in favor of verbal aggression. The tension between these two seemingly opposing forces gets resolved/alleviated by a tendency to replace physical aggression with verbal aggression, and with verbal behavior more generally. This also helps solve the paradox of the Self Domestication Hypothesis regarding aggression, more precisely why aggression in humans has been reduced only when it comes to reactive aggression, but not when it comes to proactive aggression, the latter exhibiting an increase with the advent of modern language. We postulate that this feedback loop was particularly important during the time period before 50 kya, arguably between 200 kya and 50 kya, when humans were not fully modern, neither in terms of their skull/brain morphology and their behavior/culture, nor in terms of their self-domestication. The novelty of our approach lies (i) in giving an active role to early forms of language in interacting with self-domestication processes; (ii) in providing specific linguistic details and functions of this early stage of grammar (including insult and humor); (iii) in supplying neurobiological, ontogenetic, and clinical evidence of a link between (reactive) aggression and (reactive) verbal behavior; (iv) in identifying a variety of proxies of the earlier stages in evolution among cognitive disorders; and (v) in identifying specific points of contact and mutual reinforcement between these two processes (self-domestication and early language evolution), including reduction in physical aggression and stress/tension, as well as sexual selection. (shrink)

Aggression and Its Causes explores the causes and control of aggression from a broad scientific perspective, offering many recent findings on aggression and integrating several perspectives often viewed as incompatible. Its balanced approach combines biological, environmental, and social components to illustrate how these bases contribute to the problems of aggression. The biological section describes the possible contributions of genetic mechanisms, gender, and sexual hormones, including investigations of the premenstrual syndrome. There is also a discussion of the roles that brain mechanisms (...) may play in aggressive behavior, as well as the problems with human brain dysfunction and drug use. The environmental section describes stimuli and environmental conditions that may produce aggression, and the effects of conditioning and learning. Finally, social psychological factors are described, along with the media's effect on aggression. The author covers various applied areas of special contemporary concern, such as juvenile delinquency, sexual and physical abuse of children, spousal abuse, and rape, concluding with a final chapter that discusses various psychiatric disorders that may involve aggression. Appropriate for upper-level undergraduates in psychology, sociology, social work, criminal justice, and education, and for professionals who encounter aggression, this text offers an excellent basis for understanding the causes of aggression and many ideas for how it may be controlled. (shrink)

The current study is aimed at creating a psychological profile of characteristics of aggressive and self-aggressive behaviour exhibited by females with bulimia, as well as conducting a comparative analysis of the differences between bulimic females and individuals displaying no mental disorders in terms of the major characteristics of aggressive and selfaggressive behaviour. The methods: the Buss-Durkee Hostility-Guilt Inventory, the Psychological Inventory of Aggression Syndrome by Zbigniew. B. Gaś. The data analysis revealed significant differences between the females suffering from bulimia and (...) the subjects displaying no mental disorders in terms of the level of aggressive and self-aggressive tendencies. It was discovered that the control participants exhibited an appropriate level of aggressive behaviour as opposed to the subjects with bulimia. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Impulsive Forces in and Against WordsAlphonso Lingis (bio)In his lecture "Nietzsche, le polythéisme et la parodie" given at the Collège de Philosophie in 1957 and published in 1963 in his Un si funeste désir, Pierre Klossowski explicated certain radical passages from Nietzsche's The Gay Science, a work he had newly translated into French (two prior translations existed). In the philosophical world of France where perception seemed to have found (...) its definitive elucidation in the phenomenology of perception of Maurice Merleau-Ponty (1945), Nietzsche's exposition of sensory experience, as Klossowski laid it out, was so radically different from that phenomenology that it could not be assimilated. In his Nietzsche et le cercle vicieux, published in 1969, Klossowski worked on texts Nietzsche left unpublished and which date from the years of The Gay Science onward. Philosophers, Nietzsche had written, do not simply coordinate and justify the works and science of society; they break at least in part with the common language by formulating their own aggressivity, tolerance, intimidation, anxieties, need of solitude, or need to forget themselves. And Nietzsche too speaks not of what is common and communicable but of what he experienced inwardly. Now Klossowski presented Nietzsche's exposition of sensory experience as an exposition of the experience peculiar to Nietzsche, in the most troubled period of his life. This experience, moreover, Klossowski aimed to show, was wholly premonitory of Nietzsche's final state, in which he could no longer say what he was experiencing nor who he was.The environment is not simply passively impressed upon our sensory surfaces; we have to awaken, move our eyes, and focus on things and circumscribe their contours with our look, and assume a posture that enables us to advance our look. When we are born, and when we awaken each day, that is, are born again to the world, we are needy and vulnerable, to be sure; the organism is porous and needs to replenish fluids and substance lost. But our organisms are material systems that generate excess energies; it is because excess energies have to be discharged that the organism moves into the environment and depletes its substance, and needs develop. Nietzsche calls these excess energies impulses, also multiple wills to power, that is, not conscious drives to acquire power, but positive forces that expand and exist only in expansion. They seek resistances on which to discharge themselves. They push against one another and become multiple.For the phenomenology of Edmund Husserl and Maurice Merleau-Ponty, the movements of perception are intentional; they are from the first correlative with objects, or, for Merleau-Ponty, intersensory things, Gestalten agglomerated by an intrinsic intelligible essence or sensory meaning, arising against a background of potential objects or latent things. Yet every glance around us encompasses innumerable unnamed and unnameable shapes, hues, textures, slidings, illuminations. Do not in fact the excess energies of life open upon an environment of swarming sensory patterns, streamings, scintillations, and shadows which quicken life before or without acquiring meaningful identities? [End Page 60]What in classical epistemology were called sensations were the information bits these forces impressed on our sensory surfaces, resulting also in sensory affects of pleasure or pain, according to the passive conception of our sensibility. For Nietzsche the multiple impulses that confront the forces of the environment are active and not reactive; confronting what is not from the first meaningful but resists or empowers, they laugh and weep, bless and curse. And it is these multiple and conflicting impulses, not a conceptual grasp of the essences of things, that know environmental events, know the forces exerted by the multiple hues, textures, glows, savors, reflections, halos, echos, projections, and shadows scattered about us.The impulses do more than know all that; they exalt and consecrate events of the world, they put over each an azure bell of blessing, they give them a space to stand forth and to dance—"they come and offer their hands and laugh and flee—and come back."1 They give themselves form and multiple forms and dance with all things. They are Apollonian and Dionysian.What is called conscious thought is elaborated in words of the common... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mental Disorder and Moral Responsibility:Disorders of Personhood as Harmful Dysfunctions, With Special Reference to AlcoholismJerome C. Wakefield (bio)Keywordsalcohol dependence, philosophy of psychiatry, mental disorder, harmful dysfunction, psychiatric diagnosis, person, moral responsibilityIn his paper, Ethical Decisions in the Classification of Mental Conditions as Mental Illness, Craig Edwards grapples with a profound problem: why is it that when we classify a mental condition as a mental disorder, that (...) tends to take the condition out of the sphere of moral responsibility or virtuousness of character? For example, it is not uncommon when someone commits suicide and the question is raised as to why he or she did it, that instead of a reason or character trait that would place the act within a moral calculus, one is offered the explanation "she was clinically depressed" or "he was bipolar," and this tends to terminate discussion and make reasons and moral evaluation superfluous. Why does such a comment have that effect?As Edwards notes, this can get complicated as the moral and the disordered interact. Certainly people are sometimes morally responsible for acting on their disordered impulses (as in pedophilia), and they are responsible for putting themselves in the way of disorder, as when someone imbibes in a way likely to lead to alcoholism. But at the normal/disorder divide, there seems to be a consistent lifting of some responsibility, reflecting the application of the sick role. For example, the rough equivalent of our current category of post-traumatic stress disorder (PTSD) was recognized as a disorder in earlier wars ("shell shock," "war neurosis"), but often considered an expression of cowardice; the cowardice was morally evaluable as a failure of virtue (even if, like many personality traits, being a coward is not within the person's direct voluntary control) and led to contempt for those with PTSD, but nonetheless—except in cases thought to be malingering—the PTSD that resulted constituted a disorder for which the individual was [End Page 91] not in the same direct sense blameworthy. This moral shift requires explanation.This topic also has important social ramifications. Relief from responsibility may sound like a good thing, and it is trumpeted by mental health advocates as a reason for supporting the classification of many conditions as disorders. But as Edwards is aware, it is a two-edged sword. Disordered status may allow escape from censure and offer the protections of the sick role, but it also changes the relationship of the agent to his or her own actions and imposes the responsibility of the sick role on the individual to attempt to change ("get better"). The sick role allows for no defense of an idiosyncrasy based on normal variation ("It takes all kinds…") or the individual's eccentric vision or steadfast integrity, for that vision or sense of integrity are now seen as pathological and not morally legitimate. The individual is subjected to endless entreaties to seek help and it is implied that not to do so is irresponsible, so that a decision to embrace one's nature and remain as one is becomes illegitimate. Moreover, the sick role allows for no explanation in terms of the individual's normal defensive response to unjust, deprived, or challenging social or environmental circumstances, thus weakening the motives for social change rather than individual intervention.In sum, there is an inevitable sense in which being placed in the sick role inherently stigmatizes the "sick" condition in virtue of the special moral attitudes extended to the disordered. Cultures can thus easily exploit the sick role and its much-touted relief from responsibility to extend the reach of social control processes. This is one reason why the distinction between disorder and non-disorder is so important, and why it is crucial to identify when non-disordered conditions are mislabeled as disorders—as when, for example, psychiatry gets it wrong about the distinction between normal and disordered sadness (Horwitz and Wakefield, 2007). Such overpathologization can redefine the boundaries of our moral universe on mistaken grounds.Edwards offers two provocative answers—not entirely at ease with each other—to the question of why mental disorders relieve the patient from moral responsibility: (1) mental disorders are... (shrink)

Patient suffering of major depressive disorder (MDD) often complain that subjective time seems to “drag” with respect to physical time. This may point toward a generalized dysfunction of temporal processing in MDD. In the present study, we investigated temporal preparation in MDD. “Temporal preparation” refers to an increased readiness to act before an expected event; consequently, reaction time should be reduced. MDD patients and age-matched controls were required to make a saccadic eye movement between a central and an eccentric (...) visual target after a variable duration preparatory period. We found that MDD patients produced a larger number of premature saccades, saccades initiated prior to the appearance of the expected stimulus. These saccades were not temporally controlled; instead, they seemed to reflect reduced inhibitory control causing oculomotor impulsivity. In contrast, the latency of visually guided saccades was strongly influenced by temporal preparation in controls; significantly less so, in MDD patients. This observed reduced temporal preparation in MDD was associated with a faster decay of short-term temporal memory. Moreover, in patients producing a lot of premature responses, temporal preparation to early imperative stimuli was increased. In conclusion, reduced temporal preparation and short-term temporal memory in the oculomotor domain supports the hypothesis that temporal processing was altered in MDD patients. Moreover, oculomotor impulsivity interacted with temporal preparation. These observed deficits could reflect other underlying aspects of abnormal time experience in MDD. (shrink)

Prior research has demonstrated that antisocial behavior, substance-use disorders, and personality dimensions of aggression and impulsivity are indicators of a highly heritable underlying dimension of risk, labeled externalizing. Other work has shown that individual trait constructs within this psychopathology spectrum are associated with reduced self-monitoring, as reflected by amplitude of the error-related negativity (ERN) brain response. In this study of undergraduate subjects, reduced ERN amplitude was associated with higher scores on a self-report measure of the broad externalizing construct that links (...) these various indicators. In addition, the ERN was associated with a response-locked increase in anterior theta (4–7 Hz) oscillation; like the ERN, this theta response to errors was reduced among high-externalizing individuals. These findings suggest that neurobiologically based deficits in endogenous action monitoring may underlie generalized risk for an array of impulse-control problems. (shrink)

ABSTRACT The paper is a discussion of moral responsibility and excuses in regard to psychiatric disorders involving abnormal desires (e.g. impulse control disorders such as kleptomania and pyromania, psychosexual disorders such as exhibitionism, obsessive‐compulsive disorder and others). It points out problems with previous approaches to the question of whether or not to excuse persons with these disorders, and offers a new approach based on the concept of duress. There is a discussion of duress in regard to non‐psychiatric cases based (...) on the core notion of duress involving a choice between undesirables, and the paper concludes with an argument that moral blame for individuals with these sorts of disorders should often be lessened and in some cases removed entirely. (shrink)

Borderline Personality disorder is a severe personality dysfunction characterized by behavioural features such as impulsivity, identity disturbance, suicidal behaviour, emptiness, and intense and unstable relationships. Approximately 2% of the population are thought to meet the criteria for BPD. The authors of this volume - Anthony Bateman and Peter Fonagy - have developed a psychoanalytically oriented treatment to BPD known as mentalization treatment. With randomised controlled trials having shown this method to be effective, this book presents the first account of (...) mentalization treatment for BPD. The first section gives an overview of BPD, including discussion of nosology, epidemiology, natural history, and psychosocial aetiology. It additionally summarises the present state of our research knowledge about effective psychotherapeutic treatments and use of medication. The second section outlines the authors' theoretical approach and contrasts it with other well known methods, including DBT, CAT, and CBT. In the extensive final section, the authors outline their clinical approach starting with how treatment is organised. A detailed account of the transferable features of the model is provided along with the main strategies and techniques of treatment. Numerous clinical examples are given to illustrate the core techniques and detailed information provided about how to apply aspects of the mentalization based treatment approach in everyday practice. Aimed at mental health professionals, along with counsellors, psychotherapists, and psychoanalysts, the book will be a valuable tool, providing an effective means of treating those suffering from Borderline Personality Disorder. (shrink)

Psychopathic individuals are characterized by impaired affective processing, impulsivity, sensation-seeking, poor planning skills and heightened aggressiveness with poor self-regulation. Based on brain self-regulation studies using neurofeedback of Slow Cortical Potentials (SCPs) in disorders associated with a dysregulation of cortical activity thresholds and evidence of deficient cortical functioning in psychopathy, a neurobiological approach seems to be promising in the treatment of psychopathy. The results of our intensive brain regulation intervention demonstrate, that psychopathic offenders are able to gain control of their brain (...) excitability over fronto-central brain areas. After SCP self-regulation training, we observed reduced aggression, impulsivity and behavioral approach tendencies, as well as improvements in behavioral-inhibition and increased cortical sensitivity for error-processing. This study demonstrates improvements on the neurophysiological, behavioral and subjective level in severe psychopathic offenders after SCP-neurofeedback training and could constitute a novel neurobiologically-based treatment for a seemingly change-resistant group of criminal psychopaths. (shrink)

The DSM-IV-TR (American Psychiatric Association 1994, 689) defines personality disorder (PD) as: An enduring pattern of experience and behavior that deviates markedly from the expectations of an individual’s culture. This pattern is manifested in two (or more) of the following areas: 1 Cognition (i.e., ways of perceiving and interpreting self, other people, and events); 2 Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response); 3 Interpersonal functioning; and 4 Impulse control. B The enduring ..

PurposeThe aim of this study was to investigate and compare impulsiveness, negative emotion, cognitive function, and P300 components among gamma-hydroxybutyrate -addicted patients, heroin-dependent patients, and methadone maintenance treatment subjects.MethodsA total of 48 men including 17 GHB addicts, 16 heroin addicts, 15 MMT subjects, and 15 male mentally healthy controls were recruited. All subjects were evaluated for symptoms of depression, anxiety, impulsiveness, and cognitive function through the Patient Health Questionnaire, the Generalized Anxiety Disorder 7-item, the Barratt Impulsiveness Scale version II, (...) the Beijing version of the Montreal Cognitive Assessment, the behavioral test, and event-related potential P300 detection.Results The mean scores of BIS-II in the GHB addiction group, heroin dependence group, and MMT group were significantly higher than those of the HC group. The total scores of BJ-MOCA in GHB addiction group was the worst among the four groups, followed by heroin addiction, MMT group and HC group. The response time in the GHB addiction group was the longest among the four groups, followed by the heroin addiction, MMT, and HC groups. The amplitude and latency of P300 in GHB addiction subjects were significantly lower and longer than those of the MMT group and the HC group. For the three types of addiction, the P300 amplitudes at Fz, Cz, Pz, T5, and T6 were negatively correlated with the scores of GAD-7, PHQ-9, and BIS-II; the P300 latencies were positively correlated with the response time and negatively correlated with the scores of the BJ-MoCA.ConclusionPeople with an addiction were likely to have increased impulsiveness. The cognitive function of the GHB and heroin-addicted subjects, including the heroin detoxification and the MMT groups, was severely impaired, especially for the GHB-addicted patients. The impairment manifested as abnormalities of BJ-MoCA, response time, and P300 components. (shrink)

Considering his status as the best fighter on the Trojan side, Hector’s flight in “Iliad” 22.131-7 is unexpected and surprising, even though Hector is never overtly reproached for his reaction. This article proposes a psychological explanation for Hector’s behaviour, drawing on recent insights concerning combat stress reaction (CSR) and post-traumatic stress disorder (PTSD): Hector does not flee from fear of death, but from the “Wind of Hate”, i. e. the terror felt when confronted with direct and personal aggression. An (...) examination of the actions of Achilles in the “Iliad” supports this conclusion, for Achilles exhibits behaviour which would qualify for a diagnosis of antisocial personality disorder. The intense personal hatred of Achilles is sufficient to shock Hector into flight, even if he ultimately recovers and heroically faces Achilles in battle. Thus, the scene bears testimony to the “Iliad”’s understanding of the universal human experiences of warfare and aggression. (shrink)

I argue that the magnitude and nature of sex differences in aggression, their development, causation, and variability, can be better explained by sexual selection than by the alternative biosocial version of social role theory. Thus, sex differences in physical aggression increase with the degree of risk, occur early in life, peak in young adulthood, and are likely to be mediated by greater male impulsiveness, and greater female fear of physical danger. Male variability in physical aggression is consistent with an alternative (...) life history perspective, and context-dependent variability with responses to reproductive competition, although some variability follows the internal and external influences of social roles. Other sex differences, in variance in reproductive output, threat displays, size and strength, maturation rates, and mortality and conception rates, all indicate that male aggression is part of a sexually selected adaptive complex. Physical aggression between partners can be explained using different evolutionary principles, arising from the conflicts of interest between males and females entering a reproductive alliance, combined with variability following differences in societal gender roles. In this case, social roles are particularly important since they enable both the relatively equality in physical aggression between partners from Western nations, and the considerable cross-national variability, to be explained. (shrink)

Objective: There is a demonstrated link between the mental health and substance use comorbidities experienced by young adults, however the vast majority of psychological interventions are disorder specific. Novel psychological approaches that adequately acknowledge the psychosocial complexity and transdiagnostic needs of vulnerable young people are urgently needed. A modular skills-based program for emotion regulation and impulse control addresses this gap. The current one armed open trial was designed to evaluate the impact that 12 weeks exposure to ERIC alongside usual (...) care had on young people's ability to regulate emotions, as well as examine potential moderating mechanisms.Methods: Seventy nine young people were enrolled to the 12 week intervention period. Twenty one practitioners from youth and community health services delivered relevant ERIC modules adjunct to usual care. Linear mixed effects regression was used to examine change over time across the primary outcome of emotion dysregulation and secondary outcomes of depression, anxiety, stress, experiential avoidance and mindfulness. Moderation analyses were conducted to test whether the magnitude of change in emotion dysregulation moderated change over time in secondary outcomes.Results: Analyses revealed significant improvement in the primary outcome of emotion dysregulation with a moderate effect size, in addition to decreases in the secondary outcomes of depression, anxiety, stress and experiential avoidance. No improvements in mindfulness were reported. Moderation analyses revealed that the residualised change over time in emotion dysregulation moderated the change over time in symptoms of distress, depression, anxiety, stress, experiential avoidance, and mindfulness.Conclusion: Reductions in the severity of emotion dysregulation, depression, anxiety, stress and experiential avoidance are promising, and were evident despite the complexity of the participants and the diversity of the service setting. The improvements found in each outcome were only observed for those young people whose emotion regulation also improved, providing preliminary evidence for the role of emotion regulation as a key treatment target in this population. (shrink)

Selective serotonin reuptake inhibitors’ wide use, combined with the blurry limit between health and psychological illness, have led neuroscientists, clinicians and ethicists to envision the possibility of these medications’ use in non-clinical populations. This prospect has evoked ethical debates, which have often ignored the findings of the empirical literature. In this context, an evaluation of the empirical evidence for SSRIs’ personality enhancing effects is needed. The present paper examines SSRIs’ effects on healthy personality, including the Five Factor Model traits Neuroticism (...) and Extraversion, as well as some of their facets: Angry Hostility, Impulsiveness, Vulnerability, Warmth, Gregariousness and Assertiveness. The review encompasses investigations in healthy humans, human clinical populations, as well as relevant animal studies. Emerging data raise the possibility that SSRIs, when used by people without a currently diagnosable mental disorder, may reduce some facets of Neuroticism, especially Angry Hostility. On the other hand, very limited support exists for an SSRI-driven change in other Neuroticism facets, such as Impulsiveness, in healthy humans. An increase in Extraversion is possible, but currently available evidence is only indirect. Future research is needed, both to clarify methodological ambiguities in existing studies, and to answer unaddressed questions, such as ones of the stability, predictors, moderators, dose- and context-dependency of the effects. (shrink)

Obsessive-compulsive disorder (OCD) is considered to be one of the more common serious mental disorders, with a prevalence rate of about 1% (Heyman et al. 2006). It is characterized by obsessions, or compulsions, or both. According to the DSM-IV (American Psychiatric Association 1994), obsessions are “recurrent and persistent thoughts, impulses, or images that are experienced at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress.” Compulsions, on the other hand, are repetitive behaviors (...) (e.g., hand washing, ordering, checking) or “mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied .. (shrink)

Introduction: Previous findings that inattention and hyperactive/impulsive symptoms predict later peer problems have been mixed. Utilizing two culturally diverse samples with shared methodologies, we assessed the predictive power of dimensionally measured childhood IA and HI symptoms regarding adolescent peer relationships.Methods: A US-based, clinical sample of 228 girls with and without childhood diagnosed attention-deficit/hyperactivity disorder was assessed and followed 5 years later. A Norwegian, population-based sample of 3,467 children was assessed and followed approximately 4 years later. Both investigations used parent (...) and teacher reports of ADHD symptoms and peer relations. Multivariate regression analyses examined the independent contributions of IA and HI symptoms to later peer problems, adjusting for baseline childhood peer problems. We also examined childhood sex as a potential moderator within the Norwegian sample.Results: Higher levels of childhood HI symptoms, but not IA symptoms, independently predicted adolescent peer problems in the all-female clinical sample. Conversely, higher levels of IA symptoms, but not HI symptoms, independently predicted preadolescent peer problems in the mixed-sex population sample. Results did not differ between informants. Associations between ADHD symptom dimensions and peer problems within the Norwegian sample were not moderated by child sex.Discussion: Differential associations between childhood hyperactive/impulsive and inattention symptoms and adolescent peer problems were found across two diverse samples using a shared methodology. Potential explanations for different findings in the clinical vs. population samples include symptom severity as well as age, sex, and cultural factors. We discuss implications for future research, including the importance of dimensional measures of ADHD-related symptoms and the need for shared methodologies across clinical and normative samples. (shrink)

This book discusses and provides insight on the legal and ethical dilemmas of managing those with Fetal Alcohol Spectrum Disorder (FASD). This book provides a clear perspective for those clinicians and legal professionals who are working with those with this disorder, and correspondingly increases their understanding when arranging effective supports for this population. Historically, the primary focus on FASD has been on children. However, this is a lifelong disorder, and the implications of this disorder become even (...) more prominent and complex in adulthood. Those with this condition can struggle with impulsiveness, and a host of cognitive difficulties. This correspondingly impacts their independence and employability, and produces an elevated risk for homelessness and other residential issues, involvement in substance use, being exploited, development of behavioural issues, and subsequent legal difficulties. Their cognitive difficulties result in challenges for legal systems around the world to understand their issues, and to design appropriate remedial strategies, recommendations for treatments and supports, and even for understanding the failure of many of these individuals to be able to change their behaviours effectively. This produces various legal and ethical dilemmas, which are discussed in detail in this volume by 28 authors from Europe, New Zealand, and North America. These include discussions regarding the rights of the unborn child, the alcohol industry's duty to warn, whether small amounts of alcohol during pregnancy can be condoned, and even the current use of involuntary hospitalization for addicted mothers. Other chapters discuss the need for training on FASD for front line officers, use of lies during interrogation of those with FASD, medical and legal interventions for offenders with FASD, access to diagnostic services and follow-up supports, and whether FASD can be considered a mitigating factor for sentencing. Furthermore, caregivers also provide their stories regarding the daily dilemmas that are faced in raising those with FASD. (shrink)

This paper highlights the evolutionary biological epistemology in Freud psychoanalytic theory. The concepts of aggressive and sexual drives are fulcrum of the psychoanalytic epistemological system, concerning the motivational/emotional roots of mental functioning. These biological roots of mental functioning, especially with regard to aggressive drive, have gradually faded away from psychoanalytic epistemology, as we show in the paper. Currently, however, Neurosciences, and in particular Affective Neuroscience (Panksepp 1998), can contribute to increase the knowledge of the biological roots of human mental functioning. (...) The motivational/emotional systems studied by Affective Neuroscience can give a new epistemological foundation to the aggressive drive concept in psychoanalytic theory. Over the course of human evolution motivational/emotional systems have assumed the role of organizers of social relationships and also of mental functioning. In this regard, among the various types of aggression (ANGER in Panksepp taxonomy 1998), that we consider in our paper is inter-male aggression, also named Dominance motivational/emotional system, which regulates social interactions between sexually mature adults. This type of aggression acts in complementary connection with FEAR motivational/emotional system, that regulate Submissive behaviour and Social defeat, the latter one of the more important stressors. The interaction between aggressiion and FEAR motivational/emotional systems gives rise to Agonistic behaviour or Dominance/Submission motivational/emotional system, as we propose in our paper. There is now a large literature that identifies in the dynamic of Agonistic behaviour one of the main factors of mental illness. When social interactions activate the Agonistic behavior, the subject can perceive himself as "destined to victory" or "destined to defeat", activating either behaviours and emotions connected to the Involuntary Defeat Strategy or Involuntary Dominant Strategy, that we can find in many types of mental disorders, e.g. mood disorders or anxiety disorders. (shrink)

Sagvolden, Johansen, Aase, and Russell (Sagvolden et al.) examine attention-deficit/hyperactivity disorder (ADHD) at levels of analysis ranging from neurotransmitters to behavior. At the behavioral level they attribute aspects of ADHD to anomalies of delay-of-reinforcement gradients. With a normal gradient, responses followed after a long delay by a reinforcer may share in the effects of that reinforcer; with a diminished or steepened gradient they may fail to do so. Steepened gradients differentially select rapidly emitted responses (hyperactivity), and they limit the (...) effectiveness with which extended stimuli become conditioned reinforcers, so that observing behavior is less well maintained (attention deficit). Impulsiveness also follows from steepened gradients, which increase the effectiveness of smaller, more immediate consequences relative to larger, more delayed ones. Individuals who vary in the degree to which their delay gradients are steepened will show different balances between hyperactivity and attention deficit. Given the range of ADHD phenomena addressed, it may be unnecessary to appeal to additional behavioral processes such as extinction deficit. Extinction deficit is more likely a derivative of attention deficit, in that failure to attend to stimuli differentially correlated with extinction should slow its progress. The account suggests how relatively small differences in delay gradients early in development might engender behavioral interactions leading to very large differences later on. The steepened gradients presumably originate in properties of neurotransmitter function, but behavioral interventions that use consistently short delays of reinforcement to build higher-order behavioral units as a scaffolding to support complex cognitive and social skills may nonetheless be feasible. Key Words: ADHD; attention deficit; delay gradient; exponential decay; extinction deficit; hyperactivity; impulsiveness; intervention; observing responses; self-control. Footnotes1000 Jeffrey Gray was the BBS Editor for this treatment. When he accepted Sagvolden et al. for publication, he invited Catania, who was one of the reviewers of the original submission, to prepare a precommentary. Com-mentators were then invited to respond to the Sagvolden et al. article, to the Catania precommentary, or to both. (shrink)

Impairment of self-control is often said to be a defining feature of addiction. Yet many addicts display what appears to be a considerable amount of control over their drug-oriented actions. Not only are their actions clearly intentional and frequently carried out in a conscious and deliberate manner, there is evidence that many addicts are responsive to a wide range of ordinary incentives and counter-incentives. Moreover, addicts have a wide variety of reasons for using drugs, reasons which often seem to go (...) a long way towards explaining their drug-oriented behavior. Many use drugs, for example, to cope with stressful or traumatic experiences. In this article I argue that some standard philosophical explanations of addicts’ impairment of self-control are inadequate, and propose an alternative. (shrink)

BackgroundAttention Deficit Hyperactivity Disorder is one of the most prevalent psychiatric disorders among school-age children and is characterized by varying degrees of inattention, hyperactivity, and impulsivity. Diagnosis, which currently relies on the DSM-V criteria, is complex. This research proposes an integrated procedure for ADHD diagnosis in children, improving the diagnostic process and scientific research on etiopathology.Materials and methodsWe conducted a clinical report on ADHD diagnosis in children between the ages of 8 and 13, based on the results of the (...) application of different scales to parents of school-age children in Chile. The children were divided into two groups, those with an ADHD diagnosis and those without.ResultsThe results revealed statistically significant differences between groups for scales EDAH y SDQ-Cas, Conners Comprehensive Behavior Scale, Conners Parent Scale and the criteria according to the DSM-V and its dimensions, with the exception of inattention.ConclusionThe findings indicate the importance of appropriate criteria and procedures to establish a diagnosis and implement effective interventions in ADHD. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:diacritics 35.1 (2005) 8-21MuseSearchJournalsThis JournalContents[Access article in PDF]Klossowski's Reading of Nietzsche Impulses, Phantasms, Simulacra, StereotypesDaniel W. SmithIn his writings on Nietzsche, Pierre Klossowski makes use of various concepts—such as intensities, phantasms, simulacra and stereotypes, resemblance and dissemblance, gregariousness and singularity—that have no place in Nietzsche's own oeuvre. These concepts are Klossowski's own creations, his own contributions to thought. Although Klossowski consistently refused to characterize himself as a philosopher ("Je (...) suis une 'maniaque,'" he once said, "Un point, c'est tout!"),1 his work in its entirety was marked by an extraordinary conceptual creation. From this point of view, his Nietzsche and the Vicious Circle can be read as a work in philosophy—at least in the idiosyncratic sense given to this term by Gilles Deleuze, who defined philosophy as the creation or invention of concepts [Deleuze and Guattari 2]. No doubt, Klossowski remains an almost unclassifiable figure—philosopher, novelist, essayist, translator, artist—and attempting to analyze his work through the prism of philosophy may seem to be a reductive approach that belies the complexity of his exceptional oeuvre. Reading Klossowski as a conceptual innovator, however, at least has the advantage of allowing us to chart a consistent trajectory through his difficult and often labyrinthine text, without denying its other dimensions (affective, perceptive, literary, and so on). In what follows, then, I would like to examine three of Klossowski's most characteristic and important concepts—impulses and their intensities, phantasms, and simulacra and their stereotypes—as well as the precise interrelations he establishes among them. Taken together, these three concepts describe what Klossowski terms the tripartite economy of soul, which constitutes the implicit model through which he interprets Nietzsche's thought.1Impulses as Fluctuating IntensitiesKlossowski describes his books on both Nietzsche and Sade as "essays devoted not to ideologies but to the physiognomies of problematic thinkers who differ greatly from each other" ["Postface" 137, emphasis added]. This emphasis on the "physiognomy" of thinkers reflects Nietzsche's insistence on taking the body rather than the mind as a guide for philosophy since the body is a more accessible phenomenon, less surrounded by myth and superstition. "The body and physiology as the starting point," Nietzsche wrote. "Why?... The phenomenon of the body is the richer, clearer, more tangible [End Page 8] phenomenon.... Belief in the body is more fundamental than belief in the soul" [WP §§492, 489, 491]. Klossowski himself, however, when writing of the intensive status of the impulses, frequently makes use of the term "soul" (âme), owing in part, no doubt, to his interest in the theological literature of the mystics, such as Meister Eckhardt and Teresa of Avila. For the mystics, the depth of the soul is something irreducible and uncreated: it eludes the exercise of the created intellect, and can only be grasped negatively.2 Nonetheless, if one can find a similar apophaticism (or "negative theology") in Klossowski, it is related exclusively to the immanent and chaotic movements of the soul's intensive affects, and not to the transcendence of God. What is incommunicable in the soul (or body) are its "impulses"—their fluctuations of intensity, their rises and falls, their manic elations and depressive descents, which are in constant variation.Nietzsche himself had recourse to a highly varied vocabulary to describe what Klossowski summarizes in the term "impulse": "drive" (Triebe), "desire" (Begierden), "instinct" (Instinke), "power" (Mächte), "force" (Kräfte), "impulse" (Reize, Impulse), "passion" (Leidenschaften), "feeling" (Gefülen), "affect" (Affekte), "pathos" (Pathos), and so on.3 Klossowski frequently employs the musical term tonalité to describe these states of the soul's fluctuating intensities—their diverse tones, timbres, and changing amplitudes—which can take on various forms ("aggressiveness, tolerance, intimidation, anguish, the need for solitude, the forgetting of oneself" [NVC 6]). At bottom, what these impulses express are what Klossowski calls the "obstinate singularity" of the human soul, which is by nature noncommunicable; they constitute "the unexchangeable depth" (le fond inéchangeable) or "the unintelligible depth" (le fond unintelligible) of the soul. What makes every individual... (shrink)

Hormonal changes across the menstrual cycle have been shown to influence reward-related motivation and impulsive behaviors. Here, to compare neural mechanisms of cognitive impulse control during the mid-luteal phase (LP) versus during the late follicular phase (FP), we employed functional magnetic resonance imaging (fMRI) with an event-related monetary delay discounting (EMDD) behavioral task (study 1) and then employed resting state (RS)-fMRI (study 2). The imaging data were analyzed and related to behavior-associated neural activation. In study 1, women in the late (...) FP showed a preference for sooner rewards while exhibiting enhanced activity in the dorsal striatum (DS), whereas women in the mid-LP showed a preference for delayed, higher-value rewards with enhanced activity in the dorsolateral prefrontal cortex (dlPFC). Discount rate (transformed k) in the EMDD task correlated with functional connectivity (FC) of the DS-dlPFC circuitry, consistent with the possibility that DS-dlPFC circuitry may regulate impulsivity. In study 2, the right dlPFC was significantly more active in mid-LP than in late FP, and this effect was sensitive to estradiol (E2) and relative E2 levels during mid-LP. The magnitude of DS-dlPFC FC correlated negatively with psychometric impulsivity scores during the late FP. These results replicated findings from study 1 and further indicated that relative E2 levels may play an important role in increasing cognitive control during the mid-LP, which provides new insight into the treatment of conditions characterized by hyper-impulsivity, such as obsessive-compulsive disorder, Parkinson disease, and attention deficit hyperactivity disorder. In conclusion, our results suggest that cyclical gonadal hormones affect cognitive control on impulsive behavior periodically, possibility via DS-dlPFC circuitry. (shrink)

If someone with dissociative identity disorder commits a wrongful act, is she responsible? If one adopts the Multiple Persons Thesis, it may seem that one alter cannot be responsible for the actions of another alter. Conversely, if one regards the subject as a single person, it may seem that she is responsible for any actions she performs. I will argue that this subject is a single person, but one who suffers from delusions of disownership and therefore does not fulfill (...) ordinary requirements for responsible agency. This is because she suffers from extreme ambivalence: her deep-seated needs and desires conflict, and she forms alter-personalities as a way to cope with inner discord without abandoning any of these contradictory impulses. However, although the ability to exercise autonomous agency is eroded in such cases, the capacity for autonomous agency is preserved. The subject with DID is weakly responsible for her wrongful acts. (shrink)