The belief that memory is essential to the self is common. Extreme amnesia, e.g., Korsakoff Syndrome, is held to dissolve the afflicted person’s self. This belief is a misconception that rests on a confusion of epistemic with ontological relevance. Epistemically, memory is relevant to the self: a subject’s self-knowledge partly depends on memories of past experiences. However, it is not by virtue of these memories that the subject is a self: ontologically, memory is irrelevant to that status. The fact (...) that an individuals conception of herself as existing through time is wanting does not prevent that individual from being a self at a given point in time. As the past is there whether or not it is remembered, so the self is there whether or not it remembers. If instead we define the self as awareness of being a subject of experience, the self may survive even the most extreme forms of amnesia. Being a self is an important social value, a prerequisite of numerous legal or moral rights. This in itself is questionable, like the social exclusion it may entail. Denying an amnesic person a self is therefore more than a logical mistake: it is a social exclusion that can also be questioned on ethical grounds. (shrink)

The belief that memory is essential to the self is common. Extreme amnesia, e.g., Korsakoff Syndrome, is held to dissolve the afflicted person’s self. This belief is a misconception that rests on a confusion of epistemic with ontological relevance. Epistemically, memory is relevant to the self: a subject’s self-knowledge partly depends on memories of past experiences. However, it is not by virtue of these memories that the subject is a self: ontologically, memory is irrelevant to that status. The fact (...) that an individuals conception of herself as existing through time is wanting does not prevent that individual from being a self at a given point in time. As the past is there whether or not it is remembered, so the self is there whether or not it remembers. If instead we define the self as awareness of being a subject of experience, the self may survive even the most extreme forms of amnesia. Being a self is an important social value, a prerequisite of numerous legal or moral rights. This in itself is questionable, like the social exclusion it may entail. Denying an amnesic person a self is therefore more than a logical mistake: it is a social exclusion that can also be questioned on ethical grounds. (shrink)

As earlier research on Korsakoff syndrome, a frequent neurological complication of alcohol-dependence, mainly focused on cognition, affective impairments have been little investigated despite their crucial impact in AD. This article proposes new research avenues on this topic by combining two theoretical frameworks: dual-process models, positing that addictions are due to an imbalance between underactivated reflective system and overactivated affective-automatic one; continuity theory, postulating a gradual worsening of cognitive impairments from AD to KS. We suggest that this joint perspective may (...) renew the current knowledge by clarifying the affective-automatic deficits in KS and their interactions with reflective impairments, but also by offering a direct exploration of the continuity between AD and KS regarding reflective and affective-automatic abilities. (shrink)

Patient’s decision making competence is a widely discussed subject. Issues of competence, autonomy, well-being and protection of the patient come up every day. In this article we analyse what role PDMC plays in Dutch legislation and what dilemmas healthcare professionals may experience, notably in patients suffering from Korsakoff’s syndrome. Dilemmas emerge if professionals want to meet the requirements mentioned in Dutch law and the desires of their patients. The autonomy of the patient and the healthcare professionals’ duty to take (...) care of their patient’s best interests, create a tension and lead to uncomfortable situations. Healthcare professionals describe difficulty finding a balance between these issues and assessing the degree of mental competence still present. In long term care situations, quality of the relationship between healthcare professionals and their patients seems to be of much more importance in decision making on minor issues of competence than simply relying on legal or house rules. In being committed to their cases, professionals will be more sensitive to individuals habits, abilities, welfare and dignity, which will make it easier to decide on issues of competence, and to find creative solutions to their dilemmas. (shrink)

Aim:This study explores experiences of patients suffering from Korsakoff’s syndrome. It contributes to improved reflection on the value of patient knowledge.Background:An ethics of care perspective states the importance of moving to patients in their vulnerable state of being, and to figure out patients’ individual needs necessary to provide good care. The information given by patients suffering from Korsakoff’s syndrome might be mistaken, invented and even not true. The value of these patients’ experiences and knowledge had not been researched (...) to date.Method:Data from six in-depth interviews were analysed concurrently through the constant comparative method.Ethical considerations:The principles of voluntariness, confidentiality and anonymity were respected during the research process.Findings:Four important themes within patients’ knowledge emerged: health condition, involuntary admission into the nursing home, the daily routine and interpretation of the caring abilities of healthcare professionals. The findings show that our respondents were able to provide a window into their inner perspective.Conclusion:This study deepens our understanding of the value of patient knowledge in situations where patients see the world in a different manner as do healthcare professionals. The conversations revealed personal subjective knowledge which our respondents create and live by. Healthcare professionals are encouraged to discover and affirm the understandings of these patients, and not be prepossessed due to the diagnosis or general nursing home rules. Understanding patients’ unique knowledge through appreciation of the complexity and richness of different views on the situation can assist to give a more humane response to individual needs and pain. Health staff in healthcare institutions are encouraged to evaluate the – unintended – effect of rigidly applied nursing home rules, and the government is challenged to rethink its policy about care, and provide more resources permitting relational care that nurtures the dignity of patients suffering from Korsakoff’s syndrome. (shrink)

The main objective of this paper is to describe how quality of care may be improved during an involuntary admission process of patients suffering from Korsakoff's syndrome. It presents an empirically grounded analysis with different perspectives on ‘doing good’ during this process. Family carers', healthcare professionals' and legal professionals' ways of understanding and ordering this problematic situation appear very different. This could prevent patients from getting the proper care they need, with risk of more suffering and quality of life (...) below the minimum acceptable. All this possibly lead to immoral dehumanizing situations. Firstly, the background of our empirical study is sketched. Secondly, the different perspectives on ‘doing good’ are summarized and compared. Thirdly, the tensions arising from the different conceptualizations of autonomy and different types of responsibilities of the actors are clarified. A common ‘doing good’ during involuntary admission necessitates removal of any tensions within the relational network by weighing and balancing the different perspectives on autonomy and the resulting responsibilities. With this in mind, we propose a renewed time/action table for involuntary admission, which tends to address all patients' needs at the right time. The solution presented might help healthcare professionals, who are squeezed in between patients, family carers, legal professionals and overall rules, to create practices in which patients suffering from Korsakoff's syndrome can maintain their dignity and receive the care they need. Earlier interventions, timely and adequate diagnosis, and diminishment of tensions between the different actors by fine‐tuning their paradigmatic frameworks are suggested to be part of a solution. (shrink)

Je lui ai associÉ un court extrait d'une revue de questions portant sur le même thème. Implicit memory is revealed when previous experiences facilitate perf on a task that does not require conscious or intentional recollection of those expces. Explicit memory is revealed when perf on a task requires conscious recolelction of previous expces. Il s'agit de defs descriptives qui n'impliquent pas l'existence de deux systs de mÉmo sÉparÉs. Historiquement Descartes est le premier ˆ faire mention de phÉnomènes de mÉmo (...) implicites, Leibniz, Maine de Biran, Bergson en ont Également parlÉ. Korsakoff (1889) avec ses travaux sur les amnÉsiques montre qu'ils sont capables d'utiliser de l'info qu'ils ont acquises dans des Épisodes rÉcents sans pour autant manifester le moindre souvenir de l'Épisode. L'interprÉtation de ces phÉnomènes Était alors que ça renvoyait ˆ des traces en mÉmoire trop tÉnues pour accèder jusqu'au champ de la conscience. Cette interprÉtation va pouvoir être ÉcartÉe par les travaux rÉcents. Thorndike a Également conduit un nbre important de travaux sur MI. Les trauvaux un peu plus rÉcents ont montrÉ qu'un apprentissage antÉrieur pouvait faciliter une perfce sans qu'il y ait ref explicite à l'Épisode d'apprentissage. On a montrÉ aussi l'effet de stimuli subliminaux, qui en tant que tels ne peuvent pas être rappelÉs consciemment, mais qui influencent la conduite ou les jugts ultÉrieurs. Par ex, la prÉsentation de formes sur des temps très courts qui excluent la possibilitÉ d'une perception consciente influence significativement lechoix de formes dans une pÉreuve ultÉrieure de choix forcÉs où les sjts doivent indiquer la forme qu'il prÉfère entre deux. Ils choisissent prÉfÉrentiellement celles qui leur ont ÉtÉ prÉsentÉes de manière subliminale. De même Bargh et al. ont montrÉ que des sjts soumis de manière subliminale ˆ des mots hostiles portent ultÉrieurement des jugts plus nÉgatifs sur une personne target. Il ya Également eu des travaux sur l'apprsge ou le condt without awareness en particulier apprsge implicite de règles de grammaire (ie le sjt peut construire de nouvelles phrases conformes ˆ la syntaxe de celles qui lui ont ÉtÉ prÉsentÉes sans pour autant petre capables d'noncer les règles de grammaire qu'il utilise) Rem: N'est ce pas un pbe de typemÉtacognition??? Enfin, tous les travaux sur le priming sont des elts en faveur de MI: Facilitation in the processing of a stimulus as a function of a recent encounter with the same stimulus. Type de perfce sur lesquels les effets de priming ont ÉtÉ dÉmontrÉs: -T‰ches de dÉcision lexicale: Le sjt doit dire si la cha"ne de caractères qu'on lui prÉsente est un mot ou pas: Le temps de latence est beaucoup plus court si la cha"ne a dÉjˆ ÉtÉ prÉsentÉe une première fois. -Mesures de temps d'identification de mots en rpÉsentation tachitoscopiques -ComplÉmentation de mots: les sjts ont tendance ˆ complÉter pour crÉer les mots qui leur ont ÉtÉ prÉsentÉs antÉrieurement. L'intÉrêt pour le paradigme de priming se retouve chez les gens qui s'intÉressent ˆ: -reconnaissance de mots et organisation lexicale. les effets de priming permettent de faire des hyps sur l'accès lexical et la reprÉsentation. -M. Épisodique: travux sur les amnÉsiques qui ne se souviennent pas qu'on vient de leur prÉsenter des mots mais qui manifestent une mÉmoire implicite lorsqu'on leur fait faire de la complÉmentation de mots. DISSOCIATION ENTRE M.I. ET M EXPLICITE 1-Si de nombreux travaux montrent que la M explicite est influencÉe par le travail d'Élaboration (profondeur de traitement) en jeu pendant la première phase d'Étude des stimuli, il semble que la MI ne le soit pas. 2-Le changt de modalitÉ (par ex auditif -> visuel) entre la phase d'Étude et la phase de test provoque une attÉnuation importante de l'effet de priming si le test est un test de MI mais pas si c'est un test de ME. 3-Les effets de primings persistent assez largement sur plusieurs jours ce qui n'est pas le cas des perfces ˆ une Épreuve de reconnaissance. 4-Les perfces sur des tests de MI ne semblent pas influencÉes par des manipulations d'interfÉrences proactives ou rÉtroactives dont on sait qu'elles influencent les perfces en ME. 5-Absce de corrÉlation entre perfces ˆ des tests de reconnaissance et perfces ˆ une Épreuve de complÉmentation de mots. SIMILARITES ENTRE PRIMING ET REMEMBERING 1- A certaines conditions les durÉes de rÉtention on des effets parallèles sur les effets de priming et les mesures de ME (REm: en partie contradictoire avec 3 ci dessus) 2-La manipulation du contexte de la liste lors de la phase d'Étude affecte ˆ la fois les perfces en reconnaissance et en identification de mots. 3- ME et MI sont influencÉes par des associations nouvellement acquises entre des paires de mots non reliÉes (Rem: contradictoires avec 4 ci dessus ??) 4- Rem: Le contraire de 1 du pt "dissociation" !!!! dans une manip particulière 5-Johnston et al. ont montrÉ que des mots identifÉs plus rapidement Étaient plus svt jugÉs comme 'old' dans une t‰che de reconnaissance que les mots identifiÉs plus lentement. Il n'est pas exclu que les phÉnomènes que l'on interprètent comme relevant de MI soient parfois de la ME involontaire cad des cas o les cues fournis dans le test conduisent ˆ un souvenir involontaire mais totalement conscient. LES INTERPRETATIONS THEORIQUES DE MI 1-Les effets de priming sur des test de MI sont attribuables ˆ l'activation temporaires de reprÉsentations ou structures de K prÉ-existantes . Cette activation est supposÉe avoir lieu de manière automatique, indÉpendamment des processus d'Élaboration nÉcessaires pour Établir de nouvelles traces Épisodiques. 2- les difÉrences entre ME et MI sont dues ˆ la nature et aux relations entre les processus d'encodage et de rÉcupÉration. Une version de cette approche est celle qui s'appuie sur la distinction entre processus dirigÉs par les donnÉes et processus dirigÉs par les concepts. Ces derniers reflètent des activitÉs initiÉes par le sjt comme l'Élaboration, l'organisation et la reconstruction, c'est sur ce type de processus que reposerait la ME alors que la MI reposerait sur des processus data-driven. 3-ME et MI renvoient ˆ des systs sous jacents diffÉrents. Pour Cohen & Squire (1984), la ME est supportÉe par une M DECLARATIVE , syst qui est en jeu dans la formation de nouvelles reprÉsentations. La MI repose sur un syst PROCEDURAL dans lequel la M se manifeste par des modifications on line de procÉdures ou opÉrations de traitement. Le syst de M Épisodique est vu comme la base pour le souvenir explicite d'evts rÉcents tandis que la M sÉmantique est responsable des perfces sur des tests de MI. Chacune de ces approches est conforme ˆ certaines des donnÉes recueillies mais pas ˆ d'autres. (shrink)

The current dominant perspective on addiction as a brain disease has been challenged recently by Marc Lewis, who argued that the brain-changes related to addiction are similar to everyday changes of the brain. From this alternative perspective, addictions are bad habits that can be broken, provided that people are motivated to change. In that case, autonomous choice or “free will” can overcome bad influences from genes and or environments and brain-changes related to addiction. Even though we concur with Lewis that (...) there are issues with the brain disease perspective, we also argue that pointing to black swans can be important, that is: there can be severe cases where addiction indeed tips over into the category of brain disease, but obviously that does not prove that every case of addiction falls into the disease category, that all swans are black. We argue that, for example, people suffering from Korsakoff’s syndrome, can be described as having a brain disease, often caused by alcohol addiction. Moreover, the brain changes occurring with addiction are related to choice-behaviour, habit formation and insight, hence essential mental abilities to break the addiction. We argue for a more graded perspective, where both black swans and white swans are rare, and most cases of addiction come as geese in different shades of gray. (shrink)

A new diagnostic system for organic psychiatry is presented. We first define "organic psychiatry", and then give the theoretical basis for conceiving organic psychiatric disorders in terms of hypothetical psychopathogenetic processes, HPP:s. Such hypothetical disorders are not strictly identical to the clusters of symptoms in which they typically manifest themselves, since the symptoms may be concealed or modified by intervening factors in non typical circumstances and/or in the simultaneous presence of several disorders. The six basic disorders in our system are (...) Astheno Emotional Disorder (AED), Somnolence Sopor Coma Disorder (SSCD), Hallucination Coenestopathy Depersonalisation Disorder (HCDD), Confusional Disorder (CD), Emotional Motivational Blunting Disorder (EMD) and Korsakoff's Amnestic Disorder (KAD). We describe their usual etiologies, their typical symptoms and course, and some forms of interaction between them. (shrink)

Rosenthal makes assertions about what can and cannot happen without being conscious. Although his distinctions are informative, they do not substitute for data. We have little precise information that differentiates the immediate feeling of awareness, such as that possible for Korsakoff patients, from the later episodic memory of conscious experience. Appeals to introspection are useful starting points, but they are clearly are not to be trusted in this context. Rosenthal also asks why conscious thinking would be more efficacious than (...) thinking that is not conscious. The answer is that the whole armamentarium of planning becomes available to conscious thought, together with episodic memory and the linguistic mediation that goes along with it. (shrink)

Background and aims: Recent investigations have highlighted the value of neuropsychological testing for the assessment and screening of Alcohol-Related Brain Damage. The aim of the present study was to evaluate the suitability of the Addenbrooke’s Cognitive Examination and the Repeatable Battery for the Assessment of Neuropsychological Status for this purpose. Methods: Comparing 28 participants with ARBD and 30 alcohol-dependent participants without ARBD we calculated Area Under the Curve statistics, sensitivity and specificity values, base-rate adjusted predictive values, and likelihood ratios for (...) both tests. Results: High levels of screening accuracy were found for the total scores of both the ACE-III and RBANS at multiple cut-off points. Removing participants with a history of polysubstance from the samples improved the diagnostic capabilities of the RBANS substantially, while only minor improvements to the ACE-III’s accuracy were observed. Conclusions: Overall, both the ACE-III and RBANS are suitable tools for ARBD screening within an alcohol-dependent population, though the RBANS is the superior of the two. Clinicians using these tools for ARBD screening should be cautious of false-positive outcomes and should therefore combine them with other assessment methods and more detailed neuropsychological testing before reaching diagnostic decisions. (shrink)