The practice of covertly administering medication is controversial. Although condemned by some as overly paternalistic, others have suggested that it may be acceptable if patients have permanent mental incapacity and refuse needed treatment. Ethical, legal, and clinical considerations become more complex when the mental incapacity is temporary and when the medication actually serves to restore autonomy. We discuss these issues in the context of a young man with schizophrenia. His mother had been giving him antipsychotic medication covertly in his soup. (...) Should the doctor continue to provide a prescription, thus allowing this to continue? We discuss this case based on the “four principles” ethical framework, addressing the conflict between autonomy and beneficence/non-maleficence, the role of antipsychotics as an autonomy restoring agent, truth telling and the balance between individual versus family autonomy. (shrink)

ObjectiveTo prospectively study the cingulate cortex for the localization and role of the grasping action in humans during electrical stimulation of depth electrodes.MethodsAll the patients with intractable focal epilepsy and a depth electrode stereotactically placed in the cingulate cortex, as part of their pre-surgical epilepsy evaluation from 2015 to 2017, were included. Cortical stimulation was performed and examined for grasping actions. Post-implantation volumetric T1 MRIs were co-registered to determine the exact electrode position.ResultsFive patients exhibited contralateral grasping actions during electrical stimulation. (...) All patients had electrodes implanted in the ventral bank of the right cingulate sulcus adjacent to the vertical anterior commissure line. Stimulation of other electrodes in adjacent regions did not elicit grasping.ConclusionGrasping action elicited from a localized region in the mid-cingulate cortex directly supports the concept of the cingulate cortex being crucially involved in the grasping network. This opens an opportunity to explore this region with deep brain stimulation as a motor neuromodulation target for treatment in specific movement disorders or neurorehabilitation. (shrink)

Background: Freezing of gait is a common symptom in Parkinson’s disease and can be difficult to treat with dopaminergic medications or with deep brain stimulation. Novel stimulation paradigms have been proposed to address suboptimal responses to conventional DBS programming methods. Burst-cycling deep brain stimulation delivers current in various frequencies of bursts, while maintaining an intra-burst frequency identical to conventional DBS.Objective: To evaluate the safety and tolerability of BCDBS in PD patients with FOG.Methods: Ten PD subjects with STN or GPi DBS (...) and complaints of FOG were recruited for this single center, single blinded within-subject crossover study. For each subject, we compared 4, 10, and 15 Hz BCDBS to conventional DBS during the PD medication-OFF state.Results: There were no serious adverse events with BCDBS. It was feasible and straightforward to program BCDBS in the clinic setting. The benefit was comparable to conventional DBS in measures of FOG, functional mobility and in PD motor symptoms. BCDBS had lower battery consumption when compared to conventional DBS.Conclusions: BCDBS was feasible, safe and well tolerated and it has potential to be a viable future DBS programming strategy. (shrink)

DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers can freely discuss current and emerging deep brain stimulation technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in (...) its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury. (shrink)

We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field. (...) The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS Think Tank was held virtually on September 1 and 2, 2020 (Zoom Video Communications) due to restrictions related to the COVID-19 pandemic. The meeting focused on advances in: (1) optogenetics as a tool for comprehending neurobiology of diseases and on optogenetically-inspired DBS, (2) cutting edge of emerging DBS technologies, (3) ethical issues affecting DBS research and access to care, (4) neuromodulatory approaches for depression, (5) advancing novel hardware, software and imaging methodologies, (6) use of neurophysiological signals in adaptive neurostimulation, and (7) use of more advanced technologies to improve DBS clinical outcomes. There were 178 attendees who participated in a DBS Think Tank survey, which revealed the expansion of DBS into several indications such as obesity, post-traumatic stress disorder, addiction and Alzheimer’s disease. This proceedings summarizes the advances discussed at the Eighth Annual DBS Think Tank. (shrink)

Objectives: To study the attitudes of both medical and non-medical students towards the do-not-resuscitate decision in a university in Hong Kong, and the factors affecting their attitudes.Methods: A questionnaire-based survey conducted in the campus of a university in Hong Kong. Preferences and priorities of participants on cardiopulmonary resuscitation in various situations and case scenarios, experience of death and dying, prior knowledge of DNR and basic demographic data were evaluated.Results: A total of 766 students participated in the study. There were statistically (...) significant differences in their DNR decisions in various situations between medical and non-medical students, clinical and preclinical students, and between students who had previously experienced death and dying and those who had not. A prior knowledge of DNR significantly affected DNR decision, although 66.4% of non-medical students and 18.7% of medical students had never heard of DNR. 74% of participants from both medical and non-medical fields considered the patient’s own wish as the most important factor that the healthcare team should consider when making DNR decisions. Family wishes might not be decisive on the choice of DNR.Conclusions: Students in medical and non-medical fields held different views on DNR. A majority of participants considered the patient’s own wish as most important in DNR decisions. Family wishes were considered less important than the patient’s own wishes. (shrink)

The etiology of visual hallucinations is largely undetermined in schizophrenia. Collerton et al.'s PAD model partly concurs with what we know about neurocognition in schizophrenia, but we need to specify the types of perceptual and attentional abnormalities that are implicated in recurrent complex visual hallucinations (RCVH). Available data suggest that abnormal attentional control and top-down processing play a larger role than the ventral stream deficits.

In this essay, I introduce the symposium on Jordan Wessling’s book, Love Divine: A Systematic Account of God’s Love for Humanity, by discussing its origin as a book panel, providing the context for the significance of Wessling’s contribution, and previewing the essays that follow.

Trenton Merricks has objected to dualist conceptions of the Incarnation in a similar way to Jaegwon Kim’s pairing problem. On the original pairing problem, so argues Kim, we lack a pairing relationship between bodies and souls such that body A is causally paired with soul A and not soul B. Merricks, on the other hand, argues that whatever relations dualists propose that do pair bodies and souls together (e.g. causal relations) are relations that God the Son has with all bodies (...) whatsoever via his divine attributes (e.g. God the Son could cause motion in any and all bodies via his omnipotence). So if we count these relations as sufficient for embodiment, then dualism implies that God the Son is embodied in all bodies whatsoever. I shall argue that while the original pairing problem might be easily answerable, the Christological pairing problem is not and that dualists must shift some of their focus from the defense of the soul’s existence to explicating the nature of the mind-body relationship. (shrink)

Drawing on the behavioral theory, this study examines how the misalignment between a firm's environmental effort and the level of subsidies received from the government in affecting the firm's investment in non-environmental R&D. Based on a sample of Chinese A-share listed firms from 2008 to 2019 and using polynomial regression techniques, our findings reveal that firms in the “low effort-high subsidies” group exhibit lower non-environmental R&D intensity compared to firms in the “high effort-low subsidies” group. This study contributes to the (...) literature by shedding light on the interplay between corporate environmental efforts, government subsidies, and non-environmental R&D investment. The findings suggest the importance of aligning the environmental efforts of firms with subsidy levels from the government to effectively allocate resources for different types of R&D. The implications of this research suggest that firms should carefully consider aligning their environmental efforts with government subsidies to optimize their investment in non-environmental R&D and overall innovation strategy. Furthermore, the study indicates that firms and governments should prudently balance the relationship between environmental R&D and non-environmental R&D to avoid any negative impact on the latter. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hermeneutics, Neuroscience and PsychiatryMichael T. H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM (bio)Hermeneutic practice in mental health has been a theme in Philosophy, Psychiatry, & Psychology (PPP) since its very beginnings. In this essay I argue that hermeneutics, the theory and practice of interpretation, promotes therapeutic interaction between mental health professionals, patients and their family.Why does this patient present in such a way at this (...) particular point in time? The distressing symptoms are there. The changes in behavior are obvious. Impairments of functions are hurting. A mental illness clearly runs in the family. There were early losses of loved ones, physical abuse at home, bullying by peers and self-medication with drugs and alcohol. Three in four adults with a mental illness first experienced that before they turned 24. The brain goes through major reorganization during adolescence and early adulthood. If synaptic pruning went wrong, psychoses emerged. When stresses activated the hypothalamic–pituitary–adrenal axis the elevated cortisol level impacted the size and function of the hippocampus and amygdala in the genetically vulnerable; anxiety, depression, bipolar, and personality disorders developed. The patient needs a voice/language to describe all these experiences and events and the psychiatrist needs a discourse to make sense of them.Eisenberg laments the swings between "brainlessness" and "mindlessness" in psychiatry. Engel argues for a "biopsychosocial" discourse. The major challenge for psychiatry is how to organize clinical information of different nature (categories, dimensions, narratives; i.e., objective vs. subjective, personal vs. interpersonal) into a coherent and comprehensible account for us all. Mental illnesses are not only neuropsychiatric spectrum disorders but also dysfunctions of social relationship and environmental/ecological adaptation. Psychiatry as a clinical neuroscience per se lacks the semantics to address the rich interactions between the physical, psychological, social, cultural, and spiritual in the illness experience of our patients. Explanation in the diagnostic formulation (objective scientific discourse on cause and effect) and understanding in the patient narrative (subjective ordinary everyday discourse on significance and meaning) are irreducible to each other (Wong, 2018). They instead interact with one another to achieve an integrative formulation, not through merging different discourses into a single assertion/monologue but via the dialectic/dialogue of "explaining more in order to understand better," as Ricoeur puts it, and between "the whole and the parts," as Schleiermacher highlights.This "therapeutic hermeneutic circle" of "explanation vs understanding" and "the whole vs the parts" includes symptoms behavior function and life events. It correlates between bio-psychosociocultural-spiritual dimensions/perspectives and does not reduce them to any particular/single [End Page 13] stance. The whole integrates the parts and the parts enrich the whole. It explains but does not explain away. It understands through an articulation of meaning and significance. This discourse is a multilayered (bio-psycho-social-cultural-spiritual) personal narrative that formulates diagnosis and care in a correlative (linking different voices/discourses) and non-reductive (no particular voice/discourse is prejudiced against) manner that is comprehensible to us all (Wong, 2021).PPP will be an excellent forum for discussing clinical hermeneutics in the future. In this digital era of social media and virtual reality, hermeneutics has the never-ending task to tackle the unprecedented challenges to meaning illness and health posed by polarizing discourses.Michael T. H. Wong Michael T.H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM, is Hon Clinical Professor, Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, HKSAR, China. Michael is Chair, Section of Philosophy & Humanities in Psychiatry, World Psychiatric Association. He is an Organizational Partner & International Lead with The Collaborating Centre for Values-Based Practice in Health and Social Care, St Catherine's College Oxford. He is Advisor to the Chinese Health Foundation of Australia.ReferencesWong M. T. H. (2018). Ricoeur and the third discourse of the person: From philosophy and neuroscience to psychiatry and theology. London: Lexington Books. Google ScholarWong, M. T. H. (2021). Values, meanings, hermeneutics and mental health. In Stoyanov, D., Fulford, K. M. W. F., Stanghellini, G., Van Staden, W., & Wong, M. TH. (Eds.), International perspectives in values-based mental health practice: Case studies and commentaries (pp. 341–349... (shrink)

According to Kant, we refer to what is out there in the world by performing a demonstrative act, like pointing at an object with a finger. A Kantian mode of demonstrative reference is characterized by the existence of a real, 2-placed affective relation between an intuiting subject and the referent. Parsons suggests that Kantian intuition is both singular and immediate, and immediacy demands an object of intuition to be present, a condition clearly satisfied by objects within our immediate perceptual field. (...) But since we do not have an immediate relation with remote objects, the scope of our demonstrative reference is severely restricted by intuitional immediacy. I wish to develop a global Kantian intuition in order to extend the scope of demonstrative reference. Kant's ontology of space entails that the global representability of space be given to an intuiting subject as a form of intuition. According to Melnick, Kantian intuition is a kinematic operation which involves directing attention and moving about. To make contact with the world, the subject must move away from its locale: although a spatially remote object is not immediately present, we can shift our location by taking a path such that W will become so. Once we are close enough to be affected by W, we will be able to point at W and say "This." Thus, the intuitive scope of demonstrative reference is globalized as we shift our location. (shrink)

Libertarians such as J.R. Lucas have abandoned traditional Christian doctrines because they cannot reconcile them with the freedom of the will. Traditional Christian thinkers such as Augustine have repudiated libertarianism because they cannot reconcile it with the dogmas of the Faith. In Free Will and the Christian Faith, W.S. Anglin demonstrates that free will and traditional Christianity are ineed compatible. He examines, and solves, puzzles about the relationships between free will and omnipotence, omniscience, and God's goodness, using the idea of (...) free will to answer the question of why God allows evil, and presenting arguments that link free will to eternal life and to the nature of revelation. Topics covered include the meaning of life, the soul and Lesbegue measure, and strategies for discerning the voice of God. (shrink)

The authors' novel approach to some interesting mathematical concepts - not normally taught in other courses - places them in a historical and philosophical setting. Although primarily intended for mathematics undergraduates, the book will also appeal to students in the sciences, humanities and education with a strong interest in this subject. The first part proceeds from about 1800 BC to 1800 AD, discussing, for example, the Renaissance method for solving cubic and quartic equations and providing rigorous elementary proof that certain (...) geometrical problems posed by the ancient Greeks cannot be solved by ruler and compass alone. The second part presents some fundamental topics of interest from the past two centuries, including proof of G del's incompleteness theorem, together with a discussion of its implications. (shrink)

In 1962 a mimeographed sheet of paper fell into my possession. It had been prepared by Ernest Adams of the Philosophy Department at Berkeley as a handout for a colloquim. Headed 'SOME FALLACIES OF FORMAL LOGIC' it simply listed eleven little pieces of reasoning, all in ordinary English, and all absurd. I still have the sheet, and quote a couple of the arguments here to give the idea. • If you throw switch S and switch T, the motor will start. (...) There fore, either if you throw switch S the motor will start, or, if you throw switch T the motor will start. • It is not the case that if John passes history he will graduate. Therefore, John will pass history. The disconcerting thing about these inferences is, of course, that under the customary truth-functional interpretation of and, or, not, and if-then, they are supposed to be valid. What, if anything, is wrong? At first I was not disturbed by the examples. Having at that time consider able personal commitment to rationality in general and formal logic in par ticular, I felt it my duty and found myself easily able (or so I thought) to explain away most of them. But on reflection I had to admit that my expla nations had an ad hoc character, varying suspiciously from example to example. (shrink)

A fundamental philosophical question that arises in connection with evolutionary theory is whether the fittest patterns of behavior are always the most rational. Are fitness and rationality fully compatible? When behavioral rationality is characterized formally as in classical decision theory, the question becomes mathematically meaningful and can be explored systematically by investigating whether the optimally fit behavior predicted by evolutionary process models is decision-theoretically coherent. Upon investigation, it appears that in nontrivial evolutionary models the expected behavior is not always in (...) accord with the norms of the standard theory of decision as ordinarily applied. Many classically irrational acts, e.g. betting on the occurrence of one event in the knowledge that the probabilities favor another, can under certain circumstances constitute adaptive behavior.One interesting interpretation of this clash is that the criterion of rationality offered by classical decision theory is simply incorrect (or at least incomplete) as it stands, and that evolutionary theory should be called upon to provide a more generally applicable theory of rationality. Such a program, should it prove feasible, would amount to the logical reduction of the theory of rational choice to evolutionary theory. (shrink)

Heidegger’s characterization of Dasein as Being-in-the-world suggests a natural relation to environmental philosophy. Among environmentalists, however, closer inspection must raise alarm, both since Heidegger’s approach is in some senses inescapably anthropocentric and since Dasein discovers its environment through its usability, serviceability, and accessibility. Yet Heidegger does not simply adopt a traditionally modern, instrumental view. The conditions under which the environment appears imply neither that the environment consists only of tools, nor that what is true of the parts is also true (...) of the whole, nor that an orientation to use—where appropriate—precludes any other orientation. Heidegger’s anthropocentric commitments thus do not rule out the possibility of a non-instrumental perspective on the natural world. (shrink)

This is a concise introductory textbook for a one semester course in the history and philosophy of mathematics. It is written for mathematics majors, philosophy students, history of science students and secondary school mathematics teachers. The only prerequisite is a solid command of pre-calculus mathematics. It is shorter than the standard textbooks in that area and thus more accessible to students who have trouble coping with vast amounts of reading. Furthermore, there are many detailed explanations of the important mathematical procedures (...) actually used by famous mathematicians, giving more mathematically talented students a greater opportunity to learn the history and philosophy by way of problem solving. Several important philosophical topics are pursued throughout the text, giving the student an opportunity to come to a full and consistent knowledge of their development. These topics include infinity, the nature of motion, and Platonism. This book offers, in fewer pages, a deep penetration into the key mathematical and philosophical aspects of the history of mathematics. (shrink)

This text is organized around the distinction between finite and infinite. It includes a brief overview of what different philosophers have said about infinity, and looks at some of the arguments to the effect that one should adopt a pro-infinity attitude. Other chapters contain an exposition of the ontological schools; interactions among these schools and various theories of truth; the relationship between mathematics and values; a history of mathematics; an analysis of mathematical knowledge; the role of mathematics in eduction; the (...) implications of religion for the philosophy of mathematics; and referenc eto mathematical objects. (shrink)

That conditional, if-then reasoning does not emerge until 4–5 years has long been accepted. Here we show that children barely 3 years old can do conditional reasoning. All that was needed was a superficial change to the stimuli: When color was a property of the shapes rather than of the background, 3-year-olds could succeed. Three-year-olds do not seem to use color to inform them which shape is correct unless color is a property of the shapes themselves. While CD requires integrating (...) color and shape information, the dimensional change card sort task requires keeping those dimension cognitively separate – inhibiting attention to one when sorting by the other. For DCCS, a superficial change to the stimuli that is the inverse of what helps on CD enables 3-year-olds to succeed when normally they do not until ∼4⁤12 years. As we and others have previously shown, 3-year-olds can succeed at DCCS when color is a property of the background, instead of a property of the stimulus. Our findings on CD and DCCS suggest that scaffolding preschoolers’ emerging conceptual skills by changing the way stimuli look enables 3-year-olds to demonstrate reasoning abilities long thought beyond their grasp. Evidently, children of 3 years have difficulty mentally separating dimensions of the same object and difficulty mentally integrating dimensions not part of the same object. Our present CD findings plus our earlier DCCS findings provide strong evidence against prominent cognitive complexity, conditional reasoning, and graded memory theories for why 3-year-olds fail these two tasks. The ways we have traditionally queried children may have obscured the budding reasoning competencies present at 3 years of age. (shrink)

In an article on ‘The Name of the Euxine Pontus’ in C.Q.xxxiv , pp. 123 ff., A. C. Moorhouse rejects the suggestion made by M. Vasmer and supported by Boisacq that the original Greek title ξενος was a popular rendering of the Avestan adjective αχṦαệνα, ‘of dark colour’. Moorhouse raises the following objections to this theory: i. There is no direct evidence of the Avestan adjective ever being applied to the Black Sea. ii. In historical times ‘Avestan is a long (...) way from Greek’ and in prehistorical times it is doubtful whether the speakers of Avestan had any close connexion with the Black Sea. iii. Assuming πόντος to denote ‘way’, ‘the dark way’ would be a fantastic name for any sea. iv. The early Greek form is ξενος, and only metri gratia ξεινος, whereas if the word is a loan from αχṧαēνα we should expect the phonetically closer form ξενος. (shrink)