Neurological diseases, particularly in the context of aging, have serious impacts on quality of life and can negatively affect bone health. The brain-bone axis is critically important for skeletal metabolism, sensory innervation, and endocrine cross-talk between these organs. This review discusses current evidence for the cellular and molecular mechanisms by which various neurological disease categories, including autoimmune, developmental, dementia-related, movement, neuromuscular, stroke, trauma, and psychological, impart changes in bone homeostasis and mass, as well as fracture risk. Likewise, how (...) bone may affect neurological function is discussed. Gaining a better understanding of brain-bone interactions, particularly in patients with underlying neurological disorders, may lead to development of novel therapies and discovery of shared risk factors, as well as highlight the need for broad, whole-health clinical approaches toward treatment. (shrink)

Apotemnophilia, a disorder that blurs the distinction between neurology and psychiatry, is characterized by the intense and longstanding desire for amputation of a speci¢c limb. Here we present evidence from two individuals suggestive that this condition, long thought to be entirely psychological in origin, actually has a neurological basis. We found heightened skin conductance response..

The prelims comprise: Introduction A (re)Defmition of what Human Gene Therapy is About Neurological Gene Therapy Ethics and Gene Therapy Acknowledgments Notes.

Psychiatric and neurological disorders have historically provided key insights into the structure-function rela- tionships that subserve human social cognition and behavior, informing the concept of the ‘social brain’. In this review, we take stock of the current status of this concept, retaining a focus on disorders that impact social behavior. We discuss how the social brain, social cognition, and social behavior are interdependent, and emphasize the important role of development and com- pensation. We suggest that the social brain, and (...) its dysfunction and recovery, must be understood not in terms of specific structures, but rather in terms of their interaction in large-scale networks. (shrink)

The diagnosis of Functional Neurological Disorder (FND) requires differentiation from other neurologic diseases/syndromes, and from the comparatively rare diagnosis of feigning (Malingering and Factitious Disorder). Analyzing the process of diagnosing FND reveals a necessary element of presumption, which I propose underlies some of the uncertainty, discomfort, and stigma associated with this diagnosis. A conflict between the neurologist’s natural social cognition and professional judgement (cognitive dissonance) can be understood by applying a framework originally designed for the determination of (...) moral responsibility. Understanding the source of this cognitive dissonance may effect its alleviation, and in turn, allow more compassionate treatment of patients with FND. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Seeking the Everyday Meaning of Autonomy in Neurologic DisordersGeorge J. Agich (bio)The Socratic aphorism that the unexamined life is not worth living and dictums like "Know thyself" remind us of the centrality of self-understanding in the history of philosophical reflections on autonomy. These traditional concerns with autonomy may seem far removed from the neurologic impairments to which Joel Anderson and Warren Lux draw our attention. Nonetheless, Anderson and Lux (...) have provided an important discussion that links the traditional philosophical commitment to self-knowledge with an account that parses these concepts in the context of neurologic disorders. Theirs is a potentially productive approach for improving our understanding of autonomy, one that Emilio Mordini and I advocated in a paper entitled, "Autonomy and the Ethics of Neurosurgery" (Agich and Mordini 1998, 54). We argued that the focus of bioethics on issues such as informed consent misses the more challenging and potentially fruitful collaboration that neurosurgery and neurology affords for advancing the philosophical understanding of the conditions of autonomy. The challenge is in the integration of concepts used in one context of meaning with other domains of discourse. A good example of the challenges embedded in pursuing this kind of project can be found in Anderson and Lux's discussion of the concept of accurate self-assessment.Anderson and Lux argue that accurate self-assessment is a requirement for one to act autonomously. On first hearing, this phrase sounds unsurprising and consistent with standard approaches that assume a higher degree of awareness of one's capacities. Their characterization, however, derives from their observations of cases involving severe neurologic impairments, which point to more basic processes than the reflective awareness or knowledge that is often assumed. Paradoxically, the language of accurate self-assessment sounds remarkably like an intellectual function. It appears to fall squarely within the traditional philosophical tendency to define autonomy in terms of ego-centered, intellectual functions involving relatively high-level reflective capacities. Despite their terminology, Anderson and Lux stress that their account requires a type of reflexivity that is not the same as self-conscious reflection understood in the highest degree. They stress this in a number of places. For example, they see the neurologic concept of executive function as involving basic feedback mechanisms that are "broadly isomorphic with capacities associated [End Page 295] with autonomy;" these include anticipation, goal seeking, planning, initiation, sequencing, monitoring, error detection, self-correction, as well as initiation of novel responses, a clearly heterogenous set of capacities (Anderson and Lux 2004, 285). These capacities are not capacities of the "mind," but basic neurologic functions of the intact embodied agent who is actively engaged in the world. Thus, these concepts capture or express a practical (or clinical) as opposed to a theoretical understanding of the basic conditions or capacities defining autonomy. Similarly, their talk of "self-assessment" does not need to be understood as explicit or conscious; rather, it typically operates in the background (Anderson and Lux 2004). They term this character of self-assessment "mundane" (Anderson and Lux 2004, 289), which strikes me as exactly the right way to characterize this key feature of autonomy (Agich 1995). Their phenomenological and clinically based insights are quite sound, but the reader struggles with a terminology that seems to run in a different direction. To be sure, they stress that they intend their language of "autonomy" and "accurate self-assessment" to involve ordinary, background, and everyday functions that do not require high levels or significant capacities for reflective self-assessment, but their very insistence underscores the problem inherent in this terminology.Anderson and Lux argue that the capacity for self-assessment has a task-relative dimension that requires a degree of "accuracy." They characterize accuracy in a way that may promote rather than forestall misunderstanding. They state that "an adequate degree of precision" (281) is required in such assessment. For example, in assessing whether one is able to jump a hurdle, they say "one must accurately estimate not only the strength of one's legs but also the height of the hurdle" (Anderson and Lux 2004, 281). They further characterize their account of "accuracy" as involving an epistemological externalism, which might lead some readers to assume... (shrink)

The understanding of locomotion in neurological disorders requires technologies for quantitative gait analysis. Numerous modalities are available today to objectively capture spatiotemporal gait and postural control features. Nevertheless, many obstacles prevent the application of these technologies to their full potential in neurological research and especially clinical practice. These include the required expert knowledge, time for data collection, and missing standards for data analysis and reporting. Here, we provide a technological review of wearable and vision-based portable motion analysis tools (...) that emerged in the last decade with recent applications in neurological disorders such as Parkinson's disease and Multiple Sclerosis. The goal is to enable the reader to understand the available technologies with their individual strengths and limitations in order to make an informed decision for own investigations and clinical applications. We foresee that ongoing developments toward user-friendly automated devices will allow for closed-loop applications, long-term monitoring, and telemedical consulting in real-life environments. (shrink)

An estimated 15% of patients seen by neurologists have neurological symptoms, such as paralysis, tremors, dystonia, or seizures, that cannot be medically explained. For a long time, such patients were diagnosed as having conversion disorder and referred to psychiatrists, but for the last two decades or so, neurologists have started to pay more serious attention to this patient group. Instead of maintaining the commonly used label of conversion disorder – which refers to Freud’s idea that traumatic events (...) can be converted into deviant behaviour – these neurologists use the term functional neurological disorder and explain that the problems are due to abnormal central nervous system functioning. The situation that some patients with medically unexplained neurological symptoms are diagnosed with CD and treated by psychiatrists while others are diagnosed with FND and stay under the control of neurologists provides a unique case for analysing how neurological and psychological explanations affect subjectivity. In this article, I compare patient reports from English-language websites from the past 15 years to find out how minds, bodies, brains, and selves act and interact in the accounts of both patient groups. I conclude that the change in label from CD to FND has not only influenced ideas of medically unexplained disorders, but also affected ideas of the self and the body; of self-control and accountability. (shrink)

The aim of this contribution is to provide a few historical and conceptual insights on the question of the impact of current developments in the neurosciences on the concept of psychiatric disease. Alzheimer’s disease is a good example when considering this important question. On the one hand, Alzheimer’s disease has a somewhat ambiguous status in terms of disorders affecting the mind or the psyche. This ambiguous status is illustrated by the fact that one commonly qualifies Alzheimer’s disease as a ‘neuropsychiatric’ (...) disorder, because it cannot easily be classified as either a ‘neurological’ or ‘psychiatric’ disorder. On the other hand, the concept of Alzheimer’s disease was created at the beginning of the twentieth century, as the neurosciences were beginning to take shape themselves as scientific disciplines. To compare Alzheimer’s original ideas with current conceptions may thus help us to precisely specify current developments in the neurosciences. (shrink)

_The Disordered Mind: An Introduction to Philosophy of Mind and Mental Illness, second edition_ examines and explains, from a philosophical standpoint, what mental disorder is: its reality, causes, consequences, and more. It is also an outstanding introduction to philosophy of mind from the perspective of mental disorder. Revised and updated throughout, this _second edition_ includes new discussions of grief and psychopathy, the problems of the psychophysical basis of disorder, the nature of selfhood, and clarification of the relation (...) between rationality and mental disorder. Each chapter explores a central question or problem about mental disorder, including: what is mental disorder and can it be distinguished from neurological disorder? what roles should reference to psychological, cultural, and social factors play in the medical/scientific understanding of mental disorder? what makes mental disorders undesirable? Are they diseases? mental disorder and the mind–body problem is mental disorder a breakdown of rationality? What is a rational mind? addiction, responsibility and compulsion ethical dilemmas posed by mental disorder, including questions of dignity and self-respect. Each topic is clearly explained and placed in a clinical and philosophical context. Mental disorders discussed include clinical depression, dissociative identity disorder, anxiety, religious delusions, and paranoia. Several non-mental neurological disorders that possess psychological symptoms are also examined, including Alzheimer’s disease, Down’s syndrome, and Tourette’s syndrome. Containing chapter summaries and suggestions for further reading at the end of each chapter, _The Disordered Mind, second edition_ is a superb introduction to the philosophy of mental disorder for students of philosophy, psychology, psychiatry, and related mental health professions. (shrink)

Deep brain stimulation (DBS) of the globus pallidus interna and subthalamic nucleus has restored some degree of motor control in many patients in advanced stages of Parkinson’s disease. DBS has also been used to treat dystonia, essential tremor (progressive neurological condition causing trembling), chronic pain, obsessive-compulsive disorder, Tourette’s syndrome, major depressive disorder, obesity, cerebral palsy, and the minimally conscious state. Although the underlying mechanisms of the technique are still not clear, DBS can modulate underactive or overactive neural (...) circuits and restore disrupted communication between and among groups of neurons in interacting regions of the brain. This can control and relieve many symptoms associated with a range of neurological and psychiatric disorders.But the procedures of implanting and stimulating the electrodes are brain-invasive and entail significant risks. Some patients receiving DBS have experienced intracerebral hemorrhage, infection, cognitive disturbances such as impulsive behavior, and affective disturbances such as mania. It is not known whether continuous electrical stimulation of the brain would reshape synaptic connectivity and permanently alter neural circuits in ways that may not be salutary. The risk of these effects indicates that DBS should be used only when a patient’s condition is refractory to all other interventions and when there is a high probability that the technique will benefit the patient and improve his or her quality of life. If a patient’s quality of life is poor and all other treatment options have been exhausted, then the likelihood of benefit can justify physicians’ exposing patients to some risk. The clinical and ethical significance of the risk in DBS underscores the obligation of physicians to obtain fully informed consent from patients undergoing the procedure. (shrink)

Functional Neurological Symptom Disorder or Conversion Disorder, is a fairly common diagnosis among mental health patients in Pakistan. Despite its prevalence there's a dearth of research on the phenomenon, particularly on the experience of FNSD. The study was conducted with the aim to ascertain the lived experiences of individuals with Functional Neurological Symptom Disorder around stressful situations in their families in Pakistan. For this purpose, a total sample of 10 participants were recruited from the psychiatry (...) department of a tertiary care hospital in Lahore, Pakistan. Semi-structured interviews were conducted and analyzed through Interpretative Phenomenological Analysis. The two main themes revealed in the analyses were quarrels and unexpressed emotions. The sub-themes of quarrels included quarrels with family members, quarrels within family, parental/marital discord, and quarrels with extended family members. The subthemes for unexpressed emotions were hurt, anger, sadness, and jealousy. In conclusion, this study revealed that in Pakistan, stressors related to family serve as significant contributing factors in the development of FNSD. (shrink)

As our knowledge of the functional and pharmacological architecture of the nervous system increases, we are getting better at treating cognitive and affective disorders. Along with the ability to modify cognitive and affective systems in disease, we are also learning how to modify these systems in health. “Cosmetic neurology,” the practice of intervening to improve cognition and affect in healthy individuals, raises several ethical concerns. However, its advent seems inevitable. In this paper I examine this claim of inevitability by reviewing (...) the evolution of another medical practice, cosmetic surgery. Cosmetic surgery also enhances healthy people and, despite many critics, it is practiced widely. Can we expect the same of cosmetic neurology? The claim of inevitability poses a challenge for both physicians and bioethicists. How will physicians reconsider their professional role? Will bioethicists influence the shape of cosmetic neurology? But first, how did cosmetic surgery become common? (shrink)

The nature of reality has exercised philosophers and mystics, theologians and shamans. Yet what we perceive as reality is bounded, if not defined, by the apparatus with which we perceive: our brains. Neurology has to know the capacity normal and disordered of the tool with which we see the world; neurologists use evidence of disordered perception to recognize and classify illness in the brain.

While the self-representation of our bodies is a key element in our belief that we are autonomous individuals with a “first-person perspective,” the term body image covers and has covered a variety of meanings. In neurology, this term currently designates the verbal representation of the body parts. Psychoanalysis considers body image as intertwining the imaginary and symbolic aspects of identity, and insists on its dependence on the Other’s regard; this link to regard appears in the term specular image. This paper (...) first presents a history of the modern psychiatrical, psychological and neurological conceptions of own-body representation. Next, it considers applications of the Lacanian notion of specular image in neurological disorders of body image. (shrink)

The transition from research to patient following advances in transplantation research is likely to be disappointing unless it includes a better understanding of critically relevant characteristics of the neurological disorder and improvements in the animal models, particularly the behavioral features. The appropriateness of the model has less to do with the species than with how the species is used.

The Disordered Mind, Third Edition is a wide-ranging introduction to the philosophy of mental disorder or illness. It examines and explains, from a philosophical standpoint, what mental disorder is: its reality, causes, consequences, compassionate treatment, and more. Revised and updated throughout, the third edition includes enhanced discussions of the distinction between mental health and illness, selfhood and delusions about the self, impairments of basic psychological capacities in mental disorder and the distinct roles that mental causation and neural (...) mechanisms play in mental illness. The book is organized around four questions: What is a mental disorder or illness? What makes mental disorder something bad? What are various mental disorders and what do they tell us about the mind? What is mental health and how may it be restored? Numerous disorders are discussed including: addiction, agoraphobia, delusion, depression, dissociative identity disorder, obsession-compulsion, schizophrenia, and religious scrupulosity, among others. Several neurological disorders are examined. Various problems associated with DSM-5 and with psychiatric diagnosis are explored. Including chapter summaries and suggestions for further reading at the end of each chapter, The Disordered Mind presupposes no special background in philosophy, and as such will be of interest to those in related disciplines such as psychology, psychiatry and mental health, and professions such as nursing and social work. (shrink)

The aim of this chapter is to argue against the idea that there needs to be a polar opposition between "biological" and "humanistic" psychiatry. The basis for this idea lies in the philosophical tradition-the view that "mind" and "brain" must be conceived either as two separate "substances" or as one and the same. It is argued that this ontological conception of the problem should be replaced with a phenomenological description of what is actually meant by talk of human mental life. (...) In particular, Merleau-Ponty's account of human beings as "body-subjects" enables us to explain some aspects of some mental disorders as manifestations of neurological dysfunction, others as human responses to traumatic situations, and others as both. (shrink)

I much appreciate the honour of being invited to deliver the first Manson lecture, which, its founder has laid down, is to be devoted to the consideration of some subject of common interest to philosophy and medicine. I cannot think of anything which better fulfils that condition than the neurological approach to the problem of perception. The neurologist holds the bridge between body and mind. Every day he meets with examples of disordered perception and he learns from observing the (...) effects of lesions produced by disease, or by the physiologist's experiments, something of how the neural basis of perception is organized. It is possible to study perception as though this was largely irrelevant. How far that view is right will be for you to judge when I have finished. (shrink)

There is a spectrum of child psychiatric and neurological disorders, in all of which a comorbidity with obsessive-compulsive disorder and ritualized behavior is very common. Therefore, they may appear as a basis for the rituals in children that cross into adolescence and adulthood. Resolving the nature of these disorders may help us to better understand “Why ritualized behavior?” (Published Online February 8 2007).

The intact nervous system has an exquisite ability to modulate the activity of multiple muscles acting at one or more joints to produce an enormous range of actions. Seemingly simple tasks, such as reaching for an object or walking, in fact rely on very complex spatial and temporal patterns of muscle activations. Neurological disorders such as stroke and focal dystonia affect the ability to coordinate multi-joint movements. This article reviews the state of the art of research of muscle synergies (...) in the intact and damaged nervous system, their implications for recovery and rehabilitation, and proposes avenues for research aimed at restoring the nervous system’s ability to control movement. (shrink)

The ethical recruitment of participants with neurological disorders in clinical research requires obtaining initial and ongoing informed consent. The purpose of this study is to characterize barriers faced by research personnel in obtaining informed consent from research participants with neurological disorders and to identify strategies applied by researchers to overcome those barriers. This study was designed as a web-based survey of US researchers with an optional follow-up interview. A subset of participants who completed the survey were selected using (...) a stratified purposeful sampling strategy and invited to participate in an in-depth qualitative interview by phone or video conference. Data were analyzed using a mixed methods approach, including content analysis of survey responses and thematic analysis of interview responses. Over 1 year, 113 survey responses were received from US research personnel directly involved in obtaining informed consent from participants in neurological research. Frequently identified barriers to informed consent included: cognitive and communication impairments (e.g. aphasia), unrealistic expectations of research participants, mistrust of medical research, time constraints, literacy barriers, lack of available social support, and practical or resource-related constraints. Strategies to enhance informed consent included: involving close others to support participant understanding of study-related information, collaborating with more experienced research personnel to facilitate training in obtaining informed consent, encouraging participants to review consent forms in advance of consent discussions, and using printed materials and visual references. Beyond conveying study-related information, researchers included in this study endorsed ethical responsibilities to support deliberation necessary to informed consent in the context of misconceptions about research, unrealistic expectations, limited understanding, mistrust, and/or pressure from close others. Findings highlight the importance of training researchers involved in obtaining informed consent in neurological research to address disease-specific challenges and to support the decision-making processes of potential research participants and their close others. (shrink)

Abstract:This paper, presented as the 2019 Cambridge Quarterly Neuroethics NetworkCharcot Lecture, traces the nosology of disorders of consciousness in light of 2018 practice guidelines promulgated by the American Academy of Neurology, the American College of Rehabilitation Medicine and the National Institute on Disability, Independent Living and Rehabilitation Research. By exploring the ancient origins of Jennett and Plum’s persistent vegetative state and subsequent refinements in the classification of disorders of consciousness—epitomized by the minimally conscious state, cognitive motor dissociation, and the recently (...) described chronic vegetative state—the author argues that there is a counter-narrative to the one linking these conditions to the right to die. Instead, there is a more nuanced schema distinguishing futility from utility, informed by technical advances now able to identify covert consciousness contemplated by Jennett and Plum. Their prescience foreshadows recent developments in the disorders of consciousness literature yielding a layered legacy with implications for society’s normative and legal obligations to these patients. (shrink)

For the last thirty years, cognitive scientists have attempted to describe the cognitive architecture of typically developing human beings, using, among other sources of evidence, the dissociations that result from developmental psychopathologies such as autism spectrum disorders, Williams syndrome, and Down syndrome. Thus, in his recent defense of the massive modularity hypothesis, Steven Pinker insists on the importance of such dissociations to identify the components of the typical cognitive architecture (2005, 4; my emphasis): This kind of faculty psychology has numerous (...) advantages (...). It is supported by the existence of neurological and genetic disorders that target these faculties unevenly, such as a difficulty in recognizing faces (and facelike shapes) but not other objects, or a difficulty in reasoning about minds but not about objects or pictures. Similarly, Simon Baron-Cohen writes (1998, 335; my emphasis; see also Temple, 1997): I suggest that the study of mental retardation would profit from the application of the framework of cognitive neuropsychology (…). In cognitive neuropsychology, one key question running through the investigator’s mind is “Is this process or mechanism intact or impaired in this person?” When cognitive neuropsychology is done well, a patient’s cognitive system is examined with specific reference to a model of the normal cognitive system. And, not infrequently, evidence from the patient’s cognitive deficits leads to a revision of the model of the normal system. However, in recent years, the use of developmental psychopathologies to identify the components of the typical cognitive architecture has come under heavy fire. In a series of influential articles, neuropsychologist Annette Karmiloff-Smith has argued that findings about the pattern of impairments and preserved capacities in people with developmental psychopathologies say nothing about the cognitive architecture of.. (shrink)

Neurological diseases (NDs), featured by progressive dysfunctions of the nervous system, have become a growing burden for the aging populations. N‐Deacetylase and N‐sulfotransferase 3 (NDST3) is known to catalyze deacetylation and N‐sulfation on disaccharide substrates. Recently, NDST3 is identified as a novel deacetylase for tubulin, and its newly recognized role in modulating microtubule acetylation and lysosomal acidification provides fresh insights into ND therapeutic approaches using NDST3 as a target. Microtubule acetylation and lysosomal acidification have been reported to be critical (...) for activities in neurons, implying that the regulators of these two biological processes, such as the previously known microtubule deacetylases, histone deacetylase 6 (HDAC6) and sirtuin 2 (SIRT2), could play important roles in various NDs. Aberrant NDST3 expression or tubulin acetylation has been observed in an increasing number of NDs, including amyotrophic lateral sclerosis and frontotemporal dementia (ALS/FTD), schizophrenia and bipolar disorder, Alzheimer's disease (AD), and Parkinson's disease (PD), suggesting that NDST3 is a key player in the pathogenesis of NDs and may serve as a target for development of new treatment of NDs. (shrink)

In cases where one sense-modality is stimulated by another, we speak of synesthesia, i.e., of a subjective experience of multiple distinct sensations as being quite literally conjoined. The term “synesthesia” is derived indirectly from the Greek words “syn,” meaning “together,” and “aisthesis,” meaning “sensation.” This article focuses on the question of whether synesthesia is in fact a mental disorder or a creative gift. Both the commonsense views that have emerged in recent times, and neurological research, demonstrate that our (...) knowledge of this relatively uncommon phenomenon is slowly but constantly expanding. Proper experimental research conducted with the right sorts of synesthete, and philosophically and scientifically nuanced conceptual studies of synesthesia, can all be helpful when seeking answers to the question posed above, while also confirming general claims about the extent to which our perceptions are reallysubjective. Most synesthetes see themselves as gifted, and claim that this “conjoining of the senses” enriches the quality of their lives. (shrink)

Philosophers, psychologists, neuroscientists, and psychiatrists examine the will and its pathologies from theoretical and empirical perspectives, offering a conceptual overview and discussing schizophrenia, depression, prefrontal lobe damage, and substance abuse as disorders of volition. Science tries to understand human action from two perspectives, the cognitive and the volitional. The volitional approach, in contrast to the more dominant "outside-in" studies of cognition, looks at actions from the inside out, examining how actions are formed and informed by internal conditions. In Disorders of (...) Volition, scholars from a range of disciplines seek to advance our understanding of the processes supporting voluntary action by addressing conditions in which the will is impaired. Philosophers, psychologists, neuroscientists, and psychiatrists examine the will and its pathologies from both theoretical and empirical perspectives, offering a conceptual overview and discussing specific neurological and psychiatric conditions as disorders of volition. After presenting different conceptual frameworks that identify agency, decision making, and goal pursuit as central components of volition, the book examines how impairments in these and other aspects of volition manifest themselves in schizophrenia, depression, prefrontal lobe damage, and substance abuse. Contributors George Ainslie, Tim Bayne, Antoine Bechara, Paul W. Burgess, Anna-Lisa Cohen, Daniel Dennett, Stéphanie Dubal, Philippe Fossati, Chris Frith, Sam J. Gilbert, Peter Gollwitzer, Jordan Grafman, Patrick Haggard, Jay G. Hull, Marc Jeannerod, Roland Jouvent, Frank Krueger, Neil Levy, Peter F. Liddle, Kristen L. Mackiewitz, Thomas Metzinger, Jack B. Nitschke, Jiro Okuda, Adrian M. Owen, Chris Parry, Wolfgang Prinz, Joëlle Proust, Michael A. Sayette, Werner X. Schneider, Natalie Sebanz, Jon S. Simons, Laurie B. Slone, Sean A. Spence. (shrink)

This article is a discourse analysis of two historical inquiries into what clinici-ans today call attention deficit hyperactivity disorder . Of primary con-cern in this regard are psychodynamic perspectives towards ADHD symptoms, championed by psychoanalysts and psychologists, and neurological perspectives towards ADHD, which continue to favor a purely physiological approach to understanding the disorder. Those within the psychodynamic camp are inclined to view ADHD as an interactional difficulty between self and social environment - a condition best remedied (...) by psychotherapy. Those within the neurological camp see ADHD as a specific brain process, whose effective treatment depends upon adequate psychopharmacology. This essay argues that both psychodynamic and neurological perspectives towards ADHD have strategized to legitimate one perspective through the expulsion of the other. Within the current era of ADHD nomenclature and treatment it is clear that neurological perspectives dominate the debate. However, neurological perspectives continue to be haunted by a considerable amount of skepticism, both nationally and internationally. Because of this it would be difficult to assert that neurological perspectives, though winning the “legitimation race” in contemporary understandings of ADHD, are entirely monolithic sources of ADHD knowledge. (shrink)

BackgroundFunctional neurodiagnostics could allow researchers and clinicians to distinguish more accurately between the unresponsive wakefulness syndrome and the minimally conscious state. It remains unclear how it informs surrogate decision-making.ObjectiveTo explore how the next of kin of patients with disorders of consciousness interpret the results of a functional neurodiagnostics measure and how/why their interpretations influence their attitudes towards medical decisions.Methods and SampleWe conducted problem-centered interviews with seven next of kin of patients with DOC who had undergone a functional HD-EEG examination at (...) a neurological rehabilitation center in Germany. The examination included an auditory oddball paradigm and a motor imagery task to detect hidden awareness. We analyzed the interview transcripts using structuring qualitative content analysis.ResultsRegardless of the diagnostic results, all participants were optimistic of the patients’ meaningful recovery. We hypothesize, that participants deal with the results of examinations according to their belief system. Thus, an unfavorable evaluation of the patient’s state had the potential to destabilize the participant’s belief system. To re-stabilize or to prevent the destabilization of their belief system, participants used different strategies. Participants accepted a “positive” HD-EEG result since it stabilized their belief system.ConclusionWe hypothesize, that a group of next of kin of patients with DOC deals with functional neurodiagnostics results on the basis of the result’s value and their high hope that the patient will recover meaningfully. A psychological mechanism seems to moderate the impact of functional neurodiagnostics on surrogate treatment decisions. (shrink)

Some scholars believe thot Cognitive Science is the attempt to achieve in artificial systems what has already been achieved in the brain. Others, by contrast, argue that the study of ideal adaptive mechanisms could go on without reference to the brain. The author points out that the brain may not be the ideal cognitive device because of biological limitotions on its capacity. Although it may not be ideal, it is still of major interest to cognitive scientists because of the great (...) interest in the human mind, and, in addition, because at this moment the brain is the most important single reservoir of odoptive mechanisms.The paper discusses several areas of neuroscience which are likely to shed light on mechanisms of adaptation. The study of simple nervous systems is likely to reveal important design principles of cognitive devices. The study of complex nervous systems will, of course, exert a major influence. The study of such systems leads to certain general principles concerning the neural circuits involved in complex odoptive behaviors: (1) There exist innate specialized systems for the learning of many specific behaviors that at first might appeor to be purely cultural. (2) There is no evidence for the existence of any all‐purpose computer in the brain. (3) There are many surprising dissociations manifested by the specialized systems in the brain, e.g., a special system for recognition of faces as against other visual patterns. (4) The study of the nervous system enables one to formulate more precise mechanisms for the role of emotion in cognitive function.(5) Some human behoviors con probably be understood poorly or not at all if the neural substrate is not considered. (6) The cognitive systems designed for dealing with ottentionol processes may be among the most complex neural structures which underlie behavior.There are certain other properties of brains that should be kept in mind by the cognitive scientists who are studying human behovior: (1) Brains differ from each other in structure, and it is very likely that the strategy for the solution of certain problems differs from person to person. (2) The presence of certain innate cognitive strategies in the brain may prevent that organism from employing other strategies which might be optimal for other problems. (3) Any theory about a particular cognitive strategy will have implications as to the particular mode of breakdown that might be expected after brain lesions. The study of disordered function from brain disease may thus be a valuable way to test certain cognitive theories. (shrink)