Tuesday 26 July 2022
Tuesday 19 July 2022
In today's post, Anneli Jefferson discusses her new book, Are Mental Disorders Brain Disorders? (Routledge 2022). She is a lecturer at Cardiff University who works in the philosophy of psychology, moral philosophy, and at the intersection of the two.
I argue that resistance to calling mental disorders brain disorders stems primarily from a very narrow and specific view of what is entailed when we call a condition a brain disorder. This narrow view looks to paradigmatic brain disorders such as brain cancer as a model for what makes a condition a brain disorder. It concludes that a condition can only be a brain disorder if the following conditions are met: dysfunction in the brain is specifiable independently of the psychological level, it causally precedes mental symptoms, and treatment of the disorder targets the brain directly, for example through medication or surgery. (This specification that the brain is targeted directly is important because psychological treatment through talking therapy targets the brain as well, but does so indirectly.)
The narrow view is unsatisfactory because both the etiology of brain disorders and the treatment involve a plurality of factors (Kendler 2012). Furthermore, somatic dysfunction, too, is not specifiable independently of the adverse effects a structural or functional anomaly in the body has for an organism. It’s therefore unclear why we should demand a higher standard for brain dysfunction.
Instead, we should say that differences in brain structure or function that we find in mental health conditions are dysfunctional precisely because they realize mental dysfunction. This gives us a more modest notion of brain dysfunction and disorder, which only requires that we find differences in the brain that are sufficient for realising psychological dysfunction. This means that for many psychiatric disorders, brain dysfunction will only be specifiable as such because it realises psychological dysfunction.
The second half of the book considers objections and implications, I address the objection that brain disorder labels are committed to a problematic reductionism and that mental disorders are relational (externalist) in a way that a focus on dysfunction in the brain cannot allow for.
Finally, I discuss worries about how brain disorders affect responsible agency and how the ‘brain disorder’ label might influence people’s self-perception and the way others see them. I argue that while brain disorders do often have an impact on responsible agency, we can and should only assess responsibility by looking at an agent’s psychological profile. Knowledge of brain dysfunction can inform such psychological assessments, but it cannot replace them.
I then consider the worry that rightly or wrongly, hearing that a person is suffering from a condition that involves dysfunction in the brain will make people see them as unable to do anything to recover from or manage their condition and make them think that person is not responsible for their actions. I discuss two possible explanations for such effects: one is that we draw unwarranted conclusions by drawing analogies to certain paradigm brain disorders such as brain cancer, the other is the hypothesis that we are intuitive dualists, who think of brain and mind as separate. I end by proposing ways to mitigate these undesirable associations.
Tuesday 12 July 2022
Today's post is by Pablo López-Silva who is an Adjunct Professor at the School of Psychology and Research Professor at the Institute of Philosophy, Universidad de Valparaíso, Chile. He is Young Research Fellow at the Millenium Institute for Research in Depression and Personality (Chile).
Pablo's areas of research are Philosophy of Mind, Philosophy of Psychology, Psychopathology, and Neuroethics and he's director of the Project FONDECYT 1221058 'The architecture of psychotic delusions'. Here, he discusses his new book, Protecting the Mind: Challenges in Law, Neuroprotection, and Neurorights (Springer 2022, edited by Pablo López-Silva & Luca Valera).
Protecting the Mind: Challenges in Law, Neuroprotection, and Neurorights is a multidisciplinary effort to think critically about philosophical, ethical, and empirical issues that emerge from the potential misuses of neurotechnologies in medical and non-medical contexts. The contributions contained in the collection cover a wide range of topics, but, altogether, they are able to inform current discussion that local governments are having in light of the many threats posited for the unregulated use of neurotechnologies with access to neural data around the world.
One of the main concerns that guide this collection has to do with the lack of clear and specific legal frameworks that could protect the mind from external intromission allowed by such neurotechnologies. We believe that important philosophical discussion about how to conceptualize our mind arise from this threat. But, at the same time, we believe that conceptual discussions must be accompanied by specific actions focused on protecting the life of citizens. In this collection, we have tried to maintain an equilibrium between these complementary levels of analysis in order to invite the academic community to keep discussing these matters. Given the ongoing nature of these debates, we hope this collection of essays motivates further discussion to develop comprehensive concepts and to inform contextualized legal frameworks.
In the last chapter of our collection, we leave open some questions:
- Must we protect our mind and persons?
- Is this protection only motivated by the fear of the unknown—e.g., the possible consequences that neurotechnologies may have on our society—and by the current lack of knowledge?
In any case, what is clear, here, is the twofold role of neurotechnologies: “Neuro-technology is developing powerful ways to treat serious diseases, to improve lifestyles and even, potentially, to enhance the human body. However, this progress is also associated with new self-understandings, existential challenges and problems never seen before” (Echarte 2016, 137). The bet we have to make concerns, then, both what we can gain and what we can lose: we could achieve qualitatively better lives but forgetting our vulnerability and losing our “image;” we could be better off, but we would lose the possibility of experiencing authentically. We need to evaluate if such a gamble is convenient and, above all, if it is authentically human.
Tuesday 5 July 2022
Various philosophers of science, from John Stuart Mill to Ruth Millikan, have proposed that the basis of scientific classification ought to be causal and that valid categories in science should track causal relationships. Building on this basic insight, we argue that by focusing on the etiology of the disorder, it becomes apparent that the differences between BDD and OCD are such that they should not both be subsumed under the category of OCRD. We propose a tentative causal model of BDD that sets it apart as a psychiatric disorder and corroborates the claim that it has been misclassified in the DSM-5. Reclassification of BDD on the basis of its causal profile should have implications for the diagnosis and treatment of patients.
We think that there are three causal factors implicated in BDD that do not appear to be present in the disorders that it has been classified with. BDD involves a perceptual deficit that is not apparent in OCD. People with BDD tend to focus on details at the expense of the whole picture or “configural” features. Neuropsychological studies suggest that those with BDD tend to over-focus on minor details when drawing complex figures from memory, compared to those without BDD. This is congruent with other research suggesting that people with BDD are more likely to examine details in visual tasks and less likely to take in the holistic picture. This phenomenon seems to be supported by studies in which people with BDD and controls perform matching tasks (e.g. matching images of inverted faces).
In addition to a perceptual deficit, people with BDD also have distinctive cognitive deficits. Compared to people with OCD, people with BDD show a theory of mind deficit and they engage in referential thinking especially when it comes to social situations. People with BDD tend to have difficulty in understanding others’ intentions and attitudes in social settings. When asked to observe video sequences of a dinner party and report on those people’s attitudes and intentions, people with BDD tend to perform poorly relative to controls. When it comes to referential thinking, people with BDD tend to perceive neutral or even positive stimuli as being negative. A smile from a stranger on the sidewalk is more likely to be perceived as a mocking gesture rather than a friendly greeting.
People with BDD also seem to differ from those with OCD when it comes to level of insight into their own condition. Whereas people with OCD usually have a fair level of insight, those with BDD tend to show poor insight. People with OCD will often report knowing that their behaviour – such as checking the stove 20 times to make sure it is off -- is senseless. They might know that checking once is enough, but they still carry out the ritual of checking repeatedly. By contrast, people with BDD really believe that their body is mis-shaped, and they think that they are justified in mirror-checking as often as they do. In other words, they have different attitudes towards their own behaviours. Moreover, BDD patients also report feeling worse after engaging in repetitive behaviors and experience no reduction in anxiety, as compared with OCD patients, whose rituals seem to relieve their anxiety, albeit temporarily.
Additionally, people with BDD are resistant to others’ attempts at reassurance and reject evidence that contradicts their beliefs. No matter how often someone says, “your nose looks fine,” or provides evidence that their facial features are not asymmetrical, people with BDD do not accept this information. This suggests that they might have a strong version of a confirmation bias, which has also been found in other psychiatric patients with entrenched delusions, such as those with schizophrenia. Meanwhile, OCD patients do not seem to have such entrenched delusions. This cognitive bias may be a third causal factor that is distinctive of BDD and contributes to the occurrence of the disorder.
These contrasts with OCD have led us to posit a causal model of the emergence and persistence of BDD in certain people. We conjecture that their perceptual abnormality may lead them to focus excessively on specific body parts, which may result in dissatisfaction with their appearance. Moreover, their theory of mind deficit may lead them to think that others disapprove of their appearance, further confirming their own dissatisfaction. These negative attitudes may be reinforced by an exaggerated form of confirmation bias, which helps give rise to a full-blown delusion about their appearance that is difficult to dislodge and bring about a lack of insight into their own condition. We conjecture that these three causal factors, when found together in a single individual, result in this distinctive psychiatric condition and set it apart from the disorders that it has been lumped with in the DSM-5.