In this paper I consider, in connection with dementia, two views of the person. One view of the person is derived from Locke and Parfit. This tends to regard the person solely in terms of psychological states and his/her connections. The second view of the person is derived from a variety of thinkers. I have called it the situated-embodied-agent view of the person. This view, I suggest, more readily squares with the reality of clinical experience. It regards the person as embedded in a history and culture. The human person is also an embodied agent. I contend that this view encourages a more appropriate approach towards the ethical issues that arise in dementia and towards people with dementia.
Key Words: Person • dementia • advance directives • psychological phenomena • narrative • end of life
Should an institutional scheme prioritize the rectification or compensation of harms it has wrongfully caused over provision of aid to persons it has not harmed? Some who think so rely on an analogy with the view that persons should give higher priority to rectification than to aid. Inference from the personal view to the institutional view would be warranted if either (i) the correct moral principles for institutional assessment are nearest possible equivalents of the correct personal moral principles, or (ii) the moral principles which ground the personal view also ground the institutional view. Neither claim can be justified. I briefly assess some alternative ways of defending the view that institutions should prioritize rectification over aid.
How does witnessing a hateful person in pain compare to witnessing a likable person in pain? The current study compared the brain bases for how we perceive likable people in pain with those of viewing hateful people in pain. While social bonds are built through sharing the plight and pain of others in the name of empathy, viewing a hateful person in pain also has many potential ramifications. In this functional Magnetic Resonance Imaging (fMRI) study, Caucasian Jewish male participants viewed videos of (1) disliked, hateful, anti-Semitic individuals, and (2) liked, non-hateful, tolerant individuals in pain. The results showed that, compared with viewing liked people, viewing hateful people in pain elicited increased responses in regions associated with observation of physical pain (the insular cortex, the anterior cingulate cortex (ACC), and the somatosensory cortex), reward processing (the striatum), and frontal regions associated with emotion regulation. Functional connectivity analyses revealed connections between seed regions in the left ACC and right insular cortex with reward regions, the amygdala, and frontal regions associated with emotion regulation. These data indicate that regions of the brain active while viewing someone in pain may be more active in response to the danger or threat posed by witnessing the pain of a hateful individual more so than the desire to empathize with a likable person's pain.
empathy; observation of pain; social group membership; fMRI; pain matrix
Personality disorders have a complex relationship with the law that in many ways reflects their complexity within the clinical and research communities. This paper addresses expert testimony about personality disorders, outlines how personality disorders are assessed in forensic cases, and describes how personality disorders are viewed in different legal contexts. Reasons are identified why personality disorders are not generally accepted as significant mental illness within the legal system, including high incidence of personality dysfunction in criminal populations, frequent comorbidity of personality disorders making it difficult to determine direct causation, and difficulty determining where on a continuum personality traits should be defined as illness (or not). In summary, the legal system, to a significant degree, mirrors the clinical conception of personality disorders as not severe mental diseases or defects, not likely to change, and most often, under volitional control.
personality disorder; forensic psychiatry; expert testimony; mental health law
Previous theories have proposed that the amygdala is hyper-responsive to novel stimuli in persons with an inhibited temperament—a biologically based predisposition to respond to novelty with wariness or avoidance behavior. In the current study, we used functional magnetic resonance imaging (fMRI) to assess amygdala blood oxygenation level-dependent (BOLD) response when viewing novel or recently familiarized faces in persons with an extreme inhibited or uninhibited temperament. In persons with an inhibited temperament, the amygdala showed increased BOLD response when viewing both novel and recently familiarized faces. In contrast, in persons with an uninhibited temperament, BOLD response in the amygdala was increased only when viewing novel faces. These findings suggest that inhibited temperament is characterized not by a simple exaggerated response to novel faces, but rather by a sustained increase in amygdala response to faces even after the faces have become familiarized. In individuals with an inhibited temperament, this sustained response may be related to the wariness of social situations that persists beyond initial exposure.
temperament; amygdala; novelty; familiarity; social anxiety; fMRI
Research indicates that many people do not use condoms consistently but rather rely on illusory control strategies for avoiding an infection with HIV. Preliminary evidence suggests that people form impressions of a partner’s HIV risk based on his or her physical appearance. To examine the neural correlates of such appearance-based HIV risk impressions, event-related potentials were recorded while participants viewed portraits of unacquainted persons. Participants’ explicit HIV risk ratings for each of the presented unacquainted persons were used to form categories of low and high HIV risk persons. Results showed that risky, compared to safe persons elicited distinct event-related potential (ERP) modulations. Viewing risky persons was associated with an increased positivity over right frontal regions between 180 and 240 ms. This suggests that impressions related to HIV risk occur rapidly, presumably reflecting automatic person evaluations eluding introspection. In a time window between 450 and 600 ms, risky persons elicited an increased late positive potential. Consistent with previous findings reporting augmented late positive potentials (LPP) amplitudes to affectively significant stimuli, the results support the assumption that risky faces draw more attention resources. These findings are in accordance with the ‘risk as feeling’ notion.
risk perception; affect; intuition; ERP; P3; late positive potential
This study tested the effects of distraction using virtual-reality (VR) technology on acute pain tolerance in young adults. Forty-one undergraduate students, aged 18–23 years, used a VR head-mounted display helmet, steering wheel, and foot pedal to play an auto racing video game while undergoing exposure to very cold water (cold pressor set at 1°C). Two different game views were tested that were hypothesized to affect the degree to which participants felt “present” in the virtual environment: a first-person view, in which the participant saw the virtual environment through the eyes of the game character being manipulated; and a third-person view, in which the participant viewed the game character from a distance. The length of time participants tolerated the cold-water exposure (pain tolerance) under each distraction condition was compared to a baseline (no distraction) trial. Subjects also rated the degree to which they felt “present” in the virtual environment after each distraction trial. Results demonstrated that participants had significantly higher pain tolerance during both VR-distraction conditions relative to baseline (no distraction) trials. Although participants reported a greater sense of presence during the first-person condition than the third-person condition, pain-tolerance scores associated with the two distraction conditions did not differ. The types of VR applications in which presence may be more or less important are discussed.
Recent evidence shows that workers in white collar roles consume more alcohol than other groups within the workforce, yet little is known about their views of drinking.
Focus groups were conducted in five workplaces to examine the views of white collar workers regarding the effect of alcohol use on personal and professional lives, drinking patterns and perceived norms. Analysis followed the method of constant comparison.
Alcohol use was part of everyday routine. Acceptable consumption and ‘excess’ were framed around personal experience and ability to function rather than quantity of alcohol consumed. Public health messages or the risk of adverse health consequences had little impact on views of alcohol consumption or reported drinking.
When developing public health alcohol interventions it is important to consider the views of differing groups within the population. Our sample considered public health messages to be of no relevance to them, rather they reinforced perceptions that their own alcohol use was controlled and acceptable. To develop effective public health alcohol interventions the views of this group should be examined in more detail.
Alcohol; Focus groups; Public health; Norms
Self-esteem variability is often associated with poor functioning. However, in disorders with entrenched negative views of self and in a context designed to challenge those views, variable self-esteem might represent a marker of change. We examined self-esteem variability in a sample of 27 patients with Avoidant and Obsessive-Compulsive Personality Disorders who received Cognitive Therapy (CT). A therapy coding system was used to rate patients’ positive and negative views of self expressed in the first ten sessions of a 52-week treatment. Ratings of negative (reverse scored) and positive view of self were summed to create a composite score for each session. Self-esteem variability was calculated as the standard deviation of self-esteem scores across sessions. More self-esteem variability predicted more improvement in personality disorder and depression symptoms at the end of treatment, beyond baseline and average self-esteem. Early variability in self-esteem, in this population and context, appeared to be a marker of therapeutic change.
self-esteem; cognitive therapy; personality disorders
Reading facial emotion is disrupted by both psychopathology, such as autism, and altered function of neurotransmitter, such as serotonin. These effects could result from reduced sensitivity of emotional processing systems to facial emotion. The impact of facial expression is also greater when personally directed than when averted. We therefore hypothesized that brain activity associated with emotional representation, would be more susceptible to manipulation of serotonin function by Acute Tryptophan Depletion (ATD) for front-viewed than side-viewed faces, measured using functional imaging (fMRI). ATD reduced activity independent of face view in left superior temporal sulcus (STS) and anterior cingulate. In temporal pole, medial frontal cortex and orbitofrontal cortex, ATD also reduced activity, but specifically for front-viewed faces. In right STS, ATD increased activity, but specifically for side-viewed faces. Activity in the amygdalae depended on face view and emotion type. We suggest that engagement of empathic and associative learning functions when viewing faces is facilitated by direct facial view and intact serotonin transmission. Averted faces, and reduced serotonin function facilitate attention to the external goal of gaze. These changes could be adaptive in a threatening context and markedly affect empathic function in conditions associated with impaired serotonin function, such as depression and autism.
gaze; facial expression; empathy; serotonin; tryptophan depletion; social cognition
In the hand laterality task participants judge the handedness of visually presented stimuli – images of hands shown in a variety of postures and views - and indicate whether they perceive a right or left hand. The task engages kinaesthetic and sensorimotor processes and is considered a standard example of motor imagery. However, in this study we find that while motor imagery holds across egocentric views of the stimuli (where the hands are likely to be one's own), it does not appear to hold across allocentric views (where the hands are likely to be another person's). First, we find that psychophysical sensitivity, d', is clearly demarcated between egocentric and allocentric views, being high for the former and low for the latter. Secondly, using mixed effects methods to analyse the chronometric data, we find high positive correlation between response times across egocentric views, suggesting a common use of motor imagery across these views. Correlations are, however, considerably lower between egocentric and allocentric views, suggesting a switch from motor imagery across these perspectives. We relate these findings to research showing that the extrastriate body area discriminates egocentric (‘self’) and allocentric (‘other’) views of the human body and of body parts, including hands.
Research involving incapacitated persons with dementia involves complex scientific, legal, and ethical issues, making traditional surveys of layperson views regarding the ethics of such research challenging. We therefore assessed the impact of democratic deliberation (DD)—involving balanced, detailed education and peer deliberation—on the views of those responsible for persons with dementia.
178 community-recruited caregivers or primary decision-makers for persons with dementia were randomly assigned to either an all-day DD session group or a control group. Educational materials used for the DD session were vetted for balance and accuracy by an interdisciplinary advisory panel. We assessed the acceptability of family surrogate consent for dementia research (‘surrogate-based research’ or SBR) from a societal policy perspective as well as from the more personal perspectives of deciding for a loved one or for oneself (surrogate and self perspectives), assessed at baseline, immediately post-DD session, and a month after DD date, for 4 research scenarios of varying risk-benefit profiles.
At baseline, a majority in both DD and control groups supported a policy of family consent for dementia research for all research scenarios. The support for a policy of family consent for SBR increased for the DD group, but not for the control group; the change in the DD group was maintained one month later. In the DD group, there were transient changes in attitudes from surrogate or self perspectives; in the control group, there were no changes from baseline in attitude toward surrogate consent from any perspective.
Intensive, balanced, and accurate education along with peer deliberation provided by democratic deliberation leads to a sustained increase in support for a societal policy of family consent for dementia research among those responsible for dementia patients.
Alzheimer’s Disease; informed consent; deliberative democracy; bioethics; research ethics; surrogate-based research; impaired decision-making capacity
The aim of the project was to develop an instrument for the assessment of subjective quality of life specific to schizophrenic persons on the basis of patients’ views on their own life and on sound psychometric principles.
The project applied a six-step multiphase development process with six distinct studies. (1) The elicitation of schizophrenic persons’ views on their quality of life was based on open-ended interviews with interviewees from different settings (acute ward inpatients, long-term care patients, community care patients; n = 268). (2) A cross-sectional study with schizophrenic and healthy persons was conducted to quantify the relative importance of the various aspect of quality of life that emerged from the qualitative study (n = 143). (3) We conducted an empirical comparison of response formats with schizophrenic persons (n = 32). (4) A scale construction- and reliability-testing study was performed (n = 203) as well as (5) a test-retest reliability study (n = 49). (6) The final questionnaire (QLiS, quality of life in schizophrenia) was tested in an additional study on convergent and discriminant validity (n = 135).
The QLiS comprises 52 items (plus 2 optional items related to work) in 12 subscales: social contacts, appreciation by others, relationship to family, appraisal of pharmacotherapy, appraisal of psychopathological symptoms, cognitive functioning, abilities to manage daily living, appraisal of accommodation/housing, financial situation, leading a ’normal‘ life, confidence, general life-satisfaction. An item response format with four response categories was preferred by the schizophrenic persons. The mean values of the subscales clustered around the theoretical mean of the subscales and only minimal ceiling effects were found. The reliability (test-retest-reliability and internal consistency) was with one exception > .70 for all subscales.
Taking the low numbers of items per subscale into account, the QLiS can be regarded as an accurate assessment instrument of subjective quality of life in schizophrenia with good content validity.
Quality of life; Personal satisfaction; Schizophrenia; Questionnaires; Outcome assessment
There is fMRI evidence that women are neurally predisposed to process infant laughter and crying. Other findings show that women might be more empathic and sensitive than men to emotional facial expressions. However, no gender difference in the brain responses to persons and unanimated scenes has hitherto been demonstrated.
Twenty-four men and women viewed 220 images portraying persons or landscapes and ERPs were recorded from 128 sites. In women, but not in men, the N2 component (210–270) was much larger to persons than to scenes. swLORETA showed significant bilateral activation of FG (BA19/37) in both genders when viewing persons as opposed to scenes. Only women showed a source of activity in the STG and in the right MOG (extra-striate body area, EBA), and only men in the left parahippocampal area (PPA).
A significant gender difference was found in activation of the left and right STG (BA22) and the cingulate cortex for the subtractive condition women minus men, thus indicating that women might have a greater preference or interest for social stimuli (faces and persons).
The literature on preferences for behavioral interventions is limited in terms of understanding treatment-related factors that underlie treatment choice. The objectives of this study were to examine the direct relationships between personal beliefs about clinical condition, perception of treatment acceptability, and preferences for behavioral interventions for insomnia.
The data set used in this study was obtained from 431 persons with insomnia who participated in a partially randomized clinical trial and expressed preferences for treatment options. The data were collected at baseline. Logistic regression was used to examine the relationships between personal beliefs and treatment acceptability, and preferences. The relationships between personal beliefs and perception of treatment acceptability were explored with correlational analysis.
Perception of treatment acceptability was associated with preferences. Persons viewing the option as convenient tended to choose that option for managing insomnia. Personal beliefs were not related to preferences. However, beliefs about sleep promoting behaviors were correlated with perceived treatment effectiveness.
Perception of treatment acceptability underlies expressed preferences for behavioral interventions. Personal beliefs about insomnia are not directly associated with preferences. Importance is highlighted for providing information about treatment options and exploring perception of each option’s acceptability during the process of treatment selection.
treatment preference; treatment acceptability; treatment attributes; beliefs about condition; chronic insomnia; behavioral treatment
Imitation of people on educational television is a potential way for very young children to learn new skills. Although toddlers in previous studies exhibited a “video deficit” in learning, 24-month-olds in Study 1 successfully reproduced behaviors modeled by a person who was on video as well as they did those modeled by a person who was present in the room (even after a 24-hour delay). Neither displaced filming context nor cuts between actions affected toddler’s imitation from video. Shortening the demonstration in Study 2 affected imitation in the video condition but not in the live condition. In Study 3, 24-month-olds who viewed the original, longer videos on their family TV (with which they had a viewing history) imitated significantly less than those who viewed the videos on the lab monitor. Imitation of a live modeler was the same across settings (home or lab). Implications for toddlers’ judgments of reliable information sources and for the design of educational television programs are discussed.
Representation; symbol; imitation; social cognition; video; television
We used functional magnetic resonance imaging (fMRI) and a naturalistic joint attention scenario to evaluate two, alternative hypotheses concerning the social brain. The first, Content Specific Attribution hypothesis, was that core regions previously identified as being involved in social cognition also participate in representing the contents of another mind. The second, Dual Role hypothesis, was that extrastriate, category-specific visual regions respond to a visible stimulus of a specific category and to the same stimulus occluded, but when it appears to be the focus of another person’s visual attention. Participants viewed category-specific stimuli (Place and Body images) to localize the extrastriate body area (EBA) and parahippocampal place area (PPA). Then, they observed a computerized character viewing each stimulus category, occluded from the participant’s view. In support of the Content Specific Attribution hypothesis, whole-brain analyses revealed that viewing someone else looking at an occluded picture of a body activated brain regions previously associated with components of social cognition more than viewing someone else looking at an occluded picture of a place. Counter to the Dual Role hypothesis, functional region of interest (ROI) analyses revealed that the EBA and PPA were not clearly involved in representing what the character was seeing.
fMRI; body; place; occlusion; social perception
One way of furthering our understanding of suicidal behaviour is to examine people's attitudes towards it and how they conceive the act. The aim of this study was to understand how lay persons conceive the impact of suicide on others and how that influences their attitudes towards suicide; and discuss the implications for suicide prevention in Ghana. This is a qualitative study, using a semi-structured interview guide to investigate the attitudes and views of 27 lay persons from urban and rural settings in Ghana. Interpretative Phenomenological Analysis was used to analyse the data. Findings showed that the perceived breach of interrelatedness between people due to suicidal behaviour influenced the informants’ view of suicide as representing a social injury. Such view of suicide influenced the negative attitudes the informants expressed towards the act. The negative attitudes towards suicide in Ghana are cast in consequential terms. Thus, suicide is an immoral act because it socially affects others negatively. The sense of community within the African ethos and The Moral Causal Ontology for Suffering are theoretical postulations that are used to offer some explanations of the findings in this study.
Social injury; attitudes; lay persons; suicide; Ghana
The shift in the prevailing view of alcoholism from a moral paradigm towards a biomedical paradigm is often characterized as a form of biomedicalization. We will examine and critique three reasons offered for the claim that viewing alcoholism as a disease is morally problematic. The first is that the new conceptualization of alcoholism as a chronic brain disease will lead to individualization, e.g., a too narrow focus on the individual person, excluding cultural and social dimensions of alcoholism. The second claim is that biomedicalization will lead to stigmatization and discrimination for both alcoholics and people who are at risk of becoming alcoholics. The third claim is that as a result of the biomedical point of view, the autonomy and responsibility of alcoholics and possibly even persons at risk may be unjustly restricted. Our conclusion is that the claims against the biomedical conceptualization of alcoholism as a chronic brain disease are neither specific nor convincing. Not only do some of these concerns also apply to the traditional moral model; above that they are not strong enough to justify the rejection of the new biomedical model altogether. The focus in the scientific and public debate should not be on some massive “biomedicalization objection” but on the various concerns underlying what is framed in terms of the biomedicalization of alcoholism.
Alcoholism; Biomedicalization; Coercion; Ethics
This study investigated how Korean (N = 397) and U.S. (N = 333) children and adolescents (10 and 13 years of age) evaluated personality (aggression, shyness) and group (gender, nationality) characteristics as a basis for peer rejection in three contexts (friendship rejection, group exclusion, victimization). Overall, peer rejection based on group membership was viewed as more unfair than peer rejection based on personality traits. Children viewed friendship rejection as more legitimate than group exclusion or victimization and used more personal choice reasoning for friendship rejection than for rejection in any other context. Although there were a few cultural differences, overall, the findings provided support for the cultural generalizability of social reasoning about peer rejection.
Symptom improvement in Borderline Personality Disorder (BPD) is more common than previously hypothesised. However, it remains unclear whether it reflects service users' personal goals of recovery. The present study aimed to explore what service users with BPD view as recovery.
48 service users were recruited from secondary mental health services and their views on their personal goals and the meaning of recovery were explored in in-depth semi-structured interviews. The study drew on grounded theory and thematic analysis.
Service users believed that recovery involved developing self-acceptance and self-confidence, gaining control over emotions, improving relationships, employment, and making progress in symptoms like suicidality and self-harming. They felt that psychotherapies for BPD often had an extreme focus on specific areas, like self-harming or relationships, and that some of their goals were neglected. Although full recovery was seen as a distant goal, interviewees felt that they could learn how to deal with their problems in more effective ways and make meaningful progress in their lives.
Specialist therapies for BPD explicitly address some of the recovery goals that are important to service users, whereas other goals are only indirectly or poorly addressed. Professionals might need to work with service users towards devising comprehensive individualised case formulations, including all treatment targets that are important to service users, their priorities, and long-term plans on how their targets might be met and which services might be involved.
The human voice is described in dialogic linguistics as an embodiment of self in a social context, contributing to expression, perception and mutual exchange of self, consciousness, inner life, and personhood. While these approaches are subjective and arise from phenomenological perspectives, scientific facts about personal vocal identity, and its role in biological development, support these views. It is our purpose to review studies of the biology of personal vocal identity -- the familiar voice pattern-- as providing an empirical foundation for the view that the human voice is an embodiment of self in the social context. Recent developments in the biology and evolution of communication are concordant with these notions, revealing that familiar voice recognition (also known as vocal identity recognition or individual vocal recognition) or contributed to survival in the earliest vocalizing species. Contemporary ethology documents the crucial role of familiar voices across animal species in signaling and perceiving internal states and personal identities. Neuropsychological studies of voice reveal multimodal cerebral associations arising across brain structures involved in memory, emotion, attention, and arousal in vocal perception and production, such that the voice represents the whole person. Although its roots are in evolutionary biology, human competence for processing layered social and personal meanings in the voice, as well as personal identity in a large repertory of familiar voice patterns, has achieved an immense sophistication.
personal voice recognition; self and voice; neuropsychology of voice; evolutionary biology
The cardiovascular and respiratory effects of exercise have been widely studied, as have the autonomic effects of imagined and observed exercise. However, the effects of observed exercise in the first person have not been documented, nor have direct recordings of muscle sympathetic nerve activity (MSNA) been obtained during observed or imagined exercise. The aim of the current study was to measure blood pressure, heart rate, respiration, skin blood flow, sweat release, and MSNA (via microelectrodes inserted into the common peroneal nerve), during observation of exercise from the first person point of view. It was hypothesized that the moving stimuli would produce robust compensatory increases in the above-mentioned parameters as effectively as those generated by mental imagery and—to a lesser extent—actual exercise. Nine subjects watched a first-person running video, allowing them to view the action from the perspective of the runner rather than viewing someone else perform the exercise. On average, statistically significant increases from baseline during the running phase were seen in heart rate, respiratory rate, skin blood flow, and burst amplitude of MSNA. These results suggest that observation of exercise in the first person is a strong enough stimulus to evoke “physiologically appropriate” autonomic responses that have a purely psychogenic origin.
autonomic nervous system; muscle sympathetic nerve activity; cardiovascular; exercise; microneurography
Volition can be studied from two perspectives. From the third-person view, volitional behaviour is internally generated, rather than being determined by the immediate environmental context, and is therefore, to some extent, unpredictable. Such behaviour is not unique to humans, since it is seen in many other species including invertebrates. From the first-person view, our experience of volitional behaviour includes a vivid sense of agency. We feel that, through our intentions, we can cause things to happen and we can choose between different actions. Our experience of agency is not direct. It depends on sub-personal inferences derived from prior expectations and sensations associated with movement. As a result, our experiences and intuitions about volition can be unreliable and uncertain. Nevertheless, our experience of agency is not a mere epiphenomenon. Anticipation of the regret we might feel after making the wrong choice can alter behaviour. Furthermore, the strong sense of responsibility, associated with agency, has a critical role in creating social cohesion and group benefits. We can only study the experience of agency in humans who can describe their experiences. The discussion of the experience of volition, that introspection and communication make possible, can change our experience of volitional actions. As a result, agency, regret and responsibility are cultural phenomena that are unique to humans.
Volition; Agency; Responsibility; Discussion; Culture
A range of human factors have been shown to impact on surgical performance although little is known about the impact of training on the views of surgeons towards these factors or how receptive surgeons are to such training.
SUBJECTS AND METHODS
This was an observational pilot study using a short questionnaire designed to elicit views of surgeons towards a range of human factors prior to, and immediately following, a course designed to address human factors in surgical performance. Focus groups were also conducted before and immediately after the course to elicit views.
Of all the human factors assessed, decision-making was rated on a visual analogue scale as having the biggest impact on performance both before and after the course. In general, views of human factors changed following the course, most notably an increase in the extent to which work stress, interpersonal difficulties and personality were believed to affect performance. Three themes emerged from the focus groups: (i) personal professional development; (ii) the relationship between trainer and trainee; and (iii) the changing perspective.
Surgeons from a range of specialties are receptive to training on the impact of human factors on performance and this study has shown that views may change following a course designed to address this. Further training to address the theory–practice gap is warranted in addition to an evaluation of its effectiveness.
Human factors; Surgical performance; Training; Evalution; Qualitative