Body Integrity Identity Disorder: Deranged Body Processing,Right Fronto-Parietal Dysfunction,and Phenomenological Experience of Body Incongruity

Body integrity identity disorder (BIID) is characterised by profound experience of incongruity between the biological and desired body structure. The condition manifests in “non-belonging” of body parts, and the subsequent desire to amputate, paralyse or disable a limb. Little is known about BIID; however, a neuropsychological model implicating right fronto-parietal and insular networks is emerging, with potential disruption to body representation. We argue that, as there is scant systematic research on BIID published to date and much of the research is methodologically weak, it is premature to assume that the only process underlying bodily experience that is compromised is body representation. The present review systematically investigates which aspects of neurological processing of the body, and sense of self, may be compromised in BIID. We argue that the disorder most likely reflects dysregulation in multiple levels of body processing. That is, the disunity between self and the body could arguably come about through congenital and/or developmental disruption of body representations, which, together with altered multisensory integration, may preclude the experience of self-attribution and embodiment of affected body parts. Ulimately, there is a need for official diagnostic criteria to facilitate epidemiological characterisation of BIID, and for further research to systematically investigate which aspects of body representation and processing are truly compromised in the disorder.     

Morality Work among the Transabled

In the present article, I address the process of moral stigma resistance using an accounts studies framework. Specifically, I delineate and illustrate the concept of morality work. I demonstrate morality work empirically through a qualitative analysis of 17 years (1994–2011) of blog posts, archived content, and links to and from Transabled.org. Transabled.org is a website, blog, support group, and interaction forum for people with body integrity identity disorder (BIID)—a highly stigmatizing condition of incorrectly abled embodiment. Detractors accuse people with BIID of deep moral failings, including sexual perversion, dishonesty, greed, and attention seeking. In turn, persons with BIID neutralize claims of immorality through medicalization and biologization, and locate themselves on a moral high ground with a discourse of authenticity. In deconstructing transabled bloggers’ moral battle, I examine the process underlying deviant accounts.     

Body ownership: When feeling and knowing diverge

Individuals with the peculiar disturbance of ‘overcompleteness’ experience an intense desire to amputate one of their healthy limbs, describing a sense of disownership for it (Body Integrity Identity Disorder – BIID). This condition is similar to somatoparaphrenia, the acquired delusion that one’s own limb belongs to someone else. In ten individuals with BIID, we measured skin conductance response to noxious stimuli, delivered to the accepted and non-accepted limb, touching the body part or simulating the contact (stimuli approach the body without contacting it), hypothesizing that these individuals have responses like somatoparaphrenic patients, who previously showed reduced pain anticipation, when the threat was directed to the disowned limb. We found reduced anticipatory response to stimuli approaching, but not contacting, the unwanted limb. Conversely, stimuli contacting the non-accepted body-part, induced stronger SCR than those contacting the healthy parts, suggesting that feeling of ownership is critically related to a proper processing of incoming threats.     

Agency and responsibility: The personal and the political

In this paper, I review arguments according to which harsh criminal punishments and poverty are undeserved and therefore unjust. Such arguments come in different forms. First, one may argue that no one deserves to be poor or be punished, because there is no such thing as desert-entailing moral responsibility. Second, one may argue that poor people in particular do not deserve to remain in poverty or to be punished if they commit crimes, because poor people suffer from psychological problems that undermine their agency and moral responsibility. Third, one may argue that poor and otherwise marginalized people frequently face external obstacles that prevent them from taking alternative courses of action. The first kind of argument has its place in the philosophy seminar. Psychological difficulties may be important to attend to both in personal relationships and when holding ourselves responsible. Nevertheless, I argue that neither type of argument belongs in political contexts. Moral responsibility scepticism ultimately rests on contested intuitions. Labelling certain groups of people particularly irrational, weak-willed, or similar is belittling and disrespectful; such claims are also hard to prove, and may have the opposite effect to the intended one on people's attitudes. Arguments from external obstacles have none of these problems. Such arguments may not take us all the way to criminal justice reform, but in this context, we can supplement them with epistemic arguments and crime prevention arguments.     

Taking responsibility for health in an epistemically polluted environment

Proposals for regulating or nudging healthy choices are controversial. Opponents often argue that individuals should take responsibility for their own health, rather than be paternalistically manipulated for their own good. In this paper, I argue that people can take responsibility for their own health only if they satisfy certain epistemic conditions, but we live in an epistemic environment in which these conditions are not satisfied. Satisfying the epistemic conditions for taking responsibility, I argue, requires regulation of this environment. I describe some proposals for such regulation and show that we cannot reject all regulation in the name of individual responsibility. We must either regulate individuals’ healthy choices or regulate the epistemic environment.     

Striving for God's Attention: Gendered Spaces and Piety

This article looks at the inadequacy of space available to women in the two most holy sites for all Muslims: Masjid al‐Haram in Makkah and Masjid an‐Nabawi in Madinah, Saudi Arabia. I argue that religious discourse, shaped by geopolitical factors, has framed piety for women primarily in terms of modesty, such that a woman is often considered a good Muslim if she is visible only within her female community but invisible to the larger society. Furthermore, I argue that the allocation of meager space affects not only the perception of women's religious standing in society, but also women's own perception about their moral selves. The article claims that by being relegated to small sections within religious spaces, women's collective worship is evident neither to the community at large nor can it be fully experienced by individual women, thus placing obstacles in women's path to seek to closeness to God.     

Against Value Empiricism in Aesthetics

Value empiricists in aesthetics claim that we can explain the value of artworks by appeal to the value of the experiences they afford. I raise the question of the value of those experiences. I argue that while there are many values that such experiences might have, none is adequate to explaining the value of the works that afford the experiences. I then turn to defending the alternative to value empiricism, which I dub the object theory. I argue that if there is some problem attending the object theory, commensurate with the problems attending empiricism, no one seems to have any idea what it is. I close by urging that the object theory be granted a fresh hearing.     

Body Integrity Identity Disorder: From A Psychological to A Neurological Syndrome

Body Integrity Identity Disorder (BIID) is a condition in which individuals experience an intense desire for amputation of an healthy limb. Recently, McGeoch and colleagues provided the first direct evidence that this syndrome may be neurological rather than psychological in its origin. However, before including BIID in body ownership disorders, several concerns should be clarified, exploring other components of body representation and not only somatosensory perception.     

Medieval <Emphasis Type="Italic">Obligationes</Emphasis> as Logical Games of Consistency Maintenance

I argue that the medieval form of dialectical disputation known as obligationes can be viewed as a logical game of consistency maintenance. The game has two participants, Opponent and Respondent. Opponent puts forward a proposition P; Respondent must concede, deny or doubt, on the basis of inferential relations between P and previously accepted or denied propositions, or, in case there is none, on the basis of the common set of beliefs. Respondent loses the game if he concedes a contradictory set of propositions. Opponent loses the game if Respondent is able to maintain consistency during the stipulated period of time. The obligational rules are here formalised by means of familiar notational devices, and the application of some game-theoretical concepts, such as (winning) strategy, moves, motivation, allows for an analysis of some crucial properties of the game. In particular, the primacy of inferential (syntactic) relations over semantic aspects and the dynamic character of obligations are outlined.     

Knowledge,safety, and Gettierized lottery cases: Why mere statistical evidence is not a (safe) source of knowledge

The lottery problem is the problem of explaining why mere reflection on the long odds that one will lose the lottery does not yield knowledge that one will lose. More generally, it is the problem of explaining why true beliefs merely formed on the basis of statistical evidence do not amount to knowledge. Some have thought that the lottery problem can be solved by appeal to a violation of the safety principle for knowledge, i.e., the principle that if S knows that p, not easily would S have believed that p without p being the case. Against the standard safety‐based solution, I argue that understanding safe belief as belief that directly covaries with the truth of what is believed in a suitably defined set of possible worlds forces safety theorists to make a series of theoretical choices that ultimately prevent a satisfactory solution to the problem. In this way, I analyze several safety principles that result from such choices—the paper thus gives valuable insights into the nature of safety—and explain why none solves the lottery problem, including their inability to explain away Gettierized lottery cases. On a more positive note, I show that there is a viable solution in terms of safety if we get rid of the unquestioned assumption that safe beliefs directly track the truth. The alternative is a conception of safe belief according to which what safe beliefs directly track is the appropriateness of the circumstances and, indirectly, the truth. The resulting safety principle, I argue, explains why mere statistical evidence is not a safe source of knowledge.     

An Integrated Sleep and Reward Processing Model of Major Depressive Disorder

Major depressive disorder with comorbid sleep disturbance has been associated with negative outcomes, including lower rates of treatment response and a greater likelihood of depressive relapse compared to those without sleep disturbance. However, little, if any, research has been conducted to understand why such negative treatment outcomes occur when sleep disturbance is present. In this conceptual review, we argue that the relationship of sleep disturbance and negative treatment outcomes may be mediated by alterations in neural reward processing in individuals with blunted trait-level reward responsivity. We first briefly characterize sleep disturbance in depression, discuss the nature of reward processing impairments in depression, and summarize the sleep/reward relationship in healthy human subjects. We then introduce a novel Integrated Sleep and Reward model of the course and maintenance of major depressive disorder and present preliminary evidence of sleep and reward interaction in unipolar depression. Finally, we discuss limitations of the model and offer testable hypotheses and directions for future research.     

Indexical contextualism and the challenges from disagreement

In this paper I argue against one variety of contextualism about aesthetic predicates such as “beautiful.” Contextualist analyses of these and other predicates have been subject to several challenges surrounding disagreement. Focusing on one kind of contextualism—individualized indexical contextualism—I unpack these various challenges and consider the responses available to the contextualist. The three responses I consider are as follows: giving an alternative analysis of the concept of disagreement; claiming that speakers suffer from semantic blindness; and claiming that attributions of beauty carry presuppositions of commonality. I will argue that none of the available strategies gives a response which both (a) satisfactorily explains all of the disagreement-data and (b) is plausible independent of significant evidence in favor of contextualism. I conclude that individualized indexical contextualism about the aesthetic is untenable, although this does not rule out alternative contextualist approaches to the aesthetic.     

Health of Organisms and Health of Persons: An Embedded Instrumentalist Approach

In a time when we as a society are in the process of deciding what our basic rights to health care are, it is critically important for us to have a full and complete understanding of what constitutes health. We argue for an analysis of health according to which certain states are healthy not in themselves but because they allow an individual to reach actual goals. Recognizing that the goals of an individual considered from the point of view of biology and the goals of the same individual considered as an agent in the world might be different, we introduce a distinction between the health of an individual qua organism and the health of an individual qua person. We then argue that this distinction characterizes the evaluations made by patients and healthcare providers better than the widely discussed distinction between disease and illness.     

A Right to Understand Injustice: Epistemology and the “Right to the Truth” in International Human Rights Discourse

People's “right to truth” or their “right to know” about their government's human rights abuses is a growing consensus in human rights discourses and a fertile area of work in international and humanitarian law. In most discussions of this right to know the truth, it is commonly seen as requiring the state or international institutions to provide access to evidence of the violations. In this paper, I argue that such a right naturally has many epistemic aspects, and the tools of social epistemology can be helpful in elucidating what such a right entails. As a beginning for this project, I draw on those resources to argue that the right to know the truth is only meaningful if it includes a right to understand the abuses, and that such understanding can only come through the development of community epistemic capacities. Given this, I further argue that the state has a duty to support the development of these capacities, and that a critical place for beginning this process is in public schools.     

Medicalization and linguistic agency

Medicalization is the process by which conditions, for example, intellectual disability, hyperactivity in children, and posttraumatic stress disorder, become understood as medical disorders. During this process, the medical community often collectively assigns a label to a condition and consequently to those who would be said to have the disorder. We argue that there are at least two previously overlooked ways in which this linguistic practice may be wrongful, and sometimes, unjust: first, when the initial introduction of a medical label is done without the participation of those individuals who are being labelled, and second, when attempts by those individuals to renegotiate the labels are thwarted or otherwise rendered ineffective. In both cases, we argue, individuals are unfairly excluded from a linguistic practice that would be valuable for them to participate in. Furthermore, we argue that their exclusion depends in part on the authority of the medical institution to ignore their demands for participation. In making this case, we will propose the more general claim that participating in the linguistic processes of determining and renegotiating the words that will be used to describe oneself is an exercise of linguistic agency, a capacity that has both instrumental and intrinsic value.     

No Harm,No Foul? Justifying Bans On Safe Performance-Enhancing Drugs

Scholars such as Simon (2007; 2004) and Loland (2002) as well as the authors of the World Anti-Doping Code (2001) argue that using performance-enhancing substances is unhealthy and unfairly coercive for other athletes. Critics of the anti-doping position such as Hoberman (1995), Miah et al. (2005) and Tamburrini (2007) are quick to argue that such prohibitions, even though well-intended, constitute an unjustifiable form of paternalism. However, advocates for both of these positions assume that preserving good health and, conversely, avoiding health-related harms, lie at the centre of the debate. Given the apparent stalemate in the debate over the validity of health concerns on performance-enhancing drugs, in this essay, I investigate ethical issues of ‘harm-free’ pharmaceutical performance enhancement. Beginning with the hypothesis that a harm-free performance-enhancing drug may be produced in the future, I ask if there would still be compelling reasons for prohibiting such a drug. I address this question by providing two arguments against allowing athletes to use pharmaceutical performance-enhancing drugs – the damage to the testing and contesting of sport and the loss of internal goods that are intrinsically satisfying. These two arguments taken together, I argue, are sufficient to sustain the prohibition of pharmaceutical performance-enhancing drugs without citing their harmful side effects.     

The Charcot Effect: The Invention of Mental Illnesses

This article proposes the Charcot effect, in which clinicians describe what they themselves prescribe. It is argued that the Charcot effect can be a critical instrument for exposing how mental illnesses are invented in the process of developing diagnostic systems and conducting psychopharmacological research. We argue that the Charcot effect helps explain the expansion of depression to epidemic proportions, the promotion of social phobia as a pharmaceutical marketing strategy, the profile of panic disorder according to the available medication, and the worse prognosis of schizophrenia in developed countries than in developing countries. Having undertaken this review, we situate the Charcot effect in relation to constructivist psychology.     

Defending internalists from acquired sociopaths

People who suffer brain damage to their ventromedial prefrontal cortex (VM patients) have a puzzling psychological profile: they seem to retain high intellect and practical reasoning skills after their brain injuries, but continually make poor decisions in many aspects of their lives. Adina Roskies argues that their behavior is explained by the fact that, although VM patients make correct judgments about what they ought to do, they are entirely unmotivated by those judgments. Roskies thus takes VM patients to be real-world counterexamples to motivational internalism: the thesis that, necessarily, if S judges that she ought to φ in circumstances C, then S is somewhat motivated to φ in C. In this paper, however, I argue that the neuropsychological evidence that Roskies appeals to does not actually show that VM patients are entirely unmotivated by their normative judgments. Rather, I argue, the evidence suggests that VM patients form weaker normative judgments than normals during practical deliberation. And this affords the internalist with a plausible explanation for VM patients’ behavior: because VM patients form weaker normative judgments than normals, they are less motivated by their normative judgments than normals, which allows their decision-making to be overruled by their standing desires for greater and more immediate rewards.     

When and how politicians' disrespect affects voters' trust in the political system: The roles of social judgments and category prototypicality

We propose that one politician's disrespectful behavior can spill over to voters' generalized judgments of politicians and thereby affect trust in the political system. We delineate the spillover effect along the basic dimensions of social judgment, communion, and agency. Moreover, we argue that any spillover effect is contingent on the focal politicians' category prototypicality, that is, their representativeness of politicians as such. Conducting an experiment (N = 392) and a field study (N = 273), we found that politicians' respect only affected trust through generalized communion ratings. This spillover only occurred if the observed politician was perceived as prototypical. Our findings provide new insights on when and how individual politicians may be able to undermine voters' trust in the political system.