Can we define mental disorder by using the criterion of mental dysfunction?

The concept of mental disorder is often defined by reference to the notion of mental dysfunction, which is in line with how the concept of disease in somatic medicine is often defined. However, the notions of mental function and dysfunction seem to suffer from some problems that do not affect models of physiological function. Functions in general have a teleological structure; they are effects of traits that are supposed to have a particular purpose, such that, for example, the heart serves the goal of pumping blood. But can we single out mental functions in the same way? Can we identify mental functions scientifically, for instance, by applying evolutionary theory? Or are models of mental functions necessarily value-laden? I want to identify several philosophical problems regarding the notion of mental function and dysfunction and point out some possible solutions. As long as these questions remain unanswered, definitions of mental disorder that rest upon the concept of mental dysfunction will lack a secure foundation.     

The end of mental illness thinking?

Mental health theory and practice are in a state of significant flux. This theoretical article places the position taken by the British Psychological Society Division of Clinical Psychology (DCP) in the context of current practice and seeks to critically examine some of the key factors that are driving these transformations. The impetus for a complete overhaul of existing thinking comes from the manifestly poor performance of mental health services in which those with serious mental health problems have reduced life expectancy. It advocates using the advances in our understanding of the psychological, social and physical mechanisms that underpin psychological wellbeing and mental distress, and rejecting the disease model of mental distress as part of an outdated paradigm. Innovative research in genetics, neuroscience, psychological and social theory provide the platform for changing the way we conceptualise, formulate and respond to psychological distress at both community and individual levels.     

Evolutionary economics of mental time travel?

What is the function of our capacity for 'mental time travel'? Evolutionary considerations suggest that vivid memory and imaginative foresight may be crucial cognitive devices for human decision making. Our emotional engagement with past or future events gives them great motivational force, which may counter a natural tendency towards time discounting and impulsive, opportunistic behavior. In this view, whereas simple episodic memory provides us with a store of relevant, case-based information to guide decisions, mental time travel nudges us towards more restrained choices, which in the long term are advantageous, especially so given human dependence on cooperation and coordination.     

Task-specific strategies of mental “rotation” of facial representations

The effects of task demands on the visual comparison of facial patterns and of comparable nonfacial patterns were explored in two studies. The studies yielded two primary findings. First, faces, despite their holistic properties, are not rotated faster than comparable non-face-like patterns, although subjects’ judgments of them were uniformly more rapid than judgments for nonfaces. Second, the nature of the same-different judgment task required of subjects had a large effect on the pattern of results obtained: When stimuli were compared to their mirror images, results indicative of mental “rotation” were obtained. When stimuli were compared on the basis of similarity of individual features, the pattern of results was very different. This one manipulation produced effects that exceeded those of all of the other manipulations, including that of rotation.     

The mother’s mental representation of her infant

Abstract

The mother’s intrapsychic mental representation of her infant begins before pregnancy and is modified during pregnancy and thereafter. Parents have conscious expectations and unconscious fantasies about their infant, which are all too often not consistent with reality. Early intervention in infant–parent disturbances is important for repair of the relationship and prevention of later pathogenic development. A clinical example of a mother’s unconscious ambivalent mental representations of her infant is presented.     

Coventry university students’ experience of mental health problems

Growing numbers of university students are reporting mental health problems and using counselling services. The purpose of this study was to examine Coventry University students’ experience of mental health problems. The Department of Health (DoH) Mental Health Survey questionnaire (2003) was used to examine the experience of mental health problems and help seeking behaviour. Within the last 12 months nearly three quarters of students had experienced anxious or depressed moods, or, personal, mental, nervous or emotional problems, with a third of students failing to seek help. Ethnic minority students were more likely to report problems and less likely to seek help when compared to white students. Male students were less likely to seek help compared to female students. There are few existing studies that have focused on the mental health of students at universities established after 1992 from existing polytechnics. Coventry University exceeds the Government benchmark targets for recruiting students from non-traditional backgrounds. Our results show that it is these groups of students who are more likely to experience mental health problems.     

An eye movement analysis of “mental rotation” of simple scenes

Participants saw a standard scene of three objects on a desktop and then judged whether a comparison scene was either thesame, except for the viewpoint of the scene, ordifferent, when one or more of the objects either exchanged places or were rotated around their center. As in Nakatani, Pollatsek, and Johnson (2002), judgment times were longer when the rotation angles of the comparison scene increased, and the size of the rotation effect varied for different axes and was larger forsame judgments than fordifferent judgments. A second experiment, which included trials without the desktop, indicated that removing the desktop frame of reference mainly affected they-axis rotation conditions (the axis going vertically through the desktop plane). In addition, eye movement analyses indicated that the process was far more than a simple analogue rotation of the standard scene. The total response latency was divided into three components: theinitial eye movement latency, the first-pass time, and thesecond-pass time. The only indication of arotation effect in the time to execute the first two components was forz-axis (plane of sight) rotations. Thus, forx- andy-axis rotations, rotation effects occurred only in the probability of there being a second pass and the time to execute it. The data are inconsistent either with an initial rotation of the memory representation of the standard scene to the orientation of the comparison scene or with a holistic alignment of the comparison scene prior to comparing it with the memory representation of the standard scene. Indeed, the eye movement analysis suggests that little of the increased response time for rotated comparison scenes is due to something like a time-consuming analogue process but is, instead, due to more comparisons on individual objects being made (possibly moredouble checking).     

The illusion of mental health: in the mind of which beholder?

We reference self-ratings and clinician ratings of childhood anxious symptoms to a third data source well delineated with regard to the pathophysiology of anxiety. A total of 36 children with anxiety disorders and other children were administered yohimbine, an alpha-sub-2-adrenoreceptor antagonist, in response to which anxiety-prone children have blunted output of growth hormone. We assessed neuroendocrine reactions. In general, participants who claimed anxiety that was unconfirmed by clinicians displayed anxiotypic neuroendocrine profiles, whereas those who denied anxiety detected by clinicians did not, suggesting self-report may have had the advantage over clinician ratings in some instances. Nuanced and contextualized conclusions in this area of work are needed. In response to the question "the illusion of mental health: in the mind of which beholder?," we answer "it depends on the sample and the syndrome under study."     

Baptist senior pastors’ knowledge and perceptions of mental illness

Senior pastors at churches affiliated with the Baptist General Convention of Texas (BGCT) were anonymously surveyed using an online questionnaire to ascertain their knowledge and perceptions of the causes and potential treatments of mental illness. BGCT senior pastors reported a moderate level of contact with the mentally ill and populations known to have higher than average rates of mental illness (e.g., homeless). They also reported that the individuals with whom they counsel are rarely diagnosed with mental illness. While Baptist senior pastors embraced biological causes and treatments for mental illness as most important and effective, they varied greatly across disorders as to the perceived contribution of psychosocial and spiritual factors. Senior pastors in the present study reported being open to referring their congregants to mental health care professionals with whom they shared common values. Overall, the results of the study point to a need for greater mental health education for Baptist clergy as well as opportunities for the development of increased collaboration between the mental health and faith communities.     

The format of children’s mental images: Penetrability of spatial images

To investigate the format of mental images and the penetrability of mental imagery performance to top-down influences in the form of gravity information, children (4-, 6-, 8- and 10-year-olds) and adults (N = 112) performed mental rotation tasks. A linear increase in response time with rotation angle emerged at 6-years, suggesting that spatial properties are represented in children’s mental images. Moreover, 6-, 8-, and 10-year-olds, but not 4-year-olds or adults, took longer to respond to rotated stimuli pairs when gravity information was incongruent with the direction of rotation rather than congruent. Overall, findings suggest that in contrast to adults’, 6- to 10-year-olds’ mental rotation performance was penetrated by top-down information. This research (a) provides insight into the format of young children’s mental images and (b) shows that children’s mental rotation performance is penetrable by top-down influences.     

A review of: “Quality of life and mental health services”

Joseph Oliver, Peter Huxley, Keith Bridges and Hadi Mohamad (1996) Quality of Life and Mental Health Services, London: Routledge, $16.99 (pb)     

Does fear of coercion keep people away from mental health treatment? Evidence from a survey of persons with schizophrenia and mental health professionals

Mental health consumer advocates have long argued that involuntary treatment frightens persons with mental disorder and thus deters them from voluntarily seeking help. We surveyed 85 mental health professionals and 104 individuals with schizophrenia spectrum conditions to assess their experience with and perceptions of involuntary treatment and other treatment mandates. Of the clinicians, 78% reported that overall they thought legal pressures made their patients with schizophrenia more likely to stay in treatment. Regarding involuntary outpatient commitment, 81% of clinicians disagreed with the premise that mandated community treatment deters persons with schizophrenia from seeking voluntary treatment in the future. Of the consumer sample, 63% reported a lifetime history of involuntary hospitalization, while 36% reported fear of coerced treatment as a barrier to seeking help for a mental health problem-termed here "mandated treatment-related barriers to care." In bivariate analyses, reluctance to seek outpatient treatment associated with fear of coerced treatment (mandated treatment-related barriers to care) was significantly more likely in subjects with a lifetime history of involuntary hospitalization, criminal court mandates to seek treatment, and representative payeeship. However, experience with involuntary outpatient commitment was not associated with barriers to seeking treatment. Recent reminders or warnings about potential consequences of treatment nonadherence, recent hospitalization, and high levels of perceived coercion generally were also associated with mandated treatment-related barriers to care. In multivariable analyses, only involuntary hospitalization and recent warnings about treatment nonadherence were found to be significantly associated with these barriers. These results suggest that mandated treatment may serve as a barrier to treatment, but that ongoing informal pressures to adhere to treatment may also be important barriers to treatment.     

Mapping drivers’ mental models of adaptive cruise control to performance

Driver support features (DSF) have the potential to improve safety, but they also change the driver-vehicle relationship —as well as their respective roles and responsibilities. To maximize safety, it is important to understand how drivers’ knowledge and understanding of these technologies—referred to as drivers’ mental models—impact performance and safety. This simulator study examined how drivers with different mental models of adaptive cruise control performed in edge cases. The study compared the responses of groups of drivers, with strong and weak mental models of ACC, established through a combination of screening, training, and exposure, in edge case situations in a high-fidelity driving simulator. In general, participants with strong mental models were faster than those with weak mental models to respond in edge-case situations—defined as cases where the ACC did not detect an approaching object, such as a slow-moving motorcycle. The performance deficits observed for drivers with weak mental models appear to reflect uncertainty surrounding how ACC will behave in edge cases.     

Is color an integral part of a rich mental simulation?

Research suggests that language comprehenders simulate visual features such as shape during language comprehension. In sentence-picture verification tasks, whenever pictures match the shape or orientation implied by the previous sentence, responses are faster than when the pictures mismatch implied visual aspects. However, mixed results have been demonstrated when the sentence-picture paradigm was applied to color (Connell, Cognition, 102(3), 476–485, 2007; Zwaan & Pecher, PLOS ONE, 7(12), e51382, 2012). One of the aims of the current investigation was to resolve this issue. This was accomplished by conceptually replicating the original study on color, using the same paradigm but a different stimulus set. The second goal of this study was to assess how much perceptual information is included in a mental simulation. We examined this by reducing color saturation, a manipulation that does not sacrifice object identifiability. If reduction of one aspect of color does not alter the match effect, it would suggest that not all perceptual information is relevant for a mental simulation. Our results did not support this: We found a match advantage when objects were shown at normal levels of saturation, but this match advantage disappeared when saturation was reduced, yet still aided in object recognition compared to when color was entirely removed. Taken together, these results clearly show a strong match effect for color, and the perceptual richness of mental simulations during language comprehension.     

Demythologizing the attitudes of family caretakers about “mental illness”

This paper introduces the Boundary-Control Model. The model provides an account of the emergence, maintenance, and treatment of anorexia nervosa, with particular emphasis on the role of boundaries and control. The model delineates four basic emotional needs, which shape the adolescent's sense of self-worth. It assumes that when those needs are damaged, anxiety is induced and anorexia emerges as a defense mechanism. Treatment involves stripping away the adolescent's false sense of power by creating a crisis and provoking the hidden anxieties. The development and maintenance of anorexia nervosa, as well as its treatment, will be discussed in light of the proposed model.     

Challenges of patient‐led mental health services to psychoanalytic clinicians

This paper considers implications to psychoanalytic psychotherapy of the British Government's decision to implement a patient choice agenda for state‐funded mental health services in England and Wales. It places the patient choice agenda in the context of consumerist society and argues that the complex nature of psychoanalytic psychotherapy leaves it more vulnerable than other psychological therapy modalities to compete in the current reality of ‘consumer’‐led public mental health, which, in turn reflects a profoundly changed social context from that to which psychoanalysis traces its roots. Unless psychoanalytic clinicians recognize and find ways to adjust to this context they will jeopardize the survival of psychoanalytic psychotherapy in an increasingly market‐orientated model of mental healthcare provision in the public sector, eager to promote more ‘consumer friendly’ psychological therapy models.     

The mental representation of numerical fractions: real or integer?

Numerical fractions are commonly used to express ratios and proportions (i.e., real numbers), but little is known about how they are mentally represented and processed by skilled adults. Four experiments employed comparison tasks to investigate the distance effect and the effect of the spatial numerical association of response codes (SNARC) for fractions. Results showed that fractions were processed componentially and that the real numerical value of the fraction was not accessed, indicating that processing the fraction's magnitude is not automatic. In contrast, responses were influenced by the numerical magnitude of the components and reflected the simple comparison between numerators, denominators, and reference, depending on the strategy adopted. Strategies were used even by highly skilled participants and were flexibly adapted to the specific experimental context. In line with results on the whole number bias in children, these findings suggest that the understanding of fractions is rooted in the ability to represent discrete numerosities (i.e., integers) rather than real numbers and that the well-known difficulties of children in mastering fractions are circumvented by skilled adults through a flexible use of strategies based on the integer components.     

Where did the ventricular localization of mental faculties come from?

During the Middle Ages it was widely believed that the various mental faculties-sensation, cognition, memory, and so forth-were each located in a specific part of the three ventricles that were thought to be housed in the brain. The origin of this scheme was commonly attributed to the ancient scholars, but it was rare for a specific individual to be identified as the originator. Modern researchers sometimes attribute it to Galen, but Galen was clear in his contention that the mental faculties were located in the substance of the brain rather than in the ventricles. It was only later scholars who, using Galen's anatomy as their basis, placed the mental faculties in the ventricles themselves. The system came together piece by piece over a period of centuries, probably not appearing fully in the form known to the Medieval world until the Middle Ages themselves. This article traces the development of the theory of ventricular localization of the mental faculties from the Ancient world to the early part of the Middle Ages.