Schizophrenia,mental capacity,and rational suicide

A diagnosis of schizophrenia is often taken to denote a state of global irrationality within the psychiatric paradigm, wherein psychotic phenomena are seen to equate with a lack of mental capacity. However, the little research that has been undertaken on mental capacity in psychiatric patients shows that people with schizophrenia are more likely to experience isolated, rather than constitutive, irrationality and are therefore not necessarily globally incapacitated. Rational suicide has not been accepted as a valid choice for people with schizophrenia due in part to a belief that characteristic irrationality prevents autonomous decision-making. Since people with schizophrenia are often seen to lack insight into the nature of their disorder, both psychiatric and ethical perspectives generally presume that suicidal acts result directly from mental illness itself and not from second-order desires. In this article, I challenge notions of global irrationality conferred by a diagnosis of schizophrenia and argue that, where delusional beliefs are unifocal, schizophrenia does not necessarily lead to a state of mental incapacity. I then attempt to show that people with schizophrenia can sometimes be rational with regard to suicide, where this decision stems from a realistic appraisal of psychological suffering.     

Demon or disorder: A survey of attitudes toward mental illness in the Christian church

The present study assessed the attitudes and beliefs that mentally ill Christians encountered when they seek counsel from the church. Participants (n?=?293) completed an anonymous online survey in relation to their interactions with the church. Analysis of the results found that while a majority of the mentally ill participants were accepted by the church, approximately 30% reported a negative interaction. Negative interactions included abandonment by the church, equating mental illness with the work of demons, and suggesting that the mental disorder was the result of personal sin. Analysis of the data by gender found that women were significantly more likely than men to have their mental illness dismissed by the church and/or be told not to take psychiatric medication. Given that a religious support system can play a vital role in recovery from serious mental disorders, these results suggest that continued education is needed to bring the Christian and mental health communities together.     

Defining mental disorder. Exploring the 'natural function' approach

Due to several socio-political factors, to many psychiatrists only a strictly objective definition of mental disorder, free of value components, seems really acceptable. In this paper, I will explore a variant of such an objectivist approach to defining metal disorder, natural function objectivism. Proponents of this approach make recourse to the notion of natural function in order to reach a value-free definition of mental disorder. The exploration of Christopher Boorse's 'biostatistical' account of natural function (1) will be followed an investigation of the 'hybrid naturalism' approach to natural functions by Jerome Wakefield (2). In the third part, I will explore two proposals that call into question the whole attempt to define mental disorder (3). I will conclude that while 'natural function objectivism' accounts fail to provide the backdrop for a reliable definition of mental disorder, there is no compelling reason to conclude that a definition cannot be achieved.     

Leadership as a predictor of stigma and practical barriers toward receiving mental health treatment: a multilevel approach

The present research examined positive and negative leadership behaviors as predictors of stigma and practical barriers to mental health treatment. Soldiers completed measures of noncommissioned officer (NCO) and officer leadership, stigma, and practical barriers to getting mental health treatment at 2, 3, and 4 months following a 15-month deployment to Afghanistan. The results revealed that positive and negative NCO and officer leader behaviors were predictive of overall stigma and barriers to care (collapsed across the three time periods), with only NCO positive and negative behaviors being uniquely predictive of stigma when included in the same model with officer behaviors. In addition, negative and positive NCO leader behaviors were predictive of stigma within participants over the course of the three month time period, and positive NCO leader behaviors were inversely related to practical barriers to mental health treatment within participants across the same time period. The results are discussed in terms of how different leader behaviors may be linked to different factors influencing a soldier's decision to seek mental health treatment.     

Williams, Truth-Aimedness and the Voluntariness of Judgement

I contend that while at least one of the arguments advanced by Bernard Williams in his paper 'Deciding To Believe' does establish that beliefs, or more precisely, judgements cannot be decided upon 'at will', the notion of truth-aimedness presupposed by that argument also, ironically, provides the key to understanding why judgements are necessarily voluntary.     

Challenges and opportunities in moving toward a public health approach in school mental health

These three outstanding papers are important for the discipline of school psychology, the field of school-based mental health, and more generally for systems of education and mental health for children and adolescents. As the authors emphasize, there is an unprecedented focus on improving programs that remove barriers to learning and enhance development, health, and mental health in youth, in the most universal natural setting—the schools. The authors also correctly highlight that school psychology is uniquely positioned to play a leading role in this reform and change effort. Two interconnected themes of the public health approach—applying the evidence base and moving toward preventive and population-focused interventions—are emphasized in these papers, and while they focus on school psychology, the issues discussed are generalizable to the many disciplines that operate within educational and mental health systems. In the following discussion, I react to the papers' two major themes, discuss realities that should be addressed for progress to be made, and comment on their implications for school psychology.     

Intention as action under development: why intention is not a mental state

This paper constructs a theory according to which an intention is not a mental state but an action at a certain developmental stage. I model intention on organic life, and thus intention stands to action as (e.g.) tadpole stands to frog. I then argue for this theory by showing how it overcomes three problems: intending while (1) merely preparing, (2) not taking any steps, and (3) the action is impossible. The problems vanish when we see that not all actions are mature. Just as some frogs (such as tadpoles) are immature frogs, some actions (such as intentions) are immature actions.     

Harm should not be a necessary criterion for mental disorder: some reflections on the DSM-5 definition of mental disorder

Theoretical Medicine and Bioethics - The general definition of mental disorder stated in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders seems to identify a mental...     

Appraising the threat of illness: a mental representational approach

This article (a) describes a mental model underlying initial evaluations of illness signs and (b) reports an experiment demonstrating the model's utility by showing how the model represents evidence of defensiveness among people who test positively for a sign of illness. The model consists of a set of cognitive elements that people consider to evaluate the threat represented by a sign of possible illness. Seventy-two undergraduates were led to believe that they tested positively or negatively on a saliva test for a fictitious risk factor for a disease. In addition, half the participants were told about the existence of a simple preventive treatment for the disease, whereas the others were not. Subsequently the participants answered questions about elements of the threat-appraisal model. Analysis of their responses reveals evidence of defensiveness on several elements of the model. Those testing positively for the risk factor, especially those uninformed about its treatment, minimized threat by (a) increasing their estimates of the false-positive rate of the test, (b) decreasing their estimates of the seriousness of the risk factor, and (c) decreasing their estimates of the extent to which the disease itself is life-threatening. Applications of the model to actual illness threats and the relation between threat-related judgments and health-related behavior are discussed.     

Free will and mental disorder: Exploring the relationship

A link between mental disorder and freedom is clearly present in the introduction of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). It mentions “an important loss of freedom” as one of the possible defining features of mental disorder. Meanwhile, it remains unclear how “an important loss of freedom” should be understood. In order to get a clearer view on the relationship between mental disorder and (a loss of) freedom, in this article, I will explore the link between mental disorder and free will. I examine two domains in which a connection between mental disorder and free will is present: the philosophy of free will and forensic psychiatry. As it turns out, philosophers of free will frequently refer to mental disorders as conditions that compromise free will and reduce moral responsibility. In addition, in forensic psychiatry, the rationale for the assessment of criminal responsibility is often explained by referring to the fact that mental disorders can compromise free will. Yet, in both domains, it remains unclear in what way free will is compromised by mental disorders. Based on the philosophical debate, I discuss three senses of free will and explore their relevance to mental disorders. I conclude that in order to further clarify the relationship between free will and mental disorder, the accounts of people who have actually experienced the impact of a mental disorder should be included in future research.     

Hyperreflexivity as a condition of mental disorder: a clinical and historical perspective

Hyperreflexivity, understood as intensified self-consciousness in which subjects disengage from normal forms of involvement with nature and society, often considering themselves as objects of focal awareness, is proposed here as a condition of mental disorders, without which they would not exist. This thesis is argued from a dual perspective: clinical and historical. In the clinical perspective, it is shown that hyperreflexivity is not merely concomitant with mental disorders, but indeed has causal priority over them. Empirical evidence of a correlational, experimental and therapeutic nature, or deriving from cultural change, supports this claim of causal priority. In the historical perspective, it is shown that hyperreflexivity depends on certain historical-cultural circumstances that have prevailed since the Renaissance. These circumstances have to do with the emergence of the modern subject, displaced, autonomous and condemned to a hapless 'interior journey'. This means that mental disorders as such would not have existed prior to that era. Nor in the wake of the Renaissance would mental disorders automatically come into being, depending as they do on a reflexive, institutional clinical context, which would not emerge until practically the nineteenth century, but which would extend swiftly from then on.     

Saying a bundle: meaning,intention, and underdetermination

Synthese - People often speak loosely, uttering sentences that are plainly false on their most strict interpretation. In understanding such speakers, we face a problem of underdetermination: there...     

Antecedents of Taiwanese adolescents' purchase intention toward the merchandise of a celebrity: the moderating effect of celebrity adoration

The purpose of the present study was to investigate the relative importance of adolescents' attitude toward an act (the degree to which the person had a favorable or unfavorable evaluation or appraisal of the act's behavior in question), perceived norm, and perceived behavioral control in predicting Taiwanese adolescents' intention to purchase the merchandise of a celebrity when they had different levels of celebrity adoration. The present results showed that the relative strengths of attitude toward the act and the perception of behavioral control in predicting purchase intention toward the merchandise of a celebrity were stronger for adolescents in the celebrity adoration group than for adolescents in the celebrity nonadoration group. On the other hand, the relative importance of the perceived norm in predicting the attitude toward the act and the purchase intention was stronger for adolescents in the celebrity nonadoration group than for adolescents in the celebrity adoration group.