Madness versus badness: the ethical tension between the recovery movement and forensic psychiatry

The mental health recovery movement promotes patient self-determination and opposes coercive psychiatric treatment. While it has made great strides towards these ends, its rhetoric impairs its political efficacy. We illustrate how psychiatry can share recovery values and yet appear to violate them. In certain criminal proceedings, for example, forensic psychiatrists routinely argue that persons with mental illness who have committed crimes are not full moral agents. Such arguments align with the recovery movement’s aim of providing appropriate treatment and services for people with severe mental illness, but contradict its fundamental principle of self-determination. We suggest that this contradiction should be addressed with some urgency, and we recommend a multidisciplinary collaborative effort involving ethics, law, psychiatry, and social policy to address this and other ethical questions that arise as the United States strives to implement recovery-oriented programs.     

Subtypes of obsessive-compulsive disorder: Implications for specialized cognitive behavior therapy

Although obsessive-compulsive disorder (OCD) is a heterogeneous condition, OCD subtypes have received limited attention in trials of cognitive behavior therapy (CBT). Because many patients with OCD do not respond optimally to CBT, it is important for clinicians to consider whether variability in treatment response is related to symptom presentation. Treatment modifications for patients without overt compulsions or with hoarding symptoms show promise. In this article we discuss the available research addressing the treatment of OCD subtypes, review the clinical characteristics and treatment recommendations for prominent OCD subtypes, raise the prospect of using dysfunctional beliefs as a potentially helpful conceptual approach to subtyping OCD and matching treatment to subtypes, and consider future directions in the treatment of OCD subtypes.     

Quiddistic Knowledge

Is the relation between properties and the causal powers they confer necessary, or contingent? Necessary, says Sydney Shoemaker on pain of skepticism about the properties. Contingent, says David Lewis, swallowing the skeptical conclusion. I shall argue that Lewis is right about the metaphysics, but that Shoemaker and Lewis are wrong about the epistemology. Properties have intrinsic natures (quiddities), which we can know. On route I shall also argue that (i) the main necessitarian arguments do not converge on a single view, (ii) properties are transworld entities that cannot be handled by counterpart theory, and (iii) quiddistic skepticism is merely external world skepticism writ small.     

Constraint Respecters, Constraint Challengers, and Crisis Decision Making in Democracies: A Case Study Analysis of Kennedy versus Reagan

Models linking domestic political constraints (audience costs, pressures for the diversionary use of force, democratic norms and institutions) to foreign policy behavior generally assume that leaders simply recognize and submit to constraints in their domestic environments—a strong structural argument. In contrast, research on political leadership and decision making suggests that leaders vary systematically in their orientations toward constraints: "constraint respecters" tend to internalize potential constraints, while "constraint challengers" are more likely to view them as obstacles to be overcome. This article develops an integrative theoretical framework that explicitly incorporates these insights and applies them to the domain of crisis decision making. After identifying leaders' expected orientations toward constraints via at-a-distance methods, the plausibility of hypotheses derived from this framework is examined through case studies that explore the decision-making processes employed by President Kennedy (a "constraint respecter") and President Reagan (a "constraint challenger") during international crises. The results suggest that there is important variation in how leaders perceive and respond to domestic constraints, and that leadership style is one—though not the only—important source of this variation.     

The duality principle: irreducibility of sub-threshold psychophysical computation to neuronal brain activation

A key working hypothesis in neuroscience is ‘materialistic reductionism’, i.e., the assumption whereby all physiological, behavioral or cognitive phenomena is produced by localized neurochemical brain activation (but not vice versa). However, analysis of sub-threshold Weber’s psychophysical stimulation indicates its computational irreducibility to the direct interaction between psychophysical stimulation and any neuron/s. This is because the materialistic-reductionistic working hypothesis assumes that the determination of the existence or non-existence of any psychophysical stimulation [s] may only be determined through its direct interaction [di1] with a given neuron/s [N] that together forms the ‘neural registry’ computational level [NR/di1]. But, this implies that in cases of (initial) sub-threshold (sensory-specific) psychophysical stimulation which is increased above the sensory-specific threshold but below Weber’s psychophysical ‘dv’—the psychophysical computational processing [PCP] produces an apparently ‘computationally indeterminate’ output. This is because materialistic reductionism asserts the contingency of PCP upon the existence of a direct interaction between ‘s’ and ‘N’ within the NR/di1 level, but in the special case of Weber’s sub-threshold psychophysical stimulation the same PCP/di1 also asserts the non-existence of ‘s’ (as demanded by Weber’s psychophysical law). However, given robust empirical evidence indicating the capability of PCP to determine whether (or not) ‘s’ exists, we must conclude that PCP may not be carried out from within NR’s direct interaction between a particular psychophysical stimulation and any set of neuron/s in the brain. Hence, the Duality Principle asserts the conceptual irreducibility of sub-threshold psychophysical stimulation to any direct NR/di1: s-N interaction, thereby challenging the current materialistic-reductionistic assumption.     

The Interaction of Motivation and Therapist Adherence Predicts Outcome in Cognitive Behavioral Therapy for Panic Disorder: Preliminary Findings

This report is a post-hoc, exploratory examination of the relationships among patient motivation, therapist protocol adherence, and panic disorder outcome in patients treated with cognitive behavioral therapy within the context of a randomized clinical trial for the treatment of panic disorder (Barlow, Gorman, Shear, & Woods, 2000). Results suggested that motivation and adherence interacted to predict change in panic severity. Among patients rated as less motivated, greater therapist protocol adherence was associated with poorer outcome. Among patients rated as more motivated, adherence was not significantly associated with outcome. Further process research is needed to confirm these preliminary results and to understand the interactions of patient and therapist factors and how they are related to outcome in standardized protocols such as cognitive behavioral therapy for panic disorder.     

Enlarging the Societal Pie Through Wise Legislation

ABSTRACT— We offer a psychological perspective to explain the failure of governments to create near-Pareto improvements. Our tools for analyzing these failures reflect the difficulties people have trading small losses for large gains: the fixed-pie approach to negotiations, the omission bias and status quo bias, parochialism and dysfunctional competition, and the neglect of secondary effects. We examine the role of human judgment in the failure to find wise trade-offs by discussing diverse applications of citizen and government decision making, including AIDS treatment, organ-donation systems, endangered-species protection, subsidies, and free trade. Our overall goal is to offer a psychological approach for understanding suboptimality in government decision making.