Louis C. Charland

(1958 - 2021)

Contemporary diagnostic criteria for anorexia nervosa explicitly refer to affective states of fear and anxiety regarding weight gain, as well as a fixed and very strong attachment to the pursuit of thinness as an overarching personal goal. Yet current treatments for that condition often have a decidedly cognitive orientation and the exact nature of the contribution of affective states and processes to anorexia nervosa remains largely uncharted theoretically. Taking our inspiration from the history of psychiatry, we argue that conceptualizing anorexia nervosa as a passion is a promising way forward in both our understanding and treatment of that condition. Building on the theory of the passions elaborated by Théodule Ribot, the founder of scientific psychology in France, we argue that there is convincing empirical evidence in defense of the empirical hypothesis that anorexia nervosa is a passion in Ribot’s specific, technical sense. We then explore the implications of this finding for current approaches to treatment, including cognitive–behavioral therapy, and clinical and ethical issues associated with treatment refusals.

The Diagnostic Statistical Manual of the American Psychiatric Association defines substance dependence, more commonly known as “drug addiction,” as “a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of repeated self-administration that usually results in tolerance, withdrawal, and compulsive drug-taking behavior.” If drug addiction is a matter of compulsion, as this definition suggests, then is it correct to say that a drug addict chooses to take their drug of choice? Similarly, does it make sense to say that a person in the grip of fear really chooses to flee from what frightens them? In this book, Jon Elster argues that in general drug addicts and people subject to powerful emotions should be interpreted as making choices. Although there is a compulsion to choose, there is choice nonetheless. This is different from cases where there is a compulsion to act but no choice. But what kind of choice is this? And are such choices rational or not? These are among the central questions addressed in this book.

In his target article, Barsalou cites current work on emotion theory but does not explore its relevance for this project. The connection is worth pursuing, since there is a plausible case to be made that emotions form a distinct symbolic information processing system of their own. On some views, that system is argued to be perceptual: a direct connection with Barsalou's perceptual symbol systems theory. Also relevant is the hypothesis that there may be different modular subsystems within emotion and the perennial tension between cognitive and perceptual theories of emotion.

It has been argued recently that some basic emotions should be considered natural kinds. This is different from the question whether as a class emotions form a natural kind; that is, whether emotion is a natural kind. The consensus on that issue appears to be negative. I argue that this pessimism is unwarranted and that there are in fact good reasons for entertaining the hypothesis that emotion is a natural kind. I interpret this to mean that there exists a distinct natural class of organisms whose behavior and development are governed by emotion. These are emoters. Two arguments for the natural kind status of emotion are considered. Both converge on the existence of emotion as a distinct natural domain governed by its own laws and regularities. There are then some reasons for being optimistic about the prospects for consilience in emotion theory. 1 The mantra 2 Griffiths on emotions as natural kinds 3 Panksepp on emotions as natural kinds 4 Emotion as a neurobiological kind 5 Emotion as a psychological kind 6 Response to the mantra 7 Unification or fragmentation? 8 Concluding remarks.

When emotions are mentioned in the literature on mental competence, it is generally because they are thought to influence competence negatively; that is, they are thought to impede or compromise the cognitive capacities that are taken to underlie competence. The purpose of the present discussion is to explore the possibility that emotions might play a more positive role in the determination of competence. Using the MacArthur Treatment Competence Study as an example, it is argued that appreciation, a central theoretical concept in many contemporary approaches to competence, has important emotive components that are seldom sufficiently recognized or acknowledged. If true, this means that some leading contemporary accounts of competence need to be revised in order to make more adequate provision for the positive contribution of emotion.

In this paper I link two hitherto disconnected sets of results in the philosophy of emotions and explore their implications for the computational theory of mind. The argument of the paper is that, for just the same reasons that some computationalists have thought that cognition may be a natural kind, so the same can plausibly be argued of emotion. The core of the argument is that emotions are a representation-governed phenomenon and that the explanation of how they figure in behaviour must as such be undertaken in those terms. I conclude with some interdisciplinary reflections in defence of the hypothesis that emotions might be more fundamental in the organization of behaviour than cognition; that, in effect, we may be emoters before we are cognizers. The aim of the paper is: (1) to introduce a number of promising results in philosophical and empirical emotion theory to a wider audience; and (2) to begin the task of organizing those results into a computational theoretical framework.

Psychiatric labeling has been the subject of considerable ethical debate. Much of it has centered on issues associated with the application of psychiatric labels. In comparison, far less attention has been paid to issues associated with the removal of psychiatric labels. Ethical problems of this last sort tend to revolve around identity. Many sufferers are reticent to relinquish their iatrogenic identity in the face of official label change; some actively resist it. New forms of this resistance are taking place in the private chat rooms and virtual communities of the Internet, a domain where consumer autonomy reigns supreme. Medical sociology, psychiatry, and bioethics have paid little attention to these developments. Yet these new consumer-driven initiatives actually pose considerable risks to consumers. They also present complex ethical challenges for researchers. Clinically, there is even sufficient evidence to wonder whether the Internet may be the nesting ground for a new kind of identity disturbance. The purpose of the present discussion is to survey these developments and identify potential issues and problems for future research. Taken as a whole, the entire episode suggests that we may have reached a turning point in the history of psychiatry where consumer autonomy and the Internet are now powerful new forces in the manufacture of madness.

THE TARGET OF ERICA LILLELEHT'S interesting comparison between 19th-century moral treatment and 20th-century psychiatric rehabilitation is contemporary psychiatric rehabilitation. Using Foucault's (1979) Discipline and Punish as her critical foil, she argues that psychiatric rehabilitation is "an approach to madness fraught with paradox." The paradox lies in the fact that the techniques of psychiatric rehabilitation can be practiced in a manner that contradicts its professed humanitarian intentions; notably, liberating the mad from "resource dependency and segregated living." The lesson to be drawn from this paradox is that "our practices, may be shaped and reformulated to serve goals of which we are only dimly aware." The resulting "mindfulness" is supposed to make us more careful and critical of what to count as success and progress in psychiatric treatment...

Medicalization in contemporary psychopharmacology is increasingly dominated by commercial interests that threaten the scientific and ethical integrity of psychiatry. At the same time, the proliferation of new social media has altered the manner in which the social groups and institutions that have stakes in medicalization interact. Consumers are at once more powerful than ever before, but also more vulnerable. The upshot of all these developments is that medicalization is no longer simply the professed enemy of anti-psychiatry and its supporters. It is now also an enemy of psychiatry. Once a welcome ally of psychiatry, medicalization appears to have turned into a fearsome enemy.

In a recent survey of contemporary philosophy of emotion, Ronald de Sousa states that "in recent years … emotions have once again become the focus of vigorous interest in philosophy, as well as in other branches of cognitive science" (de Sousa 2003, 1). He then goes on to make the important observation that "in view of the proliferation of increasingly fruitful exchanges between researchers of different stripes, it is no longer useful to speak of the philosophy of emotion in isolation from the approaches of other disciplines, particularly psychology, neurology and evolutionary biology" (de Sousa 2003, 1). This last remark is particularly apt in the case of a topic like modularity and emotion, which represents an ideal opportunity for reflecting on the emerging alliance between the philosophy of emotion and emotion science. In addition to being interesting in its own right, the topic also illustrates some of the perils associated with the new alliance, as different academic traditions must adapt to interdisciplinary dialogue...

How does one scientifically verify a psychometric instrument designed to assess the mental competence of medical patients who are asked to consent to medical treatment? Aside from satisfying technical requirements like statistical reliability, results yielded by such a test must conform to at least some accepted pretheoretical desiderata; for example, determinations of competence, as measured by the test, must capture a minimal core of accepted basic intuitions about what competence means and what a theory of competence is supposed to do. The concepts of “face validity” and “content validity” are both important here. Face validity “indicates that an instrument appears to test what it is supposed to and that it is a plausible method for doing so” (Portney and Watkins 2000, 82). Content validity “means that the test contains all the elements that reflect the variable being studied” (Portney and..

Paradoxically, the profession whose primary mandate is to instruct and comment on matters of ethics spends inordinately little time reflecting on its own ethical practices. Consider the fact that while professional ethicists of all stripes crusade to expose and denounce conflicts of interests in all other branches of the health care system, they typically fail to pay much attention to their own potential ‘ethical’ conflicts of interest. Admittedly, there have been some efforts to address the problem. However, despite laudable intentions, they are highly unsatisfactory. Unenforceable ‘model’ draft codes of ethics on professional websites,1 and obscure addenda to technical reports that are only available at a cost,2 do not constitute acceptable responses to this predicament. Th is is a problem of profound social importance, a matter that threatens the very foundation, integrity and accountability of one of the most powerful forces in the modern health care system.

The passions have vanished. After centuries of dominance in the ethical and scientific discourse of the West, they have been eclipsed by the emotions. To speak of the passions now is to refer to a relic of the past, the crumbling foundation of a once mighty conceptual empire that permeated all aspects of Western cultural life. Philosophical and scientific wars continue to be fought in these ruins; new encampments are built, rebels plot in the catacombs, and bold victors plant their flags on the highest peaks. But it is hard to escape the conclusion that now it is the emotions which reign supreme in affective science. It is in their terms that conflicts are fought and settled.

I am delighted that Zachar and Potter have chosen to refer to my work on the DSM-IV cluster B personality disorders in their very interesting and ambitious target article. Their suggestion that we turn to virtue ethics rather than traditional moral theory to understand the relation between moral and nonmoral factors in personality disorders is certainly original and worth pursuing. Yet, in the final instance, I am not entirely sure about the exact scope of their proposed analysis. I also worry whether they may have inadvertently presented a slightly inaccurate account of my views on the cluster B personality disorders, as they seek to formulate and defend their own views, which seem to be far wider in scope. I..

This is a chapter on the history of ideas related to recovery. Moral treatment was a novel approach to caring for mentally ill patients that arose towards the end of the eighteenth century in Europe, and then spread to North America. It is most famously associated with the names of William Tuke in York, and Philippe Pinel in Paris. These two very different men—Tuke was a wealthy English Quaker businessman and philanthropist, and Pinel was a famous French medical author and doctor—formulated two quite different approaches to the care of the mentally ill. Yet there are also important similarities in their approaches. The concept of “recovery” plays a fundamental role in both Tuke's and Pinel's conceptions of the care and treatment of mental illness. It is interesting, and important, to consider the underlying premises of their respective clinical approaches as we consider the nature and origins of the concept of “recovery” today.

Philosophical discussions regarding the status of emotion as a scientific domain usually get framed in terms of the question whether emotion is a natural kind. That approach to the issues is wrongheaded for two reasons. First, it has led to an intractable philosophical impasse that ultimately misconstrues the character of the relevant debate in emotion science. Second, and most important, it entirely ignores valence, a central feature of emotion experience, and probably the most promising criterion for demarcating emotion from cognition and other related domains. An alternate philosophical hypothesis for addressing the issues is pro- posed. It is that emotion is a naturally occurring valenced phenomenon that is..

The distinction between cognitive and perceptual theories of emotion is entrenched in the literature on emotion and is openly used by individual emotion theorists when classifying their own theories and those of others. In this paper, I argue that the distinction between cognitive and perceptual theories of emotion is more pernicious than it is helpful, while at the same time insisting that there are nonetheless important perceptual and cognitive factors in emotion that need to be distinguished. A general representational metatheoretical framework for reconciling cognitive and perceptual theories is proposed. This is the Representational Theory of Emotion (RTE). A detailed case study of Antonio Damasio's important new contribution to emotion theory is presented in defense of the RTE. The paper is intended for readers interested in the foundations of emotion theory and cognitive science.

Most contemporary models and tests for mental competence do not make adequate provision for the positive influence of emotion in the determination of competence. This most likely is due to a reliance on an outdated view of emotion according to which these models are essentially noncognitive. Leading developments in modern emotion theory indicate that this noncognitive theory of emotion is no longer tenable. Emotions, in fact, are essentially representational in a manner that makes them “cognitive” in an important sense. This requires a reassessment of the place of emotion in the theory of mental competence. Building on Benjamin Freedman’s “recognizable reasons” account of competence, it will be argued that (1) emotions form a class of recognizable reasons of their own, and (2) that competence to consent is a matter of practical, rather than theoretical, reasoning. Emotions, then, are an essential ingredient in mental competence, and the cognitive bias that permeates the theory of mental competence today must be rejected.

Interdisciplinary work of the sort attempted in my paper is fraught with risks and obstacles. One especially pernicious obstacle is the short-sighted prejudice that insists we should always divide a problem into its various components, allocate different parts to their respective disciplines, publish each separately, and, above all, keep the ethics separate from the rest. Although this may sometimes constitute good tactical advice in the mature stages of inquiry on a complex topic, it begs the question in the early initial stages of discussion on a subject like the present one, which is tangled and complex and not suited to the traditional disciplinary boundaries of professional journals...

The main purpose of my paper was to encourage discussion on the link between contemporary emotion theory and current work on mental competence. All of the commentators appear to be sympathetic to this project, although Youngner disagrees with how I have gone about it. In this response, I will try and correct a few misunderstandings and expand on several points that obviously need a far more detailed treatment than could have been provided in a single paper. I start with a reply to some of Youngner’s more pointed criticisms...