Louis C. Charland

(1958 - 2021)

Mental competence, or decision‐making capacity, is an important concept in law, psychiatry, and bioethics. A major problem faced in the development and implementation of standards for assessing mental competence is the issue of objectivity. The problem is that objective standards are hard to formulate and apply. The aim here is to review the limited philosophical literature on the place of value in competence in an attempt to introduce the issues to a wider audience. The thesis that the assessment of competence must incorporate elements of value and rationality is defended, and some tentative suggestions offered about how this might be achieved in a clinical setting.

The York Retreat is famous in the histor y of nineteenth-centur y psychiatr y because of its association with moral treatment. Although there exists a substantial historical literature on the evolution of moral treatment at the Retreat, several interpretive problems continue to obscure its unique therapeutic legacy. The nature of moral treatment as practised at the Retreat will be clarified and discussed in a historical perspective. It will be argued that moral treatment at the Retreat was pr imar ily a matter of affective conditioning guided by `benevolent theory'.

Alexander Crichton (1763—1856) made significant contributions to the medical theory of the passions, yet there exists no systematic exegesis of this particular aspect of his work. The present article explores four themes in Crichton's work on the passions: (1) the role of irritability in the physiology of the passions; (2) the manner in which irritability and sensibility contribute to the valence, or polarity, of the passions; (3) the elaboration of a psychopathology of the passions that emphasizes their physiological form rather than meaningful content or connections; and (4) the insistence that medical science ought to ignore ethical and other `moral' psychological and social aspects of the passions.

Building on what he believed was a new ‘medico-philosophical’ method, Philippe Pinel made a bold theoretical attempt to find a place for the passions and other affective posits in psychopathology. However, his courageous attempt to steer affectivity onto the high seas of medical science ran aground on two great reefs that still threaten the scientific status of affectivity today. Epistemologically, there is the elusive nature of the signs and symptoms of affectivity. Ethically, there is the stubborn manner in which fact and value are intermingled in affectivity. Both obstacles posed insuperable difficulties for Pinel, who never really managed to extricate his affective psychopathology from the confines of the Lockean intellectual paradigm.

Purpose of review This review considers the literature on ethical and conceptual issues in eating disorders from the last 18 months. Some reference to earlier work is necessary in order to provide context for the recent findings from research that is ongoing. Recent findings Empirical ethics research on anorexia nervosa includes novel ethical and conceptual findings on the role of authenticity and personal identity in individuals’ reports of their experience, as well as new evidence on the role of affective states and values in decision making at later stages of the illness. Evidence points to the hypothesis that anorexia nervosa may be a distinct affective syndrome that organizes feelings and emotions in accordance with a fixed idea. Summary There has been impressive progress in empirical ethics research on anorexia nervosa, with important implications for ethical and conceptual issues that surround decision-making capacity and our understanding of the illness.

Locke is famous for defining madness as an intellectual disorder in the realm of ideas. Numerous commentators take this to be his main and only contribution to the history of psychiatry. However, a detailed exegetical review of all the relevant textual evidence suggests that this intellectualist interpretation of Locke’s account of madness is both misleading and incomplete. Affective states of various sorts play an important role in that account and are in fact primordial in the determination of human conduct generally. Locke’s legacy in this domain must therefore be revised and the intellectualist bias that dominates discussions of his views must be redressed.

Following a Canadian Supreme Court ruling invalidating an absolute prohibition on physician assisted dying, two reports and several commentators have recommended that the Canadian criminal law allow medical assistance in dying (MAID) for persons with a diagnosis of mental disorder. A key element in this process is that the person requesting MAID be deemed to have the ‘mental capacity’ or ‘mental competence’ to consent to that option. In this context, mental capacity and mental competence refer to ‘decision-making capacity’, which is a distinct area of clinical study and research in the theory of informed consent. The purpose of this discussion is to bring several controversial but insufficiently acknowledged problems associated with decision-making capacity to the forefront of the proposed extension of MAID to persons diagnosed with mental disorders. Open-ended access to MAID by persons who suffer from mental health conditions already exists in Belgium and the Netherlands, where the issues raised here are equally relevant. In this paper, we highlight the serious limitations of relying on capacity assessments to allow access to MAID/Euthanasia.

Philippe Pinel is widely regarded as one of the founders of modern evidence-based psychiatry. Yet, until recently, his most important contributions to psychiatric theory and practice were effectively lost in myth, or lost in translation. It is instructive to review the history of these developments in order to correct any errors or omissions that may stand in the way of an accurate recognition of Pinel’s contributions to psychiatry, while at the same time highlighting some of his achievements that have been hidden by his celebrated mythical status as a pioneering humanitarian reformer. The aim of this article is to motivate further historical study of Pinel’s work, especially his 1809 Medico-Philosophical Treatise on Mental Alienation, which has only recently become available in English translation.

The engine of reason, the seat of the soul: a philosophical journey into the brain, Paul M. Churchland. Cambridge: Bradford Books, MIT Press, 1995 ISBN: 0–262–03244–4Cognition in the wild, Edwin Hutchins. Cambridge, MA: MIT Press, 1995. ISBN: 0–262–08231–4Dimensions of creativity, Margaret A. Boden, (Ed.) Cambridge, MA: MIT Press, 1994 ISBN 0–262–02368–7Contemplating minds: a forum for Artificial Intelligence, William J. Clancey, Stephen W. Smoliar & Mark J. Stefik (Eds) Cambridge: Bradford Books, MIT Press, 1994 ISBN 0–262–53119–4Passion and reason: making sense of our emotions, Richard S. Lazarus & Bernice N. Lazarus. Oxford: Oxford University Press, 1994. ISBN 0–19–508757–7Mental reality, Galen Strawson. Cambridge, MA: MIT Press, 1994 ISBN 0–262–19352–3The body and the self, Jose Luis Bermudez, Anthony Marcel & Naomi Eilan (Eds) Cambridge, MA: MIT Press, 1995. ISBN 0–262–02386–5.

First ever English Translation of Philippe PInel's 2nd Medico-Philosophical Treatise on Mental Alienation. The founder of French psychiatry wrote Medico-Philosophical Treatise on Mental Alienation in 1800 and reworked it nine years later. This book is the "Entirely Reworked and Extensively Expanded" version from 1809. Today, it can give historians of medicine and psychiatrists an overview of mental illnesses as they were viewed in that era. The author, Philippe Pinel, became known as the doctor who worked to free the insane from chains.

There is a large amount of scientific work on emotion in psychology, neuroscience, biology, physiology, and psychiatry, which assumes that it is possible to study emotions and other affective states, objectively. Emotion science of this sort is concerned primarily with 'facts' and not 'values', with 'description' not 'prescription'. The assumption behind this vision of emotion science is that it is possible to distinguish factual from evaluative aspects of affectivity and emotion, and study one without the other. But what really is the basis for distinguishing fact and value in emotion and affectivity? And can the distinction withstand careful scientific and philosophical scrutiny? The essays in this collection all suggest that the problems behind this vision of emotion science may be more complex than is commonly supposed.

This case study in the history of “passion” and “emotion” is based on the writings of William James. James is famous for his (1884) theory of emotion. However, like his illustrious colleague, Théodule Ribot, he also recognized the importance of “passion” in psychology. That aspect of James’s work is underappreciated. Ribot explicitly defends the necessity of including “passion” in psychology. James does not go that far. But he does utilize a very similar concept in connection with the term “passion” and there can be little doubt he considered it scientifically legitimate. Consequently, like Ribot, James must be considered an exception to historical accounts of this period which describe a transition from “passion” to “emotion” in which “passion” plays no part.

There are reasons to believe that decision‐making capacity (mental competence) of women in labor may be compromised in relation to giving informed consent to epidural analgesia. Not only severe labor pain, but also stress, anxiety, and premedication of analgesics such as opioids, may influence women’s decisional capacity. Decision‐making capacity is a complex construct involving cognitive and emotional components which cannot be reduced to ‘understanding’ alone. A systematic literature search identified a total of 20 empirical studies focused on women’s decision‐making about epidural analgesia for labor pain. Our review of these studies suggests that empirical evidence to date is insufficient to determine whether women undergoing labor are capable of consenting to epidural analgesia. Given such uncertainties, sufficient information about pain management should be provided as part of prenatal education and the consent process must be carefully conducted to enhance women’s autonomy. To fill in the significant gap in clinical knowledge about laboring women’s decision‐making capacity, well‐designed prospective and retrospective studies may be required.

The question of decision-making capacity for informed consent to experimental brain surgery for severely ill anorectic patients is about as dramatic an ethical issue one can imagine. Sabine Müller and her co-authors (2015) should be commended for this extremely timely and original clinical and ethical discussion of decision-making capacity in relation to the issues raised by informed consent to such therapies. It is not only the therapies themselves that are innovative in this discussion, but also the overall theoretical approach taken to decision-making capacity and informed consent. Even the understanding of anorexia nervosa is novel. The ethical stakes are certainly very high, since by some measures this is the deadliest off all mental disorders...

I very much enjoyed reading the interesting and original article by Steel and colleagues (2017). But I found myself strongly disagreeing with its conclusion once the real point of the argument became clear to me. At the same time, I believe that the authors are correct to draw attention to the importance of context and inequities in framing discussions of the ethics of voluntary consent in heroin prescription research. I begin with a brief summary of the authors’ conclusion, quoting directly and adding my own emphases, since there are major philosophical points I wish to make that hinge on nuances in wording...

What follows is a case study in the foundations of cognitive science. In it I explore the relation between the computational theory of mind and the theory of emotion. The argument of the thesis is that these two domains have much more to do with one another than has traditionally been supposed. The strategy adopted is to formulate a computational theory of emotion and then go on to extol its virtues. On the whole the aim of the project is to explore the possibility of interpreting information processing models of emotion computationally. The conclusion reached is that computational foundations for emotion theory are not only possible, but that in fact they provide a provocative perspective within which to reinterpret and focus a large amount of hitherto ossified and otherwise nomologically scattered results in emotion theory

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.

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..

In this paper I review some leading developments in the empirical theory of affect. I argue that (1) affect is a distinct perceptual representation governed system, and (2) that there are significant modular factors in affect. The paper concludes with the observation thatfeeler (affective perceptual system) may be a natural kind within cognitive science. The main purpose of the paper is to explore some hitherto unappreciated connections between the theory of affect and the computational theory of mind.

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.

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.