Grant Gillett

The aim of this paper was to explore the issue of consent when considering the use of a life saving but not necessarily restorative surgical intervention for severe traumatic brain injury. A previous study has investigated the issue amongst 500 healthcare workers by using a two-part structured interview to assess opinion regarding decompressive craniectomy for three patients with varying injury severity. A visual analogue scale was used to assess the strengths of their opinions both before and after being shown objective outcome data. Opinions were assessed in a number of scenarios, one of which was that the participants themselves were the injured party. The implication, which was clearly stated, was whether they would provide consent for the procedure to be performed. The study demonstrated that participants were relatively risk aversive in regards to survival with severe disability especially when the injury was severe and there was high probability of that outcome occurring. This finding was not however universal and a minority of participants would provide consent even when the possibility of survival with severe disability was very high. The obvious difficulty comes when considering consent in patients who are unable to express their wishes. In order to address this issue we propose a model of consent based on a balance of the various factors that seem to be of material relevance. These include the severity of the injury, the willingness or otherwise to accept survival with severe disability and the willingness to “risk” the possibility of an unacceptable outcome in order to achieve an acceptable outcome

Aesthetic responsivity and the phenomenology of arts processes reflect integrative self-world engagements, and are informative about the nature of the world and our biology in ways that are often not be made evident through scientific research. Akins’ and Hahn’s research regarding human trichromatic visual perception brings together the art of photography, neuroscience, and psychophysics, along with analyses of perspectives on vision in science and philosophy, to invoke anti-reductive, holistic understandings of how we see colour. We bring aesthetics and the phenomenology of arts processes to bear in exploring creaturely re-sponsivity to the complex inter-relational dynamics of light perception, and o˙er reflective metaphors for human engagements that challenge Darwinian utilitarian conceptions. We argue that attending to aesthetic and phenomenological aspects of experiences is essential to understanding how the shared circuits of cognition and sensory-motor engagement shape our perceptive responsive interactions.

This book is an analysis and discussion of the soul as a psychophysical process and its role in mental representation, meaning, understanding and agency. Grant Gillett and Walter Glannon combine contemporary neuroscience and philosophy to address fundamental issues about human existence and living and acting in the world. Based in part on Aristotle's hylomorphism and model of the psyche, their approach is informed by a neuroscientific model of the brain as a dynamic organ in which patterns of neural oscillation and synchronization are shaped by biological, social and cultural factors inside and outside of it. The authors provide a richer and more robust account of the soul, or mind, than other accounts by framing it in neuroscientific and philosophical terms that do not explain it away but explain it as something that is shaped by how it responds to the natural and social environment in enabling flexible and adaptive behavior.

Medea killed her children to take away the smile from her husband's face, according to Euripides, an offence against nature and morality. What if Medea had still been carrying her two children, perhaps due to give birth within a week or so, and had done the same? If this would also have been morally reprehensible, would that be a judgment based on her motives or on her action? We argue that the act has multiple and holistic moral features and that, in fact, there is no absolute principle, such as the right of the fetus to life, which governs our moral judgments about fetal-maternal conflicts. We suggest that they illustrate a pervasive feature of human moral discourse and can only be addressed by attending to a range of negotiable moral considerations which depend on particular features of each situation

There is a marked disparity between medical intuitions and philosophical argument about euthanasia. In this paper I argue that the following objections can be raised. First, medical intuitions are against it and this is an area in which judgement and sensitivity are required in that death is a unique and complex process and the patient has many needs including the need to know that others have not discounted his or her worth. Also, part of the moral constitution of a good doctor is a devotion to the protection and preservation of life whatever reasons are produced to dissuade her. Finally, we do not know what the final events of a person's life might hold

The discursive approach to psychiatry, taking as it does an ethological approach to the human organism, directs us to rules and story lines that structure our ways of dealing with the challenges thrown up by particular situated positions in our discursive world. For human beings this means engaging with the sense they are making of the world and the words they use to try and communicate that. Doing things with words is behavior that draws on certain skills attuned to prompts, cues, expectations, and so on, all of which can go seriously awry in any setting where certain features are unfamiliar or where one of the participants is "impaired" or out of step with prevailing norms and assumptions. Discursive competence and the reality of the human psyche as a mode of being-in-relation-with others crucially depends on intact neural function and brain pathways slowly and cumulatively developed throughout life and is vulnerable to disruption of that substrate. Hysteria and dementia represent two very different situations in which the discursive mismatch between an individual and his or her context of being causes the voice of a person to be "lost in translation" so that understanding what is happening and then care and restoration demand a great deal of us not just as biomedical scientists but also as human beings who are reaching out to those who suffer and try to endure so as to help hold them in being.

Neuroscience and technological medicine in general increasingly faces us with the imminent reality of cyborgs—integrated part human and part machine complexes.If my brain functions in a way that is supported by and exploits intelligent technology both external and implantable, then how should I be treated and what is my moral status—am I a machine or am I a person? I explore a number of scenarios where the balance between human and humanoid machine shifts, and ask questions about the moral status of the individuals concerned. The position taken is very much in accordance with the Aristotelian idea that our moral behaviour is of a piece with our social and personal skills and forms a reactive and reflective component of those skills

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.1 (2005) 83-85 [Access article in PDF] Lacan, Science, and Determinism Douglas McConnell Grant Gillett Keywords Lacan, the unconscious, free will Van Staden And Hinshelwood's commen-taries raise a number of issues, but there are two particular themes common to both that we pick up in this response.The first theme concerns the reconcilability of Lacanian theory to the disciplines of analytic philosophy and "Anglo-American positivist psychiatry." This is closely related to the relationship between the unconscious and the empirical sciences discussed in the editorial (McConnell and Pickering 2005). The second theme concerns the relevance of Lacanian theory to our understanding of free will and the structure of the mind. Lacan, Analytic Philosophy, and Scientific Psychiatry First, psychoanalysis or psychotherapy generally should not try to reunite with neuroscience because of the fundamental difference in their approaches to the patient, which is likely to mean that even if a theoretical rapprochement can be found, a working relationship is unlikely.Although there are many facets of Lacan's theory that were not addressed in our paper and even if many of those are totally irreconcilable to analytic philosophy, we believe that we have addressed the most ontologically fundamental issues and that these can genuinely contribute to and challenge analytic philosophy of mind.As Hinshelwood points out, psychiatry does operate with a philosophical basis, critical (or sometimes relatively uncritical) scientific realism (even though it may not be acknowledged), and it as such it can legitimately be contributed to or challenged by the philosophical aspects of Lacanian theory outlined in our paper.In fact, the theoretical basis is evinced in van Staden's commentary when he remarks on the relation between Lacanian theory and psychiatry: "... the unconscious is not only structured like a language but actually reflects and is produced by linguistic interaction between the subject and others. This is a difficult claim to verify, no doubt, but it prompts further related questions... whether the conscious mind is structured like a language" (van Staden 2005, 78). And one must ask whether this is the kind of claim that can be verified or whether it is a hermeneutic claim (in somewhat the way suggested by Jaspers), serving more as a framing belief to allow people to make sense of what has influenced them in their life histories and is currently played out in their relationships with others. We would lean toward this interpretation of the unconscious, explicitly distancing ourselves from any overreaching, quasi-scientific realism about unconscious contents and mental structures, but clinging to the thought that dealing with such contents is an essential part of the therapeutic encounter. [End Page 83]Looked at in this way, both the Lacanian unconscious and conscious mental life bear the imprint of language due to the subject's immersion and participation in the symbolic realm. This may seem a "difficult claim to verify," but because verification is linked to the scientific framework of inquiry rather than the hybrid that is clinical knowledge, we would better regard it as being difficult to establish as an axiom of therapy. The linguistic structure of the conscious and unconscious mind is, on this account, a conceptual implication of the role of the symbolic register in thought and not a thesis that requires verification (a Wittgensteinian thesis espoused by a number of contemporary philosophers, including Dummett and Davidson).As it happens, cognitive science has found linguistic structure to be important in operations of the cognitive unconscious (arguably different from the dynamic unconscious due to the former's dependence on scientific experiment and the latter's connections to life history rather than mere psychological or cognitive traits [see Gillett and McConnell 2005]). Given that language and problem solving are so closely intertwined, it would suggest that cognitive science was overlooking something important rather than damaging Lacanian theory if linguistic structure did not appear on cognitive science's "radar." So, how does language logically (in the sense defended by Husserl and Frege, that is, to do with the sense or content of thoughts not merely the processes underpinning one's contingently evolving stream...

Lacan, despite being largely ignored and misunderstood in Anglo-American analytic philosophy, brings psychoanalytic theory into close contact with the philosophy of mind and psychiatry as illuminated by the continental tradition. He draws on Freud, phenomenology, existentialism, and structuralism to construct a subtle theoretical approach to the psyche according to which our engagement in discourse and our existence in the world combine to generate a many layered structure of meanings and influences that forms us. This allows him to focus on the nature and role of language and our discursively constructed self-conceptions both in the therapeutic encounter and in the maladies of the psyche. The relevance of Lacan's thought for analytic philosophy of psychiatry can be explored by pursuing his links to Freud, his complex treatment of issues in the philosophy of language, and a subtle blend of existentialism and continentally inspired naturalism that paints the contours of the unconscious mind in operationally compelling terms.

This study examines the relationship between thought and language by considering the views of Kant and the later Wittgenstein along with many strands of contemporary debate in the area of mental content. Building on an analysis of the nature of concepts and conceptions of objects, Gillett provides an account of psychological explanation and the subject of experience, offers a novel perspective on mental representation and linguistic meaning, looks at the difficult topics of cognitive roles and singular thought, and concludes with an outline of certain considerations relevant to skeptical arguments and the nature of perception. The resulting synthesis demonstrates interesting correlations with current work in cognitive and developmental psychology, and is directly relevant to continuing work in epistemology, philosophy of mind, and philosophical psychology.

Responses to brain injury sit in the intersection between neuroscience and an ethic of care, and require sensitive and dynamic indicators of how an individual with brain injury can learn how to live in the context of a changing environment and multiple timescales. Therapeutic relationships and rhythms underpinning such a dynamic approach are currently obscured by existing models of brain function. Something older is required and we put forward narrative types articulating outcomes of brain injury over various periods and starting points in time. Such storytelling challenges a static neuropsychological paradigm and moves from an ethics that focuses on patient autonomy into one that is reflective of the cognitive supports and therapeutic relationships that underpin ways that the patient can re-find the beat that proves the music is not over.

In all fields of clinical medicine, there is an increasing awareness that outcome must be assessed in terms of quality of life and cost effectiveness, rather than merely length of survival. This is especially the case when considering decompressive craniectomy for severe traumatic brain injury. The procedure itself is technically straightforward and involves temporarily removing a large section of the skull vault in order to provide extra space into which the injured brain can expand. A number of studies have demonstrated many patients going on to make a good long-term functional recovery, however, this is not always the case and a significant number survive but are left with severe neurocognitive impairment. Unfortunately, many of these patients are young adults who were previously fit and well and are, therefore, likely to spend many years in a condition that they may feel to be unacceptable, and this raises a number of ethical issues regarding consent and resource allocation. In an attempt to address these issues, we have used the analytical framework proposed by Jonsen, that requires systematic consideration of medical indications, patient preferences, quality of life and contextual features

Public health and pandemic ethics frequently concern themselves with organizing principles, utility, and public policy. But the effects of pandemics, and the impact of measures to control them, are experienced by individuals and families. This is particularly true for those who are most vulnerable to COVID-19—the elderly and “infirm.” So while ethics must assist in articulating the policies that will determine the allocation of resources during this and future pandemics, it must, at the same time, be alert to the intimate narratives of the infection. This is an account from someone looking down the muzzle of COVID-19.

From Aristotle to Cognitive Neuroscience identifies the strong philosophical tradition that runs from Aristotle, through phenomenology, to the current analytical philosophy of mind and consciousness. In a fascinating account, the author integrates the history of philosophy of mind and phenomenology with recent discoveries on the neuroscience of conscious states. The reader can trace the development of a neuro-philosophical synthesis through the work of Aristotle, Kant, Wittgenstein, Husserl, Merleau-Ponty, Brentano and Hughlings-Jackson, among others, and so explore contemporary philosophical puzzles surrounding consciousness and its relation to cerebral synchrony and connectedness. Of interest to students and scholars of neuroethics, neurophilosophy and philosophy of mind, as well as philosophy of psychiatry, From Aristotle to Neuroscience demonstrates the real essence of consciousness as it increasingly connects with philosophy, law, morality, aesthetics, and spirituality.

This open access book is a systematic update of the philosophical and scientific foundations of the biopsychosocial model of health, disease and healthcare. First proposed by George Engel 40 years ago, the Biopsychosocial Model is much cited in healthcare settings worldwide, but has been increasingly criticised for being vague, lacking in content, and in need of reworking in the light of recent developments. The book confronts the rapid changes to psychological science, neuroscience, healthcare, and philosophy that have occurred since the model was first proposed and addresses key issues such as the model’s scientific basis, clinical utility, and philosophical coherence. The authors conceptualise biology and the psychosocial as in the same ontological space, interlinked by systems of communication-based regulatory control which constitute a new kind of causation. These are distinguished from physical and chemical laws, most clearly because they can break down, thus providing the basis for difference between health and disease. This work offers an urgent update to the model’s scientific and philosophical foundations, providing a new and coherent account of causal interactions between the biological, the psychological and social.

Abstract:Patients with repeated minor head injury are a challenge to our clinical skills of neurodiagnosis because the relevant evidence objectively demonstrating their impairment was collected in New Zealand (although published in theBMJandLancet) and, at the time, was mired in controversy. The effects of repeated closed diffuse head injury are increasingly recognized worldwide, but now suffer from the relentless advance of imaging technology as the dominant form of neurodiagnosis and the considerable financial interests that underpin the refusal to recognize that acute accelerational injury is the most subtle and insidiously damaging (especially when seen in the light of biopsychosocial medicine), and potentially one of the most financially momentous (given the large incomes impacted and needing compensation) phenomena in modern sports medicine. The vested interests in downplaying this phenomenon are considerable and concentrated in North America where diffuse head injury is a widespread feature of the dominant winter sports code: Gridiron or American Rules football. The relationship of this to shattered lives among the brightest and best of young men and the relatively dated objective evidence are a toxic mix in terms of ethical analysis and, therefore, there is a malignant confluence of social forces that tends toward minimizing the injury.

Psychopaths are often regarded as a scourge of contemporary society and, as such, are the focus of much public vilification and outrage. But, arguably, psychopaths are both sinned against as well as sinners. If that is true, then their status as the victims of abusive subcultures partially mitigates their moral responsibility for the harms they cause. We argue, from the neuroethics of psychopathy and antisocial personality disorder (ASPD), that communities have a moral obligation to psychopaths as well as a case against them. A reflection on the genesis and developmental epidemiology of psychopathy reveals an individualist, attribution-type error evident in much Western psychological and legal thinking—an error that obscures important moral truths about psychopaths. The resulting analysis makes us reconsider the distinction between disorders and moral failings and the ethical significance of the biological or neurocognitive mechanisms underpinning psychopathy. We claim that casting aside the deficit model (based on the presupposition that psychopaths are intrinsically unlike the rest of us) in favor of a relational and holistic view of personality potentiates a more informed and inclusive set of ethical, forensic, and therapeutic attitudes.