Grant Gillett

The relationship between "causal" and "meaningful" (Jaspers) influences on behavior is explored. The nature of meaning essentially involves rules and the human practices in which they are imparted to a person and have a formative influence on that person's thinking. The meanings that come to be discerned in life experience are then important in influencing the shape of that person's conduct. The reasoning and motivational structures that develop on this basis are realized by the shape of the neural processing networks that constitute the mature human brain. This implies that meaning is not only realized by brain micro-structure but, in part, explains its workings. This in turn entails that in psychiatry we must continue to avail ourselves both of neuropsychology/neurobiology and of dynamic/meaningful explanation. Keywords: brain and mind, causality and meaning, cognitive models, meaning, mind and brain, neuropsychology and meaning CiteULike Connotea Del.icio.us What's this?

It has been argued that 'brain bisection' data leads us to abandon our traditional conception of personal identity. Nagel has remarked: The ultimate account of the unity of what we call a single mind consists of an enumeration of the types of functional integration that typify it. We know that these can be eroded in different ways and to different degrees. The belief that even in their complete version they can be explained by the presence of a numerically single subject is an i1lusion.l Parfit has adopted a similar position, contending that patients with 'split brains' become two separate 'streams of consciousness' and thus that our normal sense of personal identity, or at least 'what matters' about personal identity is constituted by psychological relations between connected conscious experiences2 It is claimed that in 'split brain' patients certain of the relations are disrupted and that we thus see clearly that the nature of the unity that is normally present does not reside in a single subject with a given identity, but in the connectedness and continuity that normally obtains. Parfit draws on two sources of support for these contentions: the first is the actual events that transpire after a human being is submitted to the operation of sectioning the corpus callosum (or 'brain bisection'), and the second is the imaginative consideration of various scenarios involving graded mental and physical discontinuity, and the 'fission' and 'fusion' of persons. I shall do little more than argue that the actual data will not sustain the interpretation put on them

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.1 (2005) 23-24 [Access article in PDF] Schechtman's Narrative Account of Identity Grant Gillett Keywords personal identity, narrative self, memory I have long been an admirer of Schechtman's sensitive and psychologically realistic account of personal identity. In the present piece, she addresses the issues surrounding personal identity through Locke's view and problems attending that view and the psychological continuity theories descended from it.She examines the claim that the person is more extensive than the conscious mind and includes aspects of nonconscious mental activity. Schechtman argues that one must have a self-conception that includes a trajectory where present experience unfolds meaningfully out of one's past replete with implications for what one does and how one does it. She locates, in current writing on the self, the idea of a perceiver or narrator self who tries to make sense out of herself as a human being with certain thoughts and feelings and is sometimes at a loss to do so. To this potentially very rich starting point we need only add the fact that a person draws on discursive and narrative skills that have been inscribed in her being to do this narrative, editorial, and judicial task and that many of these skills have been imbibed with mother's milk (and father's voice). From this discursively inscribed set of resources and orientations arise guilt, shame, pride, aspiration, vulnerability, and that crucial sense of who one is as a person among others.It follows that here we might also find the source of the discontents that induce a person to apply to a psychiatrist or counselor for help with the narrative work required to fashion a liveable self. If Schechtman is right, the cognitive capacities contributing to memory and "keeping track of oneself"(in a deep and satisfying way) are to be found in part in the nonconscious domain rather than the thin layer of consciousness and propositional attitude psychology that enters the mind of an analytic philosopher or a psychiatrist uninterested in depth.I think she is right and that this paper and her more extensive work on the constitution of self represent a fertile point at which psychiatrists and psychotherapists can begin the task of understanding the nature of identity and the challenges involved in finding one that will serve the unfolding project of understanding and forming the self. I believe that the resources that individuals need for this task are derived from one's rootedness in culture and human relationships where the levels of self that support consciousness can be nurtured according to what Michel Foucault calls the techniques proper to the care of the self. Schechtman has done us a favor in taking the debates surrounding neo-Lockean [End Page 23] views of personal identity and outlining a perspective on identity and memory that can lead us to develop our understanding of the complexity of the human psyche as it roams through the jungle/jumble of discursive life and tries to nourish itself on what it finds there.Grant Gillett is a Professor of Medical Ethics at the University of Otago in Dunedin, New Zealand. He is also a practicing neurosurgeon. His philosophical work is in philosophy of mind and psychiatry, continental philosophy, and bioethics. His most recent books are The Mind and Its Discontents (Oxford University Press) and Bioethics in the Clinic (Johns Hopkins University Press). He works on postmodern and traditional analytic approaches to mind, language, and psychiatry. He can be reached at Dunedin Hospital and Otago Bioethics Centre, University of Otago Medical School, PO Box 913, Dunedin, New Zealand, or via e-mail at [email protected]....

'Representation' is a concept which occurs both in cognitive science and philosophy. It has common features in both settings in that it concerns the explanation of behaviour in terms of the way the subject categorizes and systematizes responses to its environment. The prevailing model sees representations as causally structured entities correlated on the one hand with elements in a natural language and on the other with clearly identifiable items in the world. This leads to an analysis of representation and cognition in terms of formal symbols and their relations. But human perception and cognition use multiple informational constraints and deal with unsystematic and messy input in a way best explained by Parallel Distributed Processing models. This undermines the claim that a formal representational theory of mind is 'the only game in town.' In particular it suggests a radically different model of brain function and its relation to epistemology from that found in current representational theories

This collection examines prevalent assumptions in moral reasoning which are often accepted uncritically in medical ethics. It introduces a range of perspectives from philosophy and medicine on the nature of moral reasoning and relates these to illustrative problems, such as New Reproductive Technologies, the treatment of sick children, the assessment of quality of life, genetics, involuntary psychiatric treatment and abortion. In each case, the contributors address the nature and worth of the moral theories involved in discussions of the relevant issues, and focus on the types of reasoning which are employed. 'Medical ethics is in danger of becoming a subject kept afloat by a series of platitudes about respect for persons or the importance of autonomy. This book is a bold and imaginative attempt to break away from such rhetoric into genuine informative dialogue between philosophers and doctors, with no search after consensus.' Mary Warnock.

The debates about human free will are traditionally the concern of metaphysics but neuroscientists have recently entered the field arguing that acts of the will are determined by brain events themselves causal products of other events. We examine that claim through the example of free or voluntary switch of perception in relation to the Necker cube. When I am asked to see the cube in one way, I decide whether I will follow the command (or do as I am asked) using skills that reason and language give to me and change my brain states accordingly. The voluntary shift of perspective in seeing the Necker cube this way or that exemplifies the top-down control exercised by a human being on the basis of the role of language and meaning in their activity. It also indicates the lived story that is at the centre of each human consciousness. In the third part of this essay, three arguments are used to undermine metaphysical objections to the very idea of top-down self control

The idea of cultural evolution, coined by Daniel Dennett, suggests we might be able to formulate a Darwinian type of explanation for the adaptive 'tricks' we learn as human beings. The proposed explanation makes use of the idea of memes. That idea is examined and related to semantic units linked to the terms in a natural language. It is agreed with Dennett that these are of pivotal significance in understanding the structure of human cognition. The alternative is then explored to the chaos of worddemons that Dennett appeals to in explaining why and how we think and enter into discursive relations. Beginning with certain thoughts about language games the essay moves on to consider the relations of power and knowledge that shape discursive reality and explain our subjectivities and actions. This leads to a sketch of Foucaultian theory as an advance in the philosophy of mind required to move beyond fairly gestural accounts of psychological explanation to be found in the standard biologically motivated approaches.

Perception is often analysed as a process in which causal events from the environment act on a subject to produce states in the mind or brain. The role of the subject is an increasing feature of neuroscientific and cognitive literature. This feature is linked to the need for an account of the normative aspects of perceptual competence. A holographic model is offered in which objects are presented to the subject classified according to rules governing concepts and encoded in brain function in that form. This implies that the analysis of perception must consider not only the fact that there is an interaction between the perceiving subject and the perceived object but also that the interaction is shaped by a system of concepts which the subject uses in thought and action

Objective To assess the issue of ‘retrospective consent’ among a cohort of patients who had survived with unfavourable outcome and to assess attitudes among next of kin regarding their role as surrogate decision makers. Methods Twenty patients who had survived for at least 3 years with an unfavourable outcome following a decompressive craniectomy for severe traumatic brain injury were assessed with their next of kin. During the course of a semistructured interview, participants were asked whether they would have provided consent if they had known their eventual outcome. They were also asked for general comments regarding all aspects of the clinical journey. Eighteen patients had next of kin who were available for interview. For two patients, there was no longer any family involvement. Results Of the 20 patients, 13 were able to provide a response and 11 felt that they would have provided consent even if they had known their eventual outcome. Of the 18 next of kin who were able to express an opinion, 10 felt that they would have provided retrospective consent. Conclusions Many patients appeared to have adapted to a level of disability that competent individuals might deem unacceptable. This does not necessarily mean that such outcomes should be regarded as ‘favourable’, nor that decompressive craniectomy must be performed for patients with predicted poor outcome. Nevertheless, those burdened with the initial clinical decisions and thereafter the long-term care of these patients may draw some support from the knowledge that unfavourable may not necessarily be unacceptable.

ABSTRACTThere are a number of arguments that purport to show, in general terms, that there is no difference between killing and letting die. These are used to justify active euthanasia on the basis of the reasons given for allowing patients to die. I argue that the general and abstract arguments fail to take account of the complex and particular situations which are found in the care of those with terminal illness. When in such situations, there are perceptions and intuitions available that do not easily find propositional form but lead most of those whose practice is in the care of the dying to resist active euthanasia. I make a plea for their intuitions to be heeded above the sterile voice of abstract premises and arguments by examining the completeness of the outline form of the pro‐euthanasia argument. In doing so, I make use of Nussbaum's discussion of moral perception and general claims to be found in the literature of moral particularism

It is striking that some arguments in the bioethical literature seem implausible, counterintuitive, and even ridiculous when reported to competent moral agents. When examined, these arguments bear uncanny resemblances to the discourse of patients with debilitating mental disorders. I examine the kinds of irrationality involved, and discuss the fact that such irrationality is worrying in a discipline that purports to serve as a guide for real‐life practical reasoning. I offer some thoughts about correctives that we might use to temper some of the odd opinions that bedevil our subject in the name of ethical analysis. It seems that one ought to be suspicious of neatly rational arguments that produce counterintuitive conclusions, but the alternative seems to be that we explore new constructions of old problems in Bioethics such that our discussion of them does justice to what we regard as of fundamental significance to our lives together as human beings.

Abstract:What is in the best interests of a child, and could that ever include interventions that we might regard as prima facie detrimental to a child’s physical well-being? This question is raised a fortiori by growth attenuation treatments in children with severe neurological disorders causing extreme developmental delay. I argue that two principles that provide guidance in generating a conception of best interests for each individual child yield the right results in such cases. The principles are as follows: thepotentiality principle, whereby every child should be able to develop its potential and is entitled to receive certain help in doing so, and theprinciple of psychosomatic harmony, whereby every human being is entitled to treatment that is appropriate to or enables a life in which mind and body are in tune with each other. These principles indicate a certain response to what we can call Ashley-type cases and admit certain caveats.