Tag: mental disorders

Bioethics Blogs

Dangerous Love and Anti-Love Drugs: Neuroethics & Public Health Problems

By Kelsey Drewry
Kelsey Drewry is a student in the Master of Arts in Bioethics program at the Emory University Center for Ethics where she works as a graduate assistant for the Healthcare Ethics Consortium. Her current research focuses on computational linguistic analysis of health narrative data, and the use of illness narrative for informing clinical practice of supportive care for patients with neurodegenerative disorders.
The half-priced heart-shaped boxes of chocolates lining grocery store shelves serve as an undeniable marker of the recent holiday. Replete with conceptions of idyllic romance, Valentine’s Day provides an opportunity to celebrate partnership, commitment, and love. However, for those experiencing heartbreak or unrequited love, Cupid may be a harbinger of suffering rather than giddy affection.

The transition from love to pain is an incredibly common experience, and one that is formative for many. The extent of character building in heartbreak and other negative affection experiences is bounded, though, by certain types of “dangerous love”. According to Brian Earp and colleagues, this classification might include domestic abuse, pedophilia, or even jealousy-induced homicide (Earp et al 2013). The suffering associated with these cases surpasses any beneficial emotional development, leading instead to potential enduring physical and psychological harms. Instances of “dangerous love” might become the targets for “drugs that manipulate brain systems at whim to enhance or diminish our love for one another” (Young 2009, 148), which seem to be a reasonable potential product of current trajectories of neuropharmocological research.
Image courtesy of Flikr

These “anti-love” drugs are certainly beneficently intended, and may indeed be of great value in some instances.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

If sex reassignment surgery is the answer, what is the question?

Sex reassignment surgery requires the intervention of doctors. But what kind of treatment is it? Is it a therapy for a disease which should be offered only after psychiatric authorization? Or is it a biomedical enhancement which anyone can freely choose?

The answer to this theoretical question has practical consequences. If it is a therapy, then transgenderism is a disease. If it is an enhancement, then it hardly deserves to be funded by the government.

In a very interesting article in the Journal of Medicine and Philosophy, Tomislav Bracanović, of the University of Zagreb, in Croatia, analyses the competing conceptions.

Transgender scholars contend that sex reassignment surgery is not a therapy for gender identity disorder, because the feeling of being a man in a woman’s body or a woman in a man’s body is not a disorder. It is a “normal, albeit rare, human condition that is medicalized as a consequence of general discrimination of transsexual population. It should be removed, therefore, from all classifications of mental disorders, and sex reassignment surgery should be made available without medical “gatekeepers” deciding who qualifies for it and who does not.”

Their conclusion is that a sex change is no more a therapy than a “nose job”. They would prefer to describe sex reassignment surgery as an enhancement, like cosmetic surgery.

But is it plausible to describe it as non-therapeutic enhancement? Bracanović believes that it is not. “It does not improve, augment, or increase—above average—any trait or function typically mentioned in philosophical debates about enhancement. Intelligence, vision, hearing, physical strength, and immunity, for example, after sex reassignment surgery remain more or less the same as they were before.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Should doctors talk about Trump’s mental health?

During the 2016 US Presidential Campaign, BioEdge reported on the ethics of the psychological profiling of candidates.

With what has been labelled the “bombastic” and “erratic” behaviour of President Trump, commentators are once again questioning whether psychiatrists and psychologists should share their opinions on political figures.

Writing in the BMJ Blog this week, Oxford health science professor Trish Greenhalgh said that it is permissible for doctors to publically suggest that a politician seek clinical help.   

“there is no absolute bar to a doctor suggesting that in his or her clinical opinion, it would be in the public interest for a particular public figure to undergo “occupational health” checks to assess their fitness to hold a particular office.”

Dr. Greenhalgh did not, however, comment on Mr. Trump’s mental state.

Dr. Allen Frances, a professor emeritus of psychiatry at Duke University who oversaw the creation of a previous edition of the APA’s Diagnostic and Statistical Manual of Mental Disorders, is sceptical of the attempts to diagnose Trump.

“Trump doesn’t meet DSM criteria [for any disorder]…I wrote the criteria and should know how they are meant to be applied: Personality disorder requires the presence of clinically significant distress and/or impairment. The armchair, amateur diagnosticians seem either to be unaware of this requirement, or carelessly choose to ignore it.”

Section 7.3 of the American Psychiatric Association’s Principles of Medical Ethics states that: “it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.”

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Handbook of the Philosophy of Medicine

Now available – Handbook of the Philosophy of Medicine – 68 chapters spanning over 1000 pages.


This is the first wide-ranging, multi-authored handbook in the field of philosophy of medicine, covering the underlying conceptual issues of many important social, political and ethical issues in health care. It introduces and develops over 70 topics, concepts, and issues in the field. It is written by distinguished specialists from multiple disciplines, including philosophy, health sciences, nursing, sociology, political theory, and medicine. 


Many difficult social and ethical issues in health care are based on conceptual problems, most prominently on the definitions of health and disease, or on epistemological issues regarding causality or diagnosis. Philosophy is the discipline that deals with such conceptual, metaphysical, epistemological, methodological, and axiological matters. 


This handbook covers all the central concepts in medicine, such as ageing, death, disease, mental disorder, and well-being. It is an invaluable source for laypeople, academics with an interest in medicine, and health care specialists who want be informed and up to date with the relevant discussions. The text also advances these debates and will set the agenda for years to come.


Philosophy of Medicine and Bioethics
Schramme, Thomas

Normality as Convention and as Scientific Fact
Chadwick, Ruth

On Concepts of Positive Health
Nordenfelt, Lennart

Disease as Scientific and as Value-Laden Concept
Kingma, Elselijn

Mental Disorders as Genuine Medical Conditions
Wakefield, Jerome C.

Curing and Healing: Two Goals of Medicine
Szawarska, Dorota

Illness and Its Experience: The Patient Perspective
Carel, Havi

Nursing as Caring
Sellman, Derek

Goals of Medicine
Schramme, Thomas

Suffering: Harm to Bodies, Minds, and Persons
Hofmann, Bjørn

Disability as Medical and as Social Category
Edwards, Steven

Subjective and Objective Accounts of Well-Being and Quality of Life
Schramme, Thomas

Pain as a Subjective and Objective Phenomenon
Dekkers, Wim

Death as Biological Category
Holland, Stephen

Suicide
Edwards, Steven

Enhancing Human Abilities and Characteristics Beyond Normality
Bloodworth, Andrew

How Can Aging Be Thought of as Anything Other Than a Disease?

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Sex and gender. New findings, new controversy

pdf‘Patients who had undergone sex reassignment surgery at his hospital, stated that the problems presented by patients before the surgery had not been resolved, at either human relationship, work or emotional level.

Introduction

Sex and gender. Dr. Lawrence S. Mayer, an epidemiologist specialising in Psychiatry, and Dr. Paul R. McHugh, said to be the most important American psychiatrist of the last half century, have recently published a study entitled “Sexuality and Gender” in the journal The New Atlantis (see HERE), which offers an exhaustive review of more than five hundred scientific articles related with this matter. “I was alarmed to learn that the LGBT community bears a disproportionate rate of mental health problems compared to the population as a whole”, says Dr. Mayer, one of the authors of the article. 1

Background

In November 2014, Dr. McHugh had already published a report on the website First Things2, in which he explained his decision as head of the Psychiatry Department at John Hopkins hospital in Baltimore, US, to no longer propose any sex reassignment surgery, in view of the negative findings that he obtained after a retrospective examination of patients who had undergone the procedure.

In the current article, the authors looked at studies published in recent years, in an attempt to establish statistically significant, well-proven evidence. Compared to other related studies, which often offer contradictory results on the topic, this one is distinguished by the large amount of data from many different sources, which gives it special credibility, as well as the backing of its indisputably eminent authors.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Transsexuality diagnosis and treatment

PDF version

‘The only thing that has been achieved so far is to try to adapt the body to the mind, instead of trying to alleviate the cerebral problem’

Diagnosis

The diagnosis of transsexualism is based on both medical and psychiatric findings, criteria that have been enshrined in medical guidelines, such as the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), drawn up by the American Psychiatric Association, or the tenth edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).2

However, before attempting to determine the existence of transsexuality and its possible immediate consequence, gender dysphoria, karyotyping should be performed to try to rule out a chromosome disorder, the result of an enzyme defect, that could lead to sexual ambiguity, as occurs in Turner’s or Klinefelter syndrome.3

According to the DSM-5, in order to diagnose gender dysphoria, there has to be objective incongruity between the sex assigned at birth and the one the individual desires, i.e. a marked difference between the gender that one feels and the one assigned at birth, and this disharmony must persist for at least 6 months.

In the case of children, gender dysphoria can manifest between two and four years old, when affected children can start to express preferences or social attitudes of the sex opposite to the gender to which they biologically belong, but this desire must be determined objectively.

According to World Professional Association for Transgender Health (WPATH) guidelines, the diagnosis of gender dysphoria is an essential condition in order for a person to be able to request sex reassignment surgery.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

"American Horror Story" in Real Life: Understanding Racialized Views of Mental Illness and Stigma

By Sunidhi Ramesh
Racial and ethnic discrimination has taken various forms in the
United States since its formation as a nation. The sign in the image
reads: “Deport all Iranians. Get the hell out of my country.”
Image courtesy of Wikipedia.
From 245 years of slavery to indirect racism in police sanctioning and force, minority belittlement has remained rampant in American society (1). There is no doubt that this history has left minorities in the United States with a differential understanding of what it means to be American and, more importantly, what it means to be an individual in a larger humankind.

Generally, our day-to-day experiences shape the values, beliefs, and attitudes that allow us to navigate the real world (2). And so, with regards to minorities, consistent exposure to these subjective experiences (of belittlement and discrimination, for example) can begin to shape subjective perceptions that, in turn, can mold larger perspectives and viewpoints.

Last spring, I conducted a project for a class to address the reception (3) of white and non-white, or persons of color (POC), students to part of an episode from American Horror Story: Freak Show. The video I asked them to watch portrays a mentally incapacitated woman, Pepper, who is wrongfully framed for the murder of her sister’s child. The character’s blatant scapegoating is shocking not only for the lack of humanity it portrays but also for the reality of being a human being in society while not being viewed as human.
Although the episode remains to be somewhat of an exaggeration, the opinions of the interview respondents in my project ultimately suggested that there exists a racial basis of perceiving the mental disabilities of Pepper—a racial basis that may indeed be deeply rooted in the racial history of the United States.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In the Journals – October 2016 by Livia Garofalo

Here is our “In the Journals” roundup for October. In addition to a rich selection of abstracts, also of interest this month are a Special Issue of Osiris on the “History of Science and Emotions” and two recent articles by Fernando Vidal on brains in literature and cinema (linked below). Enjoy!

 

Theory & Psychology 

Desire, indefinite lifespan, and transgenerational brains in literature and film

Fernando Vidal 

Even before the brain’s deterioration became a health problem of pandemic proportions, literature and film rehearsed the fiction of brain transplantations that would allow an aging person to inhabit a younger body, so that successive surgeries may result in that person’s immortality. Such fiction makes the brain operate like an immaterial soul that does not undergo physical decline. This article examines that fiction as elaborated in Hanif Kureishi’s The Body and several films in connection with older fantasies that articulate desire, eternal youth, and personal immortality, with philosophical discussions about brain and personhood, and with people’s assimilation of neuroscientific idioms into their views and practices of personal identity. In conclusion it discusses how, in contrast to philosophical approaches that tend to focus on self-consciousness, first-person perspectives, and individual autonomy, fiction may contribute to direct attention to relationality as constitutive of personhood.

SubStance 

Frankenstein’s Brain: “The Final Touch”

Fernando Vidal 

 

Critical Public Health

A critical examination of representations of context within research on population health interventions

Jean Shoveller, Sarah Viehbeck, Erica Di Ruggiero, Devon Greyson, Kim Thomson and Rodney Knight

Research that fulsomely characterizes context improves our understanding of the processes of implementation and the effectiveness of interventions to improve the health of populations and reduce health inequalities.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

A Gene That Could Help Explain Why Lithium Stabilizes Mood

October 20, 2016

(The Atlantic) – While the description of bipolar disorder in the various editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM)—the American Psychiatric Association’s sometimes maligned guide to psychiatric diagnosis—has changed over the years, lithium has remained a standby treatment. “It’s still arguably one of the best medications,” even if it’s not completely understood, says Ben Cheyette, a professor of psychiatry at the University of California, San Francisco. Now, a new study published on Tuesday by Cheyette’s group in Molecular Psychiatry sheds some light on lithium’s effects on the brain.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Conference Report: “Biopolitics and Psychosomatics: Participating Bodies” by Alev Sen

Biopolitics and Psychosomatics: Participating Bodies

8 July 2016, University of Cambridge

Conveners:
Darin Weinberg, University of Cambridge
Monica Greco, Goldsmiths, University of London
Robbie Duschinsky, University of Cambridge
Michael Schillmeier, University of Exeter

Introduction

Can we think of our living bodies as involving forms of social intelligence, agency, and power? And if so, how might this proposition transform the ways in which we consider the possibilities and politics of patient participation? These were the questions at the core of the intellectual agenda of the conference “Biopolitics and Psychosomatics: Participating Bodies”, held on 8 July 2016 at the Centre for Research in the Arts, Social Sciences and Humanities (CRASSH) at the University of Cambridge. The event—co-convened by Monica Greco (Goldsmiths), Darin Weinberg and Robbie Duschinsky (University of Cambridge) and Michael Schillmeier (University of Exeter)—aimed to reclaim the term ‘psychosomatic’ from the reductive and polemical forms of engagement in which it is often caught, and use it as a springboard for reframing questions of agency, embodiment, responsibility, power and choice in the context of current challenges facing state-sponsored service provision in Europe and the US.[1] The spirit of the conference was explicitly exploratory, more concerned with creating space for a new type of conversation than to provide direct answers to the many questions raised. Despite a last-minute cancellation by Laurence Kirmayer, who was scheduled to deliver the closing keynote, the conference proved successful, stimulating discussion and debate about these important and timely questions, on practical, political and intellectual levels.

After Darin Weinberg’s welcome address Monica Greco’s introduction outlined the multiple connotations of the term ‘psychosomatic’ and the striking contrast between them.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.