Agency in the absence of reason-responsiveness: The case of dispositional impulsivity in personality disorders

It has been argued recently that persons diagnosed with a personality disorder (PD) ought to be held responsible for their actions because these actions are voluntary (Pickard 2011, this journal). In what follows, I argue that this claim is grounded in a conception of voluntary action that is too coarse grained to provide an adequate understanding of the structure of agency in persons diagnosed with PD. When the concept of voluntary action and that of behaviors typical of PD are examined more carefully, the claim that PD behaviors are voluntary turns out to be tenuous in at least two ways. First, it becomes apparent that the grounds provided by Pickard do not conclusively establish that PD behaviors are voluntary. Second, a more refined conception of voluntary agency helps us to appreciate that, if indeed PD behaviors are voluntary, such behaviors seem at best to be voluntary in an anemic and limited sense—a sense that is quite distinct from the ordinary sense in which we speak of actions being voluntary

Delusions and Personal Autonomy

This article will examine the claim that personal autonomy is impaired by a paradigmatic instance of serious psychopathology – namely, the condition of being delusional – in light of the hierarchical conception of personal autonomy. This conception of personal autonomy aims at yielding value‐neutral judgements about freedom and self‐governance. I will argue that when viewed from the perspective of this specific conception of autonomy, delusions do not necessarily impair an agent's personal autonomy. In order to establish this claim, I will probe the general idea that delusional subjects are beset by a mental disease that is rationally incapacitating, to which the hierarchical theorist might appeal. I argue that, understood within the parameters set by the commitment to value neutrality, this idea fails to provide support for the claim that delusion necessarily impairs personal autonomy. One contribution this article makes to the effort of understanding how delusion impairs personal autonomy is to help us pinpoint the ways in which our value commitments inform our judgements of impaired personal autonomy in delusional agents

Psychopathy: what apology making tells us about moral agency

Psychopathy is often used to settle disputes about the nature of moral judgment. The “trolley problem” is a familiar scenario in which psychopathy is used as a test case. Where a convergence in response to the trolley problem is registered between psychopathic subjects and non-psychopathic (normal) subjects, it is assumed that this convergence indicates that the capacity for making moral judgments is unimpaired in psychopathy. This, in turn, is taken to have implications for the dispute between motivation internalists and motivation externalists, for instance. In what follows, we want to do two things: firstly, we set out to question the assumption that convergence is informative of the capacity for moral judgment in psychopathy. Next, we consider a distinct feature of psychopathy which we think provides strong grounds for holding that the capacity for moral judgment is seriously impaired in psychopathic subjects. The feature in question is the psychopathic subject’s inability to make sincere apologies. Our central claim will be this: convergence in response to trolley problems does not tell us very much about the psychopathic subject’s capacity to make moral judgments, but his inability to make sincere apologies does provide us with strong grounds for holding that this capacity is seriously impaired in psychopathy

The Concept of Emotional Disorder - International Perspectives In Philosophy & Psychiatry

Depression and anxiety are increasingly commonly diagnosed mental health conditions in modern society, but where does the boundary between ordinary emotional experiences and an emotional disorder lie? Do we over-pathologize emotional disorders as a society? Does the field of psychiatry do the same? Weighing in on this debate, Gloria Sibson Ayob investigates the concept of emotional disorder, analyses the grounds on which an emotional state can be said to be disordered, and examines judgements of emotional health and pathology. The Concept of Emotional Disorder considers the evolution-theoretic framework currently used to explore the concept of emotional disorder, and its limitations, and offers an alternative analysis anchored in a conceptual-anthropological framework. Understanding the place of emotions, especially distressing and unpleasant ones in our lives, is essential to the pathologizing debate. By highlighting the role human values and concerns play in shaping emotional disorder and introducing new considerations that are key to the concept of emotional disorder, Sibson Ayob enriches our understanding of the value of emotions in human life and their conceptual structure

Space and Sense: The Role of Location in Understanding Demonstrative Concepts

My aim in this paper is to critically evaluate John Campbell's (2002) characterization of the sense of demonstrative terms and his account of why an object's location matters in our understanding of perceptually-based demonstrative terms. Campbell thinks that the senses of a demonstrative term are the different ways of consciously attending to an object. I will evaluate Campbell's account of sense by exploring and comparing two scenarios in which the actual location of a seen object is different from its perceived location. I do this in order to motivate the following point: Campbell's characterization of the sense of a demonstrative term turns sense into a psychologistic notion. As a consequence of this, it is difficult to see how sense could underwrite reference. In short, I shall be arguing that Campbell's account of the ways of perceiving an object is simply inadequate as an account of the Fregean notion of sense, according to which the senses of a demonstrative term are the different ways of thinking about an object

Factors associated with adverse COVID-19 outcomes in patients with psoriasis : insights from a global registry–based study

Background: The multimorbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse outcomes of coronavirus disease 2019 (COVID-19), but the data are limited. Objective: Our aim was to characterize the course of COVID-19 in patients with psoriasis and identify factors associated with hospitalization. Methods: Clinicians reported patients with psoriasis with confirmed/suspected COVID-19 via an international registry, Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection. Multiple logistic regression was used to assess the association between clinical and/or demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviors. Results: Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% were receiving a nonbiologic, and 10% were not receiving any systemic treatment for psoriasis. In all, 348 patients (93%) were fully recovered from COVID-19, 77 (21%) were hospitalized, and 9 (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted odds ratio [OR] = 1.59 per 10 years; 95% CI = 1.19-2.13), male sex (OR = 2.51; 95% CI = 1.23-5.12), nonwhite ethnicity (OR = 3.15; 95% CI = 1.24-8.03), and comorbid chronic lung disease (OR = 3.87; 95% CI = 1.52-9.83). Hospitalization was more frequent in patients using nonbiologic systemic therapy than in those using biologics (OR = 2.84; 95% CI = 1.31-6.18). No significant differences were found between classes of biologics. Independent patient-reported data (n = 1626 across 48 countries) suggested lower levels of social isolation in individuals receiving nonbiologic systemic therapy than in those receiving biologics (OR = 0.68; 95% CI = 0.50-0.94). Conclusion: In this international case series of patients with moderate-to-severe psoriasis, biologic use was associated with lower risk of COVID-19-related hospitalization than with use of nonbiologic systemic therapies; however, further investigation is warranted on account of potential selection bias and unmeasured confounding. Established risk factors (being older, being male, being of nonwhite ethnicity, and having comorbidities) were associated with higher hospitalization rates