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Z. Sanuyem, M.B. B.A.O., M.B.B.Ch., Ph.D.

Medical Instructor, A. T. Still University Kirksville College of Osteopathic Medicine

Folk Psychology in the Criminal Law A key principle of civilized criminal law is the principle of mens rea: that, generally, no person can be convicted of a crime unless the prosecution proves not only a guilty act but also a guilty mind. In relation to particular offenses, further folk-psychological concepts of belief and intention may be necessary for mens rea. For example, in theft of property, it has to be proved that the accused did not believe that he or she had a legal right to take the property and that the accused did intend to deprive the owner of the property. The crime of rape is an interesting example, because the folk psychology of both the victim and the accused is particularly important. It has to be proved that sexual intercourse took place without the consent of the woman and that the accused did not believe there was consent. Whether one regards consent as being subjective willingness or communication of willingness, it irreducibly involves the folk-psychological concept of a willingness or voluntariness that is not vitiated by coercion, mistake, or lack of understanding. Accordingly, in these cases, there is generally no explicit conflict in the court between the common-sense, folk-psychological categories that the law uses and scientific accounts of causation of human behavior, which might tend to discredit these categories. In some cases, however, particularly in relation to defenses of insanity and sane automatism, these categories and other folk-psychological categories may become the subject of expert scientific and medical evidence (usually from psychiatrists or psychologists, but occasionally from neuroscientists). Thus, there is the potential for conflict between the folk-psychological categories and scientific accounts of causation of behavior. Scientific and medical evidence touching on these categories tends to raise Page 159 problems because, once one deals with human behavior in terms of scientific cause and effect, there appears to be no room left for folk-psychological concepts, which presuppose that persons are normally autonomous agents. Theoretical Problems of Folk Psychology All the categories I have identified, including the ones about which expert evidence may be given, are prescientific, folk-psychological concepts. The language that describes them is nonscientific, and, except in the clearest cases, the existence of the psychological state that they describe is not susceptible to scientific proof. The fundamental reason that there is no scientific proof is that consciousness itself has no scientific explanation. For example, no scientific answer exists for the question whether computers could be made to be conscious. Yet, these concepts are absolutely central to important issues of criminal responsibility -indeed, they are also central to our view of ourselves, our relationships, and our concepts of fairness and proper behavior (Strawson 1962). Not only does no systematic scientific explanation of these concepts and categories exist, mainstream science and philosophy often seem to suggest that these concepts and categories, particularly concepts involving ideas of freedom and responsibility, are not intellectually respectable. First, there is the recognition, which has come to the fore at least since the time of Freud, that a substantial part of our motivation is unconscious. More recently, psychological experiments have shown that our common-sense view of our behavior is often misconceived, partly because of a capacity we have for (unconsciously) fabricating and accepting plausible but untrue stories to explain our experiences and actions (Dennett 1991). Given that unconscious processes contribute to our actions, what is there about us beyond these unconscious processes, that determines how our conscious processes develop and that can make some mental processes guilty or blameworthy but others not so Second, and more broadly, there is the tendency to consider human beings as the products of nature and nurture, that is, purely the outcome of genes and environment. Whatever human beings become and do is understood as having causes in their heredity and in the circumstances in which they have been placed from time to time. Cases such as that of the girls at the Sydney youth refuge suggest that early home environment can predispose individuals to criminal behavior; much evidence supports this view. For example, according to Peter Fenwick (Clift 1993), a British forensic psychiatrist, there is evidence that abnormal brain development during the fifth month of pregnancy can result in the absence of conscience in the child and hence an inability to empathize with others. High testosterone and low fivehydroxytryptamine levels in the brain result in a tendency to violence. Thus, in the case of the girls in Sydney, it may not be reasonable to regard the murder as involving freely willed choices for which the killers were responsible-the murder was simply the outcome of the kind of persons the girls had become, by reason of nature and nurture, genes and environment. Third, and even more generally, the scientific view of the world assumes the universality of causal laws. This view regards all systems as developing over time in accordance with universal laws of nature, possibly with some randomness. That scientific view appears to leave no room for our common-sense view of choice and of intentional or voluntary action, much less for any notion of responsibility or a guilty mind. An example of the scientific view of human beings is provided by Colin Blakemore in the Mind Machine (1988). In the final chapter Blakemore begins with three sentences that he says encapsulate the central thesis of his book: the human brain is a machine, which alone accounts for all our actions, our most private thoughts, our beliefs. Blakemore then sets out a number of cases in which criminal acts were committed under various mental conditions: hypoglycemia, a sublethal dose of chlorpyrifos from handling insecticide, premenstrual tension, epilepsy, manic depression, and deprivation and abuse in early life.

That question, I think, betrays a deep confusion; it presupposes that what you are is something else, some Cartesian res cogitans in addition to all the brain-and-body activity. What you are, however, is this organization of all the competitive activity between a host of competences that your body has developed. You "automatically" know about these things going on in your Page 107 body because, if you did not, it would not be your body! The acts and events you can tell us about, and the reasons for them, are yours because you made them-and they made you. For me the "hard problem" is getting people to see that once you have solved the "easy problems," you have solved them all-except for my hard problem, which I am continuing to work on as you can see! Page 109 8 Brainshy: Nonneural Theories of Conscious Experience Patricia Smith Churchland Understanding how the mind/brain works is difficult for many reasons. Some are conceptual or theoretical, some involve unavailability of suitable techniques, and some are rooted in practical difficulties involved in performing needed experiments even given available techniques. Quite apart from these obstacles, the idea that conscious awareness is not at bottom a neural matter motivates some theorists to call for a nonneural approach. One variation on this theme suggests that consciousness is a fundamental property of the universe based in information (David Chalmers); another sees consciousness as unexplainable in terms of brain properties because it is an "intrinsic" property (John Searle); a third (Roger Penrose) adopts the hypothesis that consciousness is a property arising out of quantum-level phenomena, below the level of neurons. Otherwise discordant, the three share the conviction that understanding the brain will not yield an understanding of consciousness. In exploring each of these possibilities, I conclude that none is sufficiently appealing-empirically, theoretically, or logically-to merit serious research investment. At this stage, I believe the evidence strongly favors neuroscience and psychology as having the best shot at solving the problem. Reconceptualization was pivotal in coming to understand that the heart is really a pump for circulating blood; there are no animal spirits to concoct. My strategy here, therefore, is to take the label, "The Hard Problem" in a constructive spirit- as an attempt to provide a useful conceptualization concerning the very nature of consciousness that could help steer us in the direction of a solution. My remarks will Page 110 focus mainly on whether anything positive is to be gained from the 'Hard Problem" characterization or whether that conceptualization is counterproductive. I cannot hope to do full justice to the task in short compass, especially since the contemporary characterization of the problem of consciousness as the intractable problem has a rather large literature surrounding it. Nagel comes straight to the point: "Consciousness is what makes the mind-body problem really intractable. Although I agree that consciousness is, certainly, a difficult problem, difficulty per se does not distinguish it from oodles of other neuroscientific problems. Such as how the brains of homeotherms keep a constant internal temperature despite varying external conditions. Supposedly, something sets consciousness apart from all other macrofunction brain riddles so that consciousness stands alone as the Hard Problem. As I have tried to probe precisely what that is, I find my reservations multiplying. Carving Up the Problem Space the "Hard Problem" label invites us to adopt a principled empirical division between consciousness and problems on the "Easy" (or perhaps hard but not Hard On the other side of the ledger, all on its own, stands consciousness-a uniquely Hard Problem. My lead-off reservation arises from this question: What is the rationale for drawing the division exactly there Does dividing consciousness from all the so-called easy problems imply that we could understand those phenomena and still not know. Now that conceptualization is about as insightful as supposing babies are brought by storks. What exactly is the evidence for the conviction that we could explain all the "Easy" phenomena and still not understand the neural mechanisms for Page 111 consciousness The "evidence" derives from a thought experiment, explained roughly as follows: We can conceive of a person like us in all the aforementioned, Easy-to-explain capacities (attention, short-term memory etc.

There is an emphasis on the central importance of six executive function processes: goal-setting, cognitive flexibility/shifting, organizing, prioritizing, accessing working memory, and self-monitoring. Selected strategies are discussed for addressing the key executive function processes as part of a systematic teaching approach (see Meltzer, 2010, for specific classroom teaching techniques). It should be noted that it is beyond the scope of this chapter to include a description of inhibition, selective attention, and activation, all important executive function processes that are addressed in recent neuroscientific research (Anderson, Rani Jacobs, & Anderson, 2008; Bernstein & Waber, 2007; Diamond, 2006). Reprinted by permission Students with executive function weaknesses often struggle with academic tasks that involve the coordination and integration of different subskills such as initiating writing assignments, summarizing information, taking notes, planning, executing and completing projects in a timely manner, studying, and submitting work on time (Meltzer, 2010; Meltzer & Basho, 2010; see Table 25. These students often have difficulty organizing and prioritizing information and they struggle to shift flexibly to alternate approaches so that they overfocus on details while ignoring the major themes. As a result, information can often become "clogged" and students become "stuck," so that they struggle to produce academically (see. Because these students cannot shift flexibly among alternative approaches to unclog the funnel, their written work, study skills, and test performance are compromised, and their academic grades do not reflect their strong intellectual ability. Consequently, they may have difficulty showing what they know in the classroom and other settings. These deficits become increasingly apparent during middle and high school when the volume and complexity of the workload increase and performance is more dependent on executive function strategies (see Table 25. Reprinted by permission Executive Function Strategies, Self-Understanding, and Effort: the Underpinnings of Academic Success My success is due to the strategies I learned as well as my self-understanding and the confidence I developed after I used the strategies and got higher grades. Strategies that address executive function processes therefore provide a starting point for improving academic performance (see. When students use executive function strategies, they become more efficient and they begin to improve academically. A cycle of success is promoted when students focus their effort on using executive function strategies in the context of their academic work (Meltzer, 2010; Meltzer, Katzir, et al. To build their motivation, persistence, and work ethic, students need to understand their profiles of strengths and weaknesses, which strategies work well for them, as well as why, where, when, and how to apply specific strategies. This metacognitive awareness usually increases their willingness to make the effort needed to master the strategies needed for the many academic tasks that they face in school on a daily basis. Specifically, interest-based motivation in learning frequently influences the types of strategies students use as well as their academic performance (Renninger, Hidi, & Krapp, 2004; Yun Dai & Sternberg, 2004). Copyright 2004 by the International Academy for Research in Learning Disabilities. As a result, many bright and talented students, especially those with learning and attention difficulties, may "give up" so that they no longer make the extraordinary effort needed to master these strategies. For all these students, executive function strategies can provide a lifeline to academic success as they learn to set goals and to shift flexibly from the major themes to the details and back again (Meltzer & Basho, 2010). In fact, success is usually attainable when students use executive function strategies to target realistic goals, they focus their effort on reaching these goals, and they self-regulate their cognitive, attention, and emotional processes appropriately (see. Informal, Process-Oriented Assessment of Executive Function My teacher probably thinks I am one taco short of a combo plate, if you know what I mean. He does well on quizzes and short tests but he often does not hand in his homework. From Meltzer, Reddy, Brach, Kurkul, and Basho (2011) and pinpoint why and how particular students may be struggling. The continuous cycle linking assessment and teaching allows teachers to adjust their instructional methods to the changing needs of their students. The items assess behaviors associated with the core executive function processes. These strategy ratings focus on academic areas that depend on executive function processes and include written language, homework, studying, and taking tests (see Table 25. As was discussed above, student, teacher, and parent reports can be directly compared to determine overall consistency in their ratings of many of the core components of executive function processes across different settings (Tables 25.

The clinical indexes for the Self-Rating Form demonstrate low to good reliability with reliability coefficients across the age bands ranging from. As is expected the highest reliability coefficients are observed on the Total Composite Score. This is the core index that has the most number of items contributing to it, which allows to its high degree of reliability. The clinical indexes have lower reliability coefficients but adequate reliabilities across the three forms, which are attributed to the smaller number of items contributing to each of the indexes. However, the sample sizes for clinical groups are considerably smaller than the normative sample, which will impact the reliability data. Also, some clinical groups may have smaller score ranges than the normative sample which could lower reliability results. The Teacher Rating Form indicates higher test-retest correlations in general when compared to the Parent Rating Form. The core index ratings for the Self-Rating Form are more variable with corrected stability coefficients ranging from. Meanwhile, the clinical indexes report corrected stability coefficients ranging from. Use of the Test or Rating Scale/ Case Study George is a 9-year-old boy in the fourth grade whose parents have referred him for a psychoeducational evaluation. The reason for the referral is concerns regarding behavior and academic performance in the home and in school. George met all his developmental milestones such as sitting up, crawling, and walking within the normal period of development. He sees a physician and a dentist for routine checkups and is not on any prescribed medications. His preschool teacher reported that George was overactive and did not seem to have the same attention span as that of his classmates. When George entered kindergarten, his teacher reported similar behaviors consistent with reports from his preschool teacher. In the fourth grade, George is experiencing similar behaviors such as the ability to stay on task, is frequently distracted by his peers and outside stimuli, and has difficulty staying seated. Due to these behaviors, George is having difficulty in keeping up with his classwork and is falling further and further behind in the academic content areas. He is currently failing most of his classes due to incomplete work and does not consistently turn his work in on time. George approached the testing situation easily and rapport was quickly established. However, the Sequential index, a measure of short-term memory, and the Planning Index, a measure of executive processes, were in the below-average range. This suggests that George is having difficulties with impulsivity, maintaining attention, and disruptive behaviors as compared to same-aged mate peers. At times George exhibited some problems associated with poor frustration tolerance, noncompliance, and problems interacting with his peers. As a result of the evaluation, a behavioral plan was developed to assist George with his behavior in the classroom. In addition, George was taught self-monitoring strategies to help increase his attention to tasks and completion of assignments. The family was referred to their physician for additional evaluation related to attention and hyperactivity. The results from the physician indicated a diagnosis of attention deficit hyperactivity disorder. Under the Individuals with Disabilities Education Act (2004), George could be eligible as a student with an Other Health Impairment.

Pridmore S: Substitution of rapid transcranial magnetic stimulation treatments for electroconvulsive therapy treatments in a course of electroconvulsive therapy. Leichsenring F, Rabung S: Effectiveness of longterm psychodynamic psychotherapy: a meta-analysis. Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Third Edition 1132. Burnand Y, Andreoli A, Kolatte E, Venturini A, Rosset N: Psychodynamic psychotherapy and clomipramine in the treatment of major depression. De Jonghe F, Kool S, Van Aalst G, Dekker J, Peen J: Combining psychotherapy and antidepressants in the treatment of depression. De Jonghe F, Hendricksen M, Van Aalst G, Kool S, Peen V, Van R, van den Eijnden E, Dekker J: Psychotherapy alone and combined with pharmacotherapy in the treatment of depression. Gupta S, Tobiansky R, Bassett P, Warner J: Efficacy of maintenance electroconvulsive therapy in recurrent depression: a naturalistic study. Frederikse M, Petrides G, Kellner C: Continuation and maintenance electroconvulsive therapy for the treatment of depressive illness: a response to the National Institute for Clinical Excellence report. Appointments to the twelve-member Commission in 1984 included representatives of organized labor, the insurance industry, the business community and the public-at-large. In 1986, the Commission issued its final recommendations, among which was the establishment of published uniform medical guidelines for the evaluation of functional impairments. Such guidelines would be available to the public in general, and to medical and legal practitioners in particular. The utilization of guidelines should result in a more uniform evaluation process and greater consistency among providers in making functional impairment determinations, ultimately leading to a lesser amount of litigation with regard to such evaluations. In addition, because of crowded court calendars, years frequently passed before a decision was rendered. Consequently, it was quite difficult for injured workers to receive adequate and timely compensation for their injuries. In 1909, the New York State Legislature created the Wainwright Commission to "inquire into the working of a law in the State of New York relative to the liability of employer to employees for industrial accidents. The Legislature enacted these proposals in 1910, but the compulsory aspect of the law was declared unconstitutional by the New York Court of Appeals. The intent is to permit an injured employee to receive wage replacement and complete payment of medical bills without being required to prove which party was at fault. Weekly indemnity benefits are determined by several factors including the degree of impairment. It is expected that the development of a body of information providing guidelines to the evaluation of both work-related injuries and illnesses leading ultimately to a recommendation as to the degree of disability, will provide for greater equity for all parties as well as expedite the review process. It is hoped that they will serve as a convenient reference source for evaluating workrelated injuries, and introduce clarity and regularity into the determination of disability. When the health provider wishes to comment on non-medical factors such as age, occupation, education, etc. The impact of such extrinsic factors should generally not be used in determining disability, but should be taken into account by the health provider in making a recommendation as to whether a claimant can perform within his or her regular course of employment and what medical limitations exist. The Law Judges preside at hearings, hear witnesses, rule on evidentiary issues, and issue decisions. The Law Judge may, where appropriate, order a deposition and other forms of discovery. Health care providers, whether they be impartial specialists, treating doctors or carrier consultants, submit reports and make recommendations. These reports and recommendations are part of the evidence to be considered by the Judge in making a final determination on all issues including medical issues. It is against this background that our Law Judges must consider and make the medical findings necessary in each case. It is important that the Judge in evaluating the medical reports be advised of the basis and criteria used by health providers in reaching their diagnosis and recommendations.