Jillian Craigie

Hopping, skipping or jumping to conclusions? Clarifying the role of the JTC bias in delusions

Introduction. There is substantial evidence that patients with delusions exhibit a reasoning bias—known as the “jumping to conclusions” (JTC) bias—which leads them to accept hypotheses as correct on the basis of less evidence than controls. We address three questions concerning the JTC bias that require clarification. Firstly, what is the best measure of the JTC bias? Second, is the JTC bias correlated specifically with delusions, or only with the symptomatology of schizophrenia? And third, is the bias enhanced by emotionally salient material? Methods. To address these questions, we conducted a series of meta-analyses of studies that used the Beads task to compare the probabilistic reasoning styles of individuals with and without delusions. Results. We found that only one of four measures of the JTC bias—“draws to decision”—reached significance. The JTC bias exhibited by delusional subjects—as measured by draws to decision—did not appear to be solely an epiphenomenal effect of schizophrenic symptomatology, and was not amplified by emotionally salient material. Conclusions. A tendency to gather less evidence in the Beads task is reliably associated with the presence of delusional symptomatology. In contrast, certainty on the task, and responses to contradictory evidence, do not discriminate well between those with and without delusions. The implications for the underlying basis of the JTC bias, and its role in the formation and maintenance of delusions, are discussed.

Thinking and feeling: Moral deliberation in a dual-process framework

Empirical research in the field of moral cognition is increasingly being used to draw conclusions in philosophical moral psychology, in particular regarding sentimentalist and rationalist accounts of moral judgment. This paper calls for a reassessment of both the empirical and philosophical conclusions being drawn from the moral cognition research. It is proposed that moral decision making is best understood as a species of Kahneman and Fredericks dual-process model of decision making. According to this model, emotional intuition-generating processes and reflective processes operate in an integrated way in moral deliberation, and metacognition is assigned an essential role in the monitoring and shaping of moral intuitions. In combination with observations from philosophical moral psychology, this proposal cautions against endorsing simple sentimentalism or rejecting rationalist accounts on the basis of the moral cognition research.

A Fine Balance: Reconsidering Patient Autonomy in Light of the UN Convention on the Rights of Persons with Disabilities

The Convention on the Rights of Persons with Disabilities is increasingly seen as driving a paradigm shift in mental health law, particularly in relation to the understanding that it requires a shift from substituted to supported decisions. This article identifies two competing moral commitments implied by this shift, both of which appeal to the notion of autonomy. It is argued that because of these commitments the Convention is in tension with more general calls in the medical ethics literature for preserving patient autonomy through support. The competing commitments within the Convention also present a particular challenge in putting the support it requires into practice. A discursive control account of freedom is used to develop some practical guidelines for navigating this new moral territory.

Capacity, value neutrality and the ability to consider the future.

Calls for the adoption of a universal capacity approach to replace dedicated mental health law are motivated by the idea that the measures designed to protect patient autonomy in legislation such as the Mental Capacity Act 2005 should apply to everyone, including people with a psychiatric diagnosis. In this article it is argued that a diachronic perspective on questions of mental capacity is necessary if capacity law is to play this broader role, but that employing this perspective in assessments of capacity undermines central patient autonomy preserving features of the legislation, which presents a moral dilemma.

Interdisciplinary workshop on “mental disorder and self over time”

Visiting Senior Research Fellow, Department of Philosophy, Kings College London, London, UK Senior Lecturer, Centre of Medical Law and Ethics, Dickson Poon School of Law, Kings College London, London, UK Wellcome Trust Senior Research Fellow, Mental Health, Ethics and Law research group, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK

Problems of control: Alcohol dependence, anorexia nervosa and the flexible interpretation of mental incapacity tests

Abstract This article investigates the ability of mental incapacity tests to account for problems of control, through a study of the approach to alcohol dependence and a comparison with the approach to anorexia nervosa, in England and Wales. The focus is on two areas of law where questions of legal and mental capacity arise for people who are alcohol dependent: decisions about treatment for alcohol dependence and diminished responsibility for a killing. The mental incapacity tests used in these legal contexts are importantly different—one involves a ‘cognitive’ test, while the other includes an explicit impaired-control limb—and the comparison provides insight into a longstanding debate about the virtues of one type of test over the other. It is shown that both kinds of test can take control problems into account, but also that both can be interpreted in narrow and wide ways that significantly influence the outcome of the assessment. It is therefore argued that to a large extent, it is not the kind of mental incapacity test that matters, but how the test is interpreted. It is further proposed that value judgements are playing an unrecognised and inappropriate role in shaping this interpretation. This raises concerns about the current approach to assessing the impact of alcohol dependency on the capacity to make decisions about alcohol use or treatment, as well as broader concerns about flexibility within incapacity tests.