Temporal inabilities and decision-making capacity in depression

Owen, Gareth; Freyenhagen, Fabian; Hotopf, Matthew; Martin, Wayne

doi:10.1007/s11097-013-9327-x

Cited by 32 publications

(30 citation statements)

References 12 publications

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“…By way of clarification, we would emphasize first that the questions posed by the interviewer were designed to be open rather than leading. That they were indeed open questions is confirmed by the fact that use of a similar interview schedule elicited quite different replies about the future in a related study focusing on persons diagnosed with severe depression (Owen et al, 2015). Finally, we note that BP9’s remark about plans to renew a television license (see extract 5, above) was made independently of any interview question about the future, being offered spontaneously at the end of a nearly 300-word response to a question about the differences between the participant’s experiences inside and outside of hospital.…”

Section: Notesmentioning

confidence: 81%

“…We employed the technique of “second-person phenomenology” on which we have reported in earlier work (Owen, Freyenhagen, Hotopf, & Martin, 2015; Owen, Freyenhagen, & Martin, 2018; Owen, Freyenhagen, Martin, & David, 2017). We approached the research participants as collaborators, and as informants as to the character of their own manic experience.…”

Section: Six Patternsmentioning

confidence: 99%

“…The number of participants made multiple, in-depth interviews and analysis feasible, but precluded statistical analysis. There was no control group, although our analysis was informed by experience using a similar protocol with two populations of persons diagnosed with depression (Owen, Freyenhagen, Hotopf, & Martin, 2015). The research methodology dictated selection of participants characterized by high verbal skills, severe illness, and absence of significant co-morbidities (e.g.…”

Section: Limitations and Future Researchmentioning

confidence: 99%

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Manic temporality

Martin

Gergel

Owen

2018

Philosophical Psychology

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Time-consciousness has long been a focus of research in phenomenology and phenomenological psychology. We advance and extend this tradition of research by focusing on the character of temporal experience under conditions of mania. Symptom scales and diagnostic criteria for mania are peppered with temporally inflected language: increased rate of speech, racing thoughts, flight-of-ideas, hyperactivity. But what is the underlying structure of temporal experience in manic episodes? We tackle this question using a strategically hybrid approach. We recover and reconstruct three hypotheses regarding manic temporality that were advanced and modeled by two pioneers of clinical phenomenology: Eugène Minkowski (1885–1972) and Ludwig Binswanger (1881–1966). We then test, critique, and refine these hypotheses using heterophenomenological methods in an interview-based study of persons with a history of bipolar and a current diagnosis of acute mania. Our conclusions support a central hypothesis due to Minkowski and Binswanger, namely, that disturbance in the formal structure of temporal experience is a core feature of mania. We argue that a suitably refined variant of Binswanger’s model of disturbance in manic protention helps to explain a striking pattern of impaired insight and impaired reasoning in manic episodes.

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Section: Notesmentioning

confidence: 81%

Section: Six Patternsmentioning

confidence: 99%

Section: Limitations and Future Researchmentioning

confidence: 99%

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Manic temporality

Martin

Gergel

Owen

2018

Philosophical Psychology

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“…The analysis started with close reading of the transcribed texts and, through a process of textual coding, moved toward thematisation. The phenomenological method and analysis is described and illustrated in more detail elsewhere [22, 23, 26]. Interpretative phenomenological analysis aims to purposefully collect homogeneous samples to address a question about subjectivity or experiential structure.…”

Section: Methodsmentioning

confidence: 99%

“…Contemporary psychopathologists and philosophers of psychiatry continue to express significant interest in the theme [17-21]. This is a rich literature, but clarity and consistency remain problematic [22, 23], and, to our knowledge, the study of temporal experience has not, before our work, been extended to problems in DMC.…”

Section: Introductionmentioning

confidence: 99%

Misevaluating the Future: Affective Disorder and Decision-Making Capacity for Treatment – A Temporal Understanding

2018

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Background: Within psychiatric practice and policy there is considerable controversy surrounding the nature and assessment of impairments of decision-making capacity (DMC) for treatment in persons diagnosed with affective disorders. We identify the problems of “cognitive bias” and “outcome bias” in assessment of DMC for treatment in affective disorder and aim to help resolve these problems with an analysis of how time is experienced in depression and mania. Sampling and Methods: We conducted purposeful sampling and a qualitative phenomenological analysis of interview data on patients with depression and mania, exploring temporal experience and decision-making regarding treatment. Results: In both severe depression and mania there is a distinctive experience of the future. Two consequences can follow: a loss of evaluative differentiation concerning future outcomes and, relatedly, inductive failure. This temporal inability can compromise an individual’s ability to appreciate or “use or weigh” treatment information. Conclusions: The decision-making abilities required for self-determination involve an ability to evaluate alternative future outcomes. Our results show that, within severe depression or mania, anticipation of future outcomes is inflexibly fixed at one end of the value spectrum. We therefore propose a temporal model of decision-making abilities, which could be used to improve assessment of DMC in affective disorder.

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Decision-making capacity should not be decisive in emergencies

Hubbeling

2013

Med Health Care and Philos

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Examples of patients with anorexia nervosa, depression or borderline personality disorder who have decision-making capacity as currently operationalized, but refuse treatment, are discussed. It appears counterintuitive to respect their treatment refusal because their wish seems to be fuelled by their illness and the consequences of their refusal of treatment are severe. Some proposed solutions have focused on broadening the criteria for decision-making capacity, either in general or for specific patient groups, but these adjustments might discriminate against particular groups of patients and render the process less transparent. Other solutions focus on preferences expressed when patients are not ill, but this information is often not available. The reason for such difficulties with assessing decision-making capacity is that the underlying psychological processes of normal decision-making are not well known and one cannot differentiate between unwise decisions caused by an illness or other factors. The proposed alternative, set out in this paper, is to allow compulsory treatment of patients with decision-making capacity in cases of an emergency, if the refusal is potentially life threatening, but only for a time-limited period. The argument is also made for investigating hindsight agreement, in particular after compulsory measures.

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Temporal inabilities and decision-making capacity in depression

Cited by 32 publications

References 12 publications

Manic temporality

Manic temporality

Misevaluating the Future: Affective Disorder and Decision-Making Capacity for Treatment – A Temporal Understanding

Decision-making capacity should not be decisive in emergencies

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