Reductionism in retreat.

We address the commentaries on our target article in terms of four major themes. First, we note that virtually all commentators agree that mental disorders are not brain disorders in the common interpretation of these terms, and establish the consensus that explanatory reductionism is not a viable thesis. Second, we address criticisms to the effect that our article was misdirected or aimed at a straw man; we argue that this is unlikely, given the widespread communication of reductionist slogans in psychopathology research and society. Third, we tackle the question of whether intentionality, extended systems, and multiple realizability are as problematic as claimed in the target article, and we present a number of nuances and extensions with respect to our article. Fourth, we discuss the question of how the network approach should incorporate biological factors, given that wholesale reductionism is an unlikely option.

Brain disorders? Not really: Why network structures block reductionism in psychopathology research.

In the past decades, reductionism has dominated both research directions and funding policies in clinical psychology and psychiatry. The intense search for the biological basis of mental disorders, however, has not resulted in conclusive reductionist explanations of psychopathology. Recently, network models have been proposed as an alternative framework for the analysis of mental disorders, in which mental disorders arise from the causal interplay between symptoms. In this target article, we show that this conceptualization can help explain why reductionist approaches in psychiatry and clinical psychology are on the wrong track. First, symptom networks preclude the identification of a common cause of symptomatology with a neurobiological condition; in symptom networks, there is no such common cause. Second, symptom network relations depend on the content of mental states and, as such, feature intentionality. Third, the strength of network relations is highly likely to depend partially on cultural and historical contexts as well as external mechanisms in the environment. Taken together, these properties suggest that, if mental disorders are indeed networks of causally related symptoms, reductionist accounts cannot achieve the level of success associated with reductionist disease models in modern medicine. As an alternative strategy, we propose to interpret network structures in terms of D. C. Dennett's (1987) notion of real patterns, and suggest that, instead of being reducible to a biological basis, mental disorders feature biological and psychological factors that are deeply intertwined in feedback loops. This suggests that neither psychological nor biological levels can claim causal or explanatory priority, and that a holistic research strategy is necessary for progress in the study of mental disorders.

Running away from the marshmallow: the relevance of behaviour settings for a situated science of self-control.

The behaviour settings approach was introduced as a means to study the variability of human beings' behaviour outside the lab. More recently, it has been argued that it also provides a fruitful avenue for developing situated accounts of cognition. This article will provide a proof of concept for the latter suggestion, focusing on the science of self-control. Self-control is the ability of individuals to pursue goals they value in the face of conflicting motivations. The hypothesis we bring forward is that this ability should be understood as a set of skills by which individuals modulate their relation to their environment, more specifically the behaviour settings they inhabit. With this conception of self-control in hand, we will take a critical look at well-known experiments involving delayed gratification tasks and propose concrete suggestions on how to improve them. This will bring us to the conclusion that the behaviour settings framework might have a valuable role to play in developing a situated science of self-control. This article is part of the theme issue 'People, places, things and communities: expanding behaviour settings theory in the twenty-first century'.

The cognitive and neural basis of option generation and subsequent choice.

Decision-making research has thoroughly investigated how people choose from a set of externally provided options. However, in ill-structured real-world environments, possible options for action are not defined by the situation but have to be generated by the agent. Here, we apply behavioral analysis (Study 1) and functional magnetic resonance imaging (Study 2) to investigate option generation and subsequent choice. For this purpose, we employ a new experimental task that requires participants to generate options for simple real-world scenarios and to subsequently decide among the generated options. Correlational analysis with a cognitive test battery suggests that retrieval of options from long-term memory is a relevant process during option generation. The results of the fMRI study demonstrate that option generation in simple real-world scenarios recruits the anterior prefrontal cortex. Furthermore, we show that choice behavior and its neural correlates differ between self-generated and externally provided options. Specifically, choice between self-generated options is associated with stronger recruitment of the dorsal anterior cingulate cortex. This impact of option generation on subsequent choice underlines the need for an expanded model of decision making to accommodate choice between self-generated options.

No Intentions in the Brain: A Wittgensteinian Perspective on the Science of Intention.

In their paper "Why we may not find intentions in the brain," Uithol et al. (2014) convincingly argue that "the processes underlying action initiation and control are considerably more dynamic and context sensitive than the concept of intention can allow for." Their paper could be seen as a critical note to the widespread tendency to search for identifiable neurocorrelates of mental concepts. Their more specific suggestion is that the absence of clear neural correlates undermines the traditional understanding of intention. In this paper I will try to take their argument a step further. First of all, I will argue that our folk psychology leaves room for various understandings of intentions, and that the concept of intention discussed by Uithol et al. is an academic concept that has its roots in the causal theory of action and in functionalist approaches to cognition. I will argue that both these paradigms are contested, and that there seems to be theoretical wiggle room for alternative understandings of intention. Subsequently I outline such an alternative perspective based on Wittgensteinian philosophy of psychology, emphasizing the regulative role of intention talk. However, the proposed understanding raises the question how to think about neural realization: is intention talk "just" talk, or do intentions really exist? I will propose that intention talk should be understood as a form of pattern recognition, and that the patterns involved are extended in both space and time. The conclusion outlines some important implications for the neuroscientific investigation of intentions.

The Cognitive Underpinnings of Option Generation in Everyday Life Decision-Making: A Latent Variable Analysis.

The ability to generate options for action is crucial for everyday life decision-making. In this article, we propose and test a model of the cognitive underpinnings of option generation in everyday life situations. We carried out a laboratory study using measures of a wide range of cognitive functions and asked participants (N = 157) to generate options for actions for different everyday life decision-making scenarios. The results of a latent variable analysis show that the cognitive underpinnings of option generation are consistent across different everyday life situations and, hence, option generation can be conceptualized as a general construct. Moreover, the results of a confirmatory factor analysis reveal that, when controlling for the shared variance among the cognitive processes assessed, verbal fluency, working memory capacity, ideation fluency, and processing speed predicted option generation. These findings suggest that option generation in everyday life situations can be distinguished from other cognitive constructs, such as divergent thinking (in terms of ideas' originality) and long-term memory.

Apathy in schizophrenia as a deficit in the generation of options for action.

Negative symptoms are a core feature of schizophrenia and have been grouped into 2 factors: a motivational factor, which we refer to as apathy, and a diminished expression factor. Recent studies have shown that apathy is closely linked to functional outcome. However, knowledge about its mechanisms and its relation to decision-making is limited. In the current study, we examined whether apathy in schizophrenia is associated with predecisional deficits, that is, deficits in the generation of options for action. We applied verbal protocol analysis to investigate the quantity of options generated in ill-structured real world scenarios in 30 patients with schizophrenia or schizoaffective disorder and 21 healthy control participants. Patients generated significantly fewer options than control participants and clinical apathy ratings correlated negatively with the quantity of generated options. We show that the association between measures of psychopathology and option generation is most pronounced in regard to apathy symptoms and that it is only partially mediated by deficits in verbal fluency. This study provides empirical support for dysfunctional option generation as a possible mechanism for apathy in schizophrenia. Our data emphasize the potential importance of predecisional stages in the development and persistence of apathy symptoms in neuropsychiatric disorders and might also inform the development of novel treatment options in the realm of cognitive remediation.

Mental disorder and legal responsibility: the relevance of stages of decision making.

The paper discusses the relevance of decision-making models for evaluating the impact of mental disorder on legal responsibility. A three-stage model is presented that analyzes decision making in terms of behavioral control. We argue that understanding dysfunctions in each of the three stages of decision making could provide important insights in the relation between mental disorder and legal responsibility. In particular, it is argued that generating options for action constitutes an important but largely ignored stage of the decision-making process, and that dysfunctions in this early stage might undermine the whole process of making decisions (and thus behavioral control) more strongly than dysfunctions in later stages. Lastly, we show how the presented framework could be relevant to the actual psychiatric assessment of a defendant's decision making within the context of an insanity defense.

The effects of caffeine on option generation and subsequent choice.

RATIONALE: Although the effects of caffeine on basic cognitive functions are well-known, its effects on more complex decision making, particularly on option generation, is yet to be explored. OBJECTIVE: We examined the effects of caffeine on option generation in decision making using everyday life decisional situations. METHODS: In a double-blind placebo-controlled experiment, participants (N = 47) either received 300 mg of caffeine or a placebo. Participants had to generate choice options (things they could do) for a series of high and low familiar real-world scenarios and, subsequently, to decide among these options. RESULTS: Analyses revealed that participants in the caffeine condition generated significantly fewer options than participants in the placebo condition. Moreover, caffeine significantly reduced the option generation onset time, that is, participants in the caffeine condition generated their first option significantly faster than participants in the placebo condition. Regarding subsequent choice, we found evidence supporting the "take-the-first" heuristic, that is, the tendency to select the first generated option. This tendency was neither affected by caffeine nor by the familiarity of the scenarios. CONCLUSIONS: Caffeine results in fewer options generated in unconstrained real-life decision-making situations and decreases generation onset times.

Why we should talk about option generation in decision-making research.

Most empirical studies on decision-making start from a set of given options for action. However, in everyday life there is usually no one asking you to choose between A, B, and C. Recently, the question how people come up with options has been receiving growing attention. However, so far there has been neither a systematic attempt to define the construct of "option" nor an attempt to show why decision-making research really needs this construct. This paper aims to fill that void by developing definitions of "option" and "option generation" that can be used as a basis for decision-making research in a wide variety of decision-making settings, while clarifying how these notions relate to familiar psychological constructs. We conclude our analysis by arguing that there are indeed reasons to believe that option generation is an important and distinct aspect of human decision-making.

The role of moral utility in decision making: an interdisciplinary framework.

What decisions should we make? Moral values, rules, and virtues provide standards for morally acceptable decisions, without prescribing how we should reach them. However, moral theories do assume that we are, at least in principle, capable of making the right decisions. Consequently, an empirical investigation of the methods and resources we use for making moral decisions becomes relevant. We consider theoretical parallels of economic decision theory and moral utilitarianism and suggest that moral decision making may tap into mechanisms and processes that have originally evolved for nonmoral decision making. For example, the computation of reward value occurs through the combination of probability and magnitude; similar computation might also be used for determining utilitarian moral value. Both nonmoral and moral decisions may resort to intuitions and heuristics. Learning mechanisms implicated in the assignment of reward value to stimuli, actions, and outcomes may also enable us to determine moral value and assign it to stimuli, actions, and outcomes. In conclusion, we suggest that moral capabilities can employ and benefit from a variety of nonmoral decision-making and learning mechanisms.

Weakness of will, akrasia, and the neuropsychiatry of decision making: an interdisciplinary perspective.

This article focuses on both daily forms of weakness of will as discussed in the philosophical debate (usually referred to as akrasia) and psychopathological phenomena as impairments of decision making. We argue that both descriptions of dysfunctional decision making can be organized within a common theoretical framework that divides the decision making process in three different stages: option generation, option selection, and action initiation. We first discuss our theoretical framework (building on existing models of decision-making stages), focusing on option generation as an aspect that has been neglected by previous models. In the main body of this article, we review how both philosophy and neuropsychiatry have provided accounts of dysfunction in each decision-making stage, as well as where these accounts can be integrated. Also, the neural underpinnings of dysfunction in the three different stages are discussed. We conclude by discussing advantages and limitations of our integrative approach.

Ideals regarding a good life for nursing home residents with dementia: views of professional caregivers.

This study investigates what professional caregivers working in nursing homes consider to be a good life for residents suffering from dementia. Ten caregivers were interviewed; special attention was paid to the way in which they deal with conflicting values. Transcripts of the interviews were analysed qualitatively according to the method of grounded theory. The results were compared with those from a similar, earlier study on ideals found in mission statements of nursing homes. The concepts that were mentioned by most interviewed participants as important for a good life were 'peace and quiet', 'going along with subjective experience' and 'no enforcement: the way the resident wants it'. A considerable overlap was found between the interviews and the mission statements; however, when compared with the mission statements, the interviews put less emphasis on individuality and on giving meaning, and more on offering residents pleasant activities. When faced with conflicting values, caregivers tend to make pragmatic and more or less intuitive decisions. Although this has its merits, it may be desirable to stimulate conscious reflection regarding conflict between different values.

"The good life" for demented persons living in nursing homes.

BACKGROUND: This study investigated which concepts regarding "the good life" are used in mission statements of nursing homes providing care for demented patients. METHOD: All 317 Dutch nursing homes caring for demented patients were asked to participate; of these, 69% responded. Their mission statements were qualitatively analyzed on content. Whether different types of nursing home differed significantly in the content of their mission statements was investigated by means of chi2 analyses. RESULTS: Six main concepts were found that are considered important for a good life: 1) autonomy and freedom, 2) individuality and lifestyle, 3) relationships and social networks, 4) warmth and safety and familiarity, 5) developing capacities and giving meaning to life and 6) subjective experience and feelings of well-being. It was found that mission statements specifically developed for demented patients attach less importance to the concepts 1) autonomy and freedom and 2) individuality and lifestyle, than mission statements which are also aimed at non-demented residents. Most mission statements turned out to be highly eclectic in content. CONCLUSION: Nursing homes with a separate statement for demented residents seem to acknowledge the special position of demented residents and the tension between dementia and the ideal of autonomy. Although the eclecticism found in mission statements is understandable, a coherent view on the good life for demented residents should aim for a sound internal structure, and make choices between values. Only then can mission statements provide real guidance for everyday care.

Tailor-made pharmacotherapy: future developments and ethical challenges in the field of pharmacogenomics.

Pharmacogenomics is the study of the myriad interactions between genes and pharmacotherapy. Developments in pharmacogenomics have changed and will affect pharmaceutical research, drug development and the practice of medicine in a significant way. In this article, we make an inventory of the ethical implications that might arise as a result of possible developments in pharmacogenomics and investigate whether the present ethical framework will be able to adequately answer arising questions. We think that many of the questions related to the consequences of pharmacogenomics are answerable along the lines of present ethical thinking. We also believe, however, that many 'changes of degree' may result in a 'change of kind.' We therefore think that pharmacogenomics may potentially have such a profound influence on scientific research and the pharmaceutical industry, the practice of medicine and society at large, that this will generate its own unique dynamic, which will require new ethical research. We suggest that the notion of 'responsibility' will be a major focus of such research.