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- Malmgren, Helge, 1945
(författare)
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Asteno-emotionellt syndrom, kognitiv dysfunktion : Astheno-emotional syndrome and cognitive dysfunction after whiplash injuries
- 1999
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Ingår i: Konferens och utbildningsdag om whiplash-skador, Göteborg 19/10 1999.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Typiska manifestationer av lindriga till måttliga asteno-emotionella syndrom (AE-syndrom, AED): • Koncentrationssvårigheter (ssk. svårighet att upprätthålla koncentration över tid) • Psykisk uttröttbarhet • Sekundära minnestörningar (påverkan såväl på korttidsminnet som på lagring till och framtagning från långtidsminnet) • Emotionell labilitet • Irritabilitet • Överkänslighet för sensoriska stimuli Tänkbara orsaker till AED vid whiplash-trauma: • Vid uppenbar hjärnskada kan ett tydligt AED framträda relativt tidigt. • Ett lindrigt AED baserat på en centralnervös funktionsrubbning kan möjligen uppstå primärt, även om amnesi för episoden inte föreligger. Observera att ett lindrigt AE-syndrom i denna fas kan maskeras av andra, mer påtagliga symtom. • Ett patologiskt signalflöde från den skadade nackregionen (vare sig det når medvetandet eller ej) kan sannolikt innebära en överbelastning av högre centra i CNS, och därför ge ett lindrigt sekundärt AED utan primär dysfunktion i CNS. • Kroniska, upplevda symtom av skadan (smärta, yrsel etc) kan på längre sikt också ge en sådan överbelastning , vilket leder till ett lindrigt AED. Tänkbara följder av AED vid whiplash: AED kan i sig ge psykogena komplikationer, svåra eller omöjliga att skilja från reaktioner av typ PTSD och från sekundära reaktioner på övriga kroniska symtom av skadan. Vanliga psykogena komplikationer: • Ängslan och ångest • Spänning • Huvudvärk • Vegetativa symptom • Depressivitet Av dessa reaktioner är den sekundära depressionen vid utdragna besvär särskilt viktig att beakta, liksom givetvis möjligheten till många onda cirklar med övrig symtomatologi vid whiplashskador (AED --> ökad smärtreaktivitet --> värre AED). Förslag till revision av vårdprogram: • Anamnes beträffande AED bör alltid tas tidigt i förloppet • Neuropsykologisk utredning kan vara indicerad tidigt, även om tydliga kognitiva symtom inte spontant rapporterats • Patientinformationen bör tidigt innefatta en diskussion av symptom, prognos och lämpliga åtgärder vid lindriga astenoemotionella syndrom • Försiktighet med återgång till fullt arbete innan AED har uteslutits.
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- Malmgren, Helge, 1945
(författare)
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Epilepsy, economics and ethics
- 1998
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Ingår i: Epilepsia 39, Suppl. 2 (1998), p. 63. - 0013-9580. ; 39:Suppl. 2
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- In this lecture I consider some ethical aspects of economic analyses of health and disease. The focus is on the relations between on the one hand health economics, on the other hand utilitarian ethics; i.e. the thesis that maximising the sum total of good in society is the morally right thing to strive for. Epilepsy surgery is chosen as the main example in order to show that an abstract ethical discussion may have concrete implications for epilepsy outcome resarch. As an introduction, a few elementary facts and distinctions concerning health-economic analyses are recapitulated. After that, you are introduced to a certain discussion in the recent philosophical literature, and a thesis about the proper limits of utilitarianism as a decision tool in the allocation of medical resources will be presented. This thesis is then applied to the field of epilepsy surgery.
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- Malmgren, Helge, 1945
(författare)
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Etik och ekonomi i sjukvårds- och miljödebatten : Ethics and economy in the health care and environmental debates
- 1998
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Ingår i: Humanistdagarna vid Göteborgs Universitet, 10/10 1998.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- • Etik, ekonomi, sjukvård, miljö – ett stort ämne... • Kanske finns det en skärningspunkt? • Ekonomiskt värde gentemot andra värden: liv, hälsa, livskvalitet, estetiska naturvärden, biologisk mångfald etc. • Exempel: sjuka ögon, och en kontroversiell väg • Är nu detta frågor för filosofer snarare än för miljö- och sjukvårdsekonomer? • Värdefrågor innebär begreppsliga och etiska problem som definitivt hör hemma i filosofin - även om de involverar ekonomiskt värde! • Ekonomi och etik vid Filosofiska Institutionen/GU • Vad är miljöetik? • Vad miljöetiken säga om samspelet mellan ekonomiska och andra värderingar i miljöfrågor? • Vilka värdebegrepp är (borde vara) relevanta för ekonomer? • (Idén om den fria marknaden; dess tillämpningar i sjukvård och miljöpolitik. Onekligen intressant, men tyvärr har vi inte tid i dag...) • Begreppet tillväxt och dess relevans i (miljö)politik
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- Malmgren, Helge, 1945
(författare)
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Moving towards the Other. The relevance of Hermann Rorschach’s method for the philosophy of perception
- 1998
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Ingår i: Toward a Science of Consciousness. Tucson, AZ, April 27-May 2, 1998.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Recent careful research on mental development in the child (Meltzoff & Moore 1995) has shown beyond much doubt that the capacity to perceive and imitate the actions of others is innate. It has been suggested that this capacity to imitate involves an “amodal” perception in which visual information about another organism is immediately transformed into a motor schema in the perceiving subject. Hence one might talk about a mechanism of immediate motor identification. In this paper I point to a number of antecedents of this idea and to some of its psychological and philosophical implications. One important early application of the idea of an immediate motor identification is found in the works of Hermann Rorschach (Rorschach 1921), who describes a category of inkblot interpretations based on “kinesthetic imagery”. These interpretations are variously labelled “kinesthetic responses” or “movement responses” (although they need not involve movement). Abstracting from the associationist psychology in terms of which Rorschach uses to express his ideas, it is clear that he was conceiving these responses in terms of an immediate motor identification. Among philosophers, Maurice Merleau-Ponty (Merleau-Ponty 1945) also makes the observation that imitation involves a capacity for immediate motor identification. Indeed, his concept of body image is defined in terms of the capacity to translate motor schemata between different possible action perspectives. This capacity corresponds to the “amodal” perception postulated by recent theorists. It is well known that Merleau-Ponty stresses the point that our mastering of action schemata is primary to our knowledge of objective (“Cartesian”) space. Taken together, his arguments imply that our knowledge of other minds may be prior to our knowledge of objective space (cf. Malmgren 1976). In the developmental psychology of Heinz Werner (Werner 1961), it is emphasised that human beings – and especially children – tend to perceive not only living beings, but also inanimate objects, in terms of motor identifications. Trees are seen as literally standing or bending, etc. According to Werner (and the so-called “percept-genetic school” which builds upon his works) this tendency towards a generalised “physiognomic” perception remains operative at a subconscious level even in mature perception. Klaus Conrad describes (Conrad 1961) how such latent physiognomic perception surfaces abundantly in the prodromal stage of confusion (“clouded consciousness”). It is clear that the concept of immediate motor identification has important bearings for any systematic theory of perception. From an ecological point of view, such a mechanism would serve an important function in terms of the ability to quickly predict future positions of an aggressor, a prey or a potential mate (J.J. Gibson 1979). Looking instead at computational models of perception, many of these hypothesise a mechanism for immediate translations between an egocentric and an object-centered space (Kosslyn 1994). The findings about immediate motor identifications implies that there is also a general ability to make translations between these spaces and an other-centered – allocentric – space (or several such spaces), which like the egocentric one is perceptually prior to the apprehension of object-centered space.
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- Malmgren, Helge, 1945
(författare)
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Perceptual expectations and the learning of temporal sequences.
- 1996
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Ingår i: Philosophical Communications, Red Series. - 0347-5794. ; :35
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The paper starts with an overview of some central unsolved problems of intentionality. Partly basing my argument on an analysis of how the heard temporal Gestalt develops during the listenting to a musical phrase, I then present my model of mental simulation and associative learning through "natural resonance" in considerable detail.
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- Malmgren, Helge, 1945
(författare)
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Quantifying Quality of Life
- 1997
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Ingår i: Philosophical Communications, Web Series. - 1652-0459. ; :3
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- • The concept of quality of life (QoL) which is most relevant to medical and medico-political decisions is QoL as goodness of life, e.g., the value of a life for the person who lives it. • Mainly because of the interdependence of values, components of an individual human life cannot be ordered in such a way as to permit a complete and context-free ordinal scale. However, local orderings (given a set of fixed conditions) can often be found. • Similarly, although local ratio scaling of the desirability of life components using direct ratio estimation seems to be possible, the scales cannot be made complete. • Ratio scale values assigned by an individual to the goodness of life components by estimation need not always be even locally additive, since there may not exist any principle of composition. • By statistical means, representations of (something like) the value of life components have been derived, which are locally near-additive and which may be useful on a population basis (the QUALY methodology). They are however not useful on an individual basis, nor outside the proven domain of additivity. • The question whether the numbers representing the values of different lives can be added is wrongly put. There is no such thing as a composition of a supra-life from individual lives. The real question is whether the numbers should be added - whether the sum is the morally decisive arithmetical quantity to be calculated here. To this, utilitarianism answers Yes, while egalitarianism answers No. • The measurement part of QUALY methodology must be kept conceptually apart from utilitarian ethics.
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- Malmgren, Helge, 1945
(författare)
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Without a proper definition, you do not see the phenomenon
- 1997
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Ingår i: Consciousness and its pathologies. San Diego, CA, May 17-18, 1997.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- At the beginning of the century, pioneer psychiatrists in the classical German school (Kraepelin, Bonhoeffer) had established beyond reasonable doubt the existence of a certain organic mental syndrome or “reaction form”, variously named “Reizbare Schwäche” (irritable weakness) or “Emotionell-hyperaestetisches Schwächezustand” (emotional-hypersensitive weakness state). This reaction form is typically manifested by concentration difficulties, mental fatiguability, secondary memory disturbances, irritability and emotional lability. The term “astheno-emotional disorder” (AED) has recently been suggested. Patients showing this constellation of symptoms are very common in all parts of organic psychiatry, for example after moderate trauma to the brain, in chronic intoxications, in certain chronic infectious states, in endocrine disorders, as the initial manifestation of a brain tumour, after an intracranial bleeding, and so on. Mild forms of the same disorder are sometimes met with in which no organic cause can be found but where the patient has instead suffered great mental stress. The condition usually affects the patients’ ability to work and is often socially handicapping. In spite of the importance of AED, and in spite of its being well-known to most practitioners in each of the separate areas where it occurs, academic psychiatry has displayed very little interest in the condition during the last 40 years, and the major diagnostic systems of today do not allow for a unitary classification of these cases. For example, in DSM-IV a certain share of the mild cases would receive the diagnosis “mild cognitive disorder”, which would however fit neither mild cases with dominating emotional lability nor any of the (equally common) more severe cases. In this paper, I suggest the following causes of the present situation concerning the diagnosis of AED: (1) The astheno-emotional syndrome is often complicated by secondary, psychogenic reactions such as anxiety, feelings of tension and depressive mood, which can be difficult to disentangle from the primary symptoms. Many earlier classificatory attempts in this area (often in terms of “neurasthenia”) stumbled on a failure to distinguish the primary from the secondary symptoms. (2) The fact that the primary symptoms can themselves be psychogenic in nature, and the fact that the etiology cannot always be known for certain, entail that the disorder has to be delimited without recourse to causes. Many systems instead prefer seperate diagnoses for psychogenic cases. (3) Clinically, cases of AED form a continuum, ranging from very mild disturbances without clinical import to severe disturbances justifying a global diagnosis of dementia. Most diagnostic systems of today do not allow for such large-scale gradations of the severity of a disorder. (4) The conceptual apparatus which is used to describe symptoms is often too coarse to be able to distinguish typical symptoms of AED from similar symptoms which do not belong to this disorder. A clear examples of this is “memory difficulties”, which can refer either to a primary memory disturbance of the kind seen in Korsakov’s amnestic disorder or to secondary effects of concentration difficulties, as in mild AED. Another example is the term “emotional disturbance”, which does not differentiate between the emotional flattening typically seen in severe frontolimbic injuries and the emotional instability which is very common in AED. (5) The operationalistic bias in several recent systems of psychiatric classification prohibits hypothetical diagnoses based on knowledge of the interaction between different psychiatric disorders. From longitudinal studies of patients it is clear that the emotional lability and the manifest fatiguability of a patient with AED can both be completely neutralized if the same patient also suffers an emotional flattening. This means that the diagnosis of AED cannot be completely operationalized in terms of present symptoms. (6) The isolation of different parts of organic psychiatry from each other and from general psychiatry implies that few psychiatrists have a sufficiently broad experience to see the full spectrum of AED.
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