Articles in peer-reviewed journals by Elisabetta Sirgiovanni
Bioethics, 2024
Critics of clinical artificial intelligence (AI) suggest that the technology is ethically harmful... more Critics of clinical artificial intelligence (AI) suggest that the technology is ethically harmful because it may lead to the dehumanization of the doctor-patient relationship (DPR) by eliminating moral empathy, which is viewed as a distinctively human trait. The benefits of clinical empathy-that is, moral empathy applied in the clinical context-are widely praised, but this praise is often unquestioning and lacks context. In this article, I will argue that criticisms of clinical AI based on appeals to empathy are misplaced. As psychological and philosophical research has shown, empathy leads to certain types of biased reasoning and choices. These biases of empathy consistently impact the DPR. Empathy may lead to partial judgments and asymmetric DPRs, as well as disparities in the treatment of patients, undermining respect for patient autonomy and equality. Engineers should consider the flaws of empathy when designing affective artificial systems in the future. The nature of sympathy and compassion (i.e., displaying emotional concern while maintaining some balanced distance) has been defended by some ethicists as more beneficial than perspectivetaking in the clinical context. However, these claims do not seem to have impacted the AI debate. Thus, this article will also argue that if machines are programmed for affective behavior, they should also be given some ethical scaffolding.
Journal of the History of the Neurosciences, 2014
In 1908, Norwegian artist Edvard Munch—already famous for The Scream and other paintings showing ... more In 1908, Norwegian artist Edvard Munch—already famous for The Scream and other paintings showing sickness, despair, and suffering —put himself under the care of Dr. Daniel Jacobson, a nerve doctor in Copenhagen. Jacobson had previously attended some of Jean-Martin Charcot’s lectures in Paris, as had Knud Pontoppidan, his mentor. Munch, in turn, had long been showing signs and symptoms of an anxiety disorder and what might have been viewed as neurasthenia or hysteria. Now, he also seemed to be suffering from acute alcoholic toxicity. In this article, we explore Scandinavian psychiatry at the turn of the century; Jacobson and Pontoppidan’s connections to Paris; and how some of Munch’s treatments, most notably his electrotherapy sessions, related to therapeutics at La Salpêtrière. Additionally, various ways in which Munch learned about French medicine are examined. This material reveals how well-known and influential Charcot and his ideas about disorders of the brain and mind had become at the turn of the century, affecting not just the French physicians but also a world-famous artist and his nerve doctor in Scandinavia.
Journal of the History of the Neurosciences, 2024
In 1908–1909, Norwegian artist Edvard Munch (1863–1944), best remembered for The Scream (1893), s... more In 1908–1909, Norwegian artist Edvard Munch (1863–1944), best remembered for The Scream (1893), spent eight months under Daniel Jacobson’s care in a private nerve clinic in Copenhagen. Munch was suffering from alcohol abuse, and his signs and symptoms included auditory hallucinations, persecutory delusions, paresthesias, paralyses, violent mood swings, depression, loss of control, fatigue, and the loss of his basic ability to take care of himself. He was treated with rest, a fortifying diet, massages, baths, fresh air, limited exercise, and nonconvulsive electrotherapy. After he had settled in, Jacobson allowed Munch to draw, paint, and engage in photography. Munch responded with a portrait of Jacobson and a small but intriguing sketch of himself at one of his electrotherapy sessions. In this article, we examine the circumstances that brought Munch to Jacobson’s clinic and his therapies, with particular attention to electrotherapies. In so doing, we hope to provide a more complete picture of Munch’s crisis in 1908, his nerve doctor, the rationales for medical electricity and other treatments he endured, and Scandinavian psychiatry at this moment in time.
Introduction: A general trend in the psychological literature suggests that guilt contributes to ... more Introduction: A general trend in the psychological literature suggests that guilt contributes to morality more than shame does. Unlike shame-prone individuals, guilt-prone individuals internalize the causality of negative events, attribute responsibility in the first person, and engage in responsible behavior. However, it is not known how guilt-and shame-proneness interact with the attribution of responsibility to others. Methods: In two Web-based experiments, participants reported their attributions of moral culpability (i.e., responsibility, causality, punishment and decisionmaking) about morally ambiguous acts of killing in different conditions. In Study 1 the vignettes were presented in the 1st person, while in Study 2 in the 3rd person. To test proneness to guilt and shame, we utilized the GASP scale, which differentiates between the affective and behavioral components of each emotion. Statistical analyses were performed in Matlab and R. Results: We found that guilt-and shame-proneness were associated with the severity of attributions in both the first and the third person, but the effect was strong only in the guilt case (both subtypes) and shame-affect case, and not in the shame-behavior case. We call this the Moralizing Effect. Discussion: We wonder whether our finding that guilt-prone people tend to attribute a higher degree of culpability to others is really consistent with the view that guilt motivates people to choose the "moral paths in life". This echoes views about the harmful aspects of guilt, which have been expressed historically in philosophy, for example, by Friedrich Nietzsche.
Medical History, 2023
In the years 1947-57, following a turbulent retirement, Ugo Cerletti, the father of electroconvul... more In the years 1947-57, following a turbulent retirement, Ugo Cerletti, the father of electroconvulsive therapy (ECT) (1938), invested his energies in a new audacious project conceived as an extension of his ECT research. Forced to leave the direction of the Sapienza University Clinic, he got funds from the National Research Council of Italy to carry out his experimental activities, and founded a 'Center for the study of the physiopathology of Electro-shock' in Rome. The Center was aimed at studying liquid substances extracted from electro-shocked animals' brains that Cerletti named acroagonine and injected into human patients. Inspired by coeval literature, Cerletti believed that electroshock efficacy was due to stimulating some homeostatic processes in the brain, specifically in the meso-diencephalic area (i.e. involving neuroendocrine response in the hypothalamic-pituitary-adrenal axis). Cerletti's team wished not only to find these effects, but also to reproduce them. With this hypothesis, that proved ineffective, Cerletti anticipated intuitions on the neuroendocrine effects of ECT and the necessity for the development of psychopharmacology. In this article, I cross-combined previously unexplored archival materials stored at Sapienza University of Rome ('ES Section') with established bibliographic and archival sources.
Behavioral and Brain Sciences , 2022
Trolley-like dilemmas are other cases of what Bermúdez refers to as (conscious) quasi-cyclical pr... more Trolley-like dilemmas are other cases of what Bermúdez refers to as (conscious) quasi-cyclical preferences. In these dilemmas, identical outcomes are obtained through morally non-identical actions. I will argue that morality is the context where descriptive invariance and ecological relevance may be crucially distinguished. Logically irrational moral choices in the short term may promote greater social benefits in the longer term.
doi: 10.1017/S0140525X2200098X
Medicina nei secoli, 2022
Although it is true that past thinkers developed relevant taxononomies of the phenomenon of memor... more Although it is true that past thinkers developed relevant taxononomies of the phenomenon of memory at the behavioral level,
only in the last century has our scientific understanding of the
underlying brain mechanisms of memory progressed remarkably. New acquisitions include that memory is not just a functional or physiological process, but a structural or anatomical
one as well, that conceiving of memory as merely cognitive or
centered on cognition is misleading, or that memory does not
require any consciousness or intentionality. On the applicative
side, recent technological advances offered opportunities of
modifying memory with biological means, and detecting more
effectively whether someone is remembering or lying. The
current issue of Medicina nei Secoli is dedicated to Memory
in contemporary biomedicine: cross-disciplinary scenarios. It
hosts seven expert contributions to the field covering different
areas of medical inquiry (i.e., immunology, neuroscience, gerontology) and humanistic-social perspectives (history, epistemology, ethics, and law).
Medicina nei secoli, 2022
In the ancient Greek world, memory permeates every aspect of human life. Memory plays a central r... more In the ancient Greek world, memory permeates every aspect of human life. Memory plays a central role in the compositional and ecdotic phases of the ancients' literary production and has long been linked to a mode of oral-aural transmission, in which poetry survives without support from writing. The 'book of memory' metaphor appears in ancient philosophy. the transformation of figures and utternances into μνήματα (records) by iconography and writing leads the ancients to a metaphorical interpretation of cognitive processes. Memory plays a central role in theurgical medicine. Acting as the pivot around which dream therapy revolves, memory requires dream recollection and cataloging. Memory plays a central role in rational medicine as well: dreams amplify perceptual phenomena, so analyzing them may improve clinical diagnosis, as in the Hippocratic authors, establishing a functional link between the pathophysiology of the body, understood as humoral δυσκρασία (bad temperament), and the φαντάσματα (sensations) produced during sleep. This special issue of Medicina nei Secoli aims at investigating the role accorded to memory in the ancient Greek world . The issue covers various topics, from the role that memory plays in explanations of cognitive processes and in the exercise of medical art, up to the emotional salience that memory assumes in literature, especially in the private dimension of writing, or in real life, including pathological manifestations.
Lebenswelt, 2020
Based on the empirical findings correlating disgust with conservatism, most disgust scholars have... more Based on the empirical findings correlating disgust with conservatism, most disgust scholars have fed arguments for its moral unreliability and concluded with moral condemnation of this emotion. In this paper, I will examine common arguments about whether relying on disgust in the moral domain is to be considered good or bad. I will problematize the suggestion that we are justified in firmly believing that disgust is an ethically «dumb» – or an ethically «smart» – emotion. It rather seems that moral disgust can be rational or irrational, pro-social or anti-social, liberal or conservative depending on the eliciting contexts, and that such case-by-case conclusions rely on additional meta-ethical premises.
The existence of pediatric applications of electroconvulsive therapy (ECT) in the 1940s in Italy ... more The existence of pediatric applications of electroconvulsive therapy (ECT) in the 1940s in Italy has been neglected by international literature. However, 2 case reports by Ferdinando Accornero and Mario Anderson, both assistants of Ugo Cerletti at the Sapienza Clinic for Nervous and Mental Diseases, should be brought to the attention of historians of ECT. The work presented therein began in Rome in September 1940, approximately at the same time of the first reported ECT administration on a child in Bristol, United Kingdom. The 2 reports described applications on 19 children and adolescents during 3 different sessions (1940–1941, 1944–1947, and 1947–1949), with a 3-year-long interruption due to the circumstances of World War II. Unfortunately, this research appeared belatedly in 2 articles from 1948 and 1950, respectively, in an Italian journal with limited distribution, when more extensive research contributions on pediatric ECT had already received international exposure. The Italian reports may cast light on the progress made by the early generation of ECT researchers in the 1940s toward the refinement of ECT techniques and the subsequent identification of diagnostic indicators for ECT among children.
History of Psychiatry, Apr 20, 2020
In the early 1960s, a climate of public condemnation of electroconvulsive therapy was emerging in... more In the early 1960s, a climate of public condemnation of electroconvulsive therapy was emerging in the USA and Europe. In spite of this, the electroshock apparatus prototype, introduced in Rome in 1938, was becoming hotly contended. This article explores the disputes around the display of the electroshock apparatus prototype in the summer of 1964 and sheds new light on the triangle of personalities that shaped its future: Karl and William Menninger, two key figures of American psychiatry in Topeka; their competitor, Adalberto Pazzini, the founder of the Sapienza Museum of the History of Medicine in Rome; and, between them, Lucio Bini, one of the original inventors of ECT, who died unexpectedly that summer.
Nuncius, 2020
The first electroconvulsive therapy (ECT) device for the treatment of psychiatric disorders was i... more The first electroconvulsive therapy (ECT) device for the treatment of psychiatric disorders was introduced in 1938 by Ugo Cerletti and Lucio Bini, two neuropsychiatrists at the Clinic for Nervous and Mental Diseases, La Sapienza University (Rome). No trace of what became of this device after its use at the clinic can be found until the 1960s, when it appears in a silent black-and-white video dedicated to the university's recently rehoused and completely renovated Museum of the History of Medicine (MHM), where Cerletti's original prototype is on display today. However, there is no record of the circumstances under which the electroshock apparatus prototype was transferred from the Clinic of Neuropsychiatry to the museum. Our investigation of this intriguing mystery has uncovered a number of pertinent details that allow us to view the history of the ECT device in a new light. It also emerges that Adalberto Pazzini, the founder of the MHM, played a larger role than was previously thought in this story.
Frontiers in psychology, 2020
We comment on a recent attempt to justify the coercive moral bioenhancement (MB) of psychopaths a... more We comment on a recent attempt to justify the coercive moral bioenhancement (MB) of psychopaths as an extensionof the idea that psychopaths’ cognitive-affective system would justify MB of other psychopaths. Firstly, we state that this account is flawed. Specifically, psychopaths follow what we may call a Dark Rule - an antithetic version of the Golden Rule – according to which they believe and feel that one can treat others, in ways that one would not like to be treated. This means their reasons cannot be made universal on this basis. Secondly, we oppose coercion of MB, even when justified by public reasons of social security. Aligning with recent international standards and considering the difficulties surrounding the diagnosis of psychopathy, we defend the view that the right to refuse MB must be protected.
Studia Bioethica, 2018
In this paper I intend to focus on common alterations and distortions to an informed, voluntary, ... more In this paper I intend to focus on common alterations and distortions to an informed, voluntary, and decisionally-capacitated consent in the medical setting, especially those that impact the patient’s decision-making process. In doing so, I will focus on two specific issues. On the one hand, I will examine cognitive biases and self-deceptive processes that may affect the patient’s choice and autonomy. On the other hand, I will discuss the capacity of self-government as what usually referred to as the neurocognitive capacity of self-control. My view thus consists of two main claims: that even in capacitated individuals, consent to treatment/research is not necessarily identifiable as fully rational and deliberative choice; however, that empirical literature about self-control may shed some light on how to improve informed consent procedures as such.
Teoria, 2017
Folk ethical theories presupposed by prevailing moral theories and current legal systems tend to ... more Folk ethical theories presupposed by prevailing moral theories and current legal systems tend to identify a close link between responsibility and conscious control. They generally claim that we can hold an agent responsible for outcomes of actions over which s/he exercises a certain degree of conscious control. In the last few decades, however, cognitive neuroscience has offered evidence about unconscious control processes and self-deceptive attributions of control, the so-called Frail Control Hypothesis. This hypothesis threatens the common notion of responsibility itself. I will consider possible solutions to the neuroscientific threat and discuss objections to all of them. Then, I will provide some suggestions for building a neuroethical account of responsibility that unifies the benefits of the different solutions but takes their limitations into consideration.
At the end of the nineteenth century the Italian physician and anthropologist Cesare Lombroso est... more At the end of the nineteenth century the Italian physician and anthropologist Cesare Lombroso established the foundations of criminological sciences by introducing a biological theory of delinquency, which was later discredited and replaced by the sociological approach. The theory of the " born criminal " was poor in methods and analysis, and turned out to be controversial in its formulations, assumptions, and mostly in its predictions. However, recent research in behavioral genetics and neuroscience has brought back some version of the Lombrosian idea by providing evidence for the genetic and biological correlates of criminality. This research has been impacting legal proceedings worldwide. In this paper, I compare the Lombrosian and the contemporary scientific meanings of "heredity" and "predisposition" to aggressive and violent behavior, by highlighting theoretical similarities and differences in the two approaches. On the one hand, the paper is arguing against the idea that contemporary theories are radically deterministic, while on the other hand it aims at rehabilitating the intellectual image of Lombroso by showing that the denigration of his brilliant work by his successors was unjustified.
The term " enhancement " has come to represent a very precise form of improving individual skills... more The term " enhancement " has come to represent a very precise form of improving individual skills. By means of pharmaceutics, surgery, and reproductive technology, all originally intended for clinical use, healthy individuals may improve their cognitive and emotional capacities for many reasons, such as to gain a competitive edge. In today's society, cognitive performance and mood assume a more relevant role than physical ability if one aspires to emerge above the average. In this paper, we present and discuss common views on " neuroenhancement, " a term often used to describe the use of artificial means that interfere with brain function to improve cognitive skills. Most philosophical arguments and beliefs on the topic are based on some inappropriate distinctions and definitions which favour unfruitful alarmist attitudes and may obscure the complexity of the issue. In particular, we point out that both radical prohibitionist and libertarian approaches are affected by paternalistic ideas which we refute. We also show that even though enhancement nowadays is occurring at an impressive rate, we cannot infer that it is a present-day phenomenon, because enhancement is a human disposition, shared between most species and has always existed. We argue against moralistic views on neuroenhancement and defend a reasoned libertarian perspective. We believe that case-by-case evolutionary medical heuristics is the best approach to help individuals in their autonomous choices.
In this paper I discuss the naturalistic and objectivist concept of mental illness as biological ... more In this paper I discuss the naturalistic and objectivist concept of mental illness as biological dysfunction. I argue for the so-called selected effect accounts, as alternative to bio-statistical accounts. In order to reply to accuses of normativism, particularly ethical one, I defend a minimalist account according to which the term "function" should be understood as, if not replaced by, the mechanistic-evolutionary expression “evolutionarily pertinent activity”.
The history and conceptual evolution of the Diagnostic and Statistical Manual (DSM) of mental dis... more The history and conceptual evolution of the Diagnostic and Statistical Manual (DSM) of mental disorders of the American Psychiatric Association provide a lens through which to examine recent development, debates and state of the art of psychiatry. In this article, I identify and critically discuss key epistemological features and crucial historical stages of the rise and fall of the DSM approach, in order to provide indications of what might be expected in the field of mental health in the near future.
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Articles in peer-reviewed journals by Elisabetta Sirgiovanni
doi: 10.1017/S0140525X2200098X
only in the last century has our scientific understanding of the
underlying brain mechanisms of memory progressed remarkably. New acquisitions include that memory is not just a functional or physiological process, but a structural or anatomical
one as well, that conceiving of memory as merely cognitive or
centered on cognition is misleading, or that memory does not
require any consciousness or intentionality. On the applicative
side, recent technological advances offered opportunities of
modifying memory with biological means, and detecting more
effectively whether someone is remembering or lying. The
current issue of Medicina nei Secoli is dedicated to Memory
in contemporary biomedicine: cross-disciplinary scenarios. It
hosts seven expert contributions to the field covering different
areas of medical inquiry (i.e., immunology, neuroscience, gerontology) and humanistic-social perspectives (history, epistemology, ethics, and law).
doi: 10.1017/S0140525X2200098X
only in the last century has our scientific understanding of the
underlying brain mechanisms of memory progressed remarkably. New acquisitions include that memory is not just a functional or physiological process, but a structural or anatomical
one as well, that conceiving of memory as merely cognitive or
centered on cognition is misleading, or that memory does not
require any consciousness or intentionality. On the applicative
side, recent technological advances offered opportunities of
modifying memory with biological means, and detecting more
effectively whether someone is remembering or lying. The
current issue of Medicina nei Secoli is dedicated to Memory
in contemporary biomedicine: cross-disciplinary scenarios. It
hosts seven expert contributions to the field covering different
areas of medical inquiry (i.e., immunology, neuroscience, gerontology) and humanistic-social perspectives (history, epistemology, ethics, and law).
In the past the inability to explain and face mental disorders produced theoretical conceptions and containment strategies that reflected the needs of the historical contexts in which they originated and had sometimes even led to abuses and aberrations. Psychiatric conceptualizations that we inherited from the tradition bring with them approximations and/or philosophical confusion, some of which are still deeply rooted in our clinical explanations and practices.
We will defend the hypothesis that a properly elaborated evolutionary psychiatry is able to complete and adjust neurocognitive mechanistic explanations of mental disorders, by introducing environmental factors in a sophisticated way, that is within a medical-biological approach, unlike traditional sociological approaches that dominated psychiatry during the seventies. We believe that a biological organism is not a system that operates in isolation from the environment, to other bodies and mechanisms connected to it.
Such systems exist as evolutionarily physical and social adaptations. The aim of the book is to present critically the evolutionary approach, to argue for plausible reasons to endorse it, but also to show those inaccuracies and misunderstandings that have generated more or less justified sceptical reactions, but that instead had risked to overshadow the potential of evolution theory in the project of re-foundation of psychiatry.
Under contract for: Il Mulino, Bologna (Expected for 2017, Language: Italian)
Table of contents (provisional)
Introduction 1. The origin and history of the idea of mental illness and its treatments 2. What is mental illness: definitions, taxonomies and disputes 3. Genes, brain, evolution, and mental disorders 4. Epidemiology of mental disorders: the importance of context 5. The re-foundation of Darwinian neuropsychiatry: stalls, critical points and future directions 6. The ethics of clinical and evolutionary neuroscience. Conclusions
Il libro è VINCITORE DEI PREMI:
- PREMIO NAZIONALE PER LA DIVULGAZIONE SCIENTIFICA 2014
- PREMIO PER LA CULTURA "MARIO TIENGO" 2014
Oltre a contesti accademici, il libro è stato menzionato da: quotidiani maggiori italiani (Il Corriere della Sera, Il Sole 24 Ore, La Stampa, Avvenire), radio (Radio 1 Rai, Radio 3 Scienza, Radio Popolare, Radio Radicale) and TV (Rai 1, "Super Quark")
[English] This book discusses the impact of brain researches on different domains, not only on biological and medical/health ones, but more generally on social ones. A decade ago, neuroscience and neurotechnology gave official birth to a new field of inquiry called “neuroethics”. This term is usually referred to both the analysis of ethical implications of research and clinical practice in the neuroscientific area, and to the understanding of how brain processes moral judgements. After historically reconstructing the origins of neuroethics, the authors show main issues related to the spreading of neuroimaging, the technology with which neuroscientific advancements and applications are identified. The book faces principal neuroethical questions, from the impact of neuroscientific theories and technologies on the explanation and treatment of psychiatric disorders, to the controversial argument of the enhancement of cognitive capacities (the possibility of using drugs, implants and other neurotechnological devices to intervene on the brain in order to improve cognitive performances). Moreover, staring off with some Italian legal cases, a debate on the relevance of neuroscientific data and arguments in legal proceedings will be develop all along the book. This book has the ambition to present neuroethical and bioethical issues in a coherent philosophical framework, in order to go beyond the usual polarizations, which have alimented confusion and misunderstandings within the debate.
This book has been awarded with:
- AWARD FOR BEST 2014 NATIONAL SCIENTIFIC COMMUNICATION
- CULTURAL AWARD "MARIO TIENGO" 2014
Beyond academic context, the book was mentioned by: major Italian newspapers (Il Corriere della Sera, Il Sole 24 Ore, La Stampa, Avvenire), radios (Radio 1 Rai, Radio 3 Scienza, Radio Popolare, Radio Radicale) and TV (Rai 1, Science Show "Super Quark")
Indice
Introduzione; 1. Dalla bioetica alla neuroetica; 2. Neuroimmagini: motore della svolta neuroetica; 3. Neuroetica clinica; 4. Enhancement: un punto di vista non paternalista; 5. Le radici neuroevolutive della morale; 6. Le neuroscienze e il diritto; 7. Neuroetica e filosofia: verso un matrimonio di convenienza?; 8. In conclusione: non è colpa di nessuno; Bibliografia.