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Abstract
Research on decision-making from the perspectives of economics, game theory, and neuroscience has been expanding rapidly over the last three decades [Kable, J. W., & Glimcher, P. W. (2009). The neurobiology of decision: Consensus and Controversy. Neuron, 63, 733–745]. However, there is relatively little exploration of impairment of decision-making, as a symptom of psychic dysfunction, in clinical psychiatric or psychoanalytic literature. As a result there is a widening gap between the understanding of psychopathology among clinically oriented psychiatrists and psychoanalysts, and the evolving importance of decision-making as presented by the neuroscience research community. “Decision-making” as a psychic function is not currently considered an important criteria for defining, classifying, understanding or treating psychopathology. This paper is an attempt by a clinician to point to the significance of decision-making as a clinical phenomenon, and to explore the various components of decision-making that are relevant to clinicians and can serve as guideposts for further neurobiological research.
Acknowledgements
I would like to thank Jag Kanwal for persistently encouraging me to write this paper.
Disclosure statement
No potential conflict of interest was reported by the author.
Notes
1. Bleuler's “Four A's” were (1) Association: Referring to looseness of associations. (2) Affect: Flat or inappropriate affect. (3) Ambivalence: “the tendency … to endow the most diverse psychisms with both a positive and negative indicator at one and the same time” – (Bleuler, Citation1950) (4) Autism: Referring to the tendency to withdraw from social interactions.
2. Demographic details have been changed, and features of various patients combined, in all the case vignettes to protect the identity of patients.