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Failing to act 

Failing to act
Failing to act

Sean A Spence

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date: 17 September 2021

The purpose of this chapter has been to examine some of the dysfunctional processes via which a human agent may be deprived of their ability to act. We have seen that there is a wide range of terms deployed, across medical disciplines, in order to describe such phenomena and that often the same brain systems are implicated in their emergence: the frontal lobes, especially the medial prefrontal and premotor cortices, and the components of the anterior cingulate (‘limbic’) loop system, that is, specific, related subcortical nuclei. What is most striking is the impact on a formerly ‘normal’ human being of such apparently focal, discrete disturbances: actions cease, emotions are no longer discernible, and thoughts are apparently absent. These are devastating conditions, impacting not solely the patient but also their families, the people with whom they had enjoyed their premorbid ‘relationships’. For, under such conditions, relationships are radically perturbed: the patient does not communicate, he does not act; he does not seem to ‘care’. However, the situation is not entirely hopeless. In Chapter 10, we shall review one of the methods that clinicians have deployed to restore such actions, to counteract avolition and apathy.

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