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Mis-evaluating the future. Affective Disorder and Decision-Making Capacity for Treatment: a Temporal Understanding

Research output: Contribution to journalArticle

Gareth Owen, Wayne Martin, Tania Gergel

Original languageEnglish
Early online date28 Nov 2018
Accepted/In press31 Oct 2018
E-pub ahead of print28 Nov 2018


King's Authors


Within psychiatric practice and policy there is considerable controversy surrounding the nature and assessment of impairments of decision-making capacity (DMC) for treatment in persons diagnosed with affective disorders. We identify the problems of “cognitive bias” and “outcome bias” in assessment of DMC for treatment in affective disorder and aim to help resolve these problems with an analysis of how time is experienced in depression and mania.
Sampling and Methods:
We conducted purposeful sampling and a qualitative phenomenological analysis of interview data on patients with depression and mania, exploring temporal experience and decision-making regarding treatment.
In both severe depression and mania there is a distinctive experience of the future. Two consequences can follow: a loss of evaluative differentiation concerning future out- comes and, relatedly, inductive failure. This temporal inability can compromise an individual’s ability to appreciate or “use or weigh” treatment information.
The decision-making abilities required for self-determination involve an ability to evaluate alternative future outcomes. Our results show that, within severe depression or mania, anticipation of future outcomes is inflexibly fixed at one end of the value spectrum. We therefore propose a temporal model of decision-making abilities, which could be used to improve assessment of DMC in affective disorder.

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