Dialogues in Clinical Neuroscience & Mental Health

The Proteus Effect by Proxy: Neuroethical Implications of Avatar Embodiment, Therapeutic Identity Change and Digital Grief

2026-09-26T19:42:36+03:00

Background: Immersive virtual reality (VR) is increasingly moving beyond its traditional role as an exposure-based therapeutic environment and is emerging as a technology capable of modulating bodily self-consciousness, self-perception, and identity. This shift is closely linked to avatar embodiment and the Proteus Effect, whereby users unconsciously adapt their behaviours, attitudes, and self-representations according to the characteristics of their digital avatars. Although these mechanisms may offer promising therapeutic applications in psychiatry, they also raise important neuroethical questions, particularly when applied to vulnerable clinical contexts such as depression, body image disturbance, and grief.
Methods: This hypothesis driven article provides a conceptual synthesis of literature on VR embodiment, the Proteus Effect, therapeutic identity change, digital bereavement, continuing bonds, prolonged grief disorder, and neuroethics. The aim is to examine avatar embodiment as a hypothetical micro-model of therapeutic identity modification and to introduce a novel theoretical framework for understanding immersive interactions with avatars of deceased loved ones.
Results: The paper proposes the concept of the “Proteus Effect by Proxy” to describe a process in which the bereaved individual does not embody the deceased, but interacts with a highly immersive and responsive avatar of the deceased. Through simulated reciprocity, conversational responsiveness, and activation of relational schemas, the avatar may influence the mourner’s emotional state, behaviour, autobiographical memory, and post-loss identity. This framework highlights three major neuroethical concerns: threats to patient autonomy and narrative authenticity through implicit identity modification; risks of internalizing algorithmic distortions, biases, or maladaptive relational scripts; and the ethical boundaries of digitally mediated interactions with the deceased, particularly in individuals vulnerable to prolonged grief disorder.
Conclusions: Avatar embodiment represents a powerful frontier in psychiatric technology, with the potential to facilitate therapeutic identity change but also to disrupt autonomy, memory, and grief adaptation. The Proteus Effect by Proxy offers a heuristic framework for examining how immersive digital bereavement technologies may reshape the mourner’s identity through interaction with simulated representations of the deceased. Before such technologies are integrated into clinical practice, rigorous ethical, regulatory, and empirical safeguards are required.

Echoes of the Rupture: Anguish in Prolonged Grief Disorder

2026-09-26T19:42:36+03:00

Background: Prolonged Grief Disorder (PGD) is a newly recognized diagnostic category in the ICD-11 and DSM-5-TR, defined by persistent yearning and preoccupation with the deceased. Despite established diagnostic criteria, there remains a gap in capturing the lived experience of patients, who often report a profound suffering that exceeds standard symptom checklists. This profound suffering aligns with the phenomenological concept of “anguish,” an affective state where existence feels threatened, constricted, and stripped of its future horizons.
Methods: This article utilizes a conceptual and historical framework to argue that anguish deserves standing as a core affective construct in PGD. The paper synthesizes existential philosophy and phenomenological with contemporary clinical, epidemiological, and neurobiological research concerning severe grief.
Results: The phenomenology of anguish in PGD is organized across four distinct dimensions: embodied anguish characterized by somatic constriction and chest tightness, temporal rupture involving deep desynchronization where time feels frozen, self-world disturbance marked by a breakdown of identity and affective trust, and diffuse existential insecurity. Neurobiologically, this phenomenological state corresponds to alterations in the brain’s reward and pain circuits hypothalamic-pituitary-adrenal (HPA) axis dysregulation and autonomic disarray. While anguish can operate as a transdiagnostic affective process, its presentation in PGD is uniquely characterized by the paradox of the deceased’s “presence in absence”.
Conclusions: Standard assessment tools operationalize diagnostic criteria but do not directly assess the distinct existential and somatic features of anguish. Utilizing a phenomenology-informed case formulation allows clinicians to capture the depth of this self-world disturbance. To effectively treat PGD, evidence-based therapies must integrate narrative, temporal, and body-oriented interventions to address the profound ruptures in the patient’s relational and embodied existence, ultimately facilitating a more comprehensive healing process.

Ideological Worldviews, Religiosity, and COVID-19 Vaccine Hesitancy: Evidence from Greece

2026-09-26T19:42:35+03:00

To examine associations between ideological orientations, religiosity, and COVID-19 vaccine perceptions in Greece before the vaccination rollout. A sample of 166 Greek university students completed measures of Right-Wing Authoritarianism (RWA), Social Dominance Orientation (SDO), belief in a just world (BJW), and religiosity (general/COVID-related). Vaccine perceptions included perceived protection, side effects, institutional trust, and vaccination willingness. Higher SDO was associated with lower perceived protection and institutional trust. BJW associated with greater institutional trust. RWA and increased religiosity/spirituality were associated with stronger perceptions of vaccine side effects. Logistic regression showed that RWA was associated with vaccination reluctance. Indirect effect analysis indicated that increased religiosity/spirituality statistically accounted for part of the association between RWA and perceived vaccine side effects. Ideological orientations and pandemic-related religious engagement were associated with vaccine perceptions during the crisis. Findings highlight the relevance of existential threat and worldview defense to public health interventions.

Gender Parity and Quality of Life in Greek Military Personnel

2026-09-26T19:42:35+03:00

Gender equality is a fundamental principle of modern democratic societies and is linked both to the guarantee of equal rights and opportunities and to broader dimensions of social well-being and quality of life. In this context, it is particularly interesting to examine gender equality in organizational environments characterized by a strong hierarchical structure, strict operating rules, and historically male-dominated traits, such as the Armed Forces. This paper theoretically examines the relationship between gender equality and quality of life within the Greek Armed Forces, focusing both on the institutional and social dimensions of equality and on the impact that gender attitudes, organizational cultures, and professional roles may have on the daily experiences of officers. The analysis is structured around four main themes: first, the conceptual and theoretical approach to gender equality; second, the specific characteristics of the Armed Forces as a unique work and institutional environment; third, the concept of quality of life and the factors that influence it in the military context; and fourth, the Greek dimension of the issue. The purpose of this study is to demonstrate that gender equality is not only a legal or ethical requirement but also an important factor in improving the quality of life, professional well-being, and cohesion of personnel in the Greek Armed Forces.