Northoff provides a compelling argument supporting a kind of “double dissociation” of Parkinson's disease and catatonia. We discuss a related form of akinetic mutism linked to mesodiencephalic injuries and suggest an alternative to the proposed “horizontal” versus “vertical” modulation distinction. Rather than a “directional” difference in patterned neuronal activity, we propose that both disorders reflect hypersynchrony within typically interdependent but segregated networks facilitated by a common thalamic gating mechanism.

In this article we will draw on experiences from our own research on deep brain stimulation of the central thalamus in the minimally conscious state. We describe ethical challenges faced in clinical research involving medical devices and offer several cautionary notes about its funding and the interplay of market forces and scientific inquiry and suggest some reforms.

DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers can freely discuss current and emerging deep brain stimulation technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in (...) its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury. (shrink)

This is the first article in a two-part series describing subject and family perspectives from the central thalamic deep brain stimulation for the treatment of traumatic brain injury using the Medtronic PC + S first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury, with subjects who were deemed capable of providing voluntary informed consent. In this article, we report on interviews conducted prior to surgery wherein we asked participants about their experiences recovering from (...) brain injury and their perspectives on study enrollment and participation. We asked how risks and benefits were weighed, what their expectations and fears were, and how decisions were reached about trial participation. We found that informed consent and enrollment decisions are fraught. Subjects and families were often split, with subjects more focused on putative benefits and families concerned about incremental risk. Both subjects and families viewed brain injury as disruptive to personal identity and relationships. As decisions were made about study enrollment, families struggled with recognizing the re-emergent agency of subjects and ceding decision-making authority to subjects who had previously been dependent upon them for protection and guidance. Subjects and family members reported a hope for the relief of cognitive disabilities, improved quality of life, normalization of interpersonal interactions, and a return to work or school as reasons for study participation, along with altruism and a desire to advance science. Despite these aspirations, both subjects and families appreciated the risks of the intervention and did not suffer from a therapeutic misconception. A second essay to be published in the next issue of Cambridge Quarterly of Healthcare Ethics—Clinical Neuroethics will describe interviews conducted after surgery, the effects of cognitive restoration for subjects, families, and challenges presented to the social structures they will call upon to support them through recovery. This subsequent article will be available online prior to its formal publication in October 2023. (shrink)

This is the second paper in a two-part series describing subject and family perspectives from the CENTURY-S (CENtral Thalamic Deep Brain Stimulation for the Treatment of Traumatic Brain InjURY-Safety) first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury (msTBI). To participate, subjects were independently assessed to formally establish decision-making capacity to provide voluntary informed consent. Here, we report on post-operative interviews conducted after a successful trial of thalamic stimulation. All five msTBI subjects met (...) a pre-selected primary endpoint of at least a 10% improvement in completion time on Trail-Making-Test Part B, a marker of executive function. We describe narrative responses of subjects and family members, refracted against that success. Interviews following surgery and the stimulation trial revealed the challenge of adaptation to improvements in cognitive function and emotional regulation as well as altered (and restored) relationships and family dynamics. These improvements exposed barriers to social reintegration made relevant by recoveries once thought inconceivable. The study’s success sparked concerns about post-trial access to implanted devices, financing of device maintenance, battery replacement, and on-going care. Most subjects and families identified the need for supportive counseling to adapt to the new trajectory of their lives. (shrink)

Nietzsche's Ecce Homo was published posthumously in 1908, eight years after his death, and has been variously described ever since as useless, mad, or merely inscrutable. Against this backdrop, Nicholas D. More provides the first complete and compelling analysis of the work, and argues that this so-called autobiography is instead a satire. This form enables Nietzsche to belittle bad philosophy by comic means, attempt reconciliation with his painful past, review and unify his disparate works, insulate himself with humor from (...) the danger of 'looking into abysses', and establish wisdom as a special kind of 'good taste'. After showing how to read this much-maligned book, More argues that Ecce Homo presents the best example of Nietzsche making sense of his own intellectual life, and that its unique and complex parody of traditional philosophy makes a powerful case for reading Nietzsche as a philosophical satirist across his corpus. (shrink)

The writer responds to the commentary “Physician Burnout Calls for Legal Intervention,” by Sharona Hoffman, in the November‐December 2019 issue of the Hastings Center Report.

Nicholas D. Smith considers an original interpretation of the Republic, presenting it as a work about knowledge and education. Smith pays particular attention to Plato's use of images as representations of higher realities in education, as well as the power of knowledge in the Republic.

In lieu of an abstract, here is a brief excerpt of the content:Plato on Knowledge as a Power1Nicholas D. SmithAt 471C4 in Plato’s Republic, the argument takes a sudden turn when Glaucon becomes impatient with all of the specific prescriptions Socrates has been making, and asks to return to the issue Socrates had earlier set aside—whether or not the city he was describing could ever be brought into being. In response to Glaucon’s impatient question, Socrates articulates his “third wave of (...) paradox” (472ag–7), namely, that the ills of the cities will never be ended until either philosophers become rulers or rulers become philosophers (473c11–d6). Glaucon immediately responds that such a view is likely to be greeted with violence and scorn (473e6–474a4), and so Socrates must hasten to explain his odd claim. His explanation, it turns out, is that true philosophers have an enormous cognitive advantage over non-philosophers—philosophers have and use knowledge (ἐπιστήμη), whereas non-philosophers have and use only opinion (δόξα).2 This distinction, between επιστήμη and δόξα, turns out: to be a distinction between two different cognitive powers (δυνάμεις—477d7–e3). And different powers, Plato clearly tells us, apply to or take as their objects (Plato says they are “ἐπί”) different things (477dl).In this paper, I shall argue that the relationship between the cognitive powers and their various objects has been fundamentally misunderstood, which has led scholars into one or more misinterpretations of important and explicit features of the text. At the heart of these misunderstandings, I claim, is [End Page 145] their shared misconception of the relation between the cognitive power and its objects as interpretable in terms of the relationship between a cognitive stale and what the content of that state is of or about.3 One consequence of the view for which I shall argue is that what has come to be known as the “two-worlds theory”4 of Plato’s epistemology is seriously mistaken, but no less mistaken than the alternatives given by its recent critics. Another consequence that I shall draw from my argument is that Plato should be understood neither as a kind of foundationalist with regard to knowledge and warrant, as some have supposed him to be,5 nor as a coherentist, as others have supposed,6 but, rather, as a kind of causal reliabilist. [End Page 146]1. KNOWLEDGE AS A POWERScholarly interpretations of Plato’s epistemology have routinely sought to understand the relationships between each cognitive power of Republic Book V and the objects of the ἐφ’ ᾦ (“what it is related to”) condition by which it is differentiated from other δυνάμεις as Plato’s way of telling us what each sort of cognition is of or aboul. 7 So, for example, we find Gail Fine using the expressions “belief [δόξα] is set over [Fine’s translation of Plato’s ἐπί] …” and “knowledge is set over …” interchangeably with “belief is of …” or “belief is about…” and “knowledge is of …” or “knowledge is about …”8 Against the “two-worlds theory,” Fine argues that, for Plato, there can be knowledge of sensibles and beliefs about Forms. Accordingly, since she assimilates the power-ἐπί-object set of relations to the cognilion-of/about-object relation, she concludes—in order to account for knowledge of sensibles and beliefs about Forms—that the objects of knowledge and opinion must be propositions. Plato’s claims that knowledge is ἐπί what is, whereas opinion is ἐπί what is and is not, Fine understands as, “One can only know true propositions; one can believe both true and false propositions.”9 We shall see later that this “veridical” understanding of what Plato means to identify as “what is,” and “what is and is not” fails to account for important and explicit elements of Plato’s exposition of the epistemological and metaphysical distinctions he is making. For now, it is enough to note that Fine understands the ἐφ’ᾦ) relation in terms of our cognition-of/about-object relation. One finds the same assimilation made by those who advance existential readings of Plato’s “is” and “is not,”10 as [End Page 147] well as those who have urged that we adopt predicative readings of “is” and “is not.”11But I think there are very serious problems with this assimilation. Plato is very... (shrink)

Cocreating meaning in collaboration is challenging. Success is often determined by people's abilities to coordinate their language to converge upon shared mental representations. Here we explore one set of low‐level linguistic behaviors, linguistic alignment, that both emerges from, and facilitates, outcomes of high‐level convergence. Linguistic alignment captures the ways people reuse, that is, “align to,” the lexical, syntactic, and semantic forms of others' utterances. Our focus is on the temporal change of multi‐level linguistic alignment, as well as how alignment is (...) related to communicative outcomes within a unique collaborative problem‐solving paradigm. The primary task, situated within a virtual educational video game, requires creative thinking between three people where the paths for possible solutions are highly variable. We find that over time interactions are marked by decreasing lexical and syntactic alignment, with a trade‐off of increasing semantic alignment. However, greater semantic alignment does not translate into better team performance. Overall, these findings provide greater clarity on the role of linguistic coordination within complex and dynamic collaborative problem‐solving tasks. (shrink)

The chapter outlines Nietzsche's view of decadence, its history and effects. The philosopher held decadence to be any condition, deceptively thought good, which limits what something or someone can be. This concept informs his critical and affirmative projects, acting as a versatile tool to identify and overcome his own decadence and to resist the decadence of Western culture. Decadence appears in five major areas of concern to Nietzsche: physiology; psychology; art and artists; politics; and philosophy. Physical and mental phenomena provide (...) the substrate of his understanding, but they manifest in cultural, political, and philosophical forms that, in turn, affect the body and mind. In each of the five areas, the concept of decadence for Nietzsche serves 1) to unmask valued cultural phenomena as corrupt, 2) to name and analyze degenerate effects, and 3) to spur reflection on how to respond. (shrink)

Scholars still struggle to characterize, evaluate, and understand the mesmerizing prose pieces of Ficciones that raised Jorge Luis Borges to the first ranks of literary fame. Speaking to Philosophy and Literature, Borges once described his work as "the fiction of philosophy," and the two prologues he wrote for Ficciones leave enticing clues about what this means in practice. I argue that these long-neglected prologues open critical space for Ficciones, slyly mocking three idols of literary cant: that genre informs a work, (...) that epic tomes best represent the real, and that great authors write unprecedented books. Borges knew better. (shrink)

The chapter considers philosophical views of satire, philosophy as an object of satiric scorn, kinship and tension between satire and philosophy as activities, and what philosophy's relationship to satire suggests about philosophy as a discipline.

The article explores Nietzsche’s view that the Greek agonistic impulse in sport led to an ancient culture that prized the dialectics of philosophy and its humane offspring. The Greeks did not invent physical contests, but the Olympics are unique in the ancient world for bringing together once and future enemies under formal terms of contest. What did this signify? And what were its consequences? In Nietzsche’s view, the ancient Greek obsession with agon (contest) led to the greatest civilization of the (...) western world. How so? The paper shows how the Greeks learned to “spiritualize” violence and redirect its otherwise destructive power. This aggressive but rule-bound ethos became the competitive force in Greek culture to which we owe the disciplines of philosophy, drama, history, and science,—because each was conceived as a new arena of intellectual or artistic competition on the model of competitive sport. (shrink)

This volume brings together mostly previously unpublished studies by prominent historians, classicists, and philosophers on the roles and effects of religion in Socratic philosophy and on the trial of Socrates. Among the contributors are Thomas C. Brickhouse, Asli Gocer, Richard Kraut, Mark L. McPherran, Robert C. T. Parker, C. D. C. Reeve, Nicholas D. Smith, Gregory Vlastos, Stephen A. White, and Paul B. Woodruff.

What model of knowledge does Plato's Socrates use? In this book, Nicholas D. Smith argues that it is akin to knowledge of a craft which is acquired by degrees, rather than straightforward knowledge of facts. He contends that a failure to recognize and identify this model, and attempts to ground ethical success in contemporary accounts of propositional or informational knowledge, have led to distortions of Socrates' philosophical mission to improve himself and others in the domain of practical ethics. He (...) shows that the model of craft-knowledge makes sense of a number of issues scholars have struggled to understand, and makes a case for attributing to Socrates a very sophisticated and plausible view of the improvability of the human condition. (shrink)

Why would God make us ask for some good He might supply, and why would it be right for God to withhold that good unless and until we asked for it? We explain why present defences of petitionary prayer are insufficient, but argue that a world in which God makes us ask for some goods and then supplies them in response to our petitions adds value to the world that would not be available in worlds in which God simply supplied (...) such goods without our asking for them. This added value, we argue, is what we call ‘partnership with God’. (shrink)

Hastings Center Report, Volume 52, Issue 1, Page 21-28, January/February 2022.

Recent advances in molecular biology and microanatomy have supported homologies of body parts between vertebrates and extant invertebrate chordates, thus providing insights into the body plan of the proximate ancestor of the vertebrates. For example, this ancestor probably had a relatively complex brain and a precursor of definitive neural crest. Additional insights into early vertebrate evolution have come from recent discoveries of Lower Cambrian soft body fossils of Haikouichthys and Myllokunmingia (almost certainly vertebrates, possibly related to modern lampreys) and Yunnanozoon (...) and Haikouella (evidently stem-group vertebrates). The earliest vertebrates had an unequivocally marine origin, probably evolved mineralised pharyngeal denticles before the dermal skeleton, and evidently utilised elastic recoil of the visceral arch skeleton for suction feeding. Moreover, the new data emphasise that the advent of definitive neural crest was supremely important for the evolutionary origin of the vertebrates. BioEssays 23:142–151, 2001. © 2001 John Wiley & Sons, Inc. (shrink)